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NIHR Signal Length of steroid course for childhood nephrotic syndrome makes little difference to later recurrences
For children with a first presentation of nephrotic syndrome, an extended sixteen-week treatment regimen with prednisolone does not reduce the risk of relapse compared with the standard eight-week course. Most children will experience a relapse with either regimen, but the longer course may delay it by a month or so which may, in turn, reduce the resource use, such as emergency department visits, shorter admissions and less need to see the GP. This can also make the longer course cheaper overall...
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 Adding behavioural support to drug treatment helps more people quit smoking
Among people using drug treatment to stop smoking, adding telephone or face-to-face behavioural support boosts their chances of success. Adding support increases the proportion of people quitting from around 17% on average to about 20%. This is a small but worthwhile increase given the health risks associated with smoking. These were the findings of an updated Cochrane review, which included 83 studies. All 29,536 participants were using nicotine replacement therapy or another drug to help them...
NIHR Signal On balance, antiplatelet drugs may be restarted for stroke survivors who have bled into the brain
Early research suggests that antiplatelet drugs, such as aspirin, can provide more benefit than harm if restarted at about 2 to 3 months after a brain bleed. The results seem to apply best to those patients with a good prognosis who survive with less disability. Antiplatelet drugs are of proven benefit to those with a high risk of vascular events; they reduce the risk of heart attacks and strokes because they prevent platelets from clumping together. However, after a type of a stroke caused by ...
NIHR Signal Mucus-thinning drugs slightly reduce COPD symptom flare-ups
People with chronic obstructive pulmonary disease (COPD) have a slightly reduced risk of having a flare-up of symptoms if they take mucolytic drugs. The number of days on which they are too ill to perform their normal activities is also slightly reduced, from 1.57 days to 1.14 days per month. A review of placebo-controlled trials, including 10,377 people taking a variety of mucolytic drugs, for between two months to three years, found improvements in exacerbations, days of disability, and hospi...
NIHR Signal Antibiotics reduce complications after assisted vaginal delivery
Preventative antibiotics halve the risk of infection for women who have assisted vaginal delivery using forceps or suction-cup devices. About 10% of women receiving antibiotics develop an infection within six weeks of delivery compared with 20% of women who receive a placebo. Antibiotics are not routinely recommended for women undergoing assisted delivery as there hasn’t been enough evidence that they reduce maternal infection rates. This large NIHR-funded trial, including almost 3,500 wo...
NIHR Signal Levetiracetam is a useful alternative to phenytoin in stopping prolonged epileptic seizures in children
Levetiracetam is as effective as phenytoin at stopping prolonged epileptic seizures in children. In this trial, levetiracetam stopped 70% of children convulsing compared with 64% for phenytoin within 35 to 45 minutes. Adverse events were similar. This combined with the fact levetiracetam may be easier to administer safely make it an important option. Most epileptic seizures stop by themselves within a few minutes, but sometimes they continue for much longer. If this happens emergency treatment ...
NIHR Signal Routine use of progesterone does not prevent miscarriage
Progesterone did not affect the chance of live birth among women presenting with vaginal bleeding in the first 12 weeks of pregnancy. Live birth rates were 72% with placebo and 75% with progesterone, which is not a clinically or statistically important difference. Progesterone has been prescribed for threatened miscarriage in some centres since the 1950s, but there has been poor evidence for its use. NICE recently highlighted this as a priority area for research asking for large, robust trials ...
NIHR Signal Using both nicotine patches and gum together improves the chances of quitting smoking
Using a nicotine patch together with a fast-acting type of nicotine replacement therapy (NRT) such as gum or lozenges improves smoking cessation rates compared to using only a single type of NRT. Higher-dose nicotine patches are also more effective than lower dose ones, this NIHR-funded review suggests. A previous Cochrane systematic review found that NRT boosts people’s chances of successfully quitting smoking compared to none, but it was unclear which types, doses and schedules were mos...
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...
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