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NIHR Signal Surgery to fix the womb in position after prolapse is an alternative to hysterectomy
Women who have surgery that uses stitches to lift and keep their prolapsed womb in place (called hysteropexy) are less likely to have recurrent symptoms after five years than those who havetheir womb removed (vaginal hysterectomy). These results from a Dutch trial involving 204 women showed comparable outcomes for the two surgical options for other measures such as quality of life, repeat surgery and sexual functioning. While vaginal hysterectomy is still widely seen as the first treatment cho...
NIHR Signal Universal ultrasound in late pregnancy did not reduce serious harms to babies
Offering all women third trimester ultrasounds did not reduce the rate of serious illness or death in babies in the first week of life. Monitoring fetal growth is part of routine antenatal care, using regular tape measurements from the pubic bone to the top of the uterus. To date, it has been unclear whether also monitoring babies’ growth using ultrasound late in pregnancy can reduce the risks for babies. The large Dutch IRIS trial investigated whether a policy of offering third trimeste...
NIHR Signal Boosting omega-3 fatty acid intake is unlikely to prevent type 2 diabetes
Increasing the intake of polyunsaturated fats in the diet with supplements of omega-3 fatty acids, for example, is unlikely to affect people’s risk of developing type 2 diabetes. However, this review only looked at the effect of supplements on diabetes, not wider health. This large systematic review included 83 long-term trials comparing higher and lower intake of omega-3 and omega-6 fatty acids and total polyunsaturated fats in healthy adults and those with existing diabetes. It found no...
NIHR Signal Significant risk of another thrombosis remains if anticoagulation is stopped
Unprovoked venous thromboembolism (VTE), including deep vein thrombosis in the leg and pulmonary embolism, are clots within veins that occur spontaneously in people without risk factors and are treated with anticoagulant drugs. If those drugs are stopped after three months or more, the risk of another clot appears to be on average 10% in the first year, 16% by two years, 25% by five years and 36% by 10 years. This systematic review and meta-analysis of 18 studies included a total of 7,515 patie...
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 Four-drug treatment for HIV offers no benefit over standard three-drug treatment
Quadruple drug therapy for people starting HIV treatment offers no benefit over the currently recommended triple therapy. Antiretroviral (anti-HIV) therapy is highly effective, with almost all treated individuals in the UK surviving as long as non-infected people. The courses now available mean those treated are usually unable to pass on the virus. There are several classes of treatment and individual drugs which can be used in various combinations. The British HIV Association currently recomme...
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...
NIHR Signal 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, ...
NIHR Signal Keyhole surgery may be better than physiotherapy for hip impingement
Adults with painful restriction of movement of their hip had greater improvements in their symptoms after arthroscopy (keyhole surgery) than those who had physiotherapy. This NIHR-funded study included 222 people with hip pain and limited movement due to femoro-acetabular (hip) impingement but without a diagnosis of osteoarthritis. Their average age was 36 years. Half of the people who had surgery had significant benefit compared with a third of those having physiotherapy. NICE has recommended...
NIHR Signal Torn Achilles tendons have similar outcomes if treated with or without surgery
Outcomes for ruptured Achilles tendons appear similar irrespective of the choice of intervention. This systematic review and meta-analysis found that while the risk of re-rupture with corrective surgery was small at 2.3%, with conservative management (immobilisation in a cast), the rate was only 3.9%. The complication rate at 4.9% was three times higher in those who had surgery. Nearly all of the included studies were observational in this review, and no information was provided on the severit...
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