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Background

The concept of hybrid coronary revascularization (HCR) combines the left internal mammary artery (LIMA)–left anterior descending (LAD) graft and percutaneous coronary intervention (PCI) to non-LAD vessels. Multiple comparative studies have evaluated the safety and feasibility of HCR and coronary artery bypass grafting (CABG) for multivessel coronary artery disease (MCAD). However, the sample size of each study was small, and evidences based on single-institutional experience. The purpose of this meta-analysis was to compare the short-term outcomes of HCR with those of CABG for MCAD.
Method

PubMed, EMBASE and Cochrane Library databases, as well as conference proceedings, were searched for eligible studies published up to March 2014. We calculated summary odds ratios (OR) for primary endpoints (death, stroke; myocardial infarction (MI); target vessel revascularization (TVR); major adverse cardiac or cerebrovascular events (MACCEs)) and secondary endpoints (atrial fibrillation (AF); renal failure; length of stay in the intensive care unit (LoS in ICU); length of stay in hospital (LoS in hospital); red blood cell (RBC) transfusion). Data from 6176 participants were derived from ten cohort studies.
Results

HCR was non-inferior to CABG in terms of MACCEs during hospitalization (odds ratio (OR), 0.68, 95% confidence interval (CI), 0.34–1.33)and at one-year follow-up(0.32, 0.05–1.89) , and no significant difference was found between HCR and CABG groups in in-hospital and one-year follow-up outcomes of death, MI, stroke, the prevalence of AF and renal failure, whereas HCR was associated with a lower requirement of RBC transfusion and shorter LoS in ICU and LoS in hospital than CABG (weighted mean difference (WMD) –1.25, 95% CI, –1.62 to –0.88; –17.47, –31.01 to –3.93; –1.77, –3.07 to –0.46; respectively).
Conclusion

Our meta-analysis indicates that HCR is feasible, safe and effective for the treatment of MCAD, with similar in-hospital and one-year follow-up outcome, significantly lower requirement of RBC transfusion, and faster recovery compared with CABG.
Keywords: Hybrid coronary revascularization, Coronary artery bypass grafting, Multivessel coronary artery disease, Meta-analysis

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To be used only in patients with acute blood loss and when crystalloids alone are not sufficient.

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The National Institute for Health and Care Excellence (NICE) published interventional procedure guidance 486 on hysteroscopic morcellation of uterine fibroids in April 2014 but later withdrew the guidance because there was an error in the patient commentary considered by the Committee when it made its recommendations. 
NICE interventional procedure guidance 522 on hysteroscopic morcellation of uterine leiomyomas (fibroids) was published in June 2015 and replaces interventional procedure guidance 486.
Description
Uterine leiomyomas (also known as uterine myomas or fibroids) are benign tumours that develop within the uterine wall. They can be single or multiple. They are one of the most common gynaecological problems among women in the UK. They are often asymptomatic but they can cause symptoms such as menorrhagia, intermenstrual bleeding, a feeling of pelvic pressure, pain, and urinary incontinence. They may also be associated with reproductive problems such as subfertility and miscarriage.
Treatment depends on whether the leiomyomas cause symptoms and on the woman’s desire for future childbearing. Asymptomatic leiomyomas need no treatment. Depending on their size, number and location, symptomatic leiomyomas can be managed by hysterectomy (surgical removal of the uterus) or myomectomy (surgical removal of the leiomyomas). Smaller submucous leiomyomas can be removed by hysteroscopic resection. Uterine artery embolisation may also be used. Other treatments include endometrial ablation, using energy such as microwave or heat, which may be suitable for some leiomyomas. Hormone-based treatments may be used on a short-term basis to relieve symptoms, or to shrink the leiomyomas before surgery or other interventional treatment.
Coding and clinical classification codes for this guidance

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The emotional trauma of a near-death experience causes ongoing emotional and physical symptoms in one-third of ICU patients.

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The article discusses post-intensive care syndrome and its relation to diabetes. As the pandemic continues to spread across the world, there has been a phenomenal increase in hospitalizations, admission to hospital intensive care units (ICUs) and fatalities. During these times people with diabetes are at the risk of developing severe symptoms and complications of COVID-19 According to the Center for Disease Control and Prevention (CDC) both type 1 and type 2 diabetics are at a higher risk. It’s even riskier if your blood glucose levels are frequently high or if you’ve developed diabetes-related problems like heart or kidney disease. Being at higher risk for severe COVID-19, protection from exposure to the virus is important. In case you get sick, you should have enough critical supplies since leaving the house is not an option. It is also important that you know the situation at hand in case you require hospitalization.

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Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.

Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.

Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.

Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.

Keywords: community-acquired pneumonia; pneumonia; patient management

Brief description of media:

Background
During intensive care unit (ICU) admission, patients experience extreme physical and psychological stressors, including the abnormal ICU environment. These experiences impact on a patient’s recovery from critical illness and may result in both physical and psychological disorders. One strategy that has been developed and implemented by clinical staff to treat the psychological distress prevalent in ICU survivors is the use of patient diaries. These provide a background to the cause of the patient’s ICU admission and an ongoing narrative outlining day-to-day activities.
Objectives
To assess the effect of a diary versus no diary on patients, and their caregivers or families, during the patient's recovery from admission to an ICU.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1),Ovid MEDLINE (1950 to January 2014), EBSCOhost CINAHL (1982 to January 2014), Ovid EMBASE (1980 to January 2014), PsycINFO (1950 to January 2014), Published International Literature on Traumatic Stress (PILOTS) database (1971 to January 2014); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to January 2014); seven clinical trial registries and reference lists of identified trials. We applied no language restriction.
Selection criteria
We included randomized controlled trials (RCTs) or clinical controlled trials (CCTs) that evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs.
Data collection and analysis
We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to prespecified criteria.
Main results
We identified three eligible studies; two describing ICU patients (N = 358), and one describing relatives of ICU patients (N = 30). The study involving relatives of ICU patients was a substudy of family members from one of the ICU patient studies. There was a mixed risk of bias within the included studies. Blinding of participants to allocation was not possible and blinding of the outcome assessment was not adequately achieved or reported. Overall, the quality of the evidence was low to very low. The patient diary intervention was not identical between studies. However, each provided a prospectively prepared, day-to-day description of the participants' ICU admission.

No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, health-related quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (risk ratio (RR) 0.29, 95% confidence interval (CI) 0.07 to 1.19) or depression (RR 0.38, 95% CI 0.12 to 1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. However, the results were imprecise and consistent with benefit in either group, or no difference. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84 to 1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14 to 28), in comparison to no diary (median 28; range 14 to 38).
Authors' conclusions
Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members.

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New interaction information added includes reports of profound hypertension following anaesthetic with propofol in patients treated with rifampicin; a possible requirement for dose reduction in patients taking valproate; and information on use with other CNS depressants.

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This document provides guidance to EU/EEA Member States on environmental cleaning in healthcare and non-healthcare settings during the COVID-19 pandemic.

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Many people continue to experience symptoms, even after recovering from COVID-19. Experts believe that patients who get severely ill with COVID-19, and those that end up in the hospital and those that go to intensive care, can develop post-intensive care syndrome. This syndrome has been described well before the COVID-19 pandemic, in patients who have been critically ill, says Dr Janet Diaz, Head of Clinical Care at World Health Organization (WHO). Thus, there can be seen prolonged symptoms and functional limitations in patients who have been critically ill with COVID-19.

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Modern critical care medicine has the ability to bring people from the brink of death and to keep people alive for much longer than in the past. It has now been known that these survivors can develop myriad mental and/or physical disabilities after treatment in the intensive care unit. In fact, up to 50% of patients who stay in the ICU for at least on week are susceptible to PICS. Research is now shedding light as to the severity and the need for education and post-care for patients and families as they deal with the aftermath of this.

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Wu, of San Carlos, California, believes she had covid — although, like many others who were unable to get tested early in the pandemic, she never got an official diagnosis. And, she said, its aftereffects continue to plague her.
Wu has struggled to get help from doctors, even those who take her symptoms seriously. “There’s no actual treatment,” she said, for people experiencing these lasting symptoms, often referred to as long covid. When seeking help, “you’re basically a guinea pig at this point.”