Library, Research and Evidence Based Practice: November 2017

Tuesday 28 November 2017

WUTH publication: Care of patients undergoing weaning from mechanical ventilation in critical care

Citation: Nursing Standard. 2017, 32(13), 41-51
Author: Elliott S, Morrell-Scott N
Abstract: There are several reasons why mechanical ventilation - the use of an artificial device to assist a patient to breathe - may be initiated, for example to enable general anaesthesia for patients undergoing surgery, and for those with a compromised airway or respiratory failure. It is important that critical care nurses have the skills and knowledge to care for patients who are undergoing weaning from mechanical ventilation. This is to ensure that patients are weaned safely and as soon as possible, to improve their outcomes and avoid an increase in patient mortality and morbidity through complications that can arise such as airway trauma and ventilator-associated pneumonia. Furthermore, there are resource and cost implications of patients not being weaned as soon as possible.
KEYWORDS: critical care; critical care nursing; extubation; mechanical ventilation; mechanical ventilation weaning; respiratory failure

Link to PubMed record

Friday 24 November 2017

WUTH publication: Reducing the Rate of Abdominal Hysterectomies: Experience From a UK University Teaching Hospital

Citation: Journal of minimally invasive gynecology. 2017 Nov 14
Author: Minas V, Gul N, Aust T, Rowlands D
Abstract: KEYWORDS: abdominal hysterectomy; gynaecological surgery; laparoscopic hysterectomy; robotic hysterectomy; vaginal hysterectomy

Link to PubMed record

Wednesday 15 November 2017

WUTH publication: The role of the neutrophil:lymphocyte ratio (NLR) and the CRP:albumin ratio (CAR) in predicting mortality following emergency laparotomy in the over 80 age group

Citation: European journal of trauma and Emergency Surgery. 2018, 44(6), 877-82. [Epub 2017 Nov 13]
Author: Simpson G, Saunders R, Wilson J, Magee C
Abstract: INTRODUCTION: Emergency laparotomy in the elderly is an increasingly common procedure which carries high morbidity and mortality. Risk prediction tools, although imperfect, can help guide management decisions. Novel markers of surgical outcomes may contribute to these scoring systems. The neutrophil:lymphocyte ratio (NLR) and CRP:albumin ratio (CAR) have been associated with outcomes in malignancy and sepsis. We assessed the use of ratio NLR and CAR as prognostic indicators in patients over the age of 80 undergoing emergency laparotomy.
METHODS: A retrospective analysis of all patients over the age of 80 who underwent emergency laparotomy during a 3 year period was conducted. Pre and post-operative NLR and CAR were assessed in relation to outcome measures including inpatient, 30-day and 90-day mortality. Statistical analysis was conducted with Mann-Whitney U, receiver operating characteristics, Spearmans rank correlation coefficient and chi-squared tests.
RESULTS: One hundred and thirty-six patients over the age of 80 underwent emergency laparotomy. Median age was 84 years (range 80-96 years). Overall inpatient mortality was 19.2%. Pre-operative and post-operative NLR and CAR were significantly raised in patients with sepsis v no sepsis (p < 0.05). Pre-operative NLR was significantly associated with inpatient (p = 0.046), 30-day (p = 0.02) and 90-day mortality (p = 0.01) in patients with visceral perforation. A pre-operative NLR value of greater than 8 was associated with significantly increased mortality (p = 0.016, AUC:0.78). CAR was not associated with mortality.
CONCLUSION: Pre-operative NLR is associated with mortality in patients with visceral perforation undergoing emergency laparotomy. NLR > 8 is associated with a poorer outcome in this group of patients. CAR was not associated with mortality in over-80s undergoing emergency laparotomy.
KEYWORDS: CRP; Elderly; Laparotomy; Mortality; Neutrophil/lymphocyte ratio

Link to PubMed record

Dementia and Alzheimer’s

Relevant articles from MA Healthcare journals to support your staff’s education and practice

November 2017

Today 1 in 6 people over 80 are affected by dementia – 60% of these being subsequently diagnosed with Alzheimer’s disease. As a condition that progressively worsens over time, dementia has a significant emotional, social and practical impact on not just the patient but also upon their family members, friends and carers. NHS staff today need to be aware of the many complex factors that are involved in the diagnosis and care of those affected.

This month MA Healthcare is raising awareness about the importance of meeting the needs of people living with dementia and Alzheimer’s so they can receive the best care the deserve with dignity and respect.

We have provided a list of relevant articles from MA Healthcare journals dealing with this area, thereby providing your NHS staff with research, information and tips that will support both their work and their patients.

Practice Nursing:

· Communicating with people with dementia http://www.magonlinelibrary.com/doi/10.12968/pnur.2015.26.12.579

· Transforming attitudes to dementia with a little help from our friends http://www.magonlinelibrary.com/doi/10.12968/pnur.2016.27.8.395

British Journal Hospital Medicine:

· Diagnosing dementia http://www.magonlinelibrary.com/doi/10.12968/hmed.2016.77.2.C22

· Understanding safe discharge of patients with dementia from the acute hospital http://www.magonlinelibrary.com/doi/10.12968/hmed.2016.77.3.126

British Journal of Community Nursing:

· Sleep and dementia

http://www.magonlinelibrary.com/doi/10.12968/bjcn.2017.22.4.197

· “Wandering” and dementia http://www.magonlinelibrary.com/doi/10.12968/bjcn.2017.22.7.322

Nursing and Residential Care:

· Continence care and dementia: practical advice for care staff http://www.magonlinelibrary.com/doi/10.12968/nrec.2017.19.8.450

· Dementia is a disease and diseases can be treated http://www.magonlinelibrary.com/doi/10.12968/nrec.2017.19.8.464

British Journal of Healthcare Management:

· Neuroimaging in the assessment and treatment of dementias http://www.magonlinelibrary.com/doi/10.12968/bjhc.2016.22.2.63

· The needs of informal carers for people with dementia http://www.magonlinelibrary.com/doi/10.12968/bjhc.2012.18.12.628

Nurse Prescribing:

· Reducing anti-psychotic prescribing for care home residents with dementia http://www.magonlinelibrary.com/doi/10.12968/npre.2017.15.10.504

· Dementia and ethnicity http://www.magonlinelibrary.com/doi/10.12968/npre.2017.15.3.126

Independent Nurse:

· Assessing dementia

http://www.magonlinelibrary.com/doi/10.12968/indn.2017.5.22

· Drugs increase dementia risk http://www.magonlinelibrary.com/doi/10.12968/indn.2015.3.17

Practice Management:

· Dementia services in primary care http://www.magonlinelibrary.com/doi/10.12968/prma.2016.26.8.28

· Dementia: The path to a cure http://www.magonlinelibrary.com/doi/10.12968/prma.2017.27.7.16

British Journal of Neuroscience Nursing:

· Communication in end-of-life care for people with dementia: an Admiral Nurse case study http://www.magonlinelibrary.com/doi/10.12968/bjnn.2017.13.2.70

· Prevention of incontinence-associated dermatitis in people with dementia http://www.magonlinelibrary.com/doi/10.12968/bjnn.2015.11.5.228

British Journal of Healthcare Assistants:

· Back to BACE: one approach to fighting Alzheimer's http://www.magonlinelibrary.com/doi/10.12968/bjha.2017.11.1.10

· Types of dementia: an introduction http://www.magonlinelibrary.com/doi/10.12968/bjha.2017.11.3.132

British Journal of Nursing:

· Perceptions and development needs of assistant practitioners supporting individuals with dementia

http://www.magonlinelibrary.com/doi/10.12968/bjon.2017.26.16.918

· Encouraging positive interactions in dementia care http://www.magonlinelibrary.com/doi/10.12968/bjon.2016.25.21.1162

Friday 10 November 2017

FAB Change Week

Monday is the first day of Fab Change Week. Why not make it your first day to change something?

The Academy of Fabulous Stuff https://fabnhsstuff.net/ is “a collaboration to ensure best practice examples, great ideas and service solutions are available to all” by “sharing all the fabulous things about the NHS. “

This week it encourages you to make a pledge to make a change, be it service improvement, staff well-being, patient safety or experience or anything you like!

You can make a pledge on their website here https://fabnhsstuff.net/fabchangeweek/add-pledges or on social media using the hashtag #FabChangeWeek

Ask your WUTH Fab ambassador Leanne Lockley for more details

Friday 3 November 2017

Make a pledge to change!

Today is the first day of Fab Change Week. Why not make it your first day to change something?

This week it encourages you to make a pledge to make a change, be it service improvement, staff well-being, patient safety or experience or anything you like!

You can make a pledge on their website here https://fabnhsstuff.net/fabchangeweek/add-pledges or on social media using the hashtag #FabChangeWeek

Ask your WUTH Fab ambassador Leanne for more details

Dissections, cross sections and anatomical inspections

This week includes 2 awareness events in clinical support

National Pathology Week (6-12 November) celebrates the important contribution pathologists make to healthcare, through a programme of events aimed at people of all ages. Visit the Royal College of Pathologists website https://www.rcpath.org/discover-pathology/events-landing-page/national-pathology-week.html which includes a competitions to win a £100 gift card and a £100 cash prize

Wednesday November 8th. is World Radiography Day. The date marks the anniversary of the discovery of x-radiation by Wilhelm Roentgen in 1895., Visit the Society of Radiographers website for more details about the day. https://www.sor.org/about-radiography/world-radiography-day

To take a look at slides, cross sections and thousands of anatomical images, the LKS can help you access Anatomy TV. Available to all WUTH staff and students on placement, you can navigate through the anatomical structure. All you need is an Open NHS Athens account.

To enquire about Anatomy TV, please ask a member of LKS staff

WUTH publication:

Citation: The Bone & Joint Journal. 2017, 99-B(11), 1545-1551
Author: Makki D, Elgamal T, Evans P, Harvey D, Jackson G, Platt S
Abstract: AIMS: The aim of this paper was to present the clinical features of patients with musculoskeletal sources of methicillin-sensitive Staphylococcus aureus (MSSA) septicaemia.
PATIENTS AND METHODS: A total of 137 patients presented with MSSA septicaemia between 2012 and 2015. The primary source of infection was musculoskeletal in 48 patients (35%). Musculoskeletal infection was considered the primary source of septicaemia when endocarditis and other obvious sources were excluded. All patients with an arthroplasty at the time were evaluated for any prosthetic involvement.
RESULTS: The most common site of infection was the spine, which occurred in 28 patients (58%), and was associated with abscess formation in 16. Back pain was the presenting symptom in these patients, with a positive predictive value of 100%. A total of 24 patients had a total of 42 arthroplasties of the hip or knee in situ. Prosthetic joint infection occurred in six of these patients (25%). In five patients, the infection originated outside the musculoskeletal system. Three patients (6%) with MSSA septicaemia from a musculoskeletal sources died.
CONCLUSION: Amongst the musculoskeletal sources of MSSA septicaemia, the spine was the most commonly involved. We recommend an MRI scan of the whole spine and pelvis in patients with MSSA septicaemia with back pain, when the primary source of infection has not been identified or clinical examination is unreliable. Cite this article: Bone Joint J 2017;99-B:1545-51.
KEYWORDS: MRI scan; Musculoskeletal infection; Spinal infection; Staphylococcus aureus septicaemia

Link to PubMed record

Wednesday 1 November 2017

Care of the Elderly

Relevant articles from MA Healthcare journals to support your staff’s education and practice

October 2017

With the UK’s rapidly aging population, healthcare professionals within the NHS are facing an increasing number of complex health conditions relating to the health and care of elderly people. The more common conditions affecting older patients are cardiovascular disease, dementia, Alzheimer’s, diabetes, and cancer. Frailty is also a major issue with the increase in the number of bone fractures resulting from falls and accidents. Mental health is just as important, with loneliness and isolation having an additional impact on the health of elderly people today.

This month MA Healthcare is raising awareness about the importance of right care of the elderly, so that they can receive the high-quality health and social care they need in order to live happy and healthy lives.

Journal of Kidney Care:

· CKD and frailty: outcomes from a quality initiative for older patients

http://www.magonlinelibrary.com/doi/10.12968/jokc.2016.1.3.153

· Achieving the best results for older people on peritoneal dialysis

http://www.magonlinelibrary.com/doi/10.12968/jokc.2017.2.4.200

Practice Management:

· Dementia: The path to a cure

https://doi.org/10.12968/prma.2017.27.7.16

· Caring conversations

https://doi.org/10.12968/prma.2016.26.9.42

British Journal of Hospital Medicine:

· Infection in the older patient