A football programme for overweight men achieves sustained weight loss
A 12-week weight management programme for men, centred on football, achieved 4.9kg weight loss at 12 months. Modest weight loss of 2.9kg was maintained at 3.5 years.
Rates of overweight and obesity are higher for men than women in the UK, and there is little evidence that interventions are effective in the longer term. This NIHR-funded study followed 488 of 747 men (65%), average age 47 years, originally allocated to a programme of behavioural advice and football training with a professional co...
MRI scan does not help to find the cause of pelvic pain in women
MRI scans are not sufficiently accurate to find the cause of chronic pelvic pain in women and should not replace laparoscopy (keyhole surgery), which can be used for diagnosis and often treatment. MRI only correctly ruled out a gynaecological condition in half of women judged to have no obvious cause and missed half of women who did have a treatable gynaecological condition.
Pinpointing the origin of chronic pelvic pain is often difficult due to the number of possible causes. If initial tests a...
The blood-thinner apixaban is less likely to cause major bleeding than warfarin
People who take apixaban to prevent blood clots are less likely to suffer major bleeding complications than those taking warfarin. Findings are similar in different groups of people, such as those with irregular heart rhythm (atrial fibrillation) and those who have had joint replacement surgery.
Warfarin has long been used as an anticoagulant but needs frequent blood test monitoring. The new class of direct-acting oral anticoagulants does not usually need monitoring and is replacing warfarin.
Negative pressure dressings are no better than standard dressings for open fractures
Negative pressure wound dressings are neither more nor less effective than standard wound dressings for severe open fractures of the lower leg. Any difference between groups was neither clinically important nor statistically significant. The outcomes included self-rated disability at one year, quality of life and deep surgical site infections at one month which occurred in around 7-8% in each group.
Open fractures of the leg, where the broken bone is exposed by the original injury or has burst ...
No benefit from monitoring antiepileptic drug levels in pregnancy
Regular monitoring of antiepileptic drug levels in pregnant women with epilepsy does not improve seizure control compared with clinical features-based monitoring. This NIHR-funded study was conducted across 50 UK hospitals and is the largest randomised trial in pregnant women with epilepsy.
Just over 260 pregnant women with unstable antiepileptic drug levels were assigned to ongoing monthly blood checks or clinical features monitoring. There were no differences in seizures or other pregnancy ou...
Non-urgent attendances to emergency departments are more common among younger adults
Adults aged 16 to 44 years are more likely to attend emergency departments for non-urgent presentations than older adults. They were more than three times more likely to present for non-urgent reasons than those over 65 years.Non-urgent attendances are also more common during out-of-hours periods, especially at night.
Emergency departments are consistently under high pressure with long waiting times. Understanding the characteristics of non-urgent attendances that could be managed in the commun...
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...
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...
Financial incentives may help workers quit smoking
Financial incentives, when given alongside free smoking cessation aids, improved abstinence rates compared with free cessation aids or motivational information alone.
This workplace-based US trial assigned 6,000 smokers, unselected for willingness to quit, to information only, free e-cigarettes, free nicotine replacement or drug therapy, or free cessation aids with a $600 reward in one of two ways. Quit rates at six months were very low though the substantial financial incentive increased the r...
Routine measurement of grip strength can help assess frailty in hospital
Training clinical staff to routinely measure grip strength can help identify frail older hospital inpatients. This could help tailor their care.
This NIHR-funded study was conducted across five acute medical wards in one hospital in England over a nine-month period. Nursing staff were trained to measure grip strength of people aged over 80 years. They were instructed to assess if those with low grip required nutritional supplements and to refer them to physiotherapy for consideration of strengt...