New oral anticoagulants (NOACs) have emerged as an alternative for vitamin K antagonists (VKAs) for thromboembolic prevention in patients with non-valvular atrial ﬁbrillation (AF). This will have an impact on many practical considerations in the daily management of these patients. Although very promising in many regards (predictable effect without need for monitoring, fewer food and drug interactions, shorter plasma half-life, and an improved efﬁcacy/safety ratio), the proper use of NOACs will require new approaches in many daily aspects. Whereas the 2010 ESC Guidelines (and the 2012 Update) 1,2 mainly discuss the indications for anticoagulation in general (e.g. based on the CHA2DS2-VASc score) and of NOAC in particular, they guide less on how to deal with NOAC in speciﬁc clinical situations.
Moreover, despite the different AF anticoagulation trials, there are still many under-explored aspects of NOAC that are relevant already today when these drugs are used by cardiologists, neurologists, geriatricians, and general practitioners. Each of the new NOACs entering the market will be accompanied by tools for its proper use in many clinical situations (Summary of Product Characteristics or SmPC; patient card; information leaﬂets for patients and physicians), but there is a risk that multiple, and often slightly different, physician education tools could lead to more confusion than clarity. Based on these premises, the European Heart Rhythm Association (EHRA) set out to coordinate a uniﬁed way of informing physicians on the use of NOACs. This document thus supplements the AF guidelines as a practical guidance tool for safe, effective use of NOAC when prescribed.
A writing group listed 15 topics of concrete clinical scenarios, and formulated as practical answers as possible based on available knowledge. The writing group was assisted by medical experts of the companies that bring NOACs to the market: they assured that the latest information on the different NOAC was evaluated, and provided feedback on the alignment of the text with the approved SmPC. Nevertheless, the responsibility of this document resides entirely with the EHRA writing group, also because in some instances we opted to make recommendations beyond the information available in SmPC in order to provide practice advice to physicians in the ﬁeld.
Since new information is becoming available at a rapid pace, an EHRA Web site with the latest updated information accompanies this text (www.NOACforAF.eu, which links to www.escardio.org/ COMMUNITIES/EHRA, under ‘Publications’). Any item that has been changed from the original printed version will be highlighted in the future. Please note that not all drugs discussed in this document may already be European medicines agency (EMA) approved for the non-valvular AF indication, and/or not available in the different constituent EU countries at the time of publication of this document. We hope that this collaborative effort has yielded the practical tool that EHRA envisioned. The authors realize that there will be gaps, unaddressed questions, and many areas of uncertainty/debate. Therefore, readers can address their suggestions for change or improvement on the web site. This whole endeavour should be one for and by the medical community.
To read the full article, please click on the link below:
- Checklist for follow-up of patients receiving NOACs, including guidance on adherence, thromboembolism, major bleeding, blood sampling, comedications.
- Ensuring adherence should include patient’s education, family member involvement, technological aides; once-daily regimens translate to greater adherence.
- Switching covers vitamin K antagonist (VKA) to NOAC (appropriate international normalized ratio can vary by NOAC), NOAC to NOAC, NOAC to VKA (they should overlap because of slow VKA onset of action), NOAC to parenteral, and antiplatelets to NOAC.
- Drug-drug interactions, including many common prescription (anticancer, antiepileptic, rate/rhythm control) and over-the-counter (St. John’s wort) medications, consider factors such as age, food intake; algorithm provided.
- Specific patient populations: chronic kidney disease.
- NOAC plasma measurements, covering different settings (eg, in emergency, before elective surgery).
- Managing dosing errors, missed doses.
- Managing suspected overdose (eg, coagulation testing, waiting out short NOAC half-life if no active bleeding).
- Managing bleeding.
- Management in specific situations, eg, cardioversion, coronary artery disease present, acute stroke, and cancer.
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The inappropriate use of antibiotics is associated with the increase of resistance. Most antibiotics are prescribed in primary care, and most commonly for Acute Respiratory Infections (ARIs). In most cases ARIs seen in primary care are spontaneously resolved without antibiotics. The management of ARIs in primary care is therefore a key target for influencing the antibiotic prescribing behaviour of clinicians.
A new Cochrane Overview has identified effective and safe clinician-focussed interventions to reduce antibiotic prescribing for acute respiratory infections (ARIs) in primary care.
The authors concluded that point of care CRP testing reduces antibiotic prescribing for patients with ARIs in primary care with no negative effects on the outcomes of patient satisfaction and re-consultation.
Check out how the fully automated Alere Afinion™ CRP test can help guide treatment decisions with excellent precision and user friendliness in 4 minutes.
Official Statement regarding Support
Biolog 3000i & 12 Lead Patient Cable ECG System:
In January 2014, Numed announced that the Biolog 3000i ECG System was approaching its end of life due to a shortage of spare parts being available.
We realise and appreciate that the Biolog ECG System is still unique, and have extended the support on these units as much as possible. Numed Healthcare have also provided some alternative products with special pricing for MediServe customers wanting to trade in their old Biolog ECG System.
We have just managed to source an alternative manufacturer for some spare parts that were in constraint, allowing us to give more time for customers to trade in their current Biolog ECG System when funds allow.
However, Numed now has a definitive “End of Life” road map for the Biolog ECG System:
• Biolog 3000i ECG Systems covered by support contracts will be supported until the 30th September 2018
• New twelve month MediServe Contracts will be issued up until 30th September 2017
• From 1st October 2017, all remaining spares will be reserved for those Biolog ECG Systems on support contracts.
• There will be no increase in the annual support costs for MediServe in the interim period.
This provides a definitive cut-off date for support and supply of spare parts for this ECG
ANGLE plc (“the Company”)
RESEARCHERS DEVELOP PARSORTIXTM-BASED PROCESS TO EFFICIENTLY HARVEST CANCER CELLS FROM BONE MARROW
Reactivation of such dormant cells has been implicated in patients with cancer relapse.
ANGLE plc (AIM:AGL OTCQX:ANPCY), a world-leading liquid biopsy company, today announces that the Center for Women’s Health Tuebingen, Germany, has presented the first report on a successful establishment of a protocol for detecting disseminated tumour cells (DTCs) using cancer patient bone marrow with the ParsortixTM system.
The reactivation of dormant DTCs and their release into the bloodstream as circulating tumour cells (CTCs), is the process by which a patient may, sometimes after many years of remission, suffer a relapse through metastasis. There is intense interest in the existence and status of such DTCs that are “hibernating” in the bone marrow.
At present, the method of choice for detecting DTCs is a density gradient centrifugation of the bone marrow to enrich for mononuclear cells and then an antibody-based staining for various cell markers. In experiments with spiked cancer cells this procedure was shown to be accompanied by a tremendous reduction of target cells with an average of up to 80% cell loss. This may well be one reason why, in primary breast cancer, DTCs have been found in the bone marrow of only 20-30% of patients.
The Tuebingen researchers have shown that their newly established ParsortixTM based protocol allows a recovery of about 80% of input target cells. Furthermore, the Tuebingen team believe that this easy to use method may well be applicable to other (non-blood) body fluids for detection of tumor cells for liquid biopsies.
The University Hospital Tuebingen research results were presented in a poster at Europe’s leading CTC conference, the Third International Advances in Circulating Tumour Cells (ACTC) Symposium. A copy of the poster is available at https://angleplc.com/library/publications/.
ANGLE Founder and Chief Executive, Andrew Newland, commented:
“The presence of disseminated tumour cells (DTCs) in bone marrow has been shown in multiple studies to be predictive of clinical relapse. The research from the Center for Women’s Health in Tuebingen demonstrates the utility of ParsortixTM in harvesting disseminated cancer cells from bone marrow, extending the potential applications of our liquid biopsy system significantly.”
Dr. André Koch, Center for Women’s Health, Tuebingen commented:
“The ParsortixTM system shows huge promise in improving the efficiency of isolating DTCs from bone marrow. At our Women’s Hospital, taking bone marrow is routine during surgery on breast cancer patients, so improvements to processing and then analysis of the bone marrow are particularly valuable. We are excited about the opportunities this opens up.”
All cultures throughout history have used the healing effects of herbs to help treat health problems. Today, we are experiencing a resurgence in the practice of herbal medicine.
The herbs we are turning to in our quest to heal ourselves, reduce or eliminate chemicals from our bodies are the same ones that were used in ancient practices from China, India, and Egypt, where written documents of herbal medicines date back to 5,000 years.
Herbal medicine takes on many remedy forms:
- Teas and bath additives, using fresh or dried herbs and are mixed in water.
- Tinctures which contain plant extracts added to alcohol or glycerin.
- Essential oils are distilled from plant materials.
- Liniments and salves that are applied to the skin contain dried herbs.
- Powders and pills contain dried extracts.
Herbal medicine is very useful for self treating mild symptoms and chronic complaints. It is also very effective for preventing illnesses by strengthening the immune system to stimulate the body’s own healing abilities.
Have you tried Apple Cider Vinegar For Blood Pressure Fluctuation?
High blood pressure is a one condition that affects many people regardless of shape and size, age, and social class. High blood pressure is often left untreated and uncontrolled because its symptoms are difficult to recognize.
If left untreated, the walls of the blood vessels can harden, resulting in a heart attack or stroke. Constricted blood vessels cause increased resistance to the blood flow and causes the blood pressure to rise.
There are natural remedies that can help with dealing with high blood pressure, many of which are in herbal form. We’re going to break it down into three simple ways you can make your own high blood pressure remedy at home.
Learn how to use Baking Soda For Heartburn Treatment
Help strengthen the heart muscle and keep the blood pressure level. To improve cardiac function make a mix of equal parts Hawthorn flowers, blueberry leaves, shepherds purse, Hibiscus, parsley, skullcap, or alfalfa. Add to boiling water, steep for around 10 minutes then strain. Drink twice a day.
To increase circulation and help dilate the blood vessels, make a tea using dried yarrow flowers. Drink 3 times a day for maximum benefits.
Pills And Powders
If you’re looking for some relaxing herbs, try passion flower, or California poppy root. These plants helps reduce the stress that can raise the blood pressure. You can find them in pill form, but first consult your doctor whether or not they are good for you.
However, if you’re looking for something in more of a supplement form, go for Ginkgo, ginger, garlic. They are all known to prevent hardening of the arteries and reduces blood pressure.
Tinctures are most effective due to the alcohol which draws the active compounds in the herb and absorbs faster into the bloodstream. Black cohosh, Blue cohosh, or Wild Cherry are all recommended to prevent high blood pressure. Just add 7-10 drops into a water, or any hot beverage. Drink 2-3 times daily.
For more articles on nutrition, exercise, weight loss, lifestyle and beauty. Please see www.healthambition.com
Please see the following on the Swann Morton range of blades.
The above is a group of organisations that have come together to tackle the clinical condition of PAD
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The Mayo Clinic Diabetes Diet is designed to help you start losing weight quickly with a total lifestyle approach. Losing weight is the single most effective step you can take to manage diabetes and reduce your chances of ever getting it if you are at risk. Quite simply, we’re very excited to offer this book and we want you to have a copy right away.
I just want to say everyone in the clinic loves the MESI ABPI MD. We had been using the manual blood pressure / doppler method for Ankle-Brachial Index measurement. Even the person who did the most ABI’s and is the fastest would spend 30-35 minutes, including resting time of 20 minutes taking the measurement on a straight forward patient.
So either their couch was ‘tied up’ or we had to use a separate room, which is not always available.
Using the MESI unit an ABI takes less than 5 minutes from start to finish. It’s basically ‘how quickly can you put on and take off 3 cuffs’
It saves so much time that a test we didn’t really like doing is now no bother.
The Future of Defibrillators
Integration has arrived!
The Mobil-O-Graph ABPM, the QRS Universal ECG and the SpiroConnect Spirometer have all now been integrated into the Socrates patient system.
The manual attachment of diagnostic reports to a patient’s medical record is a time consuming process and, combined with the inputting of Read codes, can often mean you spend more time carrying out administration tasks than caring for your patients. Manual data entry can also compromise patient safety, through the attachment of test results to the incorrect patient medical record.
I3 integration software provides a solution to these problems by acting as a link between your GP clinical system and a range of 12 lead ECG, ABPM and spirometry devices.
I3 will retrieve a patient’s details from the GP clinical systems (SOCRATES, HELIX, HealthOne, Complete GP) and automatically pass this information to the diagnostic device you want to use, ready to perform your test. Once all the tests have been completed, I3 will then file a PDF report of the test results and any associated Read codes directly into the patient’s medical record automatically, no manual re-entry of patient data is required.
Please see the following products for videos on Integration
Murray Woods – Equipment & Engineering Specialists
Proudly supporting Hibernia Medical on all Medical Installation, Training, Support and Digital Integration. The Murray Woods Team is our sister company occupying the same premises. The company comprise a group of graduate engineers with training across multiple modalities and IT.
‘Promising the same precision and care you bring to your patients.’
website – www.murraywoods.ie
email – firstname.lastname@example.org
phone – +353 1 44 33 340