May 2016 itu current awareness1 by Musgrove Park Hospital Library

Clinical Librarian Service Musgrove Park Academy

Current Awareness

ITU Issue 3 May 2016

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

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

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

Contents Click on a section title to navigate to contents

Page Recent journal articles

New books

Cochrane Reviews

Other evidence updates

ITU in the News

Reports, publications and resources

Training & Networking Opportunities, Conferences, Events

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

Critical care management of cerebral venous thrombosis Current Opinion in Critical Care: April 2016 - Volume 22 - Issue 2 - p 113–119 Fam, David; Saposnik, Gustavo Purpose of review: 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

Relationship Between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors Critical Care Medicine: April 2016 - Volume 44 - Issue 4 - p 655–662 Moitra, Vivek K; Guerra, Carmen; Linde-Zwirble, Walter T.; Wunsch, Hannah Among 34,696 patients who survived to hospital discharge, the mean ICU length of stay was 3.4 days (± 4.5 d). Patients (88.9%) were in the ICU for 1–6 days, representing 58.6% of ICU bed-days. Patients (1.3%) were in the ICU for 21 or more days, but these patients used 11.6% of bed-days. The percentage of mechanically ventilated patients increased with increasing length of stay (6.3% for 1–6 d in the ICU and 71.3% for ≥ 21 d). One-year mortality was 26.6%, ranging from 19.4% for patients in the ICU for 1 day, up to 57.8% for patients in the ICU for 21 or more days. For each day beyond 7 days in the ICU, there was an increased odds of death by 1 year of 1.04 (95% CI, 1.03–1.05) irrespective of the need for mechanical ventilation. Increasing ICU length of stay is associated with higher 1-year mortality for both mechanically ventilated and non–mechanically ventilated patients. No specific cutoff was associated with a clear plateau or sharp increase in long-term risk. 3

Physical Function and Mental Health in Trauma Intensive Care Patients: A 2-Year Cohort Study Critical Care Medicine: April 2016 - Volume 44 - Issue 4 - p 734â&#x20AC;&#x201C;746 Physical function and mental health improved over time; however, the averages remained below Australian norms at 24 months. Optimistic perception of illness and greater selfefficacy were potentially modifiable factors associated with improved mental health and physical function over time. Greater perceived social support, also potentially modifiable, was associated with improved mental health. Injury insurance and income were significant nonmodifiable factors for mental health, with mental health gains associated with higher income. Hospital length of stay and injury insurance were nonmodifiable factors linked with physical function. Improvements in physical function and mental health are evident in the 24 months following injury, but most patients remain below Australian population norms. Factors that were associated with physical function and mental health outcomes over time that are potentially amenable to change include illness perception, self-efficacy, and perceived social support.

Damage Control Resuscitation James N. Bogert, John A. Harvin, Bryan A. Cotton J Intensive Care Med March 2016 vol. 31 no. 3 177-186 Resuscitation of the hemorrhaging patient has undergone significant changes in the last decade resulting in the concept of damage control resuscitation (DCR). Hemostatic resuscitation aims to address the physiologic derangements found in the hemorrhaging patient, namely coagulopathy, acidosis, and hypothermia. Strategies to achieve this are permissive hypotension, high ratio of plasma and platelet transfusion to packed red blood cell transfusion, and limitation of crystalloid administration. Damage control surgery aims for early hemorrhage control and minimizing operative time by delaying definitive repair until the patientâ&#x20AC;&#x2122;s physiologic status has normalized. Together these strategies constitute DCR and have led to improved outcomes for hemorrhaging patients over the last 2 decades. Recently, DCR has been augmented by both pharmacologic and laboratory adjuncts to improve the care of the hemorrhaging patient. These include thrombelastography as a detailed measure of the clotting cascade, tranexamic acid as an antifibrinolytic, and the procoagulant activated factor VII. In this review, we discuss the strategies that makeup DCR, their adjuncts, and how they fit into the care of the hemorrhaging patient.

Structure and Function of the Kidney in Septic Shock: A Prospective Controlled Experimental Study .Am J Respir Crit Care Med. First published online 11 Mar 2016 4

Matthew J Maiden, Sophia Otto et al Rationale: It is unclear how septic shock causes acute kidney injury (AKI) and whether this is associated with histological change. Objectives: We aimed to determine the nature and extent of changes in renal structure and function over time in an ovine model of septic shock. Methods: Fifteen sheep were instrumented with a renal artery flow probe and renal vein cannula. Ten were given intravenous E. coli to induce septic shock and five acted as controls. Animals were mechanically ventilated for 48 hours, while receiving protocol guided parenteral fluids and a norepinephrine infusion to maintain mean arterial pressure. Renal biopsies were taken every 24 hours or whenever animals were oliguric for two hours. A renal pathologist, blinded to tissue source, systematically quantified histological appearance under light and electron microscopy for 31 pre-specified structural changes. Measurements and Main Results: Sheep given E. coli developed septic shock, oliguria, increased serum creatinine and reduced creatinine clearance (AKI) but there were no changes over time in renal blood flow between groups (P>0.30) or over time within groups (P>0.50). Renal oxygen consumption increased only in non-septic animals (P=0.01) but there was no between-group difference in renal lactate flux (P>0.50). There was little structural disturbance in all biopsies and, while some cellular appearances changed over time, the only difference between septic and non-septic animals was mesangial expansion on electron microscopy. Conclusions: In an intensive care supported model of Gram-negative septic shock, early AKI was not associated with changes in renal blood flow, oxygen delivery or histological appearance. Other mechanisms must contribute to septic AKI.

Adjunctive corticosteroids improve the need for mechanical ventilation and shorten hospital duration in patients hospitalised with community-acquired pneumonia Mirjam Christ-Crain, Willem Jan W Bos Respiratory tract infections and pneumonia in particular are the third leading cause of death worldwide. The prognosis of community-acquired pneumonia (CAP) dramatically improved with the availability of antibiotics; however, it still carries a high risk for long-term morbidity and mortality, which has not changed over the past few decades. Systemic corticosteroids have anti-inflammatory effects that attenuate the inflammatory process in CAP which can potentially be harmful. Adjunct treatment with corticosteroids has been discussed since the 1950s and many studies were conducted to investigate the efficacy of corticosteroids in CAP. However, so far, no adjunct therapy is recommended.

ICU physicians are unable to accurately predict length of stay at admission: a prospective study Antonio Paulo Nassar, Jr and Pedro Caruso Int J Qual Health Care 2016 28: 99-103 To evaluate the accuracy of prediction of intensive care unit length of stay made by physicians at patient admission. A total of 2955 patients were admitted during the study 5

period. Physicians accurately predicted ICU length of stay in 1557 (52.7%) admissions. ICU length of stay was underestimated in 864 (29.2%) and overestimated in 534 (18.1%) cases. Agreement between predicted and actual intensive care unit length of stay was poor (Kappa = 0.22) and not associated with physician characteristics. Predictions of an intensive care unit length of stay of >5 days were significantly less accurate than those of <48 h and of 2â&#x20AC;&#x201C;5 days (31.1, 59.8 and 53.1%, respectively, P < 0.001). The intensive care unit length of stay prediction in these oncological intensive care units is inaccurate and, ideally, should not be made at admission.

Incident and error reporting systems in intensive care: a systematic review of the literature Anja H. Brunsveld-Reinders, M. Sesmu Arbous, Rien De Vos, and Evert De Jonge Int J Qual Health Care 2016 28: 2-13 We performed a systematic review to assess (i) to what extent incident reporting systems (IRSs) on the adult intensive care unit (ICU) meet the criteria of the WHO Draft Guidelines for Adverse Event Reporting and Learning Systems, (ii) to what extent the IRSs comply with the four aspects of the iterative quality loop and (iii) whether IRSs have led to improvement measures in clinical practice. None of the IRSs completely fulfilled the WHO checklist criteria. With respect to the iterative loop, data input and data collection are well established but not much attention was given to analyzing incidents and to give feedback. This resulted in an administrative report system, rather than the much desired instrument for change of practice and increase of quality as an IRS can only effectively contribute to improve patient safety and quality of care if more attention is given to analyzing incidents and feedback.

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.

ABC of intensive care (2nd ed) (2011) Nimmo, Graham R.; Singer, Mervyn This new and updated edition is a practical guide to intensive care for the non-specialist, providing the core knowledge and principles of intensive care patient management. From general principles through to critical care outreach and end of life care, it covers best practice management in the intensive care unit. It includes the key organ system support as well as monitoring, sepsis, brain-stem death, and nutrition in intensive care. There is also full coverage of organ donation.

Key clinical topics in critical care edited by Sara-Catrin Cook ...[et al] Key Clinical Topics in Critical Care offers an indispensable and practical guide for exam revision and clinical practice. Written and edited by specialists with a wealth of clinical experience, this book provides rapid access to core topics in critical care. Each topic is written in a concise and easy-to-digest format, making this book the essential resource for exam revision and quick reference at the point of care.

Monitoring the critically ill patient (3rd ed) (2012) Jevon, Philip; Ewens, Beverley Monitoring the Critically Ill Patient is an invaluable, accessible guide to caring for critically ill patients on the general ward. Now fully updated and improved throughout, this well-established and handy reference guide text assumes no prior knowledge and equips students and newlyqualified staff with the clinical skills and knowledge they need to confidently monitor patients at risk, identify key priorities, and provide prompt and effective care.

Pharmacology for anaesthesia and intensive care (4th ed) (2014) Peck, Tom E.; Hill, Sue A. The fourth edition of this marketleading anaesthetic book has been fully updated to include novel oral anticoagulants and neuromuscular reversal agents. Numerous other sections have been expanded or updated to reflect new research and current best practice, and the antibiotics chapter now includes information about commonly encountered pathogens and the drugs used to target them. Basic pharmacological principles, vital to understanding the effects of individual drugs, are dealt with methodically, and the essential physiology is described alongside the relevant pharmacology.

COCHRANE REVIEWS/UPDATES BACK TO TOP

Perioperative local anaesthesia for reducing pain following septal surgery (Protocol). Cochrane Database of Systematic Reviews 2016, Issue 1. Fujiwara T, Kuriyama A, Kato Y, Fukuoka T, Ota E. This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of perioperative local anaesthesia for reducing pain and complications in septal surgery.

High-frequency oscillatory ventilation versus conventional ventilation for acute respiratory distress syndrome Sachin Sud, Maneesh Sud, Jan O Friedrich, et al First published: 4 April 2016 The findings of this systematic review suggest that HFO does not reduce hospital and 30-day mortality due to ARDS; the quality of evidence was very low. Our findings do not support the use of HFO as a first-line strategy in people undergoing mechanical ventilation for ARDS.

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

From NICE: 

Endovascular aneurysm sealing for abdominal aortic aneurysm

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Mechanical clot retrieval for treating acute ischaemic stroke

Delirium in critically ill people

Overview:  Adults admitted to an intensive care unit who had delirium were at higher risk of in-hospital death than people without delirium.  The study supports current guidance recommendations that all hospitalised patients should be assessed for risk of delirium, and those at risk offered multicomponent delirium interventions.

Background: Delirium, also known as ‘acute confusional state’, is a common clinical syndrome characterised by disturbed consciousness, cognitive function and perception. Between 18% and 35% of people admitted to general medical wards have delirium, whereas around 50% of people admitted to surgical wards and up to 82% admitted to intensive care units have the disorder (Inouye et al. 2014). People in hospital who have delirium have an increased risk of death, dementia, and being discharged to a nursing home compared with people who do not have delirium (Witlox et al. 2010). Current advice: The NICE guideline on delirium recommends assessing people for the following risk factors for delirium when they first present to hospital:  age 65 years or older  cognitive impairment (past or present) and/or dementia  current hip fracture  severe illness (a clinical condition that is deteriorating or is at risk of deterioration). People at risk should be assessed at presentation for recent (within hours or days) changes or fluctuations in behaviour. A multicomponent intervention tailored to the person’s individual needs and care setting should be provided to prevent delirium.

All people in hospital or long-term care should be observed, at least daily, for recent (within hours or days) changes or fluctuations in usual behaviour. If any behaviour changes are present, a healthcare professional who is trained and competent in the diagnosis of delirium should carry out a clinical assessment to confirm the diagnosis. The NICE pathway on delirium brings together all related NICE guidance and associated products on the condition in a set of interactive topic-based diagrams. New evidence: A meta-analysis by Salluh et al. (2015) investigated the link between delirium in critically ill people and short-term inpatient and post-discharge outcomes. The authors sought studies of adults admitted to an intensive care unit and assessed for delirium using a validated screening or diagnostic instrument. A total of 44 papers on 42 studies were identified (n=16,595). Two of the studies were randomised controlled trials and 40 were prospective observational cohort studies. Just under a third (31.8%) of participants in intensive care had delirium. In the 28 studies that reported on mortality (n=10,656), the risk of death in the intensive care unit or in hospital was significantly higher in people with delirium than in those without delirium (random risk ratio=2.19, 95% confidence interval [CI] 1.78 to 2.70, p<0.001). This risk remained high after adjustment for age, gender and severity of illness (effect size=2.72, 95% CI 1.75 to 3.69). Among the 8 studies that reported outcomes after discharge, 2 studies reported increased mortality at 6 months in people who had delirium when they were in intensive care (p<0.001, n=523 and p=0.033, n=224). Four studies with between 3 and 12 monthsâ&#x20AC;&#x2122; follow-up reported worse scores on cognitive tests in people who had delirium in intensive care compared with those who had not had delirium. Strengths of this analysis include the large number of studies and participants. This study is 2 limited by the heterogeneity of the included studies (I =72%), such as in the patient populations and the methods used to detect delirium. In addition, the studies were at moderate risk of publication bias, and the results may have been affected by unmeasured confounders.

Routine preoperative tests for elective surgery NICE guidelines [NG45]Published date: April 2016 This guideline covers routine preoperative tests for people aged over 16 who are having elective surgery. It aims to reduce unnecessary testing by advising which tests to offer people before minor, intermediate and major or complex surgery, taking into account specific comorbidities (cardiovascular, renal and respiratory conditions and diabetes and obesity). It does not cover pregnant women or people having cardiothoracic procedures or neurosurgery.

NICE updates guidelines information to put patients at centre of decision making. NICE has updated its guidelines pages to explain how they should be used in offering patients and service users the best care. The new wording explains that guidelines should be taken fully into account but that the patient, or person receiving care, should be at the heart of decisionmaking.

Preoperative tests for elective surgery

This guideline covers routine preoperative tests for people aged over 16 who are having elective surgery. It aims to reduce unnecessary testing by advising which tests to offer people before minor, intermediate and major or complex surgery, taking into account specific comorbidities (cardiovascular, renal and respiratory conditions and diabetes and obesity). It does not cover pregnant women or people having cardiovascular procedures or neurosurgery.

INTENSIVE/CRITICAL CARE IN THE NEWS BACK TO TOP

Hip fracture: 30-day mortality rate The Health Quality Improvement Partnership has published National Hip Fracture Database (NHFD): an analysis of 30-day mortality in 2014. This document is a supplement to the 2015 audit annual report which presented results from over 64,000 patients who were admitted for hip fracture during 2014. The supplement analyses data from the Office for National Statistics which indicates the overall mortality rate within 30 days of hip fracture in 2014 was 7.5%. This continues a pattern of progressive improvement from 8.5% in 2011.

Alzheimer's disease 'wonder drug' claims are premature The number of people with Alzheimer's disease is increasing as the global population ages. Researchers have estimated 44 million people currently have the condition, and this number will grow to more than 135 million by 2050. It's believed the condition is caused at least in part by the accumulation of toxic aggregates of beta-amyloid protein pieces in the brain. Researchers hope stopping this aggregation could be a way to prevent or treat the disease, but have not yet found successful ways of doing this. This piece of research looked at nerve cells and microscopic worms genetically modified to develop beta-amyloid aggregates. The researchers aimed to develop a way to identify chemicals that could suppress the formation of toxic amyloid aggregates. They identified the cancer drug bexarotene as one drug that could do this. The main limitation of this study is it only provides very early-stage findings, which are so far in nerve cells and a short-lived worm model. As worms are much simpler organisms than humans, the next step would be confirming these findings in more complex animal models, like mice, before considering testing in humans. Bexarotene has been investigated before in animals, with mixed results. The drug only appears to slow the formation of beta-amyloid aggregates, so even if it does show an effect in further studies, it may not be able to prevent Alzheimer's completely. In addition, the drug did not show an effect in worms if given once the beta-amyloid had taken hold, which suggests it needs to be given early on. This is supported by the fact the drug has also been found to be ineffective in people with established Alzheimer's disease. But targeting very early-stage disease or using the drug in people without Alzheimer's has not been studied. Researchers will need to think about how they might target people for trials of this drug in a preventative capacity. Many people may not be willing to take a drug for a long period of time to prevent a disease they may or may not get. Also, bexarotene has a number of undesirable side effects, including increasing blood cholesterol levels, which can increase the risk of heart disease. Would healthy people be willing to reduce the risk of one chronic disease while raising the risk of another? Targeting people who have a higher risk of developing the disease is likely to be more feasible. It's also likely bexarotene would need to be refined in some way to reduce its side effects before it could ever be used as a "statin for the brain".

REPORTS, PUBLICATIONS AND RESOURCES

Ref

Title

Type

QS119

Anaphylaxis

Quality Standard

QS118

Food allergy

Quality Standard

QS120

Medicines optimisation

Quality Standard

End of life care and physician assisted dying The British Medical Association has published End-of-life care and physician-assisted dying: reflections and recommendations. This is the final part of a three volume report of a project covering both end-of-life care and physician-assisted dying. The purpose of this volume is to reflect on some of the points emerging from the public dialogue research and what lessons can be learnt and what changes are needed to ensure that doctors are able to provide high quality end-of-life care for all of their patients. It sets the agenda for future work and policy development in this area.

TRAINING & NETWORKING OPPORTUNITIES, CONFERENCES, EVENTS BACK TO TOP

The 4th Annual ACCP Conference Tol be held on Thursday 16th June 2016 at the Medical Education Centre of Northern General Hospital in Sheffield. Date: Thursday 16th June 2016. Location: Northern General Hospital, Sheffield Fee: £45 CPD Credits Anticipated: 5 Availability: Places available Event code: H25 Event organiser(s): Ms Carole Boulanger & Dr Graham Nimmo The programme will include:  Post resuscitation cardiac care  Intensive care for haematology and oncology patients  Multiple trauma  Workshops on: Organ donation, thoracic ultrasound, CPD, social media as an educational tool and setting up an ACCP programme  Delirium: recognition, assessment and treatment  Legal and ethical aspects of end of life care REGISTRATION IS NOW OPEN: PLEASE CLICK HERE TO BOOK ONLINE.

Chronic Conundrums in Critical Care After the resounding success of last year's SOS Sim: Managing Medical Emergencies in Critical Care, Central South Committee have organised another simulation study day. Due to the success of critical care nursing there is an emergence of a new population of patients who have overcome the acute phase of their critical illness but who are then dependent on techniques that support their vital functions- the chronically critically ill. In addition critical care nurses are treating patients with advanced age and multiple co-morbidities. The aim of this simulation study day is to explore the often complex and challenging care of such patients in ICU. There will be simulation stations on chronic critical illness syndrome, COPD, failure to wean, delirium and end of life care. The stations will be facilitated by internationally recognised experts in the field using state of the art simulation facilities. We hope you will join us in what will be a thoroughly informative and enjoyable day. It is scheduled for the 9th June 2016 at the Faculty of Health and Life Sciences, Oxford Brookes University, Oxford. If you would like to book your place please CLICK HERE FOR FURTHER INFORMATION

Advanced Airway Workshop

Date: Thu, 26/05/2016. Location: G&V Royal Mile Hotel Edinburgh Fee: £260 (£195 for RCoA registered trainees). Advanced days are aimed at those who are actively involved in airway education, and have a reasonable expectation of encountering potentially complex airways either through a regular list or an infrequent on-call commitment. They are also appropriate for senior trainees (ST5 - 7) who are considering making the field of airway management one of their special interests. This event tend to be less didactic and more discursive than Airway Days, and whilst the emphasis remains on a handson workshop approach the absolute format of each station will depend on the needs of the assembled group.

Patient Safety in Perioperative Practice Date: Wed, 20/07/2016 Location: The Royal College of Anaesthetists Fee: £200 (£150 for RCoA registered trainees) A one day meeting to discuss patient safety, including the barriers to delivering safe perioperative care, and strategies on how to overcome them. Its aims are to build upon existing knowledge and clinical practice to make systems, processes and organisations safer: Using the science of patient safety, drawing upon previous errors and the use of education (including simulation) and quality improvement programs, to improve patient care.

OTHER SERVICES BACK TO TOP

A. Literature & Evidence searches 

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

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Do you need a literature search carried out?

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Do you need to find evidence to support an improvement?

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

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

To request a search, please complete and return this form, providing as much information as possible. Alternatively if you would like an assisted search training session, where we will sit down with you and go through the steps of a literature search, then please contact the library. B. Journal clubs Do you have a journal club or are thinking of starting one up? If so, please contact the Library. We will be happy to attend any new or existing journal club in a contributory or facilitating role. C. Alerts One of the services offered by the Clinical Librarian is personsalised literature/evidence alerts. All you need to do is identify which ongoing evidence issues you are particularly interested in and provide that information to Terence.Harrison@tst.nhs.uk Once something comes up that matches those interests you will then be emailed the details.

TRAINING AND ATHENS BACK TO TOP Most electronic resources are available via an Athens password. You can register for this via the Library intranet page, or from home at http://www.swice.nhs.uk/ and following the link for Athens selfregistration. Please note that registering from home will take longer as it will need to be verified that you are NHS staff/student on placement.

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

TO BOOK A COURSE, click here