Measuring the levels of knowledge and attitudes regarding advance directives of families of patients admitted in UERMMMCI: A descriptive cross-sectional study / The Health Sciences Journal

INTRODUCTION@#Advance directives are documents by which a person makes provisions for health care decisions in the event that, in the future, that person becomes unable to make those decisions. There is a lack of studies on the knowledge and understanding towards advance directives among patients and their families. The purpose of this study is to address this lack of research regarding advance directives by measuring the level of knowledge and attitudes of families of hospitalized patients.@*METHODS@#A descriptive, cross-sectional study design was used to describe the attitudes and the level of knowledge on advance directives of the families of patients. Data were collected directly by the researchers via assisted questionnaires. Descriptive statistics and frequencies were reported.@*RESULTS@#A total of 79 participants consisting of immediate family members of patients from UERMMMCI were enrolled. Only 24% reported having discussed advance directives with the patient's physician. Those respondents whose families had no discussion with their physician about advance directives had the same score as those who had. Overall, 61% of participants have only medium to low knowledge of advance directives, while 70% have positive attitudes regarding advance directives.@*CONCLUSION@#The study showed that the family members of patients had a reasonable understanding of advance directives in terms of basic knowledge, and positive attitudes on advance directives. Those who denied having discussed advance directives were comparable in the knowledge of advance directives with those who did.

Effects of antithrombin III and antivenom on procoagulant activity of Russell's viper venom in a whole blood model.

The procoagulant activities of Russell's viper venom were assessed in an in vitro whole blood model. Sequential samplings showed that the generation of fibrinopeptide A (FPA), a marker of thrombin activity, and platelet factor 4 (PF4), a marker of platelet activity, exhibited bi-phasic kinetics with an initial slow phase followed by a rapid phase of secretion. In the presence of Russell's viper venom, the generation of both FPA and PF4 was accelerated with the bi-phasic kinetics of PF4 being maintained while that of FPA completely disappeared. Administration of either antivenom (1,600 ng) or 10 IU antithrombin III (AT-III) had no antagonistic effect against the venom but combination of both resulted in a significant prolongation of both FPA and PF4 release (p < 0.05). High dose AT-III (20 IU) resulted in normalization of both FPA and PF4 kinetics and serial levels of both parameters were lower than those treated with the combined regimen, although these were not statistically significant. Unlike the untreated venom activated whole blood, there was no clot formation following treatment with either the combined regimen or high dose AT-III. The results of this study suggested that the effect of Russell's viper venom on the clotting cascade is more potent and direct than that on platelet activity. There were complementary effects between antivenom and AT-III is controlling of both FPA and PF4 release induced by the venom. Furthermore, in this in vitro experiment, AT-III alone when administered in a sufficient dose, abolished the procoagulant effects of Russell's viper venom.