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NIHR Signal Peer support may reduce readmissions following mental health crises
People discharged from mental health crisis teams are less likely to re-enter acute services within a year if they receive self-management support. The support in this study was provided by a peer worker, someone with experience of mental illness. The peer worker used a workbook to provide information and talk through recovery goals. The study compared this with those who had received the workbook by post. Participating adults had a range of mental illnesses and had been managed by six crisis r...
NIHR Signal Oral steroids do not help hearing for children with glue ear
Oral steroids do not improve hearing, symptoms, or quality of life in children with glue ear. This NIHR-funded trial compared oral steroids with placebo for 389 children with glue ear, also called otitis media with effusion, and found no significant effect on those outcomes. Glue ear is when the middle ear fills with fluid, often following an ear or respiratory infection. The fluid makes hearing more difficult. It usually resolves within three months without treatment, but if it lasts longer, t...
NIHR Signal Albumin administrations can prolong survival for some people with liver disease
Weekly intravenous albumin can prolong the life for people with liver cirrhosis and uncomplicated ascites. Over about 18 months, 17% of patients given albumin died compared with 22% given standard care alone over 11 months. People with very severe (end-stage) cirrhosis develop various complications including a build-up of fluid in the abdomen (ascites). This is the first large trial to study the effects of long-term albumin infusions. In addition to improved survival, albumin also reduced hosp...
NIHR Signal A reminder that too much oxygen increases mortality in acutely ill adults
In acutely ill adults, liberal use of oxygen supplementation is found to increase the risk of death compared with more conservative oxygen strategies. More liberal oxygen therapy increases patient mortality in hospital by about 11 deaths amongst every 1,000 people exposed. Deaths also increase after 30 days follow-up, without improving other important health outcomes, such as disability, infection or length of hospital stay. Oxygen is routinely used for acutely ill patients and is widely consid...
NIHR Signal Self-monitoring improves control of high blood pressure compared with GP monitoring alone
Allowing patients who have inadequately controlled high blood pressure to monitor their own blood pressure at home helps their GPs to optimise their management. Patients who self-monitor and visit or talk to their GP when needed for medication adjustments achieve 4mmHg lower systolic blood pressure over 12 months compared with those relying only on the measurements made by a GP without self-monitoring. Effects are similar if patients write down their measurements to send to the GP or do so via ...
NIHR Signal Mesh repair of small umbilical hernias reduces recurrence compared to sutures
Repairing small umbilical hernias with surgical mesh rather than sutures reduces the chance of the hernia returning. Complications such as wound infection and pain are not affected by the type of repair. Adults with umbilical hernias need surgery to prevent serious bowel complications. There are no guidelines about how to best to treat them. In practice, larger hernias tend to be repaired with mesh, while smaller ones are repaired with sutures. This trial of adults with umbilical hernias of 1 t...
NIHR Signal Atraumatic needles reduce headaches following lumbar puncture
Use of atraumatic needles rather than conventional needles for lumbar puncture more than halves the rate of post-procedure headache. Moreover, this improvement does not come at the expense of procedure success rates. Lumbar puncture involves inserting a needle in the lower back into the spinal canal to collect cerebrospinal fluid for diagnosis, or to inject a treatment or anaesthetic into it. A common side effect is a headache, often from leakage of fluid from the puncture. Atraumatic needles ...
NIHR Signal Adding the extra antibiotic rifampicin did not improve cure rates after sepsis
Adding the antibiotic rifampicin did not improve cure rates or reduce deaths for people with bacterial blood infections caused by Staphylococcus aureus. It increased the risk of adverse reactions requiring a change in treatment and the chances of drug interactions. This NIHR-funded trial is the largest to date on adding rifampicin to standard antibiotic therapy. The study included 770 people in 29 UK hospitals. Half were assigned to 14 days of treatment with rifampicin on top of their existing ...
NIHR Signal Adding a third antiplatelet drug after a stroke doesn’t reduce the risk of another stroke
A combination of aspirin, clopidogrel and dipyridamole does not reduce the incidence or severity of recurrent stroke in people who have had a stroke or transient ischaemic attack (TIA). This NIHR-funded trial compared the triple treatment to current guideline-based antiplatelet therapy for preventing further stroke or TIA (brief loss of blood supply to the brain). UK guidance recommends aspirin initially followed by clopidogrel alone as for most people this gives the best balance of effectivene...
NIHR Signal Short-duration dual antiplatelet treatment is possible for older people receiving drug-coated stents
Drug-eluting stents are more effective than bare-metal stents for preventing repeat procedures to open narrowed heart arteries in older adults with coronary heart disease. In this trial both types of stents were used alongside short courses of dual antiplatelet medication, outcomes for those receiving drug-eluting stents were improved with no difference in bleeding complications or rates of in-stent clots. This multi-centre European study tested 1,200 people aged 75 years or older. Duration of ...
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