June 2016 itu current awareness1 by Musgrove Park Hospital Library

Clinical Librarian Service Musgrove Park Academy

Current Awareness

ITU Issue 4 June 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

Training & Networking Opportunities, Conferences, Events

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

Impact of Proactive Nurse Participation in ICU Family Conferences: A Mixed-Method Study Crit Care Med. 2016 Jun;44(6):1116-28. doi: 10.1097/CCM.0000000000001632. Garrouste-Orgeas M1, Max A, Lerin T, GrĂŠgoire C, Ruckly S, Kloeckner M, Brochon S, Pichot E, Simons C, El-Mhadri M, Bruel C, Philippart F, Fournier J, Tiercelet K, Timsit JF, Misset B. Of the 172 eligible family members, 100 (60.2%) were randomized; among them, 88 underwent semistructured interviews at ICU discharge and 86 completed the Peritraumatic Dissociative Experiences Questionnaire at ICU discharge and then the Hospital Anxiety Depression Questionnaire and the Impact of Event Scale (for posttraumatic stress-related symptoms) 3 months later. The intervention and control groups were not significantly different regarding the prevalence of posttraumatic stress-related symptoms (52.3 vs 50%, respectively; p = 0.83). Anxiety and depression subscale scores were significantly lower in the intervention group. The qualitative data indicated that the families valued the principle of the conference itself. Perceptions of nurse participation clustered into four main themes: trust that ICU teamwork was effective (50/88; 56.8%), trust that care was centered on the patient (33/88; 37.5%), trust in effective dissemination of information (15/88; 17%), and trust that every effort was made to relieve anxiety in family members (12/88; 13.6%). Families valued the conferences themselves and valued the proactive participation of a nurse. These positive perceptions were associated with significant anxiety or depression subscale scores but not with changes in posttraumatic stress-related symptoms.

Neutropenic sepsis: prevention, identification and treatment Clare Warnock Nursing Standard 2016 30 (35) p51-60 Chemotherapy-induced neutropenia may result in significant physical, social and emotional consequences for patients receiving anticancer therapy. Chemotherapy-induced neutropenia also leads to delays in treatment and reductions in dose intensity. In some cases neutropenia may be prevented by the use of granulocyte-colony stimulating factor, but it remains one of the most common side effects of chemotherapy. Patients who are neutropenic have a reduced ability to fight infection and are at increased risk of developing neutropenic sepsis. Nurses need to be able to recognise the signs and symptoms of 3

neutropenic sepsis to ensure early diagnosis and treatment. There are evidence-based pathways for the treatment of patients with neutropenic sepsis and nurses have the potential to develop services and initiatives to support best practice for this group of patients

Evidence-based fluid management in the ICU Achim W. Schindler, Gernot Marx Current Opinion in Anaesthesiology 2016 29 (2) p158â&#x20AC;&#x201C;165 Evidence-based fluid therapy is complicated by blurred boundaries toward other fields of therapy and the majority of trials not focusing on patient-relevant outcomes. Additionally, recent trials unsettled the faith in traditional concepts on fluid therapy. The article reviews the evidence on diagnosis and treatment of hypovolemia and discusses the use of balanced solutions and early goal-directed therapy (EGDT) in septic shock resuscitation.Hypovolemia should be diagnosed and its treatment guided by a multifaceted approach, including medical history, physical examination, volume responsiveness, and technical parameters - dynamic indicators, volumetric indicators, sonography, and metabolic indicators. Central venous pressure and pulmonary artery occlusion pressure should be avoided. In ICU patients, balanced crystalloids should primarily be used, because unbalanced infusions (especially saline) cause hyperchloremic acidosis which is associated with renal impairment and infections. Colloids are beneficial to restore blood volume rapidly. Hydroxyethyl starch may be harmful although the validity of the respective recent studies is limited by methodological flaws. Early aggressive fluid therapy is still beneficial in septic shock resuscitation, despite recent trials challenging the EGDT concept. Today, 10 years after Rivers, 'usual care' includes aggressive fluid resuscitation that is as effective as formal EGDT.Evidence-based fluid therapy includes a multifaceted diagnostic approach, the primary use of balanced crystalloids and early aggressive (septic) shock resuscitation.

Infection control in the operating room: is it more than a clean dish? Randy W.Loftus Current Opinion in Anaesthesiology 2016 29 (2) p192â&#x20AC;&#x201C;197 Healthcare-associated infections (HCAIs) are driven by a complex interplay between host defenses, pathogen traits, and pathogen transmission. A better understanding of each of these factors is required to extend infection control beyond antibiotic therapy to improvements in basic preventive measures that can achieve sustained HCAI reductions. The purpose of this article is to review recent advancements in our understanding of these issues for the operating room environment.The importance and implications of intraoperative bacterial transmission have been solidified, and hyper transmissible, virulent, and antibiotic resistant bacterial strains have been characterized. As a result, a best practice for improved intraoperative infection control has been delineated. Little advancement has been made in our understanding of the efficacy of higher inspired oxygen concentrations, improved postoperative glucose control, perioperative normothermia, and prophylactic antibiotic 4

selection, timing, and dose for HCAI prevention.Recent work has led to the development of evidence-based hand hygiene, environmental cleaning, patient decolonization, and intravascular catheter design and handling improvement strategies. Evidence suggests that a best practice for postoperative infection control is a multimodal program that utilizes these interventions to target patient, provider, and environmental reservoirs in parallel. The development of novel diagnostic tools for targeted attenuation of hyper virulent, transmissible and resistant strains/strain characteristics is indicated to improve patient decolonization efforts.

How to inform relatives and loved ones of a patient’s death Mags Guest et al Nursing Standard 2016 30 (34) p36-38 Examines: Informing relatives and loved ones of a patient’s death is a sensitive and often stressful task frequently undertaken by nurses; effective communication skills and demonstrating compassion are essential when informing relatives and loved ones of a patient’s death; the nurse should use suitable language and choose an appropriate environment to ensure that information is conveyed clearly, sensitively and without interruptions.

Emerging strategies for the treatment of patients with acute hepatic failure Prem A Kandiah, Jody C Olson, Ram M Subramanian Current Opinion in Critical Care 2016 22 (2) p142–151 Advances in the critical care management of ALF have translated to a substantial decrease in mortality related to this disease process. The extrapolation of therapies from general neurocritical care to the treatment of ALF-induced intracranial hypertension has resulted in improved neurologic outcomes. In addition, recognition of the systemic inflammatory response and multiorgan dysfunction in ALF has guided current treatment recommendations, and will provide avenues for future research endeavors. With respect to extracorporeal liver support systems, further randomized studies are required to assess their efficacy in ALF, with attention to nonsurvival end points such as bridging to liver transplantation

Novel therapies for severe Clostridium difficile colitis Paul Waltz, Brian Zuckerbraun Current Opinion in Critical Care 2016 22 (2) p167–173

Clostridium difficile infection (CDI) is becoming a large healthcare burden with increasing incidence, high recurrence rates, and associated morbidity and mortality. Disease severity varies from mild to severe and complicated presentations. Current mainstays of therapy in severe CDI include: fluid resuscitation, support of organ dysfunction, discontinuation of inciting agents, and antibiotic treatment.Recent focus on the impact of the microbiome and targeted therapies to reconstitute biodiversity may provide alternative therapeutic modalities with higher success and lower recurrence rates. Newer antibiotics are under development, along with targeted immunotherapies that attempt to neutralize pathogenic toxins. Alternative surgical options from traditional subtotal colectomy may provide a less morbid surgical option for those requiring intervention.With further understanding of the pathogenesis and shortcomings of current therapies, the future of management of CDI may include a multimodal approach focusing on microbiota and immunologic therapies that could result in improved cure with reduced recurrence.

Critical care management of cerebral venous thrombosis David Fam, Gustavo Saposnik; on behalf of the Stroke Outcomes Research Canada Working Group Current Opinion in Critical Care 2016 22 (2) p113–119 Although recent trials of intervention for acute ischemic stroke have been positive, similar benefit in acute cerebral venous thrombosis (CVT) remains largely unclear. This review aims to summarize the existing evidence regarding the management of CVT, including anticoagulation and endovascular therapy.The mainstay of treatment in CVT is systemic anticoagulation even in the setting of intracerebral hemorrhage. Nonrandomized studies and case series suggest that endovascular therapy in CVT is relatively safe, and can improve outcomes in the small subset of CVT patients with neurologic deterioration despite anticoagulation.Despite a generally favorable prognosis, one in four patients with CVT develop neurological deterioration in the acute phase. Predisposing factors include a neurological deficit or seizures at onset, deep venous thrombosis, venous infarctions, or intracranial hemorrhage with mass effect and an underlying thrombophilia. More randomized trials are needed to compare the benefits of anticoagulation and endovascular therapy.

Gastrointestinal failure in the ICU Annika Reintam Blaser, Stephan M Jakob, Joel Starkopf, Current Opinion in Critical Care Issue: Volume 22(2), April 2016, p 128–141 Different ways to define gastrointestinal failure have been used in the past. Recently, the term ‘acute gastrointestinal injury (AGI)’ has been proposed to specifically describe gastrointestinal dysfunction as a part of multiple organ dysfunction syndrome. Possible pathophysiological mechanisms and different aspects in assessment of gastrointestinal function in adult ICU patients are presented. Currently, there is no single marker that could reliably describe gastrointestinal dysfunction. Therefore, monitoring and management is still 6

based on complex assessment of different gastrointestinal symptoms and feeding intolerance, even though this approach includes a large amount of subjectivity. The possible role of biomarkers (citrulline, enterohormones, etc.) and additional parameters like intraabdominal pressure remains to be clarified. Defining gastrointestinal failure remains challenging but broad consensus needs to be reached and disseminated soon to allow conduct of interventional studies. A systematic approach to management of gastrointestinal problems is recommended

The future of anesthesiology: implications of the changing healthcare environment Richard C Prielipp, Neal H. Cohen Current Opinion in Anaesthesiology 2016 29 (2) p198â&#x20AC;&#x201C;205 Anesthesiology is at a crossroad, particularly in the USA. We explore the changing and future roles for anesthesiologists, including the implication of new models of care such as the perioperative surgical home, changes in payment methodology, and the impact other refinements in healthcare delivery will have on practice opportunities and training requirements for anesthesiologists.The advances in the practice of anesthesiology are having a significant impact on patient care, allowing a more diverse and complex patient population to benefit from the knowledge, skills and expertise of anesthesiologists. Expanded clinical opportunities, increased utilization of technology and expansion in telemedicine will provide the foundation to care for more patients in diverse settings and to better monitor patients remotely while ensuring immediate intervention as needed. Although the roles of anesthesiologists have been diverse, the scope of practice varies from one country to another. The changing healthcare needs in the USA in particular are creating new opportunities for American anesthesiologists to define expanded roles in healthcare delivery. To fulfill these evolving needs of patients and health systems, resident training, ongoing education and methods to ensure continued competency must incorporate new approaches of education and continued certification to ensure that each anesthesiologist has the full breadth and depth of clinical skills needed to support patient and health system needs.The scope of anesthesia practice has expanded globally, providing anesthesiologists, particularly those in the USA, with unique new opportunities to assume a broader role in perioperative care of surgical patients.

Managing pressure ulcers and moisture lesions with new hydrocolloid technology Adele Linthwaite, Elaine Bethell British Journal of Nursing 25 (8) p443-448 In efforts to reduce the number of avoidable pressure ulcers in a large trust, a number of initiatives have taken place to increase staff awareness about the importance of preventing and treating pressure ulcers and moisture lesions. New documentation, the use of the 'Think Pink' folders and a social media campaign have all proved successful in seeing the number of avoidable pressure ulcers reported within the trust reduce. As part of this initiative an 7

evaluation took place of a new hydrocolloid dressing. This proved effective at reducing healing times, reducing dressing spend and facilitating regular inspection of the affected areas.

The impact of 12-hour shifts on team effectiveness Margaret Bradley British Journal of Mental Health Nursing This paper aims to illustrate the potential impact of 12-hour shifts on teamworking 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 multiprofessional mental health teams, both community- and ward-based. It is proposed that 12-hour 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.

For ITU 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.

Critical care nursing made incredibly easy! Woodruff, David W. Part of the award-winning Incredibly Easy series, this fun-to-read text is full of fun humor and illustrations, offering plenty of down-to-earth, expert advice and direction on crucial areas such as assessments, diagnostics, imaging, monitoring, pre- and post-operative care, and more. This comprehensive reference is a must-have for class use and NCLEX or certification exam preparation--and an invaluable on-the-spot clinical guide.

Quality management in intensive care : a practical guide (2016) Guidet, Bertrand; Valentin, Andreas; Flaatten, Hans This book is one of the first to comprehensively summarise the latest thinking and research in the rapidly evolving field of quality management in intensive care. Quality indicators and outcome measures are discussed with a practical focus on patient-centred, evidence-based implementation for safer and more effective clinical practice.

Merenstein and Gardner's handbook of neonatal intensive care (8th ed.) (2016) Gardner, Sandra L Merenstein & Gardner's Handbook of Neonatal Intensive Care, 8th Edition, is the leading resource for collaborative, interprofessional critical care of newborns. Co-authored by physicians and nurses, it offers concise, comprehensive coverage with a unique multidisciplinary approach and realworld perspective that make it an essential guide for both neonatal nurses and physicians.

Cases in diagnostic reasoning : acute and critical care nurse practitioner (2016) Burns, Suzanne M.; Delgado, Sarah A The ultimate, case-based guide for learning and teaching the art of diagnostic reasoning for acute and critical care nurse practitioners Written by experienced nurse practitioners working in acute and critical care settings,and endorsed by the American Association of Critical-Care Nurses (AACN), Acute & Critical Care Nurse Practitioner:Cases in Diagnostic Reasoning presents a wide range of acute and critical care patient cases focusing on diagnosis and management. analysis of patient data.

Oxford handbook of critical care nursing (2nd ed) (2016) Baid, Heather; Creed, Fiona; Hargreaves, Jessica

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.

COCHRANE REVIEWS/UPDATES BACK TO TOP

Lateral positioning for critically ill adult patients Cochrane systematic review, May 2015 Review authors could provide no clinical practice recommendations based on the findings of included studies. Available research could not eliminate the uncertainty surrounding benefits and/or risks associated with lateral positioning of critically ill adult patients. Research gaps include the effectiveness of lateral positioning compared with semi recumbent positioning for mechanically ventilated patients, lateral positioning compared with prone positioning for acute respiratory distress syndrome (ARDS) and less frequent changes in body position. We recommend that future research be undertaken to address whether the routine practice of repositioning patients on their side benefits all, some or few critically ill patients.

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

NICE SURVEILLANCE REPORTS Acute illness in adults in hospital: recognising and responding to deterioration This Surveillance Report focuses on a summary of selected new evidence relevant to NICE clinical guideline CG50. The decision matrix includes summaries and references for all new evidence considered. Chronic obstructive pulmonary disease in over 16s: diagnosis and management This Surveillance Report focuses on a summary of selected new evidence relevant to NICE clinical guideline CG101. The decision matrix includes summaries and references for all new evidence considered. Stable angina: management This Surveillance Report focuses on a summary of selected new evidence relevant to NICE clinical guideline CG126. The decision matrix includes summaries and references for all new evidence considered. Alcohol use disorders We carried out an exceptional surveillance review of NICE clinical guideline CG100 to allow us to consider the impact of the STOPAH trial results on the guideline recommendations. The decision matrix includes summaries and references for the new evidence considered.

NICE guidance: QS 119

Anaphylaxis

NG37

Fractures (complex): assessment and management

NG38

Fractures (non-complex): assessment and management

NG39

Major trauma: assessment and initial management

NG40

Major trauma: service delivery

NG42

Spinal injury: assessment and initial management

NG45

Routine preoperative tests for elective surgery

Shared decision-making: antibiotic use for acute respiratory infections

Overview:  A Cochrane systematic review found moderate quality evidence that interventions to facilitate shared decision-making reduced short-term prescribing of antibiotics for acute respiratory infections from 47% to 29% in primary care.  There were not enough data to assess whether the interventions produced a sustained reduction in antibiotic prescribing or adverse outcomes.  The NICE guidelines on antimicrobial stewardship and medicines optimisation recommend that all people have the opportunity to be involved in making decisions about their medicines.

Background: Antibiotics are sometimes prescribed to people who see their GP for acute respiratory infections. However, antibiotics have little benefit in these types of infections, such as in acute bronchitis (Smith et al. 2014) or colds (Kenealy and Arroll 2013). In addition, prescribing antibiotics for acute respiratory infections may contribute to the growth of antimicrobial resistance (Costelloe et al. 2010). Shared decision-making is the conversation that happens between a patient and their health professional to reach a healthcare choice together (NHS 2012). Shared decision-making is a potential strategy for reducing the overuse of ineffective treatments (Elwyn et al. 2012). Current advice: The NICE guideline on antimicrobial stewardship recommends that prescribers take time to discuss with the patient and/or their family members or carers (as appropriate):  the likely nature of the condition  why prescribing an antimicrobial may not be the best option  alternative options to prescribing an antimicrobial  their views on antimicrobials, taking into account their priorities or concerns for their current illness and whether they want or expect an antimicrobial  the benefits and harms of immediate antimicrobial prescribing  what they should do if their condition deteriorates (safety netting advice) or they have problems as a result of treatment  whether they need any written information about their medicines and any 15

possible outcomes. The NICE guideline on medicines optimisation recommends that all people have the opportunity to be involved in making decisions about their medicines. Healthcare professionals should find out what level of involvement in decision-making the person would like and avoid making assumptions about this. The guideline adds that patient decision aids can support health professionals to adopt a shared decision-making approach in a consultation, to ensure that patients, and their family members or carers where appropriate, are able to make well-informed choices that are consistent with the person’s values and preferences. Further recommendations on shared decision-making are outlined in the guideline. The NICE pathways on antimicrobial stewardship and medicines optimisation bring together all related NICE guidance and associated products on these issues into sets of interactive topic-based diagrams. New evidence: A Cochrane review by Coxeter et al. (2015) looked at whether interventions that aimed to facilitate shared decision-making increased or reduced antibiotic prescribing for acute respiratory infections in primary care. The review included 9 moderate quality randomised controlled trials (RCTs) in around 492,000 patients and over 1100 primary care doctors in several countries (3 RCTs included people from the UK). Reported study duration ranged from 14 days to just over 3.5 years. All studies provided education and communication skills training to improve GPs’ understanding in several areas such as risk communication techniques, evidence for the risk–benefit of antibiotics and other treatment options, and how to deal with patients’ concerns and expectations. Several interventions contained materials developed for patients. The primary outcome was prescription of antibiotics (for example, antibiotics prescribed per consultation, or a change in the population rate of antibiotic prescriptions per unit of time) compared with usual care. A pooled analysis of moderate quality evidence from 8 RCTs (n=10,172) showed that the interventions reduced short-term prescribing of antibiotics (immediately after or within 6 weeks of the consultation) for acute respiratory infections from 47% to 29% (risk ratio=0.61, 95% confidence interval 0.55 to 0.68, p<0.001). No significant differences were seen between the intervention and usual care groups in clinical complications, such as reconsultation for the same illness. Only 2 studies (n=1052) could be pooled to assess the effects of the intervention on patient satisfaction with the consultation, and no significant difference was seen between groups. However, the authors graded the data on patient satisfaction as low quality. The study is limited by the fact that there were not enough data to assess the effects of the intervention on sustained reduction in antibiotic prescribing, adverse outcomes (such as hospital admission, pneumonia or death), or on the involvement of the patient or caregiver in shared decision-making (such as regret or conflict with the decision made).

Commentary by Professor Alastair Hay, Professor of Primary Care and NIHR Research Professor, Centre for Academic Primary Care, University of Bristol and chair of the guideline development group for the NICE guideline on antimicrobial stewardship: “The majority of antibiotics prescribed in England are prescribed in primary care (Public Health England 2014). Ashworth et al. (2015) have recently shown an association between reduced practice-level antibiotic prescribing and reduced patient satisfaction. But GPs should not prescribe more antibiotics to improve patient satisfaction. “Clinicians and policy makers seeking solutions to the problem of prescribing and patient satisfaction should be encouraged by this Cochrane review by Coxeter et al. (2015). This study synthesises the evidence on shared decision-making for optimising the prescribing of antibiotics for respiratory tract infections. The review provides robust evidence of reduced prescribing with this approach, without reducing patient satisfaction. “Sadly, despite the review analysing data from nearly 500,000 patients, only 2 of the reviewed studies reported adverse event data (pneumonia and death) and none reported impacts on antimicrobial resistance. So, there remains an absence of evidence to evaluate the safety of reduced prescribing and the likely benefits in preventing antimicrobial resistance. “All NICE guidelines state patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. The NICEantimicrobial stewardship guideline states that antimicrobial stewardship interventions should include clinical education and that health and social care practitioners across all care settings should communicate consistent messages about antimicrobial use. “However, the evidence from this review goes beyond the principles of informed decision-making and suggests that NHS antimicrobial stewardship strategies could be significantly enhanced by implementing the interventions used in these studies. These include relatively inexpensive web-based training modules that clinicians complete at their convenience. A health economic evaluation has yet to be published, but the cost-effectiveness profile is likely to be enhanced due to the benefits of shared decision-making extending beyond prescribing for respiratory tract infections.”

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REPORTS, PUBLICATIONS AND RESOURCES

BACK TO TOP Quick guides: transforming urgent and emergency care services in England The Keogh Urgent Care Review NHS England and partners have published a series of quick guides to support local health and care systems. The guides provide practical tips, case studies and links to useful documents, which can be used to implement solutions to commonly experienced issues. Use the information to manage upcoming winter pressures and plan for 2016 and beyond. The quick guides will: • bring clarity on how best to work with the care sector • help you to find out how people across the country are working with the care sector to reduce unnecessary hospital admissions and delayed transfers of care • break down commonly held myths, for example, sharing patient information across integrated care teams and continuing healthcare assessments • allow you to use other people’s ideas and resources • enable you to break down barriers between health and care organisations

A different ending: End of life care review: Care Quality Commission People from certain groups in society are experiencing poorer quality care at the end of their lives than others because providers and commissioners do not always understand or fully consider their specific needs. Some commissioners and providers might not be fulfilling their duties under the Equality Act 2010 as all public bodies have a legal duty to consider the needs of a range of equality groups when carrying out their day-to-day work. Health and care staff are not always having conversations with people early enough about their end of life care. This means they don’t have the opportunity to make plans and choices with their loved-ones about how and where they would prefer to die. We identified examples of good practice, but found that action is needed to make sure everyone has the same access to high quality, personalised care at the end of their lives, regardless of their diagnosis, age, ethnic background, sexual orientation, gender identity, disability or social circumstances. Overview report. This report provides the background to the review and the key findings: A different ending: Addressing inequalities in end of life care (Overview)PDF | 2.51 MB Good practice report. Examples of good practice in end of life care that we found through our review: A different ending: Addressing inequalities in end of life care (Good practice)PDF | 1.83 MB 18

Ventilatory Management of Acute Hypercapnic Respiratory Failure Guideline British Thoracic Society/Intensive Care Society Acute Hypercapnic Respiratory Failure Guideline Development Group

Right place, right time: better transfers of care - a call to action. NHS Providers; 2015 Over four months in 2015, NHS Providers' 'Right place, right time' commission captured evidence and good practice in transfers of care in all settings involving our members â&#x20AC;&#x201C; across acute, community, mental health and ambulance services.]

TRAINING & NETWORKING OPPORTUNITIES, CONFERENCES, EVENTS BACK TO TOP

Airway Workshop The airway workshop provides an opportunity to gain hands on practice with airway equipment and teaching in core airway skills from experienced consultants. Appropriate for all grades of anaesthetic trainees, speciality doctors and consultants Date: Wed, 15/06/2016 Location: The Royal College of Anaesthetists Fee: £260 (£195 for RCoA registered trainees) CPD Credits Anticipated: 5 Availability: Places available Event code: C81 Event organiser(s): Dr R Bhagrath (See also events listed in previous issues of ITU Current Awareness.)

OTHER SERVICES, TRAINING & 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 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 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

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.

NEW! 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

NEW! 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.