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Burnett A, Rudd KM, Triller D. Advancing anticoagulation stewardship: A call to action for stewardship from the US-based anticoagulation forum. Thrombosis Update 2022. [DOI: 10.1016/j.tru.2022.100125] [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: 11/09/2022] Open
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Rudd KM, Oertel LB, Swartz MJ, Palmer J. Barriers and motivators to national board certification as a certified anticoagulation care provider. J Thromb Thrombolysis 2022; 53:761-765. [PMID: 35132528 DOI: 10.1007/s11239-022-02634-4] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/28/2022]
Abstract
Professionals voice confusion between the distinctions of board certification and educational certificate courses, and note barriers and motivators in obtaining national anticoagulation board certification. To identify barriers vs. motivators in obtaining board certification and detail the differences in board certification and educational certificate courses, an IRB-approved electronic survey was sent to professionals completing the University of Southern Indiana (USI) Anticoagulation Therapy educational certificate course (n = 491) and existing Certified Anticoagulation Care Providers (CACP, n = 622). A total of 1049 surveys were delivered successfully, with a 26% response rate (USI = 62, CACP = 211.) Respondents identified as a nurse (n = 52, 19%), advanced practice nurse (n = 14, 5.1%), pharmacist (n = 206, 75.5%) or physician (n = 5, 1.8%). Overall, respondents indicated board certification via CACP has significant impact on patient/organizational outcomes (n = 118, 43.2%). Top motivators for board certification include personal accomplishment (n = 147, 53%) and professional growth (n = 139, 50.9%). Top barriers include lack of time to prepare (n = 102, 37.3%,) board certification exam cost (n = 95, 34.8%), and for CACP recertification, and requirement to recertify by examination (n = 74, 35.1%). Of board-certified respondents, 45.4% indicated they were not employed at an Anticoagulation Center of Excellence (ACE), 34.8% employed at an ACE and 16.8% were unsure of ACE status. Narrative comments were obtained and evaluated. Significant personal and professional barriers exist in completing, and subsequently maintaining, board certification in anticoagulation. This offers great insight for NCBAP to invoke changes to support clinicians and healthcare organizations in seeking and maintaining CACP credentialing, a component of ACE attainment.
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Affiliation(s)
- Kelly M Rudd
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
| | - Lynn B Oertel
- Massachusetts General Anticoagulation Management Service, retired, Boston, MA, USA
| | - M Jane Swartz
- University of Southern Indiana College of Nursing and Health Professions, Evansville, IN, USA
| | - Jennifer Palmer
- University of Southern Indiana College of Nursing and Health Professions, Evansville, IN, USA
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3
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Affiliation(s)
- Kelly M. Rudd
- Department of Pharmaceutical Care, Pharmacology, and Pharmacotherapy, Section of Clinical Pharmacy, Bassett Medical Center, Cooperstown, NY
| | | | - Anush Patel
- Departments of Hematology/Oncology and Medicine, Bassett Medical Center, Cooperstown, NY
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Gunasekaran K, Rudd KM, Murthi S, Kaatz S, Lone N. Spontaneous Thyroid Hemorrhage on Chronic Anticoagulation Therapy. Clin Pract 2017; 7:932. [PMID: 28243434 PMCID: PMC5304264 DOI: 10.4081/cp.2017.932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 12/14/2016] [Accepted: 01/25/2017] [Indexed: 11/23/2022] Open
Abstract
Even though highly vascularized, the thyroid gland rarely has spontaneous bleeding. Bleeding into the thyroid gland can result in potentially lethal acute airway compromise. This case report describes an elderly patient on warfarin for atrial fibrillation, who presented with swelling on the right side of her neck causing acute airway obstruction. An urgent computed tomography of the neck showed an enlarging hemorrhage into the right lobe of the thyroid gland. She was initially intubated for airway protection and her anticoagulation was reversed to stop the bleeding. She was closely monitored in the intensive care unit. After an uncomplicated tracheal extubation and recovery, she was discharged and scheduled for an elective total thyroidectomy. We desire that physicians be aware of this rare, potentially lethal bleeding complication.
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Affiliation(s)
- Kulothungan Gunasekaran
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA; Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Kelly M Rudd
- Department of Pharmaceutical Care Services, Section of Clinical Pharmacy, Bassett Medical Center , Cooperstown, NY, USA
| | - Swetha Murthi
- Department of Internal Medicine, Sinai Grace Hospital , Detroit, MI, USA
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Hospital , Detroit, MI, USA
| | - Nazir Lone
- Department of Internal Medicine, Bassett Medical Center , Cooperstown, NY, USA
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Bond AM, Bartle B, Rudd KM, McFee Winans AR. Possible Rivaroxaban Failure during the Postpartum Period: An Alternative Viewpoint. Pharmacotherapy 2016; 36:e26-7. [DOI: 10.1002/phar.1736] [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: 11/07/2022]
Affiliation(s)
- Alison M. Bond
- Sunnybrook Health Sciences Centre; Thromboembolism and Anticoagulation Management Team; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Bill Bartle
- Sunnybrook Health Sciences Centre; Thromboembolism and Anticoagulation Management Team; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
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Rudd KM, McFee Winans AR. Author Reply. Pharmacotherapy 2016; 36:e27. [PMID: 27556133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Affiliation(s)
- Kelly M. Rudd
- Section of Clinical Pharmacy; Department of Pharmaceutical Care Services; Bassett Medical Center; Cooperstown New York
| | - Amanda R. McFee Winans
- Section of Clinical Pharmacy; Department of Pharmaceutical Care Services; Bassett Medical Center; Cooperstown New York
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Rudd KM, Phillips E(LM. New oral anticoagulants in the treatment of pulmonary embolism: efficacy, bleeding risk, and monitoring. Thrombosis 2013; 2013:973710. [PMID: 23691304 PMCID: PMC3649748 DOI: 10.1155/2013/973710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 01/31/2013] [Indexed: 12/22/2022]
Abstract
Anticoagulation therapy is mandatory in patients with pulmonary embolism to prevent significant morbidity and mortality. The mainstay of therapy has been vitamin-K antagonist therapy bridged with parenteral anticoagulants. The recent approval of new oral anticoagulants (NOACs: apixaban, dabigatran, and rivaroxaban) has generated significant interest in their role in managing venous thromboembolism, especially pulmonary embolism due to their improved pharmacokinetic and pharmacodynamic profiles, predictable anticoagulant response, and lack of required efficacy monitoring. This paper addresses the available literature, on-going clinical trials, highlights critical points, and discusses potential advantages and disadvantages of the new oral anticoagulants in patients with pulmonary embolism.
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Affiliation(s)
- Kelly M. Rudd
- Department of Pharmaceutical Care Services, Bassett Medical Center, Cooperstown, NY 13326, USA
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Abstract
Background: Warfarin is highly efficacious for the treatment and prevention of thromboembolic disorders. However, anticoagulation control has been a longstanding challenge, as patients' lack of knowledge of warfarin therapy is a predictor of nonadherence and compromised patient safety. Objective: To ascertain whether hospitalized patients newly initiated on warfarin are provided adequate anticoagulation education during hospitalization, as measured at discharge, as well as determine whether there is a difference in the knowledge obtained by patients educated via a structured program versus those counseled by “usual care.” Methods: A prospective evaluation of warfarin education of inpatients new to warfarin therapy was performed at Bassett Medical Center, Cooperstown, NY. Patients who were admitted to the hospital and receiving warfarin for any given diagnosis, were >18 years of age and able to give informed consent, and spoke English were recruited. Patients with dementia or cognitive impairment, those who were pregnant, or those who had previously been on warfarin therapy were excluded. Recruited patients received warfarin education in the form of a structured program provided by a pharmacist or counseling by usual care during hospitalization. Prior to discharge, the Oral Anticoagulation Knowledge (OAK) test, a prevalidated tool used to measure warfarin knowledge, was administered to evaluate outcomes. Further warfarin education was provided post-test if necessary. Results: The intervention group (n = 20) scored significantly higher on the OAK test than the usual care group (n = 20): 74% versus 55%, respectively (p = 0.004). Conclusions: This preliminary study demonstrated that there is a large amount of variability regarding patient knowledge of warfarin on discharge from an inpatient facility. A formalized inpatient warfarin education program may empower patients to achieve a larger degree of initial warfarin knowledge than those educated by usual care. Previous studies have demonstrated that this may improve adherence and subsequently increase long-term safety associated with oral anticoagulation. Larger, prospective, randomized studies are necessary to further evaluate patient education and safety outcomes.
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Affiliation(s)
- Amanda R McFee Winans
- Department of Pharmaceutical Care Services, Section of Clinical Pharmacology, Bassett Medical Center, Cooperstown, NY
| | - Kelly M Rudd
- Department of Pharmaceutical Care Services, Section of Clinical Pharmacology, Bassett Medical Center
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Affiliation(s)
- Kelly M Rudd
- Section of Clinical Pharmacology, Department of Pharmaceutical Care Services, Bassett Medical Center, Cooperstown, New York 13326, USA.
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Affiliation(s)
- Kelly M Rudd
- Department of Pharmaceutical Care Services, Bassett Healthcare, 1 Atwell Road, Cooperstown, NY 13326, USA.
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Stack NM, Rudd KM. Advanced pharmacy practice for new practitioners. Am J Health Syst Pharm 2006; 63:1126-7. [PMID: 16754736 DOI: 10.2146/ajhp050472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
The geriatric population is a large consumer of both prescription and over-the-counter drugs. Positive outcomes from drugs depend on the delicate interplay between therapeutic and adverse effects. This relationship becomes tortuous with simultaneous administration of several drugs. Numerous concomitant drug therapies may be essential for providing quality patient care but may also increase the possibility of an adverse drug event. Increasing sensitivity to drug effects in the geriatric population also creates concern over adverse effects. Drugs that possess anticholinergic properties are especially worrisome, as these properties may manifest as hazardous physiologic and psychological adverse drug events. Consequently, clinicians strive to minimize total drug exposure to agents possessing anticholinergic properties in elderly patients. A review of the literature revealed four methods that might help clinicians systematically reduce or eliminate potentially offending anticholinergic drugs. Each of the four has merits and limitations, with no ideal evidence-based approach used. Three of the four methods described have research utility; however, only one of the methods is clinically useful.
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Affiliation(s)
- Kelly M Rudd
- Section of Clinical Pharmacology, Department of Pharmaceutical Care Services, Bassett Healthcare, Cooperstown, New York 13326, USA.
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