RESUMO
Background: Various anticoagulant therapies are prescribed to patients under physicians' discretion and recently Direct Oral Anticoagulants(DOAC) have been under trials to evaluate their safety and efficacy. In addition to this, the regimen of DOACs and Aspirin is of keen interest as researchers continue to find an optimal regimen to treat blood clots in patients. This study is a systematic review and meta-analysis of randomized controlled trials and observational studies that asses the safety and efficacy of DOAC with and without Aspirin. Methods: We queried MEDLINE and Cochrane CENTRAL from their inception to April 2021, for published and randomized controlled trials and observational studies in any language that compared dual (DOAC + ASA) therapy or mono (DOAC alone) therapy in patients with AF. The results from the studies were presented as risk ratios (RRs) with 95% confidence intervals (CIs) and were pooled using a random-effects model. Endpoints of interest included major bleeding, myocardial infarction (MI), major adverse cardiovascular events (MACEs), hospitalizations, all-cause mortality, and stroke. Results: The risk of major bleeding was significantly lower in the DOAC alone group compared with DOAC plus aspirin group. Non-significant results were obtained (P value greater than 0.05) for other outcomes establishing that DOAC monotherapy was not superior to the combined regimen in reducing the risk of MACE, Stroke, Hospitalization, Death. Conclusion: Among patients with NVAF (Non valvular Atrial Fibrillation) and VTE (Venous thromboembolism) receiving anticoagulation prophylaxis, in terms of safety profile our comparisons showed a statistically significant reduction in Major Bleeding in DOAC Alone group compared with DOAC Plus Aspirin.
RESUMO
Background Few studies have explored factors affecting preference of medical students towards general practice as a career choice. We conducted a survey in Karachi across various public and private sector medical colleges to examine factors associated with students' general practice career aspirations in Karachi, Pakistan. Methods From January to March 2018, we distributed a 21-item questionnaire to final year medical students in eight medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. Results A total of 1400 responses were obtained. The top five specialty fields chosen by students with their numbers were: internal medicine, 898 (64.2%); general practice, 337 (24.1%); pediatrics, 449 (32.1%); surgery, 380 (27.2%); and emergency medicine, 243 (17.4%). The "intent to inherit existing practice" and "other academic or professional experiences prior to medical school" had a positive association with choosing general practice while "having a physician parent'' had a negative association among the medical students demographics after adjusting for other covariates in the multivariable logistic regression. Medical students who ranked "clinical diagnostic reasoning", "community-oriented practice", "involvement in preventive medicine", and "frequent patient communication" as highly important were more likely to choose general practice, whereas, "access to advanced medical fields", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration. Conclusion The study's results depicted limited interest of family medicine as a career option in graduating students, and pointed out the factors that likely influence the choice of general practice as a career are clinical diagnostic reasoning, community-oriented practice and preventive medicine.
