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Acute kidney injury (AKI) has now replaced the term acute renal failureand an universal definition and staging system has been proposed to allow earlier detection and management of AKI. The new terminology enableshealthcare professionals to consider the disease as a spectrum of injury. This spectrum extends from less severe forms of injury to more advanced injury when acute kidney failure may requirerenal replacement therapy (RRT). Clinically AKI is characterised by a rapid reduction in kidney function resulting in a failure to maintain fluid, electrolyte and acid-base homoeostasis. There have previously been many different definitions of AKI used in the literature which has made it difficult to determine the epidemiology and outcomes of AKI. Over recent years there has been increasing recognition that relatively small rises in serum creatinine in a variety of clinical settings are associated with worse outcomes.

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Objective:
To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU.
Methods:
We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis, and family-centered care to revise the 2007 Clinical Practice Guidelines for support of the family in the patient-centered ICU. We conducted a scoping review of qualitative research that explored family-centered care in the ICU. Thematic analyses were conducted to support Population, Intervention, Comparison, Outcome question development. Patients and families validated the importance of interventions and outcomes. We then conducted a systematic review using the Grading of Recommendations, Assessment, Development and Evaluations methodology to make recommendations for practice. Recommendations were subjected to electronic voting with pre established voting thresholds. No industry funding was associated with the guideline development.
Results:
The scoping review yielded 683 qualitative studies; 228 were used for thematic analysis and Population, Intervention, Comparison, Outcome question development. The systematic review search yielded 4,158 reports after deduplication and 76 additional studies were added from alerts and hand searches; 238 studies met inclusion criteria. We made 23 recommendations from moderate, low, and very low level of evidence on the topics of: communication with family members, family presence, family support, consultations and ICU team members, and operational and environmental issues. We provide recommendations for future research and work-tools to support translation of the recommendations into practice.
Conclusions:
These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care.

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The case for adopting the 3M TegadermCHGIV securement dressing for central venous and arterial catheter insertion sites is supported by the evidence. This technology allows observation, and provides antiseptic coverage, of the catheter insertion site. It reduces catheter-related bloodstream infections and local site infections compared with semipermeable transparent (standard) dressings. It can be used with existing care bundles.
The 3M TegadermCHGIV securement dressing should be considered for use in critically ill adults who need a central venous or arterial catheter in intensive care or high dependency units.
The estimated cost saving from using a 3M Tegaderm CHGIV securement dressing (TegadermCHG) instead of a standard transparent semipermeable dressing is £93 per patient. This estimate is based on a baseline catheter-related bloodstream infection rate of 1.48 per 1,000catheter days. Tegaderm CHG is estimated to be cost neutral when the baseline catheter-related bloodstream infection rate is 0.18 per 1,000catheter days, and cost incurring when the baseline rate falls below that figure. [2019 – see section[2019 – see section5.25] 5.25]

Brief description of media:

The case for adopting the 3M TegadermCHGIV securement dressing for central venous and arterial catheter insertion sites is supported by the evidence. This technology allows observation, and provides antiseptic coverage, of the catheter insertion site. It reduces catheter-related bloodstream infections and local site infections compared with semipermeable transparent (standard) dressings. It can be used with existing care bundles.
The 3M TegadermCHGIV securement dressing should be considered for use in critically ill adults who need a central venous or arterial catheter in intensive care or high dependency units
The estimated cost saving from using a 3M TegadermCHGIV securement dressing (TegadermCHG) instead of a standard transparent semipermeable dressing is £93 per patient. This estimate is based on a baseline catheter-related bloodstream infection rate of 1.48 per 1,000catheter days. TegadermCHG is estimated to be cost neutral when the baseline catheter-related bloodstream infection rate is 0.18 per 1,000catheter days, and cost incurring when the baseline rate falls below that figure.

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Here people talk about the support they received when someone close to them was discharged from hospital after being critically ill in an intensive care unit (ICU).

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Current evidence on the efficacy and safety of living-donor liver transplantation appears adequate to support the use of this procedure for suitable donors and recipients with normal arrangements for clinical governance, consent and audit, provided that the necessary regulatory requirements are followed.
Clinicians and centres doing this procedure must follow the relevant regulatory and legal requirements of the Human Tissue Authority. This includes carrying out independent assessment interviews and getting statutory approval from the Human Tissue Authority before donation can proceed. During the consent process donors and recipients should have thorough physical and psychological screening and monitoring, and counselling about the morbidity and risks associated with this procedure. They should also be provided with clear written information, including relevant information provided by the Human Tissue Authority. In addition, the use of NICE's information for the public is recommended.
Living-donor liver transplantation should only be done in accordance with the NHS Blood and Transplant (NHSBT) Organ Donation and Transplantation Liver Advisory Group's Liver Selection Policy and the British Transplantation Society's guidelines for Directed Altruistic Organ Donation, taking into account the legal framework for living donation from the Human Tissue Authority. Non-directed altruistic donation is a possibility and should be discussed with a transplant centre or team.
Living-donor liver transplantation should be carried out in specialist centres by a multidisciplinary team.
Clinicians should enter details about all donors and recipients having living-donor liver transplantation into the NHSBT UK transplant registry, and review clinical outcomes locally.

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Many people felt there was a lack of support for ICU patients when they were discharged from hospital and recovering at home. Some said they were shocked and disappointed when the ill person had come back home but hadn't received any physiotherapy or other treatment, even though they'd still been extremely weak and immobile. One man said he had to pay for his wife to have physiotherapy privately and felt that they'd only started receiving the emotional support they needed when they joined a local support group. Some people said they'd worried about a lack of support for ICU patients during recovery, which meant they failed to discover whether the ill person was being adequately cared for when they got home.

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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.

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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.

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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.

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This NICE Pathway covers the assessment and early management of fever with no obvious cause in children under 5. It aims to improve clinical assessment and help healthcare professionals diagnose serious illness among young children who present with fever in primary and secondary care.
These recommendations should be followed until a clinical diagnosis of the underlying condition has been made. The child should then be treated according to national or local guidance for that condition.

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This document outlines British Thoracic Society (BTS) guidance on the adaptation of pulmonary rehabilitation to meet the recovery needs of the post COVID-19 patient.