website re-design

I am contemplating on re-designing the website a little to make it more 'user-friendly' on the front and back end, especialy on mobile devices.  Unfortunately, that means there would be a few changes in the ways we can access the website. 'User-friendly' usually means complex programs and software running in the background, all of which do not play nice with the arachiac versions of windows Internet Explorer, the web browser of choice on all HNEH computers.   Before I bite the bullet and go ahead, I am interested to hear many of your opinions on the matter and whether there is anything more or less you would like on our department website.  PLEASE, fill out this short survey and/or comment to this post.

 

Create your free online surveys with SurveyMonkey , the world's leading questionnaire tool.

 

Journal club: Transfusion strategies for acute upper GI bleeding

The study: in 921 patients with severe acute upper GI bleeeding, 461 were randomally assigned to a restrictive strategy (transfusion when Hb < 7 g/dL) & 460 were randomally assigned to a liberal strategy (transfusion when Hb < 9g/dL).

 

Result: In patients with severe acute upper gastrointestinal bleeding the outcomes were significantly improved with a restrictive transfusion strategy (Threshold < 7 g/dL). The restrictive group received significantly less transfusions. This resulted in a reduction in cost & use of blood. The restrictive group had a lower mortality, rebleeding & complication rate.

 

BOTTOM LINE: Having a transfusion threshold of < 7g/dL appears to have increased benefit, reduced harms & reduced costs. It appears to be a safe option for managing haemdynamically stable patients with upper GIH who are not exsanguinating. (It is important to note that patients with acute coronary syndrome, transient ischaemic attack, stroke and symptomatic peripheral vasculopathy were excluded from this study & therefore need to be considered for a more liberal transfusion strategy.)

 

Link to the full article

 

Link to the full review

Journal club: ARDS NET trial

As part of the project for our educational term, Mick Sales and I are going to be putting some regular journal article reviews on the site.

We will be using the CASP UK critical appraisal skill proforma to help us analyse these articles…but neither of us are EBM experts and so if you disagree with our review please post in the comments and let us know!

Most of the articles will be taken from the 52 landmark article post in ALiEM previously bought up by Tim Cowan.

The first study I have reviewed is the ARDS NET study of low tidal volume ventilation.

The link to the article and the appraisal tools used are listed here.

The ARDs NET ventilator protocol is here.

For those interested in the full review the link is here

Bottom line:

Lower tidal volume ventilation has a mortality benefit in patients with ARDS (8%), with a NNT of 12.5.

This has led to changes in ventilator strategies for all patients with TV of 6-8mls/kg recommended.

As a result of this study a protocolised ventilator protocol to meet oxygenation goals by titrating FiO2 and PEEP in ARDS patients has also been widely adopted.

Massive article!

Cheers - Dave

Journal club: ARDS NET trial

As part of the project for our educational term, Mick Sales and I are going to be putting some regular journal article reviews on the site.

We will be using the CASP UK critical appraisal skill proforma to help us analyse these articles…but neither of us are EBM experts and so if you disagree with our review please post in the comments and let us know!

Most of the articles will be taken from the 52 landmark article post in ALiEM previously bought up by Tim Cowan.

The first study I have reviewed is the ARDS NET study of low tidal volume ventilation.

The link to the article and the appraisal tools used are listed here.

The ARDs NET ventilator protocol is here.

For those interested in the full review the link is here

Bottom line:

Lower tidal volume ventilation has a mortality benefit in patients with ARDS (8%), with a NNT of 12.5.

This has led to changes in ventilator strategies for all patients with TV of 6-8mls/kg recommended.

As a result of this study a protocolised ventilator protocol to meet oxygenation goals by titrating FiO2 and PEEP in ARDS patients has also been widely adopted.

Massive article!

Cheers - Dave

Serotonin syndrome/toxicity and NMS

Dear All,

Further to my talk this morning a couple of links :

A very good review of serotonin syndrome/toxicity here

A 'Practice' article from early 2014 in BMJ here

The original study deriving the Hunter criteria for serotonin toxicity here

Monograph on serotonin syndrome including comparison with neuroleptic malignant syndrome here

thanks

Michael

Serotonin syndrome/toxicity and NMS

Dear All,

Further to my talk this morning a couple of links :

A very good review of serotonin syndrome/toxicity here

A 'Practice' article from early 2014 in BMJ here

The original study deriving the Hunter criteria for serotonin toxicity here

Monograph on serotonin syndrome including comparison with neuroleptic malignant syndrome here

thanks

Michael