An evidence advent calendar!

It turns out that Cochrane’s for Christmas, not just for life, with evidence in the Cochrane Library on all manner of festive things from gold, frankincense and myrrh to stockings! Ok, some of the links are a bit tenuous, but we hope you’ll enjoy our advent calendar.

Owing to some trouble with the technology elves, we couldn’t make it interactive (boo!) but each day we’ll post some Cochrane evidence related to the day’s picture, below the calendar. If you think of any others, do share them via the comments box.

A wake-up call on children’s well-being: do more, do it now

It’s official – the Chief Medical Officer is ‘profoundly ashamed’. In her report on child health, Professor Dame Sally Davies highlights appalling inequalities in the UK, with three times as many child deaths in the poorest areas compared with wealthier regions, and shows us to be a nation lagging behind our European neighbours too. Much more needs to be done to improve the health of Britain’s children and it needs to be done sooner, she says. Early, preventive action rather than reaction will benefit both the health and the wealth of the nation. I thought I’d take a look at where Cochrane evidence might fit into her vision of what needs to be done.

Midwives and movement for a better birth experience

Key messages: 1. Midwife-led continuity models of care have benefits for mothers and babies and most women should be offered it. 2. Walking and upright positions in the first stages of labour shorten labour and have other benefits for women at low risk of complications.

I seem to have blogged a lot about pregnancy and childbirth recently but there are huge numbers of you out there for whom new evidence on those topics will be important and I really want to share it with you. Two reviews from the Cochrane Pregnancy and Childbirth Group have just been updated and the addition of new studies has changed their conclusions. They focus on the implications for you and your baby of two very fundamental things – firstly, who is the main provider of care for the pregnant or labouring woman and secondly, positions and mobility during the first stage of labour. 

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.

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.

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.

What’s being served up in the Cochrane Library?

The reviews are flying into the Cochrane Library quicker than balls off Murray’s racquet this week and several aces have been served! Here’s my pick of the past fortnight.

It’s all strawberries and Pimms in SW19 but in WC1 the good folk of the Cochrane Heart Group are concentrating on garlic sandwiches and tea. Now I like a nice cuppa but a garlic sandwich? Even Jamie Oliver might balk at that, but the suggestion crops up in a new review on preventing cardiovascular disease (CVD) through providing fruit and vegetables to encourage people to eat more of them, or just advising them to do so. I asked heart doctor Harry Boardman to take a look.