Thigh length versus knee length antiembolism stockings for the prevention of deep vein thrombosis in postoperative surgical patients; a systematic review and network meta-analysis

OBJECTIVES: To assess the clinical effectiveness of thigh length versus knee length antiembolism stockings for the prevention of deep vein thrombosis (DVT) in surgical patients. DESIGN: Systematic review and meta-analysis using direct methods and network meta-analysis. METHODS: Previous systematic reviews and electronic databases were searched to February 2014 for randomised controlled trials (RCTs) of thigh length or knee length antiembolism stockings in surgical patients. Study quality was assessed using the Cochrane Risk of Bias Tool. The primary outcome was incidence of DVT. Analysis of the DVT data was performed using ORs along with 95% CIs. The I(2) statistic was used to quantify statistical heterogeneity. RESULTS: 23 RCTs were included; there was substantial variation between the trials and many were poorly reported with an unclear risk of bias. Five RCTs directly comparing thigh length versus knee length stockings were pooled and the summary estimate of effect favouring thigh length stockings was not statistically significant (OR 1.48, 95% CI 0.80 to 2.73). 13 RCTs were included in the network meta-analysis; thigh length stockings with pharmacological prophylaxis were more effective than knee length stockings with pharmacological prophylaxis, but again results were not statistically significant (OR 1.76, 95% credible intervals 0.82 to 3.53). CONCLUSIONS: Thigh length stockings may be more effective than knee length stockings, but results did not reach statistical significance and the evidence base is weak. Further research to confirm this finding is unlikely to be worthwhile. While thigh length stockings appear to have superior efficacy, practical issues such as patient acceptability may prevent their wide use in clinical practice. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42014007202

Systematic review of patient preference and adherence to the correct use of graduated compression stockings to prevent deep vein thrombosis in surgical patients

Aim: To explore patient preference and adherence to thigh and knee length graduated compression stockings for the prevention of deep vein thrombosis in surgical patients. Background: Hospitalised patients are at risk of developing deep vein thrombosis. Mechanical methods of prophylaxis include compression stockings, available as knee or thigh length. Patient adherence to correct stocking use is of critical importance to their effectiveness. Design: Systematic review of quantitative evidence. Data sources: Eleven databases were searched from inception to 2013 for systematic reviews of compression stockings. Reviews were screened for relevant primary studies and update searches of eight electronic sources were undertaken (2010-2014). Review methods: Randomised controlled trials and observational studies of surgical patients using compression stockings were quality assessed and data were extracted on patient adherence and preference. A narrative summary is presented. Results: Nine randomised controlled trials and seven observational studies were included in the systematic review. There was substantial variation between studies in terms of patient characteristics, interventions and methods of outcome assessment. Conclusion: Patient adherence was generally higher with knee length than thigh length stockings. However, the studies reflect patient adherence in a hospital setting only, where patients are observed by healthcare professionals; it is likely that adherence reduces once patients have been discharged from hospital. Patients preferred knee length stockings over thigh length stockings. In many clinical settings any difference in efficacy between thigh length and knee length stockings may be rendered irrelevant by patient preference for and likely better adherence to knee length stockings

More than a trash can : A case study of public art in an existing residential area.

The purpose of this essay is to, through a case study, increase the understanding of the impact of the design policy on existing residential areas in the pursuit of a good built environment. The case study has been realized through an observation of Klockaretorpet’s center, a district in Norrköping, and interviews with the actors that are involved in the project, Möter konsten. The essay deals with the issues in how public art can contribute to a Good built environment for the residents. Also, how the project Möter konsten can work with public art in an existing residential area. Lastly, what consequences a project of public art might bring in an existing residential area. To implement the result and the analysis, the following theoretical framework has been attached; good built environment, design policy, public art and cooperation. The result shows that public art is a generator and creates synergies in the design policy. The public art and the design policy are therefore to pursuit a good built environment on existing residential areas.Syftet med uppsatsen är, att genom en fallstudie, öka förståelsen för den gestaltade livsmiljöns påverkan på befintliga bostadsområden i strävan efter en god bebyggd miljö. Fallstudien har utförts genom en observation av Klockaretorpets centrum samt intervjuer med involverade aktörer i projektet Möter konsten. Uppsatsen besvarar frågeställningarna som berör hur den konstnärliga gestaltningen kan bidra till en God bebyggd miljö för de boende. Även hur ett projekt som Möter konsten kan arbeta med konstnärlig gestaltning i ett befintligt bostadsområde. Till sist, vilka konsekvenser ett konstnärligt gestaltningsprojekt kan få i ett befintligt bostadsområde. För genomförandet av resultat och analys har följande teoretiska ramverk varit i utgångspunkt; God bebyggd miljö, gestaltad livsmiljö, konstnärlig gestaltning och samverkan i det offentliga rummet. Resultatet visar på att konstnärlig gestaltning är en generator och skapar synergier i en gestaltad livsmiljö. Gestaltningarna påverkar därmed stävan efter en god bebyggd miljö i befintliga bostadsområden