Venous thromboembolism in orthopedic surgery: Global guidelines

Venous thromboembolism (VTE) is a severe complication that can occur after major orthopedic procedures. As VTE-related morbidity and mortality are a significant concern for both medical professionals and patients, and preventative measures are typically employed. Multiple organizations, including the American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS), have developed guidelines for VTE prophylaxis specifically in patients undergoing joint replacement procedures. However, recently, the International Consensus Meeting (ICM) was convened, which brought together over 600 experts from 68 countries and 135 international societies. These experts, spanning a range of medical disciplines including orthopedic surgery, anesthesia, cardiology, hematology, vascular, and internal medicine, conducted a comprehensive review of the literature using a strict Delphi process to generate practical recommendations for VTE prophylaxis across all types of orthopedic procedures. This review article summarizes some of the recommendations of the ICM

Patient Demographics and Reported Outcomes in Funded versus Non-funded Studies Assessing Thromboprophylaxis after Total Joint Arthroplasty: A Systematic Review

Background: There are numerous studies discussing thromboprophylaxis after total joint arthroplasty (TJA), which have varying conclusions. The purpose of this study was to investigate if industry funding of the study impacted patient demographics and overall reported outcomes of studies evaluating venous thromboembolism (VTE) prophylaxis after TJA. Methods: Electronic searches were completed for Ovid, PubMed, and Embase. Studies were included if: (1) published in the English language between 2000 and 2016 (2) including patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) (3) evaluating prevention and control of VTE with at least one thromboprophylactic agent. Results: There were 57 studies included in this systematic review. There was no overall drug effect between reporting outcomes, patient demographics, and level of funding. There were no significant differences between patient age, BMI, or revision exclusions between funded and non-funded studies. However, funded studies reported less pulmonary embolisms (PE) compared to non-funded studies. Funded studies also reported fewer events of major bleeding and less 90-day mortality than non-funded studies. Conclusion: It appears that the reported outcome of studies evaluating a drug as prophylaxis against VTE differs depending on the status of funding. Studies funded by industry report better outcome with less PE, less major bleeding, and less mortality compared to non-funded studies

Bilateral Femoroacetabular Impingement: The Fate of the Asymptomatic Hip

Introduction: The objective of this study was to evaluate the incidence of bilateral femoroacetabular impingement (FAI) in a consecutive group of patients and to evaluate the fate of the asymptomatic hip with FAI. Method: Between 2004 to 2016, 652 patients presented with hip pain arising from underlying FAI. Diagnosis of FAI was made based on clinical symptoms and imaging. 557 patients (646 hips) were included for the final analysis. Of these, 170 patients had bilateral radiological diagnosis of FAI. Of these, 88 patients presented with bilateral hip symptoms. The remaining 82 patients had unilateral hip symptoms. Of these 82 patients, 8 patients decided to have surgery on both hips under the same anesthesia. The remaining 74 patients decided to have the contralateral asymptomatic hip with FAI observed. Results: Of the cohort with bilateral FAI and an asymptomatic hip, 60 patients became symptomatic at an average 2.1 years follow-up. Of these 60 patients 43 patients needed surgical intervention. Binary logistic regression model identified that reduced neck shaft angle, increased lateral CE angle and increased alpha angle, younger age as predictors for developing symptoms in the contralateral hip. Discussion: Based on this study it appears that the incidence of bilateral FAI is common. The majority of patients with unilateral symptomatic FAI and radiographic evidence of bilateral FAI become symptomatic relatively quickly and require surgical intervention in the contralateral hip

Is intraoperative bleeding control useful after tourniquet release in arthroscopic anterior cruciate ligament reconstruction?

BackgroundArthroscopic anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery, and rehabilitation is very important to achieve successful postoperative results. Postoperative hemarthrosis causes pain and limitation of movement, which prolongs the rehabilitation period. For these reasons, various strategies are used to reduce hemarthrosis in patients undergoing ACL reconstruction. This study aimed to evaluate the effect of bleeding control after releasing the tourniquet in ACL reconstruction surgery on the amount of hemarthrosis and pain in the postoperative period.MethodologyA total of 60 patients who underwent arthroscopic single-bundle ACL reconstruction were enrolled in this prospective randomized control study. Bleeding control with the radiofrequency (RF) probe after releasing the tourniquet was done at the end of the arthroscopic ACL reconstruction in 30 patients (coagulation group) while bleeding control was not done for the other 30 patients (control group). Both groups were compared in terms of the degree of hemarthrosis using the Coupens and Yates classification in the early postoperative period and the degree of pain using the Visual Analog Scale (VAS) score and postoperative complications.ResultsIn both groups, isolated ACL reconstruction was performed in 10 patients, additional partial meniscectomy in three patients, and additional arthroscopic meniscus repair in 17 patients. There was no statistically significant difference between the coagulation and control groups in terms of VAS (p > 0.05) and the degree of hemarthrosis (p > 0.05). Although the duration of tourniquet application was similar in both groups (p = 0.78), the duration of anesthesia was significantly longer in the coagulation group (p = 0.001). There was no significant difference between the groups in terms of postoperative complications.ConclusionsBleeding control with the RF probe after tourniquet release does not yield superior outcomes. More research with larger populations is needed to confirm these findings

Ahdistuksenhallintakeinot : Opas mielenterveys- ja päihdekuntoutujien asumisyksikön hoitohenkilökunnalle

Tämän opinnäytetyön tarkoituksena oli tuottaa opas ahdistuksenhallintakeinoista mielenterveys- ja päihdekuntoutujien asumisyksikön henkilökunnalle. Opinnäytetyön tavoitteena oli, että mielenterveys- ja päihdekuntoutujien asumisyksikön hoitohenkilökunta osaisi tunnistaa ahdistuneen asukkaan, tietäisi käytettävissä olevista ahdistuksenhallintakeinoista ja osaisi soveltaa niitä hoitotyössä. Opinnäytetyö toteutettiin toiminnallisena opinnäytetyönä. Opinnäytetyömme aihe tuli Attendo Jokikodon tarpeesta. Opinnäytetyön teoreettisessa taustassa käsittelimme ahdistusta, ahdistuneisuushäiriöitä, ahdistuksen tunnistamista ja ahdistuksenhallintakeinoja. Tietoa etsimme monipuolisesti eri tietokannoista. Opinnäytetyön tuotoksena teimme oppaan mielenterveys- ja päihdekuntoutujien asumisyksikön henkilökunnalle. Oppaassa kerroimme mikä on ahdistus, kuinka tunnistaa ahdistunut ihminen eli kuvasimme erilaisia fyysisiä ja psyykkisiä oireita, joista voi huomata ihmisen ahdistuksen ja sen jälkeen kerroimme erilaisia keinoja, joilla ahdistusta voidaan helpottaa. Kerroimme oppaassa tiedot sekä ohjeistukset yksinkertaisesti ja selkeästi, koska lukijan tulee löytää etsimänsä asiat nopeasti, helposti ja ymmärrettävästi myös akuuteissa tilanteissa. Valmis opas luovutettiin toimeksiantajalle sähköisenä. Hyvä jatkokehittämisidea voisi olla, että kuinka varmistaa ahdistuksenhallintakeinojen käyttöönotto arjessa. Ahdistuksenhallintakeinojen ohjaaminen ja niiden opettaminen muille vaatii paljon aikaa, jaksamista ja ammattitaitoa, jotta voidaan todella vaikuttaa toivotulla tavalla ja lievittää asukkaiden ahdistuneisuutta. Tutkimuksessa voitaisiin selvittää, että millä keinoilla voidaan varmistaa ahdistuksenhallintakeinojen käyttöönotto ja tukea hoitajien resurssien riittävyyttä ja osaamista

Dijital Kamusal Alanda Nefret Söyleminin Gölgesinde Kadın Temsili: Miss Turkey 2024 Örneği Üzerinden Bir Analiz

Yurttaşların ortak çıkarlarını müzakere edebildikleri bir ortam olarak kamusal alan dijitalleşmenin etkisiyle birlikte Habermas’ın da belirttiği üzere yapısal bir dönüşüme uğramıştır. Bu yapısal dönüşümün kamusal alan için sağladığı potansiyeller kadar neden olduğu sorunları da dikkate almak gerekmektedir. Bu çalışmada, Miss Turkey 2024 birincisi İdil Bilgen’e yönelik dijital kamusal alanlarda üretilen cinsiyetçi ve ayrımcı söylemler, nefret söylemi çerçevesinde ele alınmıştır. Bilgen’in birinciliği sonrası sosyal medya platformlarında maruz kaldığı söylemler incelenerek, dijital kamusal alanın toplumsal cinsiyet eşitsizliklerini nasıl yeniden ürettiği ve nefret söyleminin bu süreçteki rolü tartışılmıştır. Bu nedenle X sosyal medya platformunda 11 Eylül 2024 ile 25 Eylül 2024 tarihleri arasında İdil Bilgen ile ilgili yapılan paylaşımlar ve Instagram ara yüzünde bulunan arama motoru kullanılarak “İdil Bilgen” adıyla yapılan aramada çıkan hesaplardan onaylı olarak belirtilen hesapta yer alan videoya yapılan yorumlar MAXQUADA programı kullanılarak oluşturulan kategoriler çerçevesinde analiz edilmiştir. Nitel içerik analizi kullanılarak yapılan incelemede, dijital kamusal alanın sağladığı potansiyellerin yanı sıra neden olduğu toplumsal sorunların, özellikle cinsiyetçilik ve nefret söylemi bağlamında daha iyi anlaşılması hedeflenmiştir. Yapılan analiz sonucunda dijital kamusal alan olarak belirtilen sosyal medya mecralarında belirlenen örneklem çerçevesinde cinsiyetçi yorumların nefret söylemi içerdiği gözlemlenmiştir

Venous Thromboembolism in Orthopedic Surgery: Global Guidelines

Venous thromboembolism (VTE) is a severe complication that can occur after major orthopedic procedures. As VTE-related morbidity and mortality are a significant concern for both medical professionals and patients, and preventative measures are typically employed. Multiple organizations, including the American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS), have developed guidelines for VTE prophylaxis specifically in patients undergoing joint replacement procedures. However, recently, the International Consensus Meeting (ICM) was convened, which brought together over 600 experts from 68 countries and 135 international societies. These experts, spanning a range of medical disciplines including orthopedic surgery, anesthesia, cardiology, hematology, vascular, and internal medicine, conducted a comprehensive review of the literature using a strict Delphi process to generate practical recommendations for VTE prophylaxis across all types of orthopedic procedures. This review article summarizes some of the recommendations of the ICM