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Abstract-Until the 1990s, venous thromboembolism (VTE) was viewed primarily as a complication of hospitalization for major surgery (or associated with the late stage of terminal illness). However, recent trials in patients hospitalized with a wide variety of acute medical illnesses have demonstrated a risk of VTE in medical patients comparable with that seen after major general surgery. In addition, epidemiologic studies have shown that between one quarter and one half of all clinically recognized symptomatic VTEs occur in individuals who are neither hospitalized nor recovering from a major illness. This expanding understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who could benefit from prophylaxis. Factors sufficient by themselves to prompt physicians to consider VTE prophylaxis include major surgery, multiple trauma, hip fracture, or lower extremity paralysis because of spinal cord injury. Additional risk factors, such as previous VTE, increasing age, cardiac or respiratory failure, prolonged immobility, presence of central venous lines, estrogens, and a wide variety of inherited and acquired hematological conditions contribute to an increased risk for VTE. These predisposing factors are seldom sufficient by themselves to justify the use of prophylaxis. Nevertheless, individual risk factors, or combinations thereof, can have important implications for the type and duration of appropriate prophylaxis and should be carefully reviewed to assess the overall risk of VTE in each patient. Key Words: thrombus Ⅲ risk factors Ⅲ prevention Ⅲ embolism V TE consists of 2 related conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE). This review summarizes the strength of the evidence regarding specific risk factors for VTE and provides a guide for identifying patients who could benefit from VTE prophylaxis. This article also identifies population groups whose apparent risk for VTE is too low to justify preventive treatment.In 1884, Rudolph Virchow first proposed that thrombosis was the result of at least 1 of 3 underlying etiologic factors: vascular endothelial damage, stasis of blood flow, and hypercoagulability of blood. In the last century, recognition that all DVT risk factors reflect these underlying pathophysiologic processes and that VTE does not usually develop in their absence has increased. In a review of 1231 consecutive patients treated for VTE, 96% had Ն1 recognized risk factor (Table 1). 1 Furthermore, there is convincing evidence that risk increases in proportion to the number of predisposing factors (Figure 1). 2,3 The majority of clinically recognized instances of VTE are suspected because of typical signs and symptoms in individuals who present to an outpatient clinic or hospital emergency department; 1 only one quarter to one half of VTE are diagnosed in patients who are or were recently hospitalized. 1,4,5 Risk factors convincingly demonstrated for VTE include increasing age, prolonged immobility, malignancy...

Objective To develop a clinical risk prediction tool for estimating the cumulative six month risk of death and death or myocardial infarction to facilitate triage and management of patients with acute coronary syndrome.

The Palliative Performance Scale (PPS), a modification of the Karnofsky Performance Scale, is presented as a new tool for measurement of physical status in palliative care. Its initial uses in Victoria include communication, analysis of home nursing care workload, profiling admissions and discharges to the hospice unit, and, possibly, prognostication. We assessed 119 patients at home, of whom 87 (73%) had a PPS rating between 40% and 70%. Of 213 patients admitted to the hospice unit, 175 (83%) were PPS 20%-50% on admission. The average period until death for 129 patients who died on the unit was 1.88 days at 10% PPS upon admission, 2.62 days at 20%, 6.70 days at 30%, 10.30 days at 40%, 13.87 days at 50%. Only two patients at 60% or higher died in the unit. The PPS may become a basis for comparing drug costs at home and for studying the effects of treatments (e.g. hypodermoclysis) at various levels of physical performance. Validity and reliability testing are currently being undertaken.

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