Summary of Guideline for the Treatment of Panic Disorder and Agoraphobia

2003 ◽  
Vol 11 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Gavin Andrews ◽  
Mark Oakley-Browne ◽  
David Castle ◽  
Fiona Judd ◽  
Andrew Baillie ◽  
...  
Keyword(s):  
Clinical Practice ◽  
New Zealand ◽  
Panic Disorder ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Evidence Based ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Evidence Based Treatments ◽  
The Cost

Objective: To provide a summary of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guideline for the treatment of panic disorder and agoraphobia Conclusions: Evidence-based treatments for panic disorder and agoraphobia are now clear. These conditions are chronic and disabling in nature, are complicated by delayed treatment and the presence of other psychiatric conditions, and the presence of severe agoraphobia is a negative prognostic indicator. Choice of therapy will depend on the skill of the therapist in applying psychological treatments as well as the preferences of the patient, but there is a role for both psychological and evidence-based pharmacological approaches. The present article is a summary version of the comprehensive Clinical Practice Guideline (Australian and New Zealand Journal of Psychiatry, 2003) which was developed in accordance with National Health and Medical Research Council (NHMRC) criteria. It provides a two-page desk-top summary for use in clinical practice. Economic evaluation of the available evidence-based treatments showed that at 1 year the cost of cognitive behaviour therapy (CBT) is less than the cost of the average drug therapy (CBT becomes cheaper than paroxetine at 8 months, than clomipramine at 11 months and cheaper than imipramine at 13 months). During the second and subsequent years the superiority of CBT increases whether or not the drugs are continued. Evidence levels for specific treatments are provided in the comprehensive guideline and placed in the context of overall principles of thorough assessment and quality clinical management.

Australian and New Zealand Clinical Practice Guidelines for the Treatment of Panic Disorder and Agoraphobia

2003 ◽  
Vol 37 (6) ◽  
pp. 641-656 ◽  
Author(s):  
Keyword(s):  
Clinical Practice ◽  
New Zealand ◽  
Panic Disorder ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Meta Analysis ◽  
Prognostic Indicator ◽  
Time Frame ◽  
Behaviour Therapy ◽  
Cognitive Behaviour

Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. Method: For these guidelines, the CPG team reviewed the treatment outcome literature, consulted with practitioners and patients and conducted a meta-analysis of recent outcome research. Treatment recommendations: Education for the patient and significant others covering: (i) the nature and course of panic disorder and agoraphobia; (ii) an explanation of the psychopathology of anxiety, panic and agoraphobia; (iii) rationale for the treatment, likelihood of a positive response, and expected time frame. Cognitive behaviour therapy (CBT) is more effective and more cost-effective than medication. Tricyclic antidepressants (TCAs) and serotonin selective reuptake inhibitors are equal in efficacy and both are to be preferred to benzodiazepines. Treatment choice depends on the skill of the clinician and the patient's circumstances. Drug treatment should be complemented by behaviour therapy. If the response to an adequate trial of a first-line treatment is poor, another evidence-based treatment should be used. A second opinion can be useful. The presence of severe agoraphobia is a negative prognostic indicator, whereas comorbid depression, if properly treated, has no consistent effect on outcome.

scholarly journals The development and evaluation of an online educational tool for the evidence-based management of neck pain by chiropractic teaching faculty

2020 ◽  
Author(s):  
Leslie Verville ◽  
Pierre Côté DC ◽  
Diane Grondin ◽  
Silvano Mior DC ◽  
Robin Kay
Keyword(s):  
Clinical Practice ◽  
Neck Pain ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Thinking Skills ◽  
Faculty Members ◽  
Evidence Based ◽  
Learning Design ◽  
Educational Tool ◽  
Learning Tool

Objective To develop an online, interactive educational tool to deliver an evidence-based clinical practice guideline to faculty members at a Canadian chiropractic college. Second, to evaluate the learning, design, and engagement constructs of the tool in a sample of chiropractic faculty members. Methods Using an integrated knowledge translation methodology and the Knowledge to Action Framework, we developed an evidence-based online learning tool. The context of the tool focused on a clinical practice guideline on the management of neck pain. We evaluated the learning, design, and engagement constructs in a sample of faculty members and residents using the Learning Object Evaluation Scale for Students. Participants were also asked to provide suggestions for improvement of the tool. Results Sixteen participants completed the evaluation. Most (68.8%) participants were chiropractors, 75% were male and 56% were between the ages of 25 and 44 years. At least 75% of participants agreed that the learning, design, and engagement constructs of the learning tool were adequate. The open-ended suggestions unveiled 3 pedagogical themes, relating to multimedia, thinking skills, and learner control, within the tool that could benefit from further development. These themes informed recommendations to improve the tool. Conclusion Our online, interactive, module-based learning tool has sound pedagogical properties. Further research is needed to determine if its use is associated with a change in knowledge.

Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection

2021 ◽  
Vol 47 (7) ◽  
pp. 891-907
Author(s):  
Andrew Chen ◽  
John G. Albertini ◽  
Jeremy S. Bordeaux ◽  
Michael W. Chen ◽  
Jonathan L. Cook ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Skin Cancer ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Evidence Based ◽  
Cancer Resection

scholarly journals Clinical practice guideline on the prevention and management of neonatal extravasation injury: a before-and-after study design

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kam Ming Chan ◽  
Janita Pak Chun Chau ◽  
Kai Chow Choi ◽  
Genevieve Po Gee Fung ◽  
Wai Wa Lui ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Central Line ◽  
Evidence Based ◽  
Post Intervention ◽  
Before And After ◽  
Level Of Knowledge ◽  
Intravenous Catheters ◽  
Before And After Study

Abstract Background Extravasation injury resulting from intravenous therapies delivered via peripheral intravenous catheters or umbilical and peripherally inserted central venous catheters is a common iatrogenic complication occurring in neonatal intensive care units. This study aimed to evaluate the effectiveness of an evidence-based clinical practice guideline in the prevention and management of neonatal extravasation injury by nurses. Methods A controlled before-and-after study was conducted in a neonatal unit. The clinical practice guideline was developed, and a multifaceted educational program was delivered to nurses. Neonatal outcomes, including the rates of peripheral intravenous extravasation and extravasation from a central line, were collected at the pre- and post-intervention periods. Post-intervention data for nurses, including the nurses’ level of knowledge and adherence, were collected at six months after the program. Results 104 and 109 neonates were recruited in the pre-intervention period (control) and the post-intervention period (intervention), respectively. The extravasation rate before and after the intervention was 14.04 and 2.90 per 1,000 peripheral intravenous catheters days, respectively. The adjusted odds ratio of peripheral intravenous extravasation post-intervention compared with that of pre-intervention was 0.20 (95% confidence interval: 0.05–0.74; p = 0.02) after adjusting for peripheral intravenous catheter days. The extravasation from a central line rate of the control and intervention groups post-intervention was 4.94 and zero per 1,000 central venous catheter days, respectively. Fifty-nine registered nurses were recruited. At six months post-program, there were significant improvements in the nurses’ level of knowledge and adherence. Conclusions These findings suggest that the implementation of an evidence-based clinical practice guideline significantly reduced the rate of peripheral intravenous extravasation and extravasation from a central line in neonates. However, to maintain nurses’ knowledge and adherence to the evidence-based practice, the educational program will have to be conducted periodically and incorporated into the nurses’ induction program. Trial registration ClinicalTrials.gov, Identifiers: NCT04321447. Registered 20 March 2020 - Retrospectively registered.

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