Rapid tranquilization: new approaches in the emergency treatment of behavioral disturbances

2004 ◽  
Vol 19 (5) ◽  
pp. 243-249 ◽  
Author(s):  
Jürgen De Fruyt ◽  
Koen Demyttenaere
Keyword(s):  
Atypical Antipsychotics ◽  
Care Setting ◽  
Evidence Base ◽  
Small Sample ◽  
Emergency Psychiatry ◽  
Behavioral Disturbances ◽  
Treatment Regimens ◽  
Small Sample Sizes ◽  
Common Clinical Practice ◽  
Definition Of

AbstractPsychiatric emergencies are often accompanied by behavioral disturbances that interfere with normal assessment and call for immediate intervention. Different pharmacological treatment regimens have been used for this purpose. Most of these regimens are based upon common clinical practice and have limited evidence base. Recently, a major publication by experts in the field of emergency psychiatry has covered this topic and the therapeutic armamentarium has been extended with the atypical antipsychotics. However, research is still hampered by different methodological limitations: unclear definition of the agitated state and therapeutic goal, idiosyncratic measurement, small sample sizes. The perspective of the patient and the interaction between the emergency care setting and treatment regimen also need further attention. All these important, but often neglected issues are covered in a selective review of the literature.

scholarly journals Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

2021 ◽  
Vol 10 (8) ◽  
pp. 1740
Author(s):  
Marion Bareille ◽  
Michaël Hardy ◽  
Jonathan Douxfils ◽  
Stéphanie Roullet ◽  
Dominique Lasne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Strength ◽  
Small Sample ◽  
The Common ◽  
Small Sample Sizes ◽  
Definition Of ◽  
Reported Data ◽  
Prophylactic Anticoagulation ◽  
The Impact ◽  
Heparin Neutralization

Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until December 31st, 2020. VET methods and parameters, and patients’ features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.

Nutritional intervention for ADHD

2018 ◽  
Author(s):  
Jan K. Buitelaar ◽  
Nanda Rommelse ◽  
Verena Ly ◽  
Julia J. Rucklidge
Keyword(s):  
Fatty Acids ◽  
Clinical Relevance ◽  
Randomized Clinical Trials ◽  
Nutritional Intervention ◽  
Evidence Base ◽  
Small Sample ◽  
Omega 3 ◽  
Dietary Interventions ◽  
Small Sample Sizes ◽  
Sampling Procedures

This chapter discusses four dietary interventions (exclusion of artificial colours and preservatives; restrictive elimination diets/oligoantigenic diets; supplementation with omega-3 fatty acids; and supplementation with micronutrients) and their clinical relevance for ADHD. The evidence base for exclusion of artificial colours and preservatives has many gaps. Effectiveness of the elimination phase of elimination diets has been demonstrated in several randomized clinical trials and about one-third of the children with ADHD show an excellent response. Data on maintenance of effect in the longer term, however, are lacking. Supplementation of free fatty acids was associated with a small but reliable reduction of ADHD symptoms, but the clinical relevance is unclear. The trials using a broad spectrum of micronutrients show promise but suffered from small sample sizes, lack of controls, varied sampling procedures and inclusion criteria, and multiple assessment methods, and need confirmation.

scholarly journals A Systematic Review of the Clinical Use of Gabapentin and Pregabalin in Bipolar Disorder

2021 ◽  
Vol 14 (9) ◽  
pp. 834
Author(s):  
Qin Xiang Ng ◽  
Ming Xuan Han ◽  
Seth En Teoh ◽  
Clyve Yu Leon Yaow ◽  
Yu Liang Lim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Significant Proportion ◽  
Evidence Base ◽  
Small Sample ◽  
Long Term Outcomes ◽  
Open Label ◽  
Related Drug ◽  
Small Sample Sizes

Despite its prevalence and disease burden, several chasms still exist with regard to the pharmacotherapy of bipolar disorder (BD). Polypharmacy is commonly encountered as a significant proportion of patients remain symptomatic, and the management of the depressive phase of the illness is a particular challenge. Gabapentin and pregabalin have often been prescribed off-label in spite of a paucity of evidence and clinical practice guidelines to support its use. This systematic review aimed to synthesize the available human clinical trials and inform evidence-based pharmacological approaches to BD management. A total of six randomized, controlled trials (RCTs) and 13 open-label trials involving the use of gabapentin and pregabalin in BD patients were reviewed. Overall, the studies show that gabapentin and its related drug pregabalin do not have significant clinical efficacy as either monotherapy or adjunctive therapy for BD. Gabapentin and pregabalin are probably ineffective for acute mania based on the findings of RCT, with only small open-label trials to support its potential adjunctive role. However, its effects on the long-term outcomes of BD remain to be elucidated. The evidence base was significantly limited by the generally small sample sizes and the trials also had heterogeneous designs and generally high risk of bias.

scholarly journals Rethinking research in breast-feeding: a critique of the evidence base identified in a systematic review of interventions to promote and support breast-feeding

2007 ◽  
Vol 10 (7) ◽  
pp. 726-732 ◽  
Author(s):  
MJ Renfrew ◽  
H Spiby ◽  
L D'Souza ◽  
LM Wallace ◽  
L Dyson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Breast Feeding ◽  
Professional Education ◽  
Evidence Base ◽  
Small Sample ◽  
Practice Change ◽  
Policy Goals ◽  
Breast Feed ◽  
Small Sample Sizes ◽  
The Uk

AbstractObjectiveTo appraise critically the relevance and value of the evidence base to promote and support the duration of breast-feeding, with a specific focus on disadvantaged groups.DesignA systematic review was conducted of intervention studies relevant to enhancing the duration of breast-feeding; topics included public health, public policy, clinical issues, and education, training and practice change. A systematic search was conducted. Eighty studies met the inclusion criteria. Data were systematically extracted and analysed. Full results and recommendations are reported elsewhere. Here a critique of the evidence base – topics, quality and gaps – is reported.ResultsMany studies were substantially methodologically flawed, with problems including small sample sizes, inconsistent definitions of breast-feeding and lack of appropriate outcomes. Few were based on relevant theory. Only a small number of included studies (10%) were conducted in the UK. Very few targeted disadvantaged subgroups of women. No studies of policy initiatives or of community interventions were identified. There were virtually no robust studies of interventions to prevent and treat common clinical problems, or of strategies related to women's health issues. Studies of health professional education and practice change were limited. Cost-effectiveness studies were rare.ConclusionsPolicy goals both in the UK and internationally support exclusive breast-feeding until 6 months of age. The evidence base to enable women to continue to breast-feed needs to be strengthened to include robust evaluations of policies and practices related to breast-feeding; a step change is needed in the quality and quantity of research funded.

scholarly journals Early CPAP reduced mortality in covid-19 patients. Audit results from Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust

2020 ◽  
Author(s):  
Abdul Ashish ◽  
Alison Unsworth ◽  
Jane Martindale ◽  
Luigi Sedda ◽  
Ramachandran Sundar ◽  
...  
Keyword(s):  
Best Practice ◽  
Small Sample Size ◽  
Clinical Care ◽  
Evidence Base ◽  
Good Evidence ◽  
Small Sample ◽  
Teaching Hospitals ◽  
Sufficient Evidence ◽  
Recent Experience ◽  
Common Clinical Practice

AbstractCOVID-19 infection typically causes pneumonia with bilateral changes on Chest radiograph. There is significant hypoxia and use of oxygen for patients admitted to hospital is standard. The use of Continuous Positive Airway Pressure (CPAP) in patients with COVID-19 has now become established as a common clinical practice based on recent experience. It is given as part of “best endeavours” treatment in the absence of sufficient evidence to guide best practice. The use of CPAP as a step up in clinical care is now common but has a poor evidence base.Using routinely collected data, the use of CPAP as a supportive non-invasive ventilatory treatment is described in 35 patients with COVID infection. Patients given early CPAP and in particular within 48 hours of admission, are shown to have a better outcome (a significant probability of lower mortality) than patients who received late CPAP (more than 48 hours after admission).Although the analysis is affected by a small sample size, the results have shown good evidence that supports the early use of CPAP in patients with COVID-19 infection.

Reunifying Successfully: A Systematic Review of Interventions to Reduce Child Welfare Recidivism

2020 ◽  
Vol 30 (8) ◽  
pp. 832-845
Author(s):  
Catherine A. LaBrenz ◽  
Lisa S. Panisch ◽  
Chun Liu ◽  
Rowena Fong ◽  
Cynthia Franklin
Keyword(s):  
Systematic Review ◽  
Child Welfare ◽  
Evidence Base ◽  
Small Sample ◽  
Effect Sizes ◽  
Inclusion Criteria ◽  
Welfare Systems ◽  
Prior Literature ◽  
Small Sample Sizes

As many as one third of children who reunify from child welfare systems reenter care because of continued child maltreatment. This can have long-term deleterious effects on mental health. Yet, few studies have examined interventions that have been effective in promoting successful reunification or reunification that does not result in recidivism. This study presents findings from a systematic review of interventions that target successful reunification. We searched five academic databases, governmental and educational websites to identify prior literature. Three researchers extracted data from N = 216 studies retrieved and screened in 10 that met all inclusion criteria. However, small sample sizes, lack of replication of studies, and small effect sizes limit the generalizability of findings. As such, the findings from this review highlight a need for more rigorous studies to build the evidence base of post-permanence interventions for families that reunify.

Subjective fatigue is not associated with cognitive impairment in multiple sclerosis: cross-sectional and longitudinal analysis

2009 ◽  
Vol 15 (8) ◽  
pp. 998-1005 ◽  
Author(s):  
SA Morrow ◽  
B Weinstock-Guttman ◽  
FE Munschauer ◽  
D Hojnacki ◽  
RHB Benedict
Keyword(s):  
Multiple Sclerosis ◽  
Small Sample ◽  
Cognitive Capacity ◽  
Cross Sectional ◽  
Longitudinal Approach ◽  
Fatigue Severity ◽  
Small Sample Sizes ◽  
Definition Of ◽  
Normal Controls ◽  
Medium Correlation

Background Studies in multiple sclerosis (MS) report conflicting conclusions regarding fatigue and cognition, which may partly be due to the use of small sample sizes and frequent reliance on a cross-sectional approach. Objective The ability to distinguish between these two disabling symptoms is necessary in order to properly assess and treat MS patients. Methods In a retrospective analysis, we assessed the correlation between fatigue and neuropsychological (NP) testing using a cross-sectional ( n = 465) and longitudinal approach ( n = 69). Cognition was measured using a comprehensive battery called the Minimal Assessment of Cognitive Function in MS (MACFIMS), and fatigue was measured with the Fatigue Severity Scale (FSS). FSS scores were categorized as normal (≤4.0), borderline fatigue (4 < FSS < 5.0), and fatigued (≥5.0). Repeat assessments ( n = 69) were categorized as improved or worsened by a change in FSS of either 0.5 or 1.0. Results MS patients had significantly higher FSS scores than normal controls ( P < 0.001). No correlation was found between FSS and NP scores in either cross-sectional or longitudinal analyses. Fatigue was moderately correlated with depression, assessed using the Beck Depression Inventory Fast Screen (BDIFS) ( r = 0.44, P < 0.001). Longitudinally, there was a medium correlation between change in FSS and BDIFS ( r = 0.34, P = 0.001), but no significant differences on NP scores using either definition of change. Conclusion We conclude that self-reported fatigue, while correlated with self-reported depression, is not significantly related to cognitive capacity in MS.

Integrating Visual and Bayesian Statistical Analyses in Single Case Experimental Research to Evaluate the Effectiveness and Magnitude of a Comprehensive Behavioral Intervention

2018 ◽  
Author(s):  
Prathiba Natesan ◽  
Smita Mehta
Keyword(s):  
Behavioral Intervention ◽  
Effect Size ◽  
Rate Ratio ◽  
Visual Analysis ◽  
Single Case ◽  
Small Sample ◽  
Statistical Analyses ◽  
Data Types ◽  
Ratio Effect ◽  
Small Sample Sizes

Single case experimental designs (SCEDs) have become an indispensable methodology where randomized control trials may be impossible or even inappropriate. However, the nature of SCED data presents challenges for both visual and statistical analyses. Small sample sizes, autocorrelations, data types, and design types render many parametric statistical analyses and maximum likelihood approaches ineffective. The presence of autocorrelation decreases interrater reliability in visual analysis. The purpose of the present study is to demonstrate a newly developed model called the Bayesian unknown change-point (BUCP) model which overcomes all the above-mentioned data analytic challenges. This is the first study to formulate and demonstrate rate ratio effect size for autocorrelated data, which has remained an open question in SCED research until now. This expository study also compares and contrasts the results from BUCP model with visual analysis, and rate ratio effect size with nonoverlap of all pairs (NAP) effect size. Data from a comprehensive behavioral intervention are used for the demonstration.

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