Upper extremity deep vein thrombosis in hospitalized patients: a descriptive study

Increasingly, there is a focus on the prevention of hospital-acquired conditions including venous thromboembolism. Many studies have evaluated pulmonary embolism and lower extremity deep vein thrombosis, but less is known about upper extremity deep vein thrombosis (UEDVT) in hospitalized patients. The objective of this study was to describe UEDVT incidence, associated risks, outcomes, and management in our institution. Using an information technology tool, we reviewed records of all symptomatic adult inpatients diagnosed with UEDVT at an academic tertiary center between September 2011 and November 2012. Fifty inpatients were diagnosed with 76 UEDVTs. Their mean age was 49 years; 70% were men. Sixteen percent had a history of venous thromboembolism; 20% had a history of malignancy. The mean length of stay (LOS) was 24.6 days (range, 2-91 days); 50% were transferred from outside hospitals. Thirty-eight percent of UEDVTs were in internal jugular veins, 21% in axillary veins, and 25% in brachial veins. Forty-four percent of patients had UEDVT associated with central venous catheters (CVCs). During hospitalization, 78% were fully anticoagulated; 75% of survivors at discharge. Only 38% were discharged to self-care; 10% died during hospitalization. Patients with UEDVT were more likely to have CVCs, malignancy, and severe infection. Many patients were transferred critically ill with prolonged LOS and high in-hospital mortality. Most UEDVTs were treated even in the absence of concurrent lower extremity deep vein thrombosis or pulmonary embolism. Additional research is needed to modify risks and optimize outcomes. Journal of Hospital Medicine 2014;9:48-53. © 2013 Society of Hospital Medicine.

Prevalence, heritability and significance of musculoskeletal conformational traits in Thoroughbred yearlings

REASONS FOR PERFORMING STUDY

The assessment of belief that equine conformation is associated with performance and durability is a fundamental concept of horsemanship. Surprisingly, there is almost no quantitative evidence to support these beliefs.

OBJECTIVES

To assess the prevalence and heritability of conformational traits in Thoroughbred yearlings, and investigate their significance for subsequent turf flat-racing performance and durability.

METHODS

Nine selected conformational traits were assessed in a consistent, qualitative manner by a single veterinary observer and entered into a database together with details of pedigree and racing records.

RESULTS

Conformational data were collected from 3916 Thoroughbred yearlings sold at public auction during the 7 year period 1993-1999. Most of the horses (72%) raced in the UK in turf flat races; just 7% of the yearlings failed to race. Prevalence of conformational defects for the UK horses was reported, with turned out feet the most commonly recorded defect (30% of all horses). There was a tendency towards a greater proportion of horses with defects in the group of unraced horses compared with horses that raced, but this was not statistically significant. There were some significant associations between racing performance and conformational defects but these were found to be almost completely explained by an effect of sire. All of the conformational traits showed considerable evidence of genetic influence, with heritability indices ranging 0.16-1.00.

CONCLUSIONS AND POTENTIAL RELEVANCE

Overall, there were only weak associations between performance and conformation that could not be accounted for by the very strong relationship between pedigree and conformation. Further study of potential association between highly heritable conformation traits and racing durability and racing performance should be undertaken utilising validated, quantitative methods and technology.