The Impact of Obesity on Early Complications Following Tracheostomy: An Evaluation of a Nationwide Registry.

Introduction: The obesity epidemic is an important public health problem in the United States. Previous studies have revealed the association between obesity and various surgical complications. Tracheostomy which is an important lifesaving procedure may prove technically challenging in an obese patient.

Alert-Triggered Patient Education Versus Nurse Feedback for Nonadministered Venous Thromboembolism Prophylaxis Doses: A Cluster-Randomized Controlled Trial.

Background Many hospitalized patients are not administered prescribed doses of pharmacologic venous thromboembolism prophylaxis. Methods and Results In this cluster-randomized controlled trial, all adult non-intensive care units (10 medical, 6 surgical) in 1 academic hospital were randomized to either a real-time, electronic alert-triggered, patient-centered education bundle intervention or nurse feedback intervention to evaluate their effectiveness for reducing nonadministration of venous thromboembolism prophylaxis. Primary outcome was the proportion of nonadministered doses of prescribed pharmacologic prophylaxis.

Effectiveness of a Patient Education Bundle on Venous Thromboembolism Prophylaxis Administration by Sex.

Introduction: Venous thromboembolism (VTE) is a frequent cause of preventable harm among hospitalized patients. Many prescribed prophylaxis doses are not administered despite supporting evidence. We previously demonstrated a patient-centered education bundle improved VTE prophylaxis administration broadly; however, patient-specific factors driving nonadministration are unclear.

Audit and Feedback to Surgery Interns and Residents on Prescribing Risk-Appropriate Venous Thromboembolism Prophylaxis.

Objective: To evaluate the effectiveness of feedback using an emailed scorecard and a web-based dashboard on risk-appropriate VTE prophylaxis prescribing practices among general surgery interns and residents.

Design: Prospective cohort study.

Setting: The Johns Hopkins Hospital, an urban academic medical center.

Effectiveness of ambulation to prevent venous thromboembolism in patients admitted to hospital: a systematic review.

Background: Patient ambulation is frequently recommended to help prevent venous thromboembolism during hospital admission. Our objective was to synthesize the evidence for ambulation as a prophylaxis for venous thromboembolism in hospital.

Methods: We conducted a systematic review.

Contemporary analysis of charges and mortality in the use of extracorporeal membrane oxygenation: A cautionary tale.

Objective: The use of extracorporeal membrane oxygenation (ECMO) has increased exponentially. Costs and outcomes, however, vary considerably by indication. We sought to elucidate and quantify these differences.

Using electronic health record system triggers to target delivery of a patient-centered intervention to improve venous thromboembolism prevention for hospitalized patients: Is there a differential effect by race?

Background: Racial disparities are common in healthcare. Venous thromboembolism (VTE) is a leading cause of preventable harm, and disparities observed in prevention practices. We examined the impact of a patient-centered VTE education bundle on the non-administration of preventive prophylaxis by race.

Anti-Xa activity by weight in critically ill patients receiving unfractionated heparin for venous thromboembolism prophylaxis.

Purpose: This study compared anti-Xa activity in critically ill patients receiving UFH for VTE prophylaxis between two weight groups (<100 kg vs ≥100 kg).

Methods: This prospective, observational study included critically ill patients on UFH 5000 or 7500 units every 8 h. A peak and trough anti-Xa activity assay was ordered for each patient at steady state.

Effect of Real-time Patient-Centered Education Bundle on Administration of Venous Thromboembolism Prevention in Hospitalized Patients.

Importance: Numerous interventions have improved prescription of venous thromboembolism (VTE) prophylaxis; however, many prescribed doses are not administered to hospitalized patients, primarily owing to patient refusal.

Objective: To evaluate a real-time, targeted, patient-centered education bundle intervention to reduce nonadministration of VTE prophylaxis.

Design, Setting, And Participants: This nonrandomized controlled, preintervention-postintervention comparison trial included 19 652 patient visits on 16 units at The Johns Hopkins Hospital, Baltimore, Maryland, from April 1 through December 31, 2015.

Hypertension, overweight/obesity, and diabetes among immigrants in the United States: an analysis of the 2010-2016 National Health Interview Survey.

Background: Ethnic minority populations in the United States (US) are disproportionately affected by cardiovascular disease (CVD) risk factors, including hypertension, overweight/obesity, and diabetes. The size and diversity of ethnic minority immigrant populations in the US have increased substantially over the past three decades. However, most studies on immigrants in the US are limited to Asians and Hispanics; only a few have examined the prevalence of CVD risk factors across diverse immigrant populations.

Venous Thromboembolism Prevention in Emergency General Surgery: A Review.

Importance: Venous thromboembolism (VTE) is the most preventable cause of morbidity and mortality in US hospitals, and approximately 2.5% of emergency general surgery (EGS) patients will be diagnosed with a VTE event. Emergency general surgery patients are at increased risk of morbidity and mortality because of the nature of acute surgical conditions and the challenges related to prophylaxis.

Nonadministration of medication doses for venous thromboembolism prophylaxis in a cohort of hospitalized patients.

Purpose: Results of a study to characterize patterns of nonadministration of medication doses for venous thromboembolism (VTE) prevention among hospitalized patients are presented.

Methods: The electronic records of all patients admitted to 4 floors of a medical center during a 1-month period were examined to identify patients whose records indicated at least 1 nonadministered dose of medication for VTE prophylaxis. Proportions of nonadministered doses by medication type, intended route of administration, and VTE risk categorization were compared; reasons for nonadministration were evaluated.

Venous Thromboembolism in Patients Hospitalized for Lung Transplantation.

Background: Venous thromboembolism (VTE) is an important complication after solid organ transplantation. We sought to evaluate any association between VTE and in-hospital death, length of hospitalization, and total hospital charges for patients hospitalized for lung transplantation (LT).

Methods: We retrospectively reviewed the Nationwide Inpatient Sample to identify patients hospitalized for LT from 2000 to 2011.

Exploring the impact of route of administration on medication acceptance in hospitalized patients: Implications for venous thromboembolism prevention.

Background: Non-administration of venous thromboembolism (VTE) prophylaxis contributes to preventable patient harm. We hypothesized that non-administration would be more common for parenteral VTE prophylaxis than oral infectious disease or cardiac prophylaxis or for treatment medications. The primary study goal was to determine if non-administration of parenteral VTE prophylaxis is more frequent than other prophylactic or treatment medications.

Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: A randomized clinical trial.

Background: Venous thromboembolism (VTE) is a common cause of preventable harm in hospitalized patients. While numerous successful interventions have been implemented to improve prescription of VTE prophylaxis, a substantial proportion of doses of prescribed preventive medications are not administered to hospitalized patients. The purpose of this trial was to evaluate the effectiveness of nurse education on medication administration practice.

Characterizing the relationship between age and venous thromboembolism in adult trauma patients: findings from the National Trauma Data Bank and the National Inpatient Sample.

Background: Venous thromboembolism (VTE) is a tremendous burden in health care. However, current guidelines lack recommendations regarding the prevention of VTE in older adult trauma patients. Furthermore, the appropriate method of modeling of age in VTE models is currently unclear.

ECMO Support in Lung Transplantation: A Contemporary Analysis of Hospital Charges in the United States.

Background: There is little in the literature pertaining to cost associated with the use of extracorporeal membrane oxygenation (ECMO) in lung transplantation. We sought to evaluate charges associated with the index hospitalization among recipients of a lung transplant who required ECMO to identify factors that increase hospital charges in these patients.

Methods: With the use of the Nationwide Inpatient Sample, we reviewed data pertaining to patients who received a lung transplant between 2000 and 2011 and stratified them into ECMO and non-ECMO groups based on use of ECMO.

Prevalence of graduated compression stocking-associated pressure injuries in surgical intensive care units.

Purpose: This study aimed to determine the prevalence of static graduated compression stocking (sGCS)-associated pressure injury among patients in surgical intensive care units (ICUs).

Methods: We retrospectively reviewed data from wound care rounds between April 2011 and June 2012 at 3 surgical ICUs at an urban, tertiary care hospital. Patients with sGCS-associated pressure injury were identified and descriptive analysis was performed on their demographic, perioperative, and postoperative characteristics.

The Johns Hopkins Venous Thromboembolism Collaborative: Multidisciplinary team approach to achieve perfect prophylaxis.

Venous thromboembolism (VTE) is an important cause of preventable harm in hospitalized patients. The critical steps in delivery of optimal VTE prevention care include (1) assessment of VTE and bleeding risk for each patient, (2) prescription of risk-appropriate VTE prophylaxis, (3) administration of risk-appropriate VTE prophylaxis in a patient-centered manner, and (4) continuously monitoring outcomes to identify new opportunities for learning and performance improvement. To ensure that every hospitalized patient receives VTE prophylaxis consistent with their individual risk level and personal care preferences, we organized a multidisciplinary task force, the Johns Hopkins VTE Collaborative.

Length of Residence in the United States is Associated With a Higher Prevalence of Cardiometabolic Risk Factors in Immigrants: A Contemporary Analysis of the National Health Interview Survey.

Background: Cardiometabolic risk (CMR) factors including hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia are high among United States ethnic minorities, and the immigrant population continues to burgeon.

Methods And Results: Hypothesizing that acculturation (length of residence) would be associated with a higher prevalence of CMR factors, the authors analyzed data on 54, 984 US immigrants in the 2010-2014 National Health Interview Surveys. The main predictor was length of residence.

Airway complications after lung transplantation: Contemporary survival and outcomes.

Background: Airway complications are rare and cause increased morbidity and mortality after lung transplantation (LT). We sought to examine risk factors associated with this complication and its impact on survival.

Methods: We retrospectively evaluated United Network for Organ Sharing data from 2000 to 2012.