scholarly journals Deprescribing: What is the gold standard? Themes that characterized the discussions at the first Danish symposium on evidence-based deprescribing

Author(s):  
Lykke I. Kaas Oldenburg ◽  
Dagmar Dalin ◽  
Anne Mette Drastrup ◽  
Charlotte Vermehren
Keyword(s):  
1997 ◽  
Vol 111 (7) ◽  
pp. 611-613 ◽  
Author(s):  
K. W. Ah-See ◽  
N. C. Molony ◽  
A. G. D. Maran

AbstractThere is a growth in the demand for clinical practice to be evidence based. Recent years have seen a rise in the number of randomized controlled clinical trials (RCTS). Such trials while acknowledged as the gold standard for evidence can be difficult to perform in surgical specialities. We have recently identified a low proportion of RCTS in the otolaryngology literature. Our aim was to identify any trend in the number of published RCTS within the ENT literature over a 30-year period and to identify which areas of our speciality lend themselves to this form of study design. A Medline search of 10 prominent journals published between 1966 and 1995 was performed. Two hundred and ninety-six RCTS were identified. Only five were published before 1980. Two hundred (71 per cent) of RCTS were in the areas of otology and rhinology. An encouraging trend is seen in RCTS within ENT literature.


2019 ◽  
Vol 34 (8) ◽  
pp. 501-514 ◽  
Author(s):  
Sharon L Boxall ◽  
Keryln Carville ◽  
Gavin D Leslie ◽  
Shirley J Jansen

Compression bandaging remains the ‘gold standard’ intervention for the treatment of venous leg ulcers. Numerous studies have investigated the effect of a large variety of compression bandaging techniques and materials on venous leg ulcer healing. However, the majority of these studies failed to monitor both actual bandage application pressures and the bandaging competency of participating clinicians. A series of literature searches to explore the methods, practices, recommendations and results of monitoring compression bandaging pressures in leg ulcer research trials were undertaken. This included investigating the reliability and validity of sub-bandage pressure monitors and the degree to which compression bandaging achieves the recommended sub-bandage pressure. The literature revealed inconsistencies regarding the monitoring of sub-bandage pressure and in sub-bandage pressures produced by clinicians. This creates difficulties when comparing study outcomes and attempting to develop evidence-based practice recommendations.


Author(s):  
Gilberto Sousa Alves ◽  
Felipe Kenji Sudo ◽  
Johannes Pantel

Bipolar disorder (BD) is an extremely disabling condition characterized by mood switches, and cognitive and functional impairment. The current chapter discusses the updated review on pharmacological and non-pharmacological interventions targeting BD in the elderly. The risk of concurrent medical diseases (eg, metabolic syndrome) and relatively lower tolerability than young BD make the patient safety a major concern in most cases. Evidence-based guidelines, although useful for promoting rational and effective therapy, are generally lacking in elderly BD. Current recommendations for acute mania include atypical antipsychotics, careful use of lithium, and election of valproate as the gold-standard therapy. In acute BD depression, first-line agents in monotherapy may include lithium, lamotrigine, quetiapine, and quetiapine extended release (XR). Electroconvulsive therapy may be an option for severe/refractory cases. Family members or caregivers should be encouraged to support the patient, since potential ethical issues involving patrimony or profession may arise during the treatment.


2011 ◽  
Vol 26 (S1) ◽  
pp. s71-s72
Author(s):  
A. Mirhaghi ◽  
G.R. Mohammadi ◽  
M. Asghari

Background and AimsDecision-making is the major component in triaging EDs patients. EDs Triage systems have applied different approaches to triaging intoxicated patients. Pros & Cons for these approaches need to be identified. Aim is to analysis management of intoxicated patients during various triage process.MethodsCritical review includes five triage systems, Emergency Severity Index, Australasian Triage Scale, Canadian triage and Acuity Scale, Manchester Triage System and 5-tier Triage protocol. These systems have been analyzed via meta-synthesis in terms of evidence-based criteria, inclusiveness, specific application and practicability.ResultsGeneral physiologic signs & symptoms were the gold standard for determining acuity in patients that have been applied by all triage systems. Conscious level, air way, respiratory status and circulation assessment were identified as major criteria in decision-making. 5-tier Triage protocol showed the most comprehensiveness characteristics to prioritizing intoxicated patients.DiscussionResources necessary for evidence-based performance to support nursing decisions in triaging intoxicated patients needs fundamentally to be developed. It`s necessary to develop National Triage Scale to approach intoxicated patients effectively.


2014 ◽  
Vol 44 (1) ◽  
pp. 63
Author(s):  
Dini Widiarni Widodo ◽  
Harim Priyono ◽  
Irma Suryati

Latar Belakang: Mikrotia didefinisikan sebagai daun telinga berukuran kecil dengan insiden sekitar 1 dari 7000-8000 ribu kelahiran, dengan insiden pada satu telinga sekitar empat kali lipat lebih banyak dibanding dua telinga. Rekonstruksi mikrotia merupakan salah satu prosedur cukup sulit pada bidang plastik rekonstruksi. Saat ini, penggunaan tandur tulang rawan iga autologus masih menjadi baku emas untuk rekonstruksi mikrotia. Tujuan: mengingatkan kembali para ahli THT tentang pertimbangan pemilihan rekonstruksi bersamaan pada kasus mikrotia bilateral dengan pencarian literatur berbasis bukti. Kasus: dilaporkan satu kasus mikrotia bilateral derajat 3, dengan hantaran tulang telinga kanan 60 dB, dan hantaran tulang telinga kiri 72,5 dB. Dengan pertimbangan memilih rekonstruksi bersamaan atau bertahap pada kedua telinga dan mengetahui prediksi perbaikan fungsi pendengarannya. Penatalaksanaan: aurikuloplasti tahap 1 dilakukan bersamaan pada kedua telinga. Skor Jahrsdoefer kedua telinga masing-masing 3 dan karena keterbatasan ekonomi dianjurkan menggunakan alat bantu dengar bukan BAHA untuk mengatasi hambatan komunikasi. Kesimpulan: penatalaksanaan mikrotia bilateral di bidang THT tidak hanya mencakup aspek rekonstruksi bentuk namun menekankan fungsi telinga sebagai alat berkomunikasi yang optimal. Kata kunci: mikrotia bilateral, ambang pendengaran, aurikuloplasti. ABSTRACTBackground:Microtia is defined as small sized ear with incidence approximately 1 in 7000-8000 births, which incidents in one ear is 4 times more compared to bilateral ear. Microtia reconstruction is one of difficult procedures in plastic reconstruction field. Recently, the use of rib cartilage autograft is still the gold standard for ear reconstruction. Purpose: to inform otorhinolaryngologist concerning simultaneous ear reconstruction in bilateral microtia case with evidence based method. Case: a third grade bilateral microtia, with the result of bone conduction are 60 dB for right ear dan 72,5 dB for left ear, the consideration to reconstruct both ear simultaneously or gradually, and how to predict the hearing improvement Management: first step of auriculoplasty was done in both ears, with Jahrsdoefer score is 3 for each ear, BAHA is adviceable but due to economic limitation the patients chose hearing aids. Conclusion: Bilateral microtia management in otorhinolaryngology does not only emphasize on ear reconstruction aspects but also to restore ear function as a means of optimal communicating.Keywords: bilateral microtia, hearing thresholds, auriculoplasty.


2020 ◽  
Author(s):  
Joyce W.Y. Chan ◽  
Rainbow W.H. Lau ◽  
Calvin S.H. Ng

While the gold standard for early stage lung cancers is still surgical resection, many patients have comorbidities or suboptimal lung function making surgery unfavorable. At the same time, more and more small lung nodules are being incidentally discovered on computer tomography (CT), leading to the discovery of pre-malignant or very early stage lung cancers without regional spread, which could probably be eradicated without anatomical surgical resection. Various ablative energies and technologies are available on the market, including radiofrequency ablation, microwave ablation, cryoablation, and less commonly laser ablation and irreversible electroporation. For each technology, the mechanism of action, advantages, limitations, potential complications and evidence-based outcomes will be reviewed. Traditionally, these ablative therapies were done under CT guidance with percutaneous insertion of ablative probes. Recently, bronchoscopic ablation under ultrasound, CT, or electromagnetic navigation bronchoscopy guidance is gaining popularity due to improved navigation precision, reduced pleural-based complications, and providing a true “wound-less” option.


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