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NIHR Signal NHS health check attendance improves with changes to the invitation letter
Invitation letters improve uptake when they address common concerns and reasons for not attending the free NHS Health Checks. People are invited to attend a check every five years between 40 and 74 years, but uptake has been low. This trial of 6,313 patients from six general practices in Northamptonfound that presenting reasons for non-attendance countered by a GP responseincreased uptake of NHS Health Checks by 5.5%. The ‘counterarguments’ included the reduced longer-term cost to ...
NIHR Signal GLP-1 drug for diabetes gives modest cardiovascular benefits compared with placebo
Taking a glucagon-like peptide-1 receptor (GLP-1) agonist drug lowers the likelihood of having a stroke, heart attack or dying due to cardiovascular causes by 12%. The drugs give a similar 12% reduction in overall mortality. They do not increase the risk of heart failure, very low blood sugar levels or pancreatic disease. Diabetes causes one in five strokes along with other cardiovascular complications. Clinicians aim to reduce these risks and lower blood sugar levels. This meta-analysis is the...
NIHR Signal Longer duration of urinary catheter placement associated with an increase in urinary infection
The risk of urinary infection appears low with very short-term use but increases with the time that a patient has a catheter. Women and patients with paraplegia or cerebrovascular disease are at increased risk. This US-based retrospective analysis of electronic health records identified 148,361 indwelling catheterisations, of which 61,047 were for three or more days, in five hospitals - two university hospitals, two community and one children’s hospital - where the median duration of cath...
NIHR Signal Early suppression of male hormones is better than delayed therapy for advanced prostate cancer on balance
Offering early hormone suppression therapy to men with advanced prostate cancer that is causing no symptoms improves outcomes compared with waiting until symptoms of cancer spread arise. Early treatment is associated with 23 to 57 fewer deaths per 1,000 men over five years, depending on the men’s baseline risk. However, this comes with an increased chance of some non-serious side effects. Hormone suppression works by lowering levels of the male sex hormones that fuel the cancer’s gr...
NIHR Signal Length of steroid course for childhood nephrotic syndrome makes little difference to later recurrences
For children with a first presentation of nephrotic syndrome, an extended sixteen-week treatment regimen with prednisolone does not reduce the risk of relapse compared with the standard eight-week course. Most children will experience a relapse with either regimen, but the longer course may delay it by a month or so which may, in turn, reduce the resource use, such as emergency department visits, shorter admissions and less need to see the GP. This can also make the longer course cheaper overall...
NIHR Signal New insights into how fatigue affects the lives of people on dialysis
Feelings of profound and relentless exhaustion while undergoing haemodialysis impact on patients’ ability to lead a normal life. This overwhelming fatigue is different from the immediate symptoms of post-dialysis fatigue observable in a clinical setting and can pervade all aspects of a patient’s life. This review of 65 international studies, including 1,713 participants, found that patients can feel unable to maintain fulfilling relationships and are vulnerable to misunderstandings ...
NIHR Signal Iron deficiency in people with chronic kidney disease can be managed with either oral or IV therapy
For people with chronic kidney disease who are also iron deficient, intravenous iron improves haemoglobin levels and iron stores faster than oral iron. However, the evidence is inconclusive about whether it influences survival, cardiovascular death, or quality of life. Adverse effects and such as allergic reactions or gastrointestinal side effects and other practicalities are likely to determine the choice of a route of administration. Chronic kidney disease is a long-term condition categorised...
NIHR Signal Pelvic floor muscle training can improve symptoms of urinary incontinence
Two-thirds of women with any type of urinary incontinence who have pelvic floor muscle training see improvement or cure compared with only a third of women who receive no treatment or inactive treatments. It is even more effective for women with stress incontinence, with three-quarters of women reporting improvement or resolution of symptoms, such as episodes of leakage. This systematic review included 31 trials and 1,817 women with any type of incontinence; stress, urgency or mixed urinary inc...
NIHR Signal Ethanol locks in catheters for dialysis may prevent sepsis
In patients with tunnelled central venous catheters used for dialysis, ethanol locks may reduce catheter-related bloodstream infections when compared with other locks, mainly saline. There was no increase in the risk of catheter blockage with ethanol locks in this study. Long-term catheters carry a risk of bloodstream infection. ‘Locks’ are the small amount of fluid left inside a long intravenous catheter between uses to reduce the risk of blockage with clotted blood and ideally als...
NIHR Signal Daily low-dose antibiotics halve urinary tract infections in people who self-catheterise
People who perform clean intermittent self-catheterisation can reduce symptomatic urinary tract infections from two per year to one by taking daily low-dose antibiotics. This NIHR-funded trial randomised 404 adults in the UK who perform the procedure for a variety of reasons to either daily oral low-dose antibiotics or no prophylaxis. All had a recent history of urinary tract infection. Although prophylactic antibiotics halved infection rates, it increased antimicrobial resistance compared wit...
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