Background Early physical rehabilitation in the intensive care unit (ICU) has been shown to improve short-term clinical outcomes but long-term benefit has not been proven and the optimum intensity of rehabilitation is not known.

Methods We conducted a randomised, parallel-group, allocation-concealed, assessor-blinded, controlled trial in patients who had received at least 48 hours of invasive or non-invasive ventilation. Participants were randomised in a 1:1 ratio, stratified by admitting ICU, admission type and level of independence. The intervention group had a target of 90 min physical rehabilitation per day, the control group a target of 30 min per day (both Monday to Friday). The primary outcome was the Physical Component Summary (PCS) measure of SF-36 at 6 months.

Results We recruited 308 participants over 34 months: 150 assigned to the intervention and 158 to the control group. The intervention group received a median (IQR) of 161 (67–273) min of physical rehabilitation on ICU compared with 86 (31–139) min in the control group. At 6 months, 62 participants in the intervention group and 54 participants in the control group contributed primary outcome data. In the intervention group, 43 had died, 11 had withdrawn and 34 were lost to follow-up, while in the control group, 56 had died, 5 had withdrawn and 43 were lost to follow-up. There was no difference in the primary outcome at 6 months, mean (SD) PCS 37 (12.2) in the intervention group and 37 (11.3) in the control group.

Conclusions In this study, ICU-based physical rehabilitation did not appear to improve physical outcomes at 6 months compared with standard physical rehabilitation.

A significant proportion of people in England and Wales would wish to donate their organs after death for the purpose of transplantation. This guideline recognises the complexities that arise owing to the majority of potential organ donors lacking the capacity to be directly involved in decision making at the time of their death. This guideline seeks to promote the identification and fulfilment of these wishes through:
• more effective and expedient identification and referral of potential organ donors
• a more informed, considered and timely approach to consent for donation that is based primarily on identifying the wishes of the individual whenever known and however recorded.

This NICE Pathway covers diagnosis and management of bacterial meningitis and meningococcal septicaemia in children and young people (under 16 years) in primary and secondary care.
Meningococcal disease is the leading infectious cause of death in early childhood. It most commonly presents as bacterial meningitis (15% of cases of N meningitidis) or septicaemia (25% of cases), or as a combination of the two presentations (60% of cases).
The epidemiology of bacterial meningitis in the UK has changed dramatically in the past two decades following the introduction of vaccines to control H influenzae type b, serogroup C meningococcus and pneumococcal disease.
The control of meningococcal disease is therefore a priority for clinical management (as well as public health surveillance and control).
Bacterial meningitis and meningococcal septicaemia are managed in different ways, therefore it is important that healthcare professionals are able to recognise them and manage them accordingly.