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NIHR Signal Induction of labour within 24 hours, if waters break at 37 weeks of pregnancy, can reduce womb infection
Inducing labour may halve the risk of infection in the womb when waters break from 37 weeks. The procedure was started within 24 hours and was compared to waiting for labour to start on its own. Waters breaking at full term without the onset of labour is called pre-labour rupture of membranes. This can increase risks of maternal and neonatal infection and the need for caesarean section. As most women deliver spontaneously within a day, NICE recommend that women are offered an informed choice of...
NIHR Signal Very strict blood sugar control in critically ill children provides no benefit
Strict control of blood sugar levels for critically ill children in ICU with high blood sugar did not increase the number of days they spent outside of ICU in the first month. The trial was stopped early as more infections and very low glucose levels were recorded in the strict control group. This trial found that using insulin to control blood sugar to within 4.4 to 6.1 mmol/L, rather than 8.3 to 10mmol/L, in critically ill children made no difference to the number of days they spent in the i...
NIHR Signal A dose of corticosteroids benefit most women anticipating a preterm delivery
Giving corticosteroids to most women who are anticipating labour before completing 37 weeks of pregnancy helps reduce immediate health problems in the baby compared with placebo or no intervention. Deaths around the time of birth were reduced by 28% and babies were a third (34%) less likely to develop respiratory distress syndrome. A corticosteroid dose is already used for women who go into labour or if waters break before 37 weeks or where delivery is planned for other reasons. The drug accele...
NIHR Signal A supported web-based programme helps people lose weight in the short term
A web-based programme (POWeR) with nurse support helped about 30% of people lose at least 5% of their body weight, maintained for at least 12 months. By comparison, twenty percent of people achieved this with an online information sheet only. This research does not tell us whether POWeR alone would have provided the same benefit POWer+ helped more people achieve short-term weight loss but the average weight loss of about 3-4 kg after 12 months was statistically similar for those given informati...
NIHR Signal A blood test threshold for diagnosing heart failure in general practice is reviewed
The cut-off level for the blood test NTproBNP appears to provide the best balance of detecting true cases while excluding false positives when lowered to 125 pg/ml. The trial supported by the NIHR included a sample of people presenting to their GP with suspected heart failure. It aimed to see which method was best for identifying those who needed referral: the blood test alone; clinical decision rules based on clinical symptoms; or the combination of both. The blood test alone at the 125 pg/ml...
NIHR Signal Better prescribing might prevent thousands of strokes in the UK
One third of people who had a first stroke in the UK between 2009 and 2013 had known risk factors and were not taking the drugs that might have prevented their stroke. Electronic general practice records from almost 30,000 people who had a stroke showed that about 60% had risk factors that meant they might have been eligible to take cholesterol-lowering, anti-clotting or blood pressure medication. But 54% of these people had no recent prescription for the appropriate drug(s). The researchers e...
NIHR Signal Repetitive task training can help recovery after stroke
Following a stroke, people who received repetitive task training showed greater improvements in performing functional tasks, such as picking up a cup, standing up and walking. These improvements were sustained for up to six months. Disability following stroke is common, affecting around half of all stroke survivors. This NIHR-funded review of over thirty trials found that repetitive task training provided small gains in arm and leg function, balance and walking distance (about 35 metres). We d...
NIHR Signal Giving immediate antibiotics reduces deaths from sepsis
Giving immediate antibiotics (defined as within one hour) when people present to emergency departments with suspected sepsis reduces their risk of dying by a third compared with later administration. This meta-analysis of observational data from 23,596 people in emergency department settings confirmed that giving antibiotics within one hour was linked to a lower risk of in-hospital mortality compared with giving antibiotics later. This adds weight to recommendations from NICE and other organis...
NIHR Signal Fortified donor breast milk led to similar development for very-low-birthweight babies compared with formula milk
Providing very-low-birthweight babies with fortified human donor breast milk made no difference to their developmental neurological outcomes at 18 months compared with giving formula. This randomised controlled trial looked at 363 babies with birth weights of less than 1500g in neonatal intensive care units in Canada. When the mother’s own milk supply was limited, the babies were given either nutrient-enriched donor breast milk or formula developed for premature babies. There was no diffe...
NIHR Signal New casting technique is an option for older people with ankle fracture
A new casting technique called “close contact casting” is an alternative to surgery for older people with ankle fracture. Ankle function at six months was similar in people who had casting and those who had surgery but there are some disadvantages to both that patients and surgeons could consider. This UK-based NIHR trial recruited 620 people aged over 60 years with an unstable ankle fracture that would usually be fixed with surgery. People who had a cast were less likely to have i...
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