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Haloperidol plus promethazine for psychosis‐induced aggression

When people suffer from hallucinations and delusions (psychosis) they can become agitated, scared or aggressive and will not respond very rapidly to other peoples’ reassurance or help. In some circumstances the clinical staff may be too busy to take time to help someone through this. In this situation medication is used to help agitated people relax and become more tranquil or to sleep. In low and middle‐income countries the drugs used to do this cannot be too expensive. This review includes four trials of people who have received the drugs haloperidol (an antipsychotic) in combination with promethazine (an antihistamine) compared to some other medications when they have been aggressive in an emergency situation. These four trials included 1117 individuals in cities in India and Brazil. People were monitored for whether they were tranquil or asleep at twenty minutes to four hours and also for adverse effects and how well they were.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

[Haloperidol plus promethazine for agitated patients - a systematic review]

OBJECTIVE: Rapid and safe tranquillisation is sometimes unavoidable. We conducted this systematic review to determine the value of the combination haloperidol plus promethazine, frequently used in Brazil.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Magnesium sulphate versus lytic cocktail for eclampsia

Magnesium sulphate performs better than lytic cocktail in preventing maternal deaths, further fits, respiratory depression, coma and pneumonia for pregnant women with eclampsia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Non‐opioid drugs for managing pain in labour

Women's experience of pain during labour varies greatly. Some women feel little pain whilst others find the pain extremely distressing.  A woman’s position in labour, mobility, and levels of fear and anxiety or, conversely, confidence may influence her experience of pain. Several drug and non‐drug interventions are available for managing pain during labour. In this review we have assessed the evidence on the effectiveness and safety of non‐opioid drugs in the management of pain in labour. Non‐opioid drugs are used to control mild to moderate pain and include non‐steroidal anti‐inflammatory drugs, paracetamol, antispasmodics, sedatives and antihistamines. In the past, these drugs were used to help reduce women's anxiety and thus aid pain relief. Currently, they are not commonly used for pain relief in labour. However, they may still however be offered during the early stages of labour in some countries.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

[Rapid tranquillisation: review of the literature and recommendations]

BACKGROUND: In The Netherlands, no guidelines exist for rapid tranquillisation in the context of acute agitation, excitement or aggression secondary to a psychiatric disorder.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Interventions for treating severe nausea and vomiting during pregnancy (hyperemesis gravidarum)

Although severe nausea and vomiting in pregnancy (hyperemesis gravidarum) rarely causes death, it is an important cause of ill health with emotional, physical, and economic consequences. Women may need hospital treatment and may not be able to work and it occasionally causes pregnancy complications and adverse outcomes for babies such as low birthweight. Many pharmaceutical, complementary, and alternative therapies are available and the objective of this review was to examine the effectiveness and safety of interventions for hyperemesis gravidarum.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

A Systematic Review of Prevention and Intervention Strategies for Populations at High Risk of Engaging in Violent Behaviour: Update 2002–8

It has been estimated that violence accounts for more than 1.6 million deaths worldwide each year and these fatal assaults represent only a fraction of all assaults that actually occur. The problem has widespread consequences for the individual and for the wider society in physical, psychological, social and economic terms. A wide range of pharmacological, psychosocial and organisational interventions have been developed with the aim of addressing the problem. This review was designed to examine the effectiveness of these interventions when they are developed in mental health and criminal justice populations.

Health Technology Assessment - NIHR Journals Library.

Version: February 2012
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Depression in Adults with a Chronic Physical Health Problem: Treatment and Management

This clinical guideline was commissioned by NICE and developed by the National Collaborating Centre for Mental Health. It sets out clear, evidenceand consensus-based recommendations for healthcare staff on how to treat and manage depression in adults with a chronic physical health problem.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2010
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Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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Drug Class Review: Newer Antiemetics: Final Report Update 1 [Internet]

Nausea and vomiting are major concerns for patients undergoing chemotherapy, radiation therapy and surgery with general anesthesia. Risk factors associated with chemotherapy-induced nausea and vomiting include emetogenicity of the chemotherapy regimen, dose, speed of intravenous infusion, female gender, age under 50 years, history of ethanol consumption, and history of prior chemotherapy. Factors predictive of radiation therapy-induced nausea and vomiting include site of irradiation (in particular, total body irradiation and radiation fields that include the abdomen), total field size, dose per fraction, age, and predisposition for emesis (history of sickness during pregnancy or motion sickness). Female gender, a history of motion sickness or prior postoperative nausea and vomiting, nonsmoking status, and use of postoperative opioids have been suggested as factors predictive of postoperative nausea and vomiting. The objective of this review was to evaluate the comparative effectiveness and harms of newer antiemetic drugs including the 5-HT3 and NK-1 antagonists.

Drug Class Reviews - Oregon Health & Science University.

Version: January 2009
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Sedation in Children and Young People: Sedation for Diagnostic and Therapeutic Procedures in Children and Young People [Internet]

Many children present to hospitals and dental clinics needing effective sedation or anaesthesia for painful or distressing diagnostic or therapeutic procedures. There are many sedation techniques available but there is insufficient guidance on which techniques are effective and what resources are required to deliver them safely. Sedation is not always effective enough and will occasionally require the procedure to be delayed until the child can be anaesthetised perhaps in another healthcare setting or on another day. Consequently sedation failure is both distressing for the child and has major NHS cost implications. Excessive doses of sedation can cause unintended loss of consciousness and dangerous hypoxia. In comparison, planned anaesthesia is effective, but may have resource implications. The need for sedation or anaesthesia will depend upon the type of procedure. Some types of procedures are very common and healthcare providers and practitioners need to understand whether sedation or anaesthesia is the most cost effective method of managing them

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: December 2010
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Use of Antipsychotics and/or Benzodiazepines as Rapid Tranquilization in In-Patients of Mental Facilities and Emergency Departments: A Review of the Clinical Effectiveness and Guidelines [Internet]

Patients with psychotic illnesses may exhibit agitated, threatening, or destructive behaviour that could be dangerous to themselves or others. Researchers have found that as many as 1 in 5 individuals admitted to acute psychiatric units may commit an act of violence while in hospital. Additional research suggests that patients with psychosis who have a history of violence or substance abuse may be at an increased risk of committing violence. To ensure a safe environment, clinical practice guidelines suggest that health care providers first use verbal de-escalation techniques to engage agitated patients. In some cases, however, verbal de-escalation may be ineffective, thereby necessitating the use of alternative management approaches. One such strategy is rapid tranquilization, the aim for which is to use psychotropic medications “to calm/lightly sedate the service user, reduce the risk to self and/or others and achieve an optimal reduction in agitation and aggression.” Ideally, medications for rapid tranquilization should have a rapid onset of action, result in few adverse effects, and have a short duration of action. Empirical evidence suggests that clinicians often prefer to use two major drug classes – benzodiazepines and antipsychotics, either alone or in combination – to manage agitated patients. Intramuscular (IM) injections of these drugs appear attractive as they may offer superior pharmacokinetic properties and more favourable clinical profiles versus their respective oral formulations.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: October 29, 2015
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Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010
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Interventions for preventing reactions to snake antivenom

People die or can be seriously disabled after being bitten by a venomous snake. Different venomous snake species have different effects on the body, but initial treatment is similar ‐ to try and prevent venom entering the general circulation. If it becomes apparent that the venom has reached the bloodstream, the patients start becoming extremely unwell and in these circumstances health staff may give a specific antivenom (made from horse serum). However, antivenom frequently causes adverse effects which can, in themselves, be severe and result in death.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Haloperidol as a means of calming people who are aggressive or agitated due to psychosis

People with psychosis may experience hearing voices (hallucinations) or abnormal thoughts (delusions) which can make the person frightened, distressed and agitated (restless, excitable or irritable). Experiencing such emotions can sometimes result in behaviour that is aggressive or violent. This poses a significant challenge and dilemma for staff. Mental health professionals have to diagnose and give the individual the best available treatment, often quickly, to avert the risk of the persons who are aggressive harming themselves or others.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Medicines in the treatment of emergency department nausea and vomiting

We reviewed the effects of medicines in the treatment of nausea and vomiting in adults in the emergency department.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Violence and Aggression: Short-Term Management in Mental Health, Health and Community Settings: Updated edition

This guideline has been developed to advise on the short-term management of violence and aggression in mental health, health and community settings in adults, children (aged 12 years or under) and young people (aged 13 to 17 years).

NICE Guideline - National Collaborating Centre for Mental Health (UK).

Version: 2015
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Agents that prevent the development of abdominal adhesions following surgery: an overview of Cochrane reviews

Abdominal adhesions are web like structures that commonly form following abdominal or pelvic surgery. They are a result of damage to the lining of the abdomen and can cause multiple conditions such as chronic pelvic pain and infertility. Many types of solid, liquid, gel and pharmacological agents have been developed which, when applied during surgery, supposedly reduce the chance that adhesions will develop. However, there has been considerable disagreement as to which agent is more effective. We aimed to summarise the evidence from Cochrane Reviews regarding anti‐adhesion agents in gynaecological surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Use of fluids and pharmacological agents (medicinal drugs) to prevent the formation of adhesions (scar tissue) after surgery of the female pelvis

Review question: This Cochrane systematic review evaluated all fluid and pharmacological agents that aim to prevent adhesion formation after gynaecological surgery (gels were defined as fluid agents).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Strategies To De-escalate Aggressive Behavior in Psychiatric Patients [Internet]

To compare the effectiveness of strategies to prevent and de-escalate aggressive behaviors in psychiatric patients in acute care settings, including interventions aimed specifically at reducing use of seclusion and restraint.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: July 2016
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