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NIHR Signal Uncertain benefits of BNP blood tests to monitor heart failure treatment
In specialist clinics, using B-type natriuretic peptide (BNP) blood levels to guide treatment in people with chronic heart failure shows promise but did not improve survival for all groups. In this review, the benefit was only seen in patients aged less than 75, who survived an extra 1.5 years on average, and possibly those with poor heart function (reduced ejection fraction). However, there was a reduction in hospital admissions for heart failure for everyone. BNP is a hormone released from th...
NIHR Signal A primary care intervention helps older people with depression
Enhanced case management (also called collaborative care) added to primary care reduced symptoms in people with clinical depression, compared with usual primary care. The benefit was similar to other depression treatments. However, the small benefit over usual care was not sustained to 12 months. This NIHR-funded UK trial was carried out among nearly 500 adults aged at least 65 years. Primary care mental health practitioners delivered six sessions to encourage activity and social contact (five ...
NIHR Signal Single urine samples are just as good as 24-hour collections for diagnosing pre-eclampsia
The urine spot albumin-creatinine ratio (which is done on a single, on-the-spot sample) reliably identified 99% of pregnant women with high blood pressure who went on to develop severe pre-eclampsia. The spot protein-creatinine ratio, as currently recommended by NICE, was slightly less sensitive identifying over 90% of women. Both spot tests were good value for money. Nearly 1,000 women, suspected of having pre-eclampsia, took part in this NIHR-funded study, in 36 UK obstetric units. They had h...
NIHR Signal Uncertain benefit of adding amisulpiride to clozapine for treatment-resistant schizophrenia
For adults with schizophrenia who continue to have symptoms despite treatment with the antipsychotic drug clozapine, adding amisulpride (another antipsychotic) was not shown to improve their chance of responding. It is not yet clear whether a larger trial would show an effect, as too few people were recruited to the NIHR-funded trial to be sure. Participants were more likely to experience side effects and the trial does provide some important information for future studies in this difficult trea...
NIHR Signal Breathing exercises improve asthma and can be learned by DVD
Breathing exercises taught by a physiotherapist in person or on DVD both improved the quality of life of adults with poorly controlled asthma to a small but similar extent. The DVD was the cheapest option, and it could lead to inexpensive internet delivery in the future. This NIHR-funded trial recruited 655 UK adults with poorly controlled asthma. It showed about 63% of those receiving the breathing exercises had clinically important improvements in their asthma-related quality of life over a y...
NIHR Signal Talking therapy may relieve high levels of anxiety about health conditions
A specific talking therapy called ‘cognitive behavioural therapy for health anxiety’ may help people who are excessively worried about their health. Health anxiety reduced by a small, but meaningful amount, among the medical outpatients who were identified and treated. Delivered in one-hour sessions every two weeks, therapy lasted about four months. It was provided by junior therapists and trained nurses with no previous experience of the therapy. Benefits lasted for about five year...
NIHR Signal New evidence confirms three-yearly surveillance interval for people at intermediate risk of bowel cancer
People with benign growths (adenomas), who are at intermediate risk of bowel cancer, benefit from follow-up colonoscopy. However, some of the patientsat the lower end of risk in this intermediate category may not benefit from more than one follow-up. This NIHR-funded cohort study reviewed data for 11,944 intermediate-risk patients from UK hospitals. Within this group, particular features were identified which placed them at higher risk, such as the presence of larger or highly abnormal adenomas...
NIHR Signal Guided self-help therapy for people with obsessive-compulsive disorder did not improve symptoms
Offering people book-based or computer-based cognitive behavioural therapy (CBT) whilst on a waiting list for therapist-led therapy did not improve their obsessive-compulsive symptoms when assessed after three or 12 months. However, these low-intensity interventions may reduce the likelihood of people taking up therapist-led CBT. This NIHR-funded trial included 473 adults with moderate to severe obsessive-compulsive disorder who were already waiting to receive CBT. Issues with the uptake of the...
NIHR Signal Heel casts do not improve heel ulcers in diabetes
Fibreglass casts moulded to the heel did not improve heel ulcers in people with diabetes when added to usual ulcer care. Ulcers healed within six months in 44% of people using casts compared with 37% without which was not a statistically significant difference. Foot ulcers are a common complication of diabetes, and heel ulcers are particularly difficult to treat. Based on the success of casts for treating ulcers elsewhere on the foot this trial was designed to test the effect and cost-effective...
NIHR Signal Silk clothing for children does not reduce objective measures of eczema severity
Six months of wearing special silk clothing had no effect on objective measures of child eczema severity, infection rates or medication use. Children and carers reported some small improvements in eczema severity on two scales but their awareness of the clothing worn by their child may have slightly influenced their judgment. Overall quality of life did not significantly improve. Specialist silk clothing is currently available on NHS prescription, but prior to this trial there was limited evide...
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