Latest research findings

New research findings from the NIHR Dissemination Center

The NIHR Dissemination Centre puts good research evidence at the heart of decision making in the NHS, public health and social care. The centre critically appraises the latest health research to identify the most reliable, relevant and significant findings. It then disseminates these findings as:

NIHR Signals - The latest important research, summarised
NIHR Highlights - Conditions, treatments and issues explored using NIHR evidence
Themed Reviews - Bringing together NIHR research on a particular theme

To keep up to date with the latest important research, sign up to their mailing list or follow @NIHR_DC on twitter. Visit the Discover Portal for a complete, searchable selection of NIHR Signals, or see the latest on clinical trials below.

Dexamethasone before bowel surgery reduces postoperative nausea and vomiting
A single dose of dexamethasone given at the time of anaesthesia for bowel surgery reduced vomiting in the next 24 hours, with no increase in complications. Thirteen people need to be treated to prevent one extra episode of vomiting. Dexamethasone (a steroid) is one of several drugs recommended for patients at moderate and high risk of postoperative nausea and vomiting. It isn’t widely used in bowel surgery. In this large UK-based trial, treating eight people also prevented one person requesting additional anti-sickness drugs. There was no increase in adverse events, and patients given dexamethasone returned to eating quicker. Postoperative nausea and vomiting can delay recovery, so this finding has the potential to improve outcomes for patients and reduce NHS costs.
08 August 2017

Stop smoking services can work for people in treatment or recovery from substance misuse disorders
Providing stop smoking services to people with substance misuse disorders increases the numbers of people who stop smoking by about 10% without reducing the rates of abstinence from drugs or alcohol. Combined drug treatment and counselling showed the best result though pharmacotherapy alone was also successful. However counselling alone was not beneficial. This Cochrane review included trials of people who were already either in treatment or recovery for drug or alcohol misuse in a variety of settings. Those in the treatment groups were given counselling, pharmacotherapy, or a combination of both to reduce smoking, and compared to usual care or placebo. The type of substance misuse disorder was not related to success rates. Smoking rates amongst people dependent on alcohol or drugs are high. Treatment to also reduce smoking in this group is rare as it has been thought that adding stopping smoking treatments will reduce the effectiveness of substance misuse treatments. This is not the case, and offering help to stop smoking can be safely provided.
08 August 2017

Talking therapy given by parents shows promise for childhood anxiety disorders
Brief guided cognitive behavioural therapy (CBT) delivered by parents was as good as a commonly used treatment, delivered by a therapist, in improving anxiety levels in children. Anxiety continued to improve after the end of treatment and by six months about 70% had recovered. The brief CBT was potentially the more cost-effective option. This NIHR-funded trial compared recovery from a range of common anxiety disorders in children aged five to 12 following these brief psychological treatments. CBT was delivered by parents instructed and supported in its use by a mental health worker. It was compared with a treatment commonly used in the NHS, a solution-focused brief therapy delivered directly by a trained therapist. Brief interventions such as these have the potential to improve outcomes at a reasonable cost for children with this common debilitating condition.
08 August 2017

Treating subclinical thyroid dysfunction in pregnancy probably has no benefit
Testing for and then treating pregnant women with mild or “subclinical” underactive thyroid did not improve pregnancy outcomes, newborn baby outcomes, or the child’s IQ at three to five years. A clearly underactive thyroid (clinical hypothyroidism) in pregnancy has been linked with various adverse outcomes for the mother and baby, including pre-eclampsia, preterm birth, congenital defects and neurodevelopmental delay. This needs treatment. However, there has been debate around the harms and benefits from treating only mildly abnormal blood test results in women who do not show signs of thyroid problems, subclinical hypothyroidism. These two linked trials randomised 1,203 women with borderline abnormal levels of thyroid-related hormones (but not “clinical” or “overt” hypothyroidism) to receive thyroid replacement treatment, with levothyroxine, or placebo. Treatment had no benefits for mother or baby, including the main outcome of child IQ by three to five years of age. This supports current UK practice, which does not routinely screen all pregnant women for subclinical thyroid dysfunction.
08 August 2017

Fluoride varnish every six months helps protect children’s permanent teeth from decay
Fluoride varnish and fissure sealant are equally good at preventing tooth decay on children’s first permanent back teeth when applied to six or seven year olds in South Wales. Six applications of fluoride varnish were less expensive, by about £68 per child, for the NHS at 36 months compared to applying the more expensive fissure sealant. Children’s permanent back teeth are particularly vulnerable to decay when they first come through. The pitted biting surface can make these teeth difficult to keep clean to prevent decay. This NIHR-funded trial looked at two interventions to prevent decay: fluoride varnish applied six times every six months at school and a syntheticresin, protective polymer coating, applied once and replaced if needed. This large, UK-based trial supports NICE recommendations to apply fluoride varnish to children’s teeth as part of a school-based community dental programme in areas of high need with children at risk.
01 August 2017

Mechanical clot removal for stroke reduces disability at two years
Timely mechanical removal of the blood clots from inside vessels in the brain after a stroke reduces disability and improves quality of life at two years compared with usual care. Over a third of those in the thrombectomy group had good functional outcome compared with less than a quarter of the standard care group who received clot busting drugs. This was similar to the results at 90 days and was associated with improved quality of life in terms of self-care and mobility. Findings came from a trial of almost 400 people followed up over two years in the Netherlands. The results strengthen the evidence that mechanical thrombectomy leads to good long-term outcomes, but it must be delivered promptly. Public awareness of early signs of stroke enables early medical attention. The procedure is currently planned for 24 specialist centres in England and will be available around the clock to facilitate urgent diagnosis and effective treatment.
01 August 2017

Regional anaesthesia could improve fistula function for kidney dialysis
Use of regional anaesthesia when creating a fistula for vascular access may reduce the risk of failure by about 70%. Easy access to blood vessels is important when someone needs kidney dialysis and the commonest procedure is forming of an artificial link between arteries and veins, called a fistula. Unfortunately some newly formed fistulas fail because the blood vessel is not “patent” or open wide enough to work properly. This systematic review found four randomised controlled trials of adults having surgery to make an arteriovenous fistula for kidney dialysis. The trials compared how well the fistulas worked when they had been formed using regional anaesthesia compared with those formed using local anaesthesia. This review suggests that surgeons, when creating fistulas for haemodialysis, should consider doing so under a regional anaesthetic. This may reduce the need for repeated surgery and reduce the time waiting to start dialysis.
25 July 2017

Intensive speech therapy helps stroke survivors with persistent communication difficulties
Intensive speech and language therapy begun six months or more after a stroke improved verbal communication, language comprehension and self-reported quality of life for those with persistent communication difficulties (chronic aphasia). The therapy in this trial consisted of around 30 hours over three weeks. Participants who received low-intensity therapy (around one hour per week) whilst on a waiting list did not improve during that time. NICE guidelines recommend speech and language therapy immediately after a stroke and if the person still experiences communication difficulties six months after their stroke, but do not specify the intensity of the therapy. This trial highlights the modest benefits of providing further intensive speech and language therapy for stroke survivors who continue to have aphasia after six months. The Royal College of Speech and Language Therapists previously raised concerns about lack of access to this type of therapy. However before implementation it will be important to know which component of therapy is providing the benefits and how much it costs compared to alternatives.
18 July 2017

Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation
General practice software that generated screen reminders for patients with atrial fibrillation did not increase the proportion taking oral anticoagulants appropriately by six months. This NIHR-funded trial included GPs in 47 surgeries in England and found that at the start only 63% of eligible patients with atrial fibrillation were being prescribed anticoagulants. Six months later the rate had increased to 66% in intervention practices and 64% in those following usual practice, a non-significant difference between the groups. Use of the software was associated with increased diagnosis of transient ischemic attack, which could be due to improved detection or over-diagnosis. A reduction in strokes of any type was of borderline statistical significance after 12 months. Longer term studies, collecting more detail on anticoagulant prescribing and the reasons behind patient and doctor choices, may support practice improvements in the future.
18 July 2017

Intervention delivered in Northern Irish and Scottish schools reduces binge drinking
An alcohol misuse prevention programme reduced the number of 12 to 14-year-old school pupils reporting “binge” drinking 33 months after the course. The difference was 9% compared with usual education (26% vs 17%). The NIHR-funded Steps Towards Alcohol Misuse Prevention Programme (STAMPP) was tested in a large trial in 105 schools in Northern Ireland and Scotland. It involved around 14 lessons spread over two years and a presentation evening with parents to reinforce the school lessons. Parental uptake of the presentation evening was so low that this part probably had no impact on the main findings. Overall, pupils receiving STAMPP were 40% less likely to self-report drinking 6.5 or more units in a single episode for boys, or 4.5 units or more for girls, in the last 30 days. No differences were found for self-reported behaviours like getting in trouble with the police or A&E attendance, nullifying anticipated societal cost savings. Qualitative research showed that teachers found it easy to deliver and students liked the content. The intervention was relatively cheap at £15 per pupil. STAMPP, or an adapted version, could be considered by local services as an option to reduce binge drinking.
18 July 2017

More findings are available on the NIHR Dissemination Centre website.