Systematic reviews must also make use of an expansive search stra

Systematic reviews must also make use of an expansive search strategy, with use of multiple resources,

to demonstrate the reproducibility of selection and quality-assessment criteria, selleckchem to perform a quantitative analysis and adjustment for confounding where appropriate, and to explore possible reasons for differences between the results of the primary studies. In this paper, we address the advantages and limitations of systematic reviews and metaanalyses of observational studies and suggest solutions at the design phase of protocol development.”
“In male infertility, complementary treatment with antioxidant-containing food supplements quadruples the spontaneous pregnancy rate and reduces the cost per pregnancy by 60%. (C) 2011, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.”
“OBJECTIVE: To study the

influence of a regional collaboration in epithelial ovarian S3I-201 solubility dmso cancer care on staging procedures, debulking results, and survival.

METHODS: In an effort to optimize epithelial ovarian cancer treatment, a regional collaboration was introduced in the Netherlands in 2000. Gynecologic oncologists from the university center conducted surgery in community hospitals when ovarian cancer was considered based on the risk of malignancy index or clinical suspicion. The National Cancer Registry registered 1,554 patients with epithelial ovarian cancer diagnosed in 11 participating Dutch hospitals between 1996 and 2010. Surgical procedures were compared during three periods (1996-1999, 2000-2004, and 2005-2009). Log-rank tests compared Kaplan-Meier survival curves of progression-free and overall survival before (1996-2000) and during the start of the collaboration (2001-2005).

RESULTS: Staging

was adequate for 139 patients (23.0%) before collaboration, and this proportion increased during the study periods to 32.1% and 62.1% (P<.01), when gynecologic oncologists SN-38 cell line more often staged cancer in patients (36.7% compared with 54.7% and 80.6%; P<.01). For 1,197 patients with advanced stage disease (stage IIb or greater), the proportion of debulking procedures with an optimal (residual volume less than1 cm) as well as a complete result (no residuals) increased during the 14-year study period from 57.4% to 76.5% (P<.01) and from 24.1% to 43.4% (P<.01), respectively. Survival rates were similar before and during the start of the collaboration. In multivariable analysis, the treatment variables completeness of debulking, chemotherapy, and gynecologic oncologist attendance were independent prognostic factors for overall survival, as were age, stage, and tumor grade.

CONCLUSIONS: After regional collaboration, gynecologic oncologists attended more surgeries and surgical outcomes improved, but progress in survival could not be demonstrated. Regional collaboration improved care for ovarian cancer patients.

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