Individual Proton Pump Inhibitors and Outcomes in Patients With Coronary Artery Disease on Dual Antiplatelet Therapy: A Systematic Review.

BACKGROUND: Observational studies evaluating the possible interaction between proton pump inhibitors (PPIs) and clopidogrel have shown mixed results. We conducted a systematic review comparing the safety of individual PPIs in patients with coronary artery disease taking clopidogrel. METHODS AND RESULTS: Studies performed from January 1995 to December 2013 were screened for inclusion. Data were extracted, and study quality was graded for 34 potential studies. For those studies in which follow-up period, outcomes, and multivariable adjustment were comparable, meta-analysis was performed.The adjusted odds or hazard ratios for the composite of cardiovascular or all-cause death, myocardial infarction, and stroke at 1 year were reported in 6 observational studies with data on individual PPIs. Random-effects meta-analyses of the 6 studies revealed an increased risk for adverse cardiovascular events for those taking pantoprazole (hazard ratio 1.38; 95% CI 1.12-1.70), lansoprazole (hazard ratio 1.29; 95% CI 1.09-1.52), or esomeprazole (hazard ratio 1.27; 95% CI 1.02-1.58) compared with patients on no PPI. This association was not significant for omeprazole (hazard ratio 1.16; 95% CI 0.93-1.44). Sensitivity analyses for the coronary artery disease population (acute coronary syndrome versus mixed) and exclusion of a single study due to heterogeneity of reported results did not have significant influence on the effect estimates for any PPIs. CONCLUSIONS: Several frequently used PPIs previously thought to be safe for concomitant use with clopidogrel were associated with greater risk of adverse cardiovascular events. Although the data are observational, they highlight the need for randomized controlled trials to evaluate the safety of concomitant PPI and clopidogrel use in patients with coronary artery disease.

Patient-provider communication, self-reported medication adherence, and race in a postmyocardial infarction population.

OBJECTIVES: Our objectives were to: 1) describe patient-reported communication with their provider and explore differences in perceptions of racially diverse adherent versus nonadherent patients; and 2) examine whether the association between unanswered questions and patient-reported medication nonadherence varied as a function of patients' race. METHODS: We conducted a cross-sectional analysis of baseline in-person survey data from a trial designed to improve postmyocardial infarction management of cardiovascular disease risk factors. RESULTS: Overall, 298 patients (74%) reported never leaving their doctor's office with unanswered questions. Among those who were adherent and nonadherent with their medications, 183 (79%) and 115 (67%) patients, respectively, never left their doctor's office with unanswered questions. In multivariable logistic regression, although the simple effects of the interaction term were different for patients of nonminority race (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.19-3.92) and those of minority race (OR: 1.19; 95% CI: 0.54-2.66), the overall interaction effect was not statistically significant (P=0.24). CONCLUSION: The quality of patient-provider communication is critical for cardiovascular disease medication adherence. In this study, however, having unanswered questions did not impact medication adherence differently as a function of patients' race. Nevertheless, there were racial differences in medication adherence that may need to be addressed to ensure optimal adherence and health outcomes. Effort should be made to provide training opportunities for both patients and their providers to ensure strong communication skills and to address potential differences in medication adherence in patients of diverse backgrounds.

Substance use and misuse in burn patients: testing the classical hypotheses of the interaction between posttraumatic symptomatology and substance use

Background: We aimed to test whether the three classical hypotheses of the interaction between posttraumatic symptomatology and substance use (high risk of trauma exposure, susceptibility for posttraumatic symptomatology, and self-medication of symptoms), may be useful in the understanding of substance use among burn patients. Methods: We analysed substance use data (nicotine, alcohol, cannabis, amphetamines, cocaine, opiates, and tranquilizers) and psychopathology measures among burn patients admitted to a Burns Unit and enrolled in a longitudinal observational study. Lifetime substance use information (n = 246) was incorporated to analyses aiming to test the high risk hypothesis. Only patients assessed for psychopathology in a six months follow-up (n = 183) were included in prospective analyses testing the susceptibility and self-medication hypotheses. Results: Regarding the high risk hypothesis, results show a higher proportion of heroin and tranquilizer users compared to the general population. Furthermore, in line with the susceptibility hypothesis, higher levels of symptomatology were found in lifetime alcohol, tobacco and drug users during recovery. The self-medication hypothesis could be tested partially due to the hospital stay “cleaning” effect, but severity of symptoms was linked to caffeine, nicotine, alcohol and cannabis use after discharge. Conclusions: We found that the three classical hypotheses could be used to understand the link between traumatic experiences and substance use explaining different patterns of burn patient’s risk for trauma exposure and emergence of symptomatology.

Type D Personality, Self-Efficacy, and Medication Adherence Following an Acute Coronary Syndrome

Objective: To assess the relationship among Type D personality, self-efficacy, and medication adherence in patients with coronary heart disease. Methods: The study design was prospective and observational. Type D personality, self-efficacy for illness management behaviors, and medication adherence were measured 3 weeks after hospitalization for acute coronary syndrome in 165 patients (mean [standard deviation] age = 61.62 [10.61] years, 16% women). Self-reported medication adherence was measured 6 months later in 118 of these patients. Multiple linear regression and mediation analyses were used to address the study research questions. Results: Using the original categorical classification, 30% of patients with acute coronary syndrome were classified as having Type D personality. Categorically defined patients with Type D personality had significantly poorer medication adherence at 6 months (r = j0.29, p G .01). Negative affectivity (NA; r = j0.25, p = .01) and social inhibition (r = j0.19, p = .04), the components of Type D personality, were associated with medication adherence 6 months after discharge in bivariate analyses. There was no evidence for the interaction of NA and social inhibition, that is, Type D personality, in the prediction of medication adherence 6 months after discharge in multivariate analysis. The observed association between NA and medication adherence 6 months after discharge could be partly explained by indirect effects through self-efficacy in mediation analysis (coefficient = j0.012; 95% bias-corrected and accelerated confidence interval = j0.036 to j0.001). Conclusions: The present data suggest the primacy of NA over the Type D personality construct in predicting medication adherence. Lower levels of self-efficacy may be a mediator between higher levels of NA and poor adherence to medication in patients with coronary heart disease.

Springboards into design : exploring multiple representations of interaction in a dental surgery

This paper demonstrates that in order to understand and design for interactions in complex work environments, a variety of representational artefacts must be developed and employed. A study was undertaken to explore the design of better interaction technologies to support patient record keeping in a dental surgery. The domain chosen is a challenging real context that exhibits problems that could potentially be solved by ubiquitous computing and multi-modal interaction technologies. Both transient and durable representations were used to develop design understandings. We describe the representations, the kinds of insights developed from the representations and the way that the multiple representations interact and carry forward in the design process.

Interactive lounge : an interdisciplinary approach to the design of a gestural interaction device

Among the many new opportunities that digital technologies are enabling are an increased capacity for viewers to interact not only with the program content, but with an increasingly wide array of other digital applications. Within this context this project has developed a new interaction device (incorporating gestural platform technology) and user interfaces to facilitate interactive access to digital media in a lounge room setting. This paper provides an overview of an interdisciplinary design process applied by Australasian CRC for Interaction Design (ACID) researchers—in order to develop the device and present in detail its unique features.

Co-constructed interaction in a paired speaking test : the rater's perspective

The definition and operationalisation of interactional competence in speaking tests that entail co-construction of discourse is an area of language testing requiring further research. This article explores the reactions of four trained raters to paired candidates who oriented to asymmetric patterns of interaction in a discussion task. Through an analysis of candidate discourse combined with rater notes, stimulated verbal recalls, rater discussions and scores awarded for interactional effectiveness, the article examines the extent to which raters compensate or penalise candidates for their role in co-constructing asymmetric interactional patterns. The article argues that key features of the interaction are perceived by the raters as mutual achievements, and it further suggests that the awarding of shared scores for interactional competence is one way of acknowledging the inherently co-constructed nature of interaction in a paired speaking test.

Childhood and social interaction in everyday life : an epilogue

The epilogue pulls together the conceptual and methodological significance of the papers in the special issue exploring childhood and social interaction in everyday life in Sweden, Norway, United States and Australia. In considering the special issue, four domains of childhood are identified and discussed: childhood is a social construct where children learn how to enter into and participate in their social organizations, competency is best understood when communicative practices are examined in situ, children’s talk and interaction show situated culture in action, and childhood consists of shared social orders between children and adults. Emerging analytic interests are proposed, including investigating how children understand locations and place. Finally, the epilogue highlights the core focus of this special issue, which is showing children’s own methods for making sense of their everyday contexts using the interactional and cultural resources they have to hand.

Designing interaction for local communications : an urban screen study

This paper discusses the ongoing design and use of a digital community noticeboard situated in a suburban hub. The design intention is to engage residents, collect and display local information and communications, and spark discussion. A key contribution is an understanding of Situated Display navigation that aids retrieval from a long-term collection created by and for suburban community, and engaging qualities of this collection.