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Background. Right heart thrombus or clot in transit is a rare venous thromboembolism (VTE) with high mortality. COVID-19 infection has been associated with increased risk of such events. We present the case of a 63-year-old man with no traditional VTE risk factors who was diagnosed with a clot in transit three weeks after diagnosis of COVID-19. Clinical Case. A 63-year-old male with no significant past medical history who presented to the emergency department with shortness of breath. He tested positive for COVID-19 three weeks prior. His oxygen saturation was 60% on room air and was put on nonrebreather mask. He was still showing signs of respiratory distress including tachypnea, tachycardia, diaphoresis, and accessory muscle use. The patient was subsequently intubated and mechanically ventilated. Chest computed tomography with contrast showed acute bilateral pulmonary emboli with flattening of the interventricular septum suggestive of right heart strain. Bedside echocardiogram showed severely enlarged right ventricle with reduced systolic function and evidence of right ventricular strain and a mobile echodensity in the right ventricle attached to the tricuspid valve consistent with a clot in transit. The patient was treated with full dose systemic thrombolysis with rapid improvement in his symptoms. He was extubated the following day and a repeat echocardiogram showed resolution of the clot in transit. Conclusion. Clot in transit is rare but can occur in COVID-19 patients even in the absence of traditional thromboembolism risk factors. Management includes systemic anticoagulation, systemic thrombolysis, and surgical embolectomy. Our patient was successfully treated with systemic thrombolysis.

If maintaining a high level of activity and independence is the expectation in patients considered for THA for DICHFs, then current selection criteria appear to be appropriate in identifying those capable of returning home, remaining independent and surviving to 1 year compared to the whole DICHF population. With a 75% 3-year survival, the postulated benefit of THA will not be realised in many patients and this needs to be considered. Cost-effectiveness trials are required before broad practice change occurs.

ObjectivesDiscuss the impact of religious and cultural factors on reluctance to organ donation in hospice patients and their families.Recognize the lack of discussions about organ donations between hospice staff and the hospice patients or their families. Original Research Background. Organ donation occurs infrequently within palliative care. Cultural and religious beliefs may have a major impact on willingness to organ donation in hospice care. Research Objectives. To (1) Assess knowledge of hospice patients and their families about organ donation (2) Factors associated with willingness or reluctance to donation (3) Survey the discussion of organ donation between patients with the hospice staff. Methods. Cross-sectional questionnaire survey of hospice care patients and their families.154 patients or their families in a tertiary care hospital completed the questionnaire.Results. 78% (120/154) of patients (or the families) were aware of some form of organ donation but only 14.9% (23/154) thought that they were fit enough for some kind of organ donation and only one family was willing for corneal donation. Factors associated with such high level of reluctance were family perception that donation would add to misery of the patient, religion, lack of awareness of importance of donation, and culture-specific factors. The most common factors were religion and perception of adding misery to the dying patient. Only 11% (17/154) said that they had a discussion about organ donation with a hospice care staff.Conclusions. Hospice care itself is premature in low income countries, so knowledge and understanding about organ donation is even scarcer. Despite the majority opinion of Muslim jurists that organ donation is permitted in Sharia, surveys indicate continuing resistance by lay Muslims. The first step towards a better future would be better education of hospice staff regarding organ donation and Islam so that they disseminate the knowledge to their patients with better understanding. Allaying the anxiety of adding misery to the dying patient is also the responsibility of hospice staff by making the patients and families aware of a better donor care. ObjectivesIdentify active substance abuse as an issue complicating the pain management of many patients with cancer.Recognize the potential role of UDS in managing patients with cancer.Original Research Background. The high incidence of polypharmacy, chemical coping, opioid diversion, and underlying psychosocial concerns in cancer patients necessitates a comprehensive assessment in order to ensure safe opioid prescribing in the palliative setting. An adaptation of universal precautions that were initially developed for patients with non-cancer pain has been proposed for patients with cancer. These include assessments of substance abuse risk, monitoring of aberrant behavior, and screening/symptom assessment instruments.Research Objectives.1) Characterize the patients with abnormal UDS in a palliative care clinic; 2) Describe the use of unprescribed opioids and illicit drugs in ...