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NIHR Signal On balance, antiplatelet drugs may be restarted for stroke survivors who have bled into the brain
Early research suggests that antiplatelet drugs, such as aspirin, can provide more benefit than harm if restarted at about 2 to 3 months after a brain bleed. The results seem to apply best to those patients with a good prognosis who survive with less disability. Antiplatelet drugs are of proven benefit to those with a high risk of vascular events; they reduce the risk of heart attacks and strokes because they prevent platelets from clumping together. However, after a type of a stroke caused by ...
NIHR Signal Virtual reality can help reduce the pain and anxiety of stressful medical procedures for children
Virtual reality shows promise in helping to distract children from self-reported pain and anxiety during medical procedures. Younger children in particular may benefit from the intervention. This review of seventeen trials looked at virtual reality interventions tested in trials with children receiving treatment for burns, dental and tumour related health needs, and during needle insertion for intravenous access. Results suggested a marked impact on pain and anxiety of children from these immer...
NIHR Signal Physician associates appear to make a positive contribution to inpatient care
Physician associates improve continuity of care and patient experience within the hospital setting. This first evaluation of the new role in the NHS suggests they could provide safe and equivalent care on defined tasks, freeing up time for doctors, and help with patient flow. However, some say that the actual and perceived potential is being held back by a lack of professional statutory regulation and the ability to prescribe. The number of physician associates trained in some of the tasks done...
NIHR Signal Robot-assisted training offers little useful improvement in severe arm weakness and function after stroke
People who have severe arm weakness following stroke have no better function after robot-assisted training or enhanced upper limb therapy than those who have usual NHS care. This large multicentre trial, funded by the NIHR, randomised 770 adult stroke patients to robot-assisted training using the MIT-Manus robotic gym, to an enhanced therapy programme or to usual NHS care. All three groups had improved arm function after three months, with no significant differences between the groups. The rob...
NIHR Signal Cardiac rehabilitation for heart failure can improve quality of life and fitness
Exercise-based cardiac rehabilitation may improve the quality of life and physical fitness of people with heart failure but does not reduce their risk of being admitted to hospital or dying. This is irrespective of factors such as age and ethnicity. This NIHR study summarised the outcome data from trials assessing exercise programmes for over 4,000 people with heart failure. At an individual level, the review looked for any improvements in physical symptoms and the psychological impacts of livi...
NIHR Signal Reminders to assess clotting risk increase the use of preventive measures
Reminders to assess clotting risk result in more patients being given appropriate anti-clotting measures in hospital. Computer alerts, in particular, are linked to better choice of prophylaxis and fewer blood clots in veins. Clots in deep leg veins or the lungs are common when people are bedbound in hospital. This updated Cochrane review assessed interventions aiming to increase the use of appropriate preventive measures such as anti-clotting drugs or mechanical measures, including stockings, f...
NIHR Signal Antibiotics reduce complications after assisted vaginal delivery
Preventative antibiotics halve the risk of infection for women who have assisted vaginal delivery using forceps or suction-cup devices. About 10% of women receiving antibiotics develop an infection within six weeks of delivery compared with 20% of women who receive a placebo. Antibiotics are not routinely recommended for women undergoing assisted delivery as there hasn’t been enough evidence that they reduce maternal infection rates. This large NIHR-funded trial, including almost 3,500 wo...
NIHR Signal Non-invasive brain stimulation may improve outcomes for children with brain injury
Non-invasive brain stimulation may help improve limb function in children with motor disorders following brain injury, such as cerebral palsy or one-sided weakness. This is a relatively safe procedure where pads placed on the head deliver electric or magnetic currents, which are thought to activate the motor areas of the brain. This review evaluated 14 trials, including 306 children comparing two types of brain stimulation with a control group. It found that these types of stimulation may impro...
NIHR Signal Mucus-thinning drugs slightly reduce COPD symptom flare-ups
People with chronic obstructive pulmonary disease (COPD) have a slightly reduced risk of having a flare-up of symptoms if they take mucolytic drugs. The number of days on which they are too ill to perform their normal activities is also slightly reduced, from 1.57 days to 1.14 days per month. A review of placebo-controlled trials, including 10,377 people taking a variety of mucolytic drugs, for between two months to three years, found improvements in exacerbations, days of disability, and hospi...
NIHR Signal Routine engagement in end of life planning can improve health outcomes for people with heart failure
Interventions that encourage healthcare professionals to engage in advance care planning with heart failure patients can work more effectively than stand-alone training activities in improving health outcomes. Approaches that involve patients to change clinicians’ professional practice behaviours, the use of reminder systems and educational meetings may offer the best potential. There is no cure for heart failure, and palliative care is known to help this patient group. Advance care plann...
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