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Comparison of two muscle relaxants, rocuronium and succinylcholine, to facilitate rapid sequence induction intubation

In emergency situations some people need a general anaesthetic with an endotracheal tube (a tube to help them breathe). It is important to have fast‐acting medications to allow physicians to complete this procedure quickly and safely. Currently, the medication used most frequently to relax muscles is succinylcholine. Succinylcholine is fast‐acting and lasts for only a few minutes, which is very desirable in this setting. However, some people cannot use this medication as it can cause serious salt imbalances or reactions, so an equally effective medication without these side effects would be advantageous. One possible alternative medication is rocuronium, a muscle relaxant with fewer side effects but longer duration of action. This review compares the quality of intubation conditions (the ease with which physicians can quickly and safely pass the endotracheal tube) between rocuronium and succinylcholine in all ages and varying clinical situations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Effect of applying cricoid pressure during rapid sequence induction of general anaesthesia

Rapid sequence induction (RSI) is a technique used by critical care clinicians, mainly anaesthetists, intensive care physicians and emergency physicians, when setting out to secure a clear airway for a general anaesthetic and the patient is thought to be at risk of vomiting their stomach contents into their airway and down into their lungs. Stomach contents in the lungs can cause infection of the lung and, in severe cases, death. Cricoid pressure is a technique where pressure is placed on an area of bone‐like tissue in the neck to flatten the oesophagus (tube that connects the mouth to the stomach). This is intended to prevent vomiting up of the stomach contents. The application of cricoid pressure for this purpose is very common. It is, however, a controversial practice as some clinicians and researchers believe it to be ineffective. It may also interfere with the clinician's view of the patient's airway.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010
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Induction of Labour

The purpose of this guideline is to review all aspects of the methodology of induction of labour and the appropriateness of different approaches in the various clinical circumstances that may call for such an intervention.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: July 2008
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Crohn's Disease: Management in Adults, Children and Young People

This guideline intends to show the place of both new and established treatments in the wider care pathway for Crohn's disease. This will be useful for clinicians and people with Crohn's disease because new drugs have been licensed for Crohn's disease in the last decade. The guideline also deals with those medications which are unlicensed for treatment of the condition, but which have been used in this way (off-label) for many years and their role is recognised in other NICE documents as well as the British National Formulary. They include azathioprine, mercaptopurine and methotrexate. The guideline aims to help improve the care offered to people with Crohn's disease and provide information about the clinical and cost effectiveness of potential care pathways. Management of Crohn's disease in specific populations (for example, in pregnancy) may require special consideration.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: October 10, 2012
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Ulcerative Colitis: Management in Adults, Children and Young People [Internet]

Ulcerative colitis is the most common type of inflammatory disease of the bowel. It has an incidence in the UK of approximately 10 per 100,000 people annually,and a prevalence of approximately 240 per 100,000. This amounts to around 146,000 people in the UK with a diagnosis of ulcerative colitis. The cause of ulcerative colitis is unknown. It can develop at any age, but peak incidence is between the ages of 15 and 25 years, with a second, smaller peak between 55 and 65 years (although this second peak has not been universally demonstrated). The British Paediatric Surveillance Unit reported an incidence of ulcerative colitis in children aged younger than 16 years in the United Kingdom, of 1.4 per 100,000 with a greater proportion of Asian children having ulcerative colitis than other children. The median age for diagnosis of ulcerative colitis overall in this childhood cohort was 11.7 years (range 9.3 to 13.7 years).

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2013

Patient safety in ambulance services: a scoping review

This study aimed to identify and map available evidence relating to patient safety when using ambulance services. There was inconsistency of information on attitudes and approaches to patient safety, exacerbated by a lack of common terminology. Patient safety needs to become a more prominent consideration for ambulance services and development of new models of working must include adequate training and monitoring of clinical risks. Providers and commissioners need a full understanding of the safety implications of introducing new models of care. Areas requiring further work include the safety surrounding discharging patients, patient accidents, equipment and treatment, delays in transfer/admission to hospital, and treatment and diagnosis, with a clear need for increased reliability and training for improving handover to hospital.

Health Services and Delivery Research - NIHR Journals Library.

Version: May 2015
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Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

There is limited evidence on whether shifting diagnostic services out of hospital is clinically effective and cost-effective, but some findings show reduced burden on hospitals and mixed results on quality and safety.

Health Services and Delivery Research - NIHR Journals Library.

Version: December 2016
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Buprenorphine/Naloxone Versus Methadone for the Treatment of Opioid Dependence: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Guidelines [Internet]

In 2013, Suboxone (buprenorphine/naloxone) became available as a generic and its direct cost, and cost differential with methadone, decreased. Buprenorphine/naloxone has several advantages compared with methadone. Methadone is a full agonist; there is no ceiling to respiratory depression or sedation effects and an overdose can be fatal. Buprenorphine also has a long half-life but because it is a partial agonist, it has a ceiling effect (effect plateaus at higher doses) and thus the risk of overdose is decreased. Other advantages of buprenorphine/naloxone include its long duration of action which allows for every second day dosing if needed; its administration as a sublingual tablet; its lack of requirements of an exemption to be prescribed; and its formulation with less potential for abuse.

Rapid Response Report: Peer-Reviewed Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: September 2, 2016

Rapid fetal fibronectin testing to predict preterm birth in women with symptoms of premature labour: a systematic review and cost analysis

Study found fetal fibronectin (fFN) testing to have moderate accuracy for predicting preterm birth. Evidence from randomised controlled trials suggests that fFN doesn't increase adverse outcomes and may reduce resource use.

Health Technology Assessment - NIHR Journals Library.

Version: September 2013

Improving outcomes for people in mental health crisis: a rapid synthesis of the evidence for available models of care

The study found that there was little evidence for the clinical effectiveness and cost-effectiveness of services provided before crisis. Crisis teams were found to work well and crisis houses and acute day hospitals are important alternatives to inpatient treatment. More research is needed to improve the clinical effectiveness and cost-effectiveness of crisis care, such as identifying the effective components of inpatient care.

Health Technology Assessment - NIHR Journals Library.

Version: January 2016

Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis

The study found that procalcitonin testing may be effective and cost-effective when used to guide discontinuation of antibiotics in adults being treated for suspected or confirmed sepsis in intensive care unit settings, and the initiation of antibiotics in adults presenting to the emergency department with respiratory symptoms and suspected bacterial infection. However, it is not clear that observed costs and effects are directly attributable to PCT testing, are generalisable and would be reproducible in the UK NHS.

Health Technology Assessment - NIHR Journals Library.

Version: November 2015

Bipolar Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care

This guideline has been developed to advise on the treatment and management of bipolar disorder. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, patients and guideline methodologists after careful consideration of the best available evidence. It is intended that the guidelines will be useful to clinicians and service commissioners in providing and planning high quality care for those with bipolar disorder while also emphasising the importance of the experience of care for patients and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2006

Sepsis: Recognition, Assessment and Early Management

Sepsis is a clinical syndrome caused by the body's immune and coagulation systems being switched on by an infection. Sepsis with shock is a life-threatening condition that is characterised by low blood pressure despite adequate fluid replacement, and organ dysfunction or failure. Sepsis is an important cause of death in people of all ages. Both a UK Parliamentary and Health Service Ombudsman enquiry (2013) and UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD, 2015) have recently highlighted sepsis as being a leading cause of avoidable death that kills more people than breast, bowel and prostate cancer combined.

NICE Guideline - National Guideline Centre (UK).

Version: July 2016

Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men

Study found that sex- and gender-related differences in relation to the content of weight-loss interventions should be recognised and efforts should be made to include accessible, male-friendly intervention settings and that health service staff should initiate discussion regarding weight-loss services.

Health Technology Assessment - NIHR Journals Library.

Version: May 2014

Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis

The study found that the evidence on the relative effectiveness of thigh-length graduated compression stockings (GCSs) versus knee-length GCSs, in addition to pharmacological prophylaxis (heparin), for prevention of deep-vein thrombosis in surgical patients is weak and subject to considerable heterogeneity. Studies of patient adherence and preference found that patients favour knee-length stockings over thigh-length stockings. An analysis of all the available data using standard meta-analysis and network meta-analysis suggests that thigh-length stockings are more effective than knee-length stockings but that the benefit of GCSs over and above that achieved with heparin alone is small and may not be clinically significant. Further research could more precisely estimate the difference in treatment effect between knee-length and thigh-length stockings when used in combination with heparin, although the value and feasibility of a definitive trial is less clear. The value of further research is most evident in high-risk subgroups, and the effect of changes in patient characteristics and treatment patterns on DVT risk should be considered in any decision to undertake a trial.

Health Technology Assessment - NIHR Journals Library.

Version: November 2015

Integrated sensor-augmented pump therapy systems [the MiniMed® Paradigm™ Veo system and the Vibe™ and G4® PLATINUM CGM (continuous glucose monitoring) system] for managing blood glucose levels in type 1 diabetes: a systematic review and economic evaluation

The study found evidence to suggest that integrated continuous glucose monitoring insulin pump therapy systems are more clinically effective in patients with type 1 diabetes than stand-alone treatments. However, based on the evidence available, these integrated systems are unlikely to be cost-effective in comparison with stand-alone insulin delivery and monitoring. Further research on the clinical effectiveness and cost-effectiveness of these integrated systems in different populations is warranted.

Health Technology Assessment - NIHR Journals Library.

Version: February 2016

WHO Recommendations for Prevention and Treatment of Maternal Peripartum Infections

The primary audience for this guideline is health professionals who are responsible for developing national and local health protocols and policies, as well as managers of maternal and child health programmes and policy-makers in all settings. The guideline will also be useful to those directly providing care to pregnant women, including obstetricians, midwives, nurses and general practitioners. The information in this guideline will be useful for developing job aids and tools for both pre- and inservice training of health workers to enhance their delivery of care to prevent and treat maternal peripartum infections.

World Health Organization.

Version: 2015

Impact of the intubation model on the efficacy of rocuronium during rapid sequence intubation: systematic review of randomized trials

This well-conducted review assessed the impact of the intubation model on the efficacy of rocuronium compared with succinylcholine for rapid sequence intubation (RSI). The authors concluded that, where a true RSI model was used, rocuronium could be as effective as succinylcholine, but this was also dose- and induction-agent dependent. The conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

The study found that for induction therapy in adult renal transplantation no treatment regimen appeared more effective than another in reducing graft loss or mortality, and, for maintenance therapy, none of the treatment regimens was better for all outcomes or appeared most effective at reducing graft loss. When comparing all treatment regimens only one combination of treatments was cost-effective.

Health Technology Assessment - NIHR Journals Library.

Version: August 2016
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