Opioid-induced constipation is debilitating and very common. They are compounds of the family which includes synthetic, natural, and semi-synthetic agents. Opioids act a significant role in the chronic and acute pain management due to their mediated analgesic characteristics (Argoff, et al. 2015). In most countries including the U.S., its prescriptions are annually dispensed majorly for noncancerous pains including ailments. A response can be judged as inadequate in a case where opioid-induced constipation displays symptoms of at least moderate in one of the four sign types that include hard stools, false alarm, incomplete bowel movement and straining when under dedication of one laxative dose four days in the last two weeks.
The purpose of the article is to investigate or conduct a study on the safety and efficiency of nafoxadol, a peripherally, oral acting opioid receptor used for the treatment of opioid-induced constipation. It is further intended to develop a strategy of describing nadoxolol effectiveness for OIC treatment in the chronic noncancerous patients (Argoff, et al. 2015). Guidelines are responsible for translating evidence into better practices, hence a properly crafted guideline will promote and encourage quality by decreasing variations in healthcare, and improving the accuracy of diagnostics thus promoting efficient therapy.
Scope and Purpose
The goal of the document majorly is to give the clinicians and other health practitioners recommendations based on better pieces of evidence which are presented; informing the practitioner when the evidence is absent thus aiding in better health care delivery. The clinical act guideline on Naloxegol For Treating Opioid-Induced Constipation is intended to enlighten professionals, parents, and others with recommendations, which are scientific based and available for intervention and assessment for patients with this constipation disorder (Lyman, et al. 2015). Families and practitioners are advised to apply the guide information’s care provision. The decisions in adopting a recommendation are made concisely by the family and the practitioners in relation to the resources, which are available, and the presented circumstances by those involved.
The guide describes practices and principles, which have in past produced evidence-based and quality-driven guidelines by application of transparent and efficient techniques for actions recommended in multidisciplinary applications. The major purpose of the guideline is to provide standardized recommendations based on scientific literature to encourage the use interventions to reduce complications in use Naloxegol for treating opioid-induced constipation and to offer recommendations to improve or avoid adverse events during use of the drug by providing safety. The document generally gives the foundation of effective practice guidelines including better recommendations.
The clinical guideline is all about making relevant recommendations to a larger number of patients, administrators, and practitioners. There exist various chances of involving a stakeholder in the development process of this guideline on Naloxegol For Treating Opioid-Induced Constipation. The involvements are key especially in topic selection, prerelease critique, and determination of the scope, panel development, and other important activities involved. The stakeholders involved in the development of this guideline include caregivers and the patients, healthcare professionals, managers, private and public funding agencies, and even the manufacturers (Rosenfeld, et al. 2016). They are required particularly in the evidence limitations, ownership, substantial implications of a policy, and in the principles of democracy and transparency. The stakeholders have parts to contribute at the various events in the guideline development, however, their involvement is sometimes complex.
The target population includes the adults who had opioid-induced constipation and had fails to respond to laxatives, and it was not stated as to whether the community was consulted in regards to the study and creation of this guideline. I believe that a conflict of interest in the production of this guidance would be a lack of involvement of health care personnel and other key stakeholders, which might be considered as a negative connotation of having to share an adverse event that had occurred during one of their procedures. Stakeholder involvement should be adequately resourced, equitable, and all-inclusive.
It includes methodology of the search, criteria of evidence selection, and the techniques to of formulating recommendations, including the benefits and risks of the assessment. The guideline has not mentioned the search strategy database and the exclusion of the system of evaluating the evidence quality or in grading the recommendation strengths. The comparator studies contained an insufficient detail concerning the necessary steps and that least details were availed for comparison studies, but no details were given for the baseline characteristics that include opioid dose, pain intensity, history of laxative use, among others (Lyman, et al. 2015). It is not clear whether this type of data was included in the study and because of its absence, there is no opportunity to assess the similarity of the studies included in mixed treatment comparison. Updates have been mentioned, however, the procedure required in updating the CPG has not been given. There was no preview of the guideline before the publication and the absence of pilot testing evidence in the guideline. These shortcomings make it impossible to carry out further analysis basing on the baseline characteristics.
The target population includes adults who had opioid-induced constipation fails to respond to laxatives, and it was not stated as to whether the community was consulted in regards to the study and creation of this guideline. Naloxegol or sometimes called Moving is recommended as an alternative for opioid-induced constipation that has an inadequate response to laxatives. Adult patients with opioid-induced constipation and doctors think that Naloxegol is the best treatment should have treatment on the NHS. The drug should be on the shelves upon issuance of the guidelines. Naloxegol was recommended because it works better and costs than the alternative for available treatment of NHS. Assess cost-effectiveness and effectiveness of Naloxegol as used in treating OIC whenever it persists after use of natural laxatives. The searches were conducted on all databases as stipulated by NICE. The searches were done for the original documents and their subsequent updates. There was additional information for the searches and the techniques used including clinical studies and conference proceedings.
The guideline has evaluated the issues, which are pertinent to the implementation of the guideline. It has considered the barriers and facilitators to its application and the resource implications that can be applied to the recommendations considered and the guidelines present in auditing and monitoring criteria. The poor reporting lowers the applicability of the guideline since the listed concerns have not been supported by proper documentation. The conflict of statement is discouraged in the development of the document despite the wide acceptance in the policy journals.
The domains aim to address whether there are conflicts of interest in the guideline development. The guideline has not indicated whether or not the development process, the developers received funds. When the funding was given, there are no indications on the views in the case that the funding body influenced the guideline contents. The clinical practice guideline is not editorially independent and it seems that there were no prior reviews before the publication.
The clinical practice guidelines are statements and descriptions including recommendations that are intended for patient care optimization and are informed by a special review of evidence and at depth the harms and benefits assessment including options of an alternative care (Rosenfeld et al. 2016). The intention of the CPG is to give the clinicians explicit recommendations towards managing the health condition presented as OIC and to aid in reducing harmful, ineffective, and unnecessary interventions. The potential and effectiveness of the CPG are dependent on the rigor quality in the guideline process development (Rosenfeld et al. 2016).
The clinical practice guide is a clinician and the patient tool to making major decisions, hence the use of an appraisal instrument which has been standardized in assessing the quality of the document is significant. Naloxegol or sometimes-called Moving is recommended as an alternative for opioid-induced constipation that has an inadequate response to laxatives. Adult patients with opioid-induced constipation and doctors think that Naloxegol is the best treatment should have treatment on the NHS (Webster, et al. 2014). The drug should be on the shelves upon issuance of the guidelines. Naloxegol was recommended because it works better and costs than the alternative for available treatment of NHS.
The oral combination of oxycodone and naloxone are known to alleviate severe pain and help in the prevention of OIC as a result of extensive metabolism, orally administered naloxone have less than 2% availability which is low. Oral dosage of naloxone, therefore, binds to in relevant concentrations at to peripheral opioid receptors in the gastrointestinal tract. This inhibits oxycodone from modulating gastrointestinal function, in turn, limiting the risk on OIC. There is the need for a thorough research to eliminate the effects of combining these drugs (Webster, et al. 2014). The potential cost of not following the guidelines ends up being an increase in monetary cost to the hospital, health insurance, and patient. We also need to remember that this guideline is and aid for decision-making and doesn’t replace a clinician’s clinical judgment
Argoff, C. E., Brennan, M. J., Camilleri, M., Davies, A., Rudin, J., Galluzzi, K. E., ... & Webster, L. R. (2015). Consensus Recommendations on Initiating Prescription Therapies for OpioidInduced Constipation. Pain Medicine,16(12), 2324-2337. http://onlinelibrary.wiley.com/doi/10.1111/pme.12937/full
Lyman, G. H., Bohlke, K., Khorana, A. A., Kuderer, N. M., Lee, A. Y., Arcelus, J. I., ... & Gates, L. E. (2015). Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update 2014. Journal of Clinical Oncology, 33(6), 654-656. http://ascopubs.org/doi/abs/10.1200/JCO.2014.59.7351
Rosenfeld, R. M., Shin, J. J., Schwartz, S. R., Coggins, R., Gagnon, L., Hackell, J. M., Hoelting, D., ... Corrigan, M. D. (2016). Clinical Practice Guideline. Otolaryngology - Head and Neck Surgery (united States), 154.
Webster, L., Chey, W. D., Tack, J., Lappalainen, J., Diva, U., & Sostek, M. (2014). Randomized clinical trial: the longterm safety and tolerability of nadoxolol in patients with pain and opioidinduced constipation. Alimentary pharmacology & therapeutics, 40(7), 771-779. http://onlinelibrary.wiley.com/doi/10.1111/apt.12899/full
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