Developing a Search Strategy for Systematic Review: Proquest, Embase, and Medline - Essay Sample

Introduction

I identified the keywords for every PICO element and then planned my search strategy. The databases I used include Proquest, Embase, and Medline. After that, I executed my search then refined the results I got by picking the ones that are most applicable in my case. I later reviewed the literature of the different articles that were applicable in my topic and determined their evidence level by choosing the ones that used Systematic review or Randomized Controlled Trial.

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I chose the journal on Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3) since the trail addressed the focused issue clearly, the patient's assignments were randomized, and all the patients were accounted for in conclusion. Also, I chose the article since it had information that is applicable in my research, and it provides evidence for all the processes that were undertaken during the research.

The article on Does intermittent pneumatic compression reduce the risk of post-stroke deep vein thrombosis? Was chosen since it used RCT, has information that is relevant in my research, and was written eight years ago, which means that it has recent information. Furthermore, the results of the research are applicable in my context.

The Effect of Graduated Compression Stockings on Long-term Outcomes After Stroke journal has information that is helpful in responding to the given case study. It efficiently discusses the impact of intermittent pneumatic compression on stroke. Also, I chose the article since it is a randomized controlled trial. All the groups that participated in the research were equally treated apart from experimental intervention.

Preventing deep vein thrombosis after stroke: strategies and recommendations journal has evidence that is important for my research. The article entails a systematic review of the relevant literature on the topic then make recommendations. The rights papers were used in conducting the reviews and from the reference list, I think all the significant relevant studies were utilized.

Findings From the Different Journals

Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3)In the research, 2876 patients were selected and enrolled in about 94 United Kingdom Centers from 2008 to 2012. For the IPC group, perfect adherence was only gotten in about 31% of them. According to the findings, the patients who were given 1pc had more skin breaks as compared to the ones that were not given IPC. However, for the two groups, fall risks with fractures or injuries were not different in the first 30 days. Only a few skins fall, or breaks were linked to IPC by the local researchers. Also, important reductions were noted in DVT outcome both asymptomatic and symptomatic that involves calf or proximal. Moreover, the researchers did not note a few deaths for the individuals who were given IPC for the first 30 days. Interestingly, for six months, deaths reduced among the individuals who were given IPC. Moreover, there was no evidence showing that excess venous thromboembolism in the period after treatment showed that IPC deferred the events of venous thromboembolism. The research had 76 years old median age, and the primary outcome took place in 8.5% of patients given IPC and 12.1% for the patients who were not given IPC. It showed that there was a 3.6% reduced risk with 95% confidential interval (1.4-5.8). When the 323 patients that died before getting a primary outcome and about 41 without CDU screening, the adjusted 122 of 1267 and 174 of 1245 patients was computed to be 0.65 in which the confidential interval was 95%, and the p-value was 0.001. The interpretation is that IPC is essential in reducing DVT risk.

Does intermittent pneumatic compression reduce the risk of post-stroke deep vein thrombosis? The CLOTS 3 trial: study protocol for a randomized controlled trial

The research was considered as the largest RCT as it involved about 80 hospitals. According to the researchers, IPC might not have adverse impacts than the ones that are measured directly in the trial, including falls or damage on skin legs. Essentially, IPC should not hinder mobilization as it is put on during the transfer from chai to be, and it is taken off when a patient can independently mobilize. The authors argue that theoretically, patients that have a high risk of DVT will have higher benefit as compared to the ones with low risk. Evidence shows that development of DVTs can take place on the initial three days after getting a stroke. Therefore, the authors hypothesized that IPC could reduce primary outcome frequency to a great extent among the patients who are admitted at an early stage as compared to the ones enrolled late. From the provided information, IPC reduces DVT.

The Effect of Graduated Compression Stockings on Long-term Outcomes After Stroke

In conducting the research, the first patient was enrolled in 2001 while the last one in 2009. Also, follow up was completed in 2010. The guidelines followed were 30 days for both secondary and primary outcomes. Of the 5532 patients who were in the two trials, 494 or 8.9% of them had DVT (proximal), 14.8% or 816 had any DVT, 5.2% had asymptomatic DVT while 1.3% had a pulmonary embolism. In the first trial, the confidence level was 95% (1.295 to 1205) with 1.087 hazard ration while in the second trial the confidence level was 95% (0.892 to 1205) and 1.037 hazard ratio. The authors also found out that there were not important statistical differences in different thromboembolism events. From the research, some of the patients died before the experiment was completed. The CLOTS trial 1 and 2 do not show general harm or even benefit provided by using GCS after getting a stroke. Even though the confidence interval around the treatment effects estimates includes chances of clinically relevant impacts like harmful or beneficial on long term impacts. In this research, graduated, compression stockings were only associated a little bit with long term impact of post-stroke.

Preventing Deep Vein Thrombosis After Stroke: Strategies and Recommendations

According to Kappelle (2011), deep vein thrombosis (DVT) risk after stroke is usually increased for the patients who have DVT history, comorbidities, dehydration, and restricted mobility. Thus, patients that have high DVT risk are supposed to be mobilized. For one of the reviewed articles that involved 2615 patients using graduated compression stockings were not linked to death or reduced DVT risk. From the article, the first CLOTS trial indicated that stockings did not reduce the risk of DVT as the reduction was only at 0.5% and 95% CI (1.9 -2.9) was used. In the second CLOTS trial, the group that utilized stockings of knee-length and not thigh-length showed an absolute rise of 2.5% (95%CI 0.7 to 4.4). On the research that was conducted on intermittent pneumatic compression, using IPC on the first week showed, a non-significant trend in lowering DVT with 95% confidence level, the values were (0.19 to 1.10), and it has no impact on deaths. Therefore, IPC stockings are only recommended at a clinical trial, but routine use of graduated compression stockings are not recommended.

Conclusion

According to the information that I have acquired from the four different articles, I can conclude that antithrombotic stockings should be used for patients with stroke. From the four journals written by different authors, three show that there is some link even if it is small between putting on stockings and patients with DVT. I think the stockings should be used as they reduce the process of pooling blood to the veins using great pressure on an individual's ankle as compared to the high up leg. Moreover, the antithrombotic stockings are recommended since they are easy to use, and they also provide the chance of higher mobility. However, even if they are used, they should not be used often as they may cause harm to the patients with stroke. Therefore, I recommend the use of antithrombotic stockings for patients with stoke as it will prevent deep venous thrombosis. Essentially, all doctors should use it even if it has minimal benefits to the targeted patients.

List of References

CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration, 2013. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomized controlled trial. The Lancet, 382(9891), pp.516-524.

Dennis, M., Sandercock, P., Reid, J., Graham, C., Forbes, J. and CLOTS Trials Collaboration, 2012. Does intermittent pneumatic compression reduce the risk of post stroke deep vein thrombosis? The CLOTS 3 trial: study protocol for a randomized controlled trial. Trials, 13(1), p.26.

Kappelle, L.J., 2011. Preventing deep vein thrombosis after stroke: strategies and recommendations. Current treatment options in neurology, 13(6), p.629.

Peter Sandercock, D.M., Reid, J., Graham, C. and Murray, G., 2013. The Effect of Graduated Compression Stockings on Long-term Outcomes After Stroke. Stroke.