29 research outputs found
Evaluation of the use of low-molecular-weight heparin for venous thromboembolism prophylaxis in medical patients
Background. Venous thromboembolism (VTE) complicates a significant proportion of medical admissions. As well as increasing patient morbidity, pulmonary embolism is one of the commonest preventable causes of in-hospital death. An increase in the use of pharmacological preventive measures has been advocated in recent years. South African (SA) and international guidelines have been published in an effort to promote the safe use of VTE prophylaxis.Objectives. To describe adherence to both local and international recommendations for VTE prophylaxis in an SA hospital with regard to appropriateness of the decision to prescribe or withhold low-molecular-weight heparin (LMWH), and to observe the practice of dose adjustment in special population groups.Methods. This was a prospective, observational study, and data were collected from consenting adults admitted to the medical wards. We assessed the patients’ VTE risk, bleeding risk and the presence of contraindications at the time of LMWH prescription as well as the dose prescribed, specifically taking into consideration adjustment for renal dysfunction and obesity.Results. Three hundred and fifty-two patients were enrolled, of whom 51.4% were male and 58.5% received LMWH. Primary outcomes. The appropriate overall decision according to both SA and international guidelines was made in 254 cases (72.2%). The inappropriate decision according to both guidelines was made in 79 cases (22.4%) and the appropriate decision according to one guideline only was made in 18 cases (5.1%), while 1 case (0.3%) was not categorised. Contraindications to VTE prophylaxis were present in 35 patients (9.9%), but 9 of these patients nevertheless received LMWH. An incorrect dose was prescribed in 36 cases (17.5%), the most common reason being an inappropriate reduction in the dose in mild renal dysfunction. Secondary outcomes. Other medications that may have increased bleeding risk were prescribed in 46 patients who received LMWH (22.3%). Mechanical prophylaxis was indicated in 25 (7.1%) of the total sample; however, none received this.Conclusions. Overall adherence to published guidelines for VTE prophylaxis has improved compared with other published reviews on the topic, but documentation of patients’ VTE risk in files is poor. Overuse in low-risk patients may be an unintended consequence of the widespread advocacy of LMWH use in hospital, highlighting the importance of adequate VTE risk stratification. Incorrect dosing in special population groups is an issue that needs to be addressed, as is non-utilisation of mechanical prophylaxis methods.
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Developing Range Management in Latin America
The differences in outlook on the conservation of natural resources and multiple use of rangelands between the United States and the countries of Latin America is stressed and it is shown how technical assistance in the field of range management must take these differences into account. Proposals are made for a phased program for development of integrated grazing land management in Latin America, starting with a range resources evaluation which will be the basis for a limited intensive development of suitable areas in order to alleviate the grazing pressure on the natural vegetation. This development phase should be accompanied by range research for management applications during a second action phase. The requirements and difficulties of implementing such a programme are discussed./Se pone énfasis en las diferencias entre los EE.UU. y los paÃses de América Latina en los puntos de vista sobre la conservación de recursos naturales y el uso múltiple de los pastizales naturales. La asistencia técnica en el campo de manejo de pastizales naturales debe tomar en cuenta estas diferencias. Se propone un programa para el desarrollo de un manejo integrado de las tierras de pastoreo en América Latina, empezando con una evaluación de los recursos forrajeros naturales, la cual formará la base para un desarrollo intensivo pero limitado de las mejores áreas para aliviar la presión de pastoreo sobre la vegetación natural. Al mismo tiempo se inician las investigaciones en manejo de pastizales naturales para su posterior aplicación en la segunda fase del programa. Se indican los requerimientos y dificultades para implementar un programa de este tipo.This material was digitized as part of a cooperative project between the Society for Range Management and the University of Arizona Libraries.The Journal of Range Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform August 202
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The Management of Livestock in the Xerophytic Forest Region of Central Argentina
This material was digitized as part of a cooperative project between the Society for Range Management and the University of Arizona Libraries.The Journal of Range Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform August 202
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The Survival of Velvet Mesquite (Prosopis juliflora var. velutina) After Fire
This material was digitized as part of a cooperative project between the Society for Range Management and the University of Arizona Libraries.The Journal of Range Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform August 202