Guyatt GH, Akl EA, Crowther M, et al. Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Department of Clinical Epidemiology and Biostatistics, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada.
Chest (Impact Factor: 7.13). 02/2012; 141(2 Suppl):7S-47S. DOI: 10.1378/chest.1412S3
Source: PubMed
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    • "Self-injections in an outpatient setting are encouraged to strengthen patient responsibility for her/his own disease management, grant greater independence, and reduce costs. For prophylaxis and treatment of venous thromboembolisms (VTE), the use of low-molecular-weight heparins (LMWH) is well established [1]. Therapies are often initiated during a hospital stay or at discharge, followed by daily s.c. "
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    ABSTRACT: Outpatient subcutaneous (s.c.) therapies are becoming more and more common in the treatment of different diseases. The effectiveness of community-pharmacy-based interventions in preventing problems that arise during s.c. self-injections of low-molecular-weight heparins (LMWH) is unknown. Our objective was to provide a standard operating procedure (SOP) for community pharmacists and to compare pharmaceutical vs. standard care in both clinical and daily life settings. We hypothesized that: pharmaceutical care results in improved adherence, safety, and satisfaction, and in fewer complications; the interventions used are feasible in daily life; and the results achieved in clinical and daily life settings are comparable. In the clinical setting (randomized controlled trial), patients were recruited sequentially in hospital wards; in the daily life setting (quasi-experimental design with a comparison group), recruitment took place in community pharmacies by pharmacists and trained master students during their internship. Interventions were offered according to patient needs. Data were collected by means of a monitored self-injection at home and structured questionnaire-based telephone interviews at the beginning and the end of the LMWH treatment. The main outcome measures were: scores to assess patient’s skills; syringe count to assess adherence; and frequency, effectiveness, and patient’s assessment of received interventions. The results show a median age of the 139 patients of 54 years. Interventions resulted in improved application quality (p < 0.01) and knowledge (p = 0.03). Oral instructions were pivotal for improving patients’ application quality. We found no significant score differences between the intervention groups in the clinical and daily life settings. Patients’ baseline skills were high, with the lowest score being 0.86 (score range −2.00 to +2.00). Adherence rate was high (95.8%). In conclusion, our SOP for pharmacist interventions was of good quality, adequate, appreciated, and feasible in daily life. Patients are capable of managing s.c. injection therapies if adequate assistance is provided.
    Pharmacology & Pharmacy 03/2014; 5(04):372-385. DOI:10.4236/pp.2014.54045
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    • "In our patient, anticoagulants were given for initial management. She was discharged asymptomatic on day 6 with INR level between 2 and 3 [13]. However, the renal infarction progressed after 9 months as she constantly used ketamine. "
    American Journal of Emergency Medicine 02/2014; 32(2):190-190. DOI:10.1016/j.ajem.2013.09.041 · 1.15 Impact Factor
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    • "A range of thromboprophylaxis are available including pharmacologic and mechanical methods. The recommended thromboprophylaxis for each patient depends on their condition and risk factors [Guyatt et al, 2012, NICE, 2010, SIGN, 2010]. There are 3 different types of mechanical thromboprophylaxis: anti-embolism stockings (AES); intermittent pneumatic compression devices and venous/pneumatic foot pumps. "
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    ABSTRACT: BACKGROUND: Anti-embolism stockings are commonly used worldwide to prevent the development of thrombosis in hospitalised patients. Patients are typically measured for, and fitted with, anti-embolism stockings during extended periods of non-ambulation. Anti-embolism stockings must critically fit the leg to achieve optimum blood flow and thus success of prophylaxis. Therefore, hospitals endeavour to maintain stock of anti-embolism stockings that fit the majority of their patients. OBJECTIVES: The objective of this study was to establish whether popular styles/brands of anti-embolism stockings "fitted" the legs of convenience sampled volunteers. DESIGN/METHODS: Volunteer's legs were measured at ankle, calf and thigh following guidance from British nurses and in accordance with brand instructions. Leg measurements were subsequently compared to the size charts of 10 anti-embolism stocking styles made by 4 different manufacturers. "Fit" is defined as a volunteer's leg measurements matching any stocking size in a range at all measurement points. SETTINGS: Volunteers were measured in different settings around Scotland, including private homes, work places and shopping centres. PARTICIPANTS: A convenience sample of 471 volunteers (283 female, 188 male) were recruited on the basis of willingness to participate and being over 16 years old. Volunteers ranged from 17 years to 82 years old with an average age of 35. RESULTS: The 10 different styles of anti-embolism stockings, made by 4 different brands, examined for this paper had a size match coefficient ranging from 0% to 100% for our volunteer's legs. The size match coefficient is strongly influenced by the Brand's sizing policy. CONCLUSIONS: The proportion of legs that "fit" a particular brand of anti-embolism stockings can be increased through: (1) the reduction of the number of leg measurement points that need to be matched to the size chart of the stockings; (2) the use of open-ended size ranges; (3) the use of increased size range width and (4) the use of increased overlap between sizes. However, all but the last of these measures can have a potentially deleterious impact on the ability of the stocking to deliver the optimum graduated pressure profile to all legs that "fit" the stocking, resulting in important implications to the efficacy of prophylaxis.
    International journal of nursing studies 02/2013; 50(7). DOI:10.1016/j.ijnurstu.2013.01.005 · 2.25 Impact Factor
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