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NIHR Signal Delaying pushing in labour has no benefit for women with an epidural and/or spinal for pain relief
For women having their first baby with an epidural and/or spinal anaesthetic for pain-relief, the timing of pushing after full dilatation of the cervix does not affect the numbers that achieve normal vaginal delivery. The best management for the second stage of labour is still debated. In the UK epidurals are by far the most widely used regional anaesthetic technique for pain relief in labour. In this large trial, women either pushed immediately or delayed pushing by waiting for 60 minutes. Wo...
NIHR Signal Decontamination of the mouth or digestive tract was not linked to reductions in drug-resistant bloodstream infections in the intensive care unit
Decontamination strategies to remove potentially harmful bacteria from the mouth, throat and gut of critically ill patients don’t reduce the risk of intensive care unit-acquired bloodstream infections or deaths from bacteria that were resistant to antibiotics. The study was carried out in 13 intensive care units across Europe, including the UK, with moderate to high levels of antibiotic resistance (extended resistance in more than 5% of all bloodstream infections). This fills an important ...
NIHR Signal Training for clinical competence and resilience reduced job strain among intensive care nurses in France
A five-day educational course showed potential to reduce work-based stress and burnout among nurses working in intensive care units in France. The study conducted in multiple adult intensive care units aimed to identify the effects of an intensive, continuing medical education program on occupational stress. The course focussed on nursing theory, role-play and debriefing sessions. Six months after attending the programme, intensive care unit nurses showed reduced levels of job strain compared t...
NIHR Signal Early cooling provides no benefit following traumatic brain injury
Deliberate cooling (prophylactic hypothermia) in the early management of traumatic brain injury does not improve neurological outcomes at six months. Inducing hypothermia may also increase the risk of pneumonia. Hypothermia (33-35oC) is sometimes induced to try and limit brain damage in people with severe head injuries. However, evidence for its safety and effectiveness has been mixed. A 2015 trial (Eurotherm 3235) found that therapeutic hypothermia, for adults with raised intracranial pressur...
NIHR Signal Antibiotics may be an alternative first-line treatment for uncomplicated appendicitis
Appendicectomy surgery could potentially be avoided for around 60% of adults with uncomplicated appendicitis if they receive antibiotics first. Adults in Finland with appendicitis were randomised to have appendicectomy or a course of antibiotics. In 6 out of 10 the appendicitis settled and did not return over the five years they were followed. Of those who did go on to need surgery most did so in the first year. If the findings from the study could be applied to the UK, it is estimated that up...
NIHR Signal Adding low dose theophylline to inhaled corticosteroids does not reduce COPD exacerbations
Taking low-dose theophylline tablets in addition to inhaled corticosteroids did not significantly reduce chronic obstructive pulmonary disease flare-ups (exacerbations). This NIHR funded study found that people taking the combination and those taking an inhaled steroid had the same number of exacerbations - just over two per year. People who experience frequent exacerbations are often prescribed steroid inhalers to reduce inflammation of the airways. Theophylline also helps open up the airways,...
NIHR Signal Thyroid hormone treatment does not help adults with mildly abnormal thyroid tests
There appears to be no benefit from treating adults with subclinical hypothyroidism. Treatment has no effect on quality of life or symptoms compared with placebo or no treatment. Thyroid function tests are commonly performed in general practice for patients who present with a range of symptoms, including fatigue or tiredness. When subclinical hypothyroidism is detected, there is uncertainty whether treatment is worthwhile or how to best monitor success. A recent large study found that hormone l...
NIHR Signal Opioid drugs are no better than standard painkillers for long-term back and joint pain
People with long-term back pain, or osteoarthritis of their hips or knees, do not get better pain relief from opioid drugs and are more likely to get side effects than those who take paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), like naproxen or ibuprofen. A US study assigned 240 patients to either opioid or non-opioid pain relief drugs and measured their pain over 12 months. Those who were assigned opioid drugs had less relief of their pain and also were more likely to have si...
NIHR Signal Oral ibuprofen may be an option for closing patent ductus arteriosus in premature babies
A high dose of oral ibuprofen was more likely to close a patent ductus arteriosus in premature babies when compared with standard doses of intravenous ibuprofen or indometacin. Before birth, a baby's lungs aren't needed for breathing. Most blood bypasses the lungs through a large vessel called the ductus arteriosus directly from the pulmonary artery into the aorta to supply the main circulation. Once born, blood flows through the lungs, and the ductus arteriosus usually closes in the fi...
NIHR Signal Single routine offer of a blood test for prostate cancer did not save lives
Offering all men aged 50 to 69 a single, screening prostate-specific antigen (PSA) blood test did not prevent deaths from prostate cancer. This large trial included 573 UK general practices and over 400,000 men. It found that men who were invited to have a PSA test were 19% more likely to be diagnosed with prostate cancer, but no less likely to die from the condition, over an average 10 years of follow up. Forty per cent of men took up the offer. Controversy over PSA testing has persisted for ...
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