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NIHR Signal Public health interventions may offer society a return on investment of £14 for each £1 spent
This systematic review estimates the return that public health interventions deliver to the wider health and social care economy in monetary terms. To get this figure a wide range of different interventions in different studies were identified. Results were averaged from 52 studies. The return on each £1 spent for interventions varied from -£21.3 to £221. On the whole, legislative interventions such as sugar taxes, and health protection interventions such as vaccination progra...
NIHR Signal Intervention delivered in Northern Irish and Scottish schools reduces binge drinking
An alcohol misuse prevention programme reduced the number of 12 to 14-year-old school pupils reporting “binge” drinking 33 months after the course. The difference was 9% compared with usual education (26% vs 17%). The NIHR-funded Steps Towards Alcohol Misuse Prevention Programme (STAMPP) was tested in a large trial in 105 schools in Northern Ireland and Scotland. It involved around 14 lessons spread over two years and a presentation evening with parents to reinforce the school lesso...
NIHR Signal Online education, pain coaching and advice by video conference can reduce knee pain
For people with chronic knee pain from osteoarthritis, a programme including online education, interactive pain coaching and physiotherapy advice from a professional by skype gave greater improvement in pain and function at nine months than online education alone. The small randomised control trial included 148 adults aged 50 or over in Australia. Clinically meaningful improvements in pain and physical function were achieved by around three-quarters of the comprehensive intervention group compa...
NIHR Signal Intensive speech therapy helps stroke survivors with persistent communication difficulties
Intensive speech and language therapy begun six months or more after a stroke improved verbal communication, language comprehension and self-reported quality of life for those with persistent communication difficulties (chronic aphasia). The therapy in this trial consisted of around 30 hours over three weeks. Participants who received low-intensity therapy (around one hour per week) whilst on a waiting list did not improve during that time. NICE guidelines recommend speech and language therapy ...
NIHR Signal Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation
General practice software that generated screen reminders for patients with atrial fibrillation did not increase the proportion taking oral anticoagulants appropriately by six months. This NIHR-funded trial included GPs in 47 surgeries in England and found that at the start only 63% of eligible patients with atrial fibrillation were being prescribed anticoagulants. Six months later the rate had increased to 66% in intervention practices and 64% in those following usual practice, a non-significa...
NIHR Signal Continuous insulin pumps may help manage poorly controlled type 2 diabetes
Continuous subcutaneous insulin infusions, or pumps, reduced the amount of daily insulin required by 24 units for people with advanced type 2 diabetes compared to multiple daily insulin injections. Average weight did not differ between treatments. This review compared the two treatments in 590 people from five trials and found that the pumps were linked to slightly better control for people on higher doses of insulin and those with poorer glucose control. However, looking at all the people with...
NIHR Signal Laminar airflow in surgery might not reduce surgical site infections
The type of theatre ventilation system used during hip and knee replacement, abdominal or vascular surgery has no effect on the rate of surgical site infections. Prevention of surgical site infection is a complex area with many potential targets for action. So decisions relating to commissioning or decommissioning these systems will need to consider the totality of the evidence alongside the costs. This systematic review included 12 observational studies comparing wound infection rates followin...
NIHR Signal Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes
People with type 1 diabetes offered insulin pumps did not achieve better blood glucose control compared with those using multiple daily injections. Education remains important. While both groups saw improvements in blood glucose levels and fewer hypoglycaemic episodes (very low blood sugar) over two years, only one in four participants met NICE blood glucose targets. Insulin pump users showed some modest improvements in satisfaction, dietary freedom and daily hassle. All participants in this N...
NIHR Signal Financial incentives do not increase attendance for diabetic eye screening
Two types of financial incentives are not effective at increasing attendance at eye screening for people with diabetes who do not regularly attend screening. Surprisingly, financial incentives may even reduce the numbers of people attending screening. Retinopathy is a type of eye disease common to people with diabetes. Sight deteriorates only in the later stages and early diagnosis and treatment can prevent blindness. Annual eye screening is offered for people with diabetes but take-up could be...
NIHR Signal Chlorhexidine mouthwash is useful short-term for people with mild gum disease
In people with mild gum disease chlorhexidine mouthwash, in addition to tooth brushing, reduces plaque build-up in the first weeks or months of use. However, when used for longer than four weeks chlorhexidine mouthwash can lead to tooth staining and a build-up of chalky deposits on the teeth, called tartar. There is insufficient evidence to assess its effectiveness in people with moderate to severe gum disease. Plaque is a sticky bacteria-filled substance that forms on teeth and can cause gum d...
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