The American journal of medicine
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The prevalence of atrial fibrillation increases with age, augmenting the risk of embolic stroke in elderly individuals. Clinical practice guidelines recommend the long-term use of oral anticoagulation in elderly patients with atrial fibrillation to reduce risk of stroke. Until recently, vitamin K antagonists (eg, warfarin) were the only oral anticoagulants available, but using warfarin in elderly patients can be challenging. ⋯ This review highlights the benefits and challenges of warfarin use in elderly patients with atrial fibrillation and discusses potential efficacy and safety benefits for newer oral agents in these patients. The potential for increased rates of major bleeding in the elderly, particularly those with numerous concomitant medications or renal impairment, also is discussed. Practical considerations for the use of long-term anticoagulation in elderly patients also are discussed.
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Interprofessional education for collaborative practice is an important innovation globally and in US health professions education. The recent spotlight on interprofessional education in the United States was launched by a series of reports in the US Institute of Medicine's Quality Chasm series. ⋯ In 2011, Collaborating Across Borders III, in Tucson, Arizona, drew 750 participants from 11 countries. The conference focused on interprofessional competency frameworks; strategies for preparing students for interprofessional practice; tailoring of learning environments for interprofessional education; and developing policy, infrastructure, culture, and faculty leadership for interprofessional education.
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Transfusion-associated circulatory overload is characterized by new respiratory distress and hydrostatic pulmonary edema within 6 hours after blood transfusion, but its risk factors and outcomes are poorly characterized. ⋯ The risk of transfusion-associated circulatory overload increases with the number of blood products administered and a positive fluid balance, and in patients with pre-existing heart failure and chronic renal failure. These data, if replicated, could be used to construct predictive algorithms for transfusion-associated circulatory overload, and subsequent modifications of transfusion practice might prevent morbidity and mortality associated with this complication.