scholarly journals Deaths from cardiovascular disease involving anticoagulants: a systematic synthesis of coroners’ case reports

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0150
Author(s):  
Ali Anis ◽  
Carl Heneghan ◽  
Jeffrey K Aronson ◽  
Nicholas J DeVito ◽  
Georgia C Richards
Keyword(s):  
Cardiovascular Disease ◽  
Content Analysis ◽  
Medical Records ◽  
Healthcare Professionals ◽  
Case Reports ◽  
Global Burden ◽  
England And Wales ◽  
General Practices ◽  
Effective Use ◽  
Systematic Synthesis

BackgroundThe global burden of cardiovascular disease (CVD) is forecast to increase, and anticoagulants will remain important medicines for its management. Coroners' Prevention of Future Death reports (PFDs) provide valuable insights that may enable safer and more effective use of these agents.AimTo identify CVD-related PFDs involving anticoagulants.Design and SettingRetrospective observational study of coronial case reports in England and Wales between 2013 and 2019.MethodWe screened 3037 PFDs for eligibility and included PFDs where CVD and an anticoagulant caused or contributed to the death. We descriptively analysed included cases and used content analysis to assess concerns raised by coroners and who responded to them.ResultsWe identified 113 cardiovascular disease-related PFDs involving anticoagulants. Warfarin (36%), enoxaparin (11%), and rivaroxaban (11%) were the most common anticoagulants reported. Concerns most frequently raised by coroners included poor systems (31%), poor communication (25%), and failures to keep accurate medical records (25%). These concerns were most often directed to NHS trusts (29%), hospitals (10%), and general practices (8%). Nearly two-thirds (60%) of PFDs had not received responses from such organisations, which are mandatory under regulation 28 of the Coroners' (Investigations). We created a publicly available tool, https://preventabledeathstracker.net/, which displays coroners’ reports in England and Wales to streamline access and identify important lessons to prevent future deaths.ConclusionNational organisations, healthcare professionals, and prescribers should take actions to address the concerns of coroners’ in PFDs to improve the safe use of anticoagulants in patients with cardiovascular disease.

scholarly journals Deaths from cardiovascular disease involving anticoagulants: a systematic synthesis of coroners' case reports to prevent future deaths

2021 ◽  
Author(s):  
Ali Ains ◽  
Carl Heneghan ◽  
Jeffrey K Aronson ◽  
Nicholas J DeVito ◽  
Georgia C Richards
Keyword(s):  
Cardiovascular Disease ◽  
Medical Records ◽  
Healthcare Professionals ◽  
Case Reports ◽  
Global Burden ◽  
Premature Deaths ◽  
National Importance ◽  
General Practices ◽  
Effective Use ◽  
Systematic Synthesis

Background: The global burden of cardiovascular disease (CVD) is forecast to increase, and anticoagulants will remain important medicines for its management. Coroners' Prevention of Future Death reports (PFDs) provide valuable insights that may enable safer and more effective use of these agents. Objective: To identify CVD-related PFD reports highlighting the use or lack of anticoagulants as having caused or contributed to deaths. Methods: We conducted a retrospective observational study of coronial case reports in England and Wales between 2013 and 2019. We screened 3037 PFDs for inclusion and used content analysis to assess concerns raised by coroners and who responded to them. Results: We identified 113 CVD-related PFDs (113 deaths) involving anticoagulants. Warfarin (36%), enoxaparin (11%), and rivaroxaban (11%) were the most common anticoagulants reported. In 14 cases, the coroner mentioned that the administration of an anticoagulant may have prevented the death. Concerns most frequently raised by coroners included poor systems (31%), poor communication (25%), and failures to keep accurate medical records (25%). These concerns were most often directed to NHS trusts (29%), hospitals (10%), and general practices (8%), but had national importance. Nearly two-thirds (60%) of PFDs had not received responses from such organisations, which are mandatory under regulation 28 of the Coroners' (Investigations) Regulations 2013. Conclusions: We created a tool (https://preventabledeathstracker.net/) that bring together coroner reports to identify important lessons related to preventable deaths. Here we examined instances of premature deaths from CVD involving anticoagulants. National organisations, healthcare professionals, and prescribers should take actions to address these concerns, to improve the use of anticoagulants in patients with CVD.

scholarly journals Protocol for a scoping review to understand what is known about how GPs make decisions with, for and on behalf of patients who lack capacity

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038032
Author(s):  
Simon Jack Ogden ◽  
Richard Huxtable ◽  
Jonathan Ives
Keyword(s):  
Primary Care ◽  
Content Analysis ◽  
Scoping Review ◽  
Healthcare Professionals ◽  
Research Question ◽  
Best Interests ◽  
England And Wales ◽  
Directed Content Analysis ◽  
Allied Healthcare ◽  
Made In

IntroductionGeneral Practitioners (GPs) and allied healthcare professionals working in primary care are regularly required to make decisions with, for and on behalf of patients who lack capacity. In England and Wales, these decisions are made for incapacitated adult patients under the Mental Capacity Act 2005, which primarily requires that decisions are made in the patient’s ‘best interests’. Regarding children, decisions are also made in their best interests but are done so under the Children Act 1989, which places paramount importance on the welfare of the child. Decisions for children are usually made by parents, but a GP may become involved if he or she feels a parent is not acting in the best interests of the child. Internationally, including elsewhere in the UK, different approaches are taken. We hypothesise that, despite the legislation and professional guidelines, there are many different approaches taken by GPs and allied healthcare professionals in England and Wales when making these complex decisions with, for and on behalf of patients who lack capacity. To better understand what is known about how these decisions are made, we plan to undertake a scoping review and directed content analysis of the literature. While the majority of decisions made in primary care are made by GPs, for completeness, this review will include all allied healthcare professionals working in primary care.Methods and analysisTo ensure a wide breadth of literature is captured, a scoping review will be undertaken as described by Arksey and O’Malley (2005). A five-stage approach will be taken when conducting this review: (1) identifying the research question; (2) identifying relevant papers; (3) study selection; (4) data extraction and (5) summarising and synthesis. The final stage will include a directed content analysis of the data to help establish the cross-cutting themes.Ethics and disseminationThe scoping review will be disseminated through conferences and peer-reviewed publications. This scoping review is the first (mapping) phase in a proposed larger study to explore how GPs make decisions with, for and on behalf of those who lack capacity. Qualitative research with GPs, patients and their families will follow, before all the results are synthesised using an ‘empirical bioethics’ methodology.

scholarly journals Facilitating Genetics Aware Clinical Decision Support: Putting the eMERGE Infrastructure into Practice

ACI Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e54-e58
Author(s):  
Casey Overby Taylor ◽  
Luke V. Rasmussen ◽  
Laura J. Rasmussen-Torvik ◽  
Cynthia A. Prows ◽  
David A. Dorr ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Medical Records ◽  
Clinical Decision Support ◽  
Medical Records ◽  
Case Reports ◽  
Clinical Decision ◽  
Phase Iii ◽  
Health Record ◽  
It Infrastructure ◽  
Emerge Network

AbstractThis editorial provides context for a series of published case reports in ACI Open by summarizing activities and outputs of joint electronic health record integration and pharmacogenomics workgroups in the NIH-funded electronic Medical Records and Genomics (eMERGE) Network. A case report is a useful tool to describe the range of capabilities that an IT infrastructure or a particular technology must support. The activities we describe have informed infrastructure requirements used during eMERGE phase III, provided a venue to share experiences and ask questions among other eMERGE sites, summarized potential hazards that might be encountered for specific clinical decision support (CDS) implementation scenarios, and provided a simple framework that captured progress toward implementing CDS at eMERGE sites in a consistent format.

Role of Screening Tests in the Detection and Management of Blood Pressure Abnormalities Among Young Population

Angiology ◽  
2016 ◽  
Vol 68 (5) ◽  
pp. 441-446 ◽  
Author(s):  
Mehmet Karaduman ◽  
Mustafa Aparci ◽  
Murat Unlu ◽  
Cengiz Ozturk ◽  
Sevket Balta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Heart Rate ◽  
Medical Records ◽  
Screening Tests ◽  
Young Population ◽  
Males And Females ◽  
Apparently Healthy

The prevalence of hypertension is increasing among young population worldwide. So there is an interest in detecting prehypertension and hypertension in childhood. We determined blood pressure (BP) recorded at a screening test in a young population. We retrospectively evaluated the medical records including systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, height, and body mass index (BMI) of 685 male and 130 female apparently healthy adolescents. We evaluated the prevalence of BP categories: normotension, prehypertension, and hypertension. The prevalence of normotension (n = 369), prehypertension (n = 333), and hypertension (n = 113) was 45.3%, 40.9% and 13.9%, respectively; prehypertension and hypertension were significantly higher among males. The prevalence of prehypertension and hypertension was significantly higher among overweight males and females. The BMI significantly correlated with SBP, DBP, and heart rate among both genders. The prevalence of prehypertension and hypertension is high among Turkish adolescents. Screening tests focused on BP and BMI measurement may help detect the young population at risk of hypertension and cardiovascular disease in the future.

scholarly journals Fusidic Acid: A Neglected Risk Factor for Statin-Associated Myopathy

2018 ◽  
Vol 12 ◽  
pp. 117954681881516 ◽  
Author(s):  
Josefine Rönnqvist ◽  
Pär Hallberg ◽  
Qun-Ying Yue ◽  
Mia Wadelius
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Fusidic Acid ◽  
Case Reports ◽  
Statistical Significance ◽  
Lipid Lowering ◽  
Concomitant Treatment ◽  
Swedish Medical ◽  
Statin Dose

Background: Statins are widely used lipid-lowering drugs used for the prevention of cardiovascular disease. Statins are known to cause myopathy, an adverse drug reaction with various clinical features rhabdomyolysis. Objective: To describe clinical characteristics of statin-treated individuals who experienced myopathy and identify risk factors of statin-associated myopathy. Methods: A retrospective study was conducted on cases of statin-associated myopathy reported to the Swedish Medical Products Agency. Clinical factors were compared between cases and statin-treated controls not diagnosed with myopathy. Statistical methods were univariate and multivariate logistic regression and results were presented as odds ratio (OR) with 95% confidence interval (CI). To correct for multiple comparisons, the cutoff for statistical significance was set to P < .0017. Results: In total, 47 cases of statin-associated myopathy were compared with 3871 treated controls. Rhabdomyolysis was diagnosed in 51% of the cases. Markers for cardiovascular disease were more common in cases than controls. Statistical analysis revealed the following independent risk factors for myopathy: high statin dose (OR = 1.54, calculated using the standard deviation 19.82, 95% CI = 1.32-1.80, P < .0001), and concomitant treatment with fusidic acid (OR = 1002, 95% CI = 54.55-18 410, P < .0001), cyclosporine (OR = 34.10, 95% CI = 4.43-262.45, P = .0007), and gemfibrozil (OR = 12.35, 95% CI = 2.38-64.10, P = .0028). Conclusions: The risk of myopathy increases with statin dose and cotreatment with cyclosporine and gemfibrozil. Concomitant fusidic acid has previously only been noted in a few case reports. Considering that use of fusidic acid may become more frequent, it is important to remind of this risk factor for statin-associated myopathy.

scholarly journals Cerebral Vein Thrombosis in the Antiphospholipid Syndrome: Analysis of a Series of 27 Patients and Review of the Literature

2021 ◽  
Vol 11 (12) ◽  
pp. 1641
Author(s):  
Alba Jerez-Lienas ◽  
Alexis Mathian ◽  
Jenifer Aboab ◽  
Isabelle Crassard ◽  
Miguel Hie ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Medical Records ◽  
Case Reports ◽  
Case Series ◽  
Autoimmune Disorder ◽  
Point Of View ◽  
Cerebral Vein ◽  
Review Of The Literature ◽  
Cerebral Vein Thrombosis ◽  
Vein Thrombosis

(1) Background: The Antiphospholipid Syndrome (APS) is a systemic autoimmune disorder characterized by arterial and/or venous thrombosis, pregnancy morbidity and raised titers of antiphospholipid antibodies. Cerebral vein thrombosis (CVT) is a rare form of cerebrovascular accident and an uncommon APS manifestation; the information in the literature about this feature consists of case reports and small case series. Our purpose is to describe the particular characteristics of CVT when occurs as part of the APS and compare our series with the patients published in the literature. (2) Methods: We conducted a retrospective observational study collecting data from medical records in three referral centers for APS and CVT, and a systematic review of the literature for CVT cases in APS patients. (3) Results: Twenty-seven APS patients with CVT were identified in our medical records, the majority of them diagnosed as primary APS and with the CVT being the first manifestation of the disease; additional risk factors for thrombosis were identified. The review of the literature yielded 86 cases, with similar characteristics as those of our retrospective series. (4) Conclusions: To our knowledge, our study is the largest CVT series in APS patients published to date, providing a unique point of view in this rare thrombotic manifestation.

scholarly journals RECOGNITION AND PREVENTION OF MEDICATION ERRORS IN PEDIATRIC INPATIENTS: THE ROLE OF CLINICAL PHARMACISTS

2021 ◽  
Vol 3 (2) ◽  
pp. 438-446
Keyword(s):  
Medication Errors ◽  
Medical Records ◽  
Healthcare Professionals ◽  
Dose Calculation ◽  
Medical Setting ◽  
Chi Square ◽  
Proper Action ◽  
Clinical Pharmacists ◽  
Chi Square Analysis

Introduction: Medication errors (MEs) are considered preventable errors that may occur frequently during the treatment process with or without patient harm in addition to their economic consequence. MEs occur during prescribing, dose calculation, dispensing, or administration of medicine which could be made by any healthcare professional as a physician, pharmacist or nurse, or by the patient himself. Objective: To detect and report MEs in pediatric inpatients’ medical records and potentially preventing these MEs by making recommendations/suggestions for healthcare professionals about the proper action needed to be taken. Methods: This was a prospective observational study, in which the medical records of admitted pediatric patients to Ibn Al-Atheer Teaching Hospital, Nineveh were reviewed to detect, report, and prevent MEs between the 1st of January and the 30th of June 2019. Results: Out of 6964 medical records reviewed by clinical pharmacists during the study period, 119 MEs were reported to healthcare professionals and prevented. 83% of detected MEs were dosing errors. The results of the Chi-square analysis showed that the highest percentage of dosing errors were associated with antibiotics (p=0.0493). Furthermore, the results of Chi-square analysis showed that the highest percentage of dosing errors were seen in infants and toddlers (p=0.011). Conclusion: This study highlighted the role of clinical pharmacists in recognizing, reporting and preventing MEs which are still occurring in every medical setting. Dosing errors were the most commonly occurring errors and antibiotics were the most frequent group of medicines involved in MEs.

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