Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

A relação entre a equipe de saúde e a família da criança moribunda

The present study is a review based on bibliographic search, interviews and the experience of the author about health care process, as it is currently done, for parents that face the death of their child. This research belongs to the qualita- tive paradigm, using a semi structure interview as method of data recollection. Several answers were obtained seeing parents perception about health care of health team, mainly of nursing professionals, from diagnosis to the moment of mourning they are. La presente es una revisión basada en búsqueda bibliográfica, realización de entrevistas y en la experiencia de la autora acerca del proceso de atención, tal como se realiza en la actualidad, de aquellos padres que enfrentan la muerte de un hijo. La investigación se enmarcó dentro del paradigma cualitativo, usando la entrevista semiestructurada como método de recolección de datos. Se obtuvo una serie de respuestas en las que se observa la percepción de los padres acerca de los cuidados del equipo de salud, principalmente de los profesionales de enfermería, desde el diagnóstico hasta el momento de duelo en que ellos se encuentran.A presente é uma revisão baseada na busca bibliográfica, na realização de entrevistas e na experiência da autora sobre o processo de atenção, tal como se realiza na atualidade, daqueles pais que enfrentam a morte de um filho. A pesquisa teve como marco o paradigma qualitativo, usando a entrevista semi-estruturada como método de coleta de dados. Foi obtida uma série de respostas nas quais se observa a percepção dos pais sobre os cuidados da equipe de saúde, principalmente dos profissionais de enfermagem, desde o diagnóstico até o momento de enfrentamento em que eles se encontram

A relação entre a equipe de saúde e a família da criança moribunda

The present study is a review based on bibliographic search, interviews and the experience of the author about health care process, as it is currently done, for parents that face the death of their child. This research belongs to the qualita- tive paradigm, using a semi structure interview as method of data recollection. Several answers were obtained seeing parents perception about health care of health team, mainly of nursing professionals, from diagnosis to the moment of mourning they are. La presente es una revisión basada en búsqueda bibliográfica, realización de entrevistas y en la experiencia de la autora acerca del proceso de atención, tal como se realiza en la actualidad, de aquellos padres que enfrentan la muerte de un hijo. La investigación se enmarcó dentro del paradigma cualitativo, usando la entrevista semiestructurada como método de recolección de datos. Se obtuvo una serie de respuestas en las que se observa la percepción de los padres acerca de los cuidados del equipo de salud, principalmente de los profesionales de enfermería, desde el diagnóstico hasta el momento de duelo en que ellos se encuentran.A presente é uma revisão baseada na busca bibliográfica, na realização de entrevistas e na experiência da autora sobre o processo de atenção, tal como se realiza na atualidade, daqueles pais que enfrentam a morte de um filho. A pesquisa teve como marco o paradigma qualitativo, usando a entrevista semi-estruturada como método de coleta de dados. Foi obtida uma série de respostas nas quais se observa a percepção dos pais sobre os cuidados da equipe de saúde, principalmente dos profissionais de enfermagem, desde o diagnóstico até o momento de enfrentamento em que eles se encontram

Enactment of compassionate leadership by nursing and midwifery managers: results from an international online survey

Aim To explore the views of an international sample of nursing and midwifery managers concerning attributes that they associate with compassionate management. Method A cross- sectional online survey. Using a snowballing sampling method, 1217 responses were collected from nursing and midwifery managers in 17 countries. A total of complete 933 responses to a question related to which actions and behaviours indicated that a manager was exercising compassionate leadership were analysed for this paper. First, content analysis of the responses was conducted, and second, a relative distribution of the identified themes for the overall sample and for each participating country was calculated. Results Six main themes were identified describing the attributes of a compassionate leader: (1) Virtuous support, (2) Communication, (3) Personal virtues of the manager, (4) Participatory communication, (5) Growth/flourishing/ nurturing and (6) Team cohesion. The first three themes mentioned above collectively accounted for 63% of the responses, and can therefore be considered to be the most important characteristics of compassionate management behaviour. Conclusion The key indicators of compassionate management in nursing and midwifery which were identified emphasise approachability, active and sensitive listening, sympathetic responses to staff members’ difficulties (especially concerning child and other caring responsibilities), active support of and advocacy for the staff team and active problem solving and conflict resolution. While there were differences between the countries’ views on compassionate healthcare management, some themes were widely represented among different countries’ responses, which suggest key indicators of compassionate management that apply across culture

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

Comparison of international normalized ratio audit parameters in patients enrolled in GARFIELD-AF and treated with vitamin K antagonists

Vitamin K antagonist (VKA) therapy for stroke prevention in atrial fibrillation (AF) requires monitoring of the international normalized ratio (INR). We evaluated the agreement between two INR audit parameters, frequency in range (FIR) and proportion of time in the therapeutic range (TTR), using data from a global population of patients with newly diagnosed non-valvular AF, the Global Anticoagulant Registry in the FIELD\u2013Atrial Fibrillation (GARFIELD-AF). Among 17\ua0168 patients with 1-year follow-up data available at the time of the analysis, 8445 received VKA therapy (\ub1antiplatelet therapy) at enrolment, and of these patients, 5066 with 653 INR readings and for whom both FIR and TTR could be calculated were included in the analysis. In total, 70\ua0905 INRs were analysed. At the patient level, TTR showed higher values than FIR (mean, 56\ub70% vs 49\ub78%; median, 59\ub77% vs 50\ub70%). Although patient-level FIR and TTR values were highly correlated (Pearson correlation coefficient [95% confidence interval; CI], 0\ub7860 [0\ub7852\u20130\ub7867]), estimates from individuals showed widespread disagreement and variability (Lin's concordance coefficient [95% CI], 0\ub7829 [0\ub7821\u20130\ub7837]). The difference between FIR and TTR explained 17\ub74% of the total variability of measurements. These results suggest that FIR and TTR are not equivalent and cannot be used interchangeably