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.

High-flow oxygen therapy may have a role in treating infants with more severe bronchiolitis
A randomised controlled trial of 1,472 infants with bronchiolitis found that more children improved when started on high-flow oxygen therapy than with standard oxygen therapy. Those who failed to improve on standard therapy were switched to high flow oxygen. Most then improved - overall, similar numbers were transferred to intensive care. There was also no difference between the groups in the proportion of infants needing intubation, length of time on oxygen therapy or days spent in hospital. The place in the pathway for high-flow oxygen remains to be clarified. For example, it isn’t clear from this study whether high flow oxygen is best used as first-line treatment or as "rescue" treatment in infants with bronchiolitis. Further research including cost-effectiveness will be needed before advocating high-flow oxygen for all infants hospitalised with bronchiolitis.
18 September 2018

Inducing labour at or after 41 weeks reduces risks to infants
Inducing labour after the due date slightly lowers the risk of stillbirth or infant death soon after birth compared with watchful waiting. But the overall risk is very low. Induced deliveries may reduce admissions to the neonatal intensive care unit. Pregnant women having induced labour are less likely to have a caesarean section than those who wait for labour to begin naturally. They may have a slightly higher chance of needing an assisted vaginal birth (for example, using forceps or vacuum extraction). Many pregnancies continue for longer than the average 40 weeks. Because of the risks to infants, women are often offered the option of induced labour at between 41 and 42 weeks. However, induction also carries risks to mother and baby, which must be weighed against potential benefits. The findings from a large review of 30 trials are in line with NICE guidance and may help women to make informed choices about whether or when to induce labour.
11 September 2018

Reminders help GPs to find and manage inherited cholesterol disorders
GPs and practice nurses assess more adults with inherited raised cholesterol (familial hypercholesterolaemia) when prompted by reminders. More patients have repeat cholesterol tests and assessments for heart disease, in line with NICE guidelines. This NIHR-funded study used electronic health records from six GP practices to identify patients with total cholesterol greater than 7.5mmol/l. Reminder messages appeared when their records were opened during consultations and prompted GPs to carry out further assessments. People with familial hypercholesterolaemia are at high risk of cardiovascular disease and their health outcomes improve when this is diagnosed and treated. This intervention was simple but effective in increasing assessments for patients at risk, improving their chances of diagnosis and treatment. The study wasn’t a randomised controlled trial, so the results may have been influenced by other external factors, rather than by the intervention itself.
11 September 2018

Text messages improve diabetes self-management and blood sugar control
In adults with poorly controlled diabetes, text messages offering advice and support can improve self-management and blood sugar control. This trial included 366 adults with type 1 or type 2 diabetes in New Zealand. An automated system delivered individually tailored text messages to participants over a nine-month period to support self-management of blood sugar. The control group received usual care, comparable to that in the UK. The text message group had a small reduction in blood sugar levels. Although the levels remained above target levels in both groups, the reduction is still likely to help reduce complications. The text message service was well-received by participants with almost all willing to recommend the intervention to others. However, the costs of the intervention were not reported.
04 September 2018

Adrenaline can restart the heart but is no good for the brain
Treating cardiac arrests with adrenaline during resuscitation by paramedics slightly increases survival compared with placebo. Though adrenaline initially helped restore circulation in a third of cases, 3.2% of people survived to 30 days compared to 2.4% of people in the placebo group. Severe brain damage was nearly twice as likely in those who survived after adrenaline injections. Cardiac arrest occurs when the heart no longer pumps blood around the body, usually due to an irregular heart rhythm which can have a variety of causes including coronary heart disease. This NIHR-funded trial of 8,014 people who had a cardiac arrest outside hospital provides high-quality UK-based evidence on the benefits and harms of adrenaline use during advanced cardiopulmonary resuscitation (CPR). Due to the low overall survival rate, the jury is still out on whether adrenaline should be reserved for use in certain heart rhythms or within a particular time period and not for others. Early bystander recognition and CPR, plus early defibrillation probably have a greater impact on survival.
04 September 2018

Endovascular aortic repair (EVAR) surgery more beneficial for ruptured abdominal aortic aneurysms than open repair
EVAR surgery to repair a ruptured abdominal aortic aneurysm had a slightly better survival rate after three years than open repair surgery. The survival benefit in this trial wasn’t apparent 30 days after surgery, but those having EVAR did recover more quickly and went home sooner. This NIHR-funded study also found that EVAR is likely to be more cost-effective. An abdominal aortic aneurysm is a swelling in the main artery that runs from the heart through the abdomen. If it bursts, there is catastrophic bleeding. The traditional treatment is urgent open surgery to repair the rupture. EVAR is a less invasive strategy using a tube of artificial material, placed inside the aorta from an incision in the groin under X-ray control, sealing the leak as well as reinforcing the wall of the vessel. This study is the first to show that people may have longer-term benefits from a strategy using EVAR where technically suitable for burst aneurysms and open repair if not.
28 August 2018

People with osteoarthritis can benefit from exercise but may harbour myths about safety
Programmes that show people with osteoarthritis how to exercise safely may slightly improve pain scores, self-belief and social function, but participants also report the myth that discomfort while exercising indicates on-going harm. The review combines evidence from 21 randomised controlled trials evaluating exercise in hip or knee osteoarthritis with 12 studies where people receiving the intervention were interviewed about the impact of exercise on their disease. Participants were men and women aged older than 45 years. Analysis of the randomised trials provides moderate- to low-quality evidence that exercise slightly improved pain and function and gave small improvements in depression, social function and people’s belief in their physical capability. Patient interviews highlight a common misconception that exercise can do more harm than good, and the important role healthcare professionals play in challenging these beliefs. Programmes that include clear, tailored instruction and provide opportunities to participate in supervised or group exercise may improve exercise uptake in people with hip and/or knee osteoarthritis.
21 August 2018

Cognitive behavioural therapy could benefit adults with attention deficit hyperactivity disorder (ADHD)
Cognitive behavioural therapy improves the core symptoms of attention deficit hyperactivity disorder (ADHD) in adults, compared with a range of other treatments. This Cochrane review found a general trend for improvements in inattention, hyperactivity and impulsiveness, especially when therapy was combined with medication. The review included trials that compared cognitive behavioural therapy to other specific interventions or to a range of control conditions, including waiting list and no treatment. It also looked at cognitive behavioural therapy plus drug treatment, versus drug treatment alone. The included trials were rated very low to moderate quality. They also used a variety of outcome measures, which made it difficult to compare the interventions. Despite these limitations, the review provides evidence that reinforces current guidance and practice.
21 August 2018

‘Virtual wards’ reduce readmissions in people after hospitalisation for heart failure
People with heart failure who receive care via virtual wards following discharge from hospital have lower rates of heart failure-related readmission and death than people discharged to other types of care. However, virtual wards did not show similar benefits when offered to people leaving hospital with other high-risk chronic diseases. This systematic review included randomised controlled trials of virtual wards, defined as with four operational criteria to be intensive multidisciplinary team management provided in a community setting. Out of hospital care, typically by primary care physicians, was the most common control. This study supports the idea that an enhanced and more rounded approach to care may improve post-discharge outcomes in people with heart failure. The review described interventions that are applicable to UK care models. The evidence may be a starting point for further evaluation or trials of these.
14 August 2018

Daily low-dose antibiotics halve urinary tract infections in people who self-catheterise
People who perform clean intermittent self-catheterisation can reduce symptomatic urinary tract infections from two per year to one by taking daily low-dose antibiotics. This NIHR-funded trial randomised 404 adults in the UK who perform the procedure for a variety of reasons to either daily oral low-dose antibiotics or no prophylaxis. All had a recent history of urinary tract infection. Although prophylactic antibiotics halved infection rates, it increased antimicrobial resistance compared with the control group who took short courses of antibiotics for each infection. This has implications for the individual and wider population. As overall reported health status was similar between the two groups, it is unclear if this reduction in infection is sufficient to justify wider use of prophylactic antibiotics.
14 August 2018

More findings are available on the NIHR Dissemination Centre website.