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Mahmoud F, Mueller T, Mullen A, Sainsbury C, Rushworth GF, Kurdi A. Patterns of initial and first-intensifying antidiabetic drug utilization among patients with type 2 diabetes mellitus in Scotland, 2010-2020: A retrospective population-based cohort study. Diabetes Obes Metab 2024. [PMID: 38558305 DOI: 10.1111/dom.15584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
AIM To evaluate the utilization and prescribing patterns of antidiabetic drugs (ADDs) for patients with type 2 diabetes mellitus (T2DM) at treatment initiation and first intensification. METHODS A retrospective cohort study was performed using linked routinely collected data of patients with T2DM who received ADDs between January 2010 and December 2020 in Scotland. The prescribing patterns were quantified using frequency/percentages, absolute/relative change, and trend tests. RESULTS Overall, 145 909 new ADD users were identified, with approximately 91% (N = 132 382) of patients receiving a single ADD at first treatment initiation. Metformin was the most often prescribed monotherapy (N = 118 737, 89.69%). A total of 50 731 patients (39.40%) who were started on metformin (N = 46 730/118 737, 39.36%) or sulphonylurea (SU; N = 4001/10 029, 39.89%) monotherapy had their treatment intensified with one or more additional ADD. Most initial-metformin (45 963/46 730; 98.36%) and initial-SU users (3894/4001; 97.33%) who added further drugs were intensified with single ADDs. SUs (22 197/45 963; 48.29%) were the most common first-intensifying monotherapy after initial metformin use, but these were replaced by sodium-glucose cotransporter-2 (SGLT2) inhibitors in 2019 (SGLT2 inhibitors: 2039/6065, 33.62% vs. SUs: 1924/6065, 31.72%). Metformin was the most frequently added monotherapy to initial SU use (2924/3894, 75.09%). Although the majority of patients received a single ADD, the use of combination therapy significantly increased over time. Nevertheless, there was a significant increasing trend towards prescribing the newer ADD classes (SGLT2 inhibitors, dipeptidyl peptidase-4 inhibitors) as monotherapy or in combination compared with the older ones (SUs, insulin, thiazolidinediones) at both drug initiation and first intensification. CONCLUSIONS An overall increasing trend in prescribing the newer ADD classes compared to older ADDs was observed. However, metformin remained the most commonly prescribed first-line ADD, while SGLT2 inhibitors replaced SUs as the most common add-on therapy to initial metformin use in 2019.
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Affiliation(s)
- Fatema Mahmoud
- Clinical Pharmacy Department, School of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Alexander Mullen
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | | | - Gordon F Rushworth
- Highland Pharmacy Education & Research Centre, NHS Highland, Inverness, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Department of Clinical Pharmacy, College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Mahmoud F, Mullen A, Sainsbury C, Rushworth GF, Yasin H, Abutheraa N, Mueller T, Kurdi A. Meta-analysis of factors associated with antidiabetic drug prescribing for type 2 diabetes mellitus. Eur J Clin Invest 2023; 53:e13997. [PMID: 37002856 DOI: 10.1111/eci.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND There is a lack of consensus on prescribing alternatives to initial metformin therapy and intensification therapy for type 2 diabetes mellitus (T2DM) management. This review aimed to identify/quantify factors associated with prescribing of specific antidiabetic drug classes for T2DM. METHODS Five databases (Medline/PubMed, Embase, Scopus, Web of Science) were searched using the synonyms of each concept (patients with T2DM, antidiabetic drugs and factors influencing prescribing) in both free text and Medical Subject Heading (MeSH) forms. Quantitative observational studies evaluating factors associated with antidiabetic prescribing of metformin, sulfonylurea, thiazolidinedione, Dipeptidyl-peptidase 4 inhibitors (DPP4-I), sodium glucose transporter 2 inhibitors (SGLT2-I), Glucagon-Like peptide receptor agonist (GLP1-RA) and insulin in outpatient settings and published from January 2009 to January 2021 were included. Quality assessment was performed using a Newcastle-Ottawa scale. The validation was done for 20% of identified studies. The pooled estimate was measured using a three-level random-effect meta-analysis model based on odds ratio [95% confidence interval]. Age, sex, body mass index (BMI), glycaemic control (HbA1c) and kidney-related problems were quantified. RESULTS Of 2331 identified studies, 40 met the selection criteria. Of which, 36 and 31 studies included sex and age, respectively, while 20 studies examined baseline BMI, HbA1c and kidney-related problems. The majority of studies (77.5%, 31/40) were rated as good and despite that the overall heterogeneity for each studied factor was more than 75%, it is mostly related to within-study variance. Older age was significantly associated with higher sulfonylurea prescription (1.51 [1.29-1.76]), yet lower prescribing of metformin (0.70 [0.60-0.82]), SGLT2-I (0.57 [0.42-0.79]) and GLP1-RA (0.52 [0.40-0.69]); while higher baseline BMI showed opposite significant results (sulfonylurea: 0.76 [0.62-0.93], metformin: 1.22 [1.08-1.37], SGLT2-I: 1.88 [1.33-2.68], and GLP1-RA: 2.35 [1.54-3.59]). Both higher baseline HbA1c and having kidney-related problems were significantly associated with lower metformin prescription (0.74 [0.57-0.97], 0.39 [0.25-0.61]), but more insulin prescriptions (2.41 [1.87-3.10], 1.52 [1.10-2.10]). Also, DPP4-I prescriptions were higher for patients with kidney-related problems (1.37 [1.06-1.79]) yet lower among patients with higher HbA1c (0.82 [0.68-0.99]). Sex was significantly associated with GLP1-RA and thiazolidinedione prescribing (F:M; 1.38 [1.19-1.60] and 0.91 [0.84-0.98]). CONCLUSION Several factors were identified as potential determinants of antidiabetic drug prescribing. The magnitude and significance of each factor differed by antidiabetic class. Patient's age and baseline BMI had the most significant association with the choice of four out of the seven studied antidiabetic drugs followed by the baseline HbA1c and kidney-related problems which had an impact on three studied antidiabetic drugs, whereas sex had the least impact on prescribing decision as it was associated with GLP1-RA and thiazolidinedione only.
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Affiliation(s)
- Fatema Mahmoud
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Alexander Mullen
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Chris Sainsbury
- Department of Diabetes, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Gordon F Rushworth
- Highland Pharmacy Education & Research Centre, NHS Highland, Inverness, UK
| | - Haya Yasin
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Nouf Abutheraa
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Centre of Research and Strategic Studies, Lebanese French University, Erbil, Iraq
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Forsyth P, Radley A, Rushworth GF, Marra F, Roberts S, O'Hare R, Duggan C, Maguire B. The Collaborative Care Model: Realizing healthcare values and increasing responsiveness in the pharmacy workforce. Res Social Adm Pharm 2022; 19:110-122. [DOI: 10.1016/j.sapharm.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
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Jebara T, Thomas I, Cunningham S, Rushworth GF. Pharmacy and medical student interprofessional education placement week. Clin Teach 2022; 19:143-149. [PMID: 34984853 DOI: 10.1111/tct.13450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Developing collaborative practice through interprofessional education (IPE) activities in undergraduate healthcare curricula is advocated by the World Health Organisation and the regulatory bodies for Medicine and Pharmacy within the UK. APPROACH Our local faculty, comprising educators from within the Highland Pharmacy Education and Research Centre (HPERC) and Highland Medical Education Centre (HMEC), developed a 5-day IPE placement for pharmacy and medical students on clinical placement within NHS Highland. EVALUATION We collected qualitative evaluation data using face-to-face focus group discussions with five pharmacy and four medical students (January 2020 cohort). Three key categories and multiple themes within each category were identified from participant narratives: Category 1, overall perception of experience-(themes: better than previous IPE experience; greater exposure to clinical pharmacy); Category 2, student interactions-(themes: learning with a buddy; understanding of interprofessional roles); Category 3, suggestions for improvement-(themes: choice of relevant clinical rotation and content; increase learning from clinical pharmacists; better orientation to placement). Overall, students valued their participation during this week and reported many benefits of learning with students from another profession. Students also highlighted suggestions to improve their learning experience. IMPLICATIONS This evaluation has indicated students' support for embedding interprofessional placements into their curricula. Clinical educators should consider designing similar placements, while further work should focus on inclusion of higher student numbers and look to include a range of professions and practice settings.
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Affiliation(s)
- Tesnime Jebara
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Ian Thomas
- Centre for Health Science, Highland Medical Education Centre, Inverness, UK
| | - Scott Cunningham
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Gordon F Rushworth
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK.,NHS Highland, Highland Pharmacy Education and Research Centre, Inverness, UK
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Cunningham S, Jebara T, Stewart D, Smith J, Leslie SJ, Rushworth GF. OUP accepted manuscript. International Journal of Pharmacy Practice 2022; 31:190-197. [PMID: 35639759 DOI: 10.1093/ijpp/riac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/27/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To investigate relationships between factors influencing medication taking and behavioural determinants in patients who have undergone percutaneous coronary intervention (PCI). METHODS A cross-sectional survey using a postal questionnaire distributed to PCI patients. The questionnaire was iteratively developed by the research team with reference to the theoretical domains framework (TDF) of behavioural determinants, reviewed for face and content validity and piloted. Data were analysed using descriptive and principal component analysis (PCA). Inferential analysis explored relationships between PCA component scores and factors influencing medicating taking behaviour. KEY FINDINGS Adjusted response rate was 62.4% (325/521). PCA gave three components: (C1) Self-perceptions of knowledge and abilities in relation to medication taking; (C2) Aspects relating to activities and support in medication taking; (C3) Emotional aspects in taking medication. Generally, respondents held very positive views. Statistically significant relationships between all three components and self-reported chest pain/discomfort indicated patients with ongoing chest pain/discomfort post-PCI are more likely to have behavioural determinants and beliefs which make medication taking challenging. Respondents who were on 10 or more medications had lower levels of agreement with the C2 and C3 statements indicating challenges associated with their activities/support and anxieties in medication taking. CONCLUSIONS PCI patients show links between TDF behavioural determinants and factors influencing medication taking for those reporting chest pain or polypharmacy. Further research needs to explore the effective design and implementation of behavioural change interventions to reduce the challenge of medication taking.
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Affiliation(s)
- Scott Cunningham
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Tesnime Jebara
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Jamie Smith
- Cardiac Unit, Raigmore Hospital, NHS Highland, Inverness, UK
| | - Stephen J Leslie
- Cardiac Unit, Raigmore Hospital, NHS Highland, Inverness, UK
- Institute of Health Research & Innovation, University of the Highlands & Islands, Inverness, UK
| | - Gordon F Rushworth
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
- Highland Pharmacy Education and Research Centre, NHS Highland, Inverness, UK
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Forsyth P, Rushworth GF. Advanced pharmacist practice: where is the United Kingdom in pursuit of this 'Brave New World'? Int J Clin Pharm 2021; 43:1426-1430. [PMID: 33991288 DOI: 10.1007/s11096-021-01276-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
Pharmacy has developed many novel patient-facing roles across the globe, typically delivered through the lens of pharmaceutical care. The macro-level implementation of such interventions is, however, fraught with difficulty. At an individual-level, psychological barriers of pharmacists and their ability to deliver autonomous complex clinical care are key considerations. As the United Kingdom imminently plans to launch a new advanced pharmacist practice curriculum and credentialing process to support advanced skills development, this commentary discusses where progress to date has taken us and what other developmental, environmental and cultural changes are needed to support this. The commentary also challenges some of pharmacy's historic dogma, discusses a requirement for teaching to transcend simplistic concepts of medicines-harm, considers the need for the standardisation of clinical skills and discusses the necessity of formal advanced practice programmes and preceptorship models. It finally proposes the concept of Advanced Pharmacist Practitioners as the ultimate future vision of autonomous practice and the need for Government Policy to support their creation.
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Affiliation(s)
- Paul Forsyth
- Clinical Cardiology, Pharmacy, NHS Greater Glasgow and Clyde, Clarkston Court, 56 Busby Road, Glasgow, G76 7AT, Scotland.
| | - Gordon F Rushworth
- Highland Pharmacy Education and Research Centre, NHS Highland, Inverness, Scotland
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Callum KJ, Hall L, Jack S, Farman C, Rushworth GF, Leslie SJ. External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit. J Prim Care Community Health 2020; 11:2150132720946147. [PMID: 32723141 PMCID: PMC7391424 DOI: 10.1177/2150132720946147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: External loop recorders (ELRs) are recommended for the investigation of syncope and palpitations. This study aimed to compare rates of arrhythmia detection between primary care (PC) and hospital-based cardiac unit (HBCU) fitted ELRs. Methods: Data were captured from January to December 2015. Twenty-eight general practitioner practices and 1 hospital took part. Patients were divided into those with ELR fitted in PC or HBCU. All ELR data were analyzed by a cardiac physiologist. Results: A total of 560 ELR recordings were analyzed; 219 (PC) versus 341 (HBCU). There was no difference between the baseline characteristics (all Ps > .05). The predominant indication for ELR in each group were palpitations; between-group variation was observed for syncope (P = .0004). There were no significant between-group differences in the number of recordings per patient; however, PC group wore the ELR for less time (median 7 days vs median 14 days; P < .0001). There were no differences in arrhythmia detection between PC- and HBCU-fitted ELRs (16.2% [n = 39] vs 21.7% [n = 74], respectively; P = .28). PC placement of ELRs was highest in very remote rural communities (P = .005) and correlated with distance from HBCU (r = 0.39; P = .04). Conclusions: This study showed no difference in detection of arrhythmias between PC and HBCU fitted ELRs. This suggests adequate ELR recording can be completed by suitably trained staff in PC. Furthermore, ELRs were fitted for less time in PC without an adverse effect on diagnostic yield. ELR usage increased with increasing distance from the specialist center and rurality suggesting improved local access to arrhythmia detection services.
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Affiliation(s)
| | - Lynn Hall
- NHS Highland, Raigmore Hospital, Inverness, UK
| | - Sharon Jack
- NHS Highland, Raigmore Hospital, Inverness, UK
| | | | - Gordon F Rushworth
- University of the Highlands and Islands, Centre for Health Science, Inverness, UK.,Highland Pharmacy Education & Research Centre, Centre for Health Science, Inverness, UK
| | - Stephen J Leslie
- NHS Highland, Raigmore Hospital, Inverness, UK.,University of the Highlands and Islands, Centre for Health Science, Inverness, UK
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Generalova D, Cunningham S, Leslie SJ, Rushworth GF, Mciver L, Stewart D. Prescribers' perceptions of benefits and limitations of direct acting oral anticoagulants in non-valvular atrial fibrillation. Pharm Pract (Granada) 2020; 18:1936. [PMID: 32587643 PMCID: PMC7308911 DOI: 10.18549/pharmpract.2020.2.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background: There is an acknowledged lack of robust and rigorous research focusing on the perspectives of those prescribing direct acting oral anticoagulants (DOACs) for non-valvular atrial fibrillation (AF). Objective: The objective was to describe prescribers’ experiences of using DOACs in the management of non-valvular AF, including perceptions of benefits and limitations. Methods: A cross-sectional survey of prescribers in a remote and rural area of Scotland. Among other items, the questionnaire invited free-text description of positive and negative experiences of DOACs, and benefits and limitations. Responses were independently analysed by two researchers using a summative content analysis approach. This involved counting and comparison, via keywords and content, followed by interpretation and coding of the underlying context into themes. Results: One hundred and fifty-four responses were received, 120 (77.9%) from physicians, 18 (11.7%) from nurse prescribers and 10 (6.4%) from pharmacist prescribers (6 unidentified professions). Not having to monitor INR was the most cited benefit, particularly for prescribers and patients in remote and rural settings, followed by potentially improved patient adherence. These benefits were reflected in respondents’ descriptions of positive experiences and patient feedback. The main limitations were the lack of reversal agents, cost and inability to monitor anticoagulation status. Many described their experiences of adverse effects of DOACs including fatal and non-fatal bleeding, and upper gastrointestinal disturbances. Conclusions: While prescribers have positive experiences and perceive benefits of DOACs, issues such as adverse effects and inability to monitor anticoagulation status merit further monitoring and investigation. These issues are particularly relevant given the trajectory of increased prescribing of DOACs.
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Affiliation(s)
- Daria Generalova
- MSc. School of Pharmacy and Life Sciences, Robert Gordon University. Aberdeen (United Kingdom).
| | - Scott Cunningham
- PhD. School of Pharmacy and Life Sciences, Robert Gordon University. Aberdeen (United Kingdom).
| | - Stephen J Leslie
- PhD. Department of Medicine, Raigmore Hospital. Inverness (United Kingdom).
| | - Gordon F Rushworth
- MSc. Highland Pharmacy Education and Research Centre, Centre for Health Science. Inverness (United Kingdom).
| | - Laura Mciver
- MSc. Healthcare Improvement Scotland. Glasgow (United Kingdom).
| | - Derek Stewart
- PhD. College of Pharmacy, QU Health, Qatar University. Doha (Qatar).
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Thomson P, Angus NJ, Andreis F, Rushworth GF, Mohan AR, Chung ML, Leslie SJ. Longitudinal evaluation of the effects of illness perceptions and beliefs about cardiac rehabilitation on quality of life of patients with coronary artery disease and their caregivers. Health Qual Life Outcomes 2020; 18:158. [PMID: 32460825 PMCID: PMC7254753 DOI: 10.1186/s12955-020-01405-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients' negative illness perceptions and beliefs about cardiac rehabilitation (CR) can influence uptake and adherence to CR. Little is known about the interpartner influence of these antecedent variables on quality of life of patients with coronary artery disease (CAD) and their family caregivers. The aims of the study were: 1) to assess differences in illness perceptions, beliefs about CR and quality of life between patients with CAD and their family caregivers upon entry to a CR programme and at 6 months follow-up; and 2) to examine whether patients' and caregivers' perceptions of the patient's illness and beliefs about CR at baseline predict their own and their partner's quality of life at 6 months. METHODS In this longitudinal study of 40 patient-caregiver dyads from one CR service, patients completed the Brief Illness Perception Questionnaire and Beliefs about Cardiac Rehabilitation Questionnaire at baseline and 6 months; and caregivers completed these questionnaires based on their views about the patient's illness and CR. The Short-Form 12 Health Survey was used to assess patients' and caregivers' perceived health status. Dyadic data were analysed using the Actor-Partner Interdependence Model. RESULTS Most patients (70%) were men, mean age 62.45 years; and most caregivers (70%) were women, mean age 59.55 years. Caregivers were more concerned about the patient's illness than the patients themselves; although they had similar scores for beliefs about CR. Patients had poorer physical health than caregivers, but their level of mental health was similar. Caregivers' poorer mental health at 6 months was predicted by the patient's perceptions of timeline and illness concern (i.e. partner effects). Patient's and caregiver's illness perceptions and beliefs about CR were associated with their own physical and mental health at 6 months (i.e. actor effects). CONCLUSIONS Overall, the patients and caregivers had similar scores for illness perceptions and beliefs about CR. The actor and partner effect results indicate a need to focus on specific illness perceptions and beliefs about CR, targeting both the individual and the dyad, early in the rehabilitation process to help improve patients and caregivers physical and mental health (outcomes).
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Affiliation(s)
- Patricia Thomson
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK94LA, Scotland, UK.
| | - Neil J Angus
- School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, Scotland, UK
| | - Federico Andreis
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK94LA, Scotland, UK
| | - Gordon F Rushworth
- Highland Pharmacy Education & Research Centre, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, Scotland, UK
| | - Andrea R Mohan
- School of Nursing and Health Sciences, University of Dundee, Dundee, DD1 4HN, Scotland, UK
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, 40506, USA
| | - Stephen J Leslie
- Cardiac Unit, Raigmore Hospital, NHS Highland, Old Perth Road, Inverness, IV2 3UJ, Scotland, UK
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Thomson P, Rushworth GF, Andreis F, Angus NJ, Mohan AR, Leslie SJ. Longitudinal study of the relationship between patients' medication adherence and quality of life outcomes and illness perceptions and beliefs about cardiac rehabilitation. BMC Cardiovasc Disord 2020; 20:71. [PMID: 32046646 PMCID: PMC7011382 DOI: 10.1186/s12872-020-01378-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/06/2020] [Indexed: 01/11/2023] Open
Abstract
Background Adherence to medication regimens is essential for preventing and reducing adverse outcomes among patients with coronary artery disease (CAD). Greater understanding of the relation between negative illness perceptions, beliefs about cardiac rehabilitation (CR) and medication adherence may help inform future approaches to improving medication adherence and quality of life (QoL) outcomes. The aims of the study are: 1) to compare changes in illness perceptions, beliefs about CR, medication adherence and QoL on entry to a CR programme and 6 months later; 2) to examine associations between patients’ illness perceptions and beliefs about CR at baseline and medication adherence and QoL at 6 months. Methods A longitudinal study of 40 patients with CAD recruited from one CR service in Scotland. Patients completed the Medication Adherence Report Scale, Brief Illness Perception Questionnaire, Beliefs about CR questionnaire and the Short-Form 12 Health Survey. Data were analysed using the Wilcoxon Signed Ranks test, Pearson Product Moment correlation and Bayesian multiple logistic regression. Results Most patients were men (70%), aged 62.3 mean (SD 7.84) years. Small improvements in ‘perceived suitability’ of CR at baseline increased the odds of being fully adherent to medication by approximately 60% at 6 months. Being fully adherent at baseline increased the odds of staying so at 6 months by 13.5 times. ‘Perceived necessity, concerns for exercise and practical barriers’ were negatively associated with reductions in the probability of full medication adherence of 50, 10, and 50%. Small increases in concerns about exercise decreased the odds of better physical health at 6 months by about 50%; and increases in practical barriers decreased the odds of better physical health by about 60%. Patients perceived fewer consequences of their cardiac disease at 6 months. Conclusions Patients’ beliefs on entry to a CR programme are especially important to medication adherence at 6 months. Negative beliefs about CR should be identified early in CR to counteract any negative effects on QoL. Interventions to improve medication adherence and QoL outcomes should focus on improving patients’ negative beliefs about CR and increasing understanding of the role of medication adherence in preventing a future cardiac event.
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Affiliation(s)
- Patricia Thomson
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK94LA, Scotland, UK.
| | - Gordon F Rushworth
- Highland Pharmacy Education & Research Centre, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, Scotland, UK
| | - Federico Andreis
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK94LA, Scotland, UK
| | - Neil J Angus
- School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, Scotland, UK
| | - Andrea R Mohan
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Stephen J Leslie
- Cardiac Unit, Raigmore Hospital, NHS Highland, Old Perth Road, Inverness, IV2 3UJ, Scotland, UK
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Stewart D, Cunningham S, Strath A, MacLure A, Gibson-Smith K, Rushworth GF, Dreischulte T, Nicolson C, Pfleger D, Tiernan D, MacLure K. A theoretically informed survey of the views and experiences of practicing pharmacists on research conduct, dissemination and translation. Res Social Adm Pharm 2019; 15:1298-1308. [DOI: 10.1016/j.sapharm.2018.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 11/28/2022]
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Kamona A, Cunningham S, Addison B, Rushworth GF, Call A, Bloe C, Innes A, Bond RR, Peace A, Leslie SJ. Comparing ST-segment elevation myocardial infarction care between patients residing in central and remote locations: a retrospective case series. Rural Remote Health 2018; 18:4618. [PMID: 30368234 DOI: 10.22605/rrh4618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION People who experience an ST-elevation myocardial infarction (STEMI) due to an occluded coronary artery require prompt treatment. Treatments to open a blocked artery are called reperfusion therapies (RTs) and can include intravenous pharmacological thrombolysis (TL) or primary percutaneous coronary intervention (pPCI) in a cardiac catheterisation laboratory (cath lab). Optimal RT (ORT) with pPCI or TL reduces morbidity and mortality. In remote areas, a number of geographical and organisational barriers may influence access to ORT. These are not well understood and the exact proportion of patients who receive ORT and the relationship to time of day and remoteness from the cardiac cath lab is unknown. The aim of this retrospective study was to compare the characteristics of ORT delivery in central and remote locations in the north of Scotland and to identify potential barriers to optimal care with a view to service redesign. METHOD The study was set in the north of Scotland. All patients who attended hospital with a STEMI between March 2014 and April 2015 were identified from national coding data. A data collection form was developed by the research team in several iterative stages. Clinical details were collected retrospectively from patients' discharge letters. Data included treatment location, date of admission, distance of patient from the cath lab, route of access to health care, left ventricular function and RT received. Distance of patients from the cath lab was described as remote if they were more than 90 minutes of driving time from the cardiac cath lab and central if they were 90 minutes or less of driving time from the regional centre. For patients who made contact in a pre-hospital setting, ORT was defined as pre-hospital TL (PHT) or pPCI. For patients who self-presented to the hospital first, ORT was defined as in-hospital TL or pPCI. Data were described as mean (standard deviation) as appropriate. Chi-squared and student's t-test were used as appropriate. Each case was reviewed to determine if ORT was received; if ORT was not received, the reasons for this were recorded to identify potentially modifiable barriers. RESULTS Of 627 acute myocardial infarction patients initially identified, 131 had a STEMI, and the others were non-STEMI. From this STEMI cohort, 82 (62%) patients were classed as central and 49 (38%) were remote. In terms of initial therapy, 26 (20%) received pPCI, 19 (15%) received PHTs, 52 (40%) received in-hospital TL, while 33 (25%) received no initial RT. ORT was received by 53 (65%) central and 20 (41%) remote patients; χ²=7.05, degrees of freedom =130, p<0.01).Several recurring barriers were identified. CONCLUSION This study has demonstrated a significant health inequality between the treatment of STEMI in remote compared to central locations. Potential barriers identified include staffing availability and training, public awareness and inter-hospital communication. This suggests that there remain significant opportunities to improve STEMI care for people living in the north of Scotland.
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Affiliation(s)
- Ahmad Kamona
- School of Pharmacy & Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, UK
| | - Scott Cunningham
- School of Pharmacy & Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, UK
| | - Brian Addison
- School of Pharmacy & Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, UK
| | - Gordon F Rushworth
- School of Pharmacy & Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, UK
| | - Andrew Call
- NHS Highland, Cardiac Unit, Raigmore Hospital, Inverness, IV2 3UJ, UK
| | - Charles Bloe
- NHS Highland, Cardiac Unit, Raigmore Hospital, Inverness, IV2 3UJ, UK
| | - Alistair Innes
- NHS Highland, Dr MacKinnon Memorial Hospital, Broadford, Isle of Skye, IV49 9AA, UK
| | - Raymond R Bond
- School of Computing and Mathematics, Ulster University, Northern Ireland, BT37 0QB, UK
| | - Aaron Peace
- Cardiac Unit, Altnagelvin Hospital, Glenshane Road Northern Ireland, BT47 6SB, UK
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Generalova D, Cunningham S, Leslie SJ, Rushworth GF, McIver L, Stewart D. A systematic review of clinicians' views and experiences of direct-acting oral anticoagulants in the management of nonvalvular atrial fibrillation. Br J Clin Pharmacol 2018; 84:2692-2703. [PMID: 30112826 DOI: 10.1111/bcp.13739] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 12/11/2022] Open
Abstract
AIMS While a plethora of systematic reviews have provided evidence of efficacy, effectiveness and safety of direct-acting oral anticoagulants (DOACs) in the management of nonvalvular atrial fibrillation, there has been little emphasis on clinicians' perspectives. This systematic review aimed to critically appraise, synthesize and present the available evidence of clinicians' views and experiences. METHODS Studies published in English from January 2006 to July 2017 reporting the views and/or experiences of doctors, nurses or pharmacists on any individual DOAC or as a pharmacological group were included. Studies were assessed for quality by two researchers, data extracted and findings synthesized using a narrative approach. RESULTS Following exclusion of duplicates, 777 titles, 394 abstracts and 196 studies were screened. Ten studies were included in the review, nine of which were quantitative (cross-sectional surveys) and one qualitative (semistructured interviews), with marked heterogeneity in outcomes reported. Studies were conducted exclusively in Europe and the USA. In those studies reporting clinician preference, DOACs were first choice over warfarin in naïve patients, based on perceptions of evidence of effectiveness equivalent or superior to warfarin and superior safety. Other advantageous factors were in those with an unstable International Normalized Ratio and likely to miss appointments. There were, however, concerns relating to management of over-anticoagulation and experiences of observed bleeding rates. CONCLUSION There is a limited evidence base of clinicians' perspectives of DOACs, necessitating further research, particularly given the trajectory of increased use worldwide.
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Affiliation(s)
- Daria Generalova
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Scott Cunningham
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | | | - Gordon F Rushworth
- Highland Pharmacy Education and Research Centre, Centre for Health Science, Inverness, UK
| | | | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
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Rushworth GF, Cunningham S, Pfleger S, Hall J, Stewart D. A cross-sectional survey of the access of older people in the Scottish Highlands to general medical practices, community pharmacies and prescription medicines. Res Social Adm Pharm 2018; 14:76-85. [DOI: 10.1016/j.sapharm.2017.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/22/2017] [Accepted: 01/22/2017] [Indexed: 10/20/2022]
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Kitz TM, Burnand N, Ortner A, Rudd IG, Sampson R, Rushworth GF, Leslie SJ. Unexpected deaths in cardiology outpatients - what can we learn from case review? JRSM Open 2016; 7:2054270416669301. [PMID: 27928509 PMCID: PMC5134296 DOI: 10.1177/2054270416669301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES A proportion of cardiac patients managed at a cardiology outpatient clinic will die between clinic visits. This study aimed to identify the cause of death, to determine if case review occurred and if a formal review of such cases might be useful. DESIGN Single-centre retrospective cohort study. SETTING A remote regional centre in the North of Scotland. PARTICIPANTS All patients who had been removed from the cardiology outpatient clinic due to death in the community. MAIN OUTCOME MEASURES Cause of death, comorbidities and treatments were collected from hospital records and the national register of deaths. Chi-squared test and Student's t-test were used with significance taken at the 5% level. RESULTS Of 10,606 patients who attended the cardiology outpatient clinic, 75 (0.7%) patients died in the community. The majority (57.0%) died from a non-cardiac cause. Eleven patients (14.9%) died due to an unexpected cardiac death. A detailed case note review was undertaken. In only two (18.2%) cases was any note made as to the cause of death in the hospital records and in only one was there details of post mortem discussion between primary and secondary care. CONCLUSIONS A small proportion of patients attending a cardiology outpatient clinic died in the community. Documentation of the death in the hospital notes was very poor and evidence of post mortem communication between primary and secondary care was absent in all but one case. Better documentation and communication between primary and secondary care would seem desirable.
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Affiliation(s)
- Thomas Michael Kitz
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Sciences, University of Graz, 8010 Graz, Austria
| | - Nikki Burnand
- Cardiac Unit, Raigmore Hospital, Inverness IV2 3UJ, UK
| | - Astrid Ortner
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Sciences, University of Graz, 8010 Graz, Austria
| | | | - Rod Sampson
- Cairn Medical Practice, Inverness IV2 4AG, UK
| | - Gordon F Rushworth
- Highland Pharmacy Education & Research Centre, Centre for Health Science, Inverness IV2 3JH, UK
| | - Stephen James Leslie
- Cardiac Unit, Raigmore Hospital, Inverness IV2 3UJ, UK; Department of Diabetes & Cardiovascular Science, Centre for Health Science, University of the Highlands and Islands, Inverness IV2 3JH, UK
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Affiliation(s)
| | - Harold Ellis
- Surgical Unit, Westminster Hospital, London S W1
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Pisano U, Deosaran J, Leslie SJ, Rushworth GF, Stewart D, Ford I, Watson AJM. Nicorandil, Gastrointestinal Adverse Drug Reactions and Ulcerations: A Systematic Review. Adv Ther 2016; 33:320-44. [PMID: 26861848 DOI: 10.1007/s12325-016-0294-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Nicorandil is a popular anti-anginal drug in Europe and Japan. Apart from some common adverse drug reactions (ADR), its safety is satisfactory. Several reports have suggested a link between nicorandil, gastrointestinal (GI) ulceration and fistulas. The review aims to critically appraise, synthesize and present the available evidence of all known GI ADR per anatomical location. METHODS The study complied with the PRISMA statement. Literature and pharmacovigilance databases were used to provide rate and/or calculate parameters (median age, median dose, history of symptoms, length of therapy and healing time after withdrawal of the drug). Differences in distribution of quantitative variables were analyzed via Mann-Whitney test. Correlation between quantitative variables was assessed with a Spearman's correlation coefficient. A p value <0.05 was significant. RESULTS Oral ulcerations occur in 0.2% of the subjects, anal ulcerations are present between 0.07% and 0.37% of patients. Oral and distal GI involvements are the most common ADR (28-29% and 27-31% of all GI ADR, respectively). The hepatobiliary system, the pancreas and salivary glands are not affected by nicorandil exposure. The time to develop oral ulcerations is 74 weeks among people on <30 mg/day compared to only 7.5 weeks in individuals on higher regimens (p = 0.47). There is a significant correlation between dose and ulcer healing time (Spearman's 0.525, p < 0.001). CONCLUSIONS Ulcerative disease is a very commonly reported GI ADR. A delayed ulcerative tendency supports the hypothesis of an ulcerogenic metabolite. Nicorandil seems to act as a cause of the ulcerations, but appears to also work in synergy with other promoting factors. Whether the action of the metabolites relies on a specific mechanism or a simple chemical ulceration is still to be established.
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Affiliation(s)
- Umberto Pisano
- Department of General Surgery, Raigmore Hospital, Inverness, UK.
| | | | | | | | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Rushworth GF, Diack L, MacRobbie A, Munoz SA, Pfleger S, Stewart D. Access to medicines in remote and rural areas: a survey of residents in the Scottish Highlands & Western Isles. Public Health 2015; 129:244-51. [PMID: 25698496 DOI: 10.1016/j.puhe.2015.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Sparsely populated areas are potentially predisposed to health inequalities due to limited access to services. This study aimed to explore and describe issues of access to medicines and related advice experienced by residents of the Scottish Highlands and Western Isles. STUDY DESIGN Cross-sectional cohort study. METHODS Anonymized questionnaires were mailed to a random sample of 6000 residents aged ≥18 years identified from the electoral register. The questionnaire contained items on: access to medicines; interactions with health care services; and perceptions of the services. Results were analysed using descriptive, inferential and spatial statistics. RESULTS Adjusted response rate was 49.5% (2913/5889). Almost two thirds (63.4%, 1847) were prescribed medicines regularly, 88.5% (1634) of whom considered the source convenient. Pharmacy (73.8%, 1364) or dispensing GP (24.0%, 443) were the most accessed sources. Prescription medicine advice was mainly obtained from the GP (55.7%, 1029). Respondents ≥80 years old were significantly (P < 0.0001) more likely to live alone (45.3%, 92) compared with those <80 (15.8%, 424). Almost a fifth (16.5%, 31) of those >80 years living alone disagreed that they obtained prescribed medicines from a convenient source. The majority of respondents who felt they did not have a convenient medicines source, regardless of urban/rural classification, lived within five miles of a pharmacy or GP practice. CONCLUSIONS Respondents accessed medicines and advice from a variety of sources. While most considered their access to medicines convenient, there were issues for those over 80 years and living alone. Perceived convenience would not appear to be solely based on geographical proximity to supply source. This requires further exploration given that these individuals are likely to have long-term conditions and be prescribed medicines on a chronic basis.
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Affiliation(s)
- G F Rushworth
- Highland Clinical Research Facility, Centre for Health Science, Old Perth Road, Inverness, UK; NHS Highland, Assynt House, Beechwood Park, Inverness, UK.
| | - L Diack
- School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen, UK
| | - A MacRobbie
- NHS Highland, Assynt House, Beechwood Park, Inverness, UK
| | - S-A Munoz
- Centre for Rural Health, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, UK
| | - S Pfleger
- NHS Highland, Assynt House, Beechwood Park, Inverness, UK
| | - D Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen, UK
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Rushworth GF, Diack L, Rudd IG, Stewart D. General practitioner views of an electronic high-risk medicine proforma to facilitate information transfer. Int J Clin Pharm 2014; 37:4-7. [PMID: 25394831 DOI: 10.1007/s11096-014-0033-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/30/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The potential of warfarin related harm is increased if clinicians lack the full patient specific information to make informed decisions-an e-proforma has been developed to communicate this information on hospital discharge. OBJECTIVE To determine the views of general practitioners (GPs) on a warfarin discharge e-proforma. METHOD A cross-sectional survey of all GPs (n = 272) within the Raigmore Hospital catchment area of NHS Highland, Scotland. RESULTS The response rate was 39.3 % (107/272). 84 (78.5 %) noticed recent changes to information supplied on discharge for warfarin patients. 64 (59.8 %) respondents thought this would result in more informed prescribing with regards to dosing, while 65 (60.7 %) felt this would improve safety. Accurate completion, timely receipt of the e-proforma and a realistic date for subsequent INR tests were considered important by GPs. CONCLUSION This study suggests the use of an e-proforma to communicate information about a high-risk medication, warfarin, to GPs on discharge optimises safe, informed prescribing and monitoring in primary care. The development of a discharge e-proforma for other high-risk medication as a patient safety improvement measure should be explored.
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Affiliation(s)
- Gordon F Rushworth
- Highland Clinical Research Facility, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK,
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Maskrey BH, Rushworth GF, Law MH, Treweeke AT, Wei J, Leslie SJ, Megson IL, Whitfield PD. 12-hydroxyeicosatetraenoic acid is associated with variability in aspirin-induced platelet inhibition. J Inflamm (Lond) 2014; 11:33. [PMID: 25349537 PMCID: PMC4209229 DOI: 10.1186/s12950-014-0033-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/08/2014] [Indexed: 02/02/2023]
Abstract
Background Aspirin is one of the most widely used non-steroidal anti-inflammatory drugs (NSAIDs). It is also a commonly used anti-platelet drug, which inhibits the formation of the platelet activator, thromboxane A2 (TxA2) via inhibition of cyclooxygenase-1 (COX-1). However, the presence of a patient subset that fails to respond to aspirin despite reduced TxA2 concentrations suggests that the effect of aspirin might be more complex than exclusive COX-1 inhibition. Methods In this study we evaluated the impact of in vivo oral administration of a standard anti-platelet dose (75 mg) of aspirin in healthy volunteers on the acute impact of in vitro collagen-mediated platelet aggregation and generation of platelet-derived TxA2 and the 12-lipoxygenase (LOX) metabolite 12-hydroxyeicosatetraenoic acid (12-HETE). The eicosanoids were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results Low-dose aspirin administration not only inhibited TxA2 generation but also decreased the production of 12-HETE. Furthermore, a significant correlation was observed between the levels of 12-HETE and collagen-induced platelet aggregation. Pre-treatment of platelets with the 12-LOX inhibitor, baicalein, prior to activation attenuated platelet aggregation. Conclusions These findings support a role for 12-HETE as a pro-aggregatory eicosanoid in platelet function and suggest a role for 12-HETE in variable sensitivity to aspirin. The study also highlights a potentially important mechanism by which aspirin impacts upon eicosanoid generation.
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Affiliation(s)
- Benjamin H Maskrey
- Department of Diabetes and Cardiovascular Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH UK
| | | | - Matthew H Law
- Department of Diabetes and Cardiovascular Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH UK
| | - Andrew T Treweeke
- Department of Diabetes and Cardiovascular Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH UK
| | - Jun Wei
- Department of Diabetes and Cardiovascular Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH UK
| | | | - Ian L Megson
- Department of Diabetes and Cardiovascular Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH UK
| | - Phillip D Whitfield
- Department of Diabetes and Cardiovascular Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH UK
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Rushworth GF, Connelly J, Laing W, Maskrey BH, Nicholas F, MacRury SM. Review of clinical use of glucagon-like peptide-1 in the management of type 2 diabetes. Pract Diab 2014. [DOI: 10.1002/pdi.1886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Gordon F Rushworth
- Highland Clinical Research Facility; Centre for Health Science, Inverness; UK
- NHS Highland Diabetes Centre; Centre for Health Science; Inverness UK
| | - Jennifer Connelly
- Department of Diabetes and Cardiovascular Science; University of the Highlands and Islands, Centre for Health Science; Inverness UK
| | - Wendy Laing
- NHS Highland, Assynt House, Beechwood Park; Inverness UK
| | - Benjamin H Maskrey
- Department of Diabetes and Cardiovascular Science; University of the Highlands and Islands, Centre for Health Science; Inverness UK
| | - Fiona Nicholas
- NHS Highland, Assynt House, Beechwood Park; Inverness UK
| | - Sandra M MacRury
- Highland Clinical Research Facility; Centre for Health Science, Inverness; UK
- NHS Highland Diabetes Centre; Centre for Health Science; Inverness UK
- Department of Diabetes and Cardiovascular Science; University of the Highlands and Islands, Centre for Health Science; Inverness UK
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Chapman AR, Rushworth GF, Leslie SJ. Aspirin desensitization in patients undergoing percutaneous coronary intervention: a survey of current practice. Cardiol J 2014; 20:134-8. [PMID: 23558870 DOI: 10.5603/cj.2013.0025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/05/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aspirin remains the mainstay of anti-platelet therapy in cardiac patients. However, if a patient is allergic to aspirin and dual anti-platelet therapy is indicated - such as with percutaneous coronary intervention (PCI), then there is no clear guidance. One possibility is aspirin desensitization. A variety of protocols exist for the rapid desensitization of patients with aspirin allergy. The aim of this survey was to assess current knowledge and practice regarding aspirin desensitization in the UK. METHODS AND RESULTS We conducted a UK wide survey of all UK 116 PCI centers and obtained complete responses from 40 (35.4%) centers. Of these, just 7 (17.5%) centers had previously desensitised patients; 29 (87.9%) centers suggested a lack of a local protocol prevented them from desensitizing, with 10 (30.3%) unsure of how to conduct desensitization. Only 5 (12.5%) centers had a local policy for aspirin desensitization although 25 (64.1%) units had a clinical strategy for dealing with aspirin allergy; the majority (72%) giving higher doses of thienopyridine class drugs. CONCLUSIONS In the UK, there appears to be no consistent approach to patients with aspirin allergy. Patients undergoing PCI benefit from dual anti-platelet therapy (including aspirin), and aspirin desensitization in those with known allergy may facilitate this. Sustained effort should be placed on encouraging UK centers to use desensitization as a treatment modality prior to PCI rather than avoiding aspirin altogether.
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Lambrakis P, Rushworth GF, Adamson J, Leslie SJ. Aspirin hypersensitivity and desensitization protocols: implications for cardiac patients. Ther Adv Drug Saf 2014; 2:263-70. [PMID: 25083218 DOI: 10.1177/2042098611422558] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aspirin or acetylsalicylic acid is an important therapy for many cardiology patients but hypersensitivity to this drug affects around 1% of the population and intolerance may affect up to 20%. While alternative medications to aspirin are available, in many cases there is a compelling need for aspirin therapy. In these patients, aspirin desensitization may be considered. However, this is a complex issue with a lack of international standardization. This article reviews the available evidence for aspirin desensitization and provides practical advice for the management of these patients.
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Affiliation(s)
| | - Gordon F Rushworth
- Highland Clinical Research Facility, Centre for Health Science, Inverness, UK
| | | | - Stephen J Leslie
- Consultant Cardiologist, Cardiac Unit, Raigmore Hospital, Inverness IV2 3UJ, and University of Stirling, Highland Campus, Old Perth Road, Inverness IV2 3JH, UK
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Abstract
Ivabradine is a new bradycardic agent acting on the I f channels of sinoatrial nodal cells to decrease the rate of diastolic depolarization and thus heart rate. The benefit of ivabradine over other negatively chronotropic agents is its absence of negative inotropy. Effective management of coronary artery disease, in terms of reducing morbidity and mortality, is reliant on controlling heart rate. Ivabradine has been shown to safely and effectively reduce heart rate without compromising cardiac function in patients with coronary artery disease and more recently in patients with heart failure and raised heart rate. Furthermore, ivabradine has been shown to have a favourable side-effect profile compared with alternative bradycardic agents. This article reviews the evidence for ivabradine in coronary artery disease and heart failure and compares its safety with alternative bradycardic agents for these conditions.
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Affiliation(s)
- Gordon F Rushworth
- Advanced Pharmacist Clinical Research, Highland Clinical Research Facility, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH UK
| | | | - Stephen J Leslie
- Consultant Cardiologist, Cardiac Unit, Raigmore Hospital, Inverness IV2 3UJ, UK and University of Stirling, Highland Campus, Old Perth Road, Inverness IV2 3JH, UK
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Rushworth GF, Bloe C, Diack HL, Reilly R, Murray C, Stewart D, Leslie SJ. Pre-hospital ECG E-transmission for patients with suspected myocardial infarction in the highlands of Scotland. Int J Environ Res Public Health 2014; 11:2346-60. [PMID: 24566058 PMCID: PMC3945603 DOI: 10.3390/ijerph110202346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/29/2014] [Accepted: 02/13/2014] [Indexed: 02/01/2023]
Abstract
Patients with ST elevation myocardial infarction (STEMI) require prompt treatment, best done by primary percutaneous coronary intervention (PPCI). However, for patients unable to receive PPCI, immediate pre-hospital thrombolysis (PHT) is the best alternative. Evidence indicates that diagnostic and management support for staff increases the use of PHT. This study aimed to describe the patient demographics and management of patients, to determine any potential inter-area differences in referral rates to the ECG e-transmission service and to explore the views and experiences of key staff involved in ECG e-transmission within NHS Highland. Data from 2,025 patient episodes of ECG e-transmission identified a statistically significant geographical variation in ECG e-transmission and PHT delivery. Scottish Ambulance Service (SAS) staff were more likely than GPs to deliver PHT overall, however, GPs were more likely to deliver in remote areas. Interviews with six Cardiac Care Unit (CCU) nurses and six SAS staff highlighted their positive views of ECG e-transmission, citing perceived benefits to patients and interprofessional relationships. Poor access to network signal was noted to be a barrier to engaging in the system. This study has demonstrated that a specialist triage service based on e-transmission of ECGs in patients with suspected STEMI can be implemented in a diverse geographical setting. Work is needed to ensure equity of the service for all patients.
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Affiliation(s)
- Gordon F Rushworth
- Highland Clinical Research Facility, Centre for Health Science, Old Perth Road, Inverness IV2 3JH, UK.
| | - Charlie Bloe
- Cardiac Unit, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, UK.
| | - H Lesley Diack
- School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen AB10 7GJ, UK.
| | - Rachel Reilly
- School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen AB10 7GJ, UK.
| | - Calum Murray
- School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen AB10 7GJ, UK.
| | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen AB10 7GJ, UK.
| | - Stephen J Leslie
- Cardiac Unit, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, UK.
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Mort AJ, Rushworth GF. Exploration of key stakeholders' preferences for pre-hospital physiologic monitoring by emergency rescue services. J Clin Monit Comput 2013; 27:599-607. [PMID: 23709019 DOI: 10.1007/s10877-013-9475-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 05/06/2013] [Indexed: 11/26/2022]
Abstract
To gather preferences for novel pre-hospital physiologic monitoring technologies from emergency rescue services. Qualitative semi-structured interviews and focus groups were conducted with three groups from UK Search and Rescue (SAR); (1) Extractors (e.g. SAR teams), (2) Transporters (personnel primarily responsible for casualty transport), and (3) Treaters (e.g. Emergency Department doctors). Three themes were defined; SAR casualty management, novel physiologic monitor potential, and physiologic monitor physical properties. Some SAR groups already employed physiologic monitoring but there was no consensus on which monitor(s) to carry or what to monitor and how frequently. Existing monitors also tended to be bulky and heavy and could be unreliable in an unstable environment or if the casualty was cold. Those performing monitoring tended to have only basic first-aid training, and their workload was often high particularly if there was more than one casualty. The potential benefits of employing a novel monitor were strategic and clinical; an opportunity for transmitting data off-scene in order to facilitate monitoring or generate advice (i.e. telemedicine) was also voiced. A range of more intuitive, physical properties was also raised (e.g. small/compact, lightweight). SAR-specific technology should be simple to operate by those with less medical training, which means that clinical data interpretation and presentation should be carefully considered. It would be beneficial if novel monitors carried out a majority of the interpretation, allowing rescuers to proceed with their priority task of removing the casualty to safety.
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Affiliation(s)
- Alasdair J Mort
- The Centre for Rural Health, University of Aberdeen, Old Perth Road, Inverness, IV2 3JH, Scotland, UK,
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Treweeke AT, Winterburn TJ, Mackenzie I, Barrett F, Barr C, Rushworth GF, Dransfield I, MacRury SM, Megson IL. N-Acetylcysteine inhibits platelet-monocyte conjugation in patients with type 2 diabetes with depleted intraplatelet glutathione: a randomised controlled trial. Diabetologia 2012; 55:2920-8. [PMID: 22935960 PMCID: PMC3464379 DOI: 10.1007/s00125-012-2685-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/09/2012] [Indexed: 02/05/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to determine whether oral dosing with N-acetylcysteine (NAC) increases intraplatelet levels of the antioxidant, glutathione (GSH), and reduces platelet-monocyte conjugation in blood from patients with type 2 diabetes. METHODS In this placebo-controlled randomised crossover study, the effect of oral NAC dosing on platelet-monocyte conjugation and intraplatelet GSH was investigated in patients with type 2 diabetes (eligibility criteria: men or post-menopausal women with well-controlled diabetes (HbA(1c) < 10%), not on aspirin or statins). Patients (n = 14; age range 43-79 years, HbA(1c) = 6.9 ± 0.9% [52.3 ± 10.3 mmol/mol]) visited the Highland Clinical Research Facility, Inverness, UK on day 0 and day 7 for each arm of the study. Blood was sampled before and 2 h after oral administration of placebo or NAC (1,200 mg) on day 0 and day 7. Patients received placebo or NAC capsules for once-daily dosing on the intervening days. The order of administration of NAC and placebo was allocated by a central office and all patients and research staff involved in the study were blinded to the allocation until after the study was complete and the data fully analysed. The primary outcome for the study was platelet-monocyte conjugation. RESULTS Oral NAC reduced platelet-monocyte conjugation (from 53.1 ± 4.5% to 42.5 ± 3.9%) at 2 h after administration and the effect was maintained after 7 days of dosing. Intraplatelet GSH was raised in individuals with depleted GSH and there was a negative correlation between baseline intraplatelet GSH and platelet-monocyte conjugation. There were no adverse events. CONCLUSIONS/INTERPRETATION The NAC-induced normalisation of intraplatelet GSH, coupled with a reduction in platelet-monocyte conjugation, suggests that NAC might help to reduce atherothrombotic risk in type 2 diabetes. FUNDING Chief Scientist Office (CZB/4/622), Scottish Funding Council, Highlands & Islands Enterprise and European Regional Development Fund. TRIAL REGISTRATION isrctn.org ISRCTN89304265.
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Affiliation(s)
- A T Treweeke
- Free Radical Research Facility, Department of Diabetes & Cardiovascular Science, University of the Highlands & Islands, Centre for Health Science, Inverness IV2 3JH, UK
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Rushworth GF, Leslie SJ, Forsyth P, Vincent C. Evidence-based case report: multiple thrombotic episodes associated with lenalidomide and dexamethasone therapy for multiple myeloma. Ther Adv Drug Saf 2012; 3:115-22. [PMID: 25083230 DOI: 10.1177/2042098611433773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Lenalidomide in combination with dexamethasone is a treatment for patients with relapsed or refractory myeloma. Although this combination demonstrates a high level of efficacy, it further exacerbates the hypercoaguable state that exists within myeloma. Thromboprophylactic regimen require careful selection and if warfarin is chosen, assiduous monitoring is required to ensure it will be clinically effective. We report the case of one patient who experienced multiple thrombotic events despite anticoagulant or antiplatelet thromboprophylaxis and review the contributing factors.
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Affiliation(s)
- Gordon F Rushworth
- Advanced Pharmacist Clinical Research, Highland Clinical Research Facility, Centre for Health Science, Old Perth Road, Inverness IV2 3JH, UK
| | - Stephen J Leslie
- NHS Highland, Raigmore Hospital, and University of Stirling, Inverness, UK
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Rushworth GF, Cunningham S, Mort A, Rudd I, Leslie SJ. Patient-specific factors relating to medication adherence in a post-percutaneous coronary intervention cohort. Int J Pharm Pract 2012; 20:226-37. [PMID: 22775519 DOI: 10.1111/j.2042-7174.2011.00185.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the association between medication adherence and qualitatively characterised patient-specific themes relating to medication adherence in patients following percutaneous coronary intervention (PCI). METHODS Data-collection questionnaires and qualitative topic guides were piloted in two patients. A validated questionnaire generated an adherence score for a convenience sample of 20 patients within 7 days of PCI. Semi-structured qualitative interviews were subsequently carried out with all patients to explore patient-specific themes relating to measured medication adherence. KEY FINDINGS Fourteen out of 20 patients (70%) had scores indicative of good adherence. Key factors associated with good adherence included having a good relationship with the doctor, having an understanding of the condition, knowledge of the indications and consequences of non-adherence, perceived health benefits and medications eliciting tangible symptom control. There were misconceptions of concern regarding adverse drug reactions and the importance of aspirin, both of which had a negative effect on adherence. The role of the community pharmacist was sometimes, although not always, misunderstood. CONCLUSION This study suggests there is an association between patients' beliefs, knowledge, understanding and misconceptions about medication and their adherence in a post-PCI cohort. To optimise medication adherence it is vital for prescribers to remain patient-focused and cognisant of patient-specific themes relating to medication adherence.
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Affiliation(s)
- Gordon F Rushworth
- Highland Clinical Research Facility, Centre for Health Science, Inverness, UK.
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F. Clark L, F. Rushworth G, J Leslie S, MacRury S. New Advances in Blockade of the Renin-Angiotensin System – the Role of Direct Renin Inhibition. Curr Hypertens Rev 2010. [DOI: 10.2174/157340210793611677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rushworth GF. Leiomyosarcoma of the epididymis. Proc R Soc Med 1971; 64:999. [PMID: 5114314 PMCID: PMC1812856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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