Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Patients' perspectives on care pathways and informed shared decision making in the transition between psychiatric hospitalization and the community

Rationale, aims, and objectivesPatients with mental health problems experience numerous transitions into and out of hospital. This study explores former patients' views of pathways in transition between district psychiatric hospital centres (DPCs) and community mental health services.MethodA descriptive qualitative design was chosen. Three focus group interviews with a total of 10 informants from five different communities were conducted. Interviews were transcribed and analysed thematically where themes describe promoting or inhibitory factors to the transition phase.ResultsThe informants shared their experiences on issues promoting and preventing successful care pathways in mental health. Four main paired themes were identified: (a) patient participation/activation/empowerment versus paternalism and institutionalization, (b) patient‐centred care versus care interpreted as humiliation, (c) interprofessional collaboration or teamwork versus unsafe patient pathways in mental health services, and (d) sustainable integrated care versus fragmented, noncollaborative care.ConclusionsShared decision making was reported more precisely as informed shared decision making. Shared information between all parties involved in care pathways is key

Community Alliances and Participatory Action Research as a mechanism for re-politicising social action for students in Higher Education

Evidence from the UN World Youth Report (2015) suggests that young people, while increasingly disengaged with formal political processes, are motivated by cause-related social action. Higher Education (HE), through research and partnership, provides ideal learning spaces to explore cause-related social action. However, as HE partnership opportunities continue to be reframed under a narrative of employability and one-off participation, there is a risk that these experiences miss an opportunity to critically engage young people with issues at a socio-political level. This research paper considers the potential of participatory action research (PAR) as a pedagogical mechanism for re-politicising social action for students in a UK HE context. The project explores the experiences of 160 undergraduate students, working in partnership with 400 young children, aged 2-10 years, to investigate and co-construct their views and action concerning causes represented by local community organisations. Findings suggest that using participatory, youth-action approaches students shifted their self-identified positions from a non-social orientated approach to establishing them as advocates for causes and children’s voices. We argue that PAR, as a learning experience, and service-learning pedagogy open up an alternative experience of social action through an educational context with engagement and consideration of social issues. In conclusion, we call for new alliances between HE, young people, and community organisations, to produce, through enquiry, critical knowledge aimed at social transformation, which can open-up authentic democratic spaces within the learning communities in HE and its networks