RESUMO
CLINICAL QUESTION: In pediatric populations, is nasal saline irrigation as effective as intranasal corticosteroids at relieving allergic rhinitis symptoms? ANSWER: No. Intranasal steroids are more effective than nasal saline alone to reduce symptoms of allergic rhinitis (AR) in children. Combination therapy further improves symptom reduction. LEVEL OF EVIDENCE FOR THE ANSWER: B SEARCH TERMS: Allergic Rhinitis, Nasal Saline, Nasal corticosteroids, children younger than age 18. DATE SEARCH WAS CONDUCTED: August and September 2014, October 2015. INCLUSION CRITERIA: Meta-analyses, randomized controlled trials, systematic reviews, cohort studies, nasal spray, hypertonic saline solution, nasal lavage, rhinitis, intranasal administration, nasal saline, human, English language. EXCLUSION CRITERIA: Antihistamines, Adults, Articles older than 2008.
Assuntos
Corticosteroides/farmacologia , Lavagem Nasal/métodos , Rinite Alérgica/terapia , Cloreto de Sódio/uso terapêutico , Resultado do Tratamento , Administração Intranasal , Adolescente , Corticosteroides/administração & dosagem , Criança , Terapia Combinada , Humanos , Rinite Alérgica/tratamento farmacológicoRESUMO
This article describes how to perform advance care planning in the outpatient geriatric medicine setting. The article defines advance care planning and discusses components of advance care planning, such as advance directives, do-not-resuscitate orders, and Physician Orders for Life-Sustaining Treatment. The article describes how to document advance care planning discussions in the clinic and bill Medicare and ways for clinicians to improve their skill at leading these conversations.