University Nursing Assessment: Evidence Report on Stroke and Stockings

This report addresses the clinical question of whether antithrombotic stockings should be routinely used for stroke patients. It begins by framing the question using the PICO framework, focusing on the patient population, intervention, comparison, and outcome. The report then analyzes four research papers, emphasizing the use of statistical data, confidence intervals, and p-values. Paper I examines the effectiveness of thigh-length graduated compression stockings in reducing the risk of proximal DVT after stroke. Paper II reviews databases for clinical predictions and studies on anti-inflammatory therapy and the use of compression stockings. Paper III discusses mechanical infection as an approach to thromboprophylaxis after stroke. Paper IV focuses on the use of graduated compression stockings for the prevention of DVT in patients with major stroke. The report concludes by summarizing the findings from each paper and discussing the implications for clinical practice, including adverse effects and overall effectiveness.

EVIDENCE
OF
NURSING

Table of Contents
INTRODUCTION...........................................................................................................................3
Main body of the paper....................................................................................................................6
Paper I..........................................................................................................................................6
Paper II.........................................................................................................................................7
Paper III.......................................................................................................................................8
Paper IV.......................................................................................................................................8
Conclusion.......................................................................................................................................9
References......................................................................................................................................10

INTRODUCTION
To start this evidenced based research; first step taken was to frame PICO question. The chosen
scenario for this particular research report is “Should antithrombotic stockings be routinely used
for patients with stroke or not?” The searchable question is based on three scenarios available
with research project. These scenarios were evaluated based on its effectiveness on availability
of resources and complications in finding outcomes. Based on evaluation and cause and effect
analyses, this particular question has been framed and chosen. Framing of the Research Question
has been done through effective tool PICO:
Evidence-based models use a process for framing a question, locating, assessing, evaluating, and
repeating as needed. PICO (T) elements include: Problem/Patient/Population,
Intervention/Indicator, Comparison, Outcome, and (optional) Time element or Type of Study
(Della Mirandola, 2012).
P (Problem or Patient or Population) For patients with stroke
I (Intervention/Indicator) Antithrombotic stockings
C (Comparison) Not using antithrombotic stockings
O (Outcome of interest) Reduce the affect of stroke
About Problem: Deep vein thrombosis (DVT) occurs when blood coagulation or thrombus forms
in the tissues of the giant leg or in the pelvic region. Some DVTs may not cause any pain,
although others may be difficult. On the off chance that DVT is distinguished and treated
prematurely, not many pregnancies are fatal (Philip and et.al., 1987).
About Intervention: Antithrombotic stockings or compressed stockings are curing method which
helps in reducing the area of surroundings of veins through enhancing the flow of blood; and also
supports in upward movement of blood towards heart. Some of the side effects of this particular
intervention include; your socks don't fit well; are not wearing socks properly or removing; have
a disease; and are sensitive to sock stuffing. Stocks that are not worn properly can cause
problems like rashes. In the Journal of the Canadian Medical Association, ischemia or lack of
oxygen blood flow can be reduced by the use of pressure hosiery, with the potential to reduce
weak blood flow (Caroni and Schwab, 1988).

The approach used for this particular project is Cochran reviews paper of multiple trials as a
piece of evidence and use trials or experiments clinical practice guidelines through an article for
assessment. The PubMed is used as a source for collection information’s and articles for
accessing the evidence. The new PubMed is completely reorganized with updated innovations.
Because Legacy and the new PubMed are two different approaches, contextual controls usually
do not coordinate. The command is made several times for each frame, so no increase, delete
(e.g. empty copies) or update the active tables at the same time in both jobs (PubMed, 2020).
Total four research paper has been used for answering the chosen question. The reason behind
selecting these papers is use of statistical data, confidence interval (CI) and p value in each
article. The reason is, each paper has used more than 1200 samples and takes atleast 6 months for
analyzing the result. Outcomes are properly interpreted in each article with predefined
combination of confidence level, probability and p value (Prevention of deep venous thrombosis
and pulmonary embolism following stroke: a systematic review of published articles, 2007).
The print screen of abstracts of all four papers is given below:

Main body of the paper
Paper I
Background:
Deep vein thrombosis (DVT) and pulmonary embolism are common after stroke. In some
predictions of patients undergoing medical procedures, tiered ammunition stocks (GCS) reduce
the risk of DVT. National stroke regulations that do not fit into these predictions suggest that
they are used in stroke patients despite the lack of diagnosis. We investigated the operational
capacity of GCS with the thigh to reduce DVT after stroke (Health (Nursing, Medicine, Allied
Health): Search Strategies: Framing the question (PICO), 2020).

Findings:
The results of this study showed that GCS of the thigh is not clinically feasible in reducing the
risk of proximal DVT after stroke and is associated with some adverse effects. This large
prospectus involved more patient prospecting and implementation (proximal DVT) than all
random prospectuses controlled by GCS. Patients were selected from 64 clinics in three countries
and had typical results compared with those admitted to emergency clinics in different clinics
and medical countries, indicating significant external strength results (Nursing, Medicine, Allied
Health): Search Strategies: Framing the question (PICO), 2020).
The real problems were due to abnormal GCS, but the relatively low weight and issues suggest
that these socks should not be used unless they are associated with medically necessary benefits.
Enrollment in CLOTS Introduction 2, which was intended to make GCS on the thigh more
effective than GCS below the knee, is now being maintained as acute stroke patients after this
study expected the presentation of. The risk of anxiety, illness and improper treatment is not
reasonable.
Paper II
Background:
The Medline, Cochrane, LILACS and SciELO databases were revised and the abstracts of the
Brazilian, American, and European Neurological Congress were examined for clinical
predictions. The reference provision for articles and studies has also been revised; Cohort study
of two large studies with anti-inflammatory therapy. Both unimproved heparin and low-
subatomic heparin / heparin (LMWH) are somewhat feasible to prevent VTE after CI and should
be used routinely in patients with and without motor impairment and lower carrying capacity
contraindications. Deep vein thrombosis is most commonly reduced due to the effect of lung
inflammation or mortality. Some evidence focusing on vitality is more important than LMWH.
The access test does not confirm the use of mechanical or dextran techniques (What to Know
About Compression Socks and Stockings, 2020).
Findings:

In patients who have experienced the therapeutic process, it has previously been reasonably
demonstrated that GCS mainly in the calf, before, during and after a short infusion into the deep
tissues of wooded foot DVT. Of the 17 initial studies of the same study, only eight showed
recurrence of proximal DVT (What to Know About Compression Socks and Stockings, 2020).
Only 9 out of 435 (2%) GCS designated patients and 21 out of 402 (5%) were discharged to stay
away from GCS who had an expected DVT (60% less likely; 95% CI 17 -81; p = 0.014).
Paper III
Background:
Mechanical infection is an attractive approach to thromboprophylaxis after stroke to reduce
venous balance without expanding the risk of drainage. These interventions introduce graduated
pressure quotas, which allow greater pressure in the lower leg to reduce the accumulation of
blood in deeper tissues than the foot and equipment; Irregular toxic stress, which spreads
continuously and promotes venous return. Among these options, graduated weight socks have
the advantage of being more convenient and simpler to use, while also allowing for more defined
patient carrying capacity. Based on evidence that they are applied in patients who have
undergone a medical procedure, doctors routinely change pressure shares, like a small solitary
study that recommends success in stroke patients. Graduation in intensive patient observation
after stroke (TED Stockings, 2020).
Findings:
Shocking discoveries suggest that thigh-length socks are not feasible in one-off venous
thromboembolism and that below-the-knee socks could extend thrombosis in stroke patients,
graduating stroke to a different type of venous function patients Title stock operations should be
reconsidered. Such studies should be large enough to assess the recurrence of venous aspiration
thromboembolism due to the apparent importance of the patient (TED Stockings, 2020).
Paper IV
Background:
A slow pressure sock (GCS) is generally recommended for the prevention of deep vein
thrombosis (DVT) in patients with major stroke. Given the ongoing information from CLOTS

Introduction 1, this training should be considered. Low weight socks may help reduce addiction
in low-gestation stroke patients, although studies have not been conducted to see this research in
stroke patients (DVT in acute stroke--the use of graduated compression stockings [article],
2010). A slow pressure sock (GCS) is generally recommended for the prevention of deep vein
thrombosis (DVT) in patients with major stroke. Given the ongoing information from CLOTS
Introduction 1, this training should be considered. Low weight socks may help reduce addiction
in low-gestation stroke patients, although studies have not been conducted to see this research in
stroke patients.
Findings:
GCS is accepted to diminish the danger of DVT through a few systems: speeding up by bringing
the weight angle up in the pole, decreasing the cross-sectional zone of the profound vines, and
siphoning the muscle of the calf to be increasingly powerful. This last methodology may not
work in patients with stroke who have serious leg shortcoming (DVT in acute stroke--the use of
graduated compression stockings [article], 2010), which means we will see fewer reactions in
patients with stroke than those with feeble legs.
Conclusion
All patients were admitted to the examination. The essential result happened in 126 (10.0%)
allocated to a thigh GCS and 133 (10.5%) was relegated to maintain a strategic distance from
GCS, bringing about an aggregate or complete decrease. It occurred. The hazard is critical at
0.5% (95% CI from 91.9% to 2-9%). Skin breaks, ulcers, rankles and skin corruption were
essentially more typical in patients who were directed than the doled out GCS to stay away from
use (64 [5%] versus 16 [1%]; the chances proportion is 4.18, 95% CI 2 · 40–7 · 27). In patients
with stroke and in patients with other ailments, GCS can be actuated simply after the patient's
inoculation (Effectiveness of thigh-length graduated compression stockings to reduce the risk of
deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial,
2009). Therefore this development may persevere for a considerable length of time or might be
changeless in these patients. Treatment beginning a couple of days after loss of motion and
impasse can cause DVT to grow quickly and in this way can't be successfully forestalled.

References
Books and Journals
Della Mirandola, P., 2012. Pico Della Mirandola: Oration on the Dignity of Man: a new
translation and commentary. Cambridge University Press.
Philip, T., and et.al., 1987. High-dose therapy and autologous bone marrow transplantation after
failure of conventional chemotherapy in adults with intermediate-grade or high-grade non-
Hodgkin's lymphoma. New England Journal of Medicine, 316(24), pp.1493-1498.
Caroni, P. and Schwab, M.E., 1988. Two membrane protein fractions from rat central myelin
with inhibitory properties for neurite growth and fibroblast spreading. The Journal of cell
biology, 106(4), pp.1281-1288.
Online
PubMed, 2020; Available online through: < https://www.ncbi.nlm.nih.gov/pubmed/ >
Health (Nursing, Medicine, Allied Health): Search Strategies: Framing the question (PICO),
2020; Available Online through: < https://guides.nyu.edu/c.php?g=276561&p=1847897 >
What to Know About Compression Socks and Stockings, 2020; Available online through: <
https://www.healthline.com/health/compression-socks-benefits >
TED Stockings, 2020; Available online through: < http://www.mycomedic.com.my/ted--anti-
thrombotic-stockings.html >
DVT in acute stroke--the use of graduated compression stockings [article], 2010; Available
online through: < https://www.ncbi.nlm.nih.gov/pubmed/20628662 >
Should Patients With Stroke Wear Compression Stockings to Prevent Venous
Thromboembolism? [article], 2010; Available online through: <
https://annals.org/aim/fullarticle/746387/should-patients-stroke-wear-compression-
stockings-prevent-venous-thromboembolism >
Prevention of deep venous thrombosis and pulmonary embolism following stroke: a systematic
review of published articles, 2007; Available online through: <
https://www.ncbi.nlm.nih.gov/pubmed/17222109 >
Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein
thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial, 2009;
Available online through: < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692021/ >