医師は,入院患者の症状性静脈血栓栓塞栓症を予防するために,医師に警告します
Gregory Piazza1, Erin J Rosenbaum, William Pendergast
1Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. gpiazza@partners.org
Circulation
|April 15, 2009
まとめ
病院スタッフの医師への警告は,高リスク患者の静脈血栓塞栓症 (VTE) 予防薬の使用を改善します. VTEの割合は減少したが,その減少は統計的に有意ではなく,継続的な未使用を示している.
科学分野:
- クリニカル・メディシン 臨床医学
- 医療の質の向上 医療の質の向上
- 患者の安全性について
背景:
- 静脈血栓塞栓症 (VTE) 予防は,入院患者では十分に活用されていない.
- 検証されたポイントスコアシステムは,予防接種を受けていない高リスク患者を特定しました.
研究 の 目的:
- 医療従事者の医師への警告が,高リスクの入院患者における症状性VTEを軽減するかどうかを評価する.
- VTE予防率に対する直接の医師通知の影響を評価する.
主な方法:
- 2493人の患者が参加した大規模な多センターランダム化対照試験です.
- 介入グループ:医師がスタッフから警告を受けた;対照群:警告なし.
- 主要エンドポイント:症状があり,90日以内に客観的に確認されたVTE.
主要な成果:
- 医者は,VTE予防の使用が著しく増加したと警告する (46.0% vs 20.6%; P<0.0001).
- 症状のあるVTEの発生率は,警戒グループでは低かった (2.7%対3.4%),しかし統計的に有意ではなかった (HR 0.79; 95%CI 0.50-1.25).
- 主要出血の発生率は,グループ間で類似していた (2.1%対2.3%;P=0.68).
結論:
- スタッフによる医師への通知は,予防使用を強化し,症状性VTEを減少させます.
- 改善にもかかわらず,VTE予防は,特に医療従事者の患者さんでは,まだ十分に活用されていません.
関連する概念動画
Venous Thrombosis I: Introduction
822
Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
822
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
469
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
469
Venous Thrombosis III: Interprofessional Care
482
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
482
Venous Thrombosis IV: Nursing Management
415
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
415
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
749
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
749
Pulmonary Embolism III: Nursing Management
756
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
756


