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NIHR Signal Drug and behavioural therapy are both effective for tics in people with Tourette syndrome
There are effective drug and behavioural treatments for tics in children and young people with Tourette syndrome. Although most of the studies included in this review were small with risk of bias, the effects found were moderate to large and likely to be clinically meaningful. This NIHR funded systematic review and qualitative study found that habit reversal therapy, where people with Tourette’s are taught to replace their tic with a less noticeable alternative, was effective. The drugs w...
NIHR Signal Annual lipid monitoring places more individuals in treatment and saves money long-term compared with less frequent monitoring
Annual testing to monitor blood lipids (fat and cholesterol) was both effective and saved money long term in by reducing cardiovascular disease in people with or without known heart disease. Given the relatively low cost of treating high lipids (typically by using statins) it was more cost effective to over-treat people than to under-treat them. The findings of this detailed modelling study are broadly in line with guidance. They also add clarity to previous uncertainties around the frequency ...
NIHR Signal Crisis care for people with mental health issues: some effective interventions but there is a way to go yet
Some aspects of crisis care appear effective according to a broad NIHR overview of mental health crisis services. Crisis resolution teams that offer home treatment and support early discharge from hospital, is one successful example – although UK implementation is very variable. Early intervention service models are helpful for people with psychosis, as is collaborative care for those with depression. Crisis houses and acute day hospitals, known as “safe havens”, are popular wi...
NIHR Signal Lack of evidence on whether collagenase or surgery is more clinically or cost effective in managing Dupuytren’s contracture
This review aimed to compare injections of collagenase clostridium histolyticum with standard surgical treatments for Dupuytren’s contracture. Unfortunately existing trials are small and there are no head to head trials of surgery vs collagenase, so it is not possible to determine which therapy is more effective in the short or longer term - nor which is likely to be the more cost-effective. However, collagenase was clinically successful in 63% of cases, compared to just 6% for placebo. Dr...
NIHR Signal Protocol-led therapy for septic shock did not reduce mortality compared to usual resuscitation care
This NIHR funded randomised controlled trial found that early goal-directed therapy for people with septic shock offered no benefit over usual resuscitation care. About three in ten people died in both groups. Early goal-directed therapy differed from routine care in that it involved rigorous monitoring with use of a central venous “oximetry” catheter to manage blood pressure and blood oxygen during the first six hours of care. It was consequently more expensive than usual care, on a...
NIHR Signal Intermittent pressure on the legs helps prevent leg clots in immobile people after stroke
This NIHR-funded trial found that using intermittent pneumatic compression sleeves around the legs was effective in preventing deep vein thrombosis in immobile people after a stroke. When used on people admitted within three days of an acute stroke, this technique was inexpensive and also appeared to improve survival at six months. The results of this study were used in the 2015 update to the 2010 NICE guideline about the care and treatment of people who are at risk of developing deep vein thro...
NIHR Signal Little to choose between open and keyhole surgery as options for repairing shoulder rotator cuff tears
This NIHR-funded trial in people over 50 years looked at whether open surgery compared with keyhole surgery for a common shoulder tear injury and improved shoulder function more. It found that there was little to choose between the two approaches in terms of benefits or costs. The muscles and tendons around the shoulder form the rotator cuff. It is a common site for a tear injury, particularly in middle aged and older people. We don’t know the exact number of GP visits for rotator cuff pai...
NIHR Signal Rapid tests for diagnosing drug resistant tuberculosis are accurate and may be cost effective
This NIHR funded systematic review and economic evaluation found that three rapid tests for diagnosing drug resistant tuberculosis were highly accurate and likely to be cost effective in the UK. These tests produce results within one day of obtaining a sample. This is a significant reduction compared with the standard tests which can take about six weeks or even longer to grow the bacteria. Adding rapid testing to current diagnostic pathways could speed up access to the best treatment and shorte...
NIHR Signal A coping programme moderately reduces depression and anxiety in carers of people with dementia
This NIHR-funded trial found that a programme to support carers of people with dementia was moderately effective in reducing carers’ depression and anxiety scores for up to two years. It was also cost-effective. The programme consisted of eight sessions delivered by psychology graduates, covering topics such as managing difficult behaviour, accessing support and planning for the future. One in three people over 65 develop dementia and family are often the primary caregivers. The findings o...
NIHR Signal Inhaling a saline mist did not reduce the time in hospital for babies with bronchiolitis
In this NIHR-funded trial babies with a viral chest infection (acute bronchiolitis) were treated either with a strong saline mist (nebulised 3% hypertonic sodium chloride) with standard care or standard care alone. The stronger than usual, hypertonic saline mist had no effect on the time it took for babies to be ready for discharge, nor did the trial demonstrate any other benefit from its use. The treatment itself caused some minor side effects in a few babies, such as excessive coughing and a f...
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