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Garg P, Alambayan J, Garg V. Herbal Approaches in the Management of Mental Depression. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:98-124. [PMID: 35088681 DOI: 10.2174/1871527321666220128091408] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Human's existence has become more stressful these days, most likely for the sake of improving one's lifestyle and fulfilling one's aspirations and needs. Depression is the most frequent neurological disorder, which affects millions of individuals worldwide. In clinical research, depression is the second most frequent chronic disease. A variety of herbal medications thought to have antidepressant-like effects have been reported in ancient pharmacopoeias from around the world. These provide several prospective chemicals that could be developed into modern mental medications while also causing no noticeable negative effects. OBJECTIVE The review is written to provide herbal treatment and comprehensive information about depression. METHODS Plants and plant formulations that were found effective in the treatment of depression are thoroughly reviewed. The antidepressant efficacies of medicinal plants, as well as their dosages, are investigated using experimental models. The review article contains 140 plants possessing antidepressant properties, 11 commercial formulations, and 25 active/isolated ingredients, as well as their chemical structure, which have been thoroughly reviewed with antidepressant activity after studying 283 references. RESULTS Literature revealed that a variety of medicinal plants are effective for the treatment of depression such as Hypericum perforatum, Catha edulis, Tinospora cordifolia, Curcuma longa, Ferula foetida, Rhodio larosea, Glycyrrhiza glabra, Crocus sativus, Ocimumba silicum and Embelica officinalis. CONCLUSION Potential compounds isolated from medicinal plants for the treatment of depressive disorders need to be established and herbal plant research could aid in this endeavour.
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Affiliation(s)
- Preeti Garg
- Department of Pharmacognosy and Phytochemistry, Hindu College of Pharmacy, Sonepat, Haryana, India
| | - Jyoti Alambayan
- Department of Pharmacognosy and Phytochemistry, Hindu College of Pharmacy, Sonepat, Haryana, India
| | - Vandana Garg
- Department of Pharmaceutical Sciences, M.D.U, Rohtak, Haryana, India
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O'Brien T, Russell CL, Tan A, Mion L, Rose K, Focht B, Daloul R, Hathaway D. A Pilot Randomized Controlled Trial Using SystemCHANGE™ Approach to Increase Physical Activity in Older Kidney Transplant Recipients. Prog Transplant 2020; 30:306-314. [PMID: 32912051 DOI: 10.1177/1526924820958148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in kidney transplant recipients. Physical activity after transplant is the most modifiable nonpharmacological factor for improving cardiovascular outcomes. Few studies have tested walking interventions to enhance daily steps and health outcomes in older kidney recipients. METHODS Using a pilot feasibility randomized clinical trial design, we tested the feasibility and efficacy of a 6-month SystemCHANGE™ (Change Habits by Applying New Goals and Experience) + Activity Tracker intervention for recruitment, retention, daily steps, and health outcomes (blood pressure, heart rate, body mass index, waist circumference, and physical function). The SystemCHANGE™ + Activity Tracker intervention taught participants to use a multicomponent intervention that connects person-centered systems solutions combined with visual feedback from a mobile activity tracker to achieve daily step goals. RESULTS Fifty-three participants (mean age 65 years, 66% male, and 57% white) participated with 27 in the intervention and 26 in the control group. The study protocol was feasible to deliver with high adherence to the protocol in both groups. The intervention group increased daily steps at 3 months (mean difference, 608; standard error = 283, P = .03) compared to the control group. The secondary outcome of heart rate decreased for the intervention group (baseline [mean] 74.4+ 10.8 [standard deviation, SD;] vs 6 months [mean] 67.6+ 11.3 [SD]; P = .002) compared to the control group (baseline [mean] 70.67+ 10.4 [SD]; vs 6 months [mean] 70.2 + 11.1 [SD]; P = .83). CONCLUSIONS SystemCHANGE™ + Activity Tracker intervention appears to be feasible and efficacious for increasing daily steps in older kidney recipients.
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Affiliation(s)
- Tara O'Brien
- 2647The Ohio State University College of Nursing, Columbus, OH, USA
| | - Cynthia L Russell
- School of Nursing and Health Studies, 12273University of Missouri-Kansas City, Kansas City, MO, USA
| | - Alai Tan
- 2647The Ohio State University College of Nursing, Columbus, OH, USA
| | - Lorraine Mion
- 2647The Ohio State University College of Nursing, Columbus, OH, USA
| | - Karen Rose
- 2647The Ohio State University College of Nursing, Columbus, OH, USA
| | - Brian Focht
- 15953The Ohio State University College of Education and Human Ecology, Columbus, OH, USA
| | - Reem Daloul
- 15953The Ohio State University College of Medicine, Columbus, OH, USA
| | - Donna Hathaway
- 16165University of Tennessee Health Science Center College of Nursing Memphis, TN, USA
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Driver S, McShan E, Swank C, Grobe K, Calhoun S, Bailey R, Kramer K. Creating an appropriate adaptation of a healthy lifestyle intervention for people after stroke. Brain Inj 2020; 34:1497-1503. [DOI: 10.1080/02699052.2020.1808703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Simon Driver
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX
| | - Evan McShan
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX
| | - Chad Swank
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX
| | - Katherine Grobe
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX
| | - Stephanie Calhoun
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, TX
| | - Ryan Bailey
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Kaye Kramer
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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Plow M, Moore SM, Chang J, Bachhal E, Sparks KE. Randomized controlled trial of SystemCHANGE™ weight management intervention in neurological conditions. PATIENT EDUCATION AND COUNSELING 2020; 103:112-119. [PMID: 31530424 DOI: 10.1016/j.pec.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This randomized controlled pilot study examined the feasibility and efficacy of a SystemCHANGE™ (SC) weight management intervention in adults with either multiple sclerosis or stroke. METHODS Participants (n = 61) were randomized into two interventions: SC, which taught skills to modify personal environments, or active-control (AC), which taught health behavior guidelines. Sessions were held weekly for 12 weeks. Feasibility measures included recruitment and attrition rates. The primary outcome of body weight and secondary outcomes of emotional well-being and healthy behaviors were measured before and after the interventions. RESULTS Average recruitment rate was 3.6 participants per month. Attrition rate was 14.8%. On average, 9.1 sessions were completed for SC and 10.7 for AC. Differences in weight loss were non-significant between interventions (P = 0.182), but significantly declined across both interventions (P = 0.011). Physical activity (P = 0.002), depression (P < 0.001), anxiety (P = 0.023), and self-efficacy (P = 0.022) all significantly improved for SC compared to AC. CONCLUSIONS SC was feasible to implement and efficacious in improving secondary outcomes of emotional well-being and healthy behaviors, but was not efficacious in improving the primary outcome of weight loss. More research is needed to optimize SC. PRACTICE IMPLICATIONS SC might be an alternative approach to cognitive-behavioral therapy for promoting emotional well-being and healthy behaviors.
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Affiliation(s)
- Matthew Plow
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, United States.
| | - Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, USA
| | - Julia Chang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, USA
| | - Emrose Bachhal
- Dahms Clinical Research Unit, University Hospitals, Cleveland, USA
| | - Kenneth E Sparks
- College of Education and Human Services, Cleveland State University, Cleveland, USA
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Randomized Controlled Trial of the SystemCHANGE Intervention on Behaviors Related to Cardiovascular Risk in HIV+ Adults. J Acquir Immune Defic Syndr 2019; 78:23-33. [PMID: 29373392 DOI: 10.1097/qai.0000000000001635] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine the effect of a lifestyle behavior intervention (SystemCHANGE) on physical activity and diet quality among sedentary people living with HIV (PLHIV). All participants expressed a desire to improve lifestyle health behaviors. METHODS One hundred and seven HIV+ adults were randomized to either the intervention (6, in-person, standardized group sessions focusing on improving lifestyle behaviors) or a control condition (general advice on AHA diet and exercise guidelines). All participants wore an ActiGraph accelerometer and completed 24-hour dietary recalls at baseline, 3, and 6 months. Generalized estimating equations were used to examine intervention effects. The primary activity outcome was time spent in moderate-to-vigorous physical activity, and the primary dietary outcome was Healthy Eating Index. RESULTS Mean age was 53 years, 65% were male, and 86% African American. Approximately 90% attended at least half of the sessions and 60% attended 5 or more sessions. The intervention did not significantly improve our primary lifestyle behavior endpoints (P ≥ 0.05); however, intervention participants consumed fewer carbohydrates-primarily sugar-sweetened beverages-per day and lost 0.732 kg body weight compared with a 0.153 weight gain in the control group (P = 0.03). CONCLUSIONS Among sedentary PLHIV at high risk of cardiovascular disease, the SystemCHANGE intervention reduced daily carbohydrate intake and body weight, but did not increase physical activity or improve overall diet quality. Future work should identify fundamental personal, interpersonal, and contextual factors that will increase physical activity and improve overall diet quality among this population, and integrate these factors into tailored, lifestyle interventions for aging PLHIV.
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Bridgwood B, Lager KE, Mistri AK, Khunti K, Wilson AD, Modi P. Interventions for improving modifiable risk factor control in the secondary prevention of stroke. Cochrane Database Syst Rev 2018; 5:CD009103. [PMID: 29734470 PMCID: PMC6494626 DOI: 10.1002/14651858.cd009103.pub3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Stroke services need to be configured to maximise the adoption of evidence-based strategies for secondary stroke prevention. Smoking-related interventions were examined in a separate review so were not considered in this review. This is an update of our 2014 review. OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (April 2017), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2017), CENTRAL (the Cochrane Library 2017, issue 3), MEDLINE (1950 to April 2017), Embase (1981 to April 2017) and 10 additional databases including clinical trials registers. We located further studies by searching reference lists of articles and contacting authors of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. DATA COLLECTION AND ANALYSIS Four review authors selected studies for inclusion and independently extracted data. The quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach (GRADEpro GDT).Three review authors assessed the risk of bias for the included studies. We sought missing data from trialists.The results are presented in 'Summary of findings' tables. MAIN RESULTS The updated review included 16 new studies involving 25,819 participants, resulting in a total of 42 studies including 33,840 participants. We used the Cochrane risk of bias tool and assessed three studies at high risk of bias; the remainder were considered to have a low risk of bias. We included 26 studies that predominantly evaluated organisational interventions and 16 that evaluated educational and behavioural interventions for participants. We pooled results where appropriate, although some clinical and methodological heterogeneity was present.Educational and behavioural interventions showed no clear differences on any of the review outcomes, which include mean systolic and diastolic blood pressure, mean body mass index, achievement of HbA1c target, lipid profile, mean HbA1c level, medication adherence, or recurrent cardiovascular events. There was moderate-quality evidence that organisational interventions resulted in improved blood pressure control, in particular an improvement in achieving target blood pressure (odds ratio (OR) 1.44, 95% confidence interval (CI) 1.09 to1.90; 13 studies; 23,631 participants). However, there were no significant changes in mean systolic blood pressure (mean difference (MD), -1.58 mmHg 95% CI -4.66 to 1.51; 16 studies; 17,490 participants) and mean diastolic blood pressure (MD -0.91 mmHg 95% CI -2.75 to 0.93; 14 studies; 17,178 participants). There were no significant changes in the remaining review outcomes. AUTHORS' CONCLUSIONS We found that organisational interventions may be associated with an improvement in achieving blood pressure target but we did not find any clear evidence that these interventions improve other modifiable risk factors (lipid profile, HbA1c, medication adherence) or reduce the incidence of recurrent cardiovascular events. Interventions, including patient education alone, did not lead to improvements in modifiable risk factor control or the prevention of recurrent cardiovascular events.
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Affiliation(s)
- Bernadeta Bridgwood
- Department of Health Sciences, University of Leicester, University Road, Leicester, UK, LE1 7RH
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Moore SM, Komton V, Adegbite-Adeniyi C, Dolansky MA, Hardin HK, Borawski EA. Development of the Systems Thinking Scale for Adolescent Behavior Change. West J Nurs Res 2018; 40:375-387. [PMID: 28303755 PMCID: PMC5581293 DOI: 10.1177/0193945917697219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This report describes the development and psychometric testing of the Systems Thinking Scale for Adolescent Behavior Change (STS-AB). Following item development, initial assessments of understandability and stability of the STS-AB were conducted in a sample of nine adolescents enrolled in a weight management program. Exploratory factor analysis of the 16-item STS-AB and internal consistency assessments were then done with 359 adolescents enrolled in a weight management program. Test-retest reliability of the STS-AB was .71, p = .03; internal consistency reliability was .87. Factor analysis of the 16-item STS-AB indicated a one-factor solution with good factor loadings, ranging from .40 to .67. Evidence of construct validity was supported by significant correlations with established measures of variables associated with health behavior change. We provide beginning evidence of the reliability and validity of the STS-AB to measure systems thinking for health behavior change in young adolescents.
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Sosnowski K, Mitchell ML, White H, Morrison L, Sutton J, Sharratt J, Lin F. A feasibility study of a randomised controlled trial to examine the impact of the ABCDE bundle on quality of life in ICU survivors. Pilot Feasibility Stud 2018; 4:32. [PMID: 29372070 PMCID: PMC5765639 DOI: 10.1186/s40814-017-0224-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 12/21/2017] [Indexed: 12/12/2022] Open
Abstract
Background Early rehabilitation has been found to prevent delirium and weakness that can hamper the recovery of intensive care unit (ICU) survivors. Integrated clinical practice guidelines for managing patient pain, agitation and delirium (PAD) have been developed. The Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle provides a strategy to implement PAD guidelines into everyday clinical practice. However, there is limited evidence on the effectiveness of the ABCDE bundle in the literature. The purpose of this study was to evaluate the feasibility of conducting a full-scale randomised controlled trial comparing the ABCDE bundle to standard care in an ICU. Trial feasibility was defined as the successful recruitment and retention of trial participants, adherence to the intervention, identification of barriers to the intervention, and the rigorous collection of outcome data. Methods A prospective, single-centre, randomised controlled feasibility study was conducted. Thirty adult mechanically ventilated participants were recruited from an eight-bed ICU in south east Queensland, Australia, between April 2015 and December 2015. Participants were randomised to receive either the ABCDE bundle or standard routine management. The ABCDE bundle integrated prescribed awakening and breathing trials, delirium monitoring and management, and prescribed exercise and mobility regimes. Feasibility outcomes measured included recruitment and retention rates, intervention fidelity, and the feasibility of participant outcome data collection. Outcome measurement assessors were blinded to participant assignment. It was not possible to blind the research team or the participant to group assignment. Results In total, 30 (81.1%) of 37 eligible participants consented and were randomised to the intervention group (n = 15) or the control group (n = 15). Of these, 23 (76.6%) participants successfully completed the 90-day post discharge assessment. A lengthy recruitment period of 8 months was related to overly stringent inclusion and exclusion criteria. Intervention adherence exceeded defined success rates with participation in awakening and breathing trials, delirium monitoring and exercise interventions performed on 80.2, 97.4 and 90.2% of ventilated days respectively. Outcome assessments were successfully and accurately performed at ICU and hospital discharge and 90-day post hospital discharge. Intervention participants were deemed to be delirious on 39.6% of mechanically ventilated days indicating a requirement for a scripted regime to prevent delirium. Conclusions With minor adjustment of inclusion and exclusion criteria, the inclusion of delirium management protocols, and encouragement of family engagement and involvement, a large-scale definitive randomised controlled trial to test the impact of the ABCDEF bundle will be feasible. Trial registration Australian New Zealand Clinical Trials Registry 12614000763640 Date registered 17/08/2014 Electronic supplementary material The online version of this article (10.1186/s40814-017-0224-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kellie Sosnowski
- 1Intensive Care Unit, Logan Hospital, Logan City, Australia.,2Griffith University, Brisbane, Australia
| | - Marion L Mitchell
- 3School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,4Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia
| | - Hayden White
- 1Intensive Care Unit, Logan Hospital, Logan City, Australia.,2Griffith University, Brisbane, Australia
| | | | - Joanne Sutton
- 1Intensive Care Unit, Logan Hospital, Logan City, Australia
| | | | - Frances Lin
- 3School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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O'Brien T, Hathaway D. An Integrative Literature Review of Physical Activity Recommendations for Adult Renal Transplant Recipients. Prog Transplant 2016; 26:381-385. [PMID: 27555071 DOI: 10.1177/1526924816664079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To establish the current state of knowledge regarding physical activity interventions for adult kidney transplant recipients. DATA SOURCES A comprehensive literature search was conducted for the years 2009 to 2015 using 5 electronic databases: PubMed, CINAHL, Cochrane Library, Ovid, and ScienceDirect. DATA EXTRACTION Of the 110 articles identified, only 6 met inclusion requirements. These studies were conducted between 2009 and 2015 and found that weight gain was reported most often within the first year of transplantation and that kidney transplant recipients desired early interventions to help them become more physically active. CONCLUSION Further research is recommended to design age-appropriate physical activity interventions among this aging population living with a chronic condition known to have a high prevalence of obesity and cardiovascular disease.
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Affiliation(s)
- Tara O'Brien
- 1 College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Donna Hathaway
- 1 College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
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Moore SM, Jones L, Alemi F. Family self-tailoring: Applying a systems approach to improving family healthy living behaviors. Nurs Outlook 2016; 64:306-311. [PMID: 27301950 PMCID: PMC4947020 DOI: 10.1016/j.outlook.2016.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/05/2016] [Accepted: 05/11/2016] [Indexed: 11/18/2022]
Abstract
The adoption and maintenance of healthy living behaviors by individuals and families is a major challenge. We describe a new model of health behavior change, SystemCHANGE (SC), which focuses on the redesign of family daily routines using system improvement methods. In the SC intervention, families are taught a set of skills to engage in a series of small, family self-designed experiments to test ideas to change their daily routines. The family system-oriented changes brought about by these experiments build healthy living behaviors into family daily routines so that these new behaviors happen as a matter of course, despite wavering motivation, willpower, or personal effort on the part of individuals. Case stories of the use of SC to improve family healthy living behaviors are provided. Results of several pilot tests of SC indicate its potential effectiveness to change health living behaviors across numerous populations.
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Affiliation(s)
- Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.
| | - Lenette Jones
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Farrokh Alemi
- Department of Health Administration and Policy, George Mason University, Fairfax, VA
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Brewer L, Mellon L, Hall P, Dolan E, Horgan F, Shelley E, Hickey A, Williams D. Secondary prevention after ischaemic stroke: the ASPIRE-S study. BMC Neurol 2015; 15:216. [PMID: 26492943 PMCID: PMC4619229 DOI: 10.1186/s12883-015-0466-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 10/07/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Survivors of ischaemic stroke (IS) are at high-risk for future vascular events. Comprehensive information on the adequacy of secondary prevention after IS is lacking despite the knowledge that appropriate secondary prevention improves long-term patient outcomes. ASPIRE-S (Action on Secondary Prevention Interventions and Rehabilitation in Stroke) aimed to prospectively assess secondary prevention in patients 6 months following IS. METHODS Consenting patients admitted with IS to three Dublin hospitals were recruited over 1 year, from October 2011. At 6 months post IS a comprehensive assessment was completed, modelled on the EUROASPIRE protocol for evaluation of the adequacy of secondary prevention in post-discharge cardiac patients. This assessment included measurements of blood pressure, body mass index and fasting lipid and glucose profiles. Secondary preventive medications and smoking status were also documented. RESULTS Three hundred two patients (58 % male) participated, of whom 256 (85 %) were followed-up at 6 months. Mean age was 69 years (range 22-95). At follow-up, 68 % of patients had a BMI >25 kg/m(2) and 16.4 % were still smoking. Almost two-thirds (63.4 %) had a blood pressure >140/90 and 23 % had low-density-lipoprotein >2.5 mmol/L. 28 % of diabetic patients had HbA1c ≥ 7 %. Ninety seven percent of patients were on anti-platelet and/or anticoagulant therapy. Of those with atrial fibrillation, 82 % were anti-coagulated (mean INR of 2.4). Ninety-five percent were on lipid-lowering therapy and three-quarters were on anti-hypertensive therapy. CONCLUSION This prospective multi-centre survey of IS patients demonstrated a high prevalence of remaining modifiable risk factors at 6 months post stroke, despite the widespread prescription of secondary preventive medications. There is scope to improve preventive measures after IS (in particular blood pressure) by incorporating evidence-based guidelines into quality assurance cycles in stroke care.
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Affiliation(s)
- Linda Brewer
- Department of Geriatric & Stroke Medicine, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, 9, Ireland.
| | - Lisa Mellon
- Department of Psychology, RCSI, Dublin, 2, Ireland.
| | | | - Eamon Dolan
- Department of Geriatric & Stroke Medicine, Connolly Hospital, Blanchardstown, Dublin, 15, Ireland.
| | | | - Emer Shelley
- Department of Epidemiology and Public Health, RCSI, Dublin, 2, Ireland.
| | - Anne Hickey
- Department of Psychology, RCSI, Dublin, 2, Ireland.
| | - David Williams
- Department of Geriatric & Stroke Medicine, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, 9, Ireland.
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