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NIHR Signal Goal-setting can help people with early-stage dementia improve function
Goal-setting as part of cognitive rehabilitation delivered by occupational therapists helped people with early dementia progress towards independence in daily tasks, with benefits lasting for nine months. This approach focuses on the everyday tasks needing concentration and memory and prioritising those that matter most to individuals, from using the cooker or answering the phone. The intervention was well-received, but the cost-effectiveness is not clear, because quality of life continued to de...
NIHR Signal Treating asymptomatic MRSA on discharge from hospital reduces risk of later infection
Use of medicated creams, mouthwash and body wash for six months after discharge from hospital led to a 30% lower risk of MRSA infection, compared with basic hygiene education. This study was carried out in the USA using 2,121 adults who had tested positive for MRSA in hospital, but who had no symptoms. Meticillin-resistant Staphylococcus aureus (MRSA) bacteria have developed resistance to widely-used antibiotics. MRSA is easily transferable within healthcare settings, and people may become colo...
NIHR Signal When is it best to start the Parkinson’s drug, levodopa?
Earlier treatment with levodopa provides symptomatic relief to those with symptoms but does not appear to slow Parkinson’s disease from progressing. Therefore, timing is best determined by symptoms. The treatment of Parkinson’s disease is complex. Levodopa is the main drug used to reduce tremors and muscle stiffness. Whether it modifies the course of the disease or becomes less effective over time is debated, and it can have side effects, so patients and clinicians sometimes prefer ...
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 E-cigarettes helped more smokers quit than nicotine replacement therapy
Smokers who use NHS stop smoking services appear almost twice as likely to be successful for a year if they use e-cigarettes than if they use nicotine replacement therapy (NRT) products. In a trial of 866 smokers who used NHS stop smoking services, 18% of those assigned to e-cigarettes were abstinent 12 months from their quit date, compared to 9.9% of those assigned to NRT. Everyone in the study was also offered four weeks of one-to-one behavioural support from a clinician. Of those who had suc...
NIHR Signal Various drugs are effective and well-tolerated for generalised anxiety disorder
There are various drugs options for the treatment of generalised anxiety disorder, from different medication classes. This study found that most evidence was available for the serotonin and noradrenaline re-uptake inhibitors (SNRI) duloxetine and venlafaxine, the selective serotonin reuptake inhibitor (SSRI) escitalopram, and the anti-epileptic pregabalin. All appear well-tolerated and reduce symptoms compared with placebo. The SSRI sertraline, commonly used in practice, was equally effective an...
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...
NIHR Signal Dermoscopy plus visual inspection aids melanoma diagnosis
Dermoscopy, using a relatively cheap handheld magnifying device alongside naked eye observation, is more accurate in the diagnosis of melanoma than visual inspection alone. It can also provide a photographic record which can be used for reference during follow-up. This NIHR-funded review included 104 studies of skin lesions in the dermatology clinic that looked suspicious or were present in those at high risk of developing melanoma. Melanoma is a rare form of skin cancer. Inspection of the lesi...
NIHR Signal Medication to reduce stomach acid may increase risk of hip fractures
People who take proton pump inhibitors for digestive disorders such as stomach ulcers and acid reflux may be up to 24% more likely to experience hip fractures. Nevertheless, the benefits of treatment in an individual may outweigh this effect unless the risk of osteoporosis or fracture is high. A conversation between the prescriber and the individual patient on relative risks should help in a treatment decision. The link may be important for people taking these drugs, especially if they have ot...
NIHR Signal Treating vitamin D deficiency may reduce exacerbations of COPD
Vitamin D supplements halve the number of exacerbations of chronic obstructive pulmonary disease (COPD) in people with low levels of the vitamin, from two per year to one per year. The supplements do not affect exacerbations of COPD in people who are not deficient. This NIHR-funded review is the first to pool individual-level data from randomly controlled trials to see whether taking vitamin D can help reduce exacerbations. People with moderate to severe COPD may be at risk of low vitamin D le...
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