Early, intense rehabilitation helps recovery after serious traumatic head injury
Early, intensive rehabilitation aids recovery and improves outcomes for people with moderate to severe traumatic brain injury.
A review of 11 studies found that starting rehabilitation early, while people were still in intensive care, or offering more intensive treatments helped patients with brain injury regain function compared with usual care. Early rehabilitation often included multisensory stimulation while the patient was still in a coma. The intensive multidisciplinary programmes mostly ...
Balanced electrolyte solutions give marginal benefit over saline for very ill patients
About 14% of critically ill patients receiving electrolyte-balanced crystalloids either developed kidney failure, needed kidney-replacement therapy or died compared with 15% receiving normal saline. This small but statistically significant benefit was only apparent when combining outcomes; there was no difference between fluids for the three individual outcomes analysed separately.
A solution of 0.9% sodium chloride (normal saline) is the most commonly used intravenous (IV) fluid, but it can ca...
Single routine offer of a blood test for prostate cancer did not save lives
Offering all men aged 50 to 69 a single, screening prostate-specific antigen (PSA) blood test did not prevent deaths from prostate cancer.
This large trial included 573 UK general practices and over 400,000 men. It found that men who were invited to have a PSA test were 19% more likely to be diagnosed with prostate cancer, but no less likely to die from the condition, over an average 10 years of follow up. Forty per cent of men took up the offer.
Controversy over PSA testing has persisted for ...
Fewer side-effects and similar benefits from shorter chemotherapy after bowel cancer surgery
A three-month course of chemotherapy after surgery for bowel cancer seems no less effective than the standard six-month course, and half as many people suffered from nerve damage as a side-effect. Three-quarters of people survived to three years without disease progression on either treatment.
This international trial, part funded by the NIHR, included over 6,000 people with high-risk stage II or III bowel cancer that had spread through the bowel wall or to nearby lymph nodes. Standard treatmen...
Balance of long-term benefits and risks of caesarean delivery explained
Caesarean delivery has immediate known benefits and risks for those women who need help in childbirth. This review measures the long-term outcomes for the mothers’ health, the links to a higher risk of childhood illness and the chance of problems with future pregnancies.
The large review of 80 studies from high-income countries used data from nearly 30 million women and compared caesarean section with vaginal delivery. Caesarean delivery was associated with a lower risk of urinary inconti...
Prescribing anti-inflammatories for urine infection reduces antibiotic use but increases complication risk
Urinary tract infection symptoms resolved by three days for 80% of women given antibiotics compared with 54% given anti-inflammatories. Anti-inflammatories reduced antibiotic use, but 5% of women developed more severe infection of the kidneys.
Urinary infections are the second most common reason for prescribing antibiotics in general practice, after respiratory infection. As such, this use may be contributing to increasing antibiotic resistance.
This Swiss trial provided an important head-to-h...
Aspirin may be a follow-on option to prevent blood clots, starting five days after hip or knee surgery
In a recent trial, switching to low-dose aspirin was just as effective at preventing blood clots after joint replacement surgery as continuing the anti-clotting drug rivaroxaban. Six per 1,000 people taking aspirin experienced a blood clot, compared with seven per 1,000 taking rivaroxaban. Three to five per 1,000 patients experienced major bleeding with either drug.
Rivaroxaban or similar drugs are usually prescribed for two or five weeks after knee or hip surgery, respectively, to reduce the r...
Mesh repair of small umbilical hernias reduces recurrence compared to sutures
Repairing small umbilical hernias with surgical mesh rather than sutures reduces the chance of the hernia returning. Complications such as wound infection and pain are not affected by the type of repair.
Adults with umbilical hernias need surgery to prevent serious bowel complications. There are no guidelines about how to best to treat them. In practice, larger hernias tend to be repaired with mesh, while smaller ones are repaired with sutures. This trial of adults with umbilical hernias of 1 t...
People maintain increases in physical activity three years after receiving pedometers
Middle-aged to older adults given pedometers and a walking programme as part of two NIHR trials continued to be active three years later. In one trial they were walking around 650 extra steps a day. In both trials, they spent about 30 minutes per week extra in moderate-to-vigorous physical activity compared to controls.
Brisk walking is a good way for older adults to achieve physical activity recommendations. This is the long-term follow-up of two large NIHR-funded trials that recruited adults ...
Plastic wraps or bags keep pre-term infants warm immediately after birth
Cheap and simple plastic wrapping used in the first 10 minutes after birth helps pre-term and low birth weight infants avoid hypothermia. Infants treated in this way are likely to be warmer when admitted to neonatal intensive care than those treated according to standard care. Pre-term infants are most likely to benefit.
Routine infant care usually involves ensuring the delivery room is warm, drying the infant immediately after birth, wrapping the infant in pre-warmed dry blankets and pre-warmi...