Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy.

BACKGROUND: Knee arthroscopy is a frequent surgical procedure. Arthroscopy procedures are considered minimally invasive. However, some patients will need extended surgical time, suffer injury and immobilization thus increasing the risk for thromboembolic events. Incidence of deep venous thrombosis (DVT) in patients undergoing knee arthroscopy is reported to be from 0.6% to 17.9% depending on the diagnostic method used. Different approaches are available for thromboprophylaxis (mechanical or pharmacological). OBJECTIVES: To assess the effectiveness and safety of thromboprophylaxis to reduce the incidence of DVT in patients undergoing knee arthroscopy. SEARCH STRATEGY: We searched the Cochrane Peripheral Vascular Diseases Group Specialized Register (last searched October 2006) the CENTRAL (last searched Issue 4, 2006), MEDLINE (1966 to 2006), EMBASE (1980 to 2006), and Lilacs (1988 to 2006). We contacted specialists known to be involved in phlebology and interested in post thrombotic syndrome for details of unpublished and ongoing trials. SELECTION CRITERIA: Randomized clinical trials (RCTs) and controlled clinical trials (CCTs), whether blinded or not (i.e. double blinded, single blinded or unblinded) of all type of interventions, whether mechanical or pharmacological, single or in combination, used to prevent DVT in males and females over 18 years old undergoing knee arthroscopy. There was no restriction on language. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Four trials involving 527 predominantly male participants were included. The main weakness of the studies was the lack of correct stratification of the arthroscopic intervention. The relative risk (RR) of thrombotic events was 0.20 (95% confidence interval (CI); 0.07 to 0.57) comparing any type of low molecular weight heparin (LMWH) versus placebo. All thrombotic events but one (pulmonary embolism in the LMWH group) were distal venous thrombosis. Adverse events were most common in the intervention group than in the control group, RR 2.11 (95% CI 1.26 to 3.55). There were 66 episodes of adverse events. The number needed to harm was 20 for any adverse events. AUTHORS' CONCLUSIONS: This meta-analysis suggests that LMWH reduces the incidence of distal DVT diagnosed by sonogram. The clinical benefit of this is uncertain. No strong evidence was found to conclude thromboprophylaxis is effective to prevent thromboembolic events and safe, in people with unknown risk factors for thrombosis, undergoing knee arthroscopy.

Implementación de un programa de mejoramiento de la seguridad de los pacientes: resultados preliminares / Implementation of a program of improvement of the security of the patients: preliminary results

Tradicionalmente, el error ha servido para aprender lo que no había que hacer y lo que no era verdad. Luego se sumó la reacción de castigar al responsable del error suponiendo que éste era producto de la incapacidad o irresponsabilidad individual. La búsqueda, explícita o no, del "culpable" ha promovido mayor temor en los profesionales de la salud y generado una creciente tendencia a ocultar los errores. Desde 2001, la Academia Nacional de Medicina, a través de su Centro de Investigaciones Epidemiológicas, desarrolló e implementó un programa para el mejoramiento de la seguridad en la atención de los pacientes, en cuatro instituciones sanitarias de nuestro país de diferentes características. El propósito del programa es: "diseñar, validar y evaluar metodologías que permitieran identificar errores, casi errores y eventos adversos; analizar el mecanismo de su producción y contribuir a señalar los procesos correctivos". El mismo está organizado en cuatro componentes: a) cultura organizacional para la seguridad del paciente; b) sistemas de información para la vigilancia del error durante el proceso de atención, c) mejoramiento continuo de la seguridad del paciente y d) gestión de conocimiento.

Efficacy of octreotide and sclerotherapy in the treatment of acute variceal bleeding in cirrhotic patients. A prospective, multicentric, and randomized clinical trial.

BACKGROUND: Sclerotherapy is the most widely used method for treatment of acute variceal bleeding. Previous reports have suggested that octreotide infusion is as effective as sclerotherapy. Our aim was to investigate the efficacy and safety of octreotide in comparison with sclerotherapy in controlling variceal bleeding. METHODS: Seventy-six cirrhotic patients were randomized to receive either sclerotherapy (n = 37) or octreotide (n = 39) infusion of 50 microg/h intravenously for 48 h after a bolus of 100 microg, followed by subcutaneous injection of 100 microg/8 h for an additional 72 h. RESULTS: The two groups were similar in base-line data. A similar initial control of bleeding was obtained in 94.6% for sclerotherapy and 84.6% for octreotide (NS). No difference was observed between sclerotherapy and octreotide in rebleeding (23% versus 33%) and treatment failure (22% versus 36%, respectively). Furthermore, the overall success of treatment was 78% for sclerotherapy and 64% for octreotide. No significant difference in mortality was observed between treatments (eight patients for octreotide and three patients for sclerotherapy, NS). CONCLUSIONS: These results show that both treatments present a very high and similar initial and final control of bleeding. However, there is a trend that could be clinically important towards better results in the patients treated with sclerotherapy.