A multicentre randomised assessment of the DAWN AC computer-assisted oral anticoagulant dosage program

2009 ◽  
Vol 101 (03) ◽  
pp. 487-494 ◽  
Author(s):  
Michelle Keown ◽  
Saied Ibrahim ◽  
Gordon Lowe ◽  
Marco Moia ◽  
Alexander G. Turpie ◽  
...  
Keyword(s):  
Oral Anticoagulation ◽  
Oral Anticoagulant ◽  
Safety Assessment ◽  
Computer Assisted ◽  
Clinical Safety ◽  
Randomised Study ◽  
Clinical Events ◽  
Computer Assistance ◽  
The Difference ◽  
The Eu

SummaryComputer-assisted oral anticoagulant dosage is being increasingly used to meet growing demands for oral anticoagulation. The DAWN AC is one of the most widely used computer-dosage programs. Evidence of its value and that of other computer programs has been based previously only on laboratory evidence of “time in target INR range” (TIR) not on clinical safety in practice. A five-year international randomised clinical study of computer assistance with the DAWN AC program compared with manual dosage in 2,631 patients has been performed at 13 centres with established expertise in oral anticoagulation mainly in the EU. Safety assessment have been based on the comparison of bleeding or thrombotic events with DAWN AC compared with manual dosage in a randomised study. Safety of the DAWN AC program has been demonstrated. Clinical events of bleeding and thrombosis were almost identical with the experienced manual dosage group. Therapeutic control improved with DAWN AC to 66.8% from 63.4% TIR. The program failed to provide a dosage recommendation on only 5.7% of occasions. At a group of experienced centres with a special interest in oral anticoagulation, the DAWN AC computer-dosage program proved as safe clinically as manual dosage by experienced medical staff. With DAWN AC, laboratory control was improved, the difference being highly significant. The results should reassure hospitals and community clinics that the DAWN AC program is safe and facilitate greater and longer provision of warfarin treatment where required.

State-of-the-Art Review: The Oral Anticoagulant Saga: Past, Present, and Future

2001 ◽  
Vol 7 (4) ◽  
pp. 269-275 ◽  
Author(s):  
B. McD. Duxbury ◽  
Leon Poller
Keyword(s):  
Oral Anticoagulation ◽  
Oral Anticoagulant ◽  
International Normalized Ratio ◽  
World Health ◽  
Computer Assisted ◽  
Tissue Extracts ◽  
Dose Warfarin ◽  
Anticoagulant Drug ◽  
Resultant Increase ◽  
Health Organization

Oral anticoagulation originated with the discovery of the harmful agent causing "sweet clover disease" in cattle in North America in the 1920s. The causative agent dicoumarol was isolated in Link's laboratory in 1940. A range of related compounds was then synthesized, the most popular of which proved to be warfarin. Oral anticoagulant administration posed problems of individual variation in response to these drugs and the need for regular laboratory monitoring by prothrombin time (PT). Monitoring problems arose from the introduction in the 1950s of some poorly responsive commercial tissue extracts for use as tissue extract thromboplastin reagent in the PT. More oral anticoagulant drug was then needed to prolong the test to the required therapeutic targets, with a resultant increase in bleeding. It was not until 1983 that the problem was resolved and it was shown that the less intense UK-type regimen was just as effective as the higher North American type dosage in the prevention of venous thrombosis but caused much less bleeding. This study led to the widespread adoption of the "low-dose warfarin" regimen that, combined with the World Health Organization PT standardization scheme using the international normalized ratio (INR), has led to improved effectiveness and safety of oral anticoagulation. This has permitted increased administration of warfarin in a widening spectrum of clinical disorders. The last remaining problem is the limited success of doctors in achieving the therapeutic INR targets, which may be improved by computer-assisted dosage.

Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomised clinical trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tzikas ◽  
A Samaras ◽  
A Kartas ◽  
D Vasdeki ◽  
G Fotos ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Medical Care ◽  
Oral Anticoagulation ◽  
Intervention Group ◽  
Control Group ◽  
Motivational Intervention ◽  
Clinical Events ◽  
Secondary Outcomes

Abstract Background Oral anticoagulation (OAC) is paramount to effective thromboprophylaxis; yet adherence to OAC remains largely suboptimal in patients with atrial fibrillation (AF). Purpose We aimed to assess the impact of an educational, motivational intervention on the adherence to OAC in patients with non-valvular AF. Methods Hospitalised patients with non-valvular AF who received OAC were randomly assigned to usual medical care or a proactive intervention, comprising motivational interviewing and tailored counseling on medication adherence. The primary study outcome was adherence to OAC at 1-year, evaluated as Proportion of Days Covered (PDC) by OAC regimens and assessed through nationwide prescription registers. Secondary outcomes included the rate of persistence to OAC, gaps in treatment, proportion of VKA-takers with labile INR (defined as time to therapeutic range<70%) and clinical events. Results A total of 1009 patients were randomised, 500 in the intervention group and 509 in the control group. At 1-year follow-up, 77.2% (386/500) of patients in the intervention group had good adherence (PDC>80%), compared with 55% (280/509) in the control group (adjusted odds ratio 2.84, 95% confidence interval 2.14–3.75; p<0.001). Mean PDC±SD was 0.85±0.26 and 0.75±0.31, respectively (p<0.001). Patients that received the intervention were more likely to persist in their OAC therapy at 1 year, while usual medical care was associated with more major (≥3 months) treatment gaps [Figure]. Among 212 VKA-takers, patients in the intervention group were less likely to have labile INR compared with those in the control group [21/120 (17.1%) vs 34/92 (37.1%), OR 0.33 95% CI 1.15–0.72, p=0.005]. Clinical events over a median follow-up period of 2 years occurred at a numerically lower, yet non-significant, rate in the intervention group [Table]. Conclusions In patients receiving OAC therapy for non-valvular AF, a motivational intervention significantly improved patterns of medication adherence, without significantly affecting clinical outcomes. Primary and secondary outcomes Funding Acknowledgement Type of funding source: None

scholarly journals Techno-Economic Assessment of Coal-Fired Power Unit Decarbonization Retrofit with KP-FHR Small Modular Reactors

Energies ◽  
2021 ◽  
Vol 14 (9) ◽  
pp. 2557
Author(s):  
Łukasz Bartela ◽  
Paweł Gładysz ◽  
Charalampos Andreades ◽  
Staffan Qvist ◽  
Janusz Zdeb
Keyword(s):  
Net Present Value ◽  
Economic Assessment ◽  
Plant Design ◽  
Term Operation ◽  
Small Modular Reactors ◽  
Greenfield Investments ◽  
Unit Design ◽  
The Difference ◽  
Economic Analyses ◽  
The Eu

The near and mid-term future of the existing Polish coal-fired power fleet is uncertain. The longer-term operation of unabated coal power is incompatible with climate policy and is economically challenging because of the increasing price of CO2 emission allowances in the EU. The results of the techno-economic analysis presented in this paper indicate that the retrofit of existing coal-fired units, by means of replacing coal-fired boilers with small modular reactors, may be an interesting option for the Polish energy sector. It has been shown that the retrofit can reduce the costs in relation to greenfield investments by as much as 35%. This analysis focuses on the repowering of a 460 MW supercritical coal-fired unit based on the Łagisza power plant design with high temperature small modular nuclear reactors based on the 320 MWth unit design by Kairos Power. The technical analyses did not show any major difficulties in integrating. The economic analyses show that the proposed retrofits can be economically justified, and, in this respect, they are more advantageous than greenfield investments. For the base economic scenario, the difference in NPV (Net Present Value) is more favorable for the retrofit by 556.9 M€ and the discounted payback period for this pathway is 10 years.

Computer-assisted database indexing: the state-of-the-art

1994 ◽  
Vol 19 (1) ◽  
pp. 23-27
Author(s):  
Gail M. Hodge
Keyword(s):  
Data Base ◽  
Production System ◽  
State Of The Art ◽  
The State ◽  
Computer Support ◽  
Computer Assisted ◽  
Computer Assistance ◽  
The Future ◽  
Database Indexing ◽  
Operational Systems

Discusses the state-of-the-art in computer indexing, defines indexing and computer assistance, describes the reasons for renewed interest, identifies the types of computer support in use using selected operational systems, describes the integration of various computer supports in one data base production system, and speculates on the future.

Russia and EU Countries: Partnership for Modernization

2013 ◽  
pp. 54-61
Author(s):  
T. Romanova ◽  
E. Pavlova
Keyword(s):  
Rule Of Law ◽  
New Classification ◽  
Member States ◽  
The Rule Of Law ◽  
Normative Power ◽  
Eu Member States ◽  
The World ◽  
The Difference ◽  
The Eu

The article examines how the normative power, which the EU puts forward as an ideological basis of its actions in the world, manifests itself in the national partnerships for modernization between Russia and EU member states. The authors demonstrate the influence of the EU’s normativity on its approach to modernization as well as the difference in the positions of its member countries. It is concluded that there is no unity in the EU’s approach to democracy, human rights and the rule of law, and the new classification of EU member states, which is based on their readiness to act in accordance with the Union’s concept of normative power, is offered.

Telemedicine in pediatric and perinatal cardiology: Economic evaluation of a service in English hospitals

2007 ◽  
Vol 23 (1) ◽  
pp. 116-125 ◽  
Author(s):  
Robin Dowie ◽  
Hema Mistry ◽  
Tracey A. Young ◽  
Gwyn C. Weatherburn ◽  
Helena M. Gardiner ◽  
...  
Keyword(s):  
Older Children ◽  
Telemedicine Service ◽  
Clinical Events ◽  
District Hospitals ◽  
Nonsignificant Difference ◽  
Patient Groups ◽  
Women And Children ◽  
The Difference ◽  
Set Up ◽  
Mean Cost

Objectives:Pediatric cardiology has an expanding role in fetal and pediatric screening. The aims of this study were to observe how district hospitals use a pediatric telecardiology service, and to compare the costs and outcomes of patients referred to specialists by means of this service or conventionally.Methods:A telemedicine service was set up between a pediatric cardiac center in London and four district hospitals for referrals of second trimester women, newborn babies, and older children. Clinicians in each hospital decided on the role for their service. Clinical events were audited prospectively and costed, and patient surveys were conducted.Results:The hospitals differed in their selection of patient groups for the service. In all, 117 telemedicine patients were compared with 387 patients seen in London or in outreach clinics. Patients selected for telemedicine were generally healthier. For all patients, the mean cost for the initial consultation was £411 for tele-referrals and £277 for conventional referrals, a nonsignificant difference. Teleconsultations for women and children were significantly more expensive because of technology costs, whereas for babies, ambulance transfers were much more costly. After 6-months follow-up, the difference between referral methods for all patients was nonsignificant (telemedicine, £3,350; conventional referrals, £2,172), and nonsignificant within the patient groups.Conclusions:Telemedicine was perceived by cardiologists, district clinicians, and families as reliable and efficient. The equivocal 6-month cost results indicate that investment in the technology is warranted to enhance pediatric and perinatal cardiology services.

Clinical Safety Assessment of an Ultra Absorbency Menstrual Tampon

2010 ◽  
Vol 19 (2) ◽  
pp. 273-278 ◽  
Author(s):  
Anne E. Hochwalt ◽  
Michaelle B. Jones ◽  
Sandy J. Meyer
Keyword(s):  
Safety Assessment ◽  
Clinical Safety
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