HiThere 1 | 1
Dec 01, 2012 | #1
Faisal of Quinnipiac University received the following, entirely original and properly cited two-page document:
Introduction
Long-term care involving pharmaceuticals of any sort is accompanied by a variety of complications, both directly related to patient care and health outcomes and in regards to healthcare costs and the time management and expertise of medical personnel. As new medications and other treatment plans and options continue to develop, it is incumbent upon the medical community at large and the research community specifically to ensure that best practice guidelines are regularly updated in light of available evidence, yet all too often old and familiar procedures continue to be utilized even when better alternatives are available. Changes in practice require more than simple tests or comparisons of new approaches, but rather depend on ongoing evidence collection and frequent calls for changes to practice by researchers and practitioners alike. Progress is necessarily slow due to the mandate to limit potential harm, which guides all medical decision making towards 'tried and true' methodologies. Even when sufficient evidence can be compiled to warrant a change in practice there remains the additional hurdle of disseminating this information and creating an effective argument for the change to practice that actually reaches practitioners.
The following literature review and analysis attempts to provide such an argument for changes in current best practices based on emerging evidence regarding the use of anti-coagulants in long-term care settings. A literature review is provided that investigates the development of new anti-coagulant therapies that have emerged in recent years and the potential benefits as well as risks that these new pharmaceuticals and procedures hold when compared to existing therapies that are more well-established and have been standardized in common practice. Following this review, analysis of the evidence apparent in the literature and how this compares to practice guidelines and protocols in place at many medical institutions and settings will be provided, concluding with recommendations for changes to current and future practice and an assessment of the impact this change will have on patient outcomes and in terms of cost-effectiveness. It is the goal of this meta-analysis to lead to more efficient and more effective care provision for patients in long-term care requiring an anti-coagulant regimens, leading to more positive health outcomes and freeing up medical and financial resources for other more necessary uses.
Background
Warfarin (also known by its brand name Coumadin) has long been the anti-coagulant of choice in both short- and long-term care settings and scenarios for a variety of illnesses, conditions, and outcome desires/expectations (Bets & Weitz, 2009; Fang et al, 2011; Patel et al, 2011; Adam et al, 2012; Dzik, 2012; McDuffie et al, 2012; Miller et al, 2012). Isolated in the period following World War II by researchers at the University of Wisconsin after an accidental discovery of the semi-naturally occurring compound`s benefits decades earlier, warfarin was introduced to the medical world as Coumadin in 1948 as a poison for the control of rodent populations, and purposeful as well as accidental experimentation quickly demonstrated the reversible nature of the anti-coagulation effects of the drug (Dzik, 2012). This rather checkered start has returned to plague the drug somewhat; though it is highly effective for its intended purposes, the dangers that exist in establishing proper dosage and the mechanisms by which the drug operates and through which it can be monitored and controlled often present unwarranted and certainly undesirable risks to patients.
Anti-Coagulant Use in Long-Term Care
Introduction
Long-term care involving pharmaceuticals of any sort is accompanied by a variety of complications, both directly related to patient care and health outcomes and in regards to healthcare costs and the time management and expertise of medical personnel. As new medications and other treatment plans and options continue to develop, it is incumbent upon the medical community at large and the research community specifically to ensure that best practice guidelines are regularly updated in light of available evidence, yet all too often old and familiar procedures continue to be utilized even when better alternatives are available. Changes in practice require more than simple tests or comparisons of new approaches, but rather depend on ongoing evidence collection and frequent calls for changes to practice by researchers and practitioners alike. Progress is necessarily slow due to the mandate to limit potential harm, which guides all medical decision making towards 'tried and true' methodologies. Even when sufficient evidence can be compiled to warrant a change in practice there remains the additional hurdle of disseminating this information and creating an effective argument for the change to practice that actually reaches practitioners.
The following literature review and analysis attempts to provide such an argument for changes in current best practices based on emerging evidence regarding the use of anti-coagulants in long-term care settings. A literature review is provided that investigates the development of new anti-coagulant therapies that have emerged in recent years and the potential benefits as well as risks that these new pharmaceuticals and procedures hold when compared to existing therapies that are more well-established and have been standardized in common practice. Following this review, analysis of the evidence apparent in the literature and how this compares to practice guidelines and protocols in place at many medical institutions and settings will be provided, concluding with recommendations for changes to current and future practice and an assessment of the impact this change will have on patient outcomes and in terms of cost-effectiveness. It is the goal of this meta-analysis to lead to more efficient and more effective care provision for patients in long-term care requiring an anti-coagulant regimens, leading to more positive health outcomes and freeing up medical and financial resources for other more necessary uses.Background
Warfarin (also known by its brand name Coumadin) has long been the anti-coagulant of choice in both short- and long-term care settings and scenarios for a variety of illnesses, conditions, and outcome desires/expectations (Bets & Weitz, 2009; Fang et al, 2011; Patel et al, 2011; Adam et al, 2012; Dzik, 2012; McDuffie et al, 2012; Miller et al, 2012). Isolated in the period following World War II by researchers at the University of Wisconsin after an accidental discovery of the semi-naturally occurring compound`s benefits decades earlier, warfarin was introduced to the medical world as Coumadin in 1948 as a poison for the control of rodent populations, and purposeful as well as accidental experimentation quickly demonstrated the reversible nature of the anti-coagulation effects of the drug (Dzik, 2012). This rather checkered start has returned to plague the drug somewhat; though it is highly effective for its intended purposes, the dangers that exist in establishing proper dosage and the mechanisms by which the drug operates and through which it can be monitored and controlled often present unwarranted and certainly undesirable risks to patients.