制定未来不孕不育研究的核心结局集:一项国际共识发展研究†‡。
Developing a core outcome set for future infertility research: an international consensus development study† ‡.
机构信息
King's Fertility, Fetal Medicine Research Institute, London, UK.
Institute for Women's Health, University College London, London, UK.
出版信息
Hum Reprod. 2020 Dec 1;35(12):2725-2734. doi: 10.1093/humrep/deaa241.
STUDY QUESTION
Can a core outcome set to standardize outcome selection, collection and reporting across future infertility research be developed?
SUMMARY ANSWER
A minimum data set, known as a core outcome set, has been developed for randomized controlled trials (RCTs) and systematic reviews evaluating potential treatments for infertility.
WHAT IS KNOWN ALREADY
Complex issues, including a failure to consider the perspectives of people with fertility problems when selecting outcomes, variations in outcome definitions and the selective reporting of outcomes on the basis of statistical analysis, make the results of infertility research difficult to interpret.
STUDY DESIGN, SIZE, DURATION: A three-round Delphi survey (372 participants from 41 countries) and consensus development workshop (30 participants from 27 countries).
PARTICIPANTS/MATERIALS, SETTING, METHODS: Healthcare professionals, researchers and people with fertility problems were brought together in an open and transparent process using formal consensus science methods.
MAIN RESULTS AND THE ROLE OF CHANCE
The core outcome set consists of: viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin and higher multiple pregnancy); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Time to pregnancy leading to live birth should be reported when applicable.
LIMITATIONS, REASONS FOR CAUTION: We used consensus development methods which have inherent limitations, including the representativeness of the participant sample, Delphi survey attrition and an arbitrary consensus threshold.
WIDER IMPLICATIONS OF THE FINDINGS
Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection and reporting of core outcomes. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Fertility and Sterility and Human Reproduction, have committed to implementing this core outcome set.
STUDY FUNDING/COMPETING INTEREST(S): This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund and Maurice and Phyllis Paykel Trust. The funder had no role in the design and conduct of the study, the collection, management, analysis or interpretation of data, or manuscript preparation. B.W.J.M. is supported by a National Health and Medical Research Council Practitioner Fellowship (GNT1082548). S.B. was supported by University of Auckland Foundation Seelye Travelling Fellowship. S.B. reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. J.M.L.K. reports research sponsorship from Ferring and Theramex. R.S.L. reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.J.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. C.N. reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. A.S. reports consultancy fees from Guerbet. E.H.Y.N. reports research sponsorship from Merck. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form.
TRIAL REGISTRATION NUMBER
Core Outcome Measures in Effectiveness Trials Initiative: 1023.
研究问题
是否可以制定一个核心结局集,以规范未来不孕研究中结局的选择、收集和报告?
总结答案
已经为随机对照试验(RCT)和系统评价制定了一个最小数据集,称为核心结局集,用于评估潜在的不孕治疗方法。
已知情况
在选择结局时,未考虑到有生育问题的人的观点、结局定义的差异以及基于统计分析选择性报告结局等复杂问题,使得不孕研究的结果难以解释。
研究设计、规模、持续时间:三轮 Delphi 调查(来自 41 个国家的 372 名参与者)和共识开发研讨会(来自 27 个国家的 30 名参与者)。
参与者/材料、设置、方法:使用正式的共识科学方法,将医疗保健专业人员、研究人员和有生育问题的人聚集在一起,进行公开和透明的过程。
主要结果和机会的作用
核心结局集包括:经超声确认的活宫内妊娠(包括单胎、双胞胎和更高倍数的妊娠);妊娠丢失(包括异位妊娠、流产、死产和终止妊娠);活产;分娩时的胎龄;出生体重;新生儿死亡率;以及主要先天畸形。适用时,应报告妊娠至活产的时间。
局限性、谨慎的原因:我们使用了共识发展方法,这些方法存在内在的局限性,包括参与者样本的代表性、Delphi 调查的流失率和任意的共识阈值。
研究结果的更广泛意义
将核心结局集嵌入 RCT 和系统评价中,应确保全面选择、收集和报告核心结局。研究资助机构、标准议定书项目:干预试验推荐(SPIRIT)声明以及 80 多个专业期刊,包括 Cochrane 妇科和生育组、生育与不育症和人类生殖,已承诺实施这一核心结局集。
研究资金/利益冲突:这项研究由新西兰皇家学会的 Catalyst 基金、奥克兰医学研究基金和 Maurice 和 Phyllis Paykel 信托基金资助。资助者在研究的设计和实施、数据的收集、管理、分析或解释或手稿准备方面没有任何作用。B.W.J.M. 得到了新西兰健康和医学研究委员会从业者奖学金(GNT1082548)的支持。S.B. 得到了奥克兰大学基金会 Seelye 旅行奖学金的支持。S.B. 报告担任 Human Reproduction Open 的主编和 Cochrane 妇科和生育组的编辑。J.L.H.E. 报告担任 Human Reproduction 的前任主编。J.M.L.K. 报告说他的研究赞助来自 Ferring 和 Theramex。R.S.L. 报告说他有来自 Abbvie、Bayer、Ferring、Fractyl、Insud Pharma 和 Kindex 的咨询费和研究赞助,以及来自 Guerbet 和 Hass Avocado Board 的研究赞助。B.W.J.M. 报告说他的咨询费来自 Guerbet、iGenomix、Merck、Merck KGaA 和 ObsEva。C.N. 报告说他是 Fertility and Sterility 的共同主编和 Journal of Urology 的章节编辑,他保留了对 NexHand 的财务利益。A.S. 报告说他有来自 Guerbet 的咨询费。E.H.Y.N. 报告说他的研究赞助来自 Merck。N.L.V. 报告说他的咨询费和会议费来自 Ferring、Merck 和 Merck Sharp and Dohme。其余作者声明与所呈现的工作没有利益冲突。所有作者都已完成披露表格。
临床试验注册号
有效性试验核心结局测量倡议:1023。
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