scholarly journals Amiodarone Toxicity: A Case Report

2019 ◽  
Vol 2 (10) ◽  
pp. 250-252
Author(s):  
Hina Lal ◽  
Jatinder Singh ◽  
Vijay Kumar ◽  
Ena Bhajni ◽  
Vijay K Sehgal
Keyword(s):  
Atrial Fibrillation ◽  
Thyroid Stimulating Hormone ◽  
Electrolyte Imbalance ◽  
Amiodarone Therapy ◽  
First Line ◽  
Present Patient ◽  
Monitoring Centre ◽  
System A ◽  
Wide Range ◽  
Cardiac System

Amiodarone is one of the commonly used drug in arrhythmias. It is first line of treatment for ventricular tachycardia particularly in treatment of supraventicular tachycardia like atrial fibrillation. Amiodarone has a wide range of adverse effects ranging from endocrine to cardiac system. A case of raised thyroid stimulating Hormone (TSH)  with amiodarone was reported in our Adverse drug  monitoring centre (AMC), in which several other adverse events such as raised raised billirubin and hyponatremia were present. Patient was treated with thyroxine while amiodarone along with atorvastatin and metoprolol were withdrawn. We present a case who developed subclinical hypothyroidism, electrolyte imbalance and liver dysfunction with amiodarone therapy.

Experiences of job demand and control: A study of first line managers in for-profit psychiatric and addiction care

Work ◽  
2021 ◽  
pp. 1-9
Author(s):  
Linda Widar ◽  
Erika Wall ◽  
Sven Svensson
Keyword(s):  
First Line ◽  
Line Managers ◽  
For Profit ◽  
Job Demand ◽  
Organizational Position ◽  
Wide Range ◽  
Line Manager ◽  
Addiction Care ◽  
And Control ◽  
Demand Control

BACKGROUND: The complex position of a first line manager is characterized by heavy workload and contradictory demands. Little is known about how first line managers experience demand and control in their work. OBJECTIVES: The aim of this study was to explore experiences of demand and control among first line managers within psychiatric and addiction care. METHOD: In the present study, interviews with ten managers in for-profit psychiatric and addiction care in Sweden were analyzed with a phenomenographic approach. RESULTS: The managers experiences of demand and control implied varied and extensive responsibilities for a wide range of professions; regulation by organizational, economic, and political frameworks; creating balance in their work; and handling the emergence and consequences of acute crisis. These experiences of demand and control involved high and contradictory demands together with coexisting high and low levels of control. Many of their work characteristics could be described in terms of both demand and control. CONSLUSION: The first line managers experiences of demand and control are more complex than implied by the job demand control theory. Our results suggest that the organizational position and branch should be considered when identifying health hazards in the work environment of first line managers.

scholarly journals 306 The Changing Face of Stroke in the DOAC Era

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Recie Davern ◽  
Helena Hobbs ◽  
Hannah Murugan ◽  
Paul Cotter
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
P Value ◽  
Stroke Management ◽  
Medicines Management ◽  
First Line ◽  
Stroke Registry ◽  
Multiple Factors ◽  
Direct Acting ◽  
Anticoagulated Patients

Abstract Background Patients prescribed oral anticoagulants (OAC) for atrial fibrillation (AF) can still present with stroke. The mechanism for stroke in these patients can be due to multiple factors including subtherapeutic dosing and non-compliance. With the increasing use of direct-acting OACs (DOACs) in favour of warfarin, it is unclear if the incidence of stroke in those already taking OAC has reduced. Methods Data was extracted from our unit’s stroke registry, a prospectively maintained database, for patients who presented with stroke while receiving OAC for AF from 2013 to 2017. Type of OAC, type of stroke, OAC dosing at time of event including non-compliance, stroke management and outcome were recorded. Results 67 patients were included for analysis, with 55 ischaemic and 12 haemorrhagic strokes. 52 patients were receiving warfarin at the time of their stroke vs. 15 receiving DOACs. 33/55 (60%) of ischaemic strokes occurred in patients taking warfarin with a sub-therapeutic INR. In 3/55 (5%) of ischaemic strokes, the OAC was held for a procedure while in 6/55 cases (11%) the OAC had been stopped for another reasons e.g. bleeding. 5/55 (7%) were due to non-compliance. 1 ischaemic stroke was due to under-dosing of a DOAC (dabigatran). 16 strokes were recorded in 2013 for patients prescribed OAC vs. 3 in 2017. Overall the number of ischaemic strokes due to subtherapeutic OAC decreased from 14 in 2013 to 1 in 2017 (p value 0.06). Conclusion The majority of strokes occurring in anticoagulated patients are related to warfarin use. We observed an almost significant reduction in the proportion of ischaemic strokes due to under-dosing of OAC over the study period. Warfarin continues to be recommended as the first line anticoagulant for stroke prevention in atrial fibrillation by the HSE Medicines Management Programme, a decision which we would argue warrants review.

Radiofrequency Ablation vs Antiarrhythmic Drugs as First-line Treatment of Symptomatic Atrial Fibrillation

JAMA ◽  
2005 ◽  
Vol 293 (21) ◽  
pp. 2634 ◽  
Author(s):  
Oussama M. Wazni ◽  
Nassir F. Marrouche ◽  
David O. Martin ◽  
Atul Verma ◽  
Mandeep Bhargava ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Antiarrhythmic Drugs ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

scholarly journals Rhythm and rate control of atrial fibrillation in the emergency department – A large community-based observational study

CJEM ◽  
2017 ◽  
Vol 20 (6) ◽  
pp. 834-840 ◽  
Author(s):  
Cameron J. Gilbert ◽  
Paul Angaran ◽  
Zana Mariano ◽  
Theresa Aves ◽  
Paul Dorian
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Rate Control ◽  
Primary Diagnosis ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Chads2 Score ◽  
Control Factors ◽  
Wide Range ◽  
Canadian City

AbstractObjectiveAtrial fibrillation (AF) is the most common arrhythmia presentation to the emergency department (ED) and frequently results in admission to the hospital. Although rarely life-threatening and not usually an emergent condition, AF places a large burden on our health-care system. The objective of this study was to describe the practices of ED physicians in the management of AF in a large urban Canadian city.MethodsFrom January 1, 2010 to December 31, 2010, patients with a primary diagnosis of AF were identified across 10 EDs in Toronto, Canada (N=2,609). Fifty patients were selected at random from each hospital for a detailed chart review (n=500).ResultsTwo hundred thirty-two patients (46%) received rate control, and 129 (26%) received rhythm control with the remainder (28%) receiving neither therapy. Sixty-seven percent of patients were discharged home. Most patients (79%) were symptomatic on arrival; however, only a minority of these (31%) received rhythm control. Factors that were associated with rhythm control included younger age, duration of palpitations ≤ 48 hours, a lower CHADS2 score, and the absence of left ventricular dysfunction.ConclusionOur data suggest a wide range of practice amongst ED physicians treating patients presenting to the ED with a primary diagnosis of AF. A randomized trial is needed to better understand the optimal management strategy in this patient population and setting.

Study on the Global Bifurcation of Quasi-Zero-Stiffness System

2013 ◽  
Vol 397-400 ◽  
pp. 451-456
Author(s):  
Qing Chao Yang ◽  
Li Hua Yang ◽  
Yan Ping Chen ◽  
Hao Kai Lai
Keyword(s):  
Optimization Design ◽  
Global Bifurcation ◽  
Mapping Method ◽  
Exciting Force ◽  
Force Frequency ◽  
Force Amplitude ◽  
System A ◽  
Wide Range ◽  
Chaos Motion ◽  
Dynamics Approximation

According to the characteristics of the quasi zero stiffness (QZS) system, a dynamics approximation model is established. The effect of excitation force amplitude, frequency and stiffness on the dynamic characteristics of the system is studied by continuation algorithm. The global bifurcation diagram with a wide range of parameters is achieved by using Poincaré mapping method. Results show that when the exciting force amplitude increases to a certain extent, the system will come into multi-cycle and chaos motion state. When exciting force frequency is lower, the system dynamic behavior is complicated, which is helpful for the engineering optimization design.

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