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Nqoba Tsabedze, Ahmed Vachiat, Don Zachariah, Pravin Manga
The human immunodeficiency virus epidemic is a major health challenge of the twenty-first century as the transition from infectious complications to noncommunicable disease becomes more evident. These patients may present to the emergency department with a variety of cardiovascular diseases, such as acute coronary syndromes, heart failure, pericardial disease, infective endocarditis, venothromboembolism, and other conditions. Increased awareness is needed among health care professionals to enhance adequate identification and promote prompt management of these patients...
February 2018: Cardiology Clinics
Efstathios Karamanos, Sophie Dream, Anthony Falvo, Nathan Schmoekel, Aamir Siddiqui
CONTEXT: Use of epidural analgesia in patients undergoing elective abdominal wall reconstruction is common. OBJECTIVE: To assess the impact of epidural analgesia in patients undergoing abdominal wall reconstruction. DESIGN: All patients who underwent elective ventral hernia repair from 2005 to 2014 were retrospectively identified. Patients were divided into two groups by the postoperative use of epidural analgesics as an adjunct analgesic method...
2017: Permanente Journal
Jessica H Heyer, Xiangyu Kuang, Richard L Amdur, Rajeev Pandarinath
OBJECTIVES: Shoulder arthroscopy has increased in frequency over the past decade, with rotator cuff repair comprising the majority of cases performed. Prior studies have detailed risk factors for 30-day complications and readmission rates after arthroscopic shoulder surgery using the National Surgical Quality Improvement Program (NSQIP) database, but no study has specifically looked at arthroscopic rotator cuff repair. The purpose of the study is to evaluate the risk factors for 30-day complications following arthroscopic rotator cuff repair using the NSQIP database...
February 2018: Physician and Sportsmedicine
Mahek Shah, Talal Alnabelsi, Shantanu Patil, Shilpa Reddy, Brijesh Patel, Marvin Lu, Aditya Chandorkar, Apostholos Perelas, Shilpkumar Arora, Nilay Patel, Larry Jacobs, Glenn G Eiger
Inferior vena cava filter (IVCF) placement appears to be expanding over time despite absence of clear directing evidence.Two populations were studied. The first population included patients who received an IVCF between January 2005 and August 2013 at our community hospital center. Demographic information, indications for placement, and retrieval rate was recorded among other variables. The second population comprised of patients receiving an IVCF from 2005 to 2012 according to the Nationwide Inpatient Sample (NIS) using ICD-9CM coding...
March 2017: Medicine (Baltimore)
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
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