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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 ...
NIHR Signal Low fat or low carbohydrate diets seem just as effective for weight loss
Overweight to obese adults who followed a low fat or low carbohydrate diet for 12 months both lost around 5 or 6kg in body weight. It made no difference whether they had a gene-type indicating that they break down fats or carbohydrates better. Obesity is a major public health concern and there are many weight-loss approaches and fad diets that people try. Dietary trials tend to observe only modest weight loss. Given wide population variation, some suggest that knowing the genetic or metabolic c...
NIHR Signal Giving oxygen routinely after a stroke does not improve outcomes
There was no benefit to routinely giving oxygen to people who have had a stroke. Oxygen given continuously, or just overnight, did not reduce disability or death and it did not improve people’s ability to do everyday tasks or live independently. There were no oxygen-related adverse events reported. Strokes occur when the blood supply to the brain is disrupted by either a blocked or burst blood vessel. They can lead to death or disability as parts of the brain are deprived of blood. Theref...
NIHR Signal Specialist-led improvised music therapy did not improve children’s symptoms of autism
After five months, improvised music therapy added to enhanced usual care was no better than enhanced usual care alone for young children with an autism spectrum disorder (ASD). Clinically meaningful improvements in social and communication skills were not achieved in either group over this time. This result from a large well designed NIHR-funded international trial contrasts with an earlier systematic review of small trials that suggested beneficial effects for this specialised therapy. Qualifi...
NIHR Signal A commonly used treatment does not improve chronic low back pain
This trial found that destroying nerves that take pain signals to the brain using heat (radiofrequency denervation) did not improve pain, function or a sense of “recovery”. The treatment was used alongside exercise and was a variation of the technique commonly used in the UK. In this large study, it was compared to exercise alone. Low back pain is usually short-lived, but some people develop long-term back pain which can negatively impact their lives. NICE recommends exercise, pain ...
NIHR Signal Intensive lifestyle interventions can help obese young people lose weight
Obese children and adolescents can lose up to seven pounds over six to 12 months when they engage in at least 52 hours of behaviour-based lifestyle interventions. Minimal benefit was seen with shorter contact time, with less than 25 hours ineffective. The control group gained weight. Rising obesity in the young is a global concern, which may lead to high rates of obesity-related diseases in adulthood. This review identified trials covering various weight management strategies. Lifestyle-based-i...
NIHR Signal Fortified donor breast milk led to similar development for very-low-birthweight babies compared with formula milk
Providing very-low-birthweight babies with fortified human donor breast milk made no difference to their developmental neurological outcomes at 18 months compared with giving formula. This randomised controlled trial looked at 363 babies with birth weights of less than 1500g in neonatal intensive care units in Canada. When the mother’s own milk supply was limited, the babies were given either nutrient-enriched donor breast milk or formula developed for premature babies. There was no diffe...
NIHR Signal Nine different drug classes reviewed for type 2 diabetes
Metformin worked best at keeping blood sugar levels under control and remains a good first choice as single therapy. Overall, the nine classes of blood sugar-lowering drugs had similar effect on risk of death from cardiovascular causes and overall mortality, though estimates are imprecise because so few people died in these studies. Risk of other side effects, such as weight gain or risk of low blood sugar did vary between treatments. This very large systematic review of 301 trials compared the...
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