An Ultrasound Screening Exam During Medicare Wellness Visits May Be Beneficial.

Objectives: The physical exam component of a periodic health visit in the elderly has not been considered useful. Standard Medicare Wellness visits require no physical exam beyond blood pressure and most physicians perform limited exams during these visits. The objective of this study was to test the feasibility, potential benefit, and costs of performing a screening ultrasound (US) exam during Medicare Wellness visits.

Rationale and design of an evidence-based tool to guide preoperative evaluation and management.

Background: In the United States, over-testing and over-treatment are recognised causes of excess cost and patient harm. Healthcare value, defined as health outcomes achieved relative to the costs of care, has become a focus to improve the quality and affordability of healthcare.

Aim: To describe the rationale for, and development of a standardised clinical preoperative decision-support tool.

Factor X and factor II activity levels do not always agree in warfarin-treated lupus anticoagulant patients.

Warfarin therapy is used in lupus anticoagulant patients with thrombosis and yet the prothrombin time (PT)/international normalized ratio (INR) in these patients can sometimes be falsely elevated. Both a PT-based factor II (FII) assay and a chromogenic, enzymatic factor X (CFX) assay have been used for monitoring when the INR may be artifactual. This study compared FII and CFX assays in lupus anticoagulant-positive and lupus anticoagulant-negative warfarin-treated patients in a cross-sectional study of samples from 21 lupus anticoagulant-positive and 19 lupus anticoagulant-negative outpatients.

Relationship between chromogenic factor X and international normalized ratio differs during early warfarin initiation compared with chronic warfarin administration.

Chromogenic factor X (CFX) monitoring is necessary in patients with potential international normalized ratio (INR) artifacts during warfarin therapy. The relationship of CFX with the INR needs to be quantitated to have warfarin protocols that are equivalent with either test as a monitoring parameter. This study investigated whether the CFX/INR relationship is different during warfarin initiation compared with that during chronic warfarin therapy.

Selecting an equation to estimate glomerular filtration rate for use in renal dosage adjustment of drugs in electronic patient record systems.

Study Objective: To identify a variant of the Cockcroft-Gault equation whose estimate would agree with the Modification of Diet in Renal Disease (MDRD) estimate of glomerular filtration rate (GFR) since the MDRD equation may not be programmable in some electronic patient record systems.

Design: Prospective case series.

Setting: A 625-bed, adults-only, private, tertiary care teaching hospital.

Unreliability of international normalized ratio for monitoring warfarin therapy in patients with lupus anticoagulant.

Study Objective: To compare the international normalized ratios (INRs) of patients positive for lupus anticoagulant and the INRs of control patients receiving warfarin therapy with equivalent therapeutic chromogenic factor X levels.

Design: Prospective case series.

Setting: A 625-bed, adult, private, tertiary care teaching hospital.

Achieving target antifactor Xa activity with a heparin protocol based on sex, age, height, and weight.

Study Objectives: To develop and validate an improved unfractionated heparin (UFH) dosage protocol, using antifactor Xa levels as the outcome variable.

Design: Prospective case series.

Setting: A 625-bed, adults-only private, tertiary care teaching hospital.

Unfractionated heparin infusion for thromboprophylaxis in highest risk gastric bypass surgery.

Background: Patients undergoing gastric bypass for obesity are at risk for postoperative venous thromboembolic complications. Per our routine, these patients receive unfractionated heparin (UFH) per a previously described, blood volume-based, subcutaneous prophylactic UFH protocol. However, some patients have additional risk factors for thromboembolism, and we consider these patients to be at highest risk.

Heparin thromboprophylaxis in gastric bypass surgery.

Background: Patients undergoing gastric bypass surgery are at risk for postoperative venous thromboembolism. Thromboprophylaxis often includes fixed doses of some type of heparin. However, it is unlikely that the same dose of subcutaneous heparin will be optimal for all patients, because heparin pharmacokinetics depend on a number of patient variables, including thickness of the adipose layer.