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Task 4 Deep Vein Thrombosis

Part A Summary Gap Fill Time Limit: 15 minutes

Instructions Complete the following summary using the information in the texts for this task. Skim and scan the texts to find the information required. Gaps may require 1, 2 or 3 words. Write your answers in the appropriate space in the column on the right hand side. Make sure your spelling is correct. Summary 1. There are various risks associated with flying, one of them being deep vein thrombosis. Research first linked the condition to air travel in (1)____. Since then many case reports and series have been (2)____. An English study published in the well known medical journal the (3)____ found that a persons risk increased directly as a result of (4)____ and that more people died in the (5) ____area than the (6)_____area. New Zealand and German studies found similar associations between flying and deep vein thrombosis. This was (7)____ to a Dutch study which did found no association between flying and deep vein thrombosis. Despite conflicting results, some airlines take a proactive approach and (8) ____ to passengers on how to (9)____ of deep vein thrombosis. Their recommendations include the wearing of loose clothes, avoidance of (10)____and regular movements around the plane. Sitting with your legs crossed is not (11)____ while regular stretching and (12)____may be beneficial. Finally before travelling, a (13)____with your doctor is suggested. 12. 13. 11. 7. 8. 9. 10. 6. 3. 4. 5. 2. Answers

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Part A Answer Sheet continued Summary 14. A recent study by Cannegieter et al, published in (14)____, investigated the risk factors associated with various (15)____ and (16) ____. Based on a study of (17) ____ patients, the researchers found that travelling by (18)____ had a comparable risk to that of flying. 18. For those still prepared to take the risk of travelling, common symptoms of deep vein thrombosis include (19) ____ in the leg, often associated with swelling, redness, increased warmth and bluish (20)____. However, the most significant symptom linked to deep vein thrombosis is (21)____. 22. 23. According to Cannegieter et al (2006) there are several risk factors among the general population which may increase the risk of deep vein thrombosis. Bus or train travellers with factor V Leiden who had a (22)_____of more than 30, were taller than (23)____ or who took (24)____ had a relatively high risk. Whereas air travel led to an (25)____thrombosis TOTAL SCORE risk for travellers with a height of less than (26) ____. 24. 25. 26. 21. 19. 20. 15. 16. 17. Answers

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Time Limit: 15 minutes Instructions Complete the summary on the answer page using the information in the four texts below. Skim and scan the texts to find the information required. Write your answers in the appropriate space in the column on the right hand side. Make sure your spelling is correct. Text 1 Economy Class Syndrome International flights are suspected of contributing to the formation of DVT in susceptible people, although the research evidence is currently divided. Some airlines prefer to err on the side of caution and offer suggestions to passengers on how to reduce the risk of DVT. Suggestions include: Wear loose clothes Avoid cigarettes and alcohol Move about the cabin whenever possible Dont sit with your legs crossed Perform leg and foot stretches and exercises while seated Consult with your doctor before travelling Text 2 Previous research Venous thrombosis was first linked to air travel in 1954, and as air travel has become more and more common, many case reports and case series have been published since. Several clinical studies have shown an association between air travel and the risk of venous thrombosis. English researchers proposed, in a paper published in the Lancet, that flying directly increases a person's risk. The report found that in a series of individuals who died suddenly at Heathrow Airport, death occurred far more often in the arrival than in the departure area. Two similar studies reported that the risk of pulmonary embolism in air travelers increased with the distance traveled. In terms of absolute risk, two studies found similar results: one performed in New Zealand found a frequency of 1% of venous thrombosis in 878 individuals who had traveled by air for at least 10 hours. The other was a German study which found venous thrombotic events in 2.8% of 964 individuals who had traveled for more than 8 hours in an airplane. In contrast, a Dutch study found no link between DVT and long distance travel of any kind.

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Text 3 Symptoms Pain and tenderness in the leg Pain on extending the foot Tenderness in calf (the most important sign) Swelling of the lower leg, ankle and foot Redness in the leg Bluish skin discoloration Increased warmth in the leg Text 4 Title: Travel-Related Venous Thrombosis: Results from a Large Population-Based Case Control (2006) Authors: Suzanne C. Cannegieter1, Carine J. M. Doggen1, Hans C. van Houwelingen2, Frits R. Rosendaal Study Background Recent studies have indicated an increased risk of venous thrombosis after air travel. Nevertheless, questions on the magnitude of risk, the underlying mechanism, and modifying factors remain unanswered. Methods We studied the effect of various modes of transport and duration of travel on the risk of venous thrombosis in a large ongoing case-control study on risk factors for venous thrombosis in an unselected population. We also assessed the combined effect of travel in relation to body mass index, height, and oral contraceptive use. Since March 1999, consecutive patients younger than 70 years of age with a first venous thrombosis have been invited to participate in the study, with their partners serving as matched control individuals. Information has been collected on acquired and genetic risk factors for venous thrombosis. Results: Of 1,906 patients, 233 had traveled for more than 4 hours in the 8 weeks preceding the event. Traveling in general was found to increase the risk of venous thrombosis. The risk of flying was similar to the risks of traveling by bus or train. The risk was highest in the first week after traveling. Travel by bus, or train led to a high relative risk of thrombosis in individuals with factor V Leiden, in those who had a body mass index of more than 30, those who were more than 190 cm tall , and in those who used oral contraceptives. For air travel these people shorter than 160 cm had an increased risk of thrombosis after air travel as well. Conclusions The risk of venous thrombosis after travel is moderately increased for all modes of travel. Subgroups exist in which the risk is highly increased.

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Task 4 Deep Vein Thrombosis

Answer Sheet 1. 1954 2. published 3. Lancet 4. flying 5. arrival 6. departure 7. in contrast 8. offer suggestions 9. reduce the risk 10. cigarettes and alcohol 11. recommended/advised (necessary to deduce fro the context) 12. exercising/exercises 13. consultation (necessary to change verb to noun) 14. 2006 15. modes of transport 16. duration of travel 17. 1906 18. bus or train 19. pain and tenderness 20. skin discoloration 21. tenderness in calf 22. body mass index 23. 190cm 24. oral contraceptives 25. increased 26. 160cm

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Text 1 Economy Class Syndrome International flights are suspected of contributing to the formation of DVT in susceptible people, although the research evidence is currently divided. Some airlines prefer to err on the side of caution and (8)offer suggestions to passengers on how to (9)reduce the risk of DVT. Suggestions include: Wear loose clothes Avoid (10)cigarettes and alcohol Move about the cabin whenever possible Dont sit with your legs crossed (11) i.e not recommended Perform leg and foot stretches and (12)exercises while seated (13)Consult (tation)with your doctor before travelling Text 2 Previous research Venous thrombosis was first linked to air travel in (1)1954, and as air travel has become more and more common, many case reports and case series have been (2) published since. Several clinical studies have shown an association between air travel and the risk of venous thrombosis. English researchers proposed, in a paper published in the (3) Lancet, that (4) flying directly increases a person's risk. The report found that in a series of individuals who died suddenly at Heathrow Airport, death occurred far more often in the (5)arrival than in the (6)departure area. Two similar studies reported that the risk of pulmonary embolism in air travelers increased with the distance traveled. In terms of absolute risk, two studies found similar results: one performed in New Zealand found a frequency of 1% of venous thrombosis in 878 individuals who had traveled by air for at least 10 hours. The other was a German study which found venous thrombotic events in 2.8% of 964 individuals who had traveled for more than 8 hours in an airplane. (7)In contrast, a Dutch study found no link between DVT and long distance travel of any kind.

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Text 3 Symptoms (19)Pain and tenderness in the leg Pain on extending the foot (21)Tenderness in calf (the most important sign) Swelling of the lower leg, ankle and foot Redness in the leg Bluish (20)skin discoloration Increased warmth in the leg Text 4 Title: Travel-Related Venous Thrombosis: Results from a Large Population-Based Case Control (14) (2006) Authors: Suzanne C. Cannegieter1, Carine J. M. Doggen1, Hans C. van Houwelingen2, Frits R. Rosendaal Study Background Recent studies have indicated an increased risk of venous thrombosis after air travel. Nevertheless, questions on the magnitude of risk, the underlying mechanism, and modifying factors remain unanswered. Methods We studied the effect of various (15)modes of transport and (16)duration of travel on the risk of venous thrombosis in a large ongoing case-control study on risk factors for venous thrombosis in an unselected population. We also assessed the combined effect of travel in relation to body mass index, height, and oral contraceptive use. Since March 1999, consecutive patients younger than 70 years of age with a first venous thrombosis have been invited to participate in the study, with their partners serving as matched control individuals. Information has been collected on acquired and genetic risk factors for venous thrombosis. Results: Of (17)1,906 patients, 233 had traveled for more than 4 hours in the 8 weeks preceding the event. Traveling in general was found to increase the risk of venous thrombosis. The risk of flying was similar to the risks of traveling by (18)bus or train. The risk was highest in the first week after traveling. Travel by bus, or train led to a high relative risk of thrombosis in individuals with factor V Leiden, in those who had a (22)body mass index of more than 30, those who were more than (23)190 cm tall , and in those who used (24)oral contraceptives. For air travel these people shorter than (26)160 cm had an (25)increased risk of thrombosis after air travel as well. Conclusions The risk of venous thrombosis after travel is moderately increased for all modes of travel. Subgroups exist in which the risk is highly increased.

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