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Routine prophylaxis against venous thromboembolism is indicated following total joint arthroplasty. Prophylactic strategies differ in efficacy and safety, and variable risk exists among patients. Many strategies have been successfully used for chemoprophylaxis as well as mechanical prophylaxis with the use of pneumatic compression. Advances in battery technology and pump miniaturization have expanded the use of pneumatic compression in the post-discharge setting with mobile devices. Pneumatic compression is contraindicated in certain patients, and not all patients tolerate the devices. Mobile pneumatic compression is a valuable adjunct to venous thromboembolic risk mitigation strategies, but does not eliminate the need for pharmacologic agents.

Objective: To assess the application of a structured process to consolidate the number of medication administration times for residents of aged care facilities.Design A nonblinded, matched-pair, cluster randomized controlled trial. Setting and Participants: Permanent residents who were English-speaking and taking at least 1 regular medication, recruited from 8 South Australian residential aged care facilities (RACFs). Methods: The intervention involved a clinical pharmacist applying a validated 5-step tool to identify opportunities to reduce medication complexity (eg, by administering medications at the same time or through use of longer-acting or combination formulations). Residents in the comparison group received routine care. The primary outcome at 4-month follow-up was the number of administration times per day for medications charted regularly. Resident satisfaction and quality of life were secondary outcomes. Harms included falls, medication incidents, hospitalizations, and mortality. The association between the intervention and primary outcome was estimated using linear mixed models. Results: Overall, 99 residents participated in the intervention arm and 143 in the comparison arm. At baseline, the mean resident age was 86 years, 74% were female, and medications were taken an average of 4 times daily. Medication simplification was possible for 62 (65%) residents in the intervention arm, with 57 (62%) of 92 simplification recommendations implemented at follow-up. The mean number of administration times at follow-up was reduced in the intervention arm in comparison to usual care (−0.36, 95% confidence interval −0.63 to −0.09, P = .01). No significant changes in secondary outcomes or harms were observed. Conclusions and Implications: One-off application of a structured tool to reduce regimen complexity is a low-risk intervention to reduce the burden of medication administration in RACFs and may enable staff to shift time to other resident care activities. Refereed/Peer-reviewed

Purpose This radiation treatment planning study compares two approaches to designing a bolus for patients with head and neck cancer. Our current approach, based on clinical examination, is compared with an alternative approach, based on the patient's computed tomographic image data set, to investigate potential improvements in delivering the prescribed dose to the superficial regions of the clinical target volume (CTV) while limiting the dose to normal skin. Methods Twelve consecutive head and neck radiotherapy plans requiring a bolus were selected. A clinically placed bolus was designed by a radiation oncologist through physical examination of the patient. A virtual bolus was designed using an algorithm that configured it to overlay only the superficial CTV delineated on the patient's CT data set. These two approaches were compared on the basis of dose-volume histograms of normal skin and the superficial CTV, as well as the total bolus area. Results Of 12 patients, the virtual bolus plan resulted in a decrease in the bolus area of at least 4 cm 2 for nine patients, an increase in the bolus area of at least 30 cm 2 for three patients, and an improvement in the minimum dose to the superficial CTV in six patients. Of these six patients, half had a reduction in the bolus area with a corresponding modest 2% improvement in the minimum dose to the superficial CTV, whereas the other half had an increase in the bolus area with a corresponding dramatic 10%–57% improvement in the minimum dose to the superficial CTV. Conclusions Basing bolus design on computed tomography image data rather than on clinical examination reduced the area of normal skin under the bolus in 9 patients (75%) and improved dose coverage of the superficial CTV in 3 patients (25%). All plans benefited from the virtual bolus approach because it has been shown to be more appropriate for balancing skin sparing with target coverage.