Survival Following Extreme Hypernatraemia Associated with Severe Dehydration and Undiagnosed Diabetes Mellitus.

We report a case of a previously well 58-year-old man, who presented with delirium and low GCS, and was found to have extreme hypernatraemia (Na = 191 mmol/L) and hyperglycaemia (glucose = 31 mmol/L). This resulted in a corrected serum sodium of 202 mmol/L. He was treated with fluid and electrolyte replacement in the intensive care unit, and had returned to essentially normal function by hospital discharge.

Using medico-legal claims for quality improvement in maternity care: application and revision of an NHSLA coding taxonomy.

Objective: To validate the NHSLA maternity claims taxonomy at the level of a single maternity service and assess its ability to direct quality improvement.

Design: Qualitative descriptive study.

Setting: Medico-legal claims between 1 January 2000 and 31 December 2016 from a maternity service in metropolitan Melbourne, Australia.

Early electroencephalogram does not reliably differentiate outcomes in post-hypoxic myoclonus.

Objective: Prognostication in patients with post-hypoxic brain injury remains difficult; yet, clinicians are commonly asked to guide decisions regarding withdrawal of life support. We aimed to assess whether electroencephalogram (EEG) is a useful tool in predicting neurological outcome in patients with post-hypoxic myoclonus (PHM).

Design And Setting: This study was conducted as part of an internal hospital audit assessing therapeutic hypothermia in patients with hypoxic cardiac arrest.

Proceedings of the 12th International Conference on Rapid Response Systems and Medical Emergency Teams.

Rapid Response Teams (RRTs) have been introduced into hospitals worldwide in an effort to improve the outcomes of deteriorating hospitalised patients. Recently, there has been increased awareness of the need to develop systems other than RRTs for deteriorating patients. In May 2016, the 12th International Conference on Rapid Response Systems and Medical Emergency Teams was held in Melbourne.

The epidemiology of in-hospital cardiac arrests in Australia and New Zealand.

Background: The epidemiology of in-hospital cardiac arrests (IHCA) in Australia and New Zealand (ANZ) has not been systematically assessed.

Aim: To conduct a systematic review of the frequency, characteristics and outcomes of adult IHCA in ANZ.

Methods: Medline search for studies published in 1964-2014 using MeSH terms 'arrest AND hospital AND Australia', 'arrest AND hospital AND New Zealand', 'inpatient AND arrest AND Australia' and 'inpatient AND arrest AND New Zealand'.

Findings of the first ANZICS conference on the role of intensive care in Rapid Response Teams.

Rapid Response Teams (RRTs) are specialised teams introduced into hospitals to improve the outcomes of deteriorating ward patients. Although Rapid Response Systems (RRSs) were developed by the intensive care unit (ICU) community, there is variability in their delivery, and consultant involvement, supervision and leadership appears to be relatively infrequent. In July 2014, the Australian and New Zealand Intensive Care Society (ANZICS) convened the first conference on the role of intensive care medicine in RRTs in Australia and New Zealand.

Effects on patient care caused by drug shortages: a survey.

Background: Drug shortages pose a serious challenge for health care institutions, often interfering with patient care. A common practice during a drug shortage is to select an alternate therapeutic; however, these agents often present challenges and may create safety concerns. Patient harms including adverse events and medication errors may occur.

Can an evidence-based guideline reduce unnecessary imaging of road trauma patients with cervical spine injury in the emergency department?

The aim of this study was to determine if an unvalidated imaging guideline can reduce the use of imaging in patients with cervical spine trauma. A non-randomized clinical trial using historical controls was conducted in the emergency department from October 2001 to September 2002. Following an education programme, which introduced the imaging guideline to clinicians, the use of guideline and imaging were measured.

Development of an evidence-based guideline for imaging in cervical spine trauma.

Cervical spine trauma is a common reason for presentation to an emergency department. However, less than 5% of patients who have suffered possible neck injury actually have an injury requiring medical treatment. Nevertheless, the consequences, both for the patient and the doctor, of a missed injury are well recognized by emergency department medical staff.

Implementing evidence-based practice in clinical situations.

Many nurses in a variety of clinical settings are facing the challenges posed by incorporating evidence-based practice in health care. Some of the steps involved in implementing evidence-based care in clinical practice are discussed and a two-step framework to assist practitioners in implementing evidence-based practice is outlined. Factors such as the relevance of specific guidelines or research, generalisability of research findings, the strength of the evidence relative to the risks and benefits of treatment, and patient preferences are discussed in terms of evidence-based decision making.

"Picking winners": assessing new health technology.

Are evidence-based approaches ready for health technology?

What's the evidence? Clinical effectiveness.

This learning unit explores how to find and appraise evidence from clinical information, and how to apply it to effective and appropriate clinical practice. The aim of the unit is to give nurses an understanding of the role of evidence in achieving clinical effectiveness, and to identify how nurses can find and make use of this evidence in their own practice.