Clinical Guidelines For Assessment Research Articles

The Prevalence and Management of Saliva Problems in Motor Neuron Disease: A 4-Year Analysis of the Scottish Motor Neuron Disease Register

Introduction: Saliva problems are common and distressing for people with motor neuron disease (pwMND). Despite clinical guidelines for assessment and treatment, management of saliva problems has received little research attention. Objective: We aimed to investigate the prevalence of saliva problems in pwMND, their association with clinical factors, and their management practice using a highly curated population-based register for motor neuron disease (MND) with 99% case ascertainment. Methods: We conducted an analysis of pwMND diagnosed between January 2015 and October 2019 using the Scottish MND Register (CARE-MND [Clinical, Audit, Research, and Evaluation of MND]). The association between clinical factors and saliva problems was investigated using univariate and multivariable logistic regression; results are reported as odds ratio (OR) and 95% confidence intervals. A survey of health-care professionals involved in the care of pwMND was performed to contextualize the findings. Results: 939 pwMND were included. Prevalence of saliva problems was 31.3% (294). Bulbar onset (OR 9.46 [4.7, 19.2]; p < 0.001) but not age, sex, time to diagnosis, or MND subtype were independently associated with the presence of saliva problems in multivariable regression, and 52.7% (155) of those with saliva problems received pharmacological management. The most commonly used medications were hyoscine, amitriptyline, carbocisteine, glycopyrrolate, and atropine. Evidence base (8, 72.7%) and local guidelines (10, 90.9%) were cited as the most important factors influencing treatment decision by survey respondents (n = 11). Conclusion: Saliva problems are common and associated with bulbar onset MND. A substantial proportion of pwMND with saliva problems did not receive recommended treatments. Future research is required to determine the relative efficacy of individual pharmacological treatments.

Health Policy in Nepal: An Assessment of Clinical Guidelines in Relation to the Burden of Disease

Background: Clinical guidelines provide health workers with valuable information on how to diagnose and treat patients. In many low-income countries, there appears to be a lack of appropriate clinical guidelines for conditions with high rates of morbidity; Nepal is one such nation. It is useful to examine clinical guidelines in relation to disease burden to establish any gaps which might be addressed through changes in policy and practice.Methods: The research adopted a mixed-methods approach, quantifying disease burden both nationally and in five districts served by PHASE Nepal – an NGO working in health and development – before contrasting this with available clinical guidelines in Nepal. Key informant interviews were subsequently conducted to gain greater insight into disease burden and guideline availability.Results: Of the 10 diseases found to be most burdensome in the PHASE-served districts, 3 lacked any context-specific guidelines. NCDs were found to be prevalent at both district and national level, yet guideline provision for such conditions was minimal. Mental illness was highlighted by interview participants as a growing problem; however, Nepal does not currently have any utilisable clinical guidelines for mental health. Missing data was identified as a significant issue, with lack of mortality data hindering accurate quantification of local and national disease burden.Conclusions: There is evident need for more context-appropriate clinical guidelines in Nepal to effectively diagnose and treat diseases that are most burdensome within communities. Improving health data quality is fundamental to ensuring policy makers are equipped with accurate information from which to develop appropriate protocol.Journal of Manmohan Memorial Institute of Health SciencesVol. 3, No. 1, 2017, page: 24-35

Commentary: Assessing personality disorder in adolescents from the perspective of DSM‐5.

This commentary reviews three articles in the special section on the assessment of personality pathology in adolescents from the perspective of the recently published DSM-5. The articles address general clinical guidelines for assessment, a study on the reliability and validity of an assessment instrument, and a study of informant discrepancies and their clinical relevance. Certain aspects of DSM-5 may facilitate assessment of personality pathology in adolescents, while others may make it more challenging. Because personality pathology has considerable significance with respect to ongoing mental health problems and adverse psychosocial outcomes across areas of future functioning, assessing personality pathology in adolescence should be no less of an imperative than it is in adulthood.

Current evidence on physical therapy in patients with adhesive capsulitis: what are we missing?

Adhesive capsulitis is, in most cases, a self-limiting condition of poorly understood etiology that results in shoulder pain and large mobility deficits. The socio-economic burden will increase as with continuous aging of our population. In addition, both prevalence and incidence figures of adhesive capsulitis are increasing. No literature overview solely focuses on the physiotherapeutic options in patients with adhesive capsulitis and their scientific evidence. Moreover, although some physiotherapeutic interventions show evidence regarding reducing pain or increasing mobility, there is little evidence to suggest that the disease prognosis is affected and this raises the need for new, innovative research in the area of adhesive capsulitis and its treatment. By presenting its current evidence, we hope to retrieve several gaps in the present management of adhesive capsulitis by physiotherapists and provide us with new insights for improving the physiotherapists' policy in treating adhesive capsulitis patients, e.g., continuously increasing nociceptive impulse activity, as in early stages of adhesive capsulitis, could lead to peripheral and subsequently long-lasting central sensitization, as well as to an increased activity of the sympathetic nervous system. But up to now the involvement of central sensitization in adhesive capsulitis has not been studied yet and remains speculative. Finally, when selecting a physical treatment method for adhesive capsulitis, it is extremely important to consider the patient's symptoms, stage of the condition, and recognition of different patterns of motion loss. Guidelines for clinical assessment will be presented in this scoping review.

Guidelines for histopathological specimen examination and diagnostic reporting of primary bone tumours

This review is intended to provide histopathologists with guidelines for clinical assessment, specimen handling and diagnostic reporting of benign and malignant primary bone tumours. Information from radiology, surgical, oncology and other clinical colleagues involved in the diagnosis and treatment of primary bone tumours should be properly assessed before undertaking a structured approach to specimen handling and histological reporting. This ensures that the information needed for planning appropriate treatment of these complex tumours is provided. Consistency in diagnostic evaluation with respect to both terminology and report content facilitates liaison at multidisciplinary bone tumour meetings and collaboration between cancer units and networks, as well as providing a common database for audit of the clinical, radiological and pathological aspects of bone tumours.

Psychiatric Issues in Parkinson's Disease

Psychiatric Issues in Parkinson's Disease

Mothering an Infant: Evidence‐Based Guidelines for Clinical Assessment and Interventions

Mothering an Infant: Evidence‐Based Guidelines for Clinical Assessment and Interventions

Asperger syndrome: an update.

This article provides an overview of the history and clinical features of Asperger syndrome, and considers guidelines for clinical assessment and treatment. A review of issues related to external validity is provided, which points out the limitations of current research, and lists several potentially beneficial areas of investigation into the nosologic status of the condition. It concludes with a discussion of the unequivocal need of individuals with severe social disabilities for comprehensive and adequate educational services and other treatments irrespective of the fact that the validity and the utility of this specific diagnostic concept is far from resolved.

Hyperprolactinemia: guidelines for clinical assessment and pituitary imaging

Background and Significance: The contemporary evaluation of hyperprolactinemia includes assessment of symptomatology, testing for presence of thyroid disease, and imaging of the pituitary gland. However, controversy exists regarding the prevalence of clinical presenting symptoms, incidence of co-existing thyroid disease, and the threshold value for ordering an MRI.

Metabolic complications associated with HIV protease inhibitor therapy.

HIV protease inhibitors were introduced into clinical practice over 7 years ago as an important component of combination antiretroviral drug regimens which in many ways revolutionised the treatment of HIV infection. The significant improvements in prognosis that have resulted from the use of these regimens, combined with the need for lifelong treatment, have increasingly focused attention on the adverse effects of antiretroviral drugs and on the metabolic complications of HIV protease inhibitors in particular. In this review, the cluster of metabolic abnormalities characterised by triglyceride-rich dyslipidaemia and insulin resistance associated with HIV protease inhibitor therapy are considered, along with implications for cardiovascular risk in patients affected by these complications. Toxicity profiles of individual drugs within the HIV protease inhibitor class are examined, as there is an increased recognition of significant intra-class differences both in terms of absolute risk of metabolic complications as well as the particular metabolic phenotype associated with these drugs. Guidelines for clinical assessment and treatment are emphasised, along with pathophysiological mechanisms that may provide a rational basis for the treatment of metabolic complications. Finally, these drug-specific effects are considered within the context of HIV-specific effects on lipid metabolism as well as lifestyle factors that have contributed to a rapidly increasing incidence of similar metabolic syndromes in the general population. These data highlight the importance of individualising patient management in terms of choice of antiretroviral regimen, assessment of metabolic outcomes and use of therapeutic interventions, based on the assessment of baseline (pre-treatment) metabolic status as well as the presence of potentially modifiable cardiovascular risk factors.

Assessment of Clinical Guidelines for Continuation Treatment in Major Depression

Assessment of Clinical Guidelines for Continuation Treatment in Major Depression

Family Therapy in Cases of Interminable Grief for the Loss of a Child

This paper presents a treatment method in cases where grieving for the death of a child extends beyond normal parameters. The symptoms of interminable grief are likely to continue unless there is direct, and often dramatic intervention. Guidelines for clinical assessment are presented, with particular emphasis upon the investigation of family history in which an early, unresolved death may have occurred. This approach integrates grief work with the individual into a family therapy framework and reflects the notion that grieving, even if identified in one person, is a family affair. Criteria for the inclusion of family members in treatment are considered, the stresses upon the therapist are addressed, a course of treatment is outlined, and two representative cases are presented.

MULTI‐LEVEL VULNERABILITY OF ADOLESCENT MARRIAGES: AN ECO‐SYSTEM MODEL FOR CLINICAL ASSESSMENT AND INTERVENTION

This paper utilizes the Transitionally Unintegrated‐Externally Open family system type derived from Wertheim (1973,1975) to address the multiple factors that may enhance or reduce the vulnerability of the adolescent marriage. Facilitating and constraining factors on the development of marital system autonomy and competence are identified at the individual, marital, familial and extra‐familial levels. Guidelines for clinical assessment and intervention are presented.