| Effectiveness of percutaneous vesico-amniotic shunting in congenital lower urinary tract obstruction: divergence in prior beliefs among specialist groups. | |
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MedLine Citation:
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PMID: 20546989 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To explore the prior beliefs regarding the effectiveness of percutaneous vesico-amniotic shunting in congenital lower urinary tract obstruction among different clinical specialist groups involved in caring for this condition. STUDY DESIGN: Questionnaire survey of experts in the field based on principles of Bayesian elicitation of prior beliefs. The sample was 59 consultants in three specialties. Of these, 37 (63%) were subspecialty trained fetal medicine practitioners, 16 (27%) were paediatric nephrologists and 6 (10%) were paediatric urologists. The questionnaire elicited experts' opinions as to: control arm perinatal mortality, effect of vesico-amniotic shunting on perinatal mortality, current clinical practice and the level of evidence required to change current practice. RESULTS: The response rates were 28% for fetal medicine specialists, 29% for paediatric nephrolgists and 10% for paediatric urologists. The median belief for fetal medicine specialists was a 10% (inter-quartile range, IQR 0-20%) reduction in perinatal mortality with shunting and a mean control arm perinatal mortality of 61%. For paediatric nephrologists the results were 5% (IQR -10 to 15%) and 18% and for paediatric urologists 10% (IQR 0-15%) and 17%. Fetal medicine specialists had the most optimistic beliefs regarding effect of shunting on perinatal mortality. Thirty-eight experts (68%) indicated that vesico-amniotic shunting would most likely reduce morbidity associated with renal dysfunction. CONCLUSION: The prior beliefs show a divergence of opinion among specialists. This establishes clinical equipoise, which should be resolved with a randomised trial. |
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Authors:
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Celia Brown; R Katie Morris; Jane Daniels; Khalid S Khan; Richard J Lilford; Mark D Kilby |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-05-23 |
Journal Detail:
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Title: European journal of obstetrics, gynecology, and reproductive biology Volume: 152 ISSN: 1872-7654 ISO Abbreviation: Eur. J. Obstet. Gynecol. Reprod. Biol. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-23 Completed Date: 2010-12-13 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0375672 Medline TA: Eur J Obstet Gynecol Reprod Biol Country: Ireland |
Other Details:
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Languages: eng Pagination: 25-9 Citation Subset: IM |
Copyright Information:
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Crown Copyright 2010. Published by Elsevier Ireland Ltd. All rights reserved. |
Affiliation:
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School of Health and Population Sciences, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Amnion
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surgery* Female Health Care Surveys Humans Male Physicians Pregnancy Questionnaires Ureteral Obstruction / congenital*, mortality, surgery* |
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