ABSTRACT
Objective: To explore the efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome (ACS) Chinese patients using glycoprotein â ¡b/â ¢a inhibitor (GPI). Methods: The data from CCC-ACS (Improving Care for Cardiovascular Disease in China-ACS) project were systematically reviewed in ACS patients with GPI. The patients were divided into ticagrelor and clopidogrel groups. A logistic analysis and propensity score matching (PSM) were performed to compare occurrences of major cardiovascular events (MACE) and bleeding events between the two groups during hospitalization. Results: A total of 63 641 ACS patients were collected from 150 hospitals. Logistic regression analyses showed that there was no statistically significant difference in the reduction of MACE between ticagrelor and clopidogrel when using GPI (OR=0.881, 95%CI 0.599-1.296; P=0.521). However, major bleeding rate was higher in the ticagrelor group than that in the clopidogrel group (OR=1.401, 95%CI 1.075-1.852; P=0.013). Similar results were observed after PSM. No statistic difference in MACE between the ticagrelor and clopidogrel group (OR=0.919, 95%CI 0.613-1.376; P=0.681). Major bleeding rate was higher in the ticagrelor group (OR=1.559, 95%CI 1.130-2.150; P=0.007). Conclusion: In ACS patients with GPI, ticagrelor did not reduce MACE, but increased the major bleeding risk compared with clopidogrel.
Subject(s)
Acute Coronary Syndrome , Percutaneous Coronary Intervention , Acute Coronary Syndrome/drug therapy , China , Clopidogrel/adverse effects , Glycoproteins , Humans , Ticagrelor/adverse effectsABSTRACT
BACKGROUND: A descriptive survey examined continuing education experiences of hospital nurses working in Tianjin Municipality, the third largest municipality in The People's Republic of China. METHOD: Fourteen hospitals and two hundred nurses were selected randomly. RESULTS: Over two thirds of the nurses had attended continuing education events in the previous few years. Learning experiences included on-site and off-site workshops; associate degree courses; and teaching strategies of mostly lectures, films and videos. Major barriers discouraging nurses from participating included lack of time, cost, distance, and being denied permission to attend. Nurses working in rural and suburban hospitals reported less access to continuing education opportunities than nurses in urban hospitals. Ninety-six percent of respondents reported they had made changes in their clinical practice as a result of the continuing education activities. CONCLUSION: Strategies to reduce barriers to continuing education and future research examining the impact of continuing nursing education on clinical practice in China need to be developed.
