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NIHR Signal Enhanced recovery programmes after stomach cancer surgery reduce hospital stay without increasing complications
Enhanced recovery programmes reduce length of hospital stay and associated healthcare costs after stomach cancer surgery, with no impact on short-term mortality or post-operative complications. They also improvepost-operative quality of life. The enhanced recovery approach includes a range of components designed to help people to recover more quickly and have better outcomes after surgery. These include optimising people's health preoperatively, attention to detail during anaesthesia and su...
NIHR Signal Gallbladder surgery through a single-incision is more risky than a multiple incision technique
Single-incision keyhole gallbladder removal surgery carries increased risk of adverse events, such as puncturing the gallbladder, compared with the more standard multiple-incision procedures. However, in experienced hands, there may be benefits such as reduced pain and less scarring after the operation. Current guidance recognises that using a single incision for laparoscopic cholecystectomy is more complex than using multiple incisions. The risks and benefits of all options available for pat...
NIHR Signal Fewer side-effects and similar benefits from shorter chemotherapy after bowel cancer surgery
A three-month course of chemotherapy after surgery for bowel cancer seems no less effective than the standard six-month course, and half as many people suffered from nerve damage as a side-effect. Three-quarters of people survived to three years without disease progression on either treatment. This international trial, part funded by the NIHR, included over 6,000 people with high-risk stage II or III bowel cancer that had spread through the bowel wall or to nearby lymph nodes. Standard treatmen...
NIHR Signal Mesh repair of small umbilical hernias reduces recurrence compared to sutures
Repairing small umbilical hernias with surgical mesh rather than sutures reduces the chance of the hernia returning. Complications such as wound infection and pain are not affected by the type of repair. Adults with umbilical hernias need surgery to prevent serious bowel complications. There are no guidelines about how to best to treat them. In practice, larger hernias tend to be repaired with mesh, while smaller ones are repaired with sutures. This trial of adults with umbilical hernias of 1 t...
NIHR Signal Probiotics can prevent bacterial diarrhoea in hospital patients receiving antibiotics
Giving probiotics to people taking antibiotics reduces the chance of them developing diarrhoea caused by Clostridium difficile (C. difficile) bacteria by 60%. One case of Clostridium-associated diarrhoea was prevented for every 42 people receiving probiotics. They appear to work best for patients at more than 5% risk of Clostridium infection. When antibiotics disturb healthy gut bacteria, Clostridium bacteria may multiply to toxic levels, causing diarrhoea and serious intestinal complications. ...
NIHR Signal Swimming in seawater is linked with an increased chance of some illnesses
People who swim in seawater have almost double the odds of experiencingillness than people who avoid it. The specific illnesses linked to seawater exposure are ear and gastrointestinal illnesses, but the exact or absolute rates of infection are not available. Many people enjoy coastal waters for sport and recreation, and it's important that they can access relevant risk information. This is the first systematic review to look at infection risk from swimming in seawater. It gathered data fro...
NIHR Signal Inhaled anaesthesia with anti-sickness medication in children has the same risk of vomiting as intravenous anaesthesia
Post-operative vomiting is common in children. One strategy is to use an intravenous anaesthetic, which is known to cause lower rates of sickness than inhaled anaesthetics. There are disadvantages to this though, such as the need for injections before a child is asleep, slowing of the heart and difficulty in monitoring depth of the anaesthetic. This review of four trials included 558 children who had an operation to correct a squint. A third of children in each anaesthetic group had post-operat...
NIHR Signal Low FODMAP diet may improve irritable bowel symptoms more than other diets
Adults with irritable bowel syndrome (IBS) who followed a low FODMAP diet had fewer symptoms than those who followed standard dietary advice. They scored their symptoms about 50 points better on a 500 point scale. The low FODMAP diet is an emerging approach for IBS. It is based on the theory that certain carbohydrates can expand or ferment in the gut and cause symptoms for some people. This review included five randomised trials in adults who rated their symptoms before and after introducing t...
NIHR Signal Faecal transplant effectively treats recurrent or unresponsive Clostridium difficile
Using a faecal microbiota transplant cured 92% of people with Clostridium difficile that had recurred or had not responded to antibiotics. Faecal transplant also had a lower risk of treatment failure than the antibiotic vancomycin. C. difficile is a potentially serious infection of the gut that can occur after a course of antibiotics unbalances the gut bacteria. Faecal transplant uses the diluted faeces of a healthy person delivered into the guts of the person with C. difficile to rebalance the...
NIHR Signal Talking therapy may relieve high levels of anxiety about health conditions
A specific talking therapy called ‘cognitive behavioural therapy for health anxiety’ may help people who are excessively worried about their health. Health anxiety reduced by a small, but meaningful amount, among the medical outpatients who were identified and treated. Delivered in one-hour sessions every two weeks, therapy lasted about four months. It was provided by junior therapists and trained nurses with no previous experience of the therapy. Benefits lasted for about five year...
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