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NIHR Signal Partial knee replacements have some short-term advantages compared to total knee replacements
Replacing one side of the knee, unicompartmental knee replacement, may result in shorter hospital stays, fewer short-term complications, faster recovery and better knee function than total knee replacements. However, about 8% need revision by five years - about two to three times the rate with total knee replacements. People with pain and immobility from osteoarthritis that cannot be controlled by other treatments may be referred for knee surgery. If the damage is only to one side of the knee, ...
NIHR Signal Treating asymptomatic MRSA on discharge from hospital reduces risk of later infection
Use of medicated creams, mouthwash and body wash for six months after discharge from hospital led to a 30% lower risk of MRSA infection, compared with basic hygiene education. This study was carried out in the USA using 2,121 adults who had tested positive for MRSA in hospital, but who had no symptoms. Meticillin-resistant Staphylococcus aureus (MRSA) bacteria have developed resistance to widely-used antibiotics. MRSA is easily transferable within healthcare settings, and people may become colo...
NIHR Signal Better care of deteriorating patients has reduced US mortality after surgery
Improved management of deteriorating patients with surgical complications has reduced the number of deaths in US hospitals rather than it being due to fewer complications. Over the past 10 years, complication rates have remained fairly similar. It is the reduction in 'failure to rescue'that has made the main difference in mortality. It is unclear if this is because of earlier detection of patients who are deteriorating due to complications, or improved response and treatment. This large...
NIHR Signal Intravenous magnesium can reduce shivering in patients after surgery
An infusion of magnesium, given during or immediately after surgery, reduces the proportion of patients who experience shivering in the operating theatre or in recovery from 23% to 9.9%. Shivering is unpleasant for the patient and may place strain on the cardiovascular system, as it increases oxygen use. A review of 64 trials found that intravenous magnesium was effective compared to placebo without any reported adverse effects. In the UK, frequent temperature checks and active warming are rou...
NIHR Signal Getting hospital patients up and moving shortens stay and improves fitness
Interventions to encourage patients admitted to hospital for medical problems to get out of bed and walk around increases their mobility, without increasing their risk of falls. Older inpatients frequently spend much of their time in bed, which risks a loss of physical condition and muscle tone. This can make it harder for them to manage independently at home, and may contribute to delayed discharge. A review summarised thirteen trials from the UK, Europe and Australia, involving 2,703 adults ...
NIHR Signal Switching to oral antibiotics early for bone and joint infections gave similar results to continuing intravenous therapy
For adults with bone or joint infection, many of whom had metal implants, beginning six weeks of oral antibiotics within seven days of intravenous treatment, was no worse than a regimen delivered wholly intravenously (IV). After one year, around 14% of both groups still had an infection, showing the difficulty of treatment, irrespective of the route of administration. Although current practice suggests antibiotics should be given IV for bone and joint infections, for at least six weeks, this la...
NIHR Signal When is it best to start the Parkinson’s drug, levodopa?
Earlier treatment with levodopa provides symptomatic relief to those with symptoms but does not appear to slow Parkinson’s disease from progressing. Therefore, timing is best determined by symptoms. The treatment of Parkinson’s disease is complex. Levodopa is the main drug used to reduce tremors and muscle stiffness. Whether it modifies the course of the disease or becomes less effective over time is debated, and it can have side effects, so patients and clinicians sometimes prefer ...
NIHR Signal New insights into how ethnicity and culture affect maternal mental health
Ethnicity and culture can affect how and when women seek help for mental health problems before or after having a baby. Many women avoid seeking help because they feel services are not sensitive to their beliefs. Services should ensure all women, regardless of background, can access the support they need during and after pregnancy. This mixed methods systematic review of UK evidence found that many women are not aware of the help available to them, and those that are aware often view it negativ...
NIHR Signal Keyhole surgery may be better than physiotherapy for hip impingement
Adults with painful restriction of movement of their hip had greater improvements in their symptoms after arthroscopy (keyhole surgery) than those who had physiotherapy. This NIHR-funded study included 222 people with hip pain and limited movement due to femoro-acetabular (hip) impingement but without a diagnosis of osteoarthritis. Their average age was 36 years. Half of the people who had surgery had significant benefit compared with a third of those having physiotherapy. NICE has recommended...
NIHR Signal Are track and trigger systems linked to rates of in-hospital cardiac arrest?
Use of the National Early Warning Score (NEWS) to monitor adults in hospital is associated with reduced risk of having a cardiac arrest while in hospital. Using an electronic rather than paper-based system is also linked to reduced risk. Many patients who die from a cardiac arrest while in hospital show signs of deterioration beforehand that aren’t identified or acted upon. Several interventions aimed at reducing these avoidable deaths have been introduced in the NHS. These includeNEWS, a...
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