Electronic alerts to prevent venous thromboembolism.
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Anticoagulants↗
Biomedical subjects
Craig R Keenan
Publications and source records attributed to Craig R Keenan.
Age as a risk factor for venous thromboembolism after major surgery.
PURPOSE OF REVIEW: Postoperative deep venous thrombosis and pulmonary embolism are serious and potentially life-threatening complications that frequently occur after major surgery. Most guidelines for thromboprophylaxis use advancing age as a key component to estimate thromboembolic risk. The reported effect of age on postoperative venous thromboembolism varies widely, making it unclear whether age alone is a significant risk factor. This article reviews the recent literature on the effect of age on the incidence of postoperative venous thromboembolism. RECENT FINDINGS: Between 2003 and 2005, several cohort studies assessed the risk factors for postoperative venous thromboembolism, showing a variable effect of age on its incidence in the 2- to 3-month period after major surgery. Studies also revealed a significant difference in the effect of age on the incidence of venous thromboembolism depending on the type of surgery. Obesity, postoperative immobilization, the use of thromboprophylaxis, the nature of the surgery, and underlying comorbid conditions such as heart failure seem to have a greater influence on the risk of venous thromboembolism than does age. SUMMARY: The variation in the effect of age on postoperative venous thromboembolism likely depends on whether or not other comorbid conditions or age-related changes in functional status are considered as risk factors. When these other risk factors are taken into account, the effect of advanced age decreases. More research is needed to develop validated venous thromboembolism risk-prediction tools for specific types of surgery. By use of this information, the intensity and duration of postoperative thromboprophylaxis can be tailored to the level of risk, not just age alone.
Age Factors↗
Strategies to reduce medication errors in ambulatory practice.
Medication errors generally refer to mistakes made in the processes of ordering, transcribing, dispensing, administering or monitoring of pharmaceutical agents used in clinical practice. The Institute of Medicine report, To Err Is Human: Building a Safer Health System, has helped raise public awareness surrounding the issue of patient safety within our hospitals. A number of legislative and regulatory steps have resulted in hospital authorities putting in place various systems to allow for error reporting and prevention. Medication errors are being closely scrutinized as part of these hospital-based efforts. Most Americans, however, receive their healthcare in the ambulatory primary care setting. Primary care physicians are involved in the writing of several million prescriptions annually. The steps underway in our hospitals to reduce medication errors should occur concurrently with steps to increase awareness of this problem in the out-patient setting. This article provides an overview of strategies that can be adopted by primary care physicians to decrease medication errors in ambulatory practice.
Ambulatory Care↗
Visualizing the future: technology competency development in clinical medicine, and implications for medical education.
OBJECTIVE: In this article, the authors ask three questions. First, what will physicians need to know in order to be effective in the future? Second, what role will technology play in achieving that high level of effectiveness? Third, what specific skill sets will physicians need to master in order to become effective? METHOD: Through three case vignettes describing past, present, and potential future medical practices, the authors identify trends in major medical, technological and cultural shifts that will shape medical education and practice. RESULTS: From these cases, the authors generate a series of technology-related competencies and skill sets that physicians will need to remain leaders in the delivery of medical care. Physicians will choose how they will be end-users of technology, technology developers, and/or the interface between users and developers. These choices will guide the types of skills each physician will need to acquire. Finally, the authors explore the implications of these trends for medical educators, including the competencies that will be required of educators as they develop the medical curriculum. CONCLUSIONS: Examining historical and social trends, including how users adopt current and emerging technologies, allows us to anticipate changes in the practice of medicine. By considering market pressures, global trends and emerging technologies, medical educators and practicing physicians may prepare themselves for the changes likely to occur in the medical curriculum and in the marketplace.
Attitude to Health↗
Electronic medical records and their impact on resident and medical student education.
OBJECTIVE: Electronic medical records (EMRs) are becoming prevalent and integral tools for residents and medical students. EMRs can integrate point-of-service information delivery within the context of patient care. Though it may be an educational tool, little is known about how EMR technology is currently used for medical learners. METHOD: The authors reviewed the available published literature about the impact of EMRs on learners, including learners' attitudes about EMRs, educational uses of EMRs, and the potential effects of EMRs on learners' daily work. RESULTS: Research on EMRs for education is in its infancy. The authors found fewer than 50 articles with evidence on their use in medical education. The applications to education included point-of-care knowledge delivery, computerized clinical decision support systems, profiling of learner experiences, and daily workflow management. The evidence was mainly derived from single institution studies and occasionally across disciplines. CONCLUSIONS: EMRs have great potential as an educational tool, but thus far, strong data to support their use for this are lacking. As the usage of EMRs rises, educators must continue to study how best to use technology as an educational tool and as a tool to improve the daily work of residents and medical students.
Education, Medical↗