Italian intersociety consensus statement on antithrombotic prophylaxis in hip and knee replacement and in femoral neck fracture surgery

Anticoagulant prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures (FNF). Different guidelines are available in the literature, with quite different recommendations. None of them is a multidisciplinary effort as the one presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the association of Orthopaedists and Traumatologists of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) have set down easy and quick suggestions for VTE prophylaxis in hip and knee surgery as well as in FNF treatment. This inter-society consensus statement aims at simplifying the grading system reported in the literature, and its goal is to benefit its clinical application. Special focus is given to fragile patients, those with high bleeding risk, and those receiving chronic antiplatelet (APT) and vitamin K antagonists treatment. A special chapter is dedicated to regional anaesthesia and VTE prophylaxis

Are non-slip socks really 'non-slip'? An analysis of slip resistance

Background. Non-slip socks have been suggested as a means of preventing accidental falls due to slips. This study compared the relative slip resistance of commercially available non-slip socks with other foot conditions, namely bare feet, compression stockings and conventional socks, in order to determine any traction benefit. Methods. Phase one involved slip resistance testing of two commercially available non-slip socks and one compression-stocking sample through an independent blinded materials testing laboratory using a Wet Pendulum Test. Phase two of the study involved in-situ testing among healthy adult subjects (n = 3). Subjects stood unsupported on a variable angle, inclined platform topped with hospital grade vinyl, in a range of foot conditions (bare feet, non-slip socks, conventional socks and compression stockings). Inclination was increased incrementally for each condition until slippage of any magnitude was detected. The platform angle was monitored using a spatial orientation tracking sensor and slippage point was recorded on video. Results. Phase one results generated through Wet Pendulum Test suggested that non-slip socks did not offer better traction than compression stockings. However, in phase two, slippage in compression stockings was detected at the lowest angles across all participants. Amongst the foot conditions tested, barefoot conditions produced the highest slip angles for all participants indicating that this foot condition provided the highest slip resistance. Conclusion. It is evident that bare feet provide better slip resistance than non-slip socks and therefore might represent a safer foot condition. This study did not explore whether traction provided by bare feet was comparable to 'optimal' footwear such as shoes. However, previous studies have associated barefoot mobilisation with increased falls. Therefore, it is suggested that all patients continue to be encouraged to mobilise in appropriate, well-fitting shoes whilst in hospital. Limitations of this study in relation to the testing method, participant group and sample size are discussed

Research priorities for venous conditions: results of the UK Vascular James Lind Alliance Priority Setting Process

Introduction: Venous disease comprises a range of conditions of varying severity, which can result in pain and discomfort and a reduced quality of life. The annual costs for the treatment and management of venous disease in the UK is in the order of billions of pounds. It is vitally important to direct finite National Health Service (NHS) funding into areas that will maximise health outcomes and reduce the burden on the NHS. To address the issue of where best to target resources and research, the Vascular Society of Great Britain and Ireland (VSGBI) in association with the James Lind Alliance (JLA) undertook a national Priority Setting Process (PSP) for vascular conditions. This paper presents the results of this process, with a focus on the topic of ‘venous conditions’.Methods: A modified JLA Priority Setting Partnership was developed to gather clinician, patient and carer research priorities for vascular conditions. Consensus workshops were held to discuss clinician and patient priorities and agree a list of joint research priorities. Consensus was achieved using the nominal group technique and a ranked ‘top 10’ list of research priorities for venous conditions was established.Results: In the first phase (clinician-led survey), 481 clinicians submitted 1,231 research questions related to vascular conditions in general. Of these, 130 venous-specific research priorities were reduced to 13 overarching summary priorities recirculated for interim scoring. In the second phase (patient and carer-led survey), 373 patients and carers submitted 582 research priorities. Of these, 101 venous-specific priorities were reduced to 22 overarching summary priorities and recirculated for interim scoring. In the third phase (consensus workshop), clinician and patient priorities were amalgamated into 14 priorities for discussion. The final ‘top 10’ list of venous condition research priorities relate to: access to specialist venous services, prevention, wound healing, pain management, education and compliance.Conclusions: The ‘top 10’ venous-related priorities demonstrate the research areas considered to be most important from the perspective of patients, carers and healthcare professionals. Researchers can now focus their efforts on developing research questions and studies to address these priorities and funders should increase their investment to support new studies in these areas of greatest importance