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"One of the essential qualities of the clinician is interest in humanity"
Francis W. Peabody

 

Delirium Clinical Care Standard

Launched on 15 July 2016, the Delirium Clinical Care Standard aims to ensure that patients presenting to hospital with delirium receive optimal treatment, and patients at risk of delirium are identified promptly so that preventative strategies can be commenced. The Standard is accompanied by a number of resources to support implementation including indicator specifications, clinician fact sheets and consumer information.

Source: ACSQHS, 2016

 

Australian hypertension guideline - new

This guideline is designed to equip health professionals with the latest evidence to prevent, detect and manage hypertension. The guideline recommendations, which have caused some discussion among clinicians, were prompted by recent research including a 2015 meta-analysis of patients with uncomplicated mild hypertension (reference below). The research demonstrated that blood pressure-lowering therapy is beneficial in reducing stroke, cardiovascular death and all-cause mortality.

Guideline recommendations:

  • For patients at low absolute cardiovascular disease risk with persistent blood pressure (BP) ≥ 160/100 mmHg, start antihypertensive therapy.
  • The decision to treat at lower BP levels should consider absolute cardiovascular disease risk and/or evidence of end-organ damage, together with accurate BP assessment.
  • For patients at moderate absolute cardiovascular disease risk with persistent systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, start antihypertensive therapy.
  • Treat patients with uncomplicated hypertension to a target BP of < 140/90 mmHg or lower if tolerated.

Source: MJA 2016; 205(2): 85-89 - summary;
MJA 2016; 205(2): 63-64 - editorial;
MJAInSight - RACGP response
National Heart Foundation 2016 - Guideline

Supporting studies:

Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis
Source: Annals of Internal Medicine 2015; 162(3): 184-191

Systolic Blood Pressure Intervention Trial (SPRINT): "a trial hailed as world-changing for management of hypertension; a trial that loudly called into question a global trend towards more relaxed blood pressure (BP) targets. SPRINT, halted a year ahead of schedule because of clear evidence of a benefit with more aggressive BP lowering treatment, has created consternation in primary care about how to apply its findings to real-world patients." - Pharmacy News, 18 July 2016

Blood-pressure lowering in intermediate-risk persons without cardiovascular disease
Source: NEJM 2016; 374(21): 2009-2020

A randomized trial of intensive versus standard blood-pressure control
Source: NEJM 2015; 373(22): 2103-2116

 

Sucrose for pain relief in neonates

Reviewers examined the effectiveness of sucrose as a pain reliever in newborns undergoing painful procedures such as intramuscular injections, venipuncture, or heel lance. The review concluded that sucrose is an effective analgesic for both preterm and term infants experiencing pain from single events. No serious side effects were identified, however an optimal dose could not be identified due to inconsistency in the included studies.

Source: Cochrane Database of Systematic Reviews 2016; online first: July 16

 

ED trigger tool for adverse events

This work describes the development of an emergency department (ED) trigger tool to improve the identification of adverse events in the ED setting. Using experts in the field, the authors "used a modified Delphi process which resulted in the identification of 46 final triggers for the detection of adverse events among ED patients."

Source: Journal of Patient Safety 2016; online first: 16 June

 

Victoria’s Health & Medical Research Strategy 2016-2020

This strategy outlines the Victorian Government's key priorities over the next four years to support new and evolving fields of world-class medical research including precision medicine, health services research and big data. The objectives of the Strategy are to: embed health and medical research into the Victorian health system; accelerate the translation of research into clinical practice; advance Victoria's position as the lead national jurisdiction for health and medical research; and build economic growth.

Source: Healthier lives, stronger economy: Victoria's Health and Medical Research Strategy 2016-2020

 

What’s new from NICE

The UK's National Institute for Health and Care Excellence (NICE) published the following new (or revised) guidelines and quality standards in July 2016:

NICE Guideline NG51 Sepsis: recognition, diagnosis and early management
NICE Guideline NG49 Non-alcoholic fatty liver disease (NAFLD): assessment and management
NICE Clinical Guideline CG64 Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures
NICE Clinical Guideline CG181 Cardiovascular disease: risk assessment and reduction, including lipid modification (revised)

 

Austin Health Research Online - recent submissions

Perceived barriers to endovascular repair of ruptured abdominal aortic aneurysm among Australasian vascular surgeons. Lo J, Jedynak J, Chuen J, Journal of Vascular Surgery 2016; online first: 8 April

Pulmonary hypertension assessment on echocardiography: more than peak tricuspid regurgitation velocity assessment. Ramchand J, Jones E, Yudi M, Internal Medicine Journal 2016; 46(6): 750

Denosumab-associated hypocalcaemia: incidence, severity and patient characteristics in a tertiary hospital setting. Huynh A, Baker ST, Stewardson AJ, Pharmacoepidemiology and Drug Safety 2016; online first: 3 June

How is the sustainability of chronic disease health programmes empirically measured in hospital and related healthcare services?-a scoping review. Francis L, Dunt D, Cadillhac DA, BMJ Open 2016; 6(5): e010944

See more at AHRO, Austin Health Research Online

 

eBook spotlight

Green’s operative hand surgery / editor-in-chief, Scott W. Wolfe – 7th ed. Elsevier, 2017.
“Widely recognised as the gold standard in hand, wrist, and elbow surgery, with new expert authors, Green’s remains your go-to reference for the most complete, authoritative guidance on the effective surgical and non-surgical management of upper extremity conditions.”

Obstetrics : normal and problem pregnancies / edited by Steven G Gabbe … et al. – 7th ed. Elsevier, 2017.
“This book contains relevant information on everything from foetal origins to adult disease, to improving global maternal health to important topics in day-to-day obstetrical practice. Highly readable, well-illustrated, and easy to understand, this is an ideal reference for residents and clinicians.”

Print

Understanding health / edited by Helen Keleher and Colin MacDougall – 4th ed. Oxford Uni. Press, 2016. 
This edition includes new material on the social determinants of health. It provides practical strategies for improving health practice and health outcomes.

Your final choice : hastening your death when terminally ill – eight questions to ask yourself / Kenneth Ralph – Morning Star Publishing, 2015.
A gift from ‘Dying with dignity Victoria’, this book is a comprehensive review of things to be considered when making decisions about ‘end-of-life’ matters. It is a critical guide to the making of hard yet necessary plans for a good and dignified death.

 

Journals spotlight

These links provide access to the current table of contents:

Australian Journal of Advanced Nursing

BJA Education

Current Opinion in HIV and AIDS

Holistic Nursing Practice

The Gerontologist

Journal of Cancer Survivorship

Journal of Hypertension

Journal of Pediatric Surgery

Journal of Science and Medicine in Sport

Lung Cancer

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