Name of Media:

Transcatheter aortic valve implantation for the treatment of patients with severe symptomatic aortic stenosis who are at intermediate surgical risk: Evidence Note 91

Type of Library Material:

Medical Professional Education

Brief description of media:

For patients with severe symptomatic aortic stenosis, surgical aortic valve replacement (SAVR) is the reference treatment where surgical risk is low. For those assessed by a heart team as being at increased surgical risk transcatheter aortic valve implantation (TAVI) is an alternative procedure. SAVR can be performed using different surgical approaches (full sternotomy and more minimally invasive procedures), different kinds of valves, and different kinds of valve anchoring techniques (sutured and sutureless). TAVI involves the insertion of a prosthetic valve, which functionally replaces the damaged aortic valve, using fluoroscopic and echographically guided minimally invasive procedures. The prosthetic valve is compressed within a dedicated delivery system and, once in place within the diseased aortic valve, its deployment allows its expansion and the compression of
the native diseased valve against the wall of the aorta. Depending on the anatomy of the patient and device characteristics, the procedure can be performed by one of four different approaches. The transfemoral (TF) route is the most common, whereas the others are performed when the anatomy of the patient precludes access via the TF route. These approaches are the subclavian/ transaxillary (S/T) approach, the transapical (TA) approach, and the transaortic (TAo) approach. Evidence note | 6 Data from randomised controlled trials (RCTs) in elderly patients at who are at high surgical risk indicate that TAVI is non-inferior or superior to SAVR2. This is reflected in SHTG advice on the use of TAVI in patients who are inoperable or at high surgical risk3, 4. This evidence review examines the evidence comparing outcomes of TAVI and SAVR in patients with severe aortic stenosis who are at intermediate surgical risk.

Name of Media:

Transperitoneal versus retroperitoneal approach for elective open abdominal aortic aneurysm repair

Type of Library Material:

Medical Journal

Brief description of media:

Background

There has been a lot of debate in the surgical literature about the best way to surgically access the infrarenal abdominal aorta during an operation to repair an abdominal aortic aneurysm (AAA; a ballooning of an artery (blood vessel) which occurs in the major artery in the abdomen (aorta)). Two approaches are commonly used: the retroperitoneal (RP) approach and the transperitoneal (TP) approach. Both approaches appear to have advantages and disadvantages. Many trials comparing RP and TP aortic surgery have been published with conflicting results. The aim of this Cochrane review is to assess the effectiveness and safety of the TP versus RP approach for planned surgical open AAA repair on mortality, complications, hospital stay and blood loss.

Key results

We included four small randomized controlled trials (RCTs) (129 participants) after we searched the literature up to May 2015). There were no differences between RP and TP for death. Our analysis seems to show a trend that RP might increase the complications such as hematoma (swelling of clotted blood), chronic wound pain and abdominal wall hernia compared with TP but there were variations between the included trials. We found that RP led to lower blood loss, and shorter hospital stay and ICU stay compared with TP but there were no differences between the two approaches for operating time and aortic cross‐clamp time (length of time a surgical instrument, used to clamp the aorta and separate the circulation from the outflow of the heart, is used).

Quality of the evidence

Three of the four included trials had methodological weaknesses, such as unclear randomisation methods, and no reporting of blinding of the people assessing the outcome which compromised the value of their results. In addition, the included trials only included a small number of people, there were few outcomes reported, there was a relatively short follow‐up and there were inconsistencies between the included trials resulting in very low to low quality of the evidence. More large‐scale RCTs of the RP approach versus the TP approach for planned surgical open AAA repair are needed.

Name of Media:

Traumatic rupture of the thoracic aorta: cohort study and systematic review

Type of Library Material:

Medical Research

Brief description of media:

Authors' objectives
To compare surgical techniques for traumatic rupture of the thoracic aorta.

Name of Media:

Traumatized by Hospital Stay: 1 in 3 Patients Develop PTSD from ICU

Type of Library Material:

Newspaper Article

Brief description of media:

Another reason to be wary of a hospital stay- a new study shows that patients who survive intensive care units in hospitals are at high risk for developing post-traumatic stress disorder (PTSD).

PTSD is in the news most often in relation to combat veterans, but researchers from the Johns Hopkins University School of Medicine found that one in three people who survived an intensive care unit (ICU) stay for acute lung injury showed PTSD symptoms that lasted up to two years.

Name of Media:

UK COVID-19 Update: New Vaccine Hope as Moderna Announces Encouraging Results

Type of Library Material:

Magazine Article

Brief description of media:

These are the UK coronavirus stories you need to know about today.
Moderna mRNA Vaccine 'Almost 95% Effective'.
A candidate vaccine to protect against COVID-19 is almost 95% effective, according to US company Moderna.

The results from early data, revealed in a press release, came a week after Pfizer and BioNTech announced that their vaccine could prevent more than 90% of people developing COVID-19. Both companies use the same messenger RNA (mRNA) technology.

Name of Media:

UK guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016

Type of Library Material:

Medical Journal

Brief description of media:

The overall objective of the guidelines is to provide up-to-date, evidence-based recommendations for the diagnosis and management of the full spectrum of Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and SJS–TEN overlap in adults during the acute phase of the disease. The document aims to: (i) offer an appraisal of all relevant literature up to February 2016, focusing on any key developments; (ii) address important, practical clinical questions relating to the primary guideline objective, i.e. accurate diagnosis
and identification of cases and suitable treatment; (iii) provide guideline recommendations; and (iv) discuss areas of uncertainty, potential developments and future directions SJS/TEN is rare and few healthcare professionals are confident in the recognition and management of the disorder. There is widely divergent practice among different specialities and healthcare settings, and limited information on outcomes.
These guidelines aim to provide recommendations on the diagnosis and management of SJS/TEN, to inform clinical decision-making and, when justified by evidence, to standardize practice. The breadth of this document should be sufficient to assist clinicians of all relevant specialities in the management of patients with SJS/TEN. The recommendations will also inform pathways of care to optimize healthcare delivery and highlight key areas of uncertainty for future research. In these guidelines, the term SJS/TEN encompasses the full spectrum of the disease, i.e. SJS, TEN and SJS–TEN overlap (see section 7.2 for clinical definition of the separate entities). The guideline is presented as a detailed review with highlighted recommendations for practical use (see section18.0), in addition to the development of a new patient information leaflet [available on the British Association of Dermatologists’ (BAD) website, www.bad.org.uk]. Unless otherwise specified, recommendations apply to all forms of the disease.

Name of Media:

UK to open 40 Long Covid clinics by end of month for 'many thousands' suffering

Type of Library Material:

Newspaper Article

Brief description of media:

The NHS is to set up more than 40 specialists clinics in England for those suffering with the long-term effects of coronavirus, Matt Hancock has confirmed.

Prompted by concerns thousands of patients are suffering with so-called long Covid, the 43 clinics will bring together doctors, nurses, therapists and other NHS staff to assess those experiencing enduring symptoms.

Long Covid, which is thought to affect more than 60,000 people in the UK, can cause continuing fatigue, brain fog, breathlessness and pain, according to the NHS.

Name of Media:

Understanding Delirium

Type of Library Material:

One-Pager

Brief description of media:

The two pager provide information about Delirium which included: definition, symptoms, causes. and how it can be treated

Name of Media:

University of Michigan doctor: Health care system needs to plan to treat long-term COVID

Type of Library Material:

Newspaper Article

Brief description of media:

Treating COVID-19 patients has been a call to action for medical professionals, and a year in they are still trying to understand the illness' implications, a University of Michigan doctor says.

Dr. Jake McSparron, a pulmonary and critical care physician at Michigan Medicine and a clinical associate professor at U-M in pulmonary and critical care, has seen firsthand the symptoms described by survivors in Lenawee County .

Name of Media:

Unlocking the Mysteries of Long COVID

Type of Library Material:

Newspaper Article

Brief description of media:

The quest at Mount Sinai began with a mystery. During the first wave of the coronavirus pandemic in New York City, Zijian Chen, an endocrinologist, had been appointed medical director of the hospital’s new Center for Post-COVID Care, dedicated both to research and to helping recovering patients “transition from hospital to home,” as Mount Sinai put it. One day last spring, he turned to an online survey of COVID 19 patients who were more than a month past their initial infection but still experiencing symptoms. Because COVID 19 was thought to be a two-week respiratory illness, Chen anticipated that he would find only a small number of people who were still sick. That’s not what he saw.
“I looked at the number of patients that were in the database and it was, I think, 1,800 patients,” he told me. “I freaked out a little bit. Oh my God, there’s so many patients telling us that they still have symptoms.” A realization dawned on him: America was not simply struggling to contain a once-in-a-century pandemic, caused by a virus far more dangerous than seasonal influenza. Many patients were, for unknown reasons, not recovering.

Name of Media:

Validation of a New Clinical Tool for Post-Intensive Care Syndrome

Type of Library Material:

Medical Journal

Brief description of media:

In 2010, the Society of Critical Care Medicine organized a task force to raise awareness of the long-term cognitive, psychological, and physical impairments in survivors of critical illness. Impairments in these three domains are collectively known as post-intensive care syndrome (PICS). PICS affects 50–70% of intensive care unit (ICU) survivors, and its effects can persist for 5–15 years after ICU hospitalization. One major barrier in the assessment of PICS is the lack of a single, validated clinical tool to rapidly assess impairments in all three domains of PICS.

Name of Media:

Vanderbilt ICU Communication Board

Type of Library Material:

Brochure

Brief description of media:

The communication board helps the ICU patient to communication with the care giver.