Evidence
Alert

Apps to help patients take medication on time need to be evaluated in a consistent way

Patients who used apps to remind them to take their medication were more likely to say they took it as prescribed. A review found that patients were twice as likely to say they followed the information given by their prescriber (adhered to their medication) if they used an app. Taking medication as prescribed is important …

Alert

People with late-stage Parkinson’s need personalised, flexible, home-based care

People with late-stage Parkinson’s disease have complex, unmet needs, but their voices are often not heard, say researchers. One-on-one interviews revealed that people in this group need more flexible, personalised care at home and in the community to help them manage their symptoms and maintain control over their condition. The research also highlights the need …

Alert

Loneliness, but not social isolation, predicts development of dementia in older people

Older people who feel lonely and have few close relationships may have an increased chance of developing dementia. Perhaps surprisingly, being socially isolated with few or infrequent social contacts does not seem to predict dementia risk, researchers found. This study was carried out before the coronavirus pandemic but the findings are relevant now, when the …

Alert

Largest ever trial into a rare cancer of the urinary system shows clear benefits of chemotherapy after surgery

A rare cancer of the urinary system can be effectively treated with chemotherapy after surgery. The largest trial ever conducted into the disease found that giving chemotherapy halves the risk of the cancer coming back after surgery. The results provide clear evidence for this approach to become the new standard of care for patients whose …

Alert

Social prescribing could empower patients to address non-medical problems in their lives

Many GP practices are exploring social prescribing, which is a way of linking patients to sources of support in the local community. Social prescribing addresses non-medical needs such as loneliness and financial difficulties. The NHS employs link workers to connect patients with local support networks. During the COVID-19 crisis, link workers may have an even …

Alert

Cancer screening across the world is failing people with mental illness

People with mental illness are nearly 25% less likely to receive cancer screening than those in the general population. Results from a large international study suggest this is one explanation for why people with mental illness tend to die 15-20 years earlier than other people. The study included more than 4.5 million people across the …

Alert

Support programme for GP practices increases referrals for domestic abuse

Many GPs take little action when they encounter women they suspect are affected by domestic abuse. A training and support programme used by hundreds of practices across several London boroughs was successful in increasing referrals to specialist services, a study found. The research shows that the right interventions can help doctors and nurses ensure that …

Alert

Eplerenone does not improve vision in people with central serous chorioretinopathy

Eplerenone, a drug used for people with central serous chorioretinopathy, is no more effective than placebo. Neither visual acuity nor the build-up of fluid in the eye shows an important improvement. Central serous chorioretinopathy is a serious eye condition that causes blurred and distorted vision. Fluid collects underneath the macula, which is the central area …

Alert

Functional braces are effective alternatives to plaster casts for ruptured Achilles tendons

Early weight-bearing in a below-knee rigid boot, a functional brace, following ruptured Achilles tendon can achieve similar results to traditional plaster casting. This NIHR-funded trial included 540 people, and after nine months there appeared to be no difference between the two treatments in terms of how well patients recovered from their injury. The functional brace …

Alert

Using wires to fix wrist fracture has good long-term outcome

Fixing a displaced broken wrist with wires is as effective as fixation with locking plates in the long term. Wrist function and pain continue to improve in the five years following either operation, with no evidence of a difference between the two treatments. In 2014, a trial comparing the use of Kirschner wires and locking plates …

Alert

Plasma and blood cell injections have not shown a benefit for Achilles tendon injury

Injecting a ruptured Achilles tendon with a small sample of a person’s own plasma, without the red blood cells, has no functional or other benefit. Plasma rich in platelets and white blood cells for the acute injury was compared with placebo. The NIHR-funded trial involved 230 adults with acute Achilles tendon rupture (the tendon which …

Alert

Primary prevention and shared decision-making are the key to managing decay in baby teeth

Sealing in decay, improving tooth hygiene and using conventional fillings all work to prevent future dental pain and infection for children with decay in baby teeth. The approaches are equally acceptable to children and parents. Researchers tested three methods of managing decay in the primary molars of children aged three to seven: best practice prevention …

Collection

5 ways research could save the NHS money

More than 80% of total knee replacements can last for 25 years An NIHR-funded study showed that about 82% of total knee replacements and 70% of partial (unicompartmental) knee replacements last for 25 years. In 2017 there were 106,334 knee replacement procedures carried out in England, Wales and Northern Ireland. This research suggests people could be …

Alert

Decision aids including leaflets and computer programs help patients make treatment choices

Decision aids help patients choose between treatment options in obstetrics and gynaecology, and reduce uncertainty. A systematic review of trials of decision aids used for choices of contraception, caesarean section and menopause treatment found that patients who used them felt more confident in their ability to make the decision that was right for them, and …

Alert

A lifestyle change programme not effective for those at risk of heart disease or stroke

A package of extra support, including motivational interviewing, did not add value in terms of boosting weight loss or physical activity in people at high risk of cardiovascular disease, a new study has found. This NIHR-funded trial recruited 1,220 people deemed at high risk of heart disease or stroke. Researchers compared the clinical and cost-effectiveness …

Collection

My Signals – Depression

In Collections, health and social care staff and service users tell us what research is important to them and why they feel others need to know about it. In this collection, we asked nine mental health practitioners and members of the public to tell us which Alerts have interested them most. Michelle Edgar A former …

Alert

People leave hospital after surgery sooner if hospitals follow ‘enhanced recovery protocols’

Strategies to improve or enhance recovery after planned surgery can reduce the amount of time people over 60 spend in hospital, compared with standard care. These strategies include minimising fasting before operations, targeted anaesthesia, getting people up and about quickly after surgery and an early return to eating. In this review, hospital stay could be …

Alert

Melatonin shows potential for reducing delirium among older people after surgery

Taking melatonin around the time of surgery is linked with lower odds of delirium onset in older people, compared with placebo or no treatment. In a systematic review and meta-analysis, around 15% of the melatonin group developed delirium after surgery compared with around 20% of the comparison group. Delirium is an acute state of mental …

Alert

Structured nurse ward rounds support accountability and risk management but not nurse-patient communication

Scheduling regular nurse bedside ward rounds (called ‘intentional rounding’) may not improve nurse-patient communication, as most interactions occur outside of these rounds. The rounds are intended to improve accountability and provide evidence that risks are being managed when correctly documented. Intentional rounding was introduced as a UK Government policy imperative to facilitate regular interactions between …

Alert

NHS health check attendance improves with changes to the invitation letter

Invitation letters improve uptake when they address common concerns and reasons for not attending the free NHS Health Checks. People are invited to attend a check every five years between 40 and 74 years, but uptake has been low. This trial of 6,313 patients from six general practices in Northampton found that presenting reasons for non-attendance …

Alert

ICU admission decision support tool showed promise but was rarely used

A decision support tool developed to help doctors determine whether patients should be admitted to intensive care showed promise in facilitating patient-clinician communication, but was not often used by doctors, with fewer than 30% using the forms. Intensive care can deliver lifesaving treatment. It can be invasive and distressing with no guarantee of success. At …

Alert

Age of stored blood used for transfusions in critically ill children doesn’t affect outcomes

Using more recently-collected red blood cells for transfusions does not reduce organ dysfunction, infection or risk of death in critically ill children, compared with blood that has been stored for longer. This large, international trial included more than 1,500 children in paediatric intensive care units. The study provides robust evidence to support the continued practice …

Alert

Surgery to fix the womb in position after prolapse is an alternative to hysterectomy

Women who have surgery that uses stitches to lift and keep their prolapsed womb in place (called hysteropexy) are less likely to have recurrent symptoms after five years than those who have their womb removed (vaginal hysterectomy). These results from a Dutch trial involving 204 women showed comparable outcomes for the two surgical options for other …

Themed Review

Better Health and Care for All

Download the PDF  Foreword The last thirty years has seen big changes in health and social care to support people with learning disabilities. This includes a move from long-stay hospitals to supporting more people to live well in the community. But it is not easy – and we still have a long way to go …

Alert

Pedometers can help people get more active as part of an exercise programme

Pedometers and accelerometers helped people with diabetes or cardiovascular diseases to increase their physical activity by a moderate amount, though pedometers were more successful. Programmes that involved face-to-face consultations with a facilitator were more effective than those where devices were used in isolation to track progress. This NIHR-funded systematic review included 36 trials which objectively …

Alert

Occupational therapy at home may benefit people with dementia and their carers

Multiple occupational therapy sessions, provided in a person with dementia’s own home, improve their ability to carry out daily activities, compared with usual care. Improvements are also seen in behavioural and psychological symptoms and their quality of life. In addition, carers report feeling less distress, and a better quality of life. This study was a systematic …

Alert

Text messaging support helps smokers quit, but apps not yet shown to work

Text messaging support helps people quit smoking, more than minimal support such as self-help materials. Also, when text messaging is combined with another smoking cessation intervention, it is more effective than just that intervention alone. However, the evidence to support smartphone apps is absent or of poor quality. This review included 26 studies and builds …

Alert

Outcomes similar for full or partial hip replacement after hip fracture

For older people with hip fracture, the choice between full or partial hip replacement does not greatly influence outcomes. In this trial, approximately 8% of patients having each operation required further surgery within a 24-month period. Mortality rates were also similar at around 13%. This multinational trial included 1,495 adults aged over 50 with a hip …

Alert

Increasing omega-3 intake does not prevent depression or anxiety

Increasing intake of polyunsaturated fats, for example with omega-3 fatty acid supplements, has little or no effect in preventing the onset of depression or anxiety symptoms in people without these conditions, but who might be at risk. These findings support dietary advice that omega-3 supplements are not needed in healthy people. This review also highlights …

Alert

Advance care plans improve quality of life for heart failure patients

Advance care planning (ACP) can improve the quality of life of patients with heart failure, especially if it includes follow-up, involves family members and is carried out by trained clinicians working in multidisciplinary teams. This review summarised the evidence about the effect of ACP on quality of life, compared with usual care, for 2,924 patients …

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