Complications following hip or knee surgery are more likely for people with long-term illness, but benefits are still worthwhile
People with long-term illness are just as likely to benefit from knee or hip surgery as those without. However, they are more likely to have complications following surgery and to be readmitted within three months.
This study reviewed data from 70 studies to determine the chance of short-term harms and long-term benefits linked to 11 different co-existing health conditions (such as diabetes and cancer) following hip and knee replacement. Short-term outcomes included surgical complications, infe...
A total diet replacement programme helped obese people lose weight and keep weight off
A programme of weekly behavioural support with total diet replacement led to over 7kg greater weight loss than usual care in primary care. This weight loss was maintained for a year after starting the 8-12 week low calorie programme.
This trial, funded by NIHR and a commercial sponsor, was carried out in ten primary care practices in Oxfordshire. Participants had BMI over 30. It referred half of the 278 participants to a commercial weight loss programme, free of charge for six months. The rest ...
Partial knee replacements may save costs compared with total knee replacements
Partial knee replacements, when performed by experienced surgeons, can save costs and improve quality of life compared with total knee replacements. Partial replacements for selected patients improve quality of life and savebetween £600 and £2,000 over the patient’s lifetime, depending on age and gender.
Knee replacements are commonly performed for people with ongoing pain and poor function. If the damage is limited to one side of the knee, it may be suitable to replace just t...
Using a ‘telephone first’ approach may increase the total time GPs spend consulting
A system where all patients have a telephone call with their GP before an appointment decreased the number of face-to-face consultations but increased telephone consultations. There was an overall 8% increase in the time GPs spent consulting, though there was large variation across practices.
This NIHR-funded study compared 147 practices in England before and after the implementation of the telephone management system and also with a sample of surgeries using a standard appointment system.
Young people often have negative views of sex and relationship education
Sex and relationship education in schools is intended to safeguard children from harmful relationships and promote sexual health. This review of 55 qualitative studies, mainly from the UK, suggests the classes do neither and may be failing to prepare, protect or engage young people.
Most studies covered secondary school sex and relationship education for pupils aged 12 to 18. Many pupils felt that classes were wrongly taught like other subjects and by their usual teachers, making them feel emba...
Vomiting is the most common adverse effect among children and young people sedated for emergency procedures
Vomiting is the most common adverse event when sedating a child or young person undergoing a procedure in the emergency department, occurring in 55.5 out of 1,000 cases. Agitation occurred in 17.9/1,000 cases, and hypoxia – lack of oxygen – in 14.8 out of 1,000 cases. Serious breathing problems needing intervention to provide ventilation were rare, but highlight the need for experienced staff when giving sedation to children.
This systematic review included 41 studies, six of which ...
“Case management” can prevent people with heart failure being admitted again
Case management that is initiated in hospital and led by specialist nurses may reduce unplanned hospital readmissions and length of hospital stay for adults with heart failure.
Case management is specific, intensive one-to-one care that involves many components to do with planning, coordinating and reviewing the care of people with long-term conditions.
This NIHR review of organisational type research found quite a lot of studies: 17 trials and five other studies, including three from the UK. ...
Optometrists are cautious, but may be as good as ophthalmologists at monitoring a common cause of blindness
Optometrists seem to be as good as ophthalmologists at correctly classifying wet age-related macular degeneration (AMD).
Wet AMD is a condition where new blood vessels develop at the back of the eye to supply the damaged macula, responsible for central vision. It can cause permanent vision loss if not treated quickly. Monthly follow-up in specialist clinics is then required to check the condition hasn’t reactivated, which places a high demand on resources.
This virtual trial using comput...
Community pharmacies may be a useful place to deliver stop smoking services
This NIHR review provides evidence that ‘stop smoking’ interventions delivered at a community pharmacy, are effective and probably cost-effective for stopping smoking among adults, especially when compared to usual care without nicotine replacement. These interventions often include such things as behavioural support and nicotine replacement therapy and were most effective when both were delivered together.
The review also looked at other community pharmacy-delivered interventions, ...
Two simple questions help GPs rule out depression
The Whooley questions are useful for ruling out depression in that few people who answer no to both questions are depressed according to a ‘gold standard’ diagnostic interview. A positive screen is indicated by the person answering “yes” to one or both of the Whooley questions and for these people the diagnostic interview will still be necessary to diagnose the condition.
The two simple questions are; 1) have you felt down or depressed or hopeless? and 2) have you been b...