Research highlights – 20 January 2012

Research questions“Research highlights” is a weekly round-up of research papers appearing in the print BMJ. We start off with this week’s research questions, before providing more detail on some individual research papers and accompanying articles.

What should men expect after prostate biopsy?
For men awaiting prostate biopsy, it must be difficult to resist the urge to search the internet for horror stories about the procedure. Consistent and comprehensive statistics on what to expect are hard to find. This might not surprise Derek Rosario and colleagues, whose paper reports the experiences of over 1000 men undergoing prostate biopsy in a variety of UK hospitals.

Experiences may differ depending on the expertise of the staff performing the biopsy, or what the patient expected. Variation also exists in the outcomes recorded in studies looking into men’s experiences.

It’s important to counsel patients on what to expect following all procedures, but prostatic biopsy is of particular interest. It will be a reality for many more men if PSA screening is more widely implemented, and assessing the acceptability of prostate biopsy is key to understanding the acceptability of screening for prostate cancer.

You can read some crunchy numbers, tangible to patients, in box 1 of the full version of the paper online. For example, reassuringly, 85% of the men reported no pain, or only mild pain, during the procedure itself. However, 90% of men noticed blood in their semen, about a third blood in their stools, and two thirds blood in their urine, up to a month later. Two weeks after the procedure, 15% had pain.

Writing in a linked editorial Bob Djavan and Bernardo Rocco say that biopsy procedures have seen few developments, compared with imaging techniques and blood tests for prostate cancer. They use Rosario and colleagues’ data to highlight the variation in men’s experience of prostate biopsy and call for standardisation of the procedure—for example, consistent use of analgesia and antibiotics.

Births in England and elsewhere
Two papers in this week’s issue look at births in different settings, and both articles generated debate on bmj.com.

In a prospective cohort study, the Birthplace in England Collaborative Group looked at how place of birth affected perinatal outcomes. The findings suggest that women with a pregnancy at low risk of complications can safely be offered a choice of where to give birth—at home, in freestanding midwifery units, in midwife led units on a hospital site with obstetric services, or in obstetric units. Although first-time mothers who opted for a home birth appeared to be at a higher risk of adverse outcomes, the overall risk was low in all settings. Responses to the paper online raise a wide range of questions about the study’s findings, the implications for practice, and the need for more research.

Births outside of England are also on the agenda: Amie Wilson and colleagues report that in developing countries, strategies incorporating training and support of traditional birth attendants can significantly reduce perinatal and neonatal deaths. Ellen Hodnett’s accompanying editorial says the challenge now will be translating this knowledge into practice. Read online responses to the paper.

Effectiveness of agricultural interventions that aim to improve nutritional status of children
Edoardo Masset and colleagues’ systematic review looked at agricultural interventions that had the explicit goal of improving the nutritional status of children in developing countries—including bio-fortification, home gardening, aquaculture, small scale fisheries, poultry development, animal husbandry, and dairy development. The review included 23 studies, mostly evaluating home garden interventions. Although the data showed a poor effect of these interventions on nutritional status, the authors were unable to reach a strong conclusion, because of the methodological weaknesses of the studies included in the review.

Clinical prediction rules
In a Research Methods and Reporting article, Simon Adams and Stephen Leveson discuss mathematical tools that are intended to guide clinicians in their everyday decision making. The popularity of such rules has increased greatly over the past few years, and as pressure on doctors’ time increases, they will need to become familiar with decision making tools and the statistical principles underlying them. The article outlines the concepts underlying the development of clinical prediction rules and the pros and cons of their use.

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