Systematic review of rehabilitation programmes initiated within 90 days of a transient ischaemic attack or 'minor' stroke: a protocol.

Introduction Transient ischaemic attacks (TIAs) and strokes are highly prevalent conditions. Stroke killed 5.7 million people worldwide in 2005 and is estimated to cause 6.5 million deaths globally in 2015. Stroke survivors are often left with considerable disability. Many strokes are preceded by a TIA/‘minor’ stroke in the previous 90 days and therefore the immediate period after a TIA/minor’ stroke is a crucial time to intervene to tackle known vascular risk factors. Although rehabilitation following a TIA/minor stroke is widely recommended, there is a paucity of research that offers an evidence base on which the development or optimisation of interventions can be based, particularly for home-based approaches and non-pharmacological interventions in the acute period following the initial TIA/‘minor’ stroke. This systematic review will investigate the effect of rehabilitation programmes initiated within 90 days of the diagnosis of a TIA or ‘minor’ stroke aimed at reducing the subsequent risk of stroke. Methods/design This systematic review will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses(PRISMA) guidance. Randomised and quasi-randomised controlled trials of rehabilitation programmes initiated within 90 days of a TIA or ‘minor’ stroke will be included. Articles will be identified through a comprehensive search of the following databases, guided by a medical librarian: the Cochrane Library, Web of Science, MEDLINE, Embase, CINAHL and PsycINFO. Two review authors will independently screen articles retrieved from the search for eligibility and extract relevant data on methodological issues. A narrative synthesis will be completed when there is insufficient data to permit a formal meta-analysis. Discussion This review will be of value to clinicians and healthcare professionals working in TIA and stroke services as well as to general practitioners/family physicians who care for these patients in the community and to researchers involved in designing and evaluating rehabilitation interventions

Do practitioners and friends support patients with coronary heart disease in lifestyle change? a qualitative study.

BACKGROUND: Healthy lifestyles help to prevent coronary heart disease (CHD) but outcomes from secondary prevention interventions which support lifestyle change have been disappointing. This study is a novel, in-depth exploration of patient factors affecting lifestyle behaviour change within an intervention designed to improve secondary prevention for patients with CHD in primary care using personalised tailored support. We aimed to explore patients\u27 perceptions of factors affecting lifestyle change within a trial of this intervention (the SPHERE Study), using semi-structured, one-to-one interviews, with patients in general practice. METHODS: Interviews (45) were conducted in purposively selected general practices (15) which had participated in the SPHERE Study. Individuals, with CHD, were selected to include those who succeeded in improving physical activity levels and dietary fibre intake and those who did not. We explored motivations, barriers to lifestyle change and information utilised by patients. Data collection and analysis, using a thematic framework and the constant comparative method, were iterative, continuing until data saturation was achieved. RESULTS: We identified novel barriers to lifestyle change: such disincentives included strong negative influences of social networks, linked to cultural norms which encouraged consumption of \u27delicious\u27 but unhealthy food and discouraged engagement in physical activity. Findings illustrated how personalised support within an ongoing trusted patient-professional relationship was valued. Previously known barriers and facilitators relating to support, beliefs and information were confirmed. CONCLUSIONS: Intervention development in supporting lifestyle change in secondary prevention needs to more effectively address patients\u27 difficulties in overcoming negative social influences and maintaining interest in living healthily

Systematic Review of the Effect of Diet and Exercise Lifestyle Interventions in the Secondary Prevention of Coronary Heart Disease

The effectiveness of lifestyle interventions within secondary prevention of coronary heart disease (CHD) remains unclear. This systematic review aimed to determine their effectiveness and included randomized controlled trials of lifestyle interventions, in primary care or community settings, with a minimum follow-up of three months, published since 1990. 21 trials with 10,799 patients were included; the interventions were multifactorial (10), educational (4), psychological (3), dietary (1), organisational (2), and exercise (1). The overall results for modifiable risk factors suggested improvements in dietary and exercise outcomes but no overall effect on smoking outcomes. In trials that examined mortality and morbidity, significant benefits were reported for total mortality (in 4 of 6 trials; overall risk ratio (RR) 0.75 (95% confidence intervals (CI) 0.65, 0.87)), cardiovascular mortality (3 of 8 trials; overall RR 0.63 (95% CI 0.47, 0.84)), and nonfatal cardiac events (5 of 9 trials; overall RR 0.68 (95% CI 0.55, 0.84)). The heterogeneity between trials and generally poor quality of trials make any concrete conclusions difficult. However, the beneficial effects observed in this review are encouraging and should stimulate further research

The safety climate in primary care (SAP-C) study: study protocol for a randomised controlled feasibility study

BACKGROUND: Research on patient safety has focused largely on secondary care settings, and there is a dearth of knowledge relating to safety culture or climate, and safety climate improvement strategies, in the context of primary care. This is problematic given the high rates of usage of primary care services and the myriad of opportunities for clinical errors daily. The current research programme aimed to assess the effectiveness of an intervention derived from the Scottish Patient Safety Programme in Primary Care. The intervention consists of safety climate measurement and feedback and patient chart audit using the trigger review method. The purpose of this paper is to describe the background to this research and to present the methodology of this feasibility study in preparation for a future definitive RCT. METHODS: The SAP-C study is a feasibility study employing a randomised controlled pretest-posttest design that will be conducted in 10 general practices in the Republic of Ireland and Northern Ireland. Five practices will receive the safety climate intervention over a 9-month period. The five practices in the control group will continue care as usual but will complete the GP-SafeQuest safety climate questionnaire at baseline (month 1) and at the terminus of the intervention (month 9). The outcomes of the study include process evaluation metrics (i.e. rates of participant recruitment and retention, rates of completion of safety climate measures, qualitative data regarding participants’ perceptions of the intervention’s potential efficacy, acceptability, and sustainability), patient safety culture in intervention and control group practices at posttest, and instances of undetected patient harm identified through patient chart audit using the trigger review method. DISCUSSION: The planned study investigates an intervention to improve safety climate in Irish primary care settings. The resulting data may inform our knowledge of the frequency of undetected patient safety incidents in primary care, may contribute to improved patient safety practices in primary care settings, and may inform future research on patient safety improvement initiatives. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40814-016-0096-5) contains supplementary material, which is available to authorized users

Secondary prevention lifestyle interventions initiated within 90 days after TIA or 'minor' stroke: a systematic review and meta-analysis of rehabilitation programmes

Background Strokes are often preceded by a transient ischaemic attack (TIA) or ‘minor’ stroke. The immediate period after a TIA/minor stroke is a crucial time to initiate secondary prevention. However, the optimal approach to prevention, including non-pharmacological measures, after TIA is not clear. Aim To systematically review evidence about the effectiveness of delivering secondary prevention, with lifestyle interventions, in comprehensive rehabilitation programmes, initiated within 90 days of a TIA/minor stroke. Also, to categorise the specific behaviour change techniques used. Design and setting The review identified randomised controlled trials by searching the Cochrane Library, Ovid MEDLINE, Ovid EMBASE, Web of Science, EBSCO CINAHL and Ovid PsycINFO. Method Two review authors independently screened titles and abstracts for eligibility (programmes initiated within 90 days of event; outcomes reported for TIA/minor stroke) and extracted relevant data from appraised studies; a meta-analysis was used to synthesise the results. Results A total of 31 potentially eligible papers were identified and four studies, comprising 774 patients post-TIA or minor stroke, met the inclusion criteria; two had poor methodological quality. Individual studies reported increased aerobic capacity but meta-analysis found no significant change in resting and peak systolic blood pressure, resting heart rate, aerobic capacity, falls, or mortality. The main behaviour change techniques were goal setting and instructions about how to perform given behaviours. Conclusion There is limited evidence of the effectiveness of early post-TIA rehabilitation programmes with preventive lifestyle interventions. Further robust randomised controlled trials of comprehensive rehabilitation programmes that promote secondary prevention and lifestyle modification immediately after a TIA are needed

A review of the quality and content of mobile apps to support lifestyle modifications following a transient ischaemic attack or 'minor' stroke

OBJECTIVE: Secondary prevention is recommended to reduce cardiovascular risk after transient ischaemic attack (TIA) or ‘minor’ stroke. Mobile health interventions can provide accessible, cost-effective approaches to address modifiable risk factors, such as physical inactivity, hypertension and being overweight. The objective of this study was to evaluate the quality of apps for supporting lifestyle change following a TIA or ‘minor’ stroke. METHODS: Systematic searches of Google Play and the Apple Store were carried out to identify mobile apps released between 1 November 2019 and 1 October 2021. Keywords were used including stroke, TIA, lifestyle, prevention and recovery. Quality was assessed using the Mobile Application Rating Scale (MARS). Common components were identified with the Behaviour Change Technique (BCT) Taxonomy. Descriptive statistics were used to summarize the performance results for each app. RESULTS: Searches identified 2545 potential apps. Thirty remained after removing duplicates and screening titles and descriptions. Six were eligible after full review of their content. All apps included at least one BCT (range: 1–16 BCTs). The most frequent BCTs included ‘information about health consequences’ (n = 5/6), ‘verbal or visual communication from a credible source’ (n = 4/6) and ‘action planning’ (n = 4/6). The mean MARS score was 2.57/5 (SD: 0.51; range: 1.78–3.36). No apps were of ‘good’ overall quality (scoring more than 4/5). CONCLUSIONS: This is the first review of mobile health interventions for this population. Only a small number of apps were available. None were targeted specifically at people with a TIA or ‘minor’ stroke. Overall quality was low. Further work is needed to develop and test accessible, user designed, and evidence-informed digital interventions in this population

The cost-effectiveness of the SPHERE intervention for the secondary prevention of coronary heart disease

Objectives: The Secondary Prevention of Heart disEase in geneRal practicE (SPHERE) trial has recently reported. This study examines the cost-effectiveness of the SPHERE intervention in both healthcare systems on the island of Ireland.Methods: Incremental cost-effectiveness analysis. A probabilistic model was developed to combine within-trial and beyond-trial impacts of treatment to estimate the lifetime costs and benefits of two secondary prevention strategies: Intervention - tailored practice and patient care plans; and Control - standardized usual care.Results: The intervention strategy resulted in mean cost savings per patient of €512.77 (95 percent confidence interval [CI], −1086.46–91.98) and an increase in mean quality-adjusted life-years (QALYs) per patient of 0.0051 (95 percent CI, −0.0101–0.0200), when compared with the control strategy. The probability of the intervention being cost-effective was 94 percent if decision makers are willing to pay €45,000 per additional QALY.Conclusions: Decision makers in both settings must determine whether the level of evidence presented is sufficient to justify the adoption of the SPHERE intervention in clinical practice.</jats:p

Impact of Abamectin on Anagrus Nilaparvatae, an Egg Parasitoid of Nilaparvata Lugens

Anagrus nilaparvatae (Hymenoptera: Mymaridae) is an egg parasitoid potential for controlling the major pests on rice, the brown planthopper (Nilaparvata lugens [Hemiptera: Delphacidae]).Abamectin is one of insecticides registered for N. lugens. The research was aimed to investigate the impact of contact application of abamectin on the parasitism level of A. nilaparvatae under laboratory conditions. Adults of A. nilaparvatae and the first instars as well as adults of N. lugens were exposed to the residue of abamection inside the test tube. A. nilaparvatae was much more susceptible to abamectin compared to N. lugens. Application of abamectin at the recommended concentration (22.78 ppm) for 30 min caused 100% mortality, and it reduced to 85% when the concentration was decreased to 0.36 ppm. In contrast, the mortality for the first instar of N. lugens was only 15% at 22.78 and no mortality at 0.36 ppm. No N. lugens adults died even when they were exposed to 22.78 ppm. Furthermore, the parasitism test was conducted using 38 days after planting of IR-64 rice variety. Those plants were infested with 50 females of N. lugens for 2 days. A. nilaparvatae were exposed by contact to 0.02, 0.23, and 2.28 ppm of abamectin. The survivors were released to the rice plant containing eggs of N. lugens. Contact application of abamectin reduced parasitism level of A. nilaparvatae as much as 86.34, 70.01, and 28.43% with concentrations of 2.28 ppm, 0.23 and 0.02 ppm, respectively. In addition, the number of parasitoids emerged decreased with increasing concentration of abamectin. These results suggest that abamectin could be detrimental to A. nilaparvatae due to direct mortality, reduced the parasitism level, and decreased the number of progeny produced. IntisariAnagrus nilaparvatae (Hymenoptera: Mymaridae) merupakan salah satu parasitoid telur yang berpotensi untuk mengendalikan hama utama tanaman padi, wereng batang padi cokelat (Nilaparvata lugens [Hemiptera: Delphacidae]). Abamektin adalah salah satu insektisida yang terdaftar untuk pengendalian N. lugens. Penelitian ini bertujuan untuk mengetahui dampak aplikasi kontak abamektin terhadap suseptibilitas dan tingkat parasitasi A. nilaparvatae terhadap telur N. lugens pada kondisi laboratorium. Imago A. nilaparvatae serta instar satu dan imago N. lugens dipapar dengan residu abamektin di dalam tabung reaksi. A. nilaparvatae lebih peka terhadap abamektin dibandingkan N. lugens. Aplikasi abamektin pada konsentrasi anjuran (22,78 ppm) selama 30 menit menyebabkan mortalitas A. nilaparvatae 100%, dan mengurangi sampai dengan 85% pada konsentrasi yang lebih rendah 0,36 ppm. Sebaliknya, mortalitas instar satu N. lugens hanya sebesar 15% pada 22,78 ppm dan tidak menimbulkan kematian pada 0,36 ppm. Konsentrasi 22,78 ppm tidak menimbulkan kematian imago N. lugens. Selanjutnya, uji parasitasi dilakukan menggunakan media tanaman padi varietas IR-64 umur 38 hari setelah tanam. Tanaman diinfestasi dengan 50 ekor betina N. lugens selama dua hari. A. nilaparvatae dipapar abamektin dengan metode kontak pada konsentrasi 0.02, 0,23, dan 2,28 ppm. Parasitoid yang mampu bertahan hidup dilepaskan pada tanaman padi yang telah diinfestasi telur N. lugens. Aplikasi kontak abamektin mengurangi tingkat parasitasi A. nilaparvatae sebesar 86,34, 70.01, dan 28,43% pada konsentrasi 2,28; 0,23; dan 0,02 ppm. Selain itu, jumlah parasitoid yang muncul semakin menurun dengan peningkatan konsentrasi abamektin. Hasil ini menunjukkan bahwa abamektin dapat merugikan secara langsung terhadap mortalitas serta mengurangi tingkat parasitasi dan jumlah keturunan A. nilaparvatae