Applicability of somatic monitoring instructions in clinical practice guidelines on antipsychotic drug use

Abstract Background Clinical practice guidelines (CPGs) recommend the monitoring of somatic parameters in patients treated with antipsychotic drugs in order to detect adverse effects. The objective of this study was to assess, in adult and (frail) elderly populations, the consistency and applicability of the somatic monitoring instructions recommended by established CPGs prior to and during antipsychotic drug use. Methods A search for national and international CPGs was performed by querying the electronic database PubMed and Google. Somatic monitoring instructions were assessed for adult and (frail) elderly populations separately. The applicability of somatic monitoring instructions was assessed using the Systematic Information for Monitoring (SIM) score. Somatic monitoring instructions were considered applicable when a minimum SIM score of 3 was reached. Results In total, 16 CPGs were included, with a total of 231 somatic monitoring instructions (mean: 14; range: 0–47). Of the somatic monitoring instructions, 87% were considered applicable, although critical values and how to respond to aberrant values were only present in 28 and 52% of the available instructions respectively. Only 1 CPG presented an instruction specifically for (frail) elderly populations. Conclusions We emphasize the need for a guideline with somatic monitoring instructions based on the SIM definition for both adult and (frail) elderly populations using antipsychotic drugs. In addition, CPGs should state that clear agreements should be made regarding who is responsible for interventions and somatic monitoring prior to and during antipsychotic drug use.

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Therapeutic Physical Exercise Post-Treatment in Breast Cancer: A Systematic Review of Clinical Practice Guidelines

Journal of Clinical Medicine ◽

10.3390/jcm9041239 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1239 ◽

Cited By ~ 1

Author(s):

Alicia del-Rosal-Jurado ◽

Rita Romero-Galisteo ◽

Manuel Trinidad-Fernández ◽

Manuel González-Sánchez ◽

Antonio Cuesta-Vargas ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Clinical Practice ◽

Adverse Effects ◽

Physical Exercise ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Breast Cancer Survivors ◽

Intervention Strategy

Advances achieved in diagnosis and improvements in treatment for breast cancer have resulted in a favourable survival rate. Therapeutic physical exercise (TPE) is presented as an intervention strategy that seeks to improve the functional capabilities of the subject. To analyse if clinical practice guidelines recommend therapeutic physical exercise to reduce the adverse effects of treatment in breast cancer survivors, and on what level of scientific evidence are these recommendations based. This systematic review was prepared by searching nine electronic databases to identify eligible studies. Thirteen met the criteria for inclusion. The Appraisal of Guidelines for Research and Evaluation (AGREE II) scale was used to analyse the quality of Clinical Practice Guideline (CPGs). The percentages obtained ranged between 30.07% and 75.70%. Specifically, the highest degree of evidence could be found in the application of TPE to offset adverse effects leading to effects such as: an increase in the quality of life, fatigue reduction, and reduction in body weight alterations. TPE is presented as an optimal intervention strategy to alleviate the negative effects that patients with breast cancer suffer as a result of the treatments received. The level of evidence that supports this claim is very strong for the majority of the side effects analysed. However, this evidence is not always included in the clinical practice guidelines.

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Clinical Outcomes of Antibiotic Prophylaxis in Vaginal Delivery Women at Ramathibodi Hospital

Ramathibodi Medical Journal ◽

10.33165/rmj.2019.42.3.168822 ◽

2019 ◽

Vol 42 (3) ◽

pp. 12-23

Author(s):

Sophaphan Ploungbunmee ◽

Pornsri Disorntatiwat ◽

Sommart Bumrungphuet ◽

Nitaya Rotjananirankit

Keyword(s):

Clinical Practice ◽

Drug Use ◽

Antibiotic Prophylaxis ◽

Wound Infection ◽

Vaginal Delivery ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Antibiotic Use ◽

Rational Drug Use ◽

Rational Drug

Background: The rate of antibiotic use of vaginal delivery women in Ramathibodi Hospital is higher than expected standard criteria. The obstetrician team has developed clinical practice guidelines for rational drug use in antibiotic prophylaxis in vaginal delivery women. Objectives: To examine the relationships among the percentage of using antibiotic prophylaxis, the prevalence of rational drug use and the prevalence of the episiotomy wound infection rate in vaginal delivery women before and after using the clinical practice guidelines for antibiotic prophylaxis. Methods: The sample consisted of 983 vaginal delivery women who did not in the practice guidelines and 914 joined in practice guidelines groups. The rate of antibiotic use and episiotomy wound infection were collected before and after using the clinical practice guidelines for antibiotic prophylaxis. Data were analyzed by chi-square statistics. Results: The rate of antibiotic use in vaginal delivery women is significantly related to the use of the practice guidelines (P < .01), which is reduced from 25.43% to 9.85%. The prevalence of rational drug use increased from 12.40% to 34.44%. The prevalence of episiotomy wound infection of women vaginal birth before and after using the practice guidelines was not significantly different (P = .96). There was no episiotomy wound infection in both groups. Conclusions: The clinical practice guidelines reduces antibiotic use in postpartum women without episiotomy wound infection and promotes rational drug use.

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National Quality Evaluation of Medication Use for Pediatric Otitis Media With Effusion

Ear Nose & Throat Journal ◽

10.1177/01455613211020531 ◽

2021 ◽

pp. 014556132110205

Author(s):

Yu-Lu Chen ◽

Te-Yung Fang ◽

Pa-Chun Wang ◽

Ya-Hui Chen ◽

Ting-Chuan Wang ◽

...

Keyword(s):

Clinical Practice ◽

Drug Use ◽

Otitis Media ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Otitis Media With Effusion ◽

Medication Use ◽

Intranasal Steroids ◽

Antibiotics Use ◽

Systemic Antibiotics

Objectives: Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear without the presentation of signs or symptoms of acute ear infection. The point prevalence of OME reaches as high as 60% in children younger than 2 years of age. We used the National Health Insurance Research Database (NHIRD) to investigate the use of medication in children with OME before receiving ventilation tube insertion (VTI). Methods: Data of pediatric patients (age ≤ 12 years) who had OME and received VTI from January 1, 2011, to December 30, 2012, were retrieved from the Taiwan NHIRD. We surveyed the use of 4 medications to understand whether health care providers achieved the standards of medication use recommended by clinical practice guidelines. Results: This study examines the factors affecting the use of medication for pediatric OME. Overall, according to the study’s operational definitions, the use of systemic antibiotics was most common (59.9%), followed by systemic antihistamines (23.4%), systemic steroids (8.8%), and intranasal steroids (9.6%). Systemic antibiotics use was associated with 12 factors. Ten of the 12 factors increase the use of systemic antibiotics, including namely age (age > 2 years), comorbidities, teaching hospital, and community hospital. In contrast, namely catastrophic illness and watchful waiting are the 2 factors that decrease systemic antibiotics use. For the use of systemic antihistamines, systemic steroids, and intranasal steroids were related to 6, 5, and 2 factors, respectively. Conclusions: The rate of drug use differs from the rate of use recommended by commonly used clinical practice guidelines. We found that the higher the number of factors that influenced the patients’ drug use, the higher the rate of drug use. According to these results, drafting a treatment guideline for OME patients in accordance with current clinical practices in Taiwan is highly recommended.

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High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-19-00158 ◽

2020 ◽

Vol 5 (4) ◽

pp. 1006-1010

Author(s):

Jennifer Raminick ◽

Hema Desai

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Oxygen Therapy ◽

Respiratory Illness ◽

High Flow ◽

Oral Feeding ◽

Respiratory Support ◽

Acute Respiratory Illness ◽

High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

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