scholarly journals Metformin in the management of antipsychotic-induced weight gain in adults with psychosis: development of the first evidence-based guideline using GRADE methodology

2021 ◽  
pp. ebmental-2021-300291
Author(s):  
Ita Fitzgerald ◽  
Jean O'Connell ◽  
Dolores Keating ◽  
Caroline Hynes ◽  
Stephen McWilliams ◽  
...  
Keyword(s):  
Weight Gain ◽  
De Novo ◽  
Good Practice ◽  
Dose Titration ◽  
Measurement Tool ◽  
Evidence Based ◽  
Management Options ◽  
Pharmacological Management ◽  
Grade Methodology ◽  
Assessment Of Evidence

BackgroundAdjunctive metformin is the most well-studied intervention in the pharmacological management of antipsychotic-induced weight gain (AIWG). Although a relatively unaddressed area, among guidelines recommending consideration of metformin, prescribing information that would facilitate its applied use by clinicians, for example, provision of a dose titration schedule is absent. Moreover, recommendations differ regarding metformin’s place in the hierarchy of management options. Both represent significant barriers to the applied, evidence-based use of metformin for this indication.ObjectiveTo produce a guideline solely dedicated to the optimised use of metformin in AIWG management, using internationally endorsed guideline methodology.MethodsA list of guideline key health questions (KHQs) was produced. It was agreed that individual recommendations would be ‘adopted or adapted’ from current guidelines and/or developed de novo, in the case of unanswered questions. A systematic literature review (2008–2020) was undertaken to identify published guidelines and supporting (or more recent) research evidence. Quality appraisal was undertaken using the Appraisal of Guidelines Research and Evaluation II tool, A Measurement Tool to Assess Systematic Reviews (AMSTAR) assessment,and the Cochrane Risk of Bias 2 tool, where appropriate. Assessment of evidence certainty and recommendation development was undertaken using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.FindingsWe confirmed that no published guideline—of appropriate quality, solely dedicated to the use of metformin to manage AIWG was available. Recommendations located within other guidelines inadequately addressed our KHQs.ConclusionAll 11 recommendations and 7 supporting good practice developed here were formulated de novo.Clinical implicationsThese recommendations build on the number and quality of recommendations in this area, and facilitate the optimised use of metformin when managing AIWG.

scholarly journals Clinical Guidelines and Practice

2010 ◽  
Vol 34 (4) ◽  
pp. 413-420 ◽  
Author(s):  
Derek J. Hoare ◽  
Deborah A. Hall
Keyword(s):  
Clinical Guidelines ◽  
Chronic Condition ◽  
Good Practice ◽  
Management Strategies ◽  
Evidence Based ◽  
Effective Management ◽  
Management Options ◽  
Policy Makers ◽  
Subjective Tinnitus ◽  
High Level

Subjective tinnitus is an enigmatic and chronic condition that is predominantly managed as symptomatic. Little high-level evidence exists for the efficacy and specificity of the various tinnitus management strategies currently used, and this is reflected in documents that aim to guide clinicians. As a consequence, there are clear gaps in evidence-based practice linking diagnosis to the most effective management strategies as well as a general lack of consensus about which are appropriate strategies for assessment and management. Several guidelines have been produced from research efforts and from expert opinion. All recommend standardization of assessment and a range of management options but do not yet provide a means to link the two. The authors call for clinicians, scientists, and policy makers to work together to address this barrier to good practice.

Preventing Premature Weaning: Management Options for Common Lactation Conditions, Including OMT

2020 ◽  
pp. 20-25
Author(s):  
Denise Sackett ◽  
Tala Dajani ◽  
David Shoup ◽  
Uzoma Ikonne
Keyword(s):  
Postpartum Depression ◽  
Family Physician ◽  
Treatment Options ◽  
World Health ◽  
Management Options ◽  
Pharmacological Management ◽  
Control And Prevention ◽  
Lactational Mastitis ◽  
One Year ◽  
Health Organization

The benefits of breastfeeding are well established. The World Health Organization and the Centers for Disease Control and Prevention recommend that mothers breastfeed infants for at least one year, but most children are not breastfed that long because of many factors. Breastfeeding mothers face many challenges to continued breastfeeding, including medical conditions that arise during this period, such as postpartum depression and lactational mastitis. Because of a perceived lack of consistent guidance on medication safety, it can be difficult for the family physician to treat these conditions while encouraging mothers to continue breastfeeding. The purpose of the current review is to summarize and clarify treatment options for the osteopathic family physician treating lactating mothers. We specifically focus on the pharmacological management of contraception, postpartum depression, and lactational mastitis.

Pegfilgrastim-Induced Bone Pain: A Review on Incidence, Risk Factors, and Evidence-Based Management

2017 ◽  
Vol 51 (9) ◽  
pp. 797-803 ◽  
Author(s):  
Donald C. Moore ◽  
Annie E. Pellegrino
Keyword(s):  
Risk Factors ◽  
Bone Pain ◽  
English Language ◽  
Data Extraction ◽  
Treatment Modalities ◽  
Management Options ◽  
Data Synthesis ◽  
Pharmacological Management ◽  
Study Selection ◽  
Incidence Risk

Objective: To review the incidence, risk factors, and management of pegfilgrastim-induced bone pain (PIBP). Data Sources: PubMed was searched from 1980 to March 31, 2017, using the terms pegfilgrastim and bone pain. Study Selection and Data Extraction: English-language, human studies and reviews assessing the incidence, risk factors, and management of PIBP were incorporated. Data Synthesis: A total of 3 randomized, prospective studies and 2 retrospective studies evaluated pharmacological management of PIBP. Naproxen compared with placebo demonstrated a reduction in the degree, incidence, and duration of bone pain secondary to pegfilgrastim. Loratadine was not effective in reducing the incidence of bone pain prophylactically, but a retrospective study evaluating dual antihistamine blockade with loratadine and famotidine demonstrated a decreased incidence in bone pain when administered before pegfilgrastim. Conclusion: Naproxen is effective at managing PIBP. Although commonly used, antihistamines have a paucity of data supporting their use. Dose reductions of pegfilgrastim and opioids may also be potential management options; however, data supporting these treatment modalities are scarce.

scholarly journals Elements of a clinical trial protocol for medical devices

2017 ◽  
Vol 7 (6) ◽  
pp. 65
Author(s):  
Raymond P. Briggs ◽  
Lois Ramer
Keyword(s):  
Clinical Trial ◽  
Medical Device ◽  
De Novo ◽  
Evidence Based ◽  
Trial Protocol ◽  
Risk Class ◽  
Clinical Trial Protocol ◽  
Fda Approval ◽  
Near Future

Based on a Class 2 limited risk hospital based clinical trial, and a subsequent project retrospective, Briggs and Ramer propose an expanded clinical trial protocol.  Such an expanded protocol would be especially helpful for evaluating De Novo devices:  new inventions which require new processes for full hospital integration.  Since these new processes would often require training of nurses and supporting professionals, Briggs and Ramer suggest that nurse investigators could be very effective in carrying out such expanded protocol studies.  We briefly describe the FDA approval process, the role of the nurse in evidence based medical device evaluation, the Ramer, et al. clinical trial, the proposed expanded clinical trial protocol, and candidate categories of devices that might employ the limited risk Class 2 Medical Device clinical trial protocol.  The investigators look forward to carrying out such a medical device clinical trial in the near future.

Quality Assurance and Institutional Research for University Strategic Management

2020 ◽  
pp. 287-308
Author(s):  
Ngepathimo Kadhila ◽  
Gilbert Likando
Keyword(s):  
Higher Education ◽  
Quality Assurance ◽  
Strategic Management ◽  
Higher Education Institutions ◽  
Good Practice ◽  
Evidence Based ◽  
Institutional Research ◽  
The World ◽  
The University ◽  
Evidence Based Decision Making

Strategic management in higher education (HE) has become data-reliant. Most higher education institutions (HEIs) all over the world have implemented quality assurance (QA) and institutional research (IR) with the purpose of generating data that that would assist in evidence-based decision making for better strategic management. However, data generated through QA and IR processes have to be integrated and streamlined in order to successfully inform strategic management. One of the challenges facing higher education institutions is to integrate the data generated by QA and IR processes effectively. This chapter examines examples of good practice for integrating the data generated by these processes for use as tools to inform strategic management, using the University of Namibia as a reference point. The chapter offers suggestions on how higher education institutions may be assisted to overcome challenges when integrating the outcomes of QA and IR processes in order to close the quality loop through effective strategic management.

Nausea and vomiting

2019 ◽  
pp. 531-538
Keyword(s):  
Treatment Algorithm ◽  
Nausea And Vomiting ◽  
Evidence Based ◽  
Nursing Management ◽  
Pharmacological Management ◽  
Chemotherapy Drugs ◽  
Wide Range ◽  
Detailed Assessment ◽  
Anticipatory Nausea And Vomiting ◽  
Pre Treatment

Nausea and vomiting are common and distressing symptoms of cancer and its treatments. Treatment-related nausea and vomiting are covered in depth, including pre-treatment assessment, the emetogenic level of chemotherapy drugs, and pharmacological management of chemotherapy-induced nausea and vomiting. An evidence-based treatment algorithm is described, covering the wide range of possible anti-emetics. Non-pharmacological options are also described. There is also a section on anticipatory nausea and vomiting. Nausea and vomiting in advanced cancer are covered separately. The multifactorial nature of this is discussed, with a focus on different anti-emetic regimes, as well as nursing management, including detailed assessment and ongoing nutritional and psychological support.

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