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Outcomes, atrial fibrillation, nurse practitioner,

Leonardo Méndez Boo, Ermengol Coma, Manuel Medina, Eduardo Hermosilla, Manuel Iglesias, Carmen Olmos, Sebastian Calero Muñoz, Johanna Caro Mendivelso
BACKGROUND: To determine the effectiveness of reminders compared to no reminders in improving adherence to multiple clinical recommendations measured as the resolution of the clinical condition that motivated the reminder, in a primary care setting with a well-established feedback system. METHODS/DESIGN: A 12-month, cluster-randomized, controlled clinical trial was designed (randomized by primary care team) to evaluate the impact of computerized reminders. All study participants will continue to receive the usual feedback from the electronic health records system...
2016: SpringerPlus
Alessandro Di Minno, Gaia Spadarella, Antonella Tufano, Domenico Prisco, Giovanni Di Minno
Medication adherence (taking drugs properly) is uncommon among patients on warfarin. Poor adherence to warfarin leads to an increase in adverse medical events, including stroke in atrial fibrillation (AF). Factors related to patients, physicians and the health system account for poor adherence. Direct oral anticoagulants (DOACs) are easier to use than warfarin, with fewer drug and food interactions and no need for routine blood monitoring. A proper use of DOACs may reduce the risk of stroke in AF. However, in clinical settings where no laboratory monitoring is needed, a poor medication adherence is common and may impact clinical outcomes...
May 2014: Thrombosis Research
Frederik H Verbrugge, Wilfried Mullens
Atrial fibrillation (AF) and heart failure (HF) are omnipresent cardiovascular disorders with a substantial impact on morbidity and mortality. As both share common risk factors, their pathophysiology is highly interrelated and a lot of patients present with both conditions. Surprisingly, despite their high prevalence, there is a paucity of evidence regarding the optimal combined management of AF and HF. The initial treatment for new-onset AF in the context of HF should focus on anticoagulation, rate control and prompt electrical cardioversion in case of hemodynamic instability...
May 2014: Heart Failure Reviews
Leslie L Davis
Adults with atrial fibrillation are at an increased risk for stroke. New oral antithrombotic agents are now available to help prevent stroke and other thromboembolic events. This article provides an update on factors to consider when determining various treatment options for these high-risk patients in hopes of improving outcomes.
November 10, 2013: Nurse Practitioner
Kathy Berra
Nurses and nurse practitioners play an integral role in initiating and managing antithrombotic prophylaxis in patients with atrial fibrillation (AF). Since the advent of warfarin in the 1950s, there have been few changes in this field until recently. Warfarin has been used for decades and has well-demonstrated efficacy. However, it also has well-known drawbacks, including an unpredictable dose response, need for anticoagulation monitoring, frequent dose adjustments, and many drug and food interactions. A new generation of anticoagulants, which includes direct thrombin inhibitors and selective Factor Xa inhibitors, shows the potential to significantly improve options for antithrombotic prophylaxis and to positively affect patient outcomes...
February 2014: European Journal of Cardiovascular Nursing
(no author information available yet)
UNLABELLED: SUBJECT OF THE EVIDENCE-BASED ANALYSIS: The purpose of this evidence based analysis report is to examine the safety and effectiveness of point-of-care (POC) international normalized ratio (INR) monitoring devices for patients on long-term oral anticoagulation therapy (OAT). CLINICAL NEED: TARGET POPULATION AND CONDITION Long-term OAT is typically required by patients with mechanical heart valves, chronic atrial fibrillation, venous thromboembolism, myocardial infarction, stroke, and/or peripheral arterial occlusion...
2009: Ontario Health Technology Assessment Series
Judy A Lowthian, Basia O Diug, Sue M Evans, Ellen L Maxwell, Alison M Street, Leon Piterman, John J McNeil
OBJECTIVE: To identify potential weaknesses in the system of managing warfarin therapy. DESIGN, PARTICIPANTS AND SETTING: A structured interview-based study of 40 community-dwelling patients taking warfarin and with an international normalised ratio > or = 6.0 and 36 of their treating doctors (35 general practitioners and 1 specialist), conducted between July and November 2007. Patients all received services from and were recruited sequentially by a large, private metropolitan pathology provider in Melbourne...
June 15, 2009: Medical Journal of Australia
Jaycen Cruickshank
BACKGROUND: Diagnosis of acute arrhythmias requires recognition and interpretation of important electrocardiogram (ECG) findings, and knowledge of Australian resuscitation guidelines. OBJECTIVE: This article aims to provide a guide for general practitioners in managing patients who present with acute arrhythmias in the rural or regional setting. DISCUSSION: Rural GPs need to be familiar with acute management of bradycardias, supraventricular tachycardia, atrial fibrillation and ventricular tachyarrhythmias, despite the fact that they may deal with these problems infrequently...
July 2008: Australian Family Physician
Allison M Fus, Michael H Kim, Janet M Haw, Richard G Trohman, Elaine Stephan
BACKGROUND: Therapeutic anticoagulation before elective direct current cardioversion (DCC) of atrial fibrillation reduces the risk of embolic stroke. Direct current cardioversion is performed by a variety of practitioners, and variable adherence to preprocedural anticoagulation guidelines is common. OBJECTIVE: We assessed the impact of a written policy on guideline compliance. METHODS: : Anticoagulation status and transesophageal echocardiogram (TEE) results were reviewed in 55 patients (32 men/23 women; ages 18-83 years) who underwent elective DCC during the 6-month period before a written anticoagulation policy was sent to physicians who perform, prepare, or refer patients for this procedure...
September 2007: Journal of Cardiovascular Nursing
L Boodhoo, G Bordoli, A R Mitchell, G Lloyd, N Sulke, N Patel
OBJECTIVE: To assess the safety and effectiveness of nurse led elective cardioversion of atrial fibrillation under sedation. DESIGN: Prospective, longitudinal study. SETTING: Cardiac catheterisation laboratory and recovery area of a district general hospital. PATIENTS: 300 patients referred for elective cardioversion of persistent atrial fibrillation. INTERVENTIONS: Pre-procedure evaluations (history, physical examination, blood tests), consent, sedation administration, cardioversions, and post-procedure monitoring until discharge by advanced life support certified coronary care unit nurses trained in the techniques...
December 2004: Heart: Official Journal of the British Cardiac Society
Shane L Jackson, Luke R Bereznicki, Gregory M Peterson, Katherine A Marsden, David M L Jupe, Janet H Vial, Rohan L Rasiah, Gary Misan, Sharon M Williams
OBJECTIVE: To compare the accuracy and clinical usefulness of the near-patient testing CoaguChek S INR monitor in rural medical practice. DESIGN, SETTING AND MAIN OUTCOME MEASURES: General practices were identified through Australian university departments of rural health. Study investigators trained general practitioners and/or practice nurses in the use of the CoaguChek S INR monitor. General practices obtained a fingerprick sample for testing with the INR monitor to compare with conventional pathology testing for accuracy...
August 2004: Australian Journal of Rural Health
R G Holloway, B G Vickrey, C Benesch, J A Hinchey, J Bieber
BACKGROUND AND PURPOSE: The purpose of the present study was to develop and rate performance measures for hospital-based acute ischemic stroke. METHODS: A national multidisciplinary panel of 16 individuals (2 stroke specialists, 2 general neurologists, 2 internists, 2 neuroscience nurses, 2 stroke advocacy organization representatives, 1 stroke rehabilitationist, 1 family practitioner, 1 emergency room physician, 1 neuroradiologist, 1 managed care organization director, and 1 hospital association representative) from 10 medical societies or lay organizations assisted in the development of 44 potential stroke performance measures...
September 2001: Stroke; a Journal of Cerebral Circulation
S Somerville, J Somerville, P Croft, M Lewis
The importance of atrial fibrillation as a treatable risk factor for stroke is well established. Less is known about how to find previously unidentified cases within the community so that antithrombotic treatment can be offered to a wider group of at-risk patients. The aim of our study was to examine ways to improve the efficiency of practice-based screening for atrial fibrillation, including issues of time and financial cost. We used different combinations of pulse palpation and interpretation of 12-lead and bipolar electrocardiographs as carried out by practice nurses...
September 2000: British Journal of General Practice: the Journal of the Royal College of General Practitioners
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