Cochrane's 'logo review' gets an update

Cochrane's 'logo review' gets an update

Cochrane’s logo illustrates the summary results from an iconic systematic review: Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.

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Each horizontal line represents the results of one study, while the diamond represents the combined result - our best estimate of whether the treatment is effective or harmful. The diamond sits clearly to the left of the vertical line representing “no difference”; therefore the evidence indicates that the treatment is beneficial. We call this representation a “forest plot”. This forest plot within our logo illustrates an example of the potential for systematic reviews to improve health care. It shows that corticosteroids given to women who are about to give birth prematurely can save the life of the newborn child.

Despite several trials showing the benefit of corticosteroids, adoption of the treatment among obstetricians was slow. The systematic review (originally published by Crowley et al. and with a new update published 21 March) was influential in increasing use of this treatment. This simple intervention has probably saved thousands of premature babies.

Lead author Devender Roberts discusses the latest update to this important Cochrane Review in a podcast interview, and highlights the key messages that can be taken from this update:

What does this latest update tell us? What do we know that's new?
This update clarifies some methodologies and the answers to some questions, such as gestational age at first dose, or relationships between interval of first dose to delivery and outcomes - all things that can really only be determined by [looking at] individual patient data.

Is there a need for further research around different results in different settings of care?
There are many possible factors affecting outcomes in different settings of care, but no real explanation of how an intervention that is so effective over so many decades in higher-resource settings doesn't have the same effect in lower-resource settings. And in fact the WHO is sponsoring a trial to try to generate more evidence to help answer that question.

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Thursday, May 4, 2017
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