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.

People maintain increases in physical activity three years after receiving pedometers
Middle-aged to older adults given pedometers and a walking programme as part of two NIHR trials continued to be active three years later. In one trial they were walking around 650 extra steps a day. In both trials, they spent about 30 minutes per week extra in moderate-to-vigorous physical activity compared to controls. Brisk walking is a good way for older adults to achieve physical activity recommendations. This is the long-term follow-up of two large NIHR-funded trials that recruited adults aged 45 to 75 years from 10 UK general practices. Participants received pedometers for 12 weeks with activity guidance given via post or nurse support. Around 900 people (70% of those enrolled) completed follow-up to three and four years. Controls were later given pedometers but with little instruction or support, which seems central to the effect. This is the first evidence demonstrating that simple interventions like pedometers lead to sustained increases in physical activity required for long-term health.
22 May 2018

Low fat or low carbohydrate diets seem just as effective for weight loss
Overweight to obese adults who followed a low fat or low carbohydrate diet for 12 months both lost around 5 or 6kg in body weight. It made no difference whether they had a gene-type indicating that they break down fats or carbohydrates better. Obesity is a major public health concern and there are many weight-loss approaches and fad diets that people try. Dietary trials tend to observe only modest weight loss. Given wide population variation, some suggest that knowing the genetic or metabolic characteristics of individuals might determine which diet is better for whom. This US trial including 600 adults who followed strict dietary interventions found no evidence for this. The time to weight loss and range of loss among individuals was equivalent with either diet, regardless of genetics or blood glucose control. The most important thing is that people adopt a balanced diet and lifestyle that they can maintain in the long-term, which includes regular physical activity.
22 May 2018

Plastic wraps or bags keep pre-term infants warm immediately after birth
Cheap and simple plastic wrapping used in the first 10 minutes after birth helps pre-term and low birth weight infants avoid hypothermia. Infants treated in this way are likely to be warmer when admitted to neonatal intensive care than those treated according to standard care. Pre-term infants are most likely to benefit. Routine infant care usually involves ensuring the delivery room is warm, drying the infant immediately after birth, wrapping the infant in pre-warmed dry blankets and pre-warming surfaces. Despite this, about a quarter of babies born eight weeks early have temperatures that are too low and additional measures to warm pre-term and low birth weight infants are needed. Although babies were warmer after the intervention, this review of 19 published studies did not show that these interventions improved survival, or reduced the chances of short or long-term conditions associated with cold, perhaps because of the size of the trials.
22 May 2018

Cell salvage during caesarean section doesn’t reduce blood transfusions
In a large UK trial, cell salvage for women at risk of blood loss during caesarean did not reduce the need for donor blood transfusion, though few needed transfusion (2.5% compared with 3.5% among controls). More babies are being born by caesarean section and if blood loss is excessive, transfusions may be required, probably by about one in 20 women. Collecting the mother’s own lost blood during the procedure, filtering and returning it to her (cell salvage) is a potential alternative that could reduce the need for donated blood. This NIHR-funded trial included around 3,000 women in 26 obstetric units in the UK. It sought to see if cell salvage reduced transfusions for women undergoing elective or emergency caesarean, and thought to be at increased risk of haemorrhage (over 5%). The findings suggest that cell salvage doesn’t have a routine place in obstetric care.
15 May 2018

Domperidone increases breast milk production in mothers of premature babies
The drug domperidone increases the amount of breast milk women produce. This review looked at its use for up to two weeks in women with premature babies being fed with expressed milk. Women had a moderate increase in breast milk of about 88ml a day, a clinically important increase for these small babies. Domperidone is an anti-sickness medication. It has not been widely used to increase breast milk because of unknown effectiveness and concerns that it can cause an irregular heart rhythm with longer-term use in older people. This review found it can moderately increase milk production. Though no serious or cardiac side effects occurred in the studies, only 192 women participated in the trials, so rarer side effects may still occur. Overall, the risk of irregular heart rhythms in mothers may be outweighed by the benefits of increased breast milk consumption in premature infants. Informed consent is necessary for this use of domperidone.
08 May 2018

Probiotics can prevent bacterial diarrhoea in hospital patients receiving antibiotics
Giving probiotics to people taking antibiotics reduces the chance of them developing diarrhoea caused by Clostridium difficile (C. difficile) bacteria by 60%. One case of Clostridium-associated diarrhoea was prevented for every 42 people receiving probiotics. They appear to work best for patients at more than 5% risk of Clostridium infection. When antibiotics disturb healthy gut bacteria, Clostridium bacteria may multiply to toxic levels, causing diarrhoea and serious intestinal complications. Probiotics can be found in dietary supplements or yoghurts but are increasingly sold as capsules and contain live bacteria or yeast that may counteract these effects. This updated Cochrane review pooled 39 trials comparing patients who did and did not receive probiotics. Results were consistent when taking account of the type of probiotic, inpatient or outpatient setting, or whether for adults or children. Probiotics may be suitable for use in high-risk patients needing antibiotics, for example, older adults with underlying illness. Probiotics aren’t regulated as medicines, and national guidance here and overseas does not recommend them for standard use.
01 May 2018

Case managers improve outcomes for people with dementia and their carers
Using a case manager to coordinate health and social care improves the challenging behaviour of people with dementia and reduces the burden on caregivers. Quality of life of caregivers improves the most when case managers have a professional background in nursing. This NIHR-funded review compared the effectiveness of standard community treatment and interventions with case managers overseeing the interventions for people living with dementia. It considered evidence from 14 trials in a number of countries, with different health systems and support. Care coordination is variable across the UK, but this is often not provided by a qualified professional, so they are not able to develop and update the care plan. Though the review did not provide strong evidence of effectiveness regarding hospitalisation or death, it does highlight the benefits of having a care coordinator with a background in nursing for improving quality of life.
24 April 2018

Adding the extra antibiotic rifampicin did not improve cure rates after sepsis
Adding the antibiotic rifampicin did not improve cure rates or reduce deaths for people with bacterial blood infections caused by Staphylococcus aureus. It increased the risk of adverse reactions requiring a change in treatment and the chances of drug interactions. This NIHR-funded trial is the largest to date on adding rifampicin to standard antibiotic therapy. The study included 770 people in 29 UK hospitals. Half were assigned to 14 days of treatment with rifampicin on top of their existing antibiotic regime. Rifampicin could be either oral or intravenous.
17 April 2018

Lorazepam confirmed as first-line treatment for stopping prolonged seizures in children
Intravenous lorazepam is as effective as intravenous diazepam for stopping children’s tonic-clonic seizures in hospital. Lorazepam also results in fewer breathing problems than diazepam. Giving antiepileptic drugs intravenously generally stops seizures more quickly than giving the drugs buccally (in the cheek), intranasally (in the nose) or rectally. However, this effect can be cancelled out if administering the drug into the veins takes too long. Two of the 18 included trials were carried out in the UK, but they were all carried out in large children’s hospitals or departments similar to the UK. The new evidence confirms advice in the existing NICE guideline and also describes the current options regarding the routes and preparations used when it is difficult to secure intravenous access quickly.
17 April 2018

A school-based obesity prevention programme was ineffective
A school-based healthy lifestyle programme delivered to 6-7-year-old children and their parents made no difference to children’s weight, diet or activity levels. Around 1 in 4 remained overweight or obese. The NIHR-funded year-long programme was delivered in 54 primary schools in one region of England. Teachers were trained to provide an additional 30 minutes of physical activity a day and deliver cookery workshops with parents each term. It also included activities with a local football club, Aston Villa. Children in schools that took part were no less likely to be overweight or obese after 15 or 30 months, and their diet and exercise levels did not improve. Less than one in six schools managed to deliver the activity sessions as planned. The results are similar to another recent trial of a lifestyle programme delivered to 9-10-year-olds. Both suggest that changes to reverse the tide of childhood obesity will have to take place in wider society, not just in schools, to have the desired effect.
10 April 2018

More findings are available on the NIHR Dissemination Centre website.