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NIHR Signal Partial knee replacement ‘could be first choice’ for suitable patients with osteoarthritis
Partial knee replacement surgery improves pain and function similarly tototal knee replacement in people with osteoarthritis that affects only a single compartment of the knee. Partial knee replacement surgery is also cheaper. In this NIHR-funded trial of 528 people with osteoarthritis affecting only one compartment of the knee, those who had partial knee replacement saw at least as much improvement as those who had a total joint replacement. Their care also cost about £900 less over five...
NIHR Signal Better strategies are needed to reduce preventable patient harm in healthcare
About 6% of patients in healthcare settings internationally experience harm that could have been prevented. Around one in eight of these cases result in severe harm, causing permanent disability or death. Drug errors, therapeutic management incidents and incidents involving invasive clinical procedures are the most common causes of preventable patient harm. Higher rates of harm were seen in intensive care and surgical departments than in general hospital settings. This NIHR-funded review poole...
NIHR Signal ‘Last resort’ antipsychotic remains the gold standard for treatment-resistant schizophrenia
Among patients with schizophrenia that has not responded to other drugs, the antipsychotic drug clozapine cuts the chances of hospital admissions and drugdiscontinuation. Recent trials have questioned the superior efficacy of clozapine compared with other standard antipsychotic drugs. However, a review of real-world data from observational studies confirms its place as a drug that may work when others fail. Patients prescribed clozapine had better outcomes, despite having more severe illness. ...
NIHR Signal C-reactive protein testing in general practice safely reduces antibiotic use for COPD flare-ups
Use of a rapid C-reactive protein (CRP) blood test in general practice for people with a flare-up of COPD reduces the proportion who take antibiotics over the next month by about 20 percentage points compared with usual care alone. The reduction in antibiotic use does not lead to worse health, more visits to the doctor or greater need for antibiotics later on. Flare-ups of COPD can be caused by infections of the airways or environmental triggers, and cause about 115,000 admissions to hospital e...
NIHR Signal Diagnosis of delirium in hospitals can be improved by the 4 A’s test
A new shorter test for delirium appears helpful in assessing older people in hospital who may have the condition. A normal score on the 4 A’s test effectively rules out delirium while an abnormal score is reasonably useful for detecting the condition. People detected by the test would still need a full assessment to confirm the diagnosis. Delirium is common in older people who have been hospitalised, but it can go undiagnosed. To help combat this, the 4 A’s test was developed as an ...
NIHR Signal Text message reminders increase attendance at NHS health checks
Sending text messages reminding people to book their NHS health check following their invitation letter increases attendance. There is little evidence to support pre-notification text messages telling people an invitation would soon be sent. NHS health checks are offered to adults aged 40 to 74 years. Identification and management of cardiovascular risk factors has been shown to save lives. Yet only half of adults attend a check when it is offered. This trial conducted across general practices ...
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 Closer links between police and health services can improve experiences for people in mental health crisis
Tighter working partnerships between health professionals and police services are likely to improve the care of people who come into contact with police during mental health crises. People experiencing severe mental health episodes can present with extreme and unpredictable behaviour posing a danger to themselves and members of the public. Police are often the first to respond in these challenging situations. New models are emerging of mental health staff working with police. This NIHR-funded ...
NIHR Signal Packages of care interventions ‘not effective’ to reduce repeat admissions for COPD
Care bundles for COPD are difficult to implement, and their introduction in NHS hospitals does not reduce repeat admissions, deaths or use of resources when used on or after admission. Care bundles are packages of interventions which, in other situations, can improve care. COPD care bundles include: checking inhaler technique and medication use providing a written plan for COPD management and supply of emergency medicines assessing willingness to stop smoking assessing suitability for pul...
NIHR Signal Physician associates appear to make a positive contribution to inpatient care
Physician associates improve continuity of care and patient experience within the hospital setting. This first evaluation of the new role in the NHS suggests they could provide safe and equivalent care on defined tasks, freeing up time for doctors, and help with patient flow. However, some say that the actual and perceived potential is being held back by a lack of professional statutory regulation and the ability to prescribe. The number of physician associates trained in some of the tasks done...
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