Clinical Trials Worth Knowing – CRICU Sepsis Nursing Workshop

This post is a collation of references and resource material from my second presentation in the inaugural Caboolture Redcliffe ICU Sepsis Workshop for nurses. The objective of this session was to work through critical appraisal of 5 prominent critical care trials with particular significance to our practice context. The completely unambiguous overtone of this session was to practise critical appraisal and engage with the literature that informs the medical decisions in our ICU.


Following a brief introduction and overview of the constructs of evidence based practice and grading of evidence, I lead the group through a structured critical appraisal of the SPLIT Trial (Young et al 2015). We used the Critical Appraisal Skills Programme (CASP) Randomised Contol Trial (RCT) Appraisal Tool to dissect the study. Following this, the participants were broken into four small groups and each given a prominent sepsis trial to appraise and feedback to the whole group in 30 minutes time.

The trials were purposely selected for discussion as they all hold specific relevance to practice in our ICU. These trials also share one commonality – they were all ‘negative’ or no difference trials. One key aspect discussed was the importance of no difference trials. During the group feedback particular focus was drawn to identifying the Population, Intervention, Comparison and Outcome (PICO), whether the study was believable (internal validity and biological plausibility), and whether it should change practice or confirmed our current practice.

About 20 minutes into the appraisal activity the groups were provided with the Bottom Line review for their relevant study to aid in synthesising final feedback and as an example of an excellent critical appraisal. The Bottom Line is an excellent critical appraisal and literature resource for Intensive Care. Founded by members of the Wessex Intensive Care Society and now with international authorship, this is one of my absolute go-to resources to help filter and process the swathe of ICU trials.

Primary Literature

Secondary Appraisal

HEAT Trial – Acetaminophen for Fever in Critically Ill Patients with Suspected Infection (Young et al 2015) Bottom Line on HEAT – Steve Mathieu
ARISE Trial Goal-Directed Resuscitation for Patients with Early Septic Shock (Delaney et al 2014) Bottom Line on ARISE – Steve Mathieu
CORTICUS Trial – Hydrocortisone Therapy for Patients with Septic Shock (Sprung et al 2008) Bottom Line on CORTICUS – Duncan Chambler
BLISS Trial – Beta-Lactam Infusion in Severe Sepsis (BLISS): a prospective, two-centre, open-labelled randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis (Abdul-Aziz et al 2016) Bottom Line on BLISS – Adrian Wong
SPLIT Trial – Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit (Young et al 2015) Bottom Line on SPLIT – Adrian Wong

Anthony Crocco from Sketchy EBM – How to read (most) research papers


United Medicine – Combining opinion to translate evidence into practice

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Follow @united_medicine  on Twitter

Editor: This post hosts an open letter of sorts to spread the word about an ambitious and inspired project that looks to build a forum for knowledge translation in medicine. Very quick and easy to register and completely free. In many ways my initial observations are that this is a formalisation platform for many of the discussions that occur on a daily basis in the #FOAMed community on Twitter. I see United Medicine as holding enormous potential to fill a void often noted by users of Twitter to articulate the nuances of Evidence Based Practice within 140 character microblogs. I have absolutely no conflicts of interests or disclosures related to this venture – I just think it is a great idea, well worth the price of registration – FREE is definitely the right price!

Combining Opinion to Translate Evidence into Practice     www.unitedmedicine.net

Alongside formal resources and guidelines, many of the most useful insights come from the informal discussions on healthcare evidence that occur on the shop floor, meetings, conferences or even coffee rooms.

Often we say “What’s the evidence for that?” or “What difference does this trial make to us and our patients?”. The outcomes of those discussions being key to ongoing learning and our clinical decision making. However, if you are off shift, late to the conference, or just choose to go to the costa instead of the coffee room you may miss those important insights that go no further.

A new platform is now available to facilitate consensus on the ‘coalface’ implications of the newest evidence, and makes those insights available to all healthcare professionals 24/7. You don’t have to be a professor or trialist to contribute; it’s all about creating a bigger audience for the discussion that happens in day to day practice.

The story started at 2am on a night shift in the Emergency Department with staff chatting to their colleagues about the latest trauma study. It struck them as odd that the same discussion was likely taking place in many other places around the world, but the dialogue never gets joined up in any way.

United Medicine was created to address this problem. It is completely free and open to all registered healthcare professionals providing a structured, guided review process that combines individual opinion of evidence and presents them in intelligent feeds tailored to your speciality and interests. A voting system within UM allows the very best comments to come to the fore, and to be shared with a wide base of peers.

In short, the ultimate aim is to facilitate the transformation of evidence into practice, with the end outcome being more consistent, better patient care.

Matt

Dr Matt Wilson

Co-founder United Medicine

@united_medicine

www.unitedmedicine.net

About the man behind United Medicine. Matt qualified as a doctor from Cardiff University back in 2009.  Following foundation he spent 3 years as a military doc, mostly with the Royal Marines (42 Commando) in a number of places including Somalia, Albania, Middle East, Norway and Kenya. Matt now works in Poole Hospital ED in the UK and is a big advocate of FOAM & evidence based medicine. Matt has recently become Dad and enjoys getting out on the water when he can!