Cochrane Db Syst Rev
-
Cochrane Db Syst Rev · Mar 2013
ReviewNon-pharmacological interventions for preventing secondary vascular events after stroke or transient ischemic attack.
Stroke is the second leading cause of death among adults worldwide. Individuals who have suffered a stroke are at high risk of having another stroke likely leading to greater disability and institutionalization. Non-pharmacological interventions may have a role to play in averting a second stroke. ⋯ There is limited applicable evidence. Therefore, no implications for practice can be drawn. Further research is required and several trials are underway, the findings of which are anticipated to contribute to the body of evidence.
-
Cochrane Db Syst Rev · Mar 2013
ReviewHormonal versus non-hormonal contraceptives in women with diabetes mellitus type 1 and 2.
Adequate contraceptive advice is important in both women with diabetes mellitus type 1 and type 2 to reduce the risk of maternal and infant morbidity and mortality in unplanned pregnancies. A wide variety of contraceptives are available for these women. However, hormonal contraceptives might influence carbohydrate and lipid metabolism and increase micro- and macrovascular complications, so caution in selecting a contraceptive method is required. ⋯ The four included randomised controlled trials in this systematic review provided insufficient evidence to assess whether progestogen-only and combined contraceptives differ from non-hormonal contraceptives in diabetes control, lipid metabolism and complications. Three of the four studies were of limited methodological quality, sponsored by pharmaceutical companies and described surrogate outcomes. Ideally, an adequately reported, high-quality randomised controlled trial analysing both intermediate outcomes (that is glucose and lipid metabolism) and true clinical endpoints (micro- and macrovascular disease) in users of combined, progestogen-only and non-hormonal contraceptives should be conducted. However, due to the low incidence of micro- and macrovascular disease and accordingly the large sample size and long follow-up period needed to observe differences in risk, a randomised controlled trial might not be the ideal design.