The association between nonpharmacological interventions and quality of life in children with attention deficit hyperactivity disorder: A systematic review.

BACKGROUND: Attention deficit hyperactivity disorder is a common psychiatric disorder with a worldwide prevalence of about five percent among children and adolescents. This disorder affects most aspects of their lives e.g., academic performance and social relations, and their overall quality of life is reduced compared to healthy peers. The majority of children with ADHD are treated with medication that potentially has an insufficient effect and/or frequently occurring side effects. OBJECTIVES: To enable nurses and other health care professionals to guide children with ADHD and their families in their choices of treatment, based on the best available literature on the association between nonpharmacological interventions and quality of life. DATA SOURCES: A literature search was performed in the databases CENTRAL, Embase, PubMed, CINAHL, and PsycINFO. Seven randomized controlled trials were included in this systematic review. They examined the use of polyunsaturated fatty acids, physical activity, psychoeducation, cognitive therapy, cognitive training, hippotherapy, and behavioral therapy. CONCLUSIONS: The study of behavioral therapy in the form of a sleep intervention detected an improvement in quality of life which was statistically significant compared to the control group. IMPLICATIONS FOR PRACTICE: Children with ADHD and a sleep disorder may gain improvement in their quality of life from a sleep intervention.

Plenty of pills: polypharmacy prevails in patients of a Danish anticoagulant clinic.

PURPOSE: Vitamin K antagonist (VKA) treatment can successfully prevent thromboembolic complications, but the modality has a narrow therapeutic window and numerous interactions with other pharmaceuticals. The aim of the study reported here was to describe the use of co-medications and the prevalence of polypharmacy among patients treated with VKA. METHODS: In a cross-sectional study, 250 consecutive patients (65% male, median age 68 years, most common indication for VKA treatment: atrial fibrillation) in the maintenance phase of VKA treatment were interviewed about their use of prescription medications, over-the-counter drugs and alternative medicines during the last 7 days. RESULTS: The interviewed patients used a median of five medications (range 1-13), including VKA. Approximately 50% of the patients also took alternative medicines. A wide range of conventional and alternative medicines were used, several of which harbour possible interactions with VKA. Polypharmacy was defined as the use of five or more medications, excluding alternative medicines. The group of polypharmacy patients included 53% of the study population. The use of amiodarone, age >50 years, the indication for VKA treatment being atrial fibrillation or mechanical heart valves and diabetes were independent predictors of polypharmacy. CONCLUSIONS: The results of this study highlight that polypharmacy is a common phenomenon among patients on anticoagulant medication, particularly among elderly patients or those suffering from cardiovascular disease or diabetes.