scholarly journals Treatment of acute psychotic agitation: gaps in the evidence base

2011 ◽  
Vol 17 (2) ◽  
pp. 101-103 ◽  
Author(s):  
Steve Brown
Keyword(s):  
Clinical Practice ◽  
Antipsychotic Drug ◽  
Research Evidence ◽  
Evidence Base ◽  
Current Treatment ◽  
Treatment Recommendations ◽  
Pharmacological Interventions ◽  
Similar Patient ◽  
Patient Groups ◽  
Moderate Agitation

SummaryTreatment of psychotic agitation is an area that is very poorly evidenced, principally because research evidence from patients with moderate agitation may not generalise to the more severely agitated patients. There is a significant gap between current treatment recommendations and what is seen in clinical practice. There are also big differences in clinical practice between different units treating seemingly similar patient groups. This commentary considers possible reasons for these findings and also discusses non-pharmacological interventions, which probably contribute more to the management of psychotic agitation than does the choice of one antipsychotic drug over another.

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.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jurriaan M. J. L. Brouwer ◽  
Erien Olde Hengel ◽  
Arne J. Risselada ◽  
Eric N. van Roon ◽  
Hans Mulder
Keyword(s):  
Clinical Practice ◽  
Drug Use ◽  
Adverse Effects ◽  
Antipsychotic Drug ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Frail Elderly ◽  
Antipsychotic Drugs ◽  
Electronic Database ◽  
Elderly Populations

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.

scholarly journals Professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness: A systematic review using the framework method and pillar process

2021 ◽  
pp. 026921632110321
Author(s):  
Florence Reedy ◽  
Mark Pearson ◽  
Sarah Greenley ◽  
Joseph Clark ◽  
David C Currow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
A Priori ◽  
Synthesis Method ◽  
Patient Characteristics ◽  
Severe Illness ◽  
Pharmacological Interventions ◽  
Eligibility Criteria ◽  
Treatment Regimens ◽  
Appraisal Tool

Background: In combination with non-pharmacological interventions, opioids may safely reduce chronic breathlessness in patients with severe illness. However, implementation in clinical practice varies. Aim: To synthesise the published literature regarding health professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness, identifying issues which influence implementation in clinical practice. Design: Systematic review and synthesis using the five-stage framework synthesis method. Data sources: Three electronic databases (MEDLINE, Embase via OVID, ASSIA via Proquest) were searched (March 2020) using a predefined search strategy. Studies were also citation chained from key papers. Papers were screened against a priori eligibility criteria. Data were extracted from included studies using the framework synthesis method. Qualitative and quantitative data were synthesised using the pillar process. Included studies were critically appraised using the Mixed-Methods Appraisal Tool. Results: After de-duplication, 843 papers were identified. Following screening, 22 studies were included. Five themes were developed: (i) clinician/patient characteristics, (ii) education/knowledge/experience, (iii) relationship between clinician/family, (iv) clinician/patient fear of opioids and (v) regulatory issues. Conclusions: There are significant barriers and enablers to the use of opioids for the symptomatic reduction of chronic breathlessness based on the knowledge, views and attitudes of clinicians, patients and families. Clinicians’ interactions with patients and their families strongly influences adherence with opioid treatment regimens for chronic breathlessness. Clinicians’, patients’ and families’ knowledge about the delicate balance between benefits and risks is generally poor. Education for all, but particularly clinicians, is likely to be a necessary (but insufficient) factor for improving implementation in practice.

scholarly journals Pharmacological Interventions for Pulmonary Involvement in Rheumatic Diseases

2021 ◽  
Vol 14 (3) ◽  
pp. 251 ◽  
Author(s):  
Eun Ha Kang ◽  
Yeong Wook Song
Keyword(s):  
Rheumatic Diseases ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Pulmonary Involvement ◽  
Current Treatment ◽  
Targeted Agents ◽  
Pharmacological Interventions ◽  
Inflammatory Processes ◽  
Pulmonary Arterial ◽  
Epidemiologic Features

Among the diverse forms of lung involvement, interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) are two important conditions in patients with rheumatic diseases that are associated with significant morbidity and mortality. The management of ILD and PAH is challenging because the current treatment often provides only limited patient survival benefits. Such challenges derive from their common pathogenic mechanisms, where not only the inflammatory processes of immune cells but also the fibrotic and proliferative processes of nonimmune cells play critical roles in disease progression, making immunosuppressive therapy less effective. Recently, updated treatment strategies adopting targeted agents have been introduced with promising results in clinical trials for ILD ad PAH. This review discusses the epidemiologic features of ILD and PAH among patients with rheumatic diseases (rheumatoid arthritis, myositis, and systemic sclerosis) and the state-of-the-art treatment options, focusing on targeted agents including biologics, antifibrotic agents, and vasodilatory drugs.

scholarly journals Drug information update. Lithium and chronic kidney disease: Debates and dilemmas

2017 ◽  
Vol 41 (4) ◽  
pp. 216-220 ◽  
Author(s):  
Sumeet Gupta ◽  
Udayan Khastgir
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Research Evidence ◽  
Evidence Base ◽  
Current Evidence ◽  
Treatment Resistant ◽  
The Past ◽  
Current Evidence Base ◽  
Information Update ◽  
Resistant Depression

SummaryLithium is an established treatment for bipolar disorder and an augmenting agent for treatment-resistant depression. Despite awareness of renal adverse effects, including chronic kidney disease, for the past five decades, there has been a lack of research evidence. This has led to debates around the existence and magnitude of the risk. This article discusses the current evidence base regarding the link between lithium and chronic kidney disease, monitoring of renal functions and its clinical implications.

scholarly journals Systematic review of the factors affecting cat and dog owner compliance with pharmaceutical treatment recommendations

2018 ◽  
Vol 184 (5) ◽  
pp. 154-154 ◽  
Author(s):  
Kathryn Jennifer Wareham ◽  
Marnie Louise Brennan ◽  
Rachel S Dean
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Relevant Literature ◽  
Evidence Base ◽  
Treatment Recommendations ◽  
Social Risk ◽  
Dosing Regimen ◽  
Pharmaceutical Treatment ◽  
Level Of Evidence ◽  
Factors Affecting

The aim of this systematic review is to describe and assess the quality of the existing evidence base concerning factors that influence the compliance of cat and dog owners to pharmaceutical and specifically polypharmacy treatment recommendations. PubMed, CAB Abstracts and Google were searched to identify relevant literature and search results were filtered according to predetermined inclusion and exclusion criteria. Standardised data extraction and critical appraisal were carried out on each included study, and a Centre for Evidence-Based Medicine level of evidence grading was applied. Of the 8589 studies, eight studies were included in the review. Majority (five of eight) of the included studies were examining compliance with short-term antimicrobial therapies and none examined polypharmacy. Multiple definitions of compliance, methods of measurement and different factors potentially affecting compliance were used. Factors reported to have affected compliance in at least one study were dosing regimen, discussion of dosing regimen in light of owners’ circumstances, consultation time, disease, month of consultation/treatment, physical risk, social risk and method of administration. The evidence available regarding factors affecting client compliance with pharmaceutical treatment recommendations in cats and dogs is scarce and of poor quality.

scholarly journals Improving the External Validity of Clinical Trials: The Case of Multiple Chronic Conditions

2013 ◽  
Vol 3 (2) ◽  
pp. 30-35 ◽  
Author(s):  
Fortin Martin ◽  
Smith M. Susan
Keyword(s):  
Clinical Trials ◽  
External Validity ◽  
Chronic Conditions ◽  
Evidence Base ◽  
Specific Reference ◽  
Multiple Chronic Conditions ◽  
Patient Centered ◽  
Department Of Health ◽  
Patient Groups ◽  
Intervention Trials

The U.S. Department of Health and Human Services vision and strategic framework on multiple chronic conditions (MCCs) incorporates recommendations designed to facilitate research that will improve our knowledge about interventions and systems that will benefit individuals with MCCs (or multimorbidity). The evidence base supporting the management of patients with MCCs will be built through intervention trials specifically designed to address multimorbidity and identification of MCCs in participants across the clinical trial range. This article specifically focuses on issues relating to external validity with specific reference to trials involving patients with MCCs. The exclusion of such patients from clinical trials has been well documented. Randomized control trials (RCTs) are considered the “gold standard” of evidence, but may have drawbacks in relation to external validity, particularly in relation to multimorbidity. It may, therefore, be necessary to consider a broader range of research methods that can provide converging evidence on intervention effects to address MCCs. Approaches can also be taken to increase the usefulness of RCTs in general for providing evidence to inform multimorbidity management. Additional improvements to RCTs would include better reporting of inclusion and exclusion criteria and participant characteristics in relation to MCCs. New trials should be considered in terms of how they will add to the existing evidence base and should inform how interventions may work in different settings and patient groups. Research on treatments and interventions for patients with MCCs is badly needed. It is important that this research includes patient-centered measures and that generalizability issues be explicitly addressed.

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