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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 Thrombolysis may reduce complications of deep vein thrombosis
Blood clots are cleared quickly for people who develop them in the deep leg veins if they receive thrombolysis drugs alongside other treatments directly into their veins. The chance of successful break down of the clot was compared with the chance following standard anti-clotting drugs alone, such as heparin and warfarin. This Cochrane review found that over twice as many deep clots were completely broken down in the thrombolysis group compared with usual treatments. Thrombolysis also reduced t...
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...
NIHR Signal Antibiotics by injection into the eye can prevent severe infection following cataract surgery
Injecting the antibiotics vancomycin or moxifloxacin into the eyeball after eye surgery can reduce the risk of developing severe infection inside the eye (endophthalmitis) compared to other routes. Cefuroxime is currently the antibiotic of choice for this in the UK, but researchers wanted to see if drugs with lower rates of resistance might also be effective. A review of 34 studies, mostly observational studies with nine randomised controlled trials (RCTs), explored the effects of different typ...
NIHR Signal Counselling services help expectant mothers quit smoking
Counselling services, including cognitive behavioural therapy and motivational interviewing, help women to stop smoking during pregnancy by increasing quit rates. Feedback and financial incentives may also be effective, though evidence is weaker for both. Education alone and peer support were not found to be effective. Some of the counselling interventions are already at least partly supplied through NHS Stop Smoking Services – two of the UK trials recruited through the Service. When pool...
NIHR Signal MRI scans help confirm ultrasound diagnosis of fetal brain abnormalities
If fetal brain abnormality is suspected on a pregnancy ultrasound, following this with in-utero MRI (iuMRI) improves diagnostic accuracy. This sequence could allow more informed discussions and decision-making around whether to continue with or terminate a pregnancy. The NIHR funded study included 565 women of 18 weeks’ pregnancy or more who received ultrasound followed by iuMRI. Diagnoses were confirmed either by postnatal imaging of the baby or at post-mortem examination. Overall iuMRI...
NIHR Signal The “BabyClear” programme helped pregnant women stop smoking in North East England
An evidence based stop-smoking intervention called “BabyClear” increased the chance that pregnant smokers in North East England managed to ‘quit’ smoking by the time of delivery by around 80%. It cost £952 for each extra woman who stopped. Smoking in pregnancy is associated with adverse pregnancy outcomes, but pregnant women continue to smoke, particularly in more deprived areas. The key feature of BabyClear was that an objective carbon monoxide measurement was un...
NIHR Signal Skin-to-skin contact improves breastfeeding of healthy babies
Early skin-to-skin contact improves breastfeeding of healthy full-term babies. Skin-to-skin contact is the direct contact between a naked baby and the mother’s bare chest. It can occur before or after the baby is cleaned following birth. This review found that about a quarter more women who have this contact with their babies are still breastfeeding at one to four months after birth compared with those who don’t. The evidence that skin-to-skin contact may also help to stabilise the ...
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