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NIHR Signal Adrenaline can restart the heart but is no good for the brain
Treating cardiac arrests with adrenaline during resuscitation by paramedics slightly increases survival compared with placebo. Though adrenaline initially helped restore circulation in a third of cases, 3.2% of people survived to 30 days compared to 2.4% of people in the placebo group. Severe brain damage was nearly twice as likely in those who survived after adrenaline injections. Cardiac arrest occurs when the heart no longer pumps blood around the body, usually due to an irregular heart rhyt...
NIHR Signal Lorazepam confirmed as first-line treatment for stopping prolonged seizures in children
Intravenous lorazepam is as effective as intravenous diazepam for stopping children’s tonic-clonic seizures in hospital. Lorazepam also results in fewer breathing problems than diazepam. Giving antiepileptic drugs intravenously generally stops seizures more quickly than giving the drugs buccally (in the cheek), intranasally (in the nose) or rectally. However, this effect can be cancelled out if administering the drug into the veins takes too long. Two of the 18 included trials were carrie...
NIHR Signal Hypertonic saline as effective as normal saline for trauma patients
Solutions more concentrated than normal, such as hypertonic saline, are as good as those more usually given to trauma patients with severe blood loss. Survival to hospital discharge was the same in patients treated before arrival at the hospital with either type of fluid. There are around 20,000 cases of major trauma per year in England. Outcomes for patients have improved in the UK over the last 25 years, but as there is still room for improvement this review sought to find evidence that suppo...
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 Introducing a primary care risk prediction tool did not reduce emergency admissions
Predicting emergency admissions paradoxically increased hospital admissions from primary care across all risk groups by about 3% overall. The Predictive Risk Stratification Model (PRISM) was evaluated in a trial in general practices in Wales, and there is little evidence it benefits patients by reducing deaths or improving quality of life either. The number of people living to older age with chronic health conditions is growing. Various risk stratification tools have been introduced across the...
NIHR Signal A frailty checklist was completed in only a quarter of older people at hospital admission
Frailsafe is a simple safety checklist offering the opportunity to improve safety and quality of care for frail older people while in hospital. It aims to increase key clinical assessments or practices on things like risk of falls, mobility and delirium, and to facilitate communication between staff. However, the relatively low completion rate highlights the need to understand how this approach can be better embedded in the complex care that is typical of services provided for older people. Com...
NIHR Signal Quality improvement collaboratives can improve clinical processes and patient outcomes
Quality improvement collaboratives (QICs) were largely effective across a wide range of healthcare problems and settings. Of the 64 studies included in this systematic review, 53 showed improvement in some of the healthcare processes and patient outcomes that they investigated. A small number of studies also showed that collaboratives were cost-effective, and the improvements were sustainable for at least six months. Collaboratives originated in the US in the late 1980s. They provide opportunit...
NIHR Signal Study raises questions about NHS “weekend effect”
The increased mortality observed if patients are taken to hospitals at weekends also affects night admissions and can be explained in part by the severity of illness. Five linked NIHR-funded studies reviewed mortality and time and day of admission to hospital, largely using routine England-wide data. Fewer people are admitted from A&E at the weekend. Admission is more likely if they have arrived by ambulance or been referred directly for admission from community services. Though death rate...
NIHR Signal Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently
Older people who received comprehensive geriatric assessment when in hospital were slightly more likely to be living in their own homes one year later. Sixty percent were discharged to independent living compared with 56% receiving standard ward care. People who had received this proper assessment were also 20% less likely to be in a nursing home after three months or more. Older people often have multiple complex conditions combined with frailty and are more likely to lose independence after i...
NIHR Signal Use of a facemask ventilator can reduce deaths in severe flare-ups of COPD
People admitted to hospital with a severe exacerbation of chronic obstructive pulmonary disease (COPD) were 46% less likely to die if they received non-invasive ventilation. Only 12% of those receiving non-invasive ventilation needed subsequent invasive ventilation via a tube, compared to 34% of those who had usual care. This review identified 17 trials of adults with a severe acute exacerbation of COPD with high carbon dioxide levels. Trials compared usual care, including steroids and antibiot...
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