Lower extremity

下肢
  • 文章类型: Journal Article
    下肢骨折的老年人经常担心失去行动能力,害怕失去独立性。至关重要的是制定促进他们积极参与康复进程的战略。本方案旨在创建一种定制的护理途径,以激励下肢骨折患者坚持康复。我们将开发一个观测系统,横截面,并使用德尔菲数据收集方法进行描述性研究。有目的的抽样将招募一组照顾下肢骨折患者的医疗保健专业人员和专家。与德尔菲法一致,将开展一系列的迭代循环,以就健康专业人员在下肢骨折患者康复中使用的动机策略达成共识.我们将使用Qualtrics平台进行数据收集和分析,已经预先确定了75%的共识目标。对于定量数据分析,我们将使用包含一系列衡量标准的描述性统计数据,包括计数,意思是,标准偏差,中位数,minimum,最大值,和范围。将采用归纳主题分析程序从定性数据中提取有意义的主题和模式。研究结果有望通过创建专门的护理途径来激励下肢骨折患者坚持康复,从而显着影响临床实践。专业人员采用这些明确的标准将确保统一和高质量的护理。
    Older adults with lower limb fractures often harbor concerns about losing their mobility, fearing a loss of independence. It is vital to develop strategies that foster their active engagement in the rehabilitation process. The present protocol aims to create a care pathway tailored to motivate individuals with lower limb fractures to adhere to rehabilitation. We will develop an observational, cross-sectional, and descriptive study using the Delphi data-gathering approach. Purposive sampling will recruit a panel of healthcare professionals and experts who care for patients with lower limb fractures. Aligned with the Delphi method, a series of iterative rounds will be developed to gather consensus around the motivational strategies used by health professionals in the rehabilitation of people with lower limb fractures. We will employ the Qualtrics platform for data collection and analysis, and a consensus target of 75% has been predetermined. For quantitative data analysis, we will use descriptive statistics encompassing a range of measures, including count, mean, standard deviation, median, minimum, maximum, and range. An inductive thematic analysis procedure will be employed to extract meaningful themes and patterns from qualitative data. The study results are expected to significantly impact clinical practice by creating a specialized care pathway to motivate individuals with lower limb fractures to adhere to rehabilitation. Adopting these explicit standards by professionals will ensure uniform and high-quality care.
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  • 文章类型: Journal Article
    非血栓性髂静脉病变定义为髂静脉的外部压迫。下肢慢性静脉功能不全或盆腔静脉疾病的症状可继发于非血栓性髂静脉病变。在有症状和无症状的患者中均观察到解剖压迫。导致症状表现的原因因素尚不清楚。为非血栓性髂静脉病变患者的治疗提供指导,VIVA基金会与美国静脉论坛和美国静脉和淋巴学会的代表召集了一个多学科的静脉疾病管理领导者小组。参与者起草了关于非血栓性髂静脉病变的共识声明,以解决患者选择问题。成像诊断,支架放置的技术考虑因素,术后管理,和未来的研究/教育需求。
    A nonthrombotic iliac vein lesion is defined as the extrinsic compression of the iliac vein. Symptoms of lower extremity chronic venous insufficiency or pelvic venous disease can develop secondary to nonthrombotic iliac vein lesion. Anatomic compression has been observed in both symptomatic and asymptomatic patients. Causative factors that lead to symptomatic manifestations remain unclear. To provide guidance for providers treating patients with nonthrombotic iliac vein lesion, the VIVA Foundation convened a multidisciplinary group of leaders in venous disease management with representatives from the American Venous Forum and the American Vein and Lymphatic Society. Consensus statements regarding nonthrombotic iliac vein lesions were drafted by the participants to address patient selection, imaging for diagnosis, technical considerations for stent placement, postprocedure management, and future research/educational needs.
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  • 文章类型: Journal Article
    暂无摘要。
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  • 文章类型: Journal Article
    目的:“2024ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS下肢外周动脉疾病管理指南”提供了建议,以指导临床医生治疗下肢外周动脉疾病患者的多个临床表现子集(即,无症状,慢性症状,慢性威胁肢体缺血,和急性肢体缺血)。
    方法:从2020年10月至2022年6月进行了全面的文献检索,包括研究,reviews,以及PubMed以英文发表的关于人类受试者的其他证据,EMBASE,Cochrane图书馆,CINHL完成,以及与本指南相关的其他选定数据库。其他相关研究,到2023年5月在同行评审过程中发布,也由写作委员会审议,并在适当的情况下添加到证据表中。
    “2016AHA/ACC下肢外周动脉疾病患者管理指南”的建议已更新,并有新的证据指导临床医生。此外,针对外周动脉疾病患者的综合护理提出了新的建议.
    OBJECTIVE: The \"2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease\" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia).
    METHODS: A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate.
    UNASSIGNED: Recommendations from the \"2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease\" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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  • 文章类型: Journal Article
    \“2024ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS下肢外周动脉疾病管理指南”提供了建议,以指导临床医生在下肢外周动脉疾病患者的多个临床表现子集(即,无症状,慢性症状,慢性威胁肢体缺血,和急性肢体缺血)。
    从2020年10月至2022年6月进行了全面的文献检索,包括研究,reviews,以及PubMed以英文发表的关于人类受试者的其他证据,EMBASE,Cochrane图书馆,CINHL完成,以及与本指南相关的其他选定数据库。其他相关研究,到2023年5月在同行评审过程中发布,也由写作委员会审议,并在适当的情况下添加到证据表中。
    “2016AHA/ACC下肢外周动脉疾病患者管理指南”的建议已更新,并有新的证据指导临床医生。此外,针对外周动脉疾病患者的综合护理提出了新的建议.
    UNASSIGNED: The \"2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease\" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia).
    UNASSIGNED: A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate.
    UNASSIGNED: Recommendations from the \"2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease\" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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  • 文章类型: Journal Article
    背景:深静脉血栓形成(DVT)构成了复杂的挑战,通常会导致血栓形成后综合征(PTS),使人衰弱的并发症。静脉支架的出现提供了预防这种并发症的潜在途径。本研究旨在为静脉支架治疗DVT提供共识建议。
    方法:从2023年6月到7月,20内科,血管和血管外科,血管和介入放射学专家参与了德尔菲过程。31条建议,分为三个主题领域,进行了严格的评估:支架使用的适应症,支架的选择和放置,监测和预防并发症。协议是用李克特量表评估的,三分之二的参与者达成共识。
    结果:31项建议中有23项(74.2%)达成共识。协议以考虑为中心,例如在特定急性DVT情况下放置支架,强调关键的支架特性。然而,根据髂血管分叉形态,为防止迁移而推荐的支架长度和支架特性存在差异.值得注意的是,对于由主要短暂性危险因素引起的DVT患者是否需要3个月以上的抗凝治疗,或者静脉支架置入后是否应在抗凝治疗中加入阿司匹林,目前尚无共识.
    结论:这些共识建议为优化静脉支架使用以预防DVT患者的PTS提供了实用见解。解决支架选择的关键方面,placement,和术后护理,这些建议有助于临床决策.查明的分歧强调了共识的重要性,因此表明需要进一步调查。
    BACKGROUND:  Deep vein thrombosis (DVT) poses a complex challenge and often leads to postthrombotic syndrome (PTS), a debilitating complication. The emergence of venous stents offers a potential preventive avenue against this complication. This study aimed to provide consensus recommendations on the use of venous stent for DVT.
    METHODS:  From June to July 2023, 20 internal medicine, angiology and vascular surgery, and vascular and interventional radiology experts were involved in the Delphi process. Thirty-one recommendations, categorized into three thematic areas, were rigorously evaluated: indications for stent use, stent selection and placement, and monitoring and prevention of complications. Agreement was evaluated using a Likert scale, with consensus defined as agreement by two-thirds of the participants.
    RESULTS: Consensus was reached for 23 (74.2%) of 31 recommendations. The agreement was centered on considerations, such as stent placement in specific acute DVT scenarios, emphasizing pivotal stent characteristics. However, there were divergences in the recommended stent length to prevent migration and stent characteristics based on iliocaval bifurcation morphology. Notably, there was no consensus on whether patients with DVT caused by a major transient risk factor need more than 3 months of anticoagulation therapy or whether aspirin should be added to anticoagulant treatment after venous stenting.
    CONCLUSIONS:  These consensus recommendations offer practical insights into optimizing venous stent use to prevent PTS in DVT patients. Addressing the critical aspects of stent selection, placement, and postprocedural care, these recommendations contribute to clinical decision-making. The identified divergences underscore the importance of consensus and thus indicate the need for further investigation.
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  • 文章类型: English Abstract
    Diabetic foot ulcers complicated with lower extremity vasculopathy possess the characteristics of high incidence, slow healing, and poor prognosis, which may eventually lead to amputation or even life-threatening if not treated properly. The treatment of complicated lower extremity vasculopathy is vital to improve the healing process of diabetic foot ulcers, which has gradually received attention in clinical practice. Recently, a number of clinical trials on diabetic foot ulcers complicated with lower extremity vasculopathy were reported. In order to further standardize the clinical diagnosis and treatment of diabetic foot ulcers complicated with lower extremity vasculopathy, an expert group headed by Burns and Trauma Branch of Chinese Geriatrics Society, Chinese Burn Association, and Wound Repair Professional Committee of Chinese Medical Doctor Association deliberated and compiled the National expert consensus on the diagnosis and surgical treatment of diabetic foot ulcers complicated with lower extremity vasculopathy (2024 version) together. This consensus is based on evidences from the literature, covers the disease characteristics, evidence-based evidence of clinical diagnosis and treatment, as well as the application of new technologies and new treatment approaches of diabetic foot ulcers complicated with lower extremity vasculopathy. The goal of this consensus is to provide clear guidance to practitioners on the best approaches for screening, diagnosing, and treating diabetic foot ulcers complicated with lower extremity vasculopathy in individuals, hoping to provide a normative clinical practice basis for medical staff engaged in the treatment of diabetic foot wounds.
    糖尿病足溃疡合并下肢血管病变具有发病率高、愈合缓慢、预后差的特点,如不经规范治疗易导致截肢甚至危及生命。针对合并下肢血管病变的治疗对改善糖尿病足溃疡的愈合进程至关重要,在临床实践中逐渐得到重视。近年来,关于糖尿病足溃疡合并下肢血管病变的临床研究已见诸多报道,为了进一步规范临床诊疗,由中国老年医学学会烧创伤分会、中华医学会烧伤外科学分会、中国医师协会创面修复专业委员会牵头的专家组共同审议并编写了《糖尿病足溃疡合并下肢血管病变的外科诊疗全国专家共识(2024版)》。该共识以文献证据为基础,内容涵盖了糖尿病足溃疡合并下肢血管病变的疾病特征、临床诊疗循证证据以及新技术和新治疗方法的应用,旨在为临床工作者提供关于糖尿病足溃疡合并下肢血管病变最佳筛查和诊疗方法的明确指导,希望为从事糖尿病足创面治疗的医务人员提供规范性的临床实践依据。.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    糖尿病足溃疡并发下肢血管病变的患病率高,愈合缓慢,预后不良。最后的进展导致截肢,甚至可能危及生命,严重影响患者的生活质量。下肢血管病变的治疗是临床实践的重点,对改善糖尿病足溃疡的愈合过程至关重要。最近,一些关于糖尿病足溃疡合并下肢血管病变的临床试验已经报道。中华医学会(CMA)和中国医师协会(CMDA)专家代表联合小组对此类疾病的临床诊断和治疗指南进行了评审并达成共识。这些指南基于文献证据,涵盖了糖尿病足溃疡并发下肢血管病变的发病机制以及新治疗方法的应用。已提出这些指引,以指引执业者最佳的筛检方法,诊断和治疗糖尿病足溃疡伴下肢血管病变,为了提供最优的,对从事糖尿病足伤口修复和治疗的医务人员进行循证管理。
    Diabetic foot ulcer complicated with lower extremity vasculopathy is highly prevalent, slow healing and have a poor prognosis. The final progression leads to amputation, or may even be life-threatening, seriously affecting patients\' quality of life. The treatment of lower extremity vasculopathy is the focus of clinical practice and is vital to improving the healing process of diabetic foot ulcers. Recently, a number of clinical trials on diabetic foot ulcers with lower extremity vasculopathy have been reported. A joint group of Chinese Medical Association (CMA) and Chinese Medical Doctor Association (CMDA) expert representatives reviewed and reached a consensus on the guidelines for the clinical diagnosis and treatment of this kind of disease. These guidelines are based on evidence from the literature and cover the pathogenesis of diabetic foot ulcers complicated with lower extremity vasculopathy and the application of new treatment approaches. These guidelines have been put forward to guide practitioners on the best approaches for screening, diagnosing and treating diabetic foot ulcers with lower extremity vasculopathy, with the aim of providing optimal, evidence-based management for medical personnel working with diabetic foot wound repair and treatment.
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  • 文章类型: Journal Article
    患者报告的结果指标在患者的临床评估中变得至关重要。适当的选择,在年轻人口中,该工具对于提供以患者为中心的循证医疗保健至关重要。本系统综述应用基于Consensus的标准选择健康测量指标方法,以提供针对下肢受损的儿科骨科患者的患者报告结局指标的严格评估概述。
    对电子数据库进行系统搜索,以确定报告患者报告的评估儿童下肢损伤的结果指标的发展和/或验证的原始研究。数据提取,质量评估,和偏倚风险评估是根据基于社区的健康测量指标指南选择标准以及系统评价和荟萃分析声明的首选报告项目进行的。
    共筛选了6919篇文章。包括33项研究,报告13种不同患者报告结局指标和20种翻译的测量特性的证据.四项研究报告了内容的有效性和患者报告的结局指标的发展。结构效度研究的方法学质量,内容有效性,或患者报告的结局指标发展大多被评为“可疑”或“非常好”。“关于测量特性的证据质量差异显著,大多数研究需要提高他们的方法学质量来证明他们的结果。
    本综述广泛概述了儿科骨科下肢损伤患者所有可用的患者报告结局指标。我们谨慎建议使用四种患者报告的结果指标。然而,关于内容有效性和患者报告结局指标制定的研究很少,这凸显了未来研究努力的一个领域,以提高我们对当前可用的患者报告结局指标的认识.
    诊断级别1。
    UNASSIGNED: Patient-reported outcome measures have become crucial in the clinical evaluation of patients. Appropriate selection, in a young population, of the instrument is vital to providing evidence-based patient-centered healthcare. This systematic review applies the COnsensus-based Standards for selection of health Measurement INstruments methodology to provide a critically appraised overview of patient-reported outcome measures targeted at pediatric orthopedic patients with lower limb impairment.
    UNASSIGNED: A systematic search of electronic databases was performed to identify original studies reporting the development and/or validation of patient-reported outcome measures evaluating children with impairment of the lower extremity. Data extraction, quality assessment, and risk of bias evaluation were performed following the COnsensus-based Standards for selection of health Measurement INstruments guidelines and Preferred Reporting Items for Systematic reviews and Meta-Analyses statement.
    UNASSIGNED: A total of 6919 articles were screened. Thirty-three studies were included, reporting evidence on the measurement properties of 13 different patient-reported outcome measures and 20 translations. Four studies reported on content validity and patient-reported outcome measure development. The methodological quality of studies on structural validity, content validity, or patient-reported outcome measure development was mostly rated as \"doubtful\" or \"very good.\" The quality of evidence on measurement properties varied noticeably, with most studies needing to perform improve their methodological quality to justify their results.
    UNASSIGNED: This review provides an extensive overview of all available patient-reported outcome measures for patients with lower extremity impairment within pediatric orthopedics. We cautiously advise the use of four patient-reported outcome measures. However, the scarce availability of research on content validity and patient-reported outcome measure development highlights an area for future research endeavors to improve our knowledge on the currently available patient-reported outcome measures.
    UNASSIGNED: Diagnostic level 1.
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