bluuebunny/crossref_metadata_2025 huggingface dataset:
Teaching History With Digital Historical Games
Authors: McCall Jeremiah
Published: May 2016

Background: Writing about the theory and best practices of using history-themed video games in the classroom stretches back at least to the 1980s. However, the literature on the subject is scattered, making it difficult for history educators considering the use of historical games.

Purpose: This article provides an introduction for history educators to the use of computer-based historical games in history education. In this article, I provide differing definitions for types of historical games and discuss the importance of such distinctions for the history educator. I provide the strengths and biases inherent in the medium of computer-based historical games.

Results: This article surveys best practices from the literature concerning the use of historical games in history class. The article concludes with a brief survey of potentially useful historical games.
A damage mechanics model of materials with voids and cracks
Authors: Kim In-Bong , Ri Chol-Su , So Yong-Il
Published: May 2016

In this paper we study a mechanical modeling of complicated materials with damages such as voids, defects, and cracks within the framework of continuum mechanics. We represent the voids, defects, etc. in materials by using the damage tensors based on the effective stress concept and model the cracks on the basis of crack theory, so that discontinuous models can be treated with the help of continuum mechanics method. This modeling is carried out by taking the elastic strain energy of the body with void damages and cracks as the difference between the effective strain energy due to void damages and the complementary energy due to cracks. In the effective space, the complementary energy due to cracks is obtained by the known energy release rate and the effective stiffness properties of materials are derived by using the Green’s theorem. We introduce the concept of the effective stress intensity factors and suggest a method for expressing the I, II, III-type effective stress intensity factors with consideration of crack closure effect. We obtain the expression of the complementary energy and determine the effective stiffness characteristics for various cases of plane open cracks, plane closed cracks, space open elliptic cracks, and space closed elliptic cracks. We analyze the stress and displacement of structural materials with cracks and void damages by using the obtained effective stiffness properties in ANSYS and perform the numerical comparison between the modeling method by the decomposition of total damage variable into void and crack damages and our modeling method by coupling of void damage and crack theory.
The loneliness of the enactive cell: Towards a bio-enactive framework
Authors: Cummins Fred , De Jesus Paulo
Published: May 2016

The enactive turn in cognitive science fundamentally changes how questions about experience and behaviour are addressed. We propose that there exists a suite of core concepts within enaction that are suited to the characterisation of many kinds of intentional subjects, including and especially animals, plants, collectivities and artefacts. We summarise some basic concerns of enactive theory and show how the common illustration of the single cell ascending a chemotactic gradient serves as a focus point for discussion of important topics such as identity, perspective, value, agency and life-mind continuity. We also highlight two important deficits of this example: the cell is ahistorical and asocial. Historicity and sociality are defining characteristics of living beings and are addressed within enactive theory by the concepts of structural coupling and participatory sense-making, respectively. This strongly biological framework is to be distinguished from scientific psychology which is, we argue, necessarily anthropomorphic. We propose a constrained bio-enactive framework that remains true to its biological foundations and that would allow us to negotiate consensus-based understanding in contested domains, where incompatible value systems enacted by competing systems are in conflict. A consensual ‘we’ is, we contend, a matter of negotiation, not of fixed essence. A bio-enactive framework may serve as a jumping off point for consensus-based discussion within contested domains.
Intravenous Ethchlorvynol-Induced Pulmonary Edema
Authors: Self Timothy H. , Fountain Francis F. , Dunnebacke Robert , Pipkin Michael , Patterson Herb
Published: May 2016

A case report of intravenous ethchlorvynol-induced pulmonary edema is presented. Approximately 450 mg of ethchlorvynol was withdrawn from a Placidyl® capsule and injected by a 30-year-old man. Respiratory symptoms occurred within twenty minutes and a chest X-ray taken within two hours revealed diffuse bilateral pulmonary infiltrates. The patient's condition improved rapidly.

A pertinent feature of the case is the comparatively low dose of ethchlorvynol which caused pulmonary edema. It is also of note that two colleagues of the patient did not have evidence of any adverse effects after injecting approximately 180 mg of ethchlorvynol.
Prazosin Hydrochloride
Authors: Morrison Barbara J.
Published: May 2016

This article discusses prazosin hydrochloride's capacity to decrease venous return directly, thereby indirectly decreasing afterload and cardiac mechanical work. Aspects of the pharmacology, biochemistry, biopharmaceutics, adverse effects and results of clinical studies with prazosin are included, as well as therapeutic use dosage and cost information.
The Constant Blood Withdrawal Method for the Area under the Plasma Concentration Curve
Authors: Kowarski C. R. , Kowarski A.
Published: May 2016

The area under the plasma concentration curve (AUC) was measured after an intragastric administration of either plain or buffered acetylsalicylic acid, using either an intermittent sampling, or the recently introduced constant blood withdrawal method. Six dogs were used in each study. The AUC by the constant withdrawal method was significantly higher than the AUC by the intermittent sampling method. There was no significant difference between the AUC of the plain and buffered acetylsalicylic acid. The higher AUC by the constant withdrawal method was attributed to the inclusion of the initial plasma levels, which is an inherent advantage of the constant blood withdrawal method.
Diabetic Patient Compliance as a Function of Patient Counseling
Authors: Powell M. F. , de P. Burkhart V. , Lamy P. P.
Published: May 2016

The impact of a specially designed patient education program upon the diabetes-related knowledge and compliance of insulin dependent diabetic patients was investigated. The program consisted of an audiovisual presentation, illustrated handout material, and pharmacist-patient counseling.

Based on statistical considerations, 65 eligible patients were assigned systematically to a control group (Group I) and a study group (Group II) and were evaluated for compliance following a standardized protocol. Immediately following the interview, Group II patients were instructed utilizing the patient education program. Scores for initial and final evaluations of knowledge and compliance were compared using appropriate statistical procedures. The program was successful in producing improvements in both knowledge and compliance but a need for individualization of patient education efforts was indicated. Significant improvements in compliance were not observed among patients older than the mean age for study patients and those with diabetes complicated by cardiovascular and hypertensive disease.
Self-Monitoring of Blood Pressures in Hypertensive Subjects and its Effects on Patient Compliance
Authors: Ogbuokiri Justina E.
Published: May 2016

This study investigated the effects, if any, that teaching hypertensive patients to take their own blood pressures, as well as education and counseling, would have on compliance.

Prior to the initiation of the study, the pharmacist-investigator collected data on the hypertension clinic as it traditionally functioned. This preliminary investigation included studying the work flow of the clinic and reviewing medical records to determine who among the clinic registrants met the criteria set up for inclusion in this study.

During the study phase, 12 patients were educated about their disease state, counseled, and taught to take their own blood pressures, using a home blood pressure measuring device. Upon each return visit, they were evaluated by the pharmacist using such parameters as pill counts, blood pressure readings, fluctuations in body weight, and disease symptomatology. All these data were analyzed and compared to those of the 12 patients in the control group who were educated and counseled, but not taught to take their blood pressures. An overall improvement in any or all of these monitored parameters was the criterion for determining effectiveness in promoting better compliance.

At the end of the five-month study, the frequency of proscription refill had increased from 38 to 72.56 percent for the treatment group and from 31.6 to 59.26 percent for the control group. There were no significant changes in the other parameters monitored during this period.
Long-Term Nandrolone and Testosterone Administration in Hemodialysis Patients
Authors: Mirahmadi Mike K. , Vaziri Nick D.
Published: May 2016

Androgen compounds are commonly used in the treatment of anemia in patients with end-stage renal disease. The two widely used androgen compounds, nandrolone decanoate (ND) and testosterone enanthate (TE), have been reported to improve anemia in this setting. We conducted a controlled crossover study to evaluate and compare the hematopoietic, anabolic, and endocrine effects of ND and TE in patients with end-stage renal disease. Four of ten patients receiving ND and two of nine patients receiving TE exhibited marked rises (> 1 g/dL) in their hemoglobin concentration, while others showed no significant response. Serum FSH and LH levels were elevated, and serum testosterone levels were reduced during the control periods. They all fell significantly ( p < 0.001) with the administration of ND. Serum FSH and LH levels similarly fell with TE administration, although serum testosterone levels rose (p < 0.001), the latter due to detection of TE on serum testosterone assay. Serum prolactin level was markedly elevated during the control period. It fell during the administration of ND and increased with the use of TE.
Ethics Education for Clinical Pharmacy Practice
Authors: Miederhoff Patrick A. , Olin Bernie R. , LeFevre Joseph
Published: May 2016

A review of the literature on pharmacy ethics found little concern for ethical issues that arise from pharmacist involvement in clinical practice. This lack of recognition and concern for ethical dilemmas that arise from new pharmacist roles has serious implications for clinical practitioners because of their close involvement in patient care and with other professionals. Also, implications for the profession are serious since a lack of internal control invites external control. Pharmacy educators must provide a leadership role in addressing this lack of concern by systematic evaluation and improvement of ethics education. A model of ethics education is presented that is based on a science education model — both a theoretical and a practical component leading to skill development in recognizing and resolving ethical dilemmas. In other words, pharmacy students will be trained to become their own ethics experts through the application of critical ethical thinking.
Digoxin Toxicity with Therapeutic Levels
Authors: Powell Stephen H.
Published: May 2016

A case of digoxin toxicity occurring in a patient with stable renal function and serum digoxin levels of 0.6–0.9 ng/ml is discussed. The patient is a 62-year-old black male admitted to the hospital with a chief complaint of shortness of breath.

The patient's problem list included: (1) congestive heart failure, (2) coronary artery disease, (3) adult-onset diabetes mellitus, (4) cerebral vascular accident, (5) fever, and (6) anemia. The patient complained of a poor appetite and “sour stomach” while on digoxin. Serum electrolytes were normal, and the serum creatinine was essentially stable with a range of 1.2–1.6 mg% reported. Despite the “apparent” therapeutic serum digoxin levels, a probable diagnosis of digoxin toxicity was made, and the patient responded within two days of the dechallenge with improvement in the nausea and anorexia.

The limitations and problems in assessing digoxin toxicity with serum digoxin levels are discussed.
Hexamethylmelamine: A Review
Authors: Hahn Deborah A. , Black Curtis
Published: May 2016

A review of the investigational oncolytic agent hexamethylmelamine (HMM) is presented. HMM probably acts as an antimetabolite. The value of HMM lies in its relatively mild hematologic toxicity, its ability to increase response and survival rates in combination, and in its response in patients refractory to standard chemotherapy. The greatest response is in advanced ovarian cancer: Alone (overall response, 28–42 percent) and in combination with cyclophosphamide, mediotrexate, and 5-fluorouracil (overall response, 76–79 percent). Lung cancer has shown response to HMM, with best activity exhibited in small cell carcinoma (20–28 percent). HMM alone has demonstrated activity (overall response, 39 percent) in Hodgkin's and non-Hodgkin's lymphomas, a rate equal to that of bleomycin, and without cross resistance to this agent. Its value in breast cancer is questionable. The average tolerated dose is 8 mg/kg/d. Major dose-limiting toxicities are gastrointestinal, although hematopoietic depression, peripheral neuropathies, and central nervous system disorders also occur. Pentamethylmelamine, a water soluble metabolite, is die potentially marketable form of the drug.
Liver Enzyme Elevation associated with Total Parenteral Nutrition
Authors: Greenlaw Cal Wayne
Published: May 2016

A number of complications associated with total parenteral nutrition (TPN) have been identified, and methods of prevention or treatment have been developed. However, abnormal liver function continues to occur with the use of TPN, and little is known about its incidence and etiology.

Twenty-three patients, receiving TPN through the TPN program at Holy Cross Hospital from January, 1978 to May, 1978, were studied. All patients received a basic parenteral amino acid solution (Travasol®), with varying amounts of nitrogen per day, depending on nitrogen balance studies. Dextrose was supplied in quantities necessary to provide 120 percent or more of the patient's calculated basal energy expenditure (BEE). Of the 23 patients studied, elevated liver function test values were detected in two patients (8.6 percent). In both cases, the complication developed within six to eight days, and both had received calories in excess of 213 percent of their calculated BEE and had a calorie to nitrogen (kcal: N) ratio greater than 150: 1.

Mean calories as a percent of calculated BEE and kcal: N ratio were significantly higher in the patients with elevated liver function test (LFT) values than in those with normal LFT values ( p < 0.05 and p < 0.005, respectively). Following identification of the elevated LFT values, both patients were immediately placed on cyclic TPN (CyTPN). In the one patient, liver enzymes reverted toward normal after seven days of CyTPN, while the second patient required only five days. Cyclic TPN was deemed effective in the reversal of abnormal liver function in these two patients. It is speculated that the abnormal liver function was a result of fatty liver infiltration. The mechanism by which this infiltration occurs and its treatment are discussed.
Stability of Five Antibiotics
Authors: Tung Elizabeth Chow , Gurwich Ernest L. , Sula Joseph A. , Kodack Michael
Published: May 2016

The stability of methicillin, amikacin, erythromycin lactobionate, vancomycin, and ticarcillin in plastic intravenous containers of sodium chloride injection 0.9%, USP and dextrose 5% injection, USP was studied. The study was conducted under aseptic conditions for a period of 24 hours. The samples, drawn at various times, were assayed by a modified agar gel diffusion technique. The study solutions were stored at room temperature. This study revealed that amikacin, methicillin, vancomycin, and ticarcillin are stable for 24 hours in the test solutions. Erythromycin lactobionate is stable for 24 hours in normal saline, but the addition of sodium bicarbonate 4% (Neut®) was necessary to assure stability in dextrose 5 %.
Glycosylated Hemoglobins and Diabetic Control Assessment
Authors: Torre Michael S. , Schofield David H. , Mangione Robert A. , Boisvert Alain
Published: May 2016

The historical development, biosynthesis, analysis, interpretation, and utilization of glycosylated hemoglobin determinations (HbA1 or HbA1c alone) are presented. The relationship between glycosylated hemoglobin determinations and assessment of diabetic control is discussed. HbA1 and HbA1c levels are elevated approximately twofold in diabetic patients. A correlation exists between abnormal fluctuations in blood glucose levels and HbA1 concentrations. The results of glycosylated hemoglobin determinations are not influenced by recent meals, physical activity, emotional stress, or inherited abnormalities. Although glycosylated hemoglobin determinations are subject to fewer variables than blood and urine glucose assessments, the clinician must be aware of the indications and limitations for their use. These indications and limitations are discussed.
Psychotic Exacerbation with Haloperidol
Authors: Tornatore Frank L. , Lee Dong , Sramek John J. , Bertho-Gébara Catherine
Published: May 2016

A case illustrating the worsening of a patient's schizophrenic symptoms following haloperidol dosage increases is presented. This case is remarkable in that few cases of psychotic exacerbation with haloperidol dosage increases have been reported in the world literature. The possibility exists that, like certain tricyclic antidepressants, neuroleptic medication may possess a “therapeutic window.” The concept of a therapeutic window and its relationship to the phenomenon of psychotic exacerbation is reviewed. In evaluating this condition, the clinician should consider other causes of psychotic exacerbation, such as akathisia and anticholinergic psychosis.
Plasma Concentration Monitoring of Hydroxylated Metabolites of Imipramine and Desipramine
Authors: DeVane C. Lindsay , Jusko William J.
Published: May 2016

Steady-state serum concentrations of imipramine (IMI), its demethylated metabolite desipramine (DMI), and the active, hydroxylated metabolites, 2-hydroxy-imipramine (2-OH-IMI) and 2-hydroxy-desipramine (2-OH-DMI) were monitored in 126 psychiatric patients receiving IMI therapy. DMI and 2-OH-DMI concentrations were determined in a similar group of 61 DMI-treated patients. Although significant correlations exist between hydroxy metabolite and precursor concentrations, considerable variability was also found. Mean (± SD) ratios for the IMI patients were: 2-OH-IMI:IMI = 0.27 (± 0.19) and 2-OH-DMI:DMI = 0.56 (± 0.30). The ratio of DMI: IMI for males and 2-OH-DMI:DMI for females decreased with age (r = −0.42 and −0.32, respectively, p < 0.01). Variable metabolite concentrations and the uncertainty of their relative psychoactivity may contribute to the difficulties in relating antidepressant efficacy to serum concentrations of the administered IMI or DMI.
Trimethoprim: Clinical Use and Pharmacokinetics
Authors: Friesen W.T. , Hekster Y.A. , Vree T.B.
Published: May 2016

The recent marketing of trimethoprim (TMP) as a single drug has resulted in interest in the use of this drug to treat common infections. The history and antibacterial properties of TMP are reviewed. Indications for the clinical use of TMP are presented, and possible new uses for the drug are considered. The significance of adverse effects is discussed. The pharmacokinetic properties of TMP are reviewed with particular emphasis on the renal handling of the drug and its advantages over TMP/sulfonamide combinations in relation to renal function and toxicity.
Influence of Gender on Theophylline Dosage Requirements in Children with Chronic Asthma
Authors: Hendeles Leslie , Vaughan Leigh , Weinberger Miles , Smith Gary
Published: May 2016

The total daily dose of theophylline required to achieve a four-hour steady-state serum concentration within the 10–20 μg/ml therapeutic range was examined for 49 age-matched pairs of female and male children, age 5–15 years, with chronic asthma. All patients received the same 100 percent bioavailable slow-release product (Theodur®) at eight-hour intervals for more than 72 hours. Total body clearance of theophylline was estimated from the four-hour measurement which closely approximated the average serum concentration. A clinical pharmacist interviewed all patients or parents before a blood sample was obtained to document compliance and other factors that might alter the interpretation and reliability of the measurement.
Acute Ethylene Oxide Intoxication
Authors: Salinas Ernest , Sasich Larry , Hall David H. , Kennedy Robert M. , Morriss Herbert
Published: May 2016

A case of acute ethylene oxide intoxication is described in which neurological involvement was present. Three recurrent seizures over a period of an hour were observed in a 43-year-old female. The patient continued to complain of malaise and inability to perform minor motor tasks up to one week after discharge. Neurological evaluation conducted three weeks after toxic exposure was completely normal. A two-month follow-up showed the patient to be asymptomatic without recurrence of symptoms.
Clinical Pharmacokinetics versus Therapeutic Drug Monitoring — A Perspective for Pharmacists
Authors: Kramer Paul A.
Published: May 2016

The classical role of the pharmacist in providing clinical pharmacokinetic services is reviewed and contrasted with the role in drug level interpretation now being assumed by many laboratory analysts. Arguments are presented for better articulation of the pharmacist's role and improved utilization of his unique knowledge of drug therapy in the application of drug level determinations to patient management. Without an increased presence in clinical pharmacokinetics, other professionals, less appropriately trained, may fill a substantial void which has recently developed in this important area of drug therapy.
Aminoglycoside Predictions Using a Hand-Held Calculator: Limitations of the Model
Authors: Polk Ron E. , Markowitz Sheldon M. , Mayhall C. Glen
Published: May 2016

Previously published methods for determining an appropriate aminoglycoside dosage have been adapted for use in the handheld programmable calculator (Texas Instrument-59). The purpose of this study was to evaluate the accuracy of calculator-generated serum level predictions compared with measured values. Twenty-four adult patients receiving intravenous aminoglycosides (gentamicin, netilmicin, or tobramycin) had urine and serum collected for creatinine clearance calculations and had blood obtained for peak and trough aminoglycoside concentration determinations. All but one patient had normal renal function. A statistically significant relationship between predicted and measured creatinine clearance values was found. There was also generally good agreement between the calculator-predicted aminoglycoside levels and the measured levels, although some patients exhibited unexplained deviations. Error -in the estimation of creatinine clearance and adjustments for lean body weight did not improve prediction accuracy. We conclude that the hand-held calculator was able to predict measured aminoglycoside levels for most patients with acceptable precision. However, the calculator method offers no real advantage over other methods (except speed in performing the calculation), and may give the user a false sense of security.
Comparative Trial of Two Sulfisoxazole Regimens in Acute Urinary Tract Infection
Authors: Prince Randall A. , Cassel Deborah H. , Hepler Charles D. , Wilson James L. , Jones Mark E. , Feldick Harley G. , Helling Dennis K.
Published: May 2016

Traditionally, the therapeutic regimen of sulfisoxazole in acute urinary tract infection has included either a 2- or 4-g loading dose. However, the biopharmaceutical aspects of this drug indicate that a loading dose is unnecessary. The objective of this clinical study, therefore, was to compare a traditional regimen of sulfisoxazole to a regimen not utilizing a loading dose. Fifty adult female patients with acute, uncomplicated urinary tract infections were assigned to a ten-day course of sulfisoxazole 1 g po qid. Patients were randomly allocated to a 2-g loading dose or no loading dose regimen. Data were analyzed with regard to resolution of presenting symptoms and eradication of the infecting organism (i.e., cure). Statistical analysis demonstrated no significant difference for symptom resolution and cure. It appears that the convention of using an initial 2-g oral loading dose of sulfisoxazole in the treatment of acute, uncomplicated urinary tract infection is unwarranted.
Use of Colestipol in a Patient with Digoxin Intoxication
Authors: Payne Vaughn W. , Secter Russell A. , Noback Richardson K.
Published: May 2016

The steroid-binding drug colestipol was administered to a patient with digoxin intoxication and the serial digoxin levels were measured. The actual half-life of elimination of digoxin was 55 hours, whereas the predicted half-life calculated from standard pharmacokinetic equations was at least 85 hours. Colestipol presumably interrupts the enterohepatic recycling of digoxin and enhances its fecal excretion. This is the first documented report of the successful use of colestipol for digoxin intoxication.
The Pain Cocktail as an Adjunctive Agent in the Treatment of Spine Pain Patients
Authors: Rubin Terry N. , Tomosada Wayne P.
Published: May 2016

A retrospective review of 20 spine pain patients hospitalized between May 1977 and May 1979, who received pain cocktails was performed to determine the effectiveness of this manner of decreasing pain medication requirements. The primary objective of the pain cocktail is to reduce or eliminate addiction, habituation, and pain medication consumption. The pharmacist is responsible for regulating dosages, performing the compounding, and writing the orders for the pain cocktails. Gradual medication adjustments, based on the patient's need and tolerance, are made. Medication was reduced in 19 of the 20 patients. Twelve patients who started on narcotic analgesics and six who started on pentazocine had a final medication reduction of 71 percent and 51 percent, respectively. Five of the 12 patients receiving narcotic analgesics in their initial cocktail were tapered to acetaminophen at time of discharge. Results were favorable and indicate the pain cocktail as a beneficial treatment modality for selected spine pain patients.
Propranolol Plasma Concentrations and Plasmapheresis
Authors: Talbert Robert L. , Wong Yan Yan , Duncan Douglas B.
Published: May 2016

Propranolol plasma concentrations were determined in a patient with hemolytic-uremic syndrome undergoing plasmapheresis before and after the procedure on three occasions. The mean half-life and elimination rate constant during plasmapheresis were estimated to be 25.6 percent of the values obtained without plasmapheresis. These changes suggest that plasmapheresis may influence propranolol disposition.
Trazodone (Desyrel, Mead-Johnson Pharmaceutical Division)
Authors: Rawls W. Nathan
Published: May 2016

Trazodone is the first triazolopyridine derivative to be used clinically for the treatment of depression. It has been shown to be equal in efficacy to the tricyclic antidepressants imipramine, desipramine, and amitriptyline in the treatment of major depressive episodes. Researchers have indicated that trazodone exceeds other antidepressants in relieving anxiety, but further study is needed to confirm this effect. Trazodone has been used successfully to relieve depression in schizophrenic patients without worsening their psychotic symptoms. Trazodone blocks serotonin reuptake into presynaptic neurons with little effect on norepinephrine or dopamine. It is rapidly absorbed orally and reaches peak serum levels within two hours. Trazodone is excreted primarily as metabolites by the kidneys and possesses a biphasic elimination half-life of 4.4 hours for the first 10 hours and 7.5 hours for the next 24 hours. Trazodone 200 mg is equal to imipramine 100 mg, and the therapeutic dosage range is 200–600 mg/d. Side effects are infrequent with trazodone; its anticholinergic activity is minimal. Trazodone appears to produce less cardiovascular toxicity than tricyclic antidepressants. To date, reports of fatal overdoses are rare.

Trazodone equals available antidepressant drugs in clinical efficacy, and, because it has fewer cardiovascular and anticholinergic side effects, it should prove beneficial in the treatment of depression.

See Table of Contents for location in this issue of the foreign abstracts of this article.
Baker's Asthma (Grain-Dust-Induced Asthma)
Authors: Tse C.S. Ted , Raghuprasad P.K.
Published: May 2016

A 48-year-old black male with no underlying atopy developed asthma after working nine years at a bakery. The attacks of wheezing were preceded by nasal symptoms and usually occurred after several hours of work. Skin testing revealed reactivity to dust, molds, and wheat extracts; serum level of IgE was normal, and a RAST screen to common allergens was negative. A bronchial provocation test using commercial wheat extract was negative, but the same test using the patient's own bakery flour resulted in an immediate positive reaction. The pathogenesis and management of grain-dust-induced asthma are discussed.

See Table of Contents for location in this issue of the foreign abstracts of this article.
A Comparison of Various Types of Patient Instruction in the Proper Administration of Metered Inhalers
Authors: Roberts Richard J. , Robinson J. Daniel , Doering Paul L. , Dallman John J. , Steeves Roy A.
Published: May 2016

The administration technique employed by 42 inpatients using metered inhalers was observed. Proper performance of the six steps recommended by the manufacturer provided the guidelines for correct administration. The degree of compliance with proper technique was defined as the number of steps correctly executed by the patient. The mean number of steps correctly performed was 2.9 out of the possible six (48.3 percent).

Twenty-four patients were then randomized into one of three groups. Group 1 received the manufacturer's instruction sheet, Group 2 received counseling from a pharmacist, and Group 3 received both the manufacturer's instruction sheet and counseling from a pharmacist. There was a significant improvement in the postinstruction technique in Groups 2 and 3, while Group 1 failed to demonstrate any significant improvement.

Comparisons were then made among the three groups. No significant difference was found between Group 2 and Group 3. However, both Groups 2 and 3 were found to be significantly different ( p < 0.05) from Group 1. This study shows that pharmacist counseling can significantly improve the degree of patient compliance in the administration of metered inhalers.
Needs Assessment
Authors: Scriven Michael
Published: May 2016

A review of the basic concepts in needs assessment and of the various ways in which needs assessment is performed with applications to clinical and health care programs is discussed in this article.
Acquired Methemoglobinemia and Hemolytic Anemia after Usual Doses of Phenazopyridine
Authors: Jeffery William H. , Zelicoff Alan P. , Hardy William R.
Published: May 2016

Two patients developed symptomatic methemoglobinemia and hemolytic anemia after treatment with phenazopyridine. Methemoglobinemia appears to be a rare occurrence after commonly used doses of phenazopyridine; phenazopyridine-associated hemolytic anemia has been reported both after overdose and after usual doses. The presentation of methemoglobinemia in the first patient and the response to treatment with methylene blue in the second patient were unusual, suggesting that the patients had a red cell defect or were exposed to other oxidizing substances. One of the major metabolites of phenazopyridine is aniline, a known cause of methemoglobinemia. Aniline-induced methemoglobinemia is less responsive to treatment with methylene blue than nitrate- or nitrite-induced methemoglobinemia. This may explain, in part, the poor response to methylene blue by one of our patients.
Cardiac Arrest Due to Digitalis Intoxication with Normal Serum Digoxin Levels: Effects of Hypokalemia
Authors: Gómez-Arnau J. , Maseda J. , Burgos R. , Cordón J. , Domínguez R. , Criado A. , Avello F.
Published: May 2016

A case of cardiac arrest due to digitalis toxicity is described. The patient had normal serum digoxin levels and hypokalemia, and treatment with potassium chloride, phenytoin, and pacing was successful. Comment is made on the serum digoxin levels in relation to serum potassium.
Cefoxitin Therapy in Aerobic, Anaerobic, and Mixed Aerobic-Anaerobic Infections
Authors: LeFrock Jack L. , Schell Ronald F. , Carr Bernice B. , Kowalsky Steven F. , Tillotson James R.
Published: May 2016

Cefoxitin, a new β-lactamase-resistant cephamycin, was evaluated in 66 patients for clinical and bacteriological efficacy, serum levels, tolerance, and toxicity. Seventeen patients had soft tissue infections, 14 had pleuropulmonary infections, 14 had intraabdominal infections, 13 had pelvic infections, and 8 had urinary tract infections. Among the 66 patients, 62 were cured and 4 could not be evaluated. Twelve patients had hospital-acquired infections, 31 had underlying disease, and 45 required a surgical procedure. Isolates included 116 aerobic and 72 anaerobic bacteria. Cefoxitin was more active than cephalothin against facultative and obligate anaerobic gram-negative organisms isolated from these patients. Mean peak cefoxitin levels in sera were 52 μg/ml after a 2-g infusion and 30 μg/ml after a 1-g infusion. Phlebitis occurred in two patients, eosinophilia in one, rash in two, vasculitis in one, and transient rises in SGOT and SGPT in two. Cefoxitin appears to be a safe and effective drug for the treatment of many aerobic, anaerobic, and mixed aerobic-anaerobic infections.
A Calculator Program for Adjusting Aminoglycoside Regimens That Accounts for Tissue Accumulation in Children and Adolescents
Authors: Loertscher M. Vance
Published: May 2016

The author has developed a program for the Hewlett Packard HP 41C calculator that is used in the analysis of aminoglycoside serum levels for the purpose of generating a personalized dosage regimen. Although other programs have been published, until now none has made adjustments in the half-life of drug elimination due to the tissue accumulation that occurs in the initial phases of dosing. Many of these same programs fail to locate the true peak and trough serum levels, which are essential in the calculation of the volume of distribution of the aminoglycosides. This article is not meant as a method of initial dosing, but rather assumes that the physician has chosen one of the readily usable methods of dosing, such as various nomograms.

Patient data taken from published studies were used in generating individual patient parameters. These parameters were compared to those calculated in the studies for means of comparison. While correlation in all parameters was not ideal, the correlation of dose and dosing interval was exact and correlation of predicted peaks and troughs with the given regimen of dosing was excellent.
Behavioral Management Concepts with Application for Home Parenteral Nutrition Patients
Authors: Parrish Richard H. , Mirtallo Jay M. , Fabri Peter J.
Published: May 2016

The concept of symptom-avoidance behavior is discussed, with particular reference to home intravenous hyperalimentation (HIVH) patients. Symptom-avoidance behavior is explained as a combination of a health behavior model and an expectancy motivational theory leading to a basic outcome, which is satisfactorily avoiding the onset of symptoms. A systematic behavioral assessment method is presented, based on anecdotal cases; it is experimental in nature and can serve as a guide for practitioners who wish to initiate HIVH.
Computerized Test Grading and Analysis—It Can Improve Clinical Instruction
Authors: Riley David A. , Baldwin H. John
Published: May 2016

Many health profession educators do not use computerized test grading and analysis to help them improve their courses and testing nor to assess objectively student performance and competency. The main thrust of this article is the listing of advantages and disadvantages involved in incorporating computerized test grading and analysis in the hope that more instructors will realize and pursue this as an additional effective means of accomplishing course goals and instructional objectives.
Uncharacteristic Cutaneous Reactions Induced by Quinidine
Authors: Holt Robert J.
Published: May 2016

Two patients who presented with unusual cutaneous reactions attributed to quinidine are described. One had a diffuse nonpruritic macular rash, and the other had a localized pruritis without cutaneous manifestations. Both resolved upon de-challenge with quinidine. Disopyramide phosphate was substituted for quinidine in both cases, without subsequent problems.
Anaphylactic-like Reactions to Zomepirac
Authors: Driver Paul S. , Endo Ronald K. , Levin Arnold , Hall David H. , Sasich Larry
Published: May 2016

The authors report two cases of anaphylactic reaction to zomepirac. A brief discussion of anaphylactic reactions to other nonsteroidal antiinflammatory agents, for example, tolmetin and sulindac, is included. The authors note that first exposure to the NSAIDs usually produces few, if any, adverse effects in patients who later suffer severe reactions.
Postgraduate Pharmacy Fellowships (1982–1983)
Authors: Kaul Alan F. , Powell Stephen H. , Wilson Julie A.
Published: May 2016

During June and July 1982, the Pharmacy Services Department of the Brigham and Women's Hospital conducted its second annual national survey by mail questionnaire regarding postgraduate pharmacy fellowships. There was a total response of 80 percent to the questionnaire. Sixty-three fellowships are offered at 25 fellowship sites. Information regarding type of specialty fellowship, fellowship characteristics, fellowship location and contact person, and qualifications of applicants is reported.
Aminoglycoside Pharmacokinetics on a Microcomputer
Authors: Kaka Juzar S. , Buchanan E. Clyde
Published: May 2016

The authors describe the use of a microcomputer to evaluate an existing dosage regimen and to determine a new regimen and steady-state peak and trough levels for four aminoglycoside antibiotics — Amikacin, gentamicin, kanamycin, and tobramycin.

The microcomputer program is based on a one-compartment open pharmacokinetic model for the aminoglycosides. It accounts for patients' sex, age, height, obesity, and ascitic compartment. The program is divided into seven subprograms for each of the four aminoglycosides: (1) steady-state peak and trough levels are predicted, based on serum creatinine for a given dosage regimen; (2) a dosage regimen that conforms to 6, 8, 12, 16, or 24 hours is ascertained, based on serum creatinine; (3) a dosage regimen is determined, on the basis of serum creatinine, for desired steady-state peak and trough levels; (4) a dosage regimen that conforms to 6, 8, 12, 16, or 24 hours is ascertained for given aminoglycoside serum levels; (5) a dosage regimen for desired peak and trough levels is ascertained for given aminoglycoside serum levels; (6) a dosage regimen that conforms to 6, 8, 12, 16, or 24 hours is ascertained from data collected using Sawchuk's and Zaske's method; and (7) a dosage regimen, estimated for desired peak and trough levels, is estimated from data collected using Sawchuk's and Zaske's method.
Readability Testing of Auxiliary Labels
Authors: Wilson Judy
Published: May 2016

Using a word familiarity index, we studied pharmacy auxiliary labels and selected brief information sheets to determine the reading difficulty of these forms of written communication, which cannot be evaluated by traditional readability testing methods. Results of the study show that 11.2 percent of the 110 words selected from these information sources are above the eighth-grade reading level. The word familiarity index also identified multiple meanings of words and appears to be a valuable tool for evaluating written information that is not suitable for traditional readability testing.
Drug-Induced Electrolyte Disorders
Authors: Nanji Amin A.
Published: May 2016

A wide variety of pharmacologic agents have been implicated in a number of electrolyte disorders. The present review focuses on abnormalities of sodium, potassium, calcium, magnesium, and phosphate. Several mechanisms are involved in the pathogenesis of these disorders. These involve stimulation and modulation of other hormones (e.g., antidiuretic hormone, renin-angiotensin system, parathyroid hormone), damage to renal tubules, and, in some cases, a combination of factors. Recognition of these abnormalities is important because their presence may be life threatening or may aggravate the side effects of the drug itself.
A Key to the Literature of Total Parenteral Nutrition
Authors: Mirtallo Jay M.
Published: May 2016

Parenteral nutrition is a relatively young science; texts dealing with the subject are few in number and become outdated shortly after publication. This comprehensive bibliography is intended to enhance the education of the practitioner and student in the area of parenteral nutrition and, as such, function as a key to the literature. Pertinent review articles may provide a mechanism for the practitioner to develop a baseline knowledge of nutritional support or specific patient problems.
Decreased Absorption of Cefaclor in Short Bowel Syndrome
Authors: Nahata Milap C. , Freimer Nelson , Hilty Milo D.
Published: May 2016

Oral cefaclor is rapidly absorbed in patients with a shortened gastrointestinal tract (23 cm). A case is reported of a 27-month-old female child who had received oral cefaclor for five days in treatment of otitis media. The child had had a bowel resection at birth. She did not respond to oral therapy with cefaclor and was admitted to the hospital, where she received cefamandole intramuscularly. The patient recovered in five days.

Further investigation using cefaclor with this patient demonstrated serum concentrations below the minimum inhibitory concentration of Hemophilus influenzae, pneumococcus, and many other organisms.

When oral antibiotics are prescribed, it is necessary to monitor serum concentrations to ensure absorption.
The Heart
Authors: Seaman John J. , Longe R. Leon , Calvert Jon C.
Published: May 2016

This article discusses normal and abnormal anatomy and physiology of the heart and the techniques used in physical assessment. Specific adverse drug effects are discussed and a case study is provided to illustrate key concepts.
Interaction of Penicillins with the Components of Plasma Expanders
Authors: Koshiro Akira , Fujita Toshio
Published: May 2016

The interaction of penicillin with high molecular components of plasma expander such as dextran, 6-hydroxyethylstarch, and polygeline were studied. The formation of penicilloyl polysaccharides and smaller amounts of penicilloyl polygeline during incubation were confirmed by ultrafiltration and gelfiltration.

The ultrafiltration through Collodion-Bags SM 13200 was found to be a rapid and convenient method for the determination of macromolecular penicilloates.

The accelerated degradation by the formation of penicilloyl esters with glucose and lactic acid was also suggested.
Scotomas Secondary to Digoxin Intoxication
Authors: Massaro Frank J. , Moulton Jonathan S. , Linkewich Joseph A. , Major David A.
Published: May 2016

The authors report a case of decreased visual acuity and bilateral scotomas resulting from digoxin intoxication in a 67-year-old man. Visual irregularities subsided when digoxin serum levels returned to within the therapeutic range.
Triazolam (Halcion, the Upjohn Company)
Authors: Kroboth Patricia Dowley , Juhl Randy P.
Published: May 2016

Triazolam is a sedative/hypnotic triazolo-benzodiazepine, structurally related to alprazolam. Recently, it has been approved for the short-term management of insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings, and/or early morning awakenings. Triazolam is metabolized with a half-life of 1.5–5.0 hours. Its one active metabolite, which appears in low concentrations and is inactivated rapidly, is not thought to contribute to its pharmacologic activity. Triazolam has been shown to decrease sleep latency and the number of nocturnal awakenings while increasing total sleep time in patients with insomnia. Sleep electroencephalogram studies show that triazolam has no effect on δ-sleep (Stages 3 and 4) and has variable effects on rapid-eye-movement sleep. Nighttime administration of triazolam increases daytime alertness in insomniacs and improves or has no effect on performance. The reported side effects are similar to those of other benzodiazepines and include drowsiness, dizziness, and dry mouth. The recommended dosage of triazolam is 0.25–0.5 mg hs. A reduced initial dose of 0.125 mg should be used in geriatric patients.
Reactions and Interactions in Handling Anticancer Drugs
Authors: D'Arcy P.F.
Published: May 2016

The clinical toxicity of anticancer drugs has been well documented with regard to the adverse effects of treatment in patients. However, many of these drugs have a direct irritant effect on the skin, eyes, mucous membranes, and other tissues. Handled without due care, especially when being prepared for injection, most cytotoxic drugs can cause local toxic or allergic reactions; they also present hazards of carcinogenicity and mutagenicity. This spectrum of potential risk should be kept in mind by personnel administering or handling these drugs, especially in oncology units where just a few individuals may routinely and frequently reconstitute many doses of cytotoxic agents. This is work in which the hospital pharmacist should and must be involved; indeed, many of the techniques and skills required are identical with those used in standard aseptic procedures for preparing pharmaceutical products. Pharmacy departments should take the initiative in making hospital staff aware of the potential risks of handling neoplastic agents, and they should spearhead a multidisciplinary assessment for producing local guidelines for working with these drugs.

This article warns practitioners about the inherent dangers of these practitioner-drug interactions and suggests ways in which they may be reduced. Information is given in tabular form regarding recommended procedures for reconstituting 24 anticancer drugs and precautions to protect the personnel handling them, especially when there is spillage of powdered or liquid drugs. Also, guidelines are given about incompatibilities with admixtures of such drugs, and the literature is reviewed relative to recent developments in hospital pharmacy departments where reconstitution of anticancer drugs has been incorporated into existing intravenous fluid preparation/admixture units. Not only has this been shown to be safer and more effective in terms of time and labor, but also it has cut the cost of injectable cytotoxic drugs by an appreciable percentage.