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Current Resources for Evidence-Based Practice, September/October 2014 Nicole S. Carlson
Correspondence Nicole S. Carlson, CNM, University of Colorado Denver, 221 Fayetteville Rd. Decatur, GA 30030, College of Nursing. [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, 59(5).
The Evidence on Evidence-Based Practice The phrase evidence-based practice (EBP) is used so frequently in health care that the words have lost their meaning for many clinicians. Often used as a synonym for good, EBP is too frequently used to promote health care that may not include practices based on current evidence. However, as an approach that has been linked in numerous studies to better outcomes of care, EBP is a subject worthy of true understanding. So what is evidence-based practice? Evidence-based practice is defined as the use of “the best evidence to provide the care most appropriate to each patient” (Institute of Medicine [IOM], 2009, p. 1). The IOM has set a goal that by the year 2020, 90% of all clinical decisions will be supported by the best available evidence (2009). In a traditional model of clinical practice, providers were trained in a standard way to understand and handle clinical situations; then, they spent their careers using these methodologies to care for their many patients. With time and practice, clinicians could look forward to achieving expertise in their speciality areas. With such expertise, they would know how to handle nearly every clinical situation and no longer experience the stress of having to learn new skills or new information.
The author reports no conflict of interest or relevant financial relationships.
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In the age of EBP, health care providers are still trained in the basics of clinical practice, but they are now expected to constantly change their practices and understanding of clinical phenomena in keeping with the newest evidence. Change can be stressful, even when it is understood as necessary for improvement. Some clinicians who embrace changes in EBP experience additional stress when they work within organizations that are resistant to the constant adaptations necessary in an EBP model.
Studies point to several key factors necessary for the adoption of EBP: the strong belief that EBP improves patient outcomes and care; a solid understanding of EBP knowledge and skills; professional involvement with an EBP mentor; and working within an organizational culture that promotes EBP (Melnyk, 2014; Melnyk, FineoutOverholt, Giggleman, & Cruz, 2010). Not every health care provider has these key factors in place personally or culturally. This variation in the ability to implement EBP is visible in the vast differences that currently exist in the United States, from community to community and hospital to hospital, related to common outcomes reflecting successful EBP implementation. For example, key perinatal quality indicators highlighted recently by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), such as skin-to-skin contact following birth and breastfeeding support, vary widely in hospitals across the United States (AWHONN, 2013). In various health care settings, researchers found that clinicians are less likely to use EBP when they are more stressed (Aarons et al., 2012), do not feel confident using tools to physically access new evidence (Pravikoff, Tanner, & Pierce, 2005), or work with other clinicians or administrators who resist EBP changes (Melnyk, FineoutOverholt, Gallagher-Ford, & Kaplan, 2012). Many of these barriers to EBP were first identified more than two decades ago but to date have not been the focus of widespread efforts to increase the use of EBP. Currently, individuals, organizations, and health care communities must adopt EBP or face increasingly harsh consequences. As quality in perinatal health care becomes more linked to reimbursement via the Affordable Care Act (ACA) and the recommendations of The Joint Commission, EBP is no longer optional. Starting January 1, 2014, The Joint Commission began requiring hospitals with 1,100 births or more per year to use new perinatal quality measures (The Joint Commission, 2013). These new perinatal quality measures are
C 2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
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linked outcomes that have been shown to be sensitive to the level of evidence-based care present in an institution, including rates of cesareans and elective births. Section 2701 of the ACA now mandates the use of health care quality measurement for adult beneficiaries of Medicaid (Sakala, 2010). Although health care quality measurement for Medicare patients has been enforced by The Joint Commission for many years, efforts to measure the quality of perinatal care were hampered by the state-by-state differences in the administration of Medicaid, the public insurance that is most often used by childbearing women. These changes from the ACA and The Joint Commission will bring the care of women and infants in United States under the lens of quality measurement at an unprecedented level. Wide variations in the use of EBP in perinatal care will now be revealed for consumers and health care reimbursement entities alike. With the idea that change must start at home, the Journal of Midwifery & Women’s Health and the Journal of Obstetric, Gynecologic, & Neonatal Nursing will continue to offer this column highlighting current resources for evidence-based practice as a joint publication. In the coming year, the column will focus on common barriers to EBP change as identified in the literature, provide guidance for clinicians on accessing the evidence, discuss ways to balance the results of large systematic reviews with the needs of individual women and infants, and offer tips for interpreting the conclusions of scientific studies. In addition, the column will continue to provide lists of current evidence, including featured reviews of studies with particular importance for perinatal and women’s health clinicians.
REFERENCES
Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. Journal of Nursing Administration, 42(9), 410–417. doi: 10.1097/NNA. 0b013e3182664e0a Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Cruz, R. (2010). Correlates among cognitive beliefs, EBP implementation, organizational culture, cohesion and job satisfaction in evidencebased practice mentors from a community hospital system. Nursing Outlook, 58(6), 301–308. doi: 10.1016/j.outlook.2010. 06.002 Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing, 105(9), 40–51. Sakala, C. (2010). U.S. health care reform legislation offers major new gains to childbearing women and newborns. Birth, 37(4), 337– 340. doi: 10.1111/j.1523-536X.2010.00430.x The Joint Commission. (2013). Improving performance on perinatal care measures. The Source, 11(7), 16–19. Retrieved from http://www.jointcommission.org/assets/1/6/S7_TS_V11_N7.pdf
From Cochrane Database of Systematic Reviews (CDSR) Issues 4 & 5, 2014 New Systematic Reviews in CDSR: Women’s Health
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Aarons, G. A., Glisson, C., Green, P. D., Hoagwood, K., Kelleher, K. J.,
Laparoscopic surgery for endometriosis Adjuvant chemotherapy for advanced endometrial cancer Non-steroidal anti-inflammatory agents to induce regression and prevent the progression of cervical intraepithelial neoplasia Effectiveness of different treatment modalities for the management of adult-onset granulosa cell tumours of the ovary (primary and recurrent) Hormonal contraception for women exposed to HIV infection Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus Surgical treatment of stage IA2 cervical cancer
Landsverk, J. A., . . . Schoenwald, S. (2012). The organizational social context of mental health services and clinician attitudes toward evidence-based practice: A United States national study. Implementation Science, 7, 56. doi: 10.1186/1748-5908-7-56
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Association of Women’s Health, Obstetric and Neonatal Nurses. (2013). Women’s health and perinatal nursing care quality draft measures specifications. Washington, DC: Author. Retrieved from
https://www.awhonn.org/awhonn/content.do?name=02_
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PracticeResources/02_perinatalqualitymeasures.htm Olsen, M., Goolsby, W.A., McGinnis, J.M. (2009). Leadership committments to improve value in healthcare: Finding common ground workshop summary. Washington, DC: National Academies Press. Melnyk, B. M. (2014). Building cultures and environments that facilitate clinician behavior change to evidence-based practice: What works? Worldviews Evidence Based Nursing, 11(2), 79–80. doi: 10.1111/wvn.12032
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Indwelling bladder catheterization as part of intraoperative and postoperative care for cesarean section Planned home versus hospital care for preterm prelabour rupture of membranes (PPROM) prior to 37 weeks’ gestation Prostaglandins for management of retained placenta Magnesium supplementation in pregnancy Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes
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Oral contraceptives for functional ovarian cysts Probiotics for prevention of necrotizing enterocolitis in preterm infants Kangaroo mother care to reduce morbidity and mortality in low birthweight infants Higher versus lower protein intake in formulafed low birth weight infants Formula versus donor breast milk for feeding preterm or low birth weight infants Physical activity programs for promoting bone mineralization and growth in preterm infants
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Laparoscopy for the management of acute lower abdominal pain in women of childbearing age Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women
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Customized versus population-based growth charts as a screening tool for detecting small for gestational age infants in low-risk pregnancy women Nitric oxide donors for treating preterm labour
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atic evidence review for the U.S Preventive Services Task Force Omission of the bladder flap at caesarean section reduces delivery time without increased morbidity: a meta-analysis of randomised controlled trials
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Interventions designed to promote exclusive breastfeeding in high-income countries: a systematic review
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Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: metaanalysis of individual patient data for 8135 women in 22 randomised trials
Featured Review: Henderson, J.T., Whitlock, E.P., O’Connor, E., Senger, C.A., Thompson, J.H., & Rowland, M.G. (2014). Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: A systematic evidence review for the U.S. Preventative Services Task Force. Annals of Internal Medicine, 160, 695–703.
Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review Low-dose aspirin for prevention of morbidity and mortality from pre-eclampsia: a system-
This systematic review and meta-analysis of the literature was funded by the Agency for Healthcare Research and Quality to update the U.S. Preventative Services Task Force recommendations on the use of low-dose aspirin for the prevention of preeclampsia among women with heightened risk. Predictors of women at high risk for preeclampsia vary from study to study, but the most common predictors include a history of preeclampsia in previous pregnancy, renal disease, autoimmune disease, diabetes, chronic hypertension, antiphospholipid syndrome, and multifetal pregnancy. In addition, women with several moderate risk predictors for preeclampsia might also be designated as high risk. These moderate risk predictors include nulliparity, advanced maternal age (ࣙ40 years), interpregnancy interval greater than 10 years, high body mass index (ࣙ35 kg/m2 ), and family history (mother or sister) of preeclampsia. Several other systematic reviews have found aspirin to be beneficial for the reduction of preeclampsia among women identified as high risk. However, this review also evaluated the use of aspirin for the prevention of other poor
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Late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants Early (7 days) postnatal corticosteroids for chronic lung disease in preterm infants
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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perinatal health outcomes and for harms to the woman or neonate following use in pregnancy. Following a broad search of the literature published from 2006 to 2013, authors of this review independently selected studies to be included and evaluated the quality of all included studies. All studies chosen for this review were scored as fair or good quality. In the primary analysis of this review, benefits of low-dose aspirin use during pregnancy among women at high risk for preeclampsia was evaluated from two large randomized controlled trials (RCTs) and 13 smaller RCTs. In the secondary analysis, six RCTs and two large cohort studies were chosen to estimate harms to woman at any risk level who took aspirin during pregnancy. Daily use of aspirin starting after the first trimester at doses ranging between 60 and100 mg was associated with a risk reduction of 14% for preterm birth before 37 weeks gestation (relative risk [RR] 0.86; 95% confidence interval [CI], 0.76–0.98) for 11,779 women at high risk of preeclampsia in 10 trials included in the primary meta-analysis of this study. Meta-analysis of 13 trials (n = 12,504 women) revealed a 20% reduction in intrauterine growth restriction (IUGR) (RR 0.80; 95% CI, 0.65– 0.99) with aspirin use during pregnancy by women at high risk for preeclampsia. This meta-analysis also showed a 24% reduction in preeclampsia with aspirin treatment (RR 0.76; 95% CI, 0.62–0.95). Although aspirin dosages greater than 75 mg per day were associated with greater risk reduction compared to aspirin dosages less than 75 mg per day, authors of this review were unable to make conclusions about dosage effects because there were not adequate sample sizes of women taking higher dosages of aspirin among the included studies. The authors found no evidence of perinatal harm from low-dose aspirin use during pregnancy by women at high or average risk for preeclampsia. Perinatal harms assessed included placental abruption, postpartum hemorrhage, and intracranial hemorrhage in neonates. They also noted that in the one trial of longer-term developmental outcomes of infants born to women receiving aspirin during pregnancy, no treatment differences were observed. Comment: This meta-analysis and systematic review has findings consistent with results from a recent Cochrane review and the Perinatal Antiplatelet Review of International Trials (PARIS)
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Collaboration individual participant data metaanalysis. In all of these studies, prophylactic, lowdose aspirin use during the final two trimesters of pregnancy appears to be associated with a reduced risk for preeclampsia, IUGR, preterm birth, and perinatal mortality among women at high risk for preeclampsia. Although this meta-analysis reflects only modest effect sizes, the perinatal outcomes reduced with low-dose aspirin use are associated with multiple downstream harms to both mothers and infants. The authors also found no evidence of perinatal harm from low-dose aspirin use in pregnancy, although even the large numbers of women included in this study are too small to reliably evaluate the risk of rare maternal mortality and morbidity outcomes with aspirin use during pregnancy. Although African-American women in the United States are most likely to experience preeclampsia, they are not well represented in this or other systematic reviews on preeclampsia. Therefore, future research including this important subpopulation is needed. Featured Review: Grimes, D.A., Jones, L.B., Lopez, L.M., & Schulz, K.F. (2014). Oral contraceptives for functional ovarian cysts. The Cochrane Database of Systematic Reviews, 4, CD006134, doi: 10.1002/14651858.CD006134. pub5 Functional ovarian cysts occur commonly in many women of reproductive age, and more than a quarter million US women per year are hospitalized as a result of functional ovarian cysts, including follicular and corpus luteum cysts. Although functional ovarian cysts will often resolve spontaneously, they can cause severe discomfort. Treatment for functional ovarian cysts commonly includes surgical intervention and/or combined oral contraceptives (COCs). Combined oral contraceptives were first used to treat follicular ovarian cysts in the 1970s based on the results of an uncontrolled case series report of 286 women with adnexal masses, in which the authors concluded that COCs resulted in a more rapid shrinkage of functional ovarian cysts. COCs are known to have a strong protectant effect against the formation of functional ovarian cysts. However, the use of COCs to treat pre-existing functional ovarian cysts was the basis of this updated Cochrane review. This systematic review and meta-analysis included 8 RCTs with a total of 686 women. Included studies were evaluated for methodological
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quality and chosen based on a search performed in March 2014 of all trials that focused on COCs as treatment for ovarian cysts. Data from included RCTs were abstracted and used to calculate odds ratios or mean differences with 95% CIs. Studies included in this meta-analysis were assessed to have some quality limitations involving nonrandom methods of sequence allocation, inadequate allocation concealment, and small sample sizes. Only studies in which the authors used the same COCs (exposure) and outcomes were aggregated for this meta-analysis. Use of COCs was evaluated as treatment for ovarian cysts arising spontaneously and arising following the use of fertility drugs during ovulation induction.
Albuquerque, R. C., Baltar, V. T., & Marchioni, D. M. (2014). Breast cancer and dietary patterns: A systematic review. Nutrition Reviews, 72(1), 1–17. doi: http://dx.doi.org/10.1111/nure.12083 Anthoulakis, C., & Nikoloudis, N. (2014). Pelvic MRI as the “gold standard” in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: A systematic review. Gynecologic Oncology, 132(3), 661–668. doi: http://dx.doi.org/10.1016/j.ygyno.2013.10.022
Brandao, T., Schulz, M. S., & Matos, P. M. (2014). Psychological intervention with couples coping with breast cancer: a systematic review. Psychology & Health, 29(5), 491–516. doi: http://dx.doi.org/10.1080/08870446.2013. 859257 Harris, H. R., Orsini, N., & Wolk, A. (2014). Vitamin C and survival among women with breast cancer: A meta-analysis. European Journal of Cancer, 50(7), 1223–1231. doi: http://dx.doi.org/10.1016/j.ejca.2014.02.013 Kleppe, M., Amkreutz, L. C., Van Gorp, T., Slangen, B. F., Kruse, A. J., & Kruitwagen, R. F. (2014). Lymph-node metastasis in stage I and II sex cord stromal and malignant germ cell tumours of the ovary: A systematic review. Gynecologic Oncology, 133(1), 124–127. doi: http://dx.doi.org/10.1016/j.ygyno.2014.01.011 Li, S., Xu, H., Li, S. C., Qi, X. Q., & Sun, W. J. (2014). Vitamin D receptor rs2228570 polymorphism and susceptibly to ovarian cancer: A meta-analysis. Tumour Biology, 35(2), 1319– 1322. doi: http://dx.doi.org/10.1007/s13277013-1175-1183 Mei, J., Duan, H. X., Wang, L. L., Yang, S., Lu, J. Q., Shi, T. Y., & Zhao, Y. (2014). XRCC1 polymorphisms and cervical cancer risk: An updated meta-analysis. Tumour Biology, 35(2), 1221– 1231. doi: http://dx.doi.org/10.1007/s13277013-1163-1167. Mohr, S. B., Gorham, E. D., Kim, J., Hofflich, H., & Garland, C. F. (2014). Meta-analysis of vitamin D sufficiency for improving survival of patients with breast cancer. Anticancer Research, 34(3), 1163–1166. Nagata, C., Mizoue, T., Tanaka, K., Tsuji, I., Tamakoshi, A., Matsuo, K., ... Research Group for the Development and Evaluation of Cancer Prevention Strategies in Japan. (2014). Soy intake and breast cancer risk: An evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Japanese Journal of Clinical Oncology, 44(3), 282–295. doi: http://dx.doi.org/10.1093/jjco/hyt203 Pace, L. E., & Keating, N. L. (2014). A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA, 311(13), 1327–1335. doi: http://dx.doi.org/10.1001/jama.2014.1398 Reidy, M., & Denieffe, S. (2014). Breast cancer in younger women from diverse cultural backgrounds. British Journal of Nursing, 23(4), S19S22. Robbins, C. L., Hutchings, Y., Dietz, P. M., Kuklina, E. V., & Callaghan, W. M.
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Overall, COC use was not found to hasten the resolution of functional ovarian cysts. Early studies leading to the clinical impression that COC could be used to treat functional ovarian cysts were flawed by lack of contemporaneous control groups. This meta-analysis revealed no difference in control versus COC treatment groups for the resolution of functional ovarian cysts. Most of these cysts resolved spontaneously. Those cysts that did not resolve within several months were unlikely to be functional cysts and therefore required surgical evaluation. Comment: The authors of this meta-analysis found that COCs are not effective in the treatment of functional ovarian cysts. Although COCs might be used to suppress the formation of functional ovarian cysts in women with this history, they should not be used to shrink existing cysts. Adnexal masses thought to be functional ovarian cysts might be followed with watchful waiting for 2 to 3 menstrual cycles. If ovarian cysts persist beyond this time period or are large or painful, surgical management is recommended.
Evidence-Based Reviews from Other Sources Recent Evidence-Based Reviews: Women’s Health
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(2014). History of preterm birth and subsequent cardiovascular disease: A systematic review. American Journal of Obstetrics & Gynecology, 210(4), 285–297. doi: http://dx.doi.org/10.1016/j.ajog.2013.09.020 Rositch, A. F., Soeters, H. M., Offutt-Powell, T. N., Wheeler, B. S., Taylor, S. M., & Smith, J. S. (2014). The incidence of human papillomavirus infection following treatment for cervical neoplasia: a systematic review. Gynecologic Oncology, 132(3), 767–779. doi: http://dx.doi.org/10.1016/j.ygyno.2013. 12.040 Tiernan, J. P., Verghese, E. T., Nair, A., Pathak, S., Kim, B., White, J., . . . Hanby, A. M. (2014). Systematic review and meta-analysis of cytokeratin 19-based one-step nucleic acid amplification versus histopathology for sentinel lymph node assessment in breast cancer. British Journal of Surgery, 101(4), 298–306. doi: http://dx.doi.org/10.1002/bjs.9386 van der Ploeg, J. M., van der Steen, A., Oude Rengerink, K., van der Vaart, C. H., & Roovers, J. P. (2014). Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG, 121(5), 537–547. doi: http://dx.doi.org/10.1111/1471-0528.12509 Xu, H. B., Yang, H., Liu, T., & Chen, H. (2014). Association of CTLA4 gene polymorphism (rs5742909) with cervical cancer: a metaanalysis. Tumour Biology, 35(2), 1605–1608. Yoo, G. J., Levine, E. G., & Pasick, R. (2014). Breast cancer and coping among women of color: a systematic review of the literature. Supportive Care in Cancer, 22(3), 811–824. doi: http://dx.doi.org/10.1007/s00520-013-2057-3 Zakher, B., Blazina, I., & Chou, R. (2014). Association between knowledge of HIVpositive status or use of antiretroviral therapy and high-risk transmission behaviors: Systematic review. AIDS Care, 26(4), 514–521. doi: http://dx.doi.org/10.1080/09540121.2013. 832723
Recent Evidence-Based Reviews: Pregnancy & Birth Laopaiboon, M., Lumbiganon, P., Intarut, N., Mori, R., Ganchimeg, T., Vogel, J. P., . . . WHO Multicountry Survey on Maternal Newborn Health Research, Network. (2014). Advanced maternal age and pregnancy outcomes: a multicountry assessment. BJOG, 121(Suppl 1), 49–56. doi: http://dx.doi.org/10.1111/1471-0528.12659
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Leventakou, V., Roumeliotaki, T., Martinez, D., Barros, H., Brantsaeter, A. L., Casas, M., . . . Chatzi, L. (2014). Fish intake during pregnancy, fetal growth, and gestational length in 19 European birth cohort studies. American Journal of Clinical Nutrition, 99(3), 506–516. doi: http://dx.doi.org/10.3945/ajcn.113.067421 Morisaki, N., Togoobaatar, G., Vogel, J. P., Souza, J. P., Rowland Hogue, C. J., Jayaratne, K., . . . WHO Multicountry Survey on Maternal and Newborn Health Research Network. (2014). Risk factors for spontaneous and providerinitiated preterm delivery in high and low Human Development Index countries: A secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG, 121(Suppl 1), 101–109. doi: http://dx.doi.org/10.1111/1471-0528.12631 Pineles, B. L., Park, E., & Samet, J. M. (2014). Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. American Journal of Epidemiology, 179(7), 807–823. doi: http://dx.doi.org/10.1093/aje/kwt334 Rodger, M. A., Carrier, M., Le Gal, G., Martinelli, I., Perna, A., Rey, E., . . . Low-MolecularWeight Heparin for Placenta-Mediated Pregnancy Complications Study Group. (2014). Meta-analysis of low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications. Blood, 123(6), 822– 828. doi: http://dx.doi.org/10.1182/blood-201301-478958 Sheldon, W. R., Blum, J., Vogel, J. P., Souza, J. P., Gulmezoglu, A. M., Winikoff, B., . . . WHO Multicountry Survey on Maternal and Newborn Health Research Network. (2014). Postpartum haemorrhage management, risks, and maternal outcomes: Findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG, 121(Suppl 1), 5–13. doi: http://dx.doi.org/10.1111/14710528.12636 Tolcher, M. C., Johnson, R. L., El-Nashar, S. A., & West, C. P. (2014). Decision-toincision time and neonatal outcomes: A systematic review and meta-analysis. Obstetrics & Gynecology, 123(3), 536–548. doi: http:// dx.doi.org/10.1097/AOG.0000000000000132 Vogel, J. P., Souza, J. P., Mori, R., Morisaki, N., Lumbiganon, P., Laopaiboon, M., . . . WHO Multicountry Survey on Maternal and Newborn Health Research Network. (2014). Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and
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Been, J. V., Nurmatov, U. B., Cox, B., Nawrot, T. S., van Schayck, C. P., & Sheikh, A. (2014). Effect of smoke-free legislation on perinatal and child health: A systematic review and meta-analysis. Lancet, 383(9928), 1549– 1560. doi: http://dx.doi.org/10.1016/S01406736(14)60082-9 Giaccone, A., Jensen, E., Davis, P., & Schmidt, B. (2014). Definitions of extubation success in very premature infants: A systematic review. Archives of Disease in Childhood Fetal & Neonatal Edition, 99(2), F124–F127. doi: http://dx.doi.org/10.1136/archdischild-2013304896 Gruzieva, O., Gehring, U., Aalberse, R., Agius, R., Beelen, R., Behrendt, H., . . . Pershagen, G. (2014). Meta-analysis of air pollution exposure association with allergic sensitization in European birth cohorts. Journal of Allergy & Clinical Immunology, 133(3), 767–776.e767. doi: http://dx.doi.org/10.1016/j.jaci.2013.07.048 Malin, G. L., Morris, R. K., Riley, R., Teune, M. J., & Khan, K. S. (2014). When is birthweight at term abnormally low? A systematic review and metaanalysis of the association and predictive ability of current birthweight standards for neonatal
outcomes. BJOG, 121(5), 515–526. doi: http://dx.doi.org/10.1111/1471--0528.12517 Parker, R. I. (2014). Transfusion in critically ill children: Indications, risks, and challenges. Critical Care Medicine, 42(3), 675–690. doi: http:// dx.doi.org/10.1097/CCM.0000000000000176 Peng, W., Zhu, H., Shi, H., & Liu, E. (2014). Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis. Archives of Disease in Childhood Fetal & Neonatal Edition, 99(2), F158-F165. doi: http://dx.doi.org/10.1136/archdischild-2013304613 Steiner, M. B., Tang, X., Gossett, J. M., Malik, S., & Prodhan, P. (2014). Timing of complete repair of non-ductal-dependent tetralogy of Fallot and short-term postoperative outcomes, a multicenter analysis. Journal of Thoracic & Cardiovascular Surgery, 147(4), 1299–1305. doi: http://dx.doi.org/10.1016/j.jtcvs.2013.06.019 Tinnion, R., Gillone, J., Cheetham, T., & Embleton, N. (2014). Preterm birth and subsequent insulin sensitivity: A systematic review. Archives of Disease in Childhood, 99(4), 362–368. doi: http://dx.doi.org/10.1136/archdischild-2013304615 Xu, H., Zeng, T., Liu, J. Y., Lei, Y., Zhong, S., Sheng, Y. J., . . . Ren, H. (2014). Measures to reduce mother-to-child transmission of Hepatitis B virus in China: A meta-analysis. Digestive Diseases & Sciences, 59(2), 242–258. doi: http://dx.doi.org/10.1007/s10620-013-2918-0
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Newborn Health. BJOG, 121(Suppl 1), 76– 88. doi: http://dx.doi.org/10.1111/1471-0528. 12633
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Current Resources for Evidence-Based Practice, September/October 2014 Nicole S. Carlson
Correspondence Nicole S. Carlson, CNM, University of Colorado Denver, 221 Fayetteville Rd. Decatur, GA 30030, College of Nursing. [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, 59(5).
The Evidence on Evidence-Based Practice The phrase evidence-based practice (EBP) is used so frequently in health care that the words have lost their meaning for many clinicians. Often used as a synonym for good, EBP is too frequently used to promote health care that may not include practices based on current evidence. However, as an approach that has been linked in numerous studies to better outcomes of care, EBP is a subject worthy of true understanding. So what is evidence-based practice? Evidence-based practice is defined as the use of “the best evidence to provide the care most appropriate to each patient” (Institute of Medicine [IOM], 2009, p. 1). The IOM has set a goal that by the year 2020, 90% of all clinical decisions will be supported by the best available evidence (2009). In a traditional model of clinical practice, providers were trained in a standard way to understand and handle clinical situations; then, they spent their careers using these methodologies to care for their many patients. With time and practice, clinicians could look forward to achieving expertise in their speciality areas. With such expertise, they would know how to handle nearly every clinical situation and no longer experience the stress of having to learn new skills or new information.
The author reports no conflict of interest or relevant financial relationships.
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In the age of EBP, health care providers are still trained in the basics of clinical practice, but they are now expected to constantly change their practices and understanding of clinical phenomena in keeping with the newest evidence. Change can be stressful, even when it is understood as necessary for improvement. Some clinicians who embrace changes in EBP experience additional stress when they work within organizations that are resistant to the constant adaptations necessary in an EBP model.
Studies point to several key factors necessary for the adoption of EBP: the strong belief that EBP improves patient outcomes and care; a solid understanding of EBP knowledge and skills; professional involvement with an EBP mentor; and working within an organizational culture that promotes EBP (Melnyk, 2014; Melnyk, FineoutOverholt, Giggleman, & Cruz, 2010). Not every health care provider has these key factors in place personally or culturally. This variation in the ability to implement EBP is visible in the vast differences that currently exist in the United States, from community to community and hospital to hospital, related to common outcomes reflecting successful EBP implementation. For example, key perinatal quality indicators highlighted recently by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), such as skin-to-skin contact following birth and breastfeeding support, vary widely in hospitals across the United States (AWHONN, 2013). In various health care settings, researchers found that clinicians are less likely to use EBP when they are more stressed (Aarons et al., 2012), do not feel confident using tools to physically access new evidence (Pravikoff, Tanner, & Pierce, 2005), or work with other clinicians or administrators who resist EBP changes (Melnyk, FineoutOverholt, Gallagher-Ford, & Kaplan, 2012). Many of these barriers to EBP were first identified more than two decades ago but to date have not been the focus of widespread efforts to increase the use of EBP. Currently, individuals, organizations, and health care communities must adopt EBP or face increasingly harsh consequences. As quality in perinatal health care becomes more linked to reimbursement via the Affordable Care Act (ACA) and the recommendations of The Joint Commission, EBP is no longer optional. Starting January 1, 2014, The Joint Commission began requiring hospitals with 1,100 births or more per year to use new perinatal quality measures (The Joint Commission, 2013). These new perinatal quality measures are
C 2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
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linked outcomes that have been shown to be sensitive to the level of evidence-based care present in an institution, including rates of cesareans and elective births. Section 2701 of the ACA now mandates the use of health care quality measurement for adult beneficiaries of Medicaid (Sakala, 2010). Although health care quality measurement for Medicare patients has been enforced by The Joint Commission for many years, efforts to measure the quality of perinatal care were hampered by the state-by-state differences in the administration of Medicaid, the public insurance that is most often used by childbearing women. These changes from the ACA and The Joint Commission will bring the care of women and infants in United States under the lens of quality measurement at an unprecedented level. Wide variations in the use of EBP in perinatal care will now be revealed for consumers and health care reimbursement entities alike. With the idea that change must start at home, the Journal of Midwifery & Women’s Health and the Journal of Obstetric, Gynecologic, & Neonatal Nursing will continue to offer this column highlighting current resources for evidence-based practice as a joint publication. In the coming year, the column will focus on common barriers to EBP change as identified in the literature, provide guidance for clinicians on accessing the evidence, discuss ways to balance the results of large systematic reviews with the needs of individual women and infants, and offer tips for interpreting the conclusions of scientific studies. In addition, the column will continue to provide lists of current evidence, including featured reviews of studies with particular importance for perinatal and women’s health clinicians.
REFERENCES
Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. Journal of Nursing Administration, 42(9), 410–417. doi: 10.1097/NNA. 0b013e3182664e0a Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Cruz, R. (2010). Correlates among cognitive beliefs, EBP implementation, organizational culture, cohesion and job satisfaction in evidencebased practice mentors from a community hospital system. Nursing Outlook, 58(6), 301–308. doi: 10.1016/j.outlook.2010. 06.002 Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing, 105(9), 40–51. Sakala, C. (2010). U.S. health care reform legislation offers major new gains to childbearing women and newborns. Birth, 37(4), 337– 340. doi: 10.1111/j.1523-536X.2010.00430.x The Joint Commission. (2013). Improving performance on perinatal care measures. The Source, 11(7), 16–19. Retrieved from http://www.jointcommission.org/assets/1/6/S7_TS_V11_N7.pdf
From Cochrane Database of Systematic Reviews (CDSR) Issues 4 & 5, 2014 New Systematic Reviews in CDSR: Women’s Health
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Aarons, G. A., Glisson, C., Green, P. D., Hoagwood, K., Kelleher, K. J.,
Laparoscopic surgery for endometriosis Adjuvant chemotherapy for advanced endometrial cancer Non-steroidal anti-inflammatory agents to induce regression and prevent the progression of cervical intraepithelial neoplasia Effectiveness of different treatment modalities for the management of adult-onset granulosa cell tumours of the ovary (primary and recurrent) Hormonal contraception for women exposed to HIV infection Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus Surgical treatment of stage IA2 cervical cancer
Landsverk, J. A., . . . Schoenwald, S. (2012). The organizational social context of mental health services and clinician attitudes toward evidence-based practice: A United States national study. Implementation Science, 7, 56. doi: 10.1186/1748-5908-7-56
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Association of Women’s Health, Obstetric and Neonatal Nurses. (2013). Women’s health and perinatal nursing care quality draft measures specifications. Washington, DC: Author. Retrieved from
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PracticeResources/02_perinatalqualitymeasures.htm Olsen, M., Goolsby, W.A., McGinnis, J.M. (2009). Leadership committments to improve value in healthcare: Finding common ground workshop summary. Washington, DC: National Academies Press. Melnyk, B. M. (2014). Building cultures and environments that facilitate clinician behavior change to evidence-based practice: What works? Worldviews Evidence Based Nursing, 11(2), 79–80. doi: 10.1111/wvn.12032
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Indwelling bladder catheterization as part of intraoperative and postoperative care for cesarean section Planned home versus hospital care for preterm prelabour rupture of membranes (PPROM) prior to 37 weeks’ gestation Prostaglandins for management of retained placenta Magnesium supplementation in pregnancy Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes
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Oral contraceptives for functional ovarian cysts Probiotics for prevention of necrotizing enterocolitis in preterm infants Kangaroo mother care to reduce morbidity and mortality in low birthweight infants Higher versus lower protein intake in formulafed low birth weight infants Formula versus donor breast milk for feeding preterm or low birth weight infants Physical activity programs for promoting bone mineralization and growth in preterm infants
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Laparoscopy for the management of acute lower abdominal pain in women of childbearing age Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women
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Customized versus population-based growth charts as a screening tool for detecting small for gestational age infants in low-risk pregnancy women Nitric oxide donors for treating preterm labour
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atic evidence review for the U.S Preventive Services Task Force Omission of the bladder flap at caesarean section reduces delivery time without increased morbidity: a meta-analysis of randomised controlled trials
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Interventions designed to promote exclusive breastfeeding in high-income countries: a systematic review
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Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: metaanalysis of individual patient data for 8135 women in 22 randomised trials
Featured Review: Henderson, J.T., Whitlock, E.P., O’Connor, E., Senger, C.A., Thompson, J.H., & Rowland, M.G. (2014). Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: A systematic evidence review for the U.S. Preventative Services Task Force. Annals of Internal Medicine, 160, 695–703.
Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review Low-dose aspirin for prevention of morbidity and mortality from pre-eclampsia: a system-
This systematic review and meta-analysis of the literature was funded by the Agency for Healthcare Research and Quality to update the U.S. Preventative Services Task Force recommendations on the use of low-dose aspirin for the prevention of preeclampsia among women with heightened risk. Predictors of women at high risk for preeclampsia vary from study to study, but the most common predictors include a history of preeclampsia in previous pregnancy, renal disease, autoimmune disease, diabetes, chronic hypertension, antiphospholipid syndrome, and multifetal pregnancy. In addition, women with several moderate risk predictors for preeclampsia might also be designated as high risk. These moderate risk predictors include nulliparity, advanced maternal age (ࣙ40 years), interpregnancy interval greater than 10 years, high body mass index (ࣙ35 kg/m2 ), and family history (mother or sister) of preeclampsia. Several other systematic reviews have found aspirin to be beneficial for the reduction of preeclampsia among women identified as high risk. However, this review also evaluated the use of aspirin for the prevention of other poor
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Late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants Early (7 days) postnatal corticosteroids for chronic lung disease in preterm infants
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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perinatal health outcomes and for harms to the woman or neonate following use in pregnancy. Following a broad search of the literature published from 2006 to 2013, authors of this review independently selected studies to be included and evaluated the quality of all included studies. All studies chosen for this review were scored as fair or good quality. In the primary analysis of this review, benefits of low-dose aspirin use during pregnancy among women at high risk for preeclampsia was evaluated from two large randomized controlled trials (RCTs) and 13 smaller RCTs. In the secondary analysis, six RCTs and two large cohort studies were chosen to estimate harms to woman at any risk level who took aspirin during pregnancy. Daily use of aspirin starting after the first trimester at doses ranging between 60 and100 mg was associated with a risk reduction of 14% for preterm birth before 37 weeks gestation (relative risk [RR] 0.86; 95% confidence interval [CI], 0.76–0.98) for 11,779 women at high risk of preeclampsia in 10 trials included in the primary meta-analysis of this study. Meta-analysis of 13 trials (n = 12,504 women) revealed a 20% reduction in intrauterine growth restriction (IUGR) (RR 0.80; 95% CI, 0.65– 0.99) with aspirin use during pregnancy by women at high risk for preeclampsia. This meta-analysis also showed a 24% reduction in preeclampsia with aspirin treatment (RR 0.76; 95% CI, 0.62–0.95). Although aspirin dosages greater than 75 mg per day were associated with greater risk reduction compared to aspirin dosages less than 75 mg per day, authors of this review were unable to make conclusions about dosage effects because there were not adequate sample sizes of women taking higher dosages of aspirin among the included studies. The authors found no evidence of perinatal harm from low-dose aspirin use during pregnancy by women at high or average risk for preeclampsia. Perinatal harms assessed included placental abruption, postpartum hemorrhage, and intracranial hemorrhage in neonates. They also noted that in the one trial of longer-term developmental outcomes of infants born to women receiving aspirin during pregnancy, no treatment differences were observed. Comment: This meta-analysis and systematic review has findings consistent with results from a recent Cochrane review and the Perinatal Antiplatelet Review of International Trials (PARIS)
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Collaboration individual participant data metaanalysis. In all of these studies, prophylactic, lowdose aspirin use during the final two trimesters of pregnancy appears to be associated with a reduced risk for preeclampsia, IUGR, preterm birth, and perinatal mortality among women at high risk for preeclampsia. Although this meta-analysis reflects only modest effect sizes, the perinatal outcomes reduced with low-dose aspirin use are associated with multiple downstream harms to both mothers and infants. The authors also found no evidence of perinatal harm from low-dose aspirin use in pregnancy, although even the large numbers of women included in this study are too small to reliably evaluate the risk of rare maternal mortality and morbidity outcomes with aspirin use during pregnancy. Although African-American women in the United States are most likely to experience preeclampsia, they are not well represented in this or other systematic reviews on preeclampsia. Therefore, future research including this important subpopulation is needed. Featured Review: Grimes, D.A., Jones, L.B., Lopez, L.M., & Schulz, K.F. (2014). Oral contraceptives for functional ovarian cysts. The Cochrane Database of Systematic Reviews, 4, CD006134, doi: 10.1002/14651858.CD006134. pub5 Functional ovarian cysts occur commonly in many women of reproductive age, and more than a quarter million US women per year are hospitalized as a result of functional ovarian cysts, including follicular and corpus luteum cysts. Although functional ovarian cysts will often resolve spontaneously, they can cause severe discomfort. Treatment for functional ovarian cysts commonly includes surgical intervention and/or combined oral contraceptives (COCs). Combined oral contraceptives were first used to treat follicular ovarian cysts in the 1970s based on the results of an uncontrolled case series report of 286 women with adnexal masses, in which the authors concluded that COCs resulted in a more rapid shrinkage of functional ovarian cysts. COCs are known to have a strong protectant effect against the formation of functional ovarian cysts. However, the use of COCs to treat pre-existing functional ovarian cysts was the basis of this updated Cochrane review. This systematic review and meta-analysis included 8 RCTs with a total of 686 women. Included studies were evaluated for methodological
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quality and chosen based on a search performed in March 2014 of all trials that focused on COCs as treatment for ovarian cysts. Data from included RCTs were abstracted and used to calculate odds ratios or mean differences with 95% CIs. Studies included in this meta-analysis were assessed to have some quality limitations involving nonrandom methods of sequence allocation, inadequate allocation concealment, and small sample sizes. Only studies in which the authors used the same COCs (exposure) and outcomes were aggregated for this meta-analysis. Use of COCs was evaluated as treatment for ovarian cysts arising spontaneously and arising following the use of fertility drugs during ovulation induction.
Albuquerque, R. C., Baltar, V. T., & Marchioni, D. M. (2014). Breast cancer and dietary patterns: A systematic review. Nutrition Reviews, 72(1), 1–17. doi: http://dx.doi.org/10.1111/nure.12083 Anthoulakis, C., & Nikoloudis, N. (2014). Pelvic MRI as the “gold standard” in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: A systematic review. Gynecologic Oncology, 132(3), 661–668. doi: http://dx.doi.org/10.1016/j.ygyno.2013.10.022
Brandao, T., Schulz, M. S., & Matos, P. M. (2014). Psychological intervention with couples coping with breast cancer: a systematic review. Psychology & Health, 29(5), 491–516. doi: http://dx.doi.org/10.1080/08870446.2013. 859257 Harris, H. R., Orsini, N., & Wolk, A. (2014). Vitamin C and survival among women with breast cancer: A meta-analysis. European Journal of Cancer, 50(7), 1223–1231. doi: http://dx.doi.org/10.1016/j.ejca.2014.02.013 Kleppe, M., Amkreutz, L. C., Van Gorp, T., Slangen, B. F., Kruse, A. J., & Kruitwagen, R. F. (2014). Lymph-node metastasis in stage I and II sex cord stromal and malignant germ cell tumours of the ovary: A systematic review. Gynecologic Oncology, 133(1), 124–127. doi: http://dx.doi.org/10.1016/j.ygyno.2014.01.011 Li, S., Xu, H., Li, S. C., Qi, X. Q., & Sun, W. J. (2014). Vitamin D receptor rs2228570 polymorphism and susceptibly to ovarian cancer: A meta-analysis. Tumour Biology, 35(2), 1319– 1322. doi: http://dx.doi.org/10.1007/s13277013-1175-1183 Mei, J., Duan, H. X., Wang, L. L., Yang, S., Lu, J. Q., Shi, T. Y., & Zhao, Y. (2014). XRCC1 polymorphisms and cervical cancer risk: An updated meta-analysis. Tumour Biology, 35(2), 1221– 1231. doi: http://dx.doi.org/10.1007/s13277013-1163-1167. Mohr, S. B., Gorham, E. D., Kim, J., Hofflich, H., & Garland, C. F. (2014). Meta-analysis of vitamin D sufficiency for improving survival of patients with breast cancer. Anticancer Research, 34(3), 1163–1166. Nagata, C., Mizoue, T., Tanaka, K., Tsuji, I., Tamakoshi, A., Matsuo, K., ... Research Group for the Development and Evaluation of Cancer Prevention Strategies in Japan. (2014). Soy intake and breast cancer risk: An evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Japanese Journal of Clinical Oncology, 44(3), 282–295. doi: http://dx.doi.org/10.1093/jjco/hyt203 Pace, L. E., & Keating, N. L. (2014). A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA, 311(13), 1327–1335. doi: http://dx.doi.org/10.1001/jama.2014.1398 Reidy, M., & Denieffe, S. (2014). Breast cancer in younger women from diverse cultural backgrounds. British Journal of Nursing, 23(4), S19S22. Robbins, C. L., Hutchings, Y., Dietz, P. M., Kuklina, E. V., & Callaghan, W. M.
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Overall, COC use was not found to hasten the resolution of functional ovarian cysts. Early studies leading to the clinical impression that COC could be used to treat functional ovarian cysts were flawed by lack of contemporaneous control groups. This meta-analysis revealed no difference in control versus COC treatment groups for the resolution of functional ovarian cysts. Most of these cysts resolved spontaneously. Those cysts that did not resolve within several months were unlikely to be functional cysts and therefore required surgical evaluation. Comment: The authors of this meta-analysis found that COCs are not effective in the treatment of functional ovarian cysts. Although COCs might be used to suppress the formation of functional ovarian cysts in women with this history, they should not be used to shrink existing cysts. Adnexal masses thought to be functional ovarian cysts might be followed with watchful waiting for 2 to 3 menstrual cycles. If ovarian cysts persist beyond this time period or are large or painful, surgical management is recommended.
Evidence-Based Reviews from Other Sources Recent Evidence-Based Reviews: Women’s Health
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(2014). History of preterm birth and subsequent cardiovascular disease: A systematic review. American Journal of Obstetrics & Gynecology, 210(4), 285–297. doi: http://dx.doi.org/10.1016/j.ajog.2013.09.020 Rositch, A. F., Soeters, H. M., Offutt-Powell, T. N., Wheeler, B. S., Taylor, S. M., & Smith, J. S. (2014). The incidence of human papillomavirus infection following treatment for cervical neoplasia: a systematic review. Gynecologic Oncology, 132(3), 767–779. doi: http://dx.doi.org/10.1016/j.ygyno.2013. 12.040 Tiernan, J. P., Verghese, E. T., Nair, A., Pathak, S., Kim, B., White, J., . . . Hanby, A. M. (2014). Systematic review and meta-analysis of cytokeratin 19-based one-step nucleic acid amplification versus histopathology for sentinel lymph node assessment in breast cancer. British Journal of Surgery, 101(4), 298–306. doi: http://dx.doi.org/10.1002/bjs.9386 van der Ploeg, J. M., van der Steen, A., Oude Rengerink, K., van der Vaart, C. H., & Roovers, J. P. (2014). Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG, 121(5), 537–547. doi: http://dx.doi.org/10.1111/1471-0528.12509 Xu, H. B., Yang, H., Liu, T., & Chen, H. (2014). Association of CTLA4 gene polymorphism (rs5742909) with cervical cancer: a metaanalysis. Tumour Biology, 35(2), 1605–1608. Yoo, G. J., Levine, E. G., & Pasick, R. (2014). Breast cancer and coping among women of color: a systematic review of the literature. Supportive Care in Cancer, 22(3), 811–824. doi: http://dx.doi.org/10.1007/s00520-013-2057-3 Zakher, B., Blazina, I., & Chou, R. (2014). Association between knowledge of HIVpositive status or use of antiretroviral therapy and high-risk transmission behaviors: Systematic review. AIDS Care, 26(4), 514–521. doi: http://dx.doi.org/10.1080/09540121.2013. 832723
Recent Evidence-Based Reviews: Pregnancy & Birth Laopaiboon, M., Lumbiganon, P., Intarut, N., Mori, R., Ganchimeg, T., Vogel, J. P., . . . WHO Multicountry Survey on Maternal Newborn Health Research, Network. (2014). Advanced maternal age and pregnancy outcomes: a multicountry assessment. BJOG, 121(Suppl 1), 49–56. doi: http://dx.doi.org/10.1111/1471-0528.12659
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Leventakou, V., Roumeliotaki, T., Martinez, D., Barros, H., Brantsaeter, A. L., Casas, M., . . . Chatzi, L. (2014). Fish intake during pregnancy, fetal growth, and gestational length in 19 European birth cohort studies. American Journal of Clinical Nutrition, 99(3), 506–516. doi: http://dx.doi.org/10.3945/ajcn.113.067421 Morisaki, N., Togoobaatar, G., Vogel, J. P., Souza, J. P., Rowland Hogue, C. J., Jayaratne, K., . . . WHO Multicountry Survey on Maternal and Newborn Health Research Network. (2014). Risk factors for spontaneous and providerinitiated preterm delivery in high and low Human Development Index countries: A secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG, 121(Suppl 1), 101–109. doi: http://dx.doi.org/10.1111/1471-0528.12631 Pineles, B. L., Park, E., & Samet, J. M. (2014). Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. American Journal of Epidemiology, 179(7), 807–823. doi: http://dx.doi.org/10.1093/aje/kwt334 Rodger, M. A., Carrier, M., Le Gal, G., Martinelli, I., Perna, A., Rey, E., . . . Low-MolecularWeight Heparin for Placenta-Mediated Pregnancy Complications Study Group. (2014). Meta-analysis of low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications. Blood, 123(6), 822– 828. doi: http://dx.doi.org/10.1182/blood-201301-478958 Sheldon, W. R., Blum, J., Vogel, J. P., Souza, J. P., Gulmezoglu, A. M., Winikoff, B., . . . WHO Multicountry Survey on Maternal and Newborn Health Research Network. (2014). Postpartum haemorrhage management, risks, and maternal outcomes: Findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG, 121(Suppl 1), 5–13. doi: http://dx.doi.org/10.1111/14710528.12636 Tolcher, M. C., Johnson, R. L., El-Nashar, S. A., & West, C. P. (2014). Decision-toincision time and neonatal outcomes: A systematic review and meta-analysis. Obstetrics & Gynecology, 123(3), 536–548. doi: http:// dx.doi.org/10.1097/AOG.0000000000000132 Vogel, J. P., Souza, J. P., Mori, R., Morisaki, N., Lumbiganon, P., Laopaiboon, M., . . . WHO Multicountry Survey on Maternal and Newborn Health Research Network. (2014). Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and
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Been, J. V., Nurmatov, U. B., Cox, B., Nawrot, T. S., van Schayck, C. P., & Sheikh, A. (2014). Effect of smoke-free legislation on perinatal and child health: A systematic review and meta-analysis. Lancet, 383(9928), 1549– 1560. doi: http://dx.doi.org/10.1016/S01406736(14)60082-9 Giaccone, A., Jensen, E., Davis, P., & Schmidt, B. (2014). Definitions of extubation success in very premature infants: A systematic review. Archives of Disease in Childhood Fetal & Neonatal Edition, 99(2), F124–F127. doi: http://dx.doi.org/10.1136/archdischild-2013304896 Gruzieva, O., Gehring, U., Aalberse, R., Agius, R., Beelen, R., Behrendt, H., . . . Pershagen, G. (2014). Meta-analysis of air pollution exposure association with allergic sensitization in European birth cohorts. Journal of Allergy & Clinical Immunology, 133(3), 767–776.e767. doi: http://dx.doi.org/10.1016/j.jaci.2013.07.048 Malin, G. L., Morris, R. K., Riley, R., Teune, M. J., & Khan, K. S. (2014). When is birthweight at term abnormally low? A systematic review and metaanalysis of the association and predictive ability of current birthweight standards for neonatal
outcomes. BJOG, 121(5), 515–526. doi: http://dx.doi.org/10.1111/1471--0528.12517 Parker, R. I. (2014). Transfusion in critically ill children: Indications, risks, and challenges. Critical Care Medicine, 42(3), 675–690. doi: http:// dx.doi.org/10.1097/CCM.0000000000000176 Peng, W., Zhu, H., Shi, H., & Liu, E. (2014). Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis. Archives of Disease in Childhood Fetal & Neonatal Edition, 99(2), F158-F165. doi: http://dx.doi.org/10.1136/archdischild-2013304613 Steiner, M. B., Tang, X., Gossett, J. M., Malik, S., & Prodhan, P. (2014). Timing of complete repair of non-ductal-dependent tetralogy of Fallot and short-term postoperative outcomes, a multicenter analysis. Journal of Thoracic & Cardiovascular Surgery, 147(4), 1299–1305. doi: http://dx.doi.org/10.1016/j.jtcvs.2013.06.019 Tinnion, R., Gillone, J., Cheetham, T., & Embleton, N. (2014). Preterm birth and subsequent insulin sensitivity: A systematic review. Archives of Disease in Childhood, 99(4), 362–368. doi: http://dx.doi.org/10.1136/archdischild-2013304615 Xu, H., Zeng, T., Liu, J. Y., Lei, Y., Zhong, S., Sheng, Y. J., . . . Ren, H. (2014). Measures to reduce mother-to-child transmission of Hepatitis B virus in China: A meta-analysis. Digestive Diseases & Sciences, 59(2), 242–258. doi: http://dx.doi.org/10.1007/s10620-013-2918-0
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Newborn Health. BJOG, 121(Suppl 1), 76– 88. doi: http://dx.doi.org/10.1111/1471-0528. 12633
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