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Journal of Trauma Nursing : the...Appropriate venous thromboembolism (VTE) chemoprophylaxis in trauma and emergency general surgery (EGS) patients is crucial.
BACKGROUND
Appropriate venous thromboembolism (VTE) chemoprophylaxis in trauma and emergency general surgery (EGS) patients is crucial.
OBJECTIVE
The purpose of this study is to review the recent literature and offer recommendations for VTE chemoprophylaxis in trauma and EGS patients.
METHODS
We conducted a literature search from 2000 to 2021 for articles investigating VTE chemoprophylaxis in adult trauma and EGS patients. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
RESULTS
Our search resulted in 34 articles. Most studies showed low-molecular-weight heparin (LMWH) is similar to unfractionated heparin (UFH) for VTE prevention; however, LMWH was more commonly used. Adjusted chemoprophylaxis dosing did not change the VTE rate but the timing did. Direct oral anticoagulants (DOACs) have been shown to be safe and effective in trauma and traumatic brain injury (TBI)/spinal cord injury (SCI). Studies showed VTE prophylaxis in EGS can be inconsistent and improves with guidelines that lower VTE events.
CONCLUSIONS
There may be no benefit to receiving LMWH over UFH in trauma patients. In addition, different drugs under the class of LMWH do not change the incidence of VTE. Adjusted dosing of enoxaparin does not seem to affect VTE incidence. The use of DOACs in the trauma TBI and SCI setting has been shown to be safe and effective in reducing VTE. One important consideration with VTE prophylaxis may be the timing of prophylaxis initiation, specifically as it relates to TBI, with a higher likelihood of developing VTE as time progresses. EGS patients are at a high risk of VTE. Improved compliance with clinical guidelines in this population is correlated with decreased thrombotic events.
Topics: Adult; Anticoagulants; Chemoprevention; Heparin; Heparin, Low-Molecular-Weight; Humans; Venous Thromboembolism
PubMed: 34491950
DOI: 10.1097/JTN.0000000000000606 -
Brain Hemorrhages Dec 2021In addition to the deleterious effects Covid-19 has on the pulmonary and cardiovascular systems, COVID-19 can also result in damage to the nervous system. This review... (Review)
Review
INTRODUCTION
In addition to the deleterious effects Covid-19 has on the pulmonary and cardiovascular systems, COVID-19 can also result in damage to the nervous system. This review aims to explore current literature on the association between COVID-19 and intracranial hemorrhage (ICH).
METHODS
We conducted a systematic review of PubMed for literature published on COVID-19 and ICH. Ninety-four of 295 screened papers met inclusion criteria.
RESULTS
The literature addressed incidence and mortality of ICH associated with Covid-19. It also revealed cases of COVID-19 patients with subarachnoid hemorrhage, intraparenchymal hemorrhage, subdural hematomas, and hemorrhage secondary to cerebral venous thrombosis and ischemic stroke. ICH during COVID-19 infections was associated with increased morbidity and mortality. Risk factors for ICH appeared to be therapeutic anticoagulation, ECMO, and mechanical ventilation. Outcomes varied widely, depending on the severity of COVID-19 infection and neurologic injury.
CONCLUSION
Although treatment for severe Covid-19 infections is often aimed at addressing acute respiratory distress syndrome, vasculopathy, and coagulopathy, neurologic injury can also occur. Evidence-based treatments that improve COVID-19 mortality may also increase risk for developing ICH. Providers should be aware of potential neurologic sequelae of COVID-19, diagnostic methods to rule out other causes of ICH, and treatment regimens.
PubMed: 34786548
DOI: 10.1016/j.hest.2021.11.003 -
JAMA Nov 2022It is uncertain whether hormone therapy should be used for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers.
Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
IMPORTANCE
It is uncertain whether hormone therapy should be used for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers.
OBJECTIVE
To update evidence for the US Preventive Services Task Force on the benefits and harms of hormone therapy in reducing risks for chronic conditions.
DATA SOURCES
PubMed/MEDLINE, Cochrane Library, EMBASE, and trial registries from January 1, 2016, through October 12, 2021; surveillance through July 2022.
STUDY SELECTION
English-language randomized clinical trials and prospective cohort studies of fair or good quality.
DATA EXTRACTION AND SYNTHESIS
Dual review of abstracts, full-text articles, and study quality; meta-analyses when at least 3 similar studies were available.
MAIN OUTCOMES AND MEASURES
Morbidity and mortality related to chronic conditions; health-related quality of life.
RESULTS
Twenty trials (N = 39 145) and 3 cohort studies (N = 1 155 410) were included. Participants using estrogen only compared with placebo had significantly lower risks for diabetes over 7.1 years (1050 vs 903 cases; 134 fewer [95% CI, 18-237]) and fractures over 7.2 years (1024 vs 1413 cases; 388 fewer [95% CI, 277-489]) per 10 000 persons. Risks per 10 000 persons were statistically significantly increased for gallbladder disease over 7.1 years (1113 vs 737 cases; 377 more [95% CI, 234-540]), stroke over 7.2 years (318 vs 239 cases; 79 more [95% CI, 15-159]), venous thromboembolism over 7.2 years (258 vs 181 cases; 77 more [95% CI, 19-153]), and urinary incontinence over 1 year (2331 vs 1446 cases; 885 more [95% CI, 659-1135]). Participants using estrogen plus progestin compared with placebo experienced significantly lower risks, per 10 000 persons, for colorectal cancer over 5.6 years (59 vs 93 cases; 34 fewer [95% CI, 9-51]), diabetes over 5.6 years (403 vs 482 cases; 78 fewer [95% CI, 15-133]), and fractures over 5 years (864 vs 1094 cases; 230 fewer [95% CI, 66-372]). Risks, per 10 000 persons, were significantly increased for invasive breast cancer (242 vs 191 cases; 51 more [95% CI, 6-106]), gallbladder disease (723 vs 463 cases; 260 more [95% CI, 169-364]), stroke (187 vs 135 cases; 52 more [95% CI, 12-104]), and venous thromboembolism (246 vs 126 cases; 120 more [95% CI, 68-185]) over 5.6 years; probable dementia (179 vs 91 cases; 88 more [95% CI, 15-212]) over 4.0 years; and urinary incontinence (1707 vs 1145 cases; 562 more [95% CI, 412-726]) over 1 year.
CONCLUSIONS AND RELEVANCE
Use of hormone therapy in postmenopausal persons for the primary prevention of chronic conditions was associated with some benefits but also with an increased risk of harms.
Topics: Female; Humans; Advisory Committees; Chronic Disease; Estrogens; Fractures, Bone; Hormone Replacement Therapy; Hormones; Postmenopause; Primary Prevention; Progestins; Prospective Studies; Quality of Life; Risk Assessment; United States; Urinary Incontinence; Venous Thromboembolism
PubMed: 36318128
DOI: 10.1001/jama.2022.18324 -
The Journal of Vascular Access Mar 2017Central venous catheterisation (CVC) is a technique commonly used to obtain vascular access and over five million CVCs are inserted annually. This systematic review of... (Review)
Review
INTRODUCTION
Central venous catheterisation (CVC) is a technique commonly used to obtain vascular access and over five million CVCs are inserted annually. This systematic review of CVC-related arterial injury aims to compare outcomes reported with different management strategies.
METHODS
PRISMA guidelines were followed. A search of Medline, Embase, Central and CINAHL was performed. Results were limited to papers in humans and in English with duplicates removed. Details of cases including site and nature of arterial injury, use of ultrasound, methods for identifying arterial placement, management methods used, and any reported outcomes were collated from all papers. Successful management was defined as control of haemorrhage without evidence of further complications.
RESULTS
We screened 2187 abstracts and 78 full manuscripts were obtained and reviewed. Twenty-four papers were of relevance and were included in this review. Amongst the papers, 80 cases of arterial injury were reported. Successful treatment by removal and compression, endovascular methods, and open surgical repair were 5.6%, 94.6% and 100%, respectively.
DISCUSSION
Removal and compression of the arterial site is a poor management method and is associated with a high rate of complications. Endovascular approaches had a high rate of success with advantages of endovascular techniques including access to arteries which are difficult to expose surgically and avoidance of general anaesthesia. Endovascular repair might be considered depending on site of injury or local expertise though surgical repair reported the best results in this review with no complications seen.
Topics: Algorithms; Arteries; Catheterization, Central Venous; Critical Pathways; Endovascular Procedures; Hemorrhage; Hemostatic Techniques; Humans; Pressure; Treatment Outcome; Vascular Surgical Procedures; Vascular System Injuries
PubMed: 27791256
DOI: 10.5301/jva.5000611 -
Journal of Clinical and Translational... Jun 2022Lymph node transfer surgery (LNTS) is indicated in secondary lymphedema (LE) patients who do not respond to conservative therapy. Animal models are the spearhead of LE... (Review)
Review
BACKGROUND AND AIM
Lymph node transfer surgery (LNTS) is indicated in secondary lymphedema (LE) patients who do not respond to conservative therapy. Animal models are the spearhead of LE research and were used to pioneer most of the surgical interventions currently in practice. We conducted a systematic review of the literature to explore animal models dedicated to LNTS to compare different species, techniques, and outcomes.
METHODS
Four databases were searched: PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis as our basis of organization.
RESULTS
Avascular lymph node graft (ALNG) and vascularized lymph node transfer (VLNT) effectively treated LE and lead to better outcomes than controls. Whole ALNGs are superior to fragmented ALNGs. Larger fragments are more likely to be reintegrated into the lymphatic system than small fragments. VLNT was superior to whole and fragmented ALNG. Increasing the number of VLNT resulted in better outcomes. Adipose-derived stem cells improved outcomes of VLNT; vascular endothelial growth factor C and D and platelet-rich plasma improved outcomes for ALNG. Cryopreservation of lymph nodes (LNs) did not affect outcomes for ALNG. The critical ischemia and venous occlusion time for LN flaps were 4-5 and 4 h, respectively. The critical time for reperfusion injury was 2 h. Some of the novel models included venous LNT, and cervical adipocutaneous flap to groin.
CONCLUSION
Current evidence from animals favors VLNT over other surgical interventions. Several pharmacological therapies significantly improved outcomes of ALNG and VLNT.
RELEVANCE TO PATIENTS
LE is a chronic condition affecting millions of patients worldwide. LNTS is becoming more popular as a LE treatment. Animal models have led the LE research for decades and developing new models for LE are essential for LE research. This systematic review aims to summarize the existing animal models dedicated to LNTS. We believe that this review is critical to guide researchers in the selection of the model that is best fit for their hypothesis-driven experiments.
PubMed: 35813893
DOI: No ID Found -
Phlebology Jul 2016The aim of this article was to summarize the efficacy and safety of venous stents in chronic obstructive venous disease (COVD) including postthrombotic syndrome (PTS)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aim of this article was to summarize the efficacy and safety of venous stents in chronic obstructive venous disease (COVD) including postthrombotic syndrome (PTS) and nonthrombotic iliac vein lesions (NIVL).
METHODS
We searched PubMed for case series (prospective and retrospective) that focused on venous stents in the treatment of COVD published between 1st January, 2000 and 15th July, 2014. Then, we analyzed the perioperative complications, subsequent antithrombotic treatment, clinical outcomes, and long-term patency of this procedure.
RESULTS
Overall, 1987 patients from 14 studies were included in our study. The incidence of the 30-day thrombotic events was 2.0% (4.0% in PTS vs. 0.8% in NIVL, p = 0.0002). The rates of access site complications and stent migration were 1.7% and 1.3%, respectively. The incidence of retroperitoneal bleeding and contrast extravasation was 1.8%. Back pain was more common with a rate of 62.9%. With stent placement, there was a significant pain and edema relief in COVD patients and the clinical-etiology-anatomy-pathophysiology scores declined. The rate of ulcer healing was 72.1% (70.3% in PTS vs. 86.9% in NIVL, p = 0.0022), and the ulcer recurrence rate was 8.7%. The primary, assisted primary, and secondary patency rates were 91.4%, 95.0%, and 97.8%, respectively, at 12 months and 77.1%, 92.3%, and 94.3%, respectively, at 36 months; however, the patency rates in PTS were lower than those in NIVL.
CONCLUSIONS
Stents may be a relatively effective and safe approach for PTS and NIVL patients because of the low incidence of perioperative complications and satisfying long-term patency. Some outcomes of stents in NIVL patients may be better than those in PTS patients.
Topics: Foreign-Body Migration; Hemorrhage; Humans; Iliac Vein; Postthrombotic Syndrome; Stents; Varicose Ulcer
PubMed: 26205370
DOI: 10.1177/0268355515596474 -
British Journal of Community Nursing Dec 2014Maggot debridement therapy is used extensively in the UK in both community and hospital situations, but remains a potentially under-used modality in many wound care... (Review)
Review
Maggot debridement therapy is used extensively in the UK in both community and hospital situations, but remains a potentially under-used modality in many wound care markets. It promotes wound healing by performing three key processes: debridement, disinfection and growth-promoting activity. It can be used for the debridement of non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers and non-healing traumatic of post-surgical wounds. With the increase in chronic diabetic foot wounds, maggot debridement therapy is a promising tool for health professionals dealing with difficult wounds. This article presents an overview of the research evidence surrounding maggot debridement therapy that serves as a guide to health professionals who may be users of this form of treatment now and in the future.
Topics: Animals; Debridement; Diptera; Humans; Larva; Skin Care; Wound Healing; Wounds and Injuries
PubMed: 25478859
DOI: 10.12968/bjcn.2014.19.Sup12.S6 -
The International Journal of Lower... Dec 2016A systematic review and meta-analyses of nutritional supplementation to treat chronic lower extremity wounds was done in order to test the premise that impaired... (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analyses of nutritional supplementation to treat chronic lower extremity wounds was done in order to test the premise that impaired nutrition is implicated in healing. The databases of Ovid MEDLINE, Ovid EMBASE, Cochrane Library, and EBSCO CINAHL (1972-October 2014) were searched systematically. Only randomized controlled trials in adults with chronic lower extremity wounds were included. Both topical and systemic routes of supplementing nutrition were considered. The primary outcome was wound healing. Study characteristics, outcomes, and risk of bias were extracted by trained researchers and confirmed by the principal investigator. Twenty-three of 278 (8.3%) retrieved articles met the inclusion criteria and were selected. Most of the studies were of unclear or low risk. Overall, nutritional supplementation was favorable (risk ratio [RR] = 1.44, 95% confidence interval [CI] = 1.25-1.66). The systemic route was marginally better than the topical one (RR = 1.51, 95% CI = 1.36-1.67; RR = 1.14, 95% CI = 0.96-1.36, respectively). For venous ulcers, the data showed nutritional supplementation to be significantly beneficial compared to placebo (RR = 1.44, 95% CI = 1.31-1.59). Similar data were found for diabetic foot and sickle cell ulcers (RR = 1.17, 95% CI = 0.93-1.47; RR = 1.56, 95% CI = 0.94-2.60, respectively). These data permit the inferences that nutritional supplementation in the populations studied showed significant benefits in the healing of venous ulcers and tendency (nonsignificant trends) in the healing of diabetic and sickle cell ulcers.
Topics: Humans; Lower Extremity; Nutritional Support; Wound Healing; Wounds and Injuries
PubMed: 27810941
DOI: 10.1177/1534734616674624 -
European Journal of Trauma and... Jun 2023Anemia is one of the most common complications after hip fracture surgery. Tranexamic acid (TXA) has been considered effective in preventing anemia in total hip... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Anemia is one of the most common complications after hip fracture surgery. Tranexamic acid (TXA) has been considered effective in preventing anemia in total hip arthroplasty, but its role in hemiarthroplasty is debated. The aim of this systematic review was to investigate the efficacy and safety of perioperative TXA for hip hemiarthroplasty.
METHODS
A systematic literature search was performed to identify studies comparing adult patients who underwent hemiarthroplasty for a hip fracture with and without perioperative TXA. The primary outcome was transfusion rate. Secondary outcomes included postoperative hemoglobin, length of hospital stay, adverse events (i.e., deep venous thromboses and pulmonary embolism), and 30-day mortality.
RESULTS
In total, 13 articles were included, comprising 54,843 patients of whom 14.1% received perioperative TXA. TXA was applied intravenous in ten studies, topical in two studies, one study investigated both. Pooled results showed a significant reduction in transfusion rate (pooled RR: 0.48, 95% CI 0.40-0.58, p < 0.01). Postoperative hemoglobin and length of stay were investigated in nine studies, pooled results showed significant improvement of both outcomes for patients that received TXA. Eleven studies investigated thromboembolic events, and there was no statistical difference in deep venous thromboses (pooled RR: 0.67, 95% CI 0.18-2.56, p = 0.56) or pulmonary embolism (pooled RR: 1.10, 95% CI 0.45-2.68, p = 0.83) among the two groups. There was a significant reduction in 30-day mortality for patients that received TXA.
CONCLUSION
TXA can be considered effective and safe for patients undergoing hip hemiarthroplasty, with a reduction in transfusion rate and increase in postoperative hemoglobin, without increasing adverse events. Optimal timing, dosage, and type of administration of TXA remain unclear.
Topics: Adult; Humans; Tranexamic Acid; Antifibrinolytic Agents; Hemiarthroplasty; Blood Loss, Surgical; Pulmonary Embolism; Hemoglobins; Anemia; Hip Fractures; Arthroplasty, Replacement, Hip; Venous Thrombosis
PubMed: 36512031
DOI: 10.1007/s00068-022-02180-x -
Pediatric Nephrology (Berlin, Germany) May 2021There are similarities in hemodialysis (HD) between adults and children and also unique pediatric aspects. In this systematic review, we evaluated the existing HD...
BACKGROUND
There are similarities in hemodialysis (HD) between adults and children and also unique pediatric aspects. In this systematic review, we evaluated the existing HD literature, including vascular access, indications, parameters, and outcomes as a reflection on real-life HD practices.
METHODS
Medline, Embase, CINAHL, Web of Science, and Cochrane Library were systematically searched for literature on HD in children (1-20 years). Two reviewers independently assessed the literature and data on indications; vascular access, outcomes, and specific parameters for HD were extracted.
RESULTS
Fifty-four studies (8751 patients) were included in this review. Studies were stratified into age groups 1-5, 6-12, and 13-20 years based on median/mean age reported in the study, as well as era of publication (1990-2000, 2001-2010, and 2011-2019). Across all age groups, both arteriovenous fistulas and central venous catheters were utilized for vascular access. Congenital abnormalities and glomerulopathy were the most common HD indications. HD parameters including HD session duration, dialysate and blood flow rates, urea reduction ratio, and ultrafiltration were characterized for each age group, as well as common complications including catheter dysfunction and intradialytic hypotension. Median mortality rates were 23.3% (3.3), 7.6% (14.5), and 2.0% (3.0) in ages 1-5, 6-12, and 13-20 years, respectively. Median transplantation rates were 41.6% (38.3), 52.0% (32.0), and 21% (25.6) in ages 1-5, 6-12, and 13-20, respectively.
CONCLUSION
This comprehensive systematic review summarizes available literature on HD in children and young adults, including best vascular access, indications, technical aspects, and outcomes, and reflects on HD practices over the last three decades.
Topics: Central Venous Catheters; Child; Dialysis Solutions; Humans; Hypotension; Infant; Kidney Diseases; Kidney Failure, Chronic; Renal Dialysis; Young Adult
PubMed: 33188608
DOI: 10.1007/s00467-020-04821-y