30 research outputs found
Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008
SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Vitamin C and the common cold: a retrospective analysis of Chalmers’ review.
In 1975 Thomas Chalmers analyzed the possible effect of vitamin C on the common cold by calculating the average difference in the duration of cold episodes in vitamin C and control groups in seven placebo-controlled studies. He found that episodes were 0.11 +/- 0.24 (SE) days shorter in the vitamin C groups and concluded that there was no valid evidence to indicate that vitamin C is beneficial in the treatment of the common cold. Chalmers' review has been extensively cited in scientific articles and monographs. However, other reviewers have concluded that vitamin C significantly alleviates the symptoms of the common cold. A careful analysis of Chalmers' review reveals serious shortcomings. For example, Chalmers did not consider the amount of vitamin C used in the studies and included in his meta-analysis was a study in which only 0.025-0.05 g/day of vitamin C was administered to the test subjects. For some studies Chalmers used values that are inconsistent with the original published results. Using data from the same studies, we calculated that vitamin C (1-6 g/day) decreased the duration of the cold episodes by 0.93 +/- 0.22 (SE) days; the relative decrease in the episode duration was 21%. The current notion that vitamin C has no effect on the common cold seems to be based in large part on a faulty review written two decades ago
Treating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development
Objectives—To review the current evidence base for treating episodes of delirium in palliative
care settings and propose a framework for future development.
Methods—We combined multidisciplinary input from delirium researchers and other purposely
selected stakeholders at an international delirium study planning meeting. This was supplemented
by a literature search of multiple databases and relevant reference lists to identify studies
regarding therapeutic interventions for delirium.
Results—The context of delirium management in palliative care is highly variable. The standard
management of a delirium episode includes the investigation of precipitating and aggravating
factors followed by symptomatic treatment with drug therapy. However, the intensity of this
management depends on illness trajectory and goals of care in addition to the local availability of
both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol
remains the practice standard by consensus for symptomatic control. Dosing schedules are derived
from expert opinion and various clinical practice guidelines as evidence-based data from palliative
care settings are limited. The commonly used pharmacologic interventions for delirium in this
population warrant evaluation in clinical trials to examine dosing and titration regimens, different
routes of administration, and safety and efficacy compared with placebo.
Conclusion—Delirium treatment is multidimensional and includes the identification of
precipitating and aggravating factors. For symptomatic management, haloperidol remains the
practice standard. Further high-quality collaborative research investigating the appropriate
treatment of this complex syndrome is needed