Background
The main topic of this paper is The effectiveness of intermittent pneumatic compression in preventing deep venous thrombosis in patients following stroke. Deep venous thrombosis is a disease of the veins where blood clots inside the vein, remaining stagnant inside a deep vein. The paper will have an introduction that will provide the major aspects and the paper’s main topic. The introduction will guide the reader on what they expect in the paper. The paper will have a literature review section in which the main topic will be well explained (Kakkos et al., 2022). The paper will contain a background to indicate the background source of the research. The paper will also contain the method used in obtaining the correct information to come up with this paper. The paper will give the methods results that will discuss the main topic of this research. The results will be followed by a conclusion that will summarize the main topic and later give the recommendation that will sum up the paper.
The main aim of this assessment is to critically analyze one of the many clinical delinquents, which for a very long time has been a nuisance in each practice that bases its work on clinical matters. The research will also major on how an individual or a group of people in a clinical background can systematically use a particular technique which will aid them in making the best conclusions and recommendations on an evidence-based argument.
In the essay, I will include a background of the technique used to solve any evidence-based situation. The paper will also contain a critical analysis of the specific method used to create the question. The analysis will indicate the whole method used to come up with the question, which will provide the evidence required to answer the clinical question.
In this research paper, the main search question aided in facilitating the process. The process had to use evidence-based criteria, which will involve the patient and the population, the InterventionIntervention, the comparison, and lastly, the outcomes of the process. In the search process, the hierarchy of evidence is used to develop relevant results and conclusions. It helps analyze the evidence that I will capture from the process. The paper shows evidence of the process to be evaluated a program known as the Critical Skill Program. The main aim of this program is to critically analyze the obtained evidence and give the best results as desired.
Literature Review
Deep venous thrombosis can be classified as a fatal disease under thrombo-embolic diseases. If the Deep venous thrombosis disease is not noted at an early age, it can drastically progress to forming the pulmonary embolism, which can highly increase the risk of the health of the patient. To a certain degree, if the patient has a very weak immune system, it is very easy for the Deep venous thrombosis disease to kill the patient within a very short time. When the patient has a little better immune system, the Deep venous thrombosis disease may cause a stroke to the patient, decreasing the patient’s life expectancy.
Many people and researchers have made an effort to eliminate the disease. During the practice of some nursing students, they observed that there had been a lack of understanding of the procedure to use in presenting data on the beneficial effects of intermittent compression on patients who have a stroke that is caused by Deep venous thrombosis disease. Due to the lack of an effective manner to present data about the disease, the health care providers have a hard time providing the correct diagnosis for the people who have a stroke caused by pulmonary embolism disease. It is also difficult to identify pulmonary embolism as its signs and symptoms are not precise. The signs and symptoms are not precise, especially in older people with stroke. Older people with pulmonary embolism disease and stroke have a very low life expectancy, and their health is a very high risk. The colleagues urge each person to take the correct precaution to prevent the contraction of the pulmonary embolism disease. Due to the lack of a perfect method to present data about the pulmonary embolism disease and the poor outcome of pulmonary embolism disease, this paper will provide a formulated question that will give proper evidence that will have a possibility of getting the best and perfect process to present the data about the pulmonary embolism disease. The formulated question was used to show the evidence and provide a framework that will modify the evidence research.
As mentioned earlier, this paper will use the population, InterventionIntervention, comparison(PIC), and the evidence-based outcome to develop a research question that will give the research evidence. Although the framework will not provide any comparison of the research, this paper will use this framework to come up with the required keywords and to produce a perfect list of other phrases that were incorporated to form a research question that does not require any comparison (Murali et al., 2022). Twenty to forty percent of the patient population who have had a stroke have been found with the condition. Although IPC (Intermittent Pneumatic Compression) does not have any reliable evidence of its effectiveness in preventing deep venous thrombosis, it has successfully increased the chances of survival for immobile stroke patients after stroke. When using the IPC, clinical officers must consider that it improves survival, but it does not help gain quality-adjusted survival.
Methods
For this type of evidence-based research, it is evident that comparison is not very essential. In return, it will produce questions that do not have any comparison. As we shall see in the results section, the outcome of the non-comparison question will give the effectiveness of intermittent pneumatic compression in preventing deep venous thrombosis in stroke patients. In the paper, I will use the people with stroke, especially those who acquired the stroke from the deep venous thrombosis disease, as the population.
The incidence of venous thrombosis is common among stroke patients and is a preventable medical condition that can cause death and disability. Many researchers and doctors are coming up with the best way to prevent and control venous thrombosis disease. Most of them in their research have generally recommended the use of antithrombotic or compression stockings, which are the main methods used to prevent venous thrombosis. For the research to be accepted and the two methods that use antithrombotic or compression stockings to prevent the disease, strong evidence is required to conclude the two preventive measures.
To obtain the best results and get very strong evidence on the compression stockings to identify whether the compression is an effective way of treating the disease, I decided to develop a research question that will be evidence-based. I chose this research to find out how effective compression stocking is in preventing this dangerous condition, specifically in stroke patients. To come up with the results and the evidence for this research, I decide to use clinical case scenario two, which will give the best evidence-based questions on the effectiveness of intermittent pneumatic compression in preventing deep venous thrombosis in patients following stroke. To make a PICO question, I decided to conduct literature research electronically based on the following issues about the effectiveness of intermittent pneumatic compression in preventing deep venous thrombosis in patients following stroke. Venous thrombosis has been highly detected among stroke patients, putting them at a very high risk of death.
Deep venous thrombosis is a disease of the veins where blood clots. The vein remains stagnant inside a deep vein, and it mostly occurs in the veins of the thigh or lower legs. It is caused by injury of veins, for example, during operations. When the blood platelets are exposed, they form a meshwork of fiber that traps the blood cell forming coagulation of blood which could become venous thrombosis if the patient does not have heparin enough to stop the formation of blood clots. Bone fracture, when a bone fractures, can cut open the blood vessels, which could cause blood to form the blood clots in the blood vessels. A hemorrhagic stroke can develop from bone fracture and surgery—lots of body weight (obesity). People with obesity tend to have many fats in their blood vessels. Obesity narrows the blood vessels, which ends up cramping due to stagnation forming blood clots and even coagulating, causing ischemic stroke. Also, sometimes the condition is inherited. The body cannot produce enough heparin, which is an anti-clotting factor that keeps blood in a state of liquid form.
- Stroke (cerebrovascular disease) is a disease that occurs in the blood vessels that supply blood into and out of the brain to supply oxygen and further remove metabolic wastes from the ever supposed to be active brain cells. A stroke occurs when the vessels can no longer supply oxygen into the brain and wastes are not removed from the cells. The brain cells start getting damaged, or even worse, they die. A stroke patient is most likely to have deep venous thrombosis. There are different types of strokes; Ischemic stroke – is caused by small blood vessels cutting a short supply of blood into the brain.
- Hemorrhagic stroke -caused by exposure of blood in the blood vessels when the blood vessels are injured. In the brain, it causes bleeding.
- Transient ischemic attack – it is considered a mini-stroke. Blood is blocked temporarily. When it does not flow in the brain fluently, it is when this stroke occurs.
Results
Intermitted Pneumonic Compression is a device that is used to prevent blood clots. By compressing and contracting, more like the heart making sure blood is pumped hence it does not stay in one place.
The big question is how effective the IPC is in preventing DVT in stroke patients. IPC is a method that ensures that the blood is ever-flowing; hence no blood clots are formed. The IPC devices are wrapped on the lower legs of the patient. As they inflate and deflate, they help the blood circulate well in the patient’s body. When they inflate, compressing the legs, blood is pushed out of the legs into the heart, and when it deflates, blood is allowed back into the arteries in the legs. Legs have small blood valves in the veins. The IPC damages a few making them weak, and then they are made leaky hence blood is not restricted nor made to flow back nor reduce the speed of flow blood. Hence allows blood to pool into the legs. It happens when the patient is immobile, and muscles have been inactive for a long (CLOTS et al., 2013). Muscle movements are very important in helping blood circulation. When muscles contract and expand, they help push blood into the vessels, and when this does not happen for long, blood tends to move more slowly within the blood vessels, leading to blood coagulation and the formation of blood clots (Rothwell et al., 2022). IPC sleeves also help prevent the formation of blood clots by stimulating the body release substances that ensure no blood clots are formed.
From my research, I found that to see how effective the IPC is in a certain hospital with patients with stroke who had undergone surgery. The hospital followed up on their recovery journey, but it was found that the IPC helped.
- Clot trail 1
- Clot trail 2
- Clot trial three, which is our main concern.
Clot trail one is used in patients experiencing small issues with venous thrombosis. Here there is the use of graduated compressing stockings whose length is up to the thighs.
Clot trial 2 is for advanced venous thrombosis risk. Here the graduated compression stockings are below the knees.
The electronic research is based on CINAHL libraries. From my electronic research on the CINAHL libraries, I formulated a question that gave evidence-based results. the question that I formulated was, “is intermittent pneumatic compression effective in preventing deep venous thrombosis in patients following stroke?” The main keywords that came out of the research question included; Patient/Problems: this was to refer to the stroke patients who had had stroke mostly out of the deep thrombosis infection. The other keyword is InterventionIntervention: the main InterventionIntervention in the research was the antithrombotic stockings. Antithrombotic stocking is an intermittent pneumatic compression under investigation of whether it effectively prevents deep venous thrombosis in patients following stroke. According to the research, the research question was not comparable. Hence there was no comparison for the research question. The outcome of this research clearly showed that the antithrombotic stocking is an intermittent pneumatic compression, and it is very effective in preventing deep venous thrombosis in patients following stroke.
Conclusion
The main keywords used in the research were compression stockings, patients with stroke, and using keywords such as antithrombotic stockings (Nie et al., 2022). From my research, I used the PICO questions that I had formulated together with the keywords to create a structure and the focused question that helped me get into a subsequent step of evidence-based practice from the electronic research in the CINAHL libraries.
In coming up with the evidence from the PICO question that I formulated, I decided to select four articles that I used to identify the quality of the evidence of the research question (Sees et al., 2022). The four articles that I selected were used to provide the evidence level of the research, the relevance of the research question, and the case study evidence. I found out that the research was very much relevant as it ranges from the year 2012 to the year 2020.
Level of Evidence:
Because the PICO question is about the efficacy of compression stockings for treating deep venous thrombosis, a literature review was conducted to determine the efficacy of the InterventionIntervention in the articles chosen. The qualitative approach used in all publications is adequate, and the researcher has properly explained the research design. The papers picked target a specific issue, goal, aims, and outcome, critical in clinical practice. As a result, the selected publications have a high degree of proof.
Quality of Evidence:
Deep thrombosis occurs in the blood vessels deep inside the body. It is a condition in which the blood forms blood clots in the blood vessels. However, this can be prevented as a very dangerous condition that can even make a patient disabled or even cause death to the patient. The condition is very common in patients with diseases like stroke. Compression stockings have been put forward to prevent the condition (Ng et al., 2022). According to Michael and Thaila, as stated in 2012, compression socks, as one of the recommendations for preventing deep venous thrombosis, require evidence before using them. I chose this research to determine how effective compression stocking prevents this dangerous condition, specifically in stroke patients. I came about the search based on interest, questions formulated to get proven results, and enough evidence. The question also in search has to have relevant results, and also the accuracy and how appropriate they are is key.
How I searched: I researched ProQuest, the library of Cochrane, and Embase (Robba et al., 2021). How I formulated the research question: first, I made a PICO question. The question was how effective the graduated compression stockings and the antithrombotic stockings are in treating deep venous thrombosis. How I searched it on the web “effectiveness of graduated compression stockings in treating deep venous thrombosis”{ COMMENT FROM CHROME]. Keywords not be left out were effectiveness, compression stockings, and deep venous thrombosis. To create a focused question that is well structured, I had to consider using PICO questions and choose keywords that would not miss in the question when searching. Of the present articles, I chose four of them which are more relevant to my research and the PICO question, articles with a high level of evidence, those that were latest from 2012 to 2020, and those that had high-quality papers of evidence.
The level of evidence: from the search “effectiveness of graduated compression stockings in treating deep venous thrombosis,” I reviewed the selected articles to see how effective they were in this research. All four articles qualified, and their good methodology justified my research design. Key vital clinical practice that is the outcome was addressed in the article. The issue that is to be focused on, the aims, and the objectives were also cited (Endoh et al., 2022). indicated that the selected articles were suitable since the evidence level proves that research competence is high.
Quality of evidence: the first article from Graduated Compression socks is effective. After patients undergo surgery, according to the article, the application of the socks helps prevent deep venous thrombosis.
The second article completely contradicted the first article. Findings from their research are that the graduated compression stockings were ineffective in preventing the deep venous thrombosis condition (Endoh et al. a., 2022). Their reason was that there was no difference or improvement of the condition in two years of a patient using this stocking. Hence the stockings are not effective.
The third article supported the use of IPC instead. From their research, the compression stockings on clot one and clot 2 were only effective for some time and on patients who were not in acute venous thrombosis. However, stroke patients are different, and a more advanced method is supposed to be used, the Intermitted Pneumatic Compression (Por?nik et al., 2022). The article suggests that IPC is more effective and increases the chances of survival better in immobile patients than compression socks, which are also known as graduated compression stockings.
The fourth article: the article suggested that using compression socks will help, but for a while.
Relevance of the study: The research strategy had a very high level of evidence from the articles. The type and year of publication were included for relevance and a high level of reliability in the provided information (Busby et al., 2022). also would ensure that one research on them would be using the most recent data.
Conclusion
The available data from the selected article reveals that compared with regular care or other medical InterventionIntervention, the administration of compression stockings in the treatment of deep venous thrombosis is efficient; still, more investigation is recommended. The trial of articles 1 and 3 has shown that fewer patients develop DVT with stockings than with no (Ross et al., 2022). The compression stockings are useful for DVT treatment, yet articles 2 and 4 demonstrate no difference in the intervention and control groups. Sachdeva, Dalton, and Lees (2019) said in article 1 that mechanical and pharmacological approaches are used to avoid DVT. The pharmacological procedure alters the blood coagulation profile, and the principal disadvantage is the risk of bleeding, which is particularly concerning in surgical patients. Compression stockings, on the other hand, have no disadvantages. The disadvantages of compression stockings occur primarily when the stockings are administered incorrectly. Although certain findings in the research suggest that ECS may have little impact on the normal course of DVT, compression stockings may be beneficial in alleviating DVT symptoms. Article 3 reveals that administration of IPC is associated with a 64% reduction in the risk of developing DVT (P0.001). As a result of the paper’s results, I think compression stockings or antithrombotic stockings are beneficial in treating DVT.
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