Embracing the Cascade part 3: clinical decision making in equine asthma

UK-Vet Equine ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. 19-29
Author(s):  
James Bailey ◽  
Mark Bowen
Keyword(s):  
Severe Asthma ◽  
Clinical Decision Making ◽  
Inhaled Corticosteroids ◽  
Rescue Therapy ◽  
Clinical Decision ◽  
Airway Disease ◽  
Evidence Base ◽  
Lower Airway ◽  
Mucus Production ◽  
Equine Asthma

Equine asthma is the current terminology that covers chronic non-infectious lower airway disorders in the horse. Mild and moderate equine asthma reflect the syndrome previously referred to as inflammatory airway disease, while severe asthma reflects both recurrent airway obstruction and summer pasture-associated obstructive airway disease. Corticosteroids are the most important therapeutic agents for the management of horses with all severities of equine asthma. Prednisolone and dexamethasone products are authorised for use in horses and can be used for the management of asthma. Inhaled corticosteroids have the potential advantages of reduced systemic effects and reduced detection times in competition animals. ‘Special’ (extemporaneous) formulations of oral dexamethasone may be valuable in horses with severe asthma. A range of bronchodilator therapies can be used for the management of severe asthma; although the clinical efficacy of systemic bronchodilators still lacks a robust evidence base, they may have a particular role in ‘rescue-therapy’ and in acute exacerbations. The evidence for the use of mucolytic agents is limited and excessive mucus production should resolve with improvements in airway inflammation. Inhaled saline and inhaled acetylcysteine may provide useful improvements in mucus secretion without any effects on competition horses. Mast cell stabilisers may have a role in the management of mild equine asthma, although they have a limited evidence base for their use. The use of the prescribing cascade provides access to a range of medications that are useful in the management of equine asthma.

scholarly journals In an Adult Horse With Severe Asthma (Previously Recurrent Airway Obstruction) Does Using Inhaled Corticosteroids Result in an Equal Improvement in Clinical Signs When Compared to Systemic Corticosteroids?

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Natasha A Jocelyn
Keyword(s):  
Open Access ◽  
Airway Obstruction ◽  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Clinical Signs ◽  
The Body ◽  
Recurrent Airway Obstruction ◽  
Bottom Line ◽  
Systemic Corticosteroids ◽  
Equine Asthma

<strong>PICO question</strong><br /><p>In an adult horse with severe asthma (previously recurrent airway obstruction (RAO)) does using inhaled corticosteroids result in an equal improvement in clinical signs when compared to systemic corticosteroids?</p><strong>Clinical bottom line</strong><br /><p>The level of confidence in the outcomes from the body of evidence in the 4 papers identified is high. This suggests inhaled corticosteroids (fluticasone and beclomethasone) when used at an appropriate dose can have equivalent effects on severe equine asthma as systemic intravenous dexamethasone. Inhaled corticosteroids can take longer to have the desired effects. </p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />

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

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.

Integrating research and evidence-based guidance into prescribing practice

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

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

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.

Management of severe stifle trauma: 2. Periarticular fractures

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.

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

2012 ◽  
pp. 645-650 ◽  
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.

Integrating research and evidence-based guidance into prescribing practice

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

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 checklists and research reporting tools.

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

2012 ◽  
Vol 5 (4) ◽  
pp. 83-92 ◽  
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.

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

2017 ◽  
Vol 25 (4) ◽  
pp. 395-398 ◽  
Author(s):  
Nick O’Connor ◽  
John Corish
Keyword(s):  
Clinical Decision Making ◽  
Relevant Literature ◽  
Clinical Decision ◽  
Evidence Base ◽  
Clinical Knowledge ◽  
Behavioural Disturbance ◽  
Treatment Protocols ◽  
Pharmacological Management ◽  
New Evidence ◽  
Careful Assessment

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.

Feline asthma and heartworm disease: Clinical features, diagnostics and therapeutics

2019 ◽  
Vol 21 (9) ◽  
pp. 825-834 ◽  
Author(s):  
Sarah Garrity ◽  
Tekla Lee-Fowler ◽  
Carol Reinero
Keyword(s):  
Clinical Features ◽  
Airway Disease ◽  
Evidence Base ◽  
Experimental Models ◽  
Lower Airway ◽  
Practical Relevance ◽  
Asthma Morbidity ◽  
Clinical Syndromes ◽  
Heartworm Disease ◽  
Over Time

Practical relevance: For feline practitioners, the cat with a cough or respiratory distress and thoracic radiographs with a bronchial or bronchointerstitial pattern suggests lower airway disease. Two important differentials, allergic asthma and heartworm disease (HWD), have many overlapping clinicopathologic features, but also clear and important differences in terms of cause and disease progression, treatment and prognosis. Notably, asthma is readily treatable and HWD is preventable. Clinical significance: Feline HWD comprises two clinical syndromes: the comparatively recently described heartworm-associated respiratory disease (HARD) and adult HWD. The former is much more common; very few cats with HARD develop adult HWD. In HARD, following death of immature worms, pulmonary lesions may improve over time (‘self-cure’). Lesions of adult HWD also improve over time as long as reinfection does not occur; however, with death of adult heartworms, mortality is high, and the prognosis is guarded. In asthma, morbidity is relatively high, but mortality is low, with an overall good to excellent prognosis. Disease recognition: Feline asthma is encountered worldwide. In the authors’ impression, feline HWD is often under-recognized. Aims: The aim of this review is to assist clinicians in differentiating feline asthma from feline HWD; as such, the emphasis is on distinguishing clinical features, as well as on diagnostics, therapy and prognosis. In differentiating these conditions, clinicians can attempt the goal of properly managing these diseases and can best educate owners on prognosis. Evidence base: For both feline asthma and feline HWD, the authors have drawn on the available peer-reviewed literature studies involving experimental models as well as spontaneous disease.

Sign in / Sign up

Export Citation Format

Share Document