The Journal of the American Osteopathic Association
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J Am Osteopath Assoc · Jul 2006
Venous thromboembolism: application and effectiveness of the American College of Chest Physicians 2001 guidelines for prophylaxis.
Guidelines on the use of prophylaxis in venous thromboembolism (VTE) are poorly implemented in clinical practice. ⋯ Adherence to the ACCP guidelines is suboptimal, with a substantial proportion of patients with VTE receiving inadequate prophylaxis. The additional finding that the incidence of VTE is high despite adequate prophylaxis indicates that the guidelines may need to be reevaluated.
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J Am Osteopath Assoc · Jul 2006
How misconceptions among elderly patients regarding survival outcomes of inpatient cardiopulmonary resuscitation affect do-not-resuscitate orders.
On hospital admission, many elderly patients make the decision to enact a do-not-resuscitate (DNR) order. However, few studies have evaluated the beliefs of elderly patients regarding the likelihood of surviving cardiopulmonary resuscitation (CPR) if it should become necessary during their hospitalization. ⋯ Elderly patients often hold erroneous beliefs regarding the outcomes of inpatient CPR. A significant number of our participants had standing DNR orders despite demonstrating extremely optimistic beliefs about CPR. Educating patients and their families about these poor outcomes would allow them to make more informed decisions regarding end-of-life issues.
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Although obstetrically related trauma remains the most common cause of injury to the female genital tract, trauma of nonobstetric origin is not uncommon. Reports of traumatic injuries to the vagina, especially lacerations, have been infrequent in the literature and offer only a generalized approach to this problem. ⋯ The authors report their recent experience with treating patients who have this type of trauma, review mechanisms of injury, and provide an organized treatment protocol for the nonobstetric patient with suspected vaginal laceration. Preparation for these emergencies circumvents dangerous delays and inadequate examination and treatment.