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

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

The effects of concurrent prescription of benzodiazepines for people undergoing opioid maintenance treatment: A systematic review

Background In Opioid Maintenance Treatment patients receive long acting opioids as a substitute for heroin and other common illegally used opioids. People with opioid dependence are likely to experience elevated levels of anxiety and sleep disturbance. Therefore, benzodiazepines are often prescribed for these patients to alleviate such problems. Meanwhile, benzodiazepines are readily available on the illicit street market and are in high risk to be misused. Several studies find that concurrent prescription of benzodiazepines during opioid maintenance treatment is associated with more drug abuse and dependence. Prolonged use of benzodiazepines may result in anxiety and mental health problems, and increased risk of personal injury. However, the evidence is mostly descriptive and does not distinguish between prescribed versus illicitly procured benzodiazepines. Objective The purpose of this systematic review is to assess the effects of concurrent benzodiazepines prescription among people who receive opioid maintenance treatment (i.e. methadone, buprenorphine or buprenorphine combined with naloxone). Method We first searched for systematic reviews that could answer our research question in the following databases: Epistemonikos, Cochrane Library (CDSR, DARE, HTA), MEDLINE (Ovid), PubMed [sb] and Embase (Ovid). Thereafter, we searched for primary studies to conduct a systematic review to summarize the available evidence. Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted time series were included as relevant study designs. The target population was people 18 years or older who received substitution treatment with methadone, buprenorphine or buprenorphine combined with naloxone for opioid dependence. Relevant intervention was prescription of benzodiazepines as compared with no prescription of benzodiazepines. The outcomes of interest were retention in treatment, patients’ satisfaction, opioid use (self report or biological test), other substance use (self report or biological test), extent of anxiety and depression, sleep disorders, mortality, side effects (overdose, injury and use of hospital emergency) and criminal offences. We carried out a systematic search for literature, with no limit of publication time or language, in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), PubMed [sb], Embase (Ovid), CINAHL (EBSCO) and PsycINFO. Three authors evaluated the references based on the title and abstract, in pairs independently of each other (Kristoffer Yunpeng Ding evaluated all, Annhild Mosdøl and Laila Hov half each). Potentially relevant references were read in full-text (Kristoffer Yunpeng Ding evaluated all, Annhild Mosdøl and Laila Hov half each). We planned to assess the risk of bias, synthesise the data if possible and use the GRADE method (Grading of Recommendation Assessment, Development and Evaluation) to assess our confidence in the estimated effects. Results The literature search for systematic reviews identified 998 titles and abstracts. No systematic reviews were relevant for this topic after screening. The search for primary studies identified 3696 references. We considered eight references as potentially relevant and read them in full text. However, none of these references met our inclusion criteria. Discussion We did not find any relevant systematic reviews, clinical trials or controlled studies meeting our inclusion criteria. Experimental studies with controlled use of benzodiazepines are needed to evaluate the effects and consequences of benzodiazepines prescription during opioid maintenance treatment. We suggest the following outcomes: drug retention rates and abuse; patient satisfaction; mental health; sleep disorders; side effects and criminal behaviours. Conclusion We found no controlled studies focusing on the effects and consequences of concurrent benzodiazepines prescription during opioid maintenance treatment

Tøyning etter behandling med botulinumtoksin hos voksne med spastisitet. En kartleggingsoversikt.

Nasjonalt kunnskapssenter for helsetjenesten i Fol‐ kehelseinstituttet fikk en forespørsel fra Irene Krystad ved fysioterapitjenesten i Tysvær kommune om å finne forskning om effekt av tøyning etter be‐ handling med botulinumtoksin av voksne pasienter med spastisitet. De hadde funnet begrenset doku‐ mentasjon etter egne søk etter litteratur, og så beho‐ vet for å finne fram til denne på en systematisk måte. Vi utførte en kartleggingsoversikt der vi søkte etter systematiske oversikter og randomiserte kontrol‐ lerte studier på effekten av tøyning etter behandling med botulinumtoksin versus behandling med botuli‐ numtoksin 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 resul‐ terte i 2617 referanser, hvorav vi inkluderte fem ran‐ domiserte kontrollerte studier med totalt 138 pasi‐ enter. Fire av disse primærstudiene var allerede in‐ kludert i de systematiske oversiktene. Vi avdekket kunnskapshull når det gjelder primær‐ forskning på effekten av tøyning etter behandling med botulinumtoksin versus botulinumtoksin alene

Tilpasset helseinformasjon og pasientopplæring for personer med innvandrer eller minoritetsetnisk bakgrunn: en oversikt over systematiske oversikter

publishedVersio