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Current Resources for Evidence-Based Practice, March/April 2015 Nicole S. Carlson
Correspondence Nicole S. Carlson, CNM, College of Nursing, University of Colorado Denver, 221 Fayetteville Rd., Decatur, GA 30030. [email protected] Nicole S. Carlson, CNM, is a doctoral candidate in the College of Nursing, University of Colorado Denver, Denver, CO.
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ublished simultaneously in the Journal of Midwifery & Women’s Health, 60(2).
Applying the Evidence to Practice Aguably, the most important part of evidencebased practice (EBP) is the actual application of research evidence to clinical practice. After reviewing the first three steps of the 5A Model for the practitioner’s use of evidence-based information (Ask, Acquire, Appraise, Apply, and Assess) in previous editions of this column, we now move on to the step of Apply. After initially posing a clinical question in the Ask step of the 5A Model, the practitioner must then focus on acquiring and appraising research that is applicable to the clinical problem and meets quality standards in terms of research design and the generalizability of the research to the clinical problem at hand (Duke University Medical Center & Health Sciences Library University of North Carolina, 2013). In the past few columns, I discussed techniques for identifying quality research. Clinical expertise is also necessary to determine whether a research finding applies to a particular clinical situation and to implement the evidence-based recommendation (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). The third component necessary in the application of EBP is alignment with patient preferences and values (Duke University Medical Center & Health Sciences Library University of North Carolina, 2013). If the woman and family do not understand and support the plan of care, even the most well-substantiated treatment and skilled clinicians are not enough to ensure that research findings are implemented in practice.
The author reports no conflict of interest or relevant financial relationships.
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To demonstrate these concepts in action, I offer an example from my own distant past. Early in my career while working as a labor nurse, I moved to a different state and found a position in a new labor and delivery unit. Unlike the previous facility, this new unit was in a teaching hospital with a large percentage of births attended by nurse-midwives. One of my first patients was a term nulliparous
woman who presented with regular contractions. On examination, her cervix was 3 to 4 cm dilated and 70% effaced with the fetus at –1 station and no leakage of fluid. She was distressed by her contractions and asking for epidural analgesia. At this time, research findings indicated that early admissions to the hospital in labor were associated with a greater risk of operative birth (Jackson, 2003), and ambulation in early labor was associated with better chance of vaginal birth (Albers et al., 1997). Although I was familiar with these findings, the standard practice at my previous hospital was to admit women when they presented with regular contractions, provide epidural analgesia when requested, quickly rupture membranes artificially, and augment with oxytocin (Pitocin). I made a quick call to inform the woman’s provider of her labor and moved forward with the necessary steps to initiate epidural analgesia. Twenty minutes later when the woman’s nurse-midwife arrived, I had inserted an intravenous (IV) line, completed hospital admission paperwork, and called the anesthesiologist, who was on the way to the room. The short (and personally mortifying) end to this story was that the nurse-midwife cancelled my admission, called off the anesthesiologist, and discharged the patient home within the next 2 hours. More than a week later the woman went into spontaneous labor and had an uneventful birth. What went wrong in this clinical scenario? How were the three components of EBP misaligned to result in failure to apply research evidence clinically and nearly initiate epidural analgesia and labor induction inappropriately? First, I did not have the clinical expertise to accurately triage this woman for labor. The nurse-midwife started the triage process by asking questions about the woman’s contractions, not by checking her cervix. The woman’s contractions had started a few hours earlier after she spent the day at an outdoor picnic. She was very afraid of labor and rushed to the hospital soon after noticing the contractions. Next, the nurse-midwife ordered an IV fluid bolus and an hour of ambulation. Later, the nursemidwife rechecked the woman’s cervix, which was 3 cm dilated and 60% effaced with the fetus at –2
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station. By this time her contractions were spaced out to every 10 to 15 minutes. Second, I did not did not take into account the woman’s values and preferences for the plan of care. When I rushed toward epidural analgesia, I was responding to the woman’s fears; however, I was not integrating her wishes with the bigger picture of her clinical situation and the research findings. In contrast, the nurse-midwife sat with the woman and explained that her contractions were not caused by labor but instead by dehydration. She shared with the woman that admission before strong labor could decrease her risk for a vaginal birth with minimal interventions. In short, the nurse-midwife built a relationship with the woman that allowed her to express her fears of labor and have her questions answered. In this way, the woman’s preferences and values were incorporated in the plan for her to return home. As a result, she left the hospital better informed about her body, her labor, and her options. She was not unhappy about continuing to be pregnant, and she avoided a nonindicated induction of labor. The take-away message from this story is that excellent health care is rooted in the same components outlined as essential for evidence-based practice. Nurses were some of the first health care providers to emphasize the importance of combining empirical evidence with strong clinical skills, while keeping the background and motivation of the patient in mind (Nightingale, 1860). The hallmarks of midwifery include incorporation of scientific evidence into clinical practice and empowerment of women as partners in health care (American College of Nurse-Midwives, 2013). Therefore, nurses and midwives are ideally suited to resist the urge to function simply based on protocol or the culture of the clinical setting and instead to continue the tradition of care that is based on the three components of EBP.
Jackson, D. J. (2003). Impact of collaborative management and early admission in labor on method of delivery. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 32(2), 147–157. Nightingale, F. (1860). Notes on nursing: What it is, and what it is not (1st ed.). London, England: Harrison. Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312, 71–72.
From Cochrane Database of Systematic Reviews (CDSR) Issues 10 & 11, 2014 New Systematic Reviews in CDSR: Women’s Health
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Minimally invasive surgical techniques versus open myomectomy for uterine fibroids Vasodilators for women undergoing fertility treatment
Albers, L. L., Anderson, D., Cragin, L., Daniels, S. M., Hunter, K. D.,
Interventions for managing asthma in pregnancy Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child High-dose versus low-dose oxytocin infusion regimens for induction of labor at term Ambroxol for women at risk of preterm birth for preventing neonatal respiratory distress syndrome Strategies of testing for syphilis during pregnancy Fetal assessment methods for improving neonatal and maternal outcomes in preterm prelabor rupture of membranes Early versus late initiation of epidural analgesia for labor Interventions for women in subsequent pregnancies following obstetric anal sphincter injury to reduce the risk of recurrent injury and associated harms Hepatitis B vaccination during pregnancy for preventing infant infection
& Teaf, D. (1997). The relationship of ambulation in labor to operative delivery. Journal of Midwifery & Women’s Health, 42(1), 4–8. American College of Nurse Midwives. (2013). ACNM core competencies.
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Non-nutritive sucking for gastro-esophageal reflux disease in preterm and low-birthweight infants Interventions aimed at communities to inform and/or educate about early childhood vaccination
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Pentoxifylline for the prevention of bronchopulmonary dysplasia in preterm infants
Updated Systematic Reviews in CDSR: Women’s Health
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High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer Immunotherapy for recurrent miscarriage Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome
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Antibiotic prophylaxis for third- and fourthdegree perineal tear during vaginal birth Prophylactic antibiotics for manual removal of retained placenta in vaginal birth Fetal pulse oximetry for fetal assessment in labor Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section Antibiotics for prelabor rupture of membranes at or near term Routine perineal shaving on admission in labor Different classes of antibiotics given to women routinely for preventing infection at caesarean section Interventions for preventing or reducing domestic violence against pregnant women Antibiotics for meconium-stained amniotic fluid in labor for preventing maternal and neonatal infections
From the Database of Abstracts and Reviews of Effects (DARE) Recent Abstract Entries Assessing Quality of Systematic Reviews: Pregnancy and Birth
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Waterbirth: An integrative analysis of peerreviewed literature
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Effectiveness of mass media interventions for HIV prevention, 1986–2013
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Videos to influence: A systematic review of effectiveness of video-based education in modifying health behaviors
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The effectiveness and maternal satisfaction of breastfeeding support for women from disadvantaged groups Influenza vaccination during pregnancy
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The effectiveness of music on pain among preterm infants in the NICU
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Effect of yoga on sleep quality among adult cancer patients
Featured Review: Wojcieszek, A. M., Stock, O. M., & Flenady, V. (2014). Antibiotics for prelabour rupture of membranes at or near term. Cochrane Database of Systematic Reviews, 10, CD001807. Premature rupture of membranes (PROM), defined as the rupture of membranes before the onset of labor, occurs in approximately 8% of term pregnancies (Cammu, Verlaenen, & Perde, 1990). Although some health care providers advocate prompt induction of labor (within 12 hours) with synthetic oxytocin or prostaglandins following PROM, others prefer to allow longer periods of time to elapse after PROM in anticipation of spontaneous contractions. Some authors found evidence that induction of labor following PROM reduced the risk of maternal infection and infant admission to NICU (Dare, Middleton, Crowther, Flenady, & Varatharaju, 2006). However, the optimum time between PROM and labor induction is still an issue of debate. Some providers offer antibiotics to women experiencing PROM to decrease risk of infection, thus extending the time available for labor and birth. However, the use of antibiotics given current problems with antibiotic resistance raises concern (American College of Obstetricians and Gynecologists, 2011). In this updated Cochrane review, the authors assessed the effects of antibiotics used prophylactically
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in women at or beyond 36 weeks gestation with PROM. The authors included two additional studies that more than doubled the total number of women included in the meta-analysis from the previous review (N = 2,639 in updated review). Unlike the earlier version in which the authors found a reduction in endometritis with prophylactic use of antibiotics in cases of PROM at or near term, the current authors did not find a decreased risk for endometritis with antibiotic use (relative risk [RR] = .34, 95% confidence interval [CI] [0.05, 2.31]). Also, no differences were found regarding probable early-onset neonatal sepsis (RR = .69, 95% CI [0.21, 2.33]), definite early-onset neonatal sepsis (RR = 0.57, 95% CI [0.08, 4.26]), maternal chorioamnionitis and/or endometritis (RR = .48, 95% CI [0.20, 1.15]), stillbirth (RR = 3.00, 95% [CI 0.61, 14.82]), or perinatal mortality (RR = 1.98, 95% [CI 0.60, 6.55]). Interestingly, cesarean birth increased among women receiving prophylactic antibiotics for PROM (RR = 1.33, 95% [CI 1.09, 1.61]) as did length of hospital stay (mean difference 0.06 days, 95% CI [0.01, 0.11]) based primarily on one large study included in the meta-analysis. Authors of the updated review also completed sub-group analysis on maternal and neonatal outcomes for prophylactic antibiotic use among early labor induction (ࣘ 12 hours following PROM) and late labor induction (>12 hours following PROM) groups. No significant differences were seen in any outcome category. However, there was a trend toward reduced probable or definite early-onset neonatal sepsis and reduced maternal infection morbidity in the late induction groups. Comment: The authors of this updated Cochrane systematic review and meta-analysis found no benefit for the use of prophylactic antibiotics with PROM near or at term. Antibiotics should only be administered to women with PROM at or near term exhibiting clinical indications of infection.
REFERENCES American College of Obstetricians and Gynecologists. (2011). Use of prophylactic antibiotics in labor and delivery. Obstetrics & Gynecology, 117(6), 1472–1483. Cammu, H., Verlaenen, H., & Perde, M. P. (1990). Premature rupture of membranes at term in nulliparous women: A hazard? Obstetrics & Gynecology, 76(4), 671–674.
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Dare, M. R., Middleton, P., Crowther, C. A., Flenady, V. J., & Varatharaju, B. (2006). Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database of Systematic Reviews, 1, CD005302. doi:10.1002/14651858.CD005302.pub2
Featured Review: Widman, L., Noar, S. M., Choukas-Bradley, S., & Francis, D. B. (2014). Adolescent sexual health communication and condom use: A meta-analysis. Health Psychology, 33(10), 1113–1124. doi:10.1037/hea0000112 Young adults and adolescents between age 13 and 24 years represent only one fourth of the sexually active population, yet sexually transmitted infections (STIs) in this group account for half of all STIs each year (Centers for Disease Control and Prevention, 2013). Much research during the past 20 years has focused on factors and interventions leading to improved condom use among adolescents. In this systematic review and metaanalysis, the authors synthesized evidence on sexual communication and condom use in adolescents. The review included 34 studies conducted in the United States and international locations, with a total of 15,046 participants between age 12 and 23 years (mean age = 16.77). Sexual communication between young males and females was included in this review. Overall, sexual communication with a partner (defined as the ability to discuss and negotiate safe sex) was positively associated with condom use (r = .24, p < .001). This moderate effect did not differ significantly by gender, age, setting, or country of study. Researchers also found that the specific content of sexual communication was important to the use of condoms. Sexual communication with a partner that was focused on condom use was more effective (r = .34) than sexual communication about sexual history (r = .15) or more general safe sexual topics (r = .14). This review also included results on the most effective ways to teach successful sexual communication to adolescents. Sexual communication training was significantly more likely to end in successful condom use if it was behaviorally based (r = .27) or focused on self-efficacy (r = .28) rather than focused on future intention to use condoms (r = .15) or fear/concern about condom use (r = .18). Comment: As health care providers, nurses and midwives have an important role in educating
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and encouraging safe sex practices among adolescents. This review provides valuable information on sexual communication practices that can be shared with adolescents and their parents. Rather than focus education efforts with adolescents about condom usage on fear/concerns or intention to use condoms, health care providers can more effectively serve these clients by promoting role-play communication trainings and encouraging adolescents to enact behavioral preparation for condom usage (buy condoms, practice use of condoms).
REFERENCE Centers for Disease Control and Prevention. (2010). Youth risk behavior surveillance–United States, 2009. Surveillance summaries. Morbidity and Mortality Weekly Report, 59(SS5), 1–148. Retrieved from http://www.cdc.gov/ mmwr/pdf/ss/ss5905.pdf
Evidence-Based Reviews From Other Sources Recent Evidence-Based Reviews: Women’s Health Andreano, A., Rechichi, G., Rebora, P., Sironi, S., Valsecchi, M. G., & Galimberti, S. (2014). MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: A systematic review and meta-analysis. European Radiology, 24(6), 1327–1338. doi:10.1007/s00330-014-3139-4 Barry, J. A., Azizia, M. M., & Hardiman, P. J. (2014). Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: A systematic review and meta-analysis. Human Reproduction Update, 20(5), 748–758. doi:10.1093/humupd/dmu012 Boyle, R., Hay-Smith, E. J., Cody, J. D., & Morkved, S. (2014). Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women: A short version Cochrane review. Neurourology and Urodynamics, 33(3), 269–276. doi:10.1002/nau.22402 Cui, Y., Zong, H., Yang, C., Yan, H., & Zhang, Y. (2014). The efficacy and safety of mirabegron in treating OAB: A systematic review and meta-analysis of phase III trials. International Urology and Nephrology, 46(1), 275–284. doi:10.1007/s11255-013-0509-9 Esposito, K., Chiodini, P., Capuano, A., Bellastella, G., Maiorino, M. I., & Giugliano, D. (2014). Metabolic syndrome and endometrial
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cancer: A meta-analysis. Endocrine, 45(1), 28– 36. doi:10.1007/s12020-013-9973-3 Fritz, H., Seely, D., McGowan, J., Skidmore, B., Fernandes, R., Kennedy, D. A., . . . Fergusson, D. (2014). Black cohosh and breast cancer: A systematic review. Integrative Cancer Therapies, 13(1), 12–29. doi:10.1177/1534735413477191 Houssami, N., Macaskill, P., Marinovich, M. L., & Morrow, M. (2014). The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: A meta-analysis. Annals of Surgical Oncology, 21(3), 717–730. doi:10.1245/s10434-014-3480-5 Hu, L., Bu, Z., Wang, K., & Sun, Y. (2014). Recombinant luteinizing hormone priming in early follicular phase for women undergoing in vitro fertilization: Systematic review and meta-analysis. Journal of International Medical Research, 42(2), 261–269. doi:10.1177/0300060513509044 Huang, Y., Zhang, X., Li, W., Song, F., Dai, H., Wang, J., . . . Chen, K. (2014). A meta-analysis of the association between induced abortion and breast cancer risk among Chinese females. Cancer Causes and Control, 25(2), 227–236. doi:10.1007/s10552-013-0325-7 Jamil, M. S., Bauer, H. M., Hocking, J. S., Ali, H., Wand, H., Walker, J., . . . Guy, R. J. (2014). Chlamydia screening strategies and outcomes in educational settings: A systematic review. Sexually Transmitted Diseases, 41(3), 180–187. doi:10.1097/olq.0000000000000095 Kolokotroni, P., Anagnostopoulos, F., & Tsikkinis, A. (2014). Psychosocial factors related to posttraumatic growth in breast cancer survivors: A review. Women and Health, 54(6), 569–592. doi:10.1080/03630242.2014.899543 Lam, J. U., Rebolj, M., Dugue, P. A., Bonde, J., von Euler-Chelpin, M., & Lynge, E. (2014). Condom use in prevention of Human Papillomavirus infections and cervical neoplasia: Systematic review of longitudinal studies. Journal of Medical Screening, 21(1), 38–50. doi:10.1177/0969141314522454 Lee, J. Y., Lee, C., Hahn, S., Kim, M. A., Kim, H. S., Chung, H. H., . . . Song, Y. S. (2014). Prognosis of adenosquamous carcinoma compared with adenocarcinoma in uterine cervical cancer: A systematic review and meta-analysis of observational studies. International Journal of Gynecological Cancer, 24(2), 289–294. doi:10.1097/igc.0000000000000063 Leggett, L. E., Lorenzetti, D. L., Noseworthy, T., Tiwana, S., Mackean, G., & Clement, F.
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(2014). Experiences and attitudes toward risk of recurrence testing in women with breast cancer: A systematic review. Breast Cancer Research and Treatment, 144(3), 457–465. doi:10.1007/s10549-014-2900-3 Liu, X. O., Huang, Y. B., Gao, Y., Chen, C., Yan, Y., Dai, H. J., . . . Chen, K. X. (2014). Association between dietary factors and breast cancer risk among Chinese females: Systematic review and meta-analysis. Asian Pacific Journal of Cancer Prevention, 15(3), 1291– 1298. Martins, W. P., Vieira, C. V., Teixeira, D. M., Barbosa, M. A., Dassuncao, L. A., & Nastri, C. O. (2014). Ultrasound for monitoring controlled ovarian stimulation: A systematic review and meta-analysis of randomized controlled trials. Ultrasound in Obstetrics and Gynecology, 43(1), 25–33. doi:10.1002/uog.12566 Meads, C., Sutton, A. J., Rosenthal, A. N., Malysiak, S., Kowalska, M., Zapalska, A., . . . Sundar, S. (2014). Sentinel lymph node biopsy in vulval cancer: Systematic review and metaanalysis. British Journal of Cancer, 110(12), 2837–2846. doi:10.1038/bjc.2014.205 Miralpeix, E., Gonzalez-Comadran, M., Sola, I., Manau, D., Carreras, R., & Checa, M. A. (2014). Efficacy of luteal phase support with vaginal progesterone in intrauterine insemination: A systematic review and meta-analysis. Journal of Assisted Reproduction and Genetics, 31(1), 89–100. doi:10.1007/s10815-013-0127-6 Nagayama, A., Hayashida, T., Jinno, H., Takahashi, M., Seki, T., Matsumoto, A., . . . Kitagawa, Y. (2014). Comparative effectiveness of neoadjuvant therapy for HER2-positive breast cancer: A network meta-analysis. Journal of the National Cancer Institute, 106(9), 1–9. doi:10.1093/jnci/dju203 Pan, H., He, Z., Ling, L., Ding, Q., Chen, L., Zha, X., . . . Wang, S. (2014). Reproductive factors and breast cancer risk among BRCA1 or BRCA2 mutation carriers: Results from ten studies. Cancer Epidemiology, 38(1), 1–8. doi:10.1016/j.canep.2013.11.004 Phe, V., Nguyen, K., Roupret, M., Cardot, V., Parra, J., & Chartier-Kastler, E. (2014). A systematic review of the treatment for female stress urinary incontinence by ACT(R) balloon placement (Uromedica, Irvine, CA, USA). World Journal of Urology, 32(2), 495–505. doi:10.1007/s00345013-1117-0 Simmons, C., Rajmohan, Y., Poonja, Z., & Adilman, R. (2014). Social media in cancer care: opportunities to improve care in locally advanced breast cancer. Current Opinion in
Supportive & Palliative Care, 8(1), 77–82. doi:10.1097/spc.0000000000000025 Tavernier, N., Fumery, M., Peyrin-Biroulet, L., Colombel, J. F., & Gower-Rousseau, C. (2013). Systematic review: Fertility in non-surgically treated inflammatory bowel disease. Alimentary Pharmacology and Therapeutics, 38(8), 847– 853. doi:10.1111/apt.12478 Valachis, A., Nearchou, A. D., & Lind, P. (2014). Surgical management of breast cancer in BRCA-mutation carriers: A systematic review and meta-analysis. Breast Cancer Research and Treatment, 144(3), 443– 455. doi:10.1007/s10549-014-2890-1 van de Water, W., Bastiaannet, E., Scholten, A. N., Kiderlen, M., de Craen, A. J., Westendorp, R. G., . . . Liefers, G. J. (2014). Breast-conserving surgery with or without radiotherapy in older breast patients with early stage breast cancer: A systematic review and meta-analysis. Annals of Surgical Oncology, 21(3), 786–794. doi:10.1245/s10434-013-3374-y Velez Toral, M., Godoy-Izquierdo, D., Padial Garcia, A., Lara Moreno, R., Mendoza Ladron de Guevara, N., Salamanca Ballesteros, A., . . . Godoy Garcia, J. F. (2014). Psychosocial interventions in perimenopausal and postmenopausal women: A systematic review of randomised and non-randomised trials and non-controlled studies. Maturitas, 77(2), 93–110. doi:10.1016/j.maturitas.2013.10. 020 Verbelen, H., Gebruers, N., Eeckhout, F. M., Verlinden, K., & Tjalma, W. (2014). Shoulder and arm morbidity in sentinel node-negative breast cancer patients: A systematic review. Breast Cancer Research and Treatment, 144(1), 21– 31. doi:10.1007/s10549-014-2846-5 Vitek, W. S., Shayne, M., Hoeger, K., Han, Y., Messing, S., & Fung, C. (2014). Gonadotropinreleasing hormone agonists for the preservation of ovarian function among women with breast cancer who did not use tamoxifen after chemotherapy: A systematic review and metaanalysis. Fertility and Sterility, 102(3), 808.e1– 815.e1. doi:10.1016/j.fertnstert.2014.06.003 Wen, K. Y., Fang, C. Y., & Ma, G. X. (2014). Breast cancer experience and survivorship among Asian Americans: A systematic review. Journal of Cancer Survivorship, 8(1), 94–107. doi:10.1007/s11764-013-0320-8 Widman, L., Noar, S. M., Choukas-Bradley, S., & Francis, D. B. (2014). Adolescent sexual health communication and condom use: A metaanalysis. Health Psychology, 33(10), 1113– 1124. doi:10.1037/hea0000112
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Worsley, R., Bell, R., Kulkarni, J., & Davis, S. R. (2014). The association between vasomotor symptoms and depression during perimenopause: A systematic review. Maturitas, 77(2), 111–117. doi:10. 1016/j.maturitas.2013.11.007 Wyatt, K. D., Anderson, R. T., Creedon, D., Montori, V. M., Bachman, J., Erwin, P., & LeBlanc, A. (2014). Women’s values in contraceptive choice: A systematic review of relevant attributes included in decision aids. BMC Women’s Health, 14(1), 28. doi:10.1186/14726874-14-28 Zhang, H., Tao, X., & Wu, J. (2014). Association of homocysteine, vitamin B12, and folate with bone mineral density in postmenopausal women: A meta-analysis. Archives of Gynecology and Obstetrics, 289(5), 1003–1009. doi:10.1007/s00404-013-3075-6
Recent Evidence-Based Reviews: Pregnancy & Birth Aune, D., Norat, T., Romundstad, P., & Vatten, L. J. (2014). Breastfeeding and the maternal risk of type 2 diabetes: A systematic review and dose-response meta-analysis of cohort studies. Nutrition, Metabolism, and Cardiovascular Diseases, 24(2), 107–115. doi:10.1016/j.numecd.2013.10.028 Baldacchino, A., Arbuckle, K., Petrie, D. J., & McCowan, C. (2014). Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: A systematic review and meta-analysis. BMC Psychiatry, 14, 104. doi:10.1186/1471-244x-14-104 Benjamin, D. R., van de Water, A. T., & Peiris, C. L. (2014). Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: A systematic review. Physiotherapy, 100(1), 1–8. doi:10.1016/j.physio.2013.08.005 Brite, J., Shiroma, E. J., Bowers, K., Yeung, E., Laughon, S. K., Grewal, J. G., & Zhang, C. (2014). Height and the risk of gestational diabetes: Variations by race/ethnicity. Diabetic Medicine, 31(3), 332– 340. doi:10.1111/dme.12355 Cecchino, G. N., Araujo Junior, E., & Elito Junior, J. (2014). Methotrexate for ectopic pregnancy: When and how. Archives of Gynecology and Obstetrics, 290(3), 417–423. doi:10.1007/s00404-014-3266-9 Fan, W., Li, S., Huang, Z., & Chen, Q. (2014). Relationship between HLA-G polymorphism and susceptibility to recurrent miscarriage: A meta-
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analysis of non-family-based studies. Journal of Assisted Reproduction and Genetics, 31(2), 173–184. doi:10.1007/s10815-013-0155-2 Flak, A. L., Su, S., Bertrand, J., Denny, C. H., Kesmodel, U. S., & Cogswell, M. E. (2014). The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: A meta-analysis. Alcoholism, Clinical and Experimental Research, 38(1), 214–226. doi:10.1111/acer.12214 Gonzalez, R., Hellgren, U., Greenwood, B., & Menendez, C. (2014). Mefloquine safety and tolerability in pregnancy: A systematic literature review. Malaria Journal, 13, 75. doi:10.1186/1475-2875-13-75 Hartling, L., Dryden, D. M., Guthrie, A., Muise, M., Vandermeer, B., & Donovan, L. (2014). Diagnostic thresholds for gestational diabetes and their impact on pregnancy outcomes: A systematic review. Diabetic Medicine, 31(3), 319–331. doi:10.1111/dme.12357 Kebed, K. Y., Bishu, K., Al Adham, R. I., Baddour, L. M., Connolly, H. M., Sohail, M. R., . . . Anavekar, N. S. (2014). Pregnancy and postpartum infective endocarditis: A systematic review. Mayo Clinic Proceedings, 89(8), 1143–1152. doi:10.1016/j.mayocp.2014.04.024 Kong, D., Liu, H., Wei, S., Wang, Y., Hu, A., Han, W., . . . Zheng, Y. (2014). A meta-analysis of the association between gestational diabetes mellitus and chronic hepatitis B infection during pregnancy. BMC Research Notes, 7, 139. doi:10.1186/1756-0500-7-139 Li, J., Chen, Y., Wu, H., & Li, L. (2014). Apolipoprotein E (Apo E) gene polymorphisms and recurrent pregnancy loss: A meta-analysis. Journal of Assisted Reproduction and Genetics, 31(2), 139–148. doi:10.1007/s10815-013-0128-5 Marom, R., Lubetzky, R., Mimouni, F. B., Ovental, A., Mandel, D., & Cohen, S. (2014). Secular trends in impact factor of breastfeeding research publications over a 20-year period. Breastfeeding Medicine, 9(2), 98–100. doi:10.1089/bfm.2013.0090 Money, D., Tulloch, K., Boucoiran, I., Caddy, S., Yudin, M. H., Allen, V., . . . van Schalkwyk, J. (2014). Guidelines for the care of pregnant women living with HIV and interventions to reduce perinatal transmission: Executive summary. Journal of Obstetrics and Gynaecology Canada. Journal d’Obstetrique et Gynecologie ´ ´ du Canada, 36(8), 721–751. Pedersen, M., Stayner, L., Slama, R., Sorensen, M., Figueras, F., Nieuwenhuijsen, M. J., . . . Dadvand, P. (2014). Ambient air pollution and pregnancy-induced hypertensive
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Akyurekli, C., Chan, J. Y., Elmoazzen, H., Tay, J., & Allan, D. S. (2014). Impact of ethnicity on human umbilical cord blood banking: A systematic review. Transfusion, 54(8), 2122–2127. doi:10.1111/trf.12630 Araujo de Franca, G. V., Restrepo-Mendez, M. C., Loret de Mola, C., & Victora, C. G. (2014). Size at birth and abdominal adiposity in adults: A systematic review and meta-analysis. Obesity Reviews, 15(2), 77–91. doi:10.1111/obr.12109 Cassina, M., Dona, M., Di Gianantonio, E., Litta, P., & Clementi, M. (2014). First-trimester exposure to metformin and risk of birth defects:
A systematic review and meta-analysis. Human Reproduction Update, 20(5), 656–669. doi:10.1093/humupd/dmu022 Khalil, A., Suff, N., Thilaganathan, B., Hurrell, A., Cooper, D., & Carvalho, J. S. (2014). Brain abnormalities and neurodevelopmental delay in congenital heart disease: Systematic review and meta-analysis. Ultrasound in Obstetrics and Gynecology, 43(1), 14–24. doi:10.1002/uog.12526 Lange, S., Shield, K., Koren, G., Rehm, J., & Popova, S. (2014). A comparison of the prevalence of prenatal alcohol exposure obtained via maternal self-reports versus meconium testing: A systematic literature review and metaanalysis. BMC Pregnancy and Childbirth, 14, 1–11. doi:10.1186/1471-2393-14-127 Luo, L., Chen, D., Qu, Y., Wu, J., Li, X., & Mu, D. (2014). Association between hypoxia and perinatal arterial ischemic stroke: A meta-analysis. PLoS One, 9(2), e90106. doi:10.1371/journal.pone.0090106 Maitra, K., Park, H. Y., Eggenberger, J., Matthiessen, A., Knight, E., & Ng, B. (2014). Difficulty in mental, neuromusculoskeletal, and movement-related school functions associated with low birthweight or preterm birth: A meta-analysis. American Journal of Occupational Therapy, 68(2), 140–148. doi:10.5014/ajot.2014.009985 Moreira, R. S., Magalhaes, L. C., & Alves, C. R. (2014). Effect of preterm birth on motor development, behavior, and school performance of school-age children: A systematic review. Jornal de Pediatr´ıa, 90(2), 119–134. doi:10.1016/j.jped.2013.05.010 Park, C. K., Paes, B. A., Nagel, K., Chan, A. K., & Murthy, P. (2014). Neonatal central venous catheter thrombosis: Diagnosis, management and outcome. Blood Coagulation and Fibrinolysis, 25(2), 97–106. doi:10.1097/MBC.0b013e328364f9b0 Parker, R. (2014). Probiotic guideline for necrotizing enterocolitis prevention in very low-birth-weight neonates. Advances in Neonatal Care, 14(2), 88–95. doi:10.1097/anc.0000000000000043 Rossi, A. C., & Prefumo, F. (2014). Perinatal outcomes of twin anemia-polycythemia sequence: A systematic review. Journal of Obstetrics and Gynaecology Canada. Journal d’Obstetrique et ´ Gynecologie du Canada, 36(8), 701–707. ´ Soubeiga, D., Gauvin, L., Hatem, M. A., & Johri, M. (2014). Birth Preparedness and Complication Readiness (BPCR) interventions to reduce maternal and neonatal mortality in developing
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disorders: A systematic review and metaanalysis. Hypertension, 64(3), 494–500. doi:10.1161/hypertensionaha.114.03545 Su, D. F., & Wang, X. Y. (2014). Metformin vs insulin in the management of gestational diabetes: A systematic review and meta-analysis. Diabetes Research and Clinical Practice, 104(3), 353– 357. doi:10.1016/j.diabres.2013.12.056 Wittkowski, A., Gardner, P. L., Bunton, P., & Edge, D. (2014). Culturally determined risk factors for postnatal depression in Sub-Saharan Africa: A mixed method systematic review. Journal of Affective Disorders, 163, 115–124. doi:10.1016/j.jad.2013.12.028 Xu, G., Jing, J., Bowers, K., Liu, B., & Bao, W. (2014). Maternal diabetes and the risk of autism spectrum disorders in the offspring: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 44(4), 766–775. doi:10.1007/s10803-013-1928-2 Xu, Y., Shen, S., Sun, L., Yang, H., Jin, B., & Cao, X. (2014). Metabolic syndrome risk after gestational diabetes: A systematic review and meta-analysis. PLoS One, 9(1), e87863. doi:10.1371/journal.pone.0087863 Yang, B., Fan, S., Zhi, X., Li, Y., Liu, Y., Wang, D., . . . Sun, G. (2014). Associations of MTHFR gene polymorphisms with hypertension and hypertension in pregnancy: A metaanalysis from 114 studies with 15411 cases and 21970 controls. PLoS One, 9(2), e87497. doi:10.1371/journal.pone.0087497 Yu, R. X., Yin, Y., Wang, G. Q., Chen, S. C., Zheng, B. J., Dai, X. Q., . . . Chen, X. (2014). Worldwide susceptibility rates of Neisseria gonorrhoeae isolates to cefixime and cefpodoxime: A systematic review and meta-analysis. PLoS One, 9(1), e87849. doi:10.1371/journal.pone.0087849
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countries: Systematic review and metaanalysis. BMC Pregnancy and Childbirth, 14, 1–11. doi:10.1186/1471-2393-14-129 Upadhyay, R. P., Krishnan, A., Rai, S. K., Chinnakali, P., & Odukoya, O. (2014). Need to focus beyond the medical causes: A systematic review of the social factors affecting neonatal deaths. Paediatric and Perinatal Epidemiology, 28(2), 127–137. doi:10.1111/ppe.12098 van den Nieuwboer, M., Claassen, E., Morelli, L., Guarner, F., & Brummer, R. J. (2014). Probiotic and synbiotic safety in infants under two years of age. Benef Microbes, 5(1), 45–60. doi:10.3920/bm2013.0046 Wang, M., Wang, Z. P., Zhang, M., & Zhao, Z. T. (2014). Maternal passive smoking during preg-
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nancy and neural tube defects in offspring: A meta-analysis. Archives of Gynecology and Obstetrics, 289(3), 513–521. doi:10.1007/s00404013-2997-3 Zarek, J., & Koren, G. (2014). The fetal safety of statins: A systematic review and meta-analysis. Journal of Obstetrics and Gynaecology Canada. Journal d’Obstetrique ´ et Gynecologie du Canada, 36(6), 506– ´ 509. Zhang, Z. Q., Huang, X. M., & Lu, H. (2014). Early biomarkers as predictors for bronchopulmonary dysplasia in preterm infants: A systematic review. European Journal of Pediatrics, 173(1), 15–23. doi:10.1007/s00431-0132148-7
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Current Resources for Evidence-Based Practice, March/April 2015 Nicole S. Carlson
Correspondence Nicole S. Carlson, CNM, College of Nursing, University of Colorado Denver, 221 Fayetteville Rd., Decatur, GA 30030. [email protected] Nicole S. Carlson, CNM, is a doctoral candidate in the College of Nursing, University of Colorado Denver, Denver, CO.
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ublished simultaneously in the Journal of Midwifery & Women’s Health, 60(2).
Applying the Evidence to Practice Aguably, the most important part of evidencebased practice (EBP) is the actual application of research evidence to clinical practice. After reviewing the first three steps of the 5A Model for the practitioner’s use of evidence-based information (Ask, Acquire, Appraise, Apply, and Assess) in previous editions of this column, we now move on to the step of Apply. After initially posing a clinical question in the Ask step of the 5A Model, the practitioner must then focus on acquiring and appraising research that is applicable to the clinical problem and meets quality standards in terms of research design and the generalizability of the research to the clinical problem at hand (Duke University Medical Center & Health Sciences Library University of North Carolina, 2013). In the past few columns, I discussed techniques for identifying quality research. Clinical expertise is also necessary to determine whether a research finding applies to a particular clinical situation and to implement the evidence-based recommendation (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). The third component necessary in the application of EBP is alignment with patient preferences and values (Duke University Medical Center & Health Sciences Library University of North Carolina, 2013). If the woman and family do not understand and support the plan of care, even the most well-substantiated treatment and skilled clinicians are not enough to ensure that research findings are implemented in practice.
The author reports no conflict of interest or relevant financial relationships.
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To demonstrate these concepts in action, I offer an example from my own distant past. Early in my career while working as a labor nurse, I moved to a different state and found a position in a new labor and delivery unit. Unlike the previous facility, this new unit was in a teaching hospital with a large percentage of births attended by nurse-midwives. One of my first patients was a term nulliparous
woman who presented with regular contractions. On examination, her cervix was 3 to 4 cm dilated and 70% effaced with the fetus at –1 station and no leakage of fluid. She was distressed by her contractions and asking for epidural analgesia. At this time, research findings indicated that early admissions to the hospital in labor were associated with a greater risk of operative birth (Jackson, 2003), and ambulation in early labor was associated with better chance of vaginal birth (Albers et al., 1997). Although I was familiar with these findings, the standard practice at my previous hospital was to admit women when they presented with regular contractions, provide epidural analgesia when requested, quickly rupture membranes artificially, and augment with oxytocin (Pitocin). I made a quick call to inform the woman’s provider of her labor and moved forward with the necessary steps to initiate epidural analgesia. Twenty minutes later when the woman’s nurse-midwife arrived, I had inserted an intravenous (IV) line, completed hospital admission paperwork, and called the anesthesiologist, who was on the way to the room. The short (and personally mortifying) end to this story was that the nurse-midwife cancelled my admission, called off the anesthesiologist, and discharged the patient home within the next 2 hours. More than a week later the woman went into spontaneous labor and had an uneventful birth. What went wrong in this clinical scenario? How were the three components of EBP misaligned to result in failure to apply research evidence clinically and nearly initiate epidural analgesia and labor induction inappropriately? First, I did not have the clinical expertise to accurately triage this woman for labor. The nurse-midwife started the triage process by asking questions about the woman’s contractions, not by checking her cervix. The woman’s contractions had started a few hours earlier after she spent the day at an outdoor picnic. She was very afraid of labor and rushed to the hospital soon after noticing the contractions. Next, the nurse-midwife ordered an IV fluid bolus and an hour of ambulation. Later, the nursemidwife rechecked the woman’s cervix, which was 3 cm dilated and 60% effaced with the fetus at –2
C 2015 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
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station. By this time her contractions were spaced out to every 10 to 15 minutes. Second, I did not did not take into account the woman’s values and preferences for the plan of care. When I rushed toward epidural analgesia, I was responding to the woman’s fears; however, I was not integrating her wishes with the bigger picture of her clinical situation and the research findings. In contrast, the nurse-midwife sat with the woman and explained that her contractions were not caused by labor but instead by dehydration. She shared with the woman that admission before strong labor could decrease her risk for a vaginal birth with minimal interventions. In short, the nurse-midwife built a relationship with the woman that allowed her to express her fears of labor and have her questions answered. In this way, the woman’s preferences and values were incorporated in the plan for her to return home. As a result, she left the hospital better informed about her body, her labor, and her options. She was not unhappy about continuing to be pregnant, and she avoided a nonindicated induction of labor. The take-away message from this story is that excellent health care is rooted in the same components outlined as essential for evidence-based practice. Nurses were some of the first health care providers to emphasize the importance of combining empirical evidence with strong clinical skills, while keeping the background and motivation of the patient in mind (Nightingale, 1860). The hallmarks of midwifery include incorporation of scientific evidence into clinical practice and empowerment of women as partners in health care (American College of Nurse-Midwives, 2013). Therefore, nurses and midwives are ideally suited to resist the urge to function simply based on protocol or the culture of the clinical setting and instead to continue the tradition of care that is based on the three components of EBP.
Jackson, D. J. (2003). Impact of collaborative management and early admission in labor on method of delivery. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 32(2), 147–157. Nightingale, F. (1860). Notes on nursing: What it is, and what it is not (1st ed.). London, England: Harrison. Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312, 71–72.
From Cochrane Database of Systematic Reviews (CDSR) Issues 10 & 11, 2014 New Systematic Reviews in CDSR: Women’s Health
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Minimally invasive surgical techniques versus open myomectomy for uterine fibroids Vasodilators for women undergoing fertility treatment
Albers, L. L., Anderson, D., Cragin, L., Daniels, S. M., Hunter, K. D.,
Interventions for managing asthma in pregnancy Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child High-dose versus low-dose oxytocin infusion regimens for induction of labor at term Ambroxol for women at risk of preterm birth for preventing neonatal respiratory distress syndrome Strategies of testing for syphilis during pregnancy Fetal assessment methods for improving neonatal and maternal outcomes in preterm prelabor rupture of membranes Early versus late initiation of epidural analgesia for labor Interventions for women in subsequent pregnancies following obstetric anal sphincter injury to reduce the risk of recurrent injury and associated harms Hepatitis B vaccination during pregnancy for preventing infant infection
& Teaf, D. (1997). The relationship of ambulation in labor to operative delivery. Journal of Midwifery & Women’s Health, 42(1), 4–8. American College of Nurse Midwives. (2013). ACNM core competencies.
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Pentoxifylline for the prevention of bronchopulmonary dysplasia in preterm infants
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High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer Immunotherapy for recurrent miscarriage Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome
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Antibiotic prophylaxis for third- and fourthdegree perineal tear during vaginal birth Prophylactic antibiotics for manual removal of retained placenta in vaginal birth Fetal pulse oximetry for fetal assessment in labor Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section Antibiotics for prelabor rupture of membranes at or near term Routine perineal shaving on admission in labor Different classes of antibiotics given to women routinely for preventing infection at caesarean section Interventions for preventing or reducing domestic violence against pregnant women Antibiotics for meconium-stained amniotic fluid in labor for preventing maternal and neonatal infections
From the Database of Abstracts and Reviews of Effects (DARE) Recent Abstract Entries Assessing Quality of Systematic Reviews: Pregnancy and Birth
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Effectiveness of mass media interventions for HIV prevention, 1986–2013
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The effectiveness and maternal satisfaction of breastfeeding support for women from disadvantaged groups Influenza vaccination during pregnancy
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Effect of yoga on sleep quality among adult cancer patients
Featured Review: Wojcieszek, A. M., Stock, O. M., & Flenady, V. (2014). Antibiotics for prelabour rupture of membranes at or near term. Cochrane Database of Systematic Reviews, 10, CD001807. Premature rupture of membranes (PROM), defined as the rupture of membranes before the onset of labor, occurs in approximately 8% of term pregnancies (Cammu, Verlaenen, & Perde, 1990). Although some health care providers advocate prompt induction of labor (within 12 hours) with synthetic oxytocin or prostaglandins following PROM, others prefer to allow longer periods of time to elapse after PROM in anticipation of spontaneous contractions. Some authors found evidence that induction of labor following PROM reduced the risk of maternal infection and infant admission to NICU (Dare, Middleton, Crowther, Flenady, & Varatharaju, 2006). However, the optimum time between PROM and labor induction is still an issue of debate. Some providers offer antibiotics to women experiencing PROM to decrease risk of infection, thus extending the time available for labor and birth. However, the use of antibiotics given current problems with antibiotic resistance raises concern (American College of Obstetricians and Gynecologists, 2011). In this updated Cochrane review, the authors assessed the effects of antibiotics used prophylactically
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in women at or beyond 36 weeks gestation with PROM. The authors included two additional studies that more than doubled the total number of women included in the meta-analysis from the previous review (N = 2,639 in updated review). Unlike the earlier version in which the authors found a reduction in endometritis with prophylactic use of antibiotics in cases of PROM at or near term, the current authors did not find a decreased risk for endometritis with antibiotic use (relative risk [RR] = .34, 95% confidence interval [CI] [0.05, 2.31]). Also, no differences were found regarding probable early-onset neonatal sepsis (RR = .69, 95% CI [0.21, 2.33]), definite early-onset neonatal sepsis (RR = 0.57, 95% CI [0.08, 4.26]), maternal chorioamnionitis and/or endometritis (RR = .48, 95% CI [0.20, 1.15]), stillbirth (RR = 3.00, 95% [CI 0.61, 14.82]), or perinatal mortality (RR = 1.98, 95% [CI 0.60, 6.55]). Interestingly, cesarean birth increased among women receiving prophylactic antibiotics for PROM (RR = 1.33, 95% [CI 1.09, 1.61]) as did length of hospital stay (mean difference 0.06 days, 95% CI [0.01, 0.11]) based primarily on one large study included in the meta-analysis. Authors of the updated review also completed sub-group analysis on maternal and neonatal outcomes for prophylactic antibiotic use among early labor induction (ࣘ 12 hours following PROM) and late labor induction (>12 hours following PROM) groups. No significant differences were seen in any outcome category. However, there was a trend toward reduced probable or definite early-onset neonatal sepsis and reduced maternal infection morbidity in the late induction groups. Comment: The authors of this updated Cochrane systematic review and meta-analysis found no benefit for the use of prophylactic antibiotics with PROM near or at term. Antibiotics should only be administered to women with PROM at or near term exhibiting clinical indications of infection.
REFERENCES American College of Obstetricians and Gynecologists. (2011). Use of prophylactic antibiotics in labor and delivery. Obstetrics & Gynecology, 117(6), 1472–1483. Cammu, H., Verlaenen, H., & Perde, M. P. (1990). Premature rupture of membranes at term in nulliparous women: A hazard? Obstetrics & Gynecology, 76(4), 671–674.
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Dare, M. R., Middleton, P., Crowther, C. A., Flenady, V. J., & Varatharaju, B. (2006). Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database of Systematic Reviews, 1, CD005302. doi:10.1002/14651858.CD005302.pub2
Featured Review: Widman, L., Noar, S. M., Choukas-Bradley, S., & Francis, D. B. (2014). Adolescent sexual health communication and condom use: A meta-analysis. Health Psychology, 33(10), 1113–1124. doi:10.1037/hea0000112 Young adults and adolescents between age 13 and 24 years represent only one fourth of the sexually active population, yet sexually transmitted infections (STIs) in this group account for half of all STIs each year (Centers for Disease Control and Prevention, 2013). Much research during the past 20 years has focused on factors and interventions leading to improved condom use among adolescents. In this systematic review and metaanalysis, the authors synthesized evidence on sexual communication and condom use in adolescents. The review included 34 studies conducted in the United States and international locations, with a total of 15,046 participants between age 12 and 23 years (mean age = 16.77). Sexual communication between young males and females was included in this review. Overall, sexual communication with a partner (defined as the ability to discuss and negotiate safe sex) was positively associated with condom use (r = .24, p < .001). This moderate effect did not differ significantly by gender, age, setting, or country of study. Researchers also found that the specific content of sexual communication was important to the use of condoms. Sexual communication with a partner that was focused on condom use was more effective (r = .34) than sexual communication about sexual history (r = .15) or more general safe sexual topics (r = .14). This review also included results on the most effective ways to teach successful sexual communication to adolescents. Sexual communication training was significantly more likely to end in successful condom use if it was behaviorally based (r = .27) or focused on self-efficacy (r = .28) rather than focused on future intention to use condoms (r = .15) or fear/concern about condom use (r = .18). Comment: As health care providers, nurses and midwives have an important role in educating
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Carlson, N. S.
and encouraging safe sex practices among adolescents. This review provides valuable information on sexual communication practices that can be shared with adolescents and their parents. Rather than focus education efforts with adolescents about condom usage on fear/concerns or intention to use condoms, health care providers can more effectively serve these clients by promoting role-play communication trainings and encouraging adolescents to enact behavioral preparation for condom usage (buy condoms, practice use of condoms).
REFERENCE Centers for Disease Control and Prevention. (2010). Youth risk behavior surveillance–United States, 2009. Surveillance summaries. Morbidity and Mortality Weekly Report, 59(SS5), 1–148. Retrieved from http://www.cdc.gov/ mmwr/pdf/ss/ss5905.pdf
Evidence-Based Reviews From Other Sources Recent Evidence-Based Reviews: Women’s Health Andreano, A., Rechichi, G., Rebora, P., Sironi, S., Valsecchi, M. G., & Galimberti, S. (2014). MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: A systematic review and meta-analysis. European Radiology, 24(6), 1327–1338. doi:10.1007/s00330-014-3139-4 Barry, J. A., Azizia, M. M., & Hardiman, P. J. (2014). Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: A systematic review and meta-analysis. Human Reproduction Update, 20(5), 748–758. doi:10.1093/humupd/dmu012 Boyle, R., Hay-Smith, E. J., Cody, J. D., & Morkved, S. (2014). Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women: A short version Cochrane review. Neurourology and Urodynamics, 33(3), 269–276. doi:10.1002/nau.22402 Cui, Y., Zong, H., Yang, C., Yan, H., & Zhang, Y. (2014). The efficacy and safety of mirabegron in treating OAB: A systematic review and meta-analysis of phase III trials. International Urology and Nephrology, 46(1), 275–284. doi:10.1007/s11255-013-0509-9 Esposito, K., Chiodini, P., Capuano, A., Bellastella, G., Maiorino, M. I., & Giugliano, D. (2014). Metabolic syndrome and endometrial
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analysis of non-family-based studies. Journal of Assisted Reproduction and Genetics, 31(2), 173–184. doi:10.1007/s10815-013-0155-2 Flak, A. L., Su, S., Bertrand, J., Denny, C. H., Kesmodel, U. S., & Cogswell, M. E. (2014). The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: A meta-analysis. Alcoholism, Clinical and Experimental Research, 38(1), 214–226. doi:10.1111/acer.12214 Gonzalez, R., Hellgren, U., Greenwood, B., & Menendez, C. (2014). Mefloquine safety and tolerability in pregnancy: A systematic literature review. Malaria Journal, 13, 75. doi:10.1186/1475-2875-13-75 Hartling, L., Dryden, D. M., Guthrie, A., Muise, M., Vandermeer, B., & Donovan, L. (2014). Diagnostic thresholds for gestational diabetes and their impact on pregnancy outcomes: A systematic review. Diabetic Medicine, 31(3), 319–331. doi:10.1111/dme.12357 Kebed, K. Y., Bishu, K., Al Adham, R. I., Baddour, L. M., Connolly, H. M., Sohail, M. R., . . . Anavekar, N. S. (2014). Pregnancy and postpartum infective endocarditis: A systematic review. Mayo Clinic Proceedings, 89(8), 1143–1152. doi:10.1016/j.mayocp.2014.04.024 Kong, D., Liu, H., Wei, S., Wang, Y., Hu, A., Han, W., . . . Zheng, Y. (2014). A meta-analysis of the association between gestational diabetes mellitus and chronic hepatitis B infection during pregnancy. BMC Research Notes, 7, 139. doi:10.1186/1756-0500-7-139 Li, J., Chen, Y., Wu, H., & Li, L. (2014). Apolipoprotein E (Apo E) gene polymorphisms and recurrent pregnancy loss: A meta-analysis. Journal of Assisted Reproduction and Genetics, 31(2), 139–148. doi:10.1007/s10815-013-0128-5 Marom, R., Lubetzky, R., Mimouni, F. B., Ovental, A., Mandel, D., & Cohen, S. (2014). Secular trends in impact factor of breastfeeding research publications over a 20-year period. Breastfeeding Medicine, 9(2), 98–100. doi:10.1089/bfm.2013.0090 Money, D., Tulloch, K., Boucoiran, I., Caddy, S., Yudin, M. H., Allen, V., . . . van Schalkwyk, J. (2014). Guidelines for the care of pregnant women living with HIV and interventions to reduce perinatal transmission: Executive summary. Journal of Obstetrics and Gynaecology Canada. Journal d’Obstetrique et Gynecologie ´ ´ du Canada, 36(8), 721–751. Pedersen, M., Stayner, L., Slama, R., Sorensen, M., Figueras, F., Nieuwenhuijsen, M. J., . . . Dadvand, P. (2014). Ambient air pollution and pregnancy-induced hypertensive
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