Evidence
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Intensive management of diabetes detected early at screening shows similar results to standard care

Intensive “early” treatment was similar to national guidance-based treatment at preventing diabetes-related complications or heart disease over five years in this large trial. General practices in the UK (49 practices), Netherlands and Denmark screened 135,000 asymptomatic adults aged 40 to 69 for type 2 diabetes before offering one of two treatment approaches. Intensive management was ...

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Large ten-year trial on treatment of localised prostate cancer will aid management decisions

New, long-term research indicates that active monitoring, with prompt treatment if needed, may be a better option than radical surgery or radiotherapy for many men who have prostate cancer if it’s confined to the prostate gland. In the ProtecT trial, after an average of ten years, few men died of prostate cancer and there was ...

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Accuracy of staff who read mammograms doesn’t decline over time

Changing the order in which readers examine screening mammograms has no effect on breast cancer detection rates, rates of recall for further tests or rates of disagreement between readers. In the UK each woman’s mammogram is examined by two independent readers (radiologists, radiographers or breast clinicians) who review each batch of mammograms from about 40 ...

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A scan may help decide if surgery is required as follow-on treatment for head and neck cancer

People with head and neck cancer in the UK usually receive chemotherapy and radiotherapy followed by surgery. Using a scan to assess cancer status after this first line chemoradiotherapy and only suggesting surgery to those with a clear indication led to similar survival rates, complications and fewer operations compared with planned cancer surgery for everyone. ...

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Exercise testing shows potential as a way to identify high-risk patients for abdominal surgery

Cardiopulmonary exercise tests could be used as a risk-stratification tool in the preoperative assessment of patients due to undergo some types of major abdominal surgery. This systematic review found that measuring anaerobic threshold during exercise testing was the most helpful predictor of risk for liver, pancreatic and general abdominal surgery, while peak oxygen uptake was ...

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Simple leg raise test may help in assessing patients’ fluid needs in intensive care

This review of 23 trials found a simple leg raise test helped predict whether patients were responsive to extra intravenous fluids in intensive care. Passive leg raising—using a hospital bed to tilt a patient’s straight legs up to a 45 degree angle—increases the amount of blood returning to their heart, similar to the effect of ...

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Two simple questions help GPs rule out depression

The Whooley questions are useful for ruling out depression in that few people who answer no to both questions are depressed according to a ‘gold standard’ diagnostic interview. A positive screen is indicated by the person answering “yes” to one or both of the Whooley questions and for these people the diagnostic interview will still ...

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Predicting severe brain injuries from apparent minor head trauma without a scan

Specific clinical decision rules applied to adults and adolescents with apparent minor head injury identified groups at low risk of severe internal head injuries, potentially reducing the number of unnecessary CT scans used in this low-risk group. For example, patients with apparent minor head injury lacking any of the features of the Canadian CT Head ...

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Ultrasound guided nerve blocks are safe, effective and save time

This Cochrane review found that nerve blocks to provide local anaesthesia in the arms or legs of adults before a surgical procedure were safe and effective when guided by ultrasound compared to other guidance techniques. They were successful about nine times out of ten with ultrasound guidance, compared to about eight times out of ten ...

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A simple test can help point to serious illness in children

This review found that the capillary refill test was useful in diagnosing serious illness or dehydration in children. The quick test, done by pressing on the nail bed, is used to monitor blood flow. The review of studies testing its accuracy showed it can be used as a “red-flag” to identify (i.e.rule in) potential serious ...

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