Please find an example from a Cochrane review.
A Cochrane review on continuity of midwife care was first published in 2004 and last updated in 2016. As more trials have been added to the Cochrane review uncertainties in the original findings have been reduced. Women who have received continuity of care from a midwife they know, rather than receiving medical-led or shared care, are:
. 24% less likely to experience preterm birth,
. 19% less likely to lose their baby before 24 weeks gestation, and
. 16% less likely to lose their baby at any gestation.
These women are also more likely to have a vaginal birth, and fewer interventions during birth (instrumental birth, amniotomy, epidural and episiotomy), and are likely to have a more positive experience of labour and birth. These findings apply to both low- and mixed-risk populations of women, and there are no significant differences in outcomes between caseload and team care models.
This Cochrane review was identified as a priority review for updating by both the World Health Organisation and the Department of Health to inform the National Institute for Health and Care Excellence (NICE) review on the latest evidence on continuity of midwife care.
Evidence from the updated Cochrane review has had a significant influence on recent policy developments in relation to maternity care in both the UK and abroad.
. The results were cited as a key piece of evidence to inform models of care in Creating a Better Future Together - National Maternity Strategy 2016-2026, the first national maternity strategy for Ireland, which was published in January 2016.
. Evidence from the review was also cited in the National Maternity Review for England published in February 2016 (Better births - Improving outcomes of maternity services in England), led by Baroness Cumberlege and conducted as part of the NHS England Five Year Forward View.
. They have also informed the RCM/RCOG statement on continuity of carer and multi-disciplinary working published in April 2016.
. Internationally, the Cochrane review was cited in a Lancet series on midwifery which aimed to inform workforce and health system development plans under the United Nations' Post-2015 Development Agenda.
Sandall J, Soltani H, Gates S, Shennan A, Devane D (2016). 'Midwife-led continuity models versus other models of care for childbearing women'. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667.
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Brian Alper MD
Sent: 23 May 2016 17:59
To: [log in to unmask]
Subject: Re: concrete contributions for EBM timeline change medicine
The WHI trial reversing the "standard of care" promoting postmenopausal hormone replacement therapy for cardiovascular disease prevention is one of the easiest to recognize, though data before the WHI trial was congruent -- an EBM approach was different than the popular/accepted approach before the WHI trial was published.
Use of antiarrythmics to treat PVCs after a heart attack (PVCs are associated with increased mortality and specific antiarrythmics flecainide and encainide are effective in reducing PVCs) was a classic example in the need for a clinical outcome focus. This was done as "good patient care" (Do you want to die while waiting for study results?) and a randomized placebo-controlled trial (I think it was called the CAST trial) found the drug reduced PVCs but killed more patients. End of that practice.
Brian S. Alper, MD, MSPH, FAAFP
Founder of DynaMed
Vice President of Innovations and EBM Development http://www.dynamed.com/
Twitter: @BrianAlperMD
Make INCREMENTAL progress to make great progress ... https://www.linkedin.com/pulse/incremental-brian-alper
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Phyll Buchanan
Sent: Monday, May 23, 2016 12:24 PM
To: [log in to unmask]
Subject: Re: concrete contributions for EBM timeline change medicine
Hi Amy,
These 3 reviews have been the most significant in early postnatal care/ infant feeding.
Timing of the introduction solid food, kangaroo care for low birth weight babies and skin to skin for term infants.
http://www.cochrane.org/CD003517/PREG_optimal-duration-of-exclusive-breastfeeding
http://www.cochrane.org/CD003519/PREG_early-skin-to-skin-contact-for-mothers-and-their-healthy-newborn-infants
http://www.cochrane.org/CD002771/NEONATAL_kangaroo-mother-care-to-reduce-morbidity-and-mortality-in-low-birthweight-infants
Phyll
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