Pharmacological management of acute severe behavioural disturbance: a survey of current protocols

Objectives: The investigators reviewed protocols for the pharmacological management of acute severe behavioural disturbance (ASBD) used in Australasian psychiatric settings. Relevant literature was also examined, with a focus on Australian research. Methods: All Fellows of the RANZCP were emailed on two occasions in 2014 requesting a copy of the guidelines for pharmacological management of the ASBD patient used in their workplace. A literature search was also undertaken. Results: Thirty-six pharmacological management protocols for the ASBD patient were received. Twenty-six of these referred to patients aged 18–65 years and were selected for analysis. A number of recent publications provided new evidence in relation to the safe and effective management of patients with ASBD. Conclusions: ASBD is a heterogeneous, transnosological set of presentations requiring careful assessment and rational clinical decision making. Treatment protocols arising from an evolving evidence base provide safe and effective pathways for the majority of patients. However, sound clinical knowledge and a careful assessment of each presentation is required to enable the clinician to tailor treatment individually.

Download Full-text

How to Evaluate Clinically Relevant Literature: Five Simple Rules for the Practicing Clinician in Stroke Neurorehabilitation

10.31234/osf.io/zvx3b ◽

2020 ◽

Author(s):

Jonathan Sanching Tsay ◽

Carolee Winstein

Keyword(s):

Clinical Decision Making ◽

Relevant Literature ◽

Clinical Decision ◽

Balance Sheets ◽

Neural Connections ◽

Recovery Processes ◽

Immediate Recovery ◽

Simple Rules ◽

Busy Clinician ◽

New Generation

Neurorehabilitation relies on core principles of neuroplasticity to activate and engage latent neural connections, promote detour circuits, and reverse impairments. Clinical interventions incorporating these principles have been shown to promote recovery while demoting compensation. However, many clinicians struggle to find evidence for these principles in our growing but nascent body of literature. Regulatory bodies and organizational balance sheets further discourage evidence-based, methodical, time-intensive, and efficacious interventions because practical needs often outweigh and dominate clinical decision making. Modern neurorehabilitation practices that result from these pressures favor strategies that encourage compensation over those that promote recovery. With a focus on helping the busy clinician evaluate the rapidly growing literature, we put forth five simple rules that direct clinicians toward intervention studies that value more enduring but slower biological recovery processes over the more alluring practical and immediate “recovery” mantra. Filtering emerging literature through this critical lens has the potential to change practice and lead to more durable long-term outcomes. This perspective is meant to serve a new generation of mechanistically minded clinicians, students, and trainees poised to not only advance our field but to also erect policy changes that promote recovery-based care of stroke survivors.

Download Full-text

Right Care, First Time: Developing a Theory-Based Automated Protocol to Help Clinically Stage Young People Based on Severity and Persistence of Mental Illness

Frontiers in Public Health ◽

10.3389/fpubh.2021.621862 ◽

2021 ◽

Vol 9 ◽

Author(s):

Frank Iorfino ◽

Vanessa Wan Sze Cheng ◽

Shane P. Cross ◽

Hannah F. Yee ◽

Tracey A. Davenport ◽

...

Keyword(s):

Mental Disorders ◽

Information Technologies ◽

Clinical Decision Making ◽

Clinical Decision ◽

Evidence Base ◽

Clinical Staging ◽

Health Information Technologies ◽

Staging Model ◽

Automated Protocol ◽

First Time

Most mental disorders emerge before the age of 25 years and, if left untreated, have the potential to lead to considerable lifetime burden of disease. Many services struggle to manage high demand and have difficulty matching individuals to timely interventions due to the heterogeneity of disorders. The technological implementation of clinical staging for youth mental health may assist the early detection and treatment of mental disorders. We describe the development of a theory-based automated protocol to facilitate the initial clinical staging process, its intended use, and strategies for protocol validation and refinement. The automated clinical staging protocol leverages the clinical validation and evidence base of the staging model to improve its standardization, scalability, and utility by deploying it using Health Information Technologies (HIT). Its use has the potential to enhance clinical decision-making and transform existing care pathways, but further validation and evaluation of the tool in real-world settings is needed.

Download Full-text

Integrating research and evidence-based guidance into prescribing practice

Journal of Prescribing Practice ◽

10.12968/jprp.2021.3.3.120 ◽

2021 ◽

Vol 3 (3) ◽

pp. 120-123

Author(s):

Adam Bedson

Keyword(s):

Decision Making ◽

Critical Appraisal ◽

Clinical Decision Making ◽

Primary Source ◽

Clinical Decision ◽

Evidence Base ◽

Evidence Based ◽

Multiple Sources ◽

Prescribing Practice ◽

Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal check lists and research reporting tools

Download Full-text

APhA Drug Treatment Protocols Support Clinical Decision-Making and Patient Care

Journal of the American Pharmaceutical Association (1996) ◽

10.1016/s1086-5802(16)30260-1 ◽

1997 ◽

Vol 37 (5) ◽

pp. 503-509

Author(s):

Patti Gasdek Manolakis

Keyword(s):

Decision Making ◽

Drug Treatment ◽

Patient Care ◽

Clinical Decision Making ◽

Clinical Decision ◽

Treatment Protocols

Download Full-text

Green walking groups: A mixed-methods review of the mental health outcomes for adults with mental health problems

British Journal of Occupational Therapy ◽

10.1177/0308022619888880 ◽

2019 ◽

Vol 83 (3) ◽

pp. 162-171

Author(s):

Tom Swinson ◽

Jennifer Wenborn ◽

Paul Sugarhood

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Health Outcomes ◽

Clinical Decision Making ◽

Mental Health Problems ◽

Clinical Decision ◽

Evidence Base ◽

Health Problems ◽

Mental Health Outcomes ◽

Natural Environments

Introduction Evidence suggests group walking in natural environments is more beneficial to the general population’s mental health than walking indoors, in urban environments, and alone. Such ‘green walking groups’ have been suggested as an occupational therapy intervention that could be suitable for adults with mental health problems. However, there have been no reviews of the mental health outcomes of participating in green walking groups for this population. Method A mixed-methods literature review was conducted. A range of databases was systematically searched electronically. Papers that met pre-defined inclusion criteria were selected, critically appraised, and qualitative and quantitative data were extracted. Thematic analysis was used to identify key qualitative outcomes. Findings Six papers were included and eight mental health outcomes identified. The evidence suggests participants can experience connections with other people, connections with nature, and a sense of freedom. There is some limited evidence to support improvements to mood, self-esteem, reflection on life tasks, and symptoms of depression, with mixed evidence for experiencing a sense of achievement. Conclusion This review can be used to build the evidence base for the link between occupation and mental health, and inform the clinical decision-making of occupational therapists, who are well-placed to design and implement green walking groups.

Download Full-text

Management of severe stifle trauma: 2. Periarticular fractures

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x19856180 ◽

2019 ◽

Vol 21 (7) ◽

pp. 633-644

Author(s):

Alessandro Conte ◽

Elena Addison

Keyword(s):

Clinical Decision Making ◽

Proximal Tibia ◽

Clinical Decision ◽

Evidence Base ◽

Deciduous Teeth ◽

Published Data ◽

Close Attention ◽

Stifle Joint ◽

Pin Fixation ◽

Adult Cats

Practical relevance: Periarticular stifle fractures are uncommon but challenging injuries to treat. There may be concurrent damage to the ligaments and stabilising structures of the stifle joint itself, which should also be evaluated (see Part 1 of this article series). Improved knowledge of the fixation options and biomechanical challenges of these injuries will aid clinical decision-making and effective repair. Clinical challenges: Due to their nature, periarticular fractures may have small juxta-articular fragments, which require additional thought to address during stabilisation. In juvenile animals, these fractures typically involve the physis and often can be managed with cross pin fixation. In adult cats, locking fixation, specialised plates or external skeletal fixators can be utilised to address the juxta-articular fragments. Readers should also be aware of patellar fracture and dental anomaly syndrome (PADS), where cats develop insufficiency fractures affecting the patella and proximal tibia. A careful oral examination should be performed in affected patients, as these cats may have persistent deciduous teeth. Close attention should be paid to preoperative radiographs for evidence of chronicity of the injury including sclerosis of the patella, remodelling and blunting of the fracture lines. Aims: The aims of the article are to review the current literature surrounding periarticular fractures of the stifle joint and to summarise the diagnosis, treatment, outcome and complications of each fracture type. As well as discussing general fracture fixation and biomechanical principles applicable to both dogs and cats, information is provided on specific issues facing cats, such as PADS. Evidence base: Published data is limited, with reports including only a small number of cats. The information and recommendations in this article have therefore been drawn from a combination of the available literature and the authors’ clinical experience.

Download Full-text

How to Decide Whether to Offer and Use “Nonstandard” Therapies in Patients with Advanced Sarcomas and Gastrointestinal Stromal Tumors: Global Variations in Clinical Practice, Assessment, and Access to Therapies in Diseases with Limited Incidence and Data

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2012.32.304 ◽

2012 ◽

pp. 645-650 ◽

Cited By ~ 2

Author(s):

Stefan Sleijfer ◽

Ian Judson ◽

George D. Demetri

Keyword(s):

Clinical Practice ◽

Rare Diseases ◽

Clinical Benefit ◽

Clinical Decision Making ◽

Clinical Decision ◽

Evidence Base ◽

Stromal Tumors ◽

Appropriate Care ◽

Social Interests ◽

Practice Assessment

Overview: As cancer is more generally recognized as a collection of various rare diseases rather than a homogeneous illness, sarcomas have become a model for the manner in which data can and cannot be used to drive clinical decision making. In this article, we explore the limitations of data generated in rare diseases such as sarcomas to provide an evidence base for clinical practice. How should patients be treated if there is no “standard” that offers “proof” of clinical benefit? By asking this question, we also raise the issue of what constitutes “clinical benefit”—and how to measure that—for patients with sarcomas and other rare diseases. As physicians become more accountable for decisions—and yet are always accountable to the patients and families who rely on them to provide the best and most appropriate care—oncologists must be cognizant of the limitations of data in rare diseases and be ready to justify actions that are in the best medical and social interests of patients.

Download Full-text

Integrating research and evidence-based guidance into prescribing practice

Journal of Paramedic Practice ◽

10.12968/jpar.2021.13.1.10 ◽

2021 ◽

Vol 13 (1) ◽

pp. 10-13

Author(s):

Adam Bedson

Keyword(s):

Decision Making ◽

Critical Appraisal ◽

Clinical Decision Making ◽

Primary Source ◽

Clinical Decision ◽

Evidence Base ◽

Evidence Based ◽

Multiple Sources ◽

Prescribing Practice ◽

Critical Appraisal Skills

Download Full-text

Developing supervisory competence: preliminary data on the impact of CBT supervision training

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x13000056 ◽

2012 ◽

Vol 5 (4) ◽

pp. 83-92 ◽

Cited By ~ 7

Author(s):

Katherine Newman Taylor ◽

Kenneth Gordon ◽

Simon Grist ◽

Charlotte Olding

Keyword(s):

Clinical Supervision ◽

Repeated Measures ◽

Clinical Decision Making ◽

Clinical Decision ◽

Evidence Base ◽

Preliminary Evaluation ◽

Repeated Measures Design ◽

Supervision Training ◽

Psychological Therapies ◽

The Impact

AbstractClinical supervision is key to the delivery and governance of effective psychological work. We place increasing emphasis on the evidence base in our clinical decision making, and yet there is no comparable body of information to inform our supervisory practice. This is a serious problem for psychological therapists; there is an urgent need for theoretically driven and empirically evaluated approaches to supervision, and the training of such skills. This preliminary evaluation examined the impact of a 5-day training designed for Improving Access to Psychological Therapies (IAPT) supervisors new to the role. A within-subject, repeated-measures design was used to compare self-assessed supervision competencies over the course of training. Twenty-eight IAPT supervisors completed 5 days’ training based on the Supervision Competencies Framework and IAPT Supervision Guidance. Significant improvements were found in ratings of generic, specific, applied and meta-supervision competencies, as well as overall competency. This evaluation gives preliminary support for the impact of training on supervisory competencies. There are clear limitations, particularly the lack of objective measures and comparison training. Nevertheless, in the context of a very limited evidence base to date, the study contributes to a more robust approach to developing supervisory competence in clinical practice.

Download Full-text

The Elderly Psychiatric Patient with Positive Syphilis Serology: The Problem of Neurosyphilis

The International Journal of Psychiatry in Medicine ◽

10.2190/cvl2-abc8-ut45-aft5 ◽

1998 ◽

Vol 28 (3) ◽

pp. 333-339 ◽

Cited By ~ 2

Author(s):

Ishwer L. Bharwani ◽

Charles O. Hershey

Keyword(s):

Elderly Patients ◽

Clinical Decision Making ◽

Relevant Literature ◽

Clinical Decision ◽

The Elderly ◽

Illustrative Case ◽

Positive Serology ◽

Important Indicator ◽

Syphilis Serology ◽

Latent Syphilis

Objective: Older patients have a high prevalence of neurological and psychiatric disorders. They also have a baseline prevalence of late latent syphilis or positive syphilis serology. Thus the clinical question arises as to whether a neuropsychiatric disorder in a geriatric patient is neurosyphilis or if the positive serology is incidental. Method: An illustrative case example is used to illustrate this dilemma. The relevant literature is reviewed. Results: The cerebrospinal fluid (CSF) protein is an important indicator of inflammatory activity in the central nervous system and is used as a clinical guide in the diagnosis. Elderly patients have higher values of normal CSF protein than younger patients. Conclusions: Given the importance of CSF protein in the diagnosis of neurosyphilis, physicians must include this knowledge, that elderly patients have higher CSF protein values, in their clinical decision making in the differentiation between neurosyphilis and late latent syphilis in the elderly patient.

Download Full-text