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A disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by feelings of giddiness, or wooziness, or having a sensation of movement, spinning, or floating.

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Study found that supporting self-management is inseparable from the high-quality care for long-term conditions. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care.

Health Services and Delivery Research - NIHR Journals Library.

Version: December 2014

People with vestibular problems often experience dizziness and trouble with vision, balance or mobility. The vestibular disorders that are called unilateral and peripheral (UPVD) are those that affect one side of the vestibular system (unilateral) and only the portion of the system that is outside of the brain (peripheral ‐ part of the inner ear). Examples of these disorders include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, labyrinthitis, one‐sided Ménière's disease or vestibular problems following surgical procedures such as labyrinthectomy or removal of an acoustic neuroma. Vestibular rehabilitation for these disorders is becoming increasingly used and involves various movement‐based regimes. Components of vestibular rehabilitation may involve learning to bring on the symptoms to 'desensitise' the vestibular system, learning to co‐ordinate eye and head movements, improving balance and walking skills, and learning about the condition and how to cope or become more active.

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

Version: 2015

Several immunotherapies have been used to treat MS, but their relative effectiveness is unclear due to the limited number of direct comparison studies. The authors of this review tried to assess the efficacy and the extent of adverse events of immunotherapies commonly used in people with MS. Eleven agents were studied, interferon ß‐1b (IFNß‐1b) (Betaseron), IFNß‐1a (Rebif and Avonex), glatiramer acetate, natalizumab, mitoxantrone, methotrexate, cyclophosphamide, azathioprine, immunoglobulins, and long‐term corticosteroids.

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

Version: 2013

Sepsis is a clinical syndrome caused by the body's immune and coagulation systems being switched on by an infection. Sepsis with shock is a life-threatening condition that is characterised by low blood pressure despite adequate fluid replacement, and organ dysfunction or failure. Sepsis is an important cause of death in people of all ages. Both a UK Parliamentary and Health Service Ombudsman enquiry (2013) and UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD, 2015) have recently highlighted sepsis as being a leading cause of avoidable death that kills more people than breast, bowel and prostate cancer combined.

NICE Guideline - National Guideline Centre (UK).

Version: July 2016

The primary audience for this guideline is health professionals who are responsible for developing national and local health protocols and policies, as well as managers of maternal and child health programmes and policy-makers in all settings. The guideline will also be useful to those directly providing care to pregnant women, including obstetricians, midwives, nurses and general practitioners. The information in this guideline will be useful for developing job aids and tools for both pre- and inservice training of health workers to enhance their delivery of care to prevent and treat maternal peripartum infections.

World Health Organization.

Version: 2015

Drug treatments are the primary treatment for bipolar disorder. Alone, however, they are not sufficient to manage the disorder. Studies on psychosocial interventions for mental disorders such as schizophrenia and anxiety show that they are effective treatments. Reports in the literature suggest that they may be useful for people with bipolar disorder as well. The role of the family is important in the care of people with bipolar disorder, with effective family functioning helping to maintain a person's psychological balance. This systematic review investigated the effectiveness of any psychosocial family intervention for people with bipolar disorder and/or their families and carers. Seven randomised controlled trials (393 participants) were included in the review, all of which evaluated psychoeducational interventions. Five studies compared family interventions against no treatment, and three studies compared one type or delivery of family intervention against another family intervention. Differences in the interventions, outcome measures and end points used in the trials did not allow us to perform a meta‐analysis. Whilst results from individual studies did not suggest a significant effect for family interventions when added to drug therapy, the studies provide insufficient evidence to draw conclusions which can be generalised to everyday practice. Further research using appropriate randomised controlled trial methodology and evaluating family interventions other than psychoeducation is called for in this under‐researched and important topic.

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

Version: 2009

The emergence and spread of MDR‐TB, caused by strains of Mycobacterium tuberculosis resistant to at least the common drugs used for TB (isoniazid and rifampicin), is a threat to people worldwide. Treatment of latent tuberculosis (infection without active disease) has been a key component in tuberculosis control for several decades. However, MDR‐TB is spreading and people are dying. This review of evidence found no randomized controlled trials that have assessed the effectiveness of treatments of latent tuberculosis infection in people exposed to MDR‐TB. Currently the balance of benefits and harms associated with treatment for latent tuberculosis infection in people exposed to MDR‐TB is far from clear. Drug treatments should only be offered within the context of a well‐designed randomized controlled trial, or where people are given the details of the current evidence on benefits or harms, along with the uncertainties.

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

Version: 2009

The aim of this review was to assess the clinical and cost-effectiveness of parent training programmes for the treatment of children up to the age of 18 years, with conduct disorder (CD).

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2005

People with chronic kidney disease (CKD) develop impaired excretion of the dietary phosphorus. This results in a condition known as mineral and bone disorder in chronic kidney disease (CKD‐MBD). CKD‐MBD is characterized by high bone turnover, increased musculoskeletal morbidity including bone pain and muscle weakness, and vascular calcification which may contribute to the high incidence of cardiovascular disease and associated deaths. Several agents such as phosphate binders, vitamin D compounds, and calcimimetics are widely used to slow the development and progression of CKD‐MBD complications.

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

Version: 2011

Raising a child with ADHD is not easy. Family life is often dominated by conflicts and sometimes there is additional pressure from other people too. Teachers, friends, family members or other parents often assume that the child’s behavior is a result of the wrong kind of parenting. But many parents of children with ADHD gradually develop strategies to help them cope better in everyday life.Raising a child with ADHD can be very challenging. It demands a lot of attention from parents. The child’s behavior often leads to tension within the family or trouble at school. Children with ADHD are abnormally impulsive and restless. They don’t follow rules or instructions and are sometimes aggressive. So it is perfectly normal for parents to sometimes feel helpless, annoyed or even furious, as well as worrying about their child. But it is important to remember that the child is not behaving that way on purpose and that their behavior has nothing to do with their character.Over time, many families come up with strategies to help them cope with everyday situations. There are various strategies to help plan the day and avoid surprises, or to at least be ready for them. Some parents are reluctant to lay down clear rules because they don’t want to be too authoritarian or strict. But the aim of these strategies is to help create an environment in which the child can cope better.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 9, 2015

Ménière's disease is characterised by three major symptoms: rotational dizziness (vertigo), hearing loss and ringing in the ears (tinnitus), sometimes accompanied by aural fullness. Intratympanic gentamicin is a relatively new therapy with promising results. Gentamicin is an antibiotic which damages the inner ear and the balance organ when it is applied behind the ear drum. This treatment may decrease the spells of vertigo in Ménière's disease. In this review we assess the effectiveness of this kind of treatment for Ménière's disease. Two randomised controlled trials, including a total of 50 patients, were identified which fulfilled the review inclusion criteria. Both of these found a beneficial effect of intratympanic gentamicin therapy for Ménière's disease, although the size of the effect differed between the two trials. Based on these findings, we conclude that intratympanic gentamicin may be an effective treatment for vertigo complaints in Ménière's disease, but it carries a risk of increasing hearing loss. Further research is needed to clarify the effect of intratympanic gentamicin on vertigo in Ménière's disease and the risk of inducing or increasing hearing loss.

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

Version: 2011

This 'umbrella' meta‐analysis assesses dopamine agonists as a drug class in early Parkinson's disease. Twenty‐nine eligible trials, involving 5247 participants, were identified. It confirms reports from individual trials that motor complications are reduced with dopamine agonists compared to levodopa, but also demonstrates that other important side‐effects are increased and symptom control is poorer with agonists. Unfortunately, the balance of risks and benefits remains unclear highlighting the need for further studies assessing patient‐rated overall quality of life and economic measures as their primary outcomes.

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

Version: 2009

This guideline has been developed to advise on the treatment and management of bipolar disorder. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, patients and guideline methodologists after careful consideration of the best available evidence. It is intended that the guidelines will be useful to clinicians and service commissioners in providing and planning high quality care for those with bipolar disorder while also emphasising the importance of the experience of care for patients and carers.

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

Version: 2006

Parkinson's disease is a disabling condition of the brain characterized by slowness of movement, shaking, stiffness, and in the later stages, loss of balance. Many of these symptoms are due to the loss of certain nerves in the brain, which results in the lack of a chemical called dopamine. Current treatments for Parkinson's are designed to increase dopamine by using levodopa (Sinemet or Madopar), which is converted in the brain into dopamine, or drugs that mimic dopamine (dopamine agonists). Although useful, these treatments do not slow the progression of the disease and can be associated with side‐effects e.g. after a while levodopa use can cause involuntary movements (dyskinesia), painful leg cramps (dystonia) and a shortened response to each dose (motor fluctuations). Monoamine oxidase B (MAO‐B) inhibitors such as selegiline (Eldepryl or Selgene) boost the levels of dopamine by a different mechanism, which may reduce the risk of these complications and slow disease progression. We reviewed 11 controlled trials with a total of 2514 patients that compared giving MAO‐B inhibitors with not giving them in people with early Parkinson's to see if it was safe and effective. The results show that, although MAO‐B inhibitors do improve symptoms of Parkinson's and delay the need for levodopa by a few months, they are too weak to have a major effect and do not seem to delay the progression of the condition. They may, however, reduce motor fluctuations although more information is needed to be certain of this. Although they can cause some side‐effects, these are generally mild.

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

Version: 2011

Critical incidents are events where individuals witness or experience tragedy, death, serious injuries, or threatening situations, which may have strong emotional impact. Emergency service workers and law enforcement workers are often affected by critical incident stress (CIS), which may or may not develop a post-traumatic stress disorders (PTSD) after a critical incident or traumatic event. The signs and symptoms of CIS can be physical (e.g., fatigue, headache, dizziness), cognitive (e.g., confusion, nightmares, poor attention and concentration), emotional (e.g., fear, guilt, anger, depression, chronic anxiety) and behavioral (e.g., restlessness, withdrawal, increased alcohol consumption). Tools for the management of CIS include demobilization, crisis management briefings, defusing, and debriefing.

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

Version: April 27, 2015

The mainstay of generalized anxiety disorder (GAD) treatment involves pharmacologic treatment but can also consist of psychological treatment (i.e. cognitive behavioural therapy). First-line pharmacological treatment involves either the selective serotonin reuptake inhibitors (SSRIs) or the selective norepinephrine/noradrenaline reuptake inhibitors (SNRIs). While these are the most effective treatments, they can produce adverse events and they also have a slower onset of action, during which there may be an increase in anxiety. Benzodiazepines (BZDs) are a class of drug that is presumed to indirectly promote gamma-amino butyric acid (GABA) activity and rapidly control the core symptoms associated with GAD. They have been historically effective when used in the short-term treatment of GAD but have to be used with caution due to their adverse effect profile such as drowsiness, falls, confusion, impairment of memory, and incoordination (which can be particularly problematic in the elderly), their tendency for dependence, and potential for substance abuse. For these reasons and to determine their appropriate use, this report will review the evidence for the short- and long-term use of BZDs for the treatment of GAD.

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

Version: July 28, 2014

Mindfulness is an integrative, mind-body based approach that helps people change the way they think and feel about their experiences. It is a way of paying attention to the present moment by using meditation, breathing techniques, and yoga. Mindfulness involves consciously bringing awareness to thoughts and feelings, without making judgments , allowing the individual to become less enmeshed and better able to manage them. The objective of this review is to summarize the clinical effectiveness and guidelines for the use of mindfulness interventions for the treatment of post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), depression, and substance use disorders in adults.

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

Version: June 19, 2015

The main treatment for coronary artery disease (CAD) is medication. But you can also do a number of other things to keep your heart as healthy as possible – for instance, try to stop smoking if you smoke, get enough exercise, and lose weight if you're overweight.The main thing that people can do to prevent complications of CAD is lead a healthy lifestyle. There's a whole load of advice out there about how to do this. But lifestyle changes can often be difficult to make and stick to, particularly if there are no obvious immediate improvements. Support from other people can be helpful, for instance if your whole family changes their diet as well, or if you do sports together with friends.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 27, 2017

The guideline on Borderline Personality Disorder, commissioned by NICE and developed by the National Collaborating Centre for Mental Health, sets out clear, evidence- and consensus-based recommendations for healthcare staff on how to treat and manage borderline personality disorder.

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

Version: 2009

Steroid preventer medications given by inhaler ('inhaled steroids') help to reduce inflammation in the air passages of people with asthma. However, it is uncertain whether these medications are beneficial in people with chronic obstructive pulmonary disease (COPD, i.e. chronic bronchitis or emphysema or both).

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

Version: 2016

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