The Rise of Aggressive Psychopharmacology

2020 ◽  
pp. 139-148
Author(s):  
Joel Paris
Keyword(s):  
Clinical Practice ◽  
Major Depression ◽  
Pharmaceutical Industry ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Base ◽  
Weak Evidence ◽  
Wide Range

Aggressive psychopharmacology describes the current practice of prescribing a large number of medications to patients with almost any mental disorder. While there is some evidence for this approach in severe and, persistent mental disorders, it has spread to common disorders, most particularly major depression. Clinical practice guidelines, which offer a wide range options for patients who are resistant to standard treatments, are being interpreted as promoting polypharmacy for a very broad group of patient. These practices have a surprisingly weak evidence base, and tend to take psychotherapy options off the table. Aggressive psychoharmacology is driven by overdiagnosis and is strongly encouraged by the pharmaceutical industry.

scholarly journals The Evolving Role of Catheter Ablation in Patients With Heart Failure and AF

2019 ◽  
Vol 8 (1) ◽  
pp. 47-53
Author(s):  
Sandeep Prabhu ◽  
Wei H Lim ◽  
Richard J Schilling
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Catheter Ablation ◽  
Patient Group ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Base ◽  
Patients With Heart Failure ◽  
Recent Developments

AF and heart failure are emerging epidemics worldwide. Several recent trials have provided a growing evidence base for the benefits of catheter ablation in this patient group, which are yet to be universally adopted in clinical practice guidelines. This paper provides a summary of recent developments in this field and provides pragmatic advice to the treating physician regarding the appropriate role of catheter ablation in the overall management of patients with comorbid AF and heart failure.

Book review: Deadly medicines and organized crime

2016 ◽  
Vol 2 (2) ◽  
pp. 138-139
Author(s):  
Shankar PR ◽  
Alshakka MAM
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Pharmaceutical Industry ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Organized Crime ◽  
Healthcare Professionals ◽  
Meta Analysis ◽  
Degree Of Control

Clinical trials have attracted negative attention recently. The degree of control of the pharmaceutical industry over the design, conduct and analysis of clinical trials has been criticized. Healthcare professionals increasingly rely on data obtained from clinical trials and from meta-analysis and systematic reviews. The process of publishing clinical trials and framing clinical practice guidelines is being increasingly influenced by the pharmaceutical industry.

On what basis should we select treatment in clinical psychiatry: a question too obvious to ask?

2019 ◽  
Vol 28 (2) ◽  
pp. 202-205
Author(s):  
Sam Restifo ◽  
Lemuel Y H Tan
Keyword(s):  
Mental Illness ◽  
Clinical Practice ◽  
Treatment Planning ◽  
Clinical Psychiatry ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Research Evidence ◽  
Conceptual Models ◽  
Evidence Base ◽  
Medical Disciplines

Objective: Given the differences between our profession and the broader set of medical disciplines, a review of the factors to be considered in treatment planning was conducted. Conclusion: Treatment planning in psychiatry is inherently more complicated than in other medical disciplines for various reasons including: a broader range of conceptual models of mental illness and treatment; greater complexities around nosology and diagnosis; the greater limitations of the research evidence base and clinical practice guidelines; and the more substantial impacts of patients’ subjectivity and contextual aspects. Diagnosis is generally neither a sufficient nor necessarily the most useful criterion for treatment planning in psychiatry, with a number of other considerations to help guide treatment being outlined.

scholarly journals Evaluation of the Level of Evidence Supporting the Recommendations Constituting the American Academy of Dermatology Clinical Practice Guidelines: Cross-Sectional Analysis (Preprint)

2019 ◽  
Author(s):  
Courtney Cook ◽  
Ryan Ottwell ◽  
Taylor Rogers ◽  
Jake Checketts ◽  
Sanjeev Musuvathy ◽  
...  
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Strong Evidence ◽  
Practice Guideline ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Weak Evidence

BACKGROUND Clinical practice guidelines are evidence-based recommendations used by physicians to improve patient care. These guidelines provide the physician with an assessment of the benefits and harms of a treatment and its alternatives. Therefore, it is essential that the clinical practice guidelines be based on the strongest available evidence. Numerous studies in a variety of different fields of medicine have demonstrated that recommendations supported by weak evidence are a common theme in clinical practice guidelines. A clinical guideline based solely on weak evidence has the capability to reduce the quality of care provided by physicians. OBJECTIVE Our primary objective is to evaluate the levels of evidence supporting the recommendations constituting the American Academy of Dermatology clinical practice guidelines. METHODS Using a cross-sectional study design, authors SM and RO located all current clinical practice guidelines on the American Academy of Dermatology website on June 10, 2017, and December 11, 2019. Each recommendation and its corresponding evidence rating were extracted in a duplicate and blinded fashion. A consensus meeting was planned a priori to resolve disagreements in extractions or stratifications. RESULTS In total, 6 clinical guidelines and their subsections were screened and 899 recommendations were identified. Our final data set included 841 recommendations, as 58 recommendations contained no level of evidence and were excluded from calculations. Many recommendations were supported by a moderate level of evidence and therefore received a B rating (346/841, 41.1%). Roughly one-third of the recommendations were supported by a strong level of evidence and were given an A rating (n=307, 36.5%). The clinical practice guideline with the highest overall strength of evidence was regarding the treatment of acne, which had 17 of 35 (48.6%) recommendations supported by strong evidence and only 2 (5.7%) supported by weak evidence. The clinical practice guideline with the fewest recommendations supported by strong evidence was melanoma (13/63, 20.6%). CONCLUSIONS Clinical practice guidelines that lack strong supporting evidence could negatively affect patient care, and dermatologists should be mindful that not all recommendations are supported by the strongest level of evidence. An increased quantity of quality research needs to be performed in the field of dermatology to improve the evidence supporting the American Academy of Dermatology clinical practice guidelines.

scholarly journals Evaluation of the Level of Evidence Supporting the Recommendations Constituting the American Academy of Dermatology Clinical Practice Guidelines: Cross-Sectional Analysis

10.2196/17370 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e17370
Author(s):  
Courtney Cook ◽  
Ryan Ottwell ◽  
Taylor Rogers ◽  
Jake Checketts ◽  
Sanjeev Musuvathy ◽  
...  
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Strong Evidence ◽  
Practice Guideline ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Weak Evidence

Background Clinical practice guidelines are evidence-based recommendations used by physicians to improve patient care. These guidelines provide the physician with an assessment of the benefits and harms of a treatment and its alternatives. Therefore, it is essential that the clinical practice guidelines be based on the strongest available evidence. Numerous studies in a variety of different fields of medicine have demonstrated that recommendations supported by weak evidence are a common theme in clinical practice guidelines. A clinical guideline based solely on weak evidence has the capability to reduce the quality of care provided by physicians. Objective Our primary objective is to evaluate the levels of evidence supporting the recommendations constituting the American Academy of Dermatology clinical practice guidelines. Methods Using a cross-sectional study design, authors SM and RO located all current clinical practice guidelines on the American Academy of Dermatology website on June 10, 2017, and December 11, 2019. Each recommendation and its corresponding evidence rating were extracted in a duplicate and blinded fashion. A consensus meeting was planned a priori to resolve disagreements in extractions or stratifications. Results In total, 6 clinical guidelines and their subsections were screened and 899 recommendations were identified. Our final data set included 841 recommendations, as 58 recommendations contained no level of evidence and were excluded from calculations. Many recommendations were supported by a moderate level of evidence and therefore received a B rating (346/841, 41.1%). Roughly one-third of the recommendations were supported by a strong level of evidence and were given an A rating (n=307, 36.5%). The clinical practice guideline with the highest overall strength of evidence was regarding the treatment of acne, which had 17 of 35 (48.6%) recommendations supported by strong evidence and only 2 (5.7%) supported by weak evidence. The clinical practice guideline with the fewest recommendations supported by strong evidence was melanoma (13/63, 20.6%). Conclusions Clinical practice guidelines that lack strong supporting evidence could negatively affect patient care, and dermatologists should be mindful that not all recommendations are supported by the strongest level of evidence. An increased quantity of quality research needs to be performed in the field of dermatology to improve the evidence supporting the American Academy of Dermatology clinical practice guidelines.

scholarly journals A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis

2020 ◽  
Vol 222 (Supplement_7) ◽  
pp. S672-S679 ◽  
Author(s):  
Amir Kirolos ◽  
Sara Manti ◽  
Rachel Blacow ◽  
Gabriel Tse ◽  
Thomas Wilson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Hospital Admission ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Hospital Admissions ◽  
Conflicts Of Interest ◽  
Evidence Base ◽  
International Standards ◽  
Diagnosis And Management ◽  
Widespread Agreement

Abstract Background Bronchiolitis is the leading cause of hospital admission for respiratory disease among infants aged <1 year. Clinical practice guidelines can benefit patients by reducing the performance of unnecessary tests, hospital admissions, and treatment with lack of a supportive evidence base. This review aimed to identify current clinical practice guidelines worldwide, appraise their methodological quality, and discuss variability across guidelines for the diagnosis and management of bronchiolitis. Methods A systematic literature review of electronic databases EMBASE, Global Health, and Medline was performed. Manual searches of the gray literature, national pediatric society websites, and guideline-focused databases were performed, and select international experts were contacted to identify additional guidelines. The Appraisal of Guidelines for Research and Evaluation assessment tool was used by 2 independent reviewers to appraise each guideline. Results Thirty-two clinical practice guidelines met the selection criteria. Quality assessment revealed significant shortcomings in a number of guidelines, including lack of systematic processes in formulating guidelines, failure to state conflicts of interest, and lack of consultation with families of affected children. There was widespread agreement about a number of aspects, such as avoidance of the use of unnecessary diagnostic tests, risk factors for severe disease, indicators for hospital admission, discharge criteria, and nosocomial infection control. However, there was variability, even within areas of consensus, over specific recommendations, such as variable thresholds for oxygen therapy. Guidelines showed significant variability in recommendations for the pharmacological management of bronchiolitis, with conflicting recommendations over whether use of nebulized epinephrine, hypertonic saline, or bronchodilators should be routinely trialled. Conclusions Future guidelines should aim to be compliant with international standards for clinical guidelines to improve their quality and clarity and to promote their adoption into practice. Variable recommendations between guidelines may reflect the evolving evidence base for bronchiolitis management, and platforms should be created to understand this variability and promote evidence-based recommendations.

scholarly journals Ensuring Consistent European-Wide Urological Care by the Use of Evidence-Based Clinical Practice Guidelines: Can We Do Better

2017 ◽  
Vol 2 (Suppl. 1) ◽  
pp. 1-7
Author(s):  
Emma Jane Smith ◽  
Steven MacLennan ◽  
Anders Bjartell ◽  
Alberto Briganti ◽  
Thomas Knoll ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
Scientific Evidence ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Evidence Based ◽  
Robust Methods ◽  
Practice Recommendations

The European Association of Urology (EAU) annually updates 21 clinical practice guidelines in which summaries of the evidence base and best practice recommendations are made. The methodology applied to achieve this and integrate stakeholder opinion is continuously improving. However, there is evidence to suggest wide variation in clinical practice indicating that many patients receive suboptimal and heterogeneous care. Studies from certain countries suggest that 2 out of 5 patients do not receive care according to the current scientific evidence, and in 1 out of 4 cases the care provided is potentially harmful. Clearly, the harmonisation of care in alignment with evidence-based best practice recommendations is something to strive for. Development of robust methods to disseminate and implement guideline recommendations and measure their impact is an objective the EAU is committed to improving. An important strategy for achieving harmonisation in urological care across Europe is to ensure the availability of high-quality clinical practice guidelines and to actively promote their implementation by clinicians and healthcare providers.

scholarly journals The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: Major depression summary

2020 ◽  
Vol 22 (8) ◽  
pp. 788-804
Author(s):  
Gin S. Malhi ◽  
Erica Bell ◽  
Ajeet B. Singh ◽  
Darryl Bassett ◽  
Michael Berk ◽  
...  
Keyword(s):  
Clinical Practice ◽  
New Zealand ◽  
Major Depression ◽  
Mood Disorders ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Zealand College
Sign in / Sign up

Export Citation Format

Share Document