Against the stream: early diagnosis of dementia, is it so desirable?

SummaryThe Prime Minister's challenge on dementia called for improved dementia diagnosis rates, based on assumptions of benefit to individuals and those who care for them. Subsequent policies have led to increased target drives for clinical practice to achieve early diagnosis of dementia through intense case identification. However, the current evidence base and treatment options do not support screening for dementia, and there is little empirical evidence that such intensive case identification and early diagnosis for dementia is justified without a better understanding of the benefits, costs and potential harms to individuals and services.Declaration of interestNone.

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Management of feline carpal injuries: What are the options and when is arthrodesis indicated?

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x19870388 ◽

2019 ◽

Vol 21 (9) ◽

pp. 809-823 ◽

Cited By ~ 1

Author(s):

Rachel M Basa ◽

Kenneth A Johnson

Keyword(s):

Treatment Options ◽

Case Series ◽

Evidence Base ◽

Careful Examination ◽

Current Evidence ◽

Collateral Ligament ◽

Retrospective Case ◽

Radial Collateral Ligament ◽

Current Evidence Base ◽

Direct Extrapolation

Practical relevance: Feline carpal injuries are usually caused by falls from a height that result in hyperextension injury or antebrachiocarpal luxation or subluxation. Isolated ligamentous damage or fracture of the carpus is unusual; it is more common to have a combination of both in the cat. These injuries can be debilitating since cats climb and jump from great heights, and have a greater range of antebrachial pronation and supination than dogs. Anatomy: There are differences in the anatomy of the feline and canine carpus. In particular, cats only have a single short radial collateral ligament, also known as the medial collateral ligament. This means that, in the cat, antebrachiocarpal subluxation is possible with rupture of the dorsal joint capsule and short radial collateral ligament alone. Clinical challenges: Many feline carpal injuries can be treated without performing pancarpal arthrodesis. However, determining which ligaments and joint levels are affected requires careful examination and often stress radiography. When pancarpal arthrodesis is performed in the cat, it has been reported to reduce the height of jumping and to increase reluctance to climb. This is speculated to be due to reduced pronation and supination movement of the carpus. Evidence base: The current evidence base for management of feline carpal injuries is grade III or IV, with most of the studies being retrospective case series involving cadaveric dissection or direct extrapolation from published information about the dog. There are few guidelines regarding the optimal treatment options for carpal injuries in the cat.

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Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2019-036192 ◽

2020 ◽

Vol 10 (5) ◽

pp. e036192 ◽

Cited By ~ 3

Author(s):

Catrin Evans ◽

Brenda Poku ◽

Ruth Pearce ◽

Jeanette Eldridge ◽

Paul Hendrick ◽

...

Keyword(s):

Clinical Practice ◽

Scoping Review ◽

Health Workforce ◽

Grey Literature ◽

Evidence Base ◽

Current Evidence ◽

Multiprofessional Team ◽

Wide Range ◽

Current Evidence Base ◽

The Uk

IntroductionA global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinical, service and patient perspective.Methods and analysisThis scoping review is registered with the Open Science Framework (https://osf.io/tzpe5). The review will follow Joanna Briggs Institute guidance and involves a multidisciplinary and multiprofessional team, including a public representative. A wide range of electronic databases and grey literature sources will be searched from 2005 to the present. The review will include primary data from any relevant research, audit or evaluation studies. All review steps will involve two or more reviewers. Data extraction, charting and summary will be guided by a template derived from an established framework used internationally to evaluate ACP (the Participatory Evidence-Informed Patient-Centred Process-Plus framework).DisseminationThe review will produce important new information on existing activity, outcomes, implementation challenges and key areas for future research around ACP in the UK, which, in the context of global workforce transformations, will be of international, as well as local, significance. The findings will be disseminated through professional and NHS bodies, employer organisations, conferences and research papers.

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Pharmacotherapy of Anxiety Disorders

Neurobiology of Mental Illness ◽

10.1093/med/9780199934959.003.0047 ◽

2013 ◽

pp. 636-639

Author(s):

James W. Murrough ◽

Dan V. Iosifescu ◽

Dennis S. Charney

Keyword(s):

Anxiety Disorders ◽

Treatment Options ◽

The United States ◽

Evidence Base ◽

Current Evidence ◽

Generalized Anxiety ◽

Pharmacological Agents ◽

Current Evidence Base ◽

High Degree ◽

Monoaminergic Agents

Anxiety disorders are among the most prevalent mental disorders in the United States and are associated with a high degree of morbidity and public health costs. This chapter will present a general approach to the diagnosis and treatment of these disorders and summarize the current evidence base for pharmacotherapeutic treatment options in individual disorders, including panic disorder, social phobia, posttraumatic stress disorder, generalized anxiety disorder.The serotonin-selective and serotonin norepinephrine reuptake inhibitors are generally considered first-line treatment while older monoaminergic agents are often efficacious but are limited by safety and tolerability issues. The benzodiazepines play an important role in the treatment of some anxiety disorders, however these agents also possess important limitations. Other pharmacological agents have a more limited evidence base. Continued progress in basic and translational neuroscience is expected to meet the need for new, more effective treatments for patients suffering from these disorders.

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What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Health Services and Delivery Research ◽

10.3310/hsdr03430 ◽

2015 ◽

Vol 3 (43) ◽

pp. 1-134 ◽

Cited By ~ 25

Author(s):

Janette Turner ◽

Joanne Coster ◽

Duncan Chambers ◽

Anna Cantrell ◽

Viet-Hai Phung ◽

...

Keyword(s):

Empirical Evidence ◽

Systematic Reviews ◽

Evidence Synthesis ◽

Evidence Base ◽

Service Planning ◽

Urgent Care ◽

Rapid Review ◽

Current Evidence ◽

Primary Research ◽

Current Evidence Base

BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Non-pharmacological Treatment Options in the Management of Diabetes Mellitus

European Endocrinology ◽

10.17925/ee.2018.14.2.31 ◽

2018 ◽

Vol 14 (2) ◽

pp. 31 ◽

Cited By ~ 14

Author(s):

Arkiath V Raveendran

Keyword(s):

Diabetes Mellitus ◽

Treatment Options ◽

Evidence Base ◽

Pharmacological Therapy ◽

Current Evidence ◽

Effective Management ◽

Pharmacological Interventions ◽

Current Evidence Base ◽

Control Of Diabetes

The global prevalence of diabetes, especially type 2 diabetes mellitus, has reached epidemic proportions in the last few decades of the 20th century because of the obesity pandemic resulting from adverse lifestyles. Diabetes as a consequence of obesity (diabesity), continues to increase exponentially in the 21st century. Although there are a multitude of drugs for the effective management of diabesity with modest benefits, most patients will require insulin for control of diabetes at some stage that would worsen obesity, and thereby diabesity. Therefore, effective non-pharmacological therapy needs to be expedited in all patients with diabesity. These measures include medical nutrition interventions, change of lifestyles and bariatric surgery. Non-pharmacological interventions are also useful for the effective management of even type 1 diabetes mellitus when used along with insulin therapy especially in those with obesity. This review summarises the current evidence base for the non-pharmacological interventions in the management of diabetes.

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CONGENITAL CHYLOTHORAX: CURRENT EVIDENCE-BASED PRENATAL AND POST-NATAL DIAGNOSIS AND MANAGEMENT

Lymphology ◽

10.2458/lymph.4632 ◽

2020 ◽

Vol 52 (3) ◽

Author(s):

LC De Angelis ◽

T Bellini ◽

MH Witte ◽

RI Kylat ◽

M Bernas ◽

...

Keyword(s):

Pleural Effusion ◽

Therapeutic Approach ◽

Neonatal Period ◽

Treatment Options ◽

Evidence Base ◽

Current Evidence ◽

Treatment Timing ◽

Current Evidence Base ◽

Uncommon Condition ◽

Congenital Chylothorax

Congenital chylothorax is an uncommon condition but represents the main cause of congenital pleural effusion during the neonatal period. It usually appears before birth, both as an isolated disorder or in association with hydrops fetalis, negatively affecting the subsequent neonatal outcome. Prenatal treatment is usually considered to ensure a satisfactory lung development in case of moderate to severe pleural effusion or in the presence of hydrops, although consensus on treatment timing and modalities has not been reached to date. Both medical and surgical therapeutic strategies are available to treat this condition and novel treatment options have been recently attempted with acceptable results in both prenatal and post-natal setting. The heterogeneous clinical presentation of congenital chylothorax together with its rarity, its numerous etiologies and the absence of a highly effective treatment renders the diagnostic and therapeutic approach difficult to standardize. In addition, adequate visualization of the lymphatic system is complex, especially in small neonates, although new promising techniques have been developed lately and may contribute to improved management of this serious but infrequent condition. This review focuses on the current evidence base for the diagnosis and treatment options for congenital chylothorax, suggesting a rational diagnostic and therapeutic approach both in the prenatal and in the neonatal period.

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Faculty Opinions recommendation of Care for patients with multiple endocrine neoplasia type 1: the current evidence base.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.6870956.7050054 ◽

2010 ◽

Author(s):

Alberto Falchetti

Keyword(s):

Multiple Endocrine Neoplasia ◽

Multiple Endocrine Neoplasia Type ◽

Evidence Base ◽

Current Evidence ◽

Endocrine Neoplasia ◽

Endocrine Neoplasia Type ◽

Current Evidence Base

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Polyphenols and Cognition In Humans: An Overview of Current Evidence from Recent Systematic Reviews and Meta-Analyses

Brain Plasticity ◽

10.3233/bpl-200111 ◽

2020 ◽

pp. 1-15

Author(s):

Daniel Joseph Lamport ◽

Claire Michelle Williams

Keyword(s):

Systematic Reviews ◽

Evidence Base ◽

Epidemiological Studies ◽

Cognitive Outcome ◽

Current Evidence ◽

Duration Of Treatment ◽

Current Evidence Base ◽

Cognitive Benefits ◽

Meta Analyses ◽

The Impact

There is increasing interest in the impact of dietary influences on the brain throughout the lifespan, ranging from improving cognitive development in children through to attenuating ageing related cognitive decline and reducing risk of neurodegenerative diseases. Polyphenols, phytochemicals naturally present in a host of fruits, vegetables, tea, cocoa and other foods, have received particular attention in this regard, and there is now a substantial body of evidence from experimental and epidemiological studies examining whether their consumption is associated with cognitive benefits. The purpose of this overview is to synthesise and evaluate the best available evidence from two sources, namely meta-analyses and systematic reviews, in order to give an accurate reflection of the current evidence base for an association between polyphenols and cognitive benefits. Four meta-analyses and thirteen systematic reviews published between 2017–2020 were included, and were categorised according to whether they reviewed specific polyphenol-rich foods and classes or all polyphenols. A requirement for inclusion was assessment of a behavioural cognitive outcome in humans. A clear and consistent theme emerged that whilst there is support for an association between polyphenol consumption and cognitive benefits, this conclusion is tentative, and by no means definitive. Considerable methodological heterogeneity was repeatedly highlighted as problematic such that the current evidence base does not support reliable conclusions relating to efficacy of specific doses, duration of treatment, or sensitivity in specific populations or certain cognitive domains. The complexity of multiple interactions between a range of direct and indirect mechanisms of action is discussed. Further research is required to strengthen the reliability of the evidence base.

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