The American journal of medicine
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Review Case Reports
Decision-Making in the Management of Venous Thromboembolism.
Venous thromboembolism comprising deep venous thrombosis and pulmonary embolus is common. Patients with venous thromboembolism may present to a variety of health care providers, and while a significant proportion of patients begin treatment in the hospital, ambulatory management of both deep venous thrombosis and pulmonary embolus is feasible and becoming more common. ⋯ Comprehensive management of venous thromboembolism requires coordinated care from the time of presentation in order to expedite diagnosis, initiate timely anticoagulant treatment, determine the need for extended anticoagulation based on risk of bleeding and recurrent thrombosis, and advise on thromboprophylaxis during future high-risk periods for venous thromboembolism. In this review we use case scenarios to provide an operational framework, based on current evidence-based recommendations, for informed decision-making about a number of clinical practice issues that are frequently encountered in the management of venous thromboembolism patients.
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Intimate partner violence and elder abuse are common in the United States but often remain undetected. The incidence of these forms of abuse is difficult to quantify, but those with a history of abuse are at risk of chronic health conditions. ⋯ By increasing awareness, through physician education and increased screening, earlier detection of abuse may prevent more serious injuries and consequences. Therefore, this review evaluates current literature regarding the orthopedic manifestations of abuse in hopes of increasing physician awareness.
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Implementation of effective preventive interventions requires identification of high-risk individuals. We sought to define the distribution and trends of heart failure risk in the US population. ⋯ Mean population risk of heart failure increased significantly from 1999-2016. A substantial proportion of US adults are at high 10-year heart failure risk (≥5%), particularly non-Hispanic black men. These data underscore the importance of identifiying individuals at increased heart failure risk for targeted prevention measures to reduce the future burden of heart failure.
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Observational Study
Retention of Point-of-care Ultrasound Skills among Practicing Physicians: Findings of the VA National Point-of-care Ultrasound Training Program.
Point-of-care ultrasound (POCUS) use continues to increase in many specialties, but lack of POCUS training is a known barrier among practicing physicians. Many physicians are obtaining POCUS training through postgraduate courses, but the impact of these courses on skill retention and frequency of POCUS use post-course is unknown. The purpose of this study was to assess the change in POCUS knowledge, skills, and frequency of use after 6-9 months of participating in a brief training course. ⋯ Practicing physicians can retain POCUS knowledge and hands-on skills 8 months after participating in a 2.5-day POCUS training course, regardless of frequency of POCUS use post-course.
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Observational Study
Adherence to stepped care for management of musculoskeletal knee pain leads to lower healthcare utilization, costs, and recurrence.
This study aimed to report compliance with stepped care management of patellofemoral pain and determine whether adherence to stepped care results in decreased recurrence and lower health care utilization. ⋯ These findings demonstrate the value of following stepped care guidelines for pain management in patients with patellofemoral pain.