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NIHR Signal Nurses and pharmacists can prescribe as effectively as doctors
Prescribing by suitably-trained pharmacists and nurses offers similar outcomes to prescribing by doctors, at least in the management of chronic conditions. This Cochrane review pooled clinical outcomes and patient satisfaction across 45 studies of nurse or pharmacist prescribing compared with doctor prescribing. Most studies were of chronic disease management in primary care settings in high income countries (25 from the US and six from the UK). Independent and supplementary prescribers in th...
NIHR Signal Personalised letters and a “taster session” help double attendance at NHS stop smoking services
Attendance at NHS stop smoking services (SSS) almost doubled after smokers were sent letters showing their personalised risk of serious illness if they continued to smoke alongside invitations to try the service. Less than 5% of smokers attend these services in England and numbers are on the decline, although this is one of the most effective ways of stopping smoking. A personalised risk letter was sent to 2,636 smokers alongside an invitation to a local taster session. 17.4% attended, compare...
NIHR Signal A group weight loss programme shows promise compared with usual approach
A new, intensive NHS group weight management programme was more effective than the more common individual sessions with a practice nurse. In an NIHR-funded trial based in deprived districts in East London, people who took part in the primary care group-based programme lost nearly 2kg more than those who had individual sessions with a nurse. Most of the participants were women, and over a third was from black and minority ethnic groups. Despite the greater intensity and duration of the group pro...
NIHR Signal Research highlights the challenges of preventing diabetes with group education sessions
In people at high risk of type 2 diabetes, the educational programme ‘Let’s prevent’ had minimal impact on blood sugar control, and cholesterol. Overall it did not prevent people developing diabetes, though the risk was reduced for the 29% of people who attended all three sessions. The NIHR-funded trial compared three educational sessions plus telephone support with usual care. The main difficulty was recruitment and attendance. Only 19% of people at high risk of type 2 diabet...
NIHR Signal GP letter to improve medication adherence did not reduce unplanned care for children with asthma
A one-off GP letter reminding parents of children with asthma to use their medications over the August summer holiday did not prevent a characteristic annual peak in unplanned care on returning to school in September, but did lead to more prescriptions. Unplanned care represents visits to the GP or accident and emergency that is not part of the child’s asthma care plan. They do not include scheduled medical review or visits for repeat prescriptions. The letter prompted about a third more...
NIHR Signal MRI scan before biopsy could detect more prostate cancer
In men with a raised prostate specific antigen (PSA) blood test, which can be a sign of prostate cancer, MRI scanning before standard biopsy could allow more targeted biopsies and increase diagnosis of medium and high-risk prostate cancer. In this NIHR-funded study, 576 men with suspected prostate cancer received a multi-parametric (MP)-MRI scan in addition to transrectal ultrasound-guided (TRUS) biopsy. They also had template mapping (TPM) biopsy of the entire prostate to reliably diagnose can...
NIHR Signal Postoperative radiotherapy reduces survival after surgery to remove non-small cell lung cancer
Postoperative radiotherapy increases the risk of death by 18% for patients with non-small cell lung cancer that has been removed by surgery. Just over half of patients (53%) given radiotherapy after surgery survived to two years following treatment. This compared to 58% of patients who did not receive postoperative radiotherapy. Previous evidence had suggested that postoperative radiotherapy may be beneficial after curative surgery. This Cochrane review contradicts this, drawing on data from 2...
NIHR Signal Intensive follow-up following curative bowel cancer surgery may detect recurrent cancers sooner but does not improve survival
Intensive follow-up of patients who have been successfully treated for bowel cancer does not improve survival outcomes compared to less intensive follow-up. This systematic review included 15 randomised controlled trials comparing different intensities of follow-up. Protocols varied in terms of the number of tests, appointments or their setting (e.g. GP or hospital) - none of them affected survival. More intensive follow-up did however detect recurrent cancers sooner, and patients were twice a...
NIHR Signal Suction drainage after rectal cancer surgery does not reduce infection
Placing a suction drain in the pelvic cavity does not reduce the risk of pelvic infection after commonly-used surgery for rectal cancer. A French trial comparing results of surgery with and without pelvic drainage showed no difference in risk of infection within 30 days. The risk of infection was about 17%. The drainage technique is less commonly used in the UK. The study was carried out in several hospitals and included 469 people having total mesorectal excision of rectal cancer. Half the pat...
NIHR Signal Mesh inserted during stoma formation reduces future hernia risk
A mesh inserted when creating a new stoma reduces the chance of a hernia developing around it (parastomal hernia) from about 37% to 16%. Meaning that about five mesh procedures are needed to prevent one hernia appearing within the first five years. A stoma is an opening of part of the intestine onto the skin, allowing waste products to leave the body. Parastomal hernias, that appear beside the stoma, are a common complication. They can be painful and prevent the stoma from working properly. Th...
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