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...
Intravenous oxytocin reduces severe bleeding after vaginal delivery
Routine oxytocin injected directly into the bloodstream, rather than into the muscle, after birth results in fewer people suffering severe bleeding (postpartum haemorrhage).
The overall rate of postpartum haemorrhage (PPH) or side effects was similar between the groups, but the intravenous group had fewer severe haemorrhages, needed fewer blood transfusions and fewer admissions to high dependency care. Intramuscular route oxytocin is currently recommended in the UK, partly due to concerns about...
Text messages improve diabetes self-management and blood sugar control
In adults with poorly controlled diabetes, text messages offering advice and support can improve self-management and blood sugar control.
This trial included 366 adults with type 1 or type 2 diabetes in New Zealand. An automated system delivered individually tailored text messages to participants over a nine-month period to support self-management of blood sugar. The control group received usual care, comparable to that in the UK.
The text message group had a small reduction in blood sugar lev...
Prescribing anti-inflammatories for urine infection reduces antibiotic use but increases complication risk
Urinary tract infection symptoms resolved by three days for 80% of women given antibiotics compared with 54% given anti-inflammatories. Anti-inflammatories reduced antibiotic use, but 5% of women developed more severe infection of the kidneys.
Urinary infections are the second most common reason for prescribing antibiotics in general practice, after respiratory infection. As such, this use may be contributing to increasing antibiotic resistance.
This Swiss trial provided an important head-to-h...
Physiotherapy education before major abdominal surgery reduces lung complications
A physiotherapy session before planned abdominal surgery, explaining the importance of breathing exercises and sitting out of bed as soon after surgery as possible, halves the risk of pneumonia.
This trial compared the physiotherapy session with usual care which was provided to all 432 participants. This consisted of a leaflet given in the pre-operative outpatient clinic outlining the exercises, and physiotherapy input in the days after surgery. Just seven people would need to receive the addit...
Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation
In people with atrial fibrillation needing anticoagulant treatment, deaths were fewer in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin.
This study pooled the data in all trials reporting efficacy, safety and cost of anticoagulant prevention of stroke events in people with...
Staying on antidepressants may prevent a relapse of anxiety
People with anxiety disorders who continued taking antidepressants after successful treatment were less likely to experience a relapse, and relapsed later, than people who stopped taking antidepressants. About 16% of people had a relapse if they remained on antidepressants for on average 44 weeks compared with 36% who stopped after 20 weeks.
Anxiety disorders are common and can interfere with people’s everyday work, family and social life. Antidepressants and psychological therapies are t...
Placing wet gauze on babies’ tummies speeds up urine collection
Almost a third of infants managed to urinate within five minutes after a painless, cheap technique that stimulates the skin, compared with 12% of infants observed only, as is standard practice.
The ‘Quick-Wee’ method involved rubbing the babies’ abdomens gently with gauze soaked in cold saline before collecting urine. This trial was carried out with 354 babies aged one to 11 months in one Australian paediatrics emergency room.
NICE guidelines recommend non-invasive ‘cle...
Dexamethasone before bowel surgery reduces postoperative nausea and vomiting
A single dose of dexamethasone given at the time of anaesthesia for bowel surgery reduced vomiting in the next 24 hours, with no increase in complications. Thirteen people need to be treated to prevent one extra episode of vomiting.
Dexamethasone (a steroid) is one of several drugs recommended for patients at moderate and high risk of postoperative nausea and vomiting. It isn’t widely used in bowel surgery.
In this large UK-based trial, treating eight people also prevented one person re...
Vitamin D supplements may reduce the chance of developing a chest infection
Vitamin D supplements may reduce the chances of contracting an acute respiratory tract infection, particularly for those with low existing levels of vitamin D.
This NIHR-funded study pooled patient data from 25 randomised controlled trials and found that daily or weekly supplements reduced respiratory tract infections compared with placebo. About 20 people would need to take regular supplements in order to prevent one infection. One-off monthly dosing gave no benefit.
Public Health England (PH...