bluuebunny/crossref_metadata_2025 huggingface dataset:
Olanzapine for Patients with Treatment-Resistant Schizophrenia: A Naturalistic Case-Series Outcome Study
Authors: Dursun Serdar M , Gardner David M , Bird Diane C , Flinn Janet
Published: January 2017

Objective:

This prospective, consecutive case-series outcome investigation evaluates the effectiveness of olanzapine in 16 patients with treatment-resistant schizophrenia.

Method:

Treatment resistance was defined as nonresponsiveness to at least 3 antipsychotic drugs from at least 2 different chemical classes. A minimum baseline score on the Brief Psychiatric Rating Scale (BPRS) of 45 was required for enrolment. Outcome evaluation measures included the BPRS, Global Assessment Scale (GAS), and Abnormal Involuntary Movement Scale (AIMS).

Results:

Subjects (n = 16) had a mean age of 40 years and mean duration of illness of 16 years. Olanzapine treatment was initiated at 5 mg daily and was increased based on clinical judgement up to a maximum of 40 mg daily. Significant decreases in mean BPRS (P < 0.001) and GAS (P < 0.01) scores were observed at weeks 4, 8, 12, and 16, compared with baseline. Eight of 16 patients responded to olanzapine, as defined by a 20% decrease in BPRS score by week 16. Dyskinetic movements significantly increased at week 4 (P < 0.01) but did not differ from baseline at weeks 8 and 16.

Conclusion:

These results suggest that olanzapine at moderate to high doses may offer an effective treatment for a significant proportion of patients with schizophrenia nonresponsive to multiple trials of conventional antipsychotics. A randomized controlled trial is encouraged to validate these findings, and comparative trials are required to determine when clinicians should consider this approach.
Autonomy, Personal Empowerment, and Quality of Life in Long-Term Care
Authors: Clark Phillip G.
Published: January 2017

The philosophical principle of autonomy provides a conceptual framework within which an understanding of quality of life for the elderly can be developed. This structure provides the basis for designing interventions to enhance the quality of life of older persons by maintaining their autonomy in spite of long-term care service needs. Such programs should encourage proactive strategies to anticipate and plan for potential health crises, promote empowerment of the elderly, expand knowledge, and clarify personal and familial values regarding service options. Examples of the kinds of programs needed to enhance autonomy in community-based and institutional long-term care settings are presented to illustrate how independence can be supported even under conditions of increasing frailty and service needs. These applied approaches to enhancing personal autonomy give explicit recognition to the importance of ethical concepts in developing and implementing long-term care services to improve the elderly's quality of life.
‘‘Quit & Win’’ Contests Among College Students
Authors: Thomas Janet L. , Luo Xianghua , Bengtson Jill E. , Weber-Main Anne Marie , Lust Katherine , Ahluwalia Jasjit S. , An Lawrence
Published: January 2017

Purpose:

To determine smoking abstinence rates and predictors of abstinence among college students enrolled in a campus-based Quit & Win contest.

Design:

Pre-post measure with no comparison group.

Setting:

Contests conducted on seven college campuses in 2007.

Subjects:

Subjects (N = 484) were 23.7 ± 6.8 years of age, 61% female, 16.3% nonwhite, and smoked 12.5 ± 7.8 cigarettes per day on 28.0 ± 4.8 days in the past month.

Intervention:

Participants abstinent for the 30-day contest were eligible for a lottery-based prize. Assessments were completed at baseline, end of contest, and 6 months after enrollment.

Measures:

The 6-month survey assessed retrospective abstinence during the contest period and the prior 6 months and 7- and 30-day point prevalence abstinence at the time of the survey.

Analysis:

Chi-square test was used to compare baseline characteristics among participants from 2-versus 4-year schools. Smoking abstinence was assessed by participant self-report. Both a simple imputation method (i.e., missing = smoking) and completers-only analyses were conducted. Stepwise logistic regression was used to determine baseline predictors of abstinence.

Results:

Thirty-day abstinence rate was 52.5% during the contest month and 20.5% at the 6-month follow-up. Baseline intention to stay quit (odds ratio [OR] = 1.56, p = .01), cigarettes smoked per day (OR = .67, p = .04), and 2-year (vs. 4-year) college (OR = 1.65, p = .05) predicted abstinence at 6 months.

Conclusion:

Intention to stay quit even without winning a prize, a measure of intrinsic motivation, predicted both short- and long-term abstinence.
The Impact of College Student Financial Health on Other Dimensions of Health
Authors: Bemel James E. , Brower Christopher , Chischillie Alyssa , Shepherd Jessica
Published: January 2017

Purpose:

Researchers examined college students’ financial health and other health indicators to determine whether the integration of financial health into undergraduate health courses is justified and justify financial health as the newest dimension of health within the field of health promotion.

Design:

The study utilized a cross-sectional design.

Setting:

The study was conducted at a large public university located in the western region of the United States. Participants completed the survey from any computer with Internet access.

Subjects:

A sample of 3000 undergraduate students was selected. A total of 686 surveys were completed (22.9% response rate). Data were collected from college students ages 18 to 30 during the first 2 weeks of June 2013.

Measures:

Participants completed an online survey regarding their financial health and other dimensions of health.

Analysis:

SPSS version 19.0 was used to examine the relationships between financial health and individual health variables using χ2, independent t-test, analysis of variance, Pearson R, point-biserial correlation, and nonparametric analyses.

Results:

Every dimension of health was impacted significantly by lower levels of financial health. Participants’ emotional health was impacted far more than any other dimension, with significant impacts on concentration ( p = .005), usefulness ( p = .006), decision making ( p = .014), and happiness ( p < .001) by the mere presence of a budget.

Conclusion:

Findings indicate an apparent relationship between financial health and other health indicators and support the need for financial education by parents and middle/high schools and the incorporation of financial health into undergraduate health courses.
Effects of Community Singing Program on Mental Health Outcomes of Australian Aboriginal and Torres Strait Islander People
Authors: Sun Jing , Buys Nicholas
Published: January 2017

Purpose:

To evaluate the impact of a meditative singing program on the health outcomes of Aboriginal and Torres Strait Islander people.

Design:

The study used a prospective intervention design.

Setting:

The study took place in six Aboriginal and Torres Strait Islander communities and Community Controlled Health Services in Queensland, Australia.

Subjects:

Study participants were 210 Australian Aboriginal and Torres Strait Islander adults aged 18 to 71 years, of which 108 were in a singing intervention group and 102 in a comparison group.

Intervention:

A participative community-based community singing program involving weekly singing rehearsals was conducted over an 18-month period.

Measures:

Standardized measures in depression, resilience, sense of connectedness, social support, and singing related quality of life were used.

Analysis:

The general linear model was used to compare differences pre- and postintervention on outcome variables, and structural equation modeling was used to examine the pathway of the intervention effect.

Results:

Results revealed a significant reduction in the proportion of adults in the singing group classified as depressed and a concomitant significant increase in resilience levels, quality of life, sense of connectedness, and social support among this group. There were no significant changes for these variables in the comparison group.

Conclusions:

The participatory community singing approach linked to preventative health services was associated with improved health, resilience, sense of connectedness, social support, and mental health status among Aboriginal and Torres Strait Islander adults.
Organisation Turnover among Registered Nurses: An Exploratory Model
Authors: Bloom Joan R. , Alexander Jeffrey A. , Flatt Sylvia
Published: January 2017

In light of current concerns over nursing shortages and productivity, turnover among hospital nurses has assumed renewed importance as a managerial issue. This study examines the thesis that organisation of hospital work is a determinant of voluntary turnover among registered nurses. This perspective differs from previous work in this area in that both turnover and its determinants are conceptualised at the organisational rather than individual level, thus opening the way for administrative intervention to reduce turnover. The conceptual model is tested using multiple regression techniques on a sample of 310 community hospitals. Results suggest the importance of administrative work structures and the professionalisation of the workforce as contributors to higher turnover.
Primary Care and Reform of Health Systems: A Framework for the Analysis of Latin American Experiences
Authors: Frenk Julio
Published: January 2017

The article first proposes a framework within which to assess the potential of health sector reforms in Latin America for primary health care (PHC). Two dimensions are recognized: the scope of the reforms, content, and the means of participation that are put into play. This framework is then complemented through a critique of the often-sought but little-analyzed PHC reform strategies of decentralization and health sector integration. The analytical framework is next directed to the financing of health services, a chief aspect of any reform aiming toward PHC. Two facets of health service finance are first distinguished: its formal aspect as a means for economic subsistence and growth, and its substantive aspect as a means to promote the rational use of services and thus improvement of health. Once finance is understood in this microeconomic perspective, the focus shifts to the analysis of health care reforms at the macro, health policy level. The article concludes by positing that PHC is in essence a new health care paradigm, oriented by the values of universality, redistribution, integration, plurality, quality, and efficiency.
Penile Human Papillomavirus Carriage among Men Attending Swedish STD Clinics
Authors: Wikström A , Lidbrink P , Johansson B , von Krogh G
Published: January 2017

Using the polymerase chain reaction (PCR) technique, we found that up to 84% of 228 men consecutively attending two Swedish STD clinics harboured human papillomavirus (HPV) types 6 or 16. Mean age of the patients was 28 years (range 17–58); 70% were between 17 and 30 years old. Among men without a previous history of, or contact with, condylomata the frequency of HPV 6 detection was 76% using the PCR/dot blot (DB) analysis and 43% with the PCR/agarose gel (AG) technique. The corresponding figures for HPV 16 were 46% and 13%, respectively. These figures were comparable to those found in men with existing condylomata infection or sexual exposure to a partner with condylomata.

Although the test group represents a selected high-risk population for STD including HPV, our results indicate that a high frequency of occult HPV carriage exists among sexually-active males. The significance of these findings is discussed.
The Healing Buddha
Authors: Chen Thomas S N , Chen Peter S Y
Published: January 2017

The iconography of the healing Buddha embraces two healing traditions, symbolized by the healing stone lapis lazuli from Central Asia and by the myrobalan fruit from the ayurvedic medicine of ancient India. The first mention of the healing Buddha is in Buddhist texts of the first century BC, and the earliest extant icons date from the fourth century AD. This suggests the cult of the healing Buddha was a relatively late development in the history of Buddhism. Worshippers sought his help in alleviating spiritual, mental and physical suffering, as well as for medical cures. In China followers believed he was also a cosmic Buddha, to whom one appealed for longevity and protection from disasters. This form of faith-based healing remains vibrant in China, Japan and Tibet to this day.
Cost-Effectiveness of Population Screening for Helicobacter Pylori in Preventing Gastric Cancer and Peptic Ulcer Disease, Using Simulation
Authors: Roderick P , Davies R , Raftery J , Crabbe D , Pearce R , Patel P , Bhandari P
Published: January 2017

Objectives:

To evaluate the cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease in England and Wales.

Methods:

A discrete event simulation model used parameter estimates, derived from peer-reviewed literature, routine data and statistical modelling. Population screening was compared with no screening but with opportunistic eradication in patients presenting with dyspepsia. Costs included screening, eradication and costs averted to provide costs per life years saved (cost/LYSj for preventing gastric cancer and peptic ulcer disease. Sensitivity analyses were undertaken.

Results:

The cost/LYS from screening at age 40 years was £5860 at discount rates of 6%. The outcomes were sensitive to H. pylori prevalence, the degree of opportunistic eradication, the discount rate, the efficacy of eradication on gastric cancer risk, the risk of complicated peptic ulcer disease and gastric cancer associated with H. pylori infection, and the duration of follow-up. In sensitivity analyses, the cost/LYS rarely exceeded £20000 over an 80-year follow-up, but did for shorter periods.

Conclusions:

H. pylori screening may be cost-effective in the long term. However, before screening can be recommended further evidence is needed to resolve some of the uncertainties, particularly over the efficacy of eradication on risk of gastric cancer, the risk associated with complicated peptic ulcers, and the effect of more widespread opportunistic testing of patients with dyspepsia.
Using Economics to Assess the Place of Screening
Authors: Donaldson Cam
Published: January 2017

To an economist the place of screening is, in principle, no different from that of any other medical intervention. Any screening activity should be evaluated in terms of the costs it incurs and the benefits it produces. The reasoning for this is based on one fundamental principle of economics: That of opportunity cost. Resources are scarce, requiring choices to be made about what health care to provide and what not to provide. Sacrifices will be made through not taking up some opportunities, and the benefits of these sacrifices are known as opportunity costs. The place of economics is to assist decision making to promote efficiency and equity in the health care sector. To do this it is necessary to relate the benefits of any screening activity to its costs. Of course, the practicalities of applying economics to assessment of screening activities may be different than for other areas of health care. For instance, screening has a broader range of outcomes than most types of health care, including investment in knowledge as well as health gain. This does have implications for the way in which these outcomes are valued in an economic analysis.

This means that economics can be applied to a wide range of policy questions about screening. In this paper examples from applications of economics are used to consider the following issues:

How should we set out and estimate costs and benefits (using the example of cholesterol screening)? What is benefit and how should it be measured (using an example from cystic fibrosis carrier screening)? How can economics be used to examine equity issues in screening (using an example from bone mineral density screening)?

Together, these case studies highlight the range of screening issues to which economics can be usefully applied.
World Market for Social Order, Embedded State Autonomy and Third World Development
Authors: Bornschier Volker , Trezzini Bruno
Published: January 2017

Various arguments have been put forward to account for socioeconomic development in East Asia's newly industrializing countries. A blend of state-centred arguments with a proposed ‘World Market for Social Order’ concept is suggested in this article. The varying degree of legitimacy of particular social orders is introduced as a key factor for explaining success and failure in late development. The proposed analytical framework allows to simultaneously address issues related to international political economy and comparative political economy. It accounts for divergent historical development trajectories as represented by the successful East Asian NICs on the one hand and the less successful Latin American ones on the other. Furthermore, the peculiar case of Malaysia, whose sociopolitical and cultural background rather clearly deviates from the East Asian ideal typical conditions for successful late development, can be much better understood. We also reflect the significance of the Asian financial crisis in 1997/98 for our analytical framework.
The Geographic Foundations of Industrial Performance
Authors: Scott Allen J.
Published: January 2017

The question of economic geography and industrial performance is broached by noting that the modern world economy is in part made up of a mosaic of interdependent regional production systems. I describe the formation of these systems in terms of a transactions-based logic of increasing returns and agglomeration economies. This logic represents a fountainhead of competitive advantages and productivity effects. I then show how regional development over time converges on a path-dependent trajectory, and some of the underlying characteristics and effects of this process are delineated. Regional economic systems are also marked by well-developed forms of collective order (both formal and informal), and 1 argue that this is a domain in which there are important opportunities for beneficial kinds of public action and policy-making. Some of these opportunities are brought to the fore by showing how specific kinds of intra-regional institutions can boost industrial performance. In the conclusion, I re-affirm the proposition that in today's global economy, geographic space has not become less significant in terms of its economic effects; on the contrary, it has become markedly more significant.
Career Counselling New and Professional Immigrants: Theories into Practice
Authors: Kennedy Tara , Chen Charles P.
Published: January 2017

New and professional immigrants encounter extreme hardships and difficulties in their career experience after arriving in Canada. In addition to underemployment or unemployment concerns, new and professional immigrants endure many cross-cultural barriers. This article attempts to examine the application of career development theories in the context of career development and counselling for new and professional immigrants. It begins with a discussion of some of the barriers that affect new and professional immigrants' career development. Subsequently, it reviews some of the key facets of social cognitive career theory, as well a narrative career counselling approach, and how they specifically relate to new and professional immigrants' career development. The article concludes with intervention strategies, implications and support strategies aimed at dealing with the career development and career counselling needs of new and professional immigrants in Canada. The problems, concepts and solutions will also apply in other settings.
Detection of Benzodiazepines in Human Hair by Radioimmunoassay
Authors: Sramek John J. , Baumgartner Werner A. , Ahrens Thomas N. , Hill Virginia A. , Cutler Neal R.
Published: January 2017

OBJECTIVE:

In this preliminary investigation, we sought to determine whether a standard benzodiazepine radioimmunoassay (RIA) could detect three benzodiazepines in human hair.

DESIGN:

Hair samples of 20–50 strands (minimum 10 mg) were cut from eight patients receiving diazepam, two patients receiving alprazolam, three patients receiving lorazepam, and two negative controls. Samples were treated with ethanol and phosphate buffer washes at 37 ° to remove external contamination. The protein hair matrix was destroyed using proprietary procedures, then analyzed with Abuscreen RIA designed to detect various benzodiazepines and their metabolites, using oxazepam as a reference standard.

SETTING:

Patients were hospitalized in a locked psychiatric facility.

PATIENTS:

Twelve patients with chronic psychiatric conditions who had received therapeutic dosages of benzodiazepines for 1–11 months were included in the sample. One outpatient who reported heavy prior diazepam use was also included.

MAIN OUTCOME MEASURE:

Detection of benzodiazepines was well above a 1.5 ng/10 mg cutoff level with the Abuscreen assay.

RESULTS:

Diazepam was readily detected, but alprazolam and lorazepam were not detected.

CONCLUSIONS:

There is no test that can currently determine duration and extent of prior benzodiazepine use. Hair analysis for diazepam offers a potential, new clinical and research tool for characterizing prior level and extent of usage.
In Vitro Delivery of Crushed Ciprofloxacin through a Feeding Tube
Authors: Druckenbrod Richard W. , Healy Daniel P.
Published: January 2017

OBJECTIVE:

The purpose of this study was to determine the relative delivery of ciprofloxacin through a small-bore feeding tube (8 fr, 106 cm, Argyle).

DESIGN:

Ciprofloxacin 750-mg tablets were individually ground in a mortar and dissolved in 50 mL of water. Each resulting solution was drawn into a syringe and injected into a glass beaker (n=10) or through a feeding tube into a beaker (n=10) over one minute. Syringe apparati were flushed with two 60-mL portions of water. Aliquots from each of the 20 beakers were taken in triplicate, diluted 1:1000 with water, and assayed by HPLC.

RESULTS:

Ciprofloxacin concentrations (mean ± SD) for the samples without and with feeding tubes were 11.77 ± 0.78 μmol/L and 12.16 ± 0.65 μmol/L, respectively. The 3.3 percent difference is statistically significant (p=0.04), but clearly is not clinically significant.

CONCLUSIONS:

Administration of crushed ciprofloxacin through a small-bore feeding tube in the manner described does not result in any measurable loss of drug delivered to the gastrointestinal tract.
Fixed Drug Eruption of the Scrotum Due to Methylphenidate
Authors: Cohen Herman A. , Ashkenazi Arie , Nussinovitch Moshe , Gross Shmuel , Frydman Moshe
Published: January 2017

OBJECTIVE:

To report two cases of fixed drug eruption induced by methylphenidate.

CASE SUMMARY:

Two children with attention deficit disorder treated with methylphenidate as a simple drug developed fixed drug eruption of the scrotum. Drug discontinuation was followed by a complete resolution of the skin eruption. Rechallenge resulted in the same drug rash. Macrophage migration-inhibiting factor (MIF) assay with methylphenidate was positive.

DISCUSSION:

The pathogenesis of fixed drug eruption and the role of MIF assay in the diagnosis of adverse drug reaction is discussed.

CONCLUSIONS:

Fixed drug rash induced by methylphenidate is a possible but rare phenomenon.
Over-the-Counter Medications in Cardiac Transplant Recipients: Guidelines for Use
Authors: Lake Kathleen D. , Nolen Jacqueline G. , Slaker Ralph A. , Reutzel Thomas J. , Milfred Sherry K. , Solbrack Diane F. , Hoffman Frances M.
Published: January 2017

OBJECTIVE:

The purpose of this article is to review the pathophysiology of the denervated heart and the factors that need to be considered before recommending the use of over-the-counter (OTC) medications in the cardiac transplant recipient.

DATA SOURCES:

Pharmacology and therapeutic textbooks, English-language journal articles, and physiology textbooks published between 1969 and 1991.

DATA EXTRACTION:

Case reports, controlled case studies, and textbook chapters evaluating drug interactions with immunosuppressive agents were reviewed. The effects of various OTC medications on the denervated heart were examined and relevant material was extrapolated.

DATA ANALYSIS:

The number of cases or studies in which a particular effect or interaction occurred was reported. Those findings that were less well documented were either identified as such or were not included in the review.

DATA SYNTHESIS:

Common pharmacokinetic and pharmacodynamic interactions with the primary immunosuppressive agents (e.g., cyclosporine, azathioprine, prednisone) are reviewed. The physiology and altered responses of the denervated heart to various medications are also explained. Using this information, recommendations are given for the use and monitoring of OTC analgesics, antacids, laxatives, sleep aids, stimulants, and other medications that may be used in the cardiac transplant recipient.

CONCLUSIONS:

Many OTC medications can be used safely in the cardiac transplant recipient. In each situation, risk/benefit assessments must always be made and therapy should be monitored closely. Most important, patients should always notify the transplant team before adding an OTC product to their immunosuppressive regimen.
Use of Drugline—A Question-and-Answer Database
Authors: Öhman Birgitta , Lyrvall Helena , Alván Gunnar
Published: January 2017

BACKGROUND:

DRUGLINE is a full-text, question-and-answer database offering drug information that has been evaluated as a result of consultations in a drug information center. A problem-oriented database such as DRUGLINE can be an efficient way to meet the increasing need among healthcare professionals for timely and accurate drug information.

OBJECTIVE:

To investigate how DRUGLINE was used during the years 1988 and 1990 and to identify any changes in needs, expectations, satisfaction, and use that occurred during those two years.

DESIGN:

This study investigated the use of DRUGLINE during two separate years. Questionnaires relating to DRUGLINE use during 1988 and 1990 were sent on two occasions to all users having access to the database. The anonymous questionnaires contained 17 and 18 questions, respectively.

SETTING:

The setting included MEDLINE/DRUGLINE use in healthcare institutions, pharmacies, medical libraries, and the pharmaceutical industry.

PARTICIPANTS:

The questionnaires were sent to all customers of the database host Medical Information Centre at the Karolinska Institute Library and Information Centre having access to DRUGLINE during 1988 and 1990.

MAIN OUTCOME MEASURES:

The responses were organized into those from users and nonusers within the following professions: Physicians, pharmacists, librarians, and others.

RESULTS:

The response rates were 87 percent in 1989 and 89 percent in 1991. The professional distribution among the respondents in 1991 was physicians, 36 percent; pharmacists, 20 percent; medical librarians, 21 percent; and others, 23 percent. One-third of the respondents had searched DRUGLINE during 1988 and 1990. The number of users increased by 25 percent between 1988 and 1990; however, the percentage of users versus nonusers did not change. Pharmacists comprised the largest user group and experienced the greatest increase in users. Most users were satisfied with the result of their searches, usually because they were guided to solve a specific drug problem at a reasonable cost.

CONCLUSIONS:

A full-text, question-and-answer drug information database has great potential to help problem-solving in medical care. The technical versatility of the information system and its factual contents need to be continuously assured. Health professionals have to identify their information needs and develop efficient procedures to meet these needs.
Loracarbef: A New Orally Administered Carbacephem Antibiotic
Authors: Force Rex W. , Nahata Milap C.
Published: January 2017

OBJECTIVE:

To discuss the in vitro activity, pharmacokinetics, clinical efficacy, adverse effects, and relative merits of loracarbef, a new orally administered carbacephem antibiotic.

DATA SOURCES:

Pertinent literature was identified by a review of selected journals and a MEDLINE search. Additional information was provided by the manufacturer of loracarbef.

STUDY SELECTION:

All studies that have evaluated the clinical efficacy of loracarbef were included. In vitro studies were included if they used similar methodologies. Additional information was incorporated regarding the chemistry, pharmacokinetics, and adverse effects of loracarbef.

DATA SYNTHESIS:

Loracarbef has antibacterial activity against most community-acquired respiratory tract, skin and skin structure, and urinary tract pathogens. The drug is well absorbed after oral administration and plasma concentrations achieved in patients are greater than the in vitro minimum inhibitory concentrations for most of the above bacteria. Although the majority of the clinical studies with loracarbef have methodologic deficiencies, loracarbef therapy has demonstrated similar efficacy in the treatment of upper respiratory tract (except otitis media), lower respiratory tract, skin and skin-structure, and urinary tract infections compared with accepted antibiotics. Potential advantages of the new carbacephem may be improved patient compliance with its less frequent dosing schedule (once or twice a day, depending on the infection), and a low incidence of adverse effects.

CONCLUSIONS:

Preliminary data indicate that loracarbef may be an alternative agent for the treatment of a variety of community-acquired infections. Additional clinical experience and rigorously controlled comparative clinical trials are necessary to enable practitioners to fully define the therapeutic role of loracarbef.
Possible Case of Procainamide-Induced Intrahepatic Cholestatic Jaundice
Authors: Chuang Linda C. , Tunier Auguste P. , Akhtar Nayeem , Levine Stephen M.
Published: January 2017

OBJECTIVE:

To describe a possible case of procainamide-induced intrahepatic cholestatic jaundice that was recognized six weeks after the initiation of procainamide therapy and to summarize the five previously reported cases.

CASE SUMMARY:

A 77-year-old woman with a history of hypertension, insulin-dependent diabetes mellitus, temporal arteritis, and Wolff-Parkinson-White syndrome who had taken procainamide for six weeks presented to the hospital with disorientation and acute renal and hepatic dysfunction. In addition to disorientation, scleral icterus, and diffuse maculopapular rash, her physical examination was generally normal. There was no evidence of fever, nausea, vomiting, lymphadenopathy, or eosinophilia. Her liver enzyme concentrations increased significantly from baseline (beginning of procainamide therapy). Her N-acetylprocainamide (NAPA) concentration was elevated to 52 mg/L upon admission. Procainamide was discontinued and her NAPA concentration returned to within normal limits in two days. Diagnostic tests were performed to rule out active hepatitis, vasculitis, and liver malignancies. After procainamide was discontinued and prednisone treatment was started, she became more oriented and her liver enzyme concentrations slowly improved.

DISCUSSION:

Only five cases of procainamide-induced liver abnormalities have been previously reported; these included granulomatous hepatitis and intrahepatic cholestasis. The mechanism for liver dysfunction is not known; however, it is proposed to be a delayed hypersensitivity reaction. Clinical hallmarks of hypersensitivity include fever, eosinophilia, rash, and lymphadenopathy; nausea and vomiting also may be present. Of the five reported cases, all experienced fever and only one experienced pruritis. No patients had eosinophilia or lymphadenopathy. Because of the temporal increase in liver enzyme concentrations after six weeks of procainamide therapy, we believe that this case represents another possible procainamide-induced hypersensitivity reaction.

CONCLUSIONS:

Procainamide-induced liver dysfunction can occur from one day to six weeks after initiation of the drug and may subside one day to several weeks after discontinuation of therapy. Symptoms may include nausea, vomiting, rash, and fever. Liver enzyme concentrations are abnormal. It is important to recognize the possibility of such a reaction early so that procainamide therapy can be discontinued promptly to avoid further liver damage.
Prospective Surveillance of Imipenem/Cilastatin Use and Associated Seizures Using a Hospital Information System
Authors: Pestotnik Stanley L. , Classen David C. , Evans R. Scott , Stevens Lane E. , Burke John P.
Published: January 2017

OBJECTIVE:

To develop computerized methods to monitor and recommend dosage changes for patients treated with excessive dosages of imipenem/cilastatin (I/C) and to determine the incidence of I/C-associated seizures in our patient population.

DESIGN:

Prospective observational and interventional study of all patients admitted to LDS Hospital and treated with I/C from May 1, 1987, through June 30, 1991.

SETTING:

LDS Hospital, Salt Lake City, UT, a 520-bed, tertiary care center associated with the University of Utah School of Medicine.

PATIENTS:

Using a hospital information system we developed computerized algorithms to identify and monitor patients receiving I/C. These algorithms screened the computer-stored medical records of all inpatient admissions for I/C prescription orders. Computer-decision support algorithms estimated the renal function of each I/C-treated patient and provided suggestions when dosages were determined to be excessive. Additional computer-generated alerts identified patients who were receiving anticonvulsants concomitantly with I/C or whose therapy reflected dosage changes in the previous 24 hours. A list of all I/C-treated patients with alerts was reviewed daily by a clinical pharmacist and prescribing physicians were contacted if the computer-generated suggestions were clinically relevant.

MAIN OUTCOME MEASURE:

The number and characterization of I/C-associated seizures.

RESULTS:

From May 1, 1987, through June 30, 1991, we prospectively monitored 107 600 patients of whom 1951 were treated with I/C. The following risk factors for I/C-associated seizures were observed in the I/C-treated population: CNS disease (6 percent), seizure disorders (0.6 percent), and abnormal renal function (70 percent). The observational and interventional methods employed in this study resulted in 79 percent of the patients receiving I/C dosages appropriate for their corresponding renal function. During the 50-month study period, we detected four seizures (0.20 percent) in the I/C-treated patients. All 4 patients were receiving I/C dosages that were excessive with respect to their renal function.

CONCLUSIONS:

Our rate of seizure (0.2 percent) was lower than the 1–2 percent rate reported in the literature despite the fact that more than 70 percent of the patients who received I/C had risk factors for seizure. We believe that appropriate dosing of I/C results in a low rate of associated seizures. Computer-assisted monitoring of I/C dosages in relation to renal function resulted in a reduced incidence of seizures.
Prophylaxis of HIV Infection following Occupational Exposure
Authors: Fish Douglas N.
Published: January 2017

OBJECTIVE:

To review the risk of HIV infection following occupational exposure, the theoretical basis for chemoprophylaxis, investigative experience with chemoprophylaxis in animals and humans, and the economic aspects of postexposure chemoprophylaxis.

DATA SOURCES:

English-language articles and conference proceedings pertaining to the risk of occupational HIV infection and to postexposure chemoprophylaxis.

STUDY SELECTION:

Studies evaluating chemoprophylaxis of HIV infection following occupational exposure were selected for review. Abstracts reporting ongoing clinical trials were also included.

DATA EXTRACTION:

In vitro studies are discussed to provide the immunologic rationale for chemoprophylaxis. Animal studies examining the efficacy of chemoprophylaxis in preventing non-HIV retroviral infection are reviewed, and their applicability to human HIV infection is critically evaluated. Human studies and case reports describing attempts at chemoprophylaxis of HIV infection following occupational exposure are discussed.

DATA SYNTHESIS:

Chemoprophylaxis of HIV infection following occupational exposure has focused on the use of zidovudine (ZDV) because it was previously the only antiretroviral agent approved for treating HIV infection. Animal models of retroviral infection provide conflicting data regarding the efficacy of ZDV chemoprophylaxis, and there are important questions about the applicability of animal data to human HIV infection because of differences in natural histories of non-HIV retroviral infections, inoculum size, dosing of ZDV, and routes of infection. Human surveillance studies are thus far inadequate to determine the efficacy of ZDV prophylaxis because of the very low HIV seroconversion rates following occupational exposure. ZDV is well tolerated during short-term administration in people without HIV infection, but long-term safety is unknown. In addition, the true cost-benefit ratio of ZDV chemoprophylaxis is uncertain.

CONCLUSIONS:

Current data from in vitro, animal, and human studies are inadequate to define the appropriate role of ZDV in preventing HIV infection following occupational exposure. Limited toxicity data and the high cost of treatment must be weighed against the theoretical benefits of ZDV use in this setting. The decision to employ ZDV for postexposure prophylaxis must ultimately be based on existing institutional policies, the attitude of the responsible physician regarding such practice, and/or the desires of the exposed healthcare worker after being properly informed of potential risks and benefits.
Pharmacy in Iceland
Authors: Cleary John D. , Gunnarsdottir Rannveig , Loftsson Thorsteinn , Magnusson Einar
Published: January 2017

OBJECTIVE:

To summarize the practice of pharmacy in Iceland.

DATA SOURCES:

Human resources were the primary sources of data for this publication. Personal observation by Cleary is the basis of this publication.

DATA EXTRACTION AND SYNTHESIS:

Data on areas related to Icelandic history, practice of pharmacy, Icelandic health system, and the European Economic Community and Education were obtained through interviews. Information is presented to give an appreciation of pharmacy practice in a Nordic country.

CONCLUSIONS:

Pharmacy education and practice is progressive and flourishing in Iceland's National Health Service. Clinical pharmacy services are in their infancy; however, the potential for growth is immense. The Fulbright experience was educational and beneficial for all parties involved.
Treatment of Bacterial Vaginosis
Authors: Schlicht John R.
Published: January 2017

OBJECTIVE:

The purposeof this articleis to review the treatment options for bacterial vaginosis, including the newer topical antibiotics, metronidazole gel and clindamycin cream. The article also examines the controversies over whether bacterial vaginosis is a sexually transmined disease and whether asymptomatic women should be treated.

DATA SOURCE:

A MEDLINE search was conducted to identify pertinent literature, including review articles.

STUDY SELECTION:

Emphasiswas placed on those clinical trials using metronidazole gel or clindamycin cream. Studies addressing the complications of bacterial vaginosis in pregnancy, the risk of treatment in pregnancy, and the method of transmission of the disease also were reviewed.

DATA EXTRACTION:

Clinical studies evaluating clindamycin cream and metronidazole gel were scarce; therefore, data from all available trials were reviewed. The objectives, methodology, and results from other studies werer eviewed; thoseaddressing complications of the disease and risksand benefits of treatment wereincluded.

DATA SYNTHESIS:

There is evidence both for and against bacterial vaginosis being a sexually transmined disease. Potential complications of the disease may warrant treatment of certain asymptomatic women, especially during pregnancy. Treatment options include oral or vaginal metronidazole or clindamycin, all of which provide high cure rates. Vaginal antibiotics result in minimal risk to the fetus in pregnant patients.

CONCLUSIONS:

Complications of bacterial vaginosis maybe associated with significant morbidity, especially among pregnant women. Treatment of asymptomatic women with the disease is controversial, but may be justified in certain high-risk populations. The topical agents, clindamycin vaginal cream 2% and metronidazole vaginal gel 0.75% provide a safe, effective, but expensive alternative to oral antibiotic regimens for the treatment of bacterial vaginosis.
Ticlopidine and Fatal Aplastic Anemia in an Elderly Woman
Authors: Mallet Louise , Mallet Jacques
Published: January 2017

OBJECTIVE:

To report a case of aplastic anemia that developed during ticlopidine treatment.

CASE SUMMARY:

An 84-year-old woman was started on ticlopidine for secondary stroke prevention. Within six weeks of initiating ticlopidine therapy she developed aplastic anemia. She was hospitalized and received empiric antibiotics, antifungal agents, blood transfusions, platelets, and granulocyte colony-stimulating factor. The patient died on day 76 after beginning ticlopidine.

DISCUSSION:

Hematologic effects such as neutropenia, thrombocytopenia, agranulocytosis, thrombotic thrombocytopenic purpura, and pancytopenia have been described with the use of ticlopidine. Previous case reports have associated ticlopidine with the development of aplastic anemia.

CONCLUSIONS:

Ticlopidine can produce fatal hematologic adverse effects, and its use should be reserved as second-line therapy.
Severe, Disabling Neurologic Toxicity Following Cisplatin Retreatment
Authors: Higa Gerald M. , Wise Tamara C. , Crowell Edward B.
Published: January 2017

Objective:

To describe a severe neurotoxic reaction following the second cycle of cisplatin-based chemotherapy.

Case Summary:

A patient with unresectable non–small-cell lung cancer was treated with combined chemotherapy and radiotherapy. Thirty-six hours after the second course of chemotherapy, the patient developed severe mental status changes consisting of aphasia, confusion, and agitation. Complete neurologic workup was most consistent with an acute vascular event.

Discussion:

Reports of acute cisplatin-induced neurologic toxicity involving the central nervous system are rare. Potential risk factors are described. Mechanisms of chemotherapy-induced vascular damage are discussed.

Conclusions:

Total dosage and administration schedule of cisplatin are associated with an increased incidence of neuropathy. However, factors predicting the development of early, acute neurotoxicity are limited by the rarity of these events. It is probable that acute neurotoxic reactions in cancer patients are caused by an unknown complex of interactions involving drugs, tumor, and host factors.
Thrombocytopenia in Intensive Care Patients: A Comprehensive Analysis of Risk Factors in 314 Patients
Authors: Bonfiglio Mark F , Traeger Sheldon M , Kier Karen L , Martin Bradley R , Hulisz Darrell T , Verbeck Stephen R
Published: January 2017

Objective:

To define the incidence and severity of thrombocytopenia in a mixed medical-surgical population of critically ill patients and to examine factors that may be related to the development of thrombocytopenia.

Design:

Retrospective chart review of 314 critically ill patients requiring at least 3 days of critical care.

Setting:

A 17-bed combined medical-surgical intensive care unit (ICU) in a 560-bed tertiary care community hospital.

Patients:

Medical and surgical patients admitted to the ICU.

Interventions:

All medical records over the duration of the ICU stay were reviewed. All scheduled medications, including dosage and start/stop dates, were recorded. All platelet counts, placement of pulmonary artery catheters, liver function test results, and admission serum creatinine concentrations were collected.

Measurement and Main Results:

Thrombocytopenia (platelet count less than 200 × 109L) was observed frequently, but rarely reached a severe stage (7 patients). No single diagnostic category was significantly associated with thrombocytopenia alone, although the combination of sepsis syndrome/septic shock and respiratory failure was strongly correlated (p < 0.0001) with thrombocytopenia. Liver function abnormalities were correlated strongly with thrombocytopenia, and the majority of patients (5 of 7) with severe thrombocytopenia (less than 20 × 109/L) were found to have concurrent severe alterations in liver function test results. Pulmonary artery catheter placement and heparin exposure were associated strongly with thrombocytopenia (p < 0.0001). Drug therapies that were correlated with thrombocytopenia included heparin and vancomycin (p < 0.05). Hemodynamic instability was correlated strongly with the presence and severity of thrombocytopenia. In a stepwise linear regression model, the admission platelet count accounted for the largest proportion of the variance (43%), followed by hemodynamic instability (8%) and the requirement for inotropic agents (2%).

Conclusions:

Thrombocytopenia in the critically ill occurs frequently, rarely reaches severely depressed concentrations, and primarily represents a manifestation of disease processes initiated prior to admission. Hemodynamic instability and/or heparin exposure appear to be the strongest identifiable correlates with thrombocytopenia. Although these may cause infrequent isolated cases, other specific drug causes of thrombocytopenia are not responsible for the majority of cases of thrombocytopenia in the critically ill.
Aerosolized Beta2-Agonists Do Not Induce Bronchial Hyperreactivity in Healthy Adults
Authors: Kelly H William , McWilliams Bennie C , Murphy Shirley
Published: January 2017

Objective:

To determine whether regular administration of beta2 agonists could induce bronchial hyperreactivity in nonasthmatic volunteers.

Design:

A prospective, randomized, double-blind, placebo-controlled, crossover clinical trial of 2 weeks therapy with a 2-week washout period between each treatment period. Treatments were albuterol or matching placebo as 2 inhalations 4 times daily.

Subjects:

Ten healthy, nonsmoking women 27—37 years old.

Setting:

General clinical research center of a tertiary care university hospital.

Main Outcome Measures:

Baseline spirometry and methacholine bronchoprovocation studies were performed immediately prior to, 12 hours following, and 1 and 2 weeks following each treatment period.

Results:

No change was detected in either baseline spirometry or methacholine responsiveness.

Conclusions:

This suggests that if beta2-agonists induce a rebound bronchial hyperreactivity, it is not the result of the production of tolerance or a direct effect on bronchial smooth muscle.
Invasive Aspergillosis: A Life-Threatening Complication of Short-Term Steroid Treatment
Authors: Conesa Dolors , Rello Jordi , Vallés Jordi , Mariscal Dolors , Ferreres Joan Carles
Published: January 2017

Objective:

To describe a patient with invasive pulmonary aspergillosis related to short-term steroid treatment.

Case Summary:

A 78-year-old man with chronic obstructive pulmonary disease (COPD) developed an invasive pulmonary aspergillosis after short-term (less than 1 week) intravenous steroid therapy. The diagnosis was established by recovering Aspergillus fumigatus from a bronchoalveolar lavage and was confirmed by autopsy, with the additional finding of an aspergilloma.

Discussion:

This case is of interest for 3 reasons: (1) it illustrates that invasive aspergillosis may be followed by a rapidly progressive respiratory failure, even in the absence of a fever; (2) this patient had simultaneously an aspergilloma and an invasive aspergillosis; and (3) it confirms reports indicating that short-term steroid therapy for COPD represents a significant risk factor for opportunistic lung infections.

Conclusions:

In patients with COPD who receive even short-term steroid therapy and who have progressive respiratory failure caused by pneumonia, invasive aspergillosis should be suspected early and acted upon accordingly.