Warfarin prevalence, indications for use and haemorrhagic events

Warfarin, the standard oral anticoagulant drug used in Ireland, is a widely prescribed medication, particularly in the elderly. A HSE Mid-Western Area wide audit was undertaken over a 12-month period to examine the prevalence and indications for warfarin use and haemorrhagic complications associated with the drug. Every patient receiving warfarin therapy over a 13-week period was included (2564). The age standardised rate varied from 0.09% of 35-39 year olds to 6.1% of 80-84 year olds. Atrial fibrillation was the most common indication (54%) in patients attending the Mid-Western Regional Hospital anticoagulation clinic. The annual cumulative incidence of adverse haemorrhagic events in patients with a recorded INR > or = 5.0 episode was 16.6%. The incidence of major and minor haemorrhagic events per INR > or = 5.0 episode was 1.3% and 15.3% respectively. The most common sites of haemorrhage were genitourinary (39%) and gastrointestinal (27%). No fatal or intracranial haemorrhage relating to episodes of over-anticoagulation were reported during the audit period. The most frequent reason for over-anticoagulation was drug interaction (43%). In 74% of patients, the elevated INR was reversed by omitting or reducing warfarin dose. In 17% of cases, vitamin K was administered. Only 3% of incidents were treated with fresh frozen plasma or prothrombin complex concentrates.Warfarin, the standard oral anticoagulant drug used in Ireland, is a widely prescribed medication, particularly in the elderly. A HSE Mid-Western Area wide audit was undertaken over a 12-month period to examine the prevalence and indications for warfarin use and haemorrhagic complications associated with the drug. Every patient receiving warfarin therapy over a 13-week period was included (2564). The age standardised rate varied from 0.09% of 35-39 year olds to 6.1% of 80-84 year olds. Atrial fibrillation was the most common indication (54%) in patients attending the Mid-Western Regional Hospital anticoagulation clinic. The annual cumulative incidence of adverse haemorrhagic events in patients with a recorded INR > or = 5.0 episode was 16.6%. The incidence of major and minor haemorrhagic events per INR > or = 5.0 episode was 1.3% and 15.3% respectively. The most common sites of haemorrhage were genitourinary (39%) and gastrointestinal (27%). No fatal or intracranial haemorrhage relating to episodes of over-anticoagulation were reported during the audit period. The most frequent reason for over-anticoagulation was drug interaction (43%). In 74% of patients, the elevated INR was reversed by omitting or reducing warfarin dose. In 17% of cases, vitamin K was administered. Only 3% of incidents were treated with fresh frozen plasma or prothrombin complex concentrates

The incidence, prevalence, nature, severity and mechanisms of injury in elite female cricketers: A prospective cohort study

Objectives Incidence, prevalence, nature, severity and mechanisms of injury in elite female cricketers over two seasons from March 2014 to March 2016, inclusive. Design Prospective cohort study. Methods Injury data collected via Cricket Australia’s Athlete Management System on all elite female players over two seasons were analysed. Profiles of the nature, anatomical location and mechanism of injuries were presented according to dominant player position. Injury incidence rates were calculated based on match playing hours. Results There were 600 medical-attention injuries; with 77.7% players reporting ≥1 injury. There were 79.5% acute injuries compared to gradual onset injuries. Of the all medical-attention injuries, 20.2% led to time-loss; 34.7% were match-time-loss injuries. Match injury incidence was 424.7 injuries/10,000 h for all injuries and 79.3 injuries/10,000 h for time-loss injuries. Of all the injuries, 31.8% were muscle injuries and 16.0% joint sprains. Wrist and hand (19.8%), lumbar spine (16.5%) and knee (14.9%) injuries were the most common time-loss injuries. Six players sustained lumber spine bone stress injury that resulted in the most days missed due to injury (average 110.5 days/injury). Conclusions There is a need to focus on specific injuries in female cricket, including thigh, wrist/hand and knee injuries because of their frequency, and lumbar spine injuries because of their severity

An investigation of the relationship between intensity of grief and coping patterns of parents of individuals affected by psychotic disorders

This study investigated the relationship between intensity of grief and coping patterns of parents of individuals affected by psychotic disorders. The study investigated the intensity of grief in a sample of parents of individuals with psychotic disorders in Western Australia to determine if the results replicate international studies. It further examined if the characteristics of the psychotic disorders of children, had an impact on the grief reactions of parents and if the disorder had a measurable impact on the nature of the relationship between parents and children. The study also identified specific coping strategies that parents consider as being most helpful to them in dealing with their grief, the relationship between intensity of grief and coping patterns of respondents and gender differences in grieving and coping strategies. The research findings suggest that there is measurable grief in a cross section of parents of individuals with psychotic disorders in Western Australia with many similarities to studies done internationally. The findings also suggest that this grief increases in intensity from the time of first diagnosis and peaks at 1-2 years after diagnosis and again 20 years after diagnosis. There was a strong association between past behaviours related to grief reactions and present feelings related to grief. To the best of my knowledge, these findings have not been reported before. IV Certain characteristics of the disorder of children had an impact on the grief reactions of the parents. Higher levels of grief were reported in parents whose children needed frequent assistance with personal care and children with a late onset of the disorder.There was a positive correlation in parents who had a close relationship with the child before the onset of the disorder and following onset of the disorder suggesting that the disorder did not affect the relationship. To the best of my knowledge, these findings have not been reported before. While this research has replicated other studies, it has also researched coping strategies that have not been identified before. Although cognitive coping strategies were most frequently used by parents and subjectively found to be more helpful, parents using predominantly behavioural methods of coping showed less intensity in their grief. Parents oscillated between approaching the feelings of grief and distracting themselves from them, which highlighted the idiosyncratic nature of coping. Although there were no gender differences in the intensity of grief, there were distinct differences in coping strategies used by fathers and mothers. These findings have important implications for social work practice and policy development within the mental health settings of Western Australia

Inter-rater Reliability in Assessing Exercise Fidelity for the Injury Prevention Exercise Programme Knee Control in Youth Football Players

Background To receive maximum benefits from injury prevention exercise programmes (IPEP) such as Knee Control, players need to perform the exercises as prescribed. But, exercise fidelity in IPEPs is seldom evaluated. We developed a checklist to assess exercise fidelity in the Knee Control IPEP, and the primary aim was to evaluate its inter-rater reliability. The secondary aim was to study Knee Control exercise fidelity in youth football players and compare sex differences. Methods This observational study included 11 teams with male and female youth players (11–18 years). On average, the players trained with the Knee Control IPEP for 7 weeks (SD 1.4, range 6–10 weeks). After the training period, two physiotherapists attended a team training session to observe players executing exercises and individually assessed their performance of these exercises as correct or incorrect based on standardised criteria set in the fidelity checklist. Agreement between observers was assessed using Cohen’s kappa coefficient. Results The observers agreed on 144 out of 160 (90%) observations (Kappa = 0.80, substantial agreement). Both observers agreed on correct exercise performance for 69 out of 144 observations (exercise fidelity 48%). Exercise fidelity was higher in females (56%) than males (40%), but the difference was not statistically significant (p = 0.18). Conclusion The Knee Control exercise fidelity checklist had high inter-rater reliability with substantial agreement. The exercise fidelity was low, which could hamper the preventive effects of an IPEP. Understanding the reasons for low exercise fidelity is important and more effort should focus on increasing exercise fidelity alongside the implementation of IPEPs.Funding Agencies|Swedish Research CouncilSwedish Research Council [2015-02414, P2018-0167]; Australia Awards - Endeavour Fellowship from the Department of Education and Training, Australia; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis - Sports Grant [HFR02510]</p

Evaluation of bone marrow examinations performed by an advanced nurse practitioner: An extended role within a haematology service

Purpose: Traditionally, medical personnel have undertaken bone marrow (BM) examination. However, specially trained nurses in advanced practice roles are increasingly undertaking this role. This paper presents the findings from an audit of BM examinations undertaken by an advanced nurse practitioner (ANP) at a regional haematology specialist centre.Methods: The audit evaluated the quality of BM examinations performed by the ANP over the past two years (September 2007 September 2009). Over the two year period, 324 BM examinations were performed at the centre of which 156 (48.1%) were performed by the ANP A random sample of 30 BM examinations undertaken by the ANP were analysed by the consultant haematologist.Results: All 30 BM examinations undertaken by the ANP were sufficient for diagnosis.Conclusions: The ANP is capable and competent to obtain BM samples which are of a sufficient quality to permit diagnosis. (C) 2010 Elsevier Ltd. All rights reserved

Analysis of Drought Severity and Duration Using Copulas in Anuradhapura, Sri Lanka

Anuradhapura district is one of the largest agricultural crop production areas in Sri Lanka. But it is often affected by droughts and droughts caused severe damage for agricultural industry. Thus it is very important to identify the drought characteristics (drought duration and drought severity) and their joint probability distribution to minimize the adverse effects of droughts. Drought characteristics were defined using 3-month standard precipitation index (SPI). It is calculated using monthly rainfall data from 1951 to 2007 in Anuradhapura. Occurrences of 46 drought events were indentified using the calculated SPI.Since dependency nature of the drought variables, copula based joint distribution was used to calculate the joint distribution. The joint distribution could be obtained by combining the marginal distributions using copula. Five copulas were examined and compared to find the best fitted copula to represent the joint distribution. The best marginal distributions were identified as the gamma distributions for drought durations and drought severity using AIC, BIC and Kolmogorov-Smirnov test. Frank copula was identified as the best copula based on AIC, BIC and Cramer-Von Mises statistics. The joint distribution was derived combining the gamma distributions using the Frank copula. The univariate and joint returns periods of droughts were calculated.A drought event occurred in 1974 was identified as a major drought event. Drought duration and severity in 1974 were 9 months and 10.95 respectively. Using the indentified univariate and multivariate return periods, drought risks could be minimized by pre-planning and making decision against adverse effects

Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the knee

Abstract Background There is no cure for knee osteoarthritis (KOA) and typically patients live approximately 30-years with the disease. Most common medical treatments result in short-term palliation of symptoms with little consideration of long-term risk. This systematic review aims to appraise the current evidence for the long-term (≥12 months) safety of common treatments for knee osteoarthritis (KOA). Methods Cochrane Database of Systematic Reviews, Medline and PubMed were systematically searched from 1990 to July 2017, inclusive. Inclusion criteria were 1) peer-reviewed publications investigating treatments for KOA referred to in the Australian Clinical Care Standard and/or Therapeutic Guidelines: Rheumatology 2) specifically addressing safety of the treatments 3) with ≥12 months of follow-up and 4) Downs and Black quality score ≥ 13. Results Thirty-four studies fulfilled the inclusion criteria. Lifestyle modifications (moderate exercise and weight loss), paracetamol, glucosamine, Intraarticular Hyaluronic Acid (IAHA) and platelet-rich-plasma (PRP) injections have a low risk of harm and beneficial ≥12 month outcomes. Although Nonsteroidal Anti-inflammatory Drugs (NSAIDs) provide pain relief, they are associated with increased risk of medical complications. Cortisone injections are associated with radiological cartilage degeneration at > 12 months. Arthroscopy for degenerative meniscal tears in KOA leads to a 3-fold increase in total knee arthroplasty (TKA). TKA improves primary outcomes of KOA but has a low rate of significant medical complications. Conclusions Given the safety and effectiveness of lifestyle interventions such as weight loss and exercise, these should be advocated in all patients due to the low risk of harm. The use of NSAIDs should be minimized to avoid gastrointestinal complications. Treatment with opioids has a lack of evidence for use and a high risk of long-term harm. The use of IAHA and PRP may provide additional symptomatic benefit without the risk of harm. TKA is associated with significant medical complications but is justified by the efficacy of joint replacement in late-stage disease. Trial registration PROSPERO International prospective register for systematic reviews; registration number CRD42017072809

Warfarin prevalence, indications for use and haemorrhagic events

Warfarin, the standard oral anticoagulant drug used in Ireland, is a widely prescribed medication, particularly in the elderly. A HSE Mid-Western Area wide audit was undertaken over a 12-month period to examine the prevalence and indications for warfarin use and haemorrhagic complications associated with the drug. Every patient receiving warfarin therapy over a 13-week period was included (2564). The age standardised rate varied from 0.09% of 35-39 year olds to 6.1% of 80-84 year olds. Atrial fibrillation was the most common indication (54%) in patients attending the Mid-Western Regional Hospital anticoagulation clinic. The annual cumulative incidence of adverse haemorrhagic events in patients with a recorded INR > or = 5.0 episode was 16.6%. The incidence of major and minor haemorrhagic events per INR > or = 5.0 episode was 1.3% and 15.3% respectively. The most common sites of haemorrhage were genitourinary (39%) and gastrointestinal (27%). No fatal or intracranial haemorrhage relating to episodes of over-anticoagulation were reported during the audit period. The most frequent reason for over-anticoagulation was drug interaction (43%). In 74% of patients, the elevated INR was reversed by omitting or reducing warfarin dose. In 17% of cases, vitamin K was administered. Only 3% of incidents were treated with fresh frozen plasma or prothrombin complex concentrates.Warfarin, the standard oral anticoagulant drug used in Ireland, is a widely prescribed medication, particularly in the elderly. A HSE Mid-Western Area wide audit was undertaken over a 12-month period to examine the prevalence and indications for warfarin use and haemorrhagic complications associated with the drug. Every patient receiving warfarin therapy over a 13-week period was included (2564). The age standardised rate varied from 0.09% of 35-39 year olds to 6.1% of 80-84 year olds. Atrial fibrillation was the most common indication (54%) in patients attending the Mid-Western Regional Hospital anticoagulation clinic. The annual cumulative incidence of adverse haemorrhagic events in patients with a recorded INR > or = 5.0 episode was 16.6%. The incidence of major and minor haemorrhagic events per INR > or = 5.0 episode was 1.3% and 15.3% respectively. The most common sites of haemorrhage were genitourinary (39%) and gastrointestinal (27%). No fatal or intracranial haemorrhage relating to episodes of over-anticoagulation were reported during the audit period. The most frequent reason for over-anticoagulation was drug interaction (43%). In 74% of patients, the elevated INR was reversed by omitting or reducing warfarin dose. In 17% of cases, vitamin K was administered. Only 3% of incidents were treated with fresh frozen plasma or prothrombin complex concentrates

Corrigendum to “Epidemiology of hospital-treated cricket injuries sustained by women from 2002–2003 to 2013–2014 in Victoria, Australia. [J. Sci. Med. Sport. 22 (2019) 1213–1218]

© 2020 Sports Medicine Australia The authors would like to highlight an error in their article, as below; the authors apologise for any inconvenience this has caused. The results section should read as follows: Results: The overall participation-adjusted injury rate was 1.5 ED-presentations per 1000 participants (95% CI 0.0–3.9) and 0.3 hospital-admissions per 1000 participants (95% CI 0.0–1.5), respectively (Appendix B in Supplementary material). [Figure presented] Figure 1 The trends in participation-adjusted annual hospital-treated injury rates in female cricketers in Victoria from 1 July 2002 and 30 June 2014, inclusive. Appendix B: Number of cricket-related hospital presentations by females in Victoria between 1 July 2002 and 30 June 2014, inclusive and trends in participation-adjusted annual hospital-treated injury rates [Table presented