The prevalence of diabetes mellitus in patients requir-ing cardiac surgery is rapidly increasing. These patients have higher perioperative morbidity and mortality, significantly reduced long-term survival, and less freedom from recurrent episodes of angina[1–3]. There isnow evidence to suggest that achieving glycemic controlin patients with diabetes decreases perioperative mor-bidity and improves short-term and long-term survival.Despite the emerging recognition of the importance of glycemic control, there are no specific guidelines forcardiac surgeons as to what the optimal level of glu-cose should be during the perioperative period, andthe best method to achieve these target values. Whatfollows is an executive summary of guidelines for the management of hyperglycemia in both patients with and without diabetes undergoing adult cardiac surgical procedures, derived from evidence-based recommen-dations.

Background: Patients who are sick enough to be admitted to an intensive care unit (ICU) commonly experience symptoms of psychological distress after discharge, yet few effective therapies have been applied to meet their needs.
Methods: Pilot randomised clinical trial with 3-month follow-up conducted at two academic medical centres. adult (≥18 years) icU patients treated for cardiorespiratory failure were randomised after discharge home to 1 of 3month-long interventions: a self-directed mobile app-based mindfulness programme; a therapist-led telephone-based mindfulness programme; or a web-based critical illness education programme.
Results: among 80 patients allocated to mobile mindfulness (n=31), telephone mindfulness (n=31) or education (n=18), 66 (83%) completed the study. For the primary outcomes, target benchmarks were exceeded by observed rates for all participants for feasibility (consent 74%, randomisation 91%, retention 83%), acceptability (mean client Satisfaction Questionnaire 27.6 (SD 3.8)) and usability (mean Systems Usability Score 89.1 (SD 11.5)). For secondary outcomes, mean values (and 95% cis) reflected clinically significant group-based changes on the Patient Health Questionnaire depression scale (mobile (−4.8 (−6.6, −2.9)), telephone (−3.9 (−5.6, −2.2)), education (−3.0 (−5.3, 0.8)); the generalized anxiety Disorder scale (mobile −2.1 (−3.7, −0.5), telephone −1.6 (−3.0, −0.1), education −0.6 (−2.5, 1.3)); the Post-traumatic Stress Scale (mobile −2.6 (−6.3, 1.2), telephone −2.2 (−5.6, 1.2), education −3.5 (−8.0, 1.0)); and the Patient Health Questionnaire physical symptom scale (mobile −5.3 (−7.0, −3.7), telephone −3.7 (−5.2, 2.2), education −4.8 (−6.8, 2.7)).
Conclusions: Among ICU patients, a mobile mindfulness app initiated after hospital discharge demonstrated evidence of feasibility, acceptability and usability and had a similar impact on psychological distress and physical symptoms as a therapist-led programme. a larger trial is warranted to formally test the efficacy of this approach.

NICE has assessed the procalcitonin tests (ADVIA Centaur BRAHMS PCT assay, BRAHMS PCT Sensitive Kryptor assay, Elecsys BRAHMS PCT assay, LIAISON BRAHMS PCT assay and VIDAS BRAHMS PCT assay) to help the NHS decide whether to use these products.

Procalcitonin is released into the bloodstream when there is a bacterial infection in the body and high levels can show that a person has a serious bacterial infection. Procalcitonin tests measure the amount of procalcitonin in the blood, and the results can help doctors to diagnose bacterial infection and decide about starting or stopping antibiotic treatment.

There was not enough evidence to recommend that these tests are used in the NHS. But NICE has recommended further research and data collection to show the impact of adding procalcitonin testing to standard clinical practice in the NHS.