Universal venous thromboembolism policy is effective but may not adequately protect hospitalized cancer patients with larger BMI.

Routine VTE prophylaxis is recommended for hospitalized patients, but its effectiveness and safety in cancer patients is unclear. By observation, larger patients seemed poorly covered by the prophylaxis policy. The effectiveness and safety of VTE prophylaxis policy in the hospitalized patients, their potential risk factors such as BMI were examined. A retrospective chart review was conducted to determine VTE incidences, risk factors for VTE and major bleeding events between 2007 and 2016 on the solid tumor units (STU). Patients were divided into pre-policy (Pre-2012) or post-policy implementation groups (Post-2012). Descriptive statistics were used to evaluate effectiveness and safety of prophylaxis, while propensity score matching (1:3, VTE:Non-VTE) was used to reduce selection bias. The VTE incidence per patient was 1.30% (57/4392) pre-policy and 0.56% (18/3210) post-policy (p value = 0.0013). After propensity score matching, a reduction (32.3%) of VTE cases was observed after policy implementation (OR = 0.677, p = 0.32). BMI was found to be a significant predictor of VTE (OR = 1.094, 95% CI 1.021-1.172, p = 0.011). Between July 2014 and July 2016, 1.7% (19/1091) patients who received anticoagulants had a documented bleeding event. The policy positively impacted VTE events on the STU. A significant predictor of VTE was BMI and patients with high BMI may pose a risk of breaking through standard VTE prophylaxis dosing. There was no reported major bleeding for patients who developed an VTE event despite receiving prophylaxis in either the pre-policy or post-policy phase of the study, although a low incidence of minor bleeding was documented in the post-phase.

Sources of drug information in neonatal guidelines of low- and middle-income countries.

OBJECTIVE: Identify drug information (DI) resources used in neonatal practice guidelines in low- and middle-income countries. METHODS: Individuals with knowledge of national neonatal guideline development completed a descriptive, cross-sectional survey. KEY FINDINGS: Eighty-five per cent (33/39) of respondents fully completed the survey. Physicians from university hospitals in Africa were primary respondents. Forty-five per cent (15/33) used a single national neonatal guideline. Primary neonatal resources for drug dosing and preparation were as follows: (1) World Health Organization Pocketbook of Hospital Care for Children, (2) Pediatric & Neonatal Dosage Handbook and (3) National Institute for Health and Care Excellence for Infants and Neonatal pathways. CONCLUSION: Low- and middle-income countries with single national neonatal guidelines cite a finite range of DI resources.

Motivations, barriers and ethical understandings of healthcare student volunteers on a medical service trip: a mixed methods study.

BACKGROUND: The motivation to volunteer on a medical service trip (MST) may involve more than a simple desire for philanthropy. Some volunteers may be motivated by an intrinsic interest in volunteering in which the context of the volunteer activity is less important. Others may volunteer because the context of their volunteering is more important than their intrinsic interest in volunteering. Furthermore, MSTs may pose a variety of ethical problems that volunteers should consider prior to engaging in a trip. This study evaluated the motivations and barriers for graduate health care students volunteering for an MST to either the Dominican Republic or Mississippi. Volunteers' understanding of some of the ethical issues associated with MSTs was also assessed. METHODS: Thirty-five graduate health professions students who volunteered on an MST were asked to complete an online survey. Students' motivations and barriers for volunteering were assessed using a 5-point Likert scale and Fisher's exact test. Ethical understanding of issues in volunteering was assessed using thematic analysis. RESULTS: Students' motivations for volunteering appeared to be related to the medical context of their service more than an inherent desire for volunteer work. Significant differences were seen in motivations and barriers for some student groups, especially those whose volunteer work had less opportunity for clinical service. Thematic analysis revealed two major themes and suggested that students had an empirical understanding that volunteer work could have both positive and negative effects. CONCLUSIONS: An understanding of students' motivations for volunteering on an MST may allow faculty to design trips with activities that effectively address student motivations. Although students had a basic understanding of some of the ethical issues involved, they had not considered the impact of a service group on the in-country partners they work with.