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NIHR Signal Group cognitive behavioural courses may reduce fatigue from rheumatoid arthritis
Fatigue can be one of the most difficult symptoms to cope with for people with rheumatoid arthritis and this study found that group cognitive behavioural courses may help. This NIHR-funded study compared six weekly group sessions plus a booster session with a single brief one-to-one meeting. Both groups also received an educational booklet. It took place in seven UK hospitals and was co-delivered by pairs of trained rheumatology nurses and occupational therapists. The group sessions caused a s...
NIHR Signal Voucher rewards do not reduce frequency of cannabis use or relapse in people with early psychosis
Contingency management - the use of positive reinforcement in the form of supermarket vouchers to shape behaviour - makes no difference in the frequency of cannabis use or relapse rates in those with early psychosis. Although psychotic symptoms initially decrease, these changes are not sustained over the longer term and are no better than with an optimised educational intervention. This NIHR-funded multicentre randomised controlled trial included 551 young adults who were being treated in an &l...
NIHR Signal Holistic services in advanced lung disease can help people cope better with breathlessness
Services providing holistic health care can improve the psychological well-being of people who are living with breathlessness associated with chronic or advanced lung disease, such as lung cancer or chronic obstructive pulmonary disease. Breathlessness is a distressing symptom in which feelings of fear and helplessness, social isolation, high levels of anxiety and significant carer burden are common experiences. Drugs can have limited effectiveness in advanced disease and do not address the und...
NIHR Signal A nurse-led intervention did not reduce post-traumatic stress disorder symptoms in critical care patients
For adults in critical care, a complex psychological intervention delivered by nurses did not reduce the severity of post-traumatic stress disorder (PTSD) symptoms at six months, compared with usual care. The intervention included creating a therapeutic environment, three stress support sessions, and a relaxation/recovery programme. A cost-effectiveness evaluation showed great uncertainty over whether the programme was value for money. The intervention was developed using the limited evidence t...
NIHR Signal Telephone-delivered CBT can provide lasting benefits for people with IBS
People with irritable bowel syndrome (IBS) who receive cognitive behavioural therapy (CBT) continue to have lower levels of symptoms over the following two years. Telephone-delivered CBT is particularly effective, with 71% of study participants experiencing a clinically significant improvement in their IBS symptoms. This NIHR-funded study is the 24-month follow-up to an earlier publication of 12-month outcomes for 558 people with IBS receiving usual care alone or additional telephone or web-bas...
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 ‘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 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 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 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...
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