Evidence
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Protocol-led therapy for septic shock did not reduce mortality compared to usual resuscitation care

This NIHR funded randomised controlled trial found that early goal-directed therapy for people with septic shock offered no benefit over usual resuscitation care. About three in ten people died in both groups. Early goal-directed therapy differed from routine care in that it involved rigorous monitoring with use of a central venous “oximetry” catheter to manage ...

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Evidence is growing that early mechanical removal of clots from blocked brain arteries may improve recovery after stroke

Restoring blood flow to the brain within a few hours of having a stroke improves a person’s chances of recovery. Early use of drugs to dissolve clots (thrombolysis) has been the mainstay of management in recent years and there has also been rapid development of devices to remove clots. Using evidence from trials published in ...

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Noradrenaline confirmed as first-choice vasopressor for septic shock

This review supports current guidance that noradrenaline should be used as the first-choice vasopressor for adults with septic shock. Noradrenaline reduced mortality by 11% and major adverse events by two-thirds compared to dopamine. However, evidence of its effectiveness compared to the other vasopressors remains limited. Septic shock accounts for nearly one in ten admissions to ...

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Workplace interventions may support return to work after sick leave

This systematic review finds that interventions based in the workplace can help to support employees’ return to work following illness or disability. There is evidence indicating that the longer period of sick leave someone takes, the less likely they are to return to work. This review identified interventions to improve return to work, with support ...

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One size does not fit all – evaluating the move to a hospital with 100% single rooms

This was a well-designed NIHR funded mixed methods evaluation of a move to a new build NHS hospital in England with 100% single inpatient rooms. The study found that while two thirds of patients preferred single rooms, a number reported feeling isolated. There were differences of opinions across groups, for example half of the men ...

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Overseas models of specialist support for primary care physicians in managing depression may not be transferrable to the UK health system

This Cochrane review found limited evidence that specialist support for primary care through a consultation liaison model may improve care for people with mental health illness for up to 12 months. Primary care is framed as general practice in the UK or family physicians in North America. Consultation liaison is where a mental health specialist ...

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Stopping Donepezil may be linked to nursing home placement for people with Alzheimer’s disease, but a “cause and effect” not conclusive

This follow up study examined whether the drugs donepezil or memantine affected the chance that people with Alzheimer’s disease could continue to live in the community, rather than move permanently to a nursing home. One or both of the drugs was taken for a year and then participants could have any treatment thereafter. The study ...

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Heated, humidified high-flow oxygen therapy may be a useful alternative to other forms of respiratory support for preterm babies

This review found that heated, humidified high-flow oxygen therapy by nose was a safe and effective alternative to other non-invasive methods for supporting breathing for preterm babies. It was less likely to cause nasal injury compared with other methods that used nose tubes. Oxygen therapy is commonly used as a form of breathing support for ...

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Preventive antibiotics for gallbladder surgery not required in those at low or moderate risk

Guidelines recommend that antibiotics are only prescribed before gallbladder keyhole surgery (laparoscopy) to those at increased risk of infection. However, 36% of surgeons still prescribe them. This systematic review found that antibiotics given before removing the gall bladder by keyhole surgery for gallstone colic did not reduce the rate of surgical site infection, distant site ...

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A low residue diet may be as effective as a clear liquid diet for colonoscopy preparation

This review found that a low residue diet with laxatives for a day before colonoscopy is just as safe and effective in clearing the bowel as the clear liquid diet with laxatives currently recommended. The low residue diet was also preferred by patients and better tolerated. Good clearance of the bowel assists diagnosis and treatment ...

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