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.

Placing wet gauze on babies’ tummies speeds up urine collection
Almost a third of infants managed to urinate within five minutes after a painless, cheap technique that stimulates the skin, compared with 12% of infants observed only, as is standard practice. The ‘Quick-Wee’ method involved rubbing the babies’ abdomens gently with gauze soaked in cold saline before collecting urine. This trial was carried out with 354 babies aged one to 11 months in one Australian paediatrics emergency room. NICE guidelines recommend non-invasive ‘clean catch’ collection if possible but this can be difficult, especially in young children. They estimate that 20 minutes of staff time can be needed to obtain a sample. Hospital paediatrics settings and primary caremay want to try this promising, cheap and safe technique. There was no difference in rates of contamination and it may reduce the number of babies who need to go on to the less desirable collection by pad samples or invasive techniques.
17 October 2017

Individual support of nurses using electronic medicine monitors can improve HIV treatment
Use of electronic pill bottles that record when they are opened and follow-up discussion of the printed readouts with nurses improved HIV outcomes. It is thought that patients became more reliable in taking the medication, which can have complicated scheduling. Overall, the HIV virus in the blood and the risk of treatment failure were lower in the group of patients who had access to this intervention compared to regular care. In addition to being more effective, the programme also reduced the estimated lifetime cost and disease burden per patient, considering quality and quantity of life lived. The readouts were used to help focus attention on any patterns of medication usage so that strategies could be discussed to improve adherence. As non-adherence is the main barrier to effective management of HIV, any measures that improve it are welcomed. However, the intervention tested here requires several hours of training for the nurses delivering it and may not be that easy to introduce in practice. Evaluation of the approach in non-trial settings is necessary before wider implementation.
10 October 2017

Early discharge ‘hospital-at-home’ gives similar outcomes to in-patient care
Supported early discharge, where patients receive on-going hospital-level treatment in their own home, had no effect on mortality compared with standard in-patient care. Patients had shorter hospital stays, were more likely to be satisfied and less likely to end up in residential care. This updated Cochrane review identified 32 international trials comparing early discharge hospital-at-home with hospital in-patient care. Most evidence related to people recovering from a stroke, where NICE already recommends supported discharge if this is appropriate. Other patient groups included those recovering from orthopaedic surgery and older people with various conditions. Trials were relatively small and the overall evidence quality was moderate to low. The review aimed to see whether early discharge has an effect on NHS costs, but found insufficient evidence. Training, staffing and equipment costs need to be measured against patient outcomes in different therapy areas. Early supported discharge needs to be driven in areas where it can make the most difference and give the greatest benefit.
03 October 2017

Head position after acute stroke does not affect disability outcomes
Lying flat for 24 hours after a stroke is no better than sitting up at an angle of at least 30 degrees. These differences in early head position did not affect people’s levels of disability or survival to 90 days, which was more than 92% in both groups. It had been thought that the head down position might increase the chance of pneumonia, but in this trial, the rates were also similar for people cared for in either position. The results of this large international randomised controlled trial are likely to be applicable to adults with different types of stroke in varied settings. As lying position did not affect outcomes, this suggests that clinicians can be guided by patients’ clinical condition, preferences and levels of comfort during the initial management of care. The current NICE guideline on diagnosis and initial management of stroke suggests that people with acute stroke should be helped to sit up as soon as possible (when their clinical condition permits).
03 October 2017

Local nerve blocks can improve outcomes for people with hip fracture
Local nerve blocks around the time of hip fracture surgery reduced pain on movement within 30 minutes of injection. People had less need for opioid pain-relief and were quicker to mobilise after surgery. Also, one case of pneumonia was prevented for every seven people given pain relief using a nerve block. By injecting local anaesthetics close to the nerves to relieve pain after a hip fracture, it is hoped that the need for opioids can be reduced and people might recover more quickly. Nerve blocks are not standard in UK hospitals for this. This updated Cochrane review identified 31 trials providing moderate to high-quality evidence. The benefits were small but could make a meaningful difference to the patient’s experience and outcomes. This lends further support to guideline recommendations and the added evidence might increase the use of nerve blocks for hip fracture.
26 September 2017

Use of a facemask ventilator can reduce deaths in severe flare-ups of COPD
People admitted to hospital with a severe exacerbation of chronic obstructive pulmonary disease (COPD) were 46% less likely to die if they received non-invasive ventilation. Only 12% of those receiving non-invasive ventilation needed subsequent invasive ventilation via a tube, compared to 34% of those who had usual care. This review identified 17 trials of adults with a severe acute exacerbation of COPD with high carbon dioxide levels. Trials compared usual care, including steroids and antibiotics with usual care plus non-invasive ventilation, which delivers air at high pressure via a mask. Airways are forced open and respiratory muscles can rest. This updated review shows benefits of immediate treatment with non-invasive ventilation for people with COPD admitted with respiratory failure. The results do not apply to patients in respiratory failure from other causes. Acceptability of the treatment to patients, quality of life and cost measures need further exploration.
19 September 2017

Guided self-help therapy for people with obsessive-compulsive disorder did not improve symptoms
Offering people book-based or computer-based cognitive behavioural therapy (CBT) whilst on a waiting list for therapist-led therapy did not improve their obsessive-compulsive symptoms when assessed after three or 12 months. However, these low-intensity interventions may reduce the likelihood of people taking up therapist-led CBT. This NIHR-funded trial included 473 adults with moderate to severe obsessive-compulsive disorder who were already waiting to receive CBT. Issues with the uptake of the low-intensity interventions and therapist-led therapy may have affected results but probably reflect the challenges of engaging people with these symptoms into therapy. There is a possibility that the book- or computer-based therapies could be effective in people with milder symptoms, but it is unlikely to be the best strategy for people with moderate to severe symptoms.
19 September 2017

Intensive lifestyle interventions can help obese young people lose weight
Obese children and adolescents can lose up to seven pounds over six to 12 months when they engage in at least 52 hours of behaviour-based lifestyle interventions. Minimal benefit was seen with shorter contact time, with less than 25 hours ineffective. The control group gained weight. Rising obesity in the young is a global concern, which may lead to high rates of obesity-related diseases in adulthood. This review identified trials covering various weight management strategies. Lifestyle-based-interventions with sufficient contact time – as recommended by UK guidelines – showed clear benefits with no evidence of harms. Investing in effective strategies to manage child obesity will ultimately save healthcare costs. Behaviour-based support should now be assessed for long-term weight loss and maintenance. The evidence is still lacking whether universal child screening for obesity should be performed in the UK.
19 September 2017

Heel casts do not improve heel ulcers in diabetes
Fibreglass casts moulded to the heel did not improve heel ulcers in people with diabetes when added to usual ulcer care. Ulcers healed within six months in 44% of people using casts compared with 37% without which was not a statistically significant difference. Foot ulcers are a common complication of diabetes, and heel ulcers are particularly difficult to treat. Based on the success of casts for treating ulcers elsewhere on the foot this trial was designed to test the effect and cost-effectiveness of using a similar approach for heel ulcers. This NIHR-funded trial indicates that specially-moulded heel casts do not improve healing rates or pain, and were not a good use of NHS resources compared with usual care. Uncertainty remains over the optimal approach for managing heel ulcers in people with diabetes.
19 September 2017

Group rehabilitation activities improve walking after stroke
Group-based circuit class therapy (CCT) focused on repetitive mobility, and functional tasks improved walking ability in people after stroke. People walked on average 61m further during six minutes than those receiving comparison interventions. CCT involves stroke survivors practising different activities at workstations in sight of each other. This Cochrane review identified 17 trials of group-based CCT, given at least weekly for four weeks, compared with other physical therapies or no intervention. Those receiving CCT showed clinically meaningful improvements in walking distance and speed, as well as independence and balance. Regular multidisciplinary team rehabilitation is a central component of post-stroke care. However, there are no specific recommendations around the format of rehabilitation. Cost effectiveness was not assessed, but it is possible that group-based physical rehabilitation programmes could reduce staff resources and offer cost savings. Local availability may be an issue. There is also the question of whether it would be practical and appropriate for individuals to attend group sessions, depending on their stroke severity.
12 September 2017

More findings are available on the NIHR Dissemination Centre website.