Current concepts of the management of dental extractions for patients taking warfarin

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.Background: Controversy has surrounded the correct management of patients therapeutically anticoagulated with warfarin who require dental extractions. The risk of bleeding must be weighed up against the risk of thromboembolism when deciding whether to interfere with a patient's warfarin regimen. An improved understanding of the importance of fibrinolytic mechanisms in the oral cavity has resulted in the development of various local measures to enable these patients to be treated on an outpatient basis. Methods: A review of the literature was undertaken. This was supplemented by the authors' clinical trials and extensive clinical experience with anticoagulated patients. Results: Various protocols for treating patients taking warfarin have been reviewed and summarized and an overview of the haemostatic and fibrinolytic systems is presented. A protocol for management of warfarinized patients requiring dental extractions in the outpatient setting is proposed. Conclusions: Patients therapeutically anticoagulated with warfarin can be treated on an ambulatory basis, without interruption of their warfarin regimen provided appropriate local measures are used.G Carter, AN Goss, JV Lloyd, R Tocchett

Evaluation of Resuscitative Endovascular Balloon Occlusion of the Aorta Complications in a Community-Based Trauma Center

Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a method of management of noncompressible torso hemorrhage in trauma patients. Increased utilization has shown increased vascular complications and mortality. This study aimed to evaluate complications of REBOA placement in a community trauma setting. Methods A 3-year retrospective review was performed of all trauma patients that underwent REBOA placement. Data collection included demographics, injury characteristics, complications, and mortality. Results Twenty-three patients were included, and the overall mortality was 65.2%. Most patients suffered blunt trauma (73.9%), and median ISS and TRISS (survival probability) were 24 and 42.2%, respectively. The median time to REBOA placement was 22 minutes, and hemorrhagic control was achieved in all patients. The most common complication was acute kidney injury at 34.8%. There was one complication associated with placement that required vascular intervention but did not lead to limb amputation. Conclusion Resuscitative endovascular balloon occlusion of the aorta was shown to have higher rates of acute kidney injury, similar rates of vascular injury, and lower rate of limb complications compared to published literature. Resuscitative endovascular balloon occlusion of the aorta remains a useful tool for trauma resuscitation without the fear of increased complications. </jats:sec

Make writing a daily habit: An evaluation of an educational intervention to improve writing self-efficacy among DNP students

Background and objective: Doctorate of Nursing Practice (DNP) students are trained to integrate both clinical care and evidence-based research in order to bring together science with application. However, the educational pathways in DNP programs can be problematic, especially with regards to scholarly writing. While several interventions have been utilized for DNP students, the results show that the intervention(s) used should be tailored to the specific student body being served. However, limited evidence exists regarding the effectiveness of tailored interventions on improving central concepts such as writing self-efficacy. Given these differences in the design and delivery of the DNP curricula, we created a tailored educational-writing curriculum for new DNP students at a medium-sized academic medical center in a Southern state.Methods: We assessed changes in writing self-efficacy over the three measurement intervals using linear mixed effects modeling to account for within-student clustering of writing self-efficacy scores over time.Results: Baseline scores of writing self-efficacy improved immediately after the workshop (Timepoint 2 – immediate post-test) and a full semester later (Timepoint 3 – semester post-test). However, we observed no statistically significant difference between Timepoint 2 (immediate post-test) and Timepoint 3 (semester post-test).Conclusions: We saw a significant benefit in writing self-efficacy among incoming DNP students from baseline scores. The tailored format and integration of real-life anecdotal feedback from faculty may have been fundamental to creating an increase in writing self-efficacy among students—a concept foundational to student, and possibly professional, nursing success.</jats:p

with an application in caries research

Conditional independence of multivariate binary dat