KEY FINDINGS: Among patients younger than 21 years of age who have provoked venous thromboembolism, anticoagulant therapy for six weeks compared with three months met noninferiority criteria based on the trade-off between recurrent venous thromboembolism risk and bleeding risk.
BACKGROUND: Clinical practice guidelines suggest a six-week course of anticoagulant therapy for pediatric venous thromboembolism instead of the three-month course recommended for adults, but there is a need for definitive evidence to support this recommendation. A randomized clinical trial was designed to test the hypothesis that a six-week course of anticoagulant therapy in patients younger than 21 years of age who had a provoked venous thromboembolism is noninferior to a three-month course of therapy.
DETAILS: The multinational trial enrolled patients younger than age 21 who had radiologically confirmed acute provoked venous thromboembolism. The main exclusion criteria were prior venous thromboembolism and clinically significant anticoagulant deficiencies. At six-week follow-up, patients with venous flow evident in the involved vessel segments and without persistent antiphospholipid antibodies were randomized to discontinuation of anticoagulants or continuation for a total of three months after diagnosis. Among the 297 patients in the per-protocol population (median age, 8.3 years), the primary efficacy outcome (adjudicated symptomatic recurrent venous thromboembolism within one year) occurred in one patient (0.65%) in the six-week treatment group and in two patients (1.40%) in the three-month group. The primary safety outcome (adjudicated clinically relevant bleeding events within one year) occurred in one patient (0.65%) in the six-week group and one patient (0.70%) in the three-month group. Based on the absolute risk differences between groups, noninferiority was demonstrated. Adverse events occurred in 26% of patients in the six-week treatment group and in 32% of those in the three-month group. The study population was characterized by a small proportion of people who had cancer or pulmonary embolism, so the results may not apply to these patient populations. Also, although most patients received low-molecular-weight heparin, direct oral anticoagulants are increasingly used for pediatric venous thromboembolism. The study points out that the low rates of recurrent venous thromboembolism they observed support shortening the duration of anticoagulant therapy for provoked venous thromboembolism in patients younger than age 21.
Copyright © Wolters Kluwer Health, Inc. All rights reserved.
Source: Rosenberg, K. (2022). Duration of Anticoagulant Therapy for Pediatric Venous Thromboembolism. AJN, American Journal of Nursing. 2022; 122(5): 49-49. Published: May, 2022. DOI: 6307900.
KEY FINDINGS: Perceived pressure to breastfeed may be an important psychosocial factor to consider when aiming to improve women's breastfeeding experiences. Reducing perceived pressure may be beneficial for promoting breastfeeding outcomes.
BACKGROUND: Purpose of the study is to develop a measure to quantitatively assess perceived pressure to breastfeed and examine associations between perceived pressure, emotional distress, and the breastfeeding experience and self-efficacy among women with 2- to 6-month-old infants.
DETAILS: A cross-sectional study using an online survey to assess perceived pressure to breastfeed, emotional distress, and the breastfeeding experience and self-efficacy was conducted. Participants were recruited through ResearchMatch, a national online service that matches potential participants to research studies, and online community forums (e.g., Facebook). Women (n = 187) reported themselves and society as the greatest sources of pressure. Pressure to breastfeed was negatively associated with the breastfeeding experience (r = -.34, p < .01) and self-efficacy (r = -.39, p < .01), but not emotional distress. Pressure to breastfeed remained a significant explanatory factor, even when considering demographic covariates, with the final models accounting for 16% and 20% of the variance in the breastfeeding experience and self-efficacy, respectively.
Copyright © Wolters Kluwer Health, Inc. All rights reserved.
Source: Korth, C. X., Keim, S. A., Crerand, C. E. et al. (2022). New Mothers' Perceptions of Pressure to Breastfeed. MCN, The American Journal of Maternal/Child Nursing. 2022: 47(3): 160-167. Published: May/June, 2022. DOI: 6307642.
KEY FINDINGS: This study showed that medication adherence in COPD was mostly affected by patient-, treatment- and condition-related factors.
BACKGROUND: This study aimed to investigate the effects of socioeconomic-, patient-, treatment-, condition- and health system-related factors on medication adherence in patients with chronic obstructive pulmonary disease (COPD). Medication adherence is essential for the management of chronic diseases. The World Health Organization created a Multidimensional Adherence Model (MAM) and showed that medication adherence is affected by a combination of numerous factors.
DETAILS: A total of 114 patients with COPD were included. Data were collected on five dimensions based on the MAM framework. Medication adherence, self-efficacy and symptoms were evaluated using the Adherence to Refills and Medications Scale-7 (ARMS-7), COPD Self-Efficacy Scale (CSES) and COPD Assessment Test (CAT), respectively. The data were analysed using descriptive statistics, correlational statistics and structural equation modelling. The STROBE checklist was used. The ARMS-7 scores were associated with the body mass index of patients (F = 4.245, p = .017), smoke pack-years (r = .277, p = .004) and the CSES total score (β = -0.249, p = .002) in patient-related factors. The ARMS-7 score was not associated with socio-economic and health system-related factors. The ARMS-7 score showed a significant correlation between COPD diagnosis duration (r = -.276, p = .003) and the total number of drugs (r = -.215, p = .022) in treatment-related factors. The ARMS-7 scores were associated with the number of comorbid illnesses of patients with COPD in condition-related factors (F = 3.533, p = .033).
Copyright © John Wiley & Sons Ltd. All rights reserved.
Source: Aldan, G., Helvaci, A., Ozdemir, L., et al. (2022). Multidimensional Factors Affecting Medication Adherence Among Patients With Chronic Obstructive Pulmonary Disease. J Clin Nurs. 2022; 31(9-10): 1202-1215. Published: May, 2022. DOI: 10.1111/jocn.15976.
KEY FINDINGS: Those with at least one ICD shock reported significantly lower HRQOL and more symptoms at 6- and 24-months. Patients receiving one or more ICD shocks reported significant reductions in HRQOL and higher symptoms.
BACKGROUND: To describe health related quality of life (HRQOL) and symptoms in the SPIRIT trial and determine effects of implantable cardioverter defibrillator (ICD) shocks on HRQOL over 24 months.
DETAILS: Ninety participants aged 66 ± 10 years, 96% men, 75% with NYHA class II, with an ICD were randomized to spironolactone 25 mg (N = 44) or placebo (N = 46). HRQOL was measured every 6 months for 24 months using: Patient Concerns Assessment (PCA), Short Form Health Survey-Veterans Version (SF-36V), and Kansas City Cardiomyopathy Questionnaire (KCCQ). Linear mixed modeling compared changes in HRQOL over-time and ANCOVA compared HRQOL between those getting an ICD shock or not. Over 24-months, there were no differences in HRQOL between the spironolactone versus placebo groups.
Copyright © SAGE Publications. All rights reserved.
Source: Liberato, A. C. S., Raitt, M. H., Zarraga, I. G. E., et al. (2022). Health-Related Quality of Life in the Spironolactone to Reduce ICD Therapy (SPIRIT) Trial. Clinical Nursing Research. 2022; 31(4): 588-597. Published: May, 2022. DOI: 10.1177/10547738211036817.
AUDIENCE: Psychiatry, Family Medicine
KEY FINDINGS: Treatment with MOUD was associated with a substantial reduction in suicide mortality as well external causes of mortality and all-cause mortality.
BACKGROUND: Understanding the effectiveness of medication treatment for opioid use disorder to decrease the risk of suicide mortality may inform clinical and policy decisions. The authors sought to describe the effect of medications for opioid use disorder (MOUD) on risk of suicide mortality.
DETAILS: This was a retrospective cohort study in Department of Veterans Affairs (VA) patients from 2003 to 2017. The authors linked three data sources: the VA Corporate Data Warehouse, Centers for Medicare and Medicaid Services Claims Data, and the VA–Department of Defense Mortality Data Repository. The exposure of interest was MOUD, including starting periods (first 14 days on treatment), stopping periods (first 14 days off treatment), stable time on treatment, and stable time off treatment (reference category). The main outcome measures included suicide mortality, external-cause mortality, and all-cause mortality in the 5 years following initiation of MOUD. Over 60,000 VA patients received MOUD. Patients were typically male (92.8%) and their mean age was 46.5 years (SD=13.1). After adjusting for demographic characteristics, mental health and physical health conditions, and health care utilization, the adjusted hazard ratio during stable MOUD was 0.45 (95% CI=0.32, 0.63) for suicide mortality, 0.35 (95% CI=0.31, 0.40) for external-cause mortality, and 0.34 (95% CI=0.31, 0.37) for all-cause mortality. MOUD starting periods were associated with an adjusted hazard ratio for suicide mortality of 0.55 (95% CI=0.25, 1.21), and MOUD stopping periods were associated with an adjusted hazard ratio for suicide mortality of 1.38 (95% CI=0.82, 2.34).
Copyright © American Psychiatric Association. All rights reserved.
Source: Watts, B. V., Gottlieb, D. J., Riblet, N. B., et al. (2022). Association of Medication Treatment For Opioid Use Disorder With Suicide Mortality. Am J Psychiatry. Published: April 1, 2022. DOI: 10.1176/appi.ajp.2021.21070700.
A Scoping Review
KEY FINDINGS: The evidence currently available on this issue is limited and often of dubious methodological rigour. Further studies are required on the treatment and follow-up of intravenous therapy-related phlebitis in different national and international contexts.
BACKGROUND: Purpose of the study was to identify and analyse topical treatments for peripheral venous catheter (PVC)-related phlebitis.
DETAILS: A search and selection were made of experimental, quasi-experimental and pre-experimental studies published between January 2015 and September 2020 that consider the use of topical products for the treatment of hospital in-patients with PVC-related phlebitis. Appraisal of the methodological quality of the study was performed independently by pairs of reviewers on the basis of the Cochrane Collaboration tool. The review was based on the guidelines in the PRISMA-ScR statement. Twenty-two articles were selected (8 randomised controlled trials (RCTs), 12 quasi-RCTs and 2 pre-experimental studies) which considered treatments applied to a total of 2042 adult patients. The topical treatments described were classified into physical measures and phytotherapeutic and pharmacological treatments. The physical measures are easy to apply, but their effectiveness is limited. The main limitation of the phytotherapeutic treatments is their marketing and use in eastern culture. The best performing pharmacological treatment is the application of magnesium sulphate either with or without glycerine. These products can be presented in different pharmaceutical formulas: ointment, solution and oil.
Copyright © John Wiley & Sons Ltd. All rights reserved.
Source: Garcia-Exposito, J., Masot, O., Gros, S., et al. (2022). Practical View Of The Topical Treatment Of Peripheral Venous Catheter-Related Phlebitis: A Scoping Review. J Clin Nurs. Published: March 1, 2022. DOI: 10.1111/jocn.15946.