The clinical effectiveness of permissive hypotension in blunt abdominal trauma with hemorrhagic shock but without head or spine injuries or burns: A systematic review:
Open Access Emergency Medicine, May 2012, vol./is. 4/(21-29), 1179-1500 (23 May 2012)
Author(s): Alsawadi A.
Abstract: Trauma is a major cause of death and disability. The current trend in trauma management is the rapid administration of fluid as per the Advanced Trauma Life Support guidelines, although there is no evidence to support this and even some to suggest it might be harmful. Some guidelines, protocols, and recommendations have been established for the use of permissive hypotension although there is reluctance concerning its application in blunt injuries.
Objectives: The aim of this review is to determine whether there is evidence of the use of permissive hypotension in the management of hemorrhagic shock in blunt trauma patients. This review also aims to search for any reason for the reluctance to apply permissive hypotension in blunt injuries.
Methods: This systematic review has followed the steps recommended in the Cochrane Handbook for Systematic Reviews of Interventions. It is also being reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement and checklist. Database searches of MEDLINE, EMBASE, the Centre for Reviews and Dissemination databases and the Cochrane Library were made for eligible studies as well as journal searches. Inclusion criteria included systematic reviews that have similar primary questions to this review and randomized controlled trials where patients with
blunt torso injuries and hemorrhagic shock were not excluded. Rapid or early fluid administration was compared with controlled or delayed fluid resuscitation and a significant outcome was obtained. Results: No systematic reviews attempting to answer similar questions were found. Two randomized controlled trials with mixed types of injuries in the included patients found no significant difference between the groups used in each study. Data concerning the question of this review was sought after these papers were appraised.
Conclusion: The limited available data are not conclusive. However, the
supportive theoretical concept and laboratory evidence do not show any reason for treating blunt injuries differently from other traumatic injuries. Moreover, permissive hypotension is being used for some nontraumatic causes of hemorrhagic shock and in theater. Therefore, this should encourage interested researchers to continue clinical work in this important field.
Publication Type: Journal: Review
Sleep apnoea may be an independent risk factor for deep vein thrombosis (DVT) but further research is required to confirm this.
Pharmacological thromboprophylaxis when used in addition to compression stockings does not reduce death rates, when compared with compression stockings alone. However, prophylaxis is still useful in reducing venous thromboembolism, unless there is a high risk of bleeding.
Risk of venous thromboembolism with non-oral hormonal contraception
An observational study suggests that women using the transdermal contraceptive patch or combined hormonal vaginal ring appear to have about twice the risk of venous thromboembolism compared with women using combined oral contraceptives containing levonorgestrel.
Dehydration in hospital-admitted stroke patients
Focusing on interventions to reduce the frequency and duration of dehydration have the potential to improve patient outcomes after stroke.
Long-term effects on renal function of tight glycaemic control in early type 1 diabetes
Long-term observational follow up of the Diabetes Control and Complications Trial shows that early tight control of blood glucose is associated with a lower risk of impaired renal function, but could not a detect a difference in the risk of severe renal impairment or end stage disease.
In the past month NICE has published online via NHS Evidence an Evidence Update on nocturnal enuresis.
This article “Faecal pyruvate kinase isoenzyme type M2 for colorectal cancer screening: A meta-analysis” by Carolin Tonus, Markus Sellinger, Konrad Koss and Gero Neupert was published earlier this month.
AIM: To present a critical discussion of the efficacy of the faecal pyruvate kinase isoenzyme type M2 (faecal M2-PK) test for colorectal cancer (CRC) screening based on the currently available studies.
METHODS: A literature search in PubMed and Embase was conducted using the following search terms: fecal Tumor M2-PK, faecal Tumour M2-PK, fecal M2-PK, faecal M2-PK, fecal pyruvate kinase, faecal pyruvate kinase, pyruvate kinase stool and M2-PK stool.
RESULTS: Stool samples from 704 patients with CRC and from 11 412 healthy subjects have been investigated for faecal M2-PK concentrations in seventeen independent studies. The mean faecal M2-PK sensitivity was 80.3%; the specificity was 95.2%. Four studies compared faecal M2-PK head-to-head with guaiac-based faecal occult blood test (gFOBT). Faecal M2-PK demonstrated a sensitivity of 81.1%, whereas the gFOBT detected only 36.9% of the CRCs. Eight independent studies investigated the sensitivity of faecal M2-PK for adenoma (n = 554), with the following sensitivities: adenoma < 1 cm in diameter: 25%; adenoma > 1 cm: 44%; adenoma of unspecified diameter: 51%. In a direct comparison with gFOBT of adenoma > 1 cm in diameter, 47% tested positive with the faecal M2-PK test, whereas the gFOBT detected only 27%.
CONCLUSION: We recommend faecal M2-PK as a routine test for CRC screening. Faecal M2-PK closes a gap in clinical practice because it detects bleeding and non-bleeding tumors and adenoma with high sensitivity and specificity.
The National End of Life Care Programme newsletter has published its August newsletter.
From NHS Networks
The National Council for Palliative Care (NCPC) has launched a toolkit to empower local people to push for the right end of life care services following reform of the health and social care system.
The Department of Health is launching a repeat of the national bowel cancer awareness campaign next week.
The Department of Health has published the second national cancer patient experience survey based on feedback from 72,000 inpatient and day case cancer patients.
Published by The Buxton Advertiser on Saturday 25 August 2012
A NEW dedicated Breast and Gynaecology Unit is set to open at Macclesfield District General Hospital.
The new purpose-built unit, which opens on September 3, will provide high quality services for the diagnosis, screening and treatment of breast cancer and outpatient facilities for a wide range of gynaecology problems, with the latest equipment and techniques all under one roof.
There will be five consultation rooms, two rooms dedicated to digital mammography and a further two rooms for breast ultrasound in the new unit.
via New unit at hospital – Health – Buxton Advertiser.
Improving outcomes for cancer patients. Hear from over 30 expert speakers.
Download new brochure at http://www.cancercarecongress.com/download-brochure
Substantial early booking discounts available – hurry, limited period only!
Our 2012/2013 Marketing Plan is published – please click on this link to view
4 September 2012
The NHS Confederation Business Development team are running a webinar on telehealth in the NHS on 4 September to discuss and resolve any issues and questions that were raised at the telehealth event at the NHS Confederation’s annual conference on 21 June and to raise more awareness around the subject in a bid to improve overall patient care in the UK.
Dr. Shahid Ali, clinical lead patients and information directorate at the National Commissioning Board, will be speaking at the webinar.
Further details can be found on the NHS Confederation’s telehealth page, where you can book online to register for the event.
The Productive Series: Releasing Time to Care™ – is a programme developed by the NHS Institute for Innovation and Improvement to help front-line staff spend more time on patient care, reduce waste and improve efficiency. The Government aim to introduce the Productive Ward methodology into 100% of Acute, Mental Health, Community Hospital wards and Community Services teams by 31st March 2014. The Productive Series programmes have already been adopted by a high percentage of organisations and front line teams are using the tools and methodology to improve care, increase the time spent with patients, deliver process efficiencies and financial savings.
See http://www.theproductives.com/ for more information
A new national programme to help foundation trust governors play their crucial roles to full effect will be launched in the new year.
The NHS foundation trust governor training and development programme will be open to the 2,600 governors across the country. As the number of foundation trusts (FTs) rises over the next few years the number of governors could triple.
This week the new NHS Leadership Academy awarded the contract for the national programme to the Foundation Trust Network (FTN).
via NHS governor training programme to be launched.
The Staff Library offers training and support to staff and students through the following courses which are arranged at times and dates to suit individuals or small groups. Our new course for the Autumn is An Introduction to Critical Appraisal Training. However, if anyone requires assistance with creating a presentation, using the Internet safely, setting up an email or Athens account please contact us on 01625 66 3923.
Introduction to the Cochrane Library (1.5 hours)
This course aims to instruct staff in effective literature searching using the Cochrane Library and will cover keyword and MESH search, combining search terms, saving search histories and printing/saving results.
Introduction to NHS Evidence & Basic Literature Searching (2 hours)
This course is for staff who wish to learn the basics of literature searching using healthcare databases and will include a brief introduction to the NHS Evidence web portal. No previous experience necessary.
An Introduction to Critical Appraisal Training
We offer courses which examine critical appraisal of systematic reviews, randomised controlled trials (RCTs) or qualitative research. You will summarise the key features of the research type, identify tools to help appraise the research and carry out an appraisal of a relevant paper selected by the Library team. No previous experience is needed.
To book a place on any of the above courses or to discuss your requirements, please contact Library Staff on 01625 66 3923.
from NHS Networks by Maria Axford
of NHS foundation trust plans (2012/13) shows that the sector still faces challenges in meeting greater demand and more challenging health care targets while delivering significant savings each year.
from Leadership/Management by natalie.murray, 22 August 2012
The Faculty of Medical Leadership and Management has launched its Transitions series with top tips for medical directors. Based on the wisdom and insight of existing medical directors across the UK, Transitions: Medical Director is a unique resource designed to support doctors in leadership roles.
FMLM members can click Transitions: Medical Director to see the full guide. Non members can view helpfulextracts from Medical Director in our resource section.
‘Excellent piece of work; deja vu everywhere! A valuable collection of thoughts and wisdom to reflect on. Well done.’ Andy Kutarski, Medical Director, St Barnabas Hospice Trust
‘Very good (even essential) tips for medical directors’ Dermot O’Riordan, Medical Director, West Suffolk NHS Foundation Trust
Look out for further editions of Transitions in 2012:
- College President
- Clinical Director
- New GP/Consultant
- Medical Students
- Female Leaders
via Google Reader
Stories this week on the network include:
Meanwhile, Denis Campbell reported for the Guardian on research by the King’s Fund, which reveals the stark social class divide in health is widening. It found better-off people are increasingly shunning damaging habits such as smoking and eating badly but poorer people are not. The story says:
The findings have cast doubt on the prospect of the health secretary, Andrew Lansley, fulfilling his pledge to “improve the health of the poorest fastest” in order to reduce glaring health inequalities.
Here’s some other headlines from around the web this week:
… of the chief executives of the 10 largest NHS acute trusts in England (measured by staff numbers collected by the NHS Information Centre) nine are men, four have knighthoods, but – based on some searching, and happily subject to correction – only one appears to be active on Twitter. The exception that proves the rule is Dr Mark Newbold, chief executive of Birmingham’s Heart of England foundation trust, who has more than 1,300 followers. He also blogs: a post on 10 reasons why his peers should join him on Twitter cites openness, accessibility, learning from others and engagement with communities. On Twitter itself, Dr Newbold often uses his account to answer questions and engage in debate.
Content navigation has been improved with a new search engine. This is complemented by a suite of new navigation tools, including:
- A to Z directory
- Bookmarking of pathways
- Browsing history
- ‘Find in page’ feature
- Local pathways widget
- Specialty browser
You can visit Map of Medicine at http://www.mapofmedicine.com/
23 August 2012
Staff at 20 NHS hospitals in the south west could see their wages reduced and their holiday entitlements cut to protect jobs, it has been claimed.
In a report, the South West Pay, Terms and Conditions Consortium (SWC) has suggested that if this action was taken in an average-sized hospital, around £9m a year could be saved. Cutting pay by 1 per cent could save £1.4m, making staff work another hour for no extra pay could save £2.6m and taking two days off people’s holiday entitlement could save £750,000.
via NHS staff could see cuts in pay and holidays – Public Service.
Looking ahead to next Monday 27 August, the Staff Library will be closed that day unless you have 24hr access. If you haven’t already requested this feature it is easy to arrange. Simply call in the library and ask at reception. Once activated your ID badge will enable you to gain ‘swipe’ access. Computers, journals and photocopier are all available as usual. Books may be borrowed by filling in a request form on the reception desk. The only thing that is missing apart from the staff, are the tea and coffee refreshments so we suggest you bring your own on that day!
Have a good weekend.
Good luck to some of our neighbours who have made it through to the Nursing Times shortlist. The awards will be held at The Hilton Hotel, Park Lane, London where the winners will be announced on Wednesday 31 October.
- The Christie NHS Foundation Trust, Promoting rest and relaxation in a cancer centre CCU
- The Christie NHS Foundation Trust, Janet Beech for Cancer Nurse Leader
- The Christie NHS Foundation Trust, Complementary therapies, supervision and wellbeing events
- East Midlands Ambulance Service NHS Trust, Crisis response falls team
- Wrightington, Wigan and Leigh NHS Foundation Trust, SSI prevention for C-sections
- Derbyshire Healthcare NHS Foundation Trust, The Way Forward Group
- University Hospital of South Manchester NHS Foundation Trust, Jacky Edwards for Nurse of the year
- 5 Boroughs Partnership NHS Foundation Trust, Pilot collaborative dementia and physical health clinic
- Stockport NHS Foundation Trust, Electronic master patient index allocation system
For the full list please visit http://www.ntawards.co.uk/446876
“Dementia is one of the most important issues we face as the population ages. There are estimated to be over 750,000 people in the UK with dementia and numbers are expected to double in the next thirty years.”
At the Department of Health’s website http://dementia.dh.gov.uk/, a dedicated section is being developed to include resources and best practice guidance … to make it the first port of call for anyone with an interest in improving services for people with dementia. It is already a most comprehensive collection, useful for carers and professionals alike, with links to all the key topics eg: residential workshops, medication, elearning, research and the benefits of cognitive stimulation as reviewed by Cochrane.
There is also a Dementia Commissioning Pack which contains a selection of additional resources. These are organised into four key themes. Within each page the resources are grouped under key topic areas.
Published in the Knutsford Guardian 17 August 2012
A patient at Knutsford’s Community Hospital claims people are being encouraged to travel to Macclesfield for appointments instead of using the town’s clinics because they can get seen quicker.
The future of the hospital on Bexton Road is up in the air after it was announced in February that a new medical centre could be built on the site.
But a Knutsford resident, who did not wish to be named, said he was told he would have to wait two months for an appointment at the audiology clinic in Knutsford when he phoned in July.
After stating he was able to drive, the receptionist then offered him an appointment at Macclesfield the week after.
“Some two months ago I attended our Knutsford Community Hospital where, after tests, I was provided with two hearing aids,” he said.
“I have recently been experiencing some problems which indicate the hearing aids need adjusting.
“I rang the audiology department at Macclesfield District General Hospital to request an appointment at Knutsford Community Hospital.
“The earliest appointment they could offer me was early September.
“Fortunately, as I can drive to Macclesfield, they were able to offer me the week after.”
As reported in the HSJ 10 August, 2012
PERFORMANCE: 5.4 per cent of patients awaiting diagnostic tests from the trust in June had been on its waiting list for more than six weeks, against a national target that fewer than 1 per cent of patients should wait that long.
Latest Department of Health data show there were 2,089 patients on East Cheshire’s diagnostics waiting list at the end of the month, of which 112 had been waiting past the six-week threshold.
The trust had the second-highest proportion of over-six-week waiters among NHS providers in the North West. The highest was for Liverpool Community Health Trust, at 17.9 per cent.
Source: Monthly Diagnostics Provider
Patients with diabetes who are at the end of life have a unique set of care needs relating to health and social care. However, end of life diabetes care has been recognised as an area lacking quality standards and guidance on best clinical practice and commissioning.