Current resources for evidence-based practice, january/february 2009
Current Resources for Evidence-Based Practice,January/February 2009
Published simultaneously in Journal of Obstetric, Gynecologic &
able without charge from Childbirth Connection’s website). (Disclosure: thisauthor is an employee of Childbirth Connection).
MILBANK REPORT PROPOSES FRAMEWORK FOR EVIDENCE-BASED MATERNITY CARE AND POLICY RECOMMENDATIONSFOR IMPROVEMENT
A new Milbank Report focuses on the potential to greatly
1. Sakala C, Corry MP. Evidence-Based Maternity Care: What It
Is and What It Can Achieve. New York, Milbank Memorial Fund,
improve maternity care in the United States through greater
2008. 115 p. Available without charge from:
fidelity to evidence-based practice.1 The report, authored
by Carol Sakala and Maureen Corry, was developed col-laboratively by Childbirth Connection and the MilbankMemorial Fund along with members of the Reforming
FROM COCHRANE DATABASE OF SYSTEMATIC REVIEWS (CDSR),
States Group. Childbirth Connection is a national, not-
for-profit organization dedicated to improving the quality
of maternity care through research, education, policy, andadvocacy. The Reforming States Group is a voluntary co-
Amniotic fluid index versus single deepest pocket as
alition of government experts in health policy from all 50
a screening test for preventing adverse pregnancy outcome
states, with additional members from Australia, Canada,
Antenatal breast examination for promoting breastfeed-
Scotland, and the UK. The Milbank Memorial Fund,
founded in 1905, is a national foundation that provides
Hysterectomy versus hysterectomy plus oophorectomy
nonpartisan analysis of health policy issues to inform and
support the work of private and public health policymakers.
Interventions for ketosis during labour
The report, entitled Evidence-Based Maternity Care:
Methods of delivering the placenta at caesarean section
What It Is and What It Can Achieve, takes stock of the per-
Ovulation triggers in anovulatory women undergoing
formance of the current maternity care system by considering
care processes, maternal and newborn outcomes and value
Preconception counseling for women with epilepsy to
for purchasers. It proposes a framework for evidence-based
maternity care based on the principles of ‘‘effective care
Psychosocial interventions for women enrolled in alco-
with least harm’’ to mothers and babies, and reliance on
best quality evidence. The proposed framework is applied
Rapid versus stepwise negative pressure application for
in an analysis of current maternity care practices in the
United States, identifying gaps between evidence and prac-
tice. Practices that are overused, under-used, or commonly
Surgical techniques for uterine incision and uterine
used despite uncertainty about their effects are called out,
and the relationship between evidence about biological
Uterine massage for preventing postpartum haemor-
childbearing processes and maternity care interventions is
discussed. Many systematic reviews that could be used toimprove maternity care for large proportions of mothers
and babies by limiting overused practices to appropriate cir-cumstances and rectifying underuse of beneficial practices
Antibiotic duration for treating uncomplicated, symp-
are reviewed. Finally, barriers to wider adoption of evi-
tomatic lower urinary tract infections in elderly women
dence-based maternity care are identified, and policy recom-
Bladder neck needle suspension for urinary inconti-
mendations for greater uptake of evidence are proposed.
Electronic copies of Milbank Reports are available
Erythromycin for the prevention and treatment of feed-
Journal of Midwifery & Women’s Health
1526-9523/09/$36.00 doi:10.1016/j.jmwh.2008.10.014
Extracorporeal membrane oxygenation for severe respi-
1 diabetes mellitus. In their analysis, the authors identified
and adjusted for potential confounders using regression
Methylxanthine treatment for apnea in preterm infants
techniques on each individual study, and then performed
Neonatal screening for sickle cell disease
meta-analysis on adjusted estimates or individual patient
Psychological interventions for women with metastatic
data. The study demonstrated a 20% increase in type 1 di-
abetes associated with cesarean delivery after controlling
Regular self-examination or clinical examination for
for gestational age, birth weight, birth order, breastfeed-
ing, maternal age and maternal diabetes.
Servo-control for maintaining abdominal skin tempera-
Comment: This study reports a significant increase in
the risk for childhood onset type 1 diabetes associated
Surgery versus primary endocrine therapy for operable
with cesarean delivery. Of interest, two other reviews pub-
primary breast cancer in elderly women (70 years plus)
lished in the journal Clinical and Experimental Allergy in
Vitamin A supplementation for reducing the risk of
the same time period and included in the current column
mother-to-child transmission of HIV infection
demonstrate an increased risk of similar magnitudebetween cesarean delivery and childhood asthma, and
Cochrane Reviews are available by subscription to The
between cesarean delivery and food allergy, allergic rhini-
Cochrane Library, and review abstracts are available
tis, asthma and hospitalization for asthma. In those
reviews, it was not possible to control for potential con-founders. Meta-analysis provides clarification of the mag-
FROM DATABASE OF ABSTRACTS OF REVIEWS OF EFFECTS
nitude of observed associations but does not allow
inferences about causation. Taken together, the evidence
Recent Abstract Entries Assessing Quality of Systematic
from these reviews strongly suggests a relationship be-
tween cesarean delivery and subsequent alteration inchildhood immune function for which the exact mecha-
Dietary supplements and herbal remedies for premen-
strual syndrome (PMS): A systematic research reviewof the evidence for their efficacy
Featured review: Himpens E, Van den Broeck C, Oostra
Disease-modifying antirheumatic drugs in pregnancy:
A, Calders P, Vanhaesebrouck P. Prevalence, type, distri-
Current status and implications for the future
bution, and severity of cerebral palsy in relation to gesta-
Effect of sulfadoxine-pyrimethamine resistance on the
tional age: A meta-analytic review. Dev Med Child Neuro
efficacy of intermittent preventive therapy for malaria
control during pregnancy: A systematic review
The authors conducted a meta-analysis of 25 epidemiolog-
Effectiveness and safety of ritodrine hydrochloride for
ical studies published after 1985 to clarify the relationship
the treatment of preterm labour: A systematic review
between gestational age and prevalence rates and charac-
Examining differential treatment effects for depression
teristics of cerebral palsy (CP) in liveborn, surviving in-
in racial and ethnic minority women: A qualitative sys-
fants. The study confirmed a significant dose-responsive
decrease in the prevalence of CP with increasing gesta-
Long-term risk of invasive cervical cancer after treat-
tional age, clarifying that this decline is first observed at
ment of squamous cervical intraepithelial neoplasia
27 weeks’ gestation. The rates of CP by gestational age
Progesterone for the prevention of preterm birth: A
were as follows: 14.6% at 22 to 27 weeks, 6.2% at 28 to
31 weeks, 0.7% at 32 to 36 weeks, and 0.1% at term.
SSRIs during breastfeeding: Spotlight on milk-to-plasma
The spastic form of CP dominated in preterm infants
whereas non-spastic CP was more common in term in-
DARE abstracts are available without charge at
fants. Due to a lack of standard nomenclature to define
the severity of CP, it was not possible to make inferencesabout acuity in relation to gestational age.
Comment: Technological advances in perinatal care in
EVIDENCE-BASED REVIEWS FROM OTHER SOURCES
recent decades have led to increased survival of infants
Featured review: Cardwell CR, Stene LC, Joner G, Cinek
born at earlier gestational ages. This study clarifies current
O, Svensson J, Goldacre MJ, et al. Caesarean section is
prevalence rates of CP, providing new information about
associated with an increased risk of childhood-onset
the association between the rate and types of CP and ges-
type 1 diabetes mellitus: A meta-analysis of observational
studies. Diabetologia 2008;51(5):726–35.
Featured review: Beining RM, Dennis LK, Smith EM, Dokras
A rigorously conducted meta-analysis explored the associ-
A. Meta-analysis of intrauterine device use and risk of endo-
ation between cesarean delivery and childhood onset type
metrial cancer. Ann Epidemiol 2008;18(6):492–9.
A meta-analysis of 10 analytic studies reporting the effect
Hannula L, Kaunonen M, Tarkka MT. A systematic re-
of intrauterine device (IUD) use on risk of endometrial
view of professional support interventions for breast-
cancer was performed. Since cancer diagnosis dates in
feeding. J Clin Nurs 2008;17(9):1132–43.
the studies predated marketing of hormonal IUDs, the ef-
Harder T, Plagemann A, Harder A. Birth weight and
fects were attributed to inert and copper-containing IUDs
subsequent risk of childhood primary brain tumors:
only. Some, but not all, included studies controlled for po-
A meta-analysis. Am J Epidemiol 2008;168(4):366–73.
tential confounders that could attenuate or magnify the as-
Mol F, Mol BW, Ankum WM, van der Veen F, Haje-
sociation between IUD use and endometrial cancer risk.
nius PJ. Current evidence on surgery, systemic metho-
Based on the adjusted pooled analysis, women who had
trexate and expectant management in the treatment of
ever used an IUD were 46% less likely to develop endome-
trial cancer than never users. In addition, a linear duration
analysis for the effect of each 5-year increment up to 20
Moretti ME, Rezvani M, Koren G. Safety of glyburide
years showed a significant decrease in risk associated
for gestational diabetes: A meta-analysis of pregnancy
with years of IUD use, years since last IUD use (recency),
outcomes. Ann Pharmacother 2008;42(4):483–90.
and years since first IUD use (latency).
Naughton F, Prevost AT, Sutton S. Self-help smoking
Comment: Despite potential limitations, this study
cessation interventions in pregnancy: A systematic re-
strongly suggests that non-hormonal IUDs exert a protec-
view and meta-analysis. Addiction 2008;103(4):566–79.
tive effect against endometrial cancer, the mechanism for
Rasmussen SA, Chu SY, Kim SY, Schmid CH, Lau J.
which is not currently understood. Future studies includ-
Maternal obesity and risk of neural tube defects: A
ing hormonal IUDs are likely to exhibit an even greater
meta-analysis. Am J Obstet Gynecol 2008;198(6):611–9.
protective effect because progestins are known to decrease
Shah NR, Jones JB, Aperi J, Shemtov R, Karne A,
proliferation of the uterine lining.
Borenstein J. Selective serotonin reuptake inhibitorsfor premenstrual syndrome and premenstrual dys-phoric disorder: A meta-analysis. Obstet Gynecol2008;111(5):1175–82.
Taylor P, Potts HW. Computer aids and human second
Aagaard H, Hall EO. Mothers’ experiences of having
reading as interventions in screening mammography:
a preterm infant in the neonatal care unit: A meta-syn-
Two systematic reviews to compare effects on cancer
thesis. J Pediatr Nurs 2008;23(3):e26–36.
detection and recall rate. Eur J Cancer 2008;44(6):
Akc¸il M, Karaag˘aog˘lu E, Demirhan B. Diagnostic accu-
racy of fine-needle aspiration cytology of palpable
Thavagnanam S, Fleming J, Bromley A, Shields MD,
breast masses: An SROC curve with fixed and random
Cardwell CR. A meta-analysis of the association be-
effects linear meta-regression models. Diagn Cytopa-
tween caesarean section and childhood asthma. Clin
Bager P, Wohlfahrt J, Westergaard T. Caesarean deliv-
Viswanathan M, Siega-Rix AM, Moos M-K, Deierlein
ery and risk of atopy and allergic disease: Meta-analy-
A, Mumford S, Knaack J, et al. Outcomes of maternal
ses. Clin Exp Allergy 2008;38(4):634–42.
weight gain. Evidence Report/Technology Assessment
Brostrøm S, Lose G. Pelvic floor muscle training in the
No.168. (Prepared by RTI International-University of
prevention and treatment of urinary incontinence in
North Carolina Evidence-based Practice Center under
women-What is the evidence? Acta Obstet Gynecol
Contract No. 290-02-0016.) AHRQ Publication No.
08-E009. Rockville, MD: AHRQ. May 2008. Available
Canonico M, Plu-Bureau G, Lowe GD, Scarabin PY.
Hormone replacement therapy and risk of venous throm-
boembolism in postmenopausal women: Systematic
Zhou B, Yang L, Sun Q, Cong R, Gu H, Tang N, et al.
review and meta-analysis. BMJ 2008;336(7655):1227–
Cigarette smoking and the risk of endometrial cancer: A
meta-analysis. Am J Med 2008;121(6):501–8.
Creanga AA, Bradley HM, McCormick C, Witkop CT.
R. Rima Jolivet, CNM, MSN, MPH, is Associate Director of Programs atChildbirth Connection, which works with health professionals and other
Use of metformin in polycystic ovary syndrome: A
audiences to promote evidence-based maternity care (
meta-analysis. Obstet Gynecol 2008;111(4):959–68.
Journal of Midwifery & Women’s Health
Inflammatory Bowel Disease What is inflammatory bowel disease? Inflammatory bowel disease (IBD) is a condition caused by the excessive infiltration of inflammatory cells (such as neutrophils, macrophages, and eosinophils) into the normal lining layers of the intestinal tract. These cel s disrupt the normal architecture of the intestine, interfere with effective digestion and absorption o
Questions --- Shevrin & Stadler Participant Is there a difference between Lupron and Zoladex? Walter Stadler, MD All of these drugs cause castration, and whether one gives a medication to cut down the testosterone or one removes the testicles, it has the same effect. In fact, I would argue that if we want to save a billion dollars in this country on Medicare, everyone with advanc