295 Secondary Prevention of Cardiovascular Risk Factors in Patients Admitted Under the Vascular Service - Full Cycle Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P H Abadi ◽  
J Forsyth ◽  
D Drury
Keyword(s):  
Smoking Cessation ◽  
Secondary Prevention ◽  
Antiplatelet Agents ◽  
Junior Doctors ◽  
Lipid Modification ◽  
Teaching Session ◽  
National Guidelines ◽  
Audit Process ◽  
Smoking Cessation Advice ◽  
Cardiovascular Morbidity And Mortality

Abstract Aim Peripheral arterial disease (PAD) is strongly associated with general cardiovascular morbidity and mortality. This audit aimed to monitor and improve compliance with NICE guidelines CG147 & TA607 for PAD patients that presented to our vascular service. Method Patients were audited from September to October 2020. The audit reviewed prescription of anticoagulant/antiplatelet agents, lipid modification, optimisation of diabetes control and smoking cessation advice. Our intervention was to conduct a single teaching session for junior doctors that emphasised medication checks, checking HBA1c/ensuring appropriate diabetic referrals, and implementation/documentation of any smoking cessation advice. We also introduced a dedicated computer for conducting the vascular surgery morning ward round. Re-audit was undertaken between November to December 2020. Results The first audit included 32 patients. It revealed 100% compliance with anticoagulant/antiplatelet prescribing. 82% were prescribed appropriate lipid modification. There was 75% compliance with diabetic referrals for patients with high HBA1c results. There was only 19% compliance with smoking cessation advice/documentation. The re-audit process included 27 patients. There was 100% compliance with antiplatelet/anticoagulant prescriptions. 26 (96%) patients were prescribed appropriate lipid modification. There was now 100% compliance with appropriate referral to the diabetic team. There was also 100% compliance with smoking cessation advice/assistance/documentation. Conclusions A single teaching session for junior doctors familiarising them with the current national guidelines, and introduction of a dedicated computer for ward rounds significantly helped improve our compliance with national guidelines for secondary prevention of vascular disease.

scholarly journals 139 Efficacy of Implementation of a Junior Doctors' Teaching Program on The Secondary Prevention of Peripheral Arterial Disease in Vascular Patients

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Daketsey ◽  
M Elkawafi ◽  
A Khallaf ◽  
R Makar
Keyword(s):  
Peripheral Arterial Disease ◽  
Secondary Prevention ◽  
Statin Therapy ◽  
Arterial Disease ◽  
Evidence Base ◽  
Junior Doctors ◽  
Teaching Session ◽  
Prescription Practices ◽  
Best Medical Therapy ◽  
Peripheral Arterial

Abstract Introduction According to NICE Guidelines, the Best medical therapy (BMT) for secondary prevention of peripheral arterial disease includes antiplatelet and statin therapy unless contraindicated. Junior Doctors are usually allocated the job of prescribing patients’ medications. Due to discrepancies in their exposure to vascular surgery in earlier training, we implemented an introductory teaching session for them regarding this BMT and audited the efficacy of this intervention. Method A retrospective review of admission and discharge medications of all vascular ward patients from August 12th to 30th September 2019 was done, and the data was analysed via Excel. Results Out of 127 patients (median age 70), 67% and 64% had antiplatelet and statin medications respectively,while on admission. 1 in each patient cohort was found discharged without either medication. The GP of the patient discharged without antiplatelets was contacted to ensure this was rectified. The other patient had refused statin therapy and thus a discharge note to their GP was conducted to reflect this. Conclusions A teaching session as part of a vascular departmental induction emphasising the evidence base for antiplatelet and statin therapy can contribute to improving prescription practices of junior doctors starting in the department.

Abstract 252: In-hospital and Discharge quality of pharmacological care among Acute Myocardial Infarction patients in Northern Italy.

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Giovanni Veronesi ◽  
Andrea Borsani ◽  
Maurizio Marzegalli ◽  
Luca Merlino ◽  
Giancarlo Cesana ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Secondary Prevention ◽  
Ldl Cholesterol ◽  
Systolic Function ◽  
Beta Blockers ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Northern Italy ◽  
Ventricular Systolic Function ◽  
Smoking Cessation Advice

Aim . We aim to evaluate the adherence to ACC/AHA guidelines for secondary prevention in a representative population of 35-79 years old living in Northern Italy, in 2007-2008. Methods . The study population comprises the 35-79 years old residents in the Varese Province. From the regional Hospital Discharge Record database we identified n=1917 hospitalizations with a main discharge code ICD-IX 410.xx occurring in the 17 surveyed hospitals. Clinical information was available for n=1908 events; according to the ACC/AHA 2008 performance measures, data collection included ASA administration at arrival, in-hospital assessment of left ventricular systolic function and LDL-cholesterol, prescription of ASA, beta-blockers and statin at discharge, as well as smoking cessation advice. Data on documented contraindications were also carefully collected. N=87 non acute events were excluded, leaving a final number of n=1821 records. The main performance measure is the proportion of patients treated according to guidelines among those without documented contraindications (eligible patients). We further considered a sex- and age at admission-adjusted analysis, by means of a logistic model. Results . Mean age at admission was 64.6±10.5 years, 72.8% were men. Data availability was above 90% for all the indicators. Almost 95% of patients received ASA at arrival; 91% had evaluation of left ventricular systolic function, and 69% had an evaluation of LDL-cholesterol during the hospitalization. ASA, beta-blockers and statin at discharge were prescribed to 94.9%; 74.3%; and 91.0% of eligible patients, respectively. Smoking cessation advice in clinical records was present in 1 smoker out of 4. Women were less likely to receive a prescription for beta-blockers, and the elderly (75-79 years old) less likely to have prescription for ASA and beta-blockers at discharge. Conclusions . Overall, a high proportion of eligible patients receives the recommended drug prescription at discharge; however, gender- and age-related disparities in secondary prevention care are present. A less than expected proportion of eligible patients had in-hospital LDL assessment, reducing the number of eligible patients for statin prescription.

scholarly journals Provider Smoking Cessation Advice among California Asian-American Smokers

2011 ◽  
Vol 25 (5_suppl) ◽  
pp. S70-S74 ◽  
Author(s):  
Elisa K. Tong ◽  
Hao Tang ◽  
Moon S. Chen ◽  
Stephen J. McPhee
Keyword(s):  
Smoking Cessation ◽  
Asian American ◽  
Smoking Cessation Advice

scholarly journals Multifactorial Background for a Low Biological Response to Antiplatelet Agents Used in Stroke Prevention

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 59
Author(s):  
Adam Wiśniewski
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Negative Impact ◽  
Platelet Reactivity ◽  
Antiplatelet Agent ◽  
Biological Response ◽  
Antiplatelet Agents ◽  
Platelet Inhibition ◽  
High Risk Group

Effective platelet inhibition is the main goal of the antiplatelet therapy recommended as a standard treatment in the secondary prevention of non-embolic ischemic stroke. Acetylsalicylic acid (aspirin) and clopidogrel are commonly used for this purpose worldwide. A low biological response to antiplatelet agents is a phenomenon that significantly reduces the therapeutic and protective properties of the therapy. The mechanisms leading to high on-treatment platelet reactivity are still unclear and remain multifactorial. The aim of the current review is to establish the background of resistance to antiplatelet agents commonly used in the secondary prevention of ischemic stroke and to explain the possible mechanisms. The most important factors influencing the incidence of a low biological response were demonstrated. The similarities and the differences in resistance to both drugs are emphasized, which may facilitate the selection of the appropriate antiplatelet agent in relation to specific clinical conditions and comorbidities. Despite the lack of indications for the routine assessment of platelet reactivity in stroke subjects, this should be performed in selected patients from the high-risk group. Increasing the detectability of low antiaggregant responders, in light of its negative impact on the prognosis and clinical outcomes, can contribute to a more individualized approach and modification of the antiplatelet therapy to maximize the therapeutic effect in the secondary prevention of stroke.

scholarly journals Effectiveness of a motivational intervention based on spirometry results to achieve smoking cessation in primary healthcare patients: randomised, parallel, controlled multicentre study

2021 ◽  
pp. jech-2020-216219
Author(s):  
Francisco Martin-Lujan ◽  
Josep Basora-Gallisa ◽  
Felipe Villalobos ◽  
Nuria Martin-Vergara ◽  
Estefania Aparicio-Llopis ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Respiratory Disease ◽  
Primary Healthcare ◽  
Intervention Group ◽  
Control Group ◽  
Smoking Cessation Advice ◽  
Registration Number ◽  
Brief Advice ◽  
Prolonged Abstinence

ObjectiveThis 12-month study in a primary healthcare network aimed to assess the effectiveness of usual smoking cessation advice compared with personalised information about the spirometry results.DesignRandomised, parallel, controlled, multicentre clinical trial.SettingThis study involved 12 primary healthcare centres (Tarragona, Spain).ParticipantsActive smokers aged 35–70 years, without known respiratory disease. Each participant received brief smoking cessation advice along with a spirometry assessment. Participants with normal results were randomised to the intervention group (IG), including detailed spirometry information at baseline and 6-month follow-up or control group (CG), which was simply informed that their spirometry values were within normal parameters.Main outcomeProlonged abstinence (12 months) validated by expired-CO testing.ResultsSpirometry was normal in 571 patients in 571 patients (45.9% male), 286 allocated to IG and 285 to CG. Baseline characteristics were comparable between the groups. Mean age was 49.8 (SD ±7.78) years and mean cumulative smoking exposure was 29.2 (±18.7) pack-years. Prolonged abstinence was 5.6% (16/286) in the IG, compared with 2.1% (6/285) in the CG (p=0.03); the cumulative abstinence curve was favourable in the IG (HR 1.98; 95% CI 1.29 to 3.04).ConclusionsIn active smokers without known respiratory disease, brief advice plus detailed spirometry information doubled prolonged abstinence rates, compared with brief advice alone, in 12-month follow-up, suggesting a more effective intervention to achieve smoking cessation in primary healthcare.Trial registration numberNCT01194596.

REVIEW OF INDEPENDENT NURSE PRESCRIBING IN A PAEDIATRIC CYSTIC FIBROSIS (CF) AND RESPIRATORY POPULATION

2016 ◽  
Vol 101 (9) ◽  
pp. e2.6-e2
Author(s):  
Gabis Chana ◽  
Michelle Tabberner ◽  
Wendy Nixon ◽  
Sue Frost ◽  
Leslie Barrett ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Medical Condition ◽  
Junior Doctors ◽  
Positive Contribution ◽  
Oral Antibiotics ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Exclusion Criteria ◽  
Patient Journey ◽  
Telephone Advice

AimWith pressures on junior doctors' availability in the NHS, non-medical prescribing is topical. Independent Nurse Prescribers (INPs) can prescribe any licensed medicine for any medical condition within their level of competence.1 An audit was undertaken of the four INPs employed by the Respiratory Department evaluating current prescribing practices.MethodThe requirement for this audit was identified by the multidisciplinary team (MDT) and Trust approval was obtained. A data collection form was designed capturing patient demographics and full details of prescribed items.Over a 3 month period (August to October 2014) outpatient cystic fibrosis (CF) and respiratory prescriptions were studied using cluster sampling. Over a 6 week period prescription requests by CF INPs faxed to General Practitioners (GPs) were reviewed. INPs also prescribe via telephone, documenting advice on trust forms; these were preliminarily audited. All data was analysed using Microsoft Excel. Legality of prescriptions and adherence to national and local guidelines were evaluated. Reference keys were used to designate non-adherence post-application of exclusion criteria.ResultsA total of 77 outpatient prescriptions (45 CF and 32 respiratory) were completed by the 4 INPs, containing 122 items (72 CF and 50 respiratory). Of the CF prescribed items 21 were oral antibiotics (29%). Respiratory INPs mainly prescribed 14 inhaler devices (28%) and 12 inhaled bronchodilators (24%).All INP prescriptions met legal requirements. Basic details of medicinal products (drug name and dose) were documented for all items. A key finding was that duration/quantity was not indicated for 27 (54%) respiratory items.After applying exclusion criteria, of the CF prescribed items, 56/59 (95%) adhered to national guidelines and 47/66 (71%) followed local guidelines. The leading reason for not following local guidelines was not documenting allergy status. Of the respiratory prescribed items, 34 (100%) adhered to national guidelines and 31/32 (97%) followed local guidelines.A total of 33 faxes (with 38 items) were completed and 35 items (92%) were oral antibiotics. Drug name, dose and frequency were stated for all items. From the faxed items, 38 (100%) adhered to national guidelines and 32/33 (97%) followed local guidelines.Over 5 days, CF INPs provided telephone advice for 12 patients. Of these, 6 patients had respiratory exacerbation. Telephone advice led to faxes being sent to GPs for 9 patients. This was preliminary data with a re-audit planned after amendment of trust form.ConclusionOverall INP prescribing was found to be safe and effective. This review enabled education of the respiratory team of prescribing practices via a local audit meeting. The positive contribution that INPs provide to patient care was highlighted as they improve the patient journey and support the MDT. The demand for INP prescribing in particular with CF has provided opportunity for a pharmacist prescriber to join the CF MDT. It is recommended medical and pharmacist prescribing to be reviewed.

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