Interventions for improving modifiable risk factor control in the secondary prevention of stroke.

Abstract:

BACKGROUND:People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Stroke services need to be configured to maximise the adoption of evidence-based strategies for secondary stroke prevention. Smoking-related interventions were examined in a separate review so were not considered in this review. This is an update of our 2014 review. OBJECTIVES:To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. SEARCH METHODS:We searched the Cochrane Stroke Group Trials Register (April 2017), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2017), CENTRAL (the Cochrane Library 2017, issue 3), MEDLINE (1950 to April 2017), Embase (1981 to April 2017) and 10 additional databases including clinical trials registers. We located further studies by searching reference lists of articles and contacting authors of included studies. SELECTION CRITERIA:We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. DATA COLLECTION AND ANALYSIS:Four review authors selected studies for inclusion and independently extracted data. The quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach (GRADEpro GDT).Three review authors assessed the risk of bias for the included studies. We sought missing data from trialists.The results are presented in 'Summary of findings' tables. MAIN RESULTS:The updated review included 16 new studies involving 25,819 participants, resulting in a total of 42 studies including 33,840 participants. We used the Cochrane risk of bias tool and assessed three studies at high risk of bias; the remainder were considered to have a low risk of bias. We included 26 studies that predominantly evaluated organisational interventions and 16 that evaluated educational and behavioural interventions for participants. We pooled results where appropriate, although some clinical and methodological heterogeneity was present.Educational and behavioural interventions showed no clear differences on any of the review outcomes, which include mean systolic and diastolic blood pressure, mean body mass index, achievement of HbA1c target, lipid profile, mean HbA1c level, medication adherence, or recurrent cardiovascular events. There was moderate-quality evidence that organisational interventions resulted in improved blood pressure control, in particular an improvement in achieving target blood pressure (odds ratio (OR) 1.44, 95% confidence interval (CI) 1.09 to1.90; 13 studies; 23,631 participants). However, there were no significant changes in mean systolic blood pressure (mean difference (MD), -1.58 mmHg 95% CI -4.66 to 1.51; 16 studies; 17,490 participants) and mean diastolic blood pressure (MD -0.91 mmHg 95% CI -2.75 to 0.93; 14 studies; 17,178 participants). There were no significant changes in the remaining review outcomes. AUTHORS' CONCLUSIONS:We found that organisational interventions may be associated with an improvement in achieving blood pressure target but we did not find any clear evidence that these interventions improve other modifiable risk factors (lipid profile, HbA1c, medication adherence) or reduce the incidence of recurrent cardiovascular events. Interventions, including patient education alone, did not lead to improvements in modifiable risk factor control or the prevention of recurrent cardiovascular events.

authors

Bridgwood B,Lager KE,Mistri AK,Khunti K,Wilson AD,Modi P

doi

10.1002/14651858.CD009103.pub3

subject

Has Abstract

pub_date

2018-05-07 00:00:00

pages

CD009103

issn

1469-493X

journal_volume

5

pub_type

杂志文章,meta分析,评审
  • Vaginal dilator therapy for women receiving pelvic radiotherapy.

    abstract:BACKGROUND:Vaginal dilation therapy is advocated after pelvic radiotherapy to prevent stenosis (abnormal narrowing of the vagina), but can be uncomfortable and psychologically distressing. OBJECTIVES:To assess the benefits and harms of different types of vaginal dilation methods offered to women treated by pelvic radi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007291.pub3

    authors: Miles T,Johnson N

    更新日期:2014-09-08 00:00:00

  • EEG for children with complex febrile seizures.

    abstract:BACKGROUND:Febrile seizures can be classified as simple or complex. Complex febrile seizures are associated with fever that lasts longer than 15 minutes, occur more than once within 24 hours and are confined to one side of the child's body. It is common in some countries for doctors to recommend an electroencephalograp...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD009196.pub2

    authors: Shah PB,James S,Elayaraja S

    更新日期:2014-01-24 00:00:00

  • Non surgical therapy for anal fissure.

    abstract:BACKGROUND:Because of the disability associated with surgery for anal fissure and the risk of incontinence, medical alternatives for surgery have been sought. Most recently, pharmacologic methods that relax the anal smooth muscle, to accomplish reversibly what occurs in surgery, have been used to obtain fissure healing...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003431.pub2

    authors: Nelson R

    更新日期:2006-10-18 00:00:00

  • Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults.

    abstract:BACKGROUND:Urinary tract infection (UTI) is the most common hospital-acquired infection. The major associated cause is indwelling urethral catheters. Several measures have been introduced to reduce catheter-associated urinary tract infections (CAUTIs). One of these measures is the introduction of specialised urethral c...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004013.pub4

    authors: Lam TB,Omar MI,Fisher E,Gillies K,MacLennan S

    更新日期:2014-09-23 00:00:00

  • Anticoagulation for heart failure in sinus rhythm.

    abstract:BACKGROUND:Patients with chronic heart failure (heart failure) are at risk of thromboembolic events, including stroke, pulmonary embolism and peripheral arterial embolism, whilst coronary ischaemic events also contribute to the progression of heart failure. Long-term oral anticoagulation is established in certain group...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003336

    authors: Lip GY,Gibbs CR

    更新日期:2001-01-01 00:00:00

  • Mesh fixation with glue versus suture for chronic pain and recurrence in Lichtenstein inguinal hernioplasty.

    abstract:BACKGROUND:Chronic pain following mesh-based inguinal hernia repair is frequently reported, and has a significant impact on quality of life. Whether mesh fixation with glue can reduce chronic pain without increasing the recurrence rate is still controversial. OBJECTIVES:To determine whether tissue adhesives can reduce...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD010814.pub2

    authors: Sun P,Cheng X,Deng S,Hu Q,Sun Y,Zheng Q

    更新日期:2017-02-07 00:00:00

  • Print-based self-help interventions for smoking cessation.

    abstract:BACKGROUND:Many smokers give up smoking on their own, but materials that provide a structured programme for smokers to follow may increase the number who quit successfully. OBJECTIVES:The aims of this review were to determine the effectiveness of different forms of print-based self-help materials that provide a struct...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD001118.pub4

    authors: Livingstone-Banks J,Ordóñez-Mena JM,Hartmann-Boyce J

    更新日期:2019-01-09 00:00:00

  • Exercise for preventing and treating osteoporosis in postmenopausal women.

    abstract:BACKGROUND:Osteoporosis is a condition resulting in an increased risk of skeletal fractures due to a reduction in the density of bone tissue. Treatment of osteoporosis typically involves the use of pharmacological agents. In general it is thought that disuse (prolonged periods of inactivity) and unloading of the skelet...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD000333.pub2

    authors: Howe TE,Shea B,Dawson LJ,Downie F,Murray A,Ross C,Harbour RT,Caldwell LM,Creed G

    更新日期:2011-07-06 00:00:00

  • Support surfaces for treating pressure ulcers.

    abstract:BACKGROUND:Pressure ulcers are treated by reducing pressure on the areas of damaged skin. Special support surfaces (including beds, mattresses and cushions) designed to redistribute pressure, are widely used as treatments. The relative effects of different support surfaces are unclear. OBJECTIVES:To assess the effects...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD009490

    authors: McInnes E,Dumville JC,Jammali-Blasi A,Bell-Syer SE

    更新日期:2011-12-07 00:00:00

  • Prostaglandins for preventing postpartum haemorrhage.

    abstract:BACKGROUND:Prostaglandins have mainly been used for postpartum haemorrhage (PPH) when other measures fail. Misoprostol, a new and inexpensive prostaglandin E1 analogue, has been suggested as an alternative for routine management of the third stage of labour. OBJECTIVES:To assess the effects of prophylactic prostagland...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD000494.pub3

    authors: Gülmezoglu AM,Forna F,Villar J,Hofmeyr GJ

    更新日期:2007-07-18 00:00:00

  • Methotrexate for maintenance of remission in Crohn's disease.

    abstract:BACKGROUND:Safe and effective long-term treatments that reduce the need for corticosteroids are needed for Crohn's disease. Although purine antimetabolites are moderately effective for maintenance of remission patients often relapse despite treatment with these agents. Methotrexate may provide a safe and effective alte...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006884.pub2

    authors: Patel V,Macdonald JK,McDonald JW,Chande N

    更新日期:2009-10-07 00:00:00

  • Opioid antagonists with minimal sedation for opioid withdrawal.

    abstract:BACKGROUND:Managed withdrawal is a necessary step prior to drug-free treatment or as the end point of long-term substitution treatment. OBJECTIVES:To assess the effectiveness of opioid antagonists in combination with minimal sedation to manage opioid withdrawal. SEARCH STRATEGY:We searched the Cochrane Central Regist...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002021.pub3

    authors: Gowing L,Ali R,White JM

    更新日期:2009-10-07 00:00:00

  • Antiviral agents for treatment of herpes simplex virus infection in neonates.

    abstract:BACKGROUND:Herpes simplex virus (HSV) is a rare but serious neonatal pathogen. Prior to the availability of antiviral drugs the mortality associated with all but localised neonatal infection was high, with 85% of infants with disseminated HSV infection and 50% of infants with encephalitis dying by one year of age. The ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004206.pub2

    authors: Jones CA,Walker KS,Badawi N

    更新日期:2009-07-08 00:00:00

  • Decompressive surgery for treating nerve damage in leprosy.

    abstract:BACKGROUND:Leprosy causes nerve damage which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage, although the effect is uncertain. OBJECTIVES:To assess the effects of decompressive surgery on nerve damage in leprosy. SEARCH STRATEGY:We searched the Cochrane...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006983.pub2

    authors: Van Veen NH,Schreuders TA,Theuvenet WJ,Agrawal A,Richardus JH

    更新日期:2009-01-21 00:00:00

  • Low molecular weight heparins versus unfractionated heparin for acute coronary syndromes.

    abstract:BACKGROUND:Acute coronary syndromes (ACS) are an important source of morbidity and mortality. Despite weak evidence for the use of unfractionated heparin (UFH) for acute coronary syndromes it is considered an accepted treatment for unstable angina and non-ST segment elevation myocardial infarction (MI). However, eviden...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002132

    authors: Magee KD,Sevcik W,Moher D,Rowe BH

    更新日期:2003-01-01 00:00:00

  • Voxel-based morphometry for separation of schizophrenia from other types of psychosis in first episode psychosis.

    abstract:BACKGROUND:Schizophrenia is a psychiatric disorder which involves distortions in thought and perception, blunted affect, and behavioural disturbances. The longer psychosis goes unnoticed and untreated, the more severe the repercussions for relapse and recovery. There is some evidence that early intervention services ca...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD011021.pub2

    authors: Palaniyappan L,Maayan N,Bergman H,Davenport C,Adams CE,Soares-Weiser K

    更新日期:2015-08-07 00:00:00

  • Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension.

    abstract:BACKGROUND:Hypertension is a modifiable cardiovascular risk factor. Although it is established that low-dose thiazides reduce mortality as well as cardiovascular morbidity, the dose-related effect of thiazides in decreasing blood pressure has not been subject to a rigorous systematic review. It is not known whether ind...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003824.pub2

    authors: Musini VM,Nazer M,Bassett K,Wright JM

    更新日期:2014-05-29 00:00:00

  • Immunosuppressive treatment for focal segmental glomerulosclerosis in adults.

    abstract:BACKGROUND:Corticosteroids remain the mainstay of treatment in idiopathic nephrotic syndrome, including focal and segmental glomerulosclerosis (FSGS). However, only about 20% of patients with FSGS experience a partial or complete remission of nephrotic syndrome despite treatment. OBJECTIVES:To assess the effects of di...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003233.pub2

    authors: Braun N,Schmutzler F,Lange C,Perna A,Remuzzi G,Risler T,Willis NS

    更新日期:2008-07-16 00:00:00

  • Hypertonic versus near isotonic crystalloid for fluid resuscitation in critically ill patients.

    abstract:BACKGROUND:Hypertonic solutions are considered to have a greater ability to expand blood volume and thus elevate blood pressure and can be administered as a small volume infusion over a short time period. On the other hand, the use of hypertonic solutions for volume replacement may also have important disadvantages. O...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002045.pub2

    authors: Bunn F,Roberts I,Tasker R,Akpa E

    更新日期:2004-01-01 00:00:00

  • Motor control exercise for acute non-specific low back pain.

    abstract:BACKGROUND:Motor control exercise (MCE) is used by healthcare professionals worldwide as a common treatment for low back pain (LBP). However, the effectiveness of this intervention for acute LBP remains unclear. OBJECTIVES:To evaluate the effectiveness of MCE for patients with acute non-specific LBP. SEARCH METHODS:W...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD012085

    authors: Macedo LG,Saragiotto BT,Yamato TP,Costa LO,Menezes Costa LC,Ostelo RW,Maher CG

    更新日期:2016-02-10 00:00:00

  • Medical interventions for primary open angle glaucoma and ocular hypertension.

    abstract:BACKGROUND:Primary open angle glaucoma (POAG) is a progressive optic neuropathy with an elevated intraocular pressure (IOP), where the optic nerve head becomes pathologically excavated and the visual field (VF) is characteristically altered. Ocular hypertension (OHT) is a condition with elevated IOP but without discern...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003167.pub3

    authors: Vass C,Hirn C,Sycha T,Findl O,Bauer P,Schmetterer L

    更新日期:2007-10-17 00:00:00

  • Chemotherapy as an adjunct to radiotherapy in locally advanced nasopharyngeal carcinoma.

    abstract:BACKGROUND:A previous meta-analysis investigated the role of chemotherapy in head and neck locally advanced carcinoma. This work had not been performed on nasopharyngeal carcinoma. OBJECTIVES:The aim of the project was to study the effect of adding chemotherapy to radiotherapy on overall survival (OS) and event-free s...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004329.pub2

    authors: Baujat B,Audry H,Bourhis J,Chan AT,Onat H,Chua DT,Kwong DL,Al-Sarraf M,Chi KH,Hareyama M,Leung SF,Thephamongkhol K,Pignon JP,MAC-NPC Collaborative Group.

    更新日期:2006-10-18 00:00:00

  • Vaccines for preventing malaria (pre-erythrocytic).

    abstract:BACKGROUND:Vaccines against all stages of the malaria parasite are in development, mainly for Plasmodium falciparum, which causes the most serious form of malaria. Pre-erythrocytic vaccines act to prevent or delay a malaria attack by attacking the sporozoite and liver stages before the parasite reaches the bloodstream....

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006198

    authors: Graves P,Gelband H

    更新日期:2006-10-18 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

  • Early erythropoiesis-stimulating agents in preterm or low birth weight infants.

    abstract:BACKGROUND:Preterm infants have low plasma levels of erythropoietin (EPO), providing a rationale for the use of erythropoiesis-stimulating agents (ESAs) to prevent or treat anaemia and to provide neuro protection and protection against necrotising enterocolitis (NEC). Darbepoetin (Darbe) and EPO are currently available...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD004863.pub6

    authors: Ohlsson A,Aher SM

    更新日期:2020-02-11 00:00:00

  • Respiratory muscle training for cervical spinal cord injury.

    abstract:BACKGROUND:Cervical spinal cord injury (SCI) severely comprises respiratory function due to paralysis and impairment of the respiratory muscles. Various types of respiratory muscle training (RMT) to improve respiratory function for people with cervical SCI have been described in the literature. A systematic review of t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD008507.pub2

    authors: Berlowitz DJ,Tamplin J

    更新日期:2013-07-23 00:00:00

  • Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases.

    abstract:BACKGROUND:Animal and physiological research as well as observational studies suggest that antioxidant supplements may improve survival. OBJECTIVES:To assess the effect of antioxidant supplements on mortality in primary or secondary prevention randomised clinical trials. SEARCH STRATEGY:We searched The Cochrane Libra...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007176

    authors: Bjelakovic G,Nikolova D,Gluud LL,Simonetti RG,Gluud C

    更新日期:2008-04-16 00:00:00

  • Sensory stimulation for brain injured individuals in coma or vegetative state.

    abstract:BACKGROUND:Coma and vegetative state follow traumatic brain injury in about one out of eight patients, and in patients with non traumatic injury the prognosis is worse. The use of sensory stimulation for coma and vegetative state has gained popularity during the 1980's but beliefs and opinions about its effectiveness v...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001427

    authors: Lombardi F,Taricco M,De Tanti A,Telaro E,Liberati A

    更新日期:2002-01-01 00:00:00

  • Cognitive-behavioural therapy (CBT) interventions for young people aged 10 to 18 with harmful sexual behaviour.

    abstract:BACKGROUND:Around 1 in 1000 adolescents aged 12 to 17 years old display problematic or harmful sexual behaviour (HSB). Examples include behaviours occurring more frequently than would be considered developmentally appropriate; accompanied by coercion; involving children of different ages or stages of development; or as...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD009829.pub2

    authors: Sneddon H,Gojkovic Grimshaw D,Livingstone N,Macdonald G

    更新日期:2020-06-22 00:00:00

  • Effectiveness of intermediate care in nursing-led in-patient units.

    abstract:BACKGROUND:The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in order to manage more successfully the transition between hospital and home for patients with extended recovery times. OBJECTIVES:To determine whether nursing-led inpatient units are effective in preparing patient...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002214.pub2

    authors: Griffiths PD,Edwards MH,Forbes A,Harris RL,Ritchie G

    更新日期:2004-10-18 00:00:00