Evidence-based treatment

Sandborn WJ. Evidence based treatment algorithm for mild to moderate Crohn s disease. Am J Gastroenterol 2003 98( 12 Suppl) Sl-S5. 

Benzodiazepines are the evidence-based treatment of choice for uncomplicated alcohol withdrawal.17 Barbiturates are not recommended because of their low therapeutic index due to respiratory depression. Some of the anticonvulsants have also been used to treat uncomplicated withdrawal (particularly car-bamazepine and sodium valproate). Although anticonvulsants provide an alternative to benzodiazepines, they are not as well studied and are less commonly used. The most commonly employed benzodiazepines are chlordiazepoxide, diazepam, lorazepam, and oxazepam. They differ in three major ways (1) their pharmacokinetic properties, (2) the available routes for their administration, and (3) the rapidity of their onset of action due to the rate of gastrointestinal absorption and rate of crossing the blood-brain barrier. 

Evidence-Based Treatment Recommendations for Cardiopulmonary Resuscitation... 

Evidence-based treatment principles for complicated intraabdominal infections are given in Table 42-6. 

An important overall approach for treatment of sepsis is goal-directed therapy. Mortality can be reduced by early placement and use of a central venous catheter, increased fluid volume administration, dobutamine therapy if needed, and red blood cell transfusion, to achieve specific physiologic goals in the first 6 hours. Evidence-based treatment recommendations for sepsis and septic shock from the Surviving Sepsis campaign are presented in Table 45-3. 

Sandborn WJ et al Medical management of mild to moderate Crohn s disease Evidence-based treatment algorithms for induction and maintenance of remission. Aliment Pharmacol Ther 2007 26 987. [PMID 17877506]... 

While the results of this trail were negative, it is nonetheless noteworthy, not only for providing comprehensive data indicating that melatonin is inappropriate for managing sleep disorders in AD patients, but also as an exemplar of exactly the type of trails that are necessary if efficacious evidence-based treatments are to be developed. 

WHO (2005b) Mayo report on addressing the worldwide tobacco epidemic through effective, evidence-based treatment. Geneva, World Health Organization (http // www.who.int/tobacco/resources/publications/mayo/en/index1.html). 

In 2005, the pharmaceutically oriented Journal of the American Academy of Child and Adolescent Psychiatry published guidelines for the diagnosis and treatment of bipolar disorder (Kowatch et al., 2005). Martha Hel-lander, a coauthor of the guidelines, declared, These kids suffer so badly, and deserve to have evidence-based treatment as early in life as possible. Many respond quickly to mood stabilizing medication. ... 

I Evidence-Based Treatment Recommendations I for Sepsis and Septic Shock... 

Advising against the purchase of an old-fashioned medicine and guiding towards a better, evidence-based treatment. For example liquid paraffin is not considered to be the best treatment for constipation. Lactulose is the preferred treatment nowadays. 

It is important to remember that EBM applies to a range of providers at a variety of levels. Thus, it should be used to support decision making by all healthcare providers, not just medical clinicians. It is for this reason that the term Evidence-Based Practice (EBP) is increasingly used. Pharmacy, nursing, physiotherapy, and all other professions allied to medicine should, where possible, be providing evidence-based treatment at an individual and service level. For example, evidence can support decisions about whether to treat stroke patients in a dedicated stroke unit or as part of a general ward. ... 

It is important to screen patients for co-occurring mental disorders, and their presence may become more apparent during the stabilization or maintenance phases of schizophrenia treatment. Examples include substance abuse disorders, depression, obsessive-compulsive disorder, and panic disorder. As co-occurring disorders will limit symptom and functional improvement and increase the risk of relapse, it is critical that they be appropriately treated. Pharmacological and nonpharmacological interventions specific for the co-occurring disorder should be implemented in combination with evidence-based treatment for schizophrenia. 

There are many approaches, and evidence-based treatment manuals are available. 

The development of non-medical prescribing, from recognition of need to widespread availability, took several years. In Baroness Julia Cumberlege s report. Neighbourhood Nursing (Department of Health and Social Security, 1986), she noted that patient care was often complicated by the nurse s inability, following a full assessment, to prescribe the evidence-based treatment for the GP to follow-up. 

Evidence-based treatment guidelines recommend Lidoderm patch and Pregabalin as first lines of treatment for neuropathic pain associated with PHN. 

Haanpaa M. Controlled release oxycodone—an evidence-based treatment for pain in acute herpes zoster. Pain 2009 142(3) 175-6. 

Local Inproving Access to Psychological Therapies (lAPT) services may suffice, but Denise may need secondary care input - discuss with the team psychologist. Evidence-based treatments include ... 

Beyond opiates, alcohol, GBL and benzodiazepines, there aren t any evidence-based treatments for withdrawal. It may help Chrissie to know what to expect, e.g. 

The large gap between efficacy and effectiveness research has resulted in a new consensus regarding the need for research that will inform practice (National Institute of Mental Health, 1999 Weisz, 2000). Epidemiological studies indicate that fewer than 20% of children who need mental health care actually receive any services (Goodman et al., 1997). Earlier studies indicated that of those children who did receive services, fewer than 50% received the appropriate service relative to their need (Kazdin, 1996). These realities have led to two important movements in child mental health services efforts to increase the effectiveness of services principally by advocating evidence-based treatments (Hibbs Jensen, 1997 Weisz, 2000) and calls for alternative models for mental health services (Bums, 1999 National Institute of Mental Health, 1999). 

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