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NIHR Signal Alternative sedative reduces the risk of acute kidney injury following cardiac surgery
The sedative drug dexmedetomidine can reduce the risk of acute kidney injury when given during non-emergency cardiac surgery. Trial participants who received dexmedetomidine were a third less likely to develop acute kidney injury than those receiving placebo or other treatments. There was no difference in mortality or length of hospital stay. This systematic review identified 10 studies of 1,575 participants. Surgical procedures included coronary artery bypass grafting with or without valve sur...
NIHR Signal One week of steroids may be as effective as two weeks in managing severe COPD
A shorter course of steroids lasting 3 to 7 days appears as effective as the recommended 7 to 14-day standard treatment for managing a flare-up of severe chronic obstructive pulmonary disease. This update to an earlier Cochrane review looked at randomised clinical trials comparing a short course (7 days or fewer) with a longer course (7 to 14 days) of steroids given by mouth or injection. All participants had been admitted to hospital, but none required mechanical ventilation. The evidence sug...
NIHR Signal Self-monitoring improves control of high blood pressure compared with GP monitoring alone
Allowing patients who have inadequately controlled high blood pressure to monitor their own blood pressure at home helps their GPs to optimise their management. Patients who self-monitor and visit or talk to their GP when needed for medication adjustments achieve 4mmHg lower systolic blood pressure over 12 months compared with those relying only on the measurements made by a GP without self-monitoring. Effects are similar if patients write down their measurements to send to the GP or do so via ...
NIHR Signal Opioid drugs are no better than standard painkillers for long-term back and joint pain
People with long-term back pain, or osteoarthritis of their hips or knees, do not get better pain relief from opioid drugs and are more likely to get side effects than those who take paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), like naproxen or ibuprofen. A US study assigned 240 patients to either opioid or non-opioid pain relief drugs and measured their pain over 12 months. Those who were assigned opioid drugs had less relief of their pain and also were more likely to have si...
NIHR Signal Oral ibuprofen may be an option for closing patent ductus arteriosus in premature babies
A high dose of oral ibuprofen was more likely to close a patent ductus arteriosus in premature babies when compared with standard doses of intravenous ibuprofen or indometacin. Before birth, a baby's lungs aren't needed for breathing. Most blood bypasses the lungs through a large vessel called the ductus arteriosus directly from the pulmonary artery into the aorta to supply the main circulation. Once born, blood flows through the lungs, and the ductus arteriosus usually closes in the fi...
NIHR Signal Cannabis derivative may reduce seizures in some severe drug-resistant epilepsies, but adverse events increase
In people with some types of severe, drug-resistant epilepsy, adding cannabidiol to their treatment may reduce seizure frequency and improve quality of life compared with a placebo. The likelihood of being free from seizures for more than a year was still low, about 8%. However, an additional 12% of people had serious adverse effects with cannabidiol. These findings come from a systematic review, which included six trials in 555 patients. Most were children and adolescents with rare forms of ep...
NIHR Signal Balanced electrolyte solutions give marginal benefit over saline for very ill patients
About 14% of critically ill patients receiving electrolyte-balanced crystalloids either developed kidney failure, needed kidney-replacement therapy or died compared with 15% receiving normal saline. This small but statistically significant benefit was only apparent when combining outcomes; there was no difference between fluids for the three individual outcomes analysed separately. A solution of 0.9% sodium chloride (normal saline) is the most commonly used intravenous (IV) fluid, but it can ca...
NIHR Signal Fewer side-effects and similar benefits from shorter chemotherapy after bowel cancer surgery
A three-month course of chemotherapy after surgery for bowel cancer seems no less effective than the standard six-month course, and half as many people suffered from nerve damage as a side-effect. Three-quarters of people survived to three years without disease progression on either treatment. This international trial, part funded by the NIHR, included over 6,000 people with high-risk stage II or III bowel cancer that had spread through the bowel wall or to nearby lymph nodes. Standard treatmen...
NIHR Signal Aspirin may be a follow-on option to prevent blood clots, starting five days after hip or knee surgery
In a recent trial, switching to low-dose aspirin was just as effective at preventing blood clots after joint replacement surgery as continuing the anti-clotting drug rivaroxaban. Six per 1,000 people taking aspirin experienced a blood clot, compared with seven per 1,000 taking rivaroxaban. Three to five per 1,000 patients experienced major bleeding with either drug. Rivaroxaban or similar drugs are usually prescribed for two or five weeks after knee or hip surgery, respectively, to reduce the r...
NIHR Signal Prescribing anti-inflammatories for urine infection reduces antibiotic use but increases complication risk
Urinary tract infection symptoms resolved by three days for 80% of women given antibiotics compared with 54% given anti-inflammatories. Anti-inflammatories reduced antibiotic use, but 5% of women developed more severe infection of the kidneys. Urinary infections are the second most common reason for prescribing antibiotics in general practice, after respiratory infection. As such, this use may be contributing to increasing antibiotic resistance. This Swiss trial provided an important head-to-h...
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