key: cord-1023533-1x1n72uc authors: Bovbjerg, Marit L. title: Current Resources for Evidence-Based Practice, September 2020 date: 2020-08-15 journal: Journal of Obstetric, Gynecologic & Neonatal Nursing DOI: 10.1016/j.jogn.2020.08.003 sha: 279f8f3f0173e405b7e66ac19116927e2b5c16f9 doc_id: 1023533 cord_uid: 1x1n72uc Abstract An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of “spin” in scientific reporting and its effect on summaries and syntheses of the literature and commentaries on reviews about early versus late amniotomy as part of labor induction protocols and the economic burden associated with maternal morbidity. This column's literature searches yielded an interesting systematic review by Ghannad et al. (2019) . Rather than reporting results of a clinical question per se, the authors analyzed how those results were reported. Specifically, they looked at the literature on biomarkers as screening, diagnostic, and prognostic tests for ovarian cancer. Drawing on a robust existing literature on "spin" in presentation of research findings for their analysis, Ghannad and colleagues (2019) evaluated the most recent 200 studies on biomarkers for ovarian cancer and looked specifically at titles, abstracts, and conclusions compared to the main findings as reported in the results sections. Spin of research findings comes in two forms: misrepresentation, defined as "misreporting and/ or distorted presentation of the study results in the title, abstract, or the main text, in a way that could mislead the reader," and misinterpretation, defined as "an interpretation of the study results in the abstract or main-text conclusion that is not consistent and/or is an extrapolation of the actual study results" (Ghannad et al., 2019, p. 11) . In other words, authors conducted their study and found X, but in the title, abstract, and/or article conclusion they reported XþY. I assume readers of a column entitled "Current Resources for Evidence-based Practice" are familiar with the concept of publication bias, wherein studies without exciting results (often defined, unfortunately, as results that are not statistically significant) are rejected for publication. This leads to errors when one is attempting to conduct systematic reviews or meta-analyses because the search of published literature only produces papers that were indeed published. Thus, the review can only include some of all studies actually conducted because the rest never made it into print. The resulting review is therefore biased because by definition it does not truly encompass what is known about a topic. Publication bias as described here applies to the entire literature on a particular topic, not to any one study specifically. Spin is likely a direct consequence of the process that leads to publication bias. When faced with research findings not deemed interesting enough to be worthy of publication, an author has a few options. One is to give up completely on publishing the work, which leads, of course, directly to publication bias. This is absolutely not ideal; publication bias aside, who wants to see months, sometimes years of work collecting, analyzing, and reporting data lead to nothing? Unfortunately, this is the simplest option and chosen not infrequently (hence, publication bias). A second possibility is to reformat the work in some way to try and make it worthy of publication. You could combine results from two studies, for instance, or rework the paper so it makes a methodologic rather than substantive point. This latter approach is one I used for a paper stemming from my dissertation work several years ago. With help from my advising committee, I found maternal physical activity during pregnancy had little bearing on risk of cesarean. The results were decidedly not statistically significant. Despite this being a worthwhile thing to know-as evidence-based practitioners we want to know what does not work as well as what does-seven journals rejected this so-called negative results paper. Eventually tiring of beating my head against that wall, I rewrote it to focus on our analytic choices instead of our findings, after which it was published immediately. Importantly, I was still able to present the findings that physical activity did not correlate with cesarean birth in our sample. These findings were just now couched within a larger discussion of how to analyze data on physical activity during pregnancy instead of within a discussion on whether physical activity could prevent cesareans (Bovbjerg et al., 2015) . Lest I portray myself as some paragon of publishing virtue, I'll admit the other paper that stemmed from my dissertation also did not contain exciting results, and when faced with the huge amount of work to redo it, I availed myself of Option 1. The final option for a troublesome paper is spin. Here, the authors rework their paper slightly so that the results seem more exciting than they really were, hoping these slights-of-hand are not called out by peer reviewers (assuming they were done consciously, which might not always be the case). This almost certainly happens behind the scenes as well, as authors choose perhaps only to present the more interesting results instead of all results. In the Ghannad et al. (2019) article on the biomarkers for ovarian cancer literature, 70% of studies included one or more forms of spin. Paper or abstract conclusions claimed a biomarker worked when the results were not statistically significant or when p-values and confidence intervals were not presented in the results section (and one must assume they were not favorable), numbers in the abstract did not match numbers in the text or tables, the abstract or title mischaracterized the extent of biomarker testing (e.g., claiming it predicts ovarian cancer deaths when the study endpoint was 6-month recurrence), and so on. The end result is that the literature is saturated with claims of biomarkers that can assist with diagnosis or prognosis for ovarian cancer, but few of these have panned out in practice. It is tempting to place the blame for spin squarely on authors, and indeed they are not blameless. However, much like when we consider how to reduce cesareans, we must look at the system as a whole rather than blaming any one class of person or any one individual person. I think the issue is larger than individual authors. It must be, for 140 out of 200 examined studies to have been written in a misleading way (Ghannad et al., 2019) . Ghannad et.al. did not report on funding sources for these studies, but I wonder how commercial interests affect spin. The system of publish-or-perish in academia has led to an ever-increasing number of global publications, as university administrators and granting agencies demand ever-more research productivity (Kovanis et al., 2016) . Not only does this system subtly encourage authors to take shortcuts so another paper can go out the door, but also the burden placed on peer reviewers (who are not paid) has increased to a level that may be unsustainable (Kovanis et al., 2016) . Journal editors in turn are evaluated based on the impact factors of their journals-a measure of how many citations, on average, each published paper in that journal receives. The impact factor contributes to publication bias because it incentivizes editors to disproportionately accept only the exciting papers that may be cited. The entire system is flawed. What does this mean for evidence-based practice if so much of the evidence is potentially questionable? Systematic reviews and metaanalyses help dilute the effect of any one perhaps suboptimal study, whether written with spin or otherwise problematic (bias, uncontrolled confounding, etc.). However, publication biasbeing unable to include null results in reviews because null results tend not to get publishedmight still lead one to the wrong conclusion. In well-done systematic reviews, reviewers formally assess publication bias. While I do not check all reviews included in these bibliographies, I do make sure the authors of the highlighted reviews have assessed publication bias to a satisfactory degree. Clinicians can and should allow more fluidity in their practice; the term "evidenceinformed" rather than "evidence-based" implies more room for clinical experience, patient and provider preferences, and unique characteristics (Nevo & Slonim-Nevo, 2011 ). If they are involved with their universities' governance structures, researchers can work to align promotion and tenure expectations with the realities of doing good science. More importantly, researchers can collectively admit when a research question does not seem answerable. Treatment of women with ovarian cancer would be infinitely easier if we had Current Resources for Evidence-Based Practice reliable diagnostic or prognostic biomarkers; however, an extremely large body of literature suggests such a thing is currently-and perhaps permanently-out of reach. The author acknowledges Sabrina Pillai, MPH, for assistance with the literature searches for this column. Systematic Reviews in CDSR: Fertility, Contraception, and ART Aspirin or heparin or both for improving pregnancy outcomes in women with persistent antiphospholipid antibodies and recurrent pregnancy loss. Factors influencing the uptake and use of nicotine replacement therapy and e-cigarettes in pregnant women who smoke: A qualitative evidence synthesis. Interventions to prevent women from developing gestational diabetes mellitus: An overview of Cochrane Reviews. Probiotic treatment for women with gestational diabetes to improve maternal and infant health and well-being. Skin preparation for preventing infection following caesarean section. Strategies for optimising antenatal corticosteroid administration for women with anticipated preterm birth. Higher versus lower protein intake in formula-fed low birth weight infants. Interventions for congenital talipes equinovarus (clubfoot). Newborn screening for galactosaemia. Antibody tests for identification of current and past infection with SARS-CoV-2. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: A rapid review. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 training load is optimal in minimizing urine loss in women with stress urinary incontinence? A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 16 (22) Comment: Shortening the interval between induction and birth is a laudable goal, and in this relatively small number of women, early amniotomy appears to do so without a concurrent Current Resources for Evidence-Based Practice S P E C I A L R E P O R T increase in risk of cesarean. The meta-analysis does not indicate whether women whose labors ended in cesarean were excluded (or otherwise censored) from the labor duration analysis; this would be a potential source for bias. However, given the similarity in cesarean rates between the groups, it is less of a concern. Much more concerning is the notion that when faced with a problem (cesareans) possibly arising from an intervention considered over-used (induction; Declercq et al., 2013; Seijmonsbergen-Schermers et al., 2020) , we attempt to solve it by intervening further in the normal physiologic process (amniotomy). Used in standard induction protocols, synthetic oxytocin causes intense uterine contractions but does not cross the blood-brain barrier as the endogenous hormone does (Buckley & Moberg, 2019) . Thus, women who undergo induction have substantially more painful labors without the concurrent pleasure center activation/pain reduction effects of oxytocin, which infiltrates the brain (Buckley & Moberg, 2019) . Women whose labors are induced are thus more likely to request epidural anesthesia (90% of participants in the De Vivo et al. [2020] meta-analysis used epidurals), which in turn further slows labor, possibly because the numbed pelvic nerves are then unable to transmit cues to release additional oxytocin as the head of the fetus descends (Buckley & Moberg, 2019) . Thus begins the cascade of interventions in obstetrics that has so infiltrated our sense of normal we now often see this sort of false dichotomy in the literature: one intervention compared to another without a physiologic comparison group as if birth is not possible without intervention. What if we instead choose to support physiologic labor processes as much as possible, even under circumstances including genuinely unavoidable interventions such as induction of labor? I'll assume here we have already reduced unnecessary inductions to the extent possible. There exists a large body of literature on continuous labor support, usually via doulas, as a low-cost, highly effective way to improve birth outcomes, including lowering cesarean rates (Bohren et al., 2017; Kozhimannil et al., 2016) . It seems very likely that providing doulas for all women who undergo induction would fare even better than early amniotomy in terms of labor duration and cesarean rate. As nurses, midwives, and public health professionals, we must push back against the idea that adding interventions to birth is the only solution or even the best solution. In this systematic review, Moran and colleagues (2020) summarized the cost of illness literature on "the economic burden of common health problems women experience over the course of their pregnancy and postpartum, excluding acute complications of labour and birth, or severe acute adverse maternal outcomes" 3). All cost results from included studies were converted to 2018 Euros. The authors found 16 studies on the costs associated with gestational diabetes, 13 for obesity, four for poor maternal mental health, four for hypertensive disorders, two for severe nausea and vomiting, and two for epilepsy. Results for these conditions are summarized in 1121 1122 1123 1124 1125 1126 1127 1128 1129 1130 1131 1132 1133 1134 1135 1136 1137 1138 1139 1140 1141 1142 1143 1144 1145 1146 1147 1148 1149 1150 1151 1152 1153 1154 1155 1156 1157 1158 1159 1160 1161 1162 1163 1164 1165 1166 1167 1168 1169 1170 1171 1172 1173 1174 1175 1176 1177 1178 1179 1180 1181 1182 1183 1184 1185 1186 1187 1188 1189 1190 1191 1192 1193 1194 1195 1196 1197 1198 1199 1200 1201 1202 1203 1204 1205 1206 1207 1208 1209 1210 1211 1212 1213 1214 1215 1216 1217 1218 1219 1220 1221 1222 1223 1224 1225 1226 1227 1228 1229 1230 1231 1232 predicted much higher costs for these conditions. The low costs may be related to lack of access to mental health services, stigma associated with seeking mental health services, or higher rates of reimbursement for other services (e.g., more billing for obesity than depression in women with comorbidities). Most studies included in this review also included only payer costs not societal costs such as lost work days, which led to underestimates for all conditions but perhaps more so for mental health. Finally, it is interesting that no studies appear to have been conducted on common pregnancy sequelae such as incontinence. Perhaps these are so common they are not considered "problems" per se, and therefore not worth studying? Any nursing graduate students in need of a thesis or dissertation topic, this would be a good one! Regardless, it is clear that existing, published numbers on costs of childbearing vastly underestimate the true costs, and here in the United States, we pay too much for care. 1233 1234 1235 1236 1237 1238 1239 1240 1241 1242 1243 1244 1245 1246 1247 1248 1249 1250 1251 1252 1253 1254 1255 1256 1257 1258 1259 1260 1261 1262 1263 1264 1265 1266 1267 1268 1269 1270 1271 1272 1273 1274 1275 1276 1277 1278 1279 1280 1281 1282 1283 1284 1285 1286 1287 1288 Effects of preeclampsia and eclampsia on maternal metabolic and biochemical outcomes in later life: A systematic review and meta-analysis Meta-analysis of long-term efficacy and safety of hypofractionated radiotherapy in the treatment of early breast cancer Meditation effect on psychological stress level in women with breast cancer: A systematic review. Revista Da Escola De Enfermagem Da USP, 53, Article e03529 Impact of overactive bladder-wet syndrome on female sexual function: A systematic review and meta-analysis Benefits of aerobic exercise for breast cancer survivors: A systematic review of randomized controlled trials The expression of galectin-3 in breast cancer and its association with chemoresistance: A systematic review of the literature Sexual problems of patients with breast cancer after treatment: A systematic review Isoflavone supplements for menopausal women: A systematic review Clinical benefits of bone targeted agents in early breast cancer Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials Self-management interventions for cancer survivors: A systematic review and evaluation of intervention content and theories Clinical evidence of Chinese medicine therapies for depression in women during perimenopause and menopause Does hormone replacement therapy impact the prognosis in endometrial cancer survivors? A systematic review Evaluation and treatment of female stress urinary incontinence after pelvic radiotherapy The effect of exercise as an intervention for women with polycystic ovary syndrome: A systematic review and meta-analysis Do women have adequate knowledge about pelvic floor dysfunctions? A systematic review What pelvic floor muscle Bed rest after an embryo transfer: A systematic review and meta-analysis The impact of uterine artery embolization on ovarian reserve: A systematic review and meta-analysis Assisted reproductive technology and the risk of pediatric cancer: A population based study and a systematic review and meta analysis Semiconductor work and the risk of spontaneous abortion: A systematic review and meta-analysis The effect of physical activity on reproductive health outcomes in young women: A systematic review and meta-analysis. Human Reproduction Update Female obesity is negatively associated with live birth rate following IVF: A systematic review and meta-analysis Effect of pretreatment with combined oral contraceptives on outcomes of assisted reproductive technology for women with polycystic ovary syndrome: A meta-analysis Firstline ovulation induction for polycystic ovary syndrome: An individual participant data meta-analysis Do the children born after assisted reproductive technology have an increased risk of birth defects? A systematic review and metaanalysis Recent Evidence Based Reviews: Pregnancy and Birth The impact of pre-pregnancy body mass index and gestational weight gain on placental abruption risk: A systematic review and meta-analysis First-line antihypertensive treatment for severe hypertension in pregnancy: A systematic review and network meta-analysis. Pregnancy Hypertension Gestational diabetes and risk of postpartum depressive symptoms: A meta-analysis of cohort studies The role of innate immunity in spontaneous preterm labor: A systematic review The role of maternal obesity in infant outcomes in polycystic ovary syndrome-A systematic review, metaanalysis, and meta-regression Maternal oral contraceptive pill use and the review Effect of maternal birth positions on duration of second stage of labor: Systematic review and meta-analysis Comparison of the effects and side effects of misoprostol and oxytocin in the postpartum period: A systematic review Risk factors for reduced fetal movements in pregnancy: A systematic review and metaanalysis Effect of delayed interval delivery of remaining fetus(es) in multiple pregnancies on survival: A systematic review and metaanalysis Maternal dietary patterns and birth outcomes: A systematic review and meta-analysis Perinatal mortality and morbidity in triplet pregnancy according to chorionicity: Systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology Global burden of antenatal depression and its association with adverse birth outcomes: An umbrella review Early amniotomy after cervical ripening for induction of labor: A systematic review and meta-analysis of randomized controlled trials The prevalence of anxiety disorders during pregnancy and the postpartum period: A multivariate Bayesian meta-analysis Lithium exposure during pregnancy and the postpartum period: A systematic review and meta-analysis of safety and efficacy outcomes Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: A systematic review and meta-analysis Effects of hemoglobin levels during pregnancy on adverse maternal and infant outcomes: A systematic review and metaanalysis Effect of environmental and pharmaceutical exposures on fetal testis development and function: A systematic review of human experimental data Vitamin B12 insufficiency is associated with increased risk of gestational diabetes mellitus: A systematic review and meta-analysis Pregnancy in women with pre-existent ischaemic heart disease: A systematic review with individualised patient data Early psychosocial development of small for gestational age and intrauterine growth-restricted children: A systematic review The effect of bladder catheterization on the incidence of urinary tract infection in laboring women with epidural analgesia: A meta-analysis of randomized controlled trials The prevalence of obstructive sleep apnea and its association with pregnancy-related health outcomes: A systematic review and metaanalysis Preterm birth as a risk factor for metabolic syndrome and cardiovascular disease in adult life: A systematic review and meta-analysis Interpregnancy weight change and hypertension during pregnancy: A systematic review and meta-analysis Heparin therapy in placental insufficiency: Systematic review and meta-analysis Economic burden of maternal morbidity-A systematic review of cost-of-illness studies Levothyroxine treatment and pregnancy outcomes in women with subclinical hypothyroidism: A systematic review and metaanalysis Cesarean delivery to prevent anal incontinence: A systematic review and meta-analysis. Techniques in Coloproctology Intimate partner violence during pregnancy and risk of fetal and neonatal death: A meta-analysis with socioeconomic context indicators Early-onset fetal growth restriction: A systematic review on mortality and morbidity Evaluation of umbilical cord entanglement as a predictive factor of adverse pregnancy outcomes: A meta-analysis Adverse health outcomes associated with fetal alcohol exposure: A systematic review focused on cardio-renal outcomes Low-moderate prenatal alcohol exposure and offspring attentiondeficit hyperactivity disorder (ADHD): Systematic review and meta-analysis Maternal disability and risk for pregnancy, delivery, and postpartum complications: A systematic review and meta-analysis Correlates of prenatal and postnatal mother-to-infant bonding quality: A systematic review Systematic review and meta-analysis to assess the safety of bupropion and varenicline in pregnancy Women's successful transition to motherhood during the early postnatal period: A qualitative systematic review of postnatal and midwifery home care literature. Midwifery, 79, 102552 Neurocognitive and behavioural outcomes in offspring exposed to maternal pre-existing diabetes: A systematic review and meta-analysis. Diabetologia Maternal hemoglobin concentrations across pregnancy and maternal and child health: A systematic review and meta-analysis The association between prenatal exposure to phthalates and cognition and neurobehavior of children-evidence from birth cohorts Early amniotomy after cervical ripening for induction of labor: A systematic review and meta-analysis of randomized controlled trials Continuous support for women during childbirth Nature and consequences of oxytocin and other neurohormones during the perinatal period Squaring the circle: Normal birth research, theory, and practice in a technological age Listening to mothers III: Pregnancy and birth Modeling the cost-effectiveness of doula care associated with reductions in preterm birth and cesarean delivery Which level of risk justifies routine induction of labor for healthy women? Economic burden of maternal morbidity-A systematic review of cost-of-illness studies Maternal and neonatal complications of fetal macrosomia: Systematic review and metaanalysis Breastfeeding support interventions by international board certified lactation consultants: A systemic review and meta-analysis Pharmacologic management of neonatal abstinence syndrome using a protocol Needs and stressors of parents of term and nearterm infants in the NICU: A systematic review with best practice guidelines Maternal prepregnancy body mass index, gestational weight gain, and cessation of breastfeeding: A systematic review and meta-analysis Comparison of health care resource utilization among preterm and term infants hospitalized with human respiratory syncytial virus infections: A systematic review and meta-analysis of retrospective cohort studies Cesarean section and the risk of neonatal respiratory distress syndrome: A meta-analysis Safety and efficacy of Lactobacillus for preventing necrotizing enterocolitis in preterm infants The experiences of parents in the neonatal intensive care unit: An integrative review of qualitative studies within the transactional model of stress and coping Use of an indeterminate range in HIV early infant diagnosis: A systematic review and metaanalysis Counselling interventions to enable women to initiate and continue breastfeeding: A systematic review and meta-analysis Association of small for gestational age with retinopathy of prematurity: A systematic review and metaanalysis The effect of skin-to-skin care on postpartum depression among mothers of preterm or low birthweight infants: A systematic review and meta-analysis Donor human milk and risk of surgical necrotizing enterocolitis: A metaanalysis Human milk expression after domperidone treatment in postpartum women: A systematic review and meta-analysis of randomized controlled trials Prevalence and nature of medication errors and preventable adverse drug events in paediatric and neonatal intensive care settings: A systematic review A systematic review of the prevalence, risk factors, and impact of pelvic floor dysfunctions in nurses