Evidence
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Mindfulness therapy may provide an alternative to continuing antidepressants in preventing recurrence of depression

This NIHR-funded RCT found no evidence that mindfulness-based cognitive therapy was better than continuing antidepressant drugs in reducing depression relapse or recurrence for people at the highest risk of depression. There was also no significant difference in cost. When interpreted alongside the broader evidence for mindfulness-based cognitive therapy and the need for patient choice, the …

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New evidence compares effectiveness of prostaglandin drugs for inducing labour

This review partly funded by the NIHR provides the largest pooling of international data on the effectiveness of prostaglandin drugs used to induce labour. It found that the most effective prostaglandin for inducing vaginal birth within 24 hours was a vaginal misoprostol tablet (≥50 micrograms). Low dose misoprostol solution (<50 micrograms) given by mouth had …

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Continuity in primary care may be linked to reduced unscheduled hospital care

One positive finding from this review of a broad range of observational studies was that being able to see the same doctor in primary care was associated with fewer emergency department visits and emergency hospital admissions. Other factors associated with less unscheduled secondary care were younger age, higher socioeconomic status, not having a chronic disease …

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Surgery is no more effective than a sling for misaligned shoulder fractures

This NIHR funded trial showed that conservative treatment involving a sling was as effective as surgery for treating people with displaced fractures of the upper arm. A linked economic analysis showed that surgery was not cost-effective. These kinds of shoulder fractures are common and disabling, and mainly affect people over 65. Slings are already used …

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Restricting blood transfusion may not be effective after cardiac surgery

This large NIHR-funded randomised trial found that using a lower haemoglobin threshold was no better or cheaper than using a higher one when deciding to transfuse blood after non-emergency cardiac surgery. People with milder anaemia, receiving blood transfusion at a haemoglobin level less than 90g/L (the liberal transfusion group) had similar health outcomes and health …

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Pulmonary rehabilitation improves quality of life and exercise capacity

This Cochrane systematic review found that pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD) improved quality of life and exercise capacity compared to usual care. It also relieved shortness of breath and fatigue. This updated review provides stronger evidence to support NICE’s recommendation that pulmonary rehabilitation should be available to everyone who is …

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Weight-loss surgery dramatically reduces risk of diabetes

This NIHR-funded study found that very obese adults who had weight-loss surgery were 80% less likely to develop type 2 diabetes within 7 years than similar obese adults who did not have weight-loss surgery. The study data came from a large UK-wide database of general practices which was representative of the UK population. The treatment …

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Interventions that help and harm patients in the critical care unit

This systematic review and expert consensus process found 15 non-surgical interventions affecting adult mortality in critical care. Seven interventions, such as the use of tranexamic acid after severe blood loss, reduced deaths. Eight interventions, such as improving oxygen supply by using a drug, dobutamine, increased them. 2015 UK guidelines only partly reflect these findings. They …

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Financial incentives change health-related behaviour in the short term, but effects may not be sustained

This comprehensive review found that financial incentives were effective in changing individual health behaviours in the short term but not, in the few studies to look at longer term effects, beyond 18 months. Improvements stopped soon after the incentive was removed, though lasted a little longer for smoking cessation. Of the 34 studies included in …

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Very early mobilisation following a stroke is no better than usual care

The AVERT trial found very early mobilisation – such as out-of-bed sitting, standing and walking – within 24 hours of stroke onset and at increased intensity, led to 4% fewer people with good recovery than usual care. No differences were found in death rates, overall disability scores, or in the time to be able to …

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