Surgeon
Department of Trauma and Orthopaedics, Stoke Mandeville Hospital, Buckinghamshire NHS Trust, Aylesbury, Bucks, UK.
Published: August 2010
Background: NSAIDs are commonly used analgesic agents in the orthopaedic trauma setting. Evidence-based guidelines recommend that patients with one or more risk factors for NSAID-associated gastrointestinal (GI) ulcer complications should be prescribed gastroprotective agents to minimise the risk of serious ulcer complications, including gastrointestinal haemorrhage. The purpose of the present audit was to evaluate and improve the adherence to these guidelines in new-NSAID users in a trauma unit at a district general hospital.
Methods: A retrospective observational cohort study was conducted over an 18-week period to assess pre-intervention practice. Subsequently, an awareness programme, including prescriber and pharmacist education and the use of reminder posters, was implemented. Following this, data were collected prospectively over 9 weeks to assess any change in performance. Assessment involved review of case-notes and prescription charts of all adults (aged ≥ 18 years) who were commenced on regular NSAIDs on or during admission to the Trauma Unit. Patients were risk-stratified according to the number of risk factors, which were defined as age ≥ 65 years, major comorbidity, oral steroids, anticoagulation, history of upper gastrointestinal ulceration or bleeding and prescription above the normal recommended dose of NSAIDs. The American College of Rheumatology guidelines recommend the use of gastroprotective agents when one or more risk factors was present. Prescription of gastroprotective drugs was recorded to measure adherence to evidence-based guidelines.
Results: A total of 644 patients were reviewed over the study period, 451 pre-intervention and 193 post-intervention. 100 patients fulfilled the inclusion criteria pre-intervention and 49 post-intervention. Before intervention, the proportion of high-risk NSAID-receivers co-prescribed gastroprotection was low at 25.3%, although the likelihood of adherence improved with the number of risk factors; overall adherence rate improved significantly following intervention at 73.1% (chi² = 18.8, p < 0.001). Furthermore, a smaller proportion of NSAID-receivers fell into the high-risk category from 75% to 56.5% (chi² = 7.25, p < 0.05).
Conclusions: (1) The majority of trauma admissions are at high risk for developing gastrointestinal haemorrhage. (2) Initial adherence to national guidelines for safe prescription of NSAIDs in our trauma unit was poor (25.3%) but improved significantly (73.1%) following an awareness programme which included education of prescribers and pharmacists. (3) A lower proportion of NSAID-receivers had multiple risk factors following our awareness programme. (4) Awareness of gastroprotection guidelines must be raised in trauma units to prevent undertreatment and hence minimise the risk of GI haemorrhage.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1016/j.surge.2009.11.007 | DOI Listing |
Endocrine
January 2025
Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China.
Purpose: To evaluate the diagnostic value of different subtypes of non-punctate echogenic foci in thyroid malignancy.
Methods: Retrospective research of 342 thyroid nodules with calcification was performed. The echogenic foci were divided into punctate echogenic foci (type I) and non-punctate echogenic foci (type II), and type II were further divided into four subtypes: macrocalcification (type IIa), continuous peripheral calcification (type IIb), discontinuous peripheral calcification (type IIc) and isolated calcification (type IId).
Am J Cardiovasc Drugs
January 2025
Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.
Background: Amiodarone is an effective anti-arrhythmic drug; however, it is frequently associated with thyroid dysfunction. The aim of this study was to investigate the incidence and risk factor of amiodarone-induced dysfunction in an iodine-sufficient area.
Methods: This retrospective cohort study included 27,023 consecutive patients treated with amiodarone for arrhythmia, using the Korean National Health Insurance database.
J Prev (2022)
January 2025
Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
The COVID-19 pandemic led to significant shifts in societal norms and individual behaviors, including changes in physical activity levels. This study examines the relationship between socioeconomic and sociodemographic factors and changes in physical activity levels during the pandemic compared to pre-pandemic levels among adult Arkansans. Survey data were collected from 1,205 adult Arkansans in July and August 2020, capturing socioeconomic and sociodemographic characteristics and information on physical activity changes since the onset of the pandemic.
View Article and Find Full Text PDFArch Orthop Trauma Surg
January 2025
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal.
Introduction: Total joint arthroplasties generally achieve good outcomes, but chronic pain and disability are a significant burden after these interventions. Acknowledging relevant risk factors can inform preventive strategies. This study aimed to identify chronic pain profiles 6 months after arthroplasty using the ICD-11 (International Classification of Diseases) classification and to find pre and postsurgical predictors of these profiles.
View Article and Find Full Text PDFGen Thorac Cardiovasc Surg
January 2025
Department of Perfusion, Faculty of Health Sciences, Harran University, Sanliurfa, Türkiye.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!
© LitMetric 2025. All rights reserved.