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NIHR Signal 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 was preferred by patients. Functional bracing is an alternative to traditional plaster casting that allows earlier weight-beari...
NIHR Signal 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 of the retina. The condition mostly affects men aged 20–45 years, although it can affect women too. A specific cause is rarely ...
NIHR Signal 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 connects the calf muscles to the heel). All were attending UK hospitals within 12 days of injury. The trial found no difference in function at 24 weeks aft...
NIHR Signal 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 continueto 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 for displaced fractures of the distal radius reported that patients treated with either operation did equally well after 12 months. This follow-up study allays fears t...
NIHR Signal Conventional fillings may not add much to standard prevention for 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 (advice on cutting down on sugar, twice-daily tooth brushing with fluoride, application of fluoride varnish) best practice prevention p...
NIHR Signal 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 of the enhanced support, which was based on cognitive theory, in either a group or individual format. A third group was referred to commun...
NIHR Signal 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 less uncertain about this decision. This was compared with usual care or an information aid. Decision aids set out information about medi...
NIHR Signal 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 nurses and patients following high profile care failures at the Mid St...
NIHR Signal 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 confusion associated with longer hospital stays and increased mortality. UK clinical guidelines do not recommend specific medications to prevent this condition...
NIHR Signal 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 reduced by up to five days with the use of enhanced recovery protocols. Exercises and nutritional programmes to prepare for surgery (&lsq...
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