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NIHR Signal Levetiracetam is a useful alternative to phenytoin in stopping prolonged epileptic seizures in children
Levetiracetam is as effective as phenytoin at stopping prolonged epileptic seizures in children. In this trial, levetiracetam stopped 70% of children convulsing compared with 64% for phenytoin within 35 to 45 minutes. Adverse events were similar. This combined with the fact levetiracetam may be easier to administer safely make it an important option. Most epileptic seizures stop by themselves within a few minutes, but sometimes they continue for much longer. If this happens emergency treatment ...
NIHR Signal Transvaginal ultrasound and MRI achieve similar accuracy for diagnosing lower bowel endometriosis
Transvaginal ultrasound and magnetic resonance imaging (MRI) scans are both accurate ways to diagnose the most severe form of deep endometriosis affecting the bowel. By using both transvaginal ultrasound and MRI, the chance of non-invasively and accurately diagnosing endometriosis of the lower bowel rises to nearly 100%. This review and meta-analysis looked at eight studies where both transvaginal ultrasound and MRI had been used to diagnose endometriosis in a total of 1,132 women. In each indi...
NIHR Signal Routine use of progesterone does not prevent miscarriage
Progesterone did not affect the chance of live birth among women presenting with vaginal bleeding in the first 12 weeks of pregnancy. Live birth rates were 72% with placebo and 75% with progesterone, which is not a clinically or statistically important difference. Progesterone has been prescribed for threatened miscarriage in some centres since the 1950s, but there has been poor evidence for its use. NICE recently highlighted this as a priority area for research asking for large, robust trials ...
NIHR Signal Insights into the transfer between children’s and adults’ services for young people with selected long-term conditions
How young people with type 1 diabetes, autistic spectrum disorder and cerebral palsy experience the transition to adult services depends on their condition and locality. Adult and children’s services need to work together to ensure they are offering young people the sources of support and resilience they need. This NIHR-funded study found that children with type 1 diabetes were more likely to receive help shown to aid transition. For example, around two-thirds said they had met a member o...
NIHR Signal Placental growth factor testing can speed up diagnosis of pre-eclampsia
Measuring the level of placental growth factor (PlGF) in women with suspected pre-eclampsia helps to reduce the time to diagnose pre-eclampsia from 4 days to 2 days. PlGF testing is also associated with fewer adverse outcomes for mothers. In this NIHR-funded trial, the test results were used alongside the NICE clinical management algorithm to help clinicians make a diagnosis. Pre-eclampsia can lead to serious complications for mothers and babies. Women with suspected pre-eclampsia require furt...
NIHR Signal Meaningful increases in physical activity levels after cancer can be sustained for three months or more
People who have had cancer, who are able to keep mobile, can benefit from interventions aimed at increasing physical activity. Being active regularly is already known to improve health and may also reduce the risk of cancer returning and improve life expectancy. This NIHR-funded review looked at what kinds of exercise interventions can lead to behaviour change in adult cancer survivors. Researchers specifically looked at the components that are linked to continued physical activity at least thr...
NIHR Signal National quality improvement programmes need time and resources to have an impact
A large trial assessing the effectiveness of a UK-wide quality improvement programme did not show any difference in patient outcomes. However, the likely reasons for this were carefully investigated and provide some useful insights on implementation. Several (37) quality improvement components were included in the ambitious package designed to reduce variation in care and improve outcomes for adults undergoing emergency abdominal surgery. There was no difference in survival at 30 days, length o...
NIHR Signal Telephone or internet delivered talking therapy can alleviate irritable bowel symptoms
People with irritable bowel syndrome may find cognitive behavioural therapy (a talking therapy) delivered via telephone or internet improves their symptoms. Compared with usual care alone, both interventions were shown to be more effective, with telephone delivery resulting in greater symptom reduction and web-based therapy being more cost-effective. Irritable bowel symptoms can persist long-term and have a major impact on the quality of life. Stress is one of the known triggers. Cognitive beha...
NIHR Signal Antiretroviral treatment can reduce the risk of HIV transmission between male partners to ‘zero’
The risk of transmission of HIV between gay couples when the HIV-positive partner is taking antiretroviral treatment that successfully suppresses the viral load is ‘effectively zero.’ A study of men from 14 European countries, including the UK, found no cases of transmission of HIV from an HIV-positive partner taking antiretroviral therapy to an HIV-negative partner, as long as the viral load of the HIV-positive partner remained undetectable or very low. The study recorded an avera...
NIHR Signal Antimicrobial central venous catheters do not reduce infections in pre-term babies
Central venous catheters (CVCs) impregnated with antimicrobial agents are no better than standard CVCs for avoiding bloodstream infection in pre-term babies. This NIHR-funded trial compared peripherally inserted CVCs that had been impregnated with a combination of the antifungal miconazole and the broad-spectrum antibiotic rifampicin, against standard non-antimicrobial-impregnated CVCs for preterm babies in intensive care. Rates of bloodstream infections were similar in both groups, and no diff...
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