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Outpatient Management of pulmonary embolus

Jacob C Easaw, Susan McCall, Adrian Azim
Stable cancer patients diagnosed with a pulmonary embolus or deep vein thrombosis are commonly referred to the emergency department for management. This practice strains an already overburdened emergency department and is associated with long wait times and poor disease/injection education for patients. This pilot study sought to determine if stable cancer patients with newly diagnosed cancer-associated thrombosis could be effectively managed by community-based pharmacists who followed an evidence-based protocol to prescribe and initiate low-molecular weight heparin therapy...
January 1, 2018: Journal of Oncology Pharmacy Practice
Adam J Singer, Henry C Thode, W Frank Peacock
OBJECTIVE: Introduction of target specific anticoagulants and recent guidelines encourage outpatient management of low risk patients with venous thromboembolism. We describe hospital admission rates over time for patients presenting to US emergency departments (EDs) with deep vein thrombosis (DVT) and pulmonary embolism (PE) and estimate the proportion of low-risk PE patients who could potentially be managed as outpatients. METHODS: We performed a structured analysis of the National Hospital Ambulatory Medical Care Survey (a nationally representative weighted sampling of US ED visits) database for the years 2006-2010 including all adult patients with a primary diagnosis of DVT or PE...
September 2016: Clinical and Experimental Emergency Medicine
David A Kane, Kevin G Friedman, David R Fulton, Robert L Geggel, Susan F Saleeb
OBJECTIVES: To determine if patients evaluated using the pediatric chest pain standardized clinical assessment and management plan (SCAMP) in cardiology clinic were later diagnosed with unrecognized cardiac pathology, and to determine if other patients with cardiac pathology not enrolled in the SCAMP would have been identified using the algorithm. STUDY DESIGN: Patients 7-21 years of age, newly diagnosed with hypertrophic or dilated cardiomyopathy, coronary anomalies, pulmonary embolus, pulmonary hypertension, pericarditis, or myocarditis were identified from the Boston Children's Hospital (BCH) cardiac database between July 1, 2010 and December 31, 2012...
September 2016: Congenital Heart Disease
James T Bernatz, Jonathan L Tueting, Scott Hetzel, Paul A Anderson
BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) now include hip and knee replacements in the Hospital Readmission Reduction Program. The 30-day readmission rate is an important quality metric; however, the incidence has not yet been defined across the numerous orthopaedic subspecialties. Elucidating the readmission rate for each subspecialty may indicate that certain services are being disincentivized by the CMS reimbursement program. Furthermore, the "planned" and "unplanned" definitions of readmission have not been well examined to determine their clinical relevance and representation of safe patient care...
March 2016: Clinical Orthopaedics and related Research
Anna M Royer, Jeremy S Smith, Ashley Miller, Marlana Spiva, Jenny M Holcombe, James R Headrick
Prolonged air leaks are the most common postoperative complication following pulmonary resection, leading to increased hospital length of stay (LOS) and cost. This study assesses the safety of discharging patients home with a chest tube (CT) after pulmonary resection. A retrospective review was performed of a single surgeon's experience with pulmonary resections from January 2010 to January 2015. All patients discharged home with a CT were included. Discharge criteria included a persistent air leak controlled by water seal, resolution of medical conditions requiring hospitalization, and pain managed by oral analgesics...
August 2015: American Surgeon
Michael Harlander-Locke, Juan Carlos Jimenez, Peter F Lawrence, Brian G Derubertis, David A Rigberg, Hugh A Gelabert, Steven M Farley
OBJECTIVE: We evaluated our experience with segmental radiofrequency ablation (RFA) of the small saphenous vein (SSV), a less common procedure than great saphenous vein ablation, and developed a classification system and algorithm for endovenous heat-induced thrombus (EHIT), based on modifications of our prior algorithm of EHIT following great saphenous ablation. METHODS: Endovenous ablation was performed on symptomatic patients with incompetent SSVs following a minimum of 3 months of compression therapy...
August 2013: Journal of Vascular Surgery
John R Spurzem, Stephen A Geraci
Pulmonary embolus is a common reason for hospitalization and requires close follow-up and management in the office setting. The main issues facing the clinician include determination of the appropriate anticoagulation regimen, how long to anticoagulate, and whether an evaluation for hypercoagulable states is indicated. The decisions will depend on individual patient factors and assessment of the risks and benefits for that patient.
November 2010: American Journal of Medicine
Andrew Saxe, Scott Schwartz, Lori Gallardo, Eanas Yassa, Abd Alghanem
BACKGROUND: Successful obesity surgery often results months later in redundant abdominal skin and subcutaneous tissue. Following open obesity surgery, ventral hernias are also common, yet little has been written about the safety of combining panniculectomy with ventral hernia repair. We performed a retrospective analysis of a single plastic surgeon's experience with panniculectomy following gastric bypass surgery including both patients undergoing and those not undergoing simultaneous ventral hernia repair...
February 2008: Obesity Surgery
Peter F Lalor, Francis Sutter
The placement of hemodialysis catheters are widely performed by vascular surgeons and surgical residents for use in both the hospital and the outpatient setting. Although long-term complications of this type of vascular access are relatively uncommon, an appreciation is warranted for the life-threatening complication of right atrial thrombus (RAT). Once recognized, medical or surgical management is mandatory to prevent further consequences from RAT. The optimal treatment for catheter-induced RAT is still controversial...
May 2006: Current Surgery
Mustafa A Salih, Abdullah S Al-Jarallah, Abdel-Galil M Abdel-Gader, Ahmed A Al-Jarallah, Muslim M Al-Saadi, Amal Y Kentab, Ibrahim A Alorainy, Hamdy H Hassan
OBJECTIVE: To ascertain the role of cardiac diseases as a risk factor for stroke in a cohort of Saudi children who were evaluated in a retrospective and prospective study. METHODS: Children with cardiac diseases were identified from within a cohort of 104 Saudi children who presented with stroke. They were seen as inpatients in the Pediatric Wards or evaluated at the Outpatient Clinics of the Division of Pediatric Neurology (DPN), and the Division of Pediatric Cardiology at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia during the periods July 1992 to February 2001 (retrospective study) and February 2001 to March 2003 (prospective study)...
March 2006: Saudi Medical Journal
Geoffrey K Isbister, L Peter Hackett, Ian M Whyte
Warfarin toxicity is common and usually results from dose changes or drug interactions. There are few reported cases of intentional overdose. The management of warfarin overdose is usually complicated by the patient using warfarin therapeutically, often for a mechanical heart valve or pulmonary embolus prophylaxis. Untreated patients have a significant bleeding risk, but treatment carries a significant risk of complete reversal of anticoagulation and consequent risk of thrombosis. The objective of this study was to describe warfarin overdoses and complications of treatment and develop a safe approach to management...
December 2003: Therapeutic Drug Monitoring
M H Ellis, Y Manor, M Witz
STUDY OBJECTIVES: To determine the prevalence of endogenous and exogenous risk factors for venous thrombosis in patients with upper limb deep vein thrombosis (DVT), and to evaluate the risk of clinically detectable pulmonary embolus, recurrent DVT, and postphlebitic symptoms in these patients. DESIGN: A combined prospective and retrospective descriptive analysis of a cohort of patients with upper limb DVT compared with age- and sex-matched patients with lower limb DVT...
January 2000: Chest
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