scholarly journals Cannabinoids in the Older Person: A Literature Review

Geriatrics ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 2 ◽  
Author(s):  
William Beedham ◽  
Magda Sbai ◽  
Isabel Allison ◽  
Roisin Coary ◽  
David Shipway
Keyword(s):  
Literature Review ◽  
Older Patients ◽  
Evidence Base ◽  
Medical Illness ◽  
Detailed Knowledge ◽  
Older Person ◽  
Mainstream Media ◽  
Drug Classes ◽  
Narrative Literature Review ◽  
The Uk

Introduction: Medical cannabinoids have received significant mainstream media attention in recent times due to an evolving political and clinical landscape. Whilst the efficacy of cannabinoids in the treatment of some childhood epilepsy syndromes is increasingly recognized, medical cannabinoids may also have potential clinical roles in the treatment of older adults. Prescribing restrictions for medical cannabinoids in certain jurisdictions (including the UK) has recently been relaxed. However, few geriatricians have the detailed knowledge or awareness of the potential risks or rewards of utilizing cannabinoids in the older person; even fewer geriatricians have direct experience of using these drugs in their own clinical practice. Older persons are more likely to suffer from medical illness representing potential indications for medical cannabinoids (e.g., pain); equally they may be more vulnerable to any adverse effects. Aim: This narrative literature review aims to provide a brief introduction for the geriatrician to the potential indications, evidence-base, contra-indications and side effects of medical cannabinoids in older people. Methods: A search was conducted of CENTRAL, Medline, Embase, CINAHL and psycINFO, Cochrane and Web of Science databases. Reference lists were hand searched. Abstracts and titles were screened, followed by a full text reading of relevant articles. Results: 35 studies were identified as relevant for this narrative review. Conclusions: Cannabinoids demonstrate some efficacy in the treatment of pain and chemotherapy-related nausea; limited data suggest potential benefits in the treatment of spasticity and anxiety. Risks of cannabinoids in older patients appear to be moderate, and their frequency comparable to other analgesic drug classes. However, the quality of research is weak, and few older patients have been enrolled in cannabinoid studies. Dedicated research is needed to determine the efficiency and safety of cannabinoids in older patients.

COVID-2019 – Time to Use Silver Diamine Fluoride for Caries Arrest in General Dental Practice?

Dental Update ◽  
2020 ◽  
Vol 47 (8) ◽  
pp. 662-668
Author(s):  
Laura Timms ◽  
Chris Deery ◽  
Claire Stevens ◽  
Helen Rodd
Keyword(s):  
Older Patients ◽  
Simple Technique ◽  
Evidence Base ◽  
Management Technique ◽  
Dental Practice ◽  
Common Condition ◽  
Silver Diamine Fluoride ◽  
Case Selection ◽  
Simple Alternative ◽  
The Uk

Silver diamine fluoride (SDF) is applied topically to arrest caries and has an increasing evidence base to support its efficacy, both in the primary dentition and to arrest root caries in older patients. It can be used as a non-aerosol generating procedure and is a simple technique. It has a side-effect of discolouring caries black, a factor which requires discussion with patients and their carers prior to application. Due to its efficacy and simplicity, it is a useful intervention for the management of caries. CPD/Clinical Relevance: Caries is a common condition in the UK, and silver diamine fluoride offers a simple alternative management technique when case selection is appropriate.

784 Management of Paediatric Epistaxis: An Appraisal of Cautery Versus Topical Antiseptics in The Prevention of Rebleeding Events

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Sagua ◽  
S Fishpool
Keyword(s):  
Literature Review ◽  
Evidence Base ◽  
Current Evidence ◽  
Short Term ◽  
Recurrent Epistaxis ◽  
Significant Difference ◽  
Current Evidence Base ◽  
Minimal Difference ◽  
The Uk ◽  
New Treatments

Abstract Introduction Epistaxis is a common acute presentation in childhood that with recurrence often causes great distress for both parent and child alike. For recurrent epistaxis it is common practice in the UK to trial either a topical antiseptic (Naseptin) or silver nitrate cautery. A literature review was conducted to assess which treatment confers greater protection against rebleeding events. Method The literature review was performed via a search on Medline via Ovid. As both cautery and topical antiseptics are not new treatments, an age limit was not set to allow older research to be included and provide perspective. Results In all but one study included, there was no statistically significant difference between the use of Naseptin versus cautery in the reduction of rebleeding events. A higher incidence of complications such as septal perforation and pain were reported in patients who underwent cautery, whilst no adverse side effects were reported with Naseptin. Conclusions The current evidence base relies mostly on short term outcomes, with most patients not being followed up for more than 2 months. If further longitudinal studies provide evidence to support there being a minimal difference in treatment outcomes, using topical antiseptics before considering cautery would be better clinical practice in paediatric patients.

Are prison-based therapeutic communities effective? Challenges and considerations

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jade Richardson ◽  
Valentina Zini
Keyword(s):  
Literature Review ◽  
Current Knowledge ◽  
Therapeutic Communities ◽  
Content Type ◽  
Effective Form ◽  
Recent Developments ◽  
Probation Service ◽  
Narrative Literature Review ◽  
The Uk ◽  
The Impact

Purpose The purpose of this paper is to detail the impact and efficacy of Her Majesty’s Prison and Probation Service ((HMPPS) Therapeutic Communities (TCs) (both democratic and hierarchical). This paper outlines recent developments in the TC literature, to provide readers with an up-to-date overview of the outcomes of prison-based TC treatment, while highlighting the strengths and challenges of this treatment approach. Trends within the research are discussed, and the authors draw attention to any gaps in the current knowledge. Design/methodology/approach This paper uses a narrative literature review approach to review the most current literature around the effectiveness of prison-based TCs in HMPPS. Academic literature published predominantly from 2010 onwards is discussed because of limited literature review publications on this topic post-2010. To obtain literature, searches of relevant databases were conducted, and/or clinical leads at prison sites were contacted for relevant publications. Findings There is a body of research which demonstrates that TCs are an effective form of treatment for people with an offending history and personality difficulties. Evidence indicates that Democratic TC treatment plays a part in reducing reoffending rates, as well as improving psychological features. Further research is needed in a number of areas, specifically with female offenders and individuals who undertake treatment in hierarchical TCs in the UK. It is also suggested that TC treatment aftercare may help to further the positive outcomes identified. Originality/value To the best of the authors’ knowledge, there is no up-to-date review of the impact and efficacy of HMPPS TC treatment. This paper reflects on available research within the current context of TC treatment and provides an original overview of the current UK TC practice. It has value in recommending areas for further research and consideration.

scholarly journals Green dementia care in accommodation and care settings: a literature review

2019 ◽  
Vol 22 (4) ◽  
pp. 193-206
Author(s):  
Julie Barrett ◽  
Simon Evans ◽  
Neil Mapes
Keyword(s):  
Pilot Study ◽  
Literature Review ◽  
Evidence Base ◽  
Dementia Care ◽  
Care Homes ◽  
Content Type ◽  
Health And Wellbeing ◽  
Barriers And Enablers ◽  
The Uk ◽  
Extra Care Housing

Purpose The purpose of this paper is to examine the recent evidence relating to green (nature-based) dementia care for people living with dementia in long-term accommodation and care settings (housing for older people that provides both accommodation and care, such as residential care homes, nursing homes and extra care housing schemes). The review formed part of a pilot study exploring interaction with nature for people living with dementia in care homes and extra care housing schemes in the UK. Rather than a comprehensive systematic or critical literature review, the intention was to increase understanding of green dementia care to support the pilot study. Design/methodology/approach The review draws together the published and grey literature on the impacts of green (nature-based) dementia care, the barriers and enablers and good practice in provision. People living with dementia in accommodation and care settings are the focus of this review, due to the research study of which the review is part. Evidence relating to the impacts of engaging with nature on people in general, older people and residents in accommodation and care is also briefly examined as it has a bearing on people living with dementia. Findings Although interaction with the natural environment may not guarantee sustained wellbeing for all people living with dementia, there is some compelling evidence for a number of health and wellbeing benefits for many. However, there is a clear need for more large-scale rigorous research in this area, particularly with reference to health and wellbeing outcomes for people living with dementia in accommodation and care settings for which the evidence is limited. There is a stronger evidence base on barriers and enablers to accessing nature for people living with dementia in such settings. Research limitations/implications The literature review was conducted to support a pilot study exploring green (nature-based) dementia care in care homes and extra care housing schemes in the UK. Consequently, the focus of the review was on green dementia care in accommodation and care settings. The study, and thus the review, also focussed on direct contact with nature (whether that occurs outdoors or indoors) rather than indirect contact (e.g. viewing nature in a photograph, on a TV screen or through a window) or simulated nature (e.g. robot pets). Therefore, this paper is not a full review of all aspects of green dementia care. Originality/value This paper presents an up-to-date review of literature relating to green dementia care in accommodation and care settings. It was successful in increasing understanding to support a pilot study exploring opportunities, benefits, barriers and enablers to interaction with nature for people living with dementia in care homes and extra care housing schemes in the UK. It demonstrated the impacts, value and accessibility of nature engagement in these settings and identified gaps in the evidence base. This review and subsequent pilot study provide a strong platform from which to conduct future research exploring green dementia care in accommodation and care settings.

scholarly journals What is the evidence base for ambulatory care for acute medical illness?

2018 ◽  
Vol 17 (3) ◽  
pp. 148-153
Author(s):  
Daniel Lasserson ◽  
◽  
C Harris ◽  
TNE Elias ◽  
JST Bowen ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Care Pathway ◽  
Point Of Care ◽  
National Policy ◽  
Healthcare Setting ◽  
Evidence Base ◽  
Policy Support ◽  
Medical Illness ◽  
Home Based ◽  
The Uk

Acute ambulatory care is a critical component of the emergency care pathway with national policy support and a dedicated NHS Improvement network. The evidence base for treating acute medical illness outside hospital is a diverse mix of randomised and observational studies with varying inclusion criteria, prognostic stratification, interventions and healthcare setting which limits synthesis of all available evidence and translation to the UK context. There is little consensus on the level of risk for home-based treatment for acute medical illness. Selection tools for referral to acute ambulatory care have been developed but there is limited evidence for their use. There are still research questions concerning optimal staffing, referral mechanisms, point of care diagnostic portfolio and tools for shared decision making.

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