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NIHR Signal Group cognitive behavioural courses may reduce fatigue from rheumatoid arthritis
Fatigue can be one of the most difficult symptoms to cope with for people with rheumatoid arthritis and this study found that group cognitive behavioural courses may help. This NIHR-funded study compared six weekly group sessions plus a booster session with a single brief one-to-one meeting. Both groups also received an educational booklet. It took place in seven UK hospitals and was co-delivered by pairs of trained rheumatology nurses and occupational therapists. The group sessions caused a s...
NIHR Signal MRI and ultrasound scans are both helpful in assessing Crohn’s disease; MRI is slightly more accurate
Two types of scan, MRI and ultrasound, work well when used for staging and monitoring Crohn’s disease. MRI is more accurate. Researchers compared a form of magnetic resonance (MR) imaging that includes an oral contrast agent, with ultrasound scans. They aimed to see which was better able to detect the presence and extent of active disease in the small bowel. The trial, carried out in eight NHS hospitals, involved 284 participants who had both MR and ultrasonography. While both tests perfo...
NIHR Signal Voucher rewards do not reduce frequency of cannabis use or relapse in people with early psychosis
Contingency management - the use of positive reinforcement in the form of supermarket vouchers to shape behaviour - makes no difference in the frequency of cannabis use or relapse rates in those with early psychosis. Although psychotic symptoms initially decrease, these changes are not sustained over the longer term and are no better than with an optimised educational intervention. This NIHR-funded multicentre randomised controlled trial included 551 young adults who were being treated in an &l...
NIHR Signal Keyhole hysterectomy is effective for women with heavy menstrual bleeding
When surgical treatment was needed, almost all women with heavy menstrual bleeding were satisfied and had a good quality of life following keyhole surgery to remove the uterus. Slightly fewer achieve this with ablation to remove the uterine lining. In a UK randomised trial, women given one or other treatment in NHS hospitals reported good benefits after both interventions, which also had similar, low rates of adverse effects. In total, 97% were satisfied with the effects a year after laparoscop...
NIHR Signal Diagnosis of delirium in hospitals can be improved by the 4 A’s test
A new shorter test for delirium appears helpful in assessing older people in hospital who may have the condition. A normal score on the 4 A’s test effectively rules out delirium while an abnormal score is reasonably useful for detecting the condition. People detected by the test would still need a full assessment to confirm the diagnosis. Delirium is common in older people who have been hospitalised, but it can go undiagnosed. To help combat this, the 4 A’s test was developed as an ...
NIHR Signal Length of steroid course for childhood nephrotic syndrome makes little difference to later recurrences
For children with a first presentation of nephrotic syndrome, an extended sixteen-week treatment regimen with prednisolone does not reduce the risk of relapse compared with the standard eight-week course. Most children will experience a relapse with either regimen, but the longer course may delay it by a month or so which may, in turn, reduce the resource use, such as emergency department visits, shorter admissions and less need to see the GP. This can also make the longer course cheaper overall...
NIHR Signal Cardiac rehabilitation for heart failure can improve quality of life and fitness
Exercise-based cardiac rehabilitation may improve the quality of life and physical fitness of people with heart failure but does not reduce their risk of being admitted to hospital or dying. This is irrespective of factors such as age and ethnicity. This NIHR study summarised the outcome data from trials assessing exercise programmes for over 4,000 people with heart failure. At an individual level, the review looked for any improvements in physical symptoms and the psychological impacts of livi...
NIHR Signal Telephone or internet delivered talking therapy can alleviate irritable bowel symptoms
People with irritable bowel syndrome may find cognitive behavioural therapy (a talking therapy) delivered via telephone or internet improves their symptoms. Compared with usual care alone, both interventions were shown to be more effective, with telephone delivery resulting in greater symptom reduction and web-based therapy being more cost-effective. Irritable bowel symptoms can persist long-term and have a major impact on the quality of life. Stress is one of the known triggers. Cognitive beha...
NIHR Signal Goal-setting can help people with early-stage dementia improve function
Goal-setting as part of cognitive rehabilitation delivered by occupational therapists helped people with early dementia progress towards independence in daily tasks, with benefits lasting for nine months. This approach focuses on the everyday tasks needing concentration and memory and prioritising those that matter most to individuals, from using the cooker or answering the phone. The intervention was well-received, but the cost-effectiveness is not clear, because quality of life continued to de...
NIHR Signal No additional weight-loss reported from a lifestyle programme for people with psychosis
For adults with psychosis, such as schizophrenia, who are taking antipsychotic medication, a carefully designed 12-month group diet and exercise programme did not lead to clinically important weight loss after 12 months. The programme was compared with those receiving usual care including written lifestyle advice. Intervention and usual care groups each lost half a kilo on average, with no measurable changes in diet or physical activity. People with schizophrenia are twice as likely to be overw...
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