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NIHR Signal C-reactive protein testing in general practice safely reduces antibiotic use for COPD flare-ups
Use of a rapid C-reactive protein (CRP) blood test in general practice for people with a flare-up of COPD reduces the proportion who take antibiotics over the next month by about 20 percentage points compared with usual care alone. The reduction in antibiotic use does not lead to worse health, more visits to the doctor or greater need for antibiotics later on. Flare-ups of COPD can be caused by infections of the airways or environmental triggers, and cause about 115,000 admissions to hospital e...
NIHR Signal Switching to oral antibiotics early for bone and joint infections gave similar results to continuing intravenous therapy
For adults with bone or joint infection, many of whom had metal implants, beginning six weeks of oral antibiotics within seven days of intravenous treatment, was no worse than a regimen delivered wholly intravenously (IV). After one year, around 14% of both groups still had an infection, showing the difficulty of treatment, irrespective of the route of administration. Although current practice suggests antibiotics should be given IV for bone and joint infections, for at least six weeks, this la...
NIHR Signal E-cigarettes helped more smokers quit than nicotine replacement therapy
Smokers who use NHS stop smoking services appear almost twice as likely to be successful for a year if they use e-cigarettes than if they use nicotine replacement therapy (NRT) products. In a trial of 866 smokers who used NHS stop smoking services, 18% of those assigned to e-cigarettes were abstinent 12 months from their quit date, compared to 9.9% of those assigned to NRT. Everyone in the study was also offered four weeks of one-to-one behavioural support from a clinician. Of those who had suc...
NIHR Signal Varicose vein injections help new venous leg ulcers heal
For patients with leg ulcers caused by varicose veins, early intervention to treat the veins results in faster healing of ulcers than standard compression therapy alone. Researchers studied 450 people with open venous leg ulcers of 6 weeks to 6 months duration and varicose veins. Those assigned to have their veins treated within two weeks had healed ulcers in an average of 56 days, compared with 82 days for those who had treatment deferred for six months, or until after the ulcer had healed. I...
NIHR Signal An emergency department protocol to restore circulation doesn’t improve outcomes in septic shock
A protocol called early goal-directed therapy (EGDT) begun in the emergency department, did not reduce mortality compared with usual care for people with septic shock. The six hour treatment protocol aims to restore circulation for people with septic shock based on treatments that progress in a structured sequence before admission to intensive care. The protocol requires early placement of a central venous catheter. The study pooled data from 3,723 patients included in three international trial...
NIHR Signal The heart failure drug levosimendan doesn’t improve outcomes in adults with severe infections
Septic shock is a life-threatening condition resulting from serious infection. Adding levosimendan to the usual care of adults with septic shock did not reduce the risk of death up to 28 days, nor the degree of damage to essential body organs. It probably also increased patients’ risk of abnormally fast heart rate and increased the time they needed mechanical ventilation. This large NIHR-supported trial included adults in UK intensive care units. It is the largest to date and presents th...
NIHR Signal A scan may help decide if surgery is required as follow-on treatment for head and neck cancer
People with head and neck cancer in the UK usually receive chemotherapy and radiotherapy followed by surgery. Using a scan to assess cancer status after this first line chemoradiotherapy and only suggesting surgery to those with a clear indication led to similar survival rates, complications and fewer operations compared with planned cancer surgery for everyone. After receiving similar initial treatment, this trial compared routine neck dissection surgery to surgery only if the scan showed resi...
NIHR Signal Early exposure to peanut snacks can lead to sustained protection in high-risk children
Early exposure, up to age five, to peanut products in children with severe eczema or egg allergy appears to induce tolerance that is sustained when peanut products are later avoided, suggesting it is not necessary to keep eating peanuts long term. This trial and its follow up study examined the effect of giving peanut products to very young children (aged four to 11 months) who were at high risk of peanut allergy. Children given regular peanut butter snacks until five years of age were much les...
NIHR Signal Inducing labour in older women having their first baby does not increase the chance of caesarean delivery
Planning to artificially start labour for older women, pregnant with their first child, in the 39th week of pregnancy does not affect the chance of having a caesarean delivery, according to a new trial funded by NIHR. Older women having a first baby have a higher risk of stillbirth and other complications than younger mothers and inducing labour at or before the due date is thought to reduce this risk. However, there have been fears that inducing labour may raise the risk of a caesarean deliver...
NIHR Signal Large trial finds no benefit from restricting limb blood supply before heart surgery
Early small studies suggested that a period of restriction of blood supply to the arm just before cardiac surgery might confer some protection to the heart during surgery (please see ‘A review of restricting blood supply to a limb before heart surgery highlights the need for better evidence’). The NIHR funded this large, multi-centre trial to investigate whether controlled restriction of blood circulation to the arm immediately before heart bypass surgery could reduce deaths, heart a...
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