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NIHR Signal A temporary clot-catching filter inserted after major trauma does not prevent lung clots
In adults after major trauma who cannot safely be given anti-clotting drugs, placing a removable metal filter in a major vein to the heart (the inferior vena cava) within 3 days of admission does not reduce their chances of having a clot in their lungs (pulmonary embolus) within 90 days, compared with having no filter. The filters do not affect the risk of bleeding. The filter aims to catch clots that might develop in the legs and travel to the lungs, until anti-clotting drugs can be safely sta...
NIHR Signal Exercise training improves physical capacity after lung cancer surgery
People who receive exercise training following surgery for lung cancer can walk about 57 metres further in six minutes than controls who did not exercise. After surgery like thisto remove all or part of a lung, people typically manage about 500 metres in six minutes on the test, and anything above 20 metres is considered a worthwhile improvement. Exercise also increases leg strength and quality of life. A decline in physical fitness is a common and debilitating effect of lung resection. Exerci...
NIHR Signal Packages of care interventions ‘not effective’ to reduce repeat admissions for COPD
Care bundles for COPD are difficult to implement, and their introduction in NHS hospitals does not reduce repeat admissions, deaths or use of resources when used on or after admission. Care bundles are packages of interventions which, in other situations, can improve care. COPD care bundles include: checking inhaler technique and medication use providing a written plan for COPD management and supply of emergency medicines assessing willingness to stop smoking assessing suitability for pul...
NIHR Signal Mucus-thinning drugs slightly reduce COPD symptom flare-ups
People with chronic obstructive pulmonary disease (COPD) have a slightly reduced risk of having a flare-up of symptoms if they take mucolytic drugs. The number of days on which they are too ill to perform their normal activities is also slightly reduced, from 1.57 days to 1.14 days per month. A review of placebo-controlled trials, including 10,377 people taking a variety of mucolytic drugs, for between two months to three years, found improvements in exacerbations, days of disability, and hospi...
NIHR Signal Pulmonary rehabilitation may modestly improve anxiety and depression in adults with chronic obstructive pulmonary disease
Pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) improves psychological symptoms modestly, compared with no intervention. Depression improves by about 2.5 points, and anxiety by 2.2 points on the Hospital Anxiety and Depression Scale (range 0 to 21). This review of 10 trials is the first to show that pulmonary rehabilitation – already known to improve quality of life and exercise capacity - may also improve anxiety and depression, which are common in people with C...
NIHR Signal Whole-body MRI scans are as accurate as standard imaging pathways for lung cancer staging
Using whole-body magnetic resonance imaging (MRI) in the initial investigation pathway is as good as standard pathways for detecting metastatic disease in adults with non-small-cell lung cancer. This NIHR-funded study also found that WB-MRI used for diagnosis and staging is quicker, cheaper and requires fewer other investigations than standard pathways. Although patients reported that having whole-body MRI was a greater burden than standard imaging, they generally preferred whole-body MRI if it...
NIHR Signal Using both nicotine patches and gum together improves the chances of quitting smoking
Using a nicotine patch together with a fast-acting type of nicotine replacement therapy (NRT) such as gum or lozenges improves smoking cessation rates compared to using only a single type of NRT. Higher-dose nicotine patches are also more effective than lower dose ones, this NIHR-funded review suggests. A previous Cochrane systematic review found that NRT boosts people’s chances of successfully quitting smoking compared to none, but it was unclear which types, doses and schedules were mos...
NIHR Signal Providing pressurised air through a mask may improve outcomes for people with deteriorating heart failure
Non-invasive positive pressure ventilation may help people with rapidly deteriorating heart failure who become short of breath due to fluid build-up in the lungs. For people not requiring immediate mechanical ventilation using an endotracheal tube, this approach may reduce the risk of death in hospital and the need for intubation. This review evaluated 24 trials of 2,664 adults comparing a group who received air under pressure through a mask, to a group receiving standard medical care. These ty...
NIHR Signal Smartphones instead of direct supervision can improve adherence rates for TB treatment
People who need supervision take their medication for tuberculosis (TB) more reliably when using a smartphone to send video evidence instead of direct observations;for example, by attending a clinic appointment. Almost double the number of observations was completed in the video-supervised arm at six months than when people were directly observed. Ensuring the effectiveness of treatment is central to worldwide TB control. Directly-observed treatment, in which a healthcare professional supervise...
NIHR Signal Decision support tools can help GPs reduce antibiotic prescriptions for respiratory conditions
A 12% reduction in GP antibiotic prescriptions for respiratory conditions was achieved through the use of electronic decision and training tools. This reduction did not increase the risk of serious infections compared to usual care. The low-cost intervention in this large NIHR-funded trial included a short training webinar for GPs and feedback on their practice’s prescribing rates. The decision support tool gave prompt access to NICE prescribing guidelines and printable patient informatio...
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