51
|
Forrester A, Till A, Simpson A, Shaw J. Mental illness and the provision of mental health services in prisons. Br Med Bull 2018; 127:101-109. [PMID: 30124765 DOI: 10.1093/bmb/ldy027] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 07/19/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Around 11 million people are held in prisons internationally, and criminal justice systems are overburdened with a high prevalence of multiple psychiatric disorders. In England and Wales over 200 000 people enter prisons each year, and in many cases, this facilitates their first contact with mental health services. SOURCES OF DATA Research, evaluations, government reports and independent reviews. AREAS OF AGREEMENT Screening, Triage, Assessment, Intervention and Re-integration (STAIR) are necessary components of prison mental health provision, offering an opportunity to improve the wellbeing of a complex population. AREAS OF CONTROVERSY There are serious problems with service provision across many parts of the world, with human rights abuses occurring in some States. Screening and service delivery models still require substantial development. In England and Wales, self-harm, self-inflicted deaths and violence are increasing. GROWING POINTS Introducing comprehensive mental health models throughout prisons would offer a massive public health initiative, providing new services for the socially disadvantaged. A rights-based framework would be useful in ensuring systemic improvements, especially in low and middle-income countries. AREAS TIMELY FOR DEVELOPING RESEARCH Mechanisms for screening and triage, specific interventions across a broad range of conditions, and practical re-integration models, should be submitted to research across international sites.
Collapse
|
52
|
Shaw J, Blakemore J, McCulloh D, Licciardi F. Can i take a break?: oocytes retrieved by time interval between in vitro fertilization (IVF) cycles. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
53
|
Neve P, Barney JN, Buckley Y, Cousens RD, Graham S, Jordan NR, Lawton‐Rauh A, Liebman M, Mesgaran MB, Schut M, Shaw J, Storkey J, Baraibar B, Baucom RS, Chalak M, Childs DZ, Christensen S, Eizenberg H, Fernández‐Quintanilla C, French K, Harsch M, Heijting S, Harrison L, Loddo D, Macel M, Maczey N, Merotto A, Mortensen D, Necajeva J, Peltzer DA, Recasens J, Renton M, Riemens M, Sønderskov M, Williams M, Rew L. Reviewing research priorities in weed ecology, evolution and management: a horizon scan. WEED RESEARCH 2018; 58:250-258. [PMID: 30069065 PMCID: PMC6055875 DOI: 10.1111/wre.12304] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 02/05/2018] [Indexed: 05/12/2023]
Abstract
Weedy plants pose a major threat to food security, biodiversity, ecosystem services and consequently to human health and wellbeing. However, many currently used weed management approaches are increasingly unsustainable. To address this knowledge and practice gap, in June 2014, 35 weed and invasion ecologists, weed scientists, evolutionary biologists and social scientists convened a workshop to explore current and future perspectives and approaches in weed ecology and management. A horizon scanning exercise ranked a list of 124 pre-submitted questions to identify a priority list of 30 questions. These questions are discussed under seven themed headings that represent areas for renewed and emerging focus for the disciplines of weed research and practice. The themed areas considered the need for transdisciplinarity, increased adoption of integrated weed management and agroecological approaches, better understanding of weed evolution, climate change, weed invasiveness and finally, disciplinary challenges for weed science. Almost all the challenges identified rested on the need for continued efforts to diversify and integrate agroecological, socio-economic and technological approaches in weed management. These challenges are not newly conceived, though their continued prominence as research priorities highlights an ongoing intransigence that must be addressed through a more system-oriented and transdisciplinary research agenda that seeks an embedded integration of public and private research approaches. This horizon scanning exercise thus set out the building blocks needed for future weed management research and practice; however, the challenge ahead is to identify effective ways in which sufficient research and implementation efforts can be directed towards these needs.
Collapse
|
54
|
Desveaux L, Mitchell JI, Shaw J, Ivers NM. Understanding the impact of accreditation on quality in healthcare: A grounded theory approach. Int J Qual Health Care 2018; 29:941-947. [PMID: 29045664 DOI: 10.1093/intqhc/mzx136] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To explore how organizations respond to and interact with the accreditation process and the actual and potential mechanisms through which accreditation may influence quality. Design Qualitative grounded theory study. Setting Organizations who had participated in Accreditation Canada's Qmentum program during January 2014-June 2016. Participants Individuals who had coordinated the accreditation process or were involved in managing or promoting quality. Results The accreditation process is largely viewed as a quality assurance process, which often feeds in to quality improvement activities if the feedback aligns with organizational priorities. Three key stages are required for accreditation to impact quality: coherence, organizational buy-in and organizational action. These stages map to constructs outlined in Normalization Process Theory. Coherence is established when an organization and its staff perceive that accreditation aligns with the organization's beliefs, context and model of service delivery. Organizational buy-in is established when there is both a conceptual champion and an operational champion, and is influenced by both internal and external contextual factors. Quality improvement action occurs when organizations take purposeful action in response to observations, feedback or self-reflection resulting from the accreditation process. Conclusions The accreditation process has the potential to influence quality through a series of three mechanisms: coherence, organizational buy-in and collective quality improvement action. Internal and external contextual factors, including individual characteristics, influence an organization's experience of accreditation.
Collapse
|
55
|
Desveaux L, Mitchell JI, Shaw J, Ivers NM. Understanding the impact of accreditation on quality in healthcare: A grounded theory approach. Int J Qual Health Care 2018; 30:241. [PMID: 29177468 DOI: 10.1093/intqhc/mzx151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Indexed: 11/12/2022] Open
|
56
|
Walsh EI, Shaw J, Cherbuin N. Trajectories of BMI change impact glucose and insulin metabolism. Nutr Metab Cardiovasc Dis 2018; 28:243-251. [PMID: 29361342 DOI: 10.1016/j.numecd.2017.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to examine, in a community setting, whether trajectory of weight change over twelve years is associated with glucose and insulin metabolism at twelve years. METHODS AND RESULTS Participants were 532 community-living middle-aged and elderly adults from the Personality and Total Health (PATH) Through Life study. They spanned the full weight range (underweight/normal/overweight/obese). Latent class analysis and multivariate generalised linear models were used to investigate the association of Body Mass Index (BMI, kg/m2) trajectory over twelve years with plasma insulin (μlU/ml), plasma glucose (mmol/L), and HOMA2 insulin resistance and beta cell function at follow-up. All models were adjusted for age, gender, hypertension, pre-clinical diabetes status (normal fasting glucose or impaired fasting glucose) and physical activity. Four weight trajectories were extracted; constant normal (mean baseline BMI = 25; follow-up BMI = 25), constant high (mean baseline BMI = 36; follow-up BMI = 37), increase (mean baseline BMI = 26; follow-up BMI = 32) and decrease (mean baseline BMI = 34; follow-up BMI = 28). At any given current BMI, individuals in the constant high and increase trajectories had significantly higher plasma insulin, greater insulin resistance, and higher beta cell function than those in the constant normal trajectory. Individuals in the decrease trajectory did not differ from the constant normal trajectory. Current BMI significantly interacted with preceding BMI trajectory in its association with plasma insulin, insulin resistance, and beta cell function. CONCLUSION The trajectory of preceding weight has an independent effect on blood glucose metabolism beyond body weight measured at any given point in time.
Collapse
|
57
|
Bernon MM, Shaw J, Burmeister S, Chinnery G, Hofmeyr S, Kloppers JC, Jonas E, Krige JE. Distal malignant biliary obstruction: a prospective randomised trial comparing plastic and uncovered self-expanding metal stents in the palliation of symptomatic jaundice. S AFR J SURG 2018; 56:30-34. [PMID: 29638090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The aim of this study was to determine the safety and clinical effectiveness of 10Fr plastic biliary stents compared to uncovered self-expanding metal stents (SEMS) for palliative treatment of patients with inoperable extra-hepatic malignant biliary obstruction in a public hospital in South Africa. METHOD From January 2009 to December 2013, 40 patients who were admitted to a tertiary academic centre because of distal malignant biliary obstruction were enrolled in a prospective randomized study. Patients were randomly assigned to receive an uncovered SEMS or a plastic stent deployed through the biliary stricture during endoscopic retrograde cholangiopancreatography (ERCP). RESULTS Patient survival time in the two groups did not differ significantly (median: SEMS - 114 days; plastic - 107 days). Stent failure was more common in the plastic stent group (7/19 vs. 1/21). The results became significant after 6 months of follow-up. There was no significant difference between the two groups in the incidence of serious adverse events. CONCLUSION SEMS had a longer duration of patency than plastic stents, which recommends their use in the palliative treatment of patients with biliary obstruction due to distal malignant biliary obstruction.
Collapse
|
58
|
Koh Y, Chu S, Shaw J, Walker R. Close Versus Distant Administration of Erythropoietin and Acute Coronary Syndrome Outcomes in Chronic Kidney Patients on Dialysis. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
59
|
Fernando H, Noaman S, Snell G, Dart A, Shaw J, Chan W. Incidence and Predictors of Coronary Artery Disease in Patients Evaluated for Lung Transplantation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
60
|
Thiessen L, Shaw J. Hepatic rupture as the initial manifestation of HELLP syndrome. S AFR J SURG 2018. [DOI: 10.17159/2078-5151/2018/v56n3a2587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
61
|
Bernon MM, Shaw J, Burmeister S, Chinnery G, Hofmeyr S, Kloppers JC, Jonas E, Krige JEJ. Distal malignant biliary obstruction: a prospective randomised trial comparing plastic and uncovered self-expanding metal stents in the palliation of symptomatic jaundice. S AFR J SURG 2018. [DOI: 10.17159/2078-5151/2018/v56n1a2208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
62
|
Walker T, Edge D, Shaw J, Wilson H, McNair L, Mitchell H, Gutridge K, Senior J, Sutton M, Meacock R, Abel K. Contemporary women's secure psychiatric services in the United Kingdom: A qualitative analysis of staff views. J Psychiatr Ment Health Nurs 2017; 24:660-670. [PMID: 28783204 DOI: 10.1111/jpm.12416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Three pilot UK-only Women's Enhanced Medium Secure Services (WEMSS) was opened in 2007 to support women's movement from high secure care and provide a bespoke, women-only service. Evidence suggests that women's secure services are particularly challenging environments to work in and staffing issues (e.g., high turnover) can cause difficulties in establishing a therapeutic environment. Research in this area has focused on the experiences of service users. Studies which have examined staff views have focused on their feelings towards women in their care and the emotional burden of working in women's secure services. No papers have made a direct comparison between staff working in different services. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: This is the first study to explore the views and experiences of staff in the three UK WEMSS pilot services and contrast them with staff from women's medium secure services. Drawing upon data from eighteen semi-structured interviews (nine WEMSS, nine non-WEMSS), key themes cover staff perceptions of factors important for women's recovery and their views on operational aspects of services. This study extends our understanding of the experiences of staff working with women in secure care and bears relevance for staff working internationally, as well as in UK services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study reveals the importance of induction and training for bank and agency staff working in women's secure services. Further, regular clinical supervision should be mandatory for all staff so they are adequately supported. ABSTRACT Introduction Women's Enhanced Medium Secure Services (WEMSS) is bespoke, gender-sensitive services which opened in the UK in 2007 at three pilot sites. This study is the first of its kind to explore the experiences of WEMSS staff, directly comparing them to staff in a standard medium secure service for women. The literature to date has focused on the experiences of service users or staff views on working with women in secure care. Aim This qualitative study, embedded in a multimethod evaluation of WEMSS, aimed to explore the views and experiences of staff in WEMSS and comparator medium secure services. Methods Qualitative interviews took place with nine WEMSS staff and nine comparator medium secure staff. Interviews focused on factors important for recovery, barriers to facilitating recovery and operational aspects of the service. Discussion This study provides a rare insight into the perspectives of staff working in UK women's secure services, an under-researched area in the UK and internationally. Findings suggest that the success of services, including WEMSS, is compromised by operational factors such as the use of bank staff. Implications for practice Comprehensive training and supervision should be mandatory for all staff, so best practice is met and staff adequately supported.
Collapse
|
63
|
Murphy MJ, Newby JM, Butow P, Kirsten L, Allison K, Loughnan S, Price MA, Shaw J, Shepherd H, Smith J, Andrews G. Correction to: iCanADAPT early protocol: randomised controlled trial (RCT) of clinician supervised transdiagnostic internet-delivered cognitive behaviour therapy (iCBT) for depression and/or anxiety in early stage cancer survivors -vs- treatment as usual. BMC Cancer 2017; 17:667. [PMID: 28969615 PMCID: PMC5625786 DOI: 10.1186/s12885-017-3655-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 11/10/2022] Open
|
64
|
Iftikhar U, Shaw J, Bilston L, Har B, Schnell G. CORONARY ANGIOGRAPHY IN OUT OF HOSPITAL CARDIAC ARREST (OHCA): A PRACTICAL GUIDE TO DECISION MAKING. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
65
|
Flynn S, Nyathi T, Tham SG, Williams A, Windfuhr K, Kapur N, Appleby L, Shaw J. Suicide by mental health in-patients under observation. Psychol Med 2017; 47:2238-2245. [PMID: 28397618 DOI: 10.1017/s0033291717000630] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Observations in psychiatric in-patient settings are used to reduce suicide, self-harm, violence and absconding risk. The study aims were to describe the characteristics of in-patients who died by suicide under observation and examine their service-related antecedents. METHOD A national consecutive case series in England and Wales (2006-2012) was examined. RESULTS There were 113 suicides by in-patients under observation, an average of 16 per year. Most were under intermittent observation. Five deaths occurred while patients were under constant observation. Patient deaths were linked with the use of less experienced staff or staff unfamiliar with the patient, deviation from procedures and absconding. CONCLUSIONS We identified key elements of observation that could improve safety, including only using experienced and skilled staff for the intervention and using observation levels determined by clinical need not resources.
Collapse
|
66
|
Papneja N, Olson C, Chalchal H, Moser M, Iqbal N, Haider K, Zaidi A, Shaw J, Brunet B, Dueck DA, Abbas T, Ahmed S. Comparisons of outcomes of patients with advanced pancreatic cancer (APC) treated with FOLFIRINOX (FX) versus gemcitabine and nab-paclitaxel (GN): A population-based cohort study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.130a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
67
|
Tsimberidou A, Verschraegen C, Weise A, Sarantopoulos J, Lopes G, Nemunaitis J, Victor A, Shaw J, Kaleta R, Kurzrock R. Phase I dose escalation study of M2698, a p70S6K/AKT inhibitor, in patients with advanced cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
68
|
Xiong W, Tian H, Clark A, Shaw J, Kaleta R, Celik I, Girard P. Pharmacodynamic (PD) biomarkers for the p70S6K/Akt inhibitor, M2698: Translation from animal to human and relevance to dose selection. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
69
|
Biswas S, Duffy S, Lefkovits J, Andrianopoulos N, Brennan A, Walton A, Shaw J, Chan W, Ajani A, Clark D, Freeman M, Hiew C, Oqueli Flores E, Reid C, Stub D. P5606Evolving trends in procedural characteristics and clinical outcomes in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
70
|
Klein J, Boyle JA, Kirkham R, Connors C, Whitbread C, Oats J, Barzi F, McIntyre D, Lee I, Luey M, Shaw J, Brown ADH, Maple-Brown LJ. Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice. Diabetes Res Clin Pract 2017; 129:105-115. [PMID: 28521194 DOI: 10.1016/j.diabres.2017.03.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/03/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
AIMS Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. METHODS Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. RESULTS Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. CONCLUSIONS Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.
Collapse
|
71
|
Shaw J, Sadowski C, Silvius J, Chelak K, Turner J, Tannenbaum C. WHAT POLICIES ARE IN USE ACROSS CANADA TO REDUCE INAPPROPRIATE MEDICATION USE IN OLDER ADULTS? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
72
|
Tannenbaum C, Morgan S, Farrell B, Trimble J, Currie J, Shaw J, Silvius J. ENABLING KNOWLEDGE TRANSLATION THROUGH THE CANADIAN DEPRESCRIBING NETWORK. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
73
|
Shaw J, de Wit C, Le Gal G, Carrier M. Thrombotic and bleeding outcomes following perioperative interruption of direct oral anticoagulants in patients with venous thromboembolic disease. J Thromb Haemost 2017; 15:925-930. [PMID: 28296069 DOI: 10.1111/jth.13670] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/04/2017] [Indexed: 11/29/2022]
Abstract
Essentials Studies evaluating the procedural interruption of direct oral anticoagulants (DOACs) are lacking. We conducted a study of the interruption of DOACs for prior venous thromboembolic disease (VTE). The post-operative risks of recurrent VTE and major bleeding are low in this patient population. A scheme based on half-life and procedure-related bleeding appears safe and efficacious. SUMMARY Background Direct oral anticoagulants (DOACs) are increasingly being used in the setting of venous thromboembolic disease (VTE). There is little evidence to guide the peri-procedural interruption of DOACs in this patient population. A number of studies have evaluated the perioperative interruption of DOACs based on half-life of the anticoagulant and the underlying procedural bleeding risk in patient with atrial fibrillation, but it remains unclear whether these findings can be extended to patients with VTE. Objective Evaluate thrombotic and bleeding outcomes following the perioperative interruption of direct oral anticoagulation in patients with prior VTE. Methods We conducted a retrospective analysis of consecutive patients on a DOAC for prior VTE requiring temporary interruption of anticoagulation for an invasive procedure. The primary efficacy outcome was the 30-day symptomatic VTE rate, and the primary safety outcome was the 30-day major bleeding rate. Secondary outcomes included overall mortality and the rate of clinically relevant non-major bleeding. Results A total of 190 patients were included in the analysis. The 30-day VTE rate was 1.05% (95% CI, 0.29-3.8%) and the 30-day major bleeding rate was 0.53% (95% CI, 0.09-2.93%). There were no deaths during the 30-day follow-up period. The rate of clinically relevant non-major bleeding was 3.16% (95%CI , 1.46-6.72%). Conclusions The perioperative interruption of DOACs in the setting of VTE, using a strategy that considers the half-life of the DOAC and the underlying procedural bleeding risk, appears to be both safe and effective.
Collapse
|
74
|
Byrne K, Waller J, Piercy J, Shaw J, Dastani H. P02.03 Real-world treatment patterns in glioblastoma multiforme (GBM). Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
75
|
Shaw J, Leonard C, Chaudhuri N. Feather bedding as a cause of hypersensitivity pneumonitis. QJM 2017; 110:233-234. [PMID: 28062740 DOI: 10.1093/qjmed/hcx010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Indexed: 11/14/2022] Open
|