title: Counselling problem drinkers in medical wards: a controlled study. Effects of a Brief Office-Based Intervention to Facilitate Diabetes Dietary Self-Management Brief physician advice for alcohol problems in older adults: a randomized community-based trial. Two-year results of a controlled study of residential rehabilitation for patients treated with percutaneous transluminal coronary angioplasty. A randomized study of a multifactorial programme. Brief intervention during hospital admission to help patients to give up smoking after myocardial infarction and bypass surgery: randomised controlled trial Evaluation of a nurse-managed minimal-contact smoking cessation intervention for cardiac inpatients. Intensive lifestyle changes for reversal of coronary heart disease. The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up. Stepped care approach to smoking cessation in patients hospitalized for coronary artery disease. Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease. High Rates of Sustained Smoking Cessation in Women Hospitalized With Cardiovascular Disease: The Women’s Initiative for Nonsmoking (WINS) Behavioral effects of a comprehensive, multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty: a prospective, randomized controlled study. Effects of a videotape information intervention at discharge on diet and exercise compliance after coronary bypass surgery. Four-week multidisciplinary cardiac rehabilitation produces similar improvements in exercise capacity and quality of life to a 10-week program. Trial of the effects of an advice and relaxation tape given within the first 24 h of admission to hospital with acute myocardial infarction. Readiness to Change and Brief Educational Interventions: Successful Strategies to Reduce Stroke Risk Smoking cessation after acute myocardial infarction: effects of a nurse-managed intervention. Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials. Clinical trial of an Internet-based case management system for secondary prevention of heart disease. The impact of behavioral counseling on stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk of coronary heart disease. A cross-national trial of brief interventions with heavy drinkers. WHO Brief Intervention Study Group. Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial. Impact of computer-generated personalized goals on cholesterol lowering. Controlled evaluation of a brief intervention for HIV prevention among injecting drug users not in treatment. Efforts to improve subsequent treatment of cardiovascular risk factors in older patients with diabetes hospitalized for a cardiac event. The effect of general practitioners' advice to heavy drinking men. A randomized controlled trial of smoking cessation counseling after myocardial infarction. Randomized controlled trial of two cigarette quit programmes in coronary care patients after acute myocardial infarction. Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions Saturated fat intake is reduced in patients with ischemic heart disease 1 year after comprehensive counseling but not after brief counseling.
abstract: Seven hundred and thirty one men admitted to medical wards were interviewed to identify problem drinkers who had not received previous treatment for alcoholism and who had some social support . One hundred and sixty one met the diagnostic criteria ; 156 agreed to a follow up interview and were allocated to one of two groups . One group received a session of counselling about their drinking habits from a nurse while the other received only routine medical care . Both groups reported a reduction in alcohol consumption when interviewed 12 months later , but the counselled group had a significantly better outcome than the control group . It is concluded that systematic screening for alcohol consumption and related problems should become a routine part of medical assessment and that advice on drinking habits is effective if given before irreversible physical or psychosocial problems have developed OBJECTIVE There is a pressing need for brief practical interventions that address diabetes management . Using a r and omized design , we evaluated a medical office-based intervention focused on behavioral issues relevant to dietary self-management . RESEARCH DESIGN AND METHODS There were 206 adult diabetes patients r and omized to usual care or brief intervention  , which consisted of touchscreen computer-assisted assessment to provide immediate feedback on key barriers to dietary self-management , and goal setting and problem-solving counseling for patients . Follow-up components to the single session intervention included phone calls and interactive video or videotape instruction as needed . RESULTS Multivariate analyses of covariance revealed that the brief intervention produced greater improvements than usual care on a number of measures of dietary behavior ( e.g. , fewer calories from saturated fat , fewer high-fat eating habits and behaviors ) at the 3-month follow-up . There were also significant differences favoring intervention on changes in serum cholesterol levels and patient satisfaction but not on glycosylated hemoglobin . The intervention effects were relatively robust across a variety of patient characteristics , the two participating physicians , and intervention staff members . CONCLUSIONS If the long-term results are equally positive and generalize to other setting , this intervention could provide a prototype for a feasible cost-effective way to integrate patient views and behavioral management into office-based care for diabetes BACKGROUND Alcohol use in older adults is common . It is associated with depression , hypertension , diabetes , drug interactions , accidents , and increased rates of emergency department visits and hospitalizations . METHODS A controlled clinical trial ( Project GOAL --Guiding Older Adult Lifestyles ) tested the efficacy of brief physician advice in reducing the alcohol use and use of health care services of older adult problem drinkers . Twenty-four community-based primary care practice s in Wisconsin ( 43 family physicians and internists ) participated in the trial . Of the 6073 patients screened , 105 men and 53 women met inclusion criteria and were r and omized into a control group ( n = 71 ) or an intervention group ( n = 87 ) . Intervention group patients received two 10- to 15-minute physician-delivered counseling sessions that included advice , education , and contracting using a scripted workbook . A total of 146 patients ( 92.4 % ) participated in the 12-month follow-up procedure . RESULTS No significant differences were found between the control and intervention groups at baseline in alcohol use , age , socioeconomic status , depression , onset of alcohol use , smoking status , activity level , or use of mood-altering drugs . The older adults who received the physician intervention demonstrated a significant reduction in 7-day alcohol use , episodes of binge drinking , and frequency of excessive drinking ( P < .005 ) compared with the control group at 3 , 6 , and 12 months after the intervention . There was a 34 % reduction in 7-day alcohol use , 74 % reduction in mean number of binge-drinking episodes , and 62 % reduction in the percentage of older adults drinking more than 21 drinks per week in the intervention group compared with the control group . There were no significant changes in health status . Patterns of health care utilization were not extensively analyzed because of the small number of events . CONCLUSIONS This study provides the first direct evidence that brief physician advice can decrease alcohol use by older adults in community-based primary care practice AIMS In a multifactorial lifestyle behaviour programme , of 2 years duration , to study the maintenance of achieved behaviour and risk factor-related changes . METHODS AND RESULTS Out of a consecutive population of 151 patients treated with percutaneous transluminal angioplasty under 65 years of age , 87 were r and omly allocated to an intervention group ( n=46 ) or to a control group ( n=41 ) . The programme started with a 4 week residential stay , which was focused on health education and the achievement of  behaviour change .  During the first year of follow-up , a maintenance programme included regular contacts with a nurse , while no further rehabilitative efforts were offered during the second year . One patient died ( control ) . During the second year the proportion of hospitalized patients was lower in the intervention group ( 4 % vs 20%;P<0.05 ) . Patients in the intervention group improved several lifestyle dependent behaviours : diet ( index at 0 , 12 and 24 months ) : 10.5+/-3 . 4 , 12.9+/-2.5 and 12.4+/-2.6 in the intervention group ( I ) vs 10 . 1+/-3.2 , 10.7+/-3.0 and 11.8+/-3.2 in the control group (C);P<0.05 , exercise sessions per week : 2.5+/-2.3 , 4.5+/-1.9 and 4.4+/-2.1 ( I ) vs 3.1+/-2.2 , 3.5+/-2.3 and 3.7+/-2.7 (C);P<0.05 , and smoking ; 18 % , 6 % and 9 % ( I ) vs 12 % , 21 % and 18 % (C);P<0.05 . This corresponded to improvement in exercise capacity ( 0 , 12 and 24 months ) : 156+/-42 , 174+/-49 and 165+/-47 W ( I ) vs 164+/-40 , 163+/-49 and 156+/-48 watts (C);P<0.05 . There were no significant differences between the two groups with regard to serum cholesterol levels at 0 and 24 months : 5 . 4+/-0.8 and 5.2+/-0.9 mmol . l(-1)(I ) vs 5.4+/-1.0 and 4.9+/-0.9 mmol . l(-1)(C ) ; ns , low density lipoprotein cholesterol level : 3.6+/-0.8 and 3.4+/-0.8 mmol . l(-1)(I ) vs 3.7+/-0.9 and 3.3+/-0.7 mmol . l(-1)(C ) ; ns , triglyceride level : 2.2+/-1.6 and 1.8+/-1.3 mmol . l(-1)(I ) vs 2.2+/-1.4 and 1.6+/-0.6 mmol . l(-1)(C ) ; ns , body mass index ( 0 , 12 and 24 months ) : 27.5+/-4.5 , 27.0+/-4.3 and 27.4+/- 4.5 kg . m(-2)(I ) vs 26.8+/-2.8 , 26.9+/-2.7 and 26.9+/- 3.2 kg . m(-2)(C ) ; ns , waist/hip ratio or blood pressure . The two groups did not differ in quality of life , or psychological factors . Return to work after 12 and 24 months was 74 % and 78 % ( I ) vs 68 % and 61 % ( C ) ; ns . CONCLUSION This rehabilitation programme influenced important lifestyle behaviour and reduced some , but not all , important risk Abstract Objective : To evaluate a  smoking cessation intervention that can be routinely delivered to smokers admitted with cardiac problems . Design : R and omised controlled trial of usual care compared with intervention delivered on hospital wards by cardiac rehabilitation nurses . Setting : Inpatient wards in 17 hospitals in Engl and . Participants : 540 smokers admitted to hospital after myocardial infa rct ion or for cardiac bypass surgery who expressed interest in stopping smoking . Intervention : Brief verbal advice and st and ard booklet ( usual care ) . Intervention lasting 20 - 30 minutes including carbon monoxide reading , special booklet , quiz , contact with other people giving up , declaration of commitment to give up , sticker in patient 's notes ( intervention group ) . Main outcome measures : Continuous abstinence at six weeks and 12 months determined by self report and by biochemical validation at these end points . Feasibility of the intervention and delivery of its components . Results : After six weeks 151 ( 59 % ) and 159 ( 60 % ) patients remained abstinent in the control and intervention group , respectively ( P=0.84 ) . After 12 months the figures were 102 ( 41 % ) and 94 ( 37 % ) ( P=0.40 ) . Recruitment was slow , and delivery of the intervention was inconsistent , raising concerns about the feasibility of the intervention within routine care . Patients who received the declaration of commitment component were almost twice as likely to remain abstinent than those who did not receive it ( P<0.01 ) . Low dependence on tobacco and high motivation to give up were the main independent predictors of positive outcome . Patients who had had bypass surgery were over twice as likely to return to smoking as patients who had had a myocardial infa rct ion . Conclusions : Single session interventions delivered within routine care may have insufficient power to influence highly dependent smokers . What is already known on this topic Stopping smoking after a serious cardiac event is associated with a significant decrease in mortality Up to 70 % of smokers who survive cardiac surgery smoke again within a year Intensive interventions delivered by dedicated staff can help cardiac patients not to start to smoke again What this study adds An intervention delivered by cardiac rehabilitation nurses within routine care during patients ' hospital stay failed to increase the number who managed to stop smoking in the long term For busy staff with competing priorities , the 30 minute intervention was also on the borderline of practicability Patients admitted after a myocardial infa rct ion were over twice as likely to give up than those admitted for a bypass This study examined the effectiveness of a nurse-managed minimal-contact smoking cessation intervention for patients hospitalized for cardiac disease . A pre-test-post-test quasi-experimental design was used . Patients who smoked prior to admission to cardiac wards of five hospitals ( n = 388 ) received the intervention , whereas smoking patients in six other hospitals were given usual care ( n = 401 ) . The intervention was initiated at the hospital and continued after discharge . The core elements were stop-smoking advice from the cardiologist , a short bedside consultation with a nurse , administration of self-help material s and aftercare by the cardiologist .  Smoking cessation was assessed after 3 months by self-report . Logistic regression analysis excluding dropouts , controlling for covariates including baseline differences showed significant intervention effects ( one-tailed significance test ) on point prevalence abstinence ( OR = 2.11 ) and continuous abstinence ( OR = 1.41 ) . Intention-to-treat analysis including dropouts as smokers showed a significant effect on point prevalence abstinence ( OR 1.35 ) . We conclude that , compared to usual care , the low-intensity smoking  cessation  intervention for cardiac in patients was more effective in achieving smoking cessation . However , the small effects and the process evaluation suggest that improvements are needed CONTEXT The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year . OBJECTIVES To determine the feasibility of patients to sustain  intensive lifestyle changes  for a total of 5 years and the effects of these lifestyle changes ( without lipid-lowering drugs ) on coronary heart disease . DESIGN R and omized controlled trial conducted from 1986 to 1992 using a r and omized invitational design . PATIENTS Forty-eight patients with moderate to severe coronary heart disease were r and omized to an  intensive lifestyle change group  or to a  usual-care control group  , and 35 completed the 5-year follow-up quantitative coronary arteriography . SETTING Two tertiary care university medical centers . INTERVENTION Intensive lifestyle changes ( 10 % fat whole foods vegetarian diet , aerobic exercise , stress management training , smoking cessation , group psychosocial support ) for 5 years . MAIN OUTCOME MEASURES Adherence to intensive lifestyle changes , changes in coronary artery percent diameter stenosis , and cardiac events . RESULTS Experimental group patients ( 20 [ 71 % ] of 28 patients completed 5-year follow-up ) made and maintained comprehensive lifestyle changes for 5 years , whereas control group patients ( 15 [ 75 % ] of 20 patients completed 5-year follow-up ) made more moderate changes . In the experimental group , the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year ( a 4.5 % relative improvement ) and by 3.1 absolute percentage points after 5 years ( a 7.9 % relative improvement ) . In contrast , the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year ( a 5.4 % relative worsening ) and by 11.8 percentage points after 5 years ( a 27.7 % relative worsening ) ( P=.001 between groups . Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up ( risk ratio for any event for the control group , 2.47 [ 95 % confidence interval , 1.48 - 4.20 ] ) . CONCLUSIONS More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group . In contrast , in the control group , coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred AIMS To examine the long-term impact of brief and early interventions for hazardous and harmful alcohol consumption . DESIGN A 9-month and 10-year follow-up of subjects recruited into a r and omized controlled trial of a range of alcohol-related brief interventions . SETTING General practice s , the outpatient or acute care services of a major city hospital , and a privately run health screening programmeme . PARTICIPANTS The cohort of 554 ( non-dependent ) hazardous and harmful drinkers recruited into the Australian arm of the Phase II World Health Organization collaborative project on identification and treatment of persons with harmful alcohol consumption . INTERVENTION The effectiveness of three forms of intervention , ranging from 5 to 60 minutes in duration , were compared with a no-treatment control condition . MEASUREMENTS Included drinking behaviour and biological markers of alcohol use . In addition , at 10 years subjects were asked about symptoms of diagnosable alcohol use disorders and their experience of alcohol-related psychological , social and physical harm . Mortality was also assessed . FINDINGS Results provide further evidence for the short-term effectiveness of alcohol-related brief interventions . In comparison to controls , subjects offered intervention : ( 1 ) report significantly lower consumption ; and ( 2 ) less unsafe drinking at 9-month follow-up . The intensity of intervention was not related to the amount of change in drinking behaviour . Analysis at 10 years failed to find any differences in outcomes between intervention and control groups in median consumption , mean reduction in consumption from baseline to follow-up , mortality and ICD-10 diagnoses of alcohol dependence or harmful alcohol use . CONCLUSIONS This study failed to find evidence that brief advice and counselling without regular follow-up and reinforcement can sustain significant long-term reductions in drinking behaviour at 10-year follow-up PURPOSE Smoking cessation is an important goal for smokers with coronary artery disease ( CAD ) because it reduces cardiac morbidity and mortality . Effective interventions for cigarette smokers with CAD exist , but they often are considered to be intensive and expensive . Stepped-care interventions have been proposed as a promising way to allocate smoking cessation treatments in a cost-effective manner . Stepped care refers to the practice of initiating treatment with low-intensity intervention and then exposing treatment failures to successively more intense interventions . METHODS To address the efficacy of this approach , 254 cigarette smokers hospitalized with CAD were provided a brief cessation intervention . The participants then were assigned r and omly to either a more intensive stepped-care treatment ( counseling and nicotine patch therapy ) or no additional treatment . Outcomes were point-prevalent abstinence measured 3 months and 1 year after hospital discharge . RESULTS Stepped-care treatment increased smoking cessation rates from 42 % to 53 % during a 3-month follow-up period ( P = .05 ) , but showed little effect at the 1-year follow-up assessment , as evidence d by a cessation rate for the minimal intervention group of 36 % versus 39 % for the stepped-care group ( P = .36 ) . CONCLUSIONS A stepped-care approach to smoking cessation increased short-but not long-term point-prevalent abstinence in patients with CAD . For improvement of long-term effectiveness , refinement of the timing and content of stepped-care interventions needs to occur BACKGROUND Disease management programs in which drugs are prescribed by dietitians or nurses have been shown to improve the coronary risk factor profile in patients with coronary heart disease . However , those disease management programs in which drugs are not prescribed by allied health professionals have not improved coronary risk factor status . The objective of the Coaching patients On Achieving Cardiovascular Health ( COACH ) study was to determine whether dietitians or nurses who did not prescribe medications could coach patients with coronary heart disease to work with their physicians to achieve the target levels for their total cholesterol ( TC ) and other risk factors . METHODS Multicenter r and omized controlled trial in which 792 patients from 6 university teaching hospitals underwent a stratified r and omization by cardiac diagnosis within each hospital : 398 were assigned to usual care plus The COACH Program and 394 to usual care alone .  Patients in The  COACH Program group  received regular personal coaching via telephone and mailings to achieve the target levels for their particular coronary risk factors . There was one coach per hospital . The primary outcome was the change in TC ( DeltaTC ) from baseline ( in hospital ) to 6 months after r and omization . Secondary outcomes included measurement of a wide range of physical , nutritional , and psychological factors . The analysis was performed by intention to treat . RESULTS The COACH Program achieved a significantly greater DeltaTC than usual care alone : the mean DeltaTC was 21 mg/dL ( 0.54 mmol/L ) ( 95 % confidence interval [ CI ] , 16 - 25 mg/dL [ 0.42 - 0.65 mmol/L ] ) in The COACH Program vs 7 mg/dL ( 0.18 mmol/L ) ( 95 % CI , 3 - 11 mg/dL [ 0.07 - 0.29 mmol/L ] ) in the usual care group ( P<.0001 ) . Thus , the reduction in TC from baseline to 6 months after r and omization was 14 mg/dL ( 0.36 mmol/L ) ( 95 % CI , 8 - 20 mg/dL [ 0.20 - 0.52 mmol/L ] ) greater in The COACH Program group than in the usual care group . Coaching produced substantial improvements in most of the other coronary risk factors and in patient quality of life . CONCLUSIONS Coaching , delivered as The COACH Program , is a highly effective strategy in reducing TC and many other coronary risk factors in patients with coronary heart disease .  Coaching has potential effectiveness in the whole area of chronic disease management Background —Although men hospitalized with cardiovascular disease ( CVD ) show high smoking-cessation rates , similar data for women are lacking . We tested the efficacy of  smoking-cessation intervention in women hospitalized for CVD . Methods and Results —In this r and omized controlled trial conducted from 1996 to 2001 , 277 women diagnosed with CVD ( mean age 61±10 years ) were r and omly assigned within 1 of 12 San Francisco Bay Area hospitals to a  usual-care group ( UG ; n=135 ) or intervention group  ( IG ; n=142 ) . Baseline histories were obtained , and interviews to ascertain self-reported smoking status occurred at 6 , 12 , 24 , and 30 months after hospitalization . The UG received strong physician ’s advice , a self-help pamphlet , and a list of community re sources . The IG received strong physician ’s advice and a nurse-managed cognitive behavioral relapse-prevention intervention at bedside , with telephone contact at intervals after discharge . The groups were similar demographically and had smoked cigarettes for a median of 38 ( IG ) or 40 ( UG ) years . Time to resumption of continuous smoking was assessed by Kaplan-Meier analysis , and risk differences between groups were determined . Time smoke-free was significantly greater for the IG than the UG ( P = 0.038 ) . Point prevalence for nonsmoking at the interviews was somewhat greater for the IG than the UG ( P > 0.15 at all times ) . Conclusions —Cognitive behavioral intervention result ed in longer average times to resumption of smoking , but in these 2 groups of older women with limited social and financial re sources , long-term success rates were similar . Systematic identification of smokers and even the brief intervention afforded the UG yielded a high smoking-cessation rate over time A group of 93 coronary patients recently treated with percutaneous transluminal coronary angioplasty ( PTCA ) were r and omly assigned to either an intervention or a control group . Subjects in the intervention group participated in a comprehensive behaviorally oriented program aim ed at achieving significant long-term changes in risk factor-related lifestyle behavior . Assessment s of lifestyle behaviors , psychological factors , biological risk factors , and rehabilitation as well as secondary prevention endpoints were carried out , at inclusion and after 12 months . Results showed that the intervention patients , as compared with controls , improved significantly on measures assessing smoking , exercise , and diet habits . These self-rated changes were confirmed by weight reductions and improved exercise capacity , as well as by between-group differences in sub clinical chest pain during an exercise test . However , few effects were found on the different psychological variables , as well as on morbidity or return to work BACKGROUND This study evaluated the relative effects on compliance with recommended lifestyle changes of two experimental videotapes that involved different approaches for preparing coronary artery bypass graft ( CABG ) patients for the posthospital recovery period . The tapes differed in the extent to which they portrayed the recovery period as a steady , forward progression versus a series of " ups and downs . " METHODS Two hundred sixteen male and female CABG patients were assigned r and omly either to view one of the two videotapes before discharge from the hospital or to receive only the st and ard discharge preparation provided by the hospital . All patients completed measures of anxiety and self-efficacy at discharge , 1 month and 3 months after discharge from the hospital . Patients also completed measures of dietary fat consumption and activity level 1 and 3 months after discharge . RESULTS Relative to controls , patients who viewed either of the videotapes before hospital release reported higher self-efficacy for adhering to the recommended low-fat diet both at discharge and 1 month after surgery . Viewing either of the videotapes also result ed in significantly less dietary fat intake 1 month after hospital release compared with controls . Patients who viewed the tape that portrayed the recovery period as consisting of ups and downs also reported significantly more frequent moderate exercise at 1 month and more frequent strenuous exercise 3 months after discharge . CONCLUSIONS The experimental videotapes proved to be an effective method for increasing dietary and exercise compliance during the first 3 months after CABG BACKGROUND Cardiac rehabilitation ( CR ) is widely accepted as beneficial for patients with myocardial infa rct ion ( MI ) and coronary artery bypass graft ( CABG ) . A need exists to evaluate how different formats of delivery can best meet CR service dem and s. METHODS AND RESULTS Cardiac patients ( n = 60 ) were r and omly assigned to either a st and ard 10-week ( 30 sessions ) or a 4-week ( 20 sessions ) multifactorial rehabilitation program . Patients underwent exercise testing using the Bruce protocol before , immediately after , and then 6 months after CR . Patients also completed the SF-36 quality of life question naire and the Hospital Anxiety and Depression scale at each time point . Compared with pre-CR , exercise time and metabolic equivalents attained were significantly increased , and heart rate significantly decreased both immediately ( P<.05 ) and 6 months after CR ( P<.05 ) in both groups , with no between-group differences . Significant improvements ( P<.05 ) in energy , pain , and general health were reported after CR , and in energy and emotional and social well-being at 6 months after CR . No differences were seen between the groups . CONCLUSIONS Cardiac rehabilitation after MI and CABG significantly improved exercise capacity and general health and well-being . No significant differences were detected between groups undergoing a 10-week or 4-week course . These preliminary data suggest that shortened courses of CR may be beneficial to cardiac patients and such courses may also facilitate more widespread use of CR BACKGROUND The study was performed to examine the effects of giving patients with acute myocardial infa rct ion an advice and relaxation audio tape within 24 h of admission to hospital . METHODS A prospect i ve , two-group design was used with 243 subjects r and omised to receive either the advice and relaxation tape or a music tape of their choice within 24 h of sustaining a myocardial infa rct ion . Outcomes comprised anxiety , cardiac misconceptions , lifestyle change , attendance at a cardiac rehabilitation programme , and quality of life . RESULTS Although the advice and relaxation tape reduced the number of cardiac misconceptions this did not lead to any improvements in outcome , whilst in hospital or at 6 months . Both tapes were equally appreciated by the patients , 98 % of whom said that they would recommend them to other patients . CONCLUSIONS An advice and relaxation tape reduces cardiac misconceptions but does not confer any other benefits over a music tape & NA ; Despite recent advances in stroke treatment and prevention , identifying effective educational interventions for “ at‐risk ” groups that will help reduce their stroke risk and improve the speed of seeking treatment remains of paramount importance . The purpose of this pilot study was to determine whether a brief educational intervention , tailored to the patient 's stage of readiness to change , could affect the initiation and achievement of stroke risk‐reducing behaviors for this at‐risk population . The study also explored potential demographic and medical confounders that could influence behavioral and knowledge goal achievement . Three groups of 20 participants , each with multiple risk factors for stroke , from a family practice clinic were r and omly assigned to a control , simple‐advice , or brief intervention group .  The majority of the participants were African American with a mean age of 68 years . Selected findings showed ( a ) significant differences in the number of newly initiated stroke‐risk‐reduction behaviors and stroke knowledge among the three groups and ( b ) significant positive correlations between the action stage of readiness to change and the initiation and achievement of the new stroke‐risk‐reduction behaviors . Although results supported the usefulness of the brief intervention model to reduce modifiable stroke‐risk factors and increase stroke knowledge , the necessity of additional longitudinal research that refines the targeting of interventions for diverse racial , cultural , and age groups was acknowledged STUDY OBJECTIVE To determine the effect of a nurse-managed intervention for smoking cessation in patients who have had a myocardial infa rct ion . DESIGN R and omized , with a 6-month treatment period and a 6-month follow-up . SETTING Kaiser Foundation hospitals in Redwood City , Santa Clara , Hayward , and San Jose , California . PATIENTS Sequential sample of 173 patients , 70 years of age or younger , who were smoking before hospitalization for acute myocardial infa rct ion . Eighty-six patients were r and omly assigned to the intervention and 87 to usual care ;  130 patients ( 75 % ) completed the study and were available for follow-up . INTERVENTION Nurse-managed and focused on preventing relapse to smoking  , the intervention was initiated in the hospital and maintained thereafter primarily through telephone contact . Patients were given an 18-page manual that emphasized how to identify and cope with high-risk situations for smoking relapse . MEASUREMENTS AND MAIN RESULTS One year after myocardial infa rct ion , the smoking cessation rate , verified biochemically , was 71 % in the intervention group compared with 45 % in the usual care group , a 26 % difference ( 95 % CI , 9.5 % to 42.6 % ) . Assuming that all surviving patients lost to follow-up were smoking , the 12-month smoking cessation rate was 61 % in the intervention group compared with 32 % in the usual care group , a 29 % difference ( 95 % CI , 14.5 % to 43.5 % ) . Patients who either resumed smoking within 3 weeks after infa rct ion or expressed little intention of stopping in the hospital were unlikely to have stopped by 12 months . CONCLUSIONS A nurse-managed smoking cessation intervention largely conducted by telephone , initiated in the hospital , and focused on relapse prevention can significantly reduce smoking rates at 12 months in patients who have had a myocardial infa rct ion R and omized clinical trials of cardiac rehabilitation following myocardial infa rct ion have typically demonstrated a lower mortality in treated patients , but with a statistically significant reduction in only one trial . To overcome the problem of not being able to detect small but clinical ly important benefits in mortality in r and omized clinical trials of exercise and risk factor rehabilitation after myocardial infa rct ion with small numbers of patients , we carried out a meta- analysis on the combined results of ten r and omized clinical trials that included 4347 patients ( control , 2145 patients ; rehabilitation , 2202 patients ) . The pooled odds ratios of 0.76 ( 95 % confidence intervals , 0.63 to 0.92 ) for all-cause death and of 0.75 ( 95 % confidence intervals , 0.62 to 0.93 ) for cardiovascular death were significantly lower in the rehabilitation group than in the control group , with no significant difference for nonfatal recurrent myocardial infa rct ion . These results suggest that , for appropriately selected patients , comprehensive cardiac rehabilitation has a beneficial effect on mortality but not on nonfatal recurrent myocardial infa rct ion PURPOSE Despite demonstrated benefits of cardiac rehabilitation and risk factor reduction , only 11 % to 38 % of eligible patients with cardiovascular disease ( CVD ) participate in cardiac rehabilitation programs .  Women and older adults are particularly less likely to participate in cardiac rehabilitation . In an effort to broaden access to cardiac rehabilitation , the authors developed an alternative Internet-based program that allows nurse case managers to provide risk factor management training , risk factor education , and monitoring services to patients with CVD . METHODS The evaluation consisted of a r and omized , clinical trial involving 104 patients with CVD , 53 of whom used the program as a special intervention ( SI ) for 6 months and 51 of whom received usual care ( UC ) .  RESULTS The results indicate that fewer cardiovascular events occurred among the SI subjects ( 15.7 % ) than among the UC subjects ( 4.1 % ) ( P = .053 ) , result ing in a gross cost savings of $ 1418 US dollars per patient . With a projected program cost of $ 453 USD per patient , the return on investment is estimated at 213 % . More weight loss occurred in the SI group ( -3.68 pounds ) than in the UC group ( + .47 pounds ) ( P = .003 ) . The differences between the two groups in terms of blood pressure , lipid levels , depression scores , minutes of exercise , and dietary habits were not statistically significant . CONCLUSION An Internet-based case management system could be used as a cost-effective intervention for patients with CVD , either independently or in conjunction with traditional cardiac rehabilitation OBJECTIVES This study assessed stages of change in fat intake , physical activity , and cigarette smoking during a r and omized controlled trial of behavioral counseling . METHODS Twenty general practice s ( primary health care centers ) were r and omized to lifestyle counseling by behavioral methods or to usual health promotion . A total of 883 patients were selected for the presence of 1 or more of the following risk factors : cigarette smoking , high cholesterol , or a combination of a high body mass index and low physical activity . Stage of change ( precontemplation , contemplation , preparation , and action/maintenance ) was assessed at baseline and after 4 and 12 months . RESULTS The odds of moving to action/maintenance for behavioral intervention vs control patients at 4 months were 2.15 ( 95 % confidence interval [ CI ] = 1.30 , 3.56 ) for fat reduction , 1.89 ( 95 % CI = 1.07 , 3.36 ) for increased physical activity , and 1.77 ( 95 % CI = 0.76 , 4.14 ) for smoking cessation . The likelihood of achieving action/maintenance was related to baseline stage for all 3 behaviors . CONCLUSIONS Brief behavioral counseling based on advice matched to stage of readiness for change may be valuable in encouraging healthy lifestyles among patients in primary care at raised risk of cardiovascular disease OBJECTIVES The relative effects of simple advice and brief counseling were evaluated with heavy drinkers identified in primary care and other health setting s in eight countries . METHODS Subjects ( 1260 men , 299 women ) with no prior history of alcohol dependence were selected if they consumed alcohol with sufficient frequency or intensity to be considered at risk of alcohol-related problems . Subjects were r and omly assigned to a control group , a simple advice group , or a group receiving brief counseling . Seventy-five percent of subjects were evaluated 9 months later . RESULTS Male patients exposed to the interventions reported approximately 17 % lower average daily alcohol consumption than those in the control group . Reductions in the intensity of drinking were approximately 10 % . For women , significant reductions were observed in both the control and the intervention groups . Five minutes of simple advice were as effective as 20 minutes of brief counseling . CONCLUSIONS Brief interventions are consistently robust across health care setting s and sociocultural groups and can make a significant contribution to the secondary prevention of alcohol-related problems if they are widely used in primary care Abstract Objective : To measure the effect of behaviourally oriented counselling in general practice on healthy behaviour and biological risk factors in patients at increased risk of coronary heart disease . Design : Cluster r and omised controlled trial . Participants : 883 men and women selected for the presence of one or more modifiable risk factors : regular cigarette smoking , high serum cholesterol concentration ( 6.5 - 9.0 mmol/l ) , and high body mass index ( 25 - 35 ) combined with low physical activity . Intervention : Brief behavioural counselling , on the basis of the stage of change model , carried out by practice nurses to reduce smoking and dietary fat intake and to increase regular physical activity . Main outcome measures : Question naire measures of diet , exercise , and smoking habits , and blood pressure , serum total cholesterol concentration , weight , body mass index , and smoking cessation ( with biochemical validation ) at 4 and 12 months . Results : Favourable differences were recorded in the intervention group for dietary fat intake , regular exercise , and cigarettes smoked per day at 4 and 12 months . Systolic blood pressure was reduced to a greater extent in the intervention group at 4 but not at 12 months No differences were found between groups in changes in total serum cholesterol concentration , weight , body mass index , diastolic pressure , or smoking cessation . Conclusions : Brief behavioural counselling by practice nurses led to improvements in healthy behaviour . More extended counselling to help patients sustain and build on behaviour changes may be required before differences in biological risk factors emerge OBJECTIVES The National Cholesterol Education Program ( NCEP ) has enhanced public awareness of the importance of cholesterol in the development of heart disease , yet most patients with cardiovascular disease ( CVD ) do not know or achieve their low-density lipoprotein cholesterol ( LDL-C ) goals . This r and omized , controlled trial was design ed to evaluate the impact of a system that provides uniquely formatted laboratory results to patients with CVD on their changes in LDL-C levels . METHODS Eighty patients with CVD were r and omized to receive  st and ard care or the intervention inclusive of a computer-generated , 11''x17 ' ' color poster depicting an individual 's LDL-C status and goals along with personalized steps to aid in goal achievement . Cholesterol profiles were obtained at baseline and 6 months after enrollment . Physicians received st and ard laboratory reports and were blinded to the r and omization . RESULTS There were no significant differences between patient groups in age , education level , race , baseline cholesterol levels , comorbidities , or percentage of patients in each group who met their NCEP goal at baseline . Patients receiving intervention tools had significant reductions in LDL-C from baseline compared with patients in the control group . Intervention patients who did not meet NCEP goals at baseline had the greatest reduction in LDL-C , with a mean change from baseline of -21.5 mg/dL ( P<0.001 ) whereas st and ard care patients had no significant change in the LDL-C levels ( -4.6 mg/dL , P=0.28 ) . At study close , 73 % of intervention patients reported that their posters remained displayed on their refrigerator . CONCLUSION This unique and personalized intervention result ed in the LDL-C lowering benefit among patients with CVD comparable to that of lipid lowering agents This study evaluated the effectiveness of a brief intervention ( BI ) , a one-session motivational interview , in reducing HIV risk-taking behaviour among injecting drug users ( IDU ) not enrolled in any form of treatment for drug dependence . IDU were r and omly assigned to either BI or a non-intervention control condition ( NIC ) .  One hundred and twenty-one subjects were successfully contacted for a 3-month follow-up and 88 subjects were followed up at 6 months . There were significant reductions for the sample as a whole for injecting risk-taking subscale scores on the HIV Risk-taking Behaviour Scale between pre-treatment and follow-up . There was no significant change in sexual risk-taking behaviour . There were no significant differences between groups on any measure at 3- and 6-month follow-up . There are a number of possible reasons why the sample as a whole showed significant improvements from initial to follow-up assessment s. It is possible that , having had their attention directed to their risk-taking behaviour , subjects attempted to reduce their injecting risk-taking behaviour . If this is the case and subjects in the NIC condition can be considered as having received a BI , this suggests that BIs involving a personal risk assessment are effective in reducing risk behaviours associated with injecting . However , this suggestion could only be confirmed by comparison with a non- assessment control group OBJECTIVE To improve the treatment of risk factors of cardiovascular disease ( CVD ) for older patients with diabetes after a cardiac event by using a low-literacy reminder card describing these risk factors in community setting s. STUDY DESIGN A multicenter , r and omized , interventional study . METHODS Patients aged 55 years or older with diabetes hospitalized with an acute myocardial infa rct ion , congestive heart failure exacerbation , or unstable angina were eligible to enter the study . Control and experimental patients were recruited from 4 sites and were enrolled in the study before discharge from the hospital . Experimental subjects received education and a reminder card describing risk factors of CVD . They were instructed to discuss the risk factors described on the reminder card with their primary care physician on their first appointment after discharge . Control subjects did not receive any intervention but were given consent to be able to review their charts . RESULTS One hundred sixty patients completed the study , 82 in the control group and 78 in the experimental group . At the end of the study there was no difference in blood pressure control , lipid levels , and glycosylated hemoglobin levels between the control and experimental patients . Aspirin use and ACE inhibitor use were found to be significantly higher in the control group ( P = .001 and .03 , respectively ) . CONCLUSIONS Reminder cards given to patients to discuss with their primary care providers in community setting s did not improve process measures of CVD risk in patients with documented CVD and diabetes . Other approaches will be needed to improve the treatment of risk factors in these high-risk patients The objective of the study was to determine the effectiveness of  advice from general practitioners to heavy drinking men ( consuming 350 - 1050 grams of alcohol per week ) to reduce their alcohol consumption .  One hundred and fifty-four men recruited from eight general practice s were allocated r and omly to treatment and control groups . Men in the treatment group received advice from their own general practitioner . At one year follow-up , when analyzed according to intention to treat , the treatment group had reduced their consumption by an excess of 65 grams of alcohol per week when compared with the control group ( p less than 0.05 ) . General practitioners should be recommended to screen for alcohol consumption amongst their patients and to give advice to those found to be at risk because of their drinking BACKGROUND Smoking cessation after myocardial infa rct ion ( MI ) has been associated with a 50 % reduction in mortality but in-hospital smoking cessation interventions are rarely part of routine clinical practice . METHODS One hundred cigarette smokers consecutively admitted during 1996 with MI were assigned to  minimal care or to a hospital-based smoking cessation program . Intervention consisted of bedside cessation counseling followed by seven telephone calls over the 6 months following discharge . Primary outcomes were abstinence rates measured at 6 months and 1 year post-discharge . RESULTS At follow-up , 43 and 34 % of participants in minimal care and 67 and 55 % of participants in intervention were abstinent at 6 and 12 months . respectively ( P<0.05 ) . Abstinence rates were calculated assuming that participants lost to attrition were smokers at follow-up . Intervention and self-efficacy were independent predictors of smoking status at follow-up . Low self-efficacy combined with no intervention result ed in a 93 % relapse rate by 1 year ( P<0.01 ) . CONCLUSIONS A hospital-based smoking cessation program consisting of inpatient counseling and telephone follow-up substantially increases smoking abstinence 1 year after discharge in patients post-MI . Patients with low self-efficacy are almost certain to relapse without intervention . Such smoking cessation programs should be part of the management of patients with MI BACKGROUND Tobacco cessation after acute myocardial infa rct ion ( AMI ) substantially improves outcome but how effective individual programmes are needs to be established . To date , few studies have examined this factor . AIMS To assess the outcome of two smoking cessation programmes after AMI . METHODS One hundred and ninety-eight current smokers admitted to coronary care with an AMI participated in a r and omized controlled study comparing two outpatient tobacco interventions , the Stanford Heart Attack Staying Free ( SF ) programme and a Usual Care ( UC ) programme . RESULTS Log-rank analyses revealed that patients in the SF programme were retained longer ( P < 0.001 ) and had higher cotinine vali date d abstinence rates ( P < 0.001 ) compared with patients in the UC programme . Twelve months after intervention , 39 % of the SF programme compared with 2 % of the UC programme demonstrated cotinine vali date d tobacco cessation , representing a significant reduced relapse rate in the SF programme ( chi2 , P < 0.001 ) . CONCLUSIONS The SF smoking cessation programme initiated in hospital can significantly reduce smoking rates at 12 months after myocardial infa rct ion . Although superior to the UC quit programme , Australian outcomes were lower than the American programme originators ' published outcomes At the end of a long week in the office , you sink back into your chair , reflecting on some of the more memorable patients you cared for and counseled . Through gentle history taking , you discovered that urinary incontinence is the underlying cause of an elderly patient 's increasing social isolation . During a careful physical examination , you detected bruising on the torso of a woman with chronic headaches and began to explore the longst and ing abusive relationship between the woman and her alcoholic partner . You discontinued procainamide therapy in a 72-year-old man who had asymptomatic premature ventricular contractions after myocardial infa rct ion . To prevent bleeding from esophageal varices , you started -blocker therapy in a woman with long-st and ing cryptogenic cirrhosis and portal hypertension . In couples ' therapy , discussing the future quality of life of a middle-aged gay man with human immunodeficiency virus infection , you journeyed through emotionally intense dialogue about advance directives . You presented the risk factors for major and minor bleeding to a 39-year-old woman who was considering warfarin therapy because of recently diagnosed atrial fibrillation and valvular heart disease . You listened to , made diagnoses for , treated , advised , and comforted many patients . Yet there were some hiccoughs in your practice along the way . You stumbled while debating the pros and cons of breast cancer screening with a healthy 48-year-old woman who has been staying current with information on the Internet . You question ed the merits of a personalized walking program suggested to you by a motivated 66-year-old man with severe claudication . Explaining that you wanted to review the best current evidence on these issues , you resolved to address your uncertainties before these patients made their next office visits , in a week 's time . Sighing deeply , you acknowledge that you have little time to read . You subscribe to three journals , which you browse months after they arrive-either when your journal stack becomes precariously high or when your guilt is sufficiently motivational . You sometimes find the conclusions of individual articles conflicting or confusing . You know that some of the decisions and suggestions you made this week , specifically your decisions about stopping procainamide therapy and starting -blocker therapy and your advice about bleeding risks from anticoagulant therapy , were based on the best current research evidence [ 1 - 3 ] . On the other h and , your patients ' inquiries about breast cancer screening and exercise treatment for claudication highlight your need for a concise , current , rigorous synthesis of the best available evidence on each of these topics : in brief , a systematic review [ 4 , 5 ] . Incorporating Research Evidence into Clinical Decision Making The foregoing scenario is familiar to practitioners . In a typical week , we encounter patients with diverse problems ; exercise numerous clinical , interpersonal , and technical skills ; and make many decisions . The factors that affect these decisions and their outcomes are complex . For instance , each patient has unique sociodemographic characteristics , cultural circumstances , and personal preferences . Each physician has unique knowledge , experiences , and values . Moreover , practitioners and their patients make decisions within the context of a rapidly changing health care system that influences the availability , accessibility , and cost of diagnostic tests and therapies [ 6 ] . Timely , useful evidence from the biomedical literature should be an integral component of clinical decision making . If one treatment has been shown to be better than another , we need to know , so that we can recommend the treatment to the appropriate patients . The worldwide effort to develop new tests and treatments , and to determine their usefulness , has never been stronger , and our patients and their families expect us to be fonts of the knowledge that results from this effort [ 7 ] . Unfortunately , it is easy for current best research evidence to pass us by [ 8 ] . We may lack the time , motivation , and basic skills needed to find , critically appraise , and synthesize information , all of which we must do if we are to integrate the results of original studies into our practice . Fortunately , several potent methods are emerging that can greatly enhance our ability to interpret and apply research evidence ; foremost among them is the systematic review . This article begins a series in Annals that will examine systematic review s in detail and explore their many applications . Systematic review s represent the best chance that most practitioners will have to underst and and accurately apply the key signals arising from the robust and increasingly productive search for solutions to medical problems . A properly conducted systematic review faithfully summarizes the evidence from all relevant studies on the topic of interest , and it does so concisely and transparently . What Is a Systematic Review ? Systematic review s are scientific investigations in themselves , with pre-planned methods and an assembly of original studies as their subjects . They synthesize the results of multiple primary investigations by using strategies that limit bias and r and om error [ 9 , 10 ] . These strategies include a comprehensive search of all potentially relevant articles and the use of explicit , reproducible criteria in the selection of articles for review . Primary research design s and study characteristics are appraised , data are synthesized , and results are interpreted . When the results of primary studies are summarized but not statistically combined , the review may be called a qualitative systematic review . A quantitative systematic review , or meta- analysis , is a systematic review that uses statistical methods to combine the results of two or more studies . The term overview is sometimes used to denote a systematic review , whether quantitative or qualitative . Summaries of research that lack explicit descriptions of systematic methods are often called narrative review s. Review articles are one type of integrative publication ; practice guidelines , economic evaluations , and clinical decision analyses are others . These other types of integrative articles often incorporate the results of systematic review s. For example , practice guidelines are systematic ally developed statements intended to assist practitioners and patients with decisions about appropriate health care for specific clinical circumstances [ 11 ] . Evidence -based practice guidelines are based on systematic review s of the literature , appropriately adapted to local circumstances and values . Economic evaluations compare both the costs and the consequences of different courses of action ; the knowledge of consequences that are considered in these evaluations is often generated by systematic review s of primary studies . Decision analyses quantify both the likelihood and the valuation of the expected outcomes associated with competing alternatives . Differences between Systematic and Narrative Review s All review s , narrative and systematic alike , are retrospective , observational research studies and are therefore subject to systematic and r and om error . Accordingly , the quality of a review - and thus its worth-depends on the extent to which scientific review methods have been used to minimize error and bias . This is the key feature that distinguishes traditional narrative review s from systematic review s ( Table 1 ) . If a review is prepared according to the steps outlined in the right column of Table 1 , it is more likely to be systematic and to provide unbiased conclusions . If review methods approximate those found in the middle column of Table 1 , the article is more likely to be a narrative review , and the conclusions are less likely to be based on an unbiased summary of all relevant evidence . Table 1 . Differences between Narrative Review s and Systematic Review s Systematic review s are generated to answer specific , often narrow , clinical questions in depth . These questions can be formulated explicitly according to four variables : a specific population and setting ( such as elderly out patients ) , the condition of interest ( for example , hypertension ) , an exposure to a test or treatment ( such as pharmacologic management ) , and one or more specific outcomes ( such as cardiovascular and cerebrovascular events and mortality ) [ 12 ] . Thus , an example of a well-formulated , clinical ly relevant question is , Does pharmacologic treatment of hypertension in the elderly prevent strokes and myocardial infa rct ions or delay death ? If the question that is driving the review is not clear from the title , abstract , or introduction , or if no methods section is included , the paper is more likely to be a narrative review than a systematic review [ 13 ] . Most narrative review articles deal with a broad range of issues related to a given topic rather than addressing a particular issue in depth [ 9 ] . For example , a narrative review on diabetes ( such as that which might be found in a textbook chapter ) might include sections on the physiology and pathophysiology of carbohydrate , lipid , and protein metabolism ; the epidemiology of and prognosis associated with diabetes ; diagnostic and screening approaches ; and preventive , therapeutic , rehabilitative , and palliative interventions . Thus , narrative review s may be most useful for obtaining a broad perspective on a topic ; they are less often useful in furnishing quantitative answers to specific clinical questions . Narrative review s are appropriate for describing the history or development of a problem and its management . Narrative review s may better describe cutting-edge developments if research is scant or preliminary or if studies are very limited by flawed design or execution [ 13 ] . They may be particularly useful for discussing data in light of underlying theory and context . Narrative review s can draw analogies and can conceptually integrate two independent fields of research , such as OBJECTIVE To examine the dietary habits of patients with ischemic heart disease 1 year after they received either  dietary advice on using the Plate Model and how to increase intakes of fruits and vegetables in a 10-minute session ( brief counseling group , BCG ) or dietary advice primarily based on the National Cholesterol Education Program Step I diet provided in 2 individually tailored 50-minute sessions held 3 months apart ( comprehensive counseling group , CCG ) . DESIGN A r and omized study that included dietary intake evaluation on basis of 7-day weighed food records completed at 3 occasions : immediately before counseling ( week zero ) , 12 weeks after counseling , and 52 weeks after counseling . SUBJECTS BCG was composed of 15 men and 2 women and CCG was composed of 16 men and 3 women with ischemic heart disease age 70 years or younger recruited from the Department of Cardiology , Odense University Hospital , Odense , Denmark . STATISTICAL ANALYSES PERFORMED ANOVA , unpaired t tests , and multiple regression analysis , as well as nonparametric statistical analyses were carried out . RESULTS The comprehensive counseling result ed in significant improvements from week 0 to 52 in the percent of energy from fat ( 33 % to 28 % ) , saturated fat ( 12 % to 9 % ) and carbohydrate ( 51 % to 54 % ) consumed by the subjects . The corresponding values in BCG did not differ significantly ( 31 % to 32 % , 11 % to 12 % , 53 % to 52 % respectively ) . Differences from week 0 to 52 between groups were significant for fat , saturated fat , and carbohydrate intake . In CCG , median intakes of fish , fruits , and vegetables were 44 g/day , 172 g/day , and 315 g/day , respectively , at week 52 . The corresponding values in BCG were 44 g/day , 129 g/day , and 224 g/day . There was no significant difference either within or between the groups . CONCLUSION This study suggests that sustained improvements in dietary behavior require individualized and reinforced counseling in patients with ischemic heart disease . Changes in intakes of fish , fruits , and vegetables need to be specifically targeted
target: There is suggestive but inconclusive evidence from the trials of a benefit in the use of brief interventions for risk factor modification in patients with coronary heart disease .
  This review , however , supports the concept that brief interventions for patients with coronary heart disease can have beneficial effects on risk factor modification and consequently on progression of coronary heart disease .
  Further trials using larger sample sizes need to be undertaken to demonstrate the benefits of brief structured intervention targeted at the modification of single or multiple risk factors
background: BACKGROUND The physical and psychosocial benefits of participation in cardiac rehabilitation following a coronary event have well been established .
  Despite these benefits there is strong evidence that participation in traditional cardiac rehabilitation programs remains low .
  Various models of cardiac rehabilitation have been implemented including the use of brief structured interventions to enable modification of coronary risk factors .
  OBJECTIVES The objective of this review was to determine the effect of brief structured interventions on risk factor modification in patients with coronary heart disease .