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Elmi G.,Azienda USL of Bologna | Di Pasquale G.,Azienda USL of Bologna | Pesavento R.,University of Padua
Vasa - European Journal of Vascular Medicine | Year: 2017

As about 50 % of patients with unprovoked venous thromboembolism (VTE) will develop new episodes after discontinuing therapy, indefinite treatment is suggested in patients with low or moderate bleeding risk. Baseline and post-baseline factors can help clinicians to identify patients at high risk of recurrence, who require extended treatment. Residual vein obstruction and D-dimer assay have been shown to be suitable methods for assessing the risk of VTE recurrences after a first unprovoked VTE. In treatment for VTE the use of direct oral anticoagulants (DOAC) is growing instead of the standard adjusted dose of vitamin K antagonists. The DOAC safety profile has recently been strengthened with systematic reviews and meta-analyses. Idarucizumab is only approved for the reversal of dabigatran etexilate; intravenous antidotes for factor Xa inhibitors are under development. Their advent is of great interest. In the extended treatment of VTE sulodexide has been demonstrated to significantly decrease the risk of recurrences with an excellent safety profile. Aspirin is substantially less effective than oral anticoagulants in preventing recurrences but could play a role among patients who decided to stop anticoagulants. In conclusion, for the secondary prevention of VTE several options are available, without a recognised best choice regarding the treatment duration and the choice of drugs. An individual strategy taking into account risk of recurrence, bleeding risk, therapeutic options, and patient preferences is appropriate. © 2017 Hogrefe.

Caricati L.,University of Parma | Mancini T.,University of Parma | Bianconcini M.,Azienda USL of Bologna | Guidi C.,Azienda Ospedaliero Universitaria of Ferrara | And 4 more authors.
Acta Biomedica | Year: 2014

Background and aim of the work: Works from healthcare management and organizational psychology prove that psychosocial variables linked to professional identity are strongly associated with nurse-physician collaborative practice. However, literature pays little attention to the role of these variables. Moreover, evidence for the relation between collaborative practice on psychosocial variables for physicians is rather sparse. The purpose of this study was to investigate the relationship among self-efficacy, team commitment, professional commitment, and collaborative practice in both nurses and physicians. Methods: A cross-sectional survey was adopted and questionnaire was distributed to 269 nurses and 124 physicians working in different hospitals. Results: The perception of collaborative practice enhanced the self-efficacy and team commitment of both professionals. For nurses, professional commitment and self-efficacy positively predicted a willingness to collaborate; for physicians, professional commitment hindered a willingness to collaborate, while selfefficacy had no effect. Conclusions: The study indicates that collaborative practice is an important contextual resource bolstering self-efficacy and team commitment in both professional groups. However, strong professional commitment hinders the willingness of physicians to collaborate with nurses in a way that recognizes the autonomy of nurses. © Mattioli 1885.

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