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.

Additional therapy helps social recovery from first episode psychosis
Social recovery therapy increases structured activity, such as work, education or sport, by eight hours per week for people with severe social withdrawal following a first episode of psychosis. This cognitive behavioural type of treatment was added to other early interventions and might be particularly useful for those lacking motivation or living with other conditions that prevent them engaging with mental health services. This NIHR-funded trial included 154 young adults with first episode of psychosis under the care of early intervention services in England. These are specialist multidisciplinary mental health services which aim to help people make a full mental, physical and social recovery. The participants had been under their care for at least a year and had extreme social withdrawal, which often limits their capacity to engage in therapy. Social recovery therapy not only increases structured activity levels but also appears to keep people in contact with services in the critical first nine months. It could be incorporated into early intervention services for people with persistent social withdrawal.
20 February 2018

Calcium channel blockers are useful in managing Raynaud’s phenomenon
Calcium channel blockers, such as nifedipine, are confirmed as useful in reducing the frequency, duration, severity of attacks, pain and disability associated with Raynaud’s phenomenon. People had two to six fewer attacks per week on average with treatment, and 13 without. Raynaud’s is a disorder which reduces blood flow to the fingers and toes as a result of the blood vessels tightening and going into spasm in the cold. This updated review suggested that calcium channel blockers may be more effective in higher doses than lower doses and help primary symptoms rather than the secondary form of Raynaud’s that is due to underlying disease. Most research has been into nifedipine. Although no serious adverse events while using calcium channel blockers were reported, more people withdrew from trials as a result of minor side effects. Previous studies have also shown that calcium channel blockers were effective, but this review expands the research for this indication and might inform future guidelines.
20 February 2018

Gout medication may slow progression of chronic kidney disease
In people with existing kidney disease, one in four will have worse disease within six to 12 months. Uric acid-lowering drugs such as allopurinol halve the risk of disease progression over this period. They also reduce heart attack or stroke by 60%. Uric acid, the cause of gout, is produced when proteins are broken down by the body. It is excreted by the kidneys and often builds up in people with chronic kidney disease. It is not certain whether increased uric acid causes progression of kidney disease or is simply a marker of its severity. This review included 16 small trials of 1,211 people with moderate chronic kidney disease from a variety of causes which were allocated to take a uric acid lowering medication or usual care. Although these results are promising, they are based on low-quality trials. The low rate of side effects should be taken into account when considering these drugs as an option to slow the progression of kidney failure and prevent heart disease.
20 February 2018

Introducing a primary care risk prediction tool did not reduce emergency admissions
Predicting emergency admissions paradoxically increased hospital admissions from primary care across all risk groups by about 3% overall. The Predictive Risk Stratification Model (PRISM) was evaluated in a trial in general practices in Wales, and there is little evidence it benefits patients by reducing deaths or improving quality of life either. The number of people living to older age with chronic health conditions is growing. Various risk stratification tools have been introduced across the NHS aiming to improve planning and delivery of care for people in the poorest health. This study, funded by the NIHR Health Services Delivery and Research Programme, evaluated the tool during implementation of a quality and outcomes framework incentive to encourage identification and better management of high-risk patients. The lack of benefit may be because of poor uptake of the tool, lack of available services to help those at risk or the concentration of efforts on too few high-risk individuals. General practices still seem to have found few alternatives to hospital admission for many patients.
20 February 2018

Diabetes drug aids fertility in women with polycystic ovaries
The diabetes drug metformin may help women with polycystic ovarian syndrome who are having problems getting pregnant, but it is unclear whether it works better than an alternative fertility drug that stimulates the ovaries. This study updates a previous review of trials that compare metformin with placebo, no treatment or with the fertility drug clomifene. It summarised results of 48 studies, including 4,451 women. The study found that metformin may work better than placebo or no treatment and helps about six in every hundred women with the condition to achieve a successful pregnancy. But there was insufficient evidence to say whether it worked better than clomifene, or whether the combination worked better than clomifene alone. The findings reflect the current state of knowledge about treatment of this condition and are aligned with current practice and guidance.
15 February 2018

Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease, but with an added risk of bleeding
People with peripheral arterial disease who took rivaroxaban plus aspirin daily over an average of 21 months reduced their risk of cardiovascular death, heart attack or stroke from seven to five in every 100 people treated compared with those given aspirin alone. The rivaroxaban plus aspirin group also reduced their risk of major limb problems or amputation but increased their risk of bleeding from one to two for every hundred people treated. Peripheral arterial disease is a condition in which the arteries in the legs and feet are narrowed by a build-up of fatty deposits. If it becomes severe, this can lead to limb damage or amputation. The blockages can also affect other arteries such as those supplying the heart and brain. This puts people with arterial disease at increased risk of other cardiovascular diseases. Current practice is to treat people daily with aspirin. This study suggests that adding a low dose of rivaroxaban to aspirin is an option that provides some additional benefits and some additional risks. The additional costs of prescribing rivaroxaban will need to be taken into account when assessing the population benefits. The trial was sponsored by Bayer AG.
14 February 2018

Type 2 diabetes can be reversed with a low-calorie diet
Nearly half of people given a formula replacement diet of 830 calories per day for three to five months, followed by food reintroduction, went into remission from type 2 diabetes. They were supported to achieve and maintain weight reduction by primary care nurses or dieticians. This trial involved 298 adults who had been diagnosed with type 2 diabetes within six years. Those that stuck with the program were more likely to lose weight (average 10kg was lost) and to go into remission compared to usual care. More than two-thirds of them were also able to stop both diabetic and high blood pressure tablets. These results were seen after one year. The challenge will be to see if the results can be maintained over the planned four year follow-up period. If successful, the program could be easily replicated by other GP surgeries with minimal training requirements.
13 February 2018

A school-based lifestyle intervention didn’t help children avoid unhealthy weight gain
The Healthy Lifestyle Programme delivered to 9-10-year-old school children did not reduce their weight over the course of two years. Around a third remained overweight or obese, the same as in schools that followed the standard syllabus. This trial, funded by the NIHR, assigned schools across Devon to follow a lifestyle programme in Year five. The comprehensive curriculum included drama and activity workshops, personal goal setting and parental involvement. Children made better food choices, but this did not affect weight outcomes. It was almost certain the programme wouldn’t give value for money. Programmes addressing the wider school environment or delivered at the community or population level may have greater scope for preventing obesity.
13 February 2018

Delayed umbilical cord clamping reduces hospital mortality for preterm infants
Delays to clamping the umbilical cord of about a minute can reduce hospital mortality for preterm infants by around 32%. Delayed clamping also reduced the proportion of infants needing a blood transfusion by 10%. This review adds more precise data on survival from new trials including a large Australian trial (over 1,600 babies) to a previous Cochrane 2012 review of trails including 738 infants and provides new more precise data on the survival benefit. These findings are consistent with current guidelines which recommend delayed clamping in preterm infants.
06 February 2018

Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation
In people with atrial fibrillation needing anticoagulant treatment, deaths were fewer in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin. This study pooled the data in all trials reporting efficacy, safety and cost of anticoagulant prevention of stroke events in people with atrial fibrillation. Researchers used a technique called network meta-analysis to compare the different drugs used. There is still a need for a trial directly comparing these drugs, to add to this evidence and to identify whether certain people might benefit more from one or other of the available agents.
06 February 2018

More findings are available on the NIHR Dissemination Centre website.