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At least 1,081 records · Page 60Linked to original sources
PubMed2006

Benzodiazepines--a necessary evil? A survey of prescribing at a specialist UK psychiatric hospital.

Guidelines on the prescription of benzodiazepines recommend their use be limited to the short-term relief of severe anxiety or insomnia. However, clinical experience suggests that in psychiatry these drugs may be being prescribed more widely. The aim of this survey was to investigate benzodiazepine prescribing in a specialist UK psychiatric hospital using a structured interview with consultant psychiatrists. Prescribers were also asked their views on the UK CSM guidance on benzodiazepines (1988). Of 412 inpatients, 77 (18.7%) were receiving 90 benzodiazepine prescriptions for psychiatric indications. Most prescriptions were for anxiety (45/90; 50.0%), aggression (23/90; 25.6%) and agitation (13/90; 14.4%). Use was commonest for acquired brain injury, schizophrenia and personality disorders. Much usage was chronic (only 4/90 (4.4%) prescriptions had been initiated within the previous 4 weeks) and off-label (85/90; 94.4%). Prescribers were concerned about the addictive nature of benzodiazepines for these patients and to a lesser extent about their abuse potential. Most consultants believed the UK CSM guidance was too restrictive in relation to their clinical practice and needed modification to encompass new indications, for example rapid tranquillization, and specialist prescribing. In psychiatry benzodiazepines are quite frequently used in the management of a number of groups of difficult-to-treat patients. Although largely not evidence based, some psychiatrists report a favourable risk-benefit ratio for benzodiazepines in the treatment of certain patients.

Adolescent↗
PubMed2000

Are women being counseled about estrogen replacement therapy?

The U.S. Preventive Services Task Force and several medical professional associations have published guidelines recommending that all women be counseled around the time of menopause about the benefits and risks of estrogen replacement therapy (ERT) so that they may make an informed decision about its use. Despite the proliferation of ERT counseling guidelines, little is known about whether these guidelines are being followed. There were 1,500 female members (aged 40 to 69) of a Northeastern U.S. Independent Practice Association--model Health Maintenance Organization who were surveyed, and 51 percent reported that a health care provider had talked with them about the benefits and risks of ERT. In multivariate analyses, a woman's demographic characteristics (age, race, income), stage of menopause, severity of menopausal symptoms, and body weight were the major correlates of receipt of ERT counseling. Women at greater risk for osteoporosis or heart disease were no more likely to be counseled, although those with diagnosed osteoporosis were. What appear to be selective ERT counseling practices will need to be modified if the goal of providing universal ERT counseling to midlife women is to be attained.

Adult↗
PubMed1999

DM program cuts back pain costs by educating, supporting primary care physicians.

Right behind the common cold, low back pain is the second leading reason why people go to the doctor's office. But nine times out of 10, the pain will resolve on its own. Discover how a combination of practice guidelines and a special spine clinic to address unresolved back pain work to create better clinical and financial outcomes for one major health plan.

Cost Control↗
PubMed2002

Interventions used in disease management programmes for patients with chronic illness-which ones work? Meta-analysis of published reports.

OBJECTIVE: To systematically evaluate the published evidence regarding the characteristics and effectiveness of disease management programmes. DESIGN: Meta-analysis. DATA SOURCES: Computerised databases for English language articles during 1987-2001. STUDY SELECTION: 102 articles evaluating 118 disease management programmes. MAIN OUTCOME MEASURES: Pooled effect sizes calculated with a random effects model. RESULTS: Patient education was the most commonly used intervention (92/118 programmes), followed by education of healthcare providers (47/118) and provider feedback (32/118). Most programmes (70/118) used more than one intervention. Provider education, feedback, and reminders were associated with significant improvements in provider adherence to guidelines (effect sizes (95% confidence intervals) 0.44 (0.19 to 0.68), 0.61 (0.28 to 0.93), and 0.52 (0.35 to 0.69) respectively) and with significant improvements in patient disease control (effect sizes 0.35 (0.19 to 0.51), 0.17 (0.10 to 0.25), and 0.22 (0.1 to 0.37) respectively). Patient education, reminders, and financial incentives were all associated with improvements in patient disease control (effect sizes 0.24 (0.07 to 0.40), 0.27 (0.17 to 0.36), and 0.40 (0.26 to 0.54) respectively). CONCLUSIONS: All studied interventions were associated with improvements in provider adherence to practice guidelines and disease control. The type and number of interventions varied greatly, and future studies should directly compare different types of intervention to find the most effective.

Chronic Disease↗
PubMed2005

Aligning patient care and asthma treatment guidelines.

This article describes how the National Asthma Education and Prevention Program Guidelines for the Diagnosis and Management of Asthma can be used in the clinical setting to improve a patient's everyday function and quality of life. Major recommendations are detailed and case studies provide a practical approach for patient management.

Adult↗
PubMed2001

Practice guideline on prophylactic cranial irradiation in small-cell lung cancer.

PURPOSE: To develop an evidence-based clinical practice guideline that would address the following questions: (a) What is the role of prophylactic cranial irradiation (PCI) in patients with limited or extensive stage small-cell lung cancer (SCLC) who have achieved complete remission in response to induction therapy (chemotherapy or chemoradiotherapy)? (b) What dose and fractionation schedules of PCI are optimal? (c) Does the use of PCI in patients with SCLC in complete remission affect quality of life? Survival, disease-free survival, quality of life, and adverse effects were the outcomes of interest. METHODS AND MATERIALS: A systematic review of the published literature was undertaken to provide the data for an evidence-based practice guideline. RESULTS: Six randomized controlled trials and one fully published individual patient data meta-analysis were included in the systematic review of the evidence. For patients who have achieved complete response after induction therapy, there is evidence of a disease-free survival benefit (4 of 6 trials) and an overall survival benefit (meta-analysis). There is insufficient evidence to make a definitive recommendation with respect to dose. There is some indication that 30-36 Gy in 2-3 Gy per fraction, or a biologically equivalent dose, may produce a better outcome than a lower dose or less aggressive fractionation regimen. The schedule commonly used in Canada is 25 Gy in 10 fractions over 2 weeks. Data from further research, including a trial currently ongoing that compares 25 Gy in 10 fractions with 36 Gy in 18 fractions, will be required to determine optimal dose of PCI. There is insufficient evidence to make recommendations concerning the optimal timing of PCI in relation to the administration of chemotherapy. Lung DSG members generally felt that it should be given as soon as possible after completion of chemotherapy. There is evidence from trials with data for up to 2 years of follow-up that prophylactic cranial irradiation does not produce significant late neurotoxicity. There is evidence from one trial that prophylactic cranial irradiation does not have a detrimental effect on quality of life in the first 12 months following the completion of therapy. There is insufficient evidence to comment on the long-term effects of prophylactic cranial irradiation on quality of life. CONCLUSION: For adult patients with limited or extensive SCLC who achieve a complete remission with induction therapy, PCI is recommended.

Carcinoma, Small Cell↗
PubMed2001

Compliance with guidelines for continuity of care in therapeutics from hospital to community.

OBJECTIVES: To evaluate compliance with the Australian Pharmaceutical Advisory Council's National guidelines to achieve the continuum of quality use of medicines between hospital and community. DESIGN: Descriptive survey, based on questionnaires filled out by general practitioners, of a sample of patients following recent discharge from public hospitals, collated with hospital record reviews for a 20% subsample of the patients. PARTICIPANTS AND SETTING: 357 GPs practising within the postcode boundaries of the South East Sydney Area Health Service were randomly selected to take part in the survey. Of 219 GPs who agreed to participate, 106 completed questionnaires on 203 patients. For a subsample of 38 patients, hospital records were reviewed and compared with the GP survey data. RESULTS: For 52% (105/203) of all patients the GP was not notified of hospital admission. Medication management was documented in the discharge plan for 13% (5/38) of the subsample. Communication in both directions between GP and hospital about medications was recorded for 13% (5/38) of the subsample. Consultation with the GP about the patient's medication during the hospital stay occurred for 11% (22/203) of all patients and 24% (9/38) of the subsample. Ninety-one per cent of patients (185/203) were discharged with sufficient medication to last until they saw their GP. Fewer than 10% of patients received all the information the Guidelines require. For 33% (66/203) of the patients, GPs considered there was at least one barrier (eg, language, cultural) to understanding the medication regimen. CONCLUSIONS: Compliance with the Guidelines is not good at present. Their acceptance may be strengthened by formulating specific target indicators. A minimum indicator would be notifying the GP of three out of four matters: the patient's admission; medications on discharge; medication changes; and follow-up arrangements.

Aftercare↗