Transcatheter aortic valve implantation may be an option for patients with aortic stenosis at lower surgical risk
Transcatheter aortic valve implantation (TAVI), the less-invasive procedure, may be associated with a reduced risk of death and stroke for up to two years when compared with surgical aortic valve replacement for adults with severe narrowing of the aortic valve, irrespective of the level of surgical risk.
TAVI is already an established procedure for those unsuitable for surgery or at high risk. This meta-analysis evaluated seven trials comparing 8,020 adults treated with one of these procedures ...
A temporary clot-catching filter inserted after major trauma does not prevent lung clots
In adults after major trauma who cannot safely be given anti-clotting drugs, placing a removable metal filter in a major vein to the heart (the inferior vena cava) within 3 days of admission does not reduce their chances of having a clot in their lungs (pulmonary embolus) within 90 days, compared with having no filter. The filters do not affect the risk of bleeding.
The filter aims to catch clots that might develop in the legs and travel to the lungs, until anti-clotting drugs can be safely sta...
Exercise training improves physical capacity after lung cancer surgery
People who receive exercise training following surgery for lung cancer can walk about 57 metres further in six minutes than controls who did not exercise. After surgery like thisto remove all or part of a lung, people typically manage about 500 metres in six minutes on the test, and anything above 20 metres is considered a worthwhile improvement. Exercise also increases leg strength and quality of life.
A decline in physical fitness is a common and debilitating effect of lung resection. Exerci...
Length of steroid course for childhood nephrotic syndrome makes little difference to later recurrences
For children with a first presentation of nephrotic syndrome, an extended sixteen-week treatment regimen with prednisolone does not reduce the risk of relapse compared with the standard eight-week course. Most children will experience a relapse with either regimen, but the longer course may delay it by a month or so which may, in turn, reduce the resource use, such as emergency department visits, shorter admissions and less need to see the GP. This can also make the longer course cheaper overall...
Four-drug treatment for HIV offers no benefit over standard three-drug treatment
Quadruple drug therapy for people starting HIV treatment offers no benefit over the currently recommended triple therapy.
Antiretroviral (anti-HIV) therapy is highly effective, with almost all treated individuals in the UK surviving as long as non-infected people. The courses now available mean those treated are usually unable to pass on the virus. There are several classes of treatment and individual drugs which can be used in various combinations. The British HIV Association currently recomme...
Surgery for a deviated nasal septum improves quality of life more than non-surgical approaches
Surgery for adults who have a deviation, or bend, in the wall running through the centre of their nose improves quality of life more than non-surgical alternatives. The benefit was maintained for at least two years. The surgery, a septoplasty, also improvesairflow through the nose.
The trial compared septoplasty to non-surgical alternatives, such as just monitoring the patient or giving treatments such as corticosteroid nasal sprays.
There has been a lack of good-quality evidence in managing t...
Closer links between police and health services can improve experiences for people in mental health crisis
Tighter working partnerships between health professionals and police services are likely to improve the care of people who come into contact with police during mental health crises.
People experiencing severe mental health episodes can present with extreme and unpredictable behaviour posing a danger to themselves and members of the public. Police are often the first to respond in these challenging situations.
New models are emerging of mental health staff working with police. This NIHR-funded ...
Packages of care interventions ‘not effective’ to reduce repeat admissions for COPD
Care bundles for COPD are difficult to implement, and their introduction in NHS hospitals does not reduce repeat admissions, deaths or use of resources when used on or after admission.
Care bundles are packages of interventions which, in other situations, can improve care. COPD care bundles include:
checking inhaler technique and medication use
providing a written plan for COPD management and supply of emergency medicines
assessing willingness to stop smoking
assessing suitability for pul...
On balance, antiplatelet drugs may be restarted for stroke survivors who have bled into the brain
Early research suggests that antiplatelet drugs, such as aspirin, can provide more benefit than harm if restarted at about 2 to 3 months after a brain bleed. The results seem to apply best to those patients with a good prognosis who survive with less disability.
Antiplatelet drugs are of proven benefit to those with a high risk of vascular events; they reduce the risk of heart attacks and strokes because they prevent platelets from clumping together. However, after a type of a stroke caused by ...
Virtual reality can help reduce the pain and anxiety of stressful medical procedures for children
Virtual reality shows promise in helping to distract children from self-reported pain and anxiety during medical procedures. Younger children in particular may benefit from the intervention.
This review of seventeen trials looked at virtual reality interventions tested in trials with children receiving treatment for burns, dental and tumour related health needs, and during needle insertion for intravenous access. Results suggested a marked impact on pain and anxiety of children from these immer...