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To see “What’s New” in your specialty (and 24 others, including drug therapy), or to read “Practice Changing UpDates” across all specialties, click here

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Prevention of graft reinfection in HCV-infected patients undergoing liver transplantation
In the absence of viral suppression or clearance of chronic hepatitis C virus (HCV) in patients who undergo liver transplantation, the new liver is almost always reinfected. In an open-label study, 16 HCV genotype 1-infected patients undergoing their first liver transplantation from an uninfected donor received a single dose of ledipasvir-sofosbuvir the day they arrived at the hospital for transplantation and once daily for four weeks postoperatively [1]. The sustained virologic response rate 12 weeks after completion of treatment was 88 percent, suggesting that an abbreviated perioperative course of direct-acting antiviral (DAA) treatment can prevent reinfection of the graft. Additional studies are warranted to confirm the efficacy and safety of this approach in other HCV-infected populations and with other DAA regimens.
See ‘Recurrence of hepatitis C virus infection following liver transplantation’, section on ‘Perioperative therapy’.
1. Levitsky J, Verna EC, O’Leary JG, et al. Perioperative Ledipasvir-Sofosbuvir for HCV in Liver-Transplant Recipients. N Engl J Med 2016; 375:2106.
 
Early introduction of egg for the prevention of egg allergy
Four recent randomized trials have examined introduction of egg for the prevention of egg allergy, with variable success. These studies are the Prevention of Egg Allergy with Tiny Amount Intake (PETIT) trial [2], the Starting Time of Egg Protein (STEP) trial [3], the Beating Egg Allergy Trial (BEAT) [4], and the Hen’s Egg Allergy Prevention (HEAP) trial [5]. Each trial enrolled a slightly different population and introduced different doses and forms of egg at ages ranging from 4 to 6 months. The most successful trial (PETIT) involved infants with eczema given a low dose of heated egg starting at 6 months of age, which resulted in egg allergy at 12 months in 8 and 38 percent in the treatment and placebo groups, respectively. The other trials that used pasteurized raw egg and started dosing as early as 4 months were negative. Further studies are needed to determine the optimal timing, patient population, and form of egg to introduce.
See ‘Introducing highly allergenic foods to infants and children’, section on ‘Introduction in a high-risk population’.
2. Natsume O, Kabashima S, Nakazato J, et al. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial. Lancet 2016.

3. Palmer DJ, Sullivan TR, Gold MS, et al. Randomized controlled trial of early regular egg intake to prevent egg allergy. J Allergy Clin Immunol 2016.

4. Tan JW-L, Valerio C, Barnes EH, et al. A randomized trial of egg introduction from 4 months of age in infants at risk for egg allergy. J Allergy Clin Immunol 2016.

5. Bellach J, Schwarz V, Ahrens B, et al. Randomized placebo-controlled trial of hen’s egg consumption for primary prevention in infants. J Allergy Clin Immunol 2016.

 
Donor fecal microbiota transplant for recurrent Clostridium difficile infection
Strong evidence to support fecal microbiota transplant (FMT) in patients with recurrent Clostridium difficile infection (CDI) has been lacking. In a randomized trial, patients with three or more recurrences of CDI who had received vancomycin for their most recent acute episode were assigned to FMT administered by colonoscopy with donor stool or their own stool (as a control) [6]. Patients who received donor FMT achieved higher clinical cure rates (92 versus 63 percent). These data support our recommendations to treat patients with recurrent CDI despite multiple courses of antibiotic therapy with donor FMT.
See ‘Fecal microbiota transplantation in the treatment of recurrent Clostridium difficile infection’, section on ‘Colonoscope’.
6. Kelly CR, Khoruts A, Staley C, et al. Effect of Fecal Microbiota Transplantation on Recurrence in Multiply Recurrent Clostridium difficile Infection: A Randomized Trial. Ann Intern Med 2016; 165:609.

New on ClinicalKey

The following journal and electronic books are now available via ClinicalKey.

MEHT staff should login with their NHS Athens account

Journal Added – CK Global

Books Added – CK Global

If you have any questions about ClinicalKey, or library services please get in touch.

New Books added to ClinicalKey

December 20, 2016 Leave a comment

The following new books & new editions are now available in ClinicalKey.

MEHT Staff can access by logging in with your Athens account

ClinicalKey updates

The following titles have been added to ClinicalKey

ClinicalKey is available to all MEHT staff via an OpenAthens login.

Auerbach’s Wilderness Medicine (Auerbach, Paul) 7th ed; ISBN: 9780323359429; Package/Collection: Emergency Medicine; New edition (replaces 9781437716788); https://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-C20130134915

Campbell’s Operative Orthopaedics (Azar, Frederick) 13th ed; ISBN: 9780323374620; Package/Collection: Orthopedics Essentials; New edition (replaces 9780323072434); https://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-C20131234092

Flaps and Reconstructive Surgery (Wei, Fu-Chan) 2nd ed; ISBN: 9780323243223; Package/Collection: Plastic Surgery; New edition (replaces 9780721605197); https://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-C20110068643

Movement Disorders in Childhood (Singer, Harvey) 2nd ed; ISBN: 9780124115736; Package/Collection: Neurology; New edition (replaces 9780750698528); https://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-C20120072717

Rockwood and Matsen’s The Shoulder (Rockwood, Charles) 5th ed; ISBN: 9780323297318; Package/Collection: Orthopedics Extended; New edition (replaces 9781416034278); https://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-C20111062227

Video Atlas of Neurosurgery: Contemporary Tumor and Skull Base Surgery (Quinones-Hinojosa, Alfredo) 1st ed; ISBN: 9780323261494; Package/Collection: Neurosurgery; New to CK; https://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-C20130000588

 
 

UpToDate News

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A better way to access UpToDate

Are you still using your Athens password to access UpToDate? If so, there is a better way to access that not only gives you access to the full UpToDate database but also the App that allows you to access from your Smart phone or tablet. The App is compatible with Apple and Android devices.

To register:

  • Go to the MEHT intranet homepage and click the UpToDate icon
  • Click Log in/Register (top right of screen)
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  • Select a Username and password.

Once registered, you use the username and password to access from a home PC or laptop, and to also login to the App (Just search for the UpToDate app in your usual App store & download to your device. You will only need to login once).

Verify your account every 90 days

You may have registered a few months ago – if so your account may be coming up for verification.

You will receive an email after 80 days to tell you to verify your account. It’s easy – just click the UpToDate logo on the Trust intranet homepage again & click Log in / Register. This time, log in (using Username and password you created) in the login box on the left hand side of the screen. All done – your account is now verified for another 90 days and you can continue to access as before.

CME Activity

You may have noticed that UpToDate records CME activity.

Once logged in, Click on the CME link at the top right of the screen.

Click “View/Change My Settings” from the menu on the left hand side.

Select “Time-based Tracking” from the options – this will now record the hours you spend on CME.

To print out a certificate, click “Process My CME/CE/CPD” from the left hand menu.

If you have previously accessed UpToDate with your Athens account it is possible to merge your Athens account with your individual account, ensuring your CME activity is carried over. To do this just email sitesupport@uptodate.com saying you wish to consolidate your Athens account with your current account. Please state your name, and the email address you used to register with Athens (if you cannot remember please email warner.library@meht.nhs.uk or phone x4708 and we can check for you)

 Training for individuals and Departments

I am now a certified Trainer for UpToDate, so if you would like to arrange a training session for yourself or your colleagues / team please get in touch. This would take about 15-20 minutes so could fit into a team meeting or CPD event.

For more help with the registration process please go to: http://meht-intranet/hr/learning-and-development/warner-library-services/uptodate/ (MEHT PC only)

Remember, you can still use your Athens account to access E-journals, E-books (including some titles from Oxford Online), Healthcare databases and ClinicalKey (hundreds of full text books and journals from Elsevier)

If you have any questions please do not hesitate to contact the Warner Library

New Books & Journals added to ClinicalKey

The following journals and books have recently been added to ClinicalKey.

Click a link and then login with your MEHT Athens account (Login top right of screen). If you haven’t used ClinicalKey before remember to click “Activate” to activate your account.

For more information on ClinicalKey please contact the Warner Library.

Journals Added – CK Global

Books Added – CK Global

New E-Books