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NIHR Signal C-reactive protein is not useful in diagnosing late-onset infection in newborns
The blood level of C-reactive protein (CRP), a marker indicating inflammation in the body, is not accurate enough alone to diagnose late-onset infection in newborn infants. Late-onset neonatal infection, occurring more than three days after birth, is potentially serious and is relatively common. Tests measuring the blood level of CRP are widely used by physicians to guide their decision on whether or not to start antibiotic treatment for suspected infection. This NIHR-funded review found 20 st...
NIHR Signal Long-term exercise programmes reduce falls and injuries in older adults
Older people who participate in year-long exercise programmes fall less and are less likely to be injured if they do fall. Exercise does not increase or decrease their risk of hospitalisation. The people aged 60 or over (average age 73 years) who were included in this review took part in supervised training programmes. Typically, about half of people at this age can fall at least once a year. These programmes combined aerobic, strength and balance training, exercising at a moderate intensity fo...
NIHR Signal Torn Achilles tendons have similar outcomes if treated with or without surgery
Outcomes for ruptured Achilles tendons appear similar irrespective of the choice of intervention. This systematic review and meta-analysis found that while the risk of re-rupture with corrective surgery was small at 2.3%, with conservative management (immobilisation in a cast), the rate was only 3.9%. The complication rate at 4.9% was three times higher in those who had surgery. Nearly all of the included studies were observational in this review, and no information was provided on the severit...
NIHR Signal Cognitive behavioural therapy may help ease depression in the workplace
Workplace-based interventions for people with depressive symptoms are effective. This review of 16 trials looked at early stage interventions to prevent depressive symptoms from developing into more severe depressive illness. Both cognitive behavioural therapy and some non-cognitive behavioural therapy interventions, such as supervised exercise, worked equally well. Telephone and internet-based therapy worked better than face-to-face therapy. These interventions were compared to usual treatment...
NIHR Signal Brain scan may predict long-term disabilities in babies with brain injury
Magnetic resonance spectroscopy, a type of scan which shows brain biochemistry, could help predict whether there will be long-term effects of brain injury (encephalopathy) in new-born babies. It is usually done alongside an MRI. Researchers scanned 82 babies being treated for brain injury, using MRI and also magnetic resonance spectroscopy. One biomarker tested at seven days after birth, thalamic N-acetylaspartate, correctly identified all babies who went on to have adverse developmental outcom...
NIHR Signal Antimicrobial stewardship programmes reduce antibiotic use in long-term care homes
Antimicrobial stewardship programmes have been found to reduce antibiotic use in long-term care residences by 14% when pooling evidence across a range of study types and interventions. Antimicrobial resistance is a public health threat, and overuse of antimicrobials is one of the main causes. Antimicrobial stewardship programmes are a government strategy to support the appropriate prescribing of antimicrobials within the NHS. There has been little evidence for their use or effectiveness in lon...
NIHR Signal Training programme to improve communication between staff and patients with dementia in hospital shows promise
Communication with people with dementia can be challenging for healthcare professionals. A new two-day training programme shows potential to help professionals become more confident in managing difficult situations on the ward. After analysis of 41 videoed exchanges between 26 healthcare professionals and 26 people with dementia in acute hospitals, researchers identified particular challenges. These included requests for action, such as asking them to take a drink or get out of bed, and at the ...
NIHR Signal Dermoscopy plus visual inspection aids melanoma diagnosis
Dermoscopy, using a relatively cheap handheld magnifying device alongside naked eye observation, is more accurate in the diagnosis of melanoma than visual inspection alone. It can also provide a photographic record which can be used for reference during follow-up. This NIHR-funded review included 104 studies of skin lesions in the dermatology clinic that looked suspicious or were present in those at high risk of developing melanoma. Melanoma is a rare form of skin cancer. Inspection of the lesi...
NIHR Signal Medication to reduce stomach acid may increase risk of hip fractures
People who take proton pump inhibitors for digestive disorders such as stomach ulcers and acid reflux may be up to 24% more likely to experience hip fractures. Nevertheless, the benefits of treatment in an individual may outweigh this effect unless the risk of osteoporosis or fracture is high. A conversation between the prescriber and the individual patient on relative risks should help in a treatment decision. The link may be important for people taking these drugs, especially if they have ot...
NIHR Signal An ultrasound scan is not as useful as a CT scan in assessing trauma
Ultrasound scans can be a useful tool to help pinpoint internal bleeding or organ damage in the chest or abdomen, but a negative scan cannot rule out damage, especially in children. Many emergency departments use portable ultrasound scanners to assess for internal damage when someone has been subject to blunt trauma (for example, involved in a car accident or fallen from a height). Ultrasound is free from radiation, non-invasive and can be used at the bedside, making it convenient if CT is not ...
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