bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Therapy of Acute Myocardial Infarction: Part II. The Role of Adjunctive Medical Therapy
Authors: Jafri Syed M. , Borzak Steven
Published: November 2015

The second part of this review summarizes the role of other classes of pharmacological therapy in treatment of acute myocardial infarction (MI). The goals of pharmacological therapy are to alleviate symptoms, to stabilize hemodynamic status, and to prevent arrhythmias. These agents have been utilized primarily because of their ability to limit infarct size. Other beneficial properties may include their effects on neurohormonal activation, hemodynamics, and arrhythmias. In an individual patient, age, associated medical conditions, and hemodynamic status are important considerations in choosing a specific class of drug therapy. The beta-adrenergic blocking agents have modest effects on mortality, and they are useful when used alone and in combination with thrombolytic agents. Calcium antagonists have a limited role in acute MI. Diltiazem reduces the incidence of reinfarction in patients with non-Q MI. Oral nitrate therapy has not been shown to reduce mortality. Data from recent trials suggest that prophylactic administration of antiarrhthymic therapy is also not useful in acute MI. The role of angiotensin-converting enzyme inhibitors when administered in the acute phase of MI needs to be evaluated further. These agents are safe and well tolerated, and they offer greatest benefit when given in patients with left ventricular dysfunction.
Persistent Pulmonary Hypertension of the Newborn: Role of Nitric Oxide
Authors: Kourembanas Stella
Published: November 2015

Persistent pulmonary hypertension of the newborn (PPHN) is a common cause of respiratory failure in the full-term neonate. Molecular and cellular studies in vascular biology have revealed that endothelial-derived mediators play a critical role in the pathogenesis and treatment of PPHN. Endothelial-derived vasoconstrictors, like endothelin, may increase smooth muscle cell contractility and growth, leading to the physiologic and structural changes observed in the pulmonary arterioles of infants with this disease. On the other hand, decreased production of the endothelial-derived relaxing factor, nitric oxide, may exacerbate pulmonary vasoreactivity and lead to more severe pulmonary hypertension. Exogenous (inhaled) nitric oxide therapy reduces pulmonary vascular resistance and improves oxygenation. The safety and efficacy of this therapy in reducing the need for extracorporeal membrane oxygenation and decreasing long-term morbidity is being tested in several trials nationally and abroad. Understanding the basic mechanisms that regulate the gene expression and production of these vasoactive mediators will lead to improved preventive and therapeutic strategies for PPHN.
Massive Overdose of Cardizem CD
Authors: Terlato Robert J. , Kopec Scott E. , Aaron Cynthia K. , Laifer Lawrence I. , Becker Richard C.
Published: November 2015

Long-acting diltiazem preparations are currently frequently prescribed, and the potential for serious morbidity and mortality with an overdose can be significant. We present a case of Cardizem CD overdose in which a 22-year-old patient ingested 18.0 g, in an apparent suicide attempt. She presented within 5 hours of ingestion with a blood pressure of 80/30 mm Hg and a pulse of 80 beats/minute. Interventions included intravenous fluids, activated charcoal, atropine, calcium, dopamine, norepinephrine, glucagon, bowel irrigation with polyethylene glycol, and placement of a temporary transvenous pacemaker. Diltiazem levels were obtained, and an elimination half-life was calculated. Unique side effects of this overdose are discussed, and a treatment approach is suggested. Early and aggressive treatment is essential, and preparation for anticipated side effects should be initiated as soon as possible.
Risk Factors to Predict Renal Failure and Death in the Medical Intensive Care Unit
Authors: Ward Laurie A. , Coritsidis George N. , Carvounis Christos P.
Published: November 2015

The ability to predict outcomes based on admission criteria has important implications, both prognostically and for assessing interventions on comparable groups. Use of severity of disease scoring systems such as the APACHE II score for predicting mortality has become widespread. There is no comparable formula for acute renal failure. We prospectively evaluated 115 consecutive admissions to the medical intensive care unit to define risk for renal failure from admission data and to assess the impact of admission hypoalbuminemia levels on outcome. Diagnosis, age, serum creatinine and albumin levels, urinary electrolyte concentrations and osmolality, daily serum creatinine levels, and urine output were recorded. Admission APACHE II score was calculated. Admission hypoalbuminemia (57% of patients) was associated with both acute renal failure and death (odds ratios, 16.19 and 8.06, respectively). The Glasgow coma score distinguished between patients in whom acute renal failure developed and in those it did not. Low urine osmolality (<400 mOsm/kg) was the most significant factor in predicting mortality (odds ratio, 9.87). Mortality was lowest in the normal albumin group (2%), intermediate in the low albumin/no renal failure group (12%), and highest in the low albumin/acute renal failure group (53%). The APACHE II score was accurate in 3 of 14 deaths in the hypoalbuminemic population and in the one normal albumin patient who died. We conclude that at admission, hypoalbuminemia, urinary hypo-osmolality, and abnormal creatinine levels are predictive of acute renal failure and death, diagnosis, and mental status impact on the risk for acute renal failure. APACHE II lacks predictive value in hypoalbuminemic patients.
Pregnancy-Associated Hemolysis, Elevated Liver Functions, Low Platelets (HELLP) Syndrome: An Obstetric Disease in the Intensive Care Unit
Authors: Gilson George , Golden Pamela , Izquierdo Luis , Curet Luis
Published: November 2015

We reviewed the experience with hemolysis, elevated liver functions, low platelets (HELLP) syndrome at the University of New Mexico Hospital over the past 10 years to delineate the epidemiology and the clinical course of the disease. A retrospective chart review of a large, university-based, largely indigent, pregnant population was undertaken with attention to diagnostic features of the syndrome and maternal and infant outcomes of affected pregnancies. Comparisons were made with other large reported clinical series. Preeclampsia complicated 5.6% of deliveries in this study, and the HELLP syndrome occurred in 116 patients (0.3% of all deliveries). Epigastric pain, nausea, vomiting, and malaise usually heralded the syndrome. Signs and symptoms of preeclampsia (e.g., hypertension, proteinuria, and edema) were most often not striking at the time of presentation. The mean platelet count at diagnosis was 60 ± 25 × 103. Initial signs of hemolysis were usually minimal, although the hematocrit decreased a mean of 11.5 ± 5 vol% over the course of the disease. Moderate elevations of hepatic enzyme levels, specifically lactic dehydrogenase, were common; hyperbilirubinemia was usually mild and late. Maternal complications included disseminated intravascular coagulation, eclampsia, pulmonary edema, adult respiratory distress syndrome, and hepatic hematoma. Eight stillbirths and 7 neonatal deaths occurred (perinatal mortality, 126/1,000). HELLP syndrome is a relatively infrequent but serious development in the evolution of preeclampsia/eclampsia. Variations in onset and severity of hemolysis, hepatic dysfunction, and thrombocytopenia are common. Maternal complications and the perinatal mortality rate are high. Pregnant patients with right upper quadrant or epigastric pain and thrombocytopenia, even in the absence of significant hypertension and proteinuria, are most likely to have HELLP syndrome, rather than some other medical condition. Awareness of the variable presentations of this syndrome permit the prompt recognition and management necessary to optimize maternal and neonatal outcomes.
Generalized Paralysis in the Intensive Care Unit: Emphasis on the Complications of Neuromuscular Blocking Agents and Corticosteroids
Authors: Gorson Kenneth C. , Ropper Allan H.
Published: November 2015

Generalized weakness in intensive care unit (ICU) patients is increasingly recognized as a frequent complication and a common cause of prolonged ventilator dependency. Intravenous corticosteroids and neuromuscular blocking agents, sepsis, and multiorgan failure have been strongly implicated in the ICU paralysis syndromes, but the pathophysiology of these disorders is poorly understood. The combination of neuromuscular blocking agents and corticosteroids may induce three distinct syndromes of generalized weakness in ICU patients: acute myopathy, prolonged neuromuscular blockade, and critical illness polyneuropathy. More than one syndrome may occur simultaneously, and the distinctions may be difficult in a particular patient, but a specific diagnosis usually can be established after careful clinical, electrodi-agnostic, and histological evaluation. Acute myopathy with generalized weakness, preserved eye movements, elevated creatine kinase levels, and myopathic motor units on electromyography (EMG) have developed in asthmatics requiring neuromuscular blockers and steroids. Muscle biopsy has shown distinctive changes, with fiber atrophy, scattered necrosis, and thick (myosin) filament depletion on ultrastructural studies. Patients who have had a prolonged ICU stay or sepsis with failure to wean from the ventilator, distal weakness, and areflexia probably have critical illness polyneuropathy. EMG in these patients has demonstrated reduced or absent motor and sensory potentials with neurogenic motor units. Prolonged neuromuscular blockade most commonly has occurred in patients with renal failure who received prolonged infusions of neuromuscular blockers. Severe flaccid, areflexic paralysis with normal sensation, facial weakness, and ophthalmoparesis persists for days or weeks after the neuromuscular blockers have been discontinued. Repetitive nerve stimulation has shown a decrement of the compound muscle action potential, and it establishes a disorder of neuromuscular transmission in most patients. We critically examine the clinical, electrophysiological, and pathological features of each of these syndromes, and we summarize current understanding of the pathophysiology of these disorders and the relationship to neuromuscular blocking agents and corticosteroids.
Gas Embolism: Part II. Arterial Gas Embolism and Decompression Sickness
Authors: Wilson Mark M. , Curley Frederick J.
Published: November 2015

Gas emboli syndromes are known to occur in many different settings, and they may result in life-threatening emergencies. Venous gas embolization was discussed previously in Part I of this review. Gas emboli that gain access to the arterial circulation or that result from exposures to decreased ambient pressures in the environment are discussed in Part II. The prevalence of arterial gas emboli and decompression sickness are likely not as high as for venous gas emboli. Most cases are preventable, and prompt treatment is frequently effective. Once present, gas bubbles generally distribute themselves throughout the body based on the relative blood flow at the time, thus making the nervous system, heart, lung, and skin the primary organ systems involved. Both mechanical and biophysical effects lead to intravascular and extracellular alterations that result in tissue injury. The clinical manifestations of these disorders are varied, and a high index of suspicion in the appropriate settings will aid health care providers in prompt recognition of these problems and allow timely intervention with specific therapy. Management of arterial gas emboli and decompression sickness is similar, with a focus on hyberbaric chamber therapy and intermittent hyperoxygenation. Recompression schedules in current use have withstood the test of time. Research continues to refine our understanding of these diseases and to optimize the treatment regimens available.
Evaluation and Management of Sudden Death Survivors
Authors: Gilman James K. , Naccarelli Gerald V.
Published: November 2015

Only 20% of patients survive a cardiac arrest. Up to 80% of patients have a cardiac arrest secondary to a ventricular tachyarrhythmia. In the adult population, over 70% of the above patients have obstructive coronary artery disease; thus, coronary arteriography should be performed in all survivors of cardiac arrest. Once reversible causes have been treated, antiarrhythmic therapy is usually guided by Holter monitoring, electrophysiologic testing or both. Due to high recurrence rates on antiarrhythmic drugs, many patients are now treated with implantable cardioverter defibrillators. Although these devices appear to improve sudden death survival, long-term overall survival may not be superior to “best drug therapy.” This hypothesis is currently being tested in two prospective randomized, multicenter trials.
Comparison of Thyroid Hormone and Cortisol Measurements with APACHE II and TISS Scoring Systems as Predictors of Mortality in the Medical Intensive Care Unit
Authors: Arem Ridha , Thornby John I. , Deppe Scott A.
Published: November 2015

Thyroid and adrenal functions were evaluated in 49 consecutive critically ill, mechanically ventilated patients admitted to the medical intensive care unit (MICU) at Ben Taub General Hospital in Houston, TX. On admission, severity of illness was assessed by Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II) and Therapeutic Intervention Scoring System (TISS) scores. Thyrotropin Stimulating hormone (TSH) measured with a sensitive assay, thyroxine (T4), tri-iodothyronine (T3), T3 resin uptake, and Cortisol levels were measured on the first MICU day at 8 am, and results were assessed based on ability to predict mortality. It was shown that severe hypothyroxinemia (T4 < 3 μg/dL) was associated with a 75% mortality as opposed to a mortality rate of 19% in patients with a T4 level of 3 μg/dL or more ( p < 0.01), and a high 8 am Cortisol level (>30 μg/mL) was associated with a 56% mortality versus 0% in patients with Cortisol values less than 30 μg/dL ( p < 0.005), whereas a high APACHE II (>25) score and a high TISS (>25) score were only associated with a mortality of 47% ( p = 0.06) and 32% (NS), respectively, versus 21 and 20%, respectively, in patients with scores less than 25. Logistical regression analysis revealed that of all the variables, 8 am Cortisol level had the best predictive value of outcome, followed by T4 levels and T3 resin uptake levels. Although high Cortisol and low T4 levels used alone had a sensitivity of 56 and 75% and a specificity of 100 and 80.5%, respectively, combined low T4 and high Cortisol levels had a sensitivity of 100% and a specificity of 81.5% in predicting mortality. Very low T4 levels, due to severe illness, combined with high Cortisol levels (implying high physiological stress), are more sensitive predictors of mortality than APACHE II, TISS, Cortisol levels, or T4 levels alone, or any other combination of predictors.
Sick Euthyroid Syndrome
Authors: Farwell Alan P.
Published: November 2015

Critical illness causes multiple alterations in thyroid hormone concentrations in patients who have no intrinsic thyroid disease. These effects are nonspecific, and they relate to the severity of illness. Because a wide variety of illnesses tend to result in the same changes in serum thyroid hormone levels, such alterations in thyroid hormone indexes has been termed the sick euthyroid syndrome. These changes are rarely isolated, and they are often associated with alterations in other endocrine systems. Similar changes in endocrine function has been shown experimentally by administration of cytokines from the interleukin and interferon families, as well as tumor necrosis factor-α. Thus, the sick euthyroid syndrome should not be viewed as an isolated pathological event, but as part of a coordinated systemic reaction to illness that involves both the immune and the endocrine systems. Recovery from the illness usually results in resolution of the alterations in thyroid hormone parameters. Supplemental thyroid hormone therapy in patients with the sick euthyroid syndrome is of no benefit and is not indicated.
Ethical and Legal Issues in Intensive Care
Authors: Paris John J. , Muir J. Cameron , Reardon Frank E.
Published: November 2015

The findings of the SUPPORT study, the largest, most comprehensive and costly study ever undertaken on decision making for critically ill patients, revealed a wide ranging gap between patient preferences and physician behavior with regard to treatment decisions for seriously ill patients. The ethical issues raised by that disparity are intensified as we enter into a market-driven managed care delivery system. This essay explores recent ethical and legal developments on several emerging issues: the decision making process; DNR orders; brain death; withdrawal of treatment; physician assisted suicide; and the constraints of managed care.
Etomidate: Applications in Pediatric Anesthesia and Critical Care
Authors: Tobias Joseph D.
Published: November 2015

Etomidate is a rapidly acting, intravenous anesthetic agent. Because of its limited effects on cardiovascular function, it has generally been used for the induction of anesthesia in adult patients with compromised cardiorespiratory function. There is limited information concerning its use in children. The author presents three cases and reviews the possible applications of etomidate in the pediatric population.
The Influence of Ischemia-Reperfusion Injury on Plasma Malondialdehyde in Children Undergoing Cardiopulmonary Bypass
Authors: Fayon Michael , Lacroix Jacques , Champagne Josée , Lepage Guy , Chartrand Claude , Vobecky Suzanne , Farrell Catherine Ann , Delvin Edgar
Published: November 2015

Toxic oxygen free radicals (OFRs) are produced after ischemia-reperfusion injury, which can be observed during cardiopulmonary bypass (CPB). In a pilot study conducted in a tertiary care pediatric intensive care unit, we sought to determine plasma malondialdehyde (MDA) levels, a marker of OFR production, in children undergoing CPB, and to relate the findings to gastric intramucosal pH and PCO2 (pHi, PiCO2) and serum lactate. Thirteen nonconsecutive children (age: 56 ± 58 months) were included in the study. After induction of general anesthesia and endotracheal intubation, a tonometer nasogastric tube was positioned in the stomach; gastric pHi and PiCO2, arterial PCO2 (PaCO2), MDA, and lactate were measured 1 hour later (time 0) and 1 to 48 hours after initiation of CPB (times 1, 4, 8, 12, 16, 20, 24, 32, 40, and 48). Data for each variable were compared with baseline values for statistical significance. Free MDA levels increased by more than 50% in 11 patients (85%) and a statistically significant difference was found between the highest and the baseline free MDA concentrations (p < .0025). Low gastric pHi after the first 8 hours post-CPB was significantly associated with a late rise in MDA levels. A stepwise multivariate regression analysis showed that the highest PiCO2:PaCO2 ratio was correlated to the highest MDA level (p < .0001). A low gastric pHi later than 8 hours after CPB or a high PiCO2: PaCO2 ratio, as observed in this study, may indicate secondary splanchnic hypoperfusion with increased OFR production.
Intra-Abdominal Abscesses: Emphasis on Image-Guided Diagnosis and Therapy
Authors: Gleason Thomas G. , Pruett Timothy L. , Sawyer Robert G.
Published: November 2015

Infection of the peritoneal cavity can be divided into acute peritonitis and chronic abscess formation. While acute peritonitis is easier to diagnose and treatment is often straightforward, the diagnosis of an intra-abdominal abscess can be subtle and treatment can involve multiple diagnostic and therapeutic modalities. The advent of high-quality computed tomography and ultrasonography has revolutionized the care of these patients, and has allowed for the definitive management of these infections without open operation. We review the current techniques for the diagnosis, localization, and treatment of these serious infections, discuss important factors influencing the decision between percutaneous and operative approaches, and examine several other controversies In this challenging area.
Investigational Drug Services —A Challenge and Opportunity for Pharmacists
Authors: Rothman Jeri J.
Published: November 2015

The opportunities and challenges in providing pharmacy coordinated Investigational Drug Services (IDS) have grown tremendously in the past 10-15 years. The evolution of the Investigational Drug Service at Rush Medical Center is described. The job of an investigational drug service pharmacist is multifaceted, and goes beyond inventory control and drug distribution. Before a clinical drug trial can be initiated, federal law requires that the study be reviewed by an Institutional Review Board. The IDS pharmacist can serve as a valuable member on this committee, providing expertise on the drug therapy and assure complete and accurate information is available. A major role of the IDS pharmacist is to review or complete summary documents called investigational drug data sheets. Each study is unique, and has its own requirements for procurement, distribution, preparation, and accountability. The IDS pharmacist should utilize the existing pharmacy system to develop protocol specific procedures for handling the investigational agent. The IDS pharmacist is frequently audited by sponsors and study monitors. Computerization and technology have also played a major role in the evolution of the IDS. In today's business environment, the IDS pharmacist must also be a skillful negotiator to guarantee funding for IDS services.
Some Practical Advice on the Interchangeability of Levothyroxine Products and Drug Product Selection
Authors: Rosen David L.
Published: November 2015

This article discusses Issues concerning levothyroxine bloequlvalence and Interchangeability and provides pharmacists and other health care professionals with some practical advice on the substitution of levothyroxine and other drug products.
Parenteral and Enteral Nutrition Support Service (NSS): A Multidisciplinary Approach in a Community Hospital
Authors: Vohra Saifi , Wang Ying
Published: November 2015

Nutritional support for hospitalized patients is recognized as an important medical therapy. Appropriate nutritional support can promote the patient's maximal response to medications, resistance to sepsis, and recovery from injury. Nutritional support service can be performed by a multidisciplinary team consisting of physicians, registered dietitians, registered nurses, and registered pharmacists. A comprehensive protocol has been developed to guide the nutritional support service. This review summarizes the guidelines of our protocol.
Antidepressants in the Treatment of Chronic Pain
Authors: Jackson Cherry W.
Published: November 2015

Antidepressants have been successfully used for chronic pain syndromes for approximately 30 years. One theory is that analgesic action is secondary to the antidepressant effects of the medications. Placebo-controlled trials have documented that antidepressants treat neuropathic pain, musculoskeletal pain, chronic pain, and cancer pain. The most frequently studied antidepressant for pain is amitriptyline. Other antidepressants that have shown analgesic activity include imipramine, citalopram, paroxetine, nortriptyline, desipramine, and mianserin. Fluoxetine and trazodone have not been shown to successfully treat pain syndromes. Venlafaxine, a new antidepressant, most recently was shown to have antidepressant activity in fibromyalgia. More studies need to be done with newer antidepressants to confirm their place in treating pain syndromes.
A Perspective on the Use of Sustained Paralytic Therapy in Critically Ill Patients
Authors: Woodford Ginger A. , Skledar Susan J. , Hess Mary M.
Published: November 2015

While the patterns of use of neuromuscular blocking agents (NMBAs) in critically ill patients have undergone changes over the past decade, NMBAs are still used in the intensive care unit to facilitate mechanical ventilation. Prior to the initiation of neuromuscular blockade (NMB), clinicians should confirm that nonpharmacologic and pharmacologic strategies have not alleviated the need for NMB therapy. Recommended agents for use are pancuronium or vecuronium in hemodynamic instability.17 In patients receiving NMB therapy, the FDA recommends and clinical studies support an improved outcome with the use of peripheral nerve stimulation monitoring. There continues to be a need to provide education to health care clinicians regarding the dosing, monitoring, and unpredictable effects of NMB therapy.
Does the Intervention of Identifying Homeless Clients Who Should Receive Lipid Altering Therapy Decrease the Occurrence of Cardiovascular Events?
Authors: Dodds Elizabeth S. , Oberg Kristin C.
Published: November 2015

One hundred and six homeless clients were identified between August 1, 1997 and March 31, 1998, via a simple medication profile screening of individuals who could potentially benefit from risk factor modification with lipid altering therapy. Medication profiles were reviewed for homeless clients housed at the New England Shelter for Homeless Veterans. Clients on lipid altering therapy (Group I) were compared to those not on lipid altering therapy (Group II) but who might benefit from therapy based on a review of their drug regimen. Following an interview with the client, an intervention letter was sent to the health care practitioner identifying those individuals who might benefit from lipid altering therapy. Descriptive statistics described client demographics and the Fisher's Exact Test compared the occurrence of cardiovascular events between the two groups. Interviews were conducted in 21 clients. Only 4 practitioners responded to the intervention letter. All Group I clients suffered at least 1 cardiovascular event during the study period. However, the occurrence of cardiovascular events was greater in Group II (not significant). Although it was easy to identify clients for lipid altering therapy, the challenge of provision and continuity of appropriate therapy to reduce cardiovascular events in this population remains.
Alternative Therapeutic Approaches to the Treatment of Arthritis
Authors: Resman-Targoff Beth H.
Published: November 2015

Alternative therapies are widely used for the treatment of arthritis. Some examples of these are acupuncture/acupressure, animal venoms, copper bracelets, dimethyl sulfoxide, herbal products, magnets, and nutritional therapy. Many products used for alternative therapies are not regulated in the United States and can vary greatly in their content. They may contain toxic contaminants, induce allergic reactions, or interact with prescription medications. Much of the support for their use is based on testimonials and poorly controlled trials. The Office of Alternative Medicine was established under the National Institutes of Health to promote study and evaluation of unconventional therapies.
Internet Connections for Arthritis and Other Rheumatic Diseases
Authors: Carlstedt Bruce C.
Published: November 2015

Access to the Internet provides us with an incredible amount of information about the rheumatic diseases. There are numerous arthritis organizations, professional associations, educational institutions, research and professional journals and patients with Web sites devoted to the rheumatic diseases. Some are reviewed and listed here.
Pathophysiology and Treatment of Hepatitis C Infection
Authors: Krick Stacie E. , Gwinn Kimberly A. , Morgan Douglas R.
Published: November 2015

The pathophysiology and treatment of hepatitis C infection, formerly known as non-A, non-B hepatitis, are discussed. The worldwide prevalence is approximately 1%. The majority of patients infected with hepatitis C virus will develop chronic infection, leading to cirrhosis in a significant percentage. Transmission of hepatitis C is primarily through parenteral routes. Those who use intravenous drugs or received blood transfusions prior to 1992 comprise the major risk groups for the infection. The progression of chronic hepatitis C infection is insidious with possible progression to an inflammatory hepatitis developing within 5–10 years, cirrhosis in 10–20 years, and hepatocellular carcinoma in 20–30 years. Combination therapy with interferon alpha-2b and ribavirin is currently the treatment of choice. Therapy for hepatitis C continues to evolve with newer forms of interferon and HCV antivirals under development.
GERD in Neonates and Pediatrics: Use of Omeprazole
Authors: Cuthrell Corey , Rubino Chris , Ransom J. Laurence , Gal Peter
Published: November 2015

Gastroesophageal reflux is a common disorder found in infants and children. Treatment modalities include conservative measures, medications, and surgery. Histamine2 receptor antagonists alone or in combination with prokinetic agents are the first-line medical options, but the addition of prokinetic agents or a change to proton pump inhibitors is reasonable. Corrective fundoplication is reserved as the last-line treatment strategy. The use of proton pump inhibitors such as omeprazole for acid suppression has been studied in children, and a stable, extemporaneous formulation can be prepared. Despite limited data in pediatrics, omeprazole appears to be safe and effective for treating reflux and for decreasing the need for fundoplication.
INDUSTY - DABBLE IN EDUCATION BUT CAREFULLY
Authors: Uberoi N.K.
Published: November 2015

The present paper examines the possibilities for attractive methods of financing education in India without being dependent on the Government. To respond to industry could only be one aspect. Unfortunately, in these days of resource crunch the thinking of universities, governments and the press is giving enough proof of education tilting towards industry's requirement at the cost of the original and basic function of academy which is knowledge and learning; training being its outcome.
BUSINESS AND INFORMATION SYSTEMS THE QUALITY LINKS
Authors: Malik Kamna
Published: November 2015

The paper explores the technology and their use that lend themselves to most effective use of Information Technology (IT) in helping organisations improve continuously. TQM tools by themselves are not enough, nor is process re-engineering. Adding a third dimension of IS makes all the three very powerful.
A Model for Faculty Development for Management Schools
Authors: Uberoi N.K.
Published: November 2015

In Management Education, faculty, development is a neglected area. The boom in management education in the last few years has led to setting up of different kinds of B-schools. The core faculty have to tackle complexities of management education. No precise guidelines exist about the profile of teachers of management schools. The faculty development has to be related to the needs of the individual teacher and those of the institution and industry. The author presents a model for faculty development for management schools.
Concentrate on Industry, Give Some Money and Subsidies to Agriculture Will this attitude Revive Industrial Growth
Authors: Singh Rakesh
Published: November 2015

The article analyses the budgetary allocations for agriculture and rural development and suggests what needs to be done to enhance agricultural growth. There is a dire need to increase investment in agriculture so that the vicious circle trap can be broken up and economy could achieve high agricultural growth rate in real terms. The major stumbling block in agricultural development has been the falling agricultural investment since the mid eighties. It is thus necessary to reverse the trend.
Presence of Friday Effect in the Indian Stock Market
Authors: Mishra DR. Bishnupriya
Published: November 2015

Identification of the day of the week effect in the capital market can be of immense help for an investor to reap handsomely from investment in the stock market. Various studies undertaken on capital markets of the developed countries have identified ‘the Monday effect’. “Is there any such effect in the Indian capital market?” To find an answer to this question is the motivating factor for our study. This study has been done by considering two different indices and is divided into three sections. Section I deals with the literature pertaining to earlier studies undertaken by different researchers. Section II discusses the methodology of our study and section III elaborately provides the results obtained. Use of vital non parametric test and Dunn's multiple pair comparison test infer the presence of seasonal effect, i.e., returns on Friday are the highest in the Indian capital market.
Snakes and Ladders of Success
Authors: Kumar Sharat
Published: November 2015

Dean, OLP, Institute of Management Technology, Ghaziabad.
Small Scale Industries: Threats And Challenges Aarti Deveshwar
Authors: Deveshwar Aarti
Published: November 2015

The Small Scale Industries sector has emerged as a vibrant and dynamic sector of Indian economy which contributes nearly 40% of the total industrial production and over 34% of the national exports. At present this sector is providing employment to over 250 lakh people. It also acts as a nursery for promoting entrepreneurial talent and as a catalyzer of industrial growth through a wide network of more than three million units in the country, accounting for about 95% of the total industrial units in the country. The world trading system is constantly offering new challenges as well as creating new threats; as tariffs and quotas are removed, new technical norms, sanitary and phyto-sanitary measures and anti-dumping actions are rendering more challenges for businesses in emerging economies. The WTO is bound to impact every economic activity- the small- scale-sector is no exception. WTO Agreements have thrown up a variety of threats and challenges. In its wake the SSIs lost the shield of protective policies and have been exposed to the onslaught of large organizations and international competition. The strategy to survive and flourish will have to begin with a clear understanding of the nuances of the changes that are taking place, not only domestically but globally. An attempt has been made in this paper to study the performance of SSIs since 1995 when WTO came into existence and to identify the various problems which the SSIs are facing in the changing environment and to suggest strategic imperatives to make them competitive in present scenario.
Organic Farming
Authors: Ghulati Suraj Prakash
Published: November 2015

Organic Farming is recognized by FAO as suitable for sustainable agriculture. The reasons for adopting Organic Farming world wide are discussed in the paper. It is explained how in the Indian context Organic Farming is most suited for small and marginal farmers. A brief description is also given of the various Organic Farming protocols. Economic implications and export potentials are also discussed.

Exponents of Organic Farming have given it various names such as Biological Farming, Regenerative Farming, Low Input Sustainable Agriculture (LISA) Low External Input Sustainable Agriculture (LEISA). Steiner's Biodynamic Farming. Mollison's ‘Permaculture’, Fukouka's Natural Farming and late Prof D. Dabholkar's ‘Paryag Pariwar’ and the Vedic based Homa Farming. The Underlying principle behind all of them is providing integrated efforts to maintain the agro eco-system in a sustainable manner.

The FAO's Codex Alimentarius Commission (June 1999) stated “Organic Agriculture is a holistic production management system which promotes and enhances agro ecosystem health, including biodiversity, biological cycles and soil, biological activity’ The founder of Cuba's Organic Farming Association has beautifully described Organic Farming. ’Many people think that farming is a simple and mundane act, but they are wrong. It is the soul of any great culture, because it requires not only a great deal of accumulated knowledge but also putting this knowledge to use every single day. Knowledge of the weather, the soil, plants, animals, the cycles of nature: all of this is used everyday by a farmer to make decisions that have to be made in order to produce the food that we eat. To us it may seem like food comes from a factory, but in reality it comes from a culture that generations have created to produce that food”.
Information Integrity Adding Value to Corporate Assets
Authors: V. Mandke Vijay
Published: November 2015

Information Integrity is dependability and trustworthiness of information. Its determinants are accuracy, consistency and reliability of information. With the availability of process data and information on current basis, business organizations are getting recognized to be “open systems”. This makes for business activity emphasizing “information” and modeled as multistage decision process based business IS. Due to ever present external and internal system environmental factors, this business IS is impacted by uncertainty at all stages of decision-making from setting operable business goal to undertaking customized planning & design for generating alternatives for evaluation and final selection of flexible information decision for control implementation for satisfactory service to the recipient (customer-external as well as internal). This results in information errors through the entire supply chain and leads to loss of Information Integrity. If business IS is to originate and process information efficiently and economically, that is if the decision process - that the IS is - is to deliver information decision as output so that recipient achieves maximum information use for the decision objective at hand (and this IS must do if business were to be competitive), then it is fundamental that the information, which constitutes the bottleneck resource and, hence, a product, is with integrity. In other words, Information Integrity is the critical factor in controlling the quantum and economy of originating and processing information for use, i.e., for adding value to the corporate assets through strategic and competitive advantage in complex and changing business environment
Achieving Integrity in the System Design: Information Integrity View
Authors: Mali M.S.
Published: November 2015

The drivers for currently practiced system design process model are globalization, international competition and changing customer expectations. The product of system model is standard and its origin is the high volume mechanical manufacture. It comprises physical work systems, which emphasize material and energy processing. This model is insensitive to customer requirements of local market factor based on individual situations and its main concern is that information system accesses, communicates, process and distribute the already generated information. This will attend only to the 'exactness' aspect of information requirement. Origination of information and information processing for decision-making is taken as a costless activity, which makes for system objectives as operational optimization and cost efficiency.
Leverage of Knowledge for the Indian Banking Sector
Authors: Singh R.P.
Published: November 2015

The banking system is undergoing drastic changes at technological level to ensure a better role in the emerging knowledge economy of India. The concern for quality has become vital and it has increased dynamism and competitiveness in the economy. For a service industry like bank, the issue of quality is more crucial due to intangible, personal and varied nature of services. The commercial banks are incorporating technological changes like remote banking (ATM, phone, electronic, collaboration and mobile banking), plastic money, BPR, etc.

The developments in information technology have opened new vistas for creativity and widened its space. The world has moved from data processing (DP) era to IT and information management era, then further to networking era (with a human requirement of better networking intelligence) and now to bio-informatics, bio-electronics and human computing/informatics. Knowledge management is critical to the banking services with frequent and diversified human contact at both deposit and withdrawal stages.
Reinventing Government Services Through Knowledge Management: Prospects In The Irrigation Services Sector
Authors: Thomas Manoj T
Published: November 2015

The paper looks at the possibilities of improving quality of government services through knowledge management interventions. This is specifically studied in the case of the irrigation services, which are currently perceived to be lacking in several aspects of effectiveness. The paper initially tries to understand the concept of knowledge management from literature as applicable to government systems, based on which a framework for analysing knowledge management in the canal irrigation system have been developed. Through a study of the processes of large canal irrigation systems, the paper analyses the nature of knowledge and knowledge management systems that are essential for the effective functioning of the system. Using a framework based on the relationship between the users and repositories of knowledge, the nature of knowledge management requirements for a canal irrigation system are elaborated. The tentative findings are that in the case of government services, knowledge management can provide a basis for smooth interactions between the different stakeholders including the bureaucracy and the beneficiaries. The paper proposes that many of the current problems besieging large canal irrigation systems can be partly addressed through focused knowledge management initiatives and provides a roadmap for this process.
Management Case: The Tale of Three Union Presidents
Authors: Justus T Frank Sunil , Ramesh M.
Published: November 2015

The case relates to a chemical company engaged in the manufacture of chemicals with a turnover of Rs. 500 crores. The company has gone through three trade union presidents each with his own style of working. To start with, the trade union was a non-political organization not influenced by any external pressures. Ravikumar as the trade union President has rendered commendable service to the workers, he is quite popular with all the employees and looks forward to become the President of the trade union sixth time in the Silver Jubilee year of the company. However, Anton became the President in the pre-jubilee year as there was nobody to contest the elections. There is unfortunate confrontation for which Ravikumar alone was not responsible. Bala becomes the next elected trade union President as Ravikumar does not contest the elections. The case leads several issues for discussion as to why Anton and Bala failed as union leaders and if the trade union leadership style is responsible for management to vary its approach.
Organizational Culture Manifesting in Employees Personal Variables: A Study of Associates of Delhi Metro Rail Corporation (DMRC)
Authors: Lather Anu Singh , Mohan Sangeeta
Published: November 2015

The main objectives of this study have been to determine the relationship of cultural variables with job satisfaction and stress, and also to see the effects of cultural variables on job satisfaction and stress. In order to complete the study a sample comprising 100 associates of Delhi Metro Rail Corporation was selected. The sample consisted of executives and nonexecutives. The study focuses on the various dimensions of organizational culture and their interrelationship with job satisfaction and job stress. Pearson's correlation has been applied to study interrelationship between organizational culture and job satisfaction, cultural variables and also stress. The results reveal that there is a significant negative correlation between power orientedness and job satisfaction to a significant level. At the same time, the study has further revealed a significant positive correlation between organizational risk-taking and stress. Regression was applied to see the effect of power-orientedness on job satisfaction. The study shows a significant positive effect of organizational risk-taking on stress.
The ROI (Return on Investment) of Career Development: A Case Study
Authors: Burkett Holly J.
Published: November 2015

Trends such as a changing workforce with greater diversity, a shrinking leadership pipeline, increased globalization, and rapid technological advances are driving organizations to take proactive steps for career development and talent management. To accelerate the development of leaders, organizations must carefully select development methods and invest development dollars wisely. In fact, senior executives are continuing to push for more accountability with human resource expenditures given the rising costs of these solutions and the intensive competition for the budgets associated with them. To that end, many best-practice organizations have developed balanced evaluation criteria, up to and including return on investment, to gauge the effectiveness of leadership development programs. This case study shows how the ROI process was used to evaluate the impact of a career development initiative implemented as a pilot talent management strategy for increased efficiency in a dynamic manufacturing environment. Results showed a positive link between participants’ on-the-job application of learned skills/knowledge and desired business results. Findings from this study support research showing that successful career development efforts must be implemented with a systems view that occurs in the context of ongoing, real-time work initiatives that are closely tied to strategic business goals. Critical success factors that have implications for HR professionals seeking to develop value-added career development solutions include: beginning with a thorough needs assessment; securing support and involvement from senior management; linking efforts to strategic objectives; integrating continuous evaluation processes; involving line managers in programme design; and piloting the programme before launch.
Managing Automobile Supply Chain for Competitiveness: The Indian Scenario
Authors: Sharma Vikram , Sahay B.S.
Published: November 2015

In the wake of increasing competitive environment, supply chain management (SCM) practices have been adopted by organizations the world over to improve their operational performance and profits. But the results have been mixed. While in some cases effective implementation of SCM practices led to improvement in performance matrices, in others positive results could not be achieved. This research is intended to study the impact of implementing supply chain management practices on competitive potential of Indian automobile industry as this industry has taken the lead in adopting SCM practices in Indio. From the research, it is found that three SCM practices, namely, customer service employee training, improving production processes, and maintaining central information database for supply chain hove positive correlation with the overall competitive potential. Moreover; two SCM practices, namely, customer service employee training and on-site suppliers supplying standardized ports con have significant positive relationship with cost saving and return on assets (ROA) factor of competitive potential. It is well known that quality is no more about quality of product only; quality of information, quality of material flow, and quality of relationships assume high importance in contemporary globally competitive environment where both product life cycle and manufacturing cycle time are reducing at a faster rate than ever before. This study also brings out some SCM practices that significantly affect quality of information, quality of material flow, and quality of relationships in the Indian automobile supply chains.