MRI scan does not help to find the cause of pelvic pain in women
MRI scans are not sufficiently accurate to find the cause of chronic pelvic pain in women and should not replace laparoscopy (keyhole surgery), which can be used for diagnosis and often treatment. MRI only correctly ruled out a gynaecological condition in half of women judged to have no obvious cause and missed half of women who did have a treatable gynaecological condition.
Pinpointing the origin of chronic pelvic pain is often difficult due to the number of possible causes. If initial tests a...
No benefit from monitoring antiepileptic drug levels in pregnancy
Regular monitoring of antiepileptic drug levels in pregnant women with epilepsy does not improve seizure control compared with clinical features-based monitoring. This NIHR-funded study was conducted across 50 UK hospitals and is the largest randomised trial in pregnant women with epilepsy.
Just over 260 pregnant women with unstable antiepileptic drug levels were assigned to ongoing monthly blood checks or clinical features monitoring. There were no differences in seizures or other pregnancy ou...
Endovascular aortic repair (EVAR) surgery more beneficial for ruptured abdominal aortic aneurysms than open repair
EVAR surgery to repair a ruptured abdominal aortic aneurysm had a slightly better survival rate after three years than open repair surgery. The survival benefit in this trial wasn’t apparent 30 days after surgery, but those having EVAR did recover more quickly and went home sooner. This NIHR-funded study also found that EVAR is likely to be more cost-effective.
An abdominal aortic aneurysm is a swelling in the main artery that runs from the heart through the abdomen. If it bursts, there i...
Daily low-dose antibiotics halve urinary tract infections in people who self-catheterise
People who perform clean intermittent self-catheterisation can reduce symptomatic urinary tract infections from two per year to one by taking daily low-dose antibiotics.
This NIHR-funded trial randomised 404 adults in the UK who perform the procedure for a variety of reasons to either daily oral low-dose antibiotics or no prophylaxis. All had a recent history of urinary tract infection.
Although prophylactic antibiotics halved infection rates, it increased antimicrobial resistance compared wit...
Lamotrigine is not effective for the treatment of borderline personality disorder
Lamotrigine, a mood-stabilising drug, is not clinically effective for the treatment of borderline personality disorder. Over one year follow up, this NIHR-funded trial did not find a difference between lamotrigine and placebo for borderline personality disorder-related symptoms and behavioural problems, depressive symptoms, self-harm, social functioning or quality of life outcomes.
Borderline personality disorder is a severe mental health disorder characterised by rapid and distressing fluctuat...
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...
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 ...
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...
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...
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...