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.

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

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

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

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

Exercise improves intermittent claudication leg pain on walking
People with intermittent claudication who participate in structured exercise programmes can walk about 80 metres further without experiencing leg pain than those who do not do the programme. They can also walk about 120 metres further overall. Intermittent claudication is a cramp-like pain in the legs caused by narrowing of the arteries, which restricts blood flow to the muscles. There’s increasing evidence that maintaining physical activity can help. This updated systematic review combined data from 32 trials involving 1,835 adults with stable leg pain. The quality of evidence was high for the main outcomes of how far people could walk in total and without pain. Exercises varied (for example, cycling, pole-striding) though most programmes were delivered at least twice weekly over three to 12 months. The findings support NICE recommendations to offer supervised exercise programmes as the first-line approach for people with intermittent claudication.
10 April 2018

Physiotherapy education before major abdominal surgery reduces lung complications
A physiotherapy session before planned abdominal surgery, explaining the importance of breathing exercises and sitting out of bed as soon after surgery as possible, halves the risk of pneumonia. This trial compared the physiotherapy session with usual care which was provided to all 432 participants. This consisted of a leaflet given in the pre-operative outpatient clinic outlining the exercises, and physiotherapy input in the days after surgery. Just seven people would need to receive the additional 30-minute pre-operative physiotherapy session to prevent one lung complication. The study was carried out in Australia and New Zealand, where usual care may differ from that provided by the Enhanced Recovery Programme in the NHS. However, the results are impressive and show the importance of face-to-face sessions to prepare people to give themselves the best chance of a speedy recovery.
03 April 2018

The most effective antidepressants for adults revealed in major review
Antidepressants are effective to treat moderate to severe depression in adults. Five antidepressants appear more effective and better tolerated than others. A major review of 522 antidepressant trials found that all of the 21 drugs studied performed better than placebo, in short-term trials measuring response to treatment. However, effectiveness varied widely. Researchers ranked drugs by effectiveness and acceptability after eight weeks of treatment. Several drugs were more effective and were stopped by fewer people than others: escitalopram paroxetine sertraline agomelatine mirtazapine. The review provides new evidence which may help people decide which antidepressant to choose first-line for moderate to severe depression. However, it did not assess antidepressants compared to other treatments such as cognitive behavioural therapy, or treatments in combination. Though there are some concerns over items not reported by individual trials, this review is likely to be reliable. It is extensive, included only placebo controlled double blind trials and searched successfully for unpublished trials.
03 April 2018

More findings are available on the NIHR Dissemination Centre website.