Miracle-dz/UniFAR-FTUs huggingface dataset:
Systematic review of medication safety assessment methods.

PURPOSE The accuracy, efficiency, and efficacy of four commonly recommended medication safety assessment methodologies were systematically reviewed. METHODS Medical literature databases were systematically searched for any comparative study conducted between January 2000 and October 2009 in which at least two of the four methodologies-incident report review, direct observation, chart review, and trigger tool-were compared with one another. Any study that compared two or more methodologies for quantitative accuracy (adequacy of the assessment of medication errors and adverse drug events) efficiency (effort and cost), and efficacy and that provided numerical data was included in the analysis. RESULTS Twenty-eight studies were included in this review. Of these, 22 compared two of the methodologies, and 6 compared three methods. Direct observation identified the greatest number of reports of drug-related problems (DRPs), while incident report review identified the fewest. However, incident report review generally showed a higher specificity compared to the other methods and most effectively captured severe DRPs. In contrast, the sensitivity of incident report review was lower when compared with trigger tool. While trigger tool was the least labor-intensive of the four methodologies, incident report review appeared to be the least expensive, but only when linked with concomitant automated reporting systems and targeted follow-up. CONCLUSION All four medication safety assessment techniques-incident report review, chart review, direct observation, and trigger tool-have different strengths and weaknesses. Overlap between different methods in identifying DRPs is minimal. While trigger tool appeared to be the most effective and labor-efficient method, incident report review best identified high-severity DRPs.
Colles’ Fracture Treated with Non-Bridging External Fixation: A 1-Year Follow-Up

The results in 75 of 105 patients with Older type II/III (AO type A2.2, A3.1, A3.2) Colles’ fractures, treated with non-bridging external fixation are presented. The mean age was 67.8 years, and all patients were followed prospectively for 12 months with radiological and functional assessment. No statistically significant loss of radial length, angulation or inclination was seen between the postoperative reduction and the 1-year follow-up examination. The clinical results after 1 year were 66 (88%) excellent/good, nine (12%) fair and 0 (0%) poor according to the modified Gartland and Werley score. Mean visual analogue scale pain score after 1 year was 0.8. In three patients (4%), re-displacement of the fracture occurred and was treated with plating. Non-bridging external fixation offers a reliable method of maintaining radiological reduction of Older type II/III fractures of the distal radius and gives a good functional outcome after 1 year.
GP attitudes to managing drug- and alcohol-dependent patients: a reluctant role

The aim of this study was to determine the experience, confidence and views of GPs in South West Sydney towards managing drug and alcohol dependence and their interest in participating in shared care methadone prescribing. Five hundred and forty-eight GPs were mailed a self complete questionnaire. Non-responders were followed-up by telephone. Seventy-six per cent of GPs responded; 52% considered methadone maintenance to be effective. GPs were more confident managing smoking than alcohol and benzodiazepine dependence and least confident in illicit drug dependence. Fifty per cent reported having no patients on methadone and 40% between one and five patients. GPs in Fairfield and Liverpool reported having most patients; 25% were interested in prescribing methadone for patients in their own practice and 17% for patients referred to them. GPs who had more patients on methadone in their practice (especially those in Fairfield and Liverpool) considered methadone effective and were more likely to be interested in.
Growth hormone therapy and treatment outcomes: current clinical practice of the Gulf Cooperation Council

Over the last 20 years, recombinant human growth hormone (somatropin) has been the cornerstone of managing children with growth hormone deficiency (GHD). Although both international and national guidelines for growth hormone (GH) therapy exist, there is currently no consensus on the optimal use of GH therapy in Gulf Cooperation Council (GCC) countries. The goals of GH therapy are to normalize height during childhood, attain normal adult height and correct metabolic abnormalities related to GHD. However, extended use of GH >50 µg/kg/day may increase frequency of adverse events. Here, we report the proceedings from a meeting of nine GCC pediatric endocrinology experts, which took place in Beirut in November 2011. The meeting was also attended by three European counterparts and aimed to provide consensus on best practice in the management of children with GHD in the GCC based on current local medical and regulatory environments.
Female offenders with psychiatric disorders in Sri Lanka

Background Female offenders are characterised by higher rates of psychiatric morbidity. Studies in developed countries show an increase in the number of female prisoners in recent years. The objectives of this study were first to describe socio-demographic factors and rates of psychiatric morbidity in female offenders, and second, among females with psychiatric illness, to compare those with and without a history of offending. Methods A retrospective case control study was carried out among 71 alleged female offenders who had been admitted to the National Institute of Mental Health (NIMH), Sri Lanka over an 18 months period. Females attending an outpatient psychiatry clinic with no prior history of offending were considered as controls. Data were collected from court reports and patient records. Results Among the alleged offences, 63% were reported as ‘‘behavioural disturbance due to mental illness’’, and 14% as physical assault. The most common diagnoses among female offenders with psychiatric illness were schizophrenia (43%) and bipolar affective disorder (22%). Childhood sexual abuse was reported by 22% of cases compared to 12% of controls (p=0.08). Rates of marriage and employment were significantly lower among the female offenders with psychiatric illness, compared to the controls. Conclusion Patterns of psychiatric illness among female offenders in Sri Lanka may differ from that of the West. Among females with psychiatric illness in Sri Lanka, being single, unemployed and use of alcohol is significantly associated with offending compared to controls. Further research is required to explore these findings. The Sri Lanka Journal of Psychiatry Vol 6(1) : 32-34
Functional adaptation after extensive small bowel resection in humans

Objective To assess the functional adaptation of the digestive remnant after extensive small bowel resection. Methods A total of 50 patients who had had an extensive small bowel resection (residual small intestine 26–150 cm, median 70cm) were studied longitudinally. None had chronic digestive disease. Early adaptation was assessed by following the evolution of faecal weight during the enteral refeeding period (first 3 months after surgery) in 34 patients, 19 of whom had a jejunostomy. Long-term adaptation was studied in 42 patients (all but one had intestinal continuity) followed for 13–248 months (median 87 months). Serial faecal analyses under the same dietary conditions were performed in 22 patients. Results During the early period, faecal weight varied mainly in relation to enteral caloric intake. If one considers the period of caloric plateau only, which lasted 25 days on average, faecal weight decreased significantly (mean 9.5%). After discharge, the incidence of diarrhoea and abdominal discomfort did not change with time; most patients returned to a normal diet and their body weight and serum albumin levels increased. Faecal weight and excretion of fat and nitrogen remained unchanged, but faecal sodium levels diminished significantly. Conclusions Functional adaptation occurs in humans following small bowel resection. This process appears minimal and time-limited, and is restricted to the early months after operation.
Clinical and economic benefits of aromatase inhibitor therapy in early-stage breast cancer.

PURPOSE The clinical and economic benefits of aromatase inhibitor (AI) therapy in early-stage breast cancer are reviewed. SUMMARY AI therapy has become a standard of care for the treatment of most postmenopausal women with early-stage breast cancer, as it significantly reduces the risk of disease recurrence and death. Using the currently accepted gold standard for clinical efficacy-improvement in disease-free survival rather than overall survival-exemestane, anastrozole, or letrozole as monotherapy or in sequence with tamoxifen has been found to be superior to tamoxifen monotherapy. Emerging data have demonstrated potential overall survival advantages for AIs subsequent to and directly related to distant recurrence. Of the nonsteroidal AIs, letrozole appears to have the efficacy advantage by demonstrating an early effect on distant recurrence and, subsequently, a potentially significant overall survival benefit, though results of a prospective head-to-head trial of anastrozole and letrozole are not yet available. When the economic burden to society is considered, it appears that all AIs are similarly beneficial on the basis of disease recurrence. However, preliminary analyses indicate that the survival benefit appears to be greater with letrozole than with anastrozole. Thus, considering potential survival benefits and cost-effectiveness, letrozole may be preferable to anastrozole in the early adjuvant setting. CONCLUSION AI therapy has become a standard of care for the treatment of most postmenopausal women with early-stage breast cancer. Emerging data have demonstrated potential overall survival advantages for AIs subsequent to and directly related to distant recurrence. When the economic burden to society is considered, it appears that all AIs are similarly beneficial on the basis of disease recurrence.
Prevalence and socioeconomic factors in schistosoma haematobium infection in a Ghanian community

Prevalence of Schistosoma haematobium infections was assessed among 160 students of Twohofo Holy International School. Cape Coast, Ghana. Overall prevalence was 34.4%, with males and females having prevalence of 32.3% and 35.8% respectively. Ago group 6-B years had 30%, while 24.2% were infected in age group 9-11 years. Prevalence was 48.2% in age group 12-14 years and 50% in age group 15-17 years. Parental occupation had affect on prevalence with children of self-employed parents showing significantly higher prevalence then children of salaried employees of government and private companies. Knowledge of the disease was very low among the subjects.
Effect of ascorbic acid on inflammatory markers after cardiothoracic surgery.

PURPOSE The effect of ascorbic acid on inflammatory markers after cardiothoracic surgery (CTS) was studied. METHODS In this randomized, double-blind, placebo-controlled trial, patients undergoing cardiopulmonary bypass graft surgery or valve replacement surgery from April 2009 through March 2010 at Hartford Hospital were randomized to receive ascorbic acid (2-g loading dose followed by 500 mg every 12 hours) or matching placebo the evening before surgery and for four days postoperatively. Inflammatory mediators were measured preoperatively and on postoperative days 1-4. Intergroup comparisons were performed using two-tailed t tests and Fisher's exact test. Multiple comparisons were conducted using repeated analyses of variance with Bonferroni tests. RESULTS Of the 62 patients screened, 24 met the study inclusion criteria. Of these, 13 were assigned to receive ascorbic acid and 11 received placebo. Ascorbic acid did not affect the natural course of inflammatory marker rise for C-reactive protein (CRP) concentration, white blood cell (WBC) count, or fibrinogen concentration versus placebo at any evaluated time point (p > 0.05 for all intergroup comparisons). Intragroup analyses demonstrated significant differences among baseline and postoperative measures of all inflammatory mediators (p < 0.05). No significant differences were noted in inflammatory markers between patients undergoing cardiothoracic surgery with or without cardiopulmonary bypass, regardless of treatment group. CONCLUSION Ascorbic acid did not attenuate the rise in inflammatory markers after CTS when compared with placebo. The use of off-pump surgery did not significantly change the levels of CRP and fibrinogen or the WBC count postoperatively when compared with on-pump surgery with a biocompatible polymer coating.
SAUDI CANCER PATIENTS’ ATTITUDES TOWARDS DISCLOSURE OF CANCER INFORMATION

Background : The aim of this study was to explore Saudi cancer patients' views regarding cancer information disclosure and whether differences existed between regions or gender. Methods : In this cross-sectional questionnaire-based prospective survey, we interviewed 332 Saudi cancer patients who received oncological care at King Fahd University Hospital, Al-Khobar, Saudi Arabia from July 2002 to July 2009 to explore their attitudes regarding disclosure of cancer information. Results : The vast majority of Saudi cancer patients wanted to know the diagnosis of cancer (98%) and only 2% wanted the information to remain undisclosed. Seventy percent of the women wanted family members to know compared to only 39% of the men (P<0.001). Only 10% of the patients wanted their friends to know. In this study, 99% and 98%, respectively, wanted to know about the benefits of therapy and about their diagnosis of cancer. Of both genders, 98% also wanted to know the side effects of therapy and the prognosis. The attitudes of Saudi men and women with cancer were almost identical apart from sharing information with their family members. 99% of eastern region cancer patients wanted the diagnosis of cancer disclosed compared to 74% of those from other regions (P=0.04). Conclusion : The findings of this study indicated that most Saudi cancer patients wanted disclosure of cancer information. Significantly more women than men wanted to share information with their family. More Eastern region patients wanted to know about their diagnosis of cancer compared to patients from other regions.
Syndrome of inappropriate antidiuretic hormone associated with moxifloxacin.

PURPOSE A possible case of moxifloxacin-induced syndrome of inappropriate antidiuretic hormone (SIADH) is reported. SUMMARY A 66-year-old Caucasian woman with stage II chronic obstructive pulmonary disease (COPD) arrived at the emergency department from an outpatient clinic complaining of worsening shortness of breath, headache, body aches, and dizziness. Five days before her arrival at the hospital, the patient was seen in an outpatient clinic with symptoms of COPD exacerbation and was given a corticosteroid taper of prednisone 40 mg daily and moxifloxacin 400 mg daily. The patient was hospitalized, and her serum sodium concentration was 110 meq/L. Moxifloxacin was continued on admission, and the patient was admitted to the intensive care unit for frequent neurologic examination, serial serum sodium measurements, and fluid restriction. Her laboratory test results were consistent with SIADH. Fluid restriction at 1 L/day initially corrected her serum sodium concentration to 119 meq/L, but increases in serum sodium plateaued by day 2 of admission (119-122 meq/L). Moxifloxacin was discontinued on hospital day 3. At discharge, on hospital day 5, her serum sodium concentration had increased to 131 meq/L. She was restarted on her home medications and followed up in an outpatient clinic one week later. After multiple etiologies were ruled out, drug-induced SIADH associated with moxifloxacin was the most likely diagnosis for this patient. Clinicians should be aware of this potential adverse drug effect when assessing patients with hyponatremia or SIADH. CONCLUSION A 66-year-old woman developed severe hyponatremia after receiving moxifloxacin for five days for treatment of COPD exacerbation.
Relationships Between Pain Treatments and Substance Use at a VA Mental Health Residential Rehabilitation Program

Pain is a universal reality, which affects high percentages of individuals in both the general population and the U.S. veteran population. Additionally, pain conditions are often complicated by co-occurring substance misuse. This study explored the functional relationships between various treatments for pain in a VA Mental Health Residential Rehabilitation Treatment Program. Data from 27 MHRRTP client records was used to form three independent variables: pharmacotherapy, individual psychotherapy for pain and group counseling for pain. This study examined the relationship between the stated independent variables and four dependent variables: changes in pain level ratings, substance use, risk factors for relapse to substance abuse, protective factors for sobriety. Though many of our results showed little statistical significance, they provide clear indications for program and clinical improvements and implications further research. PAIN TREATMENTS AND SUBSTANCE USE AT A VA 4
Teaching clinical problem solving: a preceptor's guide.

PURPOSE Instructional methods to help pharmacists succeed in their growing role in practice-based teaching are discussed, with an emphasis on techniques for fulfilling the four key preceptor roles. SUMMARY The American Society of Health-System Pharmacists (ASHP) and other organizations advocate ongoing efforts to develop the teaching skills of clinician-educators serving as preceptors to pharmacy students and residents. The broad model of teaching clinical problem solving recommended by ASHP emphasizes the creative and flexible application of the four major preceptor roles: (1) direct instruction, (2) modeling, (3) coaching, and (4) facilitating. A variety of teaching methods used in the fields of medicine and nursing that can also be adopted by practice-based pharmacy educators are presented; in particular, the advantages and disadvantages of various case-presentation formats (e.g., One-Minute Preceptor, SNAPPS, patient-witnessed teaching, "Aunt Minnie," "think-aloud") are reviewed. Other topics discussed include the appropriate use of questioning as an educational tool, strategies for providing constructive feedback, teaching learners to self-evaluate their skills and progress, and integrating residents into teaching activities. CONCLUSION The ASHP-recommended approach to teaching clinical problem-solving skills can be applied within the educational frameworks provided by schools of pharmacy as well as pharmacy residency programs. A wide range of validated teaching strategies can be used to tailor learning experiences to individual learner needs while meeting overall program goals and objectives.
Management of advanced colorectal cancer, Part 1.

PURPOSE Important developments in chemotherapy for advanced colorectal cancer over the past 15 years are reviewed, with an emphasis on the most recently published data from clinical trials of newer multidrug regimens, administration techniques, and dosing schedules. SUMMARY Eight agents are approved by the Food and Drug Administration (FDA) for use in treating patients with advanced colorectal cancer. Fluorouracil and leucovorin still constitute the foundation of most chemotherapy regimens for this population; combination fluorouracil-leucovorin therapy plus either irinotecan (the FOLFIRI regimen) or oxaliplatin (the FOLFOX regimen) are two firmly established first-line treatments shown to produce similar outcomes. In Phase III trials conducted over the past six to seven years, regimens of capecitabine plus oxaliplatin (CapeOx) were demonstrated to have clinical effectiveness comparable to that of FOLFOX therapy. Response rates of 35-55% and median overall survival of ≥20 months have been documented with some of the newer regimens. Research to define the optimal role of the three monoclonal antibody agents approved by FDA for use in managing advanced colorectal cancer is ongoing; bevacizumab has been shown to confer significant survival benefits when added to certain chemotherapy regimens, and other monoclonal antibodies (cetuximab and panitumumab) also appear to offer significant benefits in select patients as first- or second-line therapies. CONCLUSION Over the past 15 years, a shift toward multiagent treatment strategies including a variety of chemotherapy agents and monoclonal antibodies has yielded improved rates of response and prolonged survival among patients with advanced colorectal cancer. The CapeOx, FOLFOX, and FOLFIRI regimens are currently among the most widely used first-line treatments.
Implementing evidence-based supported employment

AIMS AND METHOD We evaluated the impact of implementing the individual placement and support (IPS) approach within eight community mental health teams (CMHTs) in two London boroughs. Demographic, clinical and vocational data were collected enabling a comparison of the number of people supported in work/education and individual client outcomes at 6 and 12 months. RESULTS Following the integration of employment specialists there were significant increases in the number and proportion of clients engaged in mainstream work or educational activity at 6 months and 12 months. The employment specialists supported 38% in open employment at 6 months and 39% at 12 months. CLINICAL IMPLICATIONS The results support the use of IPS in clinical practice in CMHTs.
Safety profile of antiviral medications: a pharmacovigilance study using the Italian spontaneous-reporting database.

PURPOSE The results of an analysis of suspected antiviral-associated adverse drug reactions (ADRs) in Italy over a 22-year period are presented. METHODS A case/non-case analysis was conducted using ADR reports compiled in the nationwide spontaneous-reporting database through September 2010. All reported events included in the analysis were evaluated and coded by drug safety experts; causality assessments were performed according to the algorithm of Naranjo et al. The association between an adverse reaction and antiviral use was assessed by estimating the reporting odds ratio (ROR), with 95% confidence interval (CI), as a measure of disproportionality. RESULTS Overall, 863 reports of suspected ADRs involving antivirals and 42,430 reports of adverse reactions to other drugs were identified; of those events, 3.3% and 64.3% were determined to be definite or probable ADRs, respectively, and an additional 32.4% were deemed possibly drug related. Several ADRs were disproportionately associated with antivirals relative to other drugs: renal colic (ROR, 25.5; 95% CI, 13.3-49.0), lactic acidosis (ROR, 18.6; 95% CI, 9.2-37.7), depression (ROR, 18.0; 95% CI, 11.6-27.9), anemia (ROR, 15.9; 95% CI, 12.3-20.4), hallucination (ROR, 4.3; 95% CI, 2.7-7.1), neutropenia (ROR, 4.1; 95% CI, 2.9-5.8), acute renal failure (ROR, 3.9; 95% CI, 2.3-6.4), fever (ROR, 3.8; 95% CI, 2.8-5.1), hyperpyrexia (ROR, 2.9; 95% CI, 1.7-4.9), and asthenia (ROR, 1.8; 95% CI, 1.2-2.8). CONCLUSION Analysis of data from a large Italian database showed that, among antiviral agents, the ribavirin-interferon combination, acyclovir, valacyclovir, indinavir, and zidovudine accounted for the most serious hematologic, neuropsychiatric, and renal ADRs.
Facial Nerve Palsy In Aviation Facial Baroparesis

We report a case of a patient who experienced recurrent facial nerve palsies associated with flying. Although this condition is well recognised in divers, only 7 cases have been reported related with aviation. Non of these describe a long-lasting facial nerve palsy, as once experienced by our patient. The presentation, management and the possible pathophysiology of this condition is discussed.