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...
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...
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...
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...
National quality improvement programmes need time and resources to have an impact
A large trial assessing the effectiveness of a UK-wide quality improvement programme did not show any difference in patient outcomes. However, the likely reasons for this were carefully investigated and provide some useful insights on implementation.
Several (37) quality improvement components were included in the ambitious package designed to reduce variation in care and improve outcomes for adults undergoing emergency abdominal surgery. There was no difference in survival at 30 days, length o...
More than 50% of hip replacements appear to last 25 years
Data from national registries and large case series showthat in those countries, around 85% of total hip replacements last for 15 years, with 58% lasting for 25 years. This means that those hip replacements have lasted last longer than was first thought. It is good news for an ageing population, as it should mean that the chances of needing a second hip operation are reducing.
However, it is not clear how directly relevant the results of this study are to the UK. The NIHR-funded study didn&rsqu...
More than 80% of total knee replacements can last for 25 years
Large data sets from national registries and case series show that about 82% of total knee replacements and 70% of partial (unicompartmental) knee replacements last for 25 years.
This NIHR-funded review of that data is the first to demonstrate longer-term effectiveness of these procedures. This means that the operation, which aims to relieve pain for osteoarthritis, may not need to be delayed to reduce the chance of a patient needing further surgery at a later date. It is an encouraging finding...
A laser eye procedure can be effective and safe if used early as treatment for glaucoma
Using a laser to improve drainage of fluid within the eye showed similar results to eye drops as a first-line treatment for adults with open angle glaucoma or ocular hypertension (raised pressure in the eye). It improved vision without increasing the risk of adverse events. It was preferred by patients and also associated with lower costs.
Current guidelines recommend that eye drops are used first to lower the pressure in the eye and slow the progression of glaucoma. Many patients find eye drop...
A traditional implant is as effective as more expensive newer types for people over 65 having a hip replacement
A commonly used, cheaper implant used in total hip replacement surgery is as effective as more expensive options for over-65s, a new study has found.
A range of prosthetic implants is used for hip replacement, including newer and more expensive options, with different surface materials and some that do not require cement. They may wear at different rates, and all can require further surgery if they become loose. This risk is greater for younger and more active patients.
This large NIHR-funded ...
Partial knee replacements have some short-term advantages compared to total knee replacements
Replacing one side of the knee, unicompartmental knee replacement, may result in shorter hospital stays, fewer short-term complications, faster recovery and better knee function than total knee replacements. However, about 8% need revision by five years - about two to three times the rate with total knee replacements.
People with pain and immobility from osteoarthritis that cannot be controlled by other treatments may be referred for knee surgery. If the damage is only to one side of the knee, ...