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Resources to guide effective professional practice: jognn special reports new resources for evidence-based practice, carol sakala, phd, msph, january/february 2004SPECIAL REPORTS
Resources for Evidence-Based Practice,
Published simultaneously in Journal of Midwifery Comment: Continuous labor support has no and Women’s Health (2004); 49(1).
known downsides and can help women have a satis-fying childbirth experience and avoid risks associat- This column highlights new and recently updated ed with cesareans and other major interventions.
systematic reviews and overviews of best research The organization of care in modern maternity units evidence that clarify knowledge about effects of spe- appears to limit the effectiveness of labor support cific practices in maternal/newborn and women’s provided by members of the hospital staff. It is a pri- ority to clarify whether this basic component of safeand effective maternity care also offers economic From Cochrane Database of Systematic
advantages. Full text of the review is available with-out charge from http://www.maternitywise.org/ Reviews (CDSR), Issue 3, 2003
Featured review: Hodnett, E. D., Gates, S.,
Hofmeyr, G. J., & Sakala, C. Continuous support
New Systematic Reviews
for women during childbirth.
• Amniocentesis and chorionic villus sampling The Cochrane labor support review has been entirely reconstructed with the following new ele- • Deep versus shallow suction of endotracheal ments: reviewer team, title, protocol, large random- tubes in ventilated neonates and young infants ized controlled trials (RCTs), and subgroup analy- • Early intravenous nutrition for the prevention ses. It also includes expanded background and discussion sections. The new review summarizes • G-CSF and GM-CSF for treating or preventing experiences of nearly 13,000 women who partici- pated in 15 RCTs. Women who received continuous • Gowning by attendants and visitors in new- labor support were less likely than women who did born nurseries for prevention of neonatal mor- not have continuous labor support to have regional analgesia or any analgesia/anesthesia, give birth with • Male circumcision for prevention of heterosex- vacuum extraction or forceps, give birth by cesare- an, and report dissatisfaction or negatively rate their • Oestrogen supplementation, mainly diethyl- experience. A subgroup analysis examined the stilbestrol, for preventing miscarriages and impact of the type of person providing continuous support. Effects were stronger when the person was • Oral immunoglobulin for the prevention of not a regular member of the hospital staff and was rotavirus infection in low birth weight infants an outsider present expressly to provide support.
• Rectal analgesia for pain from perineal trauma Compared to women without continuous support, those with support from nonhospital caregivers were • Regional (spinal, epidural, caudal) versus gen- 26% less likely to give birth by cesarean section, eral anaesthesia in preterm infants undergoing 41% less likely to have an instrumental birth, 28% less likely to use any analgesia or anesthesia, and • Repeat doses of prenatal corticosteroids for 36% less likely to be dissatisfied with their child- women at risk of preterm birth for preventing • Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent compend-babyfriendlywho.htm) provides evidence-based recommendations for breastfeeding support during hospi- • Treatments for gestational diabetes and impaired talization for childbirth. BFHI and the review featured here together provide guidance to help clinicians effec- • Vitamin E supplementation for prevention of mor- tively support breastfeeding throughout the childbearing cycle. Optimal breastfeeding support in primary care mayrequire services that go beyond routine prenatal and Updated Systematic Reviews
• Dopamine versus dobutamine for hypotensive Recent Abstract Entries Assessing Quality
• Growth hormone for in vitro fertilization of Systematic Reviews
• Oral beta-blockers for mild to moderate hyperten- • Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quan- • Ovulation suppression for endometriosis • Phenobarbital prior to preterm birth for preventing • Are fluid-based cytologies superior to the conven- tional Papanicolaou test: a systematic review • Planned cesarean section for term breech delivery • Diagnostic accuracy of large-core needle biopsy for • Support during pregnancy for women at increased nonpalpable breast disease: a meta-analysis • Efficacy of physical therapy methods and exercise after a breast cancer operation: a systematic review • Fetal bradycardia due to intrathecal opioids for Cochrane Reviews are available by subscription to The Cochrane Library or through various publishing partners.
• Laparoscopic surgery is not inherently dangerous Abstracts of Cochrane Reviews are available without for patients presenting with benign gynaecologic charge. See http://www.cochrane.org/reviews/ for abstracts • Luteal phase support in infertility treatment: a meta- From Database of Abstracts of Reviews of
• Management of mild chronic hypertension during Effects (DARE)
• Patient-controlled epidural analgesia versus contin- Featured review: Couto de Oliveira, M. I., Bastos
uous infusion for labour analgesia: a meta-analysis Camacho, & L. A., Tedstone, A. E. Extending breast-
• Psychological consequences of predictive genetic feeding duration through primary care: a systematic
review of prenatal and postnatal interventions. [Abstract
• Tolterodine versus oxybutynin in the treatment of 20025027]
urge urinary incontinence: a meta-analysis This review of prenatal and/or postpartum interven- • US characterization of ovarian masses: a meta- tions was performed to determine effective ways to pro- mote, protect, and support breastfeeding within primarycare. The authors report results from 27 internally valid DARE abstracts are available without charge from randomized controlled trials and 10 internally valid quasi-random studies enrolling a total of 20,253 women.
The most effective interventions tended to span the pre- Evidence-Based Reviews From Other Sources
natal period or both prenatal and postpartum periods andto offer face-to-face information, guidance, and support.
Featured review: (May 2003). Results of systematic
The research supports intensive interventions that com- review of research on diagnosis and treatment of coro-
bine group sessions, individual sessions, and/or home vis- nary heart disease in women; summary. Evidence
its over time. It does not support breastfeeding promotion Report/Technology Assessment: Number 80. AHRQ Pub-
with mixed messages (e.g., concurrent with providing lication Number 03-E034. Rockville, MD: Agency for
infant formula) and brief nonintensive interventions Healthcare Research and Quality. Available without
(including giving breastfeeding messages among other charge at: http://www.ahrq.gov/clinic/epcindex.htm#
topics and through isolated printed materials). The gynecologic.
DARE abstract authors give a high rating to the overall Although coronary heart disease (CHD) is the most common cause of death in women, most CHD research Comment: The WHO/UNICEF Baby-Friendly Hospi- reports do not provide useful data about its prevention tal Initiative (BFHI, see http://www.cdc.gov/breastfeeding/ diagnosis and treatment in women. The Agency for Healthcare Research and Quality commissioned this evi- AHRQ Publication No. 03-E036. Rockville, MD: dence overview to assess the best available research about Agency for Healthcare Research and Quality. Avail- women with a focus on 1) accurate noninvasive tests for able without charge and with full report at identifying CHD; 2) effective treatments for CHD; 3) risk http://www.ahrq.gov/clinic/epcindex.htm#cardiovascular.
factors for CHD and effects of modifying these; 4) relative • Farquhar, C., Ekeroma, A., Furness, S., & Arroll, B.
use of tests, risk factor modification, and treatments in (2003). A systematic review of transvaginal ultra- women and men; and 5) prognostic value of biochemical sonography, sonohysterography and hysteroscopy markers for diagnosing acute myocardial infarction or for the investigation of abnormal uterine bleeding in unstable angina. This comprehensive search for evidence premenopausal women. Acta Obstetricia et Gyne- focused on 42 specified subtopics and yielded just 162 cologica Scandinavica, 82(6), 493-504.
useable articles. Most articles used less definitive observa- • Fraser. A. B., & Grimes, D. A. (2003). Effect of lac-
tional designs (versus experimental designs or systematic tation on maternal body weight: A systematic reviews), and good-quality data were only available to review. Obstetrical and Gynecological Survey, address six of the subtopics. For specific details on the quality and results of currently available research, readers • Green, B. B., & Taplin, S. H. (2003). Breast cancer are referred to the summary and full report, available screening controversies. Journal of the American Board of Family Practice, 16(3), 233-241.
Comment: .Although federal policies have succeeded in • Green, J., Berrington de Gonzalez, A., Smith, J. S., increasing the proportion of female participants in Franceschi, S., Appleby, P., Plummer, M., & Beral, research, few subgroup results or focused studies are V. (2003). Human papillomavirus infection and use available to guide practice for women relating to these of oral contraceptives. British Journal of Cancer, • Harvey, M. A. (2003). Pelvic floor exercises during Recent Evidence-Based Reviews
and after pregnancy: A systematic review of their • Bachmann, L. M., Coomarasamy, A., Honest, H., & role in preventing pelvic floor dysfunction. Journal Khan, K. S. (2003). Elective cervical cerclage for of Obstetrics and Gynaecology Canada, 25(6), 487- prevention of preterm birth: A systematic review.
Acta Obstetricia et Gynecologica Scandinavica, • Kroumpouzos, G., & Cohen, L. M. (2003). Specific dermatoses of pregnancy: An evidence-based sys- • Barnhart, K. T., Gosman, G., Ashby, R., & Sammel, tematic review. American Journal of Obstetrics and M. (2003). The medical management of ectopic Gynecology, 188(4), 1083-1092.
pregnancy: A meta-analysis comparing “single • Malik, A., Hui, C. P., Pennie, R. A., & Kirpalani, H.
dose” and “multidose” regimens. Obstetrics and (2003). Beyond the complete blood cell count and Gynecology, 101(4), 778-784.
C-reactive protein: A systematic review of modern • Berkman, N. D., Thorp, J. M., Lohr, K. N., Carey, diagnostic tests for neonatal sepsis. Archives of T. S., Hartmann, K. E., Gavin, N. I., Hasselblad, V., Pediatrics and Adolescent Medicine, 157(6), 511- & Idicula, A. E. (2003). Tocolytic treatment for the management of preterm labor: A review of the evi- • Merialdi, M., Carroli, G., Villar, J., Abalos, E., Gul- dence. American Journal of Obstetrics and Gyne- mezoglu, A. M., Kulier, R., & de Onis, M. (2003).
cology, 188(6), 1648-1659.
Nutritional interventions during pregnancy for the • Carfoot, S., Williamson, P. R., & Dickson, R.
prevention or treatment of impaired fetal growth: (2003). A systematic review of randomised con- An overview of randomized controlled trials. Jour- trolled trials evaluating the effect of mother/baby nal of Nutrition, 133(5 Suppl 2), 1626s-1631s.
skin-to-skin care on successful breast feeding. Mid- • Pritchard, M. A., Flenady, V., & Woodgate, P.
wifery, 19(2), 148-155.
(2003). Systematic review of the role of pre- • Coomarasamy, A., Honest, H., Papaioannou, S., oxygenation for tracheal suctioning in ventilated Gee, H., & Khan, K. S. (2003). Aspirin for preven- newborn infants. Journal of Paediatrics and Child tion of preeclampsia in women with historical risk Health, 39(3), 163-165.
factors: A systematic review. Obstetrics and Gyne- • Ray, J. G., & Blom, H. J. (2003). Vitamin B12 insuf- cology, 101(6), 1319-1332.
ficiency and the risk of fetal neural tube defects.
• (May 2003). Diagnosis and treatment of coronary Quality Journal of Medicine, 96(4), 289-295.
heart disease in women: Systematic reviews of evi- • Rietman, J. S., Dijkstra. P. U., Hoekstra, H. J., dence on selected topics; summary. Evidence Eisma, W. H., Szabo, B. G., Groothoff, J. W., & Report/Technology Assessment: Number 81.
Geertzen, J. H. (2003). Late morbidity after treat- ment of breast cancer in relation to daily activities their knowledge and increase their participation in deci- and quality of life: A systematic review. European sion making? Does editorial peer review improve the Journal of Surgical Oncology, 29(3), 229-238.
quality of reports of biomedical studies? A growing num- • Sanchez-Ramos, L., Olivier, F., Delke, I., & Kaunitz, ber of systematic reviews are available to help clarify A. M. (2003). Labor induction versus expectant results of the best available research about these and other management for postterm pregnancies: A systemat- questions relating to effective professional practice and ic review with meta-analysis. Obstetrics and Gyne- cology, 101(6):1312-1318.
Within the Cochrane Collaboration, three review • Smith, J. S., Green, J., Berrington de Gonzalez, A., groups prepare and maintain systematic reviews in this Appleby, P., Peto, J., Plummer, M., Franceschi, S., & broad area. The Effective Practice and Organization of Beral, V. (2003). Cervical cancer and use of hor- Care Group evaluates continuing education, regulatory, monal contraceptives: A systematic review. The organizational, quality assurance, and other interventions Lancet, 361, 1159-1167.
to improve service delivery. The Consumers and Commu- • Van Kessel, K., Assefi, N., Marrazzo, J., & Eckert, nication Group evaluates interventions that affect con- L. (2003). Common complementary and alternative sumers’ interactions with health professionals, services, therapies for yeast vaginitis and bacterial vaginosis: and researchers; and the Methodology Review Group A systematic review. Obstetrical and Gynecological evaluates aspects of carrying out research and disseminat- Survey, 58(5), 351-358.
ing research results. Issue 4, 2003 of The Cochrane • Villar, J., Merialdi, M., Gulmezoglu, A. M., Abalos, Library includes 48 completed systematic reviews from E., Carroli, G., Kulier, R., & de Onis, M. (2003).
these groups and 42 protocols of additional reviews in Nutritional interventions during pregnancy for the preparation. The Cochrane Collaboration Web site prevention or treatment of maternal morbidity and (http://www.cochrane.org/) contains abstracts of complet- preterm delivery: An overview of randomized con- ed reviews and titles of reviews under development from trolled trials. Journal of Nutrition, 133(5 Suppl 2), these groups, along with links to their Web sites and PDF files of their newsletters. These resources can help policy • Yabroff, K. R., Mangan, P., & Mandelblatt, J.
makers, administrators, educators, researchers, and clini- (2003). Effectiveness of interventions to increase Papanicolaou smear use. Journal of the AmericanBoard of Family Practice, 16(3), 188-203.
Carol Sakala, PhD, MSPH, is Director of Programs at the
Commentary: Resources to Guide Effective
Maternity Center Association (MCA). MCA’s long-term nation-
al Maternity Wise program works with health professionals
and other audiences to promote evidence-based maternity care
Do continuing education meetings improve profession- (http://www.maternitywise.org). E-mail: sakala@maternity-
al practice and health outcomes? Do decision aids for wise.org.
people facing treatment or screening decisions improve
Impact of boundary conditions on the development of the thermal plume above a sitting human body Daria Zukowska1,*, Zbigniew Popiolek2 and Arsen Melikov1 1International Centre for Indoor Environment and Energy, (www.ie.dtu.dk), Department of Mechanical Engineering, Technical University of Denmark. 2Department of Heating, Ventilation and Dust Removal Technology, Silesian University of *Co