By Our correspondent
It is alarming to note that even though evidence-based consensus guidelines for prophylaxis of Venous Thrombo Embolism (VTE) - a common complication during and after hospitalisation for acute medical illness or surgery - have been available for more than 15 years, they still remain under-used.
Pulmonary embolism accounts for 5-10 per cent of deaths in hospitalised patients, making VTE the most common preventable cause of in-hospital deaths.
In addition to the acute risk of mortality, VTE is associated with long-term risks of post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension. These complications contribute substantially to patient morbidity and the cost of management.
These facts were debated during a symposium organised by Holy Family Hospital (HFH), in collaboration with Sanofi Aventis, to create awareness about VTE as part of the celebrations marking the 10th year of services being rendered by the Hospital’s Surgical Unit II.
Prof Asif Zafar Malik, head of Surgical Unit II, presented an overview of the current status of VTE, which he termed as a ‘silent killer.’ Presenting data from a global study (ENDORSE) conducted in 32 countries including Pakistan, he informed that worldwide, more than half of all hospitalised patients are at risk for VTE, and that surgical patients seem to be at higher risk than medical patients. Furthermore, only half of at-risk patients received a standardised method of prophylaxis.
The proportion of patients at risk for VTE did not vary greatly from country to country. However, there were marked differences between countries in the frequency of use of ACCP-recommended types of prophylaxis, which could be due to many factors, including physician awareness and availability of guidelines.
Surgical Unit II played a key role in assisting the Pakistan VTE Advisory Board in conducting awareness workshops and developing national guidelines for physicians to identify patients at risk and take appropriate measures.
Prof Tahira Zafar from Islamabad Medical & Dental College (IMDC) discussed the prophylaxis of such patients and treatment of established cases. She stressed the need for a multidisciplinary approach in dealing with high-risk patients and for haematological consultation.
Dr Ayesha Idress presented the audit of VTE patients. This study was conducted over a period of five years - between June 2004 and May 2009 - in the two surgical units of Holy Family Hospital, and 113 patients presented with DVT during this period were managed on the surgical floor. The mean age of presentation was 38 years, with a male to female ratio of 1:1.2. Pregnancy and puerperium resulted in 40 per cent of the cases, 18 per cent were due to idiopathic causes, 27 per cent due to immobility, and five per cent each due to malignancy and congenital factor deficiencies.
Highlighting the predominant causes of DVT in our setting, the study stresses on the fact that females during pregnancy, immobile patients either due to age, travelling, illnesses and malignancy are the main group of patients, who require close monitoring and a high index of suspicion for diagnosis of DVT.
The symposium provided a unique opportunity for reunion of hundreds of house surgeons, postgraduate trainees and faculty of Surgical Unit II. All these alumni of the department were presented shields to acknowledge their achievements and contributions to the Hospital’s Department of Surgery, which has two units catering to a large catchment area.
Surgical Unit II, which has just completed its 10 years, was established in 1999. To date, 25 postgraduate trainees of Prof Asif Zafar Malik have gone on to complete their training in Surgical Unit II and have obtained Fellowships from College of Physicians & Surgeons Pakistan (CPSP) and various Royal colleges of Surgeons in the United Kingdom and Australia. They now are serving with distinction as surgeons all over the country and abroad. Recently, one of its faculty members Dr Idress Anwar has been selected as Professor of Surgery.
Surgical Unit II has played a pioneering role in the promotion of telemedicine and e-health, and Minimal Access Surgery. Its Telemedicine/e-Health Training Centre is a designated facility for e-health training and specialist tele-consultations to remote rural sites in Punjab and Sindh. The Centre has trained over 100 doctors and nurses in telemedicine applications so far. Four remote hospitals in Attock, Pindi Gheb, Khushab and Gujrat are attached to the HFH telemedicine hub through satellite connectivity. The creation of rural telemedicine centres has enabled the rural population to seek consultation, advice and treatment from specialist doctors in urban centre hospitals, without having to travel hundreds of kilometres and waste their meagre financial resources on transportation and accommodation. More than 3,500 patients have so far received specialist consultations through this system.
Surgical Unit II also established a Virtual Trainer Lab in HFH in 2007, under phase 2 of the Pak-US Science & Technology Cooperation Programme. This lab focuses on teaching Minimal Access Surgery Skills to surgeons outside operation theatres. Equipped with conventional box trainers and virtual reality and full procedural simulators, the laboratory will train all residents in Rawalpindi Medical College allied teaching hospitals. It has already conducted short courses for faculty members.
The symposium was also attended by other staff members. Prominent among others was MS Holy Family Hospital Dr Syed Abid Hussain Shah, and Principal Rawalpindi Medical College Prof Mussadiq Khan. In the end, all faculty members joined in a cake-cutting ceremony, celebrating the 10 years of Surgical Unit II.