Non-pharmacological Interventions For Prevention Research Articles

A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline.

Hypertensive disorders of pregnancy (HDP) affect up to 10% of all pregnancies annually and are associated with an increased risk of maternal and fetal morbidity and mortality. This guideline represents an update of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) guidelines for the management of hypertensive disorders of pregnancy 2014 and has been approved by the National Health and Medical Research Council (NHMRC) under section14A of the National Health and Medical Research Council Act 1992. In approving the guideline recommendations, NHMRC considers that the guideline meets NHMRC's standard for clinical practice guidelines. A total of 39 recommendations on screening, preventing, diagnosing and managing HDP, especially preeclampsia, are presented in this guideline. Recommendations are presented as either evidence-based recommendations or practice points. Evidence-based recommendations are presented with the strength of recommendation and quality of evidence. Practice points were generated where there was inadequate evidence to develop specific recommendations and are based on the expertise of the working group. This version of the SOMANZ guideline was developed in an academically robust and rigorous manner and includes recommendations on the use of combined first trimester screening to identify women at risk of developing preeclampsia, 14 pharmacological and two non-pharmacological preventive interventions, clinical use of angiogenic biomarkers and the long term care of women who experience HDP. The guideline also includes six multilingual patient infographics which can be accessed through the main website of the guideline. All measures were taken to ensure that this guideline is applicable and relevant to clinicians and multicultural women in regional and metropolitan settings in Australia and New Zealand.

Pharmacological and Nonpharmacological Interventions for Prevention and Management of Pulmonary Embolism in Patients with Cardiac Comorbidities: A Literature Review

Pulmonary embolism (PE) presents significant healthcare challenges and potentially life-threatening consequences, demanding a nuanced approach to management. This systematic review aimed to critically evaluate available pharmacological and nonpharmacological interventions for PE, analyzing their efficacy and safety in patients with cardiac comorbiditie, ranging from traditional anticoagulants like warfarin to novel direct oral anticoagulants (DOACs) or thrombolytic therapies is commercially available options with varying benefits and limitations. Nonpharmacological interventions, including catheter-directed therapies and embolectomy, provide alternative avenues, especially when thrombolysis is contraindicated despite advancements, and gaps persist, particularly in reconciling efficacy with safety profiles and optimizing resource allocation. Addressing these challenges necessitates a multidisciplinary approach, integrating clinical expertise with evidence-based practices. By exploring these interventions' intricacies and implications, this review aims to inform clinicians, researchers, and policymakers, fostering improved care pathways and better outcomes for patients facing the complex landscape of PE management.

Dealing with the unknown: perceptions, fears and worries of SARS-CoV-2 infection among hospital workers

ObjectiveThis study explores fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives, co-workers, and patients in relation to non-pharmacological preventive interventions among healthcare workers (including physicians, nurses, aides, cleaners, maintenance, and security staff) in a healthcare institution in Barcelona (Spain), during the first and second waves of the SARS-CoV-2 pandemic. MethodThe research used an explorative qualitative approach. Six focus groups and ten individual interviews were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding. ResultsForty professionals participated in the study. Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties. ConclusionsThis study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers’ fears and worries about the risk of infection and spreading the infection to others, including families. Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization. These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, to also reduce health inequalities.

Dealing with the unknown: perceptions and fears of SARS-CoV-2 infection among hospital workers

Abstract Introduction This study aims to explore perceptions, fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives and/or co-workers and non-pharmacological preventive interventions among hospital workers. Materials and Methods The research used an explorative qualitative approach. Six focus groups and ten individual interviews across multidisciplinary workers (physicians, nurses, aides, cleaners, maintenance, and security staff) were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding. Results Forty professionals participated in the study. Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties. Conclusions This study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers’ fears and worries about the risk of infection and spreading the infection to others, including families. Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization. These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, in order to reduce also health inequalities. Key messages • Lack of pandemic preparedness increased HCW’ fear of infection, which could be reduced by ensuring the availability and good use of proper PPE, and by clear guidelines on case/contact detection. • The improvement on non-pharmacological preventive interventions must be underpinned by effective communication channels and/or communication staff, and should reach all workers in the institution.

Prevention of COVID-19 superspreading events in buses boarded by presymptomatic cases.

COVID-19 superspreader events have occurred when symptomatic individuals without wearing face masks boarded buses. To report the risk of superspreader events when presymptomatic individuals boarded buses to-gether with unvaccinated passengers, but with non-pharmacological preventive interventions being maintained. Prospec-tive study of health personnel transported in buses to a COVID-19 vaccination center for two weeks. Open windows, correct use of face masks and exclusion of symptomatic individuals were mandatory. Prospective surveillance identified workers with COVID-19 within 14 days after vaccination. Each asymptomatic passenger of buses where cases were identified was monitored for a similar time period. Voluntary screening results were available for workers who were tested in the month before or after vaccination. 1,879 workers boarded 65 buses. On-board time ranged from three to eight hours. Twenty-nine cases of COVID-19 and four asymptomatic cases were identified among 613 passengers of 21 buses. Median time between vaccina-tion and COVID-19 symptoms onset was six days. One case of suspected transmission on a bus was identi-fied. Strict nonpharmacological preventive interventions substantially reduced the risk of COVID-19 super-spreader events in buses boarded by presymptomatic individuals.

Non-pharmacological interventions for the prevention of type 2 diabetes in low-income and middle-income countries: a systematic review of randomised controlled trials

ObjectiveDiabetes poses serious health threats and economic burdens to patients, especially in low-income and middle-income countries (LMICs). This systematic review searches for non-pharmacological interventions for the prevention of type-2 diabetes...

Non-Pharmacological Preventive Measures Had an Impact on COVID-19 in Healthcare Workers before the Vaccination Effect: A Cohort Study.

Healthcare workers have been and still are at the forefront of COVID-19 patient care. Their infection had direct implications and caused important challenges for healthcare performance. The aim of this study is to assess the impact of non-pharmacological preventive measures against COVID-19 among healthcare workers. This study is based on a dynamic cohort of healthcare workers (n = 5543) who had been hired by a Spanish hospital for at least one week during 2020. Negative binomial regression models were used to estimate the incidence rate and the rate ratio (RR) between the two waves (defined from 15 March to 21 June and from 22 June to 31 December), considering natural immunity during the first wave and contextual variables. All models were stratified by socio-occupational variables. The average COVID-19 incidence rate per 1000 worker-days showed a significant reduction between the two waves, dropping from 0.82 (CI95%: 0.73–0.91) to 0.39 (0.35–0.44). The adjusted RR was 0.54 (0.48–0.87) when natural immunity was acquired during the first wave, and contextual variables were considered. The significant reduction of the COVID-19 incidence rate could be explained mainly by improvement in the non-pharmacological preventive interventions. It is needed to identify which measures were more effective. Young workers and those with a replacement contract were identified as vulnerable groups that need greater preventive efforts. Future preparedness plans would benefit from these results.

Targeting Default Mode Network Dysfunction in Persons at Risk of Alzheimer's Disease with Transcranial Magnetic Stimulation (NEST4AD): Rationale and Study Design.

Default mode network (DMN) dysfunction is well established in Alzheimer's disease (AD) and documented in both preclinical stages and at-risk subjects, thus representing a potential disease target. Multi-sessions of repetitive transcranial magnetic stimulation (rTMS) seem capable of modulating DMN dynamics and memory in healthy individuals and AD patients; however, the potential of this approach in at-risk subjects has yet to be tested. This study will test the effect of rTMS on the DMN in healthy older individuals carrying the strongest genetic risk factor for AD, the Apolipoprotein E (APOE) ɛ4 allele. We will recruit 64 older participants without cognitive deficits, 32 APOE ɛ4 allele carriers and 32 non-carriers as a reference group. Participants will undergo four rTMS sessions of active (high frequency) or sham DMN stimulation. Multimodal imaging exam (including structural, resting-state, and task functional MRI, and diffusion tensor imaging), TMS with concurrent electroencephalography (TMS-EEG), and cognitive assessment will be performed at baseline and after the stimulation sessions. We will assess changes in DMN connectivity with resting-state functional MRI and TMS-EEG, as well as changes in memory performance in APOE ɛ4 carriers. We will also investigate the mechanisms underlying DMN modulation through the assessment of correlations with measures of neuronal activity, excitability, and structural connectivity with multimodal imaging. The results of this study will inform on the physiological and cognitive outcomes of DMN stimulation in subjects at risk for AD and on the possible mechanisms. These results may outline the design of future non-pharmacological preventive interventions for AD.

Pharmacologic and non-pharmacologic interventions to prevent hypersensitivity reactions of non-ionic iodinated contrast media: a systematic review protocol

IntroductionIodinated contrast media are commonly used in medical imaging and can cause hypersensitivity reactions, including rare but severe life-threatening reactions. Although several prophylactic approaches have been proposed for severe reactions,...

Nonpharmacological interventions for the prevention of hypertension in low- and middle-income countries: a systematic review and meta-analysis

Hypertension is the single biggest cause of various cardiovascular complications and at the same time one of the most preventable phenomena. Low- and middle-income countries (LMICs) are facing increasing prevalence of hypertension which is imposing a huge burden on morbidity, premature mortality, and catastrophic health expenditure. This systematic review searched for the nonpharmacological interventions for prevention of hypertension among normotensive people in LMICs considering the period 1990–2016. This review has been conducted following standard methodology of Cochrane review involving two independent reviewers in screening, quality appraisal, and data extraction. Narrative synthesis of included articles was demonstrated using tables and meta-analysis was conducted to pool the estimates of studies which fulfilled the criteria. Total seven trials were included in the review with 6046 participants from eight LMICs. Two cluster randomized trials were pooled and there was a statistically significant effect (Systolic Blood Pressure: mean difference −2.35 [95% CI: −4.31 to −0.38], Diastolic Blood Pressure: mean difference −2.11 [95% CI: −3.20 to −1.02]) of home based health education in reducing blood pressure. Three individual studies reported reduction of blood pressure as a result of restricted dietary sodium intake. None of the studies was appraised as low risk of bias due to poor methodological quality. Non-pharmacological interventions can play important role in preventing the development of hypertension among normotensive people. Further trials with longer follow-up period and robust methods are recommended for getting stronger evidence on these interventions.

Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial

A fixed-dose combination therapy (polypill strategy) has been proposed as an approach to reduce the burden of cardiovascular disease, especially in low-income and middle-income countries (LMICs). The PolyIran study aimed to assess the effectiveness and safety of a four-component polypill including aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan for primary and secondary prevention of cardiovascular disease. The PolyIran study was a two-group, pragmatic, cluster-randomised trial nested within the Golestan Cohort Study (GCS), a cohort study with 50 045 participants aged 40-75 years from the Golestan province in Iran. Clusters (villages) were randomly allocated (1:1) to either a package of non-pharmacological preventive interventions alone (minimal care group) or together with a once-daily polypill tablet (polypill group). Randomisation was stratified by three districts (Gonbad, Aq-Qala, and Kalaleh), with the village as the unit of randomisation. We used a balanced randomisation algorithm, considering block sizes of 20 and balancing for cluster size or natural log of the cluster size (depending on the skewness within strata). Randomisation was done at a fixed point in time (Jan 18, 2011) by statisticians at the University of Birmingham (Birmingham, UK), independent of the local study team. The non-pharmacological preventive interventions (including educational training about healthy lifestyle-eg, healthy diet with low salt, sugar, and fat content, exercise, weight control, and abstinence from smoking and opium) were delivered by the PolyIran field visit team at months 3 and 6, and then every 6 months thereafter. Two formulations of polypill tablet were used in this study. Participants were first prescribed polypill one (hydrochlorothiazide 12·5 mg, aspirin 81 mg, atorvastatin 20 mg, and enalapril 5 mg). Participants who developed cough during follow-up were switched by a trained study physician to polypill two, which included valsartan 40 mg instead of enalapril 5 mg. Participants were followed up for 60 months. The primary outcome-occurrence of major cardiovascular events (including hospitalisation for acute coronary syndrome, fatal myocardial infarction, sudden death, heart failure, coronary artery revascularisation procedures, and non-fatal and fatal stroke)-was centrally assessed by the GCS follow-up team, who were masked to allocation status. We did intention-to-treat analyses by including all participants who met eligibility criteria in the two study groups. The trial was registered with ClinicalTrials.gov, number NCT01271985. Between Feb 22, 2011, and April 15, 2013, we enrolled 6838 individuals into the study-3417 (in 116 clusters) in the minimal care group and 3421 (in 120 clusters) in the polypill group. 1761 (51·5%) of 3421 participants in the polypill group were women, as were 1679 (49·1%) of 3417 participants in the minimal care group. Median adherence to polypill tablets was 80·5% (IQR 48·5-92·2). During follow-up, 301 (8·8%) of 3417 participants in the minimal care group had major cardiovascular events compared with 202 (5·9%) of 3421 participants in the polypill group (adjusted hazard ratio [HR] 0·66, 95% CI 0·55-0·80). We found no statistically significant interaction with the presence (HR 0·61, 95% CI 0·49-0·75) or absence of pre-existing cardiovascular disease (0·80; 0·51-1·12; pinteraction=0·19). When restricted to participants in the polypill group with high adherence, the reduction in the risk of major cardiovascular events was even greater compared with the minimal care group (adjusted HR 0·43, 95% CI 0·33-0·55). The frequency of adverse events was similar between the two study groups. 21 intracranial haemorrhages were reported during the 5 years of follow-up-ten participants in the polypill group and 11 participants in the minimal care group. There were 13 physician-confirmed diagnoses of upper gastrointestinal bleeding in the polypill group and nine in the minimal care group. Use of polypill was effective in preventing major cardiovascular events. Medication adherence was high and adverse event numbers were low. The polypill strategy could be considered as an additional effective component in controlling cardiovascular diseases, especially in LMICs. Tehran University of Medical Sciences, Barakat Foundation, and Alborz Darou.

Effectiveness of Polypill for Primary and Secondary Prevention of Cardiovascular Diseases: A Pragmatic Cluster Randomized Controlled Trial

Background: A fixed-dose combination therapy strategy) has been proposed as an approach to reduce the burden of cardiovascular disease (CVD), especially in lower resource settings. We conducted the PolyIran Study to assess the effectiveness and safety of a four-component polypill including aspirin, atorvastatin, hydrochlorothiazide and either enalapril or valsartan, for primary and secondary prevention of CVD. Methods: The study population comprised of rural participants of the Golestan Cohort Study aged 50 years or older. Considering villages as clusters, the study participants were cluster randomized to a package of non-pharmacological preventive interventions either alone (minimal care arm) or together with a once daily polypill (polypill arm). Participants were followed for 60 months. The primary outcome was occurrence of major cardiovascular events (MCVE), which was compared between the two arms using Cox regression models with shared frailty. Findings: Overall, 6838 individuals were enrolled in the study, including 3417 (in 116 clusters) in the minimal care arm and 3421 (in 120 clusters) in the polypill arm. Median (interquartile range) adherence to polypill tablets was 80.5% (48.5%-92.2%). During the follow up, 202 and 301 participants in the polypill and minimal care arms, respectively, had one or more MCVE (adjusted hazard ratio [HR]=0.66; 95% confidence interval [CI]: 0.55-0.80). Polypill was effective for both primary and secondary prevention of CVD. When restricted to participants with high adherence, the risk of MCVE was further reduced (adjusted HR=0.43; 95%CI: 0.33-0.55). Overall, the frequency of adverse events was comparable between the two arms. Interpretation: Using polypill was effective in preventing MCVE. Medication adherence was high, and rates of adverse events were low. The polypill strategy may be considered as an additional effective component in controlling CVDs, especially in low resources settings. Trial Registration: Cllinicaltrials.gov identifier: NCT01271985. Funding Statement: The study was supported by and Alborz Darou, Barakat Foundation, and Tehran University of Medical Sciences. Golestan Cohort study was supported by Cancer Research UK (grant number: C20/A5860), Tehran University of Medical Sciences (grant number: 81/15), and the International Agency for Research on Cancer. Declaration of Interests: The authors disclose no conflicts. Ethics Approval Statement: The protocol of the PolyIran Study was reviewed and approved by Institutional Review Board (IRB) of Digestive Diseases Research Institute and Tehran University of Medical Sciences.

Primary prevention of cardiovascular disease: an umbrella review.

The aim of this study is to determine the effectiveness of non-pharmacological interventions for prevention of cardiovascular disease (CVD) events and mortality in healthy adults or those at high risk of CVD. An umbrella review about primary prevention of non-pharmacological interventions was undertaken in key databases as PubMed Health, Effective Health Care Program AHRQ, McMaster University and the Cochrane Plus until July 2017. The primary outcomes were the relative risk of fatal and non-fatal CVD events, and mortality. Secondary outcomes were adverse events. Twenty-four reviews were included of which thirteen reported outcomes of interest. Four of these found a pooled statistically significant risk reduction: dietary supplements of vitamin D, increased consumption of omega 3 fatty acids, Qigong, and counselling or education to modify more than one cardiovascular risk factor. Seven studies reported adverse events but minor or insignificant with respect to the control group. Four non-pharmacological interventions have been shown to provide a statistically significant reduction in risk of CVD events or overall mortality, with minor adverse events if any. Further research should aim for higher methodological quality and longer follow-up of interventions to establish if these interventions, alone or in combination, translate into definite long-term health benefits.

Polypill for the prevention of cardiovascular disease (PolyIran): study design and rationale for a pragmatic cluster randomized controlled trial.

The complexity of treatment regimens, costs and pill burden decrease the medication adherence and contribute to shortfall in cardiovascular preventive drug coverage. The polypill, a fixed dose combination pill of established drugs, is expected to increase adherence and reduce the costs whilst preventing major cardiovascular events (MCVE). The PolyIran trial is a pragmatic cluster randomized trial nested within the Golestan Cohort Study (GCS). Subjects were randomized to either non-pharmacological preventive interventions alone (minimal care arm) or together with a polypill (polypill arm) comprising hydrochlorothiazide, aspirin, atorvastatin and either enalapril or valsartan. This study benefits from the infrastructure of the primary health care system in Iran and the interventions are delivered by the local auxiliary health workers (Behvarz) to the participants. The primary outcome of the study is the occurrence of first MCVE within five years defined as non-fatal and fatal myocardial infarction, unstable angina, sudden death, heart failure, coronary artery revascularization procedures, and non-fatal and fatal stroke. From February 2011 to April 2013, 8410 individuals (236 clusters) attended the eligibility assessment. Of those, 3421 in the polypill arm and 3417 in the minimal care arm were eligible. The study is ongoing. The infrastructure of GCS and the primary health care system in Iran enabled the conduct of this pragmatic large-scale trial. If the polypill strategy proves effective, it may be implemented to prevent cardiovascular disease in developing countries.

Prevention of type 2 diabetes among youth: a systematic review, implications for the school nurse.

Childhood obesity and the early development of type 2 diabetes (T2 DM) place students at risk for chronic health problems. The school nurse is uniquely situated to promote school health initiatives that influence health behavior. The purpose of this review was to determine effective nonpharmacological interventions for prevention of T2 DM in youth. Researchers from 35 reports modified T2 DM risk factors. These nonpharmacological interventions often include increasing daily activity, decreasing caloric intake, and increasing muscle mass. Some researchers also included psychological and social support interventions intended to strengthen initiating and/or maintaining health behavior. Characteristics of effective nonpharmacological T2 DM prevention interventions are discussed. Findings from this review are a useful guide for the implementation of T2 DM prevention strategies in the school setting. Few school-based studies included high school students; therefore, further research is needed among older adolescents on the efficacy of nonpharmacological interventions in the high school.

Zur Überschätzung des Nutzens von Prävention

Both pharmacological and non-pharmacological preventive interventions can do more harm than good. Health checks target a healthy or symptomless population. This is why randomised controlled trials (RCTs) must be conducted to provide high-quality evidence for the benefit of an intervention. The present article presents examples to demonstrate that the benefit of preventive interventions is usually overestimated. Standard screening criteria are used to critically appraise selected preventive interventions. Screening criteria cover the disease, the test, the treatment and the whole programme including evaluation and quality assurance. Type-2 diabetes mellitus is used as an example to discuss specific criteria for preventive interventions. The current state of the evidence is outlined. The article is based primarily on systematic / Cochrane reviews of RCTs. A recent Cochrane review including 16 RCTs concluded that there is no benefit of general health checks. High-quality evidence on individual components of health checks is frequently missing or inconclusive. Over the last 30 years reference values for normal blood glucose and normal blood pressure as well as treatment targets for patients with type-2 diabetes mellitus and hypertension have been repeatedly decreased though this is not supported by evidence. Recent high-quality RCTs have shown that these "hit hard and early" interventions are detrimental, particularly to those who were the primary target group. Consequently, treatment targets have again been raised and recent guidelines recommend individualisation of treatment goals taking age and comorbidities into account. Important criteria for the implementation of preventive interventions are not currently met. With regard to type-2 diabetes uncertainties remain as to the clinical significance of pre-diabetes, the treatment of pre-diabetes and early treatment of diabetes, the screening tests, and target groups. The ADDITION study was unable to prove the benefit of a diabetes screening. Intensive lifestyle interventions may result in modest reductions of body weight and fewer diabetes diagnoses. However, the clinical relevance of the underlying metabolic changes is doubtful or even negligible. After almost 10 years, the Look AHEAD study has been terminated early due to the ineffectiveness of its intensive lifestyle interventions and the lack of hope that the study will succeed in demonstrating any benefit on the primary cardiovascular endpoints during the originally planned study period of another 3 years. The benefit of prevention is overestimated whereas harm is underestimated. It is most unlikely that medical preventive interventions targeting individual behaviour changes will result in better health for our population.

Atrial arrhythmias after cardiac surgery in patients with diabetes mellitus

Postoperative atrial fibrillation (AF) is a common complication of cardiac surgery and has been associated with increased incidence of other complications and increased hospital length of stay (LOS). Prevention of AF is a reasonable clinical goal, and, consequently, many randomized trials have evaluated the effectiveness of pharmacological and non-pharmacological interventions for prevention of AF. To better understand the role of various prophylactic therapies against postoperative AF, a systematic review of evidence from randomized trials was performed. MEDLINE search of English-language reports published between 1966 and July 2005 and a search of references of relevant papers were conducted. Clinical studies on AF after cardiac surgery were selected for this analysis. Relevant clinical information was extracted from selected articles. Postoperative AF is associated with increased morbidity and mortality and longer, more expensive hospital stays. Prophylactic use of beta-adrenergic blockers reduces the incidence of postoperative AF and should be administered before and after cardiac surgery to all patients without contraindication. Prophylactic amiodarone and atrial overdrive pacing should be considered in patients at high risk for postoperative AF (for example, patients with previous AF or mitral valve surgery). For patients who develop AF after cardiac surgery, a strategy of rhythm management or rate management should be selected. For patients who are hemodynamically unstable or highly symptomatic or who have a contraindication to anticoagulation, rhythm management with electrical cardioversion, amiodarone, or both is preferred. Treatment of the remaining patients should focus on rate control because most will spontaneously revert to sinus rhythm within 6 weeks after discharge. All patients with AF persisting for more than 24 to 48 hours and without contraindication should receive anticoagulation. AF frequently complicates cardiac surgery. Many cases can be prevented with appropriate prophylactic therapy. A strategy of rhythm management for symptomatic patients and rate management for all other patients usually results in reversion to sinus rhythm within 6 weeks of discharge.

Die Effektivität nicht-medikamentöser Interventionen in der Schmerzbehandlung von Früh- und Termingeborenen Eine systematische Literaturübersicht

Der Schmerz von Früh- und Termingeborenen ist im Rahmen neonatologischer Intensivpflege ein zentrales Thema, zumal viele diagnostische und therapeutische Maßnahmen mit schmerzhaften Reizen verbunden sind. Weil pharmakologische Analgetika beträchtliche Nebenwirkungen mit sich bringen können, werden heute zur Schmerzprävention und -behandlung zunehmend nicht-medikamentöse Behandlungsmethoden empfohlen. Diese sind für die Pflege von großer Relevanz, legen sie doch Interventionen fest, die eigenständig durchgeführt und außerhalb von ärztlichen Verordnungen zu orten sind. Die vorliegende systematische Literaturübersicht geht der Frage nach der Effektivität nicht-medikamentöser Interventionen zur Schmerzreduktion in der Pflege von Früh- und Termingeborenen einer neonatologischen Intensivstation nach. Obwohl die analysierten Studien einige methodologische Mängel aufweisen, lässt sich eine Tendenz in der Effektivität nicht-medikamentöser Interventionen beschreiben: Sie führen zu einer Reduktion des Erregungszustandes von Früh- und Termingeborenen während und nach schmerzhaften Verrichtungen und sie regulieren physiologische und verhaltensbedingte Reaktionen. Die Studien geben erste Hinweise darauf, dass Neugeborene aufgrund nicht-medikamentöser Interventionen zur Schmerzlinderung mit deutlich weniger Schmerz und- Stresszeichen reagieren.

Antiarrhythmic therapy on prevention of postoperative atrial fibrillation in patients after heart surgery.

The incidence of supraventricular arrhythmias is high following open-heart surgery, occurring in 25% to about 50% of patients. The most common of these arrhythmias is atrial fibrillation (AF). Postoperative AF has been associated with increased incidence of other complications and increased hospital length of stay. Atrial arrhythmias are most frequent in the first two to three days after cardiothoracic surgery, but they can occur at any point in the recovery period. Age and concomitant valular heart disease are consistently the independent factors most strongly associated with postoperative atrial fibrillation. Prevention of AF seems to be a reasonable clinical goal, and, consequently, many randomized trials have evaluated the effectiveness of pharmacological and nonpharmacological interventions for prevention of AF. The main indication for AF prophylaxis remains the shorteningof length of hospital stay and possibly reduction in stroke. The optimal treatment strategies for reducing postoperative AF are not well established. Commonly used therapeutic approaches include the use of rate-controlling drugs such as beta-blockers, calcium antagonists, and digoxin. Some pharmacological strategies including beta-blockers, sotalol, and amiodarone have shown to reduce risk of postoperative AF and may reduce length of hospital stay. There is no convincing evidence that reducing postoperative AF reduces stroke. This review summarizes current evidence from randomized controlled trials to estimate the effect of pharmacological and non pharmacologic interventions on the occurrence of AF after open-heart surgery and its effects on postoperative outcome.

Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis.

Postoperative atrial fibrillation (AF) is a common complication of cardiac surgery and has been associated with increased incidence of other complications and increased hospital length of stay (LOS). Prevention of AF is a reasonable clinical goal, and, consequently, many randomized trials have evaluated the effectiveness of pharmacological and nonpharmacological interventions for prevention of AF. To better understand the role of various prophylactic therapies against postoperative AF, a systematic review of evidence from randomized trials was performed. Fifty-two randomized trials (controlled by placebo or routine treatment) of beta-blockers, sotalol, amiodarone, or pacing were identified by systematic literature search. The 3 drug treatments each prevented AF with the following odds ratios (ORs): beta-blockers, 0.39 (95% CI, 0.28 to 0.52); sotalol, 0.35 (95% CI, 0.26 to 0.49); and amiodarone, 0.48 (95% CI, 0.37 to 0.61). Pacing was also effective; for biatrial pacing, the OR was 0.46 (95% CI, 0.30 to 0.71). The influence of pharmacological interventions on LOS was as follows: -0.66 day (95% CI, 2.04 to 0.72) for beta-blockers; -0.40 day (95% CI, 0.87 to 0.08) for sotalol; and -0.91 day (95% CI, 1.59 to -0.23) for amiodarone. The influence for biatrial pacing was -1.54 day (95% CI, -2.85 to -0.24). The incidence of stroke was 1.2% in all the treatment groups combined and 1.4% in controls (OR, 0.90; 95% CI, 0.46 to 1.74). Beta-blockers, sotalol, and amiodarone all reduce risk of postoperative AF with no marked difference between them. There is evidence that use of these drugs will reduce LOS. Biatrial pacing is a promising new treatment opportunity. There was no evidence that reducing postoperative AF reduces stroke; however, data on stroke are incomplete.