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NIHR Signal Functional braces are effective alternatives to plaster casts for ruptured Achilles tendons
Early weight-bearing in a below-knee rigid boot, a functional brace, following ruptured Achilles tendon can achieve similar results to traditional plaster casting. This NIHR-funded trial included 540 people, and after nine months there appeared to be no difference between the two treatments in terms of how well patients recovered from their injury. The functional brace was preferred by patients. Functional bracing is an alternative to traditional plaster casting that allows earlier weight-beari...
NIHR Signal Eplerenone does not improve vision in people with central serous chorioretinopathy
Eplerenone, a drug used for people with central serous chorioretinopathy, is no more effective than placebo. Neither visual acuity nor the build-up of fluid in the eye shows an important improvement. Central serous chorioretinopathy is a serious eye condition that causes blurred and distorted vision. Fluid collects underneath the macula, which is the central area of the retina. The condition mostly affects men aged 20–45 years, although it can affect women too. A specific cause is rarely ...
NIHR Signal Plasma and blood cell injections have not shown a benefit for Achilles tendon injury
Injecting a ruptured Achilles tendon with a small sample of a person’s own plasma, without the red blood cells, has no functional or other benefit. Plasma rich in platelets and white blood cells for the acute injury was compared with placebo. The NIHR-funded trial involved 230 adults with acute Achilles tendon rupture (the tendon which connects the calf muscles to the heel). All were attending UK hospitals within 12 days of injury. The trial found no difference in function at 24 weeks aft...
NIHR Signal Using wires to fix wrist fracture has good long-term outcome
Fixing a displaced broken wrist with wires is as effective as fixation with locking plates in the long term. Wrist function and pain continueto improve in the five years following either operation, with no evidence of a difference between the two treatments. In 2014, a trial comparing the use of Kirschner wires and locking plates for displaced fractures of the distal radius reported that patients treated with either operation did equally well after 12 months. This follow-up study allays fears t...
NIHR Signal Decision aids including leaflets and computer programs help patients make treatment choices
Decision aids help patients choose between treatment options in obstetrics and gynaecology, and reduce uncertainty. A systematic review of trials of decision aids used for choices of contraception, caesarean section and menopause treatment found that patients who used them felt more confident in their ability to make the decision that was right for them, and less uncertain about this decision. This was compared with usual care or an information aid. Decision aids set out information about medi...
NIHR Signal Structured nurse ward rounds support accountability and risk management but not nurse-patient communication
Scheduling regular nurse bedside ward rounds (called ‘intentional rounding’) may not improve nurse-patient communication, as most interactions occur outside of these rounds. The rounds are intended to improve accountability and provide evidence that risks are being managed when correctly documented. Intentional rounding was introduced as a UK Government policy imperative to facilitate regular interactions between nurses and patients following high profile care failures at the Mid St...
NIHR Signal Melatonin shows potential for reducing delirium among older people after surgery
Taking melatonin around the time of surgery is linked with lower odds of delirium onset in older people, compared with placebo or no treatment. In a systematic review and meta-analysis, around 15% of the melatonin group developed delirium after surgery compared with around 20% of the comparison group. Delirium is an acute state of mental confusion associated with longer hospital stays and increased mortality. UK clinical guidelines do not recommend specific medications to prevent this condition...
NIHR Signal People leave hospital after surgery sooner if hospitals follow ‘enhanced recovery protocols’
Strategies to improve or enhance recovery after planned surgery can reduce the amount of time people over 60 spend in hospital, compared with standard care. These strategies include minimising fasting before operations, targeted anaesthesia, getting people up and about quickly after surgery and an early return to eating. In this review, hospital stay could be reduced by up to five days with the use of enhanced recovery protocols. Exercises and nutritional programmes to prepare for surgery (&lsq...
NIHR Signal Surgery to fix the womb in position after prolapse is an alternative to hysterectomy
Women who have surgery that uses stitches to lift and keep their prolapsed womb in place (called hysteropexy) are less likely to have recurrent symptoms after five years than those who havetheir womb removed (vaginal hysterectomy). These results from a Dutch trial involving 204 women showed comparable outcomes for the two surgical options for other measures such as quality of life, repeat surgery and sexual functioning. While vaginal hysterectomy is still widely seen as the first treatment cho...
NIHR Signal ICU admission decision support tool showed promise but was rarely used
A decision support tool developed to help doctors determine whether patients should be admitted to intensive care showed promise in facilitating patient-clinician communication, but was not often used by doctors, with fewer than 30% using the forms. Intensive care can deliver lifesaving treatment. It can be invasive and distressing with no guarantee of success. At present, there is little to guide doctors in the decision-making process, and this NIHR-funded study sought to help doctors by devel...
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