Certificate in Minor Oral Surgery
Cohort 3
2014-15
Formative Assignment 1
Anticoagulant therapy is a relatively common long term treatment in UK medicine.
Outline what medical conditions might indicate its use. Outline the different types of agents which have and are used and how they affect the physiology of the blood clotting mechanism.
Using an evidence base how should patients in this category be managed in primary and secondary care when undergoing different oral surgical procedures.
Candidate Number……………MOS 08-03……………
GDC Number…………193196……………
Word Count……………2737…………………………………
Date submitted…11/09/14………..
By submitting this work electronically I declare that the work submitted is my own original work, and I have not plagiarised and this is entirely my own work and referenced accordingly to the Vancouver System.
The aim of anticoagulant therapy is to reduce blood coagulability to an optimal therapeutic range within which the patient is provided some degree of protection from thromboembolic events. It is estimated that in the UK, there are approximately 1.25 million people currently prescribed oral anticoagulant drugs 2, with warfarin being the most commonly used worldwide. Currently there are four oral anticoagulants
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12-14 Where there is a risk of bleeding, such as patients with renal insufficiency and decreased creatinine clearance or the presence of other risk for impaired hemostasis, dabigatran may need to be discontinued for at least 24 hours prior to treatment. 13 Additionally in patients with severe renal impairment (creatinine clearance < 30 ml/min) rivaroxaban and apixaban plasma levels may be significantly increased,12,14 which may also necessitate discontinuation of the drug before surgery. 12,14 Liaising with the patient’s physician prior to treating patient on these anticoagulants would be
Dentistry is a fascinating profession for its approach to patients, restoring function as well as es-thetic. I believe that Oral & Maxillofacial Surgery is the most important specialty in dentistry and medicine which combines art with science. It is appealing when patients leave the Oral & Maxillofacial Surgery (OMS) clinics not only with good function and esthetic, but also in a better psychological status. And I find the AAOMS’s motto “Saving Faces.. Changing Lives..” very insi...
The cryoprecipitate is used for patients who don’t have enough or are unable to produce sufficient fibrinogen and clotting factor VIII. The FFP and cryoprecipitate can both be used for patients who have had a liver transplants and trauma cases in which the patients has clotting problems. The other products such as the immunoglobulin are used for fighting diseases because of the antibodies in the plasma. The anti-D is used in pregnancies in case of an RhD incompatibility between the baby and the mother; this stops the mother creating antibodies against the baby. The albumin and the clotting factors are used for patients who have a deficiency of these proteins.
27-Ussia GP, Scarabelli M, Mulè M, et al. Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation.Am J Cardiol 2011;108:1772–6.
(14) Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD.. (2009). Dabigatran versus warfarin in patients with atrial fibrillation.. New England Journal Of Medicine. 361 (12), 1139-51.
Hemophilia is a rare bleeding disorder that slows the blood clotting process, which is not normal. Some people with Hemophilia may just have a little bit of “clotting factor” or no clotting factor at all (National Institute of Health [NIH], 2013). Clotting factor is a protein in blood that controls bleeding and they are needed the blood to clot normally. In order to help the blood clot, clotting factors work with “platelets” (National Institute of Health [NIH], 2013). Platelets are small blood cell fragments that form in the bone marrow, a tissue in the bones that is similar to a sponge. The functions of platelets have a very important role in blood clotting; the role of a platelet is to stick together (by the help of clotting factors) to block cuts, break on the carriers of blood (veins or arteries) throughout the body, and stop the bleeding when “blood vessels” (National Institutes of Health [NIH], 2013) are injured. Blood vessels are tube like structures carrying blood through the tissues and organs, like a vein, artery, or capillary. People with hemophilia do not have enough “clotting factor VIII or IX” (World Federation of Hemophilia [WFH], 2013) in their blood, which results to prolonged bleeding or oozing, meaning that bleeding can last longer (though, not faster) than usual after surgeries, accidents, or having teeth pulled out at the dentist. Clotting factor VIII, which can also be called as “anti-hemophilic factor” (AHF, for short) (Patient.co.uk, 2011), is a blood clotting protein that is necessary for humans to have. Clotting Factor IX is a protein that i...
Dentistry as a profession over the years has evolved rapidly in light of new scientific evidence. Rapidly evolving science and technology have implemented changes within dentistry as evidenced by new standards and guidelines being produced by nationally recognised associations including National Institute for Health and Clinical Excellence (NICE), Faculty of General Dental Practice (FGDP) and Scottish Intercollegiate Guidelines Network (SIGN) in Scotland, in provision of new scientific evidence. The latest standards and guidelines produced, endorse everyday clinical practice through evidence based dentistry (REF). All dental professionals as part of continued professional development are expected to keep to date on relevant guidelines and knowledge related to their practice (REF). This is supported by the General Dental Council who state all clinicians must maintain their professional knowledge and competence throughout their working career (REF).
Discuss the possible drug and excipient-related constrains of the formulation (no identity of the drug was given to you at this
...ed with this drug. One of the major concerns for this treatment is the development of kidney problems, but are usually reversible after treatment is ceased. “Approximately 90-95% of adults with Hepatitis B recover and remain immune to re-infection throughout their lifetime,”(Everson and Weinburg, 2002, pg.142-143)
In today days Atrial Fibrillation (AF) is the most common cardiac dysrhythmia that is often seen in clinical practice. There are 700,000 strokes in the USA each year and 15% of it caused by Atrial Fibrillation. For a long period of time warfarin was the only oral anticoagulant available in the US for patients with atrial fibrillation to prevent stroke events. Recently a new oral anticoagulants, including apixaban, dabigatran, and rivaroxaban have been developed and became available in the US for the stoke prevention and systemic embolism for patients with atrial fibrillation. Now, when all three new anticoagulants are available as an alternative to warfarin for the same indication, they make the health care providers question which agent is the best and for which patients. New agents have practical advantages over warfarin that has many limitations such as need for monitoring, regular dose adjustment, food and drug interaction and side effects. The major goal of the health care providers is to prescribe the safest and the most effective alternative drug and dose to each individual patient with AF. However, the approval for clinical use by the Food and Drug Administration (FDA) and the European Medicine Agency differ for anticoagulants and their dosages, and for the individual indication (Harenberg & Kraemer, 2012). Thus, more research needs to be done regarding the monitoring tools for new anticoagulant agents, and extend the use of these agents to other patient population.
In septic patients, increased levels of PAI-1 inhibit plasminogen activator (t-PA), which converts plasminogen to plasmin. Release of fibrin inhibits fibrinolysis by activation of thrombin-activatable fibrinolysis inhibitor (TAFI). In addition, the release of PAF causes platelet aggregation. This combination of inhibition of fibrinolysis, fibrin strand production and platelet aggregation contribute to a state of coagulopathy. This can lead to microcirculatory dysfunction with isolated or multiple organ dysfunction and cell death. Mr Hertz’s coagulation profile showed a fibrinogen level of 5.6 g/L, indicating that coagulopathies were underway in his system.
“Time is brain” is the repeated catch phrase when addressing the treatment and management of stroke (Saver, 2006). Access to prompt and appropriate medical care during the first few hours of stroke onset is critical to patient survival and outcomes. Recent changes in the guidelines for acute stroke care released by the American Heart Association (AHA) and the American Stroke Association (ASA) have improved patient access to treatment. Stroke treatment now follows the model of myocardial infarction treatment. Hospitals are categorized into four levels based on stroke treatment capability. The most specialized treatment is available in comprehensive stroke centers followed by primary stroke centers, acute stroke-ready hospitals, and community hospitals. The use of telemedicine now enables even community hospitals, with limited specialized capabilities, to care for stroke patients. Telemedicine puts emergency hospital personnel in contact with neurologists providing expertise in the evaluation of a stroke patient and determination of their eligibility for treatment with thrombolytic medication (Jefferey, 2013).
When caring for patients it is fundamentally important to have a good selection of up to date evidence Based Practice clinical articles to support research strategies, this allows professionals to assemble the most resent and accurate information known which enables them to make decisions tailored to the individual’s plan of care. It is essential to have clinical expertise and have the involvement from the individual patient, they must have full engagement and incorporation in order to have the accurate evaluation.
As a result, there is the need for medical practitioners to find a way to reduce such cases, especially after surgery. For this to be possible, there is the need for physicians to evaluate each clinical procedure guideline using the Appraisal of guideline research and evaluation tools to ensure that it is appropriate. Research and evaluation tools, are meant to assist in evaluating the appropriate and proposed guidelines to be adopted and implemented as policies and practices in various health care facilities. Moreover, the working group or the stakeholders should extract systematic reviews and clinical trials and analyze all the findings to eliminate chances of adopting inappropriate or the wrong guidelines. In the initial stage of the process, stakeholders and the members involved obtained large chunks of their data
Palmer, C. (2013, September 16). American Dental Association. Retrieved January 28, 2014, from ADA: http://www.ada.org/news/8898.aspx
In this particular discussion we will be comparing the different blood groups and how they are structured in preventing complications.