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NIHR Signal Drug reduces deaths from bleeding after childbirth
Tranexamic acid, given to women who bleed heavily after giving birth, reduced the risk of death by 31% when given within three hours. This trial included 20,060 women with postpartum haemorrhage who were randomly assigned to receive tranexamic acid or placebo. This is the first large study to indicate that it is safe and implies it should be considered as an early drug option for postpartum haemorrhage. In keeping with other recent research, there was no increase in risk of blood clots. Tranex...
NIHR Signal Silk clothing for children does not reduce objective measures of eczema severity
Six months of wearing special silk clothing had no effect on objective measures of child eczema severity, infection rates or medication use. Children and carers reported some small improvements in eczema severity on two scales but their awareness of the clothing worn by their child may have slightly influenced their judgment. Overall quality of life did not significantly improve. Specialist silk clothing is currently available on NHS prescription, but prior to this trial there was limited evide...
NIHR Signal Humidified oxygen linked to increased chest infections
More respiratory infections in adults followed the use of humidified oxygen compared with non-humidified low-flow oxygen therapy. Bacterial contamination was common in the humidified oxygen bottles across various hospital departments including respiratory wards. UK guidelines currently recommend using non-humidified oxygen for adults requiring low-flow oxygen. However, in countries such as China, oxygen is routinely humidified regardless of flow rate to prevent respiratory dryness. This revie...
NIHR Signal Carers of stroke survivors voice an unmet need for practical and emotional support
The carers of stroke survivors express a need to be recognised by hospital rehabilitation teams as partners in care. Carers emphasised that their deep knowledge can contribute to joint decision making about the care of their spouse or family member. This research suggests that considering carers’ needs for support, information and training into care planning could ease the distress currently reported. This review describes how family, friends and spouses often felt emotionally overwhelmed...
NIHR Signal Using mesh does not improve results in vaginal prolapse surgery
Using a synthetic mesh or biological tissue graft is no better than standard surgical repair, without use of these materials, in women with vaginal wall prolapse. Some women had problems from the mesh. This large pragmatic study looked at over 3000 women with vaginal prolapse. Half of these were randomised; the rest contributed data but were not part of the main evaluation. The study separately compared mesh and biological grafts to a repair without these additions. It also took account of whet...
NIHR Signal Dexamethasone before bowel surgery reduces postoperative nausea and vomiting
A single dose of dexamethasone given at the time of anaesthesia for bowel surgery reduced vomiting in the next 24 hours, with no increase in complications. Thirteen people need to be treated to prevent one extra episode of vomiting. Dexamethasone (a steroid) is one of several drugs recommended for patients at moderate and high risk of postoperative nausea and vomiting. It isn’t widely used in bowel surgery. In this large UK-based trial, treating eight people also prevented one person re...
NIHR Signal Stop smoking services can work for people in treatment or recovery from substance misuse disorders
Providing stop smoking services to people with substance misuse disorders increases the numbers of people who stop smoking by about 10% without reducing the rates of abstinence from drugs or alcohol. Combined drug treatment and counselling showed the best result though pharmacotherapy alone was also successful. However counselling alone was not beneficial. This Cochrane review included trials of people who were already either in treatment or recovery for drug or alcohol misuse in a variety of s...
NIHR Signal Treating subclinical thyroid dysfunction in pregnancy probably has no benefit
Testing for and then treating pregnant women with mild or “subclinical” underactive thyroid did not improve pregnancy outcomes, newborn baby outcomes, or the child’s IQ at three to five years. A clearly underactive thyroid (clinical hypothyroidism) in pregnancy has been linked with various adverse outcomes for the mother and baby, including pre-eclampsia, preterm birth, congenital defects and neurodevelopmental delay. This needs treatment. However, there has been debate around...
NIHR Signal Talking therapy given by parents shows promise for childhood anxiety disorders
Brief guided cognitive behavioural therapy (CBT) delivered by parents was as good as a commonly used treatment, delivered by a therapist, in improving anxiety levels in children. Anxiety continued to improve after the end of treatment and by six months about 70% had recovered. The brief CBT was potentially the more cost-effective option. This NIHR-funded trial compared recovery from a range of common anxiety disorders in children aged five to 12 following these brief psychological treatments. C...
NIHR Signal Prescribing regular drugs to prevent febrile convulsions risks more harm than benefit
The benefits of giving anti-epileptic medication to children aged between six months and seven years who have had a convulsion while feverish, do not outweigh the harms. While diazepam given when a child becomes feverish reduced the chance of a convulsion from about 25% to 18% after a year, one in three children experienced adverse effects. Therefore, the authors suggest benefits do not seem to outweigh the harms. In the UK 2 to 5% of children less than six years old will have a febrile convuls...
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