Author | Lightnews

Mark Borthwick @markborthwick.bsky.social · Aug 29

I get why people resign from positions of authority when organisation/leadership goes down the wrong path (yes, looking at the RFK vaccine nonsense)

BUT

Who do you think replaces the leavers? A similarly minded person, or someone more allied to those views?

We give way, and so facilitate

Mark Borthwick @markborthwick.bsky.social · Jun 17

Looking for help…!

#CriticalCarePharmacist
#Oxford

www.jobs.nhs.uk/candidate/jo...

Mark Borthwick @markborthwick.bsky.social · Jun 6

😘

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Mark Borthwick @markborthwick.bsky.social · Jun 6

Whole day was great
UKCPA Critical Care Symposium
@ukcpa.bsky.social

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Reposted by Mark Borthwick

Cathrine McKenzie FRPharmS @cathymac40.bsky.social · Jun 6

Jonathan presents the UK respiratory metagenomics implementation, route to routine. @ukcpa.bsky.social was great 👍

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Reposted by Mark Borthwick

David McWilliams @david-mcwilliams.bsky.social · Jun 6

Just a week to go until the launch of the NCEPOD report Recovery Beyond Survival - a review of the quality of rehabilitation care provided to patients following an admission to an ICU.

Register now to for the lunchtime webinar on 12 June👇

bit.ly/NCEPODwebinar

Microsoft Virtual Events Powered by Teams

bit.ly

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Mark Borthwick @markborthwick.bsky.social · May 27

My sincere thanks to all my critical care pharmacy colleagues for contributing data, and to UKCPA for the use of resources to make the study happen

Mark Borthwick @markborthwick.bsky.social · May 27

Overall we found the UK has moved over to using PPIs for SUP, there is some blanket prescribing going on, enteral feeding is commonly used as stopping criteria, though SUP is not stopped in some locations meaning deprescribing processes are needed

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Mark Borthwick @markborthwick.bsky.social · May 27

Stopping criteria were dominated by “patient fed” (65% of units)

In three quarters of those, that meant “full enteral feed”, in the remaining quarter that largely meant “any enteral feed”.

Neither SUP-ICU, nor REVISE used enteral feeding as stopping criteria

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Mark Borthwick @markborthwick.bsky.social · May 27

About a fifth of units reported they administered SUP to all patients, contrary to guidelines that advocate only giving SUP to critically ill patients with risk factors

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Mark Borthwick @markborthwick.bsky.social · May 27

Overall, we gathered information from over two thirds of UK critical care units, twice

Unsurprisingly, there was a large shift towards the use of PPIs for SUP between 2020 and 2024

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Mark Borthwick @markborthwick.bsky.social · May 27

We gathered SUP practices again in 2024, just prior to the publication of REVISE (which had the potential to change practice again)

www.nejm.org/doi/abs/10.1...

Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation | NEJM

Whether proton-pump inhibitors are beneficial or harmful for stress ulcer prophylaxis in critically ill patients undergoing invasive ventilation is unclear. In this international, randomized trial,...

www.nejm.org

1

Mark Borthwick @markborthwick.bsky.social · May 27

However, the appearance of COVID and the withdrawal of ranitidine somewhat ruined the experimental conditions

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Mark Borthwick @markborthwick.bsky.social · May 27

We aimed to more completely characterise UK practice before the publication of PEPTIC (H2RA as first line SUP agent, or PPI as first line SUP agent)

We then wanted to see how or if practice would change after the publication of PEPTIC

jamanetwork.com/journals/jam...

Effect of Stress Ulcer Prophylaxis With PPIs vs H2RBs on ICU Mortality

This cluster randomized trial compares the effects of proton pump inhibitors (PPIs) vs histamine-2 receptor blockers (H2RBs) on 90-day mortality among patients requiring invasive mechanical ventilatio...

jamanetwork.com

1

Mark Borthwick @markborthwick.bsky.social · May 27

In the work up to SUP-ICU, an observational study recorded SUP practices across several countries

This revealed that unlike other countries, UK practice was divided between H2RA and PPIs

onlinelibrary.wiley.com/doi/abs/10.1...

Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries

Background Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this st...

onlinelibrary.wiley.com

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Mark Borthwick @markborthwick.bsky.social · May 27

Have stress ulcer prophylaxis practices changed in the UK since the publication of PEPTIC?

Yes, but highly likely nothing to do with PEPTIC

journals.sagepub.com/doi/10.1177/...

Stress ulcer prophylaxis practice in UK critical care units: A comparison of cross-sectional surveys between 2020 and 2024 - Mark Borthwick, Greg Barton, Emma Boxall, John P Dade, Odran Farrell, Ruth ...

Background: Critically ill patients are at risk of bleeding from stress ulcers. Comprehensive information regarding United Kingdom stress ulcer prophylaxis (SUP...

journals.sagepub.com

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Mark Borthwick @markborthwick.bsky.social · May 24

#COVID5years

Quotes that made us laugh in the moment are added to a whiteboard

My niece asks pertinent questions for a school project

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Reposted by Mark Borthwick

Cathrine McKenzie FRPharmS @cathymac40.bsky.social · May 21

Dear ICU pharmacist colleague. Please complete our brief clinical pharmacysurvey for adult ICU. @rsbournie.bsky.social @markborthwick.bsky.social @chrisremmington.bsky.social

@esicm.bsky.social @sccmcriticalcare.bsky.social @ukcpa.bsky.social
#together
#weareICU

docs.google.com/forms/d/e/1F...

A Review of Clinical Pharmacy Services in Adult Intensive Care Units: An International Cross-Sectional Study

Dear colleagues, We invite you to participate in our survey, "A Review of Clinical Pharmacy Services in Adult Intensive Care Units: An International Cross-Sectional Study," conducted by researchers fr...

docs.google.com

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Mark Borthwick @markborthwick.bsky.social · May 18

#COVID5years
Impromptu hugs between nursing staff before a shift in the critical care covid bays

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Mark Borthwick @markborthwick.bsky.social · May 4

www.thelancet.com/journals/lan...

Supporting medical science in the USA

The pursuit of rigorous medical science is not compatible with capitulation to government demands aimed at weaponising and eroding science. On April 14, Edwin R Martin Jr, the Trump-appointed interim ...

www.thelancet.com

Mark Borthwick @markborthwick.bsky.social · May 3

#COVID5years

A little ‘thank you’ light show is projected onto the hospital

Parallels are made between the Nightingale facility nearing completion, and pandemic flu facilities 100years earlier

We start collecting handprints from our ICU workers

Reposted by Mark Borthwick

Cathrine McKenzie FRPharmS @cathymac40.bsky.social · May 2

docs.google.com/forms/d/e/1F...
Dear Intensive pharmacist, please complete our short international survey . This one for pharmacists, more coming for pharmacy team, including pharmacy technicians #bepartofresearch @markborthwick.bsky.social @chrisremmington.bsky.social and team

A Review of Clinical Pharmacy Services in Adult Intensive Care Units: An International Cross-Sectional Study

Dear colleagues, We invite you to participate in our survey, "A Review of Clinical Pharmacy Services in Adult Intensive Care Units: An International Cross-Sectional Study," conducted by researchers fr...

docs.google.com

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Mark Borthwick @markborthwick.bsky.social · Apr 29

Really interesting thread Segun

Balancing sufficient assurance of knowledge, skills, behaviours and experience vs overburdening is difficult, and key

We all -public, payers, colleagues- need some form of objective assurance of competence, not none
(in medicine, nursing, pharmacy, physio, etc)

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Mark Borthwick @markborthwick.bsky.social · Apr 23

#COVID5years
PIPA going strong
Clinical trials aseptic unit making hundreds of propofol and NMB syringes each day
Clinical pharmacy services to crit care now 7 days a week, 12hours a day

Mark Borthwick @markborthwick.bsky.social · Apr 15

#COVID5years
Renal replacement fluid supplies now under pressure, and start to be micromanaged
Regular counts commence to report back to NHS central, we write on anything handy