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NIHR Signal Herpes zoster vaccine reduces chances of shingles after stem cell transplants
A non-live vaccine against herpes zoster provides good, though partial protection for adults undergoing autologous (using the patient’s own) stem cell transplant for treatment of blood cancers. These people cannot use the usual live vaccine, because of their suppressed immune system. An industry-funded trial of the vaccine involved 1,846 patients from 28 countries, including the UK. Two doses of the vaccine resulted in a 68% reduction in cases of shingles over 21 months of follow-up. Shin...
NIHR Signal Four-drug treatment for HIV offers no benefit over standard three-drug treatment
Quadruple drug therapy for people starting HIV treatment offers no benefit over the currently recommended triple therapy. Antiretroviral (anti-HIV) therapy is highly effective, with almost all treated individuals in the UK surviving as long as non-infected people. The courses now available mean those treated are usually unable to pass on the virus. There are several classes of treatment and individual drugs which can be used in various combinations. The British HIV Association currently recomme...
NIHR Signal Antiretroviral treatment can reduce the risk of HIV transmission between male partners to ‘zero’
The risk of transmission of HIV between gay couples when the HIV-positive partner is taking antiretroviral treatment that successfully suppresses the viral load is ‘effectively zero.’ A study of men from 14 European countries, including the UK, found no cases of transmission of HIV from an HIV-positive partner taking antiretroviral therapy to an HIV-negative partner, as long as the viral load of the HIV-positive partner remained undetectable or very low. The study recorded an avera...
NIHR Signal Iron deficiency in people with chronic kidney disease can be managed with either oral or IV therapy
For people with chronic kidney disease who are also iron deficient, intravenous iron improves haemoglobin levels and iron stores faster than oral iron. However, the evidence is inconclusive about whether it influences survival, cardiovascular death, or quality of life. Adverse effects and such as allergic reactions or gastrointestinal side effects and other practicalities are likely to determine the choice of a route of administration. Chronic kidney disease is a long-term condition categorised...
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...
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