July stroke current awareness by Musgrove Park Hospital Library

Library Services Musgrove Park and Somerset Partnership

Current Awareness Stroke This monthly Current Awareness Bulletin is produced by the Library, Musgrove Park Academy to provide staff with a range of stroke-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. All websites have been evaluated and details are correct at the time of publications. Details correct at time of going to print. Please note that resources are continuously updated. For further help or guidance, please contact a member of library staff.

This guide has been compiled by: Jess Pawley Senior Library Assistant Musgrove Park Hospital Library Service jessica.pawley@tst.nhs.uk

Issue 11 July 2016

Contents Click on a section title to navigate contents Page Results of Library Current Awareness Survey

Colleague App

Recent journal articles

Guidelines

UpToDate & DynaMed Plus

Stroke in the News

Reports, publications and resources

Topic Alerts and Updates

Twitter

Training & Networking Opportunities, Conferences, Events

Literature search service

Training and Athens

Library contact details: Library Musgrove Park Academy Musgrove Park Hospital Taunton Somerset TA1 5DA Tel: 01823 34 (2433)

Email: library@tst.nhs.uk Blog: http://librarymph.wordpress.com @musgrovesompar

RESULTS OF LIBRARY CURRENT AWARENESS SURVEY BACK TO TOP

During 2015-6 the library team introduced a number of new current awareness bulletins as a result of feedback from staff. Along with the fortnightly Library Alert monthly updates were produced for: Dementia Stroke End of life Sign up to safety

Mentorship Cancer ITU

While we had some feedback that these bulletins were useful, we felt due to the cost in library staff time, it would be better to have more detailed evidence. We circulated the survey via email to the various email lists, added a link on the Library webpage and also put reminders in the Library Alert and Staff Bulletin. During the month when we received 211 replies on all bulletins covering both Taunton and Somerset and Somerset Partnership staff. The final report can be found here

COLLEAGUE APP BACK TO TOP The MPH Staff App has specifically been produced and designed to offer both current and future employees relevant information related to their work. Whether seeking information about policies and procedures, following us on Twitter or even taking advantage of special offers, all can be found here.

Library monthly current awareness bulletins are also available. To download, please follow this link Please note- The app has not been created by the library. If you have any problems downloading or accessing the app then you will need to contact the IT department.

RECENT JOURNAL ARTICLES BACK TO TOP This is a list of journal articles on the topic of stroke. Some articles are available in the library or online via an OpenAthens password by following the full-text link. If you would like an article which is not available as full-text then please contact library staff. Please note that abstracts are not always available for all articles.

MUSGROVE STAFF ONLY Click on the image to access full-text-available from 1970 to current using your OpenAthens password

Title: Impact of the National Health Service Health Check on cardiovascular disease risk: a difference-in-differences matching analysis Author: Chang, Kiara Chu-Mei, MSc; Lee, John Tayu, PhD; Vamos, Eszter P, MD PhD; Soljak, Michael, PhD; Johnston, Desmond, MD PhD; Khunti, Kamlesh, MD PhD; Majeed, Azeem, MD; Millett, Christopher, PhD Abstract: Results: Overall, 21.4% of the eligible population attended a Health Check. After matching (n = 29 672 in each group), attendees had a significant absolute reduction in modelled risk for cardiovascular disease (-0.21%, 95% confidence interval [CI] -0.24% to -0.19%) and individual risk factors: systolic blood pressure (-2.51 mm Hg, 95% CI -2.77 to -2.25 mm Hg), diastolic blood pressure (-1.46 mm Hg, 95% CI -1.62 to -1.29 mm Hg), body mass index (-0.27, 95% CI -0.34 to -0.20) and total cholesterol (-0.15 mmol/L, 95% CI -0.18 to -0.13 mmol/L). Statins were prescribed for 39.9% of attendees who were at high risk for cardiovascular disease. The program resulted in significantly more diagnoses of selected vascular diseases among attendees, with the largest increases for hypertension (2.99%) and type 2 diabetes mellitus (1.31%). Relative to nonattendees, Health Check attendees had higher pre-intervention mean systolic blood pressure (131.9 v. 128.5 mm Hg), higher mean diastolic blood pressure (80.2 v. 78.7 mm Hg), higher mean BMI (27.7 v. 26.9) and slightly higher mean total cholesterol (5.5 v. 5.3 mmol/L), but a lower prevalence of current smoking (17.9% v. 22.2%) (Table 2). After the intervention, Health Check attendees had absolute reductions in systolic and diastolic blood pressure, total cholesterol and smoking prevalence, but not in BMI. After matching, there were significant reductions in the following individual risk factors among Health Check attendees: systolic blood pressure (-2.51 mm Hg, 95% CI -2.77 to -2.25 mm Hg), diastolic blood pressure (-1.46 mm Hg, 95% CI -1.62 to -1.29 mm Hg), BMI (-0.27, 95% CI -0.34 to -0.20) and total cholesterol (-0.15 mmol/L, 95% CI -0.18 to -0.13 mmol/L). Before the intervention, Health Check attendees were more likely than nonattendees to receive a prescription for a statin (9.7% v. 3.1%) or an antihypertensive medication (4.8% v. 1.8%) (Table 2). After matching, Health Check attendance was associated with significantly greater absolute increases in prescribing of statins (+3.83%, 95% CI +3.52% to +4.14%) and antihypertensive medications (+1.37%, 95% CI +1.08% to +1.66%) (Table 2). Statin prescribing increased significantly among Health Check attendees, irrespective of modelled cardiovascular risk at baseline (Figure 2, Appendix 4). However, the increases were greatest among Health Check attendees with cardiovascular risk 20% or higher at baseline (+15.2%, 95% CI +12.2% to +18.1%), followed by those with 10%-20% risk (+7.22%, 95% CI +6.20% to +8.24%) and those at less than 10% risk (+2.23%, 95% CI +1.94% to +2.52%). The level of prescribing for Health Check attendees remained low after the intervention, with prescribing of statins and antihypertensive medications for only 39.9% and 23.4%, respectively, of attendees with cardiovascular risk of 20% or higher at baseline.

CHANG, K.C., M.SC, LEE, J.T., PHD., VAMOS, E.P.,M.D.PHD., SOLJAK, M., PHD., JOHNSTON, D.,M.D.PHD., KHUNTI, K.,M.D.PHD., MAJEED, A., M.D. and MILLETT, C., PHD., 2016. Impact of the National Health Service Health Check on cardiovascular disease risk: a difference-in-differences matching analysis. Canadian Medical Association.Journal, 188(10), pp. E228-E238.

Title: Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack Author: Johnston, S Claiborne; Amarenco, Pierre; Albers, Gregory W; Denison, Hans; Easton, J Donald; Evans, Scott R; Held, Peter; Jonasson, Jenny; Minematsu, Kazuo; Molina, Carlos A; Wang, Yongjun; Wong, KS Lawrence Abstract: Ticagrelor may be a more effective antiplatelet therapy than aspirin for the prevention of recurrent stroke and cardiovascular events in patients with acute cerebral ischemia. We conducted an international double-blind, controlled trial in 674 centers in 33 countries, in which 13,199 patients with a nonsevere ischemic stroke or high-risk transient ischemic attack who had not received intravenous or intraarterial thrombolysis and were not considered to have had a cardioembolic stroke were randomly assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive either ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2 through 90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2 through 90). The primary end point was the time to the occurrence of stroke, myocardial infarction, or death within 90 days. During the 90 days of treatment, a primary end-point event occurred in 442 of the 6589 patients (6.7%) treated with ticagrelor, versus 497 of the 6610 patients (7.5%) treated with aspirin (hazard ratio, 0.89; 95% confidence interval [CI], 0.78 to 1.01; P=0.07). Ischemic stroke occurred in 385 patients (5.8%) treated with ticagrelor and in 441 patients (6.7%) treated with aspirin (hazard ratio, 0.87; 95% CI, 0.76 to 1.00). Major bleeding occurred in 0.5% of patients treated with ticagrelor and in 0.6% of patients treated with aspirin, intracranial hemorrhage in 0.2% and 0.3%, respectively, and fatal bleeding in 0.1% and 0.1%. In our trial involving patients with acute ischemic stroke or transient ischemic attack, ticagrelor was not found to be superior to aspirin in reducing the rate of stroke, myocardial infarction, or death at 90 days. (Funded by AstraZeneca; ClinicalTrials.gov number, NCT01994720.) JOHNSTON, S.C., AMARENCO, P., ALBERS, G.W., DENISON, H., EASTON, J.D., EVANS, S.R., HELD, P., JONASSON, J., MINEMATSU, K., MOLINA, C.A., WANG, Y. and WONG, K.L., 2016. Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack. The New England journal of medicine, 375(1), pp. 35-43.

Title: Prevalence and predictors of hospital prealerting in acute stroke: a mixed methods studyAuthor: Sheppard, J P; Lindenmeyer, A; Mellor, R M; Greenfield, S; Mant, J; Quinn, T; Rosser, A; Sandler, D; Sims, D; Ward, M; McManus, R J Abstract: Thrombolysis can significantly reduce the burden of stroke but the time window for safe and effective treatment is short. In patients travelling to hospital via ambulance, the sending of a 'prealert' message can significantly improve the timeliness of treatment. Examine the prevalence of hospital prealerting, the extent to which prealert protocols are followed and what factors influence emergency medical services (EMS) staff's decision to send a prealert. Cohort study of patients admitted to two acute stroke units in West Midlands (UK) hospitals using linked data from hospital and EMS records. A logistic regression model examined the association between prealert eligibility and whether a prealert message was sent. In semistructured interviews, EMS staff were asked about their experiences of patients with suspected stroke. Of the 539 patients eligible for this study, 271 (51%) were recruited. Of these, only 79 (29%) were eligible for prealerting according to criteria set out in local protocols but 143 (53%) were prealerted. Increasing number of Face, Arm, Speech Test symptoms (1 symptom, OR 6.14, 95% CI 2.06 to 18.30, p=0.001; 2 symptoms, OR 31.36, 95% CI 9.91 to 99.24, p<0.001; 3 symptoms, OR 75.84, 95% CI 24.68 to 233.03, p<0.001) and EMS contact within 5 h of symptom onset (OR 2.99, 95% CI 1.37 to 6.50 p=0.006) were key predictors of prealerting but eligibility for prealert as a whole was not (OR 1.92, 95% CI 0.85 to 4.34 p=0.12). In qualitative interviews, EMS staff displayed varying understanding of prealert protocols and described frustration when their interpretation of the prealert criteria was not shared by ED staff. Up to half of the patients presenting with suspected stroke in this study were prealerted by EMS staff, regardless of eligibility, resulting in disagreements with ED staff during handover. Aligning the expectations of EMS

and ED staff, perhaps through simplified prealert protocols, could be considered to facilitate more appropriate use of hospital prealerting in acute stroke. SHEPPARD, J.P., LINDENMEYER, A., MELLOR, R.M., GREENFIELD, S., MANT, J., QUINN, T., ROSSER, A., SANDLER, D., SIMS, D., WARD, M. and MCMANUS, R.J., 2016. Prevalence and predictors of hospital prealerting in acute stroke: a mixed methods study. Emergency Medicine Journal : EMJ, 33(7), pp. 482.

Title: Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies Author: Valtorta, Nicole K; Kanaan, Mona; Gilbody, Simon; Ronzi, Sara; Hanratty, Barbara Abstract: The influence of social relationships on morbidity is widely accepted, but the size of the risk to cardiovascular health is unclear. We undertook a systematic review and meta-analysis to investigate the association between loneliness or social isolation and incident coronary heart disease (CHD) and stroke. Sixteen electronic databases were systematically searched for longitudinal studies set in high-income countries and published up until May 2015. Two independent reviewers screened studies for inclusion and extracted data. We assessed quality using a component approach and pooled data for analysis using random effects models. Of the 35 925 records retrieved, 23 papers met inclusion criteria for the narrative review. They reported data from 16 longitudinal datasets, for a total of 4628 CHD and 3002 stroke events recorded over follow-up periods ranging from 3 to 21 years. Reports of 11 CHD studies and 8 stroke studies provided data suitable for meta-analysis. Poor social relationships were associated with a 29% increase in risk of incident CHD (pooled relative risk: 1.29, 95% CI 1.04 to 1.59) and a 32% increase in risk of stroke (pooled relative risk: 1.32, 95% CI 1.04 to 1.68). Subgroup analyses did not identify any differences by gender. Our findings suggest that deficiencies in social relationships are associated with an increased risk of developing CHD and stroke. Future studies are needed to investigate whether interventions targeting loneliness and social isolation can help to prevent two of the leading causes of death and disability in high-income countries. VALTORTA, N.K., KANAAN, M., GILBODY, S., RONZI, S. and HANRATTY, B., 2016. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and metaanalysis of longitudinal observational studies. Heart, 102(13), pp. 1009.

Title: Incidence and predictors of ischemic stroke during hospitalization for congestive heart failure Author: Hamatani, Yasuhiro; Iguchi, Moritake; Nakamura, Michikazu; Ohtani, Ryo; Yamashita, Yugo; Takagi, Daisuke; Unoki, Takashi; Ishii, Mitsuru; Masunaga, Nobutoyo; Ogawa, Hisashi; Hamatani, Mio; Abe, Mitsuru; Akao, Masaharu Abstract: Heart failure (HF) increases the risk of ischemic stroke. Data regarding the incidence and predictors of ischemic stroke during hospitalization for HF are limited. The study population of this retrospective cohort study consisted of patients with congestive HF, consecutively admitted to our center from October 2010 to April 2014. We excluded patients complicated with acute myocardial infarction, infective endocarditis, and takotsubo cardiomyopathy. We also excluded those with dialysis or mechanical circulatory support. We investigated the incidence of ischemic stroke during hospitalization for HF. Thereafter, we divided the patients without oral anticoagulants at admission into two groups: patients with ischemic stroke and those without it, and explored the predictors of ischemic stroke. A total of 558 patients (287 without atrial fibrillation (AF), 271 with AF) were enrolled. The mean age was 76.8 Âą 12.3 years, and 244 patients (44 %) were female. The mean left-ventricular ejection fraction was 47.4 %. Oral anticoagulants were prescribed in 147 patients (8 without AF, 139 with AF). During hospitalization (median length 18 days), symptomatic ischemic stroke (excluding catheter-related) occurred in 15 patients (2.7 % of the total, 8 without AF, 7 with AF). Predictors significantly associated with increased risk of ischemic stroke in patients without oral anticoagulants were as follows; short-term increases in blood urea nitrogen after admission (at day 3; odds ratio (per 1 md/dl): 1.06, 95 % confidence interval (CI) 1.01-1.11, p = 0.02, and at day 7; odds ratio: 1.03, 95 % CI 1.00-1.07, p = 0.03, respectively), and previous stroke (odds ratio; 3.33, 95 % CI 1.01-11.00, p = 0.04). The incidence of ischemic stroke during hospitalization for HF was high, even in patients

without AF. Previous stroke and short-term increases in blood urea nitrogen was significantly associated with the incidence of ischemic stroke. HAMATANI, Y., IGUCHI, M., NAKAMURA, M., OHTANI, R., YAMASHITA, Y., TAKAGI, D., UNOKI, T., ISHII, M., MASUNAGA, N., OGAWA, H., HAMATANI, M., ABE, M. and AKAO, M., 2016. Incidence and predictors of ischemic stroke during hospitalization for congestive heart failure. Heart and vessels, 31(7), pp. 1154-1161.

Title: Silent AF and Hypertrophic Stroke Risk: More Data, More Monitoring Author: Winterfield, JEFFREY R; Voss, JAMIE Abstract: None available. WINTERFIELD, J.R. and VOSS, J., 2016. Silent AF and Hypertrophic Stroke Risk: More Data, More Monitoring. Journal of cardiovascular electrophysiology, 27(7), pp. 785-787.

Title: Improved clinical outcome 3 months after endovascular treatment, including thrombectomy, in patients with acute ischemic stroke: a meta-analysis Author: Falk-Delgado, Anna; Kuntze Söderqvist, Ãsa; Fransén, Jian; Falk-Delgado, Alberto Abstract: Intravenous thrombolysis with tissue plasminogen activator is standard treatment in acute stroke today. The benefit of endovascular treatment has been questioned. Recently, studies evaluating endovascular treatment and intravenous thrombolysis compared with intravenous thrombolysis alone, have reported improved outcome for the intervention group. The aim of this study was to perform a meta-analysis of randomized controlled trials comparing endovascular treatment in addition to intravenous thrombolysis with intravenous thrombolysis alone. Databases were searched for eligible randomized controlled trials. The primary outcome was a functional neurological outcome after 90 days. A secondary outcome was severe disability and death. Data were pooled in the control and intervention groups, and OR was calculated on an intention to treat basis with 95% CIs. Outcome 2 heterogeneity was evaluated with Cochrane's Q test (significance level cut-off value at <0.10) and I (significance cut-off value >50%) with the Mantel-Haenszel method for dichotomous outcomes. A p value <0.05 was regarded as statistically significant. Six studies met the eligibility criteria, and data from 1569 patients were analyzed. A higher probability of a functional neurological outcome after 90 days was found for the intervention group (OR 2, 95% CI 2 to 3). There was a significantly higher probability of death and severe disability in the control group compared with the intervention group. Endovascular treatment in addition to intravenous thrombolysis for acute ischemic stroke leads to an improved clinical outcome after 3 months, compared with patients receiving intravenous thrombolysis alone. FALK-DELGADO, A., KUNTZE SÖDERQVIST, Ã., FRANSÉN, J. and FALK-DELGADO, A., 2016. Improved clinical outcome 3 months after endovascular treatment, including thrombectomy, in patients with acute ischemic stroke: a meta-analysis. Journal of NeuroInterventional Surgery, 8(7), pp. 665.

Title: Can dietary saturated fat be beneficial in prevention of stroke risk? A meta-analysis Author: Cheng, Pengfei; Wang, Jingxia; Shao, Weihua; Liu, Meiling; Zhang, Hui Abstract: We conducted a meta-analysis to summarize available evidence regarding the relation between saturated fatty acid (SFA) intake and stroke risk. We searched multiple electronic databases through February 2016. Log relative risks (RRs) with 95 % confidence intervals (CIs) of the highest versus the lowest for cohort studies were weighed by the inverse variance method to obtain combined RRs. 15 prospective studies including 476,569 individuals and 11,074 strokes were included. Higher SFA intake was associated with reduced overall stroke risk [RR = 0.89 (95 % CI 0.82-0.96)] and fatal stroke risk [RR = 0.75 (95 % CI 0.59-0.94)]. Subgroup analysis indicated that higher SFA intake was associated with reduced stroke risks for East-Asians [RR = 0.79 (95 % CI 0.69-0.90)], for dose <25 g/day [RR = 0.81 (95 % CI 0.71-0.92)], for males [RR = 0.85 (95 % CI 0.75-0.96)], and for individuals with body mass index (BMI) <24 [RR = 0.75 (95 % CI 0.65-0.87)], but not for non East-Asians,

females, and individuals with dose [greater than or equal to]25 g/day and BMI [greater than or equal to]24. This meta-analysis reveals that higher SFA intake is inversely associated with risk of stroke morbidity and mortality with race, sex, and BMI as key factors influencing this risk. There seems to be a threshold of SFA intake for inverse relation of SFA intake with stroke. However, the stroke-reducing or -increasing effects for specific subtypes and specific food sources of SFA can be concealed. Functions of specific subtypes of SFA (e.g. lignoceric acid) and specific food sources of SFA (i.e. plant vs. animal) in relation to stroke need to be clarified in further studies. CHENG, P., WANG, J., SHAO, W., LIU, M. and ZHANG, H., 2016. Can dietary saturated fat be beneficial in prevention of stroke risk? A meta-analysis. Neurological Sciences, 37(7), pp. 1089-1098.

GUIDELINES BACK TO TOP th

National Clinical Guideline for Stroke, 4 edition 2012 NICE Guidelines Transcervical extracorporeal reverse flow neuroprotection for reducing the risk of stroke during carotid artery stenting- NICE interventional procedure guidance [IPG561] Published date: June 2016 Mechanical clot retrieval for treating acute ischaemic stroke- NICE interventional procedure guidance [IPG548] Published date: February 2016 Secondary prevention after a myocardial infarction- NICE quality standard [QS99] Published date: September 2015 Cardiovascular risk assessment and lipid modification- NICE quality standard [QS100] Published date: September 2015 Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillationNICE technology appraisal guidance [TA355] Published date: September 2015

UPTODATE & DYNAMED PLUS BACK TO TOP What’s new from our clinical decision-making tools on the topic of stroke. UpToDate –Access for Musgrove Staff only DynaMed Plus – Access for Somerset Partnership Staff only Please contact library staff for details on how to access these resources; you will need an Athens password if accessing from home.

STROKE IN THE NEWS BACK TO TOP Behind the Headlines ‘Nine out of 10 strokes preventable,’ claims study

REPORTS, PUBLICATIONS AND RESOURCES BACK TO TOP NICE Pathway on Stroke UK Stroke Forum- hosted by Stroke Association Stroke Association website- contains information about support groups, conferences, fundraising, research and professional advice including toolkits and posters. The Sentinel Stroke National Audit Programme- 2 reports Post-acute organisational audit Presents the findings on the organisation of care for stroke survivors once they leave hospital. The audit highlights the number and location of post-acute stroke services across the UK and outlines what a patient might expect in accessing these services. Is stroke care improving? The second SSNAP annual report The second annual SSNAP report reveals today that despite steady progress in stroke care, further work needs to be done to ensure that patients have access to key interventions and assessments when they are admitted to hospital. Raconteur Report- Understanding Stroke Stroke is one of the biggest health issues people face today, taking a life every 13 minutes and costing the nation an estimated £9 billion a year in health and social costs. Yet the condition ranks low in terms of public perception and research funding, and the UK lags behind some other nations in improving patient outcomes. This report highlights the need to raise research funding, along with awareness of the condition, and identifies key risk factors. It also showcases major technological and medical breakthroughs.

TOPIC ALERTS AND UPDATES BACK TO TOP ABSTRACTS AVAILABLE VIA LINKS BELOW - FOR FULL-TEXT PLEASE ASK LIBRARY STAFF Recent Endovascular Stroke Trials and Their Impact on Stroke Systems of Care J Am Coll Cardiol. 2016 Jun 7;67(22):2645-55 Association Between CYP2C19 Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack JAMA. 2016;316(1):70-78 Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation (EVREST): a randomised, multicentre, single-blind, controlled trial Lancet Neurology, Published Online: 27 June 2016 Virtual reality versus reality in post-stroke rehabilitation Lancet Neurology, Published Online: 27 June 2016 Migraine with aura and risk of silent brain infarcts and white matter hyperintensities: an MRI study Brain Volume 139, Issue 7 pp. 2015 â&#x20AC;&#x201C; 2023 FREE FULL TEXT Prestroke Vascular Pathology and the Risk of Recurrent Stroke and Poststroke Dementia STROKE Published online before print July 14, 2016 FREE FULL TEXT

TWITTER BACK TO TOP The latest from popular Twitter pages dedicated to stroke: PLEASE NOTE LINKS WORK BETTER IN CHROME BROWSER Stroke Association @TheStrokeAssoc World Stroke Campaign @WStrokeCampaign Sign Against Stroke in Atrial Fibrillation @signagnststroke Different Strokes- Support for Younger Stroke Survivors @diffstrokes

TRAINING & NETWORKING OPPORTUNITIES, CONFERENCES, EVENTS BACK TO TOP Stroke Association- Events for Professionals- ongoing events throughout the year th

10th World Stroke Congress- 26 -29 October 2016, Hyderabad, India

LITERATURE SEARCH SERVICE BACK TO TOP Looking for the latest evidence-based research but havenâ&#x20AC;&#x2122;t got time to trawl the databases? Do you need a literature search carried out? Do you need to find evidence to support an improvement? Do you want to know how something has been done elsewhere and whether it worked?

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

To request a search please complete and return the appropriate 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. Musgrove staff click here to access literature search form Somerset Partnership staff click here to access literature search form

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 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. The library offers training on how to access and use Athens resources, as well as an introductory course on critical appraisal. You can book a course through the Learning and Development intranet page, or by contacting the library directly.