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1.
J Hosp Med ; 9(1): 48-53, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24281984

ABSTRACT

Increasingly, there is a focus on the prevention of hospital-acquired conditions including venous thromboembolism. Many studies have evaluated pulmonary embolism and lower extremity deep vein thrombosis, but less is known about upper extremity deep vein thrombosis (UEDVT) in hospitalized patients. The objective of this study was to describe UEDVT incidence, associated risks, outcomes, and management in our institution. Using an information technology tool, we reviewed records of all symptomatic adult inpatients diagnosed with UEDVT at an academic tertiary center between September 2011 and November 2012. Fifty inpatients were diagnosed with 76 UEDVTs. Their mean age was 49 years; 70% were men. Sixteen percent had a history of venous thromboembolism; 20% had a history of malignancy. The mean length of stay (LOS) was 24.6 days (range, 2-91 days); 50% were transferred from outside hospitals. Thirty-eight percent of UEDVTs were in internal jugular veins, 21% in axillary veins, and 25% in brachial veins. Forty-four percent of patients had UEDVT associated with central venous catheters (CVCs). During hospitalization, 78% were fully anticoagulated; 75% of survivors at discharge. Only 38% were discharged to self-care; 10% died during hospitalization. Patients with UEDVT were more likely to have CVCs, malignancy, and severe infection. Many patients were transferred critically ill with prolonged LOS and high in-hospital mortality. Most UEDVTs were treated even in the absence of concurrent lower extremity deep vein thrombosis or pulmonary embolism. Additional research is needed to modify risks and optimize outcomes. Journal of Hospital Medicine 2014;9:48-53. © 2013 Society of Hospital Medicine.


Subject(s)
Hospitalization , Upper Extremity Deep Vein Thrombosis/diagnosis , Upper Extremity Deep Vein Thrombosis/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Disease Management , Female , Hospitalization/trends , Humans , Male , Middle Aged , Risk Factors , Young Adult
2.
Am J Med Qual ; 26(3): 174-80, 2011.
Article in English | MEDLINE | ID: mdl-21490270

ABSTRACT

This study's purpose was to describe compliance with established venous thromboembolism (VTE) prophylaxis guidelines in medical and surgical inpatients at US academic medical centers (AMCs). Data were collected for a 2007 University HealthSystem Consortium Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE) Benchmarking Project that explored VTE in AMCs. Prophylaxis was considered appropriate based on 2004 American College of Chest Physicians guidelines. A total of 33 AMCs from 30 states participated. In all, 48% of patients received guideline-directed prophylaxis-59% were medical and 41% were surgical patients. VTE history was more common among medical patients with guideline-directed prophylaxis. Surgical patients admitted from the emergency department and with higher illness severity were more likely to receive appropriate prophylaxis. Despite guidelines, VTE prophylaxis remains underutilized in these US AMCs, particularly among surgical patients. Because AMCs provide the majority of physician training and should reflect and set care standards, this appears to be an opportunity for practice and quality improvement and for education.


Subject(s)
Academic Medical Centers , Antibiotic Prophylaxis/standards , Guideline Adherence , Inpatients , Surgery Department, Hospital , Venous Thromboembolism/prevention & control , Benchmarking , Humans , Male , Medical Audit , Middle Aged , Retrospective Studies , United States
3.
J Hosp Med ; 6(3): 151-5, 2011 Mar.
Article in English | MEDLINE | ID: mdl-20635412

ABSTRACT

BACKGROUND: It is unknown whether venous thromboembolism prophylaxis (VTEP) should be utilized in hospitalized patients with end-stage liver disease (ESLD), particularly in those admitted with variceal bleeding. OBJECTIVE: We sought to describe a cohort of patients who received pharmacologic VTEP, specifically identifying the occurrence of rebleeding. DESIGN: Descriptive case series. SETTING/PATIENTS: All adult patients with ESLD admitted to an urban county teaching hospital over three years with variceal bleeding who received pharmacologic VTEP during hospitalization. RESULTS: A total of 22 patients with ESLD and variceal bleeding received pharmacologic VTEP. Only 1 patient rebled after initiation of VTEP; 2 patients were diagnosed with lower extremity deep venous thrombosis while on VTEP including the 1 patient who rebled. CONCLUSIONS: VTEP was associated with an unexpectedly low incidence of recurrent bleeding in patients with ESLD and variceal bleeding. Further study may be warranted.


Subject(s)
End Stage Liver Disease/drug therapy , Gastrointestinal Hemorrhage/drug therapy , Thrombolytic Therapy/methods , Venous Thromboembolism/prevention & control , Adult , Aged , Aged, 80 and over , Cohort Studies , End Stage Liver Disease/complications , Female , Gastrointestinal Hemorrhage/etiology , Humans , Infusions, Intravenous , Male , Middle Aged , Venous Thromboembolism/etiology
4.
Am J Infect Control ; 38(8): 657-9, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20416973

ABSTRACT

We set out to determine whether nasal swab isolates can identify methicillin-resistant Staphylococcus aureus (MRSA) colonization and guide therapy in skin and soft tissue infections (SSTI). Among hospitalized patients admitted to a general medicine service with SSTI, specificity and positive predictive value for MRSA in nasal swab isolates were 100%; sensitivity was 55%. Thus, positive nasal swab cultures may help identify MRSA colonization and guide antimicrobial therapy for SSTI when wound cultures cannot be obtained.


Subject(s)
Methicillin-Resistant Staphylococcus aureus/isolation & purification , Nasal Mucosa/microbiology , Soft Tissue Infections/microbiology , Staphylococcal Infections/microbiology , Staphylococcal Skin Infections/microbiology , Adult , Aged , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Humans , Methicillin Resistance , Middle Aged , Nasal Cavity/microbiology , Predictive Value of Tests , Risk Factors , Sensitivity and Specificity , Soft Tissue Infections/diagnosis , Staphylococcal Infections/diagnosis , Staphylococcal Skin Infections/diagnosis , Staphylococcus aureus/isolation & purification , Wounds and Injuries/microbiology , Young Adult
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