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NIHR Signal Long-term macrolide antibiotics reduce risk of exacerbations of bronchiectasis
People with bronchiectasis (not caused by cystic fibrosis) who take long-term macrolide antibiotics are around 50% less likely to experience acute worsening of symptoms like cough and sputum production (an exacerbation) than people taking a placebo. Bronchiectasis guidelines only recommend preventative macrolide antibiotics in people with frequent exacerbations who do not carry a bacterium (Pseudomonas aeruginosa). This review pooled data from three trials in 341 patients where erythromycin or ...
NIHR Signal Clinicians prescribe antibiotics for childhood respiratory tract infection based on assessment, rather than parental expectation
Implied parental expectation of antibiotic prescription does not appear to affect clinician prescribing for childhood respiratory tract infection in primary care. Parents typically accept clinicians’ treatment recommendations based on symptoms and signs, with a minority seeking further home care advice. This NIHR-funded analysis of 56 videoed primary care consultations is the first such study to be carried out in the UK, covering diverse populations from both deprived and affluent neighbo...
NIHR Signal High-flow nasal oxygen reduces reintubation after major surgery compared with conventional oxygen therapy
In adults after major surgery, high-flow nasal oxygen decreases by about two-thirds the need for reintubation compared with conventional oxygen therapy. In this study, only about four in every 100 patients needed reintubation with high-flow nasal oxygen, compared with about 11 in every 100 patients receiving conventional oxygen therapy. This review evaluated seven randomised and three non-randomised studies in 1,327 adult patients recovering from surgery under a general anaesthetic. Most of the...
NIHR Signal C-reactive protein testing in general practice safely reduces antibiotic use for COPD flare-ups
Use of a rapid C-reactive protein (CRP) blood test in general practice for people with a flare-up of COPD reduces the proportion who take antibiotics over the next month by about 20 percentage points compared with usual care alone. The reduction in antibiotic use does not lead to worse health, more visits to the doctor or greater need for antibiotics later on. Flare-ups of COPD can be caused by infections of the airways or environmental triggers, and cause about 115,000 admissions to hospital e...
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...
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