Obstetric Recommendations in American Congress of Obstetricians and Gynecologists Practice Bulletins versus UpToDate: a comparison.

OBJECTIVE: To compare the obstetric recommendations in American Congress of Obstetricians and Gynecologists (ACOG) practice bulletins (PB) with similar topics in UpToDate (UTD). STUDY DESIGN: We accessed all obstetric PB and cross-searched UTD (May 1999-May 2013). We analyzed only the PB which had corresponding UTD chapter with graded recommendations (level A-C). To assess comparability of recommendations for each obstetric topic, two maternal-fetal medicine (MFM) subspecialists categorized the statement as similar, dissimilar, or incomparable. Simple and weighted kappa statistics were calculated to assess agreement between the two raters. RESULTS: We identified 46 ACOG obstetric PB and 86 UTD chapters. There were 50% fewer recommendations in UTD than in PB (181 vs. 365). The recommendations being categorized as level A, B, or C was significantly different (p < 0.001) for the two guidelines. While the overall concordance rate between the two MFM subspecialists was 83% regarding the recommendations for the same topic as similar, dissimilar, or incomparable, the agreement was moderate (kappa, 0.56; 95% confidence intervals, 0.48-0.65). CONCLUSION: Though obstetricians have two sources for graded recommendations, incongruity among them may be a source of consternation. Congruent recommendations from ACOG and UTD could enhance compliance and potentially optimize outcomes.

The business case for breastfeeding: a successful regional implementation, evaluation, and follow-up.

BACKGROUND: Breastfeeding benefits the health of babies and mothers, but returning to work is a significant barrier for mothers wishing to continue breastfeeding for the recommended 12 months. A resource training kit, The Business Case for Breastfeeding (BC4BF), developed by the Health Resources and Services Administration, U.S. Department of Health and Human Services, was implemented in Southeastern Virginia to assist businesses in developing lactation support programs (LSPs) and eliminating breastfeeding barriers. MATERIALS AND METHODS: The primary goals of the 1-year project were to educate 20 businesses about breastfeeding support in the workplace, engage 10 businesses to implement the BC4BF, and assess sustainability via documented policy and environmental changes and integration of the LSP into the business infrastructure. The Transtheoretical Model of Behavior Change was adapted to assess stage of organizational change. A Centers for Disease Control and Prevention tool for measuring community-level policy, systems, and environmental change was adapted to assess worksite policy and environmental changes. EVALUATION RESULTS: Over 20 businesses were educated about the BC4BF. Seventeen engaged in the project. Fourteen significantly increased their stage of change, development of LSPs, written policies, and physical and social environment changes (p≤0.001). A brief follow-up study revealed that all 14 employers maintained their programs 8 months after the program ended, with increased stages of change, policy enforcement, and physical environment (p≤0.05). CONCLUSIONS: The BC4BF provided an effective approach to assisting employers in establishing and maintaining LSPs in the workplace across several cities.