In-hospital care pathways for stroke.

Abstract:

BACKGROUND:Care within a stroke unit reduces death or dependency after stroke. However, studies have found significant variations in clinical practice, access to stroke unit care, organisation of patient care, and clinical outcome. Stroke care pathways have been introduced as a method to promote organised and efficient patient care that is based on best evidence and guidelines. OBJECTIVES:We aimed to assess the effects of care pathways, as compared to standard medical care, among patients with acute stroke who had been admitted to hospital. SEARCH STRATEGY:We searched the Cochrane Stroke Group Specialised Trials Register (last searched in May 2001), the Cochrane Controlled Trials Register (Issue 4, 2000), MEDLINE (1975-2000), EMBASE (1980-2000), CINAHL (1982-2000), the Index to Scientific and Technical Proceedings (ISTP, May 2001), and HealthSTAR (May 2001). We also handsearched the Journal of Managed Care (1997 to 1998), which was later renamed the Journal of Integrated Care (1998 to 2001). Reference lists of articles were searched. SELECTION CRITERIA:We considered randomised controlled trials and non-randomised studies (quasi-randomised trials, comparative studies, controlled and uncontrolled before and after studies, and interrupted time series) that compared care pathway care with standard medical care. DATA COLLECTION AND ANALYSIS:One reviewer selected studies for inclusion and the other independently checked the decisions. Two reviewers independently assessed the methodological quality of the studies. One reviewer extracted the data and the other checked the extracted data. Data from randomised and non-randomised studies were analysed separately. We found significant statistical heterogeneity in the analysis of two outcomes (computed tomography brain scanning and duration of stay). MAIN RESULTS:There were three randomised controlled trials (total of 340 patients) and seven non-randomised studies (total of 1673 patients) that compared care pathway care with standard medical care. We found no difference between care pathway and control groups in terms of death, dependency, or discharge destination. Evidence from mainly non-randomised studies suggests that patients managed using a care pathway may be: a) less likely to suffer a urinary tract infection (OR 0.38, CI 0.18 to 0.79), b) less likely to be readmitted (OR 0.11, CI 0.03 to 0.39), and c) more likely to have a computed tomography brain scan (OR 3.66, CI 1.45 to 9.27) or carotid duplex study (OR 2.45, CI 1.3 to 4.61). Evidence from randomised trials suggests that patient satisfaction and quality of life may be significantly lower in the care pathway group (P=0.02 and P<0.005 respectively). REVIEWER'S CONCLUSIONS:The use of care pathways to manage stroke patients in hospital may be associated with both positive and negative effects on the process of care and clinical outcomes. Since most of the results have been derived from non-randomised studies, they are likely to be influenced by potential biases and confounding factors. There is currently insufficient supporting evidence to justify routine implementation of care pathways for acute stroke management or stroke rehabilitation.

authors

Kwan J,Sandercock P

doi

10.1002/14651858.CD002924

keywords:

subject

Has Abstract

pub_date

2002-01-01 00:00:00

pages

CD002924

issue

2

issn

1469-493X

pii

CD002924

pub_type

杂志文章,评审
  • Different intensities of glycaemic control for pregnant women with pre-existing diabetes.

    abstract:BACKGROUND:The optimal glycaemic control target in pregnant women with pre-existing diabetes is unclear, although there is a clear link between high glucose concentrations and adverse birth outcomes. OBJECTIVES:To assess the effects of different intensities of glycaemic control in pregnant women with pre-existing type...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD008540.pub2

    authors: Middleton P,Crowther CA,Simmonds L,Muller P

    更新日期:2010-09-08 00:00:00

  • Dietary interventions (plant sterols, stanols, omega-3 fatty acids, soy protein and dietary fibers) for familial hypercholesterolaemia.

    abstract:BACKGROUND:A cholesterol-lowering diet and several other dietary interventions have been suggested as a management approach either independently or as an adjuvant to drug therapy in children and adults with familial hypercholesterolaemia (FH). However, a consensus has yet to be reached on the most appropriate dietary t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001918.pub3

    authors: Malhotra A,Shafiq N,Arora A,Singh M,Kumar R,Malhotra S

    更新日期:2014-06-10 00:00:00

  • T-tube drainage versus primary closure after open common bile duct exploration.

    abstract:BACKGROUND:Between 5% and 11% of people undergoing cholecystectomy have common bile duct stones. Stones may be removed at the time of cholecystectomy by opening and clearing the common bile duct. The optimal technique is unclear. OBJECTIVES:The aim is to assess the benefits and harms of T-tube drainage versus primary ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005640.pub3

    authors: Gurusamy KS,Koti R,Davidson BR

    更新日期:2013-06-21 00:00:00

  • Families and Schools Together (FAST) for improving outcomes for children and their families.

    abstract:BACKGROUND:Parents and carers have a major influence on children's learning and development from birth, through the school years, and into adulthood. Parental contributions to education include providing a secure environment in which to learn, providing intellectual stimulation, transmitting social norms and values, sh...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD012760.pub2

    authors: Valentine JC,Leach SM,Fowler AP,Stojda DK,Macdonald G

    更新日期:2019-07-31 00:00:00

  • Endovascular stents for intermittent claudication.

    abstract:BACKGROUND:Endovascular stents have been suggested as a means to improve the patency of arteries after angioplasty in patients with intermittent claudication. This is an update of a Cochrane review published in 2002. OBJECTIVES:The null hypothesis to be tested by this review is that for individuals with claudication t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003228.pub2

    authors: Bachoo P,Thorpe PA,Maxwell H,Welch K

    更新日期:2010-01-20 00:00:00

  • Antibiotic prophylaxis for hernia repair.

    abstract:BACKGROUND:The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area. OBJECTIVES:The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in electi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003769

    authors: Sanchez-Manuel FJ,Seco-Gil JL

    更新日期:2003-01-01 00:00:00

  • Propofol for procedural sedation/anaesthesia in neonates.

    abstract:BACKGROUND:Elective medical or surgical procedures are commonplace for neonates admitted to NICU. Agents such as opioids are commonly used for achieving sedation/analgesia/anaesthesia for such procedures; however, these agents are associated with adverse effects. Propofol is used widely in paediatric and adult populati...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007248.pub2

    authors: Shah PS,Shah VS

    更新日期:2011-03-16 00:00:00

  • Epidermal growth factor receptor (EGFR) inhibitors for metastatic colorectal cancer.

    abstract:BACKGROUND:Epidermal growth factor receptor (EGFR) inhibitors prevent cell growth and have shown benefit in the treatment of metastatic colorectal cancer, whether used as single agents or in combination with chemotherapy. Clear benefit has been shown in trials of EGFR monoclonal antibodies (EGFR MAb) but not EGFR tyros...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007047.pub2

    authors: Chan DLH,Segelov E,Wong RS,Smith A,Herbertson RA,Li BT,Tebbutt N,Price T,Pavlakis N

    更新日期:2017-06-27 00:00:00

  • Organised inpatient (stroke unit) care for stroke.

    abstract:BACKGROUND:Organised stroke unit care is provided by multidisciplinary teams that exclusively manage stroke patients in a dedicated ward (stroke ward), with a mobile team (stroke team) or within a generic disability service (a mixed rehabilitation ward). OBJECTIVES:The objective of this review was to assess the effect...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000197

    authors: Stroke Unit Trialists' Collaboration.

    更新日期:2002-01-01 00:00:00

  • Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction.

    abstract:BACKGROUND:Malignant gastric outlet obstruction is the clinical and pathological consequence of cancerous disease causing a mechanical obstruction to gastric emptying. It usually occurs when malignancy is at an advanced stage; therefore, people have a limited life expectancy. It is of paramount importance to restore or...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD012506.pub2

    authors: Upchurch E,Ragusa M,Cirocchi R

    更新日期:2018-05-30 00:00:00

  • Riluzole for amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND).

    abstract:BACKGROUND:Riluzole has been approved for treatment of patients with amyotrophic lateral sclerosis in most countries. Questions persist about its clinical utility because of high cost and modest efficacy. OBJECTIVES:To examine the efficacy of riluzole in prolonging survival, and in delaying the use of surrogates (trac...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001447.pub2

    authors: Miller RG,Mitchell JD,Lyon M,Moore DH

    更新日期:2007-01-24 00:00:00

  • Fetal electrocardiogram (ECG) for fetal monitoring during labour.

    abstract:BACKGROUND:Hypoxaemia during labour can alter the shape of the fetal electrocardiogram (ECG) waveform, notably the relation of the PR to RR intervals, and elevation or depression of the ST segment. Technical systems have therefore been developed to monitor the fetal ECG during labour as an adjunct to continuous electro...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD000116.pub4

    authors: Neilson JP

    更新日期:2013-05-31 00:00:00

  • Video calls for reducing social isolation and loneliness in older people: a rapid review.

    abstract:BACKGROUND:The current COVID-19 pandemic has been identified as a possible trigger for increases in loneliness and social isolation among older people due to the restrictions on movement that many countries have put in place. Loneliness and social isolation are consistently identified as risk factors for poor mental an...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD013632

    authors: Noone C,McSharry J,Smalle M,Burns A,Dwan K,Devane D,Morrissey EC

    更新日期:2020-05-21 00:00:00

  • Breastfeeding or nipple stimulation for reducing postpartum haemorrhage in the third stage of labour.

    abstract:BACKGROUND:Oxytocin and prostaglandin are hormones responsible for uterine contraction during the third stage of labour. Receptors in the uterine muscles are stimulated by exogenous or endogenous oxytocin leading to uterine contractions. Nipple stimulation or breastfeeding are stimuli that can lead to the secretion of ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD010845.pub2

    authors: Abedi P,Jahanfar S,Namvar F,Lee J

    更新日期:2016-01-27 00:00:00

  • Chlorpromazine versus placebo for schizophrenia.

    abstract:BACKGROUND:Chlorpromazine, formulated in the 1950s, remains a benchmark treatment for people with schizophrenia. OBJECTIVES:To evaluate the effects of chlorpromazine for schizophrenia in comparison with placebo. SEARCH STRATEGY:We updated previous searches of the Cochrane Schizophrenia Group Register (October 1999), ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD000284.pub2

    authors: Adams CE,Awad G,Rathbone J,Thornley B

    更新日期:2007-04-18 00:00:00

  • Hepatitis B immunisation in persons not previously exposed to hepatitis B or with unknown exposure status.

    abstract:BACKGROUND:The benefits and harms of hepatitis B vaccination in persons not previously exposed to hepatitis B infection or with unknown exposure status have not been established. OBJECTIVES:To assess the benefits and harms of hepatitis B vaccination in people not previously exposed to hepatitis B infection or with unk...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006481.pub2

    authors: Mathew JL,El Dib R,Mathew PJ,Boxall EH,Brok J

    更新日期:2008-07-16 00:00:00

  • Physical rehabilitation approaches for the recovery of function and mobility following stroke.

    abstract:BACKGROUND:Various approaches to physical rehabilitation may be used after stroke, and considerable controversy and debate surround the effectiveness of relative approaches. Some physiotherapists base their treatments on a single approach; others use a mixture of components from several different approaches. OBJECTIVE...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001920.pub3

    authors: Pollock A,Baer G,Campbell P,Choo PL,Forster A,Morris J,Pomeroy VM,Langhorne P

    更新日期:2014-04-22 00:00:00

  • Hormonal therapy in advanced or recurrent endometrial cancer.

    abstract:BACKGROUND:Endometrial cancer is a cancer of the lining of the womb and worldwide is the seventh most common cancer in women. Treatment with hormones is thought to be beneficial in patients with endometrial cancer. OBJECTIVES:To assess the indications, effectiveness and safety of hormone therapy for advanced or recurr...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007926.pub2

    authors: Kokka F,Brockbank E,Oram D,Gallagher C,Bryant A

    更新日期:2010-12-08 00:00:00

  • Milnacipran for neuropathic pain and fibromyalgia in adults.

    abstract:BACKGROUND:Milnacipran is a serotonin-norepinephrine reuptake inhibitor (SNRI) that is sometimes used to treat chronic neuropathic pain and fibromyalgia. OBJECTIVES:To evaluate the analgesic efficacy and adverse effects of milnacipran in the management of chronic neuropathic pain or fibromyalgia. SEARCH METHODS:We se...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD008244.pub2

    authors: Derry S,Gill D,Phillips T,Moore RA

    更新日期:2012-03-14 00:00:00

  • Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft.

    abstract:BACKGROUND:Following coronary artery bypass graft (CABG), the main causes of postoperative morbidity and mortality are postoperative pulmonary complications, respiratory dysfunction and arterial hypoxemia. Incentive spirometry is a treatment technique that uses a mechanical device (an incentive spirometer) to reduce su...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004466.pub2

    authors: Freitas ER,Soares BG,Cardoso JR,Atallah AN

    更新日期:2007-07-18 00:00:00

  • Short term urinary catheter policies following urogenital surgery in adults.

    abstract:BACKGROUND:Urinary catheterisation (by the urethral or suprapubic routes) is common following urogenital surgery. There is no consensus on how to minimize complications and practice varies. OBJECTIVES:To establish the optimal way to manage urinary catheters following urogenital surgery in adults. SEARCH STRATEGY:We s...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004374.pub2

    authors: Phipps S,Lim YN,McClinton S,Barry C,Rane A,N'Dow J

    更新日期:2006-04-19 00:00:00

  • Zonisamide add-on therapy for focal epilepsy.

    abstract:BACKGROUND:The majority of people with epilepsy have a good prognosis, and their seizures can be well controlled with the use of a single antiepileptic agent, but up to 30% develop refractory epilepsy, especially those with focal seizures. In this review, we summarised the evidence from randomised controlled trials (RC...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD001416.pub4

    authors: Brigo F,Lattanzi S,Igwe SC,Behzadifar M,Bragazzi NL

    更新日期:2018-10-18 00:00:00

  • Selenium for preventing cancer.

    abstract:BACKGROUND:This review is an update of the first Cochrane publication on selenium for preventing cancer (Dennert 2011).Selenium is a metalloid with both nutritional and toxicological properties. Higher selenium exposure and selenium supplements have been suggested to protect against several types of cancers. OBJECTIVE...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005195.pub3

    authors: Vinceti M,Dennert G,Crespi CM,Zwahlen M,Brinkman M,Zeegers MP,Horneber M,D'Amico R,Del Giovane C

    更新日期:2014-03-30 00:00:00

  • Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis.

    abstract:BACKGROUND:Oral 5-aminosalicylic (5-ASA) preparations were intended to avoid the adverse effects of sulfasalazine (SASP) while maintaining its therapeutic benefits. Previously, it was found that 5-ASA drugs were more effective than placebo but had a statistically significant therapeutic inferiority relative to SASP. Th...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD000544.pub3

    authors: Feagan BG,Macdonald JK

    更新日期:2012-10-17 00:00:00

  • Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury.

    abstract:BACKGROUND:High intracranial pressure (ICP) is the most frequent cause of death and disability after severe traumatic brain injury (TBI). It is usually treated with general maneuvers (normothermia, sedation, etc.) and a set of first-line therapeutic measures (moderate hypocapnia, mannitol, etc.). When these measures fa...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD003983.pub3

    authors: Sahuquillo J,Dennis JA

    更新日期:2019-12-31 00:00:00

  • Antenatal perineal massage for reducing perineal trauma.

    abstract:BACKGROUND:Perineal trauma following vaginal birth can be associated with significant short- and long-term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the incidence of perineal trauma. OBJECTIVES:To assess the effect of antenatal perineal massage on the incidence of perineal tra...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005123.pub2

    authors: Beckmann MM,Garrett AJ

    更新日期:2006-01-25 00:00:00

  • Cell salvage for minimising perioperative allogeneic blood transfusion.

    abstract:BACKGROUND:Concerns regarding the safety of transfused blood, have prompted reconsideration of the use of allogeneic (blood from an unrelated donor) red blood cell (RBC) transfusion, and a range of techniques to minimise transfusion requirements. OBJECTIVES:To examine the evidence for the efficacy of cell salvage in r...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001888

    authors: Carless PA,Henry DA,Moxey AJ,O'Connell DL,Fergusson DA

    更新日期:2003-01-01 00:00:00

  • Inhaled steroids for acute asthma following emergency department discharge.

    abstract:BACKGROUND:Patients with acute asthma treated in the emergency department (ED) are frequently treated with inhaled beta(2)-agonists and systemic corticosteroids after discharge. The use of inhaled corticosteroids (ICS) following discharge may also be beneficial in improving patient outcomes after acute asthma. OBJECTI...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002316.pub2

    authors: Edmonds ML,Milan SJ,Brenner BE,Camargo CA Jr,Rowe BH

    更新日期:2012-12-12 00:00:00

  • Maintenance immunosuppression for adults undergoing liver transplantation: a network meta-analysis.

    abstract:BACKGROUND:As part of liver transplantation, immunosuppression (suppressing the host immunity) is given to prevent graft rejections resulting from the immune response of the body against transplanted organ or tissues from a different person whose tissue antigens are not compatible with those of the recipient. The optim...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD011639.pub2

    authors: Rodríguez-Perálvarez M,Guerrero-Misas M,Thorburn D,Davidson BR,Tsochatzis E,Gurusamy KS

    更新日期:2017-03-31 00:00:00

  • Nonsteroidal anti-inflammatory drugs for assisted reproductive technology.

    abstract:BACKGROUND:Despite substantial improvements in the success of treatments through assisted reproduction technologies (ART), live birth rates remain constantly low, and practitioners are seeking aetiologic treatments to improve the outcomes.Local inflammatory response is believed to contribute to implantation failure, wh...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007618.pub2

    authors: Nyachieo A,Siristatidis CS,Vaidakis D

    更新日期:2019-10-19 00:00:00