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Harper AE, Chen YT, Tancer S, Rodgers KR, Crumb AD, Townsend WA, Knight JS, Murphy SL. Non-pharmacological rehabilitation interventions for individuals with antiphospholipid syndrome: A scoping review. Lupus 2024; 33:101-110. [PMID: 38113856 PMCID: PMC11003253 DOI: 10.1177/09612033231223336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The objective of this study was to explore what non-pharmacological interventions have been examined for individuals with antiphospholipid syndrome (APS). METHODS We conducted a systematic literature search of the databases PubMed, Embase, Scopus, Web of Science, CINAHL, and ClinicalTrials.gov from 1983-Feb. 2023. Our scoping review included studies that examined non-pharmacological interventions for individuals with APS using patient-reported outcome measures. We excluded studies that reported physiological outcomes only. RESULTS The review yielded one case study on the safety and efficacy of an exercise program for a 15-year-old male with secondary APS using physiological and patient-reported outcome measures. Despite the lack of evidence of non-pharmacological interventions for individuals with APS, one excluded study reported that individuals with APS want guidance about physical activity and exercise. We also found several types of potentially relevant non-pharmacological interventions for individuals with lupus, a disease that often co-occurs with APS. CONCLUSIONS Non-pharmacological interventions may offer a solution for addressing some non-thrombotic or non-obstetric APS symptoms, such as neurological, physical, and cognitive symptoms that are not well-controlled by anticoagulation. Due to the unique risks associated with APS, research is needed to determine the safety and efficacy of non-pharmacological interventions, particularly those involving exercise. Adopting a comprehensive, multidisciplinary approach to managing patients with APS and involving rehabilitation professionals, who are experts in the design and delivery of non-pharmacological interventions, may provide a foundation for developing and testing novel interventions that improve health outcomes while also fulfilling unmet needs reported by patients.
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Affiliation(s)
- Alexandra E. Harper
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Antiphospholipid Syndrome Program, Ann Arbor, MI, USA
| | - Yen T. Chen
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie Tancer
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kyla R. Rodgers
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amber D. Crumb
- University of Michigan Antiphospholipid Syndrome Program, Ann Arbor, MI, USA
| | | | - Jason S. Knight
- University of Michigan Antiphospholipid Syndrome Program, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Susan L. Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Antiphospholipid Syndrome Program, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Oki K, Nakajima M, Koyama T, Oyama N, Koga M, Hayase M, Ohta T, Omori T, Matsumoto K, Iguchi Y, Fujimoto S, Kakuda W, Ogasawara K. Timing of Initiation of Acute Stroke Rehabilitation and Management Corresponding to Complications at Primary Stroke Centers in Japan: A Nationwide Cross-Sectional Web-Based Questionnaire Survey. Cerebrovasc Dis 2023; 53:125-135. [PMID: 37399792 DOI: 10.1159/000530873] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/22/2023] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION Many guidelines now recommend early rehabilitation for acute stroke patients. However, evidence remains lacking regarding the specific timings for initiation of various rehabilitation steps and management when complications are encountered in acute stroke rehabilitation. This survey aimed to investigate actual clinical situations in acute stroke rehabilitation in Japan and to improve the medical systems for rehabilitation and plan further studies. METHODS This nationwide, cross-sectional, web-based questionnaire survey was administered between February 7, 2022, and April 21, 2022, targeting all primary stroke centers (PSCs) in Japan. Among several components of the survey, this paper focused on the timing of the initiation of three rehabilitation steps (passive bed exercise; head elevation; and out-of-bed mobilization), along with the management of rehabilitation (continued or suspended) in the event of complications during acute stroke rehabilitation. We also investigated the influence of facility features on these contents. RESULTS Responses were obtained from 639 of the 959 PSCs surveyed (response rate: 66.6%). In cases of ischemic stroke and intracerebral hemorrhage, most PSCs initiated passive bed exercise on day 1, head elevation on day 1, and out-of-bed mobilization on day 2 (with day of admission defined as day 1). In cases with subarachnoid hemorrhage, rehabilitation steps were delayed compared to other stroke subtypes or showed wide variation depending on the facility. Passive bed exercise was accelerated by the presence of protocols for rehabilitation and weekend rehabilitation. Out-of-bed mobilization was accelerated by the presence of a stroke care unit. Facilities with board-certified rehabilitation doctors were cautious regarding the initiation of head elevation. Most PSCs suspended rehabilitation training in the event of symptomatic systemic/neurological complications. CONCLUSION Our survey revealed the actual situation of acute stroke rehabilitation in Japan and indicated that some facility features appear to influence early increases in physical activity levels and early mobilization. Our survey provides fundamental data to improve the medical systems for acute stroke rehabilitation in the future.
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Affiliation(s)
- Koichi Oki
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Naoki Oyama
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Makoto Hayase
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomohiro Omori
- Division of Rehabilitation Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Koichi Matsumoto
- Division of Rehabilitation Medicine, General Tokyo Hospital, Tokyo, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
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Dashner A, Siders, PharmD E. A Retrospective Analysis of q12hr and q8hr Heparin for DVT/PE Prophylaxis in an Inpatient Rehabilitation Setting. J Pharm Technol 2022; 38:202-205. [PMID: 35832571 PMCID: PMC9272488 DOI: 10.1177/87551225221094171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: There is little clinical evidence comparing the safety and efficacy of prophylactic subcutaneous heparin given every 8 hours and every 12 hours. We performed a retrospective analysis incorporating these dosing intervals in an inpatient rehabilitation setting. Methods: Heparin usage data was collected and patient charts were analyzed for both therapeutic failure and bleeding events. A 2-tailed Fisher’s exact test was performed for both outcomes, with a P-value of less than 0.05 being considered significant. Odds ratios were also calculated with P-values less than 0.05 being considered significant. Study Population: A Cerner report was run to identify patients ordered prophylactic heparin in an inpatient rehabilitation setting from April 7, 2020, to October 27, 2021. One hundred patients receiving heparin every 8 hours and every 12 hours were randomly selected for chart review. These study groups were further stratified by Padua risk scores. Results: In both groups, 4 (4.0%) patients were identified as having a documented bleeding event and 2 (2.0%) patients from each group were identified as having a therapy failure. Conclusion: For both endpoints, no significant differences in bleeding rates or therapy failure rates were detected in any of the population stratifications.
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Affiliation(s)
- Adam Dashner
- Encompass Health Rehabilitation Hospital of Harmarville, Pittsburgh, PA, USA
| | - Erin Siders, PharmD
- Encompass Health Rehabilitation Hospital of Harmarville, Pittsburgh, PA, USA
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Kirshblum SC, DeLauter G, Eren F, Pomeranz B, DeLuca R, Hammerman S, Gans BM. Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital. Am J Phys Med Rehabil 2021; 100:419-423. [PMID: 33819922 DOI: 10.1097/phm.0000000000001729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The aim of the study was to determine the prevalence of deep venous thrombosis detected by duplex screening and risk factors associated with deep venous thrombosis in patients with COVID-19 upon admission to an inpatient rehabilitation hospital. DESIGN This is a retrospective review. SETTING The setting is three freestanding inpatient rehabilitation hospitals operating as one system. PARTICIPANTS The participants are consecutive patients with a diagnosis of COVID-19 admitted to an inpatient rehabilitation hospital without a diagnosis of deep venous thrombosis or screening duplex ultrasound prior to transfer. INTERVENTIONS A duplex ultrasound of lower limbs was performed upon admission to inpatient rehabilitation hospital. OUTCOME MEASURES Primary outcome was the percentage of admission patients with a lower limb deep venous thrombosis. Secondary factors included potential risk factors for a positive screen for deep venous thrombosis. RESULTS A lower limb deep venous thrombosis was diagnosed in 22% (25/113) of the patients tested, with eight patients (7.1%) having a proximal deep venous thrombosis. Risk factors for screening positive for a deep venous thrombosis included being male, younger, and having been on a ventilator during the acute illness. CONCLUSIONS The high rate of deep venous thrombosis observed in these patients suggests that the risk of venous thromboembolic disorders after severe COVID-19 illness is considerable and surveillance measures of such patients should be undertaken.
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Affiliation(s)
- Steven C Kirshblum
- From the Kessler Institute for Rehabilitation, West Orange, New Jersey (SCK, BP, RD, BMG); Rutgers NJ Medical School, Newark, New Jersey (SCK, FE, BP, BMG); Kessler Foundation, West Orange, New Jersey (SCK, FE, BMG); and Select Medical Corporation, Mechanicsburg, Pennsylvania (SCK, GD, BP, SH, BMG)
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Nori P, Kline-Quiroz C, Stubblefield MD. Cancer Rehabilitation:: Acute and Chronic Issues, Nerve Injury, Radiation Sequelae, Surgical and Chemo-Related, Part 2. Med Clin North Am 2020; 104:251-262. [PMID: 32035567 DOI: 10.1016/j.mcna.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cancer affects millions of individuals, and approximately half will develop functional impairments. Cancers that commonly, either from direct effects or from its treatments, result in functional impairments include breast, head and neck, brain, and spinal cord tumors. There is a plethora of potential impairments including pain, spasticity, dystonia, weakness, and neurogenic bowel or bladder. This article reviews the functional impairments frequently encountered in breast, head and neck, brain, and spinal cord tumors. The authors also discuss management and treatment options incorporated in comprehensive cancer rehabilitation to address these impairments to maximize and maintain function and quality of life.
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Affiliation(s)
- Phalgun Nori
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
| | - Cristina Kline-Quiroz
- MedStar Health/Georgetown, National Rehabilitation Hospital, 102 Irving Street Northwest, Washington, DC 20010, USA
| | - Michael D Stubblefield
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Select Medical, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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Should Hospitalized Patients Wear Graduated Compression Stockings for Prevention of Deep Vein Thrombosis?: A Cochrane Review Summary With Commentary. Am J Phys Med Rehabil 2019; 98:1041-1042. [PMID: 31490183 DOI: 10.1097/phm.0000000000001275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ng AH, Gupta E, Bianty J, Williams JL, Bruera E. Calf measurements screening for deep vein thrombosis in acute inpatient cancer rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Cancer patients have a fourfold increase in the frequency of thrombosis and it is a common cause of death. The purpose of this study was to review the impact of calf measurements during initial admission to an inpatient rehabilitation unit to detect deep vein thrombosis. Methods: During inpatient admission to a rehabilitation unit, calf measurement assessments were performed by nursing staff. The nurses were instructed to notify clinicians for an order for a venous Doppler ultrasound if the difference between the two calves was greater than 3 cm. Findings: A total of 374 patients were admitted to the inpatient cancer rehabilitation unit over 12 months. Only six patients (2%) did not have their calves measured, with a 98% compliance of measurement. Only two patients (0.5%) had a difference in calf measurement and clinical exam significant to warrant a venous Doppler ultrasound. Both cases were negative for thrombosis. Venous Doppler ultrasounds were performed in 63 (17%) patients before admission to the rehabilitation unit. During the rehabilitation stay, venous Doppler ultrasounds were performed on 44 (12%) patients, with 10 (3%) patients identified with having deep vein thrombosis. Conclusions: This study suggests that calf measurements at admission to a rehabilitation unit were unable to detect deep vein thrombosis in this cancer population. Venous Doppler ultrasounds were ordered and identified additional patients who had deep vein thrombosis.
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Affiliation(s)
- Amy H Ng
- Assistant Professor, Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Ekta Gupta
- Assistant Professor, Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Josephine Bianty
- Coordinator, Clinical Care, Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Janet L Williams
- Manager, Clinical Data Management Systems, Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Eduardo Bruera
- Chair, Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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Cost-Effectiveness Analysis of Routine Venous Doppler Ultrasound for Diagnosis of Deep Venous Thrombosis at Admission to Inpatient Rehabilitation. Am J Phys Med Rehabil 2018; 97:747-753. [DOI: 10.1097/phm.0000000000000961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barrio-Alonso M, Conejero-Gómez R, Craven-Bartle Coll A, Martín-Cañuelo J, García-Turrillo E, Laxe-García S, Morales-Mateu A, Torrequebrada-Giménez A, Benito-Penalva J, Cívicos-Sánchez N, Jauregui-Abrisqueta M, Montoto-Marqués A, Juan-García F, Rodríguez-Piñero M. Consenso sobre la profilaxis y tratamiento de la enfermedad tromboembólica venosa en la lesión medular y en el daño cerebral adquirido. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2015.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Coexistence of Deep Vein Thrombosis, Heterotopic Ossification, and Complex Regional Pain Syndrome due to Hemorrhagic Stroke. J Stroke Cerebrovasc Dis 2016; 25:e38-40. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/22/2015] [Accepted: 11/22/2015] [Indexed: 11/18/2022] Open
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Michetti CP, Franco E, Coleman J, Bradford A, Trickey AW. Deep vein thrombosis screening and risk factors in a high-risk trauma population. J Surg Res 2015; 199:545-51. [DOI: 10.1016/j.jss.2015.04.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/29/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
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Choi YA, Kim K. Sciatic Neuropathy Caused by Focal Venous Engorgement Associated With Deep Vein Thrombosis: A Case Report. PM R 2015; 8:78-81. [DOI: 10.1016/j.pmrj.2015.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 06/02/2015] [Accepted: 06/05/2015] [Indexed: 11/26/2022]
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Hwang HG, Schulman S. Respiratory review of 2013: pulmonary thromboembolism. Tuberc Respir Dis (Seoul) 2013; 75:89-94. [PMID: 24101932 PMCID: PMC3790026 DOI: 10.4046/trd.2013.75.3.89] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/30/2013] [Accepted: 09/02/2013] [Indexed: 11/24/2022] Open
Abstract
Pulmonary embolism (PE), which can originate as a consequence of deep vein thrombosis (DVT), is the most frequent and potentially fatal venous thromboembolic event. Despite the fact that the incidence of venous thromboembolism (VTE) in Asians is lower than that in the Western populations, a recent epidemiologic study demonstrates an increasing incidence of VTE in the Korean population. Anticoagulants, including low molecular weight heparin (LMWH) and vitamin K antagonist (VKAs), have been the main treatments for PE, however, recently new oral anticoagulants (NOACs) were introduced. We will review how well patients with PE can be managed with the existing anticoagulants and NOACs along with the time span of treatment, which still pose some challenges for clinicians.
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Affiliation(s)
- Hun Gyu Hwang
- Respiratory Division, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi, Korea
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Mayer RS, Streiff MB, Hobson DB, Halpert DE, Berenholtz SM. Evidence-based venous thromboembolism prophylaxis is associated with a six-fold decrease in numbers of symptomatic venous thromboembolisms in rehabilitation inpatients. PM R 2012; 3:1111-1115.e1. [PMID: 22192320 DOI: 10.1016/j.pmrj.2011.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 06/04/2011] [Accepted: 07/01/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To measure the impact of a standardized risk assessment tool and specialty-specific, risk-adjusted venous thromboembolism (VTE) order sets on compliance with American College of Chest Physicians (ACCP) guidelines and the number of symptomatic VTE as assessed by administrative data. DESIGN Prospective cohort study. SETTING Academic hospital inpatient rehabilitation unit. PATIENTS AND PARTICIPANTS All patients on the rehabilitation unit. METHODS AND INTERVENTIONS Assessment of VTE risk factors and evaluated admission VTE prophylaxis orders before and after implementation of an ACCP guideline-based, specialty-specific VTE risk assessment, and prophylaxis order set by using a standardized data collection form. MAIN OUTCOME MEASURES Discharge diagnostic codes for VTE and pulmonary embolism were tracked by ICD-9 (International Classification of Diseases, 9th edition) discharge diagnosis codes for the 12 months before and 36 months after the intervention. RESULTS Before implementation of the VTE order set, 27% of patients received VTE prophylaxis in compliance with the 2004 ACCP VTE guidelines. By following implementation of specialty-specific, risk-adjusted VTE order sets, compliance increased to 98%. In the year before VTE order-set implementation, the number of VTEs per admission was 49 per 1000. By following implementation, the number of VTEs steadily decreased each year to 8 per 1000 in 2007 (χ(2) = 14.985; P = .0001). CONCLUSIONS Implementation of a standardized VTE risk assessment tool and prophylaxis order set resulted in a substantial improvement in compliance with ACCP guidelines for VTE prophylaxis and was associated with a 6-fold reduction in the number of symptomatic VTEs in a hospital-based rehabilitation unit.
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Affiliation(s)
- R Samuel Mayer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21208, USA.
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Mayer MP, Suskauer SJ, Houtrow A, Watanabe T. Venous Thromboembolism Prophylaxis in the Pediatric Population. PM R 2011; 3:578-85. [DOI: 10.1016/j.pmrj.2011.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
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