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NIHR Signal Gout medication may slow progression of chronic kidney disease
In people with existing kidney disease, one in four will have worse disease within six to 12 months. Uric acid-lowering drugs such as allopurinol halve the risk of disease progression over this period. They also reduce heart attack or stroke by 60%. Uric acid, the cause of gout, is produced when proteins are broken down by the body. It is excreted by the kidneys and often builds up in people with chronic kidney disease. It is not certain whether increased uric acid causes progression of kidney ...
NIHR Signal Self-testing kits increase overall HIV testing uptake in men who have sex with men
Frequency of HIV testing in men who have sex with men may be increased by one additional test in a six month period when self-testing kits are used. Self-testing kits allow people to collect their finger-prick or saliva sample, perform the test and interpret the result themselves. This global study found that first-time testers made up around a tenth of all self-testers in high-income countries such as the US or UK, but about a third of those in resource-limited countries. About a third of self...
NIHR Signal Low FODMAP diet may improve irritable bowel symptoms more than other diets
Adults with irritable bowel syndrome (IBS) who followed a low FODMAP diet had fewer symptoms than those who followed standard dietary advice. They scored their symptoms about 50 points better on a 500 point scale. The low FODMAP diet is an emerging approach for IBS. It is based on the theory that certain carbohydrates can expand or ferment in the gut and cause symptoms for some people. This review included five randomised trials in adults who rated their symptoms before and after introducing t...
NIHR Signal Computerised decision support can improve antibiotic prescribing in hospitals
Using a computerised decision support tool (software used by hospital prescribers) improved the adequacy of antibiotic coverage and adherence to guidelines, and may have reduced the risk of people dying. Only four studies reported on resistance to antibiotics, so no conclusions can be drawn about the impact of this tool on resistance. Antibiotic stewardship programmes aim to get prescribers to think before they decide to prescribe antibiotics, then consider the type and dose of antibiotic. Comp...
NIHR Signal Better prescribing might prevent thousands of strokes in the UK
One third of people who had a first stroke in the UK between 2009 and 2013 had known risk factors and were not taking the drugs that might have prevented their stroke. Electronic general practice records from almost 30,000 people who had a stroke showed that about 60% had risk factors that meant they might have been eligible to take cholesterol-lowering, anti-clotting or blood pressure medication. But 54% of these people had no recent prescription for the appropriate drug(s). The researchers e...
NIHR Signal Antibiotics by injection into the eye can prevent severe infection following cataract surgery
Injecting the antibiotics vancomycin or moxifloxacin into the eyeball after eye surgery can reduce the risk of developing severe infection inside the eye (endophthalmitis) compared to other routes. Cefuroxime is currently the antibiotic of choice for this in the UK, but researchers wanted to see if drugs with lower rates of resistance might also be effective. A review of 34 studies, mostly observational studies with nine randomised controlled trials (RCTs), explored the effects of different typ...
NIHR Signal Patients receiving pedometers by post increased their physical activity for at least 12 months
Use of pedometers, received by post, resulted in a sustained increase in walking of around 650 steps a day, equivalent to about one km or 30 minutes of moderate to vigorous physical activity per week. The study was set in London general practices and achieved similar results whether or not people had additional support from a practice nurse. The number of people agreeing to participate was low. Of the 11,015 people invited, 1,023 took part, a take-up of just 10%. Some contacted were already mee...
NIHR Signal Enhanced patient education improves bowel preparation before colonoscopy
People who are given extra information about preparing for their colonoscopy are likely to have clearer bowels before the procedure, meaning it is more likely to be successful. About a quarter of people currently having colonoscopy are poorly prepared and this prevents a good view of the whole bowel. Better preparation allows more accurate diagnoses, shorter procedures and fewer repeat procedures. This could lower costs. The seven trials included in this evidence review all used different patie...
NIHR Signal Extended hours in primary care linked to reductions in minor A&E attendances
Practices which offered additional appointments showed a reduction in the number of their patients attending emergency departments (also known as A&E) for minor conditions. There was no overall reduction in emergency visits. Costs were reduced for emergency departments but by less than the cost of the additional appointments. The study did not evaluate whether or not this is cost saving to the health service as a whole nor if health outcomes were improved. Emergency departments are increasi...
NIHR Signal Evidence on best treatment for severe palm sweatiness
For treatment of severe sweaty palms, minimally invasive surgery to cut the sympathetic nerves at a single level, reduces the commonest complications of the procedure. This review looked at the studies of cuts made at different levels and found that compensatory sweating elsewhere in the body was minimised if the cuts were made at the level of the fourth thoracic vertebra. The success in controlling sweaty palms and patient satisfaction were similar whatever level was cut in these trials. Exces...
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