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NIHR Signal Sodium thiosulfate reduces hearing loss in children treated with chemotherapy
Treatment with sodium thiosulfate alongside cisplatin chemotherapy can reduce hearing loss in children with a liver tumour called hepatoblastoma. The risk of hearing loss was reduced by 48% in children who had the combination treatment compared with those who had cisplatin only. This phase 3 trial involved 109 children with standard-risk hepatoblastoma and tested the addition of sodium thiosulfate six hours after cisplatin treatment. The additional drug caused few major side effects, and there ...
NIHR Signal Omega-3 supplements do not prevent heart disease, stroke or death
Omega-3 fatty acid supplements from fish oils or plants have little or no effect on the risk of heart disease, stroke or overall death rates. This finding contradicts a widespread belief that omega-3 supplements are protective. Previous evidence in favour of omega-3 supplements is mainly derived from trials at high risk of bias. The better evidence identified in this review does not demonstrate any health benefit. The review provides robust evidence confirming current guidance that omega-3 supp...
NIHR Signal Methylphenidate remains first-choice drug treatment for children and young people with ADHD
The stimulant methylphenidate has the best balance of effectiveness against side effects in children and young people with attention deficit hyperactivity disorder. Amphetamines are more effective, but also more likely to be stopped for a reason other than side effects. This large, NIHR-funded systematic review compared a range of drugs against each other through a network meta-analysis. Effectiveness and tolerability were assessed at about 12 weeks of treatment. Other second-line drug treatmen...
NIHR Signal Guided online interventions can help people recover from depression
Internet-based interventions combined with remote professional support can improve outcomes for people with depression. Those receiving the intervention show better initial response to treatment and higher recovery rates compared with control groups who are either waiting for treatment or receiving less support. This meta-analysis shows people using guided internet therapy are over twice as likely to respond to treatment and achieve remission. This finding reinforces current NICE guidance which...
NIHR Signal Supporting families of those in intensive care improved family satisfaction but didn’t reduce family distress
A multicomponent support intervention for family members of patients in intensive care didn’t reduce their anxiety, depression or distress around the overall experience. However, it increased satisfaction with the quality of staff communication and delivery of care. Family members of critically unwell patients on intensive care often need to be involved in care decisions. Yet they may feel unsupported and bewildered in the process. This intervention, delivered in five US intensive care un...
NIHR Signal Tools for GPs can help reduce unnecessary antibiotic prescribing
Interventions to reduce inappropriate antibiotic prescribing for upper respiratory tract infections are most effective when they provide a negotiation tool to support patient interaction. These interventions are more likely to be rejected if they are perceived as interfering with individual clinical judgment or damaging patient relationships. Upper respiratory tract infections often resolve themselves within a few days, without the need for antibiotics, yet antibiotics are often prescribed. Thi...
NIHR Signal Amphetamines probably the best first-choice treatment for adults with ADHD
There is further evidence to support the amphetamines as the most effective group of drugs for treating adults with attention deficit hyperactivity disorder in the short-term. Two of these drugs were shown to provide the most improvement in core symptoms of attention deficit hyperactivity disorder, are tolerated as well as any other drug treatment and are less likely to be stopped. The review did not identify data to determine whether amphetamines should continue to be used for longer than 12 ...
NIHR Signal Self-monitoring of blood glucose provides no important benefit for most people with type 2 diabetes
Patients with type 2 diabetes who monitor their blood glucose themselves may see small, short-term improvements in blood sugar control. This is not enough to be clinically important or outweigh the costs and personal inconvenience of long-term self-testing. Self-monitoring is a well-established strategy for type 1 diabetes and for people with type 2 who need insulin. The benefit for all people with type 2 is debatable. This review pooled 24 randomised controlled trials comparing self-monitoring...
NIHR Signal Albumin administrations can prolong survival for some people with liver disease
Weekly intravenous albumin can prolong the life for people with liver cirrhosis and uncomplicated ascites. Over about 18 months, 17% of patients given albumin died compared with 22% given standard care alone over 11 months. People with very severe (end-stage) cirrhosis develop various complications including a build-up of fluid in the abdomen (ascites). This is the first large trial to study the effects of long-term albumin infusions. In addition to improved survival, albumin also reduced hosp...
NIHR Signal Closing five emergency departments not linked with increased hospital admissions, though ambulance call-outs increased
Closure of five small emergency departments in England was not associated with change in the number of hospital admissions, urgent care attendances or deaths among the local populations. However, ambulance call-outs increased by 14% relative to comparison areas, with a four-minute increase in the time to reach a hospital with an emergency department. Emergency departments continue to be under high pressure, while staff shortages increase patient safety concerns. One option is to close smaller s...
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