Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 14 de 14
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Leg Med ; 39(3): 229-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31626576

RESUMO

Lapses in professionalism are a common cause of disciplinary action against physicians by U.S. medical boards. However, the exact definition of "professionalism" is unclear, making it likely that a physician will not train or practice under the same framing of professionalism and so may fail to develop certain skills. The goal of this study was to identify and compare the professionalism framings of medical boards. The medical board web pages for all 50 states, the District of Columbia, and four territories were examined in June 2017 for use of the word "professionalism" or "professional" in their application, rules, or laws, which was then coded as a best fit to one of six core framings of professionalism. Of the 55 states and territories, integrity was the most common professionalism framing (40.0%), followed by excellence (23.6%), behavior (12.7%), mixed (9.1%), unclear (9.1%), and absent (5.5%). Although integrity was the most common framing, diversity exists among medical boards, which could lead to board misunderstandings of incidents labeled as professionalism violations and ineffective remediation of offenses. In order to best communicate the nature of the offense and thus best facilitate remediation, the incident should be called by its true name rather than the all-encompassing term "professionalism."


Assuntos
Papel do Médico , Médicos/normas , Prática Profissional/normas , Profissionalismo/normas , Conselho Diretor/legislação & jurisprudência , Conselho Diretor/normas , Humanos , Má Conduta Profissional , Profissionalismo/tendências , Conselhos de Especialidade Profissional/legislação & jurisprudência , Conselhos de Especialidade Profissional/normas , Estados Unidos
3.
Semin Thromb Hemost ; 45(5): 502-508, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31216587

RESUMO

Although anticoagulation without hemorrhage is a primary aim, this vision has remained as yet out of reach. Even despite the superior safety profile of the direct oral anticoagulants, hemorrhage remains a major risk of anticoagulation. Selective inhibition of the contact pathway of coagulation, specifically coagulation factor XI (FXI) and/or factor XII (FXII), has now substantial epidemiologic and preclinical data supporting the notion that these factors contribute to pathologic thrombosis and are yet primarily dispensable for in vivo hemostasis. In this way, targeting FXI and FXII may revolutionize the future anticoagulation landscape. Several drugs are under development for this purpose, including: ISIS 416858, a FXI antisense oligonucleotide which impairs hepatic synthesis of FXI; MAA868, a monoclonal antibody that binds the procoagulant enzymatic site of both zymogen and activated FXI (FXIa); BAY 1213790, a monoclonal antibody that binds the procoagulant enzymatic site of FXIa only; and AB023, a monoclonal antibody that inhibits activated FXII-mediated activation of FXI, along with two small molecules in clinical trials. Each of these drugs have demonstrated favorable safety profiles in their phases 1 and 2 studies to date, with preclinical data also supporting efficacy of abrogating thrombosis in various animal models. Other benefits of some of these drugs include once-monthly dosing and safety in patients with renal or hepatic impairment, while others offer quickly metabolized parenteral options, thus providing more convenient and widely available anticoagulation options. Though still far from the marketplace, drugs targeting FXI and FXII have the potential to usher in a new era of anticoagulation therapy.


Assuntos
Anticoagulantes/uso terapêutico , Ensaios Clínicos como Assunto , Fator XII/metabolismo , Fator XI/metabolismo , Hemostasia/efeitos dos fármacos , Trombose/sangue , Anticoagulantes/farmacologia , Humanos
4.
Medicina (Kaunas) ; 55(5)2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31137735

RESUMO

The risks of systemic anti-coagulation or its reversal are well known but accepted as necessary under certain circumstances. However, particularly in the plastic surgical patient, systemic alteration to hemostasis is often unnecessary when local therapy could provide the needed adjustments. The aim of this review was to provide a summarized overview of the clinical applications of topical anti- and pro-coagulant therapy in plastic and reconstructive surgery. While not a robust field as of yet, local tranexamic acid (TXA) has shown promise in achieving hemostasis under various circumstances, hemostats are widely used to halt bleeding, and local anticoagulants such as heparin can improve flap survival. The main challenge to the advancement of local therapy is drug delivery. However, with increasingly promising innovations underway, the field will hopefully expand to the betterment of patient care.


Assuntos
Anticoagulantes/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Hemostasia/efeitos dos fármacos , Humanos , Ácido Tranexâmico/farmacologia
5.
Eur J Haematol ; 103(1): 43-46, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31009121

RESUMO

INTRODUCTION: Direct oral anticoagulants (DOACs) are being increasingly used. However, unlike warfarin, less is known regarding their long-term side effects. To better evaluate the rates of DOAC-related adverse events (AEs) on a population level, we examined AEs reported to the FDA for three commonly used DOACs and warfarin. METHODS: We evaluated the FDA Adverse Event Reporting System (FAERS) database, which compiles reported drug-related AEs from 1969 onwards. The safety profiles of the included drugs were assessed by comparing AEs per outpatient prescription and with proportional reporting ratios (PRR). RESULTS: Rivaroxaban had the highest proportion of reported AEs. Most notably the rate for breakthrough venous thromboembolism (VTE) was higher than other DOACs. Dabigatran had the highest reported rates of ischemic stroke. When the DOAC data were analyzed using PRR, reported rates of VTE were again higher with rivaroxaban while dabigatran again showed slightly higher than expected rates of ischemic stroke. Apixaban did not show higher than expected rates in any category. CONCLUSION: Our analysis found rates of reported breakthrough VTE were significantly higher with rivaroxaban, while apixaban had no higher than expected rates of any studied AEs.


Assuntos
Anticoagulantes/efeitos adversos , Notificação de Abuso , United States Food and Drug Administration , Administração Oral , Assistência Ambulatorial , Anticoagulantes/administração & dosagem , Anticoagulantes/classificação , Bases de Dados Factuais , Prescrições de Medicamentos , Humanos , Rivaroxabana/administração & dosagem , Rivaroxabana/efeitos adversos , Estados Unidos , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/epidemiologia
8.
Intern Med J ; 48(7): 882-884, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29984509

RESUMO

Although popular for displaying dermatologic conditions before the advent of photography, the medical moulage has also illustrated injuries and accidents. Explored here are three farm accidents and the moulages based on them that occurred in rural Minnesota in the early 20th century. Besides being an object of historical interest, the medical moulage also provides a valuable learning and training opportunity, and can even be thought of as the predecessor of three dimensional printing.


Assuntos
Acidentes/história , Fazendeiros , Modelos Anatômicos , História do Século XX , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Adulto Jovem
11.
Blood Coagul Fibrinolysis ; 28(8): 612-616, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28654426

RESUMO

: When patients on anticoagulation present with intracranial bleeding, stopping the bleeding is paramount. Despite the availability of multiple options to reverse anticoagulation, no study has directly compared the effectiveness of the procoagulants recombinant activated factor VII (rFVIIa), the rFVIIa and 3-factor prothrombin complex concentrate (PCC) combination, and 4-factor PCC on improving patient outcomes compared with a control. This study examined the medical records of 197 warfarin patients with intracranial hemorrhage, an initial international normalized ratio (INR) greater than 1.5, and who received rFVIIa (26), the combination (84), 4-PCC (50), or no procoagulant, the control group (37). Mortality, length of stay, location discharged, change in INR prior to and postdrug administration, plasma use, and number of thromboembolic complications were used to assess effectiveness. Although INR decreased in all groups (1.31 rFVIIa vs. 2.04 combination vs. 1.41 4-PCC vs. 1.20 control, P = 0.07), the combination group had the greatest percentage to reach an INR of less than 1.3 (46.2 vs. 73.8 vs. 58.0 vs. 43.2%, P = 0.004). The combination and control groups experienced a high, though nonsignificant, number of thromboembolic complications (5.6 vs. 19.0 vs. 7.7 vs. 12.9%, P = 0.533). The rFVIIa group used the most plasma and had the longest length of stay. Mortality did not differ significantly among groups. Although the combination improved INR compared with control, this had a high number of complications. Judicious use of procoagulants is recommended due to their expense and lack of significant improvement in outcomes compared with control.


Assuntos
Quimioterapia Combinada , Hemorragia/prevenção & controle , Hemorragias Intracranianas/tratamento farmacológico , Varfarina/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Fatores de Coagulação Sanguínea/uso terapêutico , Estudos de Casos e Controles , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/mortalidade , Fator VIIa/uso terapêutico , Feminino , Hemorragia/tratamento farmacológico , Humanos , Coeficiente Internacional Normatizado , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/mortalidade , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Mortalidade , Proteínas Recombinantes/uso terapêutico , Tromboembolia
12.
Cardiovasc Diagn Ther ; 7(Suppl 3): S291-S298, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29399533

RESUMO

Our understanding of thrombosis formation has evolved significantly ever since physician Rudolf Virchow proposed his "triad" theory in 1856. Modern science has elucidated the mechanisms of stasis, hypercoagulability, and endothelial dysfunction. Today, we have a firm understanding of the key molecular factors involved in the coagulation cascade and fibrinolytic system, as well as the underlying genetic influences. This knowledge of cellular and genetic contributors has been translated into diverse pharmaceutical interventions. Here, we examine the molecular and cellular mechanisms of thrombosis and its associated pathologies. We also review the current state of pharmacologic interventions, including pro- and anti-thrombotics, direct oral anticoagulants, and anti-platelet therapies. The pharmacogenetic factors that guide clinical decision making and prognosis are described in detail. Finally, we explore new approaches to thrombosis drug discovery, repurposing, and diagnostics. We argue that network biology tools will enable a systems pharmacology revolution in the next generation of interventions, facilitating precision medicine applications and ultimately leading to improved patient outcomes.

13.
Blood Coagul Fibrinolysis ; 24(3): 317-20, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23429251

RESUMO

Patients on warfarin who have traumatic intracranial haemorrhage have a high mortality. The procoagulant recombinant factor VIIa (rFVIIa) is widely used off-label to treat intracranial haemorrhaging in patients taking warfarin to try to improve these adverse outcomes, but its effectiveness is unknown. In this study, medical records from 2002 to 2010 were reviewed for 27 warfarin patients who received rFVIIa for their traumatic intracranial haemorrhage and were compared with a matched control group of 27 warfarin patients who did not receive rFVIIa. The two groups were matched for sex, age and Injury Severity Score. The rFVIIa patients had 33.3% mortality compared with the 37% for the control patients, but this was not a statistically significant difference. There was also no significant difference in plasma unit use between the groups. However, the rFVIIa group had a significantly higher number of subdural haemorrhages, which carry a better prognosis. The initial international normalized ratios (INRs) of the rFVIIa patients were higher, and the decrease of INR was more pronounced than in the control patients. From the data, it appears that although the INRs of rFVIIa patients did improve compared with the control group, there was no reduction in plasma use or mortality.


Assuntos
Anticoagulantes/antagonistas & inibidores , Lesões Encefálicas/tratamento farmacológico , Coagulantes/uso terapêutico , Fator VIIa/uso terapêutico , Hemorragia Intracraniana Traumática/prevenção & controle , Varfarina/antagonistas & inibidores , Idoso , Anticoagulantes/farmacologia , Lesões Encefálicas/sangue , Lesões Encefálicas/mortalidade , Lesões Encefálicas/patologia , Estudos de Casos e Controles , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Varfarina/farmacologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA