Prelim Validation Prediction Rule for DVT

Prelim Validation Prediction Rule for DVT (Full Version)

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jma -> Prelim Validation Prediction Rule for DVT (May 29, 2005 4:29:00 AM)
Hello, Here is a nice article posted called, "A Preliminary Validation of Clinical Assessment for DVT in Orthopaedic Outpatients". A nice read. Here is the link: http://blog.evidenceinmotion.com/evidence/files/Riddle-dvt.pdf JMA

PTupdate.com -> Re: Prelim Validation Prediction Rule for DVT (May 29, 2005 11:28:00 AM)
I am away and using my someones elses computer, so won't hit that link until I get home. However, will have to dig through my site for a survey that was sent to me a few years ago regarding DVT's. Questions were asked of us and answers later mailed, in order to determine how successful we would have been at detecting this conditon. John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]

USAPT -> Re: Prelim Validation Prediction Rule for DVT (May 31, 2005 8:32:00 AM)
I believe the previous article they critiqued was www. ptjournal.org/ptjournal/aug2004/v84n8p729.cfm They were both interesting articles and I have made a small cheat sheet for the 9 step CDR. Of course it is just a guide but it is a little more specific than Homan's. One more thing to pull out of our tool bag when necessary.

jbeneciuk -> Re: Prelim Validation Prediction Rule for DVT (June 1, 2005 6:14:00 AM)
A great "cheat sheet" to have when DVT is suspected...I had a pt with a negative Homan's, yet fell within the scoring criteria for the DVT CDR....the pts physician was sure that she didn't have a DVT....the pt called me from the hospital that afternoon (she was admitted).....she did have a DVT, I contacted the author to thank him regarding the article and to let him know my experience... JBeneciuk

jma -> Re: Prelim Validation Prediction Rule for DVT (June 1, 2005 2:17:00 PM)
I would probably give a copy of this to all the operating surgeons whose patients I treat and for students to look at.

Dr.Wagner -> Re: Prelim Validation Prediction Rule for DVT (June 15, 2005 12:05:00 PM)
This is a review of Wells Criteria...but let me let you guys know (it is uncharted territory) but if you suspect a DVT and you document such, then you are obligated to tell the physician. If the patient DOES IN FACT have a DVT and was not told you can be sued for "breach of duty" as it would be your "duty" to inform the physician of a life threatening pathology. Be wary. This validation study is pretty well known stuff to those in medicine (yep unfortunately that excludes orthopods, as they are not really in touch with medicine outside of the carpentry of orthopedics).

jma -> Re: Prelim Validation Prediction Rule for DVT (June 15, 2005 5:44:00 PM)
Hmmm, how to get to the orthopods? I give their students a copy and let them give it to them personally and have them chat about it.

JLS_PT_OCS -> Re: Prelim Validation Prediction Rule for DVT (June 16, 2005 9:39:00 AM)
Well, Wags, I'm glad you and the physicians you work with are familiar with it. That has not been my experience in general practice, both civilian and military... A great tool to "pull out" as JK suggested... J

Dr.Wagner -> Re: Prelim Validation Prediction Rule for DVT (June 16, 2005 4:30:00 PM)
It is pretty basic stuff, could they have been humoring you? It wouldn't surprise me the military docs would be a bit on the "derrrr" side.

JLS_PT_OCS -> Re: Prelim Validation Prediction Rule for DVT (June 17, 2005 1:43:00 AM)
They could not have been. And it was much more common on the civilian side of the house. Especially those in primary care. But thank you for your hardly-concealed shot at military medicine, it's very professional, my good man. Hopefully that's not the sort clinical pearl you'll be imparting to those PT students someone is letting you instruct. Having experienced both, I'd take a military physician over a civilian one any day of the week and twice on sunday. But then again, maybe I'm a bit on the "derrr" side, too... J

MPT -> Re: Prelim Validation Prediction Rule for DVT (June 17, 2005 3:27:00 PM)
Using this CDR and some old fashion gut feeling I identifyed a pt with a DVT. He was another therapist’s pt who walked into the office last fri as I was on my way out. He c/o a sig sudden increase in leg pain (s/p TKA 3 months ago). I called his MD and sent him to the er. He was admitted that day. I really did not think it was a DVT but something did not seem right.

Alex Brenner PT MPT OCS -> Re: Prelim Validation Prediction Rule for DVT (June 20, 2005 2:31:00 AM)
Wagner, I don't understand the bashing that you do on the military health system. From what I have read of you in the past you worked at ONE Navy medical center and are generalizing what you saw there to the entire military health care system. That is like reading a case study and generalizing those findings to every patient. You can't do it. Military physicians are no different than what you would find at any typical hospital. They ALL went to U.S. Medical or DO schools and had to pass the same boards that you did. Many have gone to the Uniformed Health Services Medical school in Bathesda which consistently is ranked in the top percentage of all medical schools. Just because they wear a uniform does not mean that they are substandard providers.

JLS_PT_OCS -> Re: Prelim Validation Prediction Rule for DVT (June 20, 2005 4:30:00 AM)
Wags, Here's a agreement we can all live with: you don't generalize the poor care you saw from some military docs to all military providers, and I won't generalize to you the poor management of musculoskeletal problems by ER physicians I've seen. Fair enough? Got another ankle sprain in a posterior splint x2 wks.... Yes, board certified ER doc. May we dispense with the anecdotal reports of competence and just stick to facts? Thanks. Jason.

Dr.Wagner -> Re: Prelim Validation Prediction Rule for DVT (June 20, 2005 5:12:00 AM)
Well, I "bash" based upon working at the second largest airforce hospital in the country...and by mouth of 30 residents that were military and the ED attendings that were military. I "bash" because of what I saw...and also let me reverse some thoughts. Not all docs that are in the military have gone through residency...it is the ONLY place where you can practice from a single internship (ie flight surgeons, GMO's etc) The pathology in military hospitals and bases in the US is either 1. too basic, care is free 2. wrapped up in beaurocracy as it is necessary to jump through hoops to order basic emergency tests 3. the most difficult cases sent to surrounding civilian hospitals. This was a MAJOR medical center at one time, now they see no trauma, no cardiac caths, virtually no neurosurgery, no pediatric inpatients, no neonatal patients. In fact military surgeons are moonlighting in trauma centers to keep their skills up. Military ED docs are moonlighting in civilian EDs to keep their skills up. Hell, a PRESTIGIOUS military base in San Antonio is being threatened with suspension of their residency (EM) based upon poor patient census (there are only 2 residencies nationwide)...the ARMY military EM residency in Washington was suspended last year by the RRC by noncompliance with basic Civilian standards of care by teaching faculty. Hey some of the docs that come out of USUHS are brilliant, and the medical students are HIGHLY motivated...but ask any of them where they would prefer to practice if all of their military service time would spontaneously be forgiven. A good friend of mine felt obligated to work in a hospital moonlighting in the local civilian ED prior to military discharge because he felt "slower...out of touch" in the military ED. Hey don't get me wrong, this has nothing to do with the military and EVERYTHING to do with military health care cuts that has created this "clinic" environment at military medical centers. Forcing hospitals to go from 400 beds to 100 beds squeezes recources and is inept. We have different levels of quality definitions, a misdiagnosed ankle sprain (wow...oh the horror) vs inability to ultrasound a female with suspected ovarian torsion or ectopic pregnancy...or inability get a prompt CT for suspected PE.

JLS_PT_OCS -> Re: Prelim Validation Prediction Rule for DVT (June 22, 2005 8:34:00 AM)
Again, thanks for the anecodotal reports of your experience at one medical center. Don't know enough about the residency issue to comment one way or another. Though I'm not sure that equates to poor care being provided, seems to have everything to do with resources. Certainly being in the military is a unique environment, but these issues go both ways... At major military training bases we see often a compression sided stress fx of the femoral neck. THis condition is often unheard of in the civilian world. It responds quite well to forced rest and WB restriction. If it completes, it has all the devastating consquences of any other femoral neck fracture. We would send these young soldiers home on convalescent leave for a few weeks, where their mom and dad took them to a "Real Doctor" at the local orthopedic center. The surgeon, not being experienced in the difference between compression and tension sided femoral neck stress fractures, takes the kid to surgery and does an ORIF. Now they have a life and function limiting problem that would have resolved quite well with rest. So you see, I can go back and forth with you here on stories of whose medical system is better. I don't think you have any proof that there is substandard care being delivered in the military system. We agree that budget cuts are tough all over and that the system continues to evolve. But that's not different than what's going on in the civilian world. No military physician can spend more than a few years in general practice as a General Medical Officer before entering residency training, as budget cuts, resource allocation, and staff needs allow. If your beef truly is with the system and not with the providers, then don't make snide comments such as military physicians being "on the derrr side". Surely that is not the sort of professional behavior you routinely display in your much-better-than-the-military setting, is it? J

Alex Brenner PT MPT OCS -> Re: Prelim Validation Prediction Rule for DVT (June 23, 2005 1:49:00 AM)
Ok Wags, got it. Your beef is with the system not the individual providers. So your quote "military docs on the derr side" is unsubstantiated and was not appropriate to your true beliefs. "Derr", of course many military docs would prefer to work on the civilian side that is where they can make more money. Isn't this one of the main reasons people go to medical school. Like yourself from what I have read on rehabedge and on other forums, you got into medicine to make money and then realize that it is actually a lot of work with long hours, so you then complain about it and point out how easy we have it as PTs. Most military physicians that I know and work with are selfless, compassionate, patriots who are willing to work for less in return to have the since of serving their countries during times of war. In fact, one internal medicine physician, friend of mine, volunteered to deploy to Iraq and will be leaving our clinic here in Vicenza next week to do this. Finally, here are some pictures of a military "derr" physician and friend of mine from our clinic currently deployed in Afghanistan working 18 hour days taking care of soldiers and less fortunate Afghans. She is practicing "too basic" medicine, treating gun shot wounds, traumatic amputations from IED explosions and other combat related injuries. Maybe she would rather be working in your coosh civilian job, maybe not. [IMG]http://img.photobucket.com/albums/v85/brennerak/naylorkids4.jpg[/IMG] [IMG]http://img.photobucket.com/albums/v85/brennerak/naylorkids5.jpg[/IMG] [IMG]http://img.photobucket.com/albums/v85/brennerak/naylorkids6.jpg[/IMG]

jma -> Re: Prelim Validation Prediction Rule for DVT (June 24, 2005 8:24:00 AM)
Thanks for posting the interesting pictures. They are doing a great job there, despite what others think. JMA

Augustine5I -> Re: Prelim Validation Prediction Rule for DVT (July 2, 2005 3:00:00 PM)
Still no reply from Wagner...........

Dr.Wagner -> Re: Prelim Validation Prediction Rule for DVT (July 5, 2005 6:06:00 PM)
No reply primarily because I am busy...Well, as for only working "a few years" as GMO's...like 20? As my former residency has accepted a new intern who is not residency trained, but has worked in military ER's for 20 years. He is obtaining residency training as it is the new standard and you can't practice any other way. While the pictures are fantastic...does it prove your point or simply create sentiment? I am NOT speaking of docs on the front lines (where was that suggested, merely physicians at MAJOR and even small US bases). Furthermore, those pictures are EXACTLY why the military is lacking good docs...who the hell wants to go to the desert? It is clear absolutely clear, that the training now being recieved at military residencies is inferior to civilian training. Not only did the residency at U of W (famed Harborview) see the article http://www.acep.org/webportal/MemberCenter/Periodicals/EMToday/EM+TodayArchive/Archive+2005/EMTodayApril42005/EMResidentsPulledFromWashingtonHospital.htm?SetText=big but San Antonio is threatened as well...perhaps suspension. Listen guys, perhaps on the rehab side it is fine and dandy, but the medical side (get ortho out of your head for a moment, it is only a SMALL section of medicine) is in dire straits. If one of the largest airforce medical centers in the US cannot handle cardiac catherizations...then there is a problem. If virtually NO US military medical centers have adequate on site trauma to train residents, it is a problem. Military medical centers are simply substandard in the medical sense. For the common soldier it is unfortunate. Sure it is free. As for on the "derr" side, well, to trick an orthopedist ain't all that difficult. Regardless of civilian or military. I mean, what do you call a "double blinded study"...two orthopedists reading an EKG. Don't create a patriotic issue when there isn't one, don't use the sacrifice of military personnel to make a sentimental point on a chat board.

JLS_PT_OCS -> Re: Prelim Validation Prediction Rule for DVT (July 6, 2005 2:55:00 AM)
Wags- I have never worked with any physician who went more than 2 years without residency training. That has everything to do with limited numbers of training slots and the need for specialized care in certain areas (flight and dive medicine for example), and nothing to do with inferior care. It seems the link you provided talks about an emergency program from the University of Washington. The fact that Madigan Army Medical Center is affiliated with it does not make it a military facility. So your link must be critical of the U of Washington, I don't dispute your facts, but this is hardly germane to a discussion of the supposed poor care to be had in the military, now is it? As for your snide comments about Orthopedists, let me tell you (as I'm sure you already know) the kind of things they say about EM physicians...it ain't nice, either. Personally, I don't engage in that type of behavior towards my professional colleagues, but hey, to each his own. Once again, I am hearing a lot of stories about how bad things were where you worked, and a lot of cheap shots at military medicine and at other health care providers. What I'm NOT seeing is any evidence to support your points. There is some evidence to support the contention that there is quality care in the military (for example, research from military PTs, and the national ranking of USUHS, the military medical school), but I haven't seen anything other than your opinion and superior attitude to support your points. Again, I hope this isn't the kind of quality educational experience you intend to provide to the PT students you will be instructing. Don't create a quality care issue when there isn't one, don't use your limited experience with individuals to make an unfounded point on a chat board. J

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