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Issue 197 - 21 Sept 2011

Articles on Dabigatran (Pradaxa)

1. First oral thrombin inhibitor enters market: Drug does not require clinicians to monitor INR.
By: Thompson, Cheryl A. American Journal of Health-System Pharmacy, 12/1/2010, Vol. 67 Issue 23: p1974-1976
The article reports on the approval of the U.S. Food and Drug Administration (FDA) for the marketing of dabigatran etexilate or Pradaxa. According to Boehringer Ingelheim Pharmaceuticals Inc., the drug prevents stroke and systematic embolism in patients with nonvalvular atrial fibrillation. It says that clinician Snehal B. Bhatt would not recommend dabigatran etexilate therapy for patients with a peptic ulcer disease history or gastroesophageal reflux disease.

2. Dabigatran-induced rash
By Eid, Tony J. & Shah, Sachin A. American Journal of Health-System Pharmacy, 8/15/2011, Vol. 68 Issue 16: p1489-1490
The article discusses a case of dabigatran-induced rash, wherein a 78-year-old Caucasian man came to the emergency room (ER) with a rash, for which he was instructed to discontinue warfarin and start dabigatran etexilate that later resulted in a diffuse, full-body pruritic rash. Naranjo and colleagues scale revealed that the rash was caused by dabigatran. Also suggested further investigation and mentioned the need for a clear communication among health care providers and their patients.

3.  Pros and cons of dabigatran
By Cheng, Christine M. et al. American Journal of Health-System Pharmacy, 8/15/2011, Vol. 68 Issue 16: p1495-1495
In this article the author discusses the pros and cons of dabigatran etexilate which is the first oral direct thrombin inhibitor and the first oral anticoagulant. It offers details on the limitations of dabigatran and suggests avoiding its use by patients who are unable to swallow the whole capsule. Also mentioned is the RE-LY trial that recommends dabigatran for patients with poor quality of International Normalized Ratio (INR) control, and in whom medication adherence is expected to be high.

4. Dabigatran etexilate: A novel oral direct thrombin inhibitor
By Blommel, Matthew L. et al. American Journal of Health-System Pharmacy, 8/15/2011, Vol. 68 Issue 16: p1506-1519
The pharmacology, pharmacokinetics, clinical efficacy, tolerability, dosage and administration, and place in therapy of dabigatran etexilate are reviewed. Summary. Dabigatran is a reversible direct thrombin inhibitor (DTI) that has rapid and predictable anticoagulant effects and does not require the anticoagulation monitoring seen with oral vitamin K antagonists. Dabigatran etexilate has demonstrated efficacy in several clinical studies in preventing venous thromboembolism (VTE) for patients undergoing total hip or knee replacement, in preventing strokes in patients with nonvalvular atrial fibrillation, and in treating acute VTE. Dabigatran etexilate is a prodrug that is orally absorbed and completely converted to the active form dabigatran by carboxylesterases. Neither the conversion of dabigatran etexilate nor the metabolism of active dabigatran involves the cytochrome P-450 isoenzyme system. Other than hemorrhage, dabigatran is generally well tolerated, with gastrointestinal effects being the most commonly reported adverse events. All dosages should be adjusted in patients with reduced renal function. Dabigatran is currently being investigated for several thromboembolic disorders. It was approved by the Food and Drug Administration in October 2010 for stroke and VTE prevention in adult patients with nonvalvular atrial fibrillation, and it was approved by the European Medicines Agency in March 2009 for the prevention of VTE in adult patients undergoing elective total hip or knee replacement. Conclusion. Dabigatran etexilate, the first oral DTI marketed in the United States, is indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Dabigatran may be a viable option for anticoagulation in some patients due to its oral administration, rapid onset of action, and predictable anticoagulant effects. [ABSTRACT FROM AUTHOR]

Articles on Rhinitis

5. Nasal congestion and rhinitis
By Wood, Sarah. Practice Nurse, 4/29/2011, Vol. 41 Issue 7: p11-15
The article discusses the causes, signs and symptoms, allergens, and management of seasonal and perennial allergic rhinitis. Some of the symptoms of allergic rhinitis are runny nose, sneezing, watering eyes and itchy nose and threat. Some of medications for allergic rhinitis are antihistamines, topical decongestants and sodium cromoglycate eye drops. During the hay fever season, people at risk for allergic rhinitis should monitor the pollen count, wear sunglasses to minimize symptoms, and keep doors and windows closed when pollen counts are high.

6. Allergic rhinitis
By Kay, Barry & Brown, Pam. Pulse, 2/16/2011, Vol. 71 Issue 6: p18-19
The article presents questions and answers related to allergic rhinitis including the differential diagnosis of allergic rhinitis, the foods that cross-react with pollen allergies to cause oral allergy syndrome and the role played eye bathing or nasal douching in physically removing pollen.

7. Intermittent allergic rhinitis
By Sussman, Gordon et al. CMAJ: Canadian Medical Association Journal, 6/15/2010, Vol. 182 Issue 9: p935-937
The article focuses on the clinical management of a patient with intermittent allergic rhinitis. It states that a patient who shows symptoms of allergic rhinitis should undergo skin prick testing for the allergens and may use endoscopy as well as computed tomography. It mentions that allergen immunotherapy offers long-term modulatory treatment for allergic rhinitis. It adds that reaction to allergens or birch/ragweed-food syndrome can prolong allergic rhinitis.

8. Hay fever and perennial allergic rhinitis
By Bostock-Cox, Bev. Practice Nurse, 3/12/2010, Vol. 39 Issue 5: p11-14
The article provides health information on the diagnosis and management of hay fever and perennial allergic trinities. Asthma and eczema are allergic disorders that may also cause allergic rhinitis. Diagnostic procedures include the identification of personal or family history of hay fever or asthma. The pharmacological intervention depends on the severity of symptoms being experienced by patients.

9. Are nasal decongestants safer than rhinitis? A case of oxymetazoline-induced syncope
By Fabi, Marianna et al. Cardiology in the Young, Dec 2009, Vol. 19 Issue 6: p633-634
Derivatives of Imidazoline usually act to stimulate peripheral alpha2 receptors causing vasoconstriction. In young children, however, they can also stimulate alpha2receptors in the cardiovascular and central nervous systems, possibly causing cardiovascular, neurological, and respiratory depression. These medications do not require medical prescriptions, so often parents use them, bypassing paediatricians. We report here a case of cardiovascular and neurological depression induced by oxymetalzoline in a toddler. [ABSTRACT FROM PUBLISHER]

Articles on Arthritis

10. Effects of a Group-Based Exercise and Educational Program on Physical Performance and Disease Self- Management in Rheumatoid Arthritis: A Randomized Controlled Study
By Breedland, Ineke et al. Physical Therapy, Jun 2011, Vol. 91 Issue 6: p879-893
Evidence supports the use of educational and physical training programs for people with rheumatoid arthritis (RA).
Objective. The purpose of this study was to evaluate the effects of a group-based exercise and educational program on the physical performance and disease self-management of people with RA. Design. This was a randomized controlled trial.
Setting. The study was conducted at a rehabilitation center in the Netherlands.
Participants. Thirty-four people diagnosed with RA participated in the study. Participants were randomly assigned to either an intervention group (n=19) or a waiting list control group (n=15). Intervention. The intervention in this study was an 8-week, multidisciplinary, group therapy program for people with RA, consisting of physical exercise designed to increase aerobic capacity and muscle strength (force-generating capacity) together with an educational program to improve health status and self-efficacy for disease-self-management.
Measurements. The main outcome measures were maximum oxygen uptake (VO2max), muscle strength of the elbow and knee flexors and extensors, health status, and perceived self-efficacy. All data were recorded before intervention in week 1, after intervention in week 9, and at follow-up in week 22. Results. The intervention group showed significant improvement (12.1%) in VO2max at week 9 compared with the control group (-1.7%). Although significant within-group changes were found over time for muscle strength of the upper and lower extremities and health status that favored the intervention group, no between-group changes were found regarding these outcomes.
Limitations. An important limitation was the small number of participants included in our study, which may have resulted in a lack of power.
Conclusions. The present group-based exercise and educational program for people with RA had a beneficial effect on aerobic capacity but not on muscle strength, health status, or self-efficacy.  [ABSTRACT FROM AUTHOR]

11. Arthritis as a Potential Barrier to Physical Activity Among Adults with Obesity -- United States, 2007 and 2009
By Hootman, Jennifer M. et al. Morbidity & Mortality Weekly Report, 5/20/2011, Vol. 60 Issue 19: p614-618
The article focuses on a study conducted by the U.S. Centers for Disease Control and Prevention (CDC) on arthritis as a cause for physical inactivity among adults with obesity aged 18 years and above. Data from the Behavioral Risk Factor Surveillance (BRFSS) survey in 50 states in the U.S. from 2007 to 2009 were collected and evaluated. Physical inactivity was highest among those with both arthritis and obesity (22.7%), followed by arthritis only (16.1%), and obesity only (13.5%).

12. Ex Vivo Soft-Laser Treatment Inhibits the Synovial Expression of Vimentin and a-Enolase, Potential Autoantigens in Rheumatoid Arthritis
By Bálint, Géza et al. Physical Therapy, May 2011, Vol. 91 Issue 5: p665-674
Soft-laser therapy has been used to treat rheumatic diseases for decades. The major effects of laser treatment may be dependent not on thermal mechanisms but rather on cellular, photochemical mechanisms. However, the exact cellular and molecular mechanisms of action have not been elucidated. Objective. The aim of this study was to investigate the ex vivo effects of low-level laser treatment (with physical parameters similar to those applied previously) on protein expression in the synovial membrane in rheumatoid arthritis (RA). Design. Synovial tissues were laser irradiated, and protein expression was analyzed.
Methods. Synovial membrane samples obtained from 5 people who had RA and were undergoing knee surgery were irradiated with a near-infrared diode laser at a dose of 25 J/cm2 (a dose used in clinical practice). Untreated synovial membrane samples obtained from the same people served as controls. Synovial protein expression was assessed with 2-dimensional polyacrylamide gel electrophoresis followed by mass spectrometry.
Results. The expression of 12 proteins after laser irradiation was different from that in untreated controls. Laser treatment resulted in the decreased expression of a-enolase in 2 samples and of vimentin and precursors of haptoglobin and complement component 3 in 4 samples. The expression of other proteins, including 70-kDa heat shock protein, 96-kDa heat shock protein, lumican, osteoglycin, and ferritin, increased after laser therapy. Limitations. The relatively small sample size was a limitation of the study.
Conclusions. Laser irradiation (with physical parameters similar to those used previously) resulted in decreases in both a-enolase and vimentin expression in the synovial membrane in RA. Both proteins have been considered to be important autoantigens that are readily citrullinated and drive autoimmunity in RA. Other proteins that are expressed differently also may be implicated in the pathogenesis of RA. Our results raise the possibility that low-level laser treatment of joints affected with RA may be effective, at least in part, by suppressing the expression of autoantigens. Further studies are needed. [ABSTRACT FROM AUTHOR]

Journals - Table of Contents

13. From Nursing Times 6-12 September 2011, Vol 107 No 35
13A. Breaking down boundaries between medicine and nursing
Reducing professional boundaries between doctors and nurses is essential if the health service is to improve patient care while making efficiency savings
13B. Case dropped against Stepping Hill nurse linked to saline deaths
The case has been dropped against the nurse charged in connection with four deaths at Stepping Hill Hospital in Stockport, the Crown Prosecution Service has announced
13C. Developments in venous leg ulcer management
Leg ulcers are a common problem but increasing co-morbidity makes them challenging to manage. Further research is needed to boost our understanding of complex wounds
13D. DH in talks for 'international players' to take on struggling hospitals
The Department of Health has held discussions about “international players” running up to 20 NHS hospitals, according to confidential emails.
13E. European guidance recommends screening pregnant women for heart disease
Cardiology experts have recommended that pregnant women be screened for heart disease, amid rising prevalence among new mothers.
13F. Middle-aged Britons ‘most unhealthy’
Compared to their peers across the world, middle-aged Britons have a higher chance of suffering depression, being obese and being smokers, new research has revealed.
13G. Nurses asked for evidence in safe staffing investigation
An investigation has been launched into safe staffing levels for older people’s wards in the wake of continuing concern about how older people are treated in UK hospitals.
13H. Nursing courses face axe at London universities
England’s biggest funder of adult nurse training has decided to cut places by nearly a quarter, leaving the future of some of the best known nursing courses in doubt.
13I. Palliative care of a colocutaneous fistula
Caring for a person with a colocutaneous fistula at the end of life can present challenges. Symptom control and psychosocial support are vital to ensure comfort
13J. 'Protect national terms and conditions'
The RCN’s officer for Essex Mike Kavanagh on why nurses should look carefully at the benefits of their NHS employer
13K. RCN welcomes new failure regime for foundation trusts
Government plans to impose a safeguard which could potentially save key services if foundation trusts collapse have been hailed as a step forward by the Royal College of Nursing.
13L Rebecca Leighton must still face NMC panel before she can be reinstated
The nurse cleared of charges relating to deaths in Stepping Hill Hospital will have to face a Nursing and Midwifery Council panel before she can return to nursing.
13M. 'Red tabards keep patients safe and should not be undermined'
Patients like red tabards so why has there been such fury over them, asks Steve Hams
13N. Service takeovers give staff 'nasty surprises'
Nurses have been advised to be “proactive” during takeovers of NHS services or risk seeing jobs lost or downgraded and the quality of services fall.
13O. Substance abuse nursing body resignations down to 'lack of recognition'
“A decade of dilution” of the role of specialist substance abuse nurses left the board of the body representing them so disillusioned that it decided to resign en masse, its former chair has revealed.
13P. 'Too much information can be dangerous, not empowering'
Patients now self-diagnose at the click of a mouse.
13Q. Using the SKIN Bundle to prevent pressure ulcers
A systematic approach helped to reduce the incidence of pressure ulcers at a health board in Wales, and changed staff views that they were inevitable in some patients


14. 21st Annual TheMHS Conference
Resilence in Change
Date: 6-9 September 2011
Venue: Adelaide Convention centre, Australia

News - National

15. Pharmac attacked for rushing drug
Sunday Star Times - 11 Sept 2011
Dozens of  elderly patients have suffered bleeds – and at least two have died – after taking an anti-blood clotting drug which was rushed onto the market by Pharmac in a deal worth more than $100m. Some doctors say Pharmac, the government drug funding agency, may have put lives at risk by funding Pradaxa, also known as dabigatran, before more was known about managing its side effects.

16. 'Hot Air' behind allergies
Sunday Star Times - 18 Sept 2011
Many people who claim they can't eat dairy because they have an allergy or are lactose intolerant are mistaken, health experts say.
They are concerned that people decide they have an intolerance based on hearing about a celebrity's experience of a certain food rather than on sound medical evidence. Those who have talked of their problems with lactose include former Kiwi supermodel Rachel Hunter.

17. Meningococcal outbreak spurs free vaccinations
Sunday Star Times - 17 Sept 2011
An "outbreak" of Meningococcal C has spurred the Northland District Health Board (NDHB) to offer free vaccination to all young Northlanders. The campaign to target what the NDHB is calling an outbreak of the disease will start on Monday at high schools deemed to be at greatest risk and will hit primary schools by November. 

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