Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?

<p>Abstract</p> <p>Background</p> <p>It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid.</p> <p>Methods</p> <p>Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings.</p> <p>Results</p> <p>Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid.</p> <p>Conclusions</p> <p>We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.</p

Incidence of and risk factors for febrile morbidity after laparoscopic-assisted vaginal hysterectomy

Iyara Wongpia, Jadsada Thinkhamrop, Kanok Seejorn, Pranom Buppasiri, Sanguanchoke Luanratanakorn, Teerayut Temtanakitpaisan, Kovit Khampitak Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Background: The purpose of this study was to assess the incidence of and risk factors for postoperative febrile morbidity after laparoscopic-assisted vaginal hysterectomy (LAVH). Methods: This retrospective study was carried out using the medical records of women with benign gynecologic conditions who underwent LAVH between June 2007 and May 2012 at Srinagarind Hospital in Thailand. Data were collected to assess baseline patient characteristics, occurrence of body temperature &ge;38&deg;C on two occasions at least 6 hours apart in the 24 hours following the surgical procedure, and possible risk factors related to postoperative febrile morbidity. Results: In total, 199 women underwent LAVH during the study period. They had a mean age of 46&plusmn;6 years, a mean body mass index of 24.0&plusmn;3.2 kg/m2, a mean surgical duration of 134&plusmn;52 minutes, median estimated blood loss of 200 mL, a mean total hospital stay of 5&plusmn;2 days, and a mean postoperative hospital stay of 3&plusmn;2 days. Postoperative febrile morbidity was documented in 31 cases (15.6%). The cause of postoperative fever was unknown in most cases, with only two cases having an identifiable cause. The risk of postoperative febrile morbidity was highest in women treated with more than two antibacterial agents and with a regimen of more than 3 days. Conclusion: This study shows a moderately high rate of febrile morbidity after LAVH, for which the main risk factors were use of multiple drugs and doses for antibiotic prophylaxis. Keywords: laparoscopic-assisted vaginal hysterectomy, febrile morbidity, incidence, risk factor

Use of micronutrient supplements in pregnant women of south‐east Queensland

Background: Multiple micronutrient supplement use in the Australian pregnant population is rising, despite little evidence of benefit in low-risk women. While some supplement recommendations are grounded in high-quality evidence, others warrant further investigation. This highlights a research gap regarding appropriate use of supplements during pregnancy in the Australian population. Aims: To describe micronutrient supplement use during pregnancy in the context of current evidence and national recommendations in a population of south-east Queensland women. Material and methods: A cross-sectional observational design was used to examine data gathered from pregnant women aged 16-44 years residing in south-east Queensland, Australia. Women were recruited to the study between 23 May 2016 and 30 September 2017. Results: Pregnancy multivitamin use was declared by 42% of the cohort, with 26.8% declaring multivitamins in combination with individual micronutrients and 9.8% declaring specific micronutrient supplement use. Nulliparous women were more likely to declare use of supplements than their multiparous peers (adjusted odds ratio (aOR) 1.938, 95% CI 1.053-3.571, P = 0.034); smoking (aOR 2.717, 95% CI 1.011-7.302, P = 0.047) and low socio-economic status were associated with no supplement use (aOR 2.451, 95% CI 1.010-5.949, P = 0.048). Conclusions: Current recommendations regarding micronutrient supplements throughout pregnancy are based on varying degrees of evidence, resulting in supplement advice of poor cohesion and consistency. Adherence to micronutrient supplement recommendations in the peri-conception period in this population was poor; second and third trimester supplement use was high. Contemporary empirical research is required to determine what constitutes appropriate supplementation in high-income regions and the populations they will benefit most