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.

Hot off the press: catch this Cochrane evidence!

New and updated Cochrane reviews are now published daily

If your idea of a present is a new or updated Cochrane review then it’s now Christmas every day with the arrival of Publish When Ready here in Cochraneland. In a huge change to the system for publishing reviews and protocols in the Cochrane Library, new arrivals appear daily, throughout the day, instead of once a month. In the time it takes me to make a cup of tea, a new review may have popped into the Library, ready for my consumption. It’s all rather exciting! It’s also rather alarming, as I have the distinct feeling that with such a rapid flow of  evidence I may miss things and fail to shout about stuff that you might like to know about. It may calm down (or I may speed up!) but with the sudden arrival of a very large amount of new evidence I thought I’d give you a bit of a round-up. So here are my picks of the week on surgery, drugs and rock’n’roll, with some talking treatment thrown in.

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.