March 2016 itu current awareness1

Clinical Librarian Service Musgrove Park Academy

Current Awareness

ITU Issue 2 March 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

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Contents Click on a section title to navigate to contents

Page Recent journal articles

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New books

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Cochrane Reviews

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Other evidence updates

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ITU in the News

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Reports, publications and resources

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Training & Networking Opportunities, Conferences, Events

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Literature & Evidence search services

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Training and Athens

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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

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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

Use of Proton Pump Inhibitors Linked to Increased Dementia Risk Lewis H. Kuller, M JAMA Neurol. Published online February 15, 2016 Older adults who use proton pump inhibitors may be at increased risk for developing dementia, according to an observational study in JAMA Neurology. Using claims from a large German health insurer, researchers studied nearly 74,000 adults aged 75 and older without dementia in 2004. By 2011, roughly 40% were diagnosed with dementia. Overall, 4% of participants used PPIs regularly during at least one 12-to-18-month interval during the study period. After adjustment for confounders, including age, polypharmacy, stroke, and depression, PPI use was associated with a 44% increased risk for incident dementia. As potential mechanisms of action, the authors cite evidence suggesting that some PPIs can cross the blood-brain barrier and affect brain enzyme levels.

They call for randomized trials to confirm their observational findings.

Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries Giacomo Bellani, John G. Laffey, TĂ i Pham et al Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS.

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 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 3

contribute to improve patient safety and quality of care if more attention is given to analyzing incidents and feedback.

Interventions for the prevention of catheter associated urinary tract infections in intensive care units: An integrative review Galiczewski, Janet M Intensive & Critical Care Nursing32 (Feb 2016): 1-11.

Catheter associated urinary tract infections (CAUTIs) put an unnecessary burden on patients and health care systems. The purpose of this integrative review was to examine existing evidence on preventative interventions and protocols currently implemented in intensive care units (ICUs) and the impact they have on CAUTI rates and patient outcomes. This review analysed 14 research articles obtained from electronic databases and included adult patients with urinary catheters in an ICU setting. Evidence demonstrated interventions that included criteria for catheter use, daily review of catheter necessity and discontinuation of catheter prior to day seven were successful in decreasing CAUTI rates. This review provides a scientific basis for the effectiveness of these interventions and protocols. Identification and use of interventions with the greatest positive impact on CAUTI rates are an asset to healthcare professional caring for patients with indwelling catheters and nurse clinicians developing policies.

Criteria for initiation of invasive ventilation in septic shock: An international survey de Montmollin, Etienne; Aboab, Jerome; Ferrer, Ricard; Azoulay, Elie; Annane, Djillali.

Journal of Critical Care 31.1 (Feb 2016): 54-57.

The objective of this study is to record intensivists' beliefs on indications and modalities of ventilatory support in critically ill patients with septic shock. The instrument is a 23-items questionnaire, sent to all members of the Systemic Inflammation and Sepsis section of the European Society of Intensive Care Medicine. A total of 186 intensivists from 30 countries completed the survey. For 95% of respondents, intubation should be performed in patients with neurologic or respiratory failure. There was much less consensus about cardiovascular failure as a reason for initiation of invasive mechanical ventilation. Among the 7 hemodynamic criteria proposed, none achieved strong agreement. Among respiratory criteria, hypoxemia, signs of respiratory distress, and cyanosis were the most strongly associated with the will to intubate. Among neurologic criteria, a Glasgow score lower than 8 was strongly associated with the will to intubate. Strikingly, 51% of respondents believed that invasive mechanical ventilation would worsen patients with septic shock, mainly through hemodynamic deterioration (70.4%). This survey highlights the general belief that invasive mechanical ventilation may worsen hemodynamic status in patients with septic shock.

There was general agreement with the mandatory need to initiate mechanical ventilation in patients with respiratory failure and coma, but with little respect to hemodynamic criteria.

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Current management strategies and long-term clinical outcomes of upper extremity venous thrombosis Suzanne M. Bleker, Nick van Es, Ankie Kleinjan, et al.

We followed 102 and 55 patients with UEDVT and UESVT respectively, both for a median of 3.5 years. Anticoagulant treatment was started in 100 patients with UEDVT (98%) and in 40 (73%) with UESVT. Nine patients with UEDVT (9%) developed recurrent VTE, 26 (26%) died, 6 of 72 patients (8%) had moderate postthrombotic symptoms and 5 (5%) experienced major bleeding. One patient with UESVT had a recurrent VTE, 18 (33%) died, none had moderate postthrombotic symptoms and none had major bleeding. Of the cancer patients with UEDVT, 18% had recurrent VTE versus 7.5% in non-cancer patients (adjusted HR 2.2, 95%CI 0.6 to 8.2). The survival rate was 50% in cancer patients with UEDVT versus 60% in those without (adjusted HR 0.8, 95%CI 0.4 to 1.4). The risk of recurrent VTE was low in patients with UEDVT, and negligible for UESVT. Mortality was high for both diseases.

Postthrombotic symptoms were infrequent and mild. Anticoagulant therapy of UEDVT carried a substantial risk of major bleeding. Cancer patients had a significant risk of recurrent VTE.

New Bacteria Species that Causes Lyme Disease Discovered Scientists report the discovery of a new species of bacteria (Borrelia mayonii) in the upper Midwest of the U.S. that causes a unique presentation of Lyme disease. Their findings appear in the Lancet Infectious Diseases. Researchers screened over 100,000 clinical samples for the presence of B. burgdorferi bacteria, which causes Lyme disease. Of these, six were flagged as a unique species, which they called B. mayonii. Roughly 20 ticks also tested positive for this bacterium. The researchers examined medical records and found that patients infected with B. mayonii experienced nausea, vomiting, diffuse macular rashes, and elevated levels of bacteria in the blood, in addition to symptoms typically associated with B. burgdorferi infection (e.g., headache, neck pain). Three patients also experienced neurologic symptoms, including confused speech, profound somnolence, and visual difficulties. All lived in Minnesota, Wisconsin, or North Dakota. Commentators conclude: "Interestingly, candidatus B. mayonii was only detected in specimens obtained during 2012–2014, although the sample collection dates back to 2003. This suggests that candidatus B. mayonii is a newly-emerged genospecies." The CDC says that patients infected with B. mayonii should test positive for Lyme disease with current tests.

Changes in patient safety culture after restructuring of intensive care units: Two crosssectional studies Vifladt, Anne; Simonsen, Bjoerg O; Lydersen, Stian; Farup, Per G In this study, the restructuring of intensive care units was associated with a negative impact on the safety culture. When restructuring, the management should be particularly aware of changes in the safety culture dimensions manager expectations and actions promoting 5

safety, teamwork within hospital units and staffing.

Acute respiratory distress syndrome: Predictors of noninvasive ventilation failure and intensive care unit mortality in clinical practice Chawla, Rajesh; Mansuriya, Jaimin; Modi, Nikhil; Pandey, Abha; Juneja, Deven; Chawla, Aakanksha; Kansal, Sudha Noninvasive ventilation maybe useful in selected patients with mild ARDS but should be used with great caution in moderate and severe ARDS, as failure risk is high. In addition, low Pao2/Fio2and shock are associated with NIV failure. Acute Physiology and Chronic Health Evaluation II score, shock, low Pao2/Fio2, and ARDS severity are associated with increased mortality.

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For ITU automated tables of contents: click here.

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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.

Drugs in anaesthesia and intensive care (2016) Scarth, Edward The new edition includes a complete revision of all the featured drugs, and the addition of key new drugs. New diagrams of particular drug structures and comparison tables aid comparison of differences within a drug class for exam revision. Improved navigation in the indexenables prompt discoverability of information. Written in a concise, bulletpoint style to allow quick access to information, the book contains all necessary drug references for anaesthetists in training, consultant anaesthetists, intensive care nurses, and anaesthetic assistants.

Duke's anesthesia secrets [edited by] James C. Duke, Brian M. Keech. 5th ed (2016)Electronic Get quick answers to the most important clinical questions with Duke's Anesthesia Secrets, 5th Edition! Authors James Duke, MD and Brian M. Keech, MD present this easy-to-read, bestselling resource that uses the popular and trusted Secrets Series速This enhanced eBook experience allows you to search all of the text, figures, and tables from the book on a variety of devices.

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Evidence-based practice of critical care [edited by] Clifford S. Deutschman, Patrick J. Neligan. - 2nd ed (2016) Evidence-Based Practice of Critical Care, 2nd Edition, presents objective data and expert guidance on managing critically ill patients in unique question-based chapters that focus on best practices. Now thoroughly updated

by Drs. Clifford S. Deutschman, Patrick J. Neligan, and nearly 200 critical-care experts, this highly regarded title remains the only book of its kind that provides a comprehensive framework for translating evidence into practice, making it a valuable resource for both residents and practitioners

Oxford handbook of anaesthesia edited by Keith G. Allman, Iain H. Wilson. 4th ed (2016)Book Now on its fourth edition, the Oxford Handbook of Anaesthesia provides authoritative, concise guidance on all aspects of anaesthesia. Evidence-based, upto-date, and clinically-focused, it is indispensable for both anaesthetic trainees and experienced practitioners. Building on the award-winning success of previous editions, the Oxford Handbook of Anaesthesia is as relevant and important as ever.

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COCHRANE REVIEWS/UPDATES BACK TO TOP

Wang Li, Li Xiao, Yang Zongxia, et al Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation Cochrane Database of Systematic Reviews, YR: 2016, NO: 1 A semi-recumbent position (? 30º) may reduce clinically suspected VAP compared to a 0° to 10° supine position. However, the evidence is seriously limited with a high risk of bias. No adequate evidence is available to draw any definitive conclusion on other outcomes and the comparison of alternative semi-recumbent positions. Adverse events, particularly venous thromboembolism, were under-reported.

Frequency of dressing changes for central venous access devices on catheter-related infections Gavin Nicole C, Webster Joan, Chan Raymond J, Rickard Claire M Cochrane Database of Systematic Reviews, 2016, NO: 2 Two trials randomised a total of 371 participants to longer or shorter dressing intervals and measured catheter-site infection. It is unclear whether there is a difference in risk of catheter-site infection between people having long or short intervals between dressing changes (RR 1.07, 95% CI 0.71 to 1.63) (low quality evidence). Skin damageOne small trial (112 children) and three trials (1475 adults) measured skin damage. There was very low quality evidence for the effect of long intervals between dressing changes on skin damage compared with short intervals (children: RR of scoring ? 2 on the skin damage scale 0.33, 95% CI 0.16 to 0.68; data for adults not pooled).

PainTwo studies involving 193 participants measured pain. It is unclear if there is a difference between long and short interval dressing changes on pain during dressing removal (RR 0.80, 95% CI 0.46 to 1.38) (low quality evidence).Authors' conclusions: The best available evidence is currently inconclusive regarding whether longer intervals between CVAD dressing changes are associated with more or less catheter-related infection, mortality or pain than shorter intervals.

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

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

From NICE: Risk of intracranial bleeding when antidepressants are used with NSAIDs A Korean cohort study found that use of antidepressants in combination with non-steroidal antiinflammatory drugs (NSAIDs) was associated with an increased risk of bleeding inside the skull within 30 days of first taking the drugs together.

Tests for rapidly identifying bloodstream bacteria and fungi (LightCycler SeptiFast Test MGRADE, SepsiTest and IRIDICA BAC BSI assay Evidence-based recommendations on the the LightCycler SeptiFast Test MGRADE, SepsiTest and IRIDICA BAC BSI assay for rapidly identifying bloodstream bacteria and fungi.

From BMJ Evidence (note you may need to logon to BMJ Evidence to access these items): Intraoperative Goal-directed Fluid Therapy in Elective Major Abdominal Surgery: A Meta-analysis of Randomized Controlled Trials.

Ann Surg. 2016 Mar;263(3):465-76. doi: 10.1097/SLA.0000000000001366.

Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial.

Anesthesiology. 2016 Feb;124(2):362-8. doi: 10.1097/ALN.0000000000000951

Effect of Acetazolamide vs Placebo on Duration of Invasive Mechanical Ventilation Among Patients With Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial.

JAMA. 2016 Feb 2;315(5):480-8. doi: 10.1001/jama.2016.0019.

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INTENSIVE/CRITICAL CARE IN THE NEWS BACK TO TOP

The following requires registration with Medscape (free): COPD Drug Does Not Significantly Reduce Ventilator Time Medscape Medical News, February 2, 2016

Steroids in CAP: Beneficial, Harmful, or Inconsequential?A meta-analysis examines the question of whether corticosteroids are of any use in adults hospitalized with community-acquired pneumonia.

Medscape Critical Care, January 26, 2016

Respiratory Failure in Immunocompromised Patients Medscape Critical Care, January 27, 2016

Noninvasive Ventilation in the Immune-compromised Patient Medscape Critical Care, January 19, 2016

Other: Antiviral prescribing when A(H1N1)pdm09 influenza virus is the dominant circulating strain...

29 Jan 2016 Public Health England have released an update on the guidance for prescribing.

An Early Warning for Cardiac Arrest During Laparoscopic Surgery International Journal for Quality in Health Care

Zika virus: 

Questions your patients may have about Zika virus by Zosia Kmietowicz

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Zika virus – BMJ resources freely available

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World Health Organization factsheets, FAQs, media statements, and information for health authorities and and the general public 12

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Public Health England guidance about Zika virus

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Centers for Disease Control and Prevention (CDC) guidance

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List of countries with local Zika transmission from the European Centre for Disease Prevention and Control

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REPORTS, PUBLICATIONS AND RESOURCES

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Guidelines for the Provision of Anaesthetic Services (GPAS) 2016 The Royal College of Anaesthetists are pleased to announce the publication of the 2016 version of the Guidelines for the Provision of Anaesthetic Services (GPAS). These form the basis of recommendations produced by the RCoA for anaesthetists with responsibilities for service delivery and for healthcare managers. The 2016 edition of GPAS represents a landmark year in the evolution of this important document. For the first time, the GPAS document includes chapters developed using a new rigorous, evidence-based process that involves a variety of stakeholders, and developed and managed by the Clinical Quality Directorate at the College. The new development process has been based on the requirements for NICE accreditation, for which the College has applied. The chapters chosen to pilot this new methodology were the chapters describing services for effective delivery of pre-operative and post-operative care, as well as the chapter concerned with emergency anaesthesia care.

Royal College of Anaesthetists events‌ Click here for full calendar (pdf)

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TRAINING & NETWORKING OPPORTUNITIES, CONFERENCES, EVENTS BACK TO TOP

ACCP Conference The 4th Annual ACCP Conference will 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

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Intensive care for haematology and oncology patients

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Multiple trauma

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Workshops on: Organ donation, thoracic ultrasound, CPD, social media as an educational tool and setting up an ACCP programme

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Delirium: recognition, assessment and treatment

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Legal and ethical aspects of end of life care

REGISTRATION IS NOW OPEN: CLICK HERE TO BOOK ONLINE.

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OTHER SERVICES BACK TO TOP

A. Literature & Evidence searches 

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

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Do you need a literature search carried out?

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Do you need to find evidence to support an improvement?

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

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

To request a search, please complete and return this form, providing as much information as possible.

Alternatively if you would like an assisted search training session, where we will sit down with you and go through the steps of a literature search, then please contact the library.

B. Journal clubs Do you have a journal club or are thinking of starting one up? If so, please contact the Library. We will be happy to attend any new or existing journal club in a contributory or facilitating role.

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

Library staff are available to train individual staff or small groups. Training can take place in the library or at your work place if you have access to appropriate IT facilities.

COURSES INCLUDE: Library Induction You will be given a detailed overview of all library information systems and resources and how to use them. Library registration and obtaining an OpenAthens password are included.

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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

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