Co-authored by professor Robert Ali, professor John Marsden and PCM Scientific, Cogora’s CME division, the paper showcases and analyses the hard work put in by PCM Scientific and the faculty over the last seven years of running the IOTOD conference.

The publication highlights the value and effectiveness of such education initiatives and demonstrates that PCM Scientific is dedicated to measuring outcomes resulting from its education resources. 

The symposium had over 300 Europe-based key decision makers and emergency specialists on the frontline of treating patients receiving NOACs in attendance.

Delegates interacted with an internationally renowned faculty who talked them through practical strategies for emergency patient management. The audience was then updated on current and up-and-coming anticoagulation reversal options and demonstrated a significant increase in their management-based knowledge as a result of attending.

Dr Connolly, a lead ANNEXA-4 investigator, presented the latest interim analysis of the ongoing ANNEXA-4 study: Andexanet Alfa in Factor Xa Inhibitor-Associated Acute Major Bleeding, which was first presented at ACC.18 in Orlando, Florida.

The RCP-accredited webinar on this FDA-approved (pending in the EU) NOAC reversal agent will shortly be available on the website to anyone who missed out on the night. 

Although non-vitamin K antagonist oral anticoagulants (NOACs) have been available for a decade, myths surrounding their use have prevented them reaching all patients that would benefit. But with changing recommendations and new data available all the time, NOAC Education provides a reliable resource for cutting edge learning on anticoagulation.

Compelling content

Currently, NOAC Education focuses on three main topics:

• The use of oral anticoagulants in patients with atrial fibrillation
• NOAC reversal agents
• Additional considerations in patient management, such as when surgery is indicated or when internal bleeding presents

Prophylactic anticoagulation is also being explored in conditions such as embolic strokes of undetermined source (ESUS) or when there is a risk of a patient developing venous thromboembolism (VTE).

Prominent faculty

Our faculty of international experts in the field of cardiology brings confidence and clarity across all of the topics covered, condensing the wealth of real-world data into concise, interactive activities.

The NOAC Education initiative, steered by Professor John Camm and the Faculty aims to build an engaged community of global healthcare professionals with an appetite to stay abreast of the latest advances and data impacting their ability to provide optimal anticoagulation care. The faculty drives the direction of the programme and chairs or participates in all NOAC educational activities. Their prestige and renown in the field is a major draw, attracting high levels of learner participation.

Our programmes are designed for all healthcare professionals involved in the treatment of patients who require anticoagulation, including Cardiologists, Primary care physicians, Nurses, Pharmacists and Surgeons.

Valuable and accredited formats

The NOAC Education portal strives to address knowledge and clinical care gaps and is the perfect platform to host targeted, impactful education for the global community of HCPs involved in cardiac care. The varied formats currently include:

• Journal club webinars
• Symposia
• Case study videos
• Social media

Additionally, all of our live education is recorded and archived as an interactive, enduring piece of eLearning. where learners can catch-up and obtain CPD points for participation.

Meaningful engagement

NOAC Education is the only ‘NOAC-dedicated’ platform, which has become a trusted brand with both an established, repeat audience, and new viewers joining all the time. The programme provides a platform for HCPs to communicate and engage and we have shown that HCPs view our content for significantly longer periods of time than on other platforms, demonstrating evidence of ‘deeper’ learning and impact.

Opportunities for growth of the NOAC Education platform over the coming year include the introduction of myth-busters animations, journal clubs revisited and a paper network.

Multi-supported

NOAC Education is an independent educational activity supported by multiple funders, all activities are run at arm’s length from the financial supporters and all content is created by the faculty. No funder has had input into the content of the materials or presentations available on the website.

PCM Scientific is always open to additional sources of funding support to expand the educational offerings of the NOAC education site. Please contact us at [email protected] if you are interested.

 

 

 

The IOTOD 2018 conference, now running for 16 years, was a huge success with healthcare professionals from all over Europe gathering to discuss best practices and new ideas for opioid dependence care. The two-day event hosted case studies, panel discussions and expert-led talks on a diverse range of topics, including cutting-edge research, psychosocial interventions, harm reduction, psychiatric disorders, heroin-assisted treatment, hepatitis C and much more.

Opioid dependence is a major global concern associated with considerable morbidity, and many countries, including the UK, have seen a worrying rise in opioid overdose deaths in recent years. Better care and evidence-based approaches are crucial to address this rise in deaths and improve outcomes for this population.

PCM Scientific filmed with top opinion leaders in Cardiology that were at the congress. The videos provide a platform for displaying key content in an engaging format, creating an interactive experience for users to explore at their own pace and in their own time.

The case studies are part of a selection of e-learning materials that will be added onto the site throughout the year. These materials provide a learning resource for those with an interest in NOAC Education, supporting clinicians in providing optimal anticoagulation care for patients at risk of thromboembolism.

The first step has been to create case study videos with successful programmes across three settings: a prison facility in Scotland, a harm reduction centre in Barcelona and the open drug scene in Denmark. Keep a lookout for the resources to accompany these videos, coming soon. 

Supported by funding from Mundipharma International Limited. PCM Scientific is the medical education company acting as scientific secretariat and organiser for this programme. The activity is run at arm’s length from the financial supporter and all content is created by the faculty or scientific secretariat. The financial supporter has had no involvement in the creation or development of the educational content. 

The 3-day conference featured talks from CME-Celebrity Don Moore and representatives of several CME organisations. The conference covered all aspects of CME, from needs assessments to outcomes measures and educational styles to learner engagement, allowing attendees to stay focused and engaged.

A particular highlight was the “lunch with the learners” session, in which two physicians and a nurse answered questions from the audience – which was made up of CME-providers, industry representatives, accreditation bodies and QI (quality improvement) specialists. They revealed that their preferable learning styles are those that bring the entire inter-professional team together because if they learn together, they can implement changes as a team. This feedback was good news for PCM Scientific, as the majority of our programmes aim to educate the inter-professional team to bring about real clinical practice changes, and it is always a pleasure to hear feedback from the HCPs themselves.

Another hot-topic of the conference was collaboration. A new organisation, CME-EA, proposed their ambitious plan to bring together key CME-stakeholders from across Europe and to reach a consensus on what attributes high quality CME means. Through this they hope to improve the ability to reciprocate CME credits between organisations and countries. This would lead to closer alignment between Europe and the USA, which has a much more defined model of CME. It was met with mixed reviews, with some applauding their efforts and others questioning the feasibility of such a task.

Collaboration was also discussed in relation to building educational programmes. Other providers showcased programmes in which they had brought many different stakeholders together, including the provider, funder, learners, patients and universities, to produce programmes that were produced to an excellent educational standard, as well as respected due to the integrity of all those involved.

The way CME providers measure outcomes cropped up several times during the conference. The reliability of self-report was covered, as well as incentivising learners to complete feedback. The traditional model of credit designation was also touched on, with one organisation in the US – American Nurses Credentialing Center (ANCC) – piloting a new approach whereby learners gain credits based on their competence, rather than the time spent on the learning experience.  More credits are given if the learner is able to demonstrate that they have implemented the education in a clinical setting, and less credits are given for a gain in knowledge. This approach proved controversial, with critics suggesting that it would be incredibly difficult to implement. However, those in favour argued it would mean learners would be less likely to treat CME as a “tick-boxing” exercise, and focus their time on areas they genuinely need to improve on.

Overall, the conference proved to be very interesting and questioned a lot of the basic ideas behind current CME in Europe.

Despite its very long history, sepsis has existed in a ‘backwater’ as described by Sir Liam Donaldson, former Chief Medical Officer of England, and many patients globally have died prematurely or have faced long-term disability.

The Global Sepsis Alliance (GSA) was founded in 2010 with the aim to raise awareness for sepsis worldwide and reduce sepsis deaths by 20% by 2020. Earlier this year, the World Health Assembly, the decision making body of the World Health Organization, adopted a resolution suggested by the GSA on improving the prevention, management and diagnosis of sepsis.¹

Current estimates of 30 million episodes and six million deaths annually have been made from a systematic review,² although this is likely to be a significant underestimate as no data were available for low to middle income countries and so the estimate was based on data on hospital-treated sepsis in high income countries. The true burden of sepsis therefore remains unknown.

The resolution makes a number of recommendations for action to reduce the global burden of the disease such as increased awareness, prevention, early recognition and urgent treatment according to locally developed guidelines.³

A key recommendation calls for health care workers to promote public awareness by using the term “sepsis” in communication with patients, relatives, and other parties. National surveys consistently report low community awareness of sepsis, its signs and symptoms, its causes, and its toll of death and disability. Awareness programmes should also teach health care workers to recognise sepsis and understand its true time-critical nature as a medical emergency.

The WHO resolution recognises the perceived conflict between rapid administration of antibiotics for sepsis and the important issue of combating antimicrobial resistance. Reducing the burden of sepsis must be played out alongside measures to minimise resistance and be consistent with the Global Action Plan on Antimicrobial Resistance. Because this is a condition that is appropriate to treat empirically with broad-spectrum drugs, development of methods for rapid diagnosis of the causative organisms and subsequent de-escalation is crucial.

September 2017 saw updated NICE guidelines for sepsis (NG51), the fifth annual World Sepsis Day from the GSA on 13 September, and the World Sepsis Congress Spotlight on maternal and neonatal sepsis, which is an often-overlooked facet of the disease. Progress towards GSA’s vision of a ‘world free of sepsis’ is being made and together with the WHA resolution has the potential to save millions of lives, but will require coordinated efforts by policy makers, health care personnel, researchers and clinicians to realise the dream.

References
1. WHA adopts resolution on sepsis. www.global-sepsis-alliance.org/news/2017/5/26/wha-adopts-resolution-on-sepsis
2. Fleischmann C et al. Assessment of global incidence and mortality of hospital-treated sepsis: current estimates and limitations. Am J Respir Crit Care Med 2016;193:259-72
3. Reinhart K et al. Recognizing sepsis as a global health priority – a WHO resolution. N Engl J Med 2017;377:414-17.

The PRIME awards recognise and reward true excellence within the human health industry in Australia and celebrate the contributions of companies that improve Australian healthcare. Founded in 2010, they are designed to provide a platform to highlight the use of best practices and innovation in the industry.

CORE: hand-in-hand in heart failure

The CORE programme encourages best practice and collaboration amongst members of the multidisciplinary team (MDT) involved in the treatment of heart failure (HF). Designed in collaboration with internationally recognised leading experts in the field, the novel education programme addresses needs assessment-identified educational and practice gaps that lead to sub-optimal patient care. By targeting these gaps, through novel, tailored education, the CORE programme has been able to drive clinical change and improvement in patient care worldwide.

PCM Scientific is a provider of CME programmes that not only reach broad, global audiences but deliver meaningful, measurable and sustainable impact on professional behaviours and patient care.

By creating CORE, PCM Scientific successfully brought together up to 15 specialities across the HF MDT to enhance and foster key relationships to allow for the sharing of expertise and the continuation of education. A Steering Committee of 9 international HF experts, 24 National Faculty members and 108 Country Facilitators identified local clinical care gaps and educational needs. This insight was then used to design and implement a cascading educational approach with tailored, flexible content across Austria, Australia, Canada, Spain, Sweden and the UK.

A total 44 meetings have taken place in Australia with participation from 257 leaners. From the outstanding feedback received, it is clear that CORE has had a lasting impact on clinical practice, with 74% of global learners already committing to change their practice and 83% stating that CORE will improve patient outcomes.

CORE is supported by funding from Novartis Pharma AG. All educational content and materials are created by the CORE Steering Committee in collaboration with PCM Scientific, the medical education company acting as secretariat. The financial supporter has had no involvement in the creation or development of the educational content.

This problem extends to Europe, where there are approximately 1.3 million opioid users at risk of overdosing, and where opioids account for the majority of the 6,000–8,000 registered overdose fatalities that occur each year.^2,3 In addition, recently published data on drug-related deaths in England, Wales and Scotland have shown, rather worryingly, that opioid-related deaths are on the rise.^4,5

Several strategies have been developed in response to the concerning high rates of opioid-related deaths; a subset of these are used to prevent overdoses from occurring, while others aim to reverse the effects of an overdose when they do occur.³ One such intervention of stopping an overdose when it does occur involves distributing naloxone, an opioid receptor antagonist, to opioid users and people likely to witness an overdose. When administered on time, naloxone is able to completely reverse an opioid overdose and thus stop a person from dying.^1,3

The life-saving potential of naloxone is the reason why, for decades, advocates have been campaigning for the implementation of take-home naloxone (THN) programmes in medical and nonmedical settings.^6,7 These schemes are incredibly important as they provide overdose education and training, and distribute naloxone kits to people at risk of overdose and those who are likely to witness one (e.g. users’ peers and hostel staff).^6,7 Furthermore, the link between THN programmes and reduced opioid-related mortality rates is strongly supported by many pieces of compelling evidence that have been published in recent years.^8,9,10

With this in mind, it is a pity that in Europe no more than 10 countries have introduced THN programmes.³ Indeed, significant barriers (legal, clinical and patient-level) preventing access to naloxone still exist in several European countries.⁶

However, the situation is changing: the number of European countries introducing THN programmes is on the rise, as is support for naloxone distribution from clinical guidelines, governments and international strategy plans.^3,11 In exciting news, the UNODC-WHO-led S-O-S Initiative was launched this year and details a much-needed strategy for reducing rates of opioid overdose deaths at a global level by increasing naloxone availability and training to all individuals likely to witness an overdose.¹²

This is one of the many much-needed steps in the right direction, but more should be done to counteract the worrying high rates of opioid overdose mortality, which in Europe are on the rise.¹³ Therefore, it is imperative for clinicians, policy-makers and governmental bodies to actively work together to provide wider access to naloxone and to overcome any remaining barriers that prevent THN programmes from being implemented. Accomplishing this will be key to saving and improving the lives of many, both across Europe and the world.

 

 

 

 

 

References

1. World Health Organization (WHO). Information sheet on opioid overdose. http://www.who.int/substance_abuse/information-sheet/en/ [last accessed July 2017]
2. European Monitoring Centre for Drugs and Drug Addiction. Mortality among drug users in Europe: new and old challenges for public health. 2015. http://www.emcdda.europa.eu/system/files/publications/961/TDAU14010ENN.pdf [last accessed July 2017]
3. European Monitoring Centre for Drugs and Drug Addiction. Preventing overdose deaths in Europe. http://www.emcdda.europa.eu/topics/pods/preventing-overdose-deaths [last accessed July 2017]
4. Office for National Statistics (ONS). Dataset: Deaths Related to Drug Poisoning, England and Wales. 2017. Table 6a. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/deathsrelatedtodrugpoisoningenglandandwalesreferencetable [last accessed August 2017]
5. National Records of Scotland (NRS). Drug-related deaths in Scotland in 2016. 2017. Available at: https://www.nrscotland.gov.uk/files//statistics/drug-related-deaths/drd2016/16-drug-rel-deaths.pdf [last accessed August 2017]
6. European Monitoring Centre for Drugs and Drug Addiction. Preventing opioid overdose deaths with take-home naloxone. 2016. http://www.emcdda.europa.eu/system/files/publications/2089/TDXD15020ENN.pdf [last accessed July 2017]
7. Public Health England (PHE). Take-home naloxone for opioid overdose in people who use drugs. http://www.nta.nhs.uk/uploads/phetake-homenaloxoneforopioidoverdosefeb2015rev.pdf [last accessed July 2017]
8. European Monitoring Centre for Drugs and Drug Addiction. Preventing fatal overdoses: a systematic review of the effectiveness of take-home naloxone. 2015. Available at: http://www.emcdda.europa.eu/system/files/publications/932/TDAU14009ENN.web_.pdf [last accessed July 2017]
9. Clarke AK, et al. A systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med 2014;8(3):153-63.
10. McDonald R and Strang J. Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction 2016;111(7):1177-1187.
11. HM Government. 2017 Drug Strategy. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/628148/Drug_strategy_2017.PDF [last accessed August 2017]
12. United Nations Office on Drugs and Crime (UNODC) and World Health Organization (WHO). The S-O-S Initiative—Stop Overdose Safely. Available at: https://www.unodc.org/documents/commissions/CND/The_S-O-S_InitiativeStop_Overdose_Safely_-_UNODC-WHO_multi-site_study_on_community_management_of_opioid_overdose_including_emergency_naloxone.pdf [last accessed August 2017]
13. European Monitoring Centre for Drugs and Drug Addiction. European Drug Report. Trends and developments. 2017. Available at: http://www.emcdda.europa.eu/system/files/publications/4541/TDAT17001ENN.pdf_en [last accessed August 2017]

 

The survey was developed to assess clinical practice, confidence, and perceptions among cardiologists, primary care physicians and nurses involved in heart failure management. The responses from over 346 healthcare professionals revealed multiple gaps over the spectrum of heart failure (HF) care, including diagnosis (low recognition of the signs and symptoms of HF and limited use of diagnostic tests); treatment planning (under-use of recommended agents and sub-therapeutic dosing); treatment monitoring and adjustment (lack of adherence to recommendations); and long-term management (low confidence in providing patient education)

The final CORE programme aimed to address these educational gaps and ultimately lead to improved outcomes for patients with HF.

The full publication will be available soon in the next issue of ESC Heart Failure due to be published in September 2017.

CORE is supported by funding from Novartis Pharma AG. All educational content and materials are created by the CORE Steering Committee in collaboration with PCM Scientific, the medical education company acting as secretariat. The financial supporter has had no involvement in the creation or development of the educational content.

In order to assist practising clinicians keep up to date with developments in the field, NOAC Education holds periodic, CME-accredited journal clubs on a range of useful topics. These live webinars allow our audience of healthcare professional, involved in the treatment of patients at risk of ischaemic stroke, to pose questions directly to the authors of recent papers, who will be able to provide unique insights into their study and the implications on clinical practice.

During our most recent live webinar, audience members were able to pose questions directly to Dr Torben Larsen (Aalborg, Denmark) who discussed his recent paper on the comparative effectiveness and safety of NOACs compared with warfarin in patients with atrial fibrillation alongside the series Chair, Professor John Camm.

For more information, please visit http://www.noaceducation.com

This independent educational activity is supported by funding from Boehringer Ingelheim.

Investing in safety …
Research and development into bringing a new chemical entity to market is a very costly process – $2.6billion, according to the Tufts Center for the Study of Drug Development.

Proof of safety is one of the cornerstones of marketing authorisation, and maintaining safety through all aspects of preparation and administration of hazardous drugs, for example, chemotherapies, is of no less importance.

Safety in this context encompasses three core areas: (i) safety from contamination of the drug; (2) safety from contamination with the drug, and (3) safety of the patient from medication errors.

Safety from contamination of the drug
Ingress of microbial contaminants into the chemotherapy infusion product can have catastrophic consequences for the patient. Closed drug transfer devices mechanically prohibit the transfer of environmental contaminants into a system, and are heavily promoted to ensure product integrity.

Safety from contamination with the drug
The word ‘pharmacy’ derives from the Greek ‘pharmakon’, whose ambiguous meaning is ‘medicine’ or ‘poison’. Environmental contamination with the ‘poison’ can occur at any point of the product journey. Pre-hospital contamination points begin on the surfaces of vials as they leave the manufacturer, through the packaging process to delivery at the hospital. Once in the hospital, contamination can occur in the compounding units (in isolators and biosafety cabinets), on the ward (spillages) and at all points in between. Post-hospital, contamination is a major consideration in waste and linen management.

It follows that everyone who is exposed to these environments will be exposed to contamination. In the hospital alone, this will include porters, pharmacists, pharmacy technicians, ward nurses,patients and their families, and the general public – the fact that one of the main contamination points is ward toilet seats speaks volumes.
The same closed drug transfer devices that prohibit the transfer of environmental contaminants into a system also prevents the escape of hazardous drug or vapour outside the system, ie. in the pharmacy and on the ward.

Safety of the patient from medication error
The European Medicines Agency defines medication errors as unintended failures in the treatment process that lead to, or have the potential to lead to, harm to the patient. Types of medication error committed during drug reconstitution or administration fall into one of four categories: wrong medication, wrong dose, wrong route of administration or wrong product. More than half of all the most serious and most costly medication errors are associated with intravenous drugs: of the 38% of all errors that occur at the point of administration, only 2% are intercepted.

Innovative technologies report significant success in ensuring safety, and include (in addition to closed system drug transfer devices) software-controlled dispensing and infusion systems that integrate patient data and hospital drug libraries with working practices in the pharmacy and on the ward.

… while yielding cost-saving dividends
The annual cost of chemotherapy drugs to the NHS exceeds £1billion, and is set to rise in line with increasing demand and rising manufacturers’ costs.

In 2016, the Carter Review identified hospital pharmacy as being one of six areas requiring improved efficiencies to achieve savings for the NHS. He challenged Trusts to develop plans for ensuring improved efficiencies, and reducing waste of expensive drugs is suggested as being an achievable step toward significant savings for the NHS.
Not only have innovative devices been shown to minimise risk of contamination of product, place and people, they have also proven themselves to be instrumental in managing left-over product, reducing litigation expense and minimising medication preparation time – all contributing to cost-savings for the NHS.

It is often argued that any intervention in the process of cytotoxic preparation and administration that is shown to improve patient and healthcare worker safety justifies its existence. That it also yields cost savings is the icing on the cake.

For patients with diabetes, it’s a different matter, and while simple calorie reduction will have an impact on the overweight state many of this cohort are in, you haven’t necessarily addressed their sugar intake, which is undoubtedly an issue for diabetes patients. It’s perfectly feasible to reduce calories through fats, while still keeping carbohydrates at a level that’s probably too high. And if you’re going to address diabetes through dietary intervention alone, then you need to affect a person’s carb intake, so say the proponents of a low carb diet.

There is another issue to consider, alongside the total grams of carb in a diet. Simply lowering carbohydrates isn’t necessarily enough – you need to take into account the glycaemic index (GI), or in other words, how quickly it raises blood sugar levels. High GI foods – white bread, the majority of cereals, among others – cause quick spikes in blood sugar. Not ideal for diabetes sufferers. NICE guidelines recommend low GI carbohydrates – sweet potatoes, wholewheat pasta – for dietary intervention in diabetes patients.

Despite the sound theory, and the success champions of low carb, such as GP Dr David Unwin, have had with their patients, the problem is evidence. There isn’t a great deal of long-term evidence out there showing benefits of low carb over other dietary intervention. Many recent studies show similar effects for low carb-high fat vs. high carb-low fat diets. And over a prolonged period of time, the suggestion is that patients just aren’t going to be able to stick to it – most diabetes sufferers have enough of a challenge sticking to a diet that simply reduces calories, let alone one that cuts carbs out too.

Nevertheless, the low carb diet is growing in popularity. Dr Unwin discussed the issue in the House of Lords at the beginning of April, and continues to have great results with his patients using this method. But the opponents to the low carb ideal mean it would make a great debate.

Atrial fibrillation (AF) is the world’s most common arrhythmia,¹ caused by cardiac remodelling that alters the heart’s conduction pathways. This leads to episodes of flutter-like arrhythmia which, although not necessarily life-threatening itself, can cause the formation of a blood clot in the heart.² The blood clot, known as a thrombus, can then travel from the heart to the brain, blocking a blood vessel and causing a life-threatening stroke.

Such life-threatening strokes are common in AF, with an annual rate of 1–15% depending on the age, gender and comorbidities of the patient.³ This risk can be mitigated through the use of oral anticoagulants (OACs) – in fact, just one dose per day is associated with a 35% lower risk of death.⁴ Despite this, practice among clinicians worldwide remains thoroughly sub-optimal.

International guidelines are clear – AF patients at risk of stroke should receive an OAC, preferably a non-vitamin K antagonist OAC (NOAC).⁵ However, only about half of these patients receive an anticoagulant,⁶ with NOACs used in less than a third of the time.⁷ In fact, about a quarter of patients are given aspirin instead,⁷ which ESC guidelines consider a harmful approach.⁵

So, why aren’t people prescribing these life-saving medications? The most common reason: a fear of uncontrolled bleeding. While OACs stop the formation of dangerous blood clots, they also prevent clots forming in response to injury. Not only does this have implications for patients at risk of injury, such as those likely to experience a fall, it also risks internal bleeding. For example, otherwise-innocuous nicks in the gastrointestinal wall can lead to significant bleeding, which goes uncontrolled in the presence of an anticoagulant. Clinicians must therefore balance the risk of stroke against the risk of bleeding,⁵ which unfortunately leads to overly cautious practice approaches, such as reserving anticoagulant therapy until after a patient has already experienced a primary stroke.

Not only this, but clinicians have to keep up with countless new developments in the field. NOACs were originally considered risky, now they’re considered safe. Previously it was thought to be dangerous to keep patients on warfarin during certain catheter surgeries, now it’s thought to be more dangerous to interrupt the course. And this year alone, no fewer than three practice-changing trials on NOAC use during surgery are set to be published, meaning the recommendations are set to change once again.

Furthermore, what should be done in cases of bleeding? And how much of a concern should it be? Numerous reversal strategies exist for both vitamin K antagonists (VKAs) and NOACs,⁵ acting as a safety net for patients that do experience internal bleeding. Indeed, real-world data of NOAC use indicates that major bleeding should not be a significant concern.⁸ 

Because of this constant influx of new data and guidance, there is still much work to be done to disseminate information and address fear in this clinical landscape. Once such example is the NOAC Education initiative, a CME programme aiming to provide clear, reliable information to those managing atrial fibrillation. Over the next 6 months, the initiative will run a series of journal clubs, in which the lead authors of exciting new papers will discuss precisely what impact new trial data will have on day-to-day patients.

As more guidance is offered, one hopes that practice will improve in this therapy area. Ignoring the risk of stroke doesn’t prevent it from happening – clinicians should instead be providing the protection their patients need, rather than worrying about comparatively minor “what if?”s.

Funding disclosure
The NOAC Education independent educational activity is supported by funding from Boehringer Ingelheim.

 

References

On 29th November, 2016, Professor Silvio Inzucchi delivered a thorough, informative exploration of three interesting cases as submitted by our audience. Professor Inzucchi stated: ‘With Professor Matthews, I tried, along with PCM Scientific staff, to develop a programme that essentially transcended the template… What we’ve done today is chosen three cases to discuss with you that really reflect the complexities of managing type 2 diabetes in the real world.’

Viewers were encouraged to submit questions for a live Q&A, and answer polling questions throughout each case.

The webinar saw glowing feedback from participants, and was praised for its inclusive, engaging format. Those who missed the live event can still take part and receive credit by participating in the archived event by clicking here.

The second case study clinic will be hosted by Professor David Matthews on 23rd February 2017 at 13:00 (GMT). Register here.

This independent educational activity is supported by an educational grant from Novartis Pharmaceuticals.

The following presentation, delivered at the MedComms Networking event held on 2nd September 2016, examines medical education trends across the globe and looks at their commonalities and differences and offers some considerations when planning education for a global audience.

Click here to view Celeste’s full presentation.