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

Psychopathic traits in young children

Callous and unemotional (CU) traits provide researchers and clinicians with an additional dimension when assessing children displaying early-onset conduct problems. Evidence from genetic, brain and cognitive studies to date suggests that antisocial children with psychopathic personality traits are genetically more vulnerable to antisocial behaviour than their antisocial peers. Neuroimaging studies in adults with psychopathy have demonstrated amygdala hyporeactivity to emotional stimuli, while there is some suggestion that adults with antisocial behaviour but no psychopathy may show the opposite pattern. Child neuroimaging data in this area are still thin on the ground; however, behavioural data support the hypothesis that antisocial children with callous-unemotional traits may have some amygdala abnormality. When compared with each other, antisocial children with callous-unemotional traits demonstrate hyposensitivity to others’ distress, while other antisocial children appear hypersensitive to anger directed towards them. New research combining different levels of analyses will no doubt provide further insight about the distinct developmental patterns associated with psychopathy, and help to inform methods of intervention, allowing treatment of antisocial behaviour to be targeted according to whether elevated levels of CU traits are presen