Venous thromboembolism (VTE) remains a leading cause of preventable morbidity and mortality among hospitalized patients. Although pharmacological thromboprophylaxis is well established in inpatient care, initiation is frequently delayed until after hospital admission. The emergency department represents the first point of contact for many high-risk patients and a potential opportunity for earlier prevention. This systematic review and meta-analysis evaluated the effectiveness of emergency department-initiated thromboprophylaxis protocols in preventing VTE among high-risk adult patients. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review was conducted using MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to the most recent update. Eligible studies included randomized controlled trials and observational or quasi-experimental studies evaluating thromboprophylaxis initiated in, or directly facilitated by, the emergency department. Outcomes of interest included incidence of VTE, bleeding complications, mortality, length of stay, and process measures such as prophylaxis utilization and timeliness. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool for randomized trials and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool for non-randomized studies. Due to substantial clinical and methodological heterogeneity, quantitative pooling was limited, and a structured narrative synthesis was performed. The review identified a heterogeneous body of evidence comprising prospective and retrospective cohorts, before-and-after implementation studies, and health information technology interventions. Emergency department-initiated or emergency department-facilitated protocols consistently increased appropriate thromboprophylaxis use and reduced delays to the first dose. In a subset of large protocol implementation studies, earlier initiation was associated with lower rates of symptomatic VTE without a corresponding increase in major bleeding. Mortality and length of stay outcomes were inconsistently reported, precluding definitive conclusions. The overall certainty of evidence was limited by observational designs, variability in patient populations, and inconsistent outcome definitions. Emergency department-initiated thromboprophylaxis protocols improve the timeliness and appropriateness of VTE prevention and may reduce symptomatic events without increasing bleeding risk in selected high-risk populations. These findings support the integration of structured thromboprophylaxis pathways into emergency care, while highlighting the need for high-quality prospective trials to define their impact on patient-centered outcomes.
Background: Infertility affects nearly 15% of couples of reproductive age, with male factors contributing to 40–50% of cases. Varicocele, an abnormal dilation of the pampiniform plexus veins, is one of the most common reversible causes of male infertility, observed in approximately 16–21% of men presenting to infertility clinics. It impairs spermatogenesis through testicular hyperthermia and venous congestion, leading to poor semen quality. Surgical correction through varicocelectomy remains the mainstay of treatment, with microscopic and laparoscopic techniques being the most widely practiced. Objective: To compare the improvement in sperm count following laparoscopic and microscopic sub-inguinal varicocelectomy in infertile males diagnosed with varicocele. Methods: This randomized controlled trial was conducted at the Department of Urology, Hayatabad Medical Complex, Peshawar, from January 1, 2025, to June 30, 2025. A total of 80 males aged 18–40 years with Doppler-confirmed unilateral varicocele were enrolled and randomly divided into two equal groups. Group A (n=40) underwent microscopic sub-inguinal varicocelectomy, while Group B (n=40) underwent laparoscopic varicocelectomy. Semen analyses were performed preoperatively and at four months postoperatively. Data were analyzed using SPSS version 22, applying paired t-tests for within-group and independent t-tests for between-group comparisons, with a p-value <0.05 considered significant. Results: The mean preoperative sperm count in the microscopic group was 13.68 ± 4.77 million/mL, increasing to 23.86 ± 6.14 million/mL postoperatively (t = −20.03, p < 0.001). In the laparoscopic group, counts rose from 15.25 ± 3.79 million/mL to 21.55 ± 4.42 million/mL (t = −13.84, p < 0.001). The between-group comparison showed a near-significant difference (t = 1.91, p = 0.061), suggesting a trend favoring the microscopic approach. Conclusion: Both microscopic and laparoscopic varicocelectomy significantly improved sperm counts, confirming varicocelectomy as an effective surgical treatment for varicocele-related male infertility. The microscopic technique showed a slight advantage in enhancing spermatogenesis, though larger multicenter trials are needed to validate this difference.
Background: Adhesive capsulitis characterized by pain and limited ROM and functional disability. Manual therapy techniques such as Spencer and Mulligan promote shoulder function by increasing of ROM and reliving pain. Objective: To find effect of spencer technique vs mulligan mobilization on rom and functional disability among adhesive capsulitis patients Methods: A randomized clinical trial was conducted 38 frozen shoulder subjects. Data was gathered from Mian Munshi DHQ Teaching hospital ,Govt. THQ Mian Meer hospital Lahore on this basis of inclusion and exclusion criteria.2 intervention groups were made .Group A participants undergone spencer technique and group B received Mulligan Mobilization SPADI questionnaire utilized to find out functional disability and goniometer utilized to find ROM were utilized as assessment tool. Study ran April 2024 October 2024. SPSS version 22 employed for statistical analysis. Results: Revealed group B demonstrated superior outcomes compared to Group A, with reductions in SPADI pain in the QoL score for all three domains: physical health (p = .006, disability (p = .033), and total scores p = .007. Showed within-group comparisons has significant reduction in pain, disability and total scores for both groups, more so Group B (p < .001). For shoulder ROM post-intervention Group B reported significantly improved flexion, extension, abduction, internal, and external rotations (p < .05) than Group A. Conclusion: Conclusively both groups benefited in all parameters Although; Group B Mulligan Mobilization was more effective in pain and disability reduction and ROM improvement as compared to group B spencer technique.
Background: Palliative care improves quality of life across the disease trajectory, yet misconceptions and attitudinal barriers among nurses can delay timely referral, undermine analgesic stewardship, and impair end-of-life communication. Local data from tertiary hospitals in Pakistan are limited. Objective: To quantify nurses’ knowledge and attitudes toward palliative care in tertiary hospitals of Peshawar and identify priority domains for education. Methods: A cross-sectional survey (June–August 2025) was administered to registered nurses with ≥3 months’ experience across four tertiary hospitals. A structured questionnaire adapted from validated tools captured demographics and item-level agreement on knowledge and attitudes using five-point Likert responses. Descriptive statistics and Wilson 95% confidence intervals were reported for agreement prevalences. Results: Of 262 respondents, 94.8% were female and 61.0% were aged 25–35 years; 43.5% had 1–5 years’ experience and 85.1% held a nursing diploma. Evidence-aligned beliefs were common: educating families (89.6% agreement, 95% CI 85.3–92.7), facilitating patient emotional expression (86.4%, 81.7–90.0), trusting patient self-report of pain (81.8%, 76.7–86.0), and distinguishing chronic from acute pain (81.8%, 76.7–86.0). However, misconceptions were frequent: changing the topic when asked “Am I dying?” (78.6%, 73.2–83.1), perceiving emotional detachment as required (63.7%, 57.7–69.3), limiting palliative care to downhill deterioration (57.8%, 51.7–63.6), endorsing placebo use for pain (66.3%, 60.4–71.8), and preferring intramuscular opioids (48.7%, 42.7–54.7). Conclusion: Nurses demonstrated strong family-centred orientations but substantial gaps in communication and analgesic ethics, defining a tractable training agenda focused on serious-illness dialogue, scope and timing of palliative care, and WHO-concordant pain management.
