Venous thromboembolism risk assessment and prophylaxis in hospitalised medical patients in the Cape Town metropole, South Africa

Background. Venous thromboembolism (VTE) is regarded as the most preventable cause of inpatient death in hospital settings globally. VTE can be prevented through the provision of non-pharmacological and/or pharmacological thromboprophylaxis following individualised risk screening. The Caprini risk assessment model (RAM) offers a validated and well-established approach for VTE risk assessment in medical inpatients. Literature findings describe a trend towards inappropriate and under-prescribing of thromboprophylaxis in this population. Together with concerns regarding clinicians' perceived importance of VTE risk assessment, the need to clarify these aspects of practice is evident. Objectives. To describe VTE risk assessment and prophylaxis practices of medical practitioners in public sector hospitals in Western Cape Province, South Africa (SA). Methods. A retrospective, cross-sectional study design was employed in the medical wards of two district hospitals and one regional hospital in the Cape Town metropole, Western Cape. Medical folders of adult medical inpatients admitted between January and July 2020 were reviewed to assess VTE risk using the Caprini RAM. Thromboprophylaxis therapy prescribed and contraindications to chemoprophylaxis were also evaluated. Results. Of 380 patients included in the review, 51.6% were female, and the average age was 52.1 years (range 18 - 96); 21.3% had their weight recorded, while none had their height documented. Infectious disease was the predominant diagnosis (49.2%) detected in the sample. Common VTE risk factors identified included bed rest/restricted mobility for <72 hours (76.3%) and serious infection (67.4%). A total of 97.1% of patients (n=369) were found to be at moderate or higher risk of VTE (Caprini score ≥2). Of this at-risk group, 24.1% were eligible to receive chemoprophylaxis, yet no prescription for thromboprophylaxis was identified. Seventy percent of patients (n=266) were prescribed chemoprophylaxis, with enoxaparin accounting for 98.5% of regimens. Contraindications to chemoprophylaxis were recorded in 13.4% of patients. Conclusions. Although rates of VTE prophylaxis in medical inpatients may be improving, thromboprophylaxis still remains critically underutilised in this population. This study highlighted a consequence of this trend, with inappropriate chemoprophylaxis prescribing becoming more evident. Mechanical prophylaxis prescribing in medical inpatients is lacking, despite the associated benefits. RAMs should be adapted for the SA setting, where infectious diseases are prevalent. Future research should assess RAM use by clinicians, as this could provide insight into improving RAM uptake and thromboprophylaxis prescribing.

Steps walked whilst at work, by University of the Free State medical registrars: an exploratory study

Background: Doctors may have physical disabilities affecting their mobility. If they wish to specialise, they need information regarding mobility requirements for various specialities to help them select an appropriate speciality. No research has been published on the differences in physical activity demands in different medical specialities. Objective: The aim of this study was to compare the physical activity of medical registrars from six specialist departments at a South African academic hospital. The inference was that those specialities where registrars walked the most would be more challenging for those with physical disabilities, thereby limiting mobility. Methods: The number of steps walked from 07:00 to 16:00 each day was measured, using Yamax CW-701 pedometers. Kruskall-Wallis tests were used to compare the steps taken in different specialities with the level of significance set at 0.05. Results: Twenty registrars participated in the study. Significant differences in the number of steps walked per day were observed between those from different specialities (p < 0.001). Surgery, paediatric and internal medicine registrars walked the most steps per day (median of 5 991, and 5 880, 5 489, respectively). Anaesthesiology and radiology registrars walked a median of 4 521 and 3 926 steps, respectively. Registrars in obstetrics and gynaecology walked the least steps (median of 1 918). There was considerable variation in steps between participants within a department, and for the same participants on different days. Conclusion: Registrars appeared to be more physically active in some medical specialities than others, in terms of mobility. The wide intra-speciality variation is probably related to differing daily duties. Future studies should include types of work duties (e.g. sedentary vs high physical mobility), cover more specialities, and include more participants.