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Jeremy Grimshaw provides a useful report card on the first 10 years of the Cochrane Collaboration.1 In addition to showcasing its virtues, he describes existing gaps and outlines challenges for the future. However, Grimshaw did not discuss the perils of publishing a systematic review when no eligible studies can be found for inclusion.
A recent Cochrane review of support for women and families after a perinatal death2 illustrates the problem. The authors of that review described the availability of data as “sparse” and “variable.” None of the published studies met their quality criteria for inclusion. In their discussion, the authors appropriately identified the limitations of the study but then went on to conclude that the lack of trials was further complicated by “the provision of an empathic caring environment, and strategies to enable the mother and family to accept the reality of the death, as part of standard nursing and social support in most of the developed world.”2 However, the basis for that conclusion is questionable, and evidence exists to contradict the proposition.3,4,5,6 Indeed, among health care professionals, there continues to exist a sense of discomfort with this subject matter that frequently spills over into the care provided, which is often inadequate and can actually be detrimental.6
Conclusions from reviews that include no high-quality studies must be considered carefully and should be well substantiated by other evidence. Ill- informed conclusions presented in the Cochrane database can have an important steering effect on both practitioners and researchers who use review findings.
References
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