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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...
NIHR Signal Transcutaneous electrical stimulation (TENS) may help lower limb spasticity after stroke
Transcutaneous electrical stimulation (TENS) delivered alongside standard physical therapies could reduce spasticity in the lower limbs following a stroke. Spasticity is a muscle control disorder characterised by tight muscles. It is common after stroke and accounts for significant disability. TENS is often used to treat pain and can affect nervous stimulation of the muscles. The main evidence in this systematic review came from five trials which suggested that TENS combined with other physica...
NIHR Signal Updated evidence on progesterone to prevent preterm birth in at-risk pregnancies
Progesterone administered via the vagina may reduce the risk of preterm birth in women who are at risk of giving birth early when compared to a placebo, treatment as usual or no intervention. Other treatments, such as oral or injected progesterone, cervical stitch, and pessary, appear not to show the same level of effectiveness. A recent trial suggested that vaginal progesterone provided little or no benefit in preventing preterm birth. Those results have been pooled with 39 other trials in thi...
NIHR Signal Prolonging anticoagulant treatment after abdominal cancer surgery reduces clot risk
People who have low molecular weight heparin (LMWH) for between two to four weeks after abdominal or pelvic surgery, especially for cancer, have fewer blood clots in their large veins or lungs. In this review of seven trials, five per cent of people receiving extended treatment experienced a clot compared with 13% who received LMWH only while in hospital. There was no difference in bleeding complications. The optimal duration of treatment following abdominal surgery is uncertain, balancing blee...
NIHR Signal A commonly-used antidepressant doesn’t improve recovery after stroke
The antidepressant fluoxetine works no better than placebo to reduce disability after a stroke, lowering hopes that had been raised by other smaller studies. After a six month trial including more than 3,000 adult stroke patients recruited at 103 UK hospitals, researchers concluded that fluoxetine should not be used to promote recovery from stroke-related disability, or routinely prescribed to prevent depression after stroke. Several smaller studies and animal trials had found promising result...
NIHR Signal No additional weight-loss reported from a lifestyle programme for people with psychosis
For adults with psychosis, such as schizophrenia, who are taking antipsychotic medication, a carefully designed 12-month group diet and exercise programme did not lead to clinically important weight loss after 12 months. The programme was compared with those receiving usual care including written lifestyle advice. Intervention and usual care groups each lost half a kilo on average, with no measurable changes in diet or physical activity. People with schizophrenia are twice as likely to be overw...
NIHR Signal Treatments for depression may help irritable bowel symptoms
Antidepressants are likely to provide more than a placebo effect for those with symptoms of irritable bowel syndrome. Antidepressants improve symptoms in about 60% of those taking them, but two-thirds of that effect may be due to placebo. Psychological therapies, such as talking therapies also appear effective in about half of those offered them but may be partly due to expectations because it is not possible to provide a placebo control. Irritable bowel syndrome is a chronic disorder of the gu...
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