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...
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...
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 ...
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...
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...
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...
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...
Factors in men’s choice of active surveillance for low-risk prostate cancer
Many personal, organisational and national factors can help or hinder men from choosing active surveillance over radical treatment when they have low-risk prostate cancer. Men are more likely to adhere to this plan of regular monitoring if they and their families are fully informed and understand that it includes the option of further treatment if necessary.
The recent ProtecT trial demonstrated that there was no difference in 10-year survival rates between men with low risk localised prostate ...
Alternative sedative reduces the risk of acute kidney injury following cardiac surgery
The sedative drug dexmedetomidine can reduce the risk of acute kidney injury when given during non-emergency cardiac surgery. Trial participants who received dexmedetomidine were a third less likely to develop acute kidney injury than those receiving placebo or other treatments. There was no difference in mortality or length of hospital stay.
This systematic review identified 10 studies of 1,575 participants. Surgical procedures included coronary artery bypass grafting with or without valve sur...
Balanced electrolyte solutions give marginal benefit over saline for very ill patients
About 14% of critically ill patients receiving electrolyte-balanced crystalloids either developed kidney failure, needed kidney-replacement therapy or died compared with 15% receiving normal saline. This small but statistically significant benefit was only apparent when combining outcomes; there was no difference between fluids for the three individual outcomes analysed separately.
A solution of 0.9% sodium chloride (normal saline) is the most commonly used intravenous (IV) fluid, but it can ca...