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Fostering moral reflectivity in community pharmacists through moral case deliberation using the dilemma method.
Int J Clin Pharm
January 2025
Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands.
Background: Moral case deliberation has been successfully implemented in multidisciplinary groups of secondary care professionals to support ethical decision making. It has not yet been reported for community pharmacists.
Aim: This study investigated whether moral case deliberation fosters moral reflectivity in community pharmacists.
Prevention of Stroke in Intracerebral Haemorrhage Survivors with Atrial Fibrillation: Rationale and Design for PRESTIGE-AF Trial.
Thromb Haemost
December 2024
Department of Brain Sciences, Imperial College London, London, United Kingdom.
Adequate secondary prevention in survivors of intracerebral hemorrhage (ICH) who also have atrial fibrillation (AF) is a long-standing clinical dilemma because these patients are at increased risk of recurrent ICH as well as of ischemic stroke. The efficacy and safety of oral anticoagulation, the standard preventive medication for ischemic stroke patients with AF, in ICH patients with AF are uncertain. PRESTIGE-AF is an international, phase 3b, multi-center, randomized, open, blinded end-point assessment (PROBE) clinical trial that compared the efficacy and safety of direct oral anticoagulants (DOACs) with no DOAC (either no antithrombotic treatment or any antiplatelet drug).
View Article and Find Full Text PDFCOVID-19 and Cardiac Arrhythmias: Lesson Learned and Dilemmas.
J Clin Med
November 2024
Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
Over the last few years, COVID-19 has attracted medical attention both in terms of healthcare system reorganization and research. Among the different cardiovascular complications of the SARS-CoV-2 infection, cardiac arrhythmias represent an important clinical manifestation requiring proper therapy both in the acute and post-acute phase. The multiparametric in-hospital monitoring of COVID-19 patients frequently detects new-onset or recurrent cardiac arrhythmias.
View Article and Find Full Text PDFChallenging Situations in the Treatment of Cancer-Associated Thrombosis.
Hamostaseologie
December 2024
Medical Department I, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany.
Cancer-associated thrombosis (CAT) is a common clinical problem in the treatment of cancer patients posing some unique challenges. These include the need to balance between the risk of recurrent thromboembolic events and bleeding complications in the individual cancer patient. A frequently encountered dilemma is the need for long-term anticoagulation in the setting of active malignancy.
View Article and Find Full Text PDFImpact of Early Resumption of Oral Anticoagulation on Recurrence After Surgery for Chronic Subdural Hematoma in Patients With Atrial Fibrillation: A Target Trial Emulation.
Pharmacoepidemiol Drug Saf
December 2024
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Article Synopsis
- Clinicians face a complex decision when treating patients with atrial fibrillation (AF) on anticoagulants who require surgery for chronic subdural hematoma (CSDH), balancing the need to prevent embolism with the risk of hematoma recurrence.
- This study analyzed data from patients who underwent CSDH surgery while on anticoagulation, comparing those who resumed anticoagulation within 14 days post-surgery to those who did not.
- Results indicated that the 90-day risk of CSDH recurrence was similar between the two groups, although early resumption of anticoagulation may slightly increase the recurrence risk, providing key insights for clinicians' decisions about anticoagulation management.
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