bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Aging on the Strength of Cardiovascular Risk Factors: A Longitudinal Study Over 40 Years
Authors: Lind Lars , Sundström Johan , Ärnlöv Johan , Lampa Erik
Published: January 2018

Background

The knowledge of the impact of cardiovascular risk factors at different ages has mainly been based on different studies performed at different ages. This study aimed to investigate the change in impact of traditional cardiovascular risk factors over the aging process in subjects followed for 4 decades.

Methods and Results

In the ULSAM (Uppsala Longitudinal Study of Adult Men) study, 2322 men originally investigated in 1970 to 1974 have been followed regarding cardiovascular diseases until the end of 2013. This cohort has been investigated physically at ages 50, 60, 70, 77, and 82 years regarding body mass index, low‐density lipoprotein‐ and high‐density lipoprotein‐cholesterol, triglycerides, systolic blood pressure and diastolic blood pressure, fasting glucose, and smoking. These data were used to model the interactions between risk factors and age regarding incident myocardial infarction (n=540), ischemic stroke (n=343), or heart failure (n=397). Significant interactions were observed between age and the set of traditional risk factors regarding all 3 outcomes (
P
<0.05 for all). Generally, a decline in the rate ratios was seen with aging for most risk factors, being most pronounced for body mass index regarding myocardial infarction and for systolic blood pressure regarding ischemic stroke and heart failure. However, low‐density lipoprotein‐cholesterol was significantly related to incident myocardial infarction, whereas both body mass index and fasting glucose were significantly related to incident heart failure also at a high age.

Conclusions

Using a longitudinal design in middle‐aged men spanning 4 decades showed that the impact of traditional cardiovascular risk factors generally declined with aging. However, some of the risk factors remained significantly associated with incident cardiovascular disease also at old age.
Serum Matrix Metalloproteinase‐9 and Cognitive Impairment After Acute Ischemic Stroke
Authors: Zhong Chongke , Bu Xiaoqing , Xu Tan , Guo Libing , Wang Xuemei , Zhang Jintao , Cui Yong , Li Dong , Zhang Jianhui , Ju Zhong , Chen Chung‐Shiuan , Chen Jing , Zhang Yonghong , He Jiang
Published: January 2018

Background

The impact of serum matrix metalloproteinases‐9 (MMP‐9) on cognitive impairment after ischemic stroke is unclear. We aimed to investigate the association between serum MMP‐9 in the short‐term acute phase of ischemic stroke and cognitive impairment at 3 months.

Methods and Results

Our study was based on a subsample from the CATIS (China Antihypertensive Trial in Acute Ischemic Stroke); a total of 558 patients with serum MMP‐9 levels from 7 of 26 participating sites of the trial were included in this analysis. Cognitive impairment severity was categorized as severe, mild, or none (Mini‐Mental State Examination score, <23, 23–26, or ≥27, respectively; Montreal Cognitive Assessment score, <20, 20–24, or ≥25, respectively). Cognitive impairment was defined as a score of <27 for Mini‐Mental State Examination or <25 for Montreal Cognitive Assessment. According to Mini‐Mental State Examination score, 143 participants (25.6%) had mild cognitive impairment and 153 (27.4%) had severe cognitive impairment at 3 months. After adjustment for age, National Institutes of Health stroke score, education, and other covariates, the odds ratio for the highest quartile of serum MMP‐9 compared with the lowest quartile was 3.20 (95% confidence interval, 1.87–5.49) for cognitive impairment. Multiple‐adjusted spline regression model showed a linear association between MMP‐9 levels and cognitive impairment (
P
<0.001 for linearity). Sensitivity and subgroup analyses further confirmed these results. Similar significant findings were observed when cognitive impairment was defined by Montreal Cognitive Assessment score.

Conclusions

Increased serum MMP‐9 levels in the short‐term phase of ischemic stroke were associated with 3‐month cognitive impairment, independently of established risk factors.
Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta‐Analysis
Authors: Gaudino Mario , Di Franco Antonino , Rahouma Mohamed , Tam Derrick Y. , Iannaccone Mario , Deb Saswata , D'Ascenzo Fabrizio , Abouarab Ahmed A. , Girardi Leonard N. , Taggart David P. , Fremes Stephen E.
Published: January 2018

Background

Observational studies suggest a survival advantage with bilateral single internal thoracic artery (BITA) versus single internal thoracic artery grafting for coronary surgery, whereas this conclusion is not supported by randomized trials. We hypothesized that this inconsistency is attributed to unmeasured confounders intrinsic to observational studies. To test our hypothesis, we performed a meta‐analysis of the observational literature comparing BITA and single internal thoracic artery, deriving incident rate ratio for mortality at end of follow‐up and at 1 year. We postulated that BITA would not affect 1‐year survival based on the natural history of coronary artery bypass occlusion, so that a difference between groups at 1 year could not be attributed to the intervention.

Methods and Results

We searched MEDLINE and Pubmed to identify all observational studies comparing the outcome of BITA versus single internal thoracic artery. One‐year and long‐term mortality for BITA and single internal thoracic artery were compared in the propensity‐score–matched (PSM) series, that is, the form of observational evidence less prone to confounders. Thirty‐eight observational studies (174 205 total patients) were selected for final comparison. In the 12 propensity‐score–matched series (34 019 patients), the mortality reduction for BITA was similar at 1 year and at the end of follow‐up (incident rate ratio, 0.70; 95% confidence interval, 0.60–0.82 versus 0.77; 95% confidence interval, 0.70–0.85;
P
for subgroup difference=0.43).

Conclusions

Unmeasured confounders, rather than biological superiority, may explain the survival advantage of BITA in observational series.
The Destruction of Cultural Heritage in Armed Conflict: The ‘Human Element’ and the Jurisprudence of the icty
Authors: Clark Janine Natalya
Published: January 2018

During the wars in the former Yugoslavia in the 1990s, extensive attacks on cultural heritage took place. Established in 1993, the International Criminal Tribunal for the former Yugoslavia (icty) has prosecuted some of these cultural heritage crimes, and it is the Tribunal’s work in this regard that constitutes the central focus of this article. Arguing that the icty’s jurisprudence has highlighted a crucial ‘human element’ of cultural heritage destruction, the article identifies two particular ‘human’ dimensions of cultural heritage crimes that can be extracted from the icty’s cases, namely an impact dimension and an intent dimension. If the Tribunal’s jurisprudence has thereby underscored the powerful synergies between crimes against property and crimes against people, these synergies have wider practical implications. Adopting a functionalist view, this article ultimately seeks to show that cultural heritage has a potentially important and largely unexplored role to play in post-conflict reconciliation.
Questions and Answers from the F.I.X.
Authors: Cada Dennis J.
Published: January 2018

The Formulary Information Exchange (The F.I.X.) is an online drug information service available to subscribers of The Formulary Monograph Service. In this column, we present samples of recent dialog on The F.I.X. If you would like more information on The Formulary Monograph Service or The F.I.X., please call 800-322-4349.
SSRIs and Upper Gastrointestinal Bleeding? Cutaneous Reactions to Psychotropic Drugs Atrial Fibrillation and Anabolic Steroids Accidental Olanzapine Overdose in a Child
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Guard against Inadvertent IV Administration of Long-Acting Penicillins Coumadin and Generic Warfarin Given to the Same Patient Nitroglycerin Patch, Are You There? Natru-Vent and Atrovent
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute of Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writer's names will be published if desired. ISMP may be contacted at the address shown below.
New Drugs Approved by the FDA New Dosage Forms and Indications Agents Pending FDA Approval Major Labeling Changes
Authors: Baker Danial E.
Published: January 2018

This monthly feature will help readers keep current on new drugs, new indications and dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information; however, if there are any questions, let us know at hospitalpharmacy@drug-facts.com .
Zaleplon
Authors: Cada Dennis J. , Baker Danial E. , Levien Terri
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The January 2000 Formulary monographs are on entacapone, exemestane, oseltamivir, perindopril, and clinafloxacin. The DUE is on entacapone.
Where Have All the Pharmacists Gone?
Authors: Vogenberg F. Randy
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
Carboplatin and Etoposide (CE) Regimen
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
Policy Making: How the Advisory Committee on Immunization Practices Reached Recent Decisions
Authors: Grabenstein John D.
Published: January 2018

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunoprophylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.
Dose Confusion with Phosphorus-Containing Products Improper Mixing with Insulin Pens Counseling Patients on Proper Use of Measuring Devices “EDTA” Mix-Ups Modification of Percocet Nomenclature
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute of Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writer's names will be published if desired. ISMP may be contacted at the address shown below.
Ambulatory Payment Classes: Obstacle or Opportunity for Health Care Systems?
Authors: Wilson C. Nick
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
Lyme Disease: An Overview
Authors: Dib Jean G. , Fung Horatio B. , Tiu Raquel M.
Published: January 2018

Lyme disease is the most common tick-borne illness in the United States. It occurs most commonly in areas that foster and harbor the deer tick. The number of reported cases of Lyme disease in the United States has increased steadily since 1982. The tick transmits an infection of the spirochete Borrelia burgdorferi that typically manifests as a localized skin lesion and erythema migrans. If left untreated, infection may lead to localized arthritis, heartblock, and/or disease of the nervous system. The diagnosis of Lyme disease is made primarily from clinical signs and symptoms that are suggestive of the disease. Treatment includes 10 to 27 days of antibiotics depending on stage of the disease. Vaccines for the prevention of Lyme disease are now licensed and the trend of increasing incidence of Lyme disease will likely be reversed.
Metered Dose Inhaler-Spacer Technique in Hospitalized Geriatric Patients: Effect of Patient Education by a Pharmacist
Authors: Smith Valerie Strayhorn , Tolley Elizabeth A. , Demirkan Kutay , Self Timothy H.
Published: January 2018

The purpose of this study was to determine if hospitalized geriatric patients could correctly use a metered dose inhaler plus spacer (MDI-spacer) after a brief description and demonstration of proper use by a pharmacist. Twenty-three geriatric patients admitted to a university hospital were evaluated. Patients were asked to use the MDI-spacer (Aerochamber) and were scored using a 9-point checklist (pretest). Educational intervention by the pharmacist consisted of a 5-minute discussion and correct demonstration of the device. Patients were then asked to use the device again (post-test). The overall score improved from 60.4% to 88.9% after patient education (p = 0.0001), with exhaling slowly (step 4), inhaling slowly over 4 to 5 seconds (step 7), and holding breath for at least 4 seconds (step 8) showing the largest improvement, and five of nine steps having significant improvement. For the overall score, there were no differences between genders in this group of geriatric patients, including pretest and post-test. A pharmacist was an effective patient educator for this group of hospitalized geriatric patients.
Consensus Development Conference Intravenou men Drug on the Safety Systems: Balancing Safety and Cost
Authors: Bates David W. , Cousins Diane D. , Flynn Elizabeth , Gosbee John W. , Richason Linda , Schneider Philip J.
Published: January 2018

As cost-containment pressures on health care systems continue, traditional practices are searching for ways to deliver care less expensively. Intravenous drug delivery systems have become a targeted area for cost savings in many health care institutions because they are so extensively used. Benchmark systems that have been shown to improve safety, such as unit-dose drug distribution and IV admixture programs, are now being viewed as costly alternatives. Likewise, technologies and innovations that have the potential to improve efficiency and safety are being critically scrutinized. The decision matrix for selection of IV drug delivery systems needs to carefully balance cost, quality, efficiency, and safety—relative to the medication use process as a whole.

This article presents the final statement of the Consensus Development Conference on the Safety of Intravenous Drug Delivery Systems, held on September 27–28, 1999, in Phoenix, AZ. The purpose of the conference was to provide a balanced assessment of available IV drug delivery systems.
Guillain-Barré Syndrome and Vaccination: Usually Unrelated
Authors: Grabenstein John D.
Published: January 2018

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunoprophylaxis, and immunotherapy. This column is intended to help you carry out proper immunologic drug use in your practice.
Two-year Longitudinal Evaluation of Amphotericin B Lipid Complex Injection in a Tertiary Care Medical Center
Authors: Kennedy Leanne D. , Connelly Julie F. , Kuzma Kevin M.
Published: January 2018

A 2-year concurrent drug use evaluation was conducted in 156 patients to determine whether Abelcet (amphotericin B lipid complex injection) was being prescribed according to institution-approved guidelines and to characterize the patient population receiving Abelcet. Eighty-nine patients (57%) had fungal infections documented by chest x-ray, computed tomography, or fungal cultures. Sixty-seven (43%) had clinically suspected fungal infections. The Abelcet mean dose by weight was 5 mg/kg/day (actual body weight). Seventy-one patients (46%) met the established guidelines for use; 85 (54%) did not. Premedication was given to 64% of the patients; only 15 patients (10%) experienced documented fever and chills. A total of 72 patients (46%) died during therapy. Of the 75 patients who completed therapy in the hospital, 41 were switched to conventional amphotericin B, fluconazole, or itraconazole following a decrease in serum creatinine concentration, and 34 did not receive further antifungal therapy. The mean length of Abelcet therapy was 11 days. The mean increase in serum creatinine concentration at discontinuation of therapy was 0.2 mg/dL. Continued monitoring of Abelcet use was recommended and established guidelines were reaffirmed. Hydration with normal saline before and after dosing was suggested to help improve renal function, and dopamine was recommended to increase renal blood flow.
How to Evaluate an Outcomes Study
Authors: Chandramouli Jane C. , Tyler Linda S.
Published: January 2018

This special feature describes basic skills for evaluating outcomes studies and the appropriate application of outcome studies to clinical practice. The authors (1) explain the difference between a randomized controlled clinical trial and an outcome study; (2) define clinical, economic, and humanistic outcomes; (3) describe four common types of economic studies; and (4) list the steps involved in evaluating and interpreting an outcomes study.
Pharmacy Issues: Dosage Forms, Drug Strengths, and Drug Frequencies
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting prescriber computer order entry (PCOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of PCOE at the Medical Center. Questions or suggestions should be addressed to Alicia S. Miller, Department of Pharmacy, The Ohio State University Medical Center, 368 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210. E-mail: miller-4@medctr.osu.edu
Cost Avoidance and Clinical Benefits Derived from a Pharmacy-Managed Anemia Program
Authors: Quercia Robert A. , Abrahams Ronald , White C. Michael , D'Avella John , Campbell Mary
Published: January 2018

A pharmacy-managed anemia program included distribution and clinical components, with the goal of making epoetin alpha therapy for hemodialysis patients more cost-effective. The Pharmacy Department prepared epoetin alpha doses for patients in unit-dose syringes, utilizing and documenting vial overfill. Pharmacists dosed epoetin alpha and iron (oral and intravenous) per protocol for new and established patients. Baseline data were obtained in 1994, one year prior to implementation of the program, and were re-evaluated in 1995 and 1998. Cost avoidance from utilization of epoetin alpha vial overfill in 1995 and 1998 was $83,560 and $91,148 respectively. In 1995 and 1998, cost avoidance from pharmacy management of anemia was $191,159 and $203,985 respectively. The total cost avoidance from 1995 through 1998 was estimated at $1,018,638. The number of patients with hematocrits under 31% decreased from 32% in 1994 to 21% and 14% in 1995 and 1998 respectively. We conclude that a pharmacy-managed anemia program for hemodialysis patients results in significant cost savings and better achievement of target hematocrits.
Use of Growth Hormone and Insulin-like Growth Factor 1 for Treatment of Tissue Wasting in Catabolic Conditions
Authors: Zdanowicz Martin M.
Published: January 2018

Trauma, surgery, burn injury, sepsis, prolonged bed rest, cancer, and AIDS are examples of catabolic states that can lead to a significant loss of lean body tissues and skeletal muscle. The physiologic stresses associated with these catabolic conditions can impair immune function, alter drug response, and delay the recovery process. Although enhanced nutritional supplementation is a mainstay for treating tissue wasting in these conditions, it is of limited effectiveness in reversing skeletal muscle protein loss or enhancing anabolism in lean body tissues. The use of anabolic hormones such as Growth Hormone (GH) or Insulin-Like Growth Factor 1 (IGF-1) to limit lean body wasting and preserve muscle mass in these conditions has been widely investigated. This article was designed to give pharmacists and patient care professionals an overview of recent literature involving anabolic hormone treatment of tissue wasting. The use of these agents in the clinical setting may undergo significant expansion in the near future.
Double-Locking of Anesthesia Carts Expiration Dating of Insulin Unit-Dose Packaging of Liquids Accreditation with Commendation Preprinted Order Forms Recording Lot Numbers More on Used Fentanyl Patches New Pain Management Standards Dispensing Generic Drugs
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environment. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.
Basic Bibliographies
Authors: Generali Joyce A.
Published: January 2018

In order to help readers monitor the most important developments in specialized areas associated areas of pharmacy practice in organized health systems, Hospital Pharmacy commissions Basic Bibliographies by guest editors, who have expertise in their respective fields. These guest editors survey the relevant literature and rank approximately 15 to 20 references that represent the most significant research and practice contributions in their areas. The more fundamental are listed first so that persons with limited time can select reading appropriate to their needs Readers are urged to forward reactions or challenges to:
New Drugs Approved by the FDA New Dosage Forms and Indications Agents Pending FDA Approval Major Labeling Changes
Authors: Baker Danial E.
Published: January 2018

This monthly feature will help readers keep current on new drugs, new indications and dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information; however, hospitalpharmacy@drug-facts.com
Oseltamivir
Authors: Cada Dennis J. , Baker Danial E. , Levien Terri
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The February 2000 Formulary monographs are dofetilide, bexarotine, dexmedetomidine HCl, nitric oxide for inhalation, and nedocromil sodium ophthalmic solution. The DUE is on doeftilide.
Practical Approaches to Retrieving Drug Information from the Internet, Part 1
Authors: Flory Stefanie M. , Sailor Linda
Published: January 2018

This bimonthly column will keep readers up-to-date on the Internet as a source of drug information. Examples of using the Internet to answer inquiries and prepare for committee meetings will be taken from the authors' experiences at a drug information center. A list of reliable web sites—and some examples of sites that have not been useful—will be included in each column.
Misidentification of Alphanumeric Characters Confusion between Sufenta and Sublimaze Fortune 500 Company Benefit Plans Adopting Computerized Physician Order Entry Standards
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute of Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writer's names will be published if desired. ISMP may be contacted at the address shown below.
Treatment of Acute Seizures with Buccal Midazolam
Authors: Burnakis Thomas G.
Published: January 2018

Practicing clinicians come across uses of pharmacologic agents that may not always be listed in the usual references. For example, glycerin injection for nerve block, H2 antagonists in colorectal cancer, or colchicine for systemic sclerosis may represent novel, hard-to-find clinical applications. If you have encountered a new and/or unusual use of a drug, submit the information to this Hospital Pharmacy feature.
Epirubicin Temozolomide
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
Borrowed Antibodies: The Characteristics and Roles of Immune Globulins
Authors: Grabenstein John D.
Published: January 2018

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunoprophylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.
Gatifloxacin
Authors: Cada Dennis J. , Baker Danial E. , Levien Terri
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The April 2000 Formulary monographs are alsosetron, oxcarbazepine, mitoxantrone, cevimeline HCl, and cicloporox. The DUE is on alosetron.
More on Valproate-Induced Hyperammonemia Reports of Fatal Status Epilepticus and Tardive Dyskinesia with Olanzapine Hypersensitivity Syndrome Associated with Efavirenz Therapy Acute Hepatitis after Ingestion of Herbs ADRs with Various Antidepressants
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Reining in the Pharmacy Budget
Authors: Vogenberg F. Randy
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
Strategies for Therapeutic Interchange of Biotechnology Medicines: Proceedings of an Invitational Conference
Authors: Bergstrom Kimberly , Ellis Michael , Keenan-Milligan Marilyn , Mucenski John W. , Williams Donald H.
Published: January 2018

An invitational conference was held to plan a therapeutic interchange program for biotechnology products. The expanding use of biotechnology products has created new challenges and opportunities for organizations who want to implement these programs — with the dual goal of cutting costs and improving quality of care. Successful therapeutic interchange programs can use a variety of strategies, from gentle persuasion based on clinical effectiveness and cost savings to mandatory compliance and automatic substitution. After outlining risk-management considerations and motivations, as well as the barriers to the therapeutic interchange of biotechnology products, the participants identified the following key steps: (1) list biotechnology products that are potential candidates for therapeutic interchange; (2) establish an overall plan for therapeutic interchange programs; (3) select the specific biotechnology products that will be considered for therapeutic interchange; (4) devise a strategy for therapeutic interchange of the selected products; (5) implement the plan; and (6) track program success. The strategy must include a process for ongoing monitoring of clinical and economic outcomes to ensure that the program is meeting its objectives and provide feedback to program participants.
Therapeutic Interchange of H2 Antagonists: Cost Savings and Impact on Outcomes
Authors: Howard Richard T. , Wilson James P. , Smeeding James E.
Published: January 2018

The objective of this study was to measure the annual cost savings associated with implementation of a histamine-2 receptor (H2) antagonist therapeutic interchange program and to compare specific preimplementation and postimplementation outcome measures, specifically the incidence of adverse drug reactions (ADRs) and treatment failures. An analysis of all H2 antagonist patients was conducted at a private 59-bed, long-term, acute-care facility—1-year prior to and 1 year after an H2 antagonist therapeutic interchange program was implemented. The institution achieved a 99+% conversion of market share to famotidine products. Cost savings during the first year equaled $14,141. No ADRs associated with H2 antagonists were reported during the 1-year preimplementation study period. One ADR potentially associated with H2 antagonists was reported during the 1-year postimplementation study period. There was one treatment failure during each of the study periods.
Vinorelbine and Cisplatin (VC) Regimen
Authors: Brueggemeyer Dea L. , Waddell J. Aubrey , Solimando Dominic A.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
Preventing Medication Errors with Antineoplastic Agents, Part 1
Authors: Beckwith M. Christina , Tyler Linda S.
Published: January 2018

Goal — The goal of this program is to present practical ways to prevent medication errors with antineoplastic agents, identify common types of medication errors, and describe a system for reducing the incidence of medication errors and responding appropriately to antineoplastic medication errors.

Objectives — At the completion of this program, the participant will be able to:

1. Describe the scope and impact of medication errors

2. Define common terms used in medication error literature.

3. List four common types of prescribing errors made with anti-neoplastic agents.

4. Identify steps where medication errors may occur during the drug ordering, preparation, and administration process.

5. Describe ways to prevent errors at each step of the medication use process.

6. Recommend a procedure for reporting and monitoring antineoplastic medication errors within the institution.

7. Describe a system for the non-punitive management of antineoplastic medication errors in health care systems.
Dofetilide
Authors: Cada Dennis J. , Baker Danial E. , Levien Terri
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The May 2000 Formulary monographs are linezolid, pneumococcal 7-valent conjugate vaccine, apomorphine, levobetaxolol HCl, mequinol 2% and tretinoin 0.1% topical solution. The DUE is on dexmedetomidine.
Benzodiazepines and Glucose Control Mycophenolate Mofetil-Induced Dyshidrotic Eczema Concomitant Use of Bupropion and Amantadine Causes Neurotoxicity Intra-articular Steroids and Acute Adrenal Crisis
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Consumer-Driven Health Care
Authors: Vogenberg F. Randy
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
Unique Pain Management Staff Education Program in a Community Hospital
Authors: Ravnan Susan L.
Published: January 2018

This paper describes a unique and exciting way to educate medical/surgical care providers in pain management. The Medical Pathway, consisting of medicine, oncology, renal, and surgery care providers, chose pain management as a quality improvement initiative. Nurses, a pharmacist, a physical therapist, and a representative from the Healing Arts Department constituted the pain management team. The goal of the team was staff education on pain management. This education was accomplished by implementing a yearlong series of traditional lectures and nontraditional teaching techniques, such as “Pain Awareness Days.”
Perioperative Anticoagulation Practices of Surgeons in a Health System
Authors: Barnhart Donna , Gonzalez Luis S.
Published: January 2018

Several different management strategies for patients receiving long-term warfarin therapy who require surgery have been recommended in the literature. A recent article by Kearon and Hirsch made new recommendations based on estimating the risk of thromboembolism and bleeding from randomized trials and prospective studies. Because of the potential for variability in practice patterns, we surveyed physicians in our health system to identify their perioperative anticoagulation practices. Our results confirm variability in practice patterns. Perioperative intravenous heparin was the most frequently reported method of prophylaxis. Fifty-three percent of the surveyed physicians admitted patients to the hospital two or more days prior to surgery to receive prophylaxis. Further research is necessary to determine optimal management of perioperative anticoagulation.
Bexarotine and Cytarabine, Liposomal
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column examines issues related to the preparation, dispensing, and administration of cancer chemotherapy and reviews agents, both commercially available and investigational, used to treat malignant diseases.
Immunization from the Perspective of a Millennium
Authors: Grabenstein John D.
Published: January 2018

Credit

This lesson is good for 0.2 CE units, with a passing grade of 70%.

Objectives

After completing this continuing education article, the pharmacist will be able to: 1. Describe the evolution of immunization over the past thousand years. 2. Discuss the impact of specific infectious diseases on world populations before the development of immunizations against them. 3. Understand the significance of immunization in increasing human lifespan. 3. Compare immunization policies of different eras in the 20th century. 4. Identify some potential new applications of immunological drugs in the 21st century.
Use of Tramadol to Control Restless Legs Syndrome after Orthopedic Surgery
Authors: Burns Kevin E.
Published: January 2018

A patient with a history of severe osteoarthritis and restless legs syndrome (RLS), who had recently undergone orthopedic surgery, began to experience the involuntary movement and pain associated with RLS. These symptoms, which also deprived the patient of sleep, complicated her postsurgical rehabilitation. The onset of symptoms coincided with attempts to discontinue her opiate analgesic regimen. The patient was evaluated; no significant comorbid conditions or drug therapies that might have aggravated her RLS symptoms were noted. After a discussion of the risks and benefits of the pharmacologic options, it was decided that Tramadol was the best therapy for this patient. A follow-up review of the patient's clinical course at 7, 30, and 60 days showed that Tramadol was quite effective in controlling her RLS symptoms and joint pain.
New Drugs Approved by the FDA; New Dosage Forms and Indications; Agents Pending FDA Approval; Major Labeling Changes
Authors: Baker Danial E.
Published: January 2018

This monthly feature will help readers keep current on new drugs, new indications and dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information; however, if there are any questions, let us know at hospitalpharmacy@drug-facts.com .
Alosetron
Authors: Cada Dennis J. , Baker Danial E. , Levien Terri
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The June 2000 Formulary monographs are on pantoprazole, oral and intravenous; meloxicam; zonisamide; gentuzum-ab zogamicin; and vertiporfin. The DUE is on meloxicam.
Synercid-Induced Myalgias; Another Allergic Reaction to Methylprednisolone; More on Heparin Flush–Induced Thrombocytopenia; Hiccups and Steroid Injections; Topical Tricyclic Toxicity?; Priapism with OTC Hormonal Agent; Quinine-induced Thrombocytopenia and Neutropenia; Hyperventilation and Quetiapine
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Automated Dispensing Devices
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environment. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.
Evaluating the Incidence of Antidepressant-Induced Sexual Dysfunction
Authors: Barton Amy E. , Levin Gary M.
Published: January 2018

The incidence of sexual dysfunction (SD) associated with antidepressants may be higher than the rate reported in the product information. We conducted a study using a survey that included the Arizona Sexual Experiences (ASEX) scale to assess the incidence of SD before and with current antidepressant use. We also set out to determine if differences exist between antidepressant classes. Forty-four patients (12 males and 32 females) responded to the survey. Data was stratified into 3 groups, selective serotonin reuptake inhibitors (SSRIs; n = 36), tricyclic antidepressants (TCAs; n = 7), and novel agents (bupropion and nefazodone, or NA; n = 7). For the SSRI subgroup, there were significant increases in ASEX scores, indicative of SD after treatment. There were no differences in ASEX scores in the TCA or NA group. The incidence of SD was highest for the SSRIs (36%). Clinical implications of these findings include educating patients, improving clinical assessment, and enhancing awareness about options available to manage antidepressant-induced SD.
Development of a Computer-Generated Dosing Form for Use during Cardiopulmonary Resuscitation of Pediatric Patients
Authors: Wilson James P. , Baldwin Richard A.
Published: January 2018

Various methods have been devised to help reduce the time required to determine the correct dose for pediatric patients during cardiopulmonary resuscitation (CPR). The computer-generated dosing form (CGDF) appears to be among the best methods, because it calculates medication doses based on weight. A CGDF for pediatric use was implemented in order to (1) directly meet the needs of pediatric patients; (2) provide the hospital staff with a readily available, legible, and accurate dosage calculation; and (3) become part of the institution's continuous quality improvement program. The pediatric CGDF was accepted for use throughout the hospital.