bluuebunny/crossref_metadata_2025 huggingface dataset:
The Performance of Blood Pressure and other Cardiovascular Risk Factors as Screening Tests for Ischaemic Heart Disease and Stroke
Authors: Law M R , Wald N J , Morris J K
Published: January 2017

This paper summarises the main evidence and conclusions relating to using blood pressure measurement as a screening test to identify people who will develop ischaemic heart disease (IHD) or stroke, as recently published in a Health Technology Assessment report1. While blood pressure is recognised as an important cause of stroke and IHD, and lowering blood pressure can substantially lower the risk of these diseases, the measurement of blood pressure is a poor screening test. It is not good in distinguishing those who will and will not develop these diseases. The poor screening performance is illustrated by the findings that in the largest cohort study, persons in the top 10% of the distribution of systolic blood pressure experienced only 21% of all IHD events and 28% of all strokes at a given age. Using several cardiovascular risk factors in combination does not add materially to the poor screening performance of blood pressure alone. Among persons in a specified age group, the 5% at highest risk experience 17% of all heart disease deaths with risk computation based on blood pressure alone, 22% when based on blood pressure and apolipoprotein B (or LDL cholesterol) in combination, and only 28% using these two, smoking and three other cardiovascular risk factors all in combination. Identifying patients at the time of hospital discharge following myocardial infarction or stroke is the most effective screening test to identify those who will die of cardiovascular disease. In patients with a history of myocardial infarction or stroke the cardiovascular death rate in the absence of treatment is about 5% per year, a risk that persists for at least 15 years. In the absence of treatment, about half of all deaths from heart disease in a population occur after hospital discharge following the first infarct. Among persons with no history of cardiovascular disease, age is a better screening test than the reversible risk factors, and the best policy is to offer treatment to all persons above a specified age such as 55 years.
Accuracy of Ultrasound in a Screening Programme for Abdominal Aortic Aneurysms
Authors: Thomas P R S , Shaw J C , Ashton H A , Kay D N , Scott R A P
Published: January 2017

To assess the accuracy of ultrasound in the measurement of aortic diameter.

A general practice based screening programme for abdominal aortic aneurysm.

(a) comparison of ultrasound with computed tomography (CT) measurement; (b) two period crossover study to assess interobserver error; (c) comparison of ultrasound measurements by technicians and radiologists.

In 36 patients where CT showed clear maxima in anteroposterior diameter, the measurement by ultrasound was consistently less than by CT scan (mean ultrasound — CT difference — 4·4 mm, range —12·3 to 2·4 mm). There was no difference in the measurements made by different ultrasonographers, but their method of measurement produced a reading for aortic diameter less than that obtained by a vascular radiologist.

These' results show that ultrasound measurement is less accurate for smaller aneurysms, consistently gives a smaller reading for aortic diameter when compared with CT measurement, but was reproducible between ultrasonographers. Monitoring and audit of aneurysm screening programmes to assess accuracy and reproducibility of ultrasound measurement is recommended.
Evaluation of the Effect on Breast Cancer Mortality of Population Based Mammography Screening Programmes
Authors: Törnberg Sven , Carstensen John , Hakulinen Timo , Lenner Per , Hatschek Thomas , Lundgren Bengt , Tornberg S
Published: January 2017

To evaluate, by analysis of breast cancer mortality data from all the 26 Swedish counties for the years 1971 to 1990, whether the effect of the introduction of mammography screening in Sweden can be assessed by observation from existing mortality data.

A Poisson regression model was used to study whether a decrease in breast cancer mortality among women aged 50–74 years was associated with the extent of mammography screening in different counties and periods.

In regions where mammography screening had been introduced, breast cancer mortality tended to be decreased, on average, compared with regions with-'out screening. If a 10 year time lag between the start of screening and its full effect on mortality is assumed then the estimated reduction in breast cancer mortality associated with introduction of screening was 19% with a 95% confidence interval ranging from 3% to 37%.

The results suggest that the effect of mammography screening may be studied using existing routine mortality data and appropriate statistical modelling. This way of assessing the outcome of the screening is valuable when continuously monitoring a screening programme that has become a public health routine.
Assessment of Lesions Detected at Mammographic Screening: Performance at First or Repeat Screening in the Florence Programme
Authors: Ciatto Stefano , Del Turco Marco Rosselli , Giorgi Daniela , Morrone Doralba , Catarzi Sandra , Ambrogetti Daniela , Paci Eugenio , Zappa Marco
Published: January 2017

To evaluate the assessment criteria and the results achieved in the detection of breast lesions at mammographic screening.

Review of cases assessed in the last screening round of Florence city (FC.- first screening round: 29 522 subjects) and Florence district (FD — repeat screening round: 13 268 subjects) programmes. Methods – Referral and biopsy rates, predictive values, and prevalence of cancers detected by screening were determined, as well as the frequency of the diagnostic procedures used at assessment, and their contribution to the final diagnosis according to the mammographic appearance of the suspected lesion. Assessment costs were estimated.

Referral rate (FC 4.2%; FD 1.8%), referral positive predictive value (FC 18.7%; FD 28.3%), surgical biopsy rate (FC 0.96%; FD 0.6%), benign/malignant biopsy ratio (FC 0.20; FD 0.13), and prevalence of cancers detected by screening (FC 0.78%; FD 0.5%) were all within the European Community (EC) recommended standards for screening performance. The benign biopsy rate was considerably lower than that of recommended standards. The cost for each subject assessed was 179 000 Italian lire at the first and 116 000 lire at repeat screening. The cost for each subject screened that was attributable to assessment was 7600 lire at the first or 2100 lire at repeat screening.

Limited referral rates and costs were achieved and the proportion of cancers detected by screening was high. The number of referrals was further reduced at repeat screening, and assessment had a limited impact on total screening costs. Detail or magnification mammography, palpation, sonography, and fine needle aspiration cytology all contributed to the final diagnosis and should be immediately available at the assessment clinic. The observed benign biopsy rate was particularly low and suggests that EC recommended standards should be modified.
Survival of Patients with Breast Cancer Diagnosed in the United Kingdom Trial of Early Detection of Breast Cancer
Authors: Moss S M , Ellman R , Coleman D , Chamberlain J ,   For the United Kingdom Trial of Early Detection of Breast Cancer Group
Published: January 2017

To examine the survival of patients with breast cancer diagnosed in different centres and by different methods in the United Kingdom trial of early detection of breast cancer, in order to investigate the contribution of different factors to the previously observed reductions in breast cancer mortality.

A non-randomised trial of the early detection of breast cancer, in which women aged 45–64 in two districts were offered annual screening for seven years, women in a further two districts were offered education about breast self examination (BSE), and those in four districts formed a comparison group.

Patients with breast cancer are classified according to the type of centre, method of detection, and attendance for BSE education. Univariate and multivariate survival analyses are carried out, including tumour size, dissemination status, and use of adjuvant treatment as additional variables.

In the univariate analysis, patients with breast cancer who are nonattenders for screening have a significantly worse prognosis than those in the comparison centres. Patients whose cancer is detected by mammography have the best survival rate. The inclusion of size and dissemination status in the multivariate analysis explains only about one third of the improved prognosis in these cases. There is a significant difference between prognosis in the two BSE centres.

The use of prognostic factors as recorded in this trial to predict breast cancer mortality may be inadequate.
Feasibility Study of a Randomised Trial of Ovarian Cancer Screening
Authors: Tabor Ann , Jensen Flemming R , Bock Johannes E , Høgdall Claus K
Published: January 2017

To assess the feasibility of a randomised trial of ovarian cancer screening by vaginal ultrasonography.

A population based study, recruiting a random sample of the female population aged 46 to 65 years living in Copenhagen, Denmark.

Randomised controlled trial allocating 50% to the study group having vaginal ultrasonography, and 50% to the control group having no examination, (a) Acceptability of the study was evaluated by the proportion of eligible women willing to participate in the study, (b) The false positive rate was evaluated as the proportion of women without ovarian cancer referred for an operation because of abnormal ovaries detected by ultrasonography.

950 (64–3%) of the 1477 eligible women participated in the study. At the first scan abnormal ovaries were detected in 54 of 435 women (12%), significantly more frequently among younger women. Nine women were referred for an operation because of abnormal findings in the ovaries, giving a false positive rate of 2%Ovarian size and morphology found at operation corresponded with those at ultrasonography; none of them was malignant.

A randomised controlled trial of ovarian cancer screening using vaginal ultrasonography seems acceptable in the general population. The rate of abnormal ovaries at ultrasonography with the cut offs used in this study was quite high. Such a study is, therefore, feasible, but it is proposed that it is carried out in an older age group (50–64 years) and that the cut offs used for ovarian size and morphology are re-evaluated. Second line tests, such as colour Doppler flow, should be considered in order to reduce the false positive rate.
Opportunistic Screening for Abdominal Aortic Aneurysm
Authors: Derbyshire Neil D J , Lindsell David R M , Collin Jack , Creasy Terence S
Published: January 2017

To contribute to the current debate on screening for abdominal aortic aneurysm (AAA).

Radiology department of the John Radcliffe Hospital, Oxford.

The prevalence of AAA in 317 clinically referred male patients aged 65–74 undergoing abdominal ultrasonography with no clinical suspicion of an AAA was investigated over a period of one year.

Over the year 15/317 (5%) patients were found to have an aneurysm (defined as aortic diameter (≥30mm), with eight (3%) patients having an aortic diameter of ≥40 mm. Six months later appropriate management for the AAA had been started for only four patients. A knowledge assessment questionnaire sent to 245 hospital clinicians and general practitioners showed that 17 (12%) of the 139 respondents would initiate no review of patients found to have an aneurysm of 30–39 mm and two would take no action with aneurysms of 40–49 mm. Thirty two (23%) respondents would seek advice on management for all categories of aneurysm, 14% from the radiologist.

Opportunistic screening for AAA in men undergoing clinically indicated abdominal ultrasonography is easy, productive, without discernible cost, and discloses a prevalence of AAA comparable with that of population screening programmes. Routine opportunistic measurement of aortic diameter during abdominal ultrasonography in the at risk group would allow 12–15% of men aged 65–74 to be screened for AAA within five years without the need for any additional resources.
Monitoring Trends in Prenatal Diagnosis of Down's Syndrome in England and Wales, 1989–92
Authors: Morris Joan K , Mutton David E , Ide Roy , Alberman Eva , Bobrow Martin
Published: January 2017

The national register of chromosomal anomalies that lead to Down's syndrome has enabled the monitoring of change in prenatal diagnosis for this condition, and the factors which affect the change.

The proportion of cases of cytogenetically diagnosed Down's syndrome in England and Wales detected prenatally rose to 46% in 1991–2 from 31% in 1988–9, a 1·5-fold increase (95% confidence interval 1·3 to 1·7). The increase was confined to mothers under 40 years and was due to the introduction of screening by maternal serum analysis and ultrasound. Over a quarter of affected pregnancies in women aged 25–29 were detected prenatally in 1991–2 compared with less than 10% in 1988–9. Analysis of the data showed regional differences in prenatal diagnosis rates, and in the length of time elapsing between the diagnostic test and termination of an affected pregnancy. An inexplicable finding was that this period varied with the sex of the fetus, being on average a day longer for females than for males.
State Collaboration with Transnational Corporations: The Case of Singapore's Industrial Programmes (1965–1999)
Authors: Pereira Alexius A.
Published: January 2017

This paper explains how and why transnational corporations have chosen to collaborate with the Singapore government in certain industrial programmes, and not in others, between 1965 and 1999. In the analysis, this paper links two concepts, the global game of industrial production, and the developmental state, to explain the outcomes of three national industrial programmes in Singapore: the industrial transformation (1965–1980), industrial upgrading (1980–1990), and regional industrialization (1990–1999) programmes. This research finds that because of their relative autonomy from national governments, transnational corporations would collaborate not just due to the effectiveness of embedding strategies, but when these strategies were complementary to their own global business strategies within the global game of industrial production.
Investigating Differentiated Production Systems: The U.S. Machine Tool Industry
Authors: Gordon Richard , Krieger Joel
Published: January 2017

This article is intended to conceptually tighten an understanding of firm-level production systems. It should be read as part of a broader effort to conceptualize and analyze the social and spatial organization of innovation and production in a way that integrates the local, regional, national, and global dimensions within and across sectors of production. In the first section, we introduce models for analyzing (1) product and production strategies and (2) the social and technical organization of the enterprise. Taken together, they conceptually ground a typology of Differentiated Production Systems, which we present as a way of conceptualizing and analyzing the social organization of innovation and production at the level of the firm. The second section of the article introduces the machine-tool study and analyzes key variables associated with technological and organizational innovation in the respondent firms. In the third section, we present a set of case studies to demonstrate the applicability of the models we have introduced. We conclude with a brief interpretation of the U.S. machine tool sector drawn from our framework and a preliminary appraisal of the potential significance of our conceptualization.
Innovation and Performance of SMEs in Italy: The Relevance of Spatial Aspects
Authors: Camagni Roberto , Capello Roberta
Published: January 2017

The tripartite model of an old-industrial northwestern part of the country, of an efficient and dynamic Third Italy, mainly driven by small and medium firms' agglomeration, and a peripheral lagging South still influences the economic debate on regional development: small firms tend to be regarded as the most dynamic industrial organisation, and for this reason, regions with a high proportion of small firms tend to have higher economic growth. The aim of the paper is to present the Italian reality on the basis of some recent data on regional growth and innovation patterns. The results are surprising. Among them, that regional industrial structure in Italy seems to depart from the traditional tripartite model and that they diverge with the traditional tripartite model even in the level of competitiveness of Italian regions.
Globalisation and Regional Development: A Relational Perspective
Authors: Amin Ash
Published: January 2017

This paper dissents with both the view that globalisation represents the end of national and local identities and the view that it leaves the latter untouched. Instead, it seeks to develop a relational understanding centred around the claim that globalisation represents the intensification of linkage and inter-dependence between different scales of activity. This perspective is used to comment on prospects for regional economic development in a globalising political economy.
Globalisation on the Margins: Mapping Post-Apartheid South Africa's Trade and Industrial Policy
Authors: Khan Firoz , Hemson David
Published: January 2017

Industrial policy is a key avenue for the post-apartheid South African state to overcome the threats of social unrest and promote economic development. Although globalisation presents Third World countries with significant opportunities for sustained industrial development, it is critically important to underscore the impulses that undermine it through an examination of the manner in which technology is transferred from the industrialised to the developing countries. The indiscriminate adoption of a neo-liberal economic programme in South Africa has had a negative impact on sustainable growth and has given way to deindustrialisation and a rentier economy. This paper suggests that an endogenous approach — one that emphasises the unique factors of the spatial milieu in which economic activity occurs — paired to a recognition of the embeddedness of this milieu within larger structures is a more suitable paradigm for stirring sustainable growth. State intervention is not an impediment but a precondition for a flexible and responsive industrial policy in an increasingly globalised world economy.
Competitiveness and Employment: A Strategic Dilemma for Economic Policy
Authors: Charles Tony , Lehner Franz
Published: January 2017

Competitiveness policy is usually described in liberal terms, suggesting a close relationship to competition and markets. However, the outcomes of such policies may work in the opposite direction. Competitiveness policy often results in heavy market intervention and distorts rather than strengthens competition. Based on misconceived problems of globalization and competition, it shifts the problem of competitiveness from the company level, where it belongs, to the level of a game between nations and their national economies.

We show that the “national competitiveness game” and the “international productivity race” have perpetuated a vicious circle of high structural unemployment, global over-capacity in many markets, increased social exclusion and economic recession. These trends have been reinforced by cost-driven approaches to the exploitation of human and physical resources. We also argue that new forms of state intervention in the economy are vital to both maintain and enhance national wealth, but it has become more difficult to identify effective policy actions and their effect upon either national welfare. Governments at regional, national and supra-national levels increasingly have to manage or steer global and local interdependencies under conditions of increased uncertainty.
Stability of Cyclosporine in Dextrose 5%, NaCl 0.9%, Dextrose/Amino Acid Solution, and Lipid Emulsion
Authors: McLeod Howard L. , McGuire Timothy R. , Yee Gary C.
Published: January 2017

OBJECTIVE:

Because of limited intravenous access in patients who have undergone bone marrow transplant (BMT), we undertook a study to determine the safety of mixing cyclosporine in intravenous preparations commonly administered to BMT patients.

DESIGN:

In a pilot study, we investigated the stability of intravenous cyclosporine (Sandimmune) in four types of intravenous fluids: dextrose 5%, NaCl 0.9%, dextrose/amino acid solutions, and lipid emulsion. Because the pilot study showed highly variable cyclosporine concentrations that suggested inadequate mixing, we undertook another study to determine the effect of the mixing method on cyclosporine concentrations.

OUTCOME MEASURE:

Cyclosporine was considered stable in the study solutions if concentrations remained above 90 percent of the initial concentrations.

RESULTS:

Substantial variation in cyclosporine concentrations was observed in lipid emulsion and dextrose/amino acid solutions and gentle swirling of the solutions was insufficient to adequately disperse the drug. The variation was eliminated by vigorous shaking either before each sampling or once after the initial addition of cyclosporine. We used vigorous shaking methods to establish that cyclosporine is stable for up to 72 hours at room temperature in dextrose 5%, 10% amino acid solution with dextrose 50%, and Liposyn 10%, and up to 8 hours in NaCl 0.9%.

CONCLUSIONS:

These data may be used to simplify cyclosporine administration in patients who have limited intravenous access.
Trimetrexate for Pneumocystis Carinii Pneumonia in Patients with Aids
Authors: Amsden Guy W. , Kowalsky Steven F. , Morse Gene D.
Published: January 2017

OBJECTIVE:

The primary objective of this article is to introduce readers to the use of a new agent, trimetrexate (TMTX), in the treatment of Pneumocystis carinii pneumonia (PCP). The article also gives the readers an overview of PCP and discusses some of the controversies surrounding it. Pharmacokinetic data and clinical trials are reviewed, as well as adverse effects, drug interactions, and dosage guidelines.

DATA SOURCES:

A MEDLINE search was used to identify pertinent literature, including reviews.

STUDY SELECTION:

As both pharmacokinetic and clinical trials were few in number, all available trials were reviewed.

DATA EXTRACTION:

Pharmacokinetic data from trials involving patients with AIDS was sparse; therefore, those involving oncology patients, including a pediatric population, were included. Although more trials need to be done in AIDS patients, the results from the oncologic trials give us a baseline from which to extrapolate. All clinical trials available at the time of publication were reviewed as were all of the preliminary results from three ongoing trials, which were made available through a personal communication.

DATA SYNTHESIS:

TMTX has been found to be 1500 times more potent than trimethoprim as a dihydrofolate reductase inhibitor, and has the potential to provide an effective therapeutic option for PCP. TMTX is a lipid-soluble analog of methotrexate and is thus capable of greater penetration into Pneumocystis cells, which lack the folate membrane transport system necessary to take up classic folate structures like leucovorin and methotrexate, thereby negating any clinical effectiveness of methotrexate and allowing leucovorin to be used for host cell rescue. TMTX's pharmacokinetic parameters best fit a multicompartmental model with a terminal half-life of up to 12 hours. It is cleared both hepatically and renally with up to 41 percent excreted unchanged in the urine. Although TMTX's pharmacokinetic parameters are variable, the need for plasma concentration monitoring at present is unclear, as no dose-response relationship has been established. Efficacy trials involving TMTX have been conducted mostly in patients with moderate to severe PCP who were either intolerant and/or refractory to standard therapies. Response rates to TMTX therapy have ranged from 6 to 90 percent, thereby demonstrating that TMTX may be useful in the treatment of certain patients with PCP.

CONCLUSIONS:

Although more well-designed clinical trials comparing TMTX with standard therapies are necessary, initial results indicate that TMTX is a promising alternative for moderate to severe episodes of PCP. Also, additional studies of TMTX's use as a prophylactic agent in PCP, and when it should be initiated in relation to a patient's CD4 count are needed. Furthermore, difficulty may arise in using TMTX on a regular basis because of the potential cost of therapy with concomitant leucovorin.
Assessment of the Pharmacy Service Needs of HIV-Positive Outpatients Receiving Zidovudine
Authors: Greco Rafelina , Lavack Lesley , Rovers John
Published: January 2017

OBJECTIVE:

To determine the pharmacy service needs of HIV-positive outpatients.

DESIGN:

Anonymous mail-in survey.

SETTING:

Accredited, not-for-profit, outpatient pharmacy.

PATIENTS:

A total of 226 men receiving refill prescriptions for zidovudine. Relevant demographics: For 91 percent, homosexual behavior was the primary HIV risk factor, 75 percent were HIV positive with low CD4+ count; 68 percent had been receiving zidovudine for less than 12 months.

MEASUREMENTS:

Survey questions determined patients' past experience and satisfaction with pharmacy services, description of pharmacy service needs, drug history, and sociodemographics.

MAIN RESULTS:

Confidentiality was desired by 90 percent of patients. Patients also expected to receive private medication counseling on zidovudine routinely and to receive other information upon request. Twenty patients expected no medication counseling. Such patients were more likely to have contracted HIV by transfusion or intravenous drug abuse (p<0.05).

CONCLUSIONS:

The perceived pharmacy service needs of outpatients taking zidovudine can reasonably be met in all ambulatory settings. Pharmacists must be aware that all patients do not have the same needs and should tailor their activities to the needs expressed by individual patients.
Successful Use of Higher-Than-Recommended Dosage of Imipenem in Pseudomonas Aeruginosa Endocarditis
Authors: King Jeffrey H. , Kailath Elizabeth J. , Hrdy Daniel B.
Published: January 2017

OBJECTIVE:

To report a case of Pseudomonas aeruginosa endocarditis that was successfully treated with high-dose imipenem/cilastatin and to discuss dosage modification based on individual pharmacokinetic parameters.

DATA SOURCES:

Clinical studies, review articles, and relevant laboratory and pharmacokinetic information.

CASE SUMMARY:

A 27-year-old man with right-sided P. aeruginosa endocarditis was successfully treated with long-term imipenem/cilastatin and tobramycin. The imipenem dose required to achieve therapeutic serum concentrations and cidal activity was 6 g/d. The manufacturer's recommended maximum dose is 4.0 g/d or 50 mg/kg/d. Because of the patient's large apparent volume of distribution, low serum imipenem concentrations, and lack of serum cidal activity, the clinical decision was made to increase the dose to 6 g/d or 54 mg/kg/d. Treatment was tolerated for seven weeks without any adverse effects. The patient remains free of symptoms 24 months after the diagnosis.

CONCLUSIONS:

Careful and discriminate use of larger-than-recommended doses of imipenem may be indicated in certain clinical situations. Dosage may need to be adjusted to body size in order to obtain optimal serum concentrations and activity.
The Efficacy of Ergogenic Agents in Athletic Competition: Part II: Other Performance-Enhancing Agents
Authors: Smith Daniel A. , Perry Paul J.
Published: January 2017

OBJECTIVE:

To summarize the literature describing the epidemiology, pharmacology, efficacy, and adverse effects associated with growth hormone (GH), caffeine, aerobic metabolism facilitator (AMF), and sympathomimetic use among athletes.

DATA SOURCES:

Relevant articles were identified from a MEDLINE search using the search terms “Doping in Sports”, “Blood”, “Caffeine”, “Cocaine”, “Erythropoeitin”, “Somatotropin”, and “Sympathomimetics (exploded).” Additional references were found in bibliographies of these articles.

STUDY SELECTION/DATA EXTRACTION:

We reviewed studies of ergogenic drug (ED) use among athletes. Interpretation of these studies is difficult because of poor research design and the paucity of information available. This necessitated the inclusion of many anecdotal or conjectural reports in our review.

DATA SYNTHESIS:

There are no studies documenting an ergogenic effect associated with GH use in humans or animals. It is still unknown whether GH abuse causes adverse effects in healthy adults, although GH-induced acromegaly has been suspected. Amphetamines, cocaine, and caffeine are thought to improve performance via enhanced concentration among athletes. Amphetamines and cocaine may increase aggressiveness. The ergogenic effects of other sympathomimetics including ephedrine and phenylpropanolamine are unclear. AMFs (e.g., blood doping, epoetin) enhance aerobic metabolism and endurance by increasing the oxygen-carrying capacity of the blood. Risks associated with excessive AMF use include increased blood viscosity and clotting.

CONCLUSIONS:

Athletes view EDs as an essential component for success. Without adequate intervention measures, ED abuse is likely to continue unchecked.
Guidelines for Continuous Infusion Medications in the Neonatal Intensive Care Unit
Authors: Reed Michael D. , Santeiro Maria L. , Stromquist Carine , Coppola Lynda
Published: January 2017

OBJECTIVE:

To present practical guidelines in tabular form for dosage, calculation, preparation, and monitoring of common medications administered by continuous infusion to neonatal intensive care patients.

DATA SOURCES:

Review articles and clinical trials were identified through a computer literature search with subsequent bibliography scanning.

STUDY SELECTION:

Articles selected for review were considered important contributions.

DATA EXTRACTION:

Data from human studies and review articles published in the English language were evaluated.

DATA SYNTHESIS:

In emergency situations, physicians and other healthcare providers caring for critically ill newborns often perform rapid calculations to determine the dosage and rate of continuous intravenous medication infusions. Because of the crisis situation, there is the potential for calculation errors. We compiled a concise table designed to provide a standardized method for the administration of emergency medications to neonatal intensive care patients. This table must be used in conjunction with clinical judgment and each medication infusion rate must be adjusted to the patient's clinical response and individual parameters.

CONCLUSIONS:

These guidelines help to minimize the volume of fluid needed for medication administration and facilitate the calculation, preparation, and timely administration of these medications, thus preventing errors that might occur in an emergency situation.
Ambulatory Care Pharmacy Services: The Incomplete Agenda
Authors: Carter Barry L. , Helling Dennis K.
Published: January 2017

OBJECTIVE:

To review studies that document the impact of clinical pharmacy services in ambulatory care settings and to propose standards of practice and resource allocation needs in ambulatory care.

DATA SOURCES:

English-language literature from 1970 through 1991 was reviewed and the representative literature is described.

STUDY SELECTION:

Studies were selected that examined the impact of clinical pharmacy services on patient outcomes and costs. Studies that evaluated pharmacist consultations by blind peer-review panels were also evaluated.

DATA EXTRACTION:

Trials were assessed based on their methodologies and ability to assess the value of clinical pharmacy services on patient outcomes.

DATA SYNTHESIS:

Numerous studies from the past 20 years are described illustrating the impact that ambulatory care pharmacy practitioners have made on patient care. These studies demonstrate that clinical pharmacists in ambulatory care not only serve as consultants on pharmacotherapy issues, but also can improve the quality of care for individual patients.

CONCLUSIONS:

Based on the studies cited and the needs of ambulatory patients, this article highlights the authors' views on what the standards of practice should be for ambulatory care practitioners and where resources should be allocated as ambulatory programs are expanded.
Treatment of Urokinase-Related Anaphylactoid Reaction with Intravenous Famotidine
Authors: Vidovich Robin R. , Heiselman Darell E. , Hudock Debbie
Published: January 2017

OBJECTIVE:

We describe our experience with an anaphylactoid reaction to urokinase and the treatment used. We also discuss the use of histamine H1- and H2-blockers in combination for the treatment of allergic anaphylactoid reactions.

DESIGN:

Case report.

SETTING:

Hospital.

PARTICIPANTS:

Observation of a patient who had a pulmonary embolism.

INTERVENTION:

During the use of urokinase, in treatment of a pulmonary embolism, the patient developed an anaphylactoid reaction that did not respond to diphenhydramine or hydrocortisone. Famotidine was administered.

RESULTS:

Abatement of urticaria and normalization of vital signs were obtained soon after famotidine was given. Completion of thrombolysis took place.

CONCLUSIONS:

Further investigation of the use of H1- and H2-blocking agents in the presence of anaphylactoid reactions to thrombolytic agents should be performed. Consideration of intravenous famotidine for the treatment of anaphylactoid-type reactions to urokinase is suggested.
Characteristics of Pharmaceutical Opinions Written in a Quebec Community Pharmacy
Authors: Dumas Jacques , Matte Janine
Published: January 2017

OBJECTIVE:

To describe the characteristics of pharmaceutical opinions written in a community pharmacy and to estimate the possible effects of these opinions on patient drug profiles.

DESIGN:

Retrospective survey.

SETTING:

The community pharmacy where these opinions were written is located in a rural area of the province of Quebec. Only health-related items are sold and no merchandise is displayed in this pharmacy.

PARTICIPANTS:

Ten pharmacists worked at this pharmacy during the period of the study.

INTERVENTION:

Pharmacists were paid when they sent advice to a patient or a physician about the patient's drug profile or about the therapeutic value of a prescribed treatment. This survey included recommendations made from 1978 to 1983. A sample of 600 opinions was drawn at random from a total of 1992 opinions that had been written at the site of the study.

MAIN OUTCOME MEASURE:

The impact of each opinion was assessed by analyzing patient drug profiles for three months after the opinion was written to determine if the recipient had followed the pharmacist's recommendation.

RESULTS:

Pharmacists, on their own initiative, sent 97.9 percent of the opinions. Only 1.7 percent of the opinions were requested by patients and 0.4 percent by physicians. Most opinions were addressed to patients (86.7 percent) rather than to physicians (13.3 percent). Almost four of five recommendations sent to patients were about compliance (45.1 percent) or were suggestions for improving the therapeutic effect of a medication or replacing a drug with nondrug treatment (33.4 percent). The three most common recommendations sent to prescribers were to replace one drug with another (25 percent), to change the dose or dosing schedule of a drug (16.3 percent), and to discontinue drug treatment (16.3 percent). Chemical stability, underuse or overuse of a medication, and adverse effects were the most frequent causes of recommendations sent to patients. Adverse effects, interactions, and the underuse of a medication were the most frequent reasons for recommendations sent to physicians. The proportion of recommendations that were implemented was 77.7 percent for patients and 58.1 percent for physicians.

CONCLUSIONS:

The pharmaceutical opinion seemed to be a good means of communicating with patients and prescribers on a wide variety of problems encountered in a community pharmacy. It allowed pharmacists to be paid for their expertise even if a drug was not dispensed. Also, the pharmaceutical opinion could compensate for the loss of income when the pharmacist recommended replacing a prescribed medicine with nondrug treatment.
Heparin and Infusion Phlebitis: A Prospective Study
Authors: Nieto-Rodriguez Jose A. , Garcìa-Martìn M.A. , Barreda-Hernandez M.D. , Hervàs M.J. , Cano-Real O.
Published: January 2017

OBJECTIVE:

To determine whether heparin sodium, when added to fluids infused through a peripheral catheter, reduces some local catheter-related problems (i.e., phlebitis, catheter obstruction, and extravasation of fluid) and extends the catheter's useful life.

DESIGN:

Prospective, double-blind, placebo-controlled.

SETTING:

Internal medicine ward of a general hospital with 400 beds.

PATIENTS:

Eighty-one consecutive acute collaborating patients who had a venous catheter in the forearm, inserted by nurses with more than one year of professional experience.

INTERVENTION:

Heparin sodium 1000 units/mL or NaCl 0.9% was added to compatible infusion fluids just before they were given to the patients. The final concentration of heparin was 1 unit/mL.

MEASUREMENTS:

Length of time until catheters were removed and reasons for their removal.

RESULTS:

The heparin group had a lower rate of local catheter-related problems than the placebo group (34.3 vs. 61.5 percent, respectively, p<0.05; 95 percent confidence interval for the difference 4.3 to 50.1 percent). The catheter's mean life in the heparin group was longer than that of the placebo group (98.9 ± 55.2 vs. 66.2 ± 47.2 h, respectively, p<0.05; 95 percent confidence interval for the difference 9.15 to 56.25 h). This effect was mainly attributable to prevention of noninflammatory catheter-related problems (e.g., obstruction, extravasation) and to a delay in the appearance of phlebitis.

CONCLUSIONS:

Heparin sodium, when added to infusion fluids to a final concentration of 1 unit/mL, diminishes local intravenous catheter-related problems and extends the catheter's life.
Evaluation of Glipizide and Glyburide in a Health Maintenance Organization
Authors: Noyes Margaret A. , Carter Barry L. , Helling Dennis K. , McCormick William C. , Ramirez Ramie
Published: January 2017

OBJECTIVE:

To determine if there was a difference in the long-term glycemic control, average daily dose, and cost of therapy in patients with noninsulin-dependent diabetes mellitus (NIDDM) treated with glyburide and glipizide in a health maintenance organization (HMO).

DESIGN:

Retrospective evaluation of medical and pharmacy records.

SETTING:

Multispecialty group practice HMO.

PATIENTS:

140 NIDDM patients being treated with either glyburide (n=70) or glipizide (n=70) were randomly selected from the populations of patients receiving either drug using computerized pharmacy records.

MAIN OUTCOME MEASURE:

Mean daily doses and blood glucose measurements (fasting blood glucose, random blood glucose, hemoglobin A1C) were stratified in 3-month periods from the time the drug therapy was started or the patient first presented to the clinic for a total of 18 months. Long-term glycemic control was defined as fasting blood glucose <8.33 mmol/L (150 mg/dL).

RESULTS:

The groups were comparable with regard to age (53.4 y glyburide, 56.7 y glipizide), gender (43 M:27 F glyburide, 47 M:23 F glipizide), race (38 W/16 B/16 H glyburide, 45 W/16 B/9 H glipizide), concurrent medical conditions, adverse effects, and compliance. Long-term glycemic control was similar in both groups. Although the number of subjects who were controlled (by definition) tended to be greater in the glyburide group, no clinical or statistical difference was found. There was no statistical difference in mean daily dose between the ethnic groups, but the small numbers preclude further analysis. The glipizide group had a larger percentage increase in dose within the first year than did the glyburide group; however, the percentage increase from the 3-month dose was similar after 18 months (22.7 percent glyburide, 27.5 percent glipizide.) Average daily cost of therapy, based on mean daily dose, was slightly lower for glyburide-treated patients.

CONCLUSIONS:

If glycemic control is similar with glyburide and glipizide, as seen in this study, economic considerations regarding choice of therapy and formulary inclusion may be appropriate.
Acute Renal Failure in an Elderly Woman following Intramuscular Ketorolac Administration
Authors: Schoch Patricia H. , Ranno Anthony , North Donald S.
Published: January 2017

OBJECTIVE:

To report a case of ketorolac tromethamine-induced acute renal failure and to discuss the risk factors that make patients more susceptible to the renal effects of nonsteroidal antiinflammatory drugs (NSAIDs).

DATA SOURCES:

Case reports and review articles identified by MEDLINE. Indexing terms included ketorolac, renal failure, and NSAIDs.

DATA EXTRACTION:

Data were abstracted from pertinent published English-language sources and were reviewed by all authors.

DATA SYNTHESIS:

Ketorolac is an intramuscularly administered NSAID with many of the same adverse effects associated with other oral NSAIDs. Although reversible depression of renal function has been associated with several NSAIDs, to date there have been no published reports of acute renal failure secondary to ketorolac administration. A 71-year-old woman received three doses of ketorolac to control the pain associated with pelvic and T11–T12 compression fractures. Over the next two days, the patient developed signs and symptoms of acute renal failure, including significant increases in blood urea nitrogen, serum creatinine, and peripheral edema. These signs and symptoms resolved over the next three to four days. Certain risk factors, several of which were present in this woman, make individual patients more susceptible to the renal affects of NSAIDs. These risk factors include advanced age, cirrhosis, volume depletion, congestive heart failure, gastrointestinal bleeding, and preexisting mild renal dysfunction.

CONCLUSIONS:

Caution should be taken when initiating ketorolac or any NSAID therapy with specific attention to risk factors that predispose a patient to renal dysfunction.
Lactulose in the Management of Constipation: A Current Review
Authors: Kot Theresa V. , Pettit-Young Ngaire A.
Published: January 2017

OBJECTIVE:

To review the current published clinical studies evaluating the clinical efficacy and safety of lactulose compared with other laxatives or placebo. Adverse effects associated with lactulose are also reported.

DATA SOURCES:

Information was retrieved by searching the MEDLINE and EMBASE databases for clinical trials, abstracts, conference proceedings, and review articles dealing with lactulose.

STUDY SELECTION:

Emphasis was placed on clinical trials where lactulose was compared with other laxatives or placebo in patient populations where the diagnosis of constipation was reasonably established.

DATA EXTRACTION:

The methodology and results from clinical studies were evaluated. Assessment of the studies was made based on diagnosis of constipation, prior management of patients, follow-up of patients, dosage, and adverse effects.

DATA SYNTHESIS:

Clinical trials in geriatric patients, terminally ill patients, children, and normal and constipated subjects were reviewed. In most instances, lactulose was compared with a placebo, without incorporating the current education on dietary techniques for improving defecation.

CONCLUSIONS:

Generally, clinical trials have demonstrated a beneficial response compared with placebo, although sometimes that response has been only marginally better, from a clinical point of view.
Professional Self-Image among Israeli Pharmacists: Sectoral Differences
Authors: Lustig Ahuva , Zusman Shlomo P.
Published: January 2017

OBJECTIVE:

To examine sectoral differences in the professional activities and self-images of Israeli pharmacists.

DESIGN, SETTING, AND PARTICIPANTS:

Pharmacists from private, community, and hospital sectors (n=145) completed a survey that assessed the rewards accrued from their professional activities as pharmacists and evaluated their professional and sectoral self-image.

RESULTS:

Few intersectoral differences were found among Israeli pharmacists. Most agreed that the main rewards in the public sector are secure employment, intellectual challenge, and responsibility. In the private sector, the rewards are high income, responsibility, and opportunity to counsel. The majority of pharmacists in all sectors are satisfied with their profession, and 90.7 percent would choose it again. Nevertheless, they ranked pharmacy eighth among nine professions chosen for comparison, which shows quite a low professional image. The private and hospital pharmacists attributed a higher social status to their own sectors than to the community sector.

CONCLUSIONS:

The inferior professional self-image held by pharmacists, despite the rewards of the profession, should be examined in greater detail.
Lithium-Induced Parathyroid Dysfunction: A Case Report and Review of the Literature
Authors: Taylor Jerry W. , Bell Angela J.
Published: January 2017

OBJECTIVE:

Twenty-six cases of lithium-induced hyperparathyroidism have been reported in the literature. This article describes an additional case that illustrates current management recommendations.

DESIGN:

Case report. Clinical presentation and proposed mechanisms of the suspected drug-induced effect are discussed.

CONCLUSIONS:

Serum calcium concentrations should be determined before and periodically during long-term lithium carbonate therapy. Discontinuation of therapy in patients who develop lithium-induced parathyroid dysfunction generally corrects calcium and parathyroid hormone concentrations. Surgery is indicated in patients with complications of hyperparathyroidism.
Clinical Update on Pentoxifylline Therapy for Diabetes-Induced Peripheral Vascular Disease
Authors: Campbell R. Keith
Published: January 2017

OBJECTIVE:

To introduce readers to the use of pentoxifylline for diabetes-induced peripheral vascular disease. The article provides background on the pathophysiology of diabetic foot ulcers as well as a review of the literature on the therapeutic use of pentoxifylline for treating this disorder.

DATA SOURCES:

A MEDLINE search was used to identify pertinent literature, including review articles and case reports. Key index terms included pentoxifylline, diabetic foot ulcer, neuropathy, peripheral vascular disease, and intermittent claudication

DATA EXTRACTION:

Basic pharmacologic data regarding absorption, distribution, metabolism, and excretion were reported in normal subjects as well as in patients with renal impairment. Open and controlled clinical trials also were analyzed; subjective symptoms were reported. The economic implications also were reported. The pharmacist's role in patient education is discussed.

DATA SYNTHESIS:

Pentoxifylline 800 mg/d was found to be effective in improving the symptoms in patients with noninsulin-dependent diabetes mellitus, including improvement in walking distance, paresthesia, skin temperature, and subjective overall response. In nondiabetic patients, statistically significant differences in leg-ulcer healing were found between the treatment and placebo groups. Case reports illustrated healing times, which ranged from two weeks to six months. Pentoxifylline use in both insulin-dependent and noninsulin-dependent patients was assessed in clinical trials, with improvement of symptoms in both patient types.

CONCLUSIONS:

Studies show that pentoxifylline is an alternative to vascular surgery in the management of peripheral vascular disease in diabetic patients, particularly in those with chronic ulceration of the lower extremities that does not heal despite other optimal treatment regimens, including cessation of smoking, maintenance of normoglycemia, elimination of vasoconstrictive drugs, correctly fitted shoes, and appropriate wound care. Pentoxifylline therapy may provide an appropriate, economical treatment modality by reducing the need for hospitalization and vascular surgery.