High-flow nasal oxygen reduces reintubation after major surgery compared with conventional oxygen therapy
In adults after major surgery, high-flow nasal oxygen decreases by about two-thirds the need for reintubation compared with conventional oxygen therapy. In this study, only about four in every 100 patients needed reintubation with high-flow nasal oxygen, compared with about 11 in every 100 patients receiving conventional oxygen therapy.
This review evaluated seven randomised and three non-randomised studies in 1,327 adult patients recovering from surgery under a general anaesthetic. Most of the...
Short-term dual antiplatelet treatment may be best for most patients after receiving a drug-eluting stent
For patients who have had a drug-eluting stent inserted into the coronary arteries, there is no difference in mortality or cardiovascular outcomes between the standard 12-month dual antiplatelet therapy and shorter six-month courses. Longer courses above 12 months increased risk of bleeding and non-cardiac death compared with short courses.
It has been debated whether longer treatment might decrease complications, but similarly, it is unclear if shorter treatment might be as effective while red...
Partial knee replacement ‘could be first choice’ for suitable patients with osteoarthritis
Partial knee replacement surgery improves pain and function similarly tototal knee replacement in people with osteoarthritis that affects only a single compartment of the knee. Partial knee replacement surgery is also cheaper.
In this NIHR-funded trial of 528 people with osteoarthritis affecting only one compartment of the knee, those who had partial knee replacement saw at least as much improvement as those who had a total joint replacement. Their care also cost about £900 less over five...
Early suppression of male hormones is better than delayed therapy for advanced prostate cancer on balance
Offering early hormone suppression therapy to men with advanced prostate cancer that is causing no symptoms improves outcomes compared with waiting until symptoms of cancer spread arise. Early treatment is associated with 23 to 57 fewer deaths per 1,000 men over five years, depending on the men’s baseline risk. However, this comes with an increased chance of some non-serious side effects.
Hormone suppression works by lowering levels of the male sex hormones that fuel the cancer’s gr...
‘Last resort’ antipsychotic remains the gold standard for treatment-resistant schizophrenia
Among patients with schizophrenia that has not responded to other drugs, the antipsychotic drug clozapine cuts the chances of hospital admissions and drugdiscontinuation.
Recent trials have questioned the superior efficacy of clozapine compared with other standard antipsychotic drugs. However, a review of real-world data from observational studies confirms its place as a drug that may work when others fail. Patients prescribed clozapine had better outcomes, despite having more severe illness.
Better strategies are needed to reduce preventable patient harm in healthcare
About 6% of patients in healthcare settings internationally experience harm that could have been prevented. Around one in eight of these cases result in severe harm, causing permanent disability or death.
Drug errors, therapeutic management incidents and incidents involving invasive clinical procedures are the most common causes of preventable patient harm. Higher rates of harm were seen in intensive care and surgical departments than in general hospital settings.
This NIHR-funded review poole...
Enhanced communication and staff training could improve the experience of maternity services for asylum-seeking women
Pregnant asylum seekers experience significant barriers to accessing maternity services in the UK. A review found that these barriers often relate to language differences and practical challenges associated with their status. Provision of interpreter services and training for health care professionals could improve maternity support for these women.
Pregnant women seeking asylum have often experienced significant trauma. Many arrive in the country having received no maternity care and experienc...
Diagnosis of delirium in hospitals can be improved by the 4 A’s test
A new shorter test for delirium appears helpful in assessing older people in hospital who may have the condition. A normal score on the 4 A’s test effectively rules out delirium while an abnormal score is reasonably useful for detecting the condition. People detected by the test would still need a full assessment to confirm the diagnosis.
Delirium is common in older people who have been hospitalised, but it can go undiagnosed. To help combat this, the 4 A’s test was developed as an ...
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...
Diet and physical activity interventions targeting children and youth have different, yet small, effects on preventing obesity
Obesity prevention interventions which include both diet and physical activity may reduce the risk of obesity in pre-school children. Once at school, physical activity appears to be more effective for weight loss than diet alone. Resulting weight loss form any intervention, if any, has been very small with unclear benefits to the individual or population.
This NIHR-supported Cochrane systematic review pooled the results of 153 global randomised-control trials (sevenfrom the UK) aiming to preven...