The Experts below are selected from a list of 318 Experts worldwide ranked by ideXlab platform
P S Wells - One of the best experts on this subject based on the ideXlab platform.
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safety of Outpatient treatment in acute pulmonary embolism
Journal of Thrombosis and Haemostasis, 2010Co-Authors: Petra M G Erkens, Esteban Gandara, P S Wells, Alex Yihao Shen, Gauruv Bose, Marc A Rodger, Martin H Prins, Marc CarrierAbstract:See also Baglin T. Fifty per cent of patients with pulmonary embolism can be treated as Outpatients. This issue, pp 2404–5; Kovacs MJ, Hawel JD, Rekman JF, Lazo-Langner A. Ambulatory management of pulmonary embolism: a pragmatic evaluation. This issue, pp 2406–11. Summary. Introduction: Data regarding Outpatient treatment of pulmonary embolism (PE) is scarce. This study evaluates the safety of Outpatient management of acute PE. Methods: This is a retrospective cohort study of consecutive patients presenting at the Ottawa Hospital with acute PE diagnosed between 1 January 2007 and 31 December 2008. PE was defined as an arterial filling defect on CTPA or a high probability V/Q scan. Patients were managed as Outpatients if they were hemodynamically stable, did not require supplemental oxygenation and did not have contraindications to low-molecular-weight heparin therapy. Results: In this cohort of 473 patients with acute PE, 260 (55.0%) were treated as Outpatients and 213 (45.0%) were admitted to the hospital. The majority of the patients were admitted because of severe comorbidities (45.5%) or hypoxia (22.1%). No Outpatient died of fatal PE during the 3-month follow-up period. At the end of follow-up, the overall mortality was 5.0% (95% CI, 2.7–8.4%). The rates of recurrent venous thromboembolism (VTE) in Outpatients were 0.4% (95% CI, 0.0–2.1%) and 3.8% (95% CI, 1.9–7.0%) within 14 days and 3 months, respectively. The rates of major bleeding episodes were 0% (95% CI, 0–1.4%) and 1.5% (95% CI, 0.4–3.9%) within 14 days and 3 months, respectively. Four (1.5%) Outpatients were admitted to the hospital within 14 days. Conclusions: A majority of patients with acute PE can be managed as Outpatients with a low risk of mortality, recurrent VTE and major bleeding episodes.
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Outpatient treatment of pulmonary embolism with dalteparin
Thrombosis and Haemostasis, 2000Co-Authors: Michael J Kovacs, D Anderson, Bev Morrow, Lisa Gray, Donna Touchie, P S WellsAbstract:Background: Pulmonary embolism is a common complication of deep vein thrombosis. It has been established that low molecular weight heparin may be used to treat deep vein thrombosis or pulmonary embolism and randomized studies have established that Outpatient management of deep vein thrombosis with low molecular weight heparin is at least as effective as in-hospital management with unfractionated heparin. Methods: This was a prospective cohort study of eligible patients with pulmonary embolism managed as Outpatients using dalteparin (200 U/kg s/c daily) for a minimum of five days and warfarin for 3 months. Outpatients included those managed exclusively out of hospital and those managed initially for 1-3 days as inpatients who then completed therapy out of hospital. Reasons for admission included hemo-dynamic instability; hypoxia requiring oxygen therapy; admission for another medical reason; severe pain requiring parenteral analgesia or high risk of major bleeding. Patients were followed for three months for clinically apparent recurrent venous thromboembolism and bleeding. Results: Between three teaching hospitals, a total of 158 patients with pulmonary embolism were identified. Fifty patients were managed as inpatients and 108 as Outpatients. Of the Outpatients, 27 were managed for an average of 2.5 days as inpatients and then completed dalteparin therapy as Outpatients. The remaining 81 patients were managed exclusively as Outpatients with dalteparin. For all Outpatients the overall symptomatic recurrence rate of venous thromboembolism was 5.6% (6/108) with only 1.9% (2/108) major bleeds. There were a total of four deaths with none due to pulmonary embolism or major bleed. Conclusions: This prospective study suggests that Outpatient management of pulmonary embolism is feasible and safe for the majority of patients.
Giuliana Trucco - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of inpatient and Outpatient treatment strategies for women with pelvic inflammatory disease results from the pelvic inflammatory disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, David E Soper, Robert L Holley, Jeffrey Peipert, Hugh Randall, Richard L Sweet, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Giuliana TruccoAbstract:OBJECTIVE: Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic inflammatory disease are treated as Outpatients, the effectiveness of this strategy remains unproven. STUDY DESIGN: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus Outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy. RESULTS: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and Outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for Outpatients and 41.7% for inpatients). There were also no statistically significant differences between Outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic inflammatory disease recurrence, chronic pelvic pain, or ectopic pregnancy. CONCLUSION: Among women with mild-to-moderate pelvic inflammatory disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to Outpatient treatment.
Marc Carrier - One of the best experts on this subject based on the ideXlab platform.
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safety of Outpatient treatment in acute pulmonary embolism
Journal of Thrombosis and Haemostasis, 2010Co-Authors: Petra M G Erkens, Esteban Gandara, P S Wells, Alex Yihao Shen, Gauruv Bose, Marc A Rodger, Martin H Prins, Marc CarrierAbstract:See also Baglin T. Fifty per cent of patients with pulmonary embolism can be treated as Outpatients. This issue, pp 2404–5; Kovacs MJ, Hawel JD, Rekman JF, Lazo-Langner A. Ambulatory management of pulmonary embolism: a pragmatic evaluation. This issue, pp 2406–11. Summary. Introduction: Data regarding Outpatient treatment of pulmonary embolism (PE) is scarce. This study evaluates the safety of Outpatient management of acute PE. Methods: This is a retrospective cohort study of consecutive patients presenting at the Ottawa Hospital with acute PE diagnosed between 1 January 2007 and 31 December 2008. PE was defined as an arterial filling defect on CTPA or a high probability V/Q scan. Patients were managed as Outpatients if they were hemodynamically stable, did not require supplemental oxygenation and did not have contraindications to low-molecular-weight heparin therapy. Results: In this cohort of 473 patients with acute PE, 260 (55.0%) were treated as Outpatients and 213 (45.0%) were admitted to the hospital. The majority of the patients were admitted because of severe comorbidities (45.5%) or hypoxia (22.1%). No Outpatient died of fatal PE during the 3-month follow-up period. At the end of follow-up, the overall mortality was 5.0% (95% CI, 2.7–8.4%). The rates of recurrent venous thromboembolism (VTE) in Outpatients were 0.4% (95% CI, 0.0–2.1%) and 3.8% (95% CI, 1.9–7.0%) within 14 days and 3 months, respectively. The rates of major bleeding episodes were 0% (95% CI, 0–1.4%) and 1.5% (95% CI, 0.4–3.9%) within 14 days and 3 months, respectively. Four (1.5%) Outpatients were admitted to the hospital within 14 days. Conclusions: A majority of patients with acute PE can be managed as Outpatients with a low risk of mortality, recurrent VTE and major bleeding episodes.
Lewis E Kazis - One of the best experts on this subject based on the ideXlab platform.
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mental disorders and mental health treatment among u s department of veterans affairs Outpatients the veterans health study
American Journal of Psychiatry, 1999Co-Authors: Cheryl S Hankin, Avron Spiro, Donald R Miller, Lewis E KazisAbstract:OBJECTIVE: The authors examined the self-reported presence and treatment of current depressive disorder, posttraumatic stress disorder (PTSD), and alcohol-related disorder in a group of Outpatient veterans. METHOD: Data were obtained from the Veterans Health Study, a longitudinal investigation of male veterans’ health. A representative sample of 2,160 Outpatients (mean age=62 years) was drawn from Boston-area U.S. Department of Veterans Affairs (VA) Outpatient facilities. The participants completed screening measures for depression, PTSD, and alcohol-related disorder. Mental health treatment was assessed by interviews. RESULTS: The screening criteria for at least one current mental disorder were satisfied by 40% (N=856) of the patients. Screening rates were 31% (N=676) for depression, 20% (N=426) for PTSD, and 12% (N=264) for alcohol-related disorder. Patients who screened positively for current mental disorders were younger, less likely to be married or employed, and more likely to report traumatic expos...
Roberta B Ness - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of inpatient and Outpatient treatment strategies for women with pelvic inflammatory disease results from the pelvic inflammatory disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, David E Soper, Robert L Holley, Jeffrey Peipert, Hugh Randall, Richard L Sweet, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Giuliana TruccoAbstract:OBJECTIVE: Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic inflammatory disease are treated as Outpatients, the effectiveness of this strategy remains unproven. STUDY DESIGN: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus Outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy. RESULTS: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and Outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for Outpatients and 41.7% for inpatients). There were also no statistically significant differences between Outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic inflammatory disease recurrence, chronic pelvic pain, or ectopic pregnancy. CONCLUSION: Among women with mild-to-moderate pelvic inflammatory disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to Outpatient treatment.
