Effective maternity care quality improvement strategies: evidence-based practice current resources for evidence-based practice carol sakala, phd, msph, july/august 2007

Current Resources for Evidence-Based Practice,
July/August 2007

Published simultaneously in the Journal of Obstetric, Gyneco- ● Fetal movement counting for assessment of fetal well- logic and Neonatal Nursing 2007;36(4).
● Probiotics for preventing preterm labour IDENTIFYING EFFECTIVE MATERNITY CARE QUALITY
Updated Systematic Reviews
● Antibiotics for treating bacterial vaginosis in preg- Chaillet et al.1 recently published what may be the first systematic review to identify effective strategies for ● Antihypertensive drug therapy for mild to moderate improving the quality of maternity care. Although the title references “guidelines,” some of the 33 included ● Antiretrovirals for reducing the risk of mother-to-child studies measured a desired change rather than implemen- tation of a formal guideline. The review included ran- ● Combined oral contraceptive pills for treatment of domized controlled trials and observational designs.
Most studies examined physicians, and some considered ● Interventions for varicose veins and leg oedema in Educational strategies were generally ineffective with physicians and had mixed results with other health professionals. Other strategies with mixed results across ● Treatment for primary postpartum haemorrhage the included studies were the use of opinion leaders,academic detailing (topically focused outreach to indi- Cochrane Reviews are available by subscription to The vidual clinicians), and modification of existing systems Cochrane Library, and review abstracts are available and structures. Both audit and performance feedback and without charge. For abstracts, access information and multifacted interventions combining two or more strate- gies to address a specific barrier were generally effective.
Overall, studies that identified and addressed barriers FROM DATABASE OF ABSTRACTS OF REVIEWS OF
were far more likely to lead to demonstrated improve- EFFECTS (DARE)
The authors identified possible differences between Recent Abstract Entries Assessing Quality of
obstetric and general medical contexts: whereas educa- Systematic Reviews
tion achieved some success with non-physician maternity ● The accuracy of maternal anthropometry measure- providers, it has generally been unsuccessful in other ments as predictor for spontaneous preterm birth: A contexts; audit and feedback appear to be more success- ful in obstetrics than other contexts; and academic ● Assisted reproductive technologies and the risk of birth detailing has been more successful in other contexts than ● Comparison of tamoxifen and clomiphene citrate for 1. Chaillet N, Dube E, Dugas M, Audibert F, Tourigny C, Fraser WD, et al. Evidence-based strategies for ● Chemotherapy-induced cognitive impairment in women implementing guidelines in obstetrics: A systematic re- with breast cancer: A critique of the literature view. Obstet Gynecol 2006;108:1234 – 45.
● Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: A meta-analysis FROM COCHRANE DATABASE OF SYSTEMATIC REVIEWS
● Contemporary treatments for twin-twin transfusion syn- (CDSR), ISSUE 1, 2007
● Evaluating effectiveness of complex interventions aimed New Systematic Reviews
at reducing maternal mortality in developing countries ● Aromatase inhibitors for treatment of advanced breast ● Hormone therapy and cardiovascular disease: A sys- Journal of Midwifery & Women’s Health www.jmwh.org
1526-9523/07/$32.00 • doi:10.1016/j.jmwh.2007.05.001 ● Learning from success and failure in psychosocial measures that have been demonstrated to be effective intervention: An evaluation of low birth weight pre- through systematic review of the best available studies.
Featured review: Demott K, Bick D, Norman R, Ritchie ● Liquid-based cytology for cervical screening G, Turnbull N, Adams C, et al. Clinical guidelines and ● Lymphatic mapping and sentinel lymph node biopsy in evidence review for post natal care: Routine post natal early-stage breast carcinoma: A metaanalysis care of recently delivered women and their babies. ● Menopausal hormone therapy and risk of breast can- cer: A meta-analysis of epidemiological studies and London: National Collaborating Centre for Primary Care and Royal College of General Practitioners, 2006. ● Misoprostol in preventing postpartum hemorrhage: A 393 pages. Available without charge and with numer- ● Neoadjuvant versus adjuvant systemic treatment in This team reviewed best available evidence to identify ● Nonhormonal therapies for menopausal hot flashes: essential care for mothers and babies from birth through 6 to 8 weeks postpartum. The guideline identified core ● Osteoarthritis and the postmenopausal woman: Epide- information, core care, and concerns with respect to miological, magnetic resonance imaging, and radiolog- maternal health, infant feeding, and infant health. The detailed narrative describes a wealth of primary studies ● School-based teenage pregnancy prevention programs: and includes attention to timing, type of personnel, and A systematic review of randomized controlled trials economics. Companion documents provide further de- ● Selective serotonin reuptake inhibitor (SSRI) use dur- tail, summaries for professionals and the public, and ing pregnancy and effects on the fetus and newborn: A Comment: This evidence review, full guideline, and ● Skeletal consequences of hormone therapy discontinu- companion documents provide a sweeping overview of postpartum care issues that should be of great value for ● Smoking cessation in pregnancy: A review of postpar- those who plan, provide, or receive postpartum care.
● Systematic review of the risk of uterine rupture with Featured review: U.K. National Collaborating Centre the use of amnioinfusion after previous cesarean de- for Women’s and Children’s Health. Urinary inconti- nence: The management of urinary incontinence in ● Systematic review of the treatment of ovulatory infertility women. London: RCOG Press, 2006. 221 pages. Avail- with clomiphene citrate and intrauterine insemination able without charge and with numerous compan-ion documents at DARE abstracts are available without charge from: A multidisciplinary team reviewed the best evidence and EVIDENCE-BASED REVIEWS FROM OTHER SOURCES
developed guidelines to assess and treat stress, urge, andmixed incontinence and overactive bladder in women.
Featured review: Coomarasamy A, Thangaratinam S, Physical, behavioral, lifestyle, drug, complementary, and Gee H, Khan KS. Progesterone for the prevention of surgical treatments were included. First-line treatment preterm birth: A critical evaluation of evidence. Eur J for women with urge or mixed urinary incontinence is Obst Gynecol Reprod Biol 2006;129:111– 8. bladder training for at least 6 weeks to increase the The authors carried out a cumulative meta-analysis of interval between desire to void and actual void.
randomized controlled trials of progestational agents to First-line treatment for women with stress and mixed prevent preterm birth in women at elevated risk for this urinary incontinence is supervised pelvic floor muscle condition. The four trials available by 1975 demonstrated training for at least 3 months. Such training is also an the effectiveness of this intervention, and the four sub- effective preventive measure during pregnancy. The sequent trials further strengthened this association. The guideline clarifies when and how other treatments effect was found when looking just at highest quality should be carried out if initial measures are inadequate studies and at different levels of baseline risk. Depending and identifies measures that are not of value. The on baseline risk, one preterm birth is prevented from report also covers coping strategies and research treating 7 to 12 mothers. The included studies and other referenced reports found no evidence of harm in use of Comment: Urinary incontinence is prevalent in women, with varying degrees of severity. Many effective Comment: The U.S. prematurity rate has been steadily treatments are available to help those with troublesome rising. Progesterone is among a small number of preventive Volume 52, No. 4, July/August 2007
Recent Evidence-Based Reviews
and adverse pregnancy outcomes in type 1 and type 2diabetes mellitus: Systematic review of observational ● Althabe F, Bergel E, Buekens P, Sosa C, Belizán JM.
studies. BMC Pregnancy Childbirth 2006;6:30. Avail- Controlled cord traction in the third stage of labor: Systematic review. Int J Gynecol Obstet 2006;94(Suppl ● Jaakkola JJ, Ahmed P, Ieromnimon A, Goepfert P, ● Altman MR, Lydon-Rochelle MT. Prolonged second Laiou E, Quansah R, et al. Preterm delivery and stage of labor and risk of adverse maternal and asthma: A systematic review and meta-analysis. J perinatal outcomes: A systematic review. Birth 2006; Allergy Clin Immunol 2006;118:823–30.
● Badenhorst W, Riches S, Turton P, Hughes P. The ● Lee SJ, Steer PJ, Filippi V. Seasonal patterns and psychological effects of stillbirth and neonatal death preterm birth: A systematic review of the literature and on fathers: Systematic review. J Psychosom Obstet an analysis in a London-based cohort. BJOG 2006; ● Bamigboye AA, Hofmeyr GJ. Interventions for leg ● Ma H, Bernstein L, Pike MC, Ursin G. Reproductive edema and varicosities in pregnancy: What evidence? factors and breast cancer risk according to joint estro- Eur J Obstet Gynecol Reprod Biol 2005;129:3– 8.
gen and progesterone receptor status: A meta-analysis ● Boomsma CM, Eijkemans MJ, Hughes EG, Visser of epidemiological studies. Breast Cancer Res 2006;8: GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update 2006;12:673– 83.
● Nelson RL, Westercamp M, Furner SE. A systematic ● Crane JMG, Butler B, Young DC, Hannah ME. Miso- review of the efficacy of cesarean section in the prostol compared with prostaglandin E for labour induc- preservation of anal continence. Dis Colon Rectum tion in women at term with intact membranes and unfavourable cervix: A systematic review. BJOG 2006; ● Pattenden S, Antova T, Neuberger M, Nikiforov B, De Sario M, Grize L, et al. Parental smoking and chil- ● da Silva Dal Pizzol T, Knop FP, Mengue SS. Prenatal dren’s respiratory health: Independent effects of pre- exposure to misoprostol and congenital anomalies: natal and postnatal exposure. Tobacco Control 2006; Systematic review and meta-analysis. Reprod Toxicol ● Pratt TC, McGloin JM, Fearn NE. Maternal cigarette ● Dean N, Herbison P, Ellis G, Wilson D. Laparoscopic smoking during pregnancy and criminal/deviant be- colposuspension and tension-free vaginal tape: A sys- havior: A meta-analysis. Int J Offender Ther Comp tematic review. BJOG 2006;113:1345–53.
● Dennis C-L, Chung-Lee L. Postpartum depression ● Rischitelli G, Nygren P, Bougatsos C, Freeman M, help-seeking barriers and maternal treatment prefer- Helfand M. Screening for elevated lead levels in child- ences: A qualitative systematic review. Birth 2006;33: hood and pregnancy: An updated summary of evidence for the US Preventive Services Task Force. Pediatrics ● Der G, Batty GD, Deary IJ. Effect of breast feeding on 2006;118:1867-95. Available without charge at intelligence in children: Prospective study, sibling pairs analysis, and meta-analysis. BMJ 2006;333:945.
● Sharma A, Menon U, Ledermann J. Ovarian cancer (advanced). Clin Evid 2006;15:1–16. [Interventions to ● Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G. Alcohol dosing and ● Souza JP, Miquelutti MA, Cecatti JG, Makuch MY.
total mortality in men and women. Arch Int Med Maternal position during the first stage of labor: A systematic review. Reprod Health 2006;3:10. Avail- ● Geifman-Holtzman O, Grotegut CA, Gaughan JP. Diag- nostic accuracy of noninvasive fetal Rh genotyping from maternal blood: A meta-analysis. Am J Obstet Gynecol ● Stokes-Lampard H, Wilson S, Waddell C, Ryan A, Holder R, Kehow S. Vaginal vault smears after hys- ● Illuzzi JL, Bracken MG. Duration of intrapartum terectomy for reason other than malignancy: A system- prophylaxis for neonatal group B streptococcal dis- atic review of the literature. BJOG 2006;113:1354 – 65.
ease: A systematic review. Obstet Gynecol 2006;108:1254 – 65.
Carol Sakala, PhD, MSPH, is Director of Programs at Childbirth Connection,which works with health professionals and other audiences to promote ● Inkster ME, Fahey TP, Donnan PT, Leese GP, Mires GJ, Murphy DJ. Poor glycated haemoglobin control Journal of Midwifery & Women’s Health www.jmwh.org

Source: http://www.childbirthconnection.net/pdfs/JMWH2007julaug.pdf

Commission pharmacovigilance - compte rendu de la réunion du mardi 29 septembre 2009

Direction de l’Evaluation des Médicaments et des Produits Biologiques Département de Pharmacovigilance COMMISSION NATIONALE DE PHARMACOVIGILANCE Compte rendu de la réunion du mardi 29 septembre 2009 Etaient présents : Membres de la Commission nationale de pharmacovigilance : M. MERLE (président) Mme LAINE-CESSAC (vice-présidente) Mme CASTOT (représenta


Please see the “AAHA/AAFP Pain Management Guidelines for Dogs and Cats” for pain management details and a list of resources. Q: Is giving buprenorphine orally effective in dogs? Buprenorphine injectable can be delivered transmucosally in the cat and the ferret. This is NOT oral delivery. ORAL delivery inactivates the medication. The injectable solution is absorbed across the mucus membrane

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