Methods: The Ovid Medline, EMBASE, CINAHL, Web of Science, Cochrane library and selleck chemical NHS databases were searched in September 2012 along with non-catalogued resources for papers examining the effect of early warning systems or emergency
response teams on hospital survival. Inclusion criteria were original clinical trials and comparative studies in adult inpatients that assessed either an early warning system or emergency response team against any of the predefined outcome measures. Exclusion criteria were previous systematic reviews, non-English abstracts and studies incorporating paediatric data. Studies were arranged in to sections focusing on the following interventions:
Early warning systems
Single parameter systems
-Aggregate weighted scoring systems
(AWSS) Emergency response teams
-Medical emergency teams
-Multidisciplinary outreach services
In each section an appraisal of the level of evidence and a recommendation has been made using the SIGN grading system.
Results: 43 studies meeting the review criteria were identified and included for analysis. 2 studies assessed single parameter scoring systems and 4 addressed aggregate weighted scoring systems. A total of 20 studies examined medical emergency teams and 22 studies selleck chemicals llc examined multidisciplinary outreach teams.
Limitations: The exclusion of non English studies and those including paediatric patients does limit the applicability of this review.
Conclusions: Much of the available evidence is of poor quality. It is clear that a ‘whole system’ approach should be adopted and that AWSS appear to be more effective than single parameter systems. The response to deterioration appears most effective when a clinician with critical care skills leads check details it. The need for service improvement differs between
health care systems. (C) 2013 Elsevier Ireland Ltd. All rights reserved.”
“The renin-angiotensin-aldosterone system is a well-established therapeutic target in the treatment of heart failure (HF). Substantial advances have been made with existing agents-angiotensin-converting enzyme (ACE) inhibitors, angiotensin II-receptor blockers (ARBs), and mineralocorticoid-receptor antagonists (MRAs)-and new data continue to emerge. The indication for the use of MRAs has been broadened to include potentially all patients who have HF with reduced ejection fraction (HFrEF), and ACE inhibitors might have a novel application in patients who are at risk of left ventricular dysfunction (those with aortic valvular disease or pacing-induced heart disease). ARBs have been shown to be a beneficial alternative to ACE inhibitors in HFrEF, but their value when added to ACE inhibitors has been questioned. Upstream, direct renin blockade with aliskiren is being pursued in two large trials of HF, despite the premature halting of a third study. A substantial, unmet need remains in patients who have HF with preserved ejection fraction (HFpEF).