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NIHR Signal Self-monitoring improves control of high blood pressure compared with GP monitoring alone
Allowing patients who have inadequately controlled high blood pressure to monitor their own blood pressure at home helps their GPs to optimise their management. Patients who self-monitor and visit or talk to their GP when needed for medication adjustments achieve 4mmHg lower systolic blood pressure over 12 months compared with those relying only on the measurements made by a GP without self-monitoring. Effects are similar if patients write down their measurements to send to the GP or do so via ...
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 Imaging is the only way to diagnose blood clots in pregnancy
No blood test can accurately tell if a pregnant or recently pregnant woman has a blood clot. All pregnant women with a suspected clot should continue to have imaging investigations as per current UK guidelines. This NIHR-funded study recruited 328 pregnant or postpartum women with a suspected blood clot in the lung (pulmonary embolism) or leg (deep vein thrombosis). They had a blood test to measure the levels of 13 biomarkers, such as the D-dimer, to see if they could rule a blood clot in or ou...
NIHR Signal Uncertain benefits of BNP blood tests to monitor heart failure treatment
In specialist clinics, using B-type natriuretic peptide (BNP) blood levels to guide treatment in people with chronic heart failure shows promise but did not improve survival for all groups. In this review, the benefit was only seen in patients aged less than 75, who survived an extra 1.5 years on average, and possibly those with poor heart function (reduced ejection fraction). However, there was a reduction in hospital admissions for heart failure for everyone. BNP is a hormone released from th...
NIHR Signal Self-testing kits increase overall HIV testing uptake in men who have sex with men
Frequency of HIV testing in men who have sex with men may be increased by one additional test in a six month period when self-testing kits are used. Self-testing kits allow people to collect their finger-prick or saliva sample, perform the test and interpret the result themselves. This global study found that first-time testers made up around a tenth of all self-testers in high-income countries such as the US or UK, but about a third of those in resource-limited countries. About a third of self...
NIHR Signal New screening pathway could help to identify a rare, single-gene form of diabetes
A screening pathway using blood and urine tests followed by two genetic (DNA) tests identified all people with a rare subtype of diabetes called monogenic diabetes. The screening pathway performed better than current practice based on age at diagnosis and family history which misses 63%. It is, therefore, a useful approach for ruling out this form of diabetes and probably cheaper overall than offering every young person with diabetes DNA testing. Monogenic diabetes, caused by a mutation in a si...
NIHR Signal Single urine samples are just as good as 24-hour collections for diagnosing pre-eclampsia
The urine spot albumin-creatinine ratio (which is done on a single, on-the-spot sample) reliably identified 99% of pregnant women with high blood pressure who went on to develop severe pre-eclampsia. The spot protein-creatinine ratio, as currently recommended by NICE, was slightly less sensitive identifying over 90% of women. Both spot tests were good value for money. Nearly 1,000 women, suspected of having pre-eclampsia, took part in this NIHR-funded study, in 36 UK obstetric units. They had h...
NIHR Signal Fewer large babies are born to pregnant woman with type 1 diabetes if their glucose was monitored continuously
Pregnant women with type 1 diabetes who used a continuous glucose monitoring system were half as likely to have a large baby compared with those using standard finger prick blood glucose measurements. Only 15% of infants needed intensive care admissions due to low blood glucose in the continuous glucose monitoring group, compared with 28% born to mothers in the standard finger prick control group. Pregnant women using continuous monitoring spent 7% more time in the target glucose range than tho...
NIHR Signal Placing wet gauze on babies’ tummies speeds up urine collection
Almost a third of infants managed to urinate within five minutes after a painless, cheap technique that stimulates the skin, compared with 12% of infants observed only, as is standard practice. The ‘Quick-Wee’ method involved rubbing the babies’ abdomens gently with gauze soaked in cold saline before collecting urine. This trial was carried out with 354 babies aged one to 11 months in one Australian paediatrics emergency room. NICE guidelines recommend non-invasive ‘cle...
NIHR Signal Blood test and ECG may safely rule out heart attack
A high sensitivity troponin test accurately ruled out a heart attack amongst a third of patients presenting to the emergency department with chest pain. A patient with no detectable troponin and normal electrocardiogram was almost certain not to have had a heart attack. Many people come to hospital with chest pain, but more than 75% of them have not had a heart attack. The two tests accurately ruled out heart attack in 30% of all chest pain presentations, but more than a third of people who did...
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