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Venous thromboembolism prophylaxis in hospitalized elderly patients： Time to consider a ＇MUST＇ strategy

Journal of Geriatric Cardiology 2011年第2期8卷 114-120页

作者： Kwok M Ho edward litton Department of Intensive Care Medicine Royal Perth Hospital and School of Population Health University of Western Australia Perth WA 6000 Australia

Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual＇ s risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat （＇MUST＇） VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ＇selective and single-modal＇ VTE prophylaxis approach, which often becomes ＇hit or miss＇ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.

关键词： age bundle of care deep vein thrombosis prevention pulmonary embolism

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Flattening the biological age curve by improving metabolic health:to taurine or not to taurine,that’s the question

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Journal of Geriatric Cardiology 2023年第11期20卷 813-823页

作者： Kwok M.Ho Anna Lee William Wu Matthew T.V.Chan Lowell Ling Jeffrey Lipman Jason Roberts edward litton Gavin M.Joynt Martin Wong Department of Intensive Care Medicine Fiona Stanley HospitalPerthAustralia Medical School The University of Western AustraliaPerthAustralia School of Veterinary&Life Sciences Murdoch UniversityPerthAustralia Department of Anaesthesia&Intensive Care Prince of Wales HospitalChinese University of Hong KongHong KongChina Jamieson Trauma Institute Royal Brisbane and Women’s HospitalBrisbaneQueenslandAustralia Division of Anaesthesiology Critical Care Emergency and Pain Medicine Nîmes University HospitalUniversity of MontpellierNîmesFrance University of Queensland Centre for Clinical Research Faculty of MedicineThe University of QueenslandBrisbaneAustralia Herston Infectious Diseases Institute(HeIDI) Metro North HealthBrisbaneAustralia Departments of Pharmacy and Intensive Care Medicine Royal Brisbane and Women’s HospitalBrisbaneAustralia JC School of Public Health and Primary Care Centre for Health Education and Health PromotionChinese University of Hong KongHong KongChina School of Public Health Peking UniversityBeijingChina School of Public Health Fudan UniversityShanghaiChina

The aging population is an important issue around the world especially in developed *** med-ical advances have substantially extended life span,the same cannot be said for the duration of health *** are seeing in-creasing numbers of elderly people who are frail and/or have multiple chronic conditions;all of these can affect the quality of life of the elderly population as well as increase the burden on the healthcare *** is mechanistically related to common medical conditions such as diabetes mellitus,ischemic heart disease,cognitive decline,and frailty.A recently accepted concept termed‘Accelerated Biological Aging’can be diagnosed when a person’s biological age—as measured by biomarkers of DNA methylation—is older than their corresponding chronological ***,a conditionally essential amino acid,has received much attention in the past few years.A substantial number of animal studies have provided a strong scientific foundation sug-gesting that this amino acid can improve cellular and metabolic health,including blood glucose control,so much that it has been labelled one of the‘longevity amino acids’.In this review article,we propose the rationale that an adequately powered random-ized-controlled-trial(RCT)is needed to confirm whether taurine can meaningfully improve metabolic and microbiome health,and biological *** trial should incorporate certain elements in order to provide the much-needed evidence to guide doctors,and also the community at large,to determine whether this promising and inexpensive amino acid is useful in improving human metabolic health.

关键词： rational meaningful Taurine

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安全有效的静脉补铁治疗可减少异体输血需求：随机临床试验的系统性综述和荟萃分析

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英国医学杂志中文版 2014年第2期17卷 73-74页

作者： edward litton JingXiao Kwok M Ho 王倩(译) 许小平(校) Department ofIntensive CareMedicine Royal PerthHospital PerthWestern Australia6000 School of Medicineand Pharmacology University of WesternAustralia PerthWestern Australia6OO9 School of PopulationHealth University ofWestern AustraliaPerth WesternAustralia 6009 复旦大学附属上海华山医院血液科

目的为了评价静脉补铁治疗的有效性和安全性，主要对患者血红蛋白浓度的改善、输血需求及感染风险进行评估。研究设计对评价静脉补铁治疗的安全性及有效性的随机对照临床研究进行系统性综述和荟萃分析。

关键词：静脉补铁治疗系统性综述荟萃分析异体输血随机临床试验安全性随机对照临床研究血红蛋白浓度

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