Background: The novel coronavirus pandemic calls for a rapid adaptation of conventional medical practices to meet the evolving needs of such vulnerable patients. People with coronavirus disease (COVID-19) may frequently require treatment with psychotropic medications, but are at the same time at higher risk for safety issues because of the complex underlying medical condition and the potential interaction with medical treatments. Methods: In order to produce evidence-based practical recommendations on the optimal management of psychotropic medications in people with COVID-19, an international, multidisciplinary working group was established. The methodology of the WHO Rapid Advice Guidelines in the context of a public health emergency and the principles of the AGREE statement were followed. Available evidence informing on the risk of respiratory, cardiovascular, infective, hemostatic, and consciousness alterations related to the use of psychotropic medications, and drug-drug interactions between psychotropic and medical treatments used in people with COVID-19, was reviewed and discussed by the working group. Results: All classes of psychotropic medications showed potentially relevant safety risks for people with COVID-19. A set of practical recommendations was drawn in order to inform frontline clinicians on the assessment of the anticipated risk of psychotropic-related unfavorable events, and the possible actions to take in order to effectively manage this risk, such as when it is appropriate to avoid, withdraw, switch, or adjust the dose of the medication. Conclusions: The present evidence-based recommendations will improve the quality of psychiatric care in people with COVID-19, allowing an appropriate management of the medical condition without worsening the psychiatric condition and vice versa.
Aims To consider the views, understanding and training needs of members of a multidisciplinary team (MDT) around 24-hour postural care. These MDT members refer individuals with profound and multiple learning disabilities (PMLD) and postural care needs to a 24-hour postural care service. Methods This study used a mixed-methods approach, which was undertaken in two phases. The setting for this study was a community healthcare NHS trust in England, which refers patients to physiotherapy for PMLD. Phase 1 involved 57 members of the MDT including: psychologists, psychiatrists, community nurses, health facilitation nurses, speech and language therapists, and occupational therapists. Phase 2 involved a purposive sample of 14 MDT members across three profession-specific focus groups. Findings Phase 1 identified that around 50% of all MDT members refer to the 24-hour postural care service; the majority (75.4%) of these participants identified that they would be happy to receive more training on 24-hour postural care. Phase 2 suggested that while referrals were being made, MDT members were not able to identify why individuals should be referred to the 24-hour postural care service. Conclusions This study has revealed that MDT members working in a community trust within learning disability services were lacking an awareness of why individuals should be referred to 24-hour postural care. This study discusses the implications of this finding.
Aims: The purpose of this research is to help health-care professionals (HCPs) consider how hope is promoted and challenged during the rehabilitation of patients who have had a stroke or spinal cord injury (SCI). Background: Stroke and SCI are two chronic neurological conditions that require significant neurological rehabilitation. During the process of neurological rehabilitation, several internal, external or environmental factors can influence a patient's hope. While research has identified the importance of hope, it has not explicitly identified which factors influence patients' hope. Neither has existing research provided an evidence-based understanding of how health professionals can use strategies to help maintain patients' feelings of hope during rehabilitation. Methods: A qualitative narrative review was undertaken. Following a systematic search, 17 qualitative articles were identified that met the inclusion criteria. Thematic analysis was used to enable information to emerge regarding the strategies that promote hope and the factors that challenge hope. Results: The results included five hope-generating factors and four factors that challenged hope. Conclusions: This article identified several factors that influenced the hope of patients who have had a stroke or SCI. Hope is influenced by personal, social and situational factors, and many of these factors can have both positive and negative effects. Therefore, HCPs need to understand how to implement these ideas effectively. The current findings consider this.
Background Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. Methods Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. Results Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P < 0.05). There was high certainty of evidence that CGA reduces nursing home admission (risk ratio [RR] = 0.86; 95% confidence interval [CI]: 0.75–0.89), risk of falls (RR = 0.51; 95%CI: 0.29–0.89), and pressure sores (RR = 0.46; 95%CI: 0.24–0.89) in hospital medical setting; decreases the risk of delirium (OR = 0.71; 95%CI: 0.54–0.92) in hip fracture; decreases the risk of physical frailty in community-dwelling older adults (RR = 0.77; 95%CI: 0.64–0.93). Systematic reviews without meta-analysis indicate that CGA improves clinical outcomes in oncology, haematology, and in emergency department. Conclusions CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.