If you don’t have a way to access full research articles, you need to get one.  Check with your local libraries and state college system to find out what programs they offer for the local community.

Why is this so important when you can read the abstract free on Pub Med?  Because an abstract is only a teaser of what is included in the study – think of it as the advertising content created to help researchers find the articles that are most likely to pertain to their topic. The abstract will list some results and conclusions, but due to space limitations they won’t really be explained.

The full article will also have a good amount of information that is necessary for understanding the generalizability of a study. It will have complete information about who the subjects were and how they were recruited for the study.  It will give the limitations and delimitations – which means the things that limited what the researchers could study and the limits the researchers set for themselves.  Think of the difference in recording length of labor in a group of women if recruitment is done at hospital admission, or if recruitment is done at the first birth center visit.  How might these populations differ?

The full article explains the methods used, which is key to understanding how to interpret the results.  Think of the possible differences in findings between a study that asks women to rate the pain they feel in labor at two hour intervals during the process and a study that asks women to rate the pain the felt in labor when they gave birth 1- 5 years earlier.  Which method will you assume has better quality data?

Abstracts generally have a one sentence conclusion, but the full article will give you a better discussion of the way the current paper adds to past research and the next steps research should take.  Think of a paper that finds an association between obesity and cesarean surgery – if you only read the abstract you might believe the researchers think obese women are more likely to need a cesarean. But if you read the discussion you could quickly find what the researchers were able to control for, and what additional factors (perhaps higher rates of failed elective inductions) are potentially causing the association.

The full paper can also lead you to additional research on the topic to help you form a good base of knowledge – because one of the most useful parts of a paper for a person who wants to fully understand an subject is the references.  Any paper will only list a small proportion of the research reviewed by the authors before completing their study, but the ones listed are most likely the most relevant.   The references are not going to be listed in the abstract.

Bottom Line:  Find a way to get the full paper. Don’t make assumptions based on the abstract.

I admit I have become a bit of a cynic over the past couple years.  Honestly, the more information I have access to, the less I enjoy listening to people explain why everything should be done their way when they don’t provide me with solid evidence. Not that I want to be rude, but I have very limited time –we have very limited time — to make a difference in people’s lives.  I choose not to spend mine on projects that cannot be supported with evidence.

And by evidence I don’t mean something I read in a book somewhere.  I want facts, repeated, high quality research facts. I want to have access to these facts and present them in a way that makes it easy for policy makers to create strong policies that improve health. Yes, I lean toward the importance of good legislation. You probably know that about me.

So last weekend at a special two day crash course in planning interventions and field trials the teacher got my attention within the first five minutes.

“Nothing moves policy faster than a well designed randomized controlled trial.”

Nothing? Really? He went on to give various examples which are only case studies and subject to recall bias (meaning he won’t think of the research that didn’t end in swift policy change). But he did get me thinking about the importance of high quality research for the world of birth.

Ph.D.?  Not another five years…

Last month I met with the other Fellows at my nursing school to discuss general nursing scholarship issues.  When I briefly explained my policy heavy thesis the faculty adviser asked, “When are you starting the Ph.D. program?”

Ph.D.? Five more years in school….five more years in debt…five more years with my family of four in a two bedroom apartment living next door to undergrads?

Well, maybe getting a Ph.D. doesn’t have to mean all that.

I thought I had decided if I needed more schooling it would be a DNP – Doctor of Nursing Practice – because my interests lie in implementation research (how can we translate what we know is true into clinical practice?). “Ahh,” she answered, “With a Ph.D. you will learn how to conduct all types of research, you can run an implementation project and do other trials.”

And, as we’ve heard, good quality randomized controlled trials make it easy for legislators to enact good policy.

I’ve decided not to make any decisions yet.  I will work on my thesis, finish this semester, graduate and get certified.  But now the future beyond certification is a bit fuzzy.

Ever wondered about the premature birth rate of your county? Or the primary cesarean rate?

Did you know the US government makes some of this data easily accessible for you to access? You won’t find all the information you want, but if you visit http://www.healthindicators.gov/ you can find out how your community is doing at achieving the Healthy People 2020 goals.

Start by selecting maternal and infant health as a topic, then drill down to the information you want.  If you limit the data to a state, you can view the results as a map that will give you the county level data.

Enjoy.

I’ve been wanting to write about evidence based medicine for a few weeks.  I admit to enjoying research and that I like knowing what is likely to happen when I suggest a particular treatment with a client. Evidence helps me make better clinical decisions.  Evidence helps me work more effectively with my clients.

What strikes me as most interesting is how easy it is to fault others for lack of evidence for the decisions they make without providing adequate evidence for one’s own suggested treatment.  Birth professionals on both sides of the natural birth fence are at risk of making decisions not because of overwhelming research, but because “this is what I learned and so this is always right”. I am not immune. Even with my love of research and my constant quest for more knowledge I still find myself sometimes fighting for what I want to be the truth rather than what evidence really says.

With that confession, I wanted to share a very funny piece of satire about evidence based practice. Enjoy!

I’ve one final to go before I’m free from the required studying (at least for a few weeks).  I say required studying because during the break I will still study – I will just have control over what I study.  For me it will consist of reviewing all the midwifery materials from the previous semester and a texbook exploring the research on a variety of complementary and alternative therapies.

And then I started wondering about you, my readers.  What would you be choosing to study during the “break?” Did you even realize that you can do evidence based research on your own?  I propose that you take the next few days to complete this little assignment, and let me know what you learn.

Step One:  Pick an article that discusses new scientific information that interests you.  You might find this in a blog, as part of a news article or even from a tweet or facebook post.

Step Two:  Read the article, making a list of the points the article attributes to the research being discussed.  Make a second list of what the “research” is or who did it.

Step Three:  Find the original piece of research the article was referencing.  You may need to search for the title of the report, study or thesis in Pub Med.  Google can give you some information.  For some publications, you may only have access to an abstract.  Don’t forget you can check your local library to see if they give access to online journals.  A local university may have print copies of a journal you can review.

Step Four:  Read the study (or abstract if that is all you can find).  Pay special attention to the results and the conclusions.  Do the conclusions make sense based on the study question and the results?

Step Five: Compare the study (or abstract) to the original article you found. Did the article accurately represent the research?  Did the article make legitimate assumptions from the research?

OK, go have fun. And don’t forget to let me know what you learn.

One of the first prenatal questions to face a woman, when was the first day of your last menstrual period. This is asked to help estimate the date of birth.

Sigh…I received my own personal gestational wheel in class last week.  The lovely plastic double disks are a gift from Bayer Pharmaceuticals advertising a type of intra-uterine contraception I will no doubt be learning how to administer in a few weeks. Thanks Bayer, because why should I take 20 seconds to do the math in my head (add 7 days, subtract 3 months) when I can spend 10 digging your disk out of my pocket, 20 fiddling to get the dial lined up and another 15 counting the little lines to be sure I have the right date.

OK, so I’m not usually so cynical.  And the markings for specific weeks that include the estimated weight and crown to rump length are actually pretty cool – something fun to share with families that I won’t be able to quickly do math for in my head.  Even hormonal contraception you don’t have to think about every day could be perfect for some families I will work with.  It’s just that arrow pointing to the “Probable Date of Delivery” that makes me roll my eyes (yes, there is an arrow at 40 weeks, but in fairness there is a double ended arrow that sweeps from 38 to 42 weeks).

So why am I so annoyed?  I just read an article about recent research linking birth past 42 weeks with increased rates of cerebral palsy. With so many other reasons (legitimate and otherwise) doctors give for wanting to induce, I hate the idea that they might have one more.

But there is a silver lining here, and that is the risks for cerebral palsy are about the same or higher in weeks 37 and 38 when compared to weeks 42 and after.  Armed with this information, families may feel more confident in their refusal of early induction.

If you are reading the article, please don’t freak out. 40% does not mean that 40% of babies born 42 weeks and after will have cerebral palsy.  40% is the amount of increased risk – in other words the relative risk increases 40% not the total number of cases.