Hospital policies can create barriers to good management of opioid withdrawal.

The studyHarris M, Holland A, Lewer D, et al. Barriers to management of opioid withdrawal in hospitals in England: a document analysis of hospital policies on the management of substance dependence. BMC Med 2022;20:151.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/many-hospital-policies-create-barriers-to-good-management-of-opioid-withdrawal/.

Little evidence supports gabapentinoid use in bipolar disorder or insomnia.

The studyHong JSW, Atkinson LZ, Al-Juffali N, et al. Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: systematic review, meta-analysis, and rationale. Mol Psychiatry 2022;27:1339-49.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/review-finds-little-evidence-support-gabapentinoid-use-bipolar-disorder-or-insomnia/.

More people survived a cardiac arrest when first aiders received an app alert.

The studySmith CM, Lall R, Fothergill RT, Spaight R, Perkins GD. The effect of the GoodSAM volunteer first-responder app on survival to hospital discharge following out-of-hospital cardiac arrest. Eur Heart J Acute Cardiovasc Care 2022;11:20-31.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/more-people-survived-cardiac-arrest-first-aiders-goodsam-alert/.

Obesity alone should not rule out knee replacement surgery.

The studyEvans JT, Mouchti S, Blom AW, et al. Obesity and revision surgery, mortality, and patient-reported outcomes after primary knee replacement surgery in the National Joint Registry: a UK cohort study. PLoS Med 2021;18:7.

How to improve discussions about osteoarthritis in primary care.

The studyVennik J, Hughes S, Smith KA, et al. Patient and practitioner priorities and concerns about primary healthcare interactions for osteoarthritis: a meta-ethnography. Patient Educ Couns 2022;105:1865-77.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/discussions-about-osteoarthritis-in-primary-care/.

Unemployment and insecure housing are linked to less successful treatment for depression.

The studyBuckman JEJ, Saunders R, Stott J, et al. Socioeconomic indicators of treatment prognosis for adults with depression: a systematic review and individual patient data meta-analysis. JAMA Psychiatry 2022;79:5.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/unemployment-insecure-housing-linked-less-successful-depression-treatment/.

Early life inflammation is associated with spinal cord excitability and nociceptive sensitivity in human infants.

Immune function and sensitivity to pain are closely related, but the association between early life inflammation and sensory nervous system development is poorly understood-especially in humans. Here, in term-born infants, we measure brain activity and reflex withdrawal activity (using EEG and EMG) and behavioural and physiological activity (using the PIPP-R score) to assess the impact of suspected early-onset neonatal infection on tactile- and noxious-evoked responses. We present evidence that neonatal inflammation (assessed by measuring C-reactive protein levels) is associated with increased spinal cord excitability and evoked brain activity following both tactile and noxious stimulation. There are early indications that this hyperalgesia could be maintained post-inflammation, supporting pre-clinical reports of early-life immune dysfunction influencing pain sensitivity in adults.

Frail older people and those in deprived areas remain at risk from covid-19, even after vaccination.

The studyAntonelli M, Penfold RS, Merino J, et al. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis 2022;22:1.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/older-people-at-risk-from-covid-even-after-vaccine/.

Open spaces and a sense of belonging improve wellbeing.

The studyMcElroy E, Ashton M, Bagnall AM, et al. The individual, place, and wellbeing-a network analysis. BMC Public Health 2021;21:1621.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/open-spaces-and-community-cohesion-improve-wellbeing/.

One-off physiotherapy and at-home exercise are effective in treating shoulder pain.

The studyHopewell S, Keene DJ, Marian IR, et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial. Lancet 2021;398:416-28.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/one-off-physiotherapy-session-effective-for-shoulder-pain/.

People of all ages benefit from drugs to lower blood pressure.

The studyThe Blood Pressure Lowering Treatment Trialists' Collaboration. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet 2021;398:1053-64.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/people-of-all-ages-benefit-from-drugs-to-lower-blood-pressure/.

Dexamethasone should not be given to people with a chronic subdural haematoma.

The studyHutchinson P, Edlmann E, Bulters D, et al. Trial of dexamethasone for chronic subdural haematoma. N Engl J Med 2020;383:2616-27.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/dexamethasone-should-not-be-used-chronic-subdural-haematoma/.

Almost half of people on long term antidepressants can stop without relapsing.

The studyDuffy L, Clarke CS, Lewis G, et al. Antidepressant medication to prevent depression relapse in primary care: the ANTLER RCT. Health Technol Assess 2021;25:69.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/almost-half-people-long-term-antidepressants-stop-without-relapse/.

Emergency care in hospitals is as good at the weekend as on weekdays.

The studyBion J, Aldridge C, Beet C, et al. Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study. HSDR 2021;9:13.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/hospital-emergency-care-is-as-good-at-the-weekend-as-on-weekdays/.

Children with tics can be helped by a new online treatment.

The studyHollis C, Hall CL, Jones R, et al. Therapist supported online remote behavioural intervention for tics in children and adolescents in England (ORBIT): a multicentre, parallel group, single-blind, randomised controlled trial. Lancet Psychiatry 2021;8:P871-82.

When do people with abdominal symptoms need a fast track referral?

The studyHerbert A, Rafiq M, Pham TM, et al. Predictive values for different cancers and inflammatory bowel disease of 6 common abdominal symptoms among more than 1.9 million primary care patients in the UK: a cohort study. PLoS Med 2021:18;e1003708.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/combining-risks-cancer-and-ibd-allows-more-fast-track-referrals/.

One in two people admitted to hospital with covid-19 develop complications and may need support.

The studyDrake TM, Riad AM, Fairfield CJ, et al. Characterisation of in-hospital complications associated with covid-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study. Lancet 2021;398:10296.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/one-in-two-people-hospitalised-with-covid-19-develop-complications-may-need-support/.

Why don't children and young people engage with diabetes services?

The studySharpe D, Rajabi M, Harden A, et al. Supporting disengaged children and young people living with diabetes to self-care: a qualitative study in a socially disadvantaged and ethnically diverse urban area. BMJ Open 2021;11:e046989.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/why-dont-young-people-engage-with-diabetes-services/.

Risk of breast cancer with HRT depends on therapy type and duration.

The studyVinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases. BMJ 2020;371:m3873. To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/risk-of-breast-cancer-with-hrt-depends-therapy-type-and-duration/.

Combination inhaler is effective in mild asthma.

The studyCrossingham I, Turner S, Ramakrishnan S, et al. Combination fixed-dose ß agonist and steroid inhaler as required for adults or children with mild asthma: a Cochrane systematic review. BMJ Evid Based Med 2021; doi:10.1136/bmjebm-2021-111764To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/combination-inhaler-is-effective-in-mild-asthma/.