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"Simply creating and allowing the passive diffusion of evidence seldom leads to sustained clinical change"
Kate Halton et al.

 

Coroner’s case reports

Pulmonary embolism is "a diagnosis that every healthcare practitioner needs to be familiar with to adequately detect and treat it in their patients, every time". The latest Clinical Communique from the Victorian Institute of Forensic Medicine outlines three cases where despite the persistence of warning signs and symptoms, pulmonary embolus "was not considered and subsequently missed with fatal consequences".

Source: Clinical Communique 2017; 4(1)

 

Effective clinical governance in infection control

Implementing infection control improvements relies on evidence based practice, good clinical governance and a systematic integration of quality improvement initiatives. Researchers surveyed infection preventionists (IPs) in Australia and New Zealand to explore perceptions of IPs professional context and frameworks for effective clinical governance. "Focusing on strengthening contextual factors at the organizational level that otherwise undermine capacity to implement evidence-based practice is key to sustaining current infection control successes and promoting further practice improvements".

Source: American Journal of Infection Control 2017; 45(3): 278-283 

Further reading
Reducing surgical site infection
"In the Australian and New Zealand healthcare systems, between 2 and 13% of hospitalized patients develop a healthcare-associated infection, of which 20% are surgical site infections (SSIs)". This review examined patient care bundles (i.e. the addition of pre-theatre nasal and/or skin decolonisation) being used to reduce the rate of SSI. The authors conclude that "SSIs in major cardiac and orthopaedic surgeries can be effectively reduced by approximately 50% with a pre-theatre patient care bundle approach".
Source: ANZ Journal of Surgery 2017; online first: 12 February 

NSQHS factsheet: Preventing and controlling healthcare associated infections 

 

Lithium in late-life mania: a systematic review

Elderly patients presenting with bipolar disorder (BD) can exhibit highly variable responses to treatment. Recent data suggests that the onset of BD in this cohort may be related to neurologic or vascular diseases. This review examined the tolerability of lithium in late-life bipolar mania concluding that despite its effectiveness, there are significant concerns about the tolerability of lithium. The review authors found that "in the elderly lithium is as effective and better tolerated at lower doses", therefore recommending close monitoring of plasma concentrations in this cohort.
Source: Neuropsychiatric Disease & Treatment 2017; 13:755-766

Further reading
Behavioral indicators on a mobile sensing platform predict clinically validated psychiatric symptoms of mood and anxiety disorders.
Researchers used mobile sensing platforms for real-time tracking of behavioural indicators of PTSD and depression.
Source: Journal of Medical Internet Research 2017; 19(3): e75

 

To push or not?...the 2nd stage labour debate

There have been conflicting results about the influence on maternal and neonatal outcomes of maternal pushing during the second stage of labour. An updated review by the Cochrane Pregnancy and Childbirth group compared the types of maternal pushing (spontaneous vs directed) and the timing of pushing (delayed vs immediate). Results indicated that delayed pushing with epidural leads to decreased pushing time and increased spontaneous vaginal delivery, however overall length of second stage labour was increased. Researchers found no difference in perineal laceration or episiotomy rates between delayed and immediate pushing. The authors conclude that with no strong evidence for one type of pushing, a "woman's preference and comfort and clinical context should guide decisions".

Source: Cochrane Database of Systematic Reviews 2017; 3: CD009124 

 

Night-time ICU staffing

Data supporting the efficacy of day and night physician staffing in intensive care units (ICUs) has been inconsistent. The American Thoracic Society reviewed the association of night-time intensivist staffing with outcomes of ICU patients. Review authors concluded that intensivist staffing overnight was not associated with reduced patient mortality.

Source: American Journal of Respiratory and Critical Care Medicine 2017; 195(3): 383-393

Further reading
Stress and burnout in intensive care medicine: an Australian perspective
"Leadership from clinicians will be important to drive change at an institutional level. Compassionate staffing, flexible rostering, ensured leave and ongoing employee assistance programs should be broadly available. Clinicians themselves will need to foster an acceptance of their own vulnerability and cultivate an environment where open dialogue about stressors is respected."
Source: Medical Journal of Australia 2017; 206(3): 107-108

 

Did you know?

Access Medicine provides health professionals with access to more than 95 eBooks such as Harrison's principles of internal medicine or Current medical diagnosis & treatment. In addition there are quick reference tools, a multimedia library, study tools and case files.

 

Austin Health Research Online - recent submissions

Adverse cardiac effects of exogenous angiotensin 1-7 in rats with subtotal nephrectomy are prevented by ACE inhibition
Burrell LM, Gayed D, Griggs K, et al. PLoS One 2017; 12(2): e0171975

SCN1A clinical spectrum includes the self-limited focal epilepsies of childhood
Kivity S, Oliver KL, Afawi Z, et al. Epilepsy Research 2017; 131: 9-14

A ‘Disease Severity Index’ to identify individuals with Subjective Memory Decline who will progress to mild cognitive impairment or dementia
Ferreira D, Falahati F, Linden C, et al. Scientific Reports 2017; 7: 44368

Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit
Raith EP, Udy AA, Bailey M, et al. JAMA 2017; 317(3): 290-300

Mineral adaptations following kidney transplantation
Tan S, Crosthwaite A, Langsford D, et al. Transplant International 2017; online first: 5 March

See more at AHRO, Austin Health Research Online

 

eBooks Spotlight

Campbell’s operative orthopaedics / edited by Frederick M Azar et al. – 13th ed. Elsevier, 2017.
Completely reviewed and expanded with new techniques and equipment from the worlds literature this comprehensive text reflects the increasing number of less invasive surgical techniques being described with promising results.

Hurst’s the heart / edited by Valentin Fuster et al. – 14th ed. McGraw Hill, 2017.
Interactive text features an enhanced and reader-friendly design with regular updates. Pathology, pathogenesis and genetics of all diseases is provided in a concise manner in coloured boxes for ready reference and for busy clinicians.

Sim’s symptoms in the mind : textbook of descriptive psychopathology / Femi Oyebode and Andrew Sims – 5th ed. Elsevier, 2015.
The book concentrates on the psychopathological disorder of function rather that the disease category with descriptive psychopathology – the basis of clinical psychiatry. Includes videos transcripts of patient interview scenarios exploring key themes for education and training purposes.

 

Journals Spotlight

These links provide access to the current table of contents:

Australian and New Zealand Journal of Public Health

BMJ

CA: A Cancer Journal for Clinicians

Childhood Obesity

Journal of the American Society of Echocardiography

Lancet Psychiatry

MJA

New England Journal of Medicine

Nurse Education Today

Pediatric Blood & Cancer

Looking for the latest journal issues?
All our journal titles with electronic access are available via the Journal List
(outside the Austin Health network use your Library barcode no. & PIN for access)

If you require an article from a journal that is not in the Journal List, please use our online document delivery form.

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Sign up now & start using BrowZine - all you need is the free app and a Library card! 

 

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