Evidence Update (August 2015)

Evidence Update (August 2015)

For abstracts of the reviews below please click on the titles. There may be a link to the full text in the top right hand corner of the webpage. You may have to log in using your NHS Athens username and password, if you don’t have one go to Register for Athens and register for free.

If full text is not available then please email us to request a copy, directly quoting the number(s) of the articles you would like.

1) Mobile app for doctors’ professional development

The General Medical Council has launched a mobile app to help doctors manage their continuous professional development. GMC MY CPD allows doctors to record their learning activities on the go, at the click of a button. It enables doctors to store learning points and allows them to set a reminder so the app will ask them at a later date if changes to their practice have been effective.

NICE Guidance

2) Bipolar disorder in adults

3) Drug allergy: diagnosis and management

4) Implantation of a sphenopalatine ganglion stimulation device for chronic cluster headache

5) AliveCor Heart Monitor and AliveECG app for detecting atrial fibrillation

6) Visensia for early detection of deteriorating vital signs in adults in hospital

7) NICE Quality Standard: atrial fibrillation

NICE has published a Quality Standard Atrial fibrillation: treatment and management (QS93).  This quality standard covers identification, treatment and management of atrial fibrillation (including paroxysmal, persistent and permanent atrial fibrillation, and atrial flutter) in adults (18 years and older).

Additional link: NICE press release

Practice changing research, sourced from Dynamed

8) Moderate to severe traumatic brain injury

Updated 2015 Jul 20 06:59:00 AM: small intestinal feeding may reduce risk of pneumonia compared to gastric feeding in patients with severe traumatic brain injury requiring mechanical ventilation (J Neurosurg 2015 May 29 early online)

9) Long-acting beta-2 agonists for asthma

Updated 2015 Jul 20 06:50:00 AM: discontinuation of long-acting beta-2 agonist therapy may not increase exacerbations requiring systemic corticosteroids in patients with asthma well controlled with inhaled corticosteroid plus long-acting beta-2 agonist (Cochrane Database Syst Rev 2015 Jun 19)

10) Topical NSAIDs

Updated 2015 Jul 13 06:47:00 AM: topical NSAIDs that may increase clinical success in patients with acute musculoskeletal pain include diclofenac, ketoprofen, ibuprofen, piroxicam, and indomethacin (Cochrane Database Syst Rev 2015 Jun 11)

11) ST-elevation myocardial infarction (STEMI)

Updated 2015 Jul 13 06:33:00 AM: supplemental oxygen may increase myocardial injury and recurrent MI in normoxic adults with STEMI (Circulation 2015 Jun 16)

12) Cardiac troponin testing

Updated 2015 Jul 08 10:37:00 AM: high-sensitivity cardiac troponin T measured twice 1 hour apart rules out and helps diagnose myocardial infarction in most patients presenting with chest pain and no ST elevation (CMAJ 2015 May 19)

New and Updated Cochrane Systematic Reviews

13) Antiseptics for burns

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects and safety of antiseptics for the treatment of burns in any care setting.

14) The use of propofol for procedural sedation in emergency departments

Authors’ conclusions: No firm conclusions can be drawn concerning the comparative effects of administering intravenous propofol, with or without an adjunctive analgesic agent, with alternative interventions in participants undergoing PS in the ED setting on adverse effects (including pain at the injection site) and participant satisfaction. The review was limited because no two included studies employed the same comparator interventions, and because the number of participants in eight of the included studies were small (fewer than 100 participants). 

Horizon Scanning Centre Output

15) Arsenal ResQFoam™ for non-compressible abdominal haemorrhage

16) XStat® Hemostatic Device for non-compressible junctional haemorrhage

17) Emergency department bulletin - 9 July 2015

Good Quality Systematic Reviews

18) Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments

19) Systematic review of telemedicine applications in emergency rooms

20) Crowding Measures Associated With the Quality of Emergency Department Care: A Systematic Review

21) Intravenous lipid emulsion in the emergency department: a systematic review of recent literature

22) Strategies and solutions to alleviate access block and overcrowding in emergency departments

23) Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: use of a procalcitonin algorithm to guide antimicrobial therapy in COPD exacerbations can reduce antibiotic consumption with no increase in rates of treatment failure or mortality

24) Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta-analysis

25) Early goal-directed therapy reduces mortality in adult patients with severe sepsis and septic shock: Systematic review and meta-analysis

26) Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review

27) Effectiveness and Safety of Short-stay Units in the Emergency Department: A Systematic Review

28) Advance directives for older adults in the emergency department: A systematic review

29) Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: A systematic review

Economic Evaluations

30) Economic Analysis of Rapid and Sensitive Polymerase Chain Reaction Testing in the Emergency Department for Influenza Infections in Children

31) Cost-effectiveness of quantitative pretest probability intended to reduce unnecessary medical radiation exposure in emergency department patients with chest pain and dyspnea

Reports/Statistics on UK Emergency Medicine

32) People who inject drugs: HIV and viral hepatitis monitoring – 2004-2014

33) Ebola virus disease: screening and testing activity - July 2015 update

34) Urgent and emergency care vanguards

NHS England has announced eight urgent and emergency care vanguards.  These vanguards are tasked with changing the way in which all organisations work together to provide care in a more joined up way for patients.  Six vanguards will cover smaller local systems which may include hospitals and surrounding GP practices and social care, while two network vanguards will be working with much larger populations to integrate care on a greater scale.

35) Statistics

36) MenB vaccine: poster for A&E departments

Public Health England has published MenB vaccine: poster for hospital accident and emergency departments. This poster is for use in hospital accident and emergency departments and aims to encourage staff to check if a baby’s fever is due to a meningococcal capsular group B (MenB) vaccination within the previous 48 hours.  The MenB vaccine will be added to the childhood immunisation programme as part of the routine schedule in England from 1 September 2015.

37) Reasons why people with dementia are admitted to hospital in an emergency

Public Health England’s Dementia intelligence network has published Reasons why people with dementia are admitted to a general hospital in an emergency. This document shows key national data related to people with dementia and their use of inpatient general hospital services during the financial year 2012/13. It includes information about why people are admitted, short stay emergency admissions, increases in hospital admissions and preventing avoidable emergency admissions.  The dataset shows the clinical commissioning group and local authority data used in the report.

Additional link: Public Health England press release

38) Accident and Emergency statistics

The House of Commons library has published a briefing paper Accident and Emergency Statistics.  This briefing provides summaries and visualisations of a wide range of A&E trends, including: levels of attendance over time; attendance by age, time and day of the week; various measures of waiting times; and reason for attendance. It also explores the extent and limitations of the available data sources. 

Latest Journal Table of Contents

39) Academic Emergency Medicine

40) Annals of Emergency Medicine

41) Emergency Medicine Journal

42) European Journal of Emergency Medicine

43) Journal of Emergency Nursing

44) The Lancet

45) BMJ

46) New England Journal of Medicine

47) Paediatrics

48) Archives of Disease in Childhood

I Felt A Snap

I Felt A Snap