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Secondary Prevention (secondary + prevention)
Selected AbstractsBreast Cancer Detection in Asymptomatic Women: Health Beliefs Implicated in Secondary PreventionJOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 2 2003Kanayo Umeh This study assessed the usefulness of health belief model (HBM) constructs in predicting the frequency and proficiency of breast self-examination among Greek women. Both additive and multiplicative functions were tested. Cross-sectional data from 195 women were analyzed. Health beliefs explained 16.5% and 19.7% of the variance in frequency and proficiency, respectively. Frequent and proficient breast examination was associated with fewer perceived barriers. Moreover, elevated confidence and susceptibility estimates predicted greater frequency and proficiency, respectively. One moderator interaction emerged, but this was attenuated after accounting for other health beliefs. These findings provide qualified support for the HBM and present a useful template for developing interventions to promote secondary prevention. [source] Implantable Cardioverter Defibrillator Criteria for Primary and Secondary Prevention of Pediatric Sudden Cardiac DeathPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2009CHARLES I. BERUL M.D. The implantable cardioverter defibrillator is established as life-saving in specific adult populations. However, the precise indications and criteria for defibrillator implantation in children are less well defined. This article provides a succinct review of the indications and implantation criteria in pediatric populations at risk for sudden cardiac death, including specific disease substrates such as cardiomyopathies, inherited arrhythmias, and congenital heart disease. [source] The challenge of ST-segment elevation myocardial infarctionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2007M. Cohen Summary Background/introduction:, Acute coronary syndromes (ACS) represent a spectrum of ischaemic myocardial events that share a similar pathophysiology. ST-segment elevation myocardial infarction (STEMI), the most severe form of ACS short of sudden cardiac death, is a significant public health problem with an estimated 500,000 STEMI events every year in the United States. Treatment/therapy:, The mortality and morbidity associated with STEMI is significant. Early reperfusion therapy is the most important aspect of the treatment of STEMI. There are two main methods of reperfusion therapy: percutaneous coronary intervention (PCI) and fibrinolytic therapy, with PCI being the preferred method. In addition to standard reperfusion therapy, antithrombotics (unfractionated heparin and low molecular weight heparins) and antiplatelet agents (aspirin, clopidogrel and glycoprotein IIb/IIIa inhibitors) are critical adjuncts, effective in the treatment of acute STEMI. Conclusions:, The survival of patients with STEMI depends on rapid diagnosis and optimal early treatment. Guidelines for the management of patients with STEMI recommend PCI within 90 min of presentation and that fibrinolytics are administered within 30 min. However, only a fraction of patients undergo reperfusion within the recommended time. Improvements in protocols for identifying STEMI cases are therefore required to allow reperfusion therapy to be initiated sooner. Secondary prevention is another important aspect of STEMI management, and patients should be encouraged to adopt strategies that reduce the risk of subsequent ischaemic events. [source] Secondary prevention of ischemic stroke: Challenging patient scenarios,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2008Kiwon Lee MD Abstract The risk for recurrent stroke following a stroke or transient ischemic attack (TIA) is high. Prevention of a secondary event is a priority, as the associated morbidity and mortality are great. Antiplatelet agents have been shown to reduce this risk, but the choice of treatment modality depends on a number of factors, including the underlying cause of the stroke and the patient's comorbidities. For example, a cardioembolic stroke is best treated with anticoagulants, whereas one of noncardioembolic origin requires antiplatelet therapy. A number of challenging patient scenarios are explored in this article, and appropriate medical management is discussed, with the goal of examining the most recent trial data and information in the context of an actual case. Eight sample cases are presented: stroke prevention in a patient with recent stent placement, low ejection fraction, intracranial stenosis, carotid stenosis, atherosclerosis of the aortic arch, symptomatic coronary artery disease, antiplatelet failure, and stroke prevention in a patient already on warfarin. Journal of Hospital Medicine 2008;3(4 Suppl):S20,S28. © 2008 Society of Hospital Medicine. [source] Syphilis: An old enemy still lurksJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 2 2006Assistant Professor of Clinical Nursing, FNP Family Nurse Practitioner, L. A. Ferguson MSN Abstract Purpose: To review the problem of increasing cases of syphilis as a communicable disease and to review different presentations of syphilis and to discuss treatment guidelines. Data sources: Extensive review of worldwide scientific literature on the epidemiology, diagnosis, and treatment of syphilis. Conclusions: Syphilis is an infectious sexually transmitted disease, which may have devastating consequences. Previously declining rates have led to complacency in prevention and diagnosis. Primary prevention includes education regarding safer sexual practices. Secondary prevention includes early identification via screening and treatment. Implications for practice: Syphilis is a contagious disease that has devastating consequences if not diagnosed and treated. Providers should keep ever vigilant in its identification. Specifically, it should be considered when evaluating all symptom-less dermatological lesions. [source] Stroke in Developing Countries: Epidemiology, Impact and Policy ImplicationsDEVELOPMENT POLICY REVIEW, Issue 6 2010Peter Lloyd-Sherlock The burden of stroke and other non-communicable diseases has risen sharply in developing countries in recent years. This article provides a detailed review of this trend and its underlying causes, and discusses the social and economic effects of stroke and the scope for interventions to reduce incidence and mitigate impacts. It demonstrates that policy-makers have been slow to recognise the growing scale of the challenge, and argues for large-scale public health campaigns focused on primary and secondary prevention. [source] Childhood epilepsy: secondary prevention is crucialDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2003THIERRY DEONNA First page of article [source] Attenuating CV risk factors in patients with diabetes: clinical evidence to clinical practiceDIABETES OBESITY & METABOLISM, Issue 2002Alan J. Garber Abstract Individuals with diabetes are at high risk of cardiovascular (CV) disease, a risk that is significantly greater in the presence of traditional CV risk factors (hyperlipidaemia, hypertension, prothrombotic state). Glucose control and management of these risk factors decreases but does not eliminate CV events, reflecting the complexity of atherosclerosis. Novel risk factors (C-reactive protein, lipoprotein a, homocysteine, and endothelial dysfunction) have been proposed and are potentially modifiable. However, clinical trials data are not yet available to guide therapy. At this time, no single agent can achieve adequate risk reduction in patients with diabetes. Even with the use of multiple agents and classes of agents to manage CV risk, 75% of patients with diabetes are expected to die from CV causes. Despite the recent advances in primary and secondary prevention of CV events, new approaches are needed. Data from the Heart Outcomes Prevention Evaluation (HOPE) trial demonstrated that CV risk can be further reduced by the addition of the ACE inhibitor ramipril to the existing treatment regimen of high-risk patients with diabetes. [source] Risk factor control in patients with Type 2 diabetes and coronary heart disease: findings from the Swedish National Diabetes Register (NDR)DIABETIC MEDICINE, Issue 1 2009S. Gudbjörnsdottir Abstract Aims Patients with Type 2 diabetes and coronary heart disease (CHD) are infrequently treated to risk factor targets in current guidelines. We aimed to examine risk factor management and control levels in a large sample of patients with Type 2 diabetes with CHD. Methods This was an observational study of 1612 patients with first incidence of CHD before 2002, and of 4570 patients with first incidence of CHD before 2005, from the Swedish National Diabetes Register (NDR). Results In patients with CHD 1,2 years before follow-up, the achievement of cardiovascular risk factor targets (follow-up 2002/follow-up 2005) was: HbA1c < 7%, 47%/54% (P < 0.01); blood pressure , 130/80 mmHg, 31%/40% (P < 0.001); total cholesterol < 4.5 mmol/l, 47%/60% (P < 0.001); and low-density lipoprotein-cholesterol < 2.5 mmol/l, 49%/65% (P < 0.001). Use of medication: antihypertensives, 90%/94% (P < 0.01); lipid-lowering drugs, 75%/86% (P < 0.001); and aspirin, 85%/89% (P < 0.05). A high prevalence of adverse lifestyle characteristics prevailed (2002/2005): overweight [body mass index (BMI) , 25 kg/m2], 86%/85%; obesity (BMI , 30 kg/m2), 41%/42%; smokers in age group < 65 years, 16,23%/18,19%; as well as waist circumference , 102 cm (men) or , 88 cm (women), 68% in 2005. Conclusions Patients with a combination of Type 2 diabetes and CHD showed an increased use of lipid-lowering drugs over time, corresponding to improving blood lipid levels. A discrepancy existed between the prevalent use of antihypertensive drugs and the low proportion reaching blood pressure targets. Regretfully, a high prevalence of adverse lifestyle characteristics prevailed. Evidence-based therapy with professional lifestyle intervention and drugs seems urgent for improved quality of secondary prevention in these patients. [source] Prevalence of undiagnosed Type 2 diabetes and impaired fasting glucose in older B ritish men and womenDIABETIC MEDICINE, Issue 6 2005M. C. Thomas Abstract Aim To estimate the prevalence of undiagnosed diabetes and impaired fasting glucose in older British men and women, using the 1999 World Health Organization (WHO) thresholds based on fasting glucose measurements. Methods Participants in the British Regional Heart Study and the British Women's Heart and Health Study were selected from one socially representative general practice in 24 British towns. Included in this analysis were 3736 men and 3642 women aged 60,79 years (predominantly white), who provided a single fasting blood sample at a clinical examination between 1998 and 2001, and who had no previous diagnosis of diabetes. Results Two hundred and eleven men (5.7%) and 190 women (5.2%) had a fasting blood glucose level consistent with the WHO threshold for a diagnosis of diabetes (, 7.0 mmol/l), whilst a further 667 men (17.9%) and 642 women (17.6%) had impaired fasting glucose levels (6.1 , 7 mmol/l). When analyses were restricted to subjects who had fasted for at least 8 h, and whose blood sample was taken before 12.00 h, the predicted prevalence of undiagnosed diabetes (based on two separate measurements) was 6.7% in men and 6.0% in women. The predicted prevalence of impaired fasting glucose (based on two separate measurements) was approximately 20% in both sexes. Conclusions More than one-fifth of older white British men and women have either undiagnosed diabetes or impaired fasting glucose according to new WHO criteria. Strategies for the primary and secondary prevention of Type 2 diabetes among older individuals are urgently needed. [source] Changing aspirin use in patients with Type 2 diabetes in the UKPDSDIABETIC MEDICINE, Issue 12 2004C. A. Cull Abstract Aims To examine the proportion of UK Prospective Diabetes Study (UKPDS) patients with Type 2 diabetes taking aspirin regularly for the primary and secondary prevention of cardiovascular disease (CVD) before and after publication of the 1997 American Diabetes Association (ADA) Clinical Practice Recommendations and the 1998 Joint British Recommendations on the Prevention of Coronary Disease in Clinical Practice. Methods UKPDS annual review data from 1996/7 (n = 3190) and 2000/1 (n = 2467) were used to determine the prevalence of patients taking aspirin regularly in relation to known CVD risk factors and pre-existing CVD. Results Patients taking aspirin regularly were more often male than female (24 vs. 20%, P = 0.0033), older (66 ± 8 vs. 62 ± 9 years, P < 0.0001) and less often Afro-Caribbean than White Caucasian or Indian Asian (11 vs. 23 vs. 22%, respectively, P < 0.0001). Between 1996/7 and 2000/1 aspirin use in patients without pre-existing CVD increased from 17 to 31% (P < 0.0001) and for those with pre-existing CVD from 76 to 82% (P = 0.032). Conclusion The majority of patients with pre-existing CVD were taking aspirin regularly. Although aspirin use in those without pre-existing CVD approximately doubled after publication of the ADA and Joint British Recommendations, less than two-thirds of these high-risk patients were being treated according to guidelines. This may relate to a lack of convincing evidence for primary CVD prevention or failure to adhere to guidelines. It may be that more trial data is needed to convince clinicians of the value of aspirin therapy in Type 2 diabetes. [source] European comparison of costs and quality in the prevention of secondary complications in Type 2 diabetes mellitus (2000,2001)DIABETIC MEDICINE, Issue 7 2002A. Gandjour Abstract Aims To compare the out-patient costs and process quality of preventing secondary complications in patients with Type 2 diabetes mellitus in France, Germany, Italy, The Netherlands, Sweden, Switzerland, and the UK. Methods A total of 188 European physician practices assessed annual services for one hypothetical average patient (cost evaluation) and 178 practices reported retrospective data on one or two real patients (quality evaluation) in 2000/2001. In countries with a detailed fee-for-service schedule (Germany, Italy, and Switzerland) reimbursement fees were used to approximate costs. These fee-for-service schedules were also used to develop index (average) fees for all countries, in order to measure resource utilization. The following process quality indicators were evaluated: control of HbA1c; control of lipids; urine test for (micro)albuminuria; control of blood pressure; foot examination; neurological examination; eye examination; and patient education. For each country an average quality rating was calculated by weighting the response to each quality indicator with the level of scientific evidence. Results Average quality ratings ranged from 0.40 in The Netherlands to 0.62 in the UK (0 = lowest rating; 1 = highest rating). Total annual costs for secondary prevention were higher in Switzerland than in Germany and Italy (EUR475, EUR381, and EUR283, respectively). Resource utilization was highest in Germany and lowest in the UK. Conclusions The overall quality of preventive services documented was found to be poor in the seven European countries studied. The UK rated as both the most effective and the most efficient country in providing secondary prevention in Type 2 diabetes. [source] Early detection and intervention in first-episode schizophrenia: a critical reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2001T. K. Larsen Objective: To review the literature on early intervention in psychosis and to evaluate relevant studies. Method: Early intervention was defined as intervention in the prodromal phase (primary prevention) and intervention after the onset of psychosis, i.e. shortening of duration of untreated psychosis (DUP) (secondary prevention). Results: We found few studies aimed at early intervention, but many papers discussing the idea at a more general level. We identified no studies that prove that intervention in the prodromal phase is possible without a high risk for treating false positives. We identified some studies aimed at reducing DUP, but the results are ambiguous and, until now, no follow-up data showing a positive effect on prognosis have been presented. Conclusion: Early intervention in psychosis is a difficult and important challenge for the psychiatric health services. At the time being reduction of DUP seems to be the most promising strategy. Intervention in the prodromal phase is more ethically and conceptually problematic. [source] Early diagnosis of schizophrenia , the first step towards secondary preventionACTA PSYCHIATRICA SCANDINAVICA, Issue 400 2000M. Davidson Objective: To review current knowledge of risk factors associated with schizophrenia and the development of diagnostic markers aimed at the delay or attenuation of the first psychotic episode. Method: Studies relating to the development of disease and the risk factors that could inform predictive markers are reviewed, including high-risk studies, birth-cohort studies, and retrospective and follow-back studies. Results: Future schizophrenic patients present with delayed developmental milestones, speech and behavioural difficulties, and lower IQ scores than non-cases. Conclusion: Results are consistent with the notion that schizophrenia is a developmental disease and that such antecedents are present; further research is required to improve the specificity of diagnostic markers and predictive power before these can be used to prevent or delay psychotic episodes of schizophrenia. [source] SECOND LOOK COLONOSCOPY: INDICATION AND REQUIREMENTSDIGESTIVE ENDOSCOPY, Issue 2009Jean-Francois Rey Background:, There are circumstances when a colonoscopy should be repeated after a short interval following the first endoscopic procedure which has not completely fulfilled its objective. Review of the literature:, A second look colonoscopy is proposed when there remains a doubt about missed neoplastic lesions, either because the intestinal preparation was poor or because the video-endoscope did not achieved a complete course in the colon. The second look colonoscopy is also proposed at a short interval when it is suspected that the endoscopic removal of a single or of multiple neoplastic lesions was incomplete and that a complement of treatment is required. When the initial endoscopic procedure has completely fulfilled its objective, a second look colonoscopy can be proposed at longer intervals in surveillance programs. The intervals in surveillance after polypectomy are now adapted to the initial findings according to established guidelines. This also applies to the surveillance of incident focal cancer in patients suffering from a chronic inflammatory bowel disease. Conclusion:, Finally, in most developed countries, a priority is attributed to screening of colorectal cancer and focus is given on quality assurance of colonoscopy which is considered as the gold standard procedure in the secondary prevention of colorectal cancer. [source] The Epidemiology of Convulsive Status Epilepticus in Children: A Critical ReviewEPILEPSIA, Issue 9 2007Miquel Raspall-Chaure Summary:, There is ongoing debate regarding the most appropriate definition of status epilepticus. This depends upon the research question being asked. Based on the most widely used "30 min definition," the incidence of childhood convulsive status epilepticus (CSE) in developed countries is approximately 20/100,000/year, but will vary depending, among others, on socioeconomic and ethnic characteristics of the population. Age is a main determinant of the epidemiology of CSE and, even within the pediatric population there are substantial differences between older and younger children in terms of incidence, etiology, and frequency of prior neurological abnormalities or prior seizures. Overall, incidence is highest during the first year of life, febrile CSE is the single most common cause, around 40% of children will have previous neurological abnormalities and less than 15% will have a prior history of epilepsy. Outcome is mainly a function of etiology. However, the causative role of CSE itself on mesial temporal sclerosis and subsequent epilepsy or the influence of age, duration, or treatment on outcome of CSE remains largely unknown. Future studies should aim at clarifying these issues and identifying specific ethnic, genetic, or socioeconomic factors associated with CSE to pinpoint potential targets for its primary and secondary prevention. [source] Rivaroxaban , an oral, direct Factor Xa inhibitor , lessons from a broad clinical study programmeEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5 2009Sylvia Haas Abstract Anticoagulants are recommended for the prevention and treatment of venous thromboembolism (VTE), prevention of stroke in patients with atrial fibrillation (AF) and secondary prevention in patients with acute coronary syndrome (ACS). There is a clinical need for novel anticoagulants offering improvements over current standard of care, such as fixed oral dosing and no need for routine monitoring. Rivaroxaban, an oral, once-daily, direct Factor Xa inhibitor, has recently completed the RECORD phase III programme for the prevention of VTE in patients undergoing total hip or knee replacement (THR or TKR), an indication for which it is approved in Europe and Canada. It is being investigated in large-scale phase III studies for VTE treatment and prevention of stroke in patients with AF, and phase III studies will soon commence for secondary prevention in patients with ACS. Phase I studies demonstrated that no routine anticoagulation monitoring was required, while phase II studies suggested that fixed daily doses had a wide therapeutic window. The four RECORD studies consistently showed that rivaroxaban was significantly more effective than enoxaparin in the prevention of VTE after THR and TKR, with a similar safety profile. This review describes the development of this novel anticoagulant, from bench to bedside. [source] Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: to treat or not to treatEUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2010V. Parkhutik Background and purpose:, Comprehensive indications for treatment of symptomatic vertebral stenosis remain unavailable. Even less is known about endovascular treatment of asymptomatic cases. We treated symptomatic and asymptomatic vertebral ostium stenosis with angioplasty and stenting and investigated the long term outcome. Methods:, Consecutive patients with two different indications were included. Group 1 (G1) had symptomatic >50% stenosis. Group 2 (G2) had asymptomatic >50% stenosis and severe lesions of anterior circulation and were expected to benefit from additional cerebral blood supply. Results:, Twenty nine vertebral origin stenoses in 28 patients (75% men, mean age 64 ± 9 years) were treated. There were 16 G1 and 13 G2 cases. Technical success rate was 100%. Immediate neurological complications rate was 3.4% (one G1 patient with vertebral TIA due to release of emboli). Two further strokes were seen during follow up (32 ± 24 months): vertebrobasilar stroke in a G2 patient with permeable stent in V1 segment, new ipsilateral V3 occlusion and high-risk cardioembolic source, and carotid stroke in a G1 patient who had had ipsilateral carotid stenting. There were no deaths of any cause. Asymptomatic restenosis was observed in one out of 19 patients from both groups who underwent a follow up angiography. Conclusions:, Angioplasty and stenting appears to be technically feasible and safe in asymptomatic and symptomatic vertebral stenosis. More studies are needed in order to clarify its role in primary and secondary prevention of vertebrobasilar stroke. High risk anterior circulation lesions should be taken into account as a possible indication in patients with asymptomatic vertebral stenosis. [source] Severity of cerebral white matter lesions and infarcts in patients with transient or moderately disabling cerebral ischaemia: reproducibility of grading by neurologistsEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2006E. L. L. M. De Schryver Diffuse or multifocal ischaemic white matter lesions increase the risk of intracranial haemorrhage in patients using oral anticoagulants for secondary prevention after cerebral ischaemia of arterial origin. We studied whether neurologists could reliably assess the presence of these white matter abnormalities. As part of the European/Australian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT), the severity of white matter lesions and presence of ischaemic lesions were twice assessed in a consensus meeting of three neurologists (from a pool of nine) as absent, moderate or severe, in a sample of 126 randomly selected CT or MRI scans. The neurologists were not aware of the duplicate grading. The degree of agreement between the first and second observation was calculated with kappa statistics. The kappa value for agreement between the first and second assessment of white matter lesions was 0.58 (95% CI 0.40,0.76). The kappa value for the presence of clinically relevant and/or irrelevant ischaemic lesions was 0.68 (95% CI 0.58,0.78). Clinicians can assess the presence of white matter lesions with sufficient reliability. Such assessment may prevent unnecessary risk with oral anticoagulation in secondary prevention after cerebral ischaemia of arterial origin, of which the efficacy is currently being assessed in ESPRIT. [source] Stroke secondary prevention and blood pressure reduction: an observational study of the use of PROGRESS therapyFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 2 2008Jean-Marc Bugnicourt Abstract The Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) showed the efficacy of blood pressure reduction in secondary stroke prevention. This anti-hypertensive treatment (perindopril 4 mg daily plus indapamide 1.5 mg daily) is now routinely proposed to patients referred to our department for stroke or transient ischaemic attack (TIA). The aim of this study was to evaluate the prescription of PROGRESS therapy during hospitalization and to identify the predictors of therapy discontinuation after discharge. Eligible patients admitted to the Amiens University hospital for acute stroke or TIA from January to April 2003 were included (n = 101). At 1 year, the use of PROGRESS therapy was evaluated by structured phone interviews. In addition, each patient's general practitioner (GP) was also contacted to provide information. PROGRESS therapy was mentioned on the hospital discharge summary significantly less frequently after cardioembolic stroke (OR: 0.15; 95% CI: 0.05,0.5; P = 0.001) and TIA (OR: 0.12; 95% CI: 0.02,0.7; P = 0.02). At 1 year, only 25.7% of patients were treated with optimal PROGRESS therapy (perindopril 4 mg daily plus indapamide 1.5 mg daily). Mention of PROGRESS therapy in the discharge summary was the main predictor of optimal PROGRESS therapy at 1 year (OR: 10.8; 95% CI: 1.3,88.3; P = 0.03). This study shows that mention of PROGRESS therapy in the discharge summary must be improved as it is associated with a higher use of these anti-hypertensive agents 1 year after stroke/TIA. [source] Evidence based secondary prevention following a myocardial infarction (MI): the new NICE guidelineINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2007R. Minhas First page of article [source] Should erectile dysfunction be treated as secondary prevention for coronary disease?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2006Graham Jackson Editor No abstract is available for this article. [source] The influence of statin characteristics on their safety and tolerabilityINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2004G. De Angelis Summary The efficacy of the statins for both primary and secondary prevention has now been clearly established in patients across the spectrum of cardiovascular risk. In addition to their primary effect in reducing plasma cholesterol, the statins possess various ,pleiotropic' effects that may contribute to their clinical effectiveness in reducing cardiovascular events, e.g. improvement of endothelial function, reduction of low-density lipoprotein-cholesterol oxidation and stabilisation of atheromatous plaques. Although statins share similar chemical characteristics, they differ significantly in terms of their molecular synthesis, solubility and pharmacokinetic behaviour and metabolism. Side-effects secondary to long-term statin therapy are rare, but rhabdomyolysis may occur when statins are administered together with other drugs that have a direct toxic effect on muscle or which inhibit statin metabolism. Among the various statins, it would appear that fluvastatin has the lowest propensity to interact with other drugs and the least potential to induce myotoxicity. [source] Guidelines on the management of secondary prophylaxis of vascular events in stable patients in primary careINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2004D.J. Betteridge Summary Atherothrombosis, thrombus formation superimposed on an existing atherosclerotic plaque, is an acute process leading to ischaemic events such as myocardial infarction, stroke and critical limb ischaemia. Patients presenting with clinical conditions associated with atherothrombosis are at increased risk of subsequent vascular events. The beneficial effect of antiplatelet therapies for short-term and long-term secondary prevention of atherothrombotic events has been established. These guidelines aim to provide evidence-based recommendations that will assist in the antiplatelet-mediated secondary prophylaxis of vascular events in patients with stable cardiovascular disease treated in the primary healthcare setting. Medline and the Cochrane library were accessed using free-text strategies in the domains of antiplatelet agents and antithrombotics. Development of the guidelines was driven by a series of Steering Committee meetings, in which the quality of relevant studies was assessed and identified using narrative summary. These guidelines present evidence and recommendations for the treatment of numerous atherothrombotic indications depending on individual patient circumstances. [source] Cardiac rehabilitation programme for coronary heart disease patients: An integrative literature reviewINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2009Nidal F Eshah RN, PhD(c) Previous Western cardiac rehabilitation (CR) purported to improve patients' quality of life and health-related parameters for cardiovascular diseases (CVD). Nursing's role in CR was minimally identified. The purpose of this integrative literature review was to determine the effectiveness of current CR programmes and to determine if nurses are included in multidisciplinary CR teams. An online search of databases for the National Institutes of Health Library, Medline, CINAHL, Blackwell Synergy and PsychINFO electronic databases, with keywords,cardiac rehabilitation, lifestyle modification, secondary prevention, quality of life, effects of rehabilitation,identified 13 articles published 2001,2006 for inclusion. Cardiac rehabilitation programmes provided significant improvement in participants' quality of life, exercise capacity, lipid profile, body mass index, body weight, blood pressure, resting heart rate, survival rate, mortality rate and decreased myocardial infarction (MI) risk factors, although there was limited participation. They also decreased depression and anxiety. Eight studies included Nurses as CR providers, but without clear descriptions of their role. Nurses in developing countries need to participate in CR programmes to improve patients' participation, and to focus on modalities with lower overhead costs, such as home-based CR, and to clearly articulate their unique contributions. [source] Detection of in vitro demineralization of primary teeth using quantitative light-induced fluorescence (QLF)INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2002I. A. Pretty Summary. Introduction. With the advent of remineralizing therapies and the new, conservative approach to restoration placement, interest in detecting and monitoring subclinical, precavitated lesions has increased. The increased understanding of clinicians about the processes of primary and secondary prevention and the detection of lesions to which these therapies may be applied, is one of the current goals in caries management. Quantitative light-induced fluorescence (QLF) is a new method for the detection of very early caries. Objectives. To determine the ability of QLF to detect and longitudinally monitor in vitro enamel demineralization. To present the device to the paediatric community and present future in vivo uses of the device. Design. An in vitro study with combined in vivo pilot. Sample and methods. Twelve previously extracted, caries free, primary molars were selected and prepared. Two teeth were randomly selected as controls. Teeth were prepared by gentle pumicing and coating in an acid-resistant nail-varnish, except for an exposed window on the buccal surface. QLF baseline images were taken and the teeth then exposed to a demineralizing solution. Teeth were removed at regular intervals (24, 48, 72, 96, 120, and 144 h), air-dried and QLF images taken. QLF images were analysed by a single, blinded examiner (to control, to length of exposure). Mineral loss, as measured by ,Q, was recorded. Results. Demineralization was noted in all experimental teeth by 48 h, and within 24 h in six teeth. The QLF successfully monitored the increase in mineral loss over time (P < 0·05). The detected lesions were not visible clinically until 144 h and then in only the most severe lesions. No demineralization was detected by QLF in control teeth. The device was user- and patient-friendly in vivo, detecting subclinical lesions. Conclusion. Detection of very early mineral loss and subsequent monitoring of this loss is possible in primary teeth using QLF. The device is well suited to use in paediatric dentistry and offers applications for both clinicians and researchers. The determination of the status of carious lesions (active/inactive) will be possible with readings taken at recall appointments. [source] WHO-ILAR-COPCORD in the Asia-Pacific: the past, present and futureINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 1 2008Syed Atiqul HAQ Abstract The aim of the Community Oriented Program for Control of Rheumatic Disorders (COPCORD) is reduction of community burden of rheumatic disorders, particularly in developing communities. Stage I entails estimation of prevalence and incidence of musculoskeletal pain and rheumatic disorders. Stage II is dedicated to education of health workers, patients and the community. Stage III deals with identification of risk factors for common rheumatic disorders and development of strategies for their primary and secondary prevention. So far Stage I data have been reported from 15 countries in the Asia-Pacific countries. The prevalence of musculoskeletal pain has varied from 11.6% to 45.4%. The commonest sites of pain were low back, knee, neck and shoulder. Commonest rheumatic disorders were osteoarthritis of knees, non-specific low back pain and soft tissue rheumatism. A few scattered educational activities have been reported from Indonesia and India. Systematic case-controlled or cohort studies aimed at finding out the risk factors for common rheumatic disorders were scanty. However, several associations were reported from cross-sectional prevalence surveys. It is imperative that the COPCORD investigators in the Asia-Pacific region focus on finding out the modifiable risk factors for rheumatic disorders with properly designed studies, develop preventive strategies on the basis of identified risk factors and carry out interventional studies to test the efficacy of the strategies with validated outcome instruments. [source] A critical review of aspirin in the secondary prevention of noncardioembolic ischaemic strokeINTERNATIONAL JOURNAL OF STROKE, Issue 4 2010Domenico Inzitari Both secondary prevention (such as lifestyle modifications, pharmacotherapy or surgery) and an understanding of the influence of risk factors (including the different aetiologic mechanisms of cerebral ischaemia) play a pivotal role in reducing the burden of recurrent stroke. Regarding the types of preventative treatments available, variations exist across all clinical studies, including differences in target populations (including the type of cerebral ischaemia), risk factors, length of follow-up, drop-out rates and outcomes, which makes translating the results of clinical trials to individual patients difficult. However, with such limitations in mind, this critical albeit nonsystematic review, which compared aspirin with other antiplatelets and in combination with other drugs, showed that the benefit from aspirin treatment is consistently shown in ischaemic stroke, while harms are limited. Furthermore, no definite superiority is apparent across different antiplatelet therapies. Dual antiplatelet regimens may expose to a slight but measurable higher risk of haemorrhagic complications, perhaps in selective groups of patients (i.e. those with severe small-vessel disease or in selective racial groups). Based on our analysis, the indication of aspirin as the first-line choice, also recommended by several acknowledged international or national guidelines, may be confirmed. However, the complex nature of patients at risk of recurrent ischaemic stroke necessitates a comprehensive approach, which should be driven by the primary care physician, whose role is central to successful actions for secondary stroke prevention. [source] Income-Related Differences in the Use of Evidence-Based Therapies in Older Persons with Diabetes Mellitus in For-Profit Managed CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2003Arleen F. Brown MD OBJECTIVES: To determine whether income influences evidence-based medication use by older persons with diabetes mellitus in managed care who have the same prescription drug benefit. DESIGN: Observational cohort design with telephone interviews and clinical examinations. SETTING: Managed care provider groups that contract with one large network-model health plan in Los Angeles County. PARTICIPANTS: A random sample of community-dwelling Medicare beneficiaries with diabetes mellitus aged 65 and older covered by the same pharmacy benefit. MEASUREMENTS: Patients reported their sociodemographic and clinical characteristics. Annual household income (,$20,000 or <$20,000) was the primary predictor. The outcome variable was use of evidence-based therapies determined by a review of all current medications brought to the clinical examination. The medications studied included use of any cholesterol-lowering medications, use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) for cholesterol lowering, aspirin for primary and secondary prevention of cardiovascular disease, and angiotensin-converting enzyme (ACE) inhibitors in those with diabetic nephropathy. The influence of income on evidence-based medication use was adjusted for other patient characteristics. RESULTS: The cohort consisted of 301 persons with diabetes mellitus, of whom 53% had annual household income under $20,000. In unadjusted analyses, there were lower rates of use of all evidence-based therapies and lower rates of statin use for persons with annual income under $20,000 than for higher-income persons. In multivariate models, statin use was observed in 57% of higher-income versus 30% of lower-income respondents with a history of hyperlipidemia (P = .01) and 66% of higher-income versus 29% of lower-income respondents with a history of myocardial infarction (P = .03). There were no differences by income in the rates of aspirin or ACE inhibitor use. CONCLUSION: Among these Medicare managed care beneficiaries with diabetes mellitus, all of whom had the same pharmacy benefit, there were low rates of use of evidence-based therapies overall and substantially lower use of statins by poorer persons. [source] Breast Cancer Detection in Asymptomatic Women: Health Beliefs Implicated in Secondary PreventionJOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 2 2003Kanayo Umeh This study assessed the usefulness of health belief model (HBM) constructs in predicting the frequency and proficiency of breast self-examination among Greek women. Both additive and multiplicative functions were tested. Cross-sectional data from 195 women were analyzed. Health beliefs explained 16.5% and 19.7% of the variance in frequency and proficiency, respectively. Frequent and proficient breast examination was associated with fewer perceived barriers. Moreover, elevated confidence and susceptibility estimates predicted greater frequency and proficiency, respectively. One moderator interaction emerged, but this was attenuated after accounting for other health beliefs. These findings provide qualified support for the HBM and present a useful template for developing interventions to promote secondary prevention. [source] | ||||||||||||||||||||||||||||||||||||||||||||||