Venous thromboembolism has been identified as one of the common cardiovascular illnesses, which occurs after the acute coronary syndrome and has various risk factors. It is usually prevalent in adults and less prevalent in children (Tamariz et al., 2004). In the systematic review of Tamariz et al. (2004), the research question focused on establishing available therapeutic responses and interventions for venous thromboembolism. The primary purpose of the review was to examine the existing evidence of the predictive value of clinical prediction rules for the diagnosis of venous thromboembolism. The research defined a clinical prediction rule as a scoring system used to calculate and test probability of a disease. Using the PICOT analysis approach, the main population for the study included patients suffering from deep vein pain thrombosis. The review used statistics from patients in the United States, Canada, and Europe. The main intervention reviewed was the combination of clinical assessments that utilized the D-dimmer testing, ultrasonography, and the helical computed tomography. The review also examined the pretest value for patients with and without chronic infections. Finally, the review has compared interventions presented in the various evidence-based literatures that were validated against a reference standard. The current paper provides a systematic analysis of the findings on the diagnosis of venous thromboembolism.
The significant elements evident in the review were based on the patient’s history and the findings on the physical examination and laboratory tests. Patients were classified as having a low, moderate, and high probability which was compared with a particular reference standard. The review also considered the element of the geographical area where the specific research had taken place as an inclusion criterion. Another significant element considered in the review was the diagnosis of the venous thromboembolism. The review emphasized the application of the D-dimer measurement for diagnosis. Additionally, the methodology was based on qualitative and quantitative approach which played a significant role in data presentation. For instance, the quantitative design enabled the review to present the statistical data in a way that it is easier to interpret. The authors also conducted a meta-analysis between the Wells prediction rule for pulmonary embolism and the latex-based D-dimer test. It was discovered that patients with low and moderate levels of pretest probability had a lower incidence of pulmonary embolism.
It can be argued that the final findings of the study are valid because it focused on the use of evidence-based literature for analysis and the authors had designed a standard clinical prediction rule. Final results established that the addition of D-dimer tests was the most suitable for clinical assessment. It is because the review discovered that the latex-based D-dimer had a consistently high negative predictive value in patients with the low prevalence of the disease (Tamariz et al., 2004). The advanced and registered nurses can apply this procedure as a significant intervention for patients with the higher probability of the neurosis thrombosis.
The review was solely funded by the members of the US Department of Medicine and the Agency for Health Care Research Quality. Some of the authors of the review, such as Dr. Tamariz, contributed through training, which made the research successful.
Some of the strengths of the review include the utilization of evidence-based research materials that matched the research topic. This aspect made it easier to conduct an analysis of different interventions applied for patients with high probability of venous thrombosis (Tamariz et al., 2004). The authors of the review have also acknowledged that they had an eligibility criterion applied in the selection of the articles. This strategy was necessary to ensure that the selected articles for review contained adequate information that would assist in fulfilling the research objectives. Additionally, in the selection process, the authors were not masked by the title of the journal. An intensive analysis of the abstract and the hypothesis allowed avoiding having many articles that were out of topic.
However, the review also had some limitations such as including articles published in English only. It can be argued that it was a limitation because there are more articles written in other languages that offer supplementary knowledge concerning the variables researched. Another limitation is that the review excluded patients with a family history of thrombosis, those suspected to have malignant deep vein thrombosis. Therefore, it is difficult to extrapolate the results of these patients because they were exempted from the research. There is also the possibility of bias because the review has focused on patients with higher diagnoses, neglecting individuals from the general population who had a higher prevalence. The review has also failed to mention the barriers that may affect the application of clinical prediction rules in the diagnosis of venous thromboembolism (Tamariz et al., 2004). Furthermore, there was age bias because the review has used patients who were more than 50 years old despite its prevalence in adolescents and the children.
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The primary objective of the review was to summarize the evidence of the predictive value of clinical prediction rules for the diagnosis of venous thromboembolism. This objective has been fulfilled because the review has highlighted the significance of the application of this rule. The review has established that a clinical prediction rule has a standardized method that can be used in the clinical context to estimate risks. The review has also proved that clinical prediction rule can have substantial risk assessment criteria for physicians to assess the subsequent laboratory and radiology tests. The evidence regarding the D-dimer has also contributed to the achievement of the review objectives because it proved to have high predictive values (Tamariz et al., 2004). The Wells model for the diagnosis of pulmonary embolism has also had similar predictive values that enabled researchers to execute a meta-analysis of the two procedures.
It can be evident that the review has analyzed a critical procedure of the diagnosis of the venous thromboembolism. However, there is still the need to conduct a research on the barriers associated with the use of clinical prediction rules for the patients with a family history of thromboembolism. The clinical prediction rule in the review also appears to have intensified resource utilization. The review has proposed on the D-dimer tests and helical computed tomography which involve high utilization of resources compared to the management based on empirical assessment risk (Tamariz et al., 2004). Therefore, they should have reviewed further sustainable procedures that can have high performance. However, the evidence of the review strongly supports the use of clinical prediction rules for testing the pulmonary embolism in a patient with the application of another definitive pretest. As a registered nurse practitioner, this knowledge can be applied in pretesting and interpreting the subsequent test when handling or diagnosing a patient with the disease. The use of D-dimmer test can be the most effective method used by the registered nurse practitioner because it is proven to have a high predictive value.
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In conclusion, the use of D-dimer is an excellent diagnostic procedure for patients with a high, moderate, and low probability of venous thromboembolism. Therefore, nursing professionals should select this procedure for both deep venous thrombosis and pulmonary embolism. There should also be an intensified awareness of the risk factors in adults because they are the most vulnerable population. Therefore, indefinite coagulation should be considered for inpatients diagnosed with venous pulmonary embolism because it is the most fatal.
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