scholarly journals Systematic Identification of Familial Hypercholesterolaemia in Primary Care—A Systematic Review

2021 ◽  
Vol 11 (4) ◽  
pp. 302
Author(s):  
Luisa Silva ◽  
Nadeem Qureshi ◽  
Hasidah Abdul-Hamid ◽  
Stephen Weng ◽  
Joe Kai ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Familial Hypercholesterolaemia ◽  
Insufficient Evidence ◽  
Lipid Clinic ◽  
Premature Cardiovascular Disease ◽  
Laboratory Test Results ◽  
Nurse Assessment ◽  
Randomised Controlled ◽  
Systematic Identification

Familial hypercholesterolaemia (FH) is a common inherited cause of premature cardiovascular disease, but the majority of patients remain undiagnosed. The aim of this systematic review was to assess the effectiveness of interventions to systematically identify FH in primary care. No randomised, controlled studies were identified; however, three non-randomised intervention studies were eligible for inclusion. All three studies systematically identified FH using reminders (on-screen prompts) in electronic health records. There was insufficient evidence that providing comments on laboratory test results increased the identification of FH using the Dutch Lipid Clinic Network (DLCN) criteria. Similarly, using prompts combined with postal invitation demonstrated no significant increase in definite FH identification using Simon-Broome (SB) criteria; however, the identification of possible FH increased by 25.4% (CI 17.75 to 33.97%). Using on-screen prompts alone demonstrated a small increase of 0.05% (95% CI 0.03 to 0.07%) in identifying definite FH using SB criteria; however, when the intervention was combined with an outreach FH nurse assessment, the result was no significant increase in FH identification using a combination of SB and DLCN criteria. None of the included studies reported adverse effects associated with the interventions. Currently, there is insufficient evidence to determine which is the most effective method of systematically identifying FH in non-specialist settings.

scholarly journals Impact of PCSK9 monoclonal antibodies on circulating hs-CRP levels: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022348 ◽  
Author(s):  
Ye-Xuan Cao ◽  
Sha Li ◽  
Hui-Hui Liu ◽  
Jian-Jun Li
Keyword(s):  
Systematic Review ◽  
Treatment Duration ◽  
Randomised Controlled Trials ◽  
Familial Hypercholesterolaemia ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Participant Characteristics ◽  
Hs Crp ◽  
Randomised Controlled

ObjectiveTo evaluate the potential effects of proprotein convertase subtilisin/kexin type 9 monoclonal antibody (PCSK9-mAb) on high-sensitivity C reactive protein (hs-CRP) concentrations.DesignA systematic review and meta-analysis of randomised controlled trials.Data sourcesPubMed, MEDLINE, the Cochrane Library databases, ClinicalTrials.gov and recent conferences were searched from inception to May 2018.Eligibility criteria for selecting studiesAll randomised controlled trials that reported changes of hs-CRP were included.ResultsTen studies involving 4198 participants were identified. PCSK9-mAbs showed a slight efficacy in reducing hs-CRP (−0.04 mg/L, 95% CI: −0.17 to 0.01) which was not statistically different. The results did not altered when subgroup analyses were performed including PCSK9-mAb types (alirocumab: 0.12 mg/L, 95% CI: −0.18 to 0.43; evolocumab: 0.00 mg/L, 95% CI: −0.07 to 0.07; LY3015014: −0.48 mg/L, 95% CI: −1.28 to 0.32; RG7652: 0.35 mg/L, 95% CI: −0.26 to 0.96), treatment duration (≤12w: 0.00 mg/L, 95% CI: −0.07 to 0.07; >12w: −0.11 mg/L, 95% CI: −0.45 to −0.23), participant characteristics (familial hypercholesterolaemia: 0.00 mg/L, 95% CI: −0.07 to 0.07; non-familial hypercholesterolaemia: 0.07 mg/L, 95% CI: −0.12 to 0.26; mix: −0.48 mg/L, 95% CI: −1.28 to 0.32) and treatment methods (monotherapy: 0.00 mg/L, −0.08 to 0.07; combination therapy: −0.08 mg/L, −0.37 to 0.21). Meta-regression analyses suggested no significant linear correlation between baseline age (p=0.673), sex (p=0.645) and low-density lipoprotein cholesterol reduction (p=0.339).ConclusionsOur updated meta-analysis suggested that PCSK9-mAbs had no significant impact on circulating hs-CRP levels irrespective of PCSK9-mAb types, participant characteristics and treatment duration or methods.

scholarly journals Effectiveness of physical activity promotion and exercise referral in primary care: protocol for a systematic review and meta-analysis of randomised controlled trials

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jean-Pierre Laake ◽  
Joanna Fleming
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Primary Care ◽  
Sedentary Behaviour ◽  
Physical Activity Promotion ◽  
Self Report ◽  
Activity Promotion ◽  
Randomised Controlled ◽  
The Uk ◽  
Exercise Referral

Abstract Background Physical inactivity is the fourth leading risk factor for global mortality. Reducing sedentary behaviour and increasing physical activity are efficacious for improving many physical and mental health conditions including cardiovascular disease, type 2 diabetes and depression. Reducing sedentary behaviour and increasing physical activity can also be effective at reducing obesity; however, sedentary behaviour and reduced physical activity are also associated with mortality independently. Despite this, most adults in the UK do not currently meet the UK Chief Medical Officers’ guidelines for weekly physical activity. As most adults visit their general practitioner at least once a year, the primary care consultation provides a unique opportunity to deliver exercise referral or physical activity promotion interventions. This is a protocol for a systematic review of randomised controlled trials for the effectiveness of physical activity promotion and referral in primary care. Methods A comprehensive literature search of Embase, MEDLINE (Ovid), Web of Science (Core Collection), Scopus, CINAHL, PsycINFO, and The Cochrane Library (CENTRAL) will be conducted for studies with a minimum follow-up of 12 months that report physical activity as an outcome measure (by either self-report or objective measures) including an intention to treat analysis. The authors will screen papers, first by title and abstract and then by full text, independently assess studies for inclusion, appraise risk of bias and extract data. The quality of the evidence will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluations) approach. The primary outcome will be participation in physical activity at 12 months. Pooled effects will be calculated using random effects models. Results will be submitted for publication in a peer-reviewed journal and for presentation at UK national primary care conferences. Discussion This systematic review and meta-analyses will summarise the evidence for the effectiveness of physical activity promotion and referral as interventions for improving physical activity, as well as whether studies using objective measures of physical activity have similar effects to those studies using self-report measures. This knowledge has importance for primary care clinicians, patients and, given the focus of the recent NHS long-term plan on preventive medicine, those making policy decisions. Systematic review registration The protocol is registered with PROSPERO the international prospective register of systematic reviews, ID CRD42019130831

scholarly journals Effectiveness of link workers providing social prescribing on health outcomes and costs for adult patients in primary care and community settings. A protocol for a systematic review of the literature.

2020 ◽  
Vol 2 ◽  
pp. 21
Author(s):  
Bridget Kiely ◽  
Aisling Croke ◽  
Eamon O'Shea ◽  
Deirdre Connolly ◽  
Susan M. Smith
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Outcomes ◽  
Care Coordination ◽  
Randomised Controlled Trials ◽  
Social Care ◽  
Controlled Trials ◽  
Social Prescribing ◽  
Health And Social Care ◽  
Randomised Controlled

Introduction: The use of link workers for social prescribing and health and social care coordination is increasing, but there is insufficient data to demonstrate their effectiveness or for whom they work best. Multimorbidity is increasing in prevalence and affects those living in deprived areas ten years earlier than affluent areas. This systematic review aims to examine the evidence for the effectiveness and costs of link workers in improving health outcomes. We will also look for evidence for the use of link workers specifically for people living with multimorbidity and in deprived areas. Methods: Databases of published and grey literature will be searched for randomised and non-randomised controlled trials examining use of link workers based in primary care for community dwelling adults compared to usual care. Primary outcomes will be health related quality of life and mental health. Data on costs will be extracted. Studies will be selected for inclusion by title and abstract review by two reviewers. A Preferred Reporting Items for Systematic Reviews (PRISMA) flow diagram will document the selection process. A standardised form will be used to extract data. Data quality will be assessed using the Cochrane Risk of Bias tool for randomised controlled trials, a narrative synthesis will be completed and the GRADE assessment tool used to comment on evidence quality. A meta-analysis of effect size of primary outcomes and subgroup analysis for multimorbidity and social deprivation will be performed if there are sufficient comparable data. Conclusion: This systematic review will give an important overview of the evidence for the use of link workers providing social prescribing and health and social care coordination in primary care. This will help inform intervention development and guide policy makers on whether these interventions are cost effective and which groups stand to benefit most. Prospero registration: CRD42019134737 (04/07/2019)

scholarly journals Strategies to reduce the use of low-value medical tests in primary care: a systematic review

2020 ◽  
Vol 70 (701) ◽  
pp. e858-e865
Author(s):  
Toshihiko Takada ◽  
Pauline Heus ◽  
Sander van Doorn ◽  
Christiana A Naaktgeboren ◽  
Jan-Willem Weenink ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Patient Reported Outcomes ◽  
Targeted Interventions ◽  
Primary Care Settings ◽  
Medical Tests ◽  
Patient Reported ◽  
Randomised Controlled

BackgroundIt is recognised that medical tests are overused in primary care; however, it is unclear how best to reduce their use.AimTo identify which strategies are effective in reducing the use of low-value medical tests in primary care settings.Design and settingSystematic review.MethodThe databases MEDLINE, EMBASE, and Rx for Change were searched (January 1990 to November 2019) for randomised controlled trials (RCTs) that evaluated strategies to reduce the use of low-value medical tests in primary care settings. Two reviewers selected eligible RCTs, extracted data, and assessed their risk of bias.ResultsOf the 16 RCTs included in the review, 11 reported a statistically significant reduction in the use of low-value medical tests. The median of the differences between the relative reductions in the intervention and control arms was 17% (interquartile range 12% to 24%). Strategies using reminders or audit/feedback showed larger reduction than those without these components (22% versus 14%, and 22% versus 13%, respectively) and patient-targeted strategies showed larger reductions than those not targeted at patients (51% versus 17%). Very few studies investigated the sustainability of the effect, adverse events, cost-effectiveness, or patient-reported outcomes related to reducing the use of low-value tests.ConclusionThis review indicates that it is possible to reduce the use of low-value medical tests in primary care, especially by using multiple components including reminders, audit/feedback, and patient-targeted interventions. To implement these strategies widely in primary care settings, more research is needed not only to investigate their effectiveness, but also to examine adverse events, cost-effectiveness, and patient-reported outcomes.

scholarly journals The effectiveness of integrating clinical pharmacists within general practice to optimise prescribing and health outcomes in primary care patients with polypharmacy: A protocol for a systematic review

2019 ◽  
Vol 2 ◽  
pp. 32
Author(s):  
Aisling Croke ◽  
Oscar James ◽  
Barbara Clyne ◽  
Frank Moriarty ◽  
Karen Cardwell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Economic ◽  
General Practice ◽  
Cost Effectiveness ◽  
Health Outcomes ◽  
Randomised Controlled Trials ◽  
Controlled Trials ◽  
Randomised Controlled ◽  
Economic Studies

Introduction: Coordinating prescribing for patients with polypharmacy is a challenge for general practitioners. Pharmacists may improve management and outcomes for patients with polypharmacy. This systematic review aims to examine the clinical and cost-effectiveness of pharmacist interventions to optimise prescribing and improve health outcomes in patients with polypharmacy in primary care settings.  Methods: The review will be reported using the PRISMA guidelines. A comprehensive search of 10 databases from inception to present, with no language restrictions will be conducted. Studies will be included where they evaluate the clinical or cost-effectiveness of a clinical pharmacist in primary care on potentially inappropriate prescriptions using validated indicators and number of medicines. Secondary outcomes will include health related quality of life measures, health service utilisation, clinical outcomes and data relating to cost effectiveness. Randomised controlled trials, non-randomised controlled trials, controlled before-after, interrupted-time-series and health economic studies will be eligible for inclusion.  Titles, abstracts and full texts will be screened for inclusion by two reviewers. Data will be extracted using a standard form. Risk of bias in all included studies will be assessed using the Effective Practice and Organisation of Care (EPOC) criteria. Economic studies will be assessed using the Consensus Health Economic Criteria (CHEC) list as per the Cochrane Handbook for critical appraisal of methodological quality. A narrative synthesis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Where data support quantitative synthesis, a meta-analysis will be performed. Discussion: This systematic review will give an overview of the effectiveness of pharmacist interventions to improve prescribing and health outcomes in a vulnerable patient group. This will provide evidence to policy makers on strategies involving clinical pharmacists integrated within general practice, to address issues which arise in polypharmacy and multimorbidity.  PROSPERO Registration: CRD42019139679 (28/08/19)

scholarly journals Effects of discontinuation of chronic medication in primary care: a systematic review of deprescribing trials

2018 ◽  
Vol 68 (675) ◽  
pp. e663-e672 ◽  
Author(s):  
Sioe Lie Thio ◽  
Joana Nam ◽  
Mieke L van Driel ◽  
Thomas Dirven ◽  
Jeanet W Blom
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Care Physician ◽  
Evidence Based ◽  
Chronic Medication ◽  
Primary Care Settings ◽  
Number Of Patients ◽  
The Mean ◽  
Randomised Controlled

BackgroundPolypharmacy is becoming more prevalent and evaluation of appropriateness of medication use is increasingly important. The primary care physician often conducts the deprescribing process; however, there are several barriers to implementing this.AimTo examine the feasibility and safety of discontinuation of medication, with a focus on studies that have been conducted in the community, that is, primary care (or general practice) and nursing homes.Design and settingThis systematic review included randomised controlled trials published in 2005–2017, which studied withdrawal of long-term drugs prescribed in primary care settings and compared continuing medication with discontinuing.MethodPubMed and EMBASE searches were conducted and the extracted data included the number of patients who successfully stopped medication and the number of patients who experienced relapse of symptoms or restarted medication.ResultsA total of 27 studies reported in 26 papers were included in this review. The number of participants in the studies varied from 20 to 2471 and the mean age of participants ranged from 50.3 years to 89.2 years. The proportion of patients who successfully stopped their medication varied from 20% to 100%, and the range of reported relapse varied from 1.9% to 80%.ConclusionOnly a few studies have examined the success rate and safety of discontinuing medication in primary care, and these studies are very heterogeneous. Most studies show that deprescribing and cessation of long-term use seem safe; however, there is a risk of relapse of symptoms. More research is needed to advise physicians in making evidence-based decisions about deprescribing in primary care settings.

scholarly journals Estimating the prevalence of heterozygous familial hypercholesterolaemia: a systematic review and meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016461 ◽  
Author(s):  
Leo E Akioyamen ◽  
Jacques Genest ◽  
Shubham D Shan ◽  
Rachel L Reel ◽  
Jordan M Albaum ◽  
...  
Keyword(s):  
Systematic Review ◽  
Familial Hypercholesterolaemia ◽  
Meta Analysis ◽  
Geographical Location ◽  
Significant Risk ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Cvd Risk ◽  
Premature Cardiovascular Disease ◽  
Heterozygous Familial Hypercholesterolaemia

ObjectivesHeterozygous familial hypercholesterolaemia (FH) confers a significant risk for premature cardiovascular disease (CVD). However, the estimated prevalence of FH varies substantially among studies. We aimed to provide a summary estimate of FH prevalence in the general population and assess variations in frequency across different sociodemographic characteristics.Setting, participants and outcome measuresWe searched MEDLINE, EMBASE, Global Health, the Cochrane Library, PsycINFO and PubMed for peer-reviewed literature using validated strategies. Results were limited to studies published in English between January 1990 and January 2017. Studies were eligible if they determined FH prevalence using clinical criteria or DNA-based analyses. We determined a pooled point prevalence of FH in adults and children and assessed the variation of the pooled frequency by age, sex, geographical location, diagnostic method, study quality and year of publication. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were investigated through subgroups, meta-regression and sensitivity analyses.ResultsThe pooled prevalence of FH from 19 studies including 2 458 456 unique individuals was 0.40% (95% CI 0.29% to 0.52%) which corresponds to a frequency of 1 in 250 individuals. FH prevalence was found to vary by age and geographical location but not by any other covariates. Results were consistent in sensitivity analyses.ConclusionsOur systematic review suggests that FH is a common disorder, affecting 1 in 250 individuals. These findings underscore the need for early detection and management to decrease CVD risk.

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