New insights into living with inflammatory bowel disease
Living with inflammatory bowel disease as a `hidden’ condition can lead to feelings of isolation and exclusion. These experiences are characterised by exhaustion, feelings of damaged body image, loss of control and living with the fear of complications.
The condition can be unpredictable and have a profound impact on quality of life, disrupting social relationships and interactions with the outside world. The ongoing emotional and psychological difficulties caused by this chronic, long te...
Stool test is useful before GPs refer for possible inflammatory bowel disease
A stool test by GPs has been shown to support referral decisions for young adults, not suspected of cancer, to investigate possible inflammatory bowel disease (IBD - which includes Crohn’s Disease and Ulcerative Colitis). This study supports current NICE guidelines that the calprotectin stool test can usefully inform patient referral pathways and reduce unnecessary invasive tests such as colonoscopy.
High levels of faecal calprotectin are associated with gut inflammation, as occurs in IBD...
Adding emollients to the bath unlikely to help children with eczema
Adding emollients to children’s bath water does not significantly improve their eczema. Prescriptions should focus on emollients applied directly to the skin or used as a soap substitute.
Using emollients to lock in moisture is the standard treatment for childhood eczema. These can be applied in a number of ways, but there is uncertainty surrounding their use as a bath additive.
This NIHR-funded year-long trial included 482 children, mostly with mild eczema. It found there was little cha...
Calcium channel blockers are useful in managing Raynaud’s phenomenon
Calcium channel blockers, such as nifedipine, are confirmed as useful in reducing the frequency, duration, severity of attacks, pain and disability associated with Raynaud’s phenomenon. People had two to six fewer attacks per week on average with treatment, and 13 without. Raynaud’s is a disorder which reduces blood flow to the fingers and toes as a result of the blood vessels tightening and going into spasm in the cold.
This updated review suggested that calcium channel blockers ma...
Early use of tranexamic acid reduces bleeding more effectively
In people bleeding after trauma or giving birth, tranexamic acid within an hour of the start of bleeding increases the chances of survival by 72% compared with a placebo. Overall the trial data showed that at least six deaths from bleeding complications were prevented for every 1,000 people treated and potentially more if treatment is started early.
Tranexamic acid is an antifibrinolytic drug which reduces the breakdown of blood clots and is known to reduce serious bleeding. The researchers wan...
Stopping biological drugs for rheumatoid arthritis can lead to twice the relapse rate
It seems safer to reduce the dose of biological drugs, rather than to stop them if people with rheumatoid arthritis and their doctors want to avoid relapse. Stopping these powerful drugs caused the disease to recur in 58% of people compared with 29% who continued them. Reducing the dose also led to more relapses for people in remission, but did not cause those with low-grade disease activity to worsen.
Rheumatoid arthritis is a chronic disease which causes pain, swelling and stiffness in the sm...
Exercise improves symptoms and function for people with ankylosing spondylitis
People with ankylosing spondylitis showed improvement in their symptoms and their ability to perform day-to-day tasks when they did more exercise. Symptom and function scores improved by almost one point on a 10-point scale after 3 to 12 weeks of exercise.
Ankylosing spondylitis is a type of arthritis which mainly affects the spine, causing pain, stiffness and progressive fusion of the spine. There have been recent advances in pharmacological treatment, and it was uncertain whether exercise alo...
Individual support of nurses using electronic medicine monitors can improve HIV treatment
Use of electronic pill bottles that record when they are opened and follow-up discussion of the printed readouts with nurses improved HIV outcomes. It is thought that patients became more reliable in taking the medication, which can have complicated scheduling. Overall, the HIV virus in the blood and the risk of treatment failure were lower in the group of patients who had access to this intervention compared to regular care.
In addition to being more effective, the programme also reduced the e...
Silk clothing for children does not reduce objective measures of eczema severity
Six months of wearing special silk clothing had no effect on objective measures of child eczema severity, infection rates or medication use. Children and carers reported some small improvements in eczema severity on two scales but their awareness of the clothing worn by their child may have slightly influenced their judgment. Overall quality of life did not significantly improve.
Specialist silk clothing is currently available on NHS prescription, but prior to this trial there was limited evide...
The heart failure drug levosimendan doesn’t improve outcomes in adults with severe infections
Septic shock is a life-threatening condition resulting from serious infection.
Adding levosimendan to the usual care of adults with septic shock did not reduce the risk of death up to 28 days, nor the degree of damage to essential body organs. It probably also increased patients’ risk of abnormally fast heart rate and increased the time they needed mechanical ventilation.
This large NIHR-supported trial included adults in UK intensive care units. It is the largest to date and presents th...