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James C Iannuzzi, Christopher T Aquina, Aaron S Rickles, Bradley J Hensley, Christian P Probst, Katia Noyes, John R T Monson, Fergal J Fleming
BACKGROUND: Current guidelines recommend extended-duration thromboprophylaxis for all abdominal oncologic resections. However, other high-risk patients may benefit from extended thromboprophylaxis. OBJECTIVE: The purpose of this study was to identify risk factors for postdischarge venothromboembolism after colorectal procedures. DESIGN: This was a retrospective cohort study. DATA SOURCES: The New York Statewide Planning and Research Cooperative System database (2005-2013) was the data source for this study...
March 2016: Diseases of the Colon and Rectum
Philip D Hewes, Krista J Hachey, Xue Wei Zhang, Yorghos Tripodis, Pamela Rosenkranz, Michael I Ebright, David McAneny, Hiran C Fernando, Virginia R Litle
BACKGROUND: Patients undergoing esophagectomy for cancer are in the highest-risk group for venous thromboembolism, with a 7.3% incidence reported by the National Surgical Quality Improvement Program. Venothromboembolism (VTE) doubles esophagectomy mortality. The Caprini risk assessment model (RAM) is a method to stratify postoperative thromboembolism risk for consideration of prolonged preventive anticoagulation in higher-risk patients. Our aim was to examine the potential use of this model for reducing the VTE incidence in esophagectomy patients...
December 2015: Annals of Thoracic Surgery
B Alexander Knight, Aaron M Potretzke, Jeffrey A Larson, Sam B Bhayani
INTRODUCTION: Expert-reported outcomes and complications may not reflect the standardized coding that can be provided by independent, third-party evaluations. The goal of this article is to compare expert-reported complications with standardized coding by the National Surgical Quality Improvement Program (NSQIP). The procedures evaluated were laparoscopic radical nephrectomy (LRN), robot-assisted radical prostatectomy (RARP), and radical cystectomy (RC). METHODS: The 10 largest LRN, RARP, and RC series were reviewed for reported complications...
September 2015: Journal of Endourology
Christopher M Duncan, Blake P Gillette, Adam K Jacob, Rafael J Sierra, Joaquin Sanchez-Sotelo, Hugh M Smith
TKA and THA are associated with blood transfusion and risk for postoperative venothromboembolism (VTE). Reports show that tranexamic acid (TA) may be safe to use in high-risk orthopedic patients, but further data are needed to substantiate its use. All patients who underwent primary or revision TKA or THA in a five year period were retrospectively identified. In 13,262 elective TKA or THA procedures, neither the odds of VTE (OR=0.98; 95% CI 0.67-1.45; P=0.939) or adjusted odds of death (OR=0.26; 95% CI 0.04-1...
February 2015: Journal of Arthroplasty
Lucas G Leonhard, Richard L Berg, James K Burmester, Joseph J Mazza, John R Schmelzer, Steven H Yale
BACKGROUND: Warfarin is an oral anticoagulant used in the long-term treatment/prevention of venothromboembolic disease. Patients undergoing elective surgical and non-surgical procedures may require temporary warfarin discontinuation followed by reinitiation after their procedure. Because little information is available regarding best methods for warfarin reinitiation, we investigated current practices to inform management decisions. METHODS: Subjects were required to have a known and stable warfarin dose prior to discontinuation, which was operationalized by requiring, within 7-days prior to discontinuation, that they have at least one INR in therapeutic range (2...
March 2015: Clinical Medicine & Research
Francisco J Villegas
BACKGROUND: Lipoabdominoplasty can be associated with complications, particularly tissue necrosis, wound dehiscence, epigastric bulging, high transverse scar, low positioning of the umbilicus, and seroma. METHODS: Modified abdominoplasty characterized by (1) transverse elliptical plication of the lower abdominal wall, (2) no undermining of the flap above the navel, (3) unrestricted liposuction, (4) umbilical amputation and neoumbilicoplasty by skin graft, and (5) low transversely placed abdominal scar (TULUA) was performed for 42 patients...
June 2014: Aesthetic Plastic Surgery
Mary Beth Flynn Makic, Carol Rauen, Robin Watson, Ann Will Poteet
Nurses are the largest segment of the nation's health care workforce, which makes nurses vital to the translation of evidence-based practice as a practice norm. Critical care nurses are in a position to critically appraise and apply best evidence in daily practice to improve patients' outcomes. It is important for critical care nurses to continually evaluate their current practice to ensure that they are applying the current best evidence rather than practicing on the basis of tradition. This article is based on a presentation at the 2013 National Teaching Institute of the American Association of Critical-Care Nurses...
April 2014: Critical Care Nurse
Siwan Seaman, Annmarie Nelson, Simon Noble
BACKGROUND: The treatment of cancer-associated thrombosis (CAT) is well established as a daily injection of weight-adjusted low-molecular-weight heparin (LMWH). Previous qualitative research suggesting LMWH to be acceptable in the palliative care population had several recognised limitations including selection bias and limited time on LMWH treatment. AIMS: To revaluate acceptability of LMWH as a long-term treatment for patients with advanced cancer and venothromboembolic disease within the context of current clinical practice...
March 2014: BMJ Supportive & Palliative Care
James C Iannuzzi, Ankur Chandra, Kristin N Kelly, Aaron S Rickles, John R T Monson, Fergal J Fleming
OBJECTIVE: Vascular surgery patients have high readmission rates, and identification of high-risk groups that may be amenable to targeted interventions is an important strategy for readmission prevention. This study aimed to determine predictors of unplanned readmission and develop a risk score for predicting readmissions after vascular surgery. METHODS: The National Surgical Quality Improvement Program database for 2011 was queried for major vascular surgical procedures...
May 2014: Journal of Vascular Surgery
James C Iannuzzi, Aaron S Rickles, Kristin N Kelly, Fergal J Fleming, James G Dolan, John R T Monson, Katia Noyes
PURPOSE: Extended-duration thromboprophylaxis (EDTPPX) is the practice of prescribing antithrombotic therapy for 21 days after discharge, commonly used in surgical patients who are at high risk for venothromboembolism (VTE). While guidelines recommend EDTPPX, criteria are vague due to a paucity of data. The criteria can be further informed by cost-effectiveness thresholds. This study sought to determine the VTE incidence threshold for the cost-effectiveness of EDTPPX compared to inpatient prophylaxis...
January 2014: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Victoria P Tan, Alvin Chung, Bryan P Yan, Peter R Gibson
Awareness is increasing that risk of venous thromboembolism and development of atherosclerosis is elevated in patients with some chronic inflammatory diseases. This review aimed to examine the risk of vascular disease in patients with inflammatory bowel disease (IBD) and to identify potential pathogenic mechanisms and therapeutic approaches. An extensive literature search was conducted using MEDLINE database, Cochrane Library and international conference abstracts for studies pertaining to venous and arterial thromboembolism in adult IBD patients...
July 2013: Journal of Gastroenterology and Hepatology
Ingrid Glurich, Po-Huang Chyou, Jessica M Engel, Deanna S Cross, Adedayo A Onitilo
OBJECTIVE: A pilot study to examine accrual rates, efficiency of data capture approaches, study design and genotyping capacity for a future genetic validation study was undertaken. DESIGN: The process pilot evaluated feasibility of applying a matched case-control design to validate association of two candidate estrogen receptor (ER) single nucleotide polymorphisms (SNPs) with incidence of venothromboembolic events (VTE) in breast cancer patients treated with tamoxifen where criteria included frequency matching by age, number of years diagnosed with breast cancer within 4-year intervals, and geographic residency...
February 2013: Clinical Medicine & Research
Kaisorn L Chaichana, Courtney Pendleton, Christopher Jackson, Juan Carlos Martinez-Gutierrez, Andrea Diaz-Stransky, Javier Aguayo, Alessandro Olivi, Jon Weingart, Gary Gallia, Michael Lim, Henry Brem, Alfredo Quinones-Hinojosa
OBJECTIVE: The development of venothromboembolisms (VTEs), including deep vein thrombosis (DVT) and pulmonary emboli (PE), is common in brain tumor patients. Their development can be catastrophic. Studies evaluating pre-operative clinical factors that predispose patients to the development of VTE are few and limited. An understanding may help risk stratify patients and guide subsequent therapy aimed at reducing the risk of DVTs/PEs. METHODS: All adult patients who underwent surgery for an intracranial tumor at an academic tertiary care institution between 1998 and 2008 were retrospectively reviewed...
March 2013: Neurological Research
Emily Kawaler, Alexander Cobian, Peggy Peissig, Deanna Cross, Steve Yale, Mark Craven
We consider the task of predicting which patients are most at risk for post-hospitalization venothromboembolism (VTE) using information automatically elicited from an EHR. Given a set of cases and controls, we use machine-learning methods to induce models for making these predictions. Our empirical evaluation of this approach offers a number of interesting and important conclusions. We identify several risk factors for VTE that were not previously recognized. We show that machine-learning methods are able to induce models that identify high-risk patients with accuracy that exceeds previously developed scoring models for VTE...
2012: AMIA ... Annual Symposium Proceedings
G Radhakrishna, D Berridge
The relationship between cancer and venothromboembolic events is a complex, multifactorial process which is still not fully understood and therefore the use of current generic guidelines may be inadequate. Current management of cancer-related VTE may be suboptimal because of the lack of cancer-specific studies into the role of primary prophylaxis in both ambulant and non-ambulant cancer patients. Further research into developing cancer-specific risk assessment tools and the choice, dose and duration of prophylaxis is required...
2012: Phlebology
Robert J Stachler, Kathleen Yaremchuk, Jennifer Ritz
OBJECTIVE: To utilize National Surgical Quality Improvement Program (NSQIP) data to evaluate patient outcomes in otolaryngology-head and neck surgery. STUDY DESIGN: Retrospective medical chart abstraction of patients undergoing major surgical procedures in the inpatient and outpatient setting. SETTING: Academic/teaching hospitals with more than 500 beds. SUBJECTS AND METHODS: The American College of Surgeons NSQIP collects data on 135 variables including preoperative risk factors, intraoperative variables, and 30-day-postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures in the inpatient and outpatient setting...
July 2010: Otolaryngology—Head and Neck Surgery
Chip Gresham, Michael Levine, Anne-Michelle Ruha
A 50-year-old man presented to the emergency department (ED) following an overdose of his "blood thinners." The patient had become increasingly depressed over financial concerns, prompting a suicide attempt. He declined to provide any details regarding his current medications or his past medical history. A review of the computerized medical record, however, revealed he had a Factor V Leiden mutation with multiple venothromboembolic events. He previously had an inferior vena cava filter placed, and had received tissue plasminogen activator (tPA) for a cerebrovascular accident...
December 2009: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
J Matthew Fields, Munish Goyal
This article focuses on the clinical presentation, diagnosis, and management of veno-thromboembolism, including deep venous thrombosis (DVT) and pulmonary embolism (PE), from the perspective of the emergency physician. The discussion is divided into two sections: DVT and PE. Because veno-thromboembolism is a continuum, certain aspects, such as background, incidence, the use of D dimer, and anticoagulation of both DVT and PE, are discussed together. Heavier emphasis is placed on topics germane to the emergency physician, and considerations for special populations are reviewed...
August 2008: Emergency Medicine Clinics of North America
C Dewar, C Selby, K Jamieson, S Rogers
OBJECTIVES: To investigate the clinical validity of a nurse practitioner emergency department-based service for investigating outpatients with suspected deep vein thrombosis. METHODS: A prospective management study was undertaken to investigate the safety of withholding anticoagulant treatment in patients who were negative for testing after application of an evidence-based protocol. The protocol involved a nurse assessment using the Wells pretest score followed by investigations tailored to the risk category (variable combinations of strain gauge plethysmography, D-dimer and ultrasound)...
July 2008: Emergency Medicine Journal: EMJ
Mary Kate FitzPatrick, Patrick Reilly, S William Stavropoulos
Prevention of venothromboembolic complications remains a challenge in trauma care. Guidelines for prophylaxis published by the Eastern Association for the Surgery of Trauma stratify patients by risk and recommend therapies based on scientific evidence. New innovations such as retrievable inferior vena cava filters are being used by trauma surgeons for patients at risk for pulmonary embolism but in whom anticoagulation is contraindicated. Some available devices offer a limited timeframe for retrieval beyond which the device becomes permanent...
April 2006: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
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