Current Health Developments in Treating Deep Vein Thrombosis - Essay Example

?Source Purpose/problem Sample Design Instrument Results Implications Comments Paul Kyrle, Sabine Eichingher (2005) Establishment of new diagnostic and therapeutic strategies for DVT; management of the disorder in specific groups of patients, such as women and people with cancer. 146 studies Qualitative Clinical risk assessment, meta-analysis review Prophylaxis with low-dose anticoagulation before surgery or prolonged bed rest; prevention of thrombus progression and embolisation through low-molecular weight heparin followed by Vitamin K antagonists (for 6 months); for cancer patients – low molecular weight heparin Prevention of thrombus is a more effective choice in the management of DVT Both authors are experts in the field of medicine, particularly in the management of thrombus and hemostasis (Williams 2010). They are reliable in their field of practice and in researches related to their field of practice. The research is valid in terms of ethical processes, especially in ensuring that the research gathering process is voluntary and gained through informed consent (Hucker, 2001). The research is paid for by the authors, not by any private corporations. Hence, the validity of the results are not overshadowed by private funding (Friedman, 2004). Most of the materials used present unbiased and reliable results (Davies and Dodd, 2002). This study is significant in terms of establishing the importance of adopting and prioritizing preventive measures for DVT. Dennis, M. (2009) Effectiveness of thigh-length GCS to reduce DVT after stroke. 2518 patients Quantitative/experimental Outcome-blinded, randomised controlled trial Non-significant absolute reduction in risk of 0.5% (95% CI -1.9% to 2.9%). Skin breaks, ulcers, blisters, and skin necrosis were significantly more common in patients allocated to GCS than in those allocated to avoid their use. Results do not support use of thigh-length GCS in patients admitted to hospital with acute stroke. The author is a highly qualified expert in the field of medicine, most especially in cardiovascular medicine and in the clinical management of thrombus issues. He is reliable in his field and has carried out different researches in related studies (Williams, 2010). The research is valid in terms of the statistical processes applied, and different methodology applied (Strauss and Corbin, 1990). The research has been paid for by the author, not by any private corporation. The analysis and data results are based on thorough analysis of results (Glesne and Peshkin, 1992). No logical fallacies are seen from the author’s conclusions (Ethridge, 2004). This study is significant because it reviews the use of which length GC stockings in patients at risk for DVT Falanga, A (2005) To review the clinical significance of VTE in patients with cancer and the strategies for management of VTE in these patients, including the potential role of low molecular weight heparins (LMWHs). 49 studies Quantitative Clinical review The use of low molecular weight heparin (LMWH) therapy instead of VKAs may be beneficial in patients. This agent offers an effective alternative to VKAs in the long-term management of VTE, that is free from the practical problems associated with the use of VKAs and without increasing the risk of bleeding. Alternative means of managing DVT among cancer patients present with advantages which assist in their long-term care. These alternatives must be considered for patients. The author is also a highly qualified expert in the field of medicine, specifically in oncology and cardiovascular diseases. She has published several studies in cardiovascular diseases and in cancer management. She is highly respected in her field and has published numerous researches on cancer management, including thrombus management. This makes her a highly reliable author (Williams, 2010). The methods applied truly measure what they intend to measure (Joppe, 2000). The authors in the reviewed studies outline some of their methodology which is within ethical parameters of reliability and validity. Some of the other authors however do not indicate the processes they went through and hence cannot be assessed in terms of validity. This impact on the replicability of research and on its validity (Kolbe, 1991). The research is paid for by the author and the results presented follow logical and are fully supported by statistical figures. This study is significant because it presents other interventions and options in the prevention and treatment of DVTs. Hill, J. and Tom, T. (2007) Summary most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on how to reduce the risk of venous thromboembolism in inpatients having surgery NICE Guidelines Summary Review of guidelines Offer all surgical inpatients a mechanical method of prophylaxis (graduated compression or antiembolism stockings, intermittent pneumatic compression, or foot impulse devices) except where contraindicated; Offer both mechanical prophylaxis and low molecular weight heparin to all inpatients having orthopaedic surgery; Offer thigh length stockings (worn until usual level of mobility), but knee length stockings may be used to improve compliance or fit. The compression should be about 18 mm Hg at the ankle, 14 mm Hg at the mid-calf, and 8 mm Hg at the upper thigh; Encourage patients to become mobile as soon as possible after surgery and to do leg exercises if immobile NICE recommendations are based on systematic reviews of best available evidence. When limited evidence is available for some remedies then they should be discarded Both authors are highly qualified doctors of medicine, particularly in the management of thromboembolisms. They have published several studies in their area of expertise and practice. Again, this makes them reliable authors (Williams, 2010). The summary provides a review of guidelines based on set processes imposed by the government. The research is reliable because it is not privately funded by any corporation for any financial reasons (Williams, 2010). The summary is based on systematic reviews of government policies; they are reliable and valid as they are based on policies laid out by government experts (Hanney, et.al., 2003). This study is significant because it specifies government remedies and how they apply to DVT. Gutt, C; Oniu, T.; Wolkener, T. Mehrabi, A.; Mistry, S. & Buchler, M. (2005) To establish prophylaxis and treatment of deep vein thrombosis in general surgery 71 studies Quantitative Review of studies: metaanalysis and RCTs Low–molecular weight heparins (LMWHs) are relied upon more and more for prophylaxis and initial anticoagulant treatment of DVT, because of their multiple advantages in efficacy, safety, and convenience in handling; for cost-effective reasons, full-dose vitamin K antagonists are still preferred as the standard long-term anticoagulation method, while LMWHs represent the exception. Long-term use of low-intensity warfarin should be considered a new standard of care for the management of venous thrombosis. LMWHs are the better alternative in the management of DVT among surgical patients; practitioners must consider its general and more widespread application among patients at risk for DVTs. All the authors are reliable (Williams, 2010). They are clinicians whose expertise range from cardiovascular medicine, internal medicine, and various specializations in thrombus and related hemostasis. They have all published various papers and studies in medical research which all refer to improved patient management. This research is valid and reliable as a review study. The authors have laid out logical and valid parameters for inclusion and exclusion and in so doing they have assisted in establishing reliable results for the study (Clont, 1992). The conclusions reached by the authors are based on the logical progression of results from the studies reviewed then on to the cumulative results and conclusions. The statistical treatment for the researches included is well supported by valid and reliable processes (Healy and Perry, 2000). Some of the studies however do not include detailed accounting of methodology. This makes it impossible to evaluate their validity (Kolbe, 1991). Otherwise, most of the research included is valid and reliable. This study is significant because it helps provide alternative means in resolving the issue of DVT among high-risk patients. Goldenberg, A; Durham, G; Knapp-Clevenger, A (2007) To retrospectively analyze institutional experience with a thrombolytic regimen versus standard anticoagulation for acute, occlusive deep venous thrombosis (DVT) of the proximal lower extremities in children in whom plasma factor VIII activity and/or D-dimer concentration were elevated at diagnosis, from within a longitudinal pediatric cohort. 22 respondent children Quantitative Retrospective chart review The thrombolytic regimen was linked with decreased odds of PTS at 18 to 24 months compared with standard anticoagulation alone, which persisted after adjustment for significant covariates of age and lag time to therapy. Major bleeding developed in 1 child, clinically judged as not directly related to thrombolysis for DVT. Findings imply that the using thrombolysis regimen may safely and substantially reduce the risk of PTS in children with occlusive lower-extremity acute DVT, providing the basis for a future clinical trial. The three authors of this study are all clinicians and well respected in the field of medicine. They have all been involved in cardiovascular and hemostatic management. They are also published authors with various studies in thrombus, hemostasis, and pediatrics. This research is reliable and valid because the authors specified the ethical processes they followed in carrying out their research (Winter, 2000). There is however less contact with patients because it is a retrospective study, and the authors did not specify the process they underwent with the ethical committee to avail of the charts which they reviewed (Crocker and Algina, 1986). This study is not paid for by any private corporation which may stand to profit from it. The results of the study are based on statistical computation and conclusions drawn are based on such results and discussions (Ethridge, 2004). This study is relevant to the issue because it provides a possible option for treatment, one which is applicable to children. Danish, S.; Burnett, M.; Ong, J.; Sonnad, S. (2005) To establish the most efficient perioperative prophylactic strategy for deep venous thrombosis (DVT) in craniotomy patients 810 patients Quantitative Structured review Addition of heparin lowered the rate of both DVT and pulmonary embolism, however, intracranial hemorrhage is at an increased risk. Since the impact of ICH is greater than the benefits of heparinization, overall better outcomes were best with mechanical prophylaxis. This was especially true for low-molecular-weight heparin, which is linked with a higher risk of ICH. Mechanical means of prophylaxis against DVT for craniotomy patients are still better than heparinization, hence, hospitals must take caution in applying this method during craniotomies. The authors of this study are all considered reliable because they are experts in medicine and in the field of DVT management and hemostasis (Williams, 2010). They are all university lecturers, clinicians, and researchers having published various papers with each other and individually. This research is reliable because it shows “an accurate representation of the total population under study” (Joppe, 2000, p. 1). The results are repeatable and consistent over time (Kirk and Miller, 1986). This study is reliable because it is not privately funded (Williams, 2010). The results of the study are based on statistical figures with discussions and conclusions based on such results (Ethridge, 2004). This study is relevant to the issue because it assists hospitals in considering methods for preventing DVTs during craniotomies. HOU Tian-xia WANG Jian-fu (2006) To evaluate the prevention and nursing care of postpartum deep vein thrombosis of lower extremities 21 patients Quantitative Summary The study established that by increasing the venous refluence, by preventing the endothelium injury and blood hypercoagulability, thrombus can be prevented. For DVT, raising the affected limbs, monitoring PT, strengthening the catheterization can be applied by nurses to prevent it from occurring. The symptoms and signs relieved completely after treatment and nursing care, no recurrence and serious complications occurred. No data is available on the authors of this research. It is therefore difficult to evaluate their reliability as authors. The rest of the research process is nevertheless reliable because the process enumerated is repeatable in future research (Charles, 1995). The results are reliable because the means of measurement are accurate (Wainer and Braun, 1998). The results are repeatable and can be repeated and still provide the same results (Kirk and Miller, 1986). The sample population is however very limited and does not represent a larger population (Crocker and Algina, 1986). This study is relevant to the issue because it provides preventive measures for DVT. Geerts, W. (2006) To establish means of preventing venous thromboembolism among high-risk patients 29 studies Summary Systematic literature review Prevention means: routine thromboprophylaxis for trauma patients, SCI and critical care patients. Prevention for high risk patients for VTE, including those recovering from major trauma and SCI: prophylaxis with a low molecular weight heparin (LMWH) as soon as hemostasis has been demonstrated. Prevention for critical care patients at lower thrombosis risk: either LMWH or low-dose heparin. Prevention for those with a very high risk of bleeding: mechanical prophylaxis as early as possible until pharmacologic prophylaxis can be initiated. Implementing measures to prevent venous thromboembolism is a major commitment for nurses and practitioners because proper assessment has to be implemented to ensure proper DVT measures are in place The author is highly reliable because he is an expert in his field of practice which is mostly in hemostasis, cardiovascular, and thromboembolisms (Williams, 2010). He has also published several studies and books on thromboembolisms. The results of this study are reliable because they are drawn from repeatable and replicable studies (Charles, 1995). Moreover, the results and conclusions are drawn from logical and reliable data. The measurement used in the studies is also reliable and appropriate for the study question and variables (Wainer and Braun, 1998). It is not privately funded, hence very much reliable and valid. This study is relevant because it provides a compilation of options for each specific DVT and thromboembolitic consideration in patient care. Aujesky, D. Smith, K.; Cornuz, J., Roberts, M. To assess the cost-effectiveness of Low-molecular-weight heparin (LMWH) 53 studies Quantitative Systematic review Inpatient treatment costs were higher for LMWH treatment than for UFH however LMWH resulted to a greater number of QALYs than did UFH Incremental costs of $221 and the corresponding incremental effectiveness of 0.184 yielded in an incremental cost-effectiveness ratio of $1,209/QALY. LMWH was cost-saving if the daily pharmacy costs for LMWH were Read More