Journal of evaluation in clinical practice
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Direct oral anticoagulants (DOACs) effectively prevent recurrent venous thromboembolism (VTE). However, it is unknown which agents should be used to prevent recurrent VTE and which patients with unprovoked VTE should receive extended anticoagulation. We therefore sought to compare the efficacy and safety among DOACs for secondary prevention of VTE. We also determined a risk-adapted threshold for initiating extended anticoagulation based on the likelihood of VTE recurrence (without treatment) and bleeding (with treatment) in patients with unprovoked VTE. ⋯ All DOACs exhibit comparable efficacy for the prevention of recurrent VTE. Given that the risk of VTE recurrence is much higher than the calculated threshold for treatment, extended thromboprophylaxis should be considered in all patients with unprovoked VTE who do not have increased bleeding risk.
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ENT UK released guidelines in 2010 detailing the requisite structure for the creation of a laryngeal intervention clinic. The senior author's practice is the only one regionally that offers this service, and our objective was to review this to determine whether vocal cord medialization injections were showing an improvement in quality of voice for patients. ⋯ Vocal Cord local anaesthetic medialization injection is a swift, safe, and effective short-term method of improving dysphonia.
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The challenges of becoming a mature adult may distract young adults with type 1 diabetes from disease self-management, increasing risks for premature morbidity and mortality. Despite the importance of young adults with type 1 diabetes engaging with preventative diabetes-related health care services, few studies report health care professionals' experiences and perceptions of the support that is available, including during the period of transition. This study sought to determine these factors across diverse contexts in one health jurisdiction. ⋯ Findings identify opportunities for development in the planning and provision of specialist multidisciplinary health care support for this population. New ideas are needed for policy and practice innovation and for the infrastructure to facilitate this, to ensure that young adults with type 1 diabetes have access to consistent and coordinated diabetes health care services, particularly in nonmetropolitan settings.
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American Academy of Pediatrics released a clinical practice guideline (CPG) in 2016 recommending the term apparent life-threatening events (ALTE) be replaced by brief resolved unexplained events (BRUE). The CPG provides recommendations for the clinical evaluation and management of infants with this condition based on the risk of a serious underlying disorder or repeat event. The lower-risk CPG was applied to a modelled population, studying predictors of hospital admission, defined as length of stay (LOS) ≥ 24 hours. ⋯ Results suggest that use of the CPG under strict conditions would lead to fewer hospital admissions among infants with a lower-risk BRUE. Implementation of CPGs in modelled populations may help clinicians identify unanticipated factors and address these issues beforehand. We noted differences in care based on race, necessitating further investigation.
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While frailty status is an attractive risk stratification tool, the evaluation of frailty in acute care can be challenging as some inpatients are unable to complete performance-based tests as part of frailty assessment and some tools may lack discriminative ability and categorize majority of cohorts as "frail". In this study, we evaluated the feasibility of frailty screening with the simple clinical frailty scale (CFS) by different clinicians, and its association with mortality and rehospitalization in a geriatric acute care setting. ⋯ Frailty status determined by CFS adds to disease severity and comorbidity in predicting short-term mortality but not rehospitalization in older inpatients who received geriatric acute care in our setting. CFS is reliable and has the potential to be incorporated into routine screening to better identify, communicate, and address frailty in the acute settings.