Feb 2016 itu current awareness by Musgrove Park Hospital Library

Clinical Librarian Service Musgrove Park Academy

Current Awareness

ITU Issue 1 February 2016

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This monthly Current Awareness Bulletin is produced by the Clinical Librarian, Musgrove Park Academy, to provide ITU staff with a range of ITU related resources to support practice. It includes recently published guidelines and research articles, news and policy items.

This guide provides a selection of resources relevant to the subject area and is not intended to be a comprehensive list. For further help or guidance, please contact a member of library staff.

This guide has been compiled by: Terry Harrison Clinical Librarian Musgrove Park Hospital Library Service Terence.Harrison@tst.nhs.uk

Contents Click on a section title to navigate to contents

Page Recent journal articles

New books

Cochrane Reviews

Other evidence updates

ITU in the News

Reports, publications and resources

Training & Networking Opportunities, Conferences, Events

Literature & Evidence search services

Training and Athens

Library contact details: Library Musgrove Park Academy Musgrove Park Hospital Taunton Somerset TA1 5DA Email: Library@tst.nhs.uk Tel: 01823 34 (2433) Fax: 01823 34 (2434) Clinical Librarian email: Terence.Harrison@tst.nhs.uk

RECENT JOURNAL ARTICLES BACK TO TOP

This is a list of recent journal articles on the topic of ITU. Some articles are available in the library, or on-line via an Athens password, by following the link. If you would like an article which is not available as full text, please contact library staff: Library@tst.nhs.uk

Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge Intensive Care Med (2015) 41:589–604 From the 6,591 citations Initially extracted from the six databases, we included 11 studies in this review. Of these, six (55 %) reported statistically significant effects. Effective interventions included liaison nurses to improve communication and coordination of care and forms to facilitate timely, complete and accurate handover information. Effective interventions resulted in improved continuity of care (e.g., reduced discharge delay) and in reduced adverse events. Inconsistent effects were observed for use of care, namely, reduction of length of stay versus increase of readmissions to higher care. No statistically significant effects were found in the reduction of mortality. The overall methodological quality of the 11 studies reviewed was relatively low, with an average score of 4.5 out of 11 points. Conclusions: This review shows that liaison nurses and handover forms are promising interventions to improve the quality of patient handover between the ICU and general ward. More robust evidence is needed on the effectiveness of interventions aiming to improve ICU handover and supportive implementation strategies.

Identification of tele-ICU system requirements using a content validity assessment. Larinkari S1, Liisanantti JH2, Ala-Lääkkölä T1, et al Int J Med Inform. 2016 Feb;86:30-6. A total of 26 responses were received from professionals for four European countries; the majority were intensive-care specialists (77%). A total set of 50 items were selected for the survey. Thirty-six functional specifications were identified with I-CVIs above 0.75, including online access to all patient data (13 items), related risks and alarms (8 items), audio-visual contact for consultations and for monitoring patient beds (5 items), information security (5 items), and resource allocation (5 items). The highest ranking system functions were real time monitoring, alarms, audio-visual connections, and data security. Professionals not familiar with tele-ICUs regarded full patient data access, alarms, data security, and audio-visual connections the most important functions in pre-implementation phase. 3

The Effect of Paracetamol on Core Body Temperature in Acute Traumatic Brain Injury: A Randomised, Controlled Clinical Trial Background: Strategies to prevent pyrexia in patients with acute neurological injury may reduce secondary neuronal damage. The aim of this study was to determine the safety and efficacy of the routine administration of 6 grams/day of intravenous paracetamol in reducing body temperature following severe traumatic brain injury, compared to placebo. Methods: A multicentre, randomised, blind, placebo-controlled clinical trial in adult patients with traumatic brain injury (TBI). Patients were randomised to receive an intravenous infusion of either 1g of paracetamol or 0.9% sodium chloride (saline) every 4 hours for 72 hours. The primary outcome was the mean difference in core temperature during the study intervention period. Results: Forty-one patients were included in this study: 21 were allocated to paracetamol and 20 to saline. The median (interquartile range) number of doses of study drug was 18 (17-18) in the paracetamol group and 18 (16-18) in the saline group (P = 0.85). From randomisation until 4 hours after the last dose of study treatment, there were 2798 temperature measurements (median 73 [67-76] per patient). The mean ± standard deviation temperature was 37.4±0.5°C in the paracetamol group and 37.7±0.4°C in the saline group (absolute difference -0.3°C; 95% confidence interval -0.6 to 0.0; P = 0.09). There were no significant differences in the use of physical cooling, or episodes of hypotension or hepatic abnormalities, between the two groups. Conclusion: The routine administration of 6g/day of intravenous paracetamol did not significantly reduce core body temperature in patients with TBI.

Differential Outcome of an Antimicrobial Stewardship Audit and Feedback Program in Two Intensive Care Units Linda R. Taggart; Elizabeth Leung; Matthew P. Muller; Larissa M. Matukas; Nick Daneman BMC Infect Dis. 2015;15(480) Audit and feedback antimicrobial stewardship programs can lead to significant reductions in total antimicrobial use in the ICU setting. However, this effect may be context-dependent and further work is needed to determine the ingredients necessary for success.

Defining the Role of Dexmedetomidine in the Prevention of Delirium in the Intensive Care Unit Nelson, S; Muzyk, A J; Bucklin, M H; Brudney, S; Gagliardi, J P BioMed Research International, 2015 Dexmedetomidine is a highly selective [subscript] α 2 [/subscript] agonist used as a sedative agent. It also provides anxiolysis and sympatholysis without significant respiratory compromise or delirium. We conducted a systematic review to examine whether sedation of patients in the intensive care 4

unit (ICU) with dexmedetomidine was associated with a lower incidence of delirium as compared to other nondexmedetomidine sedation strategies. A search of PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews yielded only three trials from 1966 through April 2015 that met our predefined inclusion criteria and assessed dexmedetomidine and outcomes of delirium as their primary endpoint. The studies varied in regard to population, comparator sedation regimen, delirium outcome measure, and dexmedetomidine dosing. All trials are limited by design issues that limit our ability definitively to conclude that dexmedetomidine prevents delirium. Evidence does suggest that dexmedetomidine may allow for avoidance of deep sedation and use of benzodiazepines, factors both observed to increase the risk for developing delirium. Our assessment of currently published literature highlights the need for ongoing research to better delineate the role of dexmedetomidine for delirium prevention.

Delirium in critical care patients RA Laske, B Stephens - Nursing2015 Critical Care, 2016 - journals.lww.com Delirium in critical care patients is not a psychiatric disorder but a serious medical disorder that must be addressed promptly to insure patient safety and optimal patient outcomes. The nurse must be able to recognize the differences among delirium, depression, and ...

Excellence in Critical Care Units JE Sevransky, HE Fessler - Critical care medicine, 2016 - journals.lww.com 2. Kahn JM, Goss CH, Heagerty PJ, et al: Hospital volume and the outcomes of mechanical ventilation. N Engl J Med 2006; 355 (1): 41â&#x2C6;&#x2019; 50 3. Cooke CR, Kennedy EH, Wiitala WL, et al: Despite variation in volume, Veterans Affairs hospitals show consistent outcomes among ...

Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units. American journal of critical care : an official publication, American Association of Critical-Care Nurses, Jan 2016, vol. 25, no. 1, p. e14. (January 2016) Kleinpell, Ruth, Barden, Connie, Rincon, Teresa, et al. Information on the impact of tele-intensive care on nursing and priority areas of nursing care is limited. To conduct a national benchmarking survey of nurses working in intensive care telemedicine facilities in the United States. In a 2-phased study, an online survey was used to assess nurses' perceptions of intensive care telemedicine, and a modified 2-round Delphi study was used to identify priority areas of nursing. In phase 1, most of the 1213 respondents agreed to strongly agreed that using tele-intensive care enables them to accomplish tasks more quickly (63%), improves collaboration (65.9%), improves job performance (63.6%) and communication (60.4%), is useful in 5

nursing assessments (60%), and improves care by providing more time for patient care (45.6%). Benefits of tele-intensive care included ability to detect trends in vital signs, detect unstable physiological status, provide medical management, and enhance patient safety. Barriers included technical problems (audio and video), interruptions in care, perceptions of telemedicine as an interference, and attitudes of staff. In phase 2, 60 nurses ranked 15 priority areas of care, including critical thinking skills, intensive care experience, skillful communication, mutual respect, and management of emergency patient care. The findings can be used to further inform the development of competencies for tele-intensive care nursing, match the tele-intensive care nursing practice guidelines of the American Association of Critical-Care Nurses, and highlight concepts related to the association's standards for establishing and sustaining healthy work environments.

You Can't Get What You Want: Innovation for End-of-Life Communication in the Intensive Care Unit. American journal of respiratory and critical care medicine, Jan 2016, vol. 193, no. 1, p. 14-16 (January 1, 2016) Schwarze, Margaret L, Campbell, Toby C, Cunningham, Thomas V, White, Douglas B, Arnold, Robert M No abstract available.

Interventions for the prevention of catheter associated urinary tract infections in intensive care units: An integrative review. Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses, Feb 2016, vol. 32, p. 1-11 (February 2016) Galiczewski, Janet M Catheter associated urinary tract infections (CAUTIs) put an unnecessary burden on patients and health care systems. The purpose of this integrative review was to examine existing evidence on preventative interventions and protocols currently implemented in intensive care units (ICUs) and the impact they have on CAUTI rates and patient outcomes. This review analysed 14 research articles obtained from electronic databases and included adult patients with urinary catheters in an ICU setting. Evidence demonstrated interventions that included criteria for catheter use, daily review of catheter necessity and discontinuation of catheter prior to day seven were successful in decreasing CAUTI rates. This review provides a scientific basis for the effectiveness of these interventions and protocols. Identification and use of interventions with the greatest positive impact on CAUTI rates are an asset to healthcare professional caring for patients with indwelling catheters and nurse clinicians developing policies.

Chronic Obstructive Pulmonary Disease and Ventilator-Associated Pneumonia: An Analysis and Literature Review Into the Intensive Care Unit Exacerbation Progression and Acute Pulmonary Management. Dimensions of critical care nursing : DCCN, Jan 2016, vol. 35, no. 1, p. 16-22 (2016 Jan-Feb) Toney, Brandon Swain, Lynch-Smith, Donna The occurrence of ventilator-associated pneumonia (VAP) infections in mechanically ventilated patients has significantly affected how medical providers manage the severe acute pulmonary pathology in chronic obstructive pulmonary disease (COPD) and implement medical interventions to prevent infectious transmission to these patients in the intensive care unit. Severe COPD is present in more than 65 million people worldwide, thereby placing these individuals at an increased risk of intensive care unit admission and VAP contraction. Chronic obstructive pulmonary disease is well known as a risk factor for developing VAP and is related to adverse risk factors such as developing multiple drugresistant bacteria. Evidence shows that COPD immunosuppression continues to be associated with pulmonary infection, but multiple modalities are available to combat and treat acute exacerbations before decompensation begins, thereby preventing prolonged endotracheal mechanical ventilation.

Defining Appropriate Use of Proton-Pump Inhibitors Among Medical Inpatients Matt Pappas , Sanjay Jolly, Sandeep Vijan Journal of General Internal Medicine, pp 1-8; First online: 09 November 2015 For the majority of medical inpatients outside the ICU, use of PPIs likely leads to a net increase in hospital mortality. Even in patients at particularly high risk of UGIB, only those at the very lowest risk of HCAP and CDI should be considered for prophylactic PPI use. Continuation of outpatient PPIs may also increase expected hospital mortality. Apart from patients with active UGIB, use of PPIs in hospitalized patients should be discouraged.

Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study Emily J Robinson, Gary B Smith, Sarah G Power, David A Harrison, Jerry Nolan, Jasmeet Soar, Ken Spearpoint, Carl Gwinnutt, Kathryn M Rowan IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes. Organisational or care differences at night and weekends, rather than patient case mix, appear to be responsible.

Identify sepsis in patients by using early warning scores, doctors are urged (you will need to logon to BMJ or request this item via the Library) General practitioners and hospital doctors should all use an early warning score system when they suspect that a patient may have sepsis to help improve the recognition of cases, a report recommends.Nearly half (45%) of patients with sepsis admitted to hospital with no other obvious problem either died or were left with a disability, an audit of cases in England, Wales, and Northern Ireland has found. A third (34%; 184) of the 544 hospitals reviewed had no formal sepsis protocol to identify and manage patients with sepsis, and this needs to be rectified, said a report into sepsis â&#x20AC;Ś

Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial JAMA Neurol. Published online December 21, 2015. Multiple authors For every hour of reperfusion delay, the initially large benefit of IAT decreases; the absolute risk difference for a good outcome is reduced by 6% per hour of delay. Patients with acute ischemic stroke require immediate diagnostic workup and IAT in case of intracranial arterial vessel occlusion.

PPIs Associated with Increased Risk for Chronic Kidney Disease Use of proton-pump inhibitors (PPIs) is associated with a 20% to 50% increased risk for developing chronic kidney disease (CKD), suggests an observational study in JAMA Internal Medicine. In the main, population-based cohort, researchers followed over 10,000 people without CKD at baseline. Over roughly 14 years, nearly 14% developed CKD. Rates of CKD were higher among patients using PPIs at baseline, compared with nonusers (14.2 vs. 10.7 events per 1000 person-years). PPI users also had higher rates of acute kidney injury than did nonusers. Similar associations were observed in a larger replication cohort. Dr. Thomas Schwenk, deputy editor of NEJM Journal Watch General Medicine, notes that the findings "add to increasing concerns about PPI use, including excess risks for Clostridium difficile infections, pneumonia, and fractures, and less platelet inhibition when PPIs are used concomitantly with clopidogrel." Editorialists recommend monitoring renal function and magnesium levels in patients taking PPIs, switching to H2 receptor antagonists when feasible, and not using PPIs for vague complaints of "heartburn." JAMA Internal Medicine article (Free abstract); JAMA Internal Medicine editorial (Subscription required); Background: NEJM Journal Watch Gastroenterology coverage of PPIs and hypomagnesemia (Your NEJM Journal Watch registration required)

In brief:    

Mortality of emergency general surgical patients and associations with hospital structures and processes. Nurse Research Experiences and Attitudes Toward the Conduct of Intensive Care Research: A Questionnaire Study. Health-Related Quality of Life and Associated Factors in Intensive Care Unit Survivors 6 Months After Discharge. Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units.

For ITU automated tables of contents: click here.

NEW BOOKS BACK TO TOP

If you are unable to find a book, or require a book that is not on this list, please ask library staff, who will be able to locate the book for you using interlibrary loan.

Objective Structured Clinical Examination : In Intensive Care Medicine Jeyanathan, Jeyasankar; Owens, Daniel The objective structured clinical examination (OSCE) has become widely employed in intensive care medicine (ICM) exams such as the UK Final Fellowship of Intensive Care Medicine (FFICM), the European Diploma of Intensive Care (EDIC) exam, or the Australia and New Zealand Fellowship of the College of Intensive Care Medicine (CICM). This book is not only an essential tool for the rehearsal of OSCEs in preparation for these exams. Acute and critical care in adult nursing (2nd ed) (2016) Tait, Desiree This book helps adult nursing students to competently manage care of critically and acutely ill patients, and to recognize and deal with the early signs of deterioration. The book takes a practical real-life approach to care, with each chapter focusing on patients with specific problems, then interweaving the knowledge and skills needed to care for that patient.

Cardiac surgery essentials : for critical care nursing [editors] Sonya R. Hardin, Roberta Kaplow. Cardiac Surgery Essentials for Critical Care Nursing, Second Edition is an indispensable reference for new and experienced nurses caring for patients in intensive care units immediately following cardiac surgery. Completely updated and revised, it addresses significant changes in cardiac surgery, the nursing responsibilities necessary to meet the needs of acutely ill patients, and strategies to optimize patient outcomes in this dynamic field. Current therapy of trauma and surgical critical care (2nd ed) (2016) Asensio, Juan A.; Trunkey, Donald D. Demanding surgical situations require expert advice from pioneers in the field as well as from those on the front lines of trauma care. Practical and evidence-based, Current Therapy of Trauma and Surgical Critical Care, 2nd Edition, draws on the experience of Drs. Juan A. Asensio and Donald D. Trunkey to offer a comprehensive, contemporary summary of the treatment and postoperative management of traumatic injuries. Priorities in critical care nursing (7th ed) Urden, Linda D.; Stacy, Kathleen M. et al. With its succinct coverage of all core critical care nursing topics, this evidence-based text is the perfect resource for both practicing nurses and nursing students alike. Using the latest, most authoritative research, this book will help you identify priorities to accurately and effectively manage patient care. 12

COCHRANE REVIEWS/UPDATES BACK TO TOP

Prone position for acute respiratory failure in adults Cochrane Database of Systematic Reviews, 2015, 11 Bloomfield Roxanna, Noble David W, Sudlow Alexis We found no convincing evidence of benefit nor harm from universal application of PP in adults with hypoxaemia mechanically ventilated in intensive care units (ICUs). Three subgroups (early implementation of PP, prolonged adoption of PP and severe hypoxaemia at study entry) suggested that prone positioning may confer a statistically significant mortality advantage. Additional adequately powered studies would be required to confirm or refute these possibilities of subgroup benefit but are unlikely, given results of the most recent study and recommendations derived from several published subgroup analyses. Meta-analysis of individual patient data could be useful for further data exploration in this regard. Complications such as tracheal obstruction are increased with use of prone ventilation. Long-term mortality data (12 months and beyond), as well as functional, neuro-psychological and quality of life data, are required if future studies are to better inform the role of PP in the management of hypoxaemic respiratory failure in the ICU.

Corticosteroids for treating sepsis Annane Djillali, Bellissant Eric, Bollaert Pierre Edouard, et al Cochrane Database of Systematic Reviews, 2015, 12 Overall, low-quality evidence indicates that corticosteroids reduce mortality among patients with sepsis. Moderate-quality evidence suggests that a long course of low-dose corticosteroids reduced 28-day mortality without inducing major complications and led to an increase in metabolic disorders.

Routine intracranial pressure monitoring in acute coma Forsyth Rob J, Raper Joseph, Todhunter Emma Cochrane Database of Systematic Reviews, 2015, 11 The data from the single RCT studying the role of routine ICP monitoring in acute traumatic coma fails to provide evidence to support the intervention. Research in this area is complicated by the fact that RCTs necessarily assess the combined impact of measurement of ICP with the clinical management decisions made in light of this data. Future studies will need to assess the added value of ICP data alongside other information from the multimodal monitoring typically performed in 13

intensive care unit settings. Additionally, even within traumatically acquired brain injury (TBI), there is great heterogeneity in mechanisms, distribution, location and magnitude of injury, and studies within more homogeneous subgroups are likely to be more informative.

Effectiveness and risks of cricoid pressure during rapid sequence induction for endotracheal intubation Cochrane Database of Systematic Reviews, 2015, 11 Algie Catherine M, Mahar Robert K, Tan Hannah B, et al There is currently no information available from published RCTs on clinically relevant outcome measures with respect to the application of cricoid pressure during RSI in the context of endotracheal intubation. On the basis of the findings of non-RCT literature, however, cricoid pressure may not be necessary to undertake RSI safely, and therefore well-designed and conducted RCTs should nonetheless be encouraged to properly assess the safety and effectiveness of cricoid pressure.

Nitrous oxide-based techniques versus nitrous oxide-free techniques for general anaesthesia Cochrane Database of Systematic Reviews, 2015, 11 Sun Rao, Jia Wen Qin, Zhang Peng Given the evidence from this Cochrane review, the avoidance of nitrous oxide may be reasonable in participants with pre-existing poor pulmonary function or at high risk of postoperative nausea and vomiting. Since there are eight studies awaiting classification, selection bias may exist in our systematic review.

Intraoperative use of low volume ventilation to decrease postoperative mortality, mechanical ventilation, lengths of stay and lung injury in patients without acute lung injury Cochrane Database of Systematic Reviews, 2015, 12 Guay Joanne, Ochroch Edward A Low tidal volumes (defined as < 10 mL/kg) should be used preferentially during surgery. They decrease the need for postoperative ventilatory support (invasive and non-invasive). Further research is required to determine the maximum peak pressure of ventilation that should be allowed during surgery.

OTHER EVIDENCE UPDATES BACK TO TOP Dynamed updates (you will need to logon: click here

Up-to-date latest (you will need to logon: click here

More from Up-To-Date (you may need Athens logon to access): Reversal agent for factor Xa inhibitors (November 2015) Lack of reversal agents for the direct oral anticoagulants has been a concern. Andexanet alfa is a recombinant protein designed to reverse factor Xa inhibitors by binding to the drugs and sequestering them away from endogenous factor Xa. In a randomized trial in healthy volunteers, an andexanet bolus reduced anti-factor Xa activity by 94 percent and 92 percent for volunteers taking apixaban or rivaroxaban, respectively, compared with reductions of 21 and 18 percent for a placebo bolus [6]. A study evaluating andexanet efficacy in patients with factor Xa inhibitor-associated bleeding is ongoing. (See "Management of bleeding in patients receiving direct oral anticoagulants", section on

'Antidotes under development'.)

Adjunctive glucocorticoids for adults with severe community-acquired pneumonia (August 2015, Modified November 2015) For hospitalized patients with community-acquired pneumonia (CAP), glucocorticoids as adjunctive therapy to antibiotics have the potential to reduce the inflammatory response and decrease morbidity. A 2015 meta-analysis of randomized trials that included hospitalized patients with CAP suggested a modest mortality benefit for adjunctive glucocorticoids [7]. A reduction in all-cause mortality was of borderline statistical significance (relative risk [RR] 0.67, 95% CI 0.45-1.01; risk difference 2.8 percent). Rates of mechanical ventilation and acute respiratory distress syndrome were decreased, as were time to clinical stability and duration of hospitalization; rates of hyperglycemia requiring treatment increased. For hospitalized patients with CAP who require intensive care unit admission, we recommend adjunctive glucocorticoids. For other hospitalized patients with CAP, we suggest adjunctive glucocorticoids. Clinicians should make the decision whether or not to give glucocorticoids on a case-by-case basis, especially in patients with an 15

elevated risk of adverse effects. Limited evidence suggests that infections caused by certain pathogens (eg, influenza virus, Aspergillus spp) may be associated with worse outcomes in the setting of glucocorticoid use [8,9]; given these concerns, we avoid adjunctive glucocorticoids if one of these pathogens is detected. (See "Treatment of community-acquired pneumonia in adults who require hospitalization",

section on 'Glucocorticoids'.)

Venous thromboembolism risk with central versus peripheral insertion of central venous catheters (January 2016) There is accumulating evidence that peripherally-inserted central venous catheters (PICCs) are associated with a greater risk for upper extremity deep vein thrombosis (UEDVT) compared with centrally-inserted central venous catheters (CICCs). The Medical Inpatients and Thrombosis (MITH) Study evaluated catheter use in 299 venous thromboembolism cases compared with controls without venous thromboembolism at a single institution. Central catheter use was associated with a 14-fold increased risk for UEDVT, without a significantly increased risk for pulmonary embolism. PICCs were associated with a higher cumulative risk compared with CICCs (8.1 versus 4.8 per 1000 admissions). Given the higher risk for UEDVT with PICCs, we generally avoid them in patients for whom maintaining vascular patency and integrity for long-term vascular access options (eg, future hemodialysis access) is essential. See "Catheter-related upper extremity venous thrombosis", section on 'Peripheral versus

central insertion' and "Overview of central venous access".

NICE updates:

New End of Life Care guidance (NICE): End-of-life care in England must be tailored to the needs of dying patients rather than a "tick-box approach", the health watchdog NICE says. Patients must be treated with respect and compassion, it said, and doctors should avoid making "snap decisions" about whether someone was dying. The guidance is designed to address misuse of the previous system, the Liverpool Care Pathway.

Oxygen therapy for acute ST-segment-elevation myocardial infarction A randomised controlled trial in Australia found that administering inhaled oxygen did not limit damage to heart muscle and could be associated with an increase in muscle damage in people with acute ST-segment-elevation myocardial infarction

Tuberculosisâ&#x20AC;&#x201D;diagnosis, management, prevention, and control: summary of updated NICE guidance 16

BMJ Evidence updates:

Adjunctive corticosteroids improve the need for mechanical and shorten hospital duration in patients hospitalised with community-acquired pneumonia Protocolised Management In Sepsis (ProMISe): a multicentre randomised controlled trial of the clinical effectiveness and cost-effectiveness of early, goal-directed, protocolised resuscitation for emerging septic shock.

INTENSIVE/CRITICAL CARE IN THE NEWS BACK TO TOP

Intracerebral Hemorrhage May Mimic Transient Ischemic Attack Patients with intracerebral hemorrhage may present with rapidly resolving deficits resembling transient ischemic attack.

Tele-ICU systems provide nurses opportunity to improve patient care Telemedicine is changing the way patient care is provided in a growing number of intensive care units (ICUs) across the country, and tele-ICU nurses - who see its impact firsthand - say it provides an opportunity to improve care, according to results of a national survey published in the American Journal of Critical Care. [More]

Reduced bone mass puts critically ill patients at greater risk for fractures One year after being hospitalized in intensive care, patients have reduced bone mass that puts them at greater risk for fractures, according to a new study published online ahead of print in the American Journal of Respiratory and Critical Care Medicine. [More]

Queen's University Belfast-led study examines potential of new technology that could save lives in ICUs A potentially revolutionary new technology - that could saves thousands of lives in Intensive Care Units around the world - is being trialled in a UK study co-led by Queen's University Belfast. [More]

US military prepares to punish soldiers who attacked MSF hospital A military investigation into a US airstrike on a hospital run by Médecins Sans Frontières in Kunduz, Afghanistan, last October, which left 42 civilians dead, has recommended disciplinary action against the soldiers involved in the attack. Anonymous congressional staff and defence officials told Foreign Policy that the investigation focused on the US Army Green Beret unit on the ground near the hospital that called in the airstrike.

NHS trust first to face trial for corporate manslaughter after "wholly avoidable" death of patient Two anaesthetists and the NHS trust that employed them were responsible for the “wholly avoidable” death of a 30 year old teacher, a jury at Inner London Crown Court heard this week.At the start of the first trial of an NHS trust for corporate manslaughter, John Price QC told the jury that the death of Frances Cappuccini, a healthy young woman whose second baby had been delivered only hours before by emergency caesarean, was “wholly exceptional” and “wholly avoidable.”

Do high doses of vitamin D increase falls risk in the elderly? "Giving pensioners high doses of vitamin D to strengthen their leg bones may put them at higher risk of a fall," The Times reports after a Swiss study suggested high doses of the supplement offer no benefits, but do increase the risk of falling. This 12-month trial aimed to assess whether giving high doses of vitamin D to older adults with a history of falls increased their vitamin D levels and improved leg function in comparison with the lower recommended dose â&#x20AC;&#x201C; in this case, 20 micrograms (mcg) a day. This is not the recommended UK dose, which is lower still, at 10mcgâ&#x20AC;Ś The study was published in the peer-reviewed medical journal JAMA Internal Medicine.

6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial Anna L Barker, Renata T Morello, Rory Wolfe, Caroline A Brand, Terry P Haines, Keith D Hill, Sandra G Brauer, Mari Botti, Robert G Cumming, Patricia M Livingston, Catherine Sherrington, Silva Zavarsek, Richard I Lindley, and Jeannette Kamar

REPORTS, PUBLICATIONS AND RESOURCES

Care of dying adults in the last days of life This guideline covers the clinical care of adults (18 years and over) who are dying during the last 2 to 3 days of life. It aims to improve end of life care for people in their last days of life by communicating respectfully and involving them, and the people important to them, in decisions and by maintaining their comfort and dignity. The guideline covers how to manage common symptoms without causing unacceptable side effects and maintain hydration in the last days of life. This guideline includes recommendations on: 

recognising when people are entering the last few days of life

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communicating and shared decision-making

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clinically assisted hydration

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medicines for managing pain, breathlessness, nausea and vomiting, anxiety, delirium, agitation, and noisy respiratory secretions

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anticipatory prescribing

LearnICU.org Resource: Critical Care Protocol Toolkit A useful LearnICU.org resource, titled the Critical Care Protocol Toolkit.

Sepsis Action Plan On the 23rd December 2015, NHS England published an action plan to address sepsis within the NHS. This document sets out how sepsis deaths can be reduced and actions that need to be taken to reduce the number of sepsis deaths in England but is also applicable across the UK. Click here for more www.england.nhs.uk/wp-content/uploads/2015/08/Sepsis-Action-Plan-23.12.15v1.pdf

Patient Safety Alert - risk of using different airway humidification devices simultaneously MRHA and NHS England have released a National Patient Safety Alert which is applicable to all nurses working within Intensive Care. There is a risk of harm with using different airway humidification devices simultaneously. The BACCN & ICS were asked to advise on this patient safety alert issued from MRHA/NHS England following a recent paper highlighting the risk of inadvertently using an HME & Heated Water Humidifier together which may lead to an airway occlusion due to the HME becoming

fully absorbed with water. We urge all nurses/health care professionals working within critical care to read this National Patient Safety Alert. Click to read more: Patient Safety Alert - humidification devices

Continuous improvement of patient safety: The case for change in the NHS. The Health Foundation; 2015. http://www.health.org.uk/publication/continuous-improvement-patient-safety Part I illustrates why improving safety is so difficult and complex. Part II looks at some of the work being done to improve safety. Part III, the report explains why the system needs to think differently about safety]

Dementia care in hospitals The Alzheimerâ&#x20AC;&#x2122;s Society has published Fix dementia care: hospitals. This report marks the start of a new Alzheimerâ&#x20AC;&#x2122;s Society campaign looking at the experiences of people affected by dementia in a range of health and care settings. It contains the results of freedom of information requests from hospital trusts across England; a survey completed by self-selecting sample of carers of people affected by dementia; and analysis of government and NHS data. The report sets out recommendations for the NHS and health regulators to improve the experiences of people affected by dementia in hospitals. Position Paper

TRAINING & NETWORKING OPPORTUNITIES, CONFERENCES, EVENTS BACK TO TOP

36th International Symposium on Intensive Care and Emergency Medicine Dates: March 15-18, 2016 Location: Brussels, Belgium Brussels Meeting Center (SQUARE) Glass Entrance, rue Mont des Arts, B-1000 Brussels Chairman: Jean-Louis VINCENT Phone/Fax: +32 2 555 36 31/ +32 2 555 45 55 Information: sympicu@ulb.ac.be Belgian & European Accreditation

13th Annual Critical Care Symposium To register online, please visit http://www.hartleytaylor-

registration.co.uk/hartley/accsregistration.aspx Abstracts can be submitted and must be structured. The body of the abstract must not contain more than 3000 characters and have introduction, methods, results and conclusion headings. In addition to this a list of references can be given as well as acknowledgements with grant information and possible conflicts. Tables and/or Figures can be uploaded separately in a Microsoft Word document (*.docx). Only documents saved in the Microsoft Word 2007 (or higher) format with extension “.docx” are currently supported. This separate file should not contain the abstract text and cannot exceed 1 MB in size. Submit abstracts to ct.veerappan@gmail.com

A Practical Introduction to Intensive Care (from UCL and the Bloomsbury Institute for Intensive Care Medicine) Date: February 20th 2016 Cost: £130 Venue: The UCLH Education Centre, London This is a one day course aimed at doctors with little or no ITU/HDU experience (e.g. FY1s, FY2s, CT1/2 Medicine, Surgery, ACCS and Anaesthetics) covering a wide range of topics including 22

ventilation, airway management, line insertion, renal replacement therapy and pharmacology amongst others. The day combines small group workshops as well as lectures and we are honoured to have keynote speakers who are eminent in the field of critical care. For more information, please visit: https://www.ucl.ac.uk/anaesthesia/education/IntensiveCare Online booking at: https://www.uclhcharitycourses.com/ Contact: icmuclh@gmail.com Twitter: @Intro2ICM

FPM Acute Pain Study Day Date: Mon, 08/02/2016 Location: The Royal College of Anaesthetists

Places available

FPM Neuromodulation/NSUKI Study Day Date: Tue, 09/02/2016 Location: The Royal College of Anaesthetists

Places available

After the Final FRCA: Making the most of training years 5 to 7 Date: Tue, 09/02/2016 Location: The Royal College of Anaesthetists

Places available

Integrating care throughout the patientâ&#x20AC;&#x2122;s surgical journey Date: Tue, 09/02/2016 Location: The King's Fund

Places available

CPD Study Day: Care of the patient undergoing major colorectal surgery Date: Fri, 12/02/2016 Location: The Royal College of Anaesthetists

Places available

ACSA Information Day â&#x20AC;&#x201C; Non Engaged Departments Date: Tue, 16/02/2016 Location: The Royal College of Anaesthetists

Places available

Quality Improvement and Patient Safety: Improvement Science in Anaesthesia Training Date: Wed, 24/02/2016 Location: The Royal College of Anaesthetists

Places available

Airway Workshop Date: Thu, 25/02/2016 Location: The Royal College of Anaesthetists

Places available

Ultrasound Workshop Date: Fri, 26/02/2016 Location: The Royal College of Anaesthetists

Places available

OTHER SERVICES BACK TO TOP

A. Literature & Evidence searches 

Are you looking for the latest evidence-based research, but haven’t got time to trawl the databases?

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Do you need a literature search carried out?

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Do you need to find evidence to support an improvement?

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Do you want to know how something has been done elsewhere and whether it worked?

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Library staff provide a literature and evidence search service for busy clinicians who are pressed for time.

To request a search, please complete and return this form, providing as much information as possible. Alternatively if you would like an assisted search training session, where we will sit down with you and go through the steps of a literature search, then please contact the library. B. Journal clubs Do you have a journal club or are thinking of starting one up? If so, please contact the Library. We will be happy to attend any new or existing journal club in a contributory or facilitating role.

TRAINING AND ATHENS BACK TO TOP Most electronic resources are available via an Athens password. You can register for this via the Library intranet page, or from home at http://www.swice.nhs.uk/ and following the link for Athens selfregistration. Please note that registering from home will take longer as it will need to be verified that you are NHS staff/student on placement. Library staff are available to train individual staff or small groups. Training can take place in the library or at your work place if you have access to appropriate IT facilities. COURSES INCLUDE: Library Induction You will be given a detailed overview of all library information systems and resources and how to use them. Library registration and obtaining an OpenAthens password are included.

Accessing NHS eResources You will be introduced to all the electronic information resources available to NHS staff including eJournals, eBooks, healthcare databases and useful websites. Searching for Evidence (beginners) You will be introduced to the 8 leading healthcare databases and shown how to plan your literature search, how to execute it effectively and how to save and print your results. Searching for Evidence (advanced) You will be shown how to search across multiple databases, how to use the thesaurus, the subject headings and the full range of limit options. Introduction to Critical Appraisal This course introduces the basics of critical appraisal and its role in evidence-based practice. Pre-Course Skills Parts 1 & 2 These 2 sessions are designed for staff about to start a course who need a thorough update on information gathering skills. Attendance at both sessions is required. Library Mini-Breaks 30 minute sessions tailored to meet your needs e.g. Cochrane Library, how to find clinical guidelines, using eBooks, library electronic A-Z website, RSS feeds, journal contents pages using Outlook. Rapid Evidence Searching NEW Using tried and tested techniques, rapid searching of the evidence base for when quick solutions are needed. Reflective Practice NEW How to read and comment upon a paper Writing for publication NEW Everything you need to know about writing a paper for publication Collaborative "Living Evidence" Searching/Appraisal NEW Group searching/appraisal of evidence in computer labs (suitable for MDTs and similar).

TO BOOK A COURSE, click here