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NIHR Signal Abdominal aortic aneurysm screening for women is unlikely to be a fair use of NHS resources
Nearly 4,000 women would need screening to prevent one death, and a third of aneurysms detected wouldn’t have influenced the individual woman's health or lifespan. Aneurysm rupture is a life-threatening emergency with low survival. Men are known to be at higher risk of an aneurysm and are offered screening at age 65 to allow early diagnosis of aneurysms large enough to warrant surgical repair. However, a third of deaths from rupture are in women. This NIHR-funded study is the first t...
NIHR Signal Patient-centred care for multimorbidity improves patient experience, but quality of life is unchanged
A patient-centred intervention in general practice for people with multiple chronic conditions, based on recommended best practice, had no effect on patient quality of life or burden of illness and treatment. Patients were, however, more likely to report being satisfied with their care. An increasing number of people in the UK are living with multimorbidity, defined as two or more long-term health conditions. NICE recommends a comprehensive approach to care, tailored to the patient’s need...
NIHR Signal Better pain relief for women in labour
Women in labour, who had the short acting strong painkiller remifentanil, rather than pethidine, had less need for further pain relief. Only 19% of women given remifentanil received a subsequent epidural compared with 41% given pethidine. Remifentanil was given intravenously, using a patient-controlled delivery device, and pethidine given by intramuscular injection. This NIHR-funded study is the first large trial to compare intravenous remifentanil (administered via a patient-controlled deliver...
NIHR Signal Keyhole surgery is more effective than physiotherapy for hip impingement
Keyhole surgery to reshape the joint surfaces in people with hip impingement improves hip-related quality of life more than physiotherapy. In hip impingement, there is a painful restriction of the smooth movement of the ball of the femur inside the cup (acetabulum) of the pelvis. It mainly affects younger, active people. Observational studies have supported the use of keyhole surgery (arthroscopy), but there was a lack of high-quality evidence. This NIHR-funded study is the first trial to compa...
NIHR Signal The most effective antidepressants for adults revealed in major review
Antidepressants are effective to treat moderate to severe depression in adults. Five antidepressants appear more effective and better tolerated than others. A major review of 522 antidepressant trials found that all of the 21 drugs studied performed better than placebo, in short-term trials measuring response to treatment. However, effectiveness varied widely. Researchers ranked drugs by effectiveness and acceptability after eight weeks of treatment. Several drugs were more effective and were ...
NIHR Signal Additional therapy helps social recovery from first episode psychosis
Social recovery therapy increases structured activity, such as work, education or sport, by eight hours per week for people with severe social withdrawal following a first episode of psychosis. This cognitive behavioural type of treatment was added to other early interventions and might be particularly useful for those lacking motivation or living with other conditions that prevent them engaging with mental health services. This NIHR-funded trial included 154 young adults with first episode of ...
NIHR Signal Doxycycline may be a safer first option for treating a blistering skin condition
Doxycycline (an established antibiotic) may be a safer first option than the standard steroid treatment for people with the autoimmune skin condition bullous pemphigoid. The condition causes severe, itchy blistering. This NIHR-funded study showed that people started on doxycycline were 19% less likely to have severe, life-threatening or fatal events during the next 12 months than those who started a steroid (prednisolone). Blister control was considered acceptable for both treatments (74% treat...
NIHR Signal Computerised interpretation of fetal heart rate during labour does not improve outcomes
Using a computerised decision-support system to interpret the outputs of continuous electronic fetal monitoring during labour does not show any advantages over clinicians interpreting the outputs themselves. This is the first trial to assess decision support of this kind. In this large NIHR-funded trial, rates of poor neonatal outcomes, caesarean sections and assisted deliveries were not affected by whether clinicians were alerted to potential problems by the decision-support system or by their...
NIHR Signal MRI scan before biopsy could detect more prostate cancer
In men with a raised prostate specific antigen (PSA) blood test, which can be a sign of prostate cancer, MRI scanning before standard biopsy could allow more targeted biopsies and increase diagnosis of medium and high-risk prostate cancer. In this NIHR-funded study, 576 men with suspected prostate cancer received a multi-parametric (MP)-MRI scan in addition to transrectal ultrasound-guided (TRUS) biopsy. They also had template mapping (TPM) biopsy of the entire prostate to reliably diagnose can...
NIHR Signal Excision is probably better than stapling in the long-term for haemorrhoids
Recurrences of haemorrhoids (piles) are three times less likely if they are surgically removed rather than treated with a relatively new stapling procedure. There are now a wide range of techniques to tackle this common, distressing condition. Some, such as stapling, have become more popular despite a lack of evidence about improved long-term outcomes. This NIHR-funded trial compared both operations for moderate to severe haemorrhoids across multiple sites in the UK. Quality of life was simila...
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