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NIHR Signal One week of steroids may be as effective as two weeks in managing severe COPD
A shorter course of steroids lasting 3 to 7 days appears as effective as the recommended 7 to 14-day standard treatment for managing a flare-up of severe chronic obstructive pulmonary disease. This update to an earlier Cochrane review looked at randomised clinical trials comparing a short course (7 days or fewer) with a longer course (7 to 14 days) of steroids given by mouth or injection. All participants had been admitted to hospital, but none required mechanical ventilation. The evidence sug...
NIHR Signal Nurse staffing levels linked to reports of missed care in adult wards
Nurses are more likely to report omitting necessary care in acute inpatient wards when registered nurse staffing levels are low, even if there are additional healthcare assistants. Care categorised as planning and communication is reported as missed more often than clinical care. NHS hospitals are responsible for ensuring that the number and skills mix of nursing staff matches patient needs. Previous reviews have shown links between lower registered nurse staffing levels and poor patient outcom...
NIHR Signal Early, intense rehabilitation helps recovery after serious traumatic head injury
Early, intensive rehabilitation aids recovery and improves outcomes for people with moderate to severe traumatic brain injury. A review of 11 studies found that starting rehabilitation early, while people were still in intensive care, or offering more intensive treatments helped patients with brain injury regain function compared with usual care. Early rehabilitation often included multisensory stimulation while the patient was still in a coma. The intensive multidisciplinary programmes mostly ...
NIHR Signal Balanced electrolyte solutions give marginal benefit over saline for very ill patients
About 14% of critically ill patients receiving electrolyte-balanced crystalloids either developed kidney failure, needed kidney-replacement therapy or died compared with 15% receiving normal saline. This small but statistically significant benefit was only apparent when combining outcomes; there was no difference between fluids for the three individual outcomes analysed separately. A solution of 0.9% sodium chloride (normal saline) is the most commonly used intravenous (IV) fluid, but it can ca...
NIHR Signal Single routine offer of a blood test for prostate cancer did not save lives
Offering all men aged 50 to 69 a single, screening prostate-specific antigen (PSA) blood test did not prevent deaths from prostate cancer. This large trial included 573 UK general practices and over 400,000 men. It found that men who were invited to have a PSA test were 19% more likely to be diagnosed with prostate cancer, but no less likely to die from the condition, over an average 10 years of follow up. Forty per cent of men took up the offer. Controversy over PSA testing has persisted for ...
NIHR Signal Redesigning oral surgery with enhanced primary dental care, electronic referral and triage may save overall costs
An electronic referral system including consultant-led triage and an advanced oral surgery service in primary care results in fewer people requiring oral surgery in hospital. It comes at a lower overall cost than the previous arrangement. About two-thirds of patients could be treated safely in enhanced primary settings rather than hospital. This NIHR-funded study implemented several changes, an electronic referral system which standardised and improved the level of information provided in refer...
NIHR Signal Probiotics can prevent bacterial diarrhoea in hospital patients receiving antibiotics
Giving probiotics to people taking antibiotics reduces the chance of them developing diarrhoea caused by Clostridium difficile (C. difficile) bacteria by 60%. One case of Clostridium-associated diarrhoea was prevented for every 42 people receiving probiotics. They appear to work best for patients at more than 5% risk of Clostridium infection. When antibiotics disturb healthy gut bacteria, Clostridium bacteria may multiply to toxic levels, causing diarrhoea and serious intestinal complications. ...
NIHR Signal Atraumatic needles reduce headaches following lumbar puncture
Use of atraumatic needles rather than conventional needles for lumbar puncture more than halves the rate of post-procedure headache. Moreover, this improvement does not come at the expense of procedure success rates. Lumbar puncture involves inserting a needle in the lower back into the spinal canal to collect cerebrospinal fluid for diagnosis, or to inject a treatment or anaesthetic into it. A common side effect is a headache, often from leakage of fluid from the puncture. Atraumatic needles ...
NIHR Signal Adding the extra antibiotic rifampicin did not improve cure rates after sepsis
Adding the antibiotic rifampicin did not improve cure rates or reduce deaths for people with bacterial blood infections caused by Staphylococcus aureus. It increased the risk of adverse reactions requiring a change in treatment and the chances of drug interactions. This NIHR-funded trial is the largest to date on adding rifampicin to standard antibiotic therapy. The study included 770 people in 29 UK hospitals. Half were assigned to 14 days of treatment with rifampicin on top of their existing ...
NIHR Signal Lorazepam confirmed as first-line treatment for stopping prolonged seizures in children
Intravenous lorazepam is as effective as intravenous diazepam for stopping children’s tonic-clonic seizures in hospital. Lorazepam also results in fewer breathing problems than diazepam. Giving antiepileptic drugs intravenously generally stops seizures more quickly than giving the drugs buccally (in the cheek), intranasally (in the nose) or rectally. However, this effect can be cancelled out if administering the drug into the veins takes too long. Two of the 18 included trials were carrie...
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