Flu, chills and other ills: a wintry round-up of Cochrane evidence

This week it really feels like winter is upon us and infection is the dominant theme in this blog, which gives you a round-up of some new and updated Cochrane reviews on flu vaccination; antibiotics for colds, sore throats and for those having feeding tubes put in;  bringing down your poorly child’s temperature and whether avoiding lactose is helpful when diarrhoea strikes.

Managing diabetes: new evidence on targets for blood pressure and blood glucose

Key messages:

1. Current evidence does not support blood pressure targets lower than the standard targets for people with raised blood pressure and diabetes

2. Better evidence is needed to guide the choice between targeting intensive or conventional glycaemic control in people with type 2 diabetes but intensive control increases the risk of both mild and severe low blood sugar

Today is World Diabetes Day and there’s a big emphasis on knowing the complications of diabetes and trying to avoid them. Maintaining healthy blood pressure levels and blood sugar levels are important ways to reduce the risk of damage to the heart and blood vessels, kidneys, nerves and eyes. We have new evidence from Cochrane systematic reviews which helps shed some light on which approaches might be best when it comes to setting targets for blood pressure and blood glucose levels.

Migraine, art and medicine

There’s a man in my mum’s sewing box. Staggeringly handsome and, until recently, rather mysterious. I hadn’t expected to be writing about a mystery again quite so soon after learning of the woman who may have been the face of Resusci Anne, but today I’m back with new Cochrane evidence which takes some of the mystery out of medicines for migraine, plus a look at migraine art and the man behind it. The man whose face has nestled among the cotton reels for the past sixty years.

A mystery, missing evidence and some answers!

Contrary to what you might expect, you’ll have to wait until the end for the mystery, though in truth missing data and important questions that remain unanswered could also be labelled as that, and this is where I start.

My last blog was a round-up of new and updated reviews on asthma and I begin this one with another offering from the Cochrane Airways Group (do these people never take a day off?). It’s another tale of what we still don’t know, this time about a class of anti-inflammatory drugs called anti-leukotrines. For managing mild persistent asthma in children, low-dose inhaled corticosteroids (ICS) are recommended, but if symptoms aren’t well controlled with ICS then anti-leukotrines may be added. Almost ten years ago, a Cochrane review was published which pulled together the available evidence on the safety and effectiveness of this treatment for adults and children and found very little to go on, with just two small trials with children. Now a review has been published which looked for trials involving children (any age below 18) and finds we’re not much further on.

Can the Mediterranean diet help us ward off heart disease? The latest evidence

Key message: Limited evidence suggests that a Mediterranean dietary pattern reduces some cardiovascular disease (CVD) risk factors. Existing evidence is promising but more trial evidence is needed to establish the role of the Mediterranean dietary pattern in preventing CVD in the general population and high-risk individuals.

Back in 1970s Britain, I grew up with a Mediterranean diet, thanks to my French step-father, though I didn’t always appreciate it. Strawberry Mivvis for my friends, something (everything?!) in olive oil for me. I particularly hated a concoction called tian, which combined courgettes, eggs and rice to produce something truly unpleasant, particularly when served cold. In 21st century Britain, Marseilles has come to Morrisons and many of us eat Med-style. We hear much conflicting advice about what we should and shouldn’t eat, the benefits of this over that, so I was interested in the latest Cochrane evidence on the so-called Mediterranean diet.

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.

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.

Screening for abnormal heart rhythms: can we protect more people from stroke?

It’s Action on Stroke Month here in the UK and the Stroke Association hope to raise awareness of stroke and particularly its emotional impact, through the many events taking place during May. They’ve also produced a really helpful guide to making information accessible for people with aphasia, which you can download from the link here. But what can be done to prevent people from having a stroke in the first place? Screening has moved in and out of favour for various conditions in recent years, but something that might be useful is to look for people with abnormal heart rhythms (atrial fibrilliation) that put them at higher risk of stroke and offer them treatment.

Do selenium supplements reduce heart attacks?

Probably not, but it could increase your chance of baldness! Selenium is a trace element which is involved with thyroid hormone metabolism, the immune system and also glass making and electronics! It is available to buy as a supplement over the counter, but it is also found naturally in brazil nuts, fish, shellfish and grains. It has become popular in recent years as it has been thought to work as an antioxidant. A new review from the Cochrane Heart Group assessed the effect of this supplement on healthy adults, to test whether it prevented heart attacks.

Intervention reduces atrial fibrillation after heart surgery

Atrial fibrillation (AF) is the most common rhythm disturbance of the heart. It involves the top two chambers of the heart quivering (fibrillating) rather than beating effectively. This can lead to three potential problems: Firstly, without the top two chambers pumping properly the heart becomes less effective at pumping. This can make some patients feel tired or more breathless during exercise. Secondly, in some cases, the bottom two chambers of the heart try their best to keep up with the fast quivering of the top two chambers, leading them to beat faster than they normally would. This can make some people feel their heart pounding in their chest (palpitations), or tired or breathless on exertion. Thirdly, patients are more likely to have a stroke. This is because the blood moves more sluggishly through the quivering chambers and has an increased tendency to form blood clots. These can lodge in arteries in the brain, starving that area of blood and oxygen.