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There is no clear preference for any of the currently available NOACs over VKA for patients with both AF and CAD. A joint European consensus document endorsed by the Heart Rhythm Society and Asia-Pacific Heart Rhythm Society refutes the concern that dabigatran may increase the risk of acute myocardial infarction. 11 Moreover, the large FDA Medicare analysis found no evidence of an increased risk of myocardial infarction in patients taking dabigatran compared with warfarin. 12

Based on our interpretation of available data, we suggest

Only limited data are available on the use of NOACs as antithrombotic therapy in patients with peripheral artery disease (PAD). Patients with PAD in ROCKET AF (5.9%) did not have a significantly higher risk of stroke or systemic embolism than did patients without PAD, and outcomes in patients treated with rivaroxaban and warfarin paralleled those in the trial as a whole. There was a significant interaction for major or non-major clinically relevant bleeding in patients with PAD treated with rivaroxaban compared with warfarin (hazard ratio, HR: 1.40, 95% confidence interval, CI: 1.06–1.86) and those without PAD (HR: 1.03, 95% CI: 0.95–1.11; interaction P = 0.037). 13 Randomized trials of edoxaban and rivaroxaban in patients with PAD are currently underway. 14

Based on our interpretation of available data we suggest:

Patients with AF and an acute coronary syndrome or stable CAD may require percutaneous coronary intervention with stenting. In these patients, the need for OAC treatment to prevent stroke and for dual antiplatelet therapy to prevent stent thrombosis must be balanced against the increased risk of bleeding (particularly intracranial haemorrhage) with dual or triple antithrombotic therapy.

The use of VKAs in this setting has been the subject of observational studies and one completed randomized trial, 15 and is currently under investigation in comparison with NOACs in additional trials. All phase III trials of NOACs allowed the concomitant use of aspirin (≤100 mg/day) for patients undergoing percutaneous coronary interventions, but only the RE-LY trial included a substantial number of patients on concomitant clopidogrel with or without aspirin. 10 Ongoing trials will provide additional data for NOACs or warfarin in combination with aspirin and/or P2Y12 inhibitors (clopidogrel, prasugrel, or ticagrelor) (REDUAL-PCI for dabigatran NCT02164864, PIONEER-AF-PCI for rivaroxaban NCT01830543, AUGUSTUS for apixaban NCT02415400).

Management of these patients was recently addressed in the joint European consensus document. 11 The document suggested a period of triple therapy (OAC plus aspirin plus clopidogrel), followed by a period of dual therapy (OAC plus single antiplatelet agent, preferably clopidogrel). Once the patient is stable, after 1 year, an OAC alone can be given. When an OAC is prescribed, this can be either controlled VKA therapy [time in therapeutic range (TTR) of >70%; preferred international normalized ratio (INR) range 2.0–2.5] or an NOAC. When an NOAC is combined with dual antiplatelet therapy, the lower dose tested for stroke prevention in AF is recommended.

At that point, you could select one recruiter per hospital and give them a green light to submit your profile to the specific hospital should the ideal opportunity arise. This way, you can get your profile submitted quickly so you stand a better chance of landing the job. The other recruiters shouldn’t even need to be informed because they should be abiding by your first rule, don’t submit without consent.

Fourth, always request the name of the hospital prior to approving a submission. This way, you can ensure you don’t accidentally agree to getting submitted a second time. Also, if you’re hearing about a hot job on the fly and want to shop around with all your recruiters to see who has the best rate, or who might have an inside track on landing the job, then you’ll need the hospital name to do that. This is perfectly acceptable. But remember, try to accomplish this quickly because the best jobs close quickly.

Finally, let all your recruiters know when you get submitted for a job. This will ensure that there are no mix-ups. It also has the added benefit of lighting a fire under their feet to find you a job!

By taking these steps, travel nurses should be able to realize all the advantages of working with multiple agencies while avoiding the pitfall of getting submitted by multiple agencies for the same job. As always, we hope you find this information useful. We’d love to hear about your experiences with this topic or answer any questions you may have. Please post them on BluePipes Forums!


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BluePipes, Inc Health Behavior Research in the Age of Personalized Medicine

The American Academy of Health Behavior invites abstracts to be considered for poster research presentations at the 2017 annual meeting March 19-22, 2017 in Tucson, Arizona. The meeting theme: Health Behavior Research in the Age of Personalized Medicine highlights the need for public health practitioners and medical personnel to collaboratively migrate towards a tailored approach to health and well-being by accounting for unique personal characteristics (i.e., genetics, social and environmental risk factors) and individual responses to interventions. Personalized medicine has the potential to alter the way health problems are studied and managed, which can ultimately advance public and behavioral health.

poster research presentations

General Guidelines

We particularly encourage research abstracts related to the theme of the meeting; however, abstracts related to other health behavior topics and settings are welcome for submission. Preference will be given to quantitative and qualitative research-based abstracts that report complete results. Abstracts are limited to 300 words (i.e., body of abstract). Please be sure to check the word count before submitting as only the first 300 words will be considered for review.

Researchers can submit no more than 3 first-author abstract submissions. Co-authorship is unlimited. If a person submits more than 3 first-author abstracts, that person will be asked by the Abstract Review Chair to choose which 3 abstracts they would like reviewed.

No Show Policy: Any cancellations for abstract presentations must be due to professional and/or personal/family health emergencies and be made directly to the AAHB Research Review Chair. Cancellations must be made prior to the first day of the Annual Meeting. All those violating this policy will be subject to a one-year probation period during which they may not submit an abstract for presentation at an AAHB annual meeting.

Abstract Deadline: September 27, 2016 at 11:59 p.m., PST .

Abstract Deadline: September 27, 2016 at 11:59 p.m., PST

Both member and non-members are encouraged to submit abstracts for the meeting. Authors will be notified of the status of their submission(s) by November 7, 2016. If your abstract is accepted, it is expected that you or a co-author will register for the meeting and be present for the session.

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