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NIHR Signal Fewer infections with antibiotic-impregnated shunts for hydrocephalus
Antibiotic-impregnated shunt catheters led to fewer infections than standard catheters in this study, although the overall rate of shunt revision remained about the same. In hydrocephalus, a shunt is a device consisting in part of a long catheter (a tube) that relieves the raised pressure of fluid in the ventricles of the brain. It is inserted internally and works by simply draining the fluid, most commonly, to the abdomen. These shunts may need revision because of infection or mechanical failu...
NIHR Signal ‘As-needed’ combination asthma inhalers can be more effective than regular inhaled steroids
In adults with mild to moderate asthma, budesonide-formoterol used as needed for symptom relief was more effective at preventing severe exacerbations than maintenance low-dose budesonide plus as-needed terbutaline. In this trial involving 885 adults, those using the combination inhaler as required had fewer severe asthma attacks, with similar levels of general symptom control, and overall used a lower dose of corticosteroid. The results of this trial suggest that for people with mild asthma, ex...
NIHR Signal Continuing an anticoagulant at home after abdominal surgery cuts thrombosis risk
Continuing to take low molecular weight heparin for two to four weeks after major abdominal surgery significantly reduces the risk of developing a dangerous blood clot. A review of seven studies, mainly in cancer surgery, has found that 13% of patients who received anticoagulant treatment only during their hospital stay developed a clot in the deep veins or lungs, compared with 5% of those who continued with the treatment beyond discharge. There was no increased risk of bleeding complications w...
NIHR Signal Taking blood pressure medications at night seems best
People who took their blood pressure medications at bedtime were 45% less likely to experience a major cardiovascular outcome, such as heart attack or stroke, compared with people who took them in the morning. Most blood pressure medications, diuretics aside, do not have a recommended time of administration. A large trial conducted across 40 general practices in Northern Spain assigned 19,084 adults to take their blood pressure medications either in the morning or at night. Over an average of s...
NIHR Signal A patch or eye drops are similarly effective for the treatment of “lazy eye” in children
Both the use of a patch or atropine eye drops are equally suitable methods for improving clarity of vision (visual acuity) in children and young adults with amblyopia (a “lazy eye”). Amblyopia is a cause of poor vision in childhood that usually affects only one eye, resulting in the individual relying more on the good eye. The standard methods of treatment involve training the weaker eye and promoting its use by covering the strong eye with a patch, or eye drops to blur the vision i...
NIHR Signal Combined drug therapy for at least 36 weeks reduces relapse after psychotic depression
Patients with psychotic depression who achieve remission benefit from continuing the antipsychotic drug olanzapine, alongside the antidepressant sertraline for at least a further four months, a North American trial has found. Patients who reduced and stopped olanzapine when their condition stabilised were more than twice as likely to relapse when compared with those who continued combined drug therapy. The majority of relapses occurred within two months of withdrawing olanzapine. This was a ra...
NIHR Signal Patients, in theory, might prefer GP-led care to self-management for high blood pressure
Patients offered the pros and cons of different monitoring options appear reluctant to self-manage high blood pressure, and prefer frequent monitoring by a GP, pharmacist or via telehealth (where readings are sent to health professionals and medicines managed remotely). The small online survey, completed by 167 patients, was used to explore how patients might feel about moving away from GP-led care to other care models not currently routinely offered in the UK. Perhaps surprisingly, patients, i...
NIHR Signal Boosting omega-3 fatty acid intake is unlikely to prevent type 2 diabetes
Increasing the intake of polyunsaturated fats in the diet with supplements of omega-3 fatty acids, for example, is unlikely to affect people’s risk of developing type 2 diabetes. However, this review only looked at the effect of supplements on diabetes, not wider health. This large systematic review included 83 long-term trials comparing higher and lower intake of omega-3 and omega-6 fatty acids and total polyunsaturated fats in healthy adults and those with existing diabetes. It found no...
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 Significant risk of another thrombosis remains if anticoagulation is stopped
Unprovoked venous thromboembolism (VTE), including deep vein thrombosis in the leg and pulmonary embolism, are clots within veins that occur spontaneously in people without risk factors and are treated with anticoagulant drugs. If those drugs are stopped after three months or more, the risk of another clot appears to be on average 10% in the first year, 16% by two years, 25% by five years and 36% by 10 years. This systematic review and meta-analysis of 18 studies included a total of 7,515 patie...
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