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NIHR Signal ‘Virtual wards’ reduce readmissions in people after hospitalisation for heart failure
People with heart failure who receive care via virtual wards following discharge from hospital have lower rates of heart failure-related readmission and death than people discharged to other types of care. However, virtual wards did not show similar benefits when offered to people leaving hospital with other high-risk chronic diseases. This systematic review included randomised controlled trials of virtual wards, defined as with four operational criteria to be intensive multidisciplinary team ...
NIHR Signal Daily low-dose antibiotics halve urinary tract infections in people who self-catheterise
People who perform clean intermittent self-catheterisation can reduce symptomatic urinary tract infections from two per year to one by taking daily low-dose antibiotics. This NIHR-funded trial randomised 404 adults in the UK who perform the procedure for a variety of reasons to either daily oral low-dose antibiotics or no prophylaxis. All had a recent history of urinary tract infection. Although prophylactic antibiotics halved infection rates, it increased antimicrobial resistance compared wit...
NIHR Signal UK-wide study reveals a pattern of delay in referrals to specialist end-of-life care
Referrals to hospice-based specialist palliative care occur closer to death in older than in younger people and in those without cancer. Existing evidence shows that some people near the end of life have a better quality of life and symptom control if they receive specialist palliative care. This research highlights the need to better understand the reasons for any delay. In this large NIHR-funded hospice study people aged under 50 years were referred to hospice specialist palliative care about...
NIHR Signal Adding emollients to the bath unlikely to help children with eczema
Adding emollients to children’s bath water does not significantly improve their eczema. Prescriptions should focus on emollients applied directly to the skin or used as a soap substitute. Using emollients to lock in moisture is the standard treatment for childhood eczema. These can be applied in a number of ways, but there is uncertainty surrounding their use as a bath additive. This NIHR-funded year-long trial included 482 children, mostly with mild eczema. It found there was little cha...
NIHR Signal Factors in men’s choice of active surveillance for low-risk prostate cancer
Many personal, organisational and national factors can help or hinder men from choosing active surveillance over radical treatment when they have low-risk prostate cancer. Men are more likely to adhere to this plan of regular monitoring if they and their families are fully informed and understand that it includes the option of further treatment if necessary. The recent ProtecT trial demonstrated that there was no difference in 10-year survival rates between men with low risk localised prostate ...
NIHR Signal Music can reduce pain and anxiety following surgery
Recorded music played before, during or after surgery in adults reduces self-reported post-operative pain and anxiety, compared with usual care. The average effect is equivalent to a reduction in anxiety of 21 percentage points and a 10 percentage point reduction in pain within a few days of surgery. It is thought that placebo and distraction effects probably play a role, but in this review music still improved pain when used for patients under a general anaesthetic. Nearly two-thirds of patie...
NIHR Signal A fifth of people, who have no improvement on antidepressants at four weeks, respond if given more time
An adult with acute depression not yet responding to an antidepressant drug has a 1 in 5 chance of substantial symptom reduction between 5 and 8 weeks if they continue taking it. In those unresponsive after eight weeks, 1 in 10 will respond between 9 and 12 weeks. Changing treatment plans too early can mean needlessly discarding first choice anti-depressants. This is the first systematic review to calculate the proportions of people with a delayed but positive response at different time points....
NIHR Signal Ultrasound shows potential for confirming the diagnosis of pneumonia in children
Ultrasound scans of the lungs can be more accurate than chest X-rays for diagnosing pneumonia in children in some circumstances. A review of the published evidence found that lung ultrasound was more sensitive (missed fewer cases) and about as specific (gave about the same number of false alarms) as chest X-ray, when used to confirm suspected community-acquired pneumonia in children. While pneumonia is a clinical diagnosis, X-ray is often used for confirmation. Ultrasound also spares the child...
NIHR Signal School-based self-regulation interventions can improve child academic, health and behavioural outcomes
Different types of interventions improve self-regulation in children and young people, which helps children to manage their behaviour and emotions. School curriculum-based interventions show the most consistently positive results. Interventions also improve longer-term academic, health and social outcomes. Self-regulation encompasses a range of skills, including controlling your own emotions, interacting positively with others, avoiding inappropriate or aggressive actions, and carrying out self...
NIHR Signal A reminder that too much oxygen increases mortality in acutely ill adults
In acutely ill adults, liberal use of oxygen supplementation is found to increase the risk of death compared with more conservative oxygen strategies. More liberal oxygen therapy increases patient mortality in hospital by about 11 deaths amongst every 1,000 people exposed. Deaths also increase after 30 days follow-up, without improving other important health outcomes, such as disability, infection or length of hospital stay. Oxygen is routinely used for acutely ill patients and is widely consid...
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