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NIHR Signal Two commonly used pressure redistributing mattresses are similar for preventing pressure ulcers but differ on price
The choice of mattress used in hospital makes no difference to whether adults develop pressure ulcers, or how quickly, but differ on price. This large NIHR-funded trial included 2,029 participants at high risk of developing pressure ulcers and found fewer pressure ulcers overall than expected (7.9%). Half of about 2,000 participants in this large NIHR-funded trial were given high-specification foam mattresses, the current standard of care, and half used alternating pressure mattresses. The alte...
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 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 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 Steps to better understanding resistant behaviours and the culture of bedside dementia care in hospitals
High levels of resistance to care by people with dementia can be exacerbated by responses by staff on the wards. This study sought to understand the interactions and culture underlying care by closely observing and documenting what was actually happening on ten wards in five UK hospitals, and through interviews with carers and families. This in-depth study confirmed that people living with dementia are often resistant to care in acute hospital settings. Behaviour included wandering in wards, pu...
NIHR Signal Getting hospital patients up and moving shortens stay and improves fitness
Interventions to encourage patients admitted to hospital for medical problems to get out of bed and walk around increases their mobility, without increasing their risk of falls. Older inpatients frequently spend much of their time in bed, which risks a loss of physical condition and muscle tone. This can make it harder for them to manage independently at home, and may contribute to delayed discharge. A review summarised thirteen trials from the UK, Europe and Australia, involving 2,703 adults ...
NIHR Signal New insights into how ethnicity and culture affect maternal mental health
Ethnicity and culture can affect how and when women seek help for mental health problems before or after having a baby. Many women avoid seeking help because they feel services are not sensitive to their beliefs. Services should ensure all women, regardless of background, can access the support they need during and after pregnancy. This mixed methods systematic review of UK evidence found that many women are not aware of the help available to them, and those that are aware often view it negativ...
NIHR Signal Are track and trigger systems linked to rates of in-hospital cardiac arrest?
Use of the National Early Warning Score (NEWS) to monitor adults in hospital is associated with reduced risk of having a cardiac arrest while in hospital. Using an electronic rather than paper-based system is also linked to reduced risk. Many patients who die from a cardiac arrest while in hospital show signs of deterioration beforehand that aren’t identified or acted upon. Several interventions aimed at reducing these avoidable deaths have been introduced in the NHS. These includeNEWS, a...
NIHR Signal Having more registered nurses on general wards is linked to lower mortality
Higher registered nurse staffing levels are associated with lower mortality, and the fact that fewer vital sign observations are missed is the most likely explanation for this. Increasing registered nursing staff by an hour for each patient per day could reduce the risk of death by 3%. If the ratio of healthcare assistants to nurses gets too high, the data also suggest that rates of missed vital sign observations and mortality increase in line with the extra registered nurse time spent supervis...
NIHR Signal Antimicrobial stewardship programmes reduce antibiotic use in long-term care homes
Antimicrobial stewardship programmes have been found to reduce antibiotic use in long-term care residences by 14% when pooling evidence across a range of study types and interventions. Antimicrobial resistance is a public health threat, and overuse of antimicrobials is one of the main causes. Antimicrobial stewardship programmes are a government strategy to support the appropriate prescribing of antimicrobials within the NHS. There has been little evidence for their use or effectiveness in lon...
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