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NIHR Signal New strategies for maintaining blood supplies from donations may be cost-effective
Opening blood donation centres on weekday evenings and at weekends is a cost-effective way of increasing the blood supply used by hospitals in the UK. Allowing donors to give blood more often could increase supplies in the short term, but it isn’t clear if it would be cost-effective in the long-term. This NIHR-funded modelling study used data from a recent large randomised trial in the UK that investigated the safety of donating blood more frequently than current guidance allows. This was...
NIHR Signal Premature babies have fewer complications if a lower platelet count is accepted
Fewer premature babies die or have major bleeding if platelet transfusions are withheld until platelet numbers drop to a lower level. At 28 days, death or new major bleeding occurred in 19% of neonates transfused when they had less than 25,000/mm3 platelets compared to 26% of neonates transfused when they had less than 50,000/mm3 platelets. This trial included 660 premature babies with low platelet counts. The results suggest that in the absence of actual bleeding, platelet transfusions may be...
NIHR Signal 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...
NIHR Signal 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...
NIHR Signal 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...
NIHR Signal 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...
NIHR Signal 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...
NIHR Signal 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...
NIHR Signal 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...
NIHR Signal 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...
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