Evaluation of the Impact of Rehabilitation Training on the Knowledge and Attitude of Caregivers of COVID-19 Patients in Iran

Applying rehabilitative measures is shown to be influential in relieving the medical complications of the COVID-19 disease. Herein, we aimed to assess the effect of a rehabilitation training class on the knowledge and attitude of the caregivers of the COVID-19 patients. Twenty-three caregivers voluntarily filled the questionnaire before and after attending a training class that evaluated the participants' beliefs about the four types of rehabilitations in COVID-19, including musculoskeletal, respiratory, gastrointestinal, and deep vein thrombosis (DVT) prevention. Significant improvement in the caregiver's attitude about the importance of all four rehabilitation types was detected. Also, the knowledge was increased about the necessity of DVT prevention. The level of knowledge in the caregivers of COVID-19 patients in Iran is not satisfactory, which necessitates proper education to achieve the rehabilitation goals rapidly. In-person caregiver training along with presenting pamphlets is of the most useful methods.

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Performance of the Wells score in predicting deep vein thrombosis in medical and surgical hospitalized patients with or without thromboprophylaxis: The R-WITT study

Vascular Medicine ◽

10.1177/1358863x21994672 ◽

2021 ◽

pp. 1358863X2199467

Author(s):

Jean-Eudes Trihan ◽

Michael Adam ◽

Sara Jidal ◽

Isabelle Aichoun ◽

Sarah Coudray ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Risk Stratification ◽

Hospitalized Patients ◽

Operating Characteristics ◽

Vein Thrombosis ◽

Ultrasound Study ◽

Wells Score ◽

Deep Vein ◽

The Impact ◽

Test Probability

The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score’s accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% ( p = 0.22) and 1.7%, 4.2% and 25.8% ( p < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians. ClinicalTrials.gov Identifier: NCT03784937.

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The Future of Phlebology in Europe

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514527046 ◽

2014 ◽

Vol 29 (1_suppl) ◽

pp. 181-185 ◽

Cited By ~ 1

Author(s):

Brahman Dharmarajah ◽

Tristan RA Lane ◽

Hayley M Moore ◽

HA Martino Neumann ◽

Eberhard Rabe ◽

...

Keyword(s):

Cost Effective ◽

Research Strategy ◽

Clinical Severity ◽

Venous Disease ◽

Vein Thrombosis ◽

Venous Diseases ◽

Thrombus Removal ◽

Deep Vein ◽

The Impact

Background Worldwide superficial and deep venous diseases are common and associated with significant individual and socioeconomic morbidity. Increasing burden of venous disease requires Phlebology to define itself as an independent specialty representing not only patients but the multidisciplinary physicians involved in venous care. Methods & Results In this article the scope of venous disease in Europe and subsequent future governance for treatment in the region is discussed. Superficial venous disease is common with 26.9-68.6% of European populations reported to have C2-C6 disease according to the CEAP (Clinical severity, Aetiology, Anatomy and Pathophysiology) scoring system. However, a significant disparity is observed in the treatment of superficial venous disease across Europe. Post thrombotic syndrome (PTS) after deep vein thrombosis (DVT) contributes to the increasing burden of deep venous disease. Aggressive thrombus removal for acute ileofemoral DVT provides a cost-effective 14.4% risk reduction in the development of PTS. Additionally, deep venous lesions requiring endovascular intervention are being increasingly performed to prevent recurrent thrombosis. The European College of Phlebology (ECoP) has been formed to provide a responsible body for the care of the European patient with venous disease. The role of the ECoP includes unifying European member states through standardised guideline production, identification of research strategy and provision of training and accreditation of physicians. Conclusion Creation of a European venous disease specific speciality will provide a patient centred approach through understanding of the impact of disease in the region and delivery of high quality diagnostics and treatment from an appropriately certified Phlebologist.

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Impact of IVC Filter Guidelines, Registry, and Clinic on Filter Retrieval.

Proceedings of IMPRS ◽

10.18060/23511 ◽

2019 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Brandon Kiley, BS ◽

Lisa Hollister, MSN, RN ◽

T. Eric White, MD ◽

Emily Keltner, BS, MA ◽

Thein Zhu, MBBS, FACE, FRCP ◽

...

Keyword(s):

Complication Rate ◽

Dwell Time ◽

Filter Placement ◽

Vein Thrombosis ◽

Retrieval Rate ◽

Filter Retrieval ◽

Significant Difference ◽

Before And After ◽

Deep Vein

Background and hypothesis: Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE), are serious medical conditions that affect up to 900,000 Americans yearly, accounting for up to 100,000 deaths. The first line treatment for VTE is anticoagulation; however, in patients who experience a contraindication to, or failure of anticoagulation, an IVCF may be used. There are two types of IVCFs, permanent and retrievable. Retrievable filters are indicated when the contraindication to anticoagulation is transient, and they may be removed once the contraindication has passed. Retrievable filters have become associated with serious complications such as filter fracture, migration, and IVC perforation. Subsequently, they have become the subject of litigation. As such, strategies should be undertaken to reduce filter dwell time and improve filter retrieval rates. We hypothesize that implementation of IVCF guidelines, registry, and clinic will reduce dwell time while increasing retrieval rate. Methods: This study was a mixed retrospective and prospective chart review of patients who received an IVCF before and after implementation of IVCF guidelines, registry, and clinic. The guidelines, registry, and clinic were established in July 2017. Cases were analyzed during the years 2014-2015 (n=191) and 2017-2018 (n=103) beginning in July 2017. Data was obtained on filter retrieval rate, dwell time, filter-associated complications, and indication for placement. Results: There was a significant decrease in dwell time (p<.001) and a significant increase in retrieval rate (p<.001). There was no difference in complication rate, and there was a decrease in filter placement in patients with ‘soft’ indications, though this difference was not statistically significant (p=.109). Conclusion and potential impact: Implementation of dedicated efforts to increase patient follow-up and filter retrieval were effective in reducing dwell time and retrieval rate. Although there was no significant difference in complication rate, these efforts may be protective against litigation for patients who experience a filter-associated complication.

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Use of Electronic Health Record Simulation to Understand the Accuracy of Intern Progress Notes

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00201.1 ◽

2016 ◽

Vol 8 (2) ◽

pp. 237-240 ◽

Cited By ~ 10

Author(s):

Christopher A. March ◽

Gretchen Scholl ◽

Renee K. Dversdal ◽

Matthew Richards ◽

Leah M. Wilson ◽

...

Keyword(s):

Thrombosis Prophylaxis ◽

Medical Problems ◽

Vein Thrombosis ◽

Patterns Of Use ◽

Progress Notes ◽

Deep Vein Thrombosis Prophylaxis ◽

Electronic Health ◽

Deep Vein ◽

The Impact

ABSTRACT With the widespread adoption of electronic health records (EHRs), there is a growing awareness of problems in EHR training for new users and subsequent problems with the quality of information present in EHR-generated progress notes. By standardizing the case, simulation allows for the discovery of EHR patterns of use as well as a modality to aid in EHR training.Background To develop a high-fidelity EHR training exercise for internal medicine interns to understand patterns of EHR utilization in the generation of daily progress notes.Objective Three months after beginning their internship, 32 interns participated in an EHR simulation designed to assess patterns in note writing and generation. Each intern was given a simulated chart and instructed to create a daily progress note. Notes were graded for use of copy-paste, macros, and accuracy of presented data.Methods A total of 31 out of 32 interns (97%) completed the exercise. There was wide variance in use of macros to populate data, with multiple macro types used for the same data category. Three-quarters of notes contained either copy-paste elements or the elimination of active medical problems from the prior days' notes. This was associated with a significant number of quality issues, including failure to recognize a lack of deep vein thrombosis prophylaxis, medications stopped on admission, and issues in prior discharge summary.Results Interns displayed wide variation in the process of creating progress notes. Additional studies are being conducted to determine the impact EHR-based simulation has on standardization of note content.Conclusions

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Incidence of Upper Extremity Deep Vein Thrombosis in Acute Leukemia and Effect on Mortality

TH Open ◽

10.1055/s-0040-1718883 ◽

2020 ◽

Vol 04 (04) ◽

pp. e309-e317

Author(s):

Christina Poh ◽

Ann Brunson ◽

Theresa Keegan ◽

Ted Wun ◽

Anjlee Mahajan

Keyword(s):

Deep Vein Thrombosis ◽

Acute Leukemia ◽

Upper Extremity ◽

Lymphoblastic Leukemia ◽

Cox Proportional Hazards ◽

High Risk Population ◽

Vein Thrombosis ◽

Increased Risk ◽

Deep Vein ◽

The Impact

AbstractThe cumulative incidence, risk factors, rate of subsequent venous thromboembolism (VTE) and bleeding and impact on mortality of isolated upper extremity deep vein thrombosis (UE DVT) in acute leukemia are not well-described. The California Cancer Registry, used to identify treated patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) diagnosed between 2009 and 2014, was linked with the statewide hospitalization database to determine cumulative incidences of UE DVT and subsequent VTE and bleeding after UE DVT diagnosis. Cox proportional hazards regression models were used to assess the association of UE DVT on the risk of subsequent pulmonary embolism (PE) or lower extremity deep vein thrombosis (LE DVT) and subsequent bleeding, and the impact of UE DVT on mortality. There were 5,072 patients identified: 3,252 had AML and 1,820 had ALL. Three- and 12-month cumulative incidences of UE DVT were 4.8% (95% confidence interval [CI]: 4.1–5.6) and 6.6% (95% CI: 5.8–7.5) for AML and 4.1% (95% CI: 3.2–5.1) and 5.9% (95% CI: 4.9–7.1) for ALL, respectively. Twelve-month cumulative incidences of subsequent VTE after an incident UE DVT diagnosis were 5.3% for AML and 12.2% for ALL. Twelve-month cumulative incidences of subsequent bleeding after an incident UE DVT diagnosis were 15.4% for AML and 21.1% for ALL. UE DVT was associated with an increased risk of subsequent bleeding for both AML (hazard ratio [HR]: 2.07; 95% CI: 1.60–2.68) and ALL (HR: 1.62; 95% CI: 1.02–2.57) but was not an independent risk factor for subsequent PE or LE DVT for either leukemia subtype. Isolated incident UE DVT was associated with increased leukemia-specific mortality for AML (HR: 1.42; 95% CI: 1.16–1.73) and ALL (HR: 1.80; 95% CI: 1.31–2.47). UE DVT is a relatively common complication among patients with AML and ALL and has a significant impact on bleeding and mortality. Further research is needed to determine appropriate therapy for this high-risk population.

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The Impact of Body Mass Index on Lower Extremity Duplex Ultrasonography for Deep Vein Thrombosis Diagnosis

Annals of Vascular Surgery ◽

10.1016/j.avsg.2015.03.038 ◽

2015 ◽

Vol 29 (6) ◽

pp. 1136-1140 ◽

Cited By ~ 3

Author(s):

Anahita Dua ◽

Sapan S. Desai ◽

Alexander Nodel ◽

Jennifer A. Heller

Keyword(s):

Body Mass Index ◽

Deep Vein Thrombosis ◽

Lower Extremity ◽

Body Mass ◽

Duplex Ultrasonography ◽

Vein Thrombosis ◽

Deep Vein ◽

The Impact

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Effect of a Video-Assisted Teaching Program About ECT on Knowledge and Attitude of Caregivers of Patients with Major Mental Illness

Indian Journal of Psychological Medicine ◽

10.1177/0253717620938038 ◽

2020 ◽

pp. 025371762093803

Author(s):

Padmavathi Nagarajan ◽

Gomathi Balachandar ◽

Vikas Menon ◽

Balachandar Saravanan

Keyword(s):

Bipolar Affective Disorder ◽

Single Session ◽

Video Assisted ◽

Validated Questionnaire ◽

Before And After ◽

Post Test ◽

Conservative Attitude ◽

Level Of Knowledge ◽

Knowledge And Attitude ◽

Persons With Schizophrenia

Background: Electroconvulsive therapy (ECT) is a widely used treatment modality for mental disorders such as major depression, bipolar affective disorder (BPAD) and catatonia. However, it is considered as one of the most controversial and misunderstood procedures, especially among caregivers. Methods: An experimental pre-test, post-test design was adopted. Forty caregivers of persons with schizophrenia ( n = 12), depression ( n = 13), BPAD with mania ( n = 8), and BPAD with depression ( n = 7) were selected using convenience sampling. The caregiver’s knowledge and attitude toward ECT were assessed before and after the intervention with a single session video-assisted teaching on ECT. The data collection tool used to assess the caregiver’s knowledge and attitude was based on a pre-validated questionnaire. Results: The pre-test evaluation demonstrated poor knowledge among 12 (30%) and a moderate level of knowledge on the remaining 28 (70%) of the study subjects. The attitude scores revealed a neutral attitude among 47.5% and a conservative attitude among 10% of the subjects toward ECT. There was a significant improvement in both mean (±SD) knowledge (13.4 ± 4.7 vs 25.6 ± 2.9) and attitude (10.7 ± 3.5 vs 14.6 ± 3.9) scores following intervention with video-assisted teaching. Conclusion: A single session involving video-assisted teaching improves the knowledge and attitude toward ECT among caregivers by removing the myths and misconceptions about ECT.

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Cost-effectiveness of rivaroxaban compared with enoxaparin plus warfarin for the treatment of hospitalised acute deep vein thrombosis in China

BMJ Open ◽

10.1136/bmjopen-2020-038433 ◽

2020 ◽

Vol 10 (7) ◽

pp. e038433

Author(s):

Li Yang ◽

Jingjing Wu

Keyword(s):

Deep Vein Thrombosis ◽

Cost Effectiveness ◽

Cost Saving ◽

Transition Probabilities ◽

Sensitivity Analyses ◽

Vein Thrombosis ◽

Life Years ◽

Acute Deep Vein Thrombosis ◽

Deep Vein ◽

The Impact

ObjectiveLimited economic evaluation data for rivaroxaban compared with standard of care (SoC) exists in China. The objective of this analysis was to evaluate the cost-effectiveness of rivaroxaban compared with current SoC (enoxaparin overlapped with warfarin) for the treatment of acute deep vein thrombosis (DVT) in China.MethodsA Markov model was adapted from a payer’s perspective to evaluate the costs and quality-adjusted life years (QALYs) of patients with DVT treated with rivaroxaban or enoxaparin/warfarin. Clinical data from the EINSTEIN-DVT trial were obtained to estimate the transition probabilities. Data on Chinese health resource use, unit costs and utility parameters were collected from previously published literature and used to estimate the total costs and QALYs. The time horizon was set at 5 years and a 3-month cycle length was used in the model. A 5% discount rate was applied to the projected costs. One-way sensitivity analyses and probabilistic sensitivity analyses were undertaken to assess the impact of uncertainty on results.ResultsRivaroxaban therapy resulted in an increase of 0.008 QALYs and was associated with lower total costs compared with enoxaparin/warfarin (US$4744.4 vs US$5572.4, respectively), demonstrating it to be a cost-saving treatment strategy. The results were mainly sensitive to length of hospitalisation due to DVT on enoxaparin/warfarin, cost per day of hospitalisation and the difference in length of stay of rivaroxaban-treated and enoxaparin/warfarin-treated patients.ConclusionRivaroxaban therapy resulted in a cost saving compared with enoxaparin/warfarin for the anticoagulation treatment of patients with hospitalised acute DVT in China.Trial registration numberNCT00440193; Post-results.

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Trends of venous thromboembolism risk before and after diagnosis of gout: a general population-based study

Rheumatology ◽

10.1093/rheumatology/kez398 ◽

2019 ◽

Vol 59 (5) ◽

pp. 1099-1107 ◽

Cited By ~ 5

Author(s):

Lingyi Li ◽

Natalie McCormick ◽

Eric C Sayre ◽

John M Esdaile ◽

Diane Lacaille ◽

...

Keyword(s):

Venous Thromboembolism ◽

General Population ◽

Population Based ◽

Incidence Rates ◽

Vein Thrombosis ◽

Hazard Ratios ◽

Thrombosis Risk ◽

Before And After ◽

Health Database ◽

Deep Vein

Abstract Objective To estimate the overall risk and the temporal trend of venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE) before and after gout diagnosis in an incident gout cohort compared with the general population. Methods We conducted a matched cohort study using a province-wide population-based administrative health database in Canada. We calculated incidence rates (IRs) and multivariable adjusted hazard ratios (HRs) for the risk of VTE, DVT and PE before and after gout diagnosis. Results Among 130 708 incident individuals with gout (64% male, mean age 59 years), 2071 developed VTE, 1377 developed DVT and 1012 developed PE. IRs per 1000 person-years for gout were 2.63, 1.74 and 1.28 compared with 2.03, 1.28 and 1.06 for non-gout, respectively. The fully adjusted HRs (95% CI) for VTE, DVT and PE were 1.22 (1.13, 1.32), 1.28 (1.17, 1.41) and 1.16 (1.05, 1.29). For the pre-gout period, the fully adjusted HRs (95% CI) were 1.51 (1.38, 1.64), 1.55 (1.40, 1.72) and 1.47 (1.31, 1.66) for VTE, DVT and PE. During the third, second and first years preceding gout, the fully adjusted HRs for VTE were 1.44, 1.56 and 1.62. During the first, second, third, fourth and fifth years after gout, the fully adjusted HRs were 1.63, 1.29, 1.33, 1.28 and 1.22. Similar trends were also seen for DVT and PE. Conclusion Increased risks of VTE, DVT and PE were found both before and after gout diagnosis. The risk increased gradually before gout, peaking in the year prior to diagnosis, and then progressively declined. Gout-associated inflammation may contribute to venous thrombosis risk.

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Elevated Hematocrit Concentration and the Risk of Mortality and Vascular Events in Patients Undergoing Major Surgery.

Blood ◽

10.1182/blood.v120.21.2088.2088 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2088-2088 ◽

Cited By ~ 1

Author(s):

Khaled M Musallam ◽

John B Porter ◽

Assaad Soweid ◽

Jamal J Hoballah ◽

Pierre M Sfeir ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Postoperative Mortality ◽

Major Surgery ◽

Vascular Events ◽

Improvement Program ◽

Vein Thrombosis ◽

Increased Risk ◽

Deep Vein ◽

The Impact

Abstract Abstract 2088 Background: Preoperative anemia is associated with adverse outcomes after major surgery. This study evaluates the effect of elevated hematocrit concentration on 30-day postoperative mortality and vascular events in patients undergoing major surgery. Methods: We conducted a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day mortality and vascular events, demographic, and perioperative risk factors were obtained for 197,469 adult patients undergoing major surgery in nonveteran's administration hospitals across the US, Canada, Lebanon, and the UAE during 2008 and 2009. We assessed the adjusted effect of elevated (>0.50) compared to normal preoperative hematocrit concentration (≥0.41–0.50, American Medical Association reference-range) on postoperative outcomes. Separate sex-specific analysis using hematocrit concentration thresholds commonly used in the diagnosis and management of patients with apparent or absolute erythrocytosis was also done. Results: A total of 3,961 patients (2.0%) had elevated hematocrit concentration preoperatively. After adjustment, postoperative mortality at 30 days was higher in patients with elevated hematocrit concentration than in those without (odds ratio [OR]: 2.23, 95% CI: 1.77–2.80). 30-day deep vein thrombosis (OR: 1.95, 95% CI: 1.44–2.64) and pulmonary embolism (OR: 1.79, 95% CI: 1.17–2.73), but not myocardial infarction or cerebrovascular events, were also higher in patients with elevated hematocrit concentration than in those without. Similar evaluation of various clinically relevant hematocrit concentrations revealed the following: an effect on mortality was noted beyond the thresholds of 0.48 in women and 0.52 in men, with the effect estimates becoming considerably high for values >0.54. Values between 0.41–0.45 were not associated with increased odds mortality. Similar observations were noted for deep vein thrombosis, although with higher variation and uncertainty especially in women; while the effects on pulmonary embolism were restricted to men. Conclusion: Elevated hematocrit concentration is associated with an increased risk of 30-day mortality and venous thrombosis following major surgery. Further investigation of the impact of elevated hematocrit concentration and its reduction on surgical outcomes is warranted. Disclosures: No relevant conflicts of interest to declare.

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