Systematic Review of Medicine-Related Problems in Adult Patients with Atrial Fibrillation on Direct Oral Anticoagulants

New oral anticoagulant agents continue to emerge on the market and their safety requires assessment to provide evidence of their suitability for clinical use. There-fore, we searched standard databases to summarize the English language literature on medicine-related problems (MRPs) of direct oral anticoagulants DOACs (dabigtran, rivaroxban, apixban, and edoxban) in the treatment of adults with atri-al fibrillation. Electronic databases including Medline, Embase, International Pharmaceutical Abstract (IPA), Scopus, CINAHL, the Web of Science and Cochrane were searched from 2008 through 2016 for original articles. Studies pub-lished in English reporting MRPs of DOACs in adult patients with AF were in-cluded. Seventeen studies were identified using standardized protocols, and two reviewers serially abstracted data from each article. Most articles were inconclusive on major safety end points including major bleeding. Data on major safety end points were combined with efficacy. Most studies inconsistently reported adverse drug reactions and not adverse events or medication error, and no definitions were consistent across studies. Some harmful drug effects were not assessed in studies and may have been overlooked. Little evidence is provided on MRPs of DOACs in patients with AF and, therefore, further studies are needed to establish the safety of DOACs in real-life clinical practice

Improving bank quality dimensions to increase customer satisfaction

The purpose of this study is twofold: 1. examine the relationship between service quality dimensions and customer satisfaction with bank territorial units; 2. establish which quality measure method out of the four considered in this study should be applied in order to better determine the areas that need further improvement and investment. In this respect, we performed Principal Component Regression (PCR) and considered direct importance and performance measures as well. Our results reveal that human resources have the greatest impact on customers’ satisfaction with bank territorial units and that both “Convenience and Efficiency” and “Bank personnel” are the dimensions that bank management should consider in their efforts to improve and maintain the service quality level. To the best of our knowledge, this is the first study which tries to emphasize the relationship between service quality dimensions and Romanian customers’ satisfaction with bank territorial units. The main limit of the study lies in the fact that data were collected among the customers of a single bank. Nevertheless, it provides valuable information about the Romanian market and ought to be considered a starting point for further studies

Persistent/progressive subclinical contrast-induced nephropathy – predictors and effects of parenteral hydration. A prospective study in patients undergoing coronary angioplasty

Abstract Background In most cases, contrast-induced nephropathy (CIN) appears to be a transient event. The pathophysiology of CIN, which includes renal vasoconstriction and hypoxia, generation of cytotoxic reactive oxygen species, and even direct tubular toxicity, suggests however that the tubular impairment typical for CIN may not be entirely transient and that persistent/progressive subclinical kidney dysfunction could actually occur. Purpose We aimed to evaluate the incidence, identify the predictors, and assess the impact of parenteral hydration on the occurrence of persistent/progressive subclinical CIN in patients undergoing coronary angioplasty. Methods A total of 71 patients scheduled for elective coronary angioplasty were randomized into two groups: Control (n=36) and HYD (n=35). Patients in the HYD group received prophylactic hydration with saline solution (1 ml/kg/h; 6 h prior to and 12 h after the procedure). Plasma levels of neutrophil gelatinase-associated lipocalin (NGAL), a specific marker of tubular impairment, were evaluated prior to, and 48 h and 1 month after the angioplasty procedure. Persistent/progressive subclinical CIN at 1 month post-angioplasty was defined as a significant increase in NGAL at 48 h after the procedure that persisted (i.e., did not change by more than 10%) or aggravated (i.e., increased by more than 10%) at 1 month follow-up. The ability of several factors (i.e., age, hypertension, diabetes, use of nephrotoxic drugs, baseline creatinine clearance, volume of contrast agent) to predict persistent/progressive CIN was evaluated. The ability of parenteral hydration to prevent persistent/progressive CIN was also assessed. Results According to the current criteria, CIN was present in 5 (7.0%) patients. Meanwhile, subclinical CIN was identified in 36 (50.7%) patients, of which 10 (27.7%) presented persistent and 15 (41.6%) progressive CIN at 1 month follow-up. The volume of contrast administered during angioplasty was the only factor that differed significantly between patients who developed persistent/progressive CIN and those who did not (178±17 mL vs. 130±10 mL, p=0.01). In ROC analysis, contrast volume ≥150 mL predicted persistent/progressive CIN with 77% sensitivity and 60% specificity (p&amp;lt;0.001). Prophylactic hydration was associated with a 75% lower risk of persistent/progressive CIN (RR 0.25; 95% CI 0.09–0.65; p=0.001). Conclusions Despite the relatively low incidence of CIN, subclinical CIN was identified in more than 50% of the study patients. More than 2/3 of these patients presented persistent or progressive subclinical CIN at 1 month follow-up. The clinical impact of this persistent/progressive subclinical CIN in patients undergoing multiple contrast administrations remains to be established. Our data indicate that reducing the contrast volume and/or using prophylactic parenteral hydration can significantly reduce persistent/progressive subclinical CIN. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant of the Romanian Ministry of Education and Research, CNCS-UEFISCDI </jats:sec