bluuebunny/crossref_metadata_2025 huggingface dataset:
Respiratory Symptoms and Low Tar Cigarette Smoking—a Longitudinal Study on Young People
Authors: Rimpelä Arja , Teperi Juha
Published: July 2017

Longitudinal data on the effect of low tar cigarette smoking on respiratory symptoms was collected from a sample of Finnish young people born in 1966, by mailed questionnaires in 1979, 1983 and 1985. Cough was 3 to 6 times more common than expected after starting smoking low tar brands (1–10 mg tar). The increase in cough was the same as with those who started middle tar cigarette smoking (11–18 mg). Before starting smoking, the low tar cigarette smokers did not report more symptoms than the middle tar or nonsmokers. After a few years smoking cough and phlegm were 2 to 3 times more common in the low tar cigarette smokers than in the non-smokers but on the same level as in the middle tar cigarette smokers. Tar yield was not a significant predictor of symptoms in logistic regression analysis.
Unemployment, Mental Health and the Psychological Functions of Work in Male Welfare Clients in Stockholm
Authors: Isaksson Kerstin
Published: July 2017

The effects of unemployment and the relationship to symptoms of psychological distress was studied in young, male and single clients on welfare in Stockholm in 1985. One hypothesis was that unemployed men would report more symptoms of psychological distress than men who had employment. Another hypothesis concerned the relationship between the social-psychological functions of work according to the so-called “deprivation theory” of Marie Jahoda and psychological distress as measured by the General Health Questionnaire. Results showed significantly more signs of psychological distress among the unemployed and also more distress among unemployed men with low access to the social-psychological functions of work compared to unemployed men with higher values. Stepwise regression analysis showed that the latent functions had a strong effect on well-being but the effect of employment/unemployment was weaker. This cross-sectional study gave no indications of different reactions in this group of hard-core unemployed men compared to other groups of unemployed in Sweden. Longitudinal studies are needed on this group to test the direction of the causal influence.
Social Differences in Reproductive Health
Authors: Olsen Jørn , Frische Grethe
Published: July 2017

Aim: To describe differences in life style variables according to socioeconomic groupings and to analyse the association between birth weight, stillbirth and congenital malformation according to the socioeconomic grouping for the father as well as the mother.

Method: Follow-up of 11 888 pregnant women in Odense and Aalborg, Denmark who were consecutively enrolled in the study from April 1984 to April 1987 as part of a community trial.

Data: Information on socioeconomic group and life-style factors were collected by means of self-administered questionnaires in the 36th week of gestation. Data on pregnancy outcomes were collected from birth certificates and medical records according to standardized search routines.

Results: Women in the lower socioeconomic groups were younger, smaller, had a higher prepregnancy weight, smoked more and had a higher intake of coffee during pregnancy than women in higher socioeconomic groups. Better off women, on the other hand, had a higher consumption of alcohol, fish, and vegetables.

Low birth weight was found to be negatively correlated with socioeconomic grouping. The lowest birth weights were found among babies born to unskilled and unemployed women even after adjustment for smoking habits, prepregnancy height and weight and a number of other potential confounders.

Stillbirth and the prevalence of congenital malformations was not associated with socioeconomic grouping, but the amount of information was very limited regarding these outcomes.
Measurement of problem-oriented need for The Primary Health Care Services:
Authors: Miilunpalo Seppo
Published: July 2017

Based on several previous approaches, a new model for the measurement of needs for primary health care services is constructed and demonstrated. This fourfold model includes the concepts of diagnostic need, perceived need, client dependent demand and provider dependent demand. The empirical results concerning the need for exercise counseling in the primary health care indicated that the present approach is feasible and comprehensive enough to obtain valuable information about the health needs and how they are supplied. The model makes it possible to identify discrepancies, for example, between the experts' and clients' priority ratings and between the criterion-based prevalence of a problem and the practice of the care providers. It may also reveal barriers and inequalities in the use of services. For health administrators and decisionmakers the present problem-oriented model provides a systematic approach to assess needs for health care services and to develop the services provided.
Fibromyalgia
Authors: Bruusgaard Dag , Evensen Åsa Rytter , Bjerkedal Tor
Published: July 2017

Fibromyalgia is a condition under dispute. Accepted by some as a major step forward in understanding some of the patients with widespread muscular pain, looked upon as a confusing side step by others.

In 1988 fibromyalgia was by far the most frequent single diagnosis as a reason for disability pension in Norway. Disability statistics however show big differences between counties. Two neighbouring counties had among the lowest and the highest incidence of disability pensioners with the diagnosis fibromyalgia.

New pensioners with fibromyalgia and some closely related diagnoses have been studied during the year 1988 by means of reading the insurance records.

It became apparent that the difference between the two counties with respect to the incidence of fibromyalgia as a cause of disability pension could be explained by differences in diagnostic setting by the doctors and difference in the assessment from the insurance system, rather than real differences in morbidity pattern.

Complaints from the musculoskeletal system is frequent and increasing in the population both as a reason for sick leave and disability pension. Whether this complicated and challenging situation is made more easy to handle by defining a subgroup of those persons as having “fibromyalgia” is questioned.
Incontinence pads – prevalence of use and individual consumption
Authors: Sandvik Hogne , Hunskaar Steinar
Published: July 2017

The purpose was to describe the prevalence of incontinence pad use and individual consumption of pads. Data was collected at local Insurance Offices in a region of western Norway (population: 239 500). Overall prevalence was 1.6% for females and 0.4% for males, increasing sharply with age. Median daily consumption was 1.7 pads. Middle-aged persons (40–69 years) consumed fewer and smaller pads than the others.
Dietary knowledge and behaviour among schoolchildren in Copenhagen, Denmark
Authors: Osler Merete , Hansen Elisabeth Tornberg
Published: July 2017

In 1989, 674 schoolchildren aged 12–14 years in nine elementary schools in a municipality in Copenhagen, Denmark, answered a questionnaire about their dietary habits and knowledge. The majority of the pupils had fruit (87%), vegetables (72%), rye bread (81%), and drank fat-reduced milk (73%) every day. A diet score (reliability = 0.58) was calculated on the basis of the intake of 8 food items relevant to current dietary recommendations. There were no age and sex differences as to dietary habits, but immigrant children had a lower diet score than native children. Dietary knowledge was measured by the ability to state correctly whether 11 different food items had a high content or not of fat, sugar or dietary fibres. Dietary knowledge was highest for questions about fat and sugar. A knowledge score measured the number of correct answers to all 33 questions (reliability = 0.90). Knowledge was highest among older children, native children, and children with the most healthy dietary habits. In the multivariate regression analysis, knowledge, health attitudes and ethnicity were the only significant predictors of dietary behaviour. It is concluded that both social and personal factors are important for dietary behaviour, and health promotion in children should include other methods than educational programmes.
Voodoo software and boundary objects in game development: How developers collaborate and conflict with game engines and art tools
Authors: Whitson Jennifer R
Published: July 2017

This article describes how game developers successfully ‘pull off’ game development, collaborating in the absence of consensus and working with recalcitrant and wilful technologies, shedding light on the games we play and those that make them, but also how we can be forced to work together by the platforms we choose to use. The concept of ‘boundary objects’ is exported from Science and Technology Studies (STS) to highlight the vital coordinating role of game development software. Rather than a mutely obedient tool, game software such as Unity 3D is depicted by developers as exhibiting magical, even agential, properties. It becomes ‘voodoo software’. This software acts as a boundary object, aligning game developers at points of technical breakdown. Voodoo software is tidied away in later accounts of game development, emphasizing how ethnographies of software development provide an anchor from which to investigate cultural production and co-creative practice.
Collateral benefits of Internet use: Explaining the diverse outcomes of engaging with the Internet
Authors: Van Deursen Alexander JAM , Helsper Ellen J
Published: July 2017

This article examines the extent to which economic, cultural, social, and personal types of engagement with the Internet result in a variety of economic, cultural, social, and personal outcomes. Data from a representative survey of the Dutch population are analyzed to test whether engagement with a certain type of activity is related to “collateral” benefits in different domains of activities, independent from the socioeconomic or sociocultural characteristics of the person. The results show that what people do online and the skills they have affect outcomes in other domains and that this is independent of the characteristics of the person. This means that policy and interventions could potentially overcome digital inequalities in outcomes through skills training and providing opportunities to engage online in a broad variety of ways. A semiologic rather than an economistic approach is more likely to be effective in thinking about and tackling digital inequalities.
Predictions of defect detection performance of air-coupled ultrasonic rail inspection system
Authors: Mariani Stefano , di Scalea Francesco Lanza
Published: July 2017

A rail inspection system based on ultrasonic guided waves and non-contact (air-coupled) ultrasound transduction is under development at the University of California at San Diego. The system targets defects in the rail head that are major causes of train accidents. Because of the high acoustic impedance mismatch between air and steel, the non-contact system poses severe challenges and questions on the defect detection performance. This article presents an extensive numerical study, conducted with a local interaction simulation approach, to model the ultrasound propagation and interaction with defects in the proposed system. This model was used to predict the expected detection performance of the system in the presence of various defects of different sizes and positions, and at varying levels of signal-to-noise ratios. When possible, operating variables for the model were chosen consistently with the field test of an experimental prototype that was conducted in 2014. The defect detection performance was evaluated through the computation of receiver operating characteristic curves in terms of probability of detection versus probability of false alarms. The study indicates that despite the challenges of non-contact probing of the rail, quite satisfactory inspection performance can be expected for a variety of defect types, sizes, and positions. Beyond the specific cases examined in this article, this numerical framework can also be used in the future to examine a larger variety of field test conditions.
Maternal chromium restriction modulates miRNA profiles related to lipid metabolism disorder in mice offspring
Authors: Zhang Qian , Xiao Xinhua , Zheng Jia , Li Ming , Yu Miao , Ping Fan , Wang Zhixin , Qi Cuijuan , Wang Tong , Wang Xiaojing
Published: July 2017

Increasing evidence shows that maternal nutrition status has a vital effect on offspring susceptibility to obesity. MicroRNAs are related to lipid metabolism processes. This study aimed to evaluate whether maternal chromium restriction could affect miRNA expression involved in lipid metabolism in offspring. Weaning C57BL/6J mice born from mothers fed with normal control diet or chromium-restricted diet were fed for 13 weeks. The adipose miRNA expression profile was analyzed by miRNA array analysis. At 16 weeks old, pups from dams fed with chromium-restricted diet exhibit higher body weight, fat weight, and serum TC, TG levels. Six miRNAs were identified as upregulated in the RC group compared with the CC group, whereas eight miRNAs were lower than the threshold level set in the RC group. In the validated target genes of these differentially expressed miRNA, the MAPK signaling pathway serves an important role in the influence of early life chromium-restricted diet on lipid metabolism through miRNA. Long-term programming on various specific miRNA and MAPK signaling pathway may be involved in maternal chromium restriction in the adipose of female offspring.

Impact statement

For the first time, our study demonstrates important miRNA differences in the effect of maternal chromium restriction in offspring. These miRNAs may serve as “bridges” between the mother and the offspring by affecting the MAPK pathway.
Jury Nullification and the Constituent Power of the People
Authors: Burns Robert P.
Published: July 2017

Nullification constitutes a small, though important, part of what makes jury trial decision-making distinctive. The increasing bureaucratization of American criminal law means that what was thought to be the exercise of ordinary jury judgment has been transformed into nullification. Understandings that locate “We the People’s” constituent power in sovereign will tend sharply to distinguish the extraordinary moment of constitution creation from the business of ordinary legality. Consequently, those understandings have difficulty imagining a nullifying jury’s doing anything other than defying the will of the people. Hannah Arendt provides an understanding of the founding of the Constitution in the prerevolutionary political practices of the colonists that offers an understanding of jury nullification as more continuous with those practices and more continuous with ordinary jury decision-making.
Forgetting history: The mnemonic consequences of listening to selective recountings of history
Authors: Stone Charles B , Gkinopoulos Theofilos , Hirst William
Published: July 2017

Our aim here is to delineate the connection between selective remembering and selective forgetting as it applies to lay historians listening to selective recountings of history. How does what a speaker remembers about a nation’s past shape what is forgotten about the nation’s past for the listener? To address this question, we will discuss psychological research demonstrating the mnemonic consequences of this selectivity with an emphasis on retrieval-induced forgetting within social settings. In particular, we highlight how selectively remembering nationally relevant, historical events may induce forgetting of related historical information for the listener, and this forgetting may not only have important implications for individual and national identities but said identities may influence both what is remembered and forgotten. We end with some concluding thoughts and areas of future research.
The lay historian explains intergroup behavior: Examining the role of identification and cognitive structuring in ethnocentric historical attributions
Authors: Bilewicz Michał , Witkowska Marta , Stefaniak Anna , Imhoff Roland
Published: July 2017

Both historians and lay people attempt to explain national histories. However, psychological research, to date, focused predominantly on the patterns of those explanations with regard to negative historical behaviors. In this article, we assess ethnocentrism of people’s explanations of both negative and positive historical behavior of ingroup members (own nation) and outgroup members (other nation). Two studies analyze how Poles explain crimes and heroic acts committed in the General Government, as well as diverse behaviors during the Warsaw Pact invasion of Czechoslovakia in 1968. The studies confirm an ethnocentric pattern of explanation: positive historical actions of ingroup members were explained more dispositionally than positive actions of outgroup members—negative historical actions of ingroup members were explained less dispositionally than negative historical actions of outgroup members. Furthermore, we found that this effect is more pronounced among individuals who highly identify with their nation. Apart from the influence of the strength of ingroup identification, we found that people who cling to structured knowledge (i.e. a high ability to achieve cognitive closure) tend to explain well-established historical facts (e.g. the Holocaust) but not little known facts (e.g. intervention in Czechoslovakia) in a more ethnocentric way.
Using the plan–do–study–act (PDSA) cycle to make change in general practice
Authors: Crowfoot Daniel , Prasad Vibhore
Published: July 2017

As new members of the team, GP trainees can provide a fresh perspective on practice systems. They are, therefore, ideally placed to enact change within practices. However, GP trainees may feel ill-equipped to suggest and deliver change to their practices. This article will explore the concept of change management using the plan–do–study–act cycle and consider how to initiate change by providing a structure to guide the process.
Varicose veins
Authors: Shekhawat Satpal Singh
Published: July 2017

Varicose veins are tortuous, widened veins in the subcutaneous tissues, most commonly found in the lower limbs. These veins have incompetent valves, causing reflux of blood leading to dilatation of veins and venous hypertension. Varicose veins are more common in women than men, and they affect nearly a third of the adult population. They are usually harmless, but are often a common cause of cosmetic concern in patients. They can cause symptoms such as aching legs, discomfort or itching over the veins, and swollen feet and ankles. There are a variety of treatments available for varicose veins and important clinical indications for referral to secondary care exist.
Recent developments in the treatment of metastatic colorectal cancer
Authors: Loree Jonathan M. , Kopetz Scott
Published: July 2017

Over the past decade there have been significant advances in the molecular characterization of colorectal cancer (CRC) that are driving treatment decisions. Expanded RAS testing beyond KRAS exon 2 was established as crucial for identifying patients who will respond to anti-epidermal growth factor receptor (EGFR) therapies and low-frequency mutations in RAS/tumor heterogeneity are gaining recognition as potential mechanisms of resistance. Despite this progress, the fact that we do not understand why left-sided but not right-sided tumors have improved outcomes following anti-EGFR therapy highlights our superficial understanding of this disease. Even with few new targeted agents receiving approval in CRC, the incorporation of next-generation sequencing into clinical decision making represents an important step forward. Biomarkers such as BRAF mutations, microsatellite instability, and HER2 amplification represent promising molecular aberrations with therapies in various stages of development, and highlight the importance of companion diagnostics in supporting targeted agents. In this review, we will discuss the importance of incorporating biomarkers into clinical decision making and regimen selection in CRC. We will particularly focus on the recent evidence suggesting an important role for tumor location in selecting first-line therapy, the importance of recent advances in biomarker development and molecular subtyping, as well as recently approved agents (regorafenib and TAS-102) and promising targeted agents that have the potential to change the standard of care.
Increasing Sexual and Reproductive Health Education Equity for Hispanics in Schools
Authors: Valenzuela-Yu Ivette
Published: July 2017

In the United States, the overall teen birth rate has been decreasing. In 1991, the teen birth rate was 61.8 births for every 1,000 teen females, but in 2014, the same overall rate decreased to 24.2 births for every 1,000 teen females. Unfortunately, this decrease has not reflected equally across all the races/ethnic groups. In 2014, the teen birth rate for Hispanics was 38 births per 1,000 teen females. The NASN is aware about the disparities on teen birth among racial/ethnical groups and has released a specific statement about the role of school nurses on the improvement of pregnancy outcomes. This article explains the cultural, linguistic, and educational barriers faced by Hispanic teens with limited English proficiency when preventing pregnancy and describes the development and implementation of a sexual and reproductive health education curriculum. The implications for school nurses will be discussed.
Post-obstructive pulmonary edema from aspirated nuts
Authors: Bashir Ahsan , Ahmad Sabina Qureshi , Silverman Joshua , Concepcion Emily , Lee Haesoon
Published: July 2017

Objectives:

Post-obstructive pulmonary edema is thought to occur from hemodynamic changes secondary to forced inspiration against the closed airway due to acute or chronic airway obstruction. We report a case of a 13 month-old boy who developed pulmonary edema from aspirated foreign body, nuts.

Methods:

He underwent emergency bronchoscopy to confirm the clinical diagnosis of aspirated nuts in the trachea and nuts were removed endoscopically. His trachea was then intubated and he was mechanically ventilated with oxygen.

Results:

He developed florid pulmonary edema early in the course with tracheal obstruction and during endoscopic removal of nuts. After removal of obstruction he was ventilated mechanically and pulmonary edema cleared rapidly.

Conclusions:

Aspirated nuts obstructing trachea can induce obstructive pulmonary edema. Early recognition of foreign body obstruction based on clinical history and its removal resolved pulmonary edema.
A proposed link between spinal epidural lipomatosis, prostate cancer and androgen deprivation therapy
Authors: Tulloch Isabel , Laban James T , Martin Andrew J
Published: July 2017

We present a patient with prostate cancer with vertebral metastases who developed spastic paraparesis secondary to spinal epidural lipomatosis (SEL) after receiving androgen deprivation therapy (ADT). We propose a link between ADT, metastatic prostate cancer and SEL.
The feasibility of delivering constraint-induced language therapy via the Internet
Authors: Pitt Rachelle , Theodoros Deborah , Hill Anne J , Rodriguez Amy D , Russell Trevor
Published: July 2017

Objective

This study is designed to determine the feasibility of the provision of an evidenced-based aphasia therapy, constraint-induced language therapy, via telerehabilitation. It describes the computer software that was developed specifically for the delivery of constraint-induced language therapy in the online environment and presents two case studies.

Methods

Two participants with chronic aphasia were assessed before and after a two-week intensive treatment block of constraint-induced language therapy delivered via Web-based videoconferencing. The group-based, dual card request game utilized in face-to-face constraint-induced language therapy was transformed into an innovative and user-friendly Web-based game – Internet constraint-induced language therapy (iCILT). Participants accessed iCILT via the Internet from their own home every weekday for two weeks. Language and quality of life measures were administered pre- and post-therapy in order to detect treatment effects. Participant satisfaction information was also recorded.

Results

Online delivery of iCILT was technically feasible and participant satisfaction was high with a number of benefits associated with telerehabilitation identified by participants. Post-treatment performance for language functioning and communication-related quality of life was variable for each participant, however improvements in naming were noted.

Conclusions

Constraint-induced language therapy delivered via telerehabilitation may be a feasible alternative to traditional face-to-face therapy for people with chronic aphasia.
Cephalosporin-Associated Hypoprothrombinemia: Case and Review of the Literature
Authors: Stork Christine , Etzel Joseph V. , Brocavich Joseph M. , Forlenza Susan
Published: July 2017

Objective:

To present a case of cefotetan-associated hypoprothrombinemia and to review the literature concerning cephalosporin-associated hypoprothrombinemia.

Data Sources:

Information was collected by conducting a MEDLINE search for cases, clinical trials, reviews, and other articles pertaining to cephalosporin use and the development of hypoprothrombinemia.

Study Selection:

Studies, cases, and letters were selected if they addressed the development of hypoprothrombinemia in cephalosporin-treated patients.

Data Synthesis:

A case of hypoprothrombinemia is described in an 82-year-old woman who received cefotetan for the treatment of a urinary tract infection. A review of the literature revealed more than 50 reported cases and multiple clinical studies evaluating this adverse effect. The postulated mechanism behind this occurrence is the inhibition of the synthesis of vitamin K-dependent clotting factors by the N-methyl-thiotetrazole (NMTT) moiety found in certain cephalosporin side chains. Risk factors associated with the development of this adverse effect include advanced age, renal and hepatic impairment, recent surgical procedures, malnutrition, and the use of H2-antagonists.

Conclusions:

Cephalosporins containing the NMTT side chain are associated with the development of hypoprothrombinemia and possibly bleeding, especially in high-risk patients.
Gentamicin Pharmacokinetics in Elderly Patients with Normal Renal Function
Authors: Koo Ji M. , Miller Donald R. , Peterson Charles D.
Published: July 2017

Objective:

To establish the pharmacokinetic parameters of gentamicin in elderly patients and to compare predicted concentrations based on the Dettli method, with actual concentrations.

Design:

Measurement of gentamicin concentrations and pharmacokinetic parameters in a consecutive patient sample with comparison to ones predicted by the Dettli method.

Setting:

Medical and surgical units in a Veterans Affairs Medical Center.

Patients:

Forty-six consecutive elderly men treated with gentamicin for documented or presumed infection and had stable, normal renal function.

Main Outcome Measures:

The following information was calculated or measured: elimination rate constant (kel), elimination half-life, volume of distribution (Vd), and peak and trough concentrations.

Results:

The mean kel (0.16 ± 0.05 h−1) was not significantly different (p=0.2) from the Dettli method prediction, and the mean Vd (0.36 ± 0.1 L/kg) was 37 percent higher than that usually reported. Actual peak and trough concentrations were significantly lower (both p<0.01) than predicted concentrations.

Conclusions:

Based on our findings, higher than recommended loading doses and longer dosage intervals may be required in the elderly. The Dettli method is useful to estimate kel in the elderly.
Nonsterile Extemporaneous Compounding: A Bibliography for the Pharmacy Practitioner
Authors: Raymond Glynn G.
Published: July 2017

Objective:

For the pharmacist to be able to practice good professional and scientific procedures, appropriate literature sources are provided to enable rational, appropriate decisions for extemporaneous compounding.

Data Sources:

The bibliography consists of articles listed from the key word “compounding” in International Pharmaceutical Abstracts.

Study Selection:

The list of references are compiled in alphabetical order according to the title of the reference in terms of generic name, the clinical condition, or the subject heading.

Data Extraction:

Many of the extemporaneous formulations are published in accessible professional pharmacy journals, including American Druggist, American Journal of Hospital Pharmacy, The Annals of Pharmacotherapy, and US Pharmacist.

Data Synthesis:

The pharmacist must determine if the referenced expiration date was determined either by chemical stability or by successful clinical experience. The assignment of an expiration date by chemical stability is the accepted standard of the pharmaceutical industry. Assigning an expiration date by clinical response does not give the clinician any quantification of chemical potency or an indication of the absence or presence of degradation products in a formulation.

Conclusions:

With extemporaneous compounding, there must not be any careless formulation of prescription products without adequate scientific and professional judgment. For this reason, pharmacists are encouraged to use the current pharmaceutical literature to enhance their professional judgment. To make pharmacists' searches of the pharmaceutical literature for extemporaneous formulations a time-efficient procedure, a bibliography is presented.
Legal Justification for Licensure of Pharmacy Technicians
Authors: Brushwood David B.
Published: July 2017

Objective:

To review the facts and legal rationale of a lawsuit in which a hospital was held liable for discharging a pharmacy technician from employment.

The hospital and the pharmacy technician previously had disagreed about several matters. The technician believed he was being discriminated against based on his need to be away from work to serve in the National Guard. On one occasion, the technician reported to work in what appeared to be a drug-impaired state. The technician subsequently was discharged from employment. He sued, contending that the discharge was in retaliation for his asserting his rights as a National Guard member. The technician won the lawsuit.

Conclusions:

Employment law bends over backward to protect employees. When an employee is not licensed, the only effective peer review is within the employment relationship. The public may not be effectively protected from harm that might be caused by employees who are not competent. Strong laws that protect employees restrict the ability of employers to oversee employee conduct. Therefore, for employees whose incompetence may pose a threat to the public, licensure provides a necessary additional level of protection.
Treatment of Cyanide and Thiocyanate Toxicity Secondary to Sodium Nitroprusside
Authors: Burke Timothy G. , Mutnick Alan H.
Published: July 2017

Objective:

To provide the reader with an update on the disposition of nitroprusside in the body and the current therapy in managing cyanide and thiocyanate toxicity.

Data Sources:

Currently available literature reports were used to provide readers with a comprehensive framework that will enable them to monitor for, prevent, and if needed, treat patients with cyanide and/or thiocyanate toxicity. Additional sources were used to provide risk factors, which enable practitioners to identify patients predisposed to such toxicities while receiving nitroprusside.

Conclusions:

The continuously changing climate in healthcare and the added visibility of pharmacologic agents in the treatment and prevention of disease have increased pressure on pharmacy departments to provide therapeutic agents that are cost-effective and at the same time result in minimal adverse reactions. Members of the healthcare professions must be able to identify situations that warrant close therapeutic monitoring to prevent extended hospital stays caused by iatrogenic diseases. Nitroprusside is a frequently used agent that can result in extended hospital stays, increased resource use, and even death caused by cyanide and/or thiocyanate toxicity. The identification of patients at risk, methods to monitor therapy, and treatments for toxicity will help reduce such reactions and provide maximal therapeutic response with minimal toxic consequences when using nitroprusside.
Changing Patterns of Resistance to Ampicillin/Sulbactam
Authors: Yasuda Sally Usdin , Kumar Princy N , Young Mary A , Timpone Joseph G , Turner Helen C , Pierce Phillip F
Published: July 2017

Objective:

To report on methods to halt the increasing resistance of gram-negative organisms to ampicillin/sulbactam.

Design:

A before-after observational design was used to evaluate susceptibility of organisms to ampicillin/sulbactam.

Setting:

A university teaching hospital.

Interventions:

An educational program regarding appropriate prescribing of ampicillin/sulbactam and restriction of the use of ampicillin/sulbactam.

Main Outcome Measures:

Antimicrobial susceptibility to ampicillin/sulbactam.

Results:

The trend in increasing resistance was halted for Escherichia coli and Enterobacter. Emerging resistance of other organisms was not observed.

Conclusions:

The trend in increasing resistance was halted by restrictions on prescribing and by providing education regarding rational prescribing of ampicillin/sulbactam. We recommend that this combination not be used empirically to treat nosocomial infections or for bacteria against which ampicillin alone is effective.
Improving Medication Compliance: A Practical Intervention
Authors: Perri Matthew , Martin Bradley C , Pritchard Franklin L
Published: July 2017

Objective:

To examine the effect of a device specifically designed to improve patient medication compliance. This device, the Counter Cap (CC), is a prescription vial closure that mechanically indicates when the bottle was last opened, presumably to take a dose of medication. The primary objective was to assess the effect of the CC on patient compliance as measured by refill behavior.

Method:

An experimental pretest-posttest control group design was used to study the effect of the CC on patient compliance. A systematic sampling technique was used to assign subjects to the experimental and control groups. Patient compliance was assessed through prescription refill behaviors measured over a six-month period (three months pre-CC and three months post-CC).

Results:

A full six months of prescription refill data were analyzed for 186 of 337 patients from 21 pharmacies. Patients in the experimental group (n = 88) demonstrated significantly improved (F = 4.44, p = 0.0366) medication compliance and less variability in the number of days of departure from the ideal compliance rate (F = 6.89, p = 0.009) over the control group (n = 98) as measured by refill behavior.

Conclusions:

The CC proved to be an inexpensive means to improve medication compliance as defined by this investigation.
Atypical Neuroleptic Malignant Syndrome Presenting as Rhabdomyolysis, Altered Consciousness, and Leukocytosis
Authors: Azaz-Livshits Tanya L , Symmer Lev I , Fraenkel Yehuda M
Published: July 2017

Objective:

To provide a clinically accurate description of an atypical form of neuroleptic malignant syndrome (NMS) induced by perphenazine, to underline the importance of early diagnosis of this atypical form of NMS, and to stimulate discussion of possible mechanisms of this adverse drug event.

Case Summary:

A 61-year-old man had received perphenazine for 5 years for treatment of schizophrenia. He presented with progressive muscle rigidity, difficulty walking, and lower back pain. He was found to be disoriented and confused with tardive dyskinesia and muscle weakness. The patient was afebrile and normotensive. Clinical workup and laboratory test results were consistent with a diagnosis of rhabdomyolysis. The patient was treated with rehydration and sodium bicarbonate. Perphenazine therapy was discontinued and the symptoms resolved within 3 days.

Discussion:

Rhabdomyolysis has been reported in patients receiving psychotropic drugs, but the frequency of the occurrence is not known. The most frequent cause of rhabdomyolysis in psychiatric patients is NMS; however, this patient had only part of the classical picture of NMS. Other cases of atypical presentation are reviewed.

Conclusions:

Muscle injury in the presence of psychotropic drugs can manifest in many different ways. This suggests a complex mechanism of injury, involving central mechanisms as well as direct injury to the muscle.
Eosinophilia Possibly Associated with Intravenous Levofloxacin
Authors: LeDuc Andrea G , Zimmermann Anthony E
Published: July 2017

Objective:

To report the first published case of eosinophilia following the administration of intravenous levofloxacin.

Case Summary:

An 84-year-old white man was admitted for community-acquired pneumonia, for which he received intravenous levofloxacin therapy. The absolute eosinophil count on admission was 120 cells/mm3 (differential 3.5%). On day 6 of admission and therapy, the absolute eosinophil count peaked at 957 cells/mm3 (differential 16.8%) and then returned to a normal value of 1.2% on day 7, one day after discontinuation of levofloxacin.

Discussion:

Fluoroquinolones are broad-spectrum antimicrobials used frequently to treat a variety of infections. A review of MEDLINE (1996-May 1999) did not yield any previous reports of eosinophilia associated with intravenous levofloxacin therapy. However, many quinolones have been associated with eosinophilia, occasionally with significant associated morbidity. This patient's eosinophilia developed within one day of initiating levofloxacin and resolved within one day of discontinuation of the drug. To our knowledge, this is the first reported case of eosinophilia related to intravenous levofloxacin therapy.

Conclusions:

The temporal relationship of events in this case suggests that levofloxacin was the cause of this patient's eosinophilia. We report this case to alert clinicians to the possibility of eosinophilia associated with levofloxacin.
Dominant hand, non-dominant hand, or both? The effect of pre-training in hand-eye coordination upon the learning curve of laparoscopic intra-corporeal knot tying
Authors: Molinas Carlos Roger , Binda Maria Mercedes , Campo Rudi
Published: July 2017

Background

Training of basic laparoscopic psychomotor skills improves both acquisition and retention of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial (RCT) was performed to evaluate the effect of different pre-training programs in hand-eye coordination (HEC) upon the learning curve of LICK.

Results

The study was performed in a private center in Asunción, Paraguay, by 60 residents/specialists in gynaecology with no experience in laparoscopic surgery. Participants were allocated in three groups. In phase 1, a baseline test was performed (T1, three repetitions). In phase 2, participants underwent different training programs for HEC (60 repetitions): G1 with both the dominant hand (DH) and the non-dominant hand (NDH), G2 with the DH only, G3 none. In phase 3, a post HEC/pre LICK training test was performed (T2, three repetitions). In phase 4, participants underwent a standardized training program for LICK (60 repetitions). In phase 5, a final test was performed (T3, three repetitions). The score was based on the time taken for task completion system. The scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). For both HEC and LICK, the group learning curves fitted better to the two-phase exponential decay model. For HEC with the DH, G1 and G2 started from a similar point, but G1 reached a lower plateau at a higher speed. In G1, the DH curve started from a lower point than the NDH curve, but both curves reached a similar plateau at comparable speeds. For LICK, all groups started from a similar point, but immediately after HEC training and before LICK training, G1 scored better than the others. All groups reached a similar plateau but with a different decay, G1 reaching this plateau faster than the others groups.

Conclusions

This study demonstrates that pre-training in HEC with both the DH and the NDH shortens the LICK learning curve.
Analysis of Adjuvant Endocrine Therapy in Practice From Electronic Health Record Data of Patients With Breast Cancer
Authors: Harrell Morgan , Fabbri Daniel , Levy Mia
Published: July 2017

Purpose

Adjuvant endocrine therapy is a long-term drug therapy prescribed to prevent recurrence of hormone receptor–positive breast cancer. Data on adjuvant endocrine therapy are reported though clinical trials, which may differ from treatment practice and outcomes in the general population of patients with breast cancer. With secondary use of electronic health record (EHR) data, we summarize adjuvant endocrine treatment practice and outcomes in real-world settings.

Methods

We analyzed treatment data derived from EHR data on 1,587 patients with stage I to III breast cancer at a National Cancer Institute–designated comprehensive cancer center to learn the frequencies of real-world adjuvant endocrine drug switches and discontinuation and to explore the potential cause for drug switches and discontinuation from medical records. We measured rates of drug use, drug switches, early drug discontinuation, adverse events, recurrence, and death. We also measured adverse events and change in menopause status as potential causes for drug switch and discontinuation.

Results

Within the study population, approximately 49% of patients were lost to follow-up or did not complete adjuvant treatment through 5 years. Fifty-two percent of patients switched to a different endocrine therapy drug during their treatment. We found that age is correlated with drug switches and that adverse events are correlated with drug switches and discontinuation. We also found that patients who switched to an alternative endocrine therapy during treatment were more likely to complete 5 years of treatment.

Conclusion

This study describes long-term adjuvant endocrine treatment in real-world settings and demonstrates the ability to leverage longitudinal EHR data to characterize oral medication treatment patterns in patients with cancer.
Breast Cancer Chemoprevention in an Integrated Health Care Setting
Authors: Nichols Hazel B. , Stürmer Til , Lee Valerie S. , Anderson Chelsea , Lee Jean S. , Roh Janise M. , Visvanathan Kala , Muss Hyman , Kushi Lawrence H.
Published: July 2017

Purpose

National guidelines encourage counseling high-risk women about pharmacologic breast cancer risk reduction. We evaluated the use of integrated health care data to identify and characterize breast cancer chemoprevention use. Chemoprevention included US Food and Drug Administration–approved use of tamoxifen and raloxifene and off-label use of aromatase inhibitors (AIs).

Patients and Methods

Using electronic medical and pharmacy records (EMRs) in the Kaiser Permanente Northern California health care system, we sampled cancer-free women age 35 to 69 years who used tamoxifen, raloxifene, exemestane, anastrozole, or letrozole from 2005 to 2013. Risk-benefit profiles were calculated for tamoxifen and raloxifene using published indices. The proportion of days covered was calculated from pharmacy records to assess adherence.

Results

Among 90 chemoprevention users (confirmed with EMR review from a sample of 371 women), 74% used tamoxifen, 11% used raloxifene, and 13% used an AI. For tamoxifen and raloxifene users, the risk-benefit index indicated 23% of women had insufficient evidence that benefits would outweigh risks. For all agents, adherence decreased from an average proportion of days covered of 75% at 1 year to 67% at 5 years. Automated EMR searches identified breast cancer chemoprevention users with 60% positive predictive value overall and 75% for tamoxifen after post hoc modifications.

Conclusion

Our study contributes to an emerging picture of breast cancer chemoprevention use in real-world settings, where evidence of net benefit is not uniform and nonadherence is common. Among breast cancer chemoprevention agents, our automated selection best performed for tamoxifen use. We also identified off-label use of AIs for chemoprevention, suggesting that expansion of risk-benefit indices to include AIs is warranted.
Tabular Versus Synoptic Reporting of Prostate Core Needle Biopsies
Authors: Renshaw Andrew A. , Mena-Allauca Mercy , Gould Edwin W.
Published: July 2017

Purpose

To compare synoptic versus tabular formats for reporting prostate core needle biopsy results. The format of a report can significantly affect the accuracy, speed, and preference with which a reader can retrieve information.

Methods

We compared the performance of 20 nonpathologists in the identification of specific information in synoptic and tabular reports using a computerized quiz that measured both accuracy and speed.

Results

Tabular formatting was significantly more accurate (97% v 93%; P = .001) and faster (mean normalized time, 0.74 + 0.40 v 0.99 + 0.52; P < .001) than synoptic formatting. The improvement in accuracy was a result of questions that involved combining results from two different biopsies (96% v 92%; P = .03). The improvement in speed was observed for both single-value questions (0.77 + 0.41 v 0.87 + 0.39; P = .03) and combination questions (0.73 + 0.40 v 1.05 + 0.56; P < .001). Data extraction from a tabular format into a structured data file using free text extraction on the basis of punctuation was 100% successful.

Conclusion

Tabular reporting of prostate needle biopsies allows significantly faster and more accurate identification of data by the user, especially when the data involve combining data from several biopsies. The tabular format does not impact the ability to create structured data files.
Randomized Electronic Promotion of Lung Cancer Screening: A Pilot
Authors: Begnaud Abbie L. , Joseph Anne M. , Lindgren Bruce R.
Published: July 2017

Purpose

Screening for lung cancer with low-dose computed tomography is endorsed by the US Preventive Services Task Force, but many eligible patients have yet to be offered screening. Major barriers to the implementation of screening are physician and system related—the requirement for a detailed smoking history, including pack-years, to determine eligibility. We conducted this pilot to determine the feasibility of lung cancer screening (LCS) promotion that would offer screening to eligible persons and patient completion of smoking history to estimate the size of the population of former smokers who may be eligible for LCS in a single health care system.

Patients and Methods

Two hundred participants were randomly selected from former smokers who were seen at the University of Minnesota Health in the past 2 years and assigned to control (usual care) and electronic promotion, stratified by age. Electronic messages to promote LCS were sent to an intervention group, including a link to complete a detailed smoking history in the electronic health record.

Results

Of 99 participants, 66 (67%) in the intervention group read the message, 24 (36%) of 66 responded, and 19 (79%) of 24 respondents completed the smoking history. Ten intervention participants and 13 usual care participants were eligible for screening on the basis of pack-year history. Four eligible participants underwent screening in the intervention group compared with one participant in the usual care group.

Conclusion

Electronic promotion may help identify patients who are eligible for LCS but will not reliably reach all patients because of low response rates. In this sample of former smokers, the majority are ineligible for LCS on the basis of pack-year history. Electronic methods can improve documentation of smoking history.