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NIHR Signal Asthma self-management programmes can reduce unscheduled care
People with asthma who receive supported self-management are less likely to attend A&E or be admitted to hospital. The interventions are unlikely to increase overall costs for healthcare services. Those who self-manage are also likely to have more controlled asthma and a better quality of life. This extensive overview of systematic reviews included evidence from 270 randomised controlled trials exploring the effects of asthma self-management on healthcare utilisation and costs. Self-managem...
NIHR Signal An end of life strategy probably improved choice of where to die for people with severe respiratory disease
Most people prefer not to die in hospital, but the majority of patients with long-term diseases other than cancer end up dying there. In England, an NIHR study based on routine collected national data showed that roll-out of the End of Life Care strategy in 2004 was linked to a reduction in deaths in hospital. The number of deaths here fell by 6% for people with chronic obstructive pulmonary disease (COPD), and 3% for people with interstitial lung diseases. However, hospital deaths did not fall ...
NIHR Signal Benchmarking study helps hospitals improve measurement of adverse events
One in ten inpatients in Welsh hospitals experienced an adverse event of some sort, about half of which were potentially preventable. This is very similar to the rate in other countries. The figures come from a review of 4,388 patient records between October 2010 and March 2013. Welsh hospitals were using a screening tool at the time called the Global Trigger Tool to estimate rates of adverse effects. The tool surveys case notes of 20 inpatient records each month. Alongside the trigger tool pro...
NIHR Signal Induction of labour may be considered in pregnant women with a large baby
Induction of labour does not increase the risk of caesarean delivery in pregnant women with a larger than average baby. This is based on a review of four trials of 1190 women with a suspected large baby who were allocated either to have labour induced from 38 weeks or to watchful waiting. Induction did not increase the risk of most negative outcomes for the baby, such as bleeding in the brain, or mother, such as major tearing. However, these outcomes are rare, so a larger number of women would...
NIHR Signal Acupuncture shown to have benefits for treatment of some chronic pain
Acupuncture is not a placebo for treatment of chronic pain. This NIHR-funded systematic review shows that acupuncture is better than usual care and sham acupuncture for pain from musculoskeletal conditions, knee osteoarthritis and chronic headache. This NIHR review was large with over 140 trials overall, and the direct comparison with sham acupuncture helps to address uncertainty around whether acupuncture gives clinical benefit above a “placebo effect.” Acupuncture had a smaller ef...
NIHR Signal Steroid injections into the inner ear may be safe for treating Ménière’s disease
Injecting steroids into the space behind the ear drum may be a safer alternative to injections of gentamycin for treating Ménière’s disease. This disease is marked by severe attacks of dizziness and balance problems. This NIHR-funded trial randomised 60 people with Ménière’s disease who experienced severe attacks of vertigo and had not responded to standard treatment. They were randomly chosen to receive either the corticosteroid methylprednisolone or the...
NIHR Signal Pelvic floor exercises may reduce need for further treatments for pelvic organ prolapse
Pelvic floor muscle training reduced symptoms at two years slightly more than the improvement seen in women who just received a leaflet with lifestyle advice. In addition to this 1 point change on a 28 point scale, 8% fewer women who had training needed further treatment for prolapse. This randomised controlled trial included 412 women with relatively minor prolapse but who had not had any previous treatment. The basic training was provided by physiotherapists in five treatment sessions with ad...
NIHR Signal Drugs may help people pass larger kidney stones
Three-quarters of people with a large (more than 5mm) single kidney stone will pass the stone within six weeks if they take an alpha-blocker. About half of those taking placebo or no treatment pass the stone in the same period. Renal colic is a severe pain in the flank and is usually caused by kidney stones when they move into the ureter, the tube between the kidney and bladder. Most small stones pass into the urine without treatment. Evidence for drug treatment is contradictory. A recent UK t...
NIHR Signal Pneumococcal vaccines for people with COPD reduce their chance of catching pneumonia
Pneumococcal vaccines reduce the risk of community-acquired pneumonia in people with moderate to severe chronic obstructive pulmonary disease (COPD). Pneumococcal vaccination is currently recommended for people with COPD and other respiratory diseases. However, until now there has been a lack of data whether it actually improves outcomes in these groups. This updated Cochrane review identified 12 trials including 2171 adults with COPD, comparing those who did and did not receive pneumococcal v...
NIHR Signal Combination inhaler treatment in emergency departments may reduce admissions for asthma attacks
Using a combination of two inhaled drugs to open the airways may modestly reduce the need to admit an adult with asthma attack to hospital, though the underlying evidence is weak. The first-line treatment for an asthma attack is an inhaled β2 agonist, like salbutamol. This Cochrane review compared emergency department treatment with this drug alone, or combined with an inhaled short-acting anticholinergic, like ipratropium bromide. Pooled results from 16 trials included found that combina...
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