Patient characteristics among users of analgesic over-the-counter aspirin in a Danish pharmacy setting

Background Use of over-the-counter (OTC) high-dose acetylsalicylic acid (ASA) is a risk factor for experiencing gastric bleeding. However, more detailed knowledge on the characteristics of users of OTC ASA is needed. Objective To characterise users of OTC high-dose ASA in a Danish pharmacy setting. Method We conducted an interview based survey among users of OTC high-dose ASA. Questions were asked regarding: (1) demographic characteristics; (2) use patterns; (3) knowledge about adverse events; (4) risk factors for experiencing gastric bleeding; (5) reasons for choosing an ASA-containing medicine; and (6) whether their GP was informed on their use of high-dose ASA. Results One-hundred-seventeen interviews were completed. Nineteen percent and 37 % used high-dose ASA on a daily or weekly basis respectively. Sixty-eighth percent found high-dose ASA to be more effective than other analgesics. Fourty-seven percent had one or more risk factors for experiencing ulcer bleeding, most commonly age >60 years (32 %) and previous peptic ulcer (9 %). The most well-known adverse events were abdominal pain (32 %) and peptic ulcer (26 %). The most common source of information was friends and family (32 %). Conclusion A large proportion of users of high-dose ASA have risk factors for experiencing gastric bleeding. Health-care professionals needs to provide more information on potential adverse events.     

Occupational Therapy Level II Fieldwork Impact on Clinicians: A Preliminary Time Study

The aim of this preliminary study was to quantify the amount of time clinicians spend at work with and without a student and identify predictors of time spent at work with a student. A quasi-experimental design evaluated 22 occupational therapists that supervised a student. The occupational therapists completed a time log for 3 months without a student and 3 months while supervising a student. A statistically significant difference in overall time spent at work while supervising a student compared to when not supervising a student was found. Clinicians spent an average additional 25 minutes at work per day when supervising a student. Clinician years of experience and time spent without a student were found to be predictive of the time spent at work with a student. The additional time spent at work when supervising a level II fieldwork student should be considered along with all of the documented benefits of supervising a student by potential fieldwork educators.     

Pulmonary Emboli and Deep Venous Thrombosis during Adolescence

Pulmonary emboli (PE) and deep venous thrombus (DVT) are two conditions considered to affect primarily adults. These conditions, however, can and do affect neonates, toddlers, school-age children, and adolescents. Factors contributing to the development of PE and DVT are often associated with genetic mutations in Antithrombin III, Protein C, and Protein S. This article presents a primary care case study of an adolescent who was diagnosed with and underwent treatment for bilateral PE and a DVT, and reviews the underlying primary genetic mutations, diagnostic workup, and management of his clinical condition.     

Heart Failure Management in Nursing Homes: A Scoping Literature Review

Heart failure (HF) affects 20% of nursing home (NH) residents, causing high morbidity and mortality. The optimal approach to HF management in NHs remains elusive. We conducted a scoping review of published guidelines and HF management interventions in NHs. A search for English publications since 1990 was conducted using PubMed, EMBASE, CINAHL, and Scopus, for scientific statements, guidelines, recommendations, or intervention studies that addressed at least 1 principle of HF management. Of 2545 records retrieved, 19 articles were retained after screening, and 2 additional articles identified through reference list manual searches. Six articles represented 5 guidelines and 15 described interventions. All guidelines endorsed the applicability of general HF guidelines to NH residents, tailored to comorbidities, frailty, and advance care preferences. Four addressed quality assurance but not feasibility and sustainability. Methodological quality of the interventions was poor, although results suggest that guideline-based HF management in NHs can improve nursing staff knowledge and job satisfaction, prescribing, and reduce acute care utilization. Clinically-based education for staff, and access to specialist mentorship are important. NH physician involvement was limited, and resident/family education potentially ineffective. Concerns about feasibility, sustainability, and quality assurance were identified in most interventions, and advance care planning was rarely addressed. HF guidelines for NH support the applicability of general HF guidelines to the care of NH residents, and published interventions suggest that guideline-based HF management in NHs is effective. Future work should support greater physician and resident engagement, advance care planning, and provide robust guidelines on developing feasible and sustainable interventions.