Does continuing professional development make good doctors?

Lee, Joseph C.; Chong, Jia Wen

doi:10.1111/imj.14119

Cited by 1 publication

(1 citation statement)

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“…For example, intestinal inflammation takes weeks to months to resolve, while complications such as abscesses and fistulas may persist longer. Global markers of coagulation also remained elevated up to 12 weeks after discharge . Furthermore, the vast majority of patients do not receive pharmacologic prophylaxis after discharge.…”

Section: Introductionmentioning

confidence: 99%

A clinical predictive model for post‐hospitalisation venous thromboembolism in patients with inflammatory bowel disease

McCurdy

Israel

Hasan

et al. 2019

Aliment Pharmacol Ther

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Background: Patients with inflammatory bowel disease (IBD) are at increased risk of venous thromboembolism (VTE) during hospitalisation and potentially post-discharge. Aims:To determine the incidence and risk factors for post-discharge VTE in IBD patients and create a point of care predictive model to assess VTE risk. Methods:Hospitalised IBD patients were identified from our institutional discharge database between 2009 and 2016, and were assessed for VTE by chart review. Risk factors for VTE within 3 months of discharge were determined by univariable and multivariable logistic regression. A point of care model was created using variables from the univariate analysis with P < 0.05, and internally validated by bootstrap methods.Results: Sixty-six of 2161 eligible discharges (3%) were associated with VTE within 6 months of hospitalisation. The median time to event was 37 days (range 3-182 days).On multivariable analysis age >45 years (OR 3.76; 95% CI 1.80-7.89) and multiple admissions (OR 2.62; 95% CI 1.34-5.11) were independently associated with VTE risk. Our final model incorporated age >45 years, multiple admissions, intensive care unit admission, length of admission >7 days and central catheter and was able to discriminate between discharges associated with and without VTE (optimism-corrected c-statistic, 0.70; 95% CI 0.58-0.77). By limiting treatment to a high-risk group, extended thromboprophylaxis could be avoided in 92% of discharges with a miss rate of 1.6% (32/1982 discharges). Conclusion: Patients with IBD remain at risk of VTE after hospital discharge. Our model may help clinicians stratify which patients will benefit most from extended thrombophrophylaxis. Admission characteristics Multiple admissions, n (%) 341 (15.8) LOA, median (IQR) 7 (4-11) Intensive care unit, n (%) 51 (2.36) Admission flare, n (%) 1370 (63.4) MRDx IBD, n (%) 1035 (47.9) Any surgery, n (%) 679 (31.4) Abdominal surgery, n (%) 554 (25.6) Central catheter, n (%) 261 (12.1) Peak CRP, median (IQR) 37.9 (11-91.4) Albumin, median (IQR) 28 (22-38)Abbreviations: CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CRP, C reactive protein; IBD, Inflammatory bowel disease; IQR, interquartile range; LOA, length of admission; MRDx, most responsible diagnosis; SD, standard deviation; TNF, tumour necrosis factor; VTE, venous thromboembolism.

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Section: Introductionmentioning

confidence: 99%