Established Practice Standards Research Articles

Managing Substance Use Disorders and Addiction: How to Integrate Professionalism and Ethics with the Complexity of Diagnosis and Therapy

Physicians and other healthcare staff who work with the patients having substance use disorders (SUDs) and addiction have to deal with different and complex scenario invariably in comparison to other healthcare providers dealing with regular medical services sought by the patients. Hence, the unconventional nature of practice regarding patients of SUDs and addiction and the diverse range of backgrounds among substance use workers, e.g., psychiatrist, general physician, nurse, psychotherapist, counsellor, social worker, and public health specialist highlights the universal relevance of being more professional and more ethical in practice. They are expected to demonstrate a variety of ethical and professional competences to safeguard themselves and others involved. Clinical team engaged in such activities requires specific ethical training that can help them face specific ethical dilemmas and guide through deeper consideration of those pressing and complex issues, using specific framework, professional guidelines, or institutional management approaches. Professional societies and accrediting institutions should apply their authority to establish practice standards, competencies, regulatory procedures, and codes of ethics to help guide practice and protect public trust and confidence. For the team involved in practice, it is important to become familiar with and adhere to the principles and values that define professionalism and ethical conduct in care for patients suffering from SUDs and addiction. The review paper aims to examine the intersection of professionalism and ethics with the complexity of diagnosis and therapy in this specific area of practice. Besides, some frameworks will be highlighted which may help healthcare providers to foster ethical decision making. It is also a modest effort to show some new insights for improving the quality of care in addiction and mental health by the professional team and healthcare organization from both clinical and operational viewpoint. Mugda Med Coll J. 2024; 7(1): 42-47

Thromboembolism prophylaxis practices of pediatric and congenital electrophysiologists during invasive electrophysiology studies: A PACES survey.

Thromboembolic events related to invasive electrophysiology studies, while rare, can have devastating consequences. Use of systemic anticoagulation for a pediatric or adult-congenital invasive electrophysiology study is recommended, however there is no established standard of practice in this population. To report on procedural practices for thromboembolism prophylaxis during invasive electrophysiology studies for pediatric patients and adults with congenital heart disease. An anonymous web-based survey was sent to the members of the Pediatric and Congenital Electrophysiology Society. The survey focused on pre-procedural, intra-procedural, and post-procedural thromboembolism prophylaxis practices during invasive electrophysiology studies. Significant practice variation was defined as <90% concordance among respondents. Survey was completed by 73 members; 52 (71%) practicing in the United States, 65 (89%) practicing in an academic institution, and 14 (19%) in an institution that performs more than 200 invasive electrophysiology procedures annually. Responses showed significant variation in practice. Prior to an invasive electrophysiology procedure, 25% discontinue aspirin while 47% discontinue anticoagulants. Heparin is given for all procedures by 32%. When heparin is administered, the first dose is given by 32% after sheaths are placed, 42% after crossing into the systemic atrium, and 26% just prior to systemic-side ablation. Most target an activated clotting time between 200-300 seconds. Post systemic-side ablation, 58% do not initiate a heparin infusion. Post-procedural oral agents were initiated on day of procedure by 34% of respondents and on post-procedure day 1 by 53%. If treating with aspirin, 74% use low-dose (3-5mg/kg or 81mg daily), and 68% treat for 4-6weeks. There is significant variation in thromboembolism prophylaxis for invasive EP studies among pediatric and congenital electrophysiologists. Further studies are needed to optimize the management of thromboembolism prophylaxis in this population.

Mediport use as an acceptable standard for CAR T cell infusion.

Mediport use as a clinical option for the administration of chimeric antigen receptor T cell (CAR T cell) therapy in patients with B-cell malignancies has yet to be standardized. Concern for mediport dislodgement, cell infiltration, and ineffective therapy delivery to systemic circulation has resulted in variable practice with intravenous administration of CAR T cell therapy. With CAR T cell commercialization, it is important to establish practice standards for CAR T cell delivery. We conducted a study to establish usage patterns of mediports in the clinical setting and provide a standard of care recommendation for mediport use as an acceptable form of access for CAR T cell infusions. In this retrospective cohort study, data on mediport use and infiltration rate was collected from a survey across 34 medical centers in the Pediatric Real-World CAR Consortium, capturing 504 CAR T cell infusion routes across 489 patients. Data represents the largest, and to our knowledge sole, report on clinical CAR T cell infusion practice patterns since FDA approval and CAR T cell commercialization in 2017. Across 34 sites, all reported tunneled central venous catheters, including Broviac® and Hickman® catheters, as accepted standard venous options for CAR T cell infusion. Use of mediports as a standard clinical practice was reported in 29 of 34 sites (85%). Of 489 evaluable patients with reported route of CAR T cell infusion, 184 patients were infused using mediports, with no reported incidences of CAR T cell infiltration. Based on current clinical practice, mediports are a commonly utilized form of access for CAR T cell therapy administration. These findings support the safe practice of mediport usage as an accepted standard line option for CAR T cell infusion.

Cognitive impairment and behavioural emergencies within the acute hospital setting

BackgroundPatients with cognitive impairment exhibiting agitation and aggression are challenging to manage in the acute hospital setting. When a patient’s behaviours place themselves or others at risk of harm, a...

Constraint-Induced Movement Therapy for Infants With or at Risk for Cerebral Palsy: A Scoping Review.

Although research shows that older children with hemiplegic cerebral palsy (CP) benefit from constraint-induced movement therapy (CIMT), the efficacy of CIMT among the infant population is unknown. To explore the existing evidence on CIMT for infants age 24 mo and younger with CP or at risk for CP. PubMed, CINAHL, Cochrane, and ProQuest were searched. Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and American Occupational Therapy Association guidelines were used for abstracting data and assessing data quality. Two frameworks guided this scoping review. Studies met the following criteria: infants with hemiplegic CP, published in English between 2000 and 2020, peer reviewed, and addressed changes in upper limb function of the hemiplegic upper limb. Eight articles met the inclusion criteria: 2 randomized controlled trials, 1 retrospective cohort design, 1 pretest-posttest study, 2 single-subject studies, and 2 case studies. In this scoping review, we examined CIMT protocols for an overview of dosage, constraint, administration, parent training and education, and objective outcome measures. Existing literature supports CIMT protocols for infants with CP. However, much variability exists in protocol design and appropriate outcome measures among studies. Higher level research is needed to support the efficacy of CIMT among infants with CP. What This Article Adds: This scoping review summarizes the existing literature on CIMT for infants with hemiplegic CP. This information can help guide therapists to implement CIMT protocols in the clinical setting and to identify additional research to establish practice standards.

Patient safety during joint replacement surgery: experiences of operating room nurses

BackgroundAvoidable complications for surgical patients still occur despite efforts to improve patient safety processes in operating rooms. Analysis of experiences of operating room nurses can contribute to better understanding of...

Acquisition and Interpretation of Digital Information in Forensic Assessments

Despite the now ubiquitous presence of technology in everyday life, there is little written on the subject of personal digital data as it pertains to forensic mental health evaluations. Ethical concerns and limited consensus guidance on this issue have previously made it challenging to use this information in a responsible way. This Perspectives article elaborates on the different types of personal data that exist and the practical aspects of acquiring such information, including data location and legal considerations. Incorporation of personal digital information into the forensic assessment as a form of collateral information is discussed, along with the current state of the literature on technology use and its relationship to psychopathology and risk. Given the important role of technology in the life of the modern individual, deeper research into this topic will be necessary in the immediate future to establish practice standards for the safe and ethical use of digital information in both forensic and non-forensic mental health assessments.

Mapping of Community Pharmacy Practices in Medan City Indonesia

Pharmaceutical practice standards are benchmarks used, especially pharmacists in carrying out pharmaceutical services. But this pharmaceutical practice has not been carried out by community pharmacy pharmacists. Pharmaceutical services are very dependent on the application of established practice standards. Therefore, revitalization efforts need to be made to meet the criteria of pharmaceutical practice in accordance with the applicable standards. This study aims to ensure that community pharmacy practice in Medan city and coaching efforts to restore pharmaceutical practices are in accordance with predetermined standards. This is a cross sectional descriptive research, using quistionnaires in Juni – September 2020. The research sample 105 pharmacist in community pharmacy taken by cluster random sampling. The results showed that the community pharmacy practice has not been running according to standards. The percentage of pharmacies with accreditation A was 67.6%, accredited B 21.0%, accredited C was 9.5%, and not accredited was 1.9%.While the percentage of very good category of pharmaceutical practice was only 20%, good category was 48%, just 21%, 9% less, and sub-standard criteria of 2%.Several factors play a role in determining the value of accreditation and pharmaceutical practice criteria after being statistically tested, namely the presence or absence of other jobs from pharmacists, pharmacy status, pharmacist's presence, and year of graduation from the pharmacist, with a significance &lt;0.05.Based on the explanation can be concluded that the practice community pharmacy in the city of Medan has not met the established pharmaceutical standards.&#x0D;

A Systematic Review and Meta-Analysis of the Diagnostic Accuracy of the Advanced Clinical Solutions Word Choice Test as a Performance Validity Test.

Thorough assessment of performance validity has become an established standard of practice in neuropsychological assessment. While there has been a large focus on the development and cross-validation of embedded performance validity tests (PVTs) in recent years, new freestanding PVTs have also been developed, including the Word Choice Test (WCT) as part of the Advanced Clinical Solutions Effort System. And, while the WCT's general utility for identifying invalid performance has been demonstrated in the ensuing decade since its initial publication, optimal cut-scores and associated psychometric properties have varied widely across studies. This study sought to synthesize the existing diagnostic accuracy literature regarding the WCT via a systematic review and to conduct a meta-analysis to determine the performance validity cut-score that best maximizes sensitivity while maintaining acceptable specificity. A systematic search of the literature resulted in 14 studies for synthesis, with eight of those available for meta-analysis. Meta-analytic results revealed an optimal cut-score of ≤ 42 with 54% sensitivity and 93% specificity for identifying invalid neuropsychological test performance. Collectively, the WCT demonstrated adequate diagnostic accuracy as a PVT across a variety of populations. Recommendations for future studies are also provided.

A study of the reasons for prescribing and misuse of gabapentinoids in prison including their co-prescription with opioids and antidepressants

PurposeElectronic medical case files of male prisoners in a category B prison in London were studied to establish a prevalence during an eight-month period of the use of and the reasons for prescribing gabapentinoids in prison and also to establish prescribing standards in prison and compliance with these. In addition, the prevalence of co-prescription of gabapentinoids with opioids and antidepressants, particularly tricyclic antidepressants such as amitriptyline, was also assessed in light of the increased risk of respiratory depression resulting in death when these drugs are used in combination. The paper aims to discuss these issues.Design/methodology/approachA retrospective, SystmOne case-file based survey was undertaken searching by SNOMED CT supplemented by examination of free text, in a category B prison for males (Capacity 1,500 prisoners; Average turnover of prisoners up to 6,000 per year), to establish practice standards related to the prescription of Gabapentinoids in the prison and determine compliance with these.FindingsIn total, 109 cases were identified of prisoners having been prescribed gabapentinoids, pregabalin in 66 cases (61 per cent) and gabapentin in 43 cases (39 per cent). In 36 cases (33 per cent) prescriptions were for unlicensed indications. This in fact represented 50 per cent of the cases where the indications were documented. In 51 cases (47 per cent) gabapentinoids were prescribed with an opioid substitute. In 14 cases (13 per cent), prescribed gabapentinoids were diverted to other prisoners.Practical implicationsThe initiation of gabapentinoids in prison should be avoided. For prisoners who are also receiving opioid substitutes or are abusing opiates, it may be unsafe to continue on gabapentinoids. Issues raised by this study are likely to apply to other prisons, secure forensic psychiatric facilities and indeed community mental health and primary care as well.Social implicationsRisk of dependance on gabapentinoids including risk of mortality when taken with opioids and opioid substitutes.Originality/valueThis is an original study conducted at a category B prison in London.

Use Alkalinity Monitoring to Optimize Bioreactor Performance

In recent years, the agricultural community has reduced flow of nitrogen from farmed landscapes to stream networks through the use of woodchip denitrification bioreactors. Although deployment of this practice is becoming more common to treat high-nitrate water from agricultural drainage pipes, information about bioreactor management strategies is sparse. This study focuses on the use of water monitoring, and especially the use of alkalinity monitoring, in five Iowa woodchip bioreactors to provide insights into and to help manage bioreactor chemistry in ways that will produce desirable outcomes. Results reported here for the five bioreactors show average annual nitrate load reductions between 50 and 80%, which is acceptable according to established practice standards. Alkalinity data, however, imply that nitrous oxide formation may have regularly occurred in at least three of the bioreactors that are considered to be closed systems. Nitrous oxide measurements of influent and effluent water provide evidence that alkalinity may be an important indicator of bioreactor performance. Bioreactor chemistry can be managed by manipulation of water throughput in ways that produce adequate nitrate removal while preventing undesirable side effects. We conclude that (i) water should be retained for longer periods of time in bioreactors where nitrous oxide formation is indicated, (ii) measuring only nitrate and sulfate concentrations is insufficient for proper bioreactor operation, and (iii) alkalinity monitoring should be implemented into protocols for bioreactor management.

Direct-to-Consumer Sale of Prescription Drugs by Pharmaceutical Companies: An Assessment of the Patient Experience?

Background. Direct-to-consumer sale of prescription medications by pharmaceutical companies has emerged as a novel delivery method. It is important to ensure that patients who choose this method are receiving adequate pharmaceutical care that meets established practice standards. Objective. The objective of this study was to assess consultation for patients who are receiving medications via direct-to-consumer sales of prescription drugs from pharmaceutical companies. Methods. We conducted a blinded telephone survey using 10 mock prescriptions for simulated patients (secret shoppers) by contacting the 2 companies currently offering prescription medications for sale directly to consumers. Results. Simulated patients in this pilot study only had a pharmacist initiate consultation for 20% of the calls. Multiple pharmacy technicians offered consultation and this behavior does not follow state statutes. In addition, technicians also failed to forward calls to the pharmacist-on-duty, instead suggesting the patients contact their physicians. On a further direct request to speak to a pharmacist, a consultation did occur for 90% of the calls. However, the consultation failed to achieve practice standards set by Omnibus Budget Reconciliation Act of 1990 and the state statutes for the majority of the encounters. Conclusion. These results warrant a larger scale study of consultation for direct-to-consumer prescription sales. In addition, they highlight areas for training needed for all pharmacy personnel who work in this venue.

Assess the practice regarding safety measures used by nurses while handling Chemotherapy drugs

Background : In a recent study of outpatient nurses, participants reported significant unintended skin and eye exposure to chemotherapy (Friese, et al., 2011). In this study, the author concludes that the overall rate of exposure decreases when nurses report adequate staffing and resources (2011). This implies that nurse-patient ratios and workplace demands contribute to the problem of mishandling chemotherapy. Therefore, these results implicate the need for adequate staffing and resources as well as increased staff compliance to established practice standards in order to better protect oncology nurses. Other contributing factors identified in system failures that result in an unsafe work environment include lack of awareness of personal and public risks of exposure, poor communication, and direct interruptions and/or distractions while preparing to administer medications (Ashley, et al., 2011). Objectives : To assess the practice regarding safety measures used by nurses while handling chemotherapy drugs. Method : In this Study the structured checklist was used to see the practice regarding safety measures used by nurses while handling chemotherapy drugs. Result : Assessment of nurses practice while handling chemotherapy drug shows that Majority of samples 56 (56%) were having poor practice while handling chemotherapy drugs and 44% of nurses were having good practice while handling chemotherapy drugs, Maximum score was 6 and minimum score was 1. Conclusion : After the detailed analysis, this study leads to the following conclusion that assessment of nurses' practice while handling chemotherapy drug. Majority of samples were having poor practice while handling chemotherapy drugs.

Moving toward a more objective peer review process

Moving toward a more objective peer review process

Use of Potentially Curative Therapies for Muscle-invasive Bladder Cancer in the United States: Results from the National Cancer Data Base

BackgroundDespite its lethal potential, many patients with muscle-invasive bladder cancer (MIBC) do not receive aggressive, potentially curative therapy consistent with established practice standards. ObjectiveTo characterize the treatments received by patients with MIBC and analyze their use according to sociodemographic, clinical, pathologic, and facility measures. Design, setting, and participantsUsing the National Cancer Data Base, we analyzed 28 691 patients with MIBC (stages II–IV) treated between 2004 and 2008, excluding those with cT4b tumors or distant metastases. Treatments included radical or partial cystectomy with or without chemotherapy (CT), chemoradiotherapy (CRT), radiation therapy (RT), or CT alone and observation following biopsy. Aggressive therapy (AT) was defined as radical or partial cystectomy or definitive RT/CRT (total dose ≥50Gy). Outcome measurements and statistical analysisAT use and correlating variables were assessed by multivariable, generalized estimating equation models adjusted for facility clustering. Results and limitationsAccording to the database, 52.5% of patients received AT; 44.9% were treated surgically, 7.6% received definitive CRT or RT, and 25.9% of patients received observation only. AT use decreased with advancing age (odds ratio [OR]: 0.34 for age 81–90 yr vs ≤50 yr; p<0.001). AT use was also lower in racial minorities (OR: 0.74 for black race; p<0.001), the uninsured (OR: 0.73; p<0.001), Medicaid-insured patients (OR: 0.81; p=0.01), and at low-volume centers (OR: 0.64 vs high-volume centers; p<0.001). Use of AT was higher with increasing tumor stage (OR: 2.23 for T3/T4a vs T2; p<0.001) and nonurothelial histology (OR: 1.25 and 1.43 for squamous and adenocarcinoma, respectively; p<0.001). Study limitations include retrospective design and lack of information about patient and provider motivations regarding therapy selection. ConclusionsAT for MIBC appears underused, especially in the elderly and in groups with poor socioeconomic status. These data point to a significant unmet need to inform policy makers, payers, and physicians regarding appropriate therapies for MIBC.

Specialty Matters in the Treatment of Lung Cancer

The effect of surgeon volume, hospital volume, and surgeon specialty on operative outcomes has been reported in numerous studies. Short-term and long-term outcome comparisons for pulmonary resection for lung cancer have been performed between general surgeons (GS), cardiothoracic surgeons (CTS), and general thoracic surgeons (TS), using large administrative and inpatient databases. In the United States, general surgeons perform more pulmonary resection than thoracic surgeons. Studies have found that in cases involving thoracic surgeons, there is a lower operative mortality and morbidity, improved long-term survival, better adherence to established practice standards, and a lower cost compared with cases involving general surgeons. Some specific processes of care that account for these improved economic, operative, and oncological outcomes have been identified. Others are not yet specifically known and associated with specialization in thoracic surgery.

Receipt of aggressive therapies for muscle-invasive bladder cancer: Results from the National Cancer Data Base.

272 Background: Over 17,000 patients are diagnosed with muscle-invasive bladder cancer (MIBC) in the United States each year. Despite its lethal potential, emerging data has suggested that many patients do not receive aggressive therapy consistent with established practice standards. Using data from American College of Surgeons Commission on Cancer accredited facilities, we seek to characterize treatment patterns for patients with MIBC according to demographic, clinical, pathologic and facility variables. Methods: 28,691 adult patients diagnosed with MIBC (stages II-IV), excluding those with T4b tumors or distant metastases between 2004 and 2008 were selected for analyses from the National Cancer Database. Treatments included radical or partial cystectomy +/− chemotherapy (CT), chemoradiotherapy (CRT), radiotherapy (RT) or CT alone and surveillance. Aggressive therapy (AT) was defined as any open surgery or RT with a total dose ≥50 Gy. Determinants of AT were assessed by multivariate generalized estimating equations accounting for facility clustering. Results: 52.5% of patients received AT (45% were treated surgically while 7.5% received CRT or RT), 11.7% received palliative CT or RT, and 25.9% received surveillance only. Receipt of AT decreased significantly with advancing age (OR 0.29 for age &gt;80 vs. 18-59, p&lt;.001). AT was also received less frequently by minorities (OR 0.72 for blacks p&lt;.001), the uninsured (OR 0.72, p&lt;.001), Medicaid-insured patients (OR 0.81, p=.006) and by those patients treated at low-volume centers (OR 0.63 vs. high-volume, p&lt;.001). Receipt of AT increased with more advanced stage (OR 2.33 for stage III vs. stage II, p&lt;.001) and in patients with non-urothelial histology (OR 1.32 and 1.50 for squamous and adenocarcinoma histology respectively, p&lt;.001). Hydronephrosis was associated with decreased use of AT (OR 0.70, p&lt;.001). Conclusions: Aggressive therapies for MIBC are received less frequently by the elderly and those with historically poorer socioeconomic status. These data indicate a significant unmet clinical need for physician education regarding appropriate selection of patients for cystectomy and RT-based bladder sparing therapy.

Protecting the Integrity of Forensic Psychological Testing: A Reply to Geffner, et al. (2009)

Recommendations regarding psychological test use made by Geffner, Conradi, Geis, and Aranda (2009) directly contradict well established standards of practice, guidelines promulgated by several professional organizations, and well-known legal standards regarding the admissibility of evidence in Court. This article refutes these recommendations and argues that test selection in the forensic context requires adherence to the principles enumerated in established case law as well as relevant ethical principles and standards of practice reflected in practice guidelines. Utilizing subjectively based and scientifically unreliable psychological assessment tools such as those recommended by Geffner and his colleagues introduces unknowable degrees of error, jeopardizes the integrity of evaluative methodologies in use, and seriously compromises the data that comprises the foundation upon which psychological opinions are rendered and legal decisions are made. In making their recommendations, these authors ignore an extensive and important body of empirical literature, professional practice guidelines, and legal rules requiring the use of scientifically supported, validated, and reliable test instruments for forensic use.

Preventing the Soldiers of Health Care From Becoming Victims on the Pandemic Battlefield: Respirators or Surgical Masks as the Armor of Choice

The respiratory protective equipment necessary to protect health care workers from the novel swine-origin influenza A (H1N1) virus is not known. The knowledge gap created by this unanswered question has caused substantial debate and controversy on a global scale, leading public health organizations to feel pressured into issuing decisive recommendations despite a lack of supportive data. Changes in clinical practice caused by public health guidance during such high-profile events can be expected to establish a new standard of care. Also possible is an unforeseen gradual transition to widespread N95 respirator use, driven by public health pressures instead of science, for all outbreaks of influenza or influenza-like illness. Therefore, public health organizations and other influential institutions should take care to avoid making changes to established practice standards, if possible, unless these changes are bolstered by sound scientific evidence. Until definitive comparative effectiveness clinical trials are conducted, the answer to this question will continue to remain elusive. In the meantime, relying on ethical principles that have been substantiated over time may help guide public health and clinical decisions.

Thromboprophylaxis in spinal trauma surgery: consensus among spine trauma surgeons

Background context Although there are several studies evaluating the necessity and efficacy of thromboprophylaxis after spinal trauma with or without spinal cord injury (SCI), to date there is no established standard of practice pertaining to this specific patient population with regards to venous thromboembolism (VTE) prophylaxis. Purpose To reach a consensus opinion in the administration of thromboprophylaxis in both preoperative and postoperative care in the settings of spinal trauma and SCI. Study design A live survey on thromboprophylaxis after spinal surgery in the setting of trauma was conducted at a meeting among spine trauma surgeons. Methods Twenty-five spine surgeons (Neurosurgeons and Orthopedic surgeons), all members of the Spine Trauma Study Group, participated in a live survey in which they attempted to reach consensus pertaining to the management of deep vein thrombosis prophylaxis in patients with spine fractures (with and without a concomitant SCI). The consensus survey consisted of a 10-item questionnaire. Chi-square test was used for group comparisons in questionnaire responses. Results Complete agreement was reached for the need of postoperative pharmacologic thromboprophylaxis in cervical spine injuries with SCI and anterior thoracolumbar procedures with or without SCI. Postoperative pharmacologic thromboprophylaxis after cervical spine injuries without SCI was agreed not to be needed. In cases of delayed surgery for patients with SCI, pharmacologic thromboprophylaxis was recommended to be started as soon as possible in the presurgical period. The optimal duration of pharmacologic VTE prophylaxis was determined to be 3 months. Only 53% agreement was noted for the withholding of preoperative chemical prophylaxis in cervical or thoracolumbar spinal injuries with SCI (and 68% without SCI). Only 80% of the surgeons agreed that postoperative pharmacologic thromboprophylaxis is needed after posterior thoracolumbar procedures in patients with or without SCI. The use of vena cava filter after SCI was not universally recommended. Conclusions Postoperative pharmacologic thromboprophylaxis was opined to be unnecessary in patients with cervical spine injuries without SCI, however, it is recommended for cervical spine trauma with SCI or anterior thoracolumbar procedures irrespective of SCI. Pharmacologic thromboprophylaxis was recommended to start preoperatively as soon as possible in SCI cases or in cases with surgical delay. Pharmacologic prophylaxis was recommended to be administered for at least 3 months postinjury. Although these recommendations met complete consensus by this group, individual patient factors should also be considered in determining optimal thromboprophylaxis in this patient population. Future research recommendations on thromboprophylaxis in spinal trauma are proposed.