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.

Asthma self-management programmes can reduce unscheduled care
People with asthma who receive supported self-management are less likely to attend A&E or be admitted to hospital. The interventions are unlikely to increase overall costs for healthcare services. Those who self-manage are also likely to have more controlled asthma and a better quality of life. This extensive overview of systematic reviews included evidence from 270 randomised controlled trials exploring the effects of asthma self-management on healthcare utilisation and costs. Self-management programmes were slightly more expensive, but this cost was likely to be offset by reducing unplanned medical visits and improving patient quality of life. Trials covered different self-care education programmes delivered in a range of contexts. However, programmes which included written action plans supported by regular professional review were found to be most beneficial. These findings are in keeping with current guideline recommendations and emphasise that supported self-management programmes for asthma should be prioritised.
20 June 2017

Acupuncture shown to have benefits for treatment of some chronic pain
Acupuncture is not a placebo for treatment of chronic pain. This NIHR-funded systematic review shows that acupuncture is better than usual care and sham acupuncture for pain from musculoskeletal conditions, knee osteoarthritis and chronic headache. This NIHR review was large with over 140 trials overall, and the direct comparison with sham acupuncture helps to address uncertainty around whether acupuncture gives clinical benefit above a “placebo effect.” Acupuncture had a smaller effect on pain when compared with sham acupuncture than when compared with no acupuncture, but both comparisons showed statistically significant differences. Acupuncture also improved quality of life compared with standard care and was assessed to be a good use of NHS resources. Acupuncture is currently recommended for the prevention of chronic headaches, but not for musculoskeletal pain or osteoarthritis pain. The findings may inform forthcoming guideline updates. The availability of accredited acupuncturists varies across the UK. Though some are currently funded in NHS clinics, additional NHS funding for providers managing chronic pain conditions may be indicated.
20 June 2017

Induction of labour may be considered in pregnant women with a large baby
Induction of labour does not increase the risk of caesarean delivery in pregnant women with a larger than average baby. This is based on a review of four trials of 1190 women with a suspected large baby who were allocated either to have labour induced from 38 weeks or to watchful waiting. Induction did not increase the risk of most negative outcomes for the baby, such as bleeding in the brain, or mother, such as major tearing. However, these outcomes are rare, so a larger number of women would need to be studied to be confident in these findings. When mothers were not induced babies were larger and born about a week later than if they were induced. They did suffer from more fractures, which can be a complication of delivering a larger baby. Current guidance recommends only offering induction at 41 or 42 weeks in otherwise healthy women who have a larger than average baby. This analysis suggests that earlier induction is likely to be safe and may be an option for women to consider.
20 June 2017

Steroid injections into the inner ear may be safe for treating Ménière’s disease
Injecting steroids into the space behind the ear drum may be a safer alternative to injections of gentamycin for treating Ménière’s disease. This disease is marked by severe attacks of dizziness and balance problems. This NIHR-funded trial randomised 60 people with Ménière’s disease who experienced severe attacks of vertigo and had not responded to standard treatment. They were randomly chosen to receive either the corticosteroid methylprednisolone or the antibiotic gentamicin. Participants were followed for two years. Both were very effective at stopping or reducing symptoms by about 90%. Few side effects were reported in either group. Gentamicin works by permanently damaging the inner ear function that is concerned with balance, and rarely can cause deafness. Because of this, specialist healthcare professionals may prefer to use of methylprednisolone instead.
13 June 2017

Pelvic floor exercises may reduce need for further treatments for pelvic organ prolapse
Pelvic floor muscle training reduced symptoms at two years slightly more than the improvement seen in women who just received a leaflet with lifestyle advice. In addition to this 1 point change on a 28 point scale, 8% fewer women who had training needed further treatment for prolapse. This randomised controlled trial included 412 women with relatively minor prolapse but who had not had any previous treatment. The basic training was provided by physiotherapists in five treatment sessions with added pilates classes and a DVD. Pelvic floor exercises are safe and can be carried out easily by most women with this common condition. They may be helpful even before women have any troublesome symptoms of prolapse. The researchers are planning longer-term follow-up, which will help to determine whether it is a cost-effective option.
06 June 2017

Combination inhaler treatment in emergency departments may reduce admissions for asthma attacks
Using a combination of two inhaled drugs to open the airways may modestly reduce the need to admit an adult with asthma attack to hospital, though the underlying evidence is weak. The first-line treatment for an asthma attack is an inhaled β2 agonist, like salbutamol. This Cochrane review compared emergency department treatment with this drug alone, or combined with an inhaled short-acting anticholinergic, like ipratropium bromide. Pooled results from 16 trials included found that combination therapy would mean about 65 fewer patients per 1000 are admitted to hospital. As most underlying trials were conducted outside the NHS, the admission rates are likely to be quite different in the UK. Short-term minor adverse effects were more common with combined therapy. The evidence suggests combination treatment is most effective in severe attacks and this is consistent with current UK guideline recommendations. Asthma places a large burden on the NHS and reducing hospital admissions may spare resources. Further study could usefully explore the optimal drug dose and delivery method in a UK setting.
30 May 2017

Pneumococcal vaccines for people with COPD reduce their chance of catching pneumonia
Pneumococcal vaccines reduce the risk of community-acquired pneumonia in people with moderate to severe chronic obstructive pulmonary disease (COPD). Pneumococcal vaccination is currently recommended for people with COPD and other respiratory diseases. However, until now there has been a lack of data whether it actually improves outcomes in these groups. This updated Cochrane review identified 12 trials including 2171 adults with COPD, comparing those who did and did not receive pneumococcal vaccination. One episode of community-acquired pneumonia was prevented for every 21 people vaccinated. There was also evidence that vaccination reduced the risk of exacerbations of COPD. However, vaccination had no effect on deaths from respiratory causes or likelihood of hospitalisation. This evidence lends further support to current government recommendations to provide the pneumococcal vaccine to people with COPD.
30 May 2017

Drugs may help people pass larger kidney stones
Three-quarters of people with a large (more than 5mm) single kidney stone will pass the stone within six weeks if they take an alpha-blocker. About half of those taking placebo or no treatment pass the stone in the same period. Renal colic is a severe pain in the flank and is usually caused by kidney stones when they move into the ureter, the tube between the kidney and bladder. Most small stones pass into the urine without treatment. Evidence for drug treatment is contradictory. A recent UK trial did not find that drugs made any difference to who went on to require a surgical intervention. This review suggests that people with larger stones of more than 5mm may benefit from alpha-blockers. However, there are some limitations of the review in terms of applicability to the UK. If a sized based approach is used to inform treatment, this will require a scan rather than ultrasound in order to measure stone size accurately.
30 May 2017

Very strict blood sugar control in critically ill children provides no benefit
Strict control of blood sugar levels for critically ill children in ICU with high blood sugar did not increase the number of days they spent outside of ICU in the first month. The trial was stopped early as more infections and very low glucose levels were recorded in the strict control group. This trial found that using insulin to control blood sugar to within 4.4 to 6.1 mmol/L, rather than 8.3 to 10mmol/L, in critically ill children made no difference to the number of days they spent in the intensive care unit. This trial indicates that maintaining blood sugar control within tight boundaries in this group is of no benefit and may be harmful. It is time to review the target blood sugar levels for critically ill children with high blood sugar.
23 May 2017

Induction of labour within 24 hours, if waters break at 37 weeks of pregnancy, can reduce womb infection
Inducing labour may halve the risk of infection in the womb when waters break from 37 weeks. The procedure was started within 24 hours and was compared to waiting for labour to start on its own. Waters breaking at full term without the onset of labour is called pre-labour rupture of membranes. This can increase risks of maternal and neonatal infection and the need for caesarean section. As most women deliver spontaneously within a day, NICE recommend that women are offered an informed choice of either induction 24 hours after premature rupture of membranes or to watch and wait. This updated Cochrane review included new evidence and suggests that induction before 24 hours may reduce infections without increasing caesarean sections, but there remains some uncertainty. This is due to low study quality, lack of longer term outcomes, and too few participants in trials to compare the numbers of any rare serious events. These findings may help inform shared decisions about induction by providing more information to help women understand the risks.
23 May 2017

More findings are available on the NIHR Dissemination Centre website.