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NIHR Signal Oral steroids do not help hearing for children with glue ear
Oral steroids do not improve hearing, symptoms, or quality of life in children with glue ear. This NIHR-funded trial compared oral steroids with placebo for 389 children with glue ear, also called otitis media with effusion, and found no significant effect on those outcomes. Glue ear is when the middle ear fills with fluid, often following an ear or respiratory infection. The fluid makes hearing more difficult. It usually resolves within three months without treatment, but if it lasts longer, t...
NIHR Signal ‘Artificial pancreas’ improves glucose control in hospital patients with type 2 diabetes
Closed-loop insulin pumps, which continuously monitor blood glucose and administer insulin accordingly, can improve blood glucose control among patients with type 2 diabetes admitted to hospital for non-critical care. Those using the system spent about six hours longer in the target range, and this could hasten their recovery and reduce staff workload. The number of hospitalised patients with type 2 diabetes is increasing. Glucose control often worsens during illness. Closed-loop pumps have bee...
NIHR Signal Sodium thiosulfate reduces hearing loss in children treated with chemotherapy
Treatment with sodium thiosulfate alongside cisplatin chemotherapy can reduce hearing loss in children with a liver tumour called hepatoblastoma. The risk of hearing loss was reduced by 48% in children who had the combination treatment compared with those who had cisplatin only. This phase 3 trial involved 109 children with standard-risk hepatoblastoma and tested the addition of sodium thiosulfate six hours after cisplatin treatment. The additional drug caused few major side effects, and there ...
NIHR Signal Methylphenidate remains first-choice drug treatment for children and young people with ADHD
The stimulant methylphenidate has the best balance of effectiveness against side effects in children and young people with attention deficit hyperactivity disorder. Amphetamines are more effective, but also more likely to be stopped for a reason other than side effects. This large, NIHR-funded systematic review compared a range of drugs against each other through a network meta-analysis. Effectiveness and tolerability were assessed at about 12 weeks of treatment. Other second-line drug treatmen...
NIHR Signal Tools for GPs can help reduce unnecessary antibiotic prescribing
Interventions to reduce inappropriate antibiotic prescribing for upper respiratory tract infections are most effective when they provide a negotiation tool to support patient interaction. These interventions are more likely to be rejected if they are perceived as interfering with individual clinical judgment or damaging patient relationships. Upper respiratory tract infections often resolve themselves within a few days, without the need for antibiotics, yet antibiotics are often prescribed. Thi...
NIHR Signal Amphetamines probably the best first-choice treatment for adults with ADHD
There is further evidence to support the amphetamines as the most effective group of drugs for treating adults with attention deficit hyperactivity disorder in the short-term. Two of these drugs were shown to provide the most improvement in core symptoms of attention deficit hyperactivity disorder, are tolerated as well as any other drug treatment and are less likely to be stopped. The review did not identify data to determine whether amphetamines should continue to be used for longer than 12 ...
NIHR Signal Albumin administrations can prolong survival for some people with liver disease
Weekly intravenous albumin can prolong the life for people with liver cirrhosis and uncomplicated ascites. Over about 18 months, 17% of patients given albumin died compared with 22% given standard care alone over 11 months. People with very severe (end-stage) cirrhosis develop various complications including a build-up of fluid in the abdomen (ascites). This is the first large trial to study the effects of long-term albumin infusions. In addition to improved survival, albumin also reduced hosp...
NIHR Signal The blood-thinner apixaban is less likely to cause major bleeding than warfarin
People who take apixaban to prevent blood clots are less likely to suffer major bleeding complications than those taking warfarin. Findings are similar in different groups of people, such as those with irregular heart rhythm (atrial fibrillation) and those who have had joint replacement surgery. Warfarin has long been used as an anticoagulant but needs frequent blood test monitoring. The new class of direct-acting oral anticoagulants does not usually need monitoring and is replacing warfarin. ...
NIHR Signal Financial incentives may help workers quit smoking
Financial incentives, when given alongside free smoking cessation aids, improved abstinence rates compared with free cessation aids or motivational information alone. This workplace-based US trial assigned 6,000 smokers, unselected for willingness to quit, to information only, free e-cigarettes, free nicotine replacement or drug therapy, or free cessation aids with a $600 reward in one of two ways. Quit rates at six months were very low though the substantial financial incentive increased the r...
NIHR Signal No benefit from monitoring antiepileptic drug levels in pregnancy
Regular monitoring of antiepileptic drug levels in pregnant women with epilepsy does not improve seizure control compared with clinical features-based monitoring. This NIHR-funded study was conducted across 50 UK hospitals and is the largest randomised trial in pregnant women with epilepsy. Just over 260 pregnant women with unstable antiepileptic drug levels were assigned to ongoing monthly blood checks or clinical features monitoring. There were no differences in seizures or other pregnancy ou...
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