Helping, not harming: with a little help from the Cochrane Library

The Ancient Greeks knew a thing or two, not least about medicine. We are hearing a lot about shared decision-making in these days of ‘no decision about me without me’, but the notion that the patient must combat the disease along with the physician appears in Hippocratic writings from the early fourth century BC and so does the requirement that the doctor’s job is to do good or to do no harm.

HES: risks may outweigh benefits

Fast forward a couple of millennia and we come to the Cochrane Library! Looking through the newest evidence there put me in mind of these basic principles of medicine, particularly how vital it is to know about the possible harms resulting from treatments, and that researchers must ask useful questions and measure the right things if that research is going to help patients.

Would you like an elephant with your evidence?

Once upon a time, a strange breed of people called ‘systematic reviewers’ used to shut themselves away in dark places, work very hard and for a long time, and eventually slide underneath their door their mysterious product, a shiny new systematic review. This would be taken and stored very carefully, and very secretly, in a document (let’s call it a scientific journal) which could only be seen and understood by those with enough gold to pass through the paywall and who knew the meaning of the special and secret words used in it. Which was all rather a shame as the contents were often quite precious and could be very useful to large numbers of ordinary people. For anyone wanting a neat graphic showing what a systematic review is, I recommend you click here. For those wanting elephants, you’ll have to wait a bit longer.

Where there’s a Will. Why women should have support through labour

Key message: All women should have continuous support throughout labour. It has benefits for both mums and babies and no known harms.

First there was the disastrous choice of meal, eaten as I started to go into labour, of ‘chicken with 40 cloves of garlic’ (just my Other Half and me; we hadn’t done the maths…). We just knew we wouldn’t be able to say ‘hospital’ or ‘hello’, without knocking out those greeting us. Then there was the curry which OH dashed out for at some point during the long hours of the next day but which he then dropped down his front. I can’t see the Duke of Cambridge having to rough it in a shirt covered in lashings of tikka masala but let’s hope he’s there to support Kate all through labour. Unless he and his Gran want to take turns of course.

Waiting for the royal baby? We’ve new arrivals in the Cochrane Library

July is proving to be an exciting month here in the UK. Andy Murray is the new Wimbledon Champion, we’re enjoying lots of wonderful warm weather and we’re anticipating the arrival of the new royal baby. But before the Duke and Duchess of Cambridge have news for us, we have news for them, for these are exciting times too in the world of Cochrane and yesterday saw the publication of new evidence that delaying clamping the cord after birth benefits babies.

A good death at home: home palliative care services keep people where they want to be

Key message: There is good evidence that home palliative care increases the chance of dying at home and reduces symptom burden, especially for people with cancer, without increasing caregiver grief.

Where would you prefer to die, if you had an advanced illness? More than 50% of people say they would like to die at home, given the choice, but in many countries relatively few people do; just 21% in England in 2010, for example. The need for home palliative care services is increasing as the ageing population expands and an understanding of their impact on death at home and on things that matter to patients and their carers, such as how well symptoms are controlled and how they feel about their care, is important in working out how current services need to be expanded or improved.

Fetal monitoring in labour: the challenge of balancing the benefits with harms

This guest blog has been written by Leanne Jones from the Cochrane Pregnancy and Childbirth Group.

Key message: Continuous electronic fetal monitoring during labour reduces neonatal seizures (fits) but leads to increased rates of caesarean section and instrumental vaginal births, though data may not be widely applicable to current practice.

Monitoring the baby’s heartbeat is one way of checking the well-being of the baby in labour. Listening to, or recording the baby’s heartbeat, may identify babies who are becoming short of oxygen (hypoxic) and these babies may benefit from caesarean section or instrumental vaginal birth (assisted by instruments such as forceps).  The heartbeat can be checked continuously by using a cardiotocography (CTG) machine. This continuous CTG method is also called electronic fetal monitoring (EFM). It produces a paper recording of the baby’s heart rate and mother’s labour contractions.