https://journal.chestnet.org/article/S0012-3692(12)60124-X/pdf

Prevention of VTE in Nonsurgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Prevention of VTE in Orthopedic Surgery Patients

Heparin has been recognized as a valuable anticoagulant and antithrombotic for several decades and is still widely used in clinical practice for a variety of indications. The anticoagulant activity of heparin is mainly attributable to the action of a specific pentasaccharide sequence that acts in concert with antithrombin, a plasma coagulation factor inhibitor. This observation has led to the development of synthetic heparin mimetics for clinical use. However, it is increasingly recognized that heparin has many other pharmacological properties, including but not limited to antiviral, anti-inflammatory, and antimetastatic actions. Many of these activities are independent of its anticoagulant activity, although the mechanisms of these other activities are currently less well defined. Nonetheless, heparin is being exploited for clinical uses beyond anticoagulation and developed for a wide range of clinical disorders. This article provides a "state of the art" review of our current understanding of the pharmacology of heparin and related drugs and an overview of the status of development of such drugs.

https://pharmrev.aspetjournals.org/content/pharmrev/68/1/76.full.pdf

Pharmacology of Heparin and Related Drugs

Some women are at risk of forming blood clots in a deep vein during pregnancy, after a caesarean birth, or during the first few weeks after childbirth. If part of the clot breaks off and lodges in a blood vessel in the lungs, it can be life-threatening. Preventive treatments include blood-thinning drugs to prevent clots, support stockings, and exercise soon after the birth to keep circulation moving. However, some drugs might cause problems such as increased blood loss after the birth. Drugs used include heparin, low molecular weight heparin and aspirin. We included 16 randomised controlled studies in the review but only 13 trials with 1774 women contributed data for the outcomes of interest. We did not find enough evidence from the trials to be sure about the effects of these different preventive treatments.This means there is not enough evidence to show which are the best ways to prevent deep vein thrombosis (DVT) during or following pregnancy, or after a caesarean birth.

/pdf/prophylaxis-for-venous-thromboembolic-disease-in-pregnancy-4z3jmc2n35.pdf

Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period

Non-invasive Ventilation in Acute Respiratory Failure

Background:Operative repair of an acute Achilles tendon rupture (ATR) reduces the risk of re-rupture and has therefore gained popularity as a standard treatment for ATR, especially in the young and physically active patient. There is ongoing controversy over the best surgical technique and postoperative treatment. In this prospective, randomized trial, we compared cast immobilization and functional treatment with early mobilization and weightbearing after using a minimally invasive surgical technique in patients with ATR.Methods:All patients with ATR were included. Exclusion criteria were systemic immunosuppressive therapy, re-ruptures, and severe comorbidity. All included patients underwent minimally invasive surgery, after which a below-knee splint with the foot in 10 degrees of plantar flexion was applied for the first week. Patients were then randomized to the cast immobilization group (IG) for 6 weeks or to the functional group (FG) for 6 weeks. Sixty patients were included. Median age was 43 years (...

Functional Treatment or Cast Immobilization After Minimally Invasive Repair of an Acute Achilles Tendon Rupture: Prospective, Randomized Trial.

BackgroundEquestrian-related injuries (ERIs) are relatively severe compared with injuries in other popular sports. Previous studies on epidemiology of ERIs vary widely and mainly focus on incidence instead of severity of the injury.PurposeThe aim of this study was to determine incidence, mechanisms

Beware of the force of the horse: mechanisms and severity of equestrian-related injuries

/pdf/hpryn-b-wzn-mwlkhwly-khm-bry-pyshgyry-z-trwmbwmbwly-rywy-dr-32jqhtrx2c.pdf

هپارین با وزن مولکولی کم برای پیشگیری از ترومبوامبولی ریوی در بیماران با بیحرکتی اندام تحتانی

Objective Crowding is a growing concern in general and pediatric Emergency Departments (EDs). The Emergency Care Access Point (ECAP) - a collaboration between general practitioners and the ED - has been established to reduce the number of self-referrals and non-urgent ED visits. The aim of this study was to determine the impact of an ECAP on pediatric attendances in the ED. Methods Retrospective analysis of 3997 pediatric patients who visited the ED of a regional teaching hospital in the Netherlands, one year before and one year after the implementation of an ECAP. Patient characteristics, presented complaints and diagnoses, throughput times, and follow-up between the study groups were compared, both during office hours and after-hours. Results After ECAP implementation, a 16.3% reduction in pediatric ED visits was observed. ECAP implementation was associated with a decline in self-referrals by 97.2%. Presented complaints, ED diagnoses and acuity were similar pre- and post-ECAP. However, consultations and follow-up were required more frequently. The admission rate during nights increased (49.3% versus 64.0%). Overall admission rates were similar. Conclusions The implementation of an ECAP was associated with a reduction of pediatric ED use, including a considerable but expected decline in pediatric self-referrals. Patient acuity pre- and post-ECAP was similar. Our results suggest that this primary care intervention might help reduce the workload in a pediatric ED. Future studies are warranted to further investigate this hypothesis and to evaluate the impact of an ECAP in other healthcare settings. These future efforts need to include patient oriented outcomes.

The impact of an emergency care access point on pediatric attendances at the emergency department : An observational study

Background In many industries, collaboration with end users is a standard practice when developing or improving a product or service. This process aims for a much better understanding of who the end user is and how the product or service could be of added value to them. Although patient (end user) involvement in the development of eHealth apps is increasing, this involvement has mainly focused on the design, functionalities, usability, and readability of its content thus far. Although this is very important, it does not ensure that the content provided aligns with patients’ priorities. Objective In this study, we aimed to explore the added value of patient involvement in developing the content for an eHealth app. By comparing the findings from this study with the existing app, we aimed to identify the additional informational needs of patients. In addition, we aimed to help improve the content of apps that are already available for patients with knee replacements, including the app our group studied in 2019. Methods Patients from a large Dutch orthopedic clinic participated in semistructured one-on-one interviews and a focus group session. All the patients had undergone knee replacement surgery in the months before the interviews, had used the app, and were therefore capable of discussing what information they missed or wished for before and after the surgery. The output was inductively organized into larger themes and an overview of suggestions for improvement. Results The interviews and focus group session with 11 patients identified 6 major themes and 30 suggestions for improvement, ranging from information for better management of expectations to various practical needs during each stage of the treatment. The outcomes were discussed with the medical staff for learning purposes and properly translated into an improved version of the app’s content. Conclusions In this study, patients identified many suggestions for improvement, demonstrating the added value of involving patients when creating the content of eHealth interventions. In addition, our study demonstrates that a relatively small group of patients can contribute to improving an app’s content from the patient’s perspective. Given the growing emphasis on patients’ self-management, it is crucial that the information they receive is not only relevant from a health care provider’s perspective but also aligns with what really matters to patients. Trial Registration Netherlands Trial Register NL8295; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8295

https://jmir.org/api/download?alt_name=formative_v6i11e39637_app1.pdf&filename=99667acb1b6d2da4612cf7e53dd40cee.pdf

Importance of Patient Involvement in Creating Content for eHealth Interventions: Qualitative Case Report in Orthopedics

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