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NIHR Signal Keyhole hysterectomy is effective for women with heavy menstrual bleeding
When surgical treatment was needed, almost all women with heavy menstrual bleeding were satisfied and had a good quality of life following keyhole surgery to remove the uterus. Slightly fewer achieve this with ablation to remove the uterine lining. In a UK randomised trial, women given one or other treatment in NHS hospitals reported good benefits after both interventions, which also had similar, low rates of adverse effects. In total, 97% were satisfied with the effects a year after laparoscop...
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 Short-term dual antiplatelet treatment may be best for most patients after receiving a drug-eluting stent
For patients who have had a drug-eluting stent inserted into the coronary arteries, there is no difference in mortality or cardiovascular outcomes between the standard 12-month dual antiplatelet therapy and shorter six-month courses. Longer courses above 12 months increased risk of bleeding and non-cardiac death compared with short courses. It has been debated whether longer treatment might decrease complications, but similarly, it is unclear if shorter treatment might be as effective while red...
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 Partial knee replacement ‘could be first choice’ for suitable patients with osteoarthritis
Partial knee replacement surgery improves pain and function similarly tototal knee replacement in people with osteoarthritis that affects only a single compartment of the knee. Partial knee replacement surgery is also cheaper. In this NIHR-funded trial of 528 people with osteoarthritis affecting only one compartment of the knee, those who had partial knee replacement saw at least as much improvement as those who had a total joint replacement. Their care also cost about £900 less over five...
NIHR Signal Transcatheter aortic valve implantation may be an option for patients with aortic stenosis at lower surgical risk
Transcatheter aortic valve implantation (TAVI), the less-invasive procedure, may be associated with a reduced risk of death and stroke for up to two years when compared with surgical aortic valve replacement for adults with severe narrowing of the aortic valve, irrespective of the level of surgical risk. TAVI is already an established procedure for those unsuitable for surgery or at high risk. This meta-analysis evaluated seven trials comparing 8,020 adults treated with one of these procedures ...
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 Surgery for a deviated nasal septum improves quality of life more than non-surgical approaches
Surgery for adults who have a deviation, or bend, in the wall running through the centre of their nose improves quality of life more than non-surgical alternatives. The benefit was maintained for at least two years. The surgery, a septoplasty, also improvesairflow through the nose. The trial compared septoplasty to non-surgical alternatives, such as just monitoring the patient or giving treatments such as corticosteroid nasal sprays. There has been a lack of good-quality evidence in managing t...
NIHR Signal Reminders to assess clotting risk increase the use of preventive measures
Reminders to assess clotting risk result in more patients being given appropriate anti-clotting measures in hospital. Computer alerts, in particular, are linked to better choice of prophylaxis and fewer blood clots in veins. Clots in deep leg veins or the lungs are common when people are bedbound in hospital. This updated Cochrane review assessed interventions aiming to increase the use of appropriate preventive measures such as anti-clotting drugs or mechanical measures, including stockings, f...
NIHR Signal Antibiotics reduce complications after assisted vaginal delivery
Preventative antibiotics halve the risk of infection for women who have assisted vaginal delivery using forceps or suction-cup devices. About 10% of women receiving antibiotics develop an infection within six weeks of delivery compared with 20% of women who receive a placebo. Antibiotics are not routinely recommended for women undergoing assisted delivery as there hasn’t been enough evidence that they reduce maternal infection rates. This large NIHR-funded trial, including almost 3,500 wo...
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