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.

Statins are of no benefit in acute respiratory distress syndrome
Giving statins to patients with acute respiratory distress syndrome made no difference to the number of days they spent on a ventilator. It also had no effect on mortality or the length of time spent in intensive care or in hospital compared with placebo. In acute respiratory distress syndrome, the lungs become severely inflamed, fill with fluid (pulmonary oedema) and can no longer function. The person needs mechanical ventilation and is at high risk of multiple organ failure and mortality. This serious condition has high impact on both patients and NHS resources. Early studies had suggested statins may help to reverse the inflammatory process and could be a potential treatment to explore. This large, multicentre trial, funded by the NIHR, found no evidence that simvastatin (80mg daily) improved these outcomes. No practice change seems indicated.
13 March 2018

Pulmonary rehabilitation improves exercise tolerance in pulmonary fibrosis
People with idiopathic pulmonary fibrosis who received pulmonary rehabilitation could walk 44 metres further in six minutes than those who did no exercise. Quality of life also improved. Pulmonary fibrosis is a rare condition where scar tissue builds up in the lungs making them stiff and causing breathing difficulty. The term idiopathic means there is no known cause. It tends to get worse over time, reducing a person’s activity levels. Pulmonary rehabilitation is a core part of care, but most programmes were based on evidence in people with chronic obstructive pulmonary disease which is the commonest lung condition. This review looked at whether it improved outcomes for pulmonary fibrosis. Only five small trials were available, and there are some concerns about the quality of evidence. However, this may be the best evidence attainable. Programme content varied making it difficult to know which exercises help most and it’s unknown whether it affects prognosis. The review supports the use of pulmonary rehabilitation as currently recommended.
13 March 2018

Mat Pilates probably improves balance and strength in older adults
Mat Pilates appears to improve muscle strength, flexibility, balance and cardiovascular fitness in older people compared to no exercise. There are limitations to the reliability of the evidence, but the consistent effect across all the aspects of fitness suggests this is probably a useful option for the increasing number of older people who wish to maintain their fitness. This review pooled the results of nine trials of 415 older adults from around the world, though not the UK. Pilates sessions were attended at least twice weekly for four to 24 weeks. Guidelines recommend 150 minutes of moderate activity per week for older adults and two sessions of strength training. If at risk of falls, balance exercises such as yoga are recommended. This review indicates that Pilates would be a viable alternative that would improve both balance and strength. When taught by a qualified instructor and tailored to individual ability, Pilates is safe in this age group.
07 March 2018

Waiting at home after inducing labour mechanically may be an option for low-risk women
Maternal or fetal complications, following the insertion of a balloon catheter to induce labour, are rare. Pain or discomfort was most common affecting around 1 in 400 women. Balloon displacement, bleeding or abnormal fetal heart rate affected less than 1 in 1,000. The catheter is a device inserted through the cervix, where inflated balloons on the end of a tube put pressure on the cervix helping it to “ripen” and start contractions. Prostaglandin drugs are the current recommended induction method, but uterine (womb) overstimulation, where contractions become too frequent or long, is a recognised side effect. Individual trials have indicated that catheter induction could be a safer alternative. This review is the first to gather the available evidence from 26 studies including 8,292 women that have reported the adverse event rate for catheters. It supports balloon catheters as an induction method for low-risk pregnancies that could allow women to stay at home, benefiting the mother and saving NHS resources.
07 March 2018

Short-duration dual antiplatelet treatment is possible for older people receiving drug-coated stents
Drug-eluting stents are more effective than bare-metal stents for preventing repeat procedures to open narrowed heart arteries in older adults with coronary heart disease. In this trial both types of stents were used alongside short courses of dual antiplatelet medication, outcomes for those receiving drug-eluting stents were improved with no difference in bleeding complications or rates of in-stent clots. This multi-centre European study tested 1,200 people aged 75 years or older. Duration of dual antiplatelet therapy was decided by heart disease severity, rather than the type of stent. The findings support the idea that people over 75 years can have the benefit of drug-eluting stents, alongside shorter duration dual antiplatelet treatment, like younger adults.
07 March 2018

Diet and exercise programmes can prevent diabetes in high-risk individuals
Lifestyle changes can reduce the risk of diabetes by about 40% and overall prevents about four high-risk individuals in 100 developing type 2 diabetes each year. The risk remained low for an average of about seven years after the intervention, but effects did decline over time. Medications including the weight-loss drug orlistat and diabetes drug metformin also reduced risk. But in contrast, there was no evidence of sustained effect after stopping treatment. Type 2 diabetes accounts for a large proportion of the chronic disease burden globally. Past research demonstrated that interventions leading to weight loss could prevent the condition. This review combines international data from over 40 trials looking at the long-term impact of medication and lifestyle modification compared with control. Findings support current NICE recommendations. Lifestyle change programmes, targeting both diet and exercise, are promoted as a central component of care to reduce the risk of type 2 diabetes in high-risk individuals.
27 February 2018

Inhaled anaesthesia with anti-sickness medication in children has the same risk of vomiting as intravenous anaesthesia
Post-operative vomiting is common in children. One strategy is to use an intravenous anaesthetic, which is known to cause lower rates of sickness than inhaled anaesthetics. There are disadvantages to this though, such as the need for injections before a child is asleep, slowing of the heart and difficulty in monitoring depth of the anaesthetic. This review of four trials included 558 children who had an operation to correct a squint. A third of children in each anaesthetic group had post-operative vomiting. There was no difference in time spent in the recovery room. The results indicate that individual factors may be more important when deciding on which type of anaesthetic to use rather than risk of post-operative vomiting.
27 February 2018

Gout medication may slow progression of chronic kidney disease
In people with existing kidney disease, one in four will have worse disease within six to 12 months. Uric acid-lowering drugs such as allopurinol halve the risk of disease progression over this period. They also reduce heart attack or stroke by 60%. Uric acid, the cause of gout, is produced when proteins are broken down by the body. It is excreted by the kidneys and often builds up in people with chronic kidney disease. It is not certain whether increased uric acid causes progression of kidney disease or is simply a marker of its severity. This review included 16 small trials of 1,211 people with moderate chronic kidney disease from a variety of causes which were allocated to take a uric acid lowering medication or usual care. Although these results are promising, they are based on low-quality trials. The low rate of side effects should be taken into account when considering these drugs as an option to slow the progression of kidney failure and prevent heart disease.
20 February 2018

Calcium channel blockers are useful in managing Raynaud’s phenomenon
Calcium channel blockers, such as nifedipine, are confirmed as useful in reducing the frequency, duration, severity of attacks, pain and disability associated with Raynaud’s phenomenon. People had two to six fewer attacks per week on average with treatment, and 13 without. Raynaud’s is a disorder which reduces blood flow to the fingers and toes as a result of the blood vessels tightening and going into spasm in the cold. This updated review suggested that calcium channel blockers may be more effective in higher doses than lower doses and help primary symptoms rather than the secondary form of Raynaud’s that is due to underlying disease. Most research has been into nifedipine. Although no serious adverse events while using calcium channel blockers were reported, more people withdrew from trials as a result of minor side effects. Previous studies have also shown that calcium channel blockers were effective, but this review expands the research for this indication and might inform future guidelines.
20 February 2018

Introducing a primary care risk prediction tool did not reduce emergency admissions
Predicting emergency admissions paradoxically increased hospital admissions from primary care across all risk groups by about 3% overall. The Predictive Risk Stratification Model (PRISM) was evaluated in a trial in general practices in Wales, and there is little evidence it benefits patients by reducing deaths or improving quality of life either. The number of people living to older age with chronic health conditions is growing. Various risk stratification tools have been introduced across the NHS aiming to improve planning and delivery of care for people in the poorest health. This study, funded by the NIHR Health Services Delivery and Research Programme, evaluated the tool during implementation of a quality and outcomes framework incentive to encourage identification and better management of high-risk patients. The lack of benefit may be because of poor uptake of the tool, lack of available services to help those at risk or the concentration of efforts on too few high-risk individuals. General practices still seem to have found few alternatives to hospital admission for many patients.
20 February 2018

More findings are available on the NIHR Dissemination Centre website.