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.

Structured training improves skills of wheelchair users
Structured wheelchair skills training increases wheelchair users’ skills when compared with no training, standard care or education controls. The training, as developed in Canada, is more effective for new wheelchair users than experienced users. It includes difficult everyday challenges from wheeling through gravel to negotiating high curbs. Links have been found previously between wheelchair skills capacity (reflecting what the user can do) and: independent mobility, reduced reliance on caregivers, and increased social participation. This systematic review was only able to show an increase in skills capacity using the specific Wheelchair Skills Test, as this was the common outcome measure. Other measures reflecting activities of daily living or frequency of independent movement weren’t used in enough trials to enable comparisons. This Canadian programme appears to be a safe and effective way of increasing participants’ wheelchair skills. Most NHS trusts in England appear to offer only basic support in using a wheelchair. Implementing more advanced and standardised skills training programmes offers potential to improve these services, but could entail additional costs and staff training.
18 July 2018

Enhanced recovery programmes after stomach cancer surgery reduce hospital stay without increasing complications
Enhanced recovery programmes reduce length of hospital stay and associated healthcare costs after stomach cancer surgery, with no impact on short-term mortality or post-operative complications. They also improved post-operative quality of life. The enhanced recovery approach includes a range of components designed to help people to recover more quickly and have better outcomes after surgery. These include optimising people's health preoperatively, attention to detail during anaesthesia and surgery, early return to feeding and encouraging people onto their feet as soon as possible afterwards. Enhanced recovery is already established practice for many types of surgery, including for stomach cancer, in many UK hospitals. This review included trials from Asia, but these followed internationally accepted protocols. Its findings support programmes already in place and add evidence for hospitals that have not yet implemented them.
18 July 2018

Increasing inhaled steroids for short periods reduces asthma exacerbations
Taking four times the usual dose of inhaled corticosteroids for up to two weeks can modestly reduce the chance of asthma worsening. This NIHR-funded trial assessed increasing the inhaled corticosteroid dose compared with staying on the usual dose, as part of a self-management plan. Participants were adults and adolescents with uncontrolled asthma and had at least one exacerbation needing additional medical attention in the year before the trial. Quadrupling the inhaled corticosteroid dose when asthma worsens is already recommended by NICE guidance, but previously there was little research evidence to support the clinical practice. What there was, suggested that doubling the dose of inhaled corticosteroids was not effective and quadrupling the dose had been tested in trials with very few people. The results of this trial increase the confidence in this as a valid approach.
17 July 2018

Lamotrigine is not effective for the treatment of borderline personality disorder
Lamotrigine, a mood-stabilising drug, is not clinically effective for the treatment of borderline personality disorder. Over one year follow up, this NIHR-funded trial did not find a difference between lamotrigine and placebo for borderline personality disorder-related symptoms and behavioural problems, depressive symptoms, self-harm, social functioning or quality of life outcomes. Borderline personality disorder is a severe mental health disorder characterised by rapid and distressing fluctuations in mood, impaired social functioning and increased suicidal behaviour. Since emotional instability is a key clinical feature, it was thought treatments that help to stabilise mood might help in treating the condition. This was a placebo-controlled, double-blind, randomised trial of lamotrigine in 276 people with borderline personality disorder, the largest trial to date. In contrast to the results of earlier smaller trials, this larger trial did not support the use of lamotrigine in the management of borderline personality disorder.
17 July 2018

Alternative sedative reduces the risk of acute kidney injury following cardiac surgery
The sedative drug dexmedetomidine can reduce the risk of acute kidney injury when given during non-emergency cardiac surgery. Trial participants who received dexmedetomidine were a third less likely to develop acute kidney injury than those receiving placebo or other treatments. There was no difference in mortality or length of hospital stay. This systematic review identified 10 studies of 1,575 participants. Surgical procedures included coronary artery bypass grafting with or without valve surgery and aortic vascular surgery. Dexmedetomidine was given before or shortly after surgery. Most participants were followed up for the duration of their hospital stay, or for 12 to 30 days. Many strategies are currently used to reduce the risk of kidney injury following cardiac surgery. This study provides some evidence that dexmedetomidine may help reduce this risk, but larger trials are needed before it can be routinely recommended.
10 July 2018

One week of steroids may be as effective as two weeks in managing severe COPD
A shorter course of steroids lasting 3 to 7 days appears as effective as the recommended 7 to 14-day standard treatment for managing a flare-up of severe chronic obstructive pulmonary disease. This update to an earlier Cochrane review looked at randomised clinical trials comparing a short course (7 days or fewer) with a longer course (7 to 14 days) of steroids given by mouth or injection. All participants had been admitted to hospital, but none required mechanical ventilation. The evidence suggests that shorter courses of steroids could be given to people with severe chronic obstructive pulmonary disease where there are concerns about side effects. However, the research was limited by small study sizes and including only 582 people in total. Further research is needed to determine the optimum duration of steroid treatment in flare-ups of mild or moderate chronic obstructive pulmonary disease.
10 July 2018

Fish oil supplements are ineffective for treating dry eyes
Omega-3 fatty acids or ‘fish oil’ supplements are no more effective than inactive olive oil capsules for relieving dry eye disease. Some patients take fish oil supplements for this common problem, but this new evidence suggests that they consider alternatives. Dry eye disease is a common long-term inflammatory condition causing discomfort, and disturbances including blurred vision. Treatment of symptoms includes using artificial tears. Although guidelines recognise the lack of existing evidence for fish oil supplements, people continue to use them on the advice of health professionals. This US-based trial did not find a difference on several measures compared with placebo over one year of follow up. The trial was based on community patients, so is likely to apply to people visiting their GP for help with dry eye disease, or who buy supplements over the counter. Practitioners can now confidently tell their patients that new evidence suggests this widely available supplement is no better than taking olive oil for relieving dry eye symptoms.
03 July 2018

Cartoons are promising for reducing dental anxiety in children
Cartoons delivered on laptops, projectors or 3D goggles with sound can help distract anxious children who fear dental procedures. Dental anxiety can prevent children from attending the dentist for care, and this type of distraction could offer a useful tool to help them. This review looked at a range of audiovisual approaches tested in trials of healthy children receiving dental treatment under local anaesthetic. The children were assessed for physiological measures related to emotional state (such as pulse rate), anxiety and observed behaviour. Childhood dental anxiety is a common problem, and these distraction approaches sound promising, safe and relatively easy to implement.
03 July 2018

Group-based diet and exercise programmes can lead to weight loss
The evidence is growing that group-based weight loss programmes can offer effective and acceptable options for overweight people, particularly men. On average, people in group dietary advice and exercise programmes lose 3.5kg more than non-participants by six months – a modest 4% weight loss overall but less than the 5% that is often regarded as clinically important. In this systematic review on the group weight loss approach, participants in the 47 trials were adults from the general population, taking part in groups of at least three people, led by a facilitator. The interventions varied considerably in setting, contact time, group size, facilitators’ background and intervention content. This wide variation and reporting limitations mean that it is difficult to determine exactly what works and how. The group approach seems generally effective, more so for men than women, and is more effective in those programmes that target weight loss rather than maintenance.
26 June 2018

Yoga-based exercise can improve well-being for older people
Yoga-based exercise offers a safe and accessible way to improve health-related quality of life and mental well-being for people over 60. Evidence for a moderate benefit of yoga in later life now extends beyond improved balance and flexibility. Yoga includes stretches, poses, breathing routines and meditation. This review focused on the physical exercise/activity components. Most of the 12 included trials took place in Western countries and classes were all run by qualified yoga instructors as in the UK. Class attendance was high for eight weeks or more (50 to 96%). However, women outnumbered men by three to one, implying that yoga classes may need adapting to appeal to older men. Yoga classes are widely available and could offer an accessible way to improve older people’s activity levels and well-being. The research was moderate to high quality, but it cannot yet show exactly how much yoga or which kind works best for particular groups of people. However, the good news is that these approaches seem effective.
26 June 2018

More findings are available on the NIHR Dissemination Centre website.