Cochrane Collaboration

So it is really understandable that variability is high in a lot of the studies, which makes the data difficult to analyse.

When the evidence is pulled, we see in the Cochrane review in 2017, of which there were eight randomised controlled trials, 884 women, that spontaneous pushing lasted on average... 10.26 minutes longer than coached pushing right so not that long in the grand scheme of things where we may expect it to be we might expect it to be documented that people are pushing from you know one hour to up to two three hours sometimes or more so people can say it takes longer when you're spontaneously pushing and they might tell you that it's more dangerous for the baby the baby needs to come out quickly but is that really the whole truth Well, when we look at the trials where people were considered to be actively pushing, i.e. when they were purple pushing, which with coach pushing is for the vast majority of each contraction compared to the spontaneous pushing where it is instinctively sometimes done for short periods and sometimes not.

There was actually 9.76 minutes less of this pushing occurring in the spontaneous pushing group.

Love it.

However, the evidence does not demonstrate that prolonged coached valsalva pushing itself produces better birth outcomes, even when an epidural is present.

I love that.

The Cochrane review of pushing techniques included women with and without epidurals and concluded that there was insufficient evidence to show that spontaneous or directed pushing was superior.

Across the trials, there was no clear difference in spontaneous vaginal births, in serious perineal tears, in episiotomy or in neonatal outcomes.

We also know that different pouches contain different ingredients, and some people are using way more pouches at a time than they are advised to, which can cause some pretty nasty short-term effects.

Can you tell us just briefly what the Cochrane Living Systematic Review is? And then let's talk about using e-cigarettes to quit cigarettes.

Absolutely.

So to start with Living Systematic Reviews, I'm actually going to go back a step and tell you what systematic reviews are.

What we do have are really kind of top of the line, short-term studies, lab studies, extensive testing that very clearly suggests that nicotine vaping, particularly if it's, you know, an FDA authorized product is going to expose you to fewer risks than smoking.

Okay.

So maybe can you recap the Cochrane living systematic review results when it comes to using e-cigarettes with nicotine compared to what we now use to help people quit smoking?

Yeah.

But in an effort to try and keep today's podcast to the 30 minutes, I'll just sum up by saying we've also spoken about biomimetic, which is one thing, copying nature.

But then we've spoken about biologic dentists and how mainstream dentists like myself actually don't consider biologic dentistry to be mainstream because it's not backed by Cochrane, which is this evidence-based dentistry.

And they will sometimes test you for sensitivity and allergies to all the different materials.

And then they go and put in some kind of bioactive material that only they have access to that then seals.

If a MTA pulp cap keeps a nerve alive and you've avoided a root canal and possibly even a crown.

then you've actually saved thousands of rands.

There's some Cochrane reviews that found that there's no proven benefit from doing these routinely under every ordinary composite.

So one has to be careful.

completely reversed, PTAL 217.

Now, what's interesting is that the Cochrane report, which came out about one week before my article got released, said, hey, we have no good things to treat Alzheimer's at this point.

The article comes out one week later, and what I did is I proved the hypothesis, right? We're in the middle of an Alzheimer's epidemic where the NIH said that that 42% of people over 55 years old are now going to become demented.

I mean, it is really frightening, especially when they say we don't have answers.

We reversed his beta amyloid ratios with Dapsone.

So here we have an Alzheimer's epidemic where I found that all 16 MSIDS factors are associated with it.

The Cochrane report is saying, hey, we don't have anything good out there to treat.

And the drugs that are used for it, licanumab, dinanumab, they lowered phosphorylated tau by 23% in almost seven years.

But there are so many things that you could try to figure out.

Like, what are their constraints right now? Is it more of a weakness issue? Is it more of a balance issue? Is it more of a, is it a combination? Is there a visual issue? So let's talk about the good news, right? There was a Cochrane review that I came across in 2019.

I posted about this last month.

They pulled together more than 100 randomized trials in older adults living at home.

The strategy explicitly proposes expanding them and hospital at home to avoid admissions.

There's sort of encouraging evidence, the Cochrane Review of 2024, which I linked to, of 20 trials found admission avoidance hospital at home probably, and I quote, makes little or no difference to mortality or readmissions among older people and older patients.

So, does no harm, but does it help? NHS England's South East Evaluation, which I linked to this morning, associated every 2.5 virtual ward admissions with one fewer emergency hospital admission.

Encouraging, although association does not establish causation.

I don't know how to fully pronounce it, so someone correct me.

But it's spelled C-O-C-H-R-A-N-E. Cochrane Reviews.

Is it Cochrane or Cochrane? I don't know.

I

always say Cochrane, but I'm actually not sure.

But, yeah, it's like good systematic reviews where they try to kind of give a summary of evidence.

Yeah, it was definitely one of my go-tos before there was consensus and open evidence.