784 Management of Paediatric Epistaxis: An Appraisal of Cautery Versus Topical Antiseptics in The Prevention of Rebleeding Events

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Sagua ◽  
S Fishpool
Keyword(s):  
Literature Review ◽  
Evidence Base ◽  
Current Evidence ◽  
Short Term ◽  
Recurrent Epistaxis ◽  
Significant Difference ◽  
Current Evidence Base ◽  
Minimal Difference ◽  
The Uk ◽  
New Treatments

Abstract Introduction Epistaxis is a common acute presentation in childhood that with recurrence often causes great distress for both parent and child alike. For recurrent epistaxis it is common practice in the UK to trial either a topical antiseptic (Naseptin) or silver nitrate cautery. A literature review was conducted to assess which treatment confers greater protection against rebleeding events. Method The literature review was performed via a search on Medline via Ovid. As both cautery and topical antiseptics are not new treatments, an age limit was not set to allow older research to be included and provide perspective. Results In all but one study included, there was no statistically significant difference between the use of Naseptin versus cautery in the reduction of rebleeding events. A higher incidence of complications such as septal perforation and pain were reported in patients who underwent cautery, whilst no adverse side effects were reported with Naseptin. Conclusions The current evidence base relies mostly on short term outcomes, with most patients not being followed up for more than 2 months. If further longitudinal studies provide evidence to support there being a minimal difference in treatment outcomes, using topical antiseptics before considering cautery would be better clinical practice in paediatric patients.

scholarly journals Epistaxis 2016: national audit of management

2017 ◽  
Vol 131 (12) ◽  
pp. 1131-1141 ◽  
Author(s):  
Keyword(s):  
Presentation Rate ◽  
Evidence Base ◽  
Current Evidence ◽  
Event Analysis ◽  
National Audit ◽  
Inclusion Criteria ◽  
Current Evidence Base ◽  
Consensus Guidance ◽  
The Uk ◽  
Audit Standards

AbstractBackground:Epistaxis is a common condition that can be associated with significant morbidity, and it places a considerable burden on our healthcare system. This national audit of management sought to assess current practice against newly created consensus recommendations and to expand our current evidence base.Methods:The management of epistaxis patients who met the inclusion criteria, at 113 registered sites across the UK, was compared with audit standards during a 30-day window. Data were further utilised for explorative analysis.Results:Data for 1826 cases were uploaded to the database, representing 94 per cent of all cases that met the inclusion criteria at participating sites. Sixty-two per cent of patients were successfully treated by ENT clinicians within 24 hours. The 30-day recurrent presentation rate across the dataset was 13.9 per cent. Significant event analysis revealed an all-cause 30-day mortality rate of 3.4 per cent.Conclusion:Audit findings demonstrate a varying alignment with consensus guidance, with explorative analysis countering some previously well-established tenets of management.

scholarly journals ORBITA: What Goes Around, Comes Around… Or Does It?

2018 ◽  
Vol 13 (3) ◽  
pp. 135
Author(s):  
Matthew Jackson ◽  
Azfar Zaman ◽  
◽  
Keyword(s):  
Medical Therapy ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Current Evidence ◽  
Placebo Control ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Current Evidence Base ◽  
Artery Disease

Current guidelines recommend percutaneous coronary intervention (PCI) in patients with ongoing stable angina symptoms despite optimal medical therapy (OMT), although trials have shown no reduction in death or myocardial infarction. The recently published ORBITA trial compared OMT + PCI with OMT + ‘placebo’ PCI in patients with angina and single-vessel coronary artery disease (CAD), and found no significant difference in treadmill exercise time between the two groups after six weeks. The trial concluded that invasive procedures can be assessed with placebo control while numerous editorials interpreted the trial as showing that PCI has no role in the management of stable angina. However, the highly selected patient population, low ischaemic burden and level of symptoms and high proportion of nonflow-limiting stenoses on invasive physiological testing mean that, while ground-breaking in terms of its methodology, ORBITA does not add to the current evidence base supporting ischaemia-guided revascularisation if symptoms are not controlled on medical therapy alone.

scholarly journals Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e036192 ◽  
Author(s):  
Catrin Evans ◽  
Brenda Poku ◽  
Ruth Pearce ◽  
Jeanette Eldridge ◽  
Paul Hendrick ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Scoping Review ◽  
Health Workforce ◽  
Grey Literature ◽  
Evidence Base ◽  
Current Evidence ◽  
Multiprofessional Team ◽  
Wide Range ◽  
Current Evidence Base ◽  
The Uk

IntroductionA global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinical, service and patient perspective.Methods and analysisThis scoping review is registered with the Open Science Framework (https://osf.io/tzpe5). The review will follow Joanna Briggs Institute guidance and involves a multidisciplinary and multiprofessional team, including a public representative. A wide range of electronic databases and grey literature sources will be searched from 2005 to the present. The review will include primary data from any relevant research, audit or evaluation studies. All review steps will involve two or more reviewers. Data extraction, charting and summary will be guided by a template derived from an established framework used internationally to evaluate ACP (the Participatory Evidence-Informed Patient-Centred Process-Plus framework).DisseminationThe review will produce important new information on existing activity, outcomes, implementation challenges and key areas for future research around ACP in the UK, which, in the context of global workforce transformations, will be of international, as well as local, significance. The findings will be disseminated through professional and NHS bodies, employer organisations, conferences and research papers.

scholarly journals A rapid evidence assessment of psychological treatment approaches for stalking behaviour

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Shonagh Leigh ◽  
Jason Davies
Keyword(s):  
Psychological Treatment ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Current Evidence ◽  
Future Research ◽  
Behaviour Therapy ◽  
Treatment Approaches ◽  
Content Type ◽  
Current Evidence Base ◽  
The Uk

Purpose This paper aims to provide practitioners with a brief but comprehensive review of the current evidence base for psychological treatment approaches used in the UK that may be useful for stalking therapies. Design/methodology/approach A rapid evidence assessment was conducted on papers (post the UK Protection from Harassment Act, 1997) that discuss treatments of stalking (with or without a conviction) and associated offences/disorders. Therapies reviewed were Acceptance and Commitment Therapy, Cognitive Analytic Therapy, Cognitive Behavioural Therapy, Dialectical Behaviour Therapy and Schema Therapy. Searches for Mentalization-Based Therapy and Psychodynamic Therapy in relation to stalking were also performed but yielded no results that met inclusion criteria. Findings There is currently a severely limited evidence base for the efficacy of the psychological treatment of stalking behaviours. Some interventions show promise although a multifaceted, formulation-based approach is likely to be required. Practical implications Future research would benefit from robust studies focused on stalking with long-term efficacy follow-ups. Originality/value To the best of the authors’ knowledge, this is the first rapid evidence review of psychological treatments that directly address stalking behaviour.

Diagnosing COPD in general practice

2021 ◽  
Vol 32 (11) ◽  
pp. 436-442
Author(s):  
Anne Rodman
Keyword(s):  
Risk Factors ◽  
Evidence Base ◽  
Current Evidence ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Specialist Referral ◽  
Current Evidence Base ◽  
History Of ◽  
The Uk ◽  
Copd Diagnosis

COPD prevalence is likely to be underestimated in the UK. Anne Rodman explores the current evidence base for diagnosing COPD Chronic obstructive pulmonary disease (COPD) is an umbrella term for several different pathological processes in the lungs of susceptible individuals. COPD should be considered in any patient who has symptoms and a history of exposure to risk factors for the disease. The cornerstone of COPD diagnosis is to identify risk factors for this preventable condition, recognise and investigate any symptoms that are not commonly found in COPD, and confirm that obstruction is present with correctly performed and interpreted spirometry. This article explores the current evidence base for diagnosing COPD, how to differentiate it from asthma and other conditions with similar symptoms, and the rationale for specialist referral.

scholarly journals Polyphenols and Cognition In Humans: An Overview of Current Evidence from Recent Systematic Reviews and Meta-Analyses

2020 ◽  
pp. 1-15
Author(s):  
Daniel Joseph Lamport ◽  
Claire Michelle Williams
Keyword(s):  
Systematic Reviews ◽  
Evidence Base ◽  
Epidemiological Studies ◽  
Cognitive Outcome ◽  
Current Evidence ◽  
Duration Of Treatment ◽  
Current Evidence Base ◽  
Cognitive Benefits ◽  
Meta Analyses ◽  
The Impact

There is increasing interest in the impact of dietary influences on the brain throughout the lifespan, ranging from improving cognitive development in children through to attenuating ageing related cognitive decline and reducing risk of neurodegenerative diseases. Polyphenols, phytochemicals naturally present in a host of fruits, vegetables, tea, cocoa and other foods, have received particular attention in this regard, and there is now a substantial body of evidence from experimental and epidemiological studies examining whether their consumption is associated with cognitive benefits. The purpose of this overview is to synthesise and evaluate the best available evidence from two sources, namely meta-analyses and systematic reviews, in order to give an accurate reflection of the current evidence base for an association between polyphenols and cognitive benefits. Four meta-analyses and thirteen systematic reviews published between 2017–2020 were included, and were categorised according to whether they reviewed specific polyphenol-rich foods and classes or all polyphenols. A requirement for inclusion was assessment of a behavioural cognitive outcome in humans. A clear and consistent theme emerged that whilst there is support for an association between polyphenol consumption and cognitive benefits, this conclusion is tentative, and by no means definitive. Considerable methodological heterogeneity was repeatedly highlighted as problematic such that the current evidence base does not support reliable conclusions relating to efficacy of specific doses, duration of treatment, or sensitivity in specific populations or certain cognitive domains. The complexity of multiple interactions between a range of direct and indirect mechanisms of action is discussed. Further research is required to strengthen the reliability of the evidence base.

scholarly journals P-26 Challenging the pressure on nhs resources: could 48-hour continuous subcutaneous infusions (CSCIS) help? a systematically-structured review of the current evidence base

2017 ◽  
Vol 7 (Suppl 1) ◽  
pp. A9.3-A10
Author(s):  
James Baker ◽  
Andrew Dickman ◽  
Stephen Mason ◽  
John Ellershaw ◽  
Paul Skipper ◽  
...  
Keyword(s):  
Evidence Base ◽  
Current Evidence ◽  
Current Evidence Base

scholarly journals Rates of violence in patients classified as high risk by structured risk assessment instruments

2014 ◽  
Vol 204 (3) ◽  
pp. 180-187 ◽  
Author(s):  
Jay P. Singh ◽  
Seena Fazel ◽  
Ralitza Gueorguieva ◽  
Alec Buchanan
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Groups ◽  
Evidence Base ◽  
Assessment Tools ◽  
Current Evidence ◽  
Assessment Instruments ◽  
Individual Liberty ◽  
Current Evidence Base ◽  
Study Heterogeneity

BackgroundRates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies.AimsTo analyse the variation in rates of violence in individuals identified as high risk by SRAIs.MethodA systematic search of databases (1995–2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity.ResultsInformation was collected on 13 045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study.ConclusionsAfter controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety.

Sign in / Sign up

Export Citation Format

Share Document