RESUMEN
BACKGROUND: There are numerous studies discussing thromboprophylaxis after total joint arthroplasty (TJA), with varying conclusions. Patient inclusion criteria may be different for each study, which may lead to selection bias and misrepresentation of data. This study aimed to investigate if industry funding impacted patient demographics and overall reported outcomes of studies analyzing venous thromboembolism (VTE) prevention after TJA. METHODS: Electronic searches were completed using Ovid, PubMed, and Embase databases. Studies were included if (1) they are published in the English language between 2000 and 2016; (2) they included patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA); and (3) they evaluated prevention and control of postoperative VTE with at least one of the following thromboprophylactic agents: aspirin, enoxaparin, dalteparin, dabigatran, apixaban, rivaroxaban, dabigatran, ximelagatran, fondaparinux, or coumadin. Data were extracted and analyzed via mixed-effect logistic regression. RESULTS: Fifty-seven studies were included; 29 were industry funded, and 28, nonfunded. There were no significant differences between patient's age, body mass index, or revision exclusions between funded and nonfunded studies. Funded studies reported less pulmonary embolisms, fewer events of major bleeding, and significantly less 90-day mortality compared with nonfunded studies. CONCLUSION: Industry-funded studies reported less pulmonary embolisms, major bleeding, and mortality compared with nonfunded studies. Detailed demographic data were missing from the literature, and we were unable to demonstrate the cause of different reported outcomes between industry-funded and nonfunded studies. Further investigations should be aimed toward understanding how funded studies report less adverse outcomes in analyzing VTE after TJA.
Asunto(s)
Anticoagulantes/uso terapéutico , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Conflicto de Intereses , Sector de Atención de Salud/ética , Tromboembolia Venosa/prevención & control , Anciano , Aspirina/uso terapéutico , Dabigatrán , Enoxaparina/uso terapéutico , Femenino , Fondaparinux/uso terapéutico , Hemorragia/inducido químicamente , Humanos , Masculino , Embolia Pulmonar/etiología , Embolia Pulmonar/prevención & control , Pirazoles , Piridonas , Rivaroxabán , Tromboembolia Venosa/etiología , Warfarina/uso terapéuticoAsunto(s)
Cardiología/normas , Enfermedades Cardiovasculares/terapia , Prestación Integrada de Atención de Salud/normas , Medicina Basada en la Evidencia/normas , Evaluación de Procesos, Atención de Salud/normas , Indicadores de Calidad de la Atención de Salud/normas , Sistema de Registros/normas , Cardiología/ética , Enfermedades Cardiovasculares/diagnóstico , Conflicto de Intereses , Prestación Integrada de Atención de Salud/ética , Medicina Basada en la Evidencia/ética , Sector de Atención de Salud/ética , Sector de Atención de Salud/normas , Humanos , Relaciones Interinstitucionales , Evaluación de Procesos, Atención de Salud/ética , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud/ética , Sistema de Registros/ética , Resultado del TratamientoAsunto(s)
Discusiones Bioéticas , Sector de Atención de Salud/ética , Principios Morales , Publicidad , Vestuario , Suplementos Dietéticos , Personas con Discapacidad/legislación & jurisprudencia , Humanos , Trasplante de Riñón/economía , Trasplante de Riñón/ética , Rol del Médico , Competencia Profesional , Trabajo Sexual/legislación & jurisprudencia , Percepción Social , Responsabilidad Social , Factores Socioeconómicos , Deportes , Madres Sustitutas , Reino UnidoAsunto(s)
Sector de Atención de Salud , Accesibilidad a los Servicios de Salud , Legislación de Medicamentos , Preparaciones Farmacéuticas/economía , Sector Privado , Sector Público , Coerción , Análisis Costo-Beneficio , Sector de Atención de Salud/ética , Sector de Atención de Salud/legislación & jurisprudencia , Sector de Atención de Salud/normas , Sector de Atención de Salud/tendencias , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/ética , Humanos , Legislación de Medicamentos/tendencias , Programas Nacionales de Salud/economía , National Institutes of Health (U.S.) , Reino Unido , Estados UnidosRESUMEN
It is accepted throughout the world today that a new approach is needed to health care, one that brings to the forefront the role of economic development. This situation has also increased the importance of the health care sector and health data have begun to take a significant place in countries' development indicators. Health care services as a basic indicator of social and economic development in Turkey, as in the rest of the world, continue to gain in importance. However, there is a significant difference between health indicators for Turkey, which is a candidate for full membership of the European Union, and European Union countries.
Asunto(s)
Reforma de la Atención de Salud/normas , Sector de Atención de Salud/normas , Derechos del Paciente , Atención Dirigida al Paciente/normas , Atención Primaria de Salud/normas , Unión Europea , Reforma de la Atención de Salud/ética , Sector de Atención de Salud/ética , Humanos , Programas Nacionales de Salud/normas , Atención Dirigida al Paciente/ética , Atención Primaria de Salud/ética , Calidad de la Atención de Salud , Factores Socioeconómicos , TurquíaRESUMEN
In this article I attempt to transcend the mainstream conception of health care ethics, including nursing ethics, by bringing into the foreground a tension between a sense of life and an industrial-bureaucratic style of health care, with its emphasis on the systematic and procedural work culture necessary for mass production. I use the concept of 'a sense of life' to draw attention to the wisdom, sensitivity and responsibility that is necessary for the authentic care of others to be given a chance in the development of modern health care. I emphasize the mindfulness that the professional requires for genuine care, and how the systematic organization of modern health care, on the whole, ignores, obstructs and even suppresses such mindfulness.