bluuebunny/crossref_metadata_2025 huggingface dataset:
Switched sliding mode approach for motion control systems with friction
Authors: Fang Shipeng , Hu Changhua , Hu Xiaoxiang , Zhang Zhengxin
Published: May 2017

The chattering and offset phenomena, which may lead to acceleration disturbances and deteriorate control performance, are the main deficiencies caused by switching signal and mismatched uncertainties when the sliding mode control method is used for motion control systems with friction. The need is highlighted for simultaneous chattering suppression and mismatched uncertainties attenuation of sliding mode control. In this article, a switched sliding mode control method is proposed which uses three sliding surfaces to divide the error state space into three subspaces. Using different sliding mode controllers when error system state is located in different subspaces, the asymptotically stable of motion control system is guaranteed under friction and uncertainties (including matched and mismatched). In addition, through designing proper switching gain for each sliding mode controller, the control law of switched sliding mode control can be continuous. This means that the chattering phenomenon caused by switching gain will be suppressed effectively. For improving the tracking performance, a switched sliding mode control–based composite controller incorporating a LuGre model–based adaptive approximator is further presented. The predicted friction of LuGre model is used for friction compensation based on switched sliding mode control. Experimental results based on three different controllers verify the effectiveness of the proposed method on a test-bed.
Tapping into the information landscape: Refugee youth enactment of information literacy in everyday spaces
Authors: Lloyd Annemaree , Wilkinson Jane
Published: May 2017

The development of information literacy and learning practices in everyday spaces is explored.

Data for the study was collected using photo voice technique. Data analysis was conducted using photos and analysis of group transcripts. Participants describe how they tapped into social, physical and digital sites to draw information in the process of (re) forming their information landscapes, building bridges into new communities and maintaining links with family overseas. Media formats were identified according to their appropriateness as fit for purpose, suggesting that the enactment of information literacy was agile and responsive to need at the moment of practice. The results indicate that everyday spaces provide opportunities to develop information literacy practices, which support informal learning. Findings of the study conclude that information literacy is played out in a series of digital, vernacular and visual enactments, which shape the information landscape.
Compositional data analysis for physical activity, sedentary time and sleep research
Authors: Dumuid Dorothea , Stanford Tyman E , Martin-Fernández Josep-Antoni , Pedišić Željko , Maher Carol A , Lewis Lucy K , Hron Karel , Katzmarzyk Peter T , Chaput Jean-Philippe , Fogelholm Mikael , Hu Gang , Lambert Estelle V , Maia José , Sarmiento Olga L , Standage Martyn , Barreira Tiago V , Broyles Stephanie T , Tudor-Locke Catrine , Tremblay Mark S , Olds Timothy
Published: May 2017

The health effects of daily activity behaviours (physical activity, sedentary time and sleep) are widely studied. While previous research has largely examined activity behaviours in isolation, recent studies have adjusted for multiple behaviours. However, the inclusion of all activity behaviours in traditional multivariate analyses has not been possible due to the perfect multicollinearity of 24-h time budget data. The ensuing lack of adjustment for known effects on the outcome undermines the validity of study findings. We describe a statistical approach that enables the inclusion of all daily activity behaviours, based on the principles of compositional data analysis. Using data from the International Study of Childhood Obesity, Lifestyle and the Environment, we demonstrate the application of compositional multiple linear regression to estimate adiposity from children’s daily activity behaviours expressed as isometric log-ratio coordinates. We present a novel method for predicting change in a continuous outcome based on relative changes within a composition, and for calculating associated confidence intervals to allow for statistical inference. The compositional data analysis presented overcomes the lack of adjustment that has plagued traditional statistical methods in the field, and provides robust and reliable insights into the health effects of daily activity behaviours.
Nurses’ Experiences in a Turkish Internal Medicine Clinic With Syrian Refugees
Authors: Sevinç Sibel
Published: May 2017

Introduction: The increasing flow of Syrian refugees to Turkey, coupled with their extended stay, highlights the need for culturally competent health care, which includes nursing interventions. Purpose: The purpose of this study was to describe the experiences of nurses who provide care for Syrian refugees in internal medicine clinics in a hospital located in Turkey. Method: This descriptive study was based on qualitative content analysis using an inductive approach and involved discovery and description of the data. The study sample consisted of 10 nurses who work at the internal medicine clinic of a State Hospital in Turkey. Data were collected using semistructured interviews. Results: Three themes with related subthemes were derived from the data. Nurses who participated in the study experienced: (a) Nurses found communicating with Syrian refugees and their families difficult in the clinic. (b) Nurses observed and experienced differences and similarities in caring for Turkish and Syrian patients. (c) Nurses expressed and displayed compassion toward Syrian refugees during the caring process. Conclusion:In order for nurses to provide the best care for Syrian refugee patients, it is important to identify cultural caring behaviors observed by nurses in the promotion of culturally congruent nursing and health care.
Finding Theory–Method Fit: A Comparison of Three Qualitative Approaches to Theory Building
Authors: Gehman Joel , Glaser Vern L. , Eisenhardt Kathleen M. , Gioia Denny , Langley Ann , Corley Kevin G.
Published: May 2017

This article, together with a companion video, provides a synthesized summary of a Showcase Symposium held at the 2016 Academy of Management Annual Meeting in which prominent scholars—Denny Gioia, Kathy Eisenhardt, Ann Langley, and Kevin Corley—discussed different approaches to theory building with qualitative research. Our goal for the symposium was to increase management scholars’ sensitivity to the importance of theory–method “fit” in qualitative research. We have integrated the panelists’ prepared remarks and interactive discussion into three sections: an introduction by each scholar, who articulates her or his own approach to qualitative research; their personal reflections on the similarities and differences between approaches to qualitative research; and answers to general questions posed by the audience during the symposium. We conclude by summarizing insights gleaned from the symposium about important distinctions among these three qualitative research approaches and their appropriate usages.
Alteplase: A Tissue Plasminogen Activator for Acute Myocardial Infarction
Authors: Zeller Frederick P. , Spinier Sarah A.
Published: May 2017

Alteplase is a human tissue plasminogen activator (t-PA) produced by recombinant DNA technology. It is a relatively fibrin-specific thrombolytic agent, used primarily to lyse coronary artery clots. It has proven effective in the treatment of acute myocardial infarction (AMI). Despite continuous reevaluation of pharmacokinetic parameters for t-PA, limited distribution and clearance data mandate administration of t-PA as a continuous infusion. Tissue plasminogen activator is eliminated primarily by hepatic metabolism with an elimination half-life of five to ten minutes. Plasma levels show great interindividual variation but correlate with infusion rate and decrease in fibrinogen level. The current recommended dose is 100 mg administered as a 10-mg iv bolus followed by a continuous infusion over three hours. However, 40-150 mg has been used in clinical trials. The compound has undergone extensive testing, comparing it with placebo and streptokinase (SK), and combining it with angioplasty and coronary artery bypass surgery. Tissue plasminogen activator is effective at opening clotted coronary arteries in approximately 70 percent of AMI patients and has been shown to be approximately twice as effective as SK in one U.S. trial. Although there is considerable evidence of efficacy with t-PA, data evaluating the influence of t-PA on mortality are limited, but suggest a reduction to five percent. Currently, thrombolytic therapy is indicated for patients experiencing a transmural AMI with onset of symptoms within three to six hours before presenting to the emergency room. Active internal bleeding or conditions predisposing to serious hemorrhage are contraindications to thrombolytic therapy. In general, there are few side effects with t-PA, the most common being bleeding localized to the catheterization site. Alteplase is approved for administration in AMI. From data generated thus far, we feel this new drug will be a valuable addition to the hospital formulary and will replace streptokinase as the intravenous thrombolytic agent of choice for treatment of AMI.
Pleural Effusions: Pathophysiology and Management with Intrapleural Tetracycline
Authors: Oszko Michael A.
Published: May 2017

Chronic or recurrent pleural effusions are a consequence of a variety of disease states and may produce significant pain or discomfort in a patient. Both surgical and pharmacological attempts to control pleural effusions have been tried, with moderate success. This article reviews the pathophysiology of pleural effusion and the role of intrapleural tetracycline in its management.

Irritating chemicals, when instilled into the pleural space, are known to produce adhesion of the pleural membranes. Tetracycline has been shown in both animal and human studies to be effective in preventing the recurrence of a pleural effusion while producing only minor side effects, such as fever and pleuritic pain. Studies involving tetracycline in treating pleural effusions are reviewed, and guidelines for the preparation and administration of intrapleural tetracycline are presented.

Because of its efficacy, low toxicity, ease of preparation, ready availability, and low cost, tetracycline deserves strong consideration as a first-line agent in the management of recurrent pleural effusions.
Single-Dose versus Traditional Therapy for Uncomplicated Urinary Tract Infections
Authors: Zhanel George G. , Ronald Allan R.
Published: May 2017

In the treatment of uncomplicated urinary tract infection, single-dose therapy has appeared to be as efficacious as traditional 7-14 day therapy in women with cystitis without renal involvement. Current localizing techniques to differentiate between lower- and upper-tract disease are inadequate for routine clinical practice. As a result we have proposed that failure of cure with single-dose treatment may be the most specific test available to diagnose renal infection. Most of the published data on single-dose therapy involves treatment with either amoxicillin or trimethoprim-sulfamethoxazole. Single-dose therapy offers advantages over traditional therapy, including improved compliance, reduced adverse effects, and decreased cost. Appropriate patient selection is critical if the outcome of single-dose therapy is to be effective.
Comparative Dissolution Performance of Internationally Available Piroxicam Products
Authors: Barone Joseph A. , Lordi Nicholas G. , Byerly Wesley G. , Colaizzi John L.
Published: May 2017

Piroxicam is a widely used nonsteroidal antiinflammatory drug available worldwide under various trade names by several manufacturers. Only one brand of piroxicam (Feldene) is currently marketed in the U.S., and the United States Pharmacopeial Convention established an official dissolution requirement for piroxicam in 1985. The purpose of this study was to evaluate and compare the dissolution performance of several internationally available piroxicam products using the United States Pharmacopeia (USP) dissolution test for piroxicam capsules. Of 25 brands of piroxicam capsules evaluated, 72 percent of the brands failed to meet the USP requirement, several by a wide margin. Although there is no specific USP dissolution test for tablets, the test for capsules was applied to five different brands of piroxicam tablets, and 80 percent of the tablet brands tested failed to meet the USP requirement. Although comparative bioavailability studies would be required to establish any definitive relationship between dissolution test performance and bioavailability, the failure of most of these products to meet the USP requirement for dissolution indicates formulation differences that could result in altered bioavailability. The substantial differences in dissolution performance observed among the piroxicam oral dosage forms tested have implications concerning the equivalency and standards of multisource products available on the international market, and should be taken into account by health care providers worldwide.
Severe Hypersensitivity Reaction upon Rechallenge with Trimethoprim-Sulfamethoxazole in a Patient with AIDS
Authors: Arnold Patricia A. , Guglielmo B. Joseph , Hollander Harry
Published: May 2017

A patient with acquired immunodeficiency syndrome (AIDS) developed rash, fever, neutropenia, and elevated liver function tests during an initial course of trimethoprim-sulfamethoxazole (TMP-SMX) therapy. Upon reexposure to the drug, the patient experienced a severe anaphylactoid reaction associated with pulmonary edema and rhabdomyolysis. Reactions associated with TMP-SMX rechallenge in this patient population have been previously reported but have not been associated with this degree of severity. TMP-SMX therapy should be instituted with extreme caution in patients with AIDS who have demonstrated a prior hypersensitivity reaction to the drug.
Establishment and Evaluation of a Serum Cholesterol Monitoring Service in a Community Pharmacy
Authors: Einarson Thomas R. , Bootman J. Lyle , Mcghan William F. , Larson Lon N. , Gardner Marie E. , Donohue Michael
Published: May 2017

A clinical pharmacy service providing blood cholesterol testing and consultation was implemented in a community pharmacy. In this pilot study, 27 patients each paid $10 to have a serum cholesterol determination. All subjects completed a questionnaire to determine attitude toward such a service, intention to use it in the future, and willingness to pay for its use. A posttest patient satisfaction questionnaire was completed after blood-level results were reported and discussed with the patient.

All subjects stated that they were strongly in favor of such a service, that they would use it, and that they would pay an average of $11.60 for the test. On the posttest questionnaire, patients expressed strong satisfaction with various aspects of the service, and the amount that they were willing to pay increased significantly to $14.35.

It is recommended that community pharmacies implement such patient-oriented services.
Somatostatin and Octreotide: Literature Review and Description of Therapeutic Activity in Pancreatic Neoplasia
Authors: Longnecker Stephen M.
Published: May 2017

The somatostatins represent endogenous substances that serve a diversity of functions in the body. These activities are just beginning to be understood and could have major implications in the treatment of human disease. Their chief pharmacologic activities lie in the modification or modulation of protein hormone synthesis of the gastrointestinal system; a great many other systems may be involved as well. Since the discovery of the therapeutic potentials of naturally isolated somatostatins, attempts have been made to design newer analogs more conducive to practical use. Such an example is long-acting somatostatin analog octreotide. Literature has recently begun to appear describing the therapeutic activities of this and other similar compounds and the first steps to understanding their clinical pharmacology are being taken. Surprising activity has been found in the palliative treatment of a wide variety of formerly resistant gastrointestinal syndromes and endocrine tumors. These activities may have considerable future impact on the treatment of disease involving hormonal imbalance or inappropriate secretion.
Issues with Antihypertensive Therapy: Safety Perspectives
Authors: Jackson Eric A.
Published: May 2017

The benefits of treating hypertension have been documented by several long-term studies that have shown a decreased incidence of morbidity and mortality associated with stroke, left ventricular failure, and renal insufficiency. With the large number of antihypertensive drugs currently available, several safety factors need to be considered when initially choosing a regimen so as not to adversely influence the potential benefits of blood pressure control. Antihypertensive agents should be chosen based on their hemodynamic profile, the absence of adverse metabolic effects and subjective side effects, and the presence of beneficial effects on the patients' quality of life. Thiazide diuretics and beta-blocking agents have often been recommended as initial therapy in patients with mild to moderate hypertension. However, thiazide diuretics may be less desirable in certain patients because of their effects on lipids, potassium, and glucose tolerance; beta-blocking agents are not ideal for some patients because of their effects on lipids, exercise tolerance, and overall quality of life. The angiotensin-converting enzyme inhibitors, selective alpha1-blocking agents, and calcium channel blocking agents may be more appropriate for initial therapy of hypertension in many patients.
Treatment of Severe Cryptosporidium-Related Diarrhea with Octreotide in a Patient with AIDS
Authors: Katz Michael D. , Erstad Brian L. , Rose Cathryn
Published: May 2017

Cryptosporidiosis commonly causes severe diarrhea in immunosuppressed patients. There currently are no antiparasitic drugs consistently effective for this infection. This case describes a 26-year-old hemophiliac patient with acquired immunodeficiency syndrome and cryptosporidiosis whose diarrhea improved with continuous intravenous administration of a long-acting somatostatin analog, octreotide. Somatostatin has a variety of inhibitory effects on gastrointestinal hormones as well as a possible nonspecific effect on gastrointestinal mucosal fluid and electrolyte secretion. The somatostatin analog should be considered for patients with secretory diarrhea refractory to other forms of therapy.
Agranulocytosis Associated with Sulfasalazine
Authors: Derry Christine L. , Schwinghammer Terry L.
Published: May 2017

Agranulocytosis is a rare but potentially lethal adverse effect of sulfasalazine. We report a case of sulfasalazine-associated agranulocytosis that occurred in a 79-year-old woman who had been taking the drug for approximately seven weeks. The patient had discontinued the drug on her own initiative nine days prior to admission. The patient was admitted with complaints of hoarseness, fever, odynophagia, and malaise. The total white blood cell count was 600/mm3 with a differential of 0% neutrophils, 8% bands, 67% lymphocytes, and 25% monocytes; a bone marrow aspirate and biopsy revealed maturation arrest. The patient's peripheral white blood cell count and differential progressively increased over the nine-day hospital course. Upon discharge the white blood cell count was 12 000 cells/mm3 with 66% neutrophils, 8% bands, 16% lymphocytes, and 10% monocytes. Complete blood counts should be performed periodically in patients receiving sulfasalazine, especially during the first two months of therapy. Pharmacists should counsel patients to discontinue the drug and consult their physician immediately if they develop unexplained fever, chills, sore throat, malaise, or other nonspecific illness during the initial two months of treatment.
Record Linkage Studies for Postmarketing Drug Surveillance: Data Quality and Validity Considerations
Authors: Stergachis Andy S.
Published: May 2017

Large automated databases are the source of information for many record linkage studies, including postmarketing drug surveillance. Despite this reliance on prerecorded data, there have been few attempts to assess data quality and validity. This article presents some of the basic data quality and validity issues in applying record linkage methods to postmarketing surveillance. Studies based on prerecorded data, as in most record linkage studies, have all the inherent problems of the data from which they are derived. Sources of threats to the validity of record linkage studies include the completeness of data, the ability to accurately identify and follow the records of individuals through time and place, and the validity of data. This article also describes techniques for evaluating data quality and validity. Postmarketing surveillance could benefit from more attention to identifying and solving the problems associated with record linkage studies.
Postgraduate Pharmacy Fellowships (1987-88)
Authors: Kaul Alan F. , Johnson Elizabeth G. , Powell Stephen H.
Published: May 2017

During August and September 1987, the Brigham and Women's Hospital Pharmacy Services Department conducted its seventh annual national survey of postgraduate pharmacy fellowships. There are 185 fellowships offered with 150 fellows at 53 sites.
Pharmacy-Based Screening Program for Tardive Dyskinesia
Authors: Ahrens Thomas N. , Sramek John J. , Herrera John M. , Jewett Christina M. , Alcorn Velma E.
Published: May 2017

An ongoing screening program using pharmacists to detect tardive dyskinesia (TD) was developed, and a pharmacy-based prevalence survey of TD in chronic hospitalized psychiatric patients was undertaken to determine the extent of abnormal involuntary movements. The results show that older patients and women in particular are at higher risk for developing abnormal movements. Higher doses of neuroleptics were used in non-TD patients, indicating a possible masking effect caused by these drugs. By using a standardized rating method such as the Abnormal Involuntary Movement Scale, pharmacists can and should be utilized in the surveillance of TD.
Unpredictable Anaphylactic Reaction to Protamine Sulfate
Authors: Dayal Shashikar K. , Barlow Jared C. , Watson William A.
Published: May 2017

Anaphylactic reactions to protamine administration often can be predicted by the presence of patient risk factors. In the case described, an anaphylactic reaction to protamine occurred in a patient without identifiable risk factors. A history of prior protamine exposure, fish allergy, or vasectomy suggests patients may be at greater risk for anaphylactic response to protamine; however, patients can develop anaphylaxis in the absence of such factors.
Protamine Sulfate and Fatal Anaphylactoid Shock
Authors: Shikuma Lois R. , Eyer Steven D. , Zaske Darwin E.
Published: May 2017

A 73-year-old male underwent uneventful three-vessel coronary artery bypass grafting after which he received iv protamine sulfate for reversal of systemic heparinization. Shortly thereafter, the patient developed and succumbed to an anaphylactoid reaction attributed to protamine. The patient had none of the previously reported risk factors for hypersensitivity to the drug and was therefore not considered at high risk for such a severe adverse reaction. Although uncommon, the fatal outcome of this low-risk patient seriously addresses the need for alternative measures for heparin reversal.
Teicoplanin: A New Glycopeptide Antibiotic Complex
Authors: Babul Najib , Pasko Mary
Published: May 2017

The chemistry, microbiology, pharmacokinetics, clinical efficacy, and adverse effect profile of teicoplanin are reviewed and, where appropriate, compared with vancomycin. Teicoplanin is a glycopeptide antibiotic with potent bactericidal activity against a wide variety of aerobic and anaerobic gram-positive bacteria. In contrast to the structurally related vancomycin, teicoplanin has a prolonged elimination half-life of approximately 60 hours and it may be safely administered by the intramuscular route. Adverse effects of teicoplanin include ototoxicity, nephrotoxicity, skin rash, eosinophilia, neutropenia, and transient elevation of serum aminotransferases. Teicoplanin may be beneficial as an alternative to vancomycin for patients with poor vascular access and in those requiring long-term outpatient therapy. The role of teicoplanin in the treatment and prophylaxis of gram-positive infections will ultimately depend on its unfolding safety and efficacy profile.
Monoamine Oxidase Inhibitors: Safety and Efficacy Issues
Authors: Brown Candace S. , Bryant Stephen G.
Published: May 2017

Controversy has historically centered on the use of monoamine oxidase inhibitors (MAOI) in the treatment of depression because of safety and efficacy issues. Hypertensive crisis following ingestion of foods containing tyramine is the most feared problem associated with MAOI therapy. The authors conclude that only four tyramine-containing foods clearly warrant absolute prohibition, but indicate situations where moderation should apply. Although MAOI remain second-line agents in the treatment of endogenous depression, it is unclear whether MAOI or tricyclic antidepressants should be the drugs of choice in atypical depression and this question necessitates future research.
A Controlled Clinical Trial of the Cardiovascular and Psychological Effects of Phenylpropanolamine and Caffeine
Authors: Noble Rudolf
Published: May 2017

Two hundred eighty-eight healthy normotensive volunteers with various degrees of obesity participated in a double-blind, placebo-controlled evaluation of the acute effects of phenylpropanolamine hydrochloride (PPA) and caffeine on blood pressure, pulse, and subjective effects. Dosage forms studied were PPA 75 mg sustained-release (SR), PPA SR 75 mg with caffeine 200 mg, caffeine 200 mg, and placebo. Data analysis indicated no significant cardiovascular or subjective effects due to PPA. Caffeine, however, was associated with statistically reliable though clinically insignificant changes from baseline diastolic blood pressure in both supine and standing positions. The rank order of the change indicated larger increases for the subjects who received caffeine, either alone or in combination with PPA, as compared with those who received PPA alone or placebo. No statistically significant differences between PPA and placebo were observed. Subjects in the heavier weight categories had higher blood pressure levels throughout the session as compared with those of normal weight. There was no difference among the study groups in subjective effects. These results provide evidence supporting the safety of currently recommended doses of sustained-release PPA, either alone or in combination with small doses of caffeine in healthy individuals.
Chloroquine-Induced Acute Dystonic Reactions in the Presence of Metronidazole
Authors: Achumba Judy I. , Ette Ene I. , Thomas Wilkinson O.A. , Essien Ettiene E.
Published: May 2017

A 30-year-old woman underwent laparotomy and was placed on a seven-day course of metronidazole and ampicillin postoperatively. Chloroquine therapy for malaria was instituted on the sixth day and the patient developed acute dystonic reactions after a single dose. Diphenhydramine therapy before chloroquine administration did not prevent the development of the dystonic reactions. The extrapyramidal symptoms subsided upon diazepam administration and chloroquine withdrawal even though metronidazole therapy was continued. The mechanism of this adverse drug reaction based on the pharmacodynamic interaction between chloroquine and metronidazole is discussed. It is suggested that the combination of pyrimethamine and sulfadoxine be used in place of chloroquine for malaria chemotherapy in patients on metronidazole therapy.
Dystonic Reaction Possibly Induced by Cholinesterase Inhibitor Insecticides
Authors: Moody Steven B. , Terp Diane K.
Published: May 2017

A 39-year-old male presented to the emergency room following parenteral injection of a household insecticide. The patient suffered from delayed, local complications as well as a dystonic-like reaction involving the neck musculature that was relieved by intramuscular diphenhydramine. Exposure to cholinesterase inhibitor insecticides has been associated with a number of serious toxicities due to accumulation of acetylcholine at various sites. It has been suggested that dystonic reactions are caused by an imbalance between cholinergic and dopaminergic pathways in the central nervous system. Therefore, a possible explanation of the dystonic reaction in this case is the increased cholinergic activity relative to dopaminergic activity induced by the insecticide.
Nicotine Gum Dependency: A Positive Addiction
Authors: Mulry James T.
Published: May 2017

Prolonged nicotine gum dependency may provide a therapeutic interlude for the compulsive or addictive patient during the transition from smoking to a tobacco-free state. We present a case report of an addicted man with asthma who successfully converted his tobacco dependency to the daily use of nicotine gum for four years. No adverse effects were seen. Nicotine gum has potential as substitution therapy for prolonged treatment in a highly addictive, compulsive patient.
Failure of Intraarticular Ceftazidime in a Patient with Pseudomonas Aeruginosa Septic Arthritis
Authors: Kay Elizabeth A. , Klimiuk Peter S. , Ronson Gareth , Bailie George R.
Published: May 2017

This report describes a patient with Pseudomonas aeruginosa septic arthritis who received ceftazidime by the intravenous and intraarticular routes. Concentrations of ceftazidime in the synovial fluid following both routes of administration were measured and found to be above the minimum inhibitory concentration. Despite this the organism was not eradicated. We were unable to find other literature describing the disposition of ceftazidime in synovial fluid and therefore this single-patient study provides novel information. We were unable to account for the apparent failure of therapy.
Therapeutic Drug Monitoring in Neonates: Problems and Issues
Authors: Gal Peter
Published: May 2017

Therapeutic drug monitoring has been applied in several patient populations to promote safer, more effective use of drugs. The development of therapeutic ranges allows clinicians to aim for a plasma drug concentration that is usually safe and effective, and calculation of specific pharmacokinetic parameters allows selection of doses that will achieve the desired plasma concentration. This concept certainly holds true in the intensive care nursery; however, the intensity of monitoring in this setting provides opportunities for far broader application of the information obtained from drug concentration monitoring. This review provides an overview of the complexity of and potential applications for therapeutic drug monitoring in neonates based on literature and clinical experience.
Drug Safety, Pharmacoepidemiology, and Regulatory Decision Making
Authors: Nelson Robert C.
Published: May 2017

The safety or risk assessment of a pharmacotherapeutic agent begins early in its development and continues throughout its use cycle. The practice of pharmacoepidemiology is the art of using the sciences and the tools of science to generate information about pharmaceutical outcomes, including associated risks, in the postmarketing environment. A pharmacoepidemiologist must be capable of functioning with a matrix constructed of three components: a knowledge base, a conceptual framework, and an interpretive framework. From this perspective one can establish surveillance schemes, or understand a posed research question, select strategies, apply methodologies, and interpret the results of purposeful investigations. When conveyed to the risk manager, appropriately interpreted results of a properly conducted risk assessment can be used in regulatory decision making. Seven case studies are presented as examples of this approach.
Comparative Bioavailability of Praziquantel Tablets
Authors: Kaojarern Sming , Nathakarnkikool Surapol , Suvanakoot Uthai
Published: May 2017

Six different brands of 600 mg praziquantel tablets were evaluated. In vitro studies demonstrated that all but one of the products met the British Pharmacopoeia 1980 disintegration time specifications. The comparative bioavailability of four of the internationally available brands of praziquantel tablets were then studied in eight healthy volunteers using a crossover design. Serum praziquantel levels were determined by high-performance liquid chromatography. Individual serum profiles were analyzed for pharmacokinetic parameters such as maximum serum concentration, time to reach maximum, and area under the curve. Following administration of praziquantel 40 mg/kg po, the mean peak serum concentrations and the time to reach the peak ranged from 1.007 to 1.625 μg/ml and from 1.72 to 2.81 hours, respectively. The elimination half-life of praziquantel was 1.15 (0.94–1.25) hours. Differences greater than 20 percent (p < 0.05) were noted for these parameters between the original brand and the generic formulations. The relative bioavailabilities of the generic praziquantel formulations, with respect to the original brand, were 91.25, 80.95, and 69.86 percent. This is due to the failure of disintegration and subsequently poor dissolution. The effect of 30 percent reduction of bioavailability may lead to unacceptably high rates of treatment failure.
Intravenous Erythromycin Lactobionate-Induced Severe Nausea and Vomiting
Authors: Seifert Charles F. , Swaney R. Jan , Bellanger-Mccleery Renee A.
Published: May 2017

Intravenous erythromycin lactobionate has been used for several years to treat various infectious diseases. Several cases of severe nausea and vomiting associated with its use have been reported in Europe but only a few cases have been reported in the U.S. The official product information does not refer to severe nausea and vomiting associated with its intravenous use; however, we report six additional cases of severe nausea and vomiting associated with rapid administration of erythromycin lactobionate, and review the current literature on the characteristics of this adverse effect.
Leukopenia with Neutropenia Associated with Teicoplanin Therapy
Authors: Favero Albano Del , Patoia Lucio , Bucaneve Giampaolo , Biscarini Luciano , Menichetti Francesco
Published: May 2017

The first case report of leukopenia with neutropenia due to the new glycopeptide antibiotic teicoplanin is described. The side effect occurred in a 73-year-old man hospitalized because of subacute bacterial endocarditis caused by Streptococcus faecalis. Leukopenia with neutropenia (white blood cells 2000/mm3, neutrophils 46%) developed after 20 days of teicoplanin therapy. After stopping teicoplanin white blood cell and neutrophil counts reverted to normal, but dropped again on rechallenge. A review of 1500 records of patients treated with teicoplanin alone or in combination with other drugs was also performed. Five cases were found in which leukopenia was possibly (four cases) or probably (one case) related to teicoplanin therapy. From these preliminary data the incidence of leukopenia related to teicoplanin seems to be low.
Bullous Pemphigoid Associated with Captopril
Authors: Mallet Louise , Cooper James W. , Thomas Joyce
Published: May 2017

Captopril is commonly prescribed to patients with hypertension and congestive heart failure. Adverse dermatological reactions have been reported in about ten percent of patients receiving captopril. This case report describes a 77-year-old white woman who developed bullous pemphigoid associated with the use of captopril. The patient presented with bullous eruptions localized on the palms of both hands about 50 days after captopril 25 mg bid was started. Biopsy report was consistent with bullous pemphigoid. Captopril therapy was discontinued and the lesions healed after oral corticosteroid therapy was initiated.
Propafenone: A Novel Type Ic Antiarrhythmic Agent
Authors: Parker Robert B. , McCollam Patrick L. , Bauman Jerry L.
Published: May 2017

Propafenone is an investigational type Ic antiarrhythmic agent that markedly slows conduction velocity in all cardiac tissues. Propafenone also possesses weak beta- and calcium-channel blocking properties. The bioavailability of propafenone is dose-dependent. Hepatic metabolism of this agent is polymorphic and appears to correlate with the ability of the liver to oxidize debrisoquin sulfate. Propafenone is effective in suppressing spontaneous ventricular ectopy; however, the drug may be less effective in patients with sustained ventricular tachycardia or ventricular fibrillation when evaluated using programmed stimulation. Propafenone is also useful in the treatment of supraventricular tachycardias including atrioventricular (AV) nodal reentrant tachycardia, AV reentrant tachycardia associated with the Wolff-Parkinson-White syndrome, and atrial fibrillation. Adverse reactions seen with propafenone affect the gastrointestinal, central nervous, and cardiovascular systems. Comparative studies with currently available type Ic agents are needed to better define propafenone's place in therapy.
Consumer use of Nondispensing Professional Pharmacy Services
Authors: Monsanto Homero A. , Mason Holly L.
Published: May 2017

This study attempted to identify and develop an understanding of the use of 13 nondispensing services (NDSs) by consumers in the community pharmacy practice setting. A self-administered, postage prepaid questionnaire was sent to 1000 Indiana consumers randomly selected from telephone directories. A 45.5 percent response rate was achieved after one original mailing and two follow-ups. Most consumers had not used NDSs except for advice on nonprescription drugs and advice on minor health problems. Nevertheless, a substantial number of consumers expressed interest in many of the remaining services, including advice on diagnostic test kits and information on poison prevention. Consumers' past use of NDSs and their perceptions of pharmacists as providers of these services were important factors in the consumers' intention to use NDSs. Other variables significantly correlated with average intention to use NDSs were: type of pharmacy patronized, anxiety about health, age, and education. It is recommended that future investigations explore in detail consumer behavior with regard to nondispensing services.
Ranitidine-Induced Chest Pain
Authors: Shimp Leslie A. , Smith Mindy A. , Wahr Dennis W.
Published: May 2017

A 45-year-old woman with no history of heart disease twice experienced chest pain after consuming a dose of ranitidine. The chest pain, which lasted about one hour, was substernal, left of midline, dull, and pounding. H2-receptors are present in cardiovascular tissues. Although several studies have not noted an effect of ranitidine on cardiac indices there have been case reports indicating a cardiac effect. There are no reports of chest pain associated with H2-blocker ingestion; however, both bradycardia and hypotension (reported effects) might cause chest pain. A discussion of the possible mechanisms is presented.
Probability Assessment Approach to Therapeutic Drug Monitoring: Tobramycin
Authors: Slaughter Richard L.
Published: May 2017

Pharmacokinetic monitoring is an important therapeutic goal of aminoglycoside therapy. The overall goal of this study was to identify specific patient groups that would derive the maximum benefit from therapeutic drug monitoring services. These groups are patient populations with high probabilities of achieving toxic or subtherapeutic concentrations. Out of a total population of 86 stable, noncritically ill patients, 27 toxic concentrations (trough >2.0 μg/mL) occurred in 15 patients. In comparison to patients (n = 46) with therapeutic concentrations (trough < 2.0 μg/mL, peak >4.0 μg/mL), these patients were older (64 ± 11 vs. 54 ± 18years; p < 0.02) and had a higher percentage of females (66.7 vs. 37 percent; p < 0.05). Those patients with subtherapeutic concentrations (43 concentrations in 25 patients) had higher estimated creatinine clearance values than those with therapeutic concentrations (94 ± 45 vs. 74 ± 27 mL/min; p < 0.005). Probability assessment analysis of the data showed a sevenfold increase in toxic concentrations in patients above 50 years. Females over age 50 had 2.3 times the risk of developing toxic concentrations as males over age 50. In contrast, the development of low concentrations was not predicted by age or sex. Underdosage by ≥30 percent was a reasonable predictor (75 percent) of low peak concentrations. Furthermore, toxic concentrations did not occur in patients who were underdosed, justifying dosage increases prior to obtaining serum concentrations in these patients. The group with the highest probability of attaining therapeutic concentrations was males receiving therapeutic doses who were under age 50 (85.5 percent). Therefore, routine measurement of serum concentrations in this group would have limited cost-benefit potential. It is concluded that a probability assessment approach can be used to facilitate the therapeutic monitoring of tobramycin.
Thalidomide: Treatment of Severe Recurrent Aphthous Stomatitis in Patients with Aids
Authors: Nicolau David P. , West Timothy E.
Published: May 2017

An increasing number of AIDS patients have been noted to suffer severe recurrent aphthous stomatitis (RAS), a condition often associated with high morbidity that remains unresponsive to conventional therapeutic interventions. In two cases thalidomide was administered to successfully treat AIDS patients with RAS. Both patients experienced complete abatement of pain shortly after therapy was initiated. Ulcerations that were present for months resolved after three or four weeks of thalidomide therapy without any adverse effects. Thalidomide appears to be an effective agent for the treatment of severe RAS unresponsive to traditional therapies.
Gastroesophageal Reflux and Respiratory Symptoms: Is There an Association? Proposed Mechanisms and Treatment
Authors: Gonzalez Edgar R. , Bahal Neeta , Johnson Lawrence F.
Published: May 2017

Gastroesophageal reflux (GER) is a dysfunction of the distal esophagus causing movement of stomach contents into the esophagus. Patients may develop heartburn, regurgitation, dysphagia, odynophagia, and hemorrhage. Respiratory symptoms occur in 10-60 percent of patients with GER or hiatal hernia. Although there is evidence associating pulmonary symptoms and GER, causality has not been proven. The appropriate use of antireflux therapy or surgery to treat GER may consequently alleviate respiratory symptoms.
Therapeutic Drug Monitoring Analysis Systems for the Physician Office Laboratory: A Review of the Literature
Authors: Oles Karen S.
Published: May 2017

Commercially available systems for therapeutic drug monitoring in the physician office laboratory (POL) are reviewed. The Abbott Vision, Kodak Ektachem, Syntex AccuLevel, Syva EMIT QST, Ames Seralyzer ARIS, and Ames Clinimate ARIS have been found to be sensitive and accurate compared with more conventional laboratory assays, and are well-suited for the POL. The number of available drug assays is very limited with every system except the QST. The QST offers a large menu and would be appropriate for large practices. The Abbott TDx or other semiautomated systems usually found in the clinical chemistry laboratory may be particularly useful and cost-effective in office practices with a large volume of specimens. AccuLevel or ARIS might be the best choices for clinics or pharmacies that generate few samples. The start-up time is the longest with the Vision and Ektachem systems (30 minutes). Most systems have the capacity to produce results within one to five minutes with the exceptions of the Vision (13 minutes for theophylline) and AccuLevel (20 minutes). The Vision is the most automated system and both AccuLevel and the Vision use whole blood, thereby bypassing the additional time required for centrifugation of the patient specimen. The Ektachem, Vision, and QST have an operator-independent pipetting step that offers a significant advantage when operated by semiskilled personnel. Although the AccuLevel eliminates the need for a large initial capital expenditure, the individual cost per test is higher. Leasing programs are available for certain systems. Increased government regulation will improve the quality control of therapeutic drug monitoring in the POL.
Drug-Related Problems: Their Structure and Function
Authors: Strand Linda M. , Morley Peter C. , Cipolle Robert J. , Ramsey Ruthanne , Lamsam Grace D.
Published: May 2017

In order to better focus the role of the pharmacist on patient need and patient outcome, a means of categorizing drug-related problems (DRPs) is presented. A DRP exists when a patient experiences or is likely to experience either a disease or symptom having an actual or suspected relationship with drug therapy. Eight different categories of DRPs are described and examples of each category are offered. This categorization serves a number of functions, such as: (1) to illustrate how adverse drug reactions form but one category of extant DRPs, (2) to make tangible the pharmacist's role for the future, (3) to serve as a focus for developing a systematic process whereby the pharmacist contributes significantly to the overall positive outcome of patients, (4) to bring to pharmacy practice a vocabulary consistent with that of other healthcare professionals, and (5) to aid in the development of standards of practice for pharmacists.
Economic Impact with Home Delivery of Chemotherapy to Pediatric Oncology Patients
Authors: Holdsworth Mark T , Raisch Dennis W , Chavez Cathy M , Duncan Marilyn H , Parasuraman Tv , Cox Fred M
Published: May 2017

Objective

To examine the economic impact of a home chemotherapy program (HCP) for pediatric oncology patients.

Rationale

Factors that led to initiation of an HCP included availability of specially trained nurses and programmable ambulatory infusion devices at local home care agencies, routine central venous catheter placement, inpatient bed space shortages, and the availability of ondansetron.

Setting

Chemotherapy delivery in the home setting from June 1991 through June 1994.

Design

Charge data and nausea and vomiting severity data were collected for patients treated through the HCP.

Methods

Economic impact was calculated by incorporating and summing all charge categories associated with hospital admission for chemotherapy (HAC) versus delivery by the HCP. All data were adjusted for 1993 dollars, and reflect charges for the average patient size (1 m2). Charge data for each chemotherapy protocol delivered in the home were analyzed by calculating the differences between HAC and HCP charges using the following formula: charge difference (HAC - HCP) per protocol times the number of courses. Total economic impact was calculated by summing the differences in charges for each protocol.

Results

A total of 262 chemotherapy courses were given to 44 patients (mean age 9.5 ± 5.1 y) through the HCP, which represented 1012 patient care days and 24 different chemotherapy protocols. Monetary savings from the HCP ranged from $5180 per course of ifosfamide plus etoposide to $367 per course for high-dose methotrexate. Total monetary savings from the HCP during the 3-year period was $640 793. Successful control of nausea and vomiting with a combination of ondansetron plus methylprednisolone was achieved in approximately 80% of the patients receiving highly emetogenic chemotherapy protocols.

Conclusions

HCP for pediatric oncology patients results in substantial monetary savings to payors. Effective control of nausea and vomiting can be accomplished at home in the majority of patients with an ondansetron-based antiemetic regimen.