Very early mobilization of patients with stroke: a systematic review

Rapporten kan lastes ned gratis fra Folkehelseinstituttets nettsider : www.fhi.noI 2014 ble 9600 personer lagt inn i sykehus med akutt hjerneslag i Norge. Dødeligheten som følge av hjerneslag er betydelig redusert de siste ti-årene, men mange pasienter med hjerneslag får varige nevrologiske funksjonsnedsettelser. Et viktig element i behandlingen av pasienter med akutt hjerneslag er at pasienten mobiliseres tidlig, men det er uklart om det er mest effektivt om dette skjer innen 24 timer eller mellom 24 - 48 timer etter symptomdebut. Vårt mandat var å identifisere og oppsummere studier som hadde belyst dette.publishedVersio

Stretching after treatment with botulinum toxin for adult patients with spasticity; A sys‐ tematic mapping review

Rapporten lastes ned gratis fra: Folkehelseinstituttets nettsider www.fhi.noNasjonalt kunnskapssenter for helsetjenesten i Folkehelseinstituttet fikk en forespørsel fra Irene Krystad ved fysioterapitjenesten i Tysvær kommune om å finne forskning om effekt av tøyning etter behandling med botulinumtoksin av voksne pasienter med spastisitet. De hadde funnet begrenset dokumentasjon etter egne søk etter litteratur, og så behovet for å finne fram til denne på en systematisk måte. Vi utførte en kartleggingsoversikt der vi søkte etter systematiske oversikter og randomiserte kontrollerte studier på effekten av tøyning etter behandling med botulinumtoksin versus behandling med botulinumtoksin alene på voksne pasienter med spastisitet. Søket etter systematiske oversikter resulterte i 1109 referanser. Av disse inkluderte vi fire systematiske oversikter. Disse inkluderte til sammen fem randomiserte studier med totalt 119 pasienter på den aktuelle problemstillingen. Den ene primærstudien som var inkludert i oversiktene vurderte vi til at ikke å omfatte tøyning og vi inkluderte derfor ikke denne studien blant de randomiserte kontrollerte studiene. Søket etter randomiserte kontrollerte studier resulterte i 2617 referanser, hvorav vi inkluderte fem randomiserte kontrollerte studier med totalt 138 pasienter. Fire av disse primærstudiene var allerede inkludert i de systematiske oversiktene. Vi avdekket kunnskapshull når det gjelder primærforskning på effekten av tøyning etter behandling med botulinumtoksin versus botulinumtoksin alene.publishedVersio

Effect of remote patient monitoring and resource utilisation in primary and specialist healthcare services: a systematic review

Source at https://www.fhi.no/.Velferdsteknologi, inkludert digital hjemmeoppfølging, er et viktig element i utviklingen av helse- og omsorgssektoren. Formålet med denne systematiske oversikten var å undersøke effekter av digital hjemmeoppfølging for voksne med ikke-smittsomme kroniske sykdommer mht. ressursbruk i primær- og spesialisthelsetjenesten. Digital hjemmeoppfølging i denne oversikten innebærer forhåndsavtalte helserelaterte målinger som gjøres av personen selv og som overføres til helsetjenesten ved hjelp av digitalt utstyr (f.eks. applikasjoner, nettbrett og telefon). Våre hovedfunn viser at digital hjemmeoppfølging gir trolig liten eller ingen forskjell i sykehusinnleggelser, liggedøgn på sykehus, besøk på poliklinikk og akuttmottak og bruk av fastlege sammenlignet med vanlig praksis etter 12 måneder. digital hjemmeoppfølging reduserer neppe timeforbruk på helsetjenester i hjemmet sammenlignet med vanlig praksis etter 12 måneder. effekten av digital hjemmeoppfølging på bruk av fastlege er svært usikker sammenlignet med oppfølging med papirbaserte dagbok-kort etter 12 måneder. Resultatene baserer seg kun på enkeltstudier og kunnskapsgrunnlaget er for mangelfullt til å kunne si sikkert om digital hjemmeoppfølging har noen effekt på ressursbruk i primær- og spesialisthelsetjenesten sammenlignet med vanlig praksis etter 12 måneder

Tidlig samtale om sunne levevaner for gravide

Background A pregnancy is a special phase for both the mother and the child. Pregnant women can promote health and prevent several adverse health outcomes through healthy lifestyle habits. Before the forthcoming revision of the Norwegian national guidelines for antenatal care, it is necessary to critically appraise the available evidence about the effects of counselling women earlier in their pregnancy than current practice. Objective This systematic review summarizes the effects of one counselling session about healthy lifestyles during the first trimester. The lifestyle factors emphasised are alcohol consumption, tobacco use, dietary habits and physical activity. Method We searched for primary studies in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL and Swemed+ through November 2015, and checked the reference lists of included studies. Two people independently examined 6038 references, assessed 63 in full text and included two studies. The relevant study population was pregnant women without any known health problems at the study onset. The intervention was one counselling session in the first trimester about healthy lifestyle habits in addition to standard antenatal care. Control was standard antenatal care. Studies with repeated counselling sessions about healthy lifestyle habits that started in the first trimester were excluded, but are presented in an appendix. We looked for randomized controlled trials, non-randomized controlled trials, interrupted time series, and cohort studies fulfilling specific criteria. Two reviewers independently assessed risk of bias using study design specific checklists. One person retrieved data from the studies, analysed and assessed our confidence in the effect estimates, and another person checked the data and analyses. We used the GRADE-methodology (Grading of Recommendations Assessment, Development, and Evaluation) to indicate our confidence in effect estimate. The confidence may be high, medium, low, or very low. Results We included two studies: One cluster randomized controlled trial from the UK with 2187 participants and one randomized controlled trial from the US with 1093 participants. One study recruited only smokers, while the other recruited both smokers and women who had stopped smoking quite recently. In both studies, women in the intervention group received one extra smoking cessation counselling session (10-15 minutes) during the first trimester, in addition to standard antenatal care. The control groups received standard antenatal care, which included basic smoking cessation advice. One of the studies reported that a proportion of the women in the control group unintentionally received additional smoking cessation counselling (contamination of the intervention). We considered that both studies have unclear risk of bias. We did not find studies with one counselling session about healthy lifestyles within the first trimester with a focus on alcohol consumption, dietary habits or physical activity. Our confidence in the documentation of effect is low or very low. Seen overall, we found that the evidence is too uncertain to conclude whether one extra smoking cessation session within the first trimester alter the proportion of pregnant smokers who are abstinent women at birth and 6 months later. One extra smoking cessation session within the first trimester for recent ex-smokers may increase the proportion who are abstinent at birth (Relative risk 1.37; 95% Confidence interval 1.03-1.83). Evidence is lacking about possible effects of one counselling session about healthy lifestyles during the first trimester with a focus on alcohol consumption, dietary habits or physical activity. Through the literature search, we found 14 trials where an early counselling session about healthy lifestyles was part of a program of repeated counselling sessions or combined with other measures in addition to standard antenatal care. These studies are presented in an appendix, but are not analysed as they answered a related, but different objective. Discussion This systematic review found insufficient evidence to answer the research question in an adequate way. We only found two relevant studies and both focused on smoking cessation and we have low or very confidence in the documentation of effect based on these. We can only partly estimate how large the likely effects of one counselling session about healthy lifestyles during the first trimester are. Low confidence in the evidence does not mean that the intervention is ineffective, but the data is too limited to reliably estimate the magnitude of the effect. A decision regarding whether pregnant women should be offered an early counselling session about healthy lifestyles during the first trimester will be made based on several considerations beyond the question of likely effect alone. Conclusion We found sparse evidence to estimate the effects of one counselling session about healthy lifestyles during the first trimester. One extra smoking cessation session within the first trimester for recent ex-smokers may increase the proportion who are abstinent at birth. We cannot conclude whether it changes the proportion of pregnant smokers who are abstinent at birth comparted to smokers who receive standard antenatal care. Evidence is lacking about whether one counselling session in the first trimester can influence alcohol consumption, dietary habits or physical activity

Tidlig samtale om sunne levevaner for gravide

Background A pregnancy is a special phase for both the mother and the child. Pregnant women can promote health and prevent several adverse health outcomes through healthy lifestyle habits. Before the forthcoming revision of the Norwegian national guidelines for antenatal care, it is necessary to critically appraise the available evidence about the effects of counselling women earlier in their pregnancy than current practice. Objective This systematic review summarizes the effects of one counselling session about healthy lifestyles during the first trimester. The lifestyle factors emphasised are alcohol consumption, tobacco use, dietary habits and physical activity. Method We searched for primary studies in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL and Swemed+ through November 2015, and checked the reference lists of included studies. Two people independently examined 6038 references, assessed 63 in full text and included two studies. The relevant study population was pregnant women without any known health problems at the study onset. The intervention was one counselling session in the first trimester about healthy lifestyle habits in addition to standard antenatal care. Control was standard antenatal care. Studies with repeated counselling sessions about healthy lifestyle habits that started in the first trimester were excluded, but are presented in an appendix. We looked for randomized controlled trials, non-randomized controlled trials, interrupted time series, and cohort studies fulfilling specific criteria. Two reviewers independently assessed risk of bias using study design specific checklists. One person retrieved data from the studies, analysed and assessed our confidence in the effect estimates, and another person checked the data and analyses. We used the GRADE-methodology (Grading of Recommendations Assessment, Development, and Evaluation) to indicate our confidence in effect estimate. The confidence may be high, medium, low, or very low. Results We included two studies: One cluster randomized controlled trial from the UK with 2187 participants and one randomized controlled trial from the US with 1093 participants. One study recruited only smokers, while the other recruited both smokers and women who had stopped smoking quite recently. In both studies, women in the intervention group received one extra smoking cessation counselling session (10-15 minutes) during the first trimester, in addition to standard antenatal care. The control groups received standard antenatal care, which included basic smoking cessation advice. One of the studies reported that a proportion of the women in the control group unintentionally received additional smoking cessation counselling (contamination of the intervention). We considered that both studies have unclear risk of bias. We did not find studies with one counselling session about healthy lifestyles within the first trimester with a focus on alcohol consumption, dietary habits or physical activity. Our confidence in the documentation of effect is low or very low. Seen overall, we found that the evidence is too uncertain to conclude whether one extra smoking cessation session within the first trimester alter the proportion of pregnant smokers who are abstinent women at birth and 6 months later. One extra smoking cessation session within the first trimester for recent ex-smokers may increase the proportion who are abstinent at birth (Relative risk 1.37; 95% Confidence interval 1.03-1.83). Evidence is lacking about possible effects of one counselling session about healthy lifestyles during the first trimester with a focus on alcohol consumption, dietary habits or physical activity. Through the literature search, we found 14 trials where an early counselling session about healthy lifestyles was part of a program of repeated counselling sessions or combined with other measures in addition to standard antenatal care. These studies are presented in an appendix, but are not analysed as they answered a related, but different objective. Discussion This systematic review found insufficient evidence to answer the research question in an adequate way. We only found two relevant studies and both focused on smoking cessation and we have low or very confidence in the documentation of effect based on these. We can only partly estimate how large the likely effects of one counselling session about healthy lifestyles during the first trimester are. Low confidence in the evidence does not mean that the intervention is ineffective, but the data is too limited to reliably estimate the magnitude of the effect. A decision regarding whether pregnant women should be offered an early counselling session about healthy lifestyles during the first trimester will be made based on several considerations beyond the question of likely effect alone. Conclusion We found sparse evidence to estimate the effects of one counselling session about healthy lifestyles during the first trimester. One extra smoking cessation session within the first trimester for recent ex-smokers may increase the proportion who are abstinent at birth. We cannot conclude whether it changes the proportion of pregnant smokers who are abstinent at birth comparted to smokers who receive standard antenatal care. Evidence is lacking about whether one counselling session in the first trimester can influence alcohol consumption, dietary habits or physical activity

Prehospital tourniquets in civilians: A systematic review

Objectives: Terrorist attacks and civilian mass-casualty events are frequent, and some countries have implemented tourniquet use for uncontrollable extremity bleeding in civilian settings. The aim of this study was to summarize current knowledge on the use of prehospital tourniquets to assess whether their use increases the survival rate in civilian patients with life-threatening hemorrhages from the extremities. Design: Systematic literature review in Medline (Ovid), Embase (Ovid), Cochrane Library, and Epistemonikos was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. The search was performed in January 2019. Setting: All types of studies that examined use of tourniquets in a prehospital setting published after January 1, 2000 were included. Primary/Secondary Outcomes: The primary outcome was mortality with and without tourniquet, while adverse effects of tourniquet use were secondary outcomes. Results: Among 3,460 screened records, 55 studies were identified as relevant. The studies were highly heterogeneous with low quality of evidence. Most studies reported increased survival in the tourniquet group, but few had relevant comparators, and the survival benefit was difficult to estimate. Most studies reported a reduced need for blood transfusion, with few and mainly transient adverse effects from tourniquet use. Conclusion: Despite relatively low evidence, the studies consistently suggested that the use of commercial tourniquets in a civilian setting to control life-threatening extremity hemorrhage seemed to be associated with improved survival, reduced need for blood transfusion, and few and transient adverse effects