Miracle or mirage?

More than two million people in the UK are taking statins to reduce their cholesterol. But some doctors claim that they can cause affective disorders.     

What is the Role of Reversal Agents in the Management of Emergency Department Patients with Dabigatran-Associated Hemorrhage?

Background

In 2010, the U.S. Food and Drug Administration (FDA) approved dabigatran as the first non-warfarin oral anticoagulant for use in the United States. At the time of FDA approval, there was no antidote or effective treatment for dabigatran-induced hemorrhage. In 2015, the FDA approved idarucizumab for the treatment of dabigatran-induced hemorrhage. The purpose of this clinical practice statement is to evaluate the role of select reversal agents in the management of patients with dabigatran-associated bleeding.

Re-engineering of health care: opportunity or threat for occupational therapists?

The health care system is responding to a paradigm shift from the industrial era to the knowledge society. The rapidly changing administrative structures of some hospitals and increasing numbers of proposals for new models of care are disconcerting for therapists who are used to working in traditional organizational structures and models of care. However, with a broader understanding of the shift that is occurring, it becomes apparent that this paradigm shift is pushing the system toward care practices that are more consistent with occupational therapy practices than those of the traditional medical model. This paper describes the factors influencing the direction of the paradigm shift, the major emerging models of care and organizational structures associated with the paradigm shift, and then discusses the issue of whether the paradigm shift presents a threat or a challenge to occupational therapists.     

ASME proposals for reform of SHO training: threat or opportunity for the specialty of accident and emergency?

A report is made on proposals for change in postgraduate medical training that may have profound implications for the specialty of accident and emergency (A&E). The proposals are detailed with their background and rationale, together with some of their possible effects on A&E.     

CPR for children: one hand or two?

AIMS: Current guidelines for chest compressions in CPR advocate a one handed technique in children (1-8 years old) and a two handed technique in adults (>8 years old). No previous study has examined whether these two techniques generate different compression pressures. This study assesses the relative difference in intrathoracic compression pressures generated by one- and two handed chest compression techniques in a paediatric manikin. METHODS: Randomised crossover design. Subjects performed both types of chest compressions on an adapted paediatric resuscitation manikin connected to a pressure transducer and personal computer. Ethical approval was granted. RESULTS: A 30 volunteer subjects (9 male, 21 female) participated in the study. Their mean age was 30.8 years (S.D. 8.6), and mean weight was 70.5 kg (S.D. 12.8). The mean compression pressure was 86.6 mmHg (S.D. 13.68) for two handed and 75.1 mmHg (S.D. 12.02) for one handed (P < 0.001, paired t-test). The average peak compression pressure was 133.5 mmHg (S.D. 26.36) for two handed and 116.8 mmHg (S.D. 21.48) for one handed (P = 0.001, paired t-test); 29 found the two handed technique easier to perform. CONCLUSION: Two handed chest compression CPR seems to be easier to perform on a paediatric resuscitation manikin and produces significantly higher mean and peak pressures. Further work is needed to determine the comparative effects on children and which technique produces better clinical outcomes.     

Erythropoietin for stroke treatment: dead or alive?

Endothelial progenitor cell (EPC) mobilization from the bone marrow was considered to improve outcome after ischemic stroke. Erythropoietin (EPO) might be a potential candidate stroke drug that increases the number of circulating EPCs. In the previous issue of Critical Care, Yip and colleagues investigated the effect of EPO in stroke patients on both clinical outcome and EPC stimulation. Although beneficial effects of EPO were observed, several issues regarding EPO's suitability as a stroke drug remain.     

Genetics knowledge for nurses: necessity or luxury?

Senior nurses within frontline NHS Trusts in East Anglia were consulted about their perceptions of the genetics-related knowledge and education required by nurses working in their Trusts. They disagreed with policy decision makers, i.e. the Government and genetics specialists, on the currently necessary knowledge levels. They also did not recognize genetics as an important issue in current everyday nursing activities. The difference in perception also related to the speed with which its presence and importance will increase. Nurses already working under considerable pressure while not perceiving the importance of genetics in everyday practice cannot be expected to willingly absorb new genetics-related knowledge. The National Genetics Education and Development Centre in Birmingham will have to reach out to practitioners and managers throughout the UK and establish a shared platform from which to develop this issue in the future.     

Web-based information for depression: Helpful or hazardous?

The Internet cannot be underestimated as a source of information, including information for persons with depression and their families. The Internet is a resource for both persons who have not yet sought professional treatment and persons in treatment who augment professional therapy with their own research. Health care providers, including nurses, should explore this information medium because it may affect treatment of depression. To evaluate Web-based information, 25 graduate nursing students, enrolled in an informatics course, explored the Internet for information about depression. They found a wide array of Web sites focused on depression. Five levels of classification of Web sites related to depression evolved, ranging from helpful to hazardous. (J Am Psychiatr Nurses Assoc [2001]. 7, 61-6.)     

Pharmacologic therapy for the management of thrombosis: unfractionated heparin or low-molecular-weight heparin?

Heparin and heparin-derived drugs play a major therapeutic role in thrombotic and cardiovascular disorders. Infusion of unfractionated heparin (UFH) followed by warfarin has traditionally been the standard pharmacologic therapy for treatment of venous thromboembolism (VTE), which includes both deep vein thrombosis and pulmonary embolism, and for initial therapy of non-ST-elevation (NSTE) acute coronary syndrome (ACS). More recently, low-molecular-weight heparins (LMWHs) have been shown to provide at least as good efficacy and safety outcomes as UFH regimens for prevention of these conditions. In addition to good efficacy outcomes with LMWHs compared with UFH, LMWHs have other advantages over UFH, including improved bioavailability, QD administration, more predictable anticoagulant response, lack of the need for monitoring, and suitability for outpatient use, thereby increasing convenience, reducing cost, and improving cost-to-benefit ratios. In carefully screened and managed patients, LMWH offers a cost-effective, convenient, and safe alternative to UFH for thrombosis management. The aim of this article is to summarize efficacy, safety, and pharmacoeconomic considerations when selecting LMWH versus UFH for thrombosis management in VTE and NSTE ACS.