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How useful is what we have? Limitations of Cochrane Reviews, the case of substance treatment in pregnancy

Terplan, Mishka, Smith, Erica J. and Lui, Steve (2009) How useful is what we have? Limitations of Cochrane Reviews, the case of substance treatment in pregnancy. In: College on Problems of Drugs Dependence: 71st Annual Meeting, 20-25 June 2009, Reno/Sparks Nevada. (Unpublished)

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        Aims: To describe the public health promise and methodological problems of
        Cochrane reviews.
        Cochrane reviews are central to evidence-based medicine. However by focusing
        exclusively on randomized controlled trials (RCTs) a large swath of the published
        literature is excluded from their purview. Our experience conducting three of the
        four published reviews that examined interventions for substance use in pregnancy
        has brought particular methodological issues to light. Pregnancy is timelimited
        event and therefore amenable to a RCT intervention. However this study
        design is employed mostly in academic centers serving poor inner-city women.
        How useful then is this evidence? We begin with a brief overview of the
        Cochrane Library with particular emphasis on the addiction and obstetric literature.
        Then the following methodological topics are addressed: the tensions
        between clinically useful, clinically expedient, and sociologically meaningful outcomes;
        the difference between experimental and real world interventions; problems
        in external validity due to RCT recruitment in pregnancy; and confounding
        and bias in exposure assignment. We contrast our results from Cochrane
        reviews with the observational studies that were excluded from our reviews.
        Finally we argue for a more flexible design for systematic reviews that can allow
        the inclusion of more diverse study designs. The current Cochrane software
        (RevMan 5.0) appears to offer hope for this.

        Conclusions: Pregnancy is a unique moment in a woman’s life course where individual
        motivation for behavioral change is coupled with the availability of social
        support (such as prenatal care). Furthermore, interventions for drug problems in
        pregnancy have the possibility of not only improving birth outcomes, but affecting
        maternal health and child development across the life course. The summary
        of quality evidence is therefore necessary in the guidance of both clinical medicine
        and current policy.

        Support: Part of this study was funded by the Alcohol Education Research
        Council, UK.

        Item Type: Conference or Workshop Item (Poster)
        Subjects: Z Bibliography. Library Science. Information Resources > ZA Information resources > ZA4050 Electronic information resources
        R Medicine > RG Gynecology and obstetrics
        R Medicine > RM Therapeutics. Pharmacology
        R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
        Schools: School of Human and Health Sciences
        School of Human and Health Sciences > Centre for Health and Social Care Research
        Related URLs:
        Depositing User: Graham Stone
        Date Deposited: 22 Jun 2009 10:49
        Last Modified: 06 Jan 2011 18:27


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