July 2016 itu current awareness1 by Musgrove Park Hospital Library

Clinical Librarian Service Musgrove Park Academy

Current Awareness

ITU Issue 5 July 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

Reports, publications and resources

Other 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

Efficacy and safety of anticoagulant therapy in three specific populations with sepsis: a meta-analysis of randomized controlled trials: comment Journal of Thrombosis and Haemostasis: Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.) The guidance for the diagnosis and treatment of disseminated intravascular coagulation (DIC) from the Scientific Standardization (SSC) Committee on DIC of the International Society on Thrombosis Haemostasis (ISTH) [1] did not recommend anticoagulant therapy, such as antithrombin (AT), activated protein C, and thrombomodulin. Although many clinical trials have found little evidence supporting the effectiveness and safety of anticoagulant therapy against severe sepsis, several studies have suggested that certain anticoagulant therapies may reduce mortality in patients with sepsis-induced DIC [2, 3]. Therefore, we read the recent article by Umemura Y et al. with great interest [4]. They conducted separate metaanalyses of randomized controlled trials for anticoagulant therapy in three different populations: an overall population with sepsis; the population with sepsis-induced coagulopathy; and the population with sepsis-induced DIC.

Randomised, Double Blind, Controlled Trial of the Provision of Information about the Benefits of Organ Donation during a Family Donation Conversation. PLoS One. 2016 Jun 20;11(6):e0155778. Philpot SJ1,2,3, Aranha S2, Pilcher DV1,2,4, Bailey M5. â&#x20AC;ŚThere was a wide variability in what participants considered was the "right" amount of information about organ donation. Those who watched the conversation that included information about the benefits of donation were more likely to feel that the information provided to the family was sufficient. They were more likely to report that the doctor was trying to convince the family member to say yes to donation, yet were no more likely to feel uncomfortable or to feel that the doctor was uncaring or cared more about transplant recipients than he did for the patient and their family. This study suggests that community members are comfortable with health care staff providing information to family members that may be influential in supporting them to give consent for donation.

The impact of 12-hour shifts on team effectiveness British Journal of Healthcare Management May 16, 2016 This article aims to illustrate the potential impact of 12-hour shifts on team working by focusing on the restrictions such shifts create in developing effective and engaging team communication processes. It does this through presenting research on work with multi professional mental health teams, both community and ward-based. It is proposed that 12hour shifts can contribute to teams being ‘pseudo’ teams rather than ‘real teams’, and draws on the input–process–output model of team effectiveness to illustrate the points made. The premise of the paper is that team shift patterns (as an input) mediate the extent to which teams can participate in effective and engaging communication processes, which, in turn, impacts on the outputs of team effectiveness, including outcomes for patients, such as quality of care, and outcomes for staff, such as staff wellbeing.

Predictive performance of quick Sepsis-related Organ Failure Assessment for mortality and intensive care unit admission in patients with infection at the ED. Am J Emerg Med. 2016 Jun 7. pii: S0735-6757(16)30227-3. doi: 10.1016/j.ajem.2016.06.015. [Epub ahead of print] Wang JY1, Chen YX2, Guo SB3, Mei X4, Yang P5. Quick SOFA predicted ICU admission with similar performance to that of SOFA, MEDS, and APACHE II. Its prognostic ability was similar to that of SOFA and APACHE II but slightly inferior to that of MEDS.

Survival outcomes after prolonged intensive care unit length of stay among trauma patients: The evidence for never giving up Surgery (article in press) The results reveal that in contrast to expectations of high mortality associated with prolonged ICU-LOS, critically injured adult trauma patients who do not die within the first few days demonstrate an enhanced ability to survive, with an overall survival of >92% and maintained at >85% among extreme ICU-LOS (>40 days). The data advocate the utility of aggressive critical-care support for trauma patients, irrespective of duration of ICU stay.

Criteria for choosing an intravenous infusion line intended for multidrug infusion in anaesthesia and intensive care units. Maiguy-Foinard A, Genay S, Lannoy D, Barthélémy C, Lebuffe G, Debaene B, Odou P, Décaudin B. Anaesth Crit Care Pain Med. 2016 Jun 20; . Epub 2016 Jun 20 4

Several parameters impact the delivery of drugs and fluids by IV infusion. Among them are the components of infusion systems that particularly influence the flow rate of medications and fluids being delivered. By their conception, they may generate significant start-up delays and flow-rate variability. Performing multidrug infusion requires taking into account two main points: the common dead volume of drugs delivered simultaneously with potential consequences on the accuracy and amount of drug delivery and the prevention of drug incompatibilities and their clinical effects. To prevent the potentially serious effects of flowrate variability on patients, clinicians should receive instruction on the fluid dynamics of an IV administration set and so be able to take steps to minimise flow-rate changes during IV therapy.

Palliative ICU beds for potential organ donors: an effective use of resources based on quality-adjusted life-years gained Nunnink L , Cook DA; Critical Care and Resuscitation [2016, 18(1):37-42] To evaluate whether the admission of a palliative patient to the intensive care unit for end-oflife care and consideration of organ donation provides an equivalent net benefit in qualityadjusted life-years (QALYs) compared with the admission of a non-palliative patient for active management. Relevant publications from the period 1995-2015 were reviewed to estimate the mean QALYs gained from ICU admission of a critically ill patient and mean QALYs gained from transplantation of solid organs from an organ donor. Australian audit data were used to estimate the likelihood of a palliative patient admitted to the ICU progressing to organ donation. We calculated probabilities of each outcome and developed an algorithm to illustrate possible pathways for a patient who may progress to organ donation. A non-palliative ICU admission provides to the patient about 1.0 QALY per ICU bed-day. An ICU bed provided to a patient admitted to the ICU for palliation and consideration of organ donation results in 7.3 QALYs gained for the community per ICU bedday. The admission of a dying patient to the ICU when organ donation may be possible is of considerable community benefit, yielding an average of over seven times the QALYs per ICU bed-day compared with the average benefit for ICU patients expected to survive. When it is possible to offer end-of-life care in the ICU, it should not be denied on the basis of concerns about lack of benefit or inappropriate use of resources.

Hormone resuscitation therapy for brain-dead donors â&#x20AC;&#x201C; is insulin beneficial or detrimental? Dimitri Novitzky et al Clinical Transplantation, version of Record online: 9 MAY 2016 Hormonal replacement therapy to brain-dead potential organ donors remains controversial. A retrospective study was carried out of hormonal therapy on procurement of organs in 63 593 donors in whom information on thyroid hormone therapy (triiodothyronine or levothyroxine [T3/T4]) was available. In 40 124 donors, T3/T4 and all other hormonal therapy were recorded. The percentage of all organs procured, except livers, was greater when 5

T3/T4 had been administered. An independent beneficial effect of antidiuretic hormone (ADH) was also clear. Corticosteroids were less consistently beneficial (most frequently when T3/T4 had not been administered), although never detrimental. Insulin was almost never beneficial and at times was associated with a reduced yield of organs, particularly of the pancreas and intestine, an observation that does not appear to have been reported previously. In addition, there was reduced survival at 12 months of recipients of pancreases from T3/T4-treated donors, but not of pancreas grafts. The possibly detrimental effect observed following insulin therapy is discussed.

Care pathways for organ donation after brain death: guidance from available literature? Hoste P, Vanhaecht K, Ferdinande P, Rogiers X, Eeckloo K, Blot S, Hoste E, Vogelaers D, Vandewoude K. J Adv Nurs. 2016 Jun 22; . Epub 2016 Jun 22. Further research should focus on the development and standardisation of the clinical content of a care pathway for donation after brain death and the identification of quality indicators. These should be used in a prospective effectiveness assessment of the proposed pathway.

Doctors give patients potentially harmful procedures at end of life, global review finds BMJ 2016; 353, 29 June 2016 Ingrid Torjesen More than a third of dying elderly patients receive invasive treatments that are unlikely to benefit them and could even be harmful in the final weeks of life, a large global review published in the International Journal for Quality in Hea lth Care has found.

An Evidence-Based Practice Approach to End-of-Life Nursing Education in Intensive Care Units Shifrin, Megan M. DNP, RN, ACNP-BC Journal of Hospice & Palliative Nursing: August 2016 - Volume 18 - Issue 4 - p 342â&#x20AC;&#x201C;348 Despite increasing medical advances, intensive care unit registered nurses frequently care for patients at the end of life. Registered nurses have identified insufficient education as a major contributor to inadequate communication, symptom recognition, and symptom management in this population. The purpose of the project was to increase knowledge regarding evidence-based practices in management related to end-of-life care. Project implementation occurred in 6 intensive care units at a 1019-bed academic, tertiary care hospital and included providing registered nurses with a 3.5-hour classroom-based educational session on end-of-life nursing management. Before the educational sessions, 6

participants (n = 46) completed a demographic sheet and a multiple-choice pretest reflective of foundational intensive care unit end-of-life nursing knowledge. After the educational session, the same test was administered as a posttest. A statistically significant change (P < .001) existed between the mean pretest scores (79.4%) and mean posttest scores (96.7%) of participants. In addition, 100% of participants met the external benchmark of an aggregated mean posttest score of 80% or higher. Future research should focus on assessing specific areas of end-of-life nursing knowledge deficit, determining optimal educational content delivery methods, and evaluating the clinical impact of increasing knowledge on patient symptom recognition and management.

Communication With Family Members of Patients in the Intensive Care Unit: Lessons From Multidisciplinary Family Meetings Min, Jinsoo MD, MPH; Lee, Yeon Joo MD; Park, Guntae RN; Shin, Jeong Yeon RN; Yoon, Jisook RN; Park, Sang Im RN; Cho, Young-Jae MD, MPH Journal of Hospice & Palliative Nursing: August 2016 - Volume 18 - Issue 4 - p 349â&#x20AC;&#x201C;355 Interest in communication strategies, such as family meetings for intensive care unit (ICU) patients and their family members, is growing among the intensivists in South Korea. We report our experience of multidisciplinary meetings with family members of ICU patients. After seminars on communication and end-of-life care, a consensus on the guidelines for ICU family meetings was made. A weekly multidisciplinary meeting was held to review and address the plans of ICU patients. A total of 8 family meetings were held between September 2014 and January 2015. Four patients had acute respiratory failure, 2 patients had septic shock, 1 patient had postoperative acute respiratory distress syndrome, and 1 patient had ischemic encephalopathy. With the exception of 1 family meeting, which failed to make a decision, 7 family meetings were successfully conducted: 1 case of withdrawal of life-sustaining treatment (LST), 1 case of withholding of LST, 1 case of refusal to any LST, 2 cases of do-not-resuscitate, 1 case of full active treatment, and 1 case of supportive care. This is the first pilot study of ICU multidisciplinary family meetings in South Korea. More evidence regarding the culture of the local populace is required to successfully understand how to integrate family meetings into the ICU.

Myocardial infarction in intensive care units: A systematic review of diagnosis and treatment Journal of the Intensive Care Society July 1, 2016 Iain Carroll, Thomas Mount, Dougal Atkinson Regular 12 lead ECG or 12 lead ECG monitoring is more sensitive than 2 lead monitoring, regular measurement of cardiac enzymes is more sensitive than when provoked by symptoms. Coronary angiography rarely identifies treatable lesions, without regional wall motion abnormality on echocardiography. Evidence relating to treatment was limited. A potential strategy to diagnose myocardial infarctions in the ICU is proposed. 7

For ICU automated tables of contents: click here.

NEW BOOKS IN OUR COLLECTION 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. Oxford textbook of critical care (2nd ed) (2016) Webb, Andrew R. Edited and written by an international group of recognized experts from many disciplines, the second edition of the Oxford Textbook of Critical Care provides an up-to-date reference that is relevant for intensive care units and emergency departments globally.

Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia Cochrane Systematic Review Rachael Powell, Neil W Scott, Anne Manyande, Julie Bruce, Claus Vรถgele, Lucie MT Byrne-Davis, Mary Unsworth, Christian Osmer, Marie Johnston In a review and meta-analysis conducted in 1993, psychological preparation was found to be beneficial for a range of outcome variables including pain, behavioural recovery, length of stay and negative affect. Since this review, more detailed bibliographic searching has become possible, additional studies testing psychological preparation for surgery have been completed and hospital procedures have changed. The present review examines whether psychological preparation (procedural information, sensory information, cognitive intervention, relaxation, hypnosis and emotionfocused intervention) has impact on the outcomes of postoperative pain, behavioural recovery, length of stay and negative affect.

OTHER EVIDENCE UPDATES BACK TO TOP Up-to-date latest click here (and logon via Athens)

Via Dynamed: Noninvasive Ventilation with Helmet Reduces Endotracheal Intubation and Mortality Compared to Face Mask in Patients with ARDS Reference - JAMA 2016 Jun 14;315(22):2435 (level 1 [likely reliable] evidence) 

Although many patients with acute respiratory distress syndrome (ARDS) require some form of mechanical ventilation, there is limited data suggesting the methods of delivery of noninvasive positive pressure ventilation might influence patient outcomes.

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Compared to a standard face mask, a helmet interface significantly reduced intubation rates and mortality in 83 patients with ARDS requiring noninvasive ventilation for ≥ 8 hours.

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While oxygen saturation rates were similar during treatment, the helmet group had higher median sustained positive end-expiratory pressure and a lower fraction of inspired oxygen, suggesting less air leakage with the helmet may have increase the efficacy of noninvasive ventilation.

Mechanical ventilation is often required to support adequate gas exchange in patients with ARDS. While some patients can be managed with noninvasive positive pressure ventilation, endotracheal intubation with invasive mechanical ventilation is often necessary when noninvasive strategies fail to provide adequate oxygenation (Crit Care 2013 Nov 11;17(6):R269). However, endotracheal intubation of critically ill patients is associated with a high rate of complications (Crit Care 2015 Jun 17;19:258). Limited data suggests that the mode of oxygen delivery and the airway pressure may influence the outcomes of noninvasive ventilation in patients with acute hypoxemic respiratory failure (Respir Care 2004 Mar;49(3):270, N Engl J Med 2015 Jun 4;372(23):2185). To determine if noninvasive ventilation delivered by a helmet interface could reduce air leak and improve intubation rates, 83 patients with ARDS (median age 60 years) requiring noninvasive ventilation via face mask for ≥ 8 hours were randomized to continued noninvasive ventilation via either a helmet or a face mask. A standard protocol was used for titration of noninvasive ventilation in both groups and intubation decisions were made by a clinical intensive care team based on predefined criteria. This trial planned to enroll 206 patients, but the trial was terminated early after the first planned 11

interim analysis when the predefined stopping rule for efficacy of the helmet interface was reached. Compared to the face mask group during treatment, patients in the helmet group had a higher median sustained positive end-expiratory pressure, lower fraction of inspired oxygen, and greater decrease in respiratory rate. Both groups had similar oxygen saturations. The intubation rate was 18.2% with the helmet vs. 61.5% with the face mask (p < 0.001, NNT 3). The most common reason for intubation was neurological deterioration in the helmet group and respiratory failure in the face mask group. The helmet interface was also associated with reduced in-hospital mortality (27.3% vs. 48.7%, = 0.04, NNT 5) and 90-day mortality (34.1% vs. 56.4%, = 0.02, NNT 5). While the length of intensive care unit stay was significantly reduced with the helmet interface, there were no significant differences in the length of hospitalization or in the rate of skin ulcerations. The results of this trial suggest that noninvasive ventilation utilizing a helmet is more effective than ventilation via a face mask at reducing the need for intubation and mortality due to ARDS. The inclusion of patients requiring 8 hours of noninvasive ventilation ensured that the trial evaluated patients at high risk of intubation, as confirmed by the 61.5% intubation rate in the face mask control group. While the interventions could not be blinded, the a priori definition of the intubation criteria helps reduce the risk of bias. The success of the helmet interface is likely related to less air leak allowing for the significantly higher levels of positive end-expiratory pressure observed. Although this trial is fairly small, these results suggest that increased availability and proper use of helmet interfaces could substantially impact the care of patients with ARDS.

REPORTS, PUBLICATIONS AND RESOURCES

Hospital to Home Evaluation report FIONA MUNRO, CATHERINE-ROSE STOCKS-RANKIN & STUART MUIRHEAD May 2016 This evaluation concerns the final aim of the project: To develop a series of co-designed service recommendations, designed to enable older people to experience a well-supported, co-ordinated and positive pathway from hospital to home. Using a co-evaluation approach with health and social care practitioners we evaluated how the project Working Group recommendations were used in the case study areas and the impact this had, both for those delivering the new pathways, and those receiving care. The project recommendations were adapted and used in different ways across South Angus and Dundee with specific system changes being applied and tested. These were mainly adaptions that addressed coordinating care and improving communication and trust across different practitioner groups. These included: conducting multi-disciplinary team meetings in community and hospital; moving some social work function and assessment into the community; and assigning coordinators to manage the hospital/home transitions of an older person.

How to improve ‘do not resuscitate’ decisions in England Signal, NIHR/NHS 14 June 2016 This review has highlighted some variations in how ‘do not attempt cardiopulmonary resuscitation’ decisions are made across NHS hospitals. By describing the literature and giving examples where things have gone well and less well in the past it begins to surface promising areas for improvement. These include the designing and implementing of structured forms to record decisions, talking sensitively about the decisions with patients and their families early and letting other health professionals know what has been decided. A ‘do not attempt resuscitation’ decision allows resuscitation to be withheld following a cardiac arrest. This is usually done if there is little or no chance of success, if the risks outweigh the benefits, or if a person requests not to receive resuscitation. Lack of clarity can lead to confusion and conflicts within a fast-moving medical emergency. This can occasionally lead to complaints later. The main part of this study reviewed the worldwide literature to look for 13

insights into the processes, barriers and facilitators to ideal care. Other data collected in this study showed variation and inconsistency in current practice. Based on following paper: Do-not-attempt-cardiopulmonary-resuscitation decisions: an evidence synthesis Authors: Perkins GD, Griffiths F, Slowther A-M, George R, Fritz Z, Satherley P, Williams B, Waugh N, Cooke MW, Chambers S, Mockford C, Freeman K, Grove A, Field R, Owen S, Clarke B, Court R, Hawkes C. Journal: Health Services and Delivery Research Volume: 4 Issue: 11

OTHER SERVICES, TRAINING & ATHENS

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 self-registration. 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 Using tried and tested techniques, rapid searching of the evidence base for when quick solutions are needed.

Reflective Practice How to read and comment upon a paper Writing for publication Everything you need to know about writing a paper for publication Collaborative "Living Evidence" Searching/Appraisal Group searching/appraisal of evidence in computer labs (suitable for MDTs and similar).

TO BOOK A COURSE, click here

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.

Library training drop-in sessions The Library at Musgrove Park Academy is running a series of drop-in sessions that will be held in the Academy e-learning room. No booking necessary, but if you decide to attend you will need to arrive on time.    

Introduction to Critical Appraisal Evidence Searching Literature Searching Rapid Evidence review

For a list of the course dates click here

Horizon Scanning service

Horizon Scanning – also known as Early Warning Systems - is a systematic examination of information to identify potential threats, risks, emerging issues and opportunities and filter and prioritise new and emerging health technologies. Horizon Scanning service maps ‘forward alerts’ and ‘evidence predictions’, based on emerging trends. Sources searched include the usual clinical evidence sources, as well as ‘grey literature’, specialist medicines databases, health technology databases and specialist Horizon Scanning databases. To access, click here.