This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for neonatal life support includes evidence from 7 systematic reviews, 3 scoping reviews, and 12 evidence updates. The Neonatal Life Support Task Force generally determined by consensus the type of evidence evaluation to perform; the topics for the evidence updates followed consultation with International Liaison Committee on Resuscitation member resuscitation councils. The 2020 CoSTRs for neonatal life support are published either as new statements or, if appropriate, reiterations of existing statements when the task force found they remained valid. Evidence review topics of particular interest include the use of suction in the presence of both clear and meconium-stained amniotic fluid, sustained inflations for initiation of positive-pressure ventilation, initial oxygen concentrations for initiation of resuscitation in both preterm and term infants, use of epinephrine (adrenaline) when ventilation and compressions fail to stabilize the newborn infant, appropriate routes of drug delivery during resuscitation, and consideration of when it is appropriate to redirect resuscitation efforts after significant efforts have failed. All sections of the Neonatal Resuscitation Algorithm are addressed, from preparation through to postresuscitation care. This document now forms the basis for ongoing evidence evaluation and reevaluation, which will be triggered as further evidence is published. Over 140 million babies are born annually worldwide ( https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100 ). If up to 5% receive positive-pressure ventilation, this evidence evaluation is relevant to more than 7 million newborn infants every year. However, in terms of early care of the newborn infant, some of the topics addressed are relevant to every single baby born.
AimThere is an urgent need for effective geriatric interventions to meet the health service demands of the growing older population. In this paper, we systematically review and update existing literature on interventions within emergency departments (ED) targeted towards reducing ED re‐visits, hospitalizations, nursing home admissions and deaths in older patients after initial ED discharge.Methods Databases Medline, CINAHL, Embase and Web of Science were searched to identify all articles published up to June 2012 that focused on older adults in the ED, included a comparison group, and reported quantitative results in four primary outcomes: ED re‐visits, hospitalizations, nursing home admissions and death after initial ED discharge.ResultsOf the 2826 titles screened, just nine studies met our inclusion criteria. The studies varied in their design and outcome measurements such that results could not be combined. Two trends surfaced: (i) more intensive interventions more frequently resulted in reduced adverse outcomes than did simple referral intervention types; and (ii) among the lowest intensity, referral‐based interventions, studies that used a validated prediction tool to identify high‐risk patients more frequently reported improved outcomes than those that did not use such a tool.ConclusionOf the few studies that met the inclusion criteria, there was a lack of consistency and clarity in study designs and evaluative outcomes. Despite this, more intensive interventions that followed patients beyond a referral and the use of a clinical risk prediction tool appeared to be associated with improved outcomes. The dearth of rigorous evaluations with standardized methodologies precludes further recommendations. Geriatr Gerontol Int 2015; 15: 1107–1117.
Clozapine is superior to other antipsychotics as a therapy for treatment-resistant schizophrenia and schizoaffective disorder with increased risk of suicidal behavior. This drug has also been used in the off-label treatment of bipolar disorder, major depressive disorder (MDD), and Parkinson’s disease (PD). Although usually reserved for severe and treatment-refractory cases, it is interesting that electroconvulsive therapy (ECT) has also been used in the treatment of these psychiatric disorders, suggesting some common or related mechanisms. A literature review on the applications of clozapine and electroconvulsive therapy (ECT) to the disorders mentioned above was undertaken, and this narrative review was prepared. Although both treatments have multiple actions, evidence to date suggests that the ability to elicit epileptiform activity and alter EEG activity, to increase neuroplasticity and elevate brain levels of neurotrophic factors, to affect imbalances in the relationship between glutamate and γ-aminobutyric acid (GABA), and to reduce inflammation through effects on neuron–glia interactions are common underlying mechanisms of these two treatments. This evidence may explain why clozapine is effective in a range of neuropsychiatric disorders. Future increased investigations into epigenetic and connectomic changes produced by clozapine and ECT should provide valuable information about these two treatments and the disorders they are used to treat.
OBJECTIVE: Behavioral and psychological symptoms of dementia (BPSD) are a heterogeneous constellation of non-cognitive symptoms and behaviours that can cause significant patient distress and present complex management challenges. Behavioural and pharmacological treatments are used to decrease the symptoms, preserve function and increase quality of life. In the treatment of individuals with a major neurocognitive disorder, non-pharmacological interventions are often preferred as first-line treatment over pharmacological interventions, which often have modest efficacy, notable side effects and significant risks. Multisensory stimulation (MSS) interventions have become increasingly popular in the treatment of BPSD, particularly with disease progression. The objective of this review paper is to provide a brief overview of the types of MSS interventions currently used in the treatment of major neurocognitive disorders. METHODS: Searches for papers published in this area were conducted using PubMed and the Web of Science Core Collection. The searches were done for the period covering the past 20 years, and key phrases used were "multisensory stimulation for treatment of BPSD," "multisensory stimulation for treatment of major cognitive disorders," "multisensory stimulation for treatment of dementia" and "multisensory stimulation for treatment of neurodegenerative disorders." RESULTS: Multisensory environments, multisensory tools and multisensory group therapies are discussed. There is growing support for the use of MSS interventions to improve mood, behaviour and quality of life in seniors with dementia and BPSD. However, currently the utilization of these interventions is highly variable and strong evidence for their use is limited. CONCLUSION: MSS interventions in the form of multisensory environments, tools and group therapies present tremendous potential as first-line treatments or as adjuncts to pharmacological interventions in the treatment of major neurocognitive disorders. However, the body of quality evidence that currently exists is limited. A lack of evidence does not necessarily mean a lack of efficacy, and there is a pressing need for studies with improved power and study design to determine the effectiveness of specific MSS interventions and to ascertain for whom they may be most beneficial. ARTICLE HISTORY
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