Pathways for outpatient management of venous thromboembolism in a UK centre.

It has become widely recognised that outpatient treatment may be suitable for many patients with venous thromboembolism. In addition, non-vitamin K antagonist oral anticoagulants that have been approved over the last few years have the potential to be an integral component of the outpatient care pathway, owing to their oral route of administration, lack of requirement for routine anticoagulation monitoring and simple dosing regimens. A robust pathway for outpatient care is also vital; one such pathway has been developed at Sheffield Teaching Hospitals in the UK. This paper describes the pathway and the arguments in its favour as an example of best practice and value offered to patients with venous thromboembolism. The pathway has two branches (one for deep vein thrombosis and one for pulmonary embolism), each with the same five-step process for outpatient treatment. Both begin from the point that the patient presents (in the Emergency Department, Thrombosis Clinic or general practitioner's office), followed by diagnosis, risk stratification, treatment choice and, finally, follow-up. The advantages of these pathways are that they offer clear, evidence-based guidance for the identification, diagnosis and treatment of patients who can safely be treated in the outpatient setting, and provide a detailed, stepwise process that can be easily adapted to suit the needs of other institutions. The approach is likely to result in both healthcare and economic benefits, including increased patient satisfaction and shorter hospital stays

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Los mamíferos amenazados del Paraguay

Se evaluaron 178 especies, excluyendo al tapiti Sylvilagus brasiliensis y al Dasypus septemcinctus (ver capítulo Xenarthra). Entre las especies evaluadas, se resalta que 29 especies fueron catalogadas como ?datos insuficientes? o DI, esto significa que la información disponible sobre estas especies en nuestro país es tan escasa que no podemos definir cuál es su estado de conservación a nivel nacional. Esta situación se debe a que existen pocos registros de la especie hasta el momento, pero la causa de ello es desconocida. Se podría Dar el caso de que la especie dada tenga una población abundante, pero hay pocas investigaciones (o ninguna) realizadas sobre el tema o bien, o caso contrario, que las especies posean pequeños tamaños poblacionales, sean de difícil avistamiento por lo que el esfuerzo de muestreo es escaso o inexistente (no se los busco). Esto resalta la importancia de la investigación en mastozoología para poder tomar decisiones de conservación, ya que, sin investigación científica, es imposible trazar acciones de conservación prácticas y fiables a nivelpaís y regional.Fil: Saldivar, S.. Asociación Paraguaya de Mastozoología; ParaguayFil: Rojas, V.. Asociación Paraguaya de Mastozoología; Paraguay. Asociacion Guyra Paraguay (guyra); Paraguay. Programa Nacional de Incentivo a los Investigadores; ParaguayFil: Giménez, D.. Asociación Paraguaya de Mastozoología; Paraguay. Sociedad para la Preservación de Carnívoros en Peligro y su Estudio Ecológico Internacional; Estados UnidosFil: Abba, Agustin Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Estudios Parasitológicos y de Vectores. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Centro de Estudios Parasitológicos y de Vectores; ArgentinaFil: Ayala, R.. Universidad de Buenos Aires; Argentina. Asociación Paraguaya de Mastozoología; ParaguayFil: Barreto, R.. Secretaría del Ambiente; ParaguayFil: Cartes, J.L.. Asociación Paraguaya de Mastozoología; Paraguay. Asociacion Guyra Paraguay (guyra); Paraguay. Programa Nacional de Incentivo a los Investigadores; ParaguayFil: del Castillo, H.. Asociacion Guyra Paraguay (guyra); Paraguay. Programa Nacional de Incentivo a los Investigadores; ParaguayFil: Cuéllar, E.. No especifíca;Fil: de la Sancha, N.U.. Asociación Paraguaya de Mastozoología; Paraguay. Chicago State University; Estados Unidos. Field Museum of National History; Estados UnidosFil: Gamarra de Fox, I.. Asociación Paraguaya de Mastozoología; Paraguay. Secretaría del Ambiente; ParaguayFil: Giordano, A.J.. Sociedad para la Preservación de Carnívoros en Peligro y su Estudio Ecológico Internacional; Estados UnidosFil: Kowalewski, Miguel Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia". Estación Biológica de Usos Múltiples (Sede Corrientes); ArgentinaFil: López, J.. Asociación Paraguaya de Mastozoología; Paraguay. Universidad de Buenos Aires; ArgentinaFil: Martínez, V.. Asociación Paraguaya de Mastozoología; Paraguay. Itaipu Binacional; ParaguayFil: Mujica, N.. Universidad Nacional de Asunción; ParaguayFil: Neris, N.. Asociación Paraguaya de Mastozoología; Paraguay. Secretaría del Ambiente; ParaguayFil: Ortiz, M.L.. Asociación Paraguaya de Mastozoología; ParaguayFil: Ramírez, F.. Asociación Paraguaya de Mastozoología; Paraguay. Fundación Moisés Bertoni; ParaguayFil: Ríos, S.D.. Asociación Paraguaya de Mastozoología; Paraguay. Secretaría Nacional de Cultura; ParaguayFil: Ruíz Díaz, M.. Asociación Paraguaya de Mastozoología; ParaguayFil: Sánchez, J.. Asociación Paraguaya de Mastozoología; Paraguay. Universidad Nacional de Asunción; ParaguayFil: Smith, P.. Asociación Paraguaya de Mastozoología; Paraguay. Programa Nacional de Incentivo a los Investigadores; ParaguayFil: Stevens, R.. Texas Tech University; Estados UnidosFil: Teta, Pablo Vicente. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Thompson, J.J.. Asociación Paraguaya de Mastozoología; Paraguay. Asociacion Guyra Paraguay (guyra); ParaguayFil: Torres, J.. Asociación Paraguaya de Mastozoología; ParaguayFil: Velázquez, M.. Asociación Paraguaya de Mastozoología; Paraguay. Fundación Moisés Bertoni; ParaguayFil: Velilla, M.. Asociación Paraguaya de Mastozoología; Paraguay. Asociacion Guyra Paraguay (guyra); Paraguay. Programa Nacional de Incentivo a los Investigadores; ParaguayFil: Villalba, L.. Asociación Paraguaya de Mastozoología; Paraguay. Wildlife Conservation Society; ParaguayFil: Weiler, A.. Asociación Paraguaya de Mastozoología; Paraguay. Programa Nacional de Incentivo a los Investigadores; Paraguay. Universidad Nacional de Asunción; Paragua

Assessing bleeding risk in patients taking anticoagulants

Anticoagulant medications are commonly used for the prevention and treatment of thromboembolism. Although highly effective, they are also associated with significant bleeding risks. Numerous individual clinical factors have been linked to an increased risk of hemorrhage, including older age, anemia, and renal disease. To help quantify hemorrhage risk for individual patients, a number of clinical risk prediction tools have been developed. These risk prediction tools differ in how they were derived and how they identify and weight individual risk factors. At present, their ability to effective predict anticoagulant-associated hemorrhage remains modest. Use of risk prediction tools to estimate bleeding in clinical practice is most influential when applied to patients at the lower spectrum of thromboembolic risk, when the risk of hemorrhage will more strongly affect clinical decisions about anticoagulation. Using risk tools may also help counsel and inform patients about their potential risk for hemorrhage while on anticoagulants, and can identify patients who might benefit from more careful management of anticoagulation

Pulmonary hypertension in Spanish patients with systemic sclerosis. Data from the RESCLE registry

[Introduction]: Our objective was to evaluate the pulmonary hypertension (PH) data for Spanish patients with systemic sclerosis (SSc), define the PH types and determine the associated factors.[Method]: Descriptive study of PH-related data from the multicentre RESCLE registry. Estimated systolic pulmonary artery pressure (esPAP), measured via echocardiogram was considered elevated if ≥ 35 mmHg. Left heart disease (LHD) and interstitial lung disease (ILD) were identified. When performed, data from right heart catheterisation (RHC) were collected.[Results]: esPAP was elevated in 350 of 808 patients (43.3%). One hundred and forty-four patients (17.8%) were considered to have PH (88 via RHC and the rest due to elevated esPAP along with evidence of significant LHD or ILD): PAH 3.7%, secondary to ILD 8.3%, secondary to LHD 2.8% and unclassified 3%. Prevalence of elevated esPAP was greater in diffuse SSc (dSSc) than in limited scleroderma (lSSc) (50.5 vs. 42.2%, p 0.046). In the group with elevated esPAP, a lower prevalence of anti-centromere antibodies (41.9% vs. 52.3%, p 0.006) and a greater prevalence of anti-topoisomerase-1 antibodies (ATA) (25.1% vs. 18.6%, p 0.04) were observed compared to the group with normal esPAP. Patients with elevated esPAP had a lower rate of digital ulcers (50.6% vs. 60.2%, p 0.007) and esophageal involvement (83.6% vs. 88.7%, p 0.07) and higher rate of renal crisis (4.6% vs. 1.8%, p 0.066).[Conclusions]: Prevalence of PAH was lower than expected (3.7%). Probability of having elevated esPAP was higher among patients with dSSc and among those with ATA