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.

A football programme for overweight men achieves sustained weight loss
A 12-week weight management programme for men, centred on football, achieved 4.9kg weight loss at 12 months. Modest weight loss of 2.9kg was maintained at 3.5 years. Rates of overweight and obesity are higher for UK men than women, and there is little evidence that interventions are effective in the longer term. This NIHR-funded study followed 488 of 747 men (65%), average age 47 years, originally allocated to a programme of behavioural advice and football training with a professional coach or to a waiting list control. In this follow-on study, the control group also received the intervention after 12 months. Improvements in self-reported physical activity and diet were also maintained. The programme was estimated to be an effective use of NHS resources. It indicates that tailored programmes can work beyond the trial setting. Evidence for what components of this programme were linked to its success could help design other interventions that don’t involve football.
16 October 2018

No benefit from monitoring antiepileptic drug levels in pregnancy
Regular monitoring of antiepileptic drug levels in pregnant women with epilepsy does not improve seizure control compared with clinical features-based monitoring. This NIHR-funded study was conducted across 50 UK hospitals and is the largest randomised trial in pregnant women with epilepsy. Just over 260 pregnant women with unstable antiepileptic drug levels were assigned to ongoing monthly blood checks or clinical features monitoring. There were no differences in seizures or other pregnancy outcomes between the two strategies. But umbilical cord blood showed that babies whose mothers received blood checks were exposed to higher levels of antiepileptic drugs. The study provides important information about the utility of monitoring blood levels of antiepileptic drugs, which previously was standard clinical practice. NICE guidelines advised against routine monitoring in 2012 and this trial gives support to this recommendation.
09 October 2018

Better pain relief for women in labour
Women in labour, who had the short acting strong painkiller remifentanil, rather than pethidine, had less need for further pain relief. Only 19% of women given remifentanil received a subsequent epidural compared with 41% given pethidine. Remifentanil was given intravenously, using a patient-controlled delivery device, and pethidine given by intramuscular injection. This NIHR-funded study is the first large trial to compare intravenous remifentanil (administered via a patient-controlled delivery device) with intramuscular pethidine for women requesting opioid pain relief in labour. Opioid drugs can cause maternal sedation and depression of the baby's breathing but this trial found no difference in adverse maternal or neonatal outcomes between drugs. One caution is the potential for subjective bias. A quarter of women allocated to pethidine who converted to epidural requested this before they had even received the drug Nevertheless, this study could pave the way for patient-controlled remifentanil to have more widespread use in the UK.
09 October 2018

Financial incentives may help workers quit smoking
Financial incentives, when given alongside free smoking cessation aids, improved abstinence rates compared with free cessation aids or motivational information alone. This workplace-based US trial assigned 6,000 smokers, unselected for willingness to quit, to information only, free e-cigarettes, free nicotine replacement or drug therapy, or free cessation aids with a $600 reward in one of two ways. Quit rates at six months were very low though the substantial financial incentive increased the rate by 2% from the 1% with other methods. The low success rates highlight that people need to be willing to quit. Only 20% of participants showed active engagement in the study. These people achieved quit rates four to six times higher than those who did not engage. Financial incentives could be an option for reducing smoking among motivated employees. But differences in US employment structure and health insurance policies may limit applicability to the UK, where the financial return may be less for employers.
09 October 2018

Negative pressure dressings are no better than standard dressings for open fractures
Negative pressure wound dressings are neither more nor less effective than standard wound dressings for severe open fractures of the lower leg. Any difference between groups was neither clinically important nor statistically significant. The outcomes included self-rated disability at one year, quality of life and deep surgical site infections at one month which occurred in around 7-8% in each group. Open fractures of the leg, where the broken bone is exposed by the original injury or has burst through the skin, are prone to infection. Usually, the wound is thoroughly cleaned, damaged tissue removed (debridement), the bone stabilised and a standard dressing applied. Negative pressure wound therapy requires a special dressing and an additional vacuum pump. This removes surplus blood and fluid from the wound, which was expected to improve the chances of healing and reduce deep tissue infections. The results of this NIHR-funded trial suggest that this more expensive option offers no significant gains for patients.
09 October 2018

Two antiplatelet drugs may prevent further strokes but increase major bleeds
People experiencing a minor stroke or a transient ischaemic attack have a lower risk of further stroke within 90 days if given clopidogrel and aspirin, rather than aspirin alone. However, taking both drugs doubles the risk of bleeding over the same period. Current UK guidelines recommend using clopidogrel alone. In this major international trial of nearly 5,000 people, those who took the dual treatment had fewer heart attacks or strokes than those who took aspirin only, particularly in the first 30 days of treatment. Major bleeding risk was fairly constant on combined treatment throughout 90 days, occurring in 0.9% compared with 0.4% on aspirin. This study provides more evidence on the balance of benefits and risks. Further research into the timing and duration of dual antiplatelet therapy is needed.
02 October 2018

Keyhole surgery is more effective than physiotherapy for hip impingement
Keyhole surgery to reshape the joint surfaces in people with hip impingement improves hip-related quality of life more than physiotherapy. In hip impingement, there is a painful restriction of the smooth movement of the ball of the femur inside the cup (acetabulum) of the pelvis. It mainly affects younger, active people. Observational studies have supported the use of keyhole surgery (arthroscopy), but there was a lack of high-quality evidence. This NIHR-funded study is the first trial to compare arthroscopy with optimal conservative care. Both arthroscopy and physiotherapy led to improvements on a 100-point hip score by 12 months. However, arthroscopy caused an additional 6.8 points improvement, which is a clinically meaningful difference. Further follow-up is needed to show that the effect is sustained. Nevertheless, this is the first good evidence for the effectiveness of arthroscopy, although it was more costly than physiotherapy.
02 October 2018

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

More findings are available on the NIHR Dissemination Centre website.