Two new Cochrane Reviews bring together the evidence about inhaled corticosteroids in persistent childhood asthma and their effects on growth. Paediatricians and parents will in the main find the results reassuring, but both groups may be concerned about how short term many of the studies are and how confusing their results can be. Although inhaled corticosteroids are recommended as first-line treatment in major clinical guidlines, we still need additional studies to better understand these medicines' effect on growth suppresion over the long term.
Vitamin D is usually synthesised in the skin after sun exposure and may be obtained from dietary sources or supplements. There is a debate about whether sufficient doses can be obtained through diet alone, and a recent Cochrane Review added to the considerable body of evidence on the benefits and harms of vitamin D supplementation. The review investigates whether vitamin D supplementation prevents cancer in adults. The analysis showed no decrease or increase in cancer occurrence, but cancer mortality was lower following vitamin D3 supplementation, although the overall quality of the evidence was low. Vitamin D is a good example of how difficult it can be to adequately analyse and critically appraise scientific data and how probabilities need be openly and sufficiently communicated to optimise shared decision making.
Ever since the introduction of general anaesthesia in the late 1850s, assessing the depth of anaesthesia has remained a highly relevant clinical problem. Too light an anaesthesia can result in patient awareness during surgery, which in turn may lead to post-traumatic stress disorder in some of the patients who experience awareness. On the other hand, too deep an anaesthesia can result in prolonged recovery and may increase the risk for adverse postoperative outcomes, such as myocardial infarction, stroke, or cognitive dysfunction in older patients, although the evidence for this assumption is weak. A recently updated Cochrane Review summarises the current state of knowledge regarding the use of anaesthesia monitors to assess depth of anaesthesia.
Increasingly, breast cancer is being thought of as at least three or four diseases with somewhat distinctive clinical behaviours and requiring different treatment approaches. Such 'tailoring' of treatments is a work in progress, but particularly spectacular gains have been made for the subtype of breast cancer that used to be most feared: HER2-positive breast cancer.
Acute otitis media is one of the most common causes of children's visits to the doctor. It is also a common reason for prescribing antibiotics, so anything that prevents it has the extra bonus of contributing to reducing the worry of antibiotic resistance. A recently updated Cochrane Review summarises the complicated results of trials of pneumococcal vaccines with the outcome of preventing acute otitis media (rather than the original target of invasive pneumococcal disease). The data are complicated, but further trials are underway, so more information might be forthcoming to resolve what is currently confusing for clinicians.