VTE prophylaxis across the continuum of care in U.S. cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17510-e17510
Author(s):  
A. Amin ◽  
J. Lin ◽  
A. Ryan
Keyword(s):  
Hospital Stay ◽  
Cancer Patients ◽  
Healthcare Providers ◽  
Length Of Hospital Stay ◽  
Continuum Of Care ◽  
Vte Prophylaxis ◽  
Patients At Risk ◽  
The Mean ◽  
Outpatient Settings ◽  
The Continuum

e17510 Background: The period of VTE risk in cancer patients extends beyond the hospital stay. This analysis evaluated VTE prophylaxis patterns for US cancer patients across the continuum of care. Methods: Premier's Perspective inpatient data were cross-matched with Ingenix LabRx outpatient data from the I3 database (January 2005-December 2007) to assess VTE prophylaxis patterns in medical cancer patients at risk of VTE (according to the American College of Chest Physicians 2004 guidelines) and with no contraindications for anticoagulation. Inpatient anticoagulant groups were assigned based on the drug the patient received during hospital stay and were followed by their outpatient prophylaxis use. Patients were evaluated on drug utilization, diagnoses and clinical practice patterns during and after hospitalization. Results: Overall, 75.3% of 2,337 cancer patients did not receive anticoagulation during their hospital stay. Of the 577 patients receiving prophylaxis, 66% received UFH and 25% received enoxaparin ( Table ). The mean length of hospital stay was 3 days after which 97.9% of patients did not receive any prophylaxis within the following 30 days. Of the 50 patients who received outpatient prophylaxis, 60% received warfarin alone and 22% received both enoxaparin and warfarin. Conclusions: This unique analysis presents VTE prophylaxis patterns across the continuum of care. Most cancer patients did not receive anticoagulation in the inpatient or outpatient settings. Further efforts are needed to identify optimal VTE prevention in cancer patients, namely the duration of prophylaxis and how healthcare providers can increase awareness. Financial and editorial support was provided by sanofi-aventis US, Inc. [Table: see text] [Table: see text]

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

Propensity-adjusted cost analysis of radial versus femoral access for neuroendovascular procedures

2020 ◽  
pp. neurintsurg-2020-016728
Author(s):  
Joshua S Catapano ◽  
Andrew F Ducruet ◽  
Stefan W Koester ◽  
Tyler S Cole ◽  
Jacob F Baranoski ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Diagnostic Procedures ◽  
Femoral Access ◽  
Catheter Size ◽  
The Mean ◽  
The Difference ◽  
Procedure Type ◽  
Angiographic Findings

BackgroundTransradial artery (TRA) access for neuroendovascular procedures is associated with fewer complications than transfemoral artery (TFA) access. This study compares hospital costs associated with TRA access to those associated with TFA access for neurointerventions.MethodsElective neuroendovascular procedures at a single center were retrospectively analyzed from October 1, 2018 to May 31, 2019. Hospital costs for each procedure were obtained from the hospital financial department. The primary outcome was the difference in the mean hospital costs after propensity adjustment between patients who underwent TRA compared with TFA access.ResultsOf the 338 elective procedures included, 63 (19%) were performed through TRA versus 275 (81%) through TFA access. Diagnostic procedures were more common in the TRA cohort (51 of 63, 81%) compared with the TFA cohort (197 of 275, 72%), but the difference was not significant (p=0.48). The TRA cohort had a shorter length of hospital stay (mean (SD) 0.3 (0.5) days) compared with the TFA cohort (mean 0.7 (1.3) days; p=0.02) and lower hospital costs (mean $12 968 ($6518) compared with the TFA cohort (mean $17 150 ($10 946); p=0.004). After propensity adjustment for age, sex, symptoms, angiographic findings, procedure type, sheath size, and catheter size, TRA access was associated with a mean hospital cost of $2514 less than that for TFA access (95% CI −$4931 to −$97; p=0.04).ConclusionNeuroendovascular procedures performed through TRA access are associated with lower hospital costs than TFA procedures. The lower cost is likely due to a decreased length of hospital stay for TRA.

Role of integrative medicine in the continuum of care of breast cancer patients in the Indian context

2021 ◽  
Author(s):  
Partha Basu ◽  
Richa Tripathi ◽  
Ravi Mehrotra ◽  
Koninika Ray ◽  
Anurag Srivastava ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Integrative Medicine ◽  
Continuum Of Care ◽  
Breast Cancer Patients ◽  
Indian Context ◽  
The Continuum

scholarly journals Consent for the discontinuation of life-prolonging treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law

2020 ◽  
Author(s):  
YuJin Chung ◽  
JinHo Beom ◽  
JiEun Lee ◽  
Incheol Park ◽  
Junho Cho
Keyword(s):  
Emergency Room ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Life Extension ◽  
Medical Decision ◽  
Patient Consent ◽  
Before And After ◽  
The Law

Abstract Background The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of nonsensical life-prolonging treatment, and its enactment raised big controversy in Korean society. However, there is no study on whether the actual life-prolonging treatment for patients has decreased after enforcing the law. This study aimed to compare the provision of patient consent before and after the enforcement of the law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of the law on cancer patients' clinical care. Methods This retrospective single cohort study included advanced cancer patients over 19 years of age who visited the emergency room at a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the average length of hospital stay. The consent rate for cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes. Results The average length of hospital stay decreased after the law was enforced, from 4 days to 2 days (p= 0.001). The rates of direct transfers to secondary and nursing hospitals increased from 8.2% to 21.2% (p=0.001) and from 1.0% to 9.7%, respectively (p<0.001). The rate of provision of consent for admission to the ICU decreased from 6.7% to 2.3% (p=0.032). For CPR and CRRT, the rate of provision of consent decreased from 1.0% to 0.0% and from 13.9% to 8.8%, respectively, but the differences were not significant (p=0.226 and p=0.109, respectively). Conclusion According to previous research, for patients wishing only conservative treatment, the reduction in hospital stays at tertiary hospitals ultimately reduces the physical, emotional, financial burdens and also improves the quality of end-of-life at home or in a hospice facility. In this context, this research ultimately show that the purpose of the LEMD law has been achieved. Further research in several hospitals including those patients who completed the consent after hospitalization is needed to generalize the clinical implication of the LEMD law.

Malnourishment and length of hospital stay among paediatric cancer patients with febrile neutropaenia: a developing country perspective

2016 ◽  
Vol 6 (3) ◽  
pp. 338-343 ◽  
Author(s):  
J Michael Conner ◽  
Martha J Aviles-Robles ◽  
Peter H Asdahl ◽  
Fang Fang Zhang ◽  
Rohit P Ojha
Keyword(s):  
Hospital Stay ◽  
Cancer Patients ◽  
Developing Country ◽  
Length Of Hospital Stay ◽  
Paediatric Cancer

Neurogenic claudication associated with posterior vertebral rim fractures in children

2012 ◽  
Vol 10 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Jonathan G. Thomas ◽  
Jerome Boatey ◽  
Alison Brayton ◽  
Andrew Jea
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Signs And Symptoms ◽  
Leg Pain ◽  
Neurogenic Claudication ◽  
Pediatric Age Group ◽  
Fractures In Children ◽  
The Mean

Object Outside of the patient population with achondroplasia, neurogenic claudication is rare in the pediatric age group. Neurogenic claudication associated with posterior vertebral rim fracture is even more uncommon but nonetheless causes pain and disability in affected children and adolescents. The purpose of this study was to describe the surgical results of 3 adolescents presenting with neurogenic claudication and posterior vertebral rim fracture when treated with laminectomy alone. Methods The medical and operative records of the 3 pediatric patients were retrospectively reviewed. Presenting signs and symptoms and CT findings, such as the interpedicular distances between T-12 and L-5, were obtained. Perioperative results were assessed, including operative time, blood loss, length of hospital stay, and complications. Findings at latest follow-up were also recorded, including a patient satisfaction survey. Results The 3 patients (1 girl and 2 boys) had a mean age of 14.7 years (range 14–15 years) and underwent follow-up for a mean of 11.3 months (range 5–18 months). Notable preoperative signs and symptoms included back pain (all patients), leg pain (all patients), leg numbness (1 patient), and leg weakness (1 patient). No patient presented with bowel and/or bladder dysfunction. The mean blood loss during laminectomy was 123 ml (range 20–300 ml), and the mean length of hospital stay was 4.3 days (range 3–6 days). On average, decompression was performed at 2.2 levels (range 2–2.5 levels). All 3 patients reported at most recent follow-up that they were “satisfied” with the surgery. There was 1 complication of instability from an iatrogenic pars fracture, which required reoperation and posterior instrumented fusion. Conclusions To the best of the authors' knowledge, this report represents the first surgical series of pediatric neurogenic claudication associated with posterior vertebral rim fractures. Pediatric neurosurgeons may infrequently encounter neurogenic claudication associated with a posterior vertebral rim fracture in children. To treat children with neurogenic claudication associated with posterior vertebral rim fractures, a simple laminectomy may be a safe and efficacious alternative to discectomy and removal of fracture fragments.

Ambulatory care nurses responding to depression

2017 ◽  
Author(s):  
Anthony De La Cruz ◽  
Richard F. Brown ◽  
Steve Passik
Keyword(s):  
Cancer Patients ◽  
Communication Skills ◽  
Healthcare Providers ◽  
Skills Training ◽  
Communication Skills Training ◽  
Common Occurrence ◽  
Treatment Of Depression ◽  
Patient’S Experience ◽  
Patients At Risk ◽  
Risks Factors

Depression is a common occurrence among cancer patients; however, it goes undetected by healthcare providers in about 50% of cases. Ambulatory nurses are in a key position to identify and respond to a patient’s emotional distress and aid in the detection of patients at risk for or suffering from depression. Programmes in communication skills training have been shown to help nurses detect and respond to patient depression. A model of core communication components consisting of strategies, skills, and process tasks is presented. This model will enable nurses to gain an understanding of the patient’s experience and assist in the recognition and treatment of depression. The results of a pilot programme utilizing this model and skills will also be presented. An overview of the nature of depression and risks factors and barriers to the identification of depression is presented.

scholarly journals Why precision medicine should be applied across the continuum of care for metastatic colorectal cancer patients?

2020 ◽  
Vol 16 (2) ◽  
pp. 4337-4339 ◽  
Author(s):  
Marco Puzzoni ◽  
Pina Ziranu ◽  
Laura Demurtas ◽  
Eleonora Lai ◽  
Stefano Mariani ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Precision Medicine ◽  
Cancer Patients ◽  
Continuum Of Care ◽  
Colorectal Cancer Patients ◽  
The Continuum
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