Benzodiazepine Therapy

2020 ◽  
pp. 17-40
Author(s):  
Jeffrey Guina ◽  
Brian Merrill ◽  
Jo Ann LeQuang
Keyword(s):  
Adverse Effects ◽  
Response To Treatment ◽  
Evidence Based ◽  
Relaxation Techniques ◽  
Pharmacological Agents ◽  
The Right ◽  
Hygiene Education ◽  
Fast Acting ◽  
Acute And Chronic Treatments

Benzodiazepines are some of the most commonly prescribed medications worldwide. When used appropriately for the right condition, patient, dose, and duration, these drugs can provide rapid relief of the symptoms of anxiety and insomnia for some patients, but they are also linked to a variety of adverse effects (whether used long-term, short-term, or as needed). Many patients are prescribed, and take, benzodiazepines long-term without ever receiving evidence-based first-line treatments such as psychotherapy, relaxation techniques, sleep hygiene education, or serotonergic agents. This chapter discusses the risks and benefits of, and alternatives to, benzodiazepines. The evidence-based indications and contraindications are discussed, as are putative biopsychosocial bases for effectiveness, ineffectiveness, and harm. The known potential adverse effects and drug-drug interactions are summarized. Finally, alternative fast-acting/acute and chronic treatments for anxiety and/or insomnia are discussed. Response to treatment—whether benzodiazepines, other pharmacological agents, or psychotherapy—must be assessed.

scholarly journals Postoperative Delirium

2021 ◽  
Vol 16 (SP1) ◽  
pp. 37-42
Author(s):  
Camilla L. Wong ◽  
Maia Von Maltzahn
Keyword(s):  
Risk Assessment ◽  
Adverse Effects ◽  
Postoperative Delirium ◽  
Interdisciplinary Team ◽  
Evidence Based ◽  
Évaluation Gériatrique ◽  
Prevention Interventions ◽  
Short And Long Term ◽  
Long Term Adverse Effects

There is strong evidence to support prevention of postoperative delirium through comprehensive geriatric assessment and multicomponent nonpharmacologic interventions. Risk assessment must be accompanied by communication of the risk to the patient, caregivers, and perioperative interdisciplinary team to engage all in evidence-based prevention interventions. However, once postoperative delirium has developed, efforts should be focused on prevention of short- and long-term adverse effects.   RÉSUMÉDes données probantes solides appuient la prévention du délire postopératoire en recourant à une évaluation gériatrique complète et à des interventions non pharmacologiques à plusieurs composantes. L’évaluation des risques doit s’accompagner d’une communication du risque au patient, aux soignants et à l’équipe interdisciplinaire périopératoire afin que tous participent aux interventions de prévention fondées sur des données probantes. Toutefois, une fois que le délire postopératoire s’est installé, les efforts doivent être axés sur la prévention des effets indésirables à court et à long terme.

scholarly journals The right methodology for long-term vascular access research: Three burning questions

2020 ◽  
pp. 112972982090488
Author(s):  
Paolo Balsorano ◽  
Fulvio Pinelli
Keyword(s):  
Vascular Access ◽  
Evidence Based ◽  
Attrition Bias ◽  
Analytic Process ◽  
Study Selection ◽  
The Right ◽  
Meta Analyses ◽  
The Impact

Over the last 20 years, there has been a great proliferation of studies of different aspects of the long-term vascular access field. Despite the availability of such studies, methodological pitfalls surrounding long-term vascular access research are rarely mentioned. Methodological issues inherent to retrospective analyses make them very poor tools for providing generalizable results, as they often become estimates of local experiences rather than reflections of up-to-date practices. Second, despite being an often-ignored element when designing studies on catheter-related complications, a proper follow-up time definition and its length are crucial to limiting the impact of attrition bias on research results. Finally, meta-analyses constitute a powerful tool in modern evidence-based era, but several pitfalls can affect overall results. When designing a systematic review and meta-analytic process, study selection should always reflect the relevance of clinical questions and the capability to contextualize results in the modern and evidence-based vascular access era.

Update on pharmacological treatment of anxiety disorders: Where is the greatest room for imrpovement?

2011 ◽  
Vol 26 (S2) ◽  
pp. 2182-2182
Author(s):  
D. Baldwin ◽  
D. Meron ◽  
N. Tiwari
Keyword(s):  
Adverse Effects ◽  
Anxiety Disorders ◽  
Rapid Onset ◽  
Onset Of Action ◽  
Anxiolytic Drugs ◽  
Drug Treatments ◽  
Patient Groups ◽  
The Right ◽  
Patients Experience

The ideal anxiolytic drug would be effective in all anxiety disorders, with a rapid onset of action, across all symptom domains and the spectrum of severity, in achieving remission and minimising disability, in preventing relapse, and in treating comorbid depression. Ideally, the drug would be suitable for once-daily dosage, would have minimal adverse effects or cause minimal interference with everyday life, not lead to the development of tolerance, have no discontinuation symptoms, be suitable in physically ill patients and free from interactions, and be safe in overdose.But there are no ideal anxiolytic drugs. Response rates to initial treatment can be disappointing, it is not possible to reliably predict likelihood of response; a substantial proportion of patients experience unwanted effects; many will relapse despite treatment adherence; comparatively little is known about further management after initial non-response; and discontinuation symptoms can be troublesome.Hence there is much room for improvement in identifying those patients who are most likely to benefit from treatment; in choosing between drug and psychological treatments; in choosing the right drug for the right patient groups; in optimising medication dosage to achieve maximum effectiveness whilst minimising adverse effects; in combining drug treatments to enhance efficacy; and in treating over the long term to prevent relapse and recurrence.

Complementary drugs

2021 ◽  
pp. 585-595
Author(s):  
Joy A. Weydert
Keyword(s):  
Side Effects ◽  
Symptom Management ◽  
Nutritional Supplements ◽  
Evidence Based ◽  
First Line ◽  
Pharmacological Agents ◽  
Safety And Efficacy ◽  
First Line Therapy ◽  
Line Therapy

Research into the use of botanical agents, nutritional supplements, and diet to manage pain has increased owing to the interest and demand of patients and physicians. Pharmacological agents are typically used as first-line therapy for pain and symptom management; however, for some patients these agents may not work well in the long term or have side effects that are not tolerated. Other patients may prefer nonpharmacological therapies. Most clinicians are not trained or may not be comfortable recommending these complementary agents. It is the goal of this chapter to introduce to practitioners the evidence-based data that support the safety and efficacy of these complementary drugs.

Cola Beverages: Clinical Uses versus Adverse Effects

2019 ◽  
Vol 15 (2) ◽  
pp. 130-139
Author(s):  
Ehsan T. Moghaddam ◽  
Ali Tafazoli
Keyword(s):  
Adverse Effects ◽  
Health Risks ◽  
Feeding Tube ◽  
Evidence Based ◽  
Journal Articles ◽  
Healthcare Settings ◽  
Pubmed Database ◽  
Excessive Consumption ◽  
Points Of View ◽  
Medical Articles

Background: Excessive consumption of cola beverages is accompanied by numerous public health risks. But besides these well-known adverse effects, recently, several medical articles have been published that show some indications for cola beverages in clinical practice like resolution of gastrointestinal or feeding tube obstructions, increasing bioavailability and palatability of other medications, rehydration and other uses in healthcare settings. These approaches are not without shortcomings and complications. Methods: In this systematic review we tried to explore these new uses for practitioners and also reemphasize on the most evidence-based complications of cola consumption like bone loss and metabolic and cardiovascular adverse effects in cases of misuse and overuse from both clinical and nutritional points of view via searching the PubMed database. Results: We chose 145 journal articles from the most relevant ones plus 30 extra references and categorized their topics in two classes of medical uses and adverse effects. Conclusion: It could be stated that cola beverages have demonstrated interesting uses and benefits in medicine but their use should be regulated as strict as possible.

WITHWomen: User Centered Approach to the Design and Development of a suite of Intimate Partner Violence Screening and Safety Planning Web-Applications (Preprint)

2020 ◽  
Author(s):  
Patricia O'Campo ◽  
Alisa Velonis ◽  
Pearl Buhariwala ◽  
Janisha Kamalanathan ◽  
Maha Awaiz Hassan
Keyword(s):  
Partner Violence ◽  
Web Applications ◽  
Lessons Learned ◽  
Evidence Based ◽  
Safety Planning ◽  
Future Design ◽  
Mhealth Technology ◽  
The Right ◽  
Safe Access ◽  
Health Applications

BACKGROUND The popularity of mHealth technology has resulted in the development of numerous applications for almost every type of self-improvement or disease management. M- and e-health solutions for increasing awareness about and safety around partner violence is no exception. OBJECTIVE These applications allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few applications, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness. METHODS We report here on the design of a pair of evidence-based m- and e-health applications to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from population of intended users. RESULTS The demographic characteristics of those who participated in the various surveys and interviews to inform the development of our screening and safety-decision support app are presented in (Table 2). CONCLUSIONS Finally, we share challenges we faced and lessons learned that might inform future design efforts of m- and e-health evidence-based applications.

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