Racial differences in venous thromboembolism: A surveillance program in Durham County, North Carolina

BACKGROUND: Venous thromboembolism (VTE) affects approximately 1–2 individuals per 1000 annually and is associated with an increased risk for pulmonary hypertension, postthrombotic syndrome, and recurrent VTE. OBJECTIVE: To determine risk factors, incidence, treatments, and outcomes of VTE through a 2‐year surveillance program initiated in Durham County, North Carolina (population approximately 280,000 at time of study). PATIENTS/METHODS: We performed a retrospective analysis of data actively collected from three hospitals in Durham County during the surveillance period. RESULTS: A total of 987 patients were diagnosed with VTE, for an annual rate of 1.76 per 1000 individuals. Hospital‐associated VTE occurred in 167 hospitalized patients (16.9%) and 271 outpatients who were hospitalized within 90 days of diagnosis (27.5%). Annual incidence was 1.98 per 1000 Black individuals compared to 1.25 per 1000 White individuals (p < 0.0001), and Black individuals with VTE were younger than White individuals (p < 0.0001). Common risk factors included active cancer, prolonged immobility, and obesity, and approximately half were still taking anticoagulant therapy 1 year later. A total of 224 patients died by 1 year (28.5% of patients for whom outcomes could be confirmed), and Black patients were more likely to have recurrent VTE than White patients during the first 6 months following initial presentation (9.4% vs. 4.1%, p = 0.01). CONCLUSIONS: Ongoing surveillance provides an effective strategy to identify patients with VTE and monitor treatment and outcomes. We demonstrated that hospital‐associated VTE continues to be a major contributor to the burden of VTE and confirmed the higher incidence of VTE in Black compared to White individuals

Acuerdos y desacuerdos : una estrategia para mejorar la comprensión de textos argumentativos en los estudiantes del grado quinto de la Institución Educativa Agropecuaria Bernardino Becerra Rodríguez

Es de pleno conocimiento la importancia de fortalecer procesos de lectura, escritura y comprensión de textos para la lograr la aprensión y consolidación de los conocimientos en las distintas áreas del saber y esta ha sido una de las razones motivadoras de la investigación. Como principales referentes de esta propuesta se pueden mencionar a Daniel Cassany (2006), Isabel Solé (1992) y Kenneth Goodman (1982), quienes inspiraron la estructuración de este proceso investigativo y nos involucraron en los marcos teórico y conceptual. De esta manera se espera que esta propuesta tenga un impacto positivo en el aprendizaje de los estudiantes respecto a mejorar su capacidad de interpretación; así mismo que este trabajo se convierta en punto de referencia institucional, para las personas interesadas en continuar trabajando este tipo de temáticas.Magíster en EducaciónMaestrí

Establishing a Pilot Surveillance System for Venous Thromboembolism

The University of Oklahoma Health Sciences Center is collaborating with the Centers for Disease Control and Prevention to establish a pilot system for Venous Thromboembolism (VTE). We describe the features of this surveillance system that will improve the data quality and thus produce more reliable estimates of VTE disease burden in the U.S. In addition, we share lessons learned regarding how to implement a future scaled-up version of a national surveillance system for VTE

Establishing a Pilot Surveillance System for Venous Thromboembolism

The University of Oklahoma Health Sciences Center is collaborating with the Centers for Disease Control and Prevention to establish a pilot system for Venous Thromboembolism (VTE). We describe the features of this surveillance system that will improve the data quality and thus produce more reliable estimates of VTE disease burden in the U.S. In addition, we share lessons learned regarding how to implement a future scaled-up version of a national surveillance system for VTE

Correlates of in-hospital deaths among hospitalizations with pulmonary embolism: findings from the 2001-2008 National Hospital Discharge Survey.

BACKGROUND: Deep vein thrombosis and pulmonary embolism (PE) are responsible for substantial mortality, morbidity, and impaired health-related quality of life. The aim of this study was to evaluate the correlates of in-hospital deaths among hospitalizations with a diagnosis of PE in the United States. METHODS: By using data from the 2001-2008 National Hospital Discharge Survey, we assessed the correlates of in-hospital deaths among 14,721 hospitalizations with a diagnosis of PE and among subgroups stratified by age, sex, race, days of hospital stay, type of admission, cancer, pneumonia, and fractures. We produced adjusted rate ratios (aRR) and 95% confidence intervals using log-linear multivariate regression models. RESULTS: Regardless of the listing position of diagnostic codes, we observed an increased likelihood of in-hospital death in subgroups of hospitalizations with ages 50 years and older (aRR = 1.82-8.48), less than 7 days of hospital stay (aRR = 1.43-1.57), cancer (aRR = 2.10-2.28), pneumonia (aRR = 1.79-2.20), or fractures (aRR = 2.18) (except for first-listed PE), when compared to the reference groups with ages 1-49 years, 7 days or more of hospital stay, without cancer, pneumonia, or fractures while adjusting for covariates. In addition, we observed an increased likelihood of in-hospital death for first-listed PE in hospitalizations of women, when compared to those of men (aRR = 1.45). CONCLUSIONS: The results of this study provide support for identifying, developing, and implementing effective, evidence-based clinical assessment and management strategies to reduce PE-related morbidity and mortality among hospitalized PE patients who may have concurrent health conditions including cancer, pneumonia, and fractures

Estimated case-fatality rates and rate ratios for in-hospital death among hospitalizations with a PE diagnosis, 2001−2008, NHDS, United States.

a<p>Maximum subgroup sample size.</p>b<p>Confidence interval.</p>c<p><i>P</i>-value for Wald-F test.</p>d<p>Rate ratio.</p>e<p>Rate ratio from log-linear regression model that adjusted for age, sex, race, days of stay, type of admission, cancer, pneumonia, and fractures.</p>f<p>Referent rate ratio = 1.00.</p>g<p>Estimate may not be reliable due to underreporting of race information.</p>h<p>Unstable estimate due to small subgroup size.</p