Tranexamic acid is safe to use following mild-to-moderate traumatic brain injury and reduces deaths
In people with mild-to-moderate traumatic brain injury, tranexamic acid (a drug which reduces bleeding) given within three hours of injury reduces the risk of death by 22%. This effect is seen in a subgroup of those who are less severely affected.
This NIHR-funded multi-centre international trial randomised 12,737 adults with intracranial bleeding to receive either tranexamic acid or a placebo. Overall, there was no difference in risk of death within 28 days between the two groups. However, whe...
Fewer infections with antibiotic-impregnated shunts for hydrocephalus
Antibiotic-impregnated shunt catheters led to fewer infections than standard catheters in this study, although the overall rate of shunt revision remained about the same.
In hydrocephalus, a shunt is a device consisting in part of a long catheter (a tube) that relieves the raised pressure of fluid in the ventricles of the brain. It is inserted internally and works by simply draining the fluid, most commonly, to the abdomen. These shunts may need revision because of infection or mechanical failu...
‘As-needed’ combination asthma inhalers can be more effective than regular inhaled steroids
In adults with mild to moderate asthma, budesonide-formoterol used as needed for symptom relief was more effective at preventing severe exacerbations than maintenance low-dose budesonide plus as-needed terbutaline. In this trial involving 885 adults, those using the combination inhaler as required had fewer severe asthma attacks, with similar levels of general symptom control, and overall used a lower dose of corticosteroid.
The results of this trial suggest that for people with mild asthma, ex...
Surgery for a deviated nasal septum improves quality of life more than non-surgical approaches
Surgery for adults who have a deviation, or bend, in the wall running through the centre of their nose improves quality of life more than non-surgical alternatives. The benefit was maintained for at least two years. The surgery, a septoplasty, also improvesairflow through the nose.
The trial compared septoplasty to non-surgical alternatives, such as just monitoring the patient or giving treatments such as corticosteroid nasal sprays.
There has been a lack of good-quality evidence in managing t...
On balance, antiplatelet drugs may be restarted for stroke survivors who have bled into the brain
Early research suggests that antiplatelet drugs, such as aspirin, can provide more benefit than harm if restarted at about 2 to 3 months after a brain bleed. The results seem to apply best to those patients with a good prognosis who survive with less disability.
Antiplatelet drugs are of proven benefit to those with a high risk of vascular events; they reduce the risk of heart attacks and strokes because they prevent platelets from clumping together. However, after a type of a stroke caused by ...
Levetiracetam is a useful alternative to phenytoin in stopping prolonged epileptic seizures in children
Levetiracetam is as effective as phenytoin at stopping prolonged epileptic seizures in children. In this trial, levetiracetam stopped 70% of children convulsing compared with 64% for phenytoin within 35 to 45 minutes. Adverse events were similar. This combined with the fact levetiracetam may be easier to administer safely make it an important option.
Most epileptic seizures stop by themselves within a few minutes, but sometimes they continue for much longer. If this happens emergency treatment ...
National quality improvement programmes need time and resources to have an impact
A large trial assessing the effectiveness of a UK-wide quality improvement programme did not show any difference in patient outcomes. However, the likely reasons for this were carefully investigated and provide some useful insights on implementation.
Several (37) quality improvement components were included in the ambitious package designed to reduce variation in care and improve outcomes for adults undergoing emergency abdominal surgery. There was no difference in survival at 30 days, length o...
More than 80% of total knee replacements can last for 25 years
Large data sets from national registries and case series show that about 82% of total knee replacements and 70% of partial (unicompartmental) knee replacements last for 25 years.
This NIHR-funded review of that data is the first to demonstrate longer-term effectiveness of these procedures. This means that the operation, which aims to relieve pain for osteoarthritis, may not need to be delayed to reduce the chance of a patient needing further surgery at a later date. It is an encouraging finding...
Various drugs are effective and well-tolerated for generalised anxiety disorder
There are various drugs options for the treatment of generalised anxiety disorder, from different medication classes. This study found that most evidence was available for the serotonin and noradrenaline re-uptake inhibitors (SNRI) duloxetine and venlafaxine, the selective serotonin reuptake inhibitor (SSRI) escitalopram, and the anti-epileptic pregabalin. All appear well-tolerated and reduce symptoms compared with placebo. The SSRI sertraline, commonly used in practice, was equally effective an...
A care package to increase awareness of fetal movements does not reduce risk of stillbirth
A care package to increase awareness of fetal movements, and allow identification and delivery of high-risk babies, did not reduce the risk of stillbirth.
The incidence of stillbirth varies across high-income countries suggesting that many could be preventable. The AFFIRM trial is the largest to date to assess whether interventions that increase awareness of fetal movements can reduce risk of stillbirth. The trial involved 33 hospitals in the UK and Ireland who implemented the care package at ...