Thromboprophylaxis of Adult Medical Inpatients in St. John’s Newfoundland.
Bibliographic record
Abstract
Abstract Introduction: Venothromboembolic disease (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), are causes of significant morbidity and mortality in hospitalized patients. Medical inpatients often have multiple risk factors for developing VTE and as a population have been shown to have significant rates of VTE ranging from 5–15% with approximately 75% of in hospital VTE occurring in non-surgical patients. Recent large randomized controlled trials have demonstrated the safety and efficacy of low molecular weight heparins (LMWH) in the prevention of VTE in this population. Despite the evidence of the effectiveness of this prophylactic treatment, numerous studies have demonstrated its underutilization in many at risk medical inpatient populations. We aim to establish rates of VTE prophylaxis in the population of at risk general medical inpatients in two acute care adult hospitals in the St. John’s area to assess if similar underutilization exists and if there is a need for future interventions to improve outcomes. Methods: We used a modification of the inclusion/exclusion criteria of the MEDENOX trial to retrospectively identify consecutive medical inpatients at The General Hospital/St. Clare’s Mercy Hospital who were appropriate to receive VTE prophylaxis during January and February of 2005. Data was collected on demographics, VTE risk factors, and the use of any duration of low dose subcutaneous unfractionated heparin or low dose LMWH during their hospitalization. Two tailed t-tests were performed to identify any significant differences in demographics or VTE risk factors between the prophylaxis and non-prophylaxis groups. Results: 114 medical inpatients were identified as being appropriate to receive pharmacologic VTE prophylaxis between Jan.1, 2005 and Feb. 28, 2005. 26 patients (23%) received some form of pharmacologic VTE prophylaxis. Of those who received prophylaxis, 19 patients (73%) received subcutaneous unfractionated heparin and 7 patients (27%) received LMWH. The only significant difference between the prophylaxis and non prophylaxis group was a higher proportion of patients with malignancy (27% vs 11% p=0.05) in the prophylaxis group. Conclusion: This data demonstrates a significant underutilization of VTE prophylaxis in all at risk general medical patients in the two major adult acute care centres of the Eastern Health Board of Newfoundland. The data is consistent with the growing body of literature that exhibits that VTE prophylaxis in medical inpatients is deficient, with previously reported prophylaxis rates of only 20%–50%. Thus future work needs be done in translating “best practice” into “usual practice” as it relates to VTE prophylaxis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".