scholarly journals Investigating the Benefits of Out-of-Hospital External Chest Compression

2015 ◽  
Vol 5 (3) ◽  
Author(s):  
Brett Williams ◽  
Brian Fallows ◽  
Jeff Allan
Keyword(s):  
Clinical Practice ◽  
New Zealand ◽  
Severe Asthma ◽  
Chest Compression ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Status Asthmaticus ◽  
Cochrane Library ◽  
External Chest Compression ◽  
Lateral Chest

Introduction 1. To review and analyse the literature regarding out-of-hospital external chest compressions (ECC) in severe asthma and status asthmaticus. 2. To compare which ambulance services in Australia and New Zealand actively use ECC in their clinical practice guidelines for severe asthma. Methods Literature review using a variety of medical databases including, Medline, AMED, ProQuest, EMBASE, CINAHL, Scopus and Cochrane Library from 1950 to present. The following keywords were used in the search strategy, ambulance, asthma, emergency medical technicians, external chest compression, external chest pressure, lateral chest compression, lateral chest pressure, out-of-hospital, paramedic, prehospital, status asthmaticus and thoracic compression. A review of Australian and New Zealand ambulance service clinical practice guidelines was also undertaken comparing the current out-of-hospital guidelines use of ECC. Results A total of nine papers were located with low levels of evidence supporting the use of ECC. Only two papers directly discussed ECC in the context of out-of-hospital care. Three of the eight Australian ambulance services actively use ECC in their clinical practice guidelines. Conclusion High level evidence was not found supporting the use of ECC in severe asthma or status asthmaticus. Anecdotal opinions and case reports generally have supported its use in dynamic hyperinflation settings. Further research is required before recommendations can be made.

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

2020 ◽  
Vol 55 (1) ◽  
pp. 7-117 ◽  
Author(s):  
Gin S Malhi ◽  
Erica Bell ◽  
Darryl Bassett ◽  
Philip Boyce ◽  
Richard Bryant ◽  
...  
Keyword(s):  
Clinical Practice ◽  
New Zealand ◽  
Mood Disorders ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Primary Care Physicians ◽  
Scientific Evidence ◽  
Bipolar Disorders ◽  
Relevant Information ◽  
Zealand College

Objectives: To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. Methods: Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. Results: The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. Conclusion: The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Mood disorders committee: Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.

Australian and New Zealand Clinical Practice Guidelines for the Treatment of Panic Disorder and Agoraphobia

2003 ◽  
Vol 37 (6) ◽  
pp. 641-656 ◽  
Author(s):  
Keyword(s):  
Clinical Practice ◽  
New Zealand ◽  
Panic Disorder ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Meta Analysis ◽  
Prognostic Indicator ◽  
Time Frame ◽  
Behaviour Therapy ◽  
Cognitive Behaviour

Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. Method: For these guidelines, the CPG team reviewed the treatment outcome literature, consulted with practitioners and patients and conducted a meta-analysis of recent outcome research. Treatment recommendations: Education for the patient and significant others covering: (i) the nature and course of panic disorder and agoraphobia; (ii) an explanation of the psychopathology of anxiety, panic and agoraphobia; (iii) rationale for the treatment, likelihood of a positive response, and expected time frame. Cognitive behaviour therapy (CBT) is more effective and more cost-effective than medication. Tricyclic antidepressants (TCAs) and serotonin selective reuptake inhibitors are equal in efficacy and both are to be preferred to benzodiazepines. Treatment choice depends on the skill of the clinician and the patient's circumstances. Drug treatment should be complemented by behaviour therapy. If the response to an adequate trial of a first-line treatment is poor, another evidence-based treatment should be used. A second opinion can be useful. The presence of severe agoraphobia is a negative prognostic indicator, whereas comorbid depression, if properly treated, has no consistent effect on outcome.

scholarly journals Mind the gap: Mapping Variation between National and Local Clinical Practice Guidelines for Acute Paediatric Asthma from the United Kingdom and the Netherlands

2021 ◽  
Author(s):  
Charlotte Koldeweij ◽  
Jonathan Clarke ◽  
Carmen Rodriguez Gonzalvez ◽  
Joppe Nijman ◽  
Ruchi Sinha ◽  
...  
Keyword(s):  
United Kingdom ◽  
Clinical Practice ◽  
The Netherlands ◽  
Severe Asthma ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Care ◽  
Paediatric Asthma ◽  
The United Kingdom ◽  
National Guidance

Background: Clinical practice guidelines (CPGs) aim to standardize clinical care. Increasingly, hospitals rely on locally produced guidelines alongside national guidance. This study examines variation between national and local CPGs, using the example of acute paediatric asthma guidance from the United Kingdom and the Netherlands. Methods: Fifteen British and Dutch local CPGs were collected with the matching national guidance for the management of acute asthma in children under 18 years old. The drug sequences, routes and methods of administration recommended for patients with severe asthma and the tone of recommendation across both types of CPGs were schematically represented. Deviations from national guidance were measured. Variation in recommended doses of intravenous salbutamol was examined. Results: British and Dutch national CPGs differed in the recommended drug choices, sequences, routes and methods of administration for severe asthma. Dutch national guidance was more rigidly defined. Local British CPGs diverged from national guidance for 23% of their recommended interventions compared to 8% for Dutch local CPGs. Five British local guidelines and two Dutch local guidelines differed from national guidance for multiple treatment steps. Variation in second-line recommendations was greater than for first-line recommendations across local CPGs from both countries. Recommended starting doses for salbutamol infusions varied by more than tenfold. Conclusions: Local CPGs for the management of severe acute paediatric asthma featured substantial variation and frequently diverged from national guidance. Although limited to one condition, this study suggests that unmeasured variation across local CPGs may contribute to variation of care more broadly, with possible effects on healthcare quality.

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