Management of upper extremity deep venous thrombosis in a hospice patient.

BACKGROUND: In this case report, upper extremity deep venous thrombosis (UEDVT) is discussed with special attention to the diagnosis, treatment, and prevention in palliative care patients. METHODS: A 43-year-old female with a history of metastatic breast cancer presented with a UEDVT. Standard anticoagulation was unsuccessful, so after a complete discussion about the treatment options, alternative therapy was used for clot lysis. CONCLUSION: Aggressive treatment of UEDVT in a palliative care setting has the potential for improving the quality of life, yet because of the increased risk of complications and philosophy of palliative medicine, the treatment strategy for each patient should be carefully considered.

Service vs education: situational and perceptional differences in surgery residency.

OBJECTIVE: This study determined whether situational or perceptional differences exist when trying to define what constitutes "service" and "education" in surgery residency in relation to the Accreditation Council of Graduate Medical Education (ACGME) survey. DESIGN: An institutional review board-approved, single institute, cross-sectional study was conducted through a survey. Participants were asked to rate common resident tasks. Participants were also asked general questions regarding "service" and "education." SETTING: Wright State University surgery program, Dayton, OH. PARTICIPANTS: The study included 69 participants, which included medical students (19), residents (26), nurses/advanced practitioners (14), and attending surgeons (10). RESULTS: A significantly high number of attending surgeons reported that writing a history and physical examination is educational compared with residents and students. Similar results were found regarding talking with patients/families. Drawing blood and starting peripheral intravenous access were universally rated as service tasks. For laparoscopic cholecystectomy, when the resident had done one previously, it was universally thought educational. When the resident had done more, most attending surgeons thought the task educational, but residents and students thought it much less educational. When analyzing only residents, in talking with families, most interns rated this as service, whereas postgraduate years 2 and 3 reported it as more educational and postgraduate years 4 and 5 ranked it equally as service and educational. Similar results were seen in answering nursing phone calls and writing admission orders. Residents (88%) and attending surgeons (90%) agreed that service is part of residency training. Only 40% of residents, however, stated they know what the term "service" means in regard to the ACGME survey. Overall, 80% of attending surgeons and 44% of residents agree that "service" has not been well defined by the ACGME. CONCLUSIONS: Situational and perceptional differences do exist regarding "service" and "education" in our program, and most participants are unclear about the terms. As the definitions are situational and change with the person queried, then should this be the ACGME standard to assess programs and issue citations?