The effect of exercise on D-dimer levels.

OBJECTIVE: Many health care providers encounter patients with complaints of calf pain, swelling, chest pain, shortness of breath, and syncope after intense exercise. Unfortunately, these symptoms alone or in constellation could represent an underlying venous thromboembolism. A negative D-dimer can often exclude moderate-risk patients. We examined the change in D-dimer levels following strenuous exercise. METHODS: In a prospective study of 42 sailors, D-dimer levels were drawn before and after a workout that simulated the standardized Navy Physical Readiness Test. Data were analyzed using the Kruskal-Wallis and Kolmogorov-Smirnov tests. RESULTS: No significant change was found between pre- and postexercise levels. CONCLUSION: Findings indicate that neither level of conditioning, nor short, intense exercise affected D-dimer levels in participants who were considered extremely at low risk for thromboembolic disease. In essence, this allowed us to test the test, and therefore adds to our understanding of a screening tool used in the pursuit of a disease with significant consequence.

Improving medication safety and patient care in the emergency department.

INTRODUCTION: Medication errors are well documented in medical literature and the lay press. Through participation in a nationwide institute for healthcare improvement initiative, our emergency department performance improvement group focused on human and system factors that contributed to potential medication errors. METHODS: A survey conducted of ED staff examined barriers to reporting medication errors and potential "near misses." members of the emergency department performance improvement group examined contents of the ed Pyxis machines, assessing medications that physically resembled one another, similar sounding medications located in close proximity, and medications available in differing doses. RESULTS: Fifty-eight members participated in a 4-question survey. Half reported they would be likely to self-report a "near miss" if the patient was not harmed. About half would report the medication error of a colleague under certain circumstances. Fifty-one percent believed there would be repercussions for reporting medication error, but most believed they would receive support from supervisors for addressing other safety problems. Nearly one quarter of the 278 medications identified in the Pyxis survey were similar in appearance or name or existed in multidose formulations. DISCUSSION: Measures to decrease the potential of medication errors include: (1) a workplace environment that promotes reporting of medication errors or "close calls" by staff, with counseling events utilized as learning opportunities versus punitive incidents; (2) increased frequency of medication safety in-service sessions; and (3) periodic monitoring of Pyxis machine inventories to survey contents for optimum patient safety.