Alsawadi, A: Open Access Emergency Medicine, May 2012, A systematic review

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

Source:  EMBASE

Trusts struggling with PFI debts

Ministers to send senior government lawyers and auditors to help seven trusts find savings and renegotiate contracts
courtesy of The Guardian 28 August 2012

Ministers said there was evidence that the NHS was not getting a fair share of savings that PFI deals were supposed to deliver. Photograph: Cate Gillon/Getty Images

Officials are to be sent to help seven hospital trusts unable to meet the repayments for their private finance schemes, ministers have announced.

Earlier this year the Department of Health said the hospital trusts were struggling with private finance initiative debts and would get £1.5bn in emergency funding to help them avoid cutting patient services to pay their bills.

The DoH now plans to send senior government lawyers and auditors to help the seven trusts find savings and renegotiate contracts.

The trusts involved are Barking, Havering and Redbridge; Dartford and Gravesham; Maidstone and Tunbridge Wells; North Cumbria; Peterborough and Stamford Hospitals; and St Helens and Knowsley NHS trusts, as well as the South London Healthcare Trust, which has been declared bankrupt by the department.

Many of the trusts targeted have had long-standing problems. The Barking trust has to find nearly £50m this year for its PFI deal agreed in January 2004; its financial commitments also led the Care Quality Commission to warn that the trust was failing to deliver proper standards of care.

Eyes on Evidence: August update

 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.
Evidence Updates

In the past month NICE has published online via NHS Evidence an Evidence Update on nocturnal enuresis.

Carolin Tonus, Markus Sellinger, Konrad Koss and Gero Neupert; World Journal of Gastroenterology; August 2012

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.

Newsletter for End of Life care

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.

Bowel cancer awareness campaign revisited

The Department of Health is launching a repeat of the national bowel cancer awareness campaign next week.
NHS Networks
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.

New unit at hospital

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.