[Prevention of venous thromboembolism: generally accepted guidelines]. / Prevence zilní tromboembolické nemoci: obecne platná pravidla.

This article summarizes the published data on the prevention of venous thromboembolism. Routine thromboprophylaxis is the best way to lower the risk. It is recommended to sort patients according the thrombosis risk and to make use of the standard prophylactic modes. In low risk patients, no specific thromboprophylaxis is needed. Patients with moderate risk levels are candidates for administration of subcutaneous low molecular weight heparin (LMWH) at doses under 3 400 anti-Xa units a day and patients with increased risk at doses higher than 3400 anti-Xa units a day during the period of higher risk. In order to decrease the risk of bleeding, a half dose 2 hours prior or 4-6 hours after the operation can be administered. Under the highest risk conditions, there is a recommendation to combine LMWH over 3 400 anti-Xa units with elastic panty-hose or, alternatively, with intermittent pneumatic compression. At moderate risk levels, subcutaneous administration of unfractionated heparin at the doses of 5 000 units twice a day is also possible and at increased risk levels, a TID administration over the increased risk period. In patients with a significant bleeding risk, the physical method of thromboprophylaxis can be used and pharmacological prophylaxis can set in after the risk of bleeding has passed. Fondaparinux is the alternative to LMWH in people after major orthopaedic surgeries and with a history of heparin induced thrombocytopenia over the past three months. An alternative to the administration of LMWH even after the end of the hospitalization can be warfarin in certain situations. The sole use of acetylsalicylic acid or Rheodextran is not recommended. While undertaking epidural anaesthesia or analgesia, it is necessary to follow strictly the guidelines of the use of pharmacological thromboprophylaxis.

[Prevention of venous thromboembolism in surgery, in laparoscopic surgery, in venous surgery and in urology]. / Prevence zilní tromboembolické nemoci v chirurgii, v laparoskopické chirurgii, v cévní chirurgii a v urologii.

The article summarizes published data regarding the prophylaxis of venous thromboembolism in surgery, in laparoscopic surgery, in venous surgery and in urology. In surgical patients with low risk, no specific thromboprophylaxis is needed. Patients with moderate risk levels are the candidates for administration of subcutaneous low molecular weight heparin (LMWH) at doses under 3 400 anti-Xa units a day and patients with increased risk at doses higher than 3 400 anti-Xa units a day during the period of higher risk. In order to decrease the risk of bleeding, a half dose 2 hours prior or 4-6 hours after the operation can be administered. Under the highest risk conditions, there is a recommendation to combine LMWH over 3 400 anti-Xa units with elastic panty-hose or, alternatively, with intermittent pneumatic compression (IPC). At moderate risk levels, subcutaneous administration of unfractionated heparin at the doses of 5 000 units twice a day is also possible and at increased risk levels, a TID administration (LDUH) over the increased risk period. In patients with a significant bleeding risk, the physical method of thromboprophylaxis can be used and pharmacological prophylaxis can set in after the risk of bleeding has passed. Fondaparinux is the alternative to LMWH in people with a history of heparin induced thrombocytopenia over the past three months. The sole use of acetylsalycilic acid is not recommended. While undertaking epidural anaesthesia or analgesia, it is necessary to follow strictly the guidelines of the use of pharmacological thromboprophylaxis. Thromboprophylaxis with LMWH, LDUH, elastic panty-hose or IPC is indicated only in those patients who undergo laparoscopic surgeries and who moreover display the additional thrombosis factors. Patients with additional risk thrombosis factors undergoing major venous reconstructions require prophylaxis with LMWH (or LDUH). Uncomplicated patients undergoing transurethral or other low risk urologic surgery require no specific thromboprophylaxis. If they undergo a major intervention and/or they display additional risk thrombosis factors, they require the administration of LMWH or LDUH. Elastic panty-hose and/or intermittent pneumatic compression have the same indication as in abdominal surgeries.

Allocating petroleum products during oil supply disruptions.

Four options for allocating a long-term, severe shortfall of petroleum imports are analyzed: oil price and allocation controls, coupon gasoline rationing, variable gasoline tax and rebate, and no oil price controls with partial rebates. Each of these options is evaluated in terms of four criteria: microeconomic effects, macroeconomic effects, equity, and practical problems. The implications of this analysis for energy contingency planning are discussed.

Economic feasibility of solar water and space heating.

The economic feasibility in 1977 and 1978 of solar water and combined water and space heating is analyzed for single-family detached residences and multi-family apartment buildings in four representative U.S. cities: Boston, Massachusetts; Washington, D.C.; Grand Junction, Colorado; and Los Angeles, California. Three economic decision criteria are utilized: payback period, years to recovery of down payment, and years to net positive cash flow. The cost competitiveness of the solar systems compared to heating systems based on electricity, fuel oil, and natural gas is then discussed for each city, and the impact of the federal tax credit for solar energy systems is assessed. It is found that even without federal incentives some solar water and space heating systems are competitive. Enactment of the solar tax credit, however, greatly enhances their competitiveness. The implications of these findings for government tax and energy pricing policies are discussed.

Energy, manpower, and the highway trust fund.

If energy conservation were a goal of a federal budget policy maker, such conservation could be achieved by reinvesting the highway trust fund in any of several other alternative federal programs (except criminal justice), especially in railroad and mass transit construction and national health insurance (see Table 1). Total employment would increase in each alternative program examined. For example, if construction monies were shifted from highways to railroads, the energy required for construction would be reduced by about 62 percent and employment would increase by 3.2 percent. By comparing the dollar, energy, and employment requirements of a highway transportation system with such requirements for a railroad transportation system, we obtained detailed information from which we concluded the following: 1) Passenger transport by railroad was much less dollar and energy demanding and required more labor than car transport in 1963. If the dollar savings had been respent in an average way by consumers, the net impact would have been to reduce the energy savings and further increase employment. A similar conclusion was reached in a study of bus substitution for automobiles in urban areas (20). If the marginal substitution effects would have held over the whole range of change, and the dollar savings had been spent on the construction of railways, then about 3.0 billion gallons of gasoline could have been saved annually and 1.2 million new jobs created. 2) Freight transport by railroad was less expensive, in terms of dollar, energy, and labor requirements, than was truck transportation in 1963. If, under a national shift to rail freight, the dollar savings had been absorbed as personal consumption expenditures, a net increase of labor and energy would have ensued. If the dollar savings had been absorbed as a tax and respent on railroad and mass transit construction, about 0.3 billion more gallons of gasoline (energy equivalent) would have been consumed annually and 1.2 million jobs created, under a complete shift to rail. Had there been a full shift from intercity car and truck transportation to transportation by railroad with dollar savings spent on railway construction, 2.7 billion gallons of gasoline (energy equivalent) could have been saved and 2.4 million new jobs could have been created in 1963.