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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.

Cognitive behavioural therapy may help ease depression in the workplace
Workplace-based interventions for people with depressive symptoms are effective. This review of 16 trials looked at early stage interventions to prevent depressive symptoms from developing into more severe depressive illness. Both cognitive behavioural therapy and some non-cognitive behavioural therapy interventions, such as supervised exercise, worked equally well. Telephone and internet-based therapy worked better than face-to-face therapy. These interventions were compared to usual treatment or being placed on a waiting list. Given the prevalence of depression in the workplace, and its high cost to productivity, these findings should be considered by employers wishing to prevent the progression of depressive symptoms in their workforce. This must include provisions to safeguard patient confidentiality and is likely to require training of managers and workplace supervisors.
12 March 2019

Treating vitamin D deficiency may reduce exacerbations of COPD
Vitamin D supplements halve the number of exacerbations of chronic obstructive pulmonary disease (COPD) in people with low levels of the vitamin, from two per year to one per year. The supplements do not affect exacerbations of COPD in people who are not deficient. This NIHR-funded review is the first to pool individual-level data from randomly controlled trials to see whether taking vitamin D can help reduce exacerbations. People with moderate to severe COPD may be at risk of low vitamin D levels because their illness reduces their opportunities to get out into the sunlight. These findings suggest that vitamin D is an effective, safe prevention for those with COPD found to be deficient.
26 February 2019

Prolonging anticoagulant treatment after abdominal cancer surgery reduces clot risk
People who have low molecular weight heparin (LMWH) for between two to four weeks after abdominal or pelvic surgery, especially for cancer, have fewer blood clots in their large veins or lungs. In this review of seven trials, five per cent of people receiving extended treatment experienced a clot compared with 13% who received LMWH only while in hospital. There was no difference in bleeding complications. The optimal duration of treatment following abdominal surgery is uncertain, balancing bleeding against clot risk. NICE recommends using LMWH (or alternative drug) for at least seven days, extending up to 28 days for people who have had major cancer surgery. Extended treatment with LMWH may benefit a broader group of patients, but further exploration may be needed to look at whether those with non-cancer surgery might benefit to the same extent.
26 February 2019

Transcutaneous electrical stimulation (TENS) may help lower limb spasticity after stroke
Transcutaneous electrical stimulation (TENS) delivered alongside standard physical therapies could reduce spasticity in the lower limbs following a stroke. Spasticity is a muscle control disorder characterised by tight muscles. It is common after stroke and accounts for significant disability. TENS is often used to treat pain and can affect nervous stimulation of the muscles. The main evidence in this systematic review came from five trials which suggested that TENS combined with other physical therapies has moderate effect on lower limb spasticity compared with placebo. The review has limitations, with small studies and little evidence on use for upper limbs or comparing with other therapies. However, TENS machines are portable, inexpensive and widely accessible making them an appealing addition to other care. NICE does not currently recommend the use of TENS in stroke rehabilitation, though guidance covers use of other types of electrical stimulation in certain other contexts.
26 February 2019

Updated evidence on progesterone to prevent preterm birth in at-risk pregnancies
Progesterone administered via the vagina may reduce the risk of preterm birth in women who are at risk of giving birth early when compared to a placebo, treatment as usual or no intervention. Other treatments, such as oral or injected progesterone, cervical stitch, and pessary, appear not to show the same level of effectiveness. A recent trial suggested that vaginal progesterone provided little or no benefit in preventing preterm birth. Those results have been pooled with 39 other trials in this updated systematic review and network analysis. Looked at all together, this review suggests that vaginal progesterone is the only consistently effective option. But a more cautious interpretation is required because the trials are not all reliable. The NICE guidance for preterm labour and birth is currently being updated. This review and the UK-based trial should help to inform the expert discussion regarding any update.
26 February 2019

Honey may help painful mouth inflammation caused by cancer treatments
Compared to usual care, honey was more likely to reduce moderate or severe pain for patients after radiotherapy and/or chemotherapy treatment. This systematic review looked at trials from around the world comparing different types of honey with other treatments such as chamomile, golden syrup or placebo. The main outcome was the onset of moderately severe oral mucositis as measured by a range of standardised assessment scales. The findings suggest that honey might be useful, although whether the type of honey used makes a difference is uncertain. It may be prudent to choose sterilised medical honey, rather than raw natural honey, in people with reduced immunity. Possible biases in the underlying studies make it is difficult to know how certain we can be in the review’s estimates of an effect. As most trials of honey seemed to show an improvement compared to their comparator treatments, better quality research seems justified.
19 February 2019

No additional weight-loss reported from a lifestyle programme for people with psychosis
For adults with psychosis, such as schizophrenia, who are taking antipsychotic medication, a carefully designed 12-month group diet and exercise programme did not lead to clinically important weight loss after 12 months. The programme was compared with those receiving usual care including written lifestyle advice. Intervention and usual care groups each lost half a kilo on average, with no measurable changes in diet or physical activity. People with schizophrenia are twice as likely to be overweight as the general population, as medication side effects frequently include weight gain. This NIHR-funded study with over 400 participants in 10 areas across England is the largest UK randomised trial to date. It shows that this hard-to-reach group can be recruited and retained in structured self-management programmes delivered by trained facilitators. However, it was neither clinically effective nor cost-effective. Alternative, affordable approaches are much needed.
12 February 2019

Treatments for depression may help irritable bowel symptoms
Antidepressants are likely to provide more than a placebo effect for those with symptoms of irritable bowel syndrome. Antidepressants improve symptoms in about 60% of those taking them, but two-thirds of that effect may be due to placebo. Psychological therapies, such as talking therapies also appear effective in about half of those offered them but may be partly due to expectations because it is not possible to provide a placebo control. Irritable bowel syndrome is a chronic disorder of the gut which commonly causes pain, bloating, stomach cramps and diarrhoea or constipation. Despite these symptoms, no structural abnormality is present, so it is described as a functional disorder. People with these symptoms often have coexisting anxiety or depression, and there is a theory that the syndrome, a collection of symptoms, may be due to a disorder of brain-gut function. This systematic review identified 53 randomised controlled trials. The review concluded that antidepressants are effective in reducing symptoms of irritable bowel syndrome, and there is evidence to suggest that psychological therapies also appear to be effective treatments, particularly where a therapist is directly involved.
12 February 2019

New strategies for maintaining blood supplies from donations may be cost-effective
Opening blood donation centres on weekday evenings and at weekends is a cost-effective way of increasing the blood supply used by hospitals in the UK. Allowing donors to give blood more often could increase supplies in the short term, but it isn’t clear if it would be cost-effective in the long-term. This NIHR-funded modelling study used data from a recent large randomised trial in the UK that investigated the safety of donating blood more frequently than current guidance allows. This was combined with current UK donation records, cost data, and the preferences of about 34,000 existing donors who were surveyed for this study. The NHS Blood and Transplant service is looking for ways to increase supplies of blood types that are in high demand. This study adds to the evidence about which strategies are both clinically effective and cost-effective. This should help to inform future service changes.
12 February 2019

A commonly-used antidepressant doesn’t improve recovery after stroke
The antidepressant fluoxetine works no better than placebo to reduce disability after a stroke, lowering hopes that had been raised by other smaller studies. After a six month trial including more than 3,000 adult stroke patients recruited at 103 UK hospitals, researchers concluded that fluoxetine should not be used to promote recovery from stroke-related disability, or routinely prescribed to prevent depression after stroke. Several smaller studies and animal trials had found promising results from the use of fluoxetine after stroke. However, this trial of fluoxetine 20mg daily for six months found no improvement in function among those taking the drug. Although people who took fluoxetine were less likely to get depression, they were more likely to have fractures. Other studies of fluoxetine after stroke are underway, but this trial does not support using it in standard post-stroke care.
12 February 2019

More findings are available on the NIHR Dissemination Centre website.