bluuebunny/crossref_metadata_2025 huggingface dataset:
Trauma Radiology: Part V. Imaging of Acute Cervical Spine Trauma
Authors: Mirvis Stuart E. , Shanmuganathan K.
Published: November 2015

Cervical spine injury constitutes a major cause of morbidity resulting from trauma. The consequences of a missed “significant” injury can be devastating for the patient and can create potential medical legal consequences for involved physicians. Multiple imaging modalities can be applied to imaging of the cervical spine after trauma, including radiography, computed tomography (CT), myelography, CT myelography and magnetic resonance imaging (MRI). Controversy exists concerning the appropriate number of radiographic views required for the screening assessment of cervical spine injuries. CT clarifies uncertain radiological findings, identifies subtle fractures in patients with neck pain or with neurological deficits but with normal radiographs, determines details of injury, and assists in operative planning. MRI has virtually replaced myelography and CT myelography in evaluating the traumatized cervical spine. MRI is more accurate than CT with intrathecal contrast in delineating epidural pathology, ligament injury, soft-tissue edema, and cord parenchymal injury. Information derived from MRI guides appropriate management and has value in predicting injury outcome. We consider indications for and relative merits of these various diagnostic modalities, and we describe imaging features of major patterns of cervical spine injury.
Tracheoarterial Fistula: An Unusual Complication of Tracheostomy
Authors: Schaefer Oren P. , Irwin Richard S.
Published: November 2015

The tracheoarterial fistula is an unusual but devastating complication of tracheostomy. It occurs with a frequency of approximately 0.7%, and it is uniformly fatal if not recognized and surgically corrected. Mucosal damage from the tracheal cannula, pressure necrosis from high cuff pressure, or mucosal trauma from an improperly positioned cannula tip results in erosion through the tracheal wall into the vascular structures that lie in the pretracheal space. Bleeding from this complication almost always occurs late (> 48 hours postprocedure). It is often preceded by sentinel hemoptysis. A paucity of signs and symptoms that precede or are associated with this complication require a high index of clinical suspicion to make the diagnosis. In addition to bleeding, other potential clues include a low-lying tracheostomy tube, pulsation of the tracheostomy tube, and the presence of infection, hypotension, malnutrition, and corticosteroid use. Unfortunately, there are no consistently useful diagnostic tools for tracheoarterial fistula. Fiberoptic bronchoscopy and angiography have been performed with mixed results. Should no other cause be found to explain the hemorrhage from or around the tracheostomy, or from disease distal to the primary carina, the patient must be taken to the operating room for a more definitive examination and possible vascular repair. Management is divided into acute stabilization and support, with protection of the airway and restoration of circulating blood volume, followed by definitive repair should the patient survive. Measures to prevent tracheal damage by the tracheostomy tube, such as proper surgical technique and proper inflation of the tracheostomy tube cuff, may go a long way to avoid this potentially lethal complication. Early consideration of this entity may be what saves the life of its victim.
Trauma, Sepsis, and Disseminated Intravascular Coagulation
Authors: Hardaway Robert M.
Published: November 2015

Disseminated intravascular coagulation (DIC) was first observed clinically in a case of sepsis following severe trauma. It was postulated that the observed clotting defect and bleeding were due to the using up of clotting factors in an episode of intravascular clotting. It was also postulated that the multiple organ failure observed was due to obstruction of the microcirculation of the organs by microclots. Evidence for this process was worked out in many animal studies. It was then postulated that if these microclots could be lysed before organ necrosis was produced, organ failure could be prevented. This prevention was shown to be possible in animals. It was then tried in humans using plasminogen activators, and the approach was found to be effective. Using a low dose of plasminogen activator over a 24-hour period caused no changes in the coagulation profile or bleeding.
Long-term Enteral Access in Aspiration-prone Patients
Authors: Cech Alex C. , Morris Jon B. , Mullen James L. , Crooks Gary W.
Published: November 2015

Aspiration pneumonia is a serious complication of enteral feeding. Many critically ill patients are particularly at risk for aspiration. Few studies have rigorously compared various access devices. Risk factors for aspiration and studies examining aspiration associated with enteral feeding devices are reviewed. We recommend a surgical jejunostomy for all patients at high risk for aspiration who require more than 3 weeks of enteral nutrition support.
Tracheobronchial Injuries Caused by Blunt Trauma
Authors: Shaker Kamal G. , Hollingsworth Helen M , Irwin Richard S. , Umali Cynthia B.
Published: November 2015

Tracheobronchial injuries, once rare complications of blunt trauma to the anterior neck and chest, are becoming more common. Traffic accidents account for most of these injuries. There are several possible mechanisms for airway rupture, the site of which is dictated by the location of the trauma and the points of airway fixation. The vast majority of cervical tracheal injuries occur above the fourth tracheal ring, whereas thoracic tracheal and bronchial lesions tend to occur in the vicinity of the carina. The presence of respiratory distress and signs of air leak, such as subcutaneous emphysema and persistent pneumothorax despite thoracostomy tube drainage, characterize many of these injuries. In some patients, however, the paucity of clinical findings leads to a delay in diagnosis until a late complication, such as lung collapse or suppuration; occurs. Flexible bronchoscopy remains the most valuable tool for diagnosis. Early surgical repair is recommended except for some minor injuries, which can be managed expectantly and with close follow-up. Patients who reach the hospital alive have a good prognosis.
Peripherally Inserted Central Catheters in the Intensive Care Unit
Authors: Ng Philip K. , Ault Mark J. , Maldonado Lawrence S.
Published: November 2015

We report the success rate and complications of peripherally inserted central catheters (PICCs) in patients hospitalized in an intensive care unit (ICU). We performed a cohort study in the ICU of a large tertiary care, university-affiliated community hospital. All ICU patients for whom their attending physicians requested a PICC service consultation were included. Main outcome measurements included (1) the success rate for initial PICC placement, (2) the placement complication rate, and (3) the overall success and complication rate. Of the 91 consecutive attempts at PICC placement, 89 (97.8%) were successful: of the 89 successful placements, 25 (28%) required cutdown procedures. There were 20 complications of initial placement and 8 delayed complications, which occurred in 19 PICCs. Complications included recatheterization after first attempt was unsuccessful (10), catheter malposition (7), palpitations or catheter clotting (3 each), heavy bleeding or mechanical phlebitis (2 each), and arterial puncture (1). The overall success rate for completion of therapy using the PICC was 74.7%. The most frequent reasons for failure to complete therapy were catheter dislodgment in 8 patients and “infection” in 9 patients. Of these 9 patients with “infections,” 8 catheters were discontinued due to potential infection, and only 1 was removed due to confirmed infection. The confirmed infection rate was 6/10,000 patient days. The PICC appears to be a reasonable alternative to other approaches to peripheral and central venous access. The initial and overall success rates from this preliminary study justify' further evaluation of the PICC in critically ill patients.
Pathophysiology, Diagnosis, and Management of Pulmonary Hypertension in Infants and Children
Authors: Baffa Jeanne M. , Gordon John B.
Published: November 2015

Pulmonary hypertension (PH) may occur as a primary process or as a complication of several diseases. In the pediatric population, PH secondary to congenital heart disease, chronic hypoxemia, or acute respiratory failure is more common than primary PH. Regardless of etiology, PH may lead to significant morbidity or mortality as a consequence of right-to-left shunting across cardiovascular channels or right heart failure. In this review, PH is defined in terms of the determinants of pulmonary blood flow: pulmonary artery pressure, downstream pressure, and pulmonary vascular resistance. Research addressing both normal developmental changes in pulmonary vascular resistance and abnormal pulmonary vascular reactivity is then reviewed, followed by a discussion of the etiologies of PH in children. Some of the more common clinical presentations of PH are presented focussing on the differences seen between patients with and without intracardiac communications. Assessment of the severity of PH using both noninvasive (electrocardiogram, echocardiogram, magnetic resonance imaging) and invasive (cardiac catheterization, lung biopsy) techniques is then discussed. Treatment of PH is presented, focussing on restoration of adequate pulmonary blood flow through use of both conventional and newer vasodilator therapies. The review concludes by noting the limits to our understanding of the pathogenesis and therapy of PH.
Refractory Heart Failure: A Therapeutic Approach
Authors: De Marco Teresa , Chatterjee Kanu
Published: November 2015

Optimal “triple therapy” for patients with chronic congestive heart failure (CHF) includes diuretics, digoxin, and either angiotensin-converting enzyme inhibitors or hydralazine plus nitrates. Refractory CHF is defined as symptoms of CHF at rest or repeated exacerbations of CHF despite “optimal” triple-drug therapy. Most patients with refractory CHF require hemodynamic monitoring and treatment in the intensive care unit. If easily reversible causes of refractory CHF cannot be identified, then more aggressive medical and surgical interventions are necessary. The primary goal of intervention is to improve hemodynamics to palliate CHF symptoms and signs (i.e., dyspnea, fatigue, edema). Secondary goals include improved vital organ and tissue perfusion, discharge from the intensive care unit, and, in appropriate patients, bridge to cardiac transplantation. Medical interventions include inotropic resuscitation (e.g., adrenergic agents, phosphodiesterase inhibitors, allied nonglycoside inodilators), load resuscitation (e.g., afterload and preload reduction with nitroprusside or nitroglycerin; preload reduction with diuretics and diuretic facilitators, such as dopaminergic agents or ultrafiltration), and electrical resuscitation (e.g., prevention of sudden death, correction of new or rapid atrial fibrillation, or dual chamber pacing in the setting of relative prolongation of the PR interval and diastolic mitral/tricuspid regurgitation). Surgical interventions are temporizing (e.g., intra-aortic balloon pump and other mechanical assist devices) or definitive (e.g., coronary artery revascularization, valvular surgery, and cardiac transplantation). Although these interventions may improve immediate survival in the short term, only coronary artery revascularization and cardiac transplantation have been shown to improve long-term survival.
Gas Embolism: Part I. Venous Gas Emboli
Authors: Wilson Mark M. , Curley Frederick J.
Published: November 2015

Gas emboli syndromes occur in many different settings, and their medical significance ranges from being life-threatening emergencies to being totally innocuous. We discuss venous gas embolization in Part I of this review, and it can result from a variety of traumatic, diagnostic, therapeutic, and surgical interventions. The pathophysiological consequences depend on where the gas bubbles impact and obstruct the circulation—by creating an “air lock” in the right ventricle, by obstruction of pulmonary arterioles, and sometimes with passage into the arterial circulation (so called paradoxical emboli). Various monitoring techniques are available and are known to be useful in high-risk patients. Nevertheless, the diagnosis can be difficult to establish. Myriad and generally nonspecific clinical manifestations may be present; the patient may often exhibit signs and symptoms suggestive of other acute cardiopulmonary or central nervous system events. The classically described “mill-wheel murmur” is actually a rare finding, and it is transient at best. There are no specific diagnostic tests available, and clinicians, must depend on a high level of suspicion in the appropriate settings. Rapid identification of the problem, with prevention of further gas entry into the venous circulation, should be a routine measure. The left lateral decubitus position, administration of 100% oxygen, and hyperbaric oxygenation should all be considered, and they have been shown to be effective treatment modalities.
Out-patient Therapy of Iatrogenic Opioid Dependency following Prolonged Sedation in the Pediatric Intensive Care Unit
Authors: Tobias Joseph D.
Published: November 2015

As a result of heightened awareness of the need for aggressive sedation and analgesia in the pediatric intensive care unit population, the risk for opioid withdrawal continues to increase. Although gradual tapering of the intravenous dose of opioid can be used to prevent such problems, this approach mandates maintenance of intravenous access and in-patient hospital admission. I present experience with the out-patient use of oral methadone to prevent opioid withdrawal following prolonged fentanyl sedation in the pediatric intensive care unit. A cohort of 18 patients is reviewed, and suggested guidelines for out-patient management of these patients using oral methadone are presented.
Capnography in Critical Care Medicine
Authors: Cheng Eugene Y. , Woehlck Harvey , Mazzeo Anthony J.
Published: November 2015

Capnography is a noninvasive method of monitoring exhaled CO2 and is used in many situations as a reflection of arterial CO2 concentration. Expired CO2 can be accurately measured using infrared spectrometry, mass spectrometry, and Raman scattering. Colorimetric CO2 detectors are useful as a qualitive indicator of the presence of CO2. Trending end-tidal CO2 and analysis of the capnographic wave form can provide information on changes in a patient's cardiopulmonary status or malfunction of equipment used to support a patient's cardiovascular or pulmonary systems. The accuracy of end-tidal CO2 measurements as a reflection of arterial CO2 tension in critically ill patients with respiratory or cardiovascular problems is limited. Changes in deadspace, respiratory rate and depth, positive end-expiratory pressure, areolar circulation, and cardiac output can significantly impact end-tidal CO2 values more than arterial CO2 concentrations. With marked changes in end-tidal CO2 that are of concern, arterial blood gas analysis should be obtained to determine if the end-tidal CO2 measurement is representatire of a change in arterial CO2 concentrations. Despite the limitations of end-tidal CO2 as a reflection of arterial CO2, it is still useful as a noninvasive monitor to alert clinicians of potential changes in a patient's cardiopulmonary condition.
Herpes Simplex Infections in the Critical Care Setting
Authors: Knobil Katherine , Wiener Charles , Zenilman Jonathan
Published: November 2015

Infections caused by herpes simplex virus (HSV) types 1 and 2 are widely prevalent and usually asymptomatic. In the immunocompromised or severely ill patient, however, HSV can cause a variety of mucosal and systemic syndromes. Organ systems most susceptible include the gastrointestinal tract, lungs, and the central nervous system. Systemic disseminated disease may also occur. With the exception of herpes encephalitis, clinical diagnosis of serious HSV infections is difficult, because it occurs in hosts who are susceptible to a wide range of infectious and metabolic problems. We review the presenting syndromes of HSV infection in the critically ill patient, and outline current concepts for diagnosis and treatment.
Pituitary Tumor Apoplexy: Pathophysiology, Clinical Manifestations, and Management
Authors: Arafah Baha M. , Ybarra Juan , Tarr Robert W. , Madhun Zuhayr T. , Selman Warren R.
Published: November 2015

Pituitary tumor apoplexy represents a rare clinical syndrome caused by hemorrhagic infarction of an existing, often previously unrecognized, large adenoma. We present our approach and experience in the field, and we provide a summary of pertinent published literature addressing diagnosis, management, and pathophysiology of the clinical manifestations of pituitary tumor apoplexy. Although many precipitating factors are known, most episodes occur spontaneously and present clinically with relatively sudden onset of severe headache, visual field defects, and ophthalmoplegia. Either computed tomography (nonenhanced and enhanced) or magnetic resonance imaging in a symptomatic patient can define pertinent anatomical changes and aid in establishing diagnosis. Immediate treatment with corticosteroids is necessary. Patients with the mild form of the syndrome respond quickly to steroids and can be managed conservatively with continued glucocorticoid therapy. Most patients with persistent neural deficits require urgent transsphenoidal decompression. Unless surgery is delayed, results of transsphenoidal decompression are usually very good, and improvements in neurological symptoms and endocrine function are noted within hours to days of the procedure. Patients need to be closely followed up after the episode because a large number continue to have residual tumor requiring additional therapy, or they have pituitary hormone abnormalities that need treatment. Close interaction between neurosurgeons and endocrinologists in the management of patients with pituitary tumor apoplexy is essential for optimal outcome.
Therapeutic Moderate Hypothermia for Severe Traumatic Brain Injury
Authors: Marion Donald W.
Published: November 2015

Use of therapeutic hypothermia to treat patients with severe traumatic brain injury was described more than 50 years ago. Unexpected improvement in some of these patients was attributed to hypothermia, but none of the early studies systematically evaluated the efficacy of hypothermia, and many patients were thought to have been harmed by the treatment, particularly when cooled below 30°C or when cooled for longer than 48 hours. Recent investigations have found that therapeutic moderate hypothermia (32–34°C) for relatively brief durations can improve histological and behavioral outcome following experimental brain injury. Cooling to this degree and duration has not been implicated as a cause for the cardiac arrhythmias, coagulation abnormalities, or infections attributed to hypothermia in the earlier studies. These laboratory investigations also defined several neurochemical mechanisms through which hypothermia may limit secondary brain injury and brain swelling. Four clinical trials of therapeutic moderate hypothermia were completed during the past three years; each detected a beneficial effect from cooling patients with severe traumatic brain injury to 32 to 34°C for up to 48 hours. In the largest of these studies, therapeutic moderate hypothermia was shown to cause a significant improvement in neurological outcomes 3, 6, and 12 months after injury for those patients with an initial Glasgow Coma Scale score of 5 to 7. The improvement in outcome for these patients was associated with a hypothermia-induced reduction of intracranial pressure and cerebrospinal fluid levels of interleukln-1β and glutamate.
Thrombolysis in Central Splanchnic Thrombosis
Authors: Demey Hendrik E. , Lambrecht Guy , Moorkens Greta , Michielsen Peter , Van Den Ende Jef , Bossaert Leo L.
Published: November 2015

We present 4 patients treated with streptokinase for different forms of abdominal venous thrombosis. Two patients suffered from central splanchnic venous thrombosis (superior mesenteric vein and bilateral iliac veins in Patient A, portal and superior mesenteric veins in Patient B). Both patients' presenting complaint was abdominal pain. In both, a temporary infection-associated circulating lupus anticoagulant presumably caused this condition. Two other patients presented with isolated portal vein thrombosis without lupus anticoagulant. Thrombolysis with high dose streptokinase (9 MU over 6 hours) successfully reopened the veins involved in all 4 patients. A literature survey showed that thrombolysis is a therapeutic option for mesenteric vein thrombosis, but there was no consensus on which thrombolytic drug should be given or on method of administration.
Aeromedical Transport of the Mechanically Ventilated Patient
Authors: Wachtel Andrew S. , Allen Howard N. , Lewis Michael I.
Published: November 2015

The logistical, technical, and medical considerations involved in the aeromedical transport of the mechanically ventilated patient arc considerable, and not well described in the literature. We review our experience with the prolonged (14.5 hr) air transport of a mechanically ventilated patient on a commercial airline. Practical and clinical issues are highlighted including equipment requirements and composition of the team, influences of altitude on equipment, and effects of altitude on the patient. A clear understanding of flight physiology and its impact on the patient and equipment are mandatory if one is to provide optimal care to these patients. The present report integrates our own experiences with data available from the literature, and may thus assist in both planning and undertaking any future such ventures for critically ill patients.
Resources for Applying Evidence-Based Medicine in the Pediatric Intensive Care Unit
Authors: Randolph Adrienne G. , Markovitz Barry
Published: November 2015

Evidence-based medicine is an approach to practicing medicine in which the clinician is aware of the evidence in support of her practice and the strength of that evidence. It requires daily application of systematic methods for finding, appraising, and incorporating the best available evidence in the care of individual patients. The evidence-based medicine approach compliments and enhances clinician expertise. It helps clinicians put the burgeoning medical literature into perspective. This article outlines the rationale of evidence-based medicine and lists resources for learning this approach and for finding repositories of evidence applicable to the critically ill pediatric population. We address the unique challenges posed by the smaller populations typically evaluated in pediatric critical care and practical constraints of incorporating evidence-based medicine into the fast-paced practice of critical care.
Recognition and Management of Cardiac Arrhythmias: Part II. Ventricular Arrhythmias and Bradyarrhythmias
Authors: Chakko Simon , Mitrani Raul
Published: November 2015

This review discusses the treatment of ventricular arrhythmias and bradyarrhythmias. Recent studies addressing the management of nonsustained ventricular arrhythmias in patients with congestive heart failure and those recovering from myocardial infarction are discussed. Determination of the origin of wide QRS complex tachycardia is usually possible at the bedside and the diagnostic criteria are provided. Therapy to prevent recurrent ventricular tachycardia or ventricular fibrillation is difficult and controversial. A widely accepted approach based on electrophysiologic testing and implantable defibrillators appears to be the most effective. Recognition and management of common bradyarrhythmias including the indications for pacemakers are discussed.
Safety and Value of Thoracentesis in Medical ICU Patients
Authors: Le Mense Gregory P. , Sahn Steven A.
Published: November 2015

The objective of this study was to determine the safety and value of thoracentesis in an ICU, Thoracentesis is a safe procedure for critically ill patients, even those on mechanical ventilators, and usually confirms the suspected diagnosis. However, thoracentesis revealed an unexpected diagnosis that changed management in 12% of patients. Repeat or contralateral thoracentesis is indicated when either the clinical course is inconsistent or may represent a complication of the original diagnosis.
ICU Sedation: A Review of Its Pharmacology and Assessment
Authors: Hill Laureen , Bertaccini Ed , Barr Juli , Geller Eran
Published: November 2015

The need for appropriate sedation in the intensive care unit is paramount. Critically ill patients are exposed to multiple adverse stimuli stemming from both their illness and their environment. If left unchecked, these stimuli may often produce potentially harmful physiologic sequelae in patients who already have compromised physiologic reserve. The most useful sedative agents in such circumstances are those which are readily titratable and have manageable side effects. This typically focuses discussion on the intravenous administration of analgesic sedatives (opioids), anxiolytic and amnestic sedatives (benzodiazepines, barbiturates, etomidate, propofol), dissociative sedatives (ketamine), and the antipsychotic sedatives (butyrophenones). With ready titratability, though, comes the need for efficient monitoring and assessment of the degree of sedation. While no measure is without bias, this can effectively be done via the subjective means of a sedation scoring scheme or the more objective means of electrophysiologic measurements. It is the combination of pharmacological tools and consistent assessment which will allow the intensivist to readily achieve the desired sedation goal.
Organ Donor Issues for the Intensive Care Physician
Authors: Delmonico Francis L. , Reese Jeffrey C.
Published: November 2015

The opportunity for organ donation most often arises in the intensive care unit following the declaration of brain death. Thus a comprehensive discussion of the topic of organ donation is of special importance to the intensive care physician. The essential criteria of brain death are provided in this review; however, a unitarian concept is emphasized, that all death is occasioned by an irreversible loss of brain function. Recovery of organs from a non-heart-beating organ donor is presented in this context. The characteristics of the suitable cadaver organ donor are reviewed, detailing donor age considerations and the exclusion criteria of HIV infection and a history of donor malignancy. An analysis of death caused by specific poisons is presented that is amenable to cadaver organ donation. The shortage of cadaver organs for transplantation persists. The major obstacle to donation is family consent. A paradigm of procedure from organ donor referral to organ recovery in the operating room is outlined, with a discussion of the suggested best practice for achieving family consent. This emphasizes the need for highly trained personnel to request consent for organ donation. Intensive care unit management of the donor following the declaration of death is given by a problem-oriented review, intended to preserve hemodynamic stability until organ recovery can be accomplished.
Toward a New National Housing Policy
Authors: Varady David P.
Published: November 2015

This essay reviews A Decent Place to Live, by the National Housing Task Force, as well as two other reports used to prepare it. The Task Force's main recommendation is a major new housing supply initiative to address the worsening problems of low-income renters. The Low Income Housing Preservation Commission's report proposes ways to save two million units of privately owned and federally subsidized low-income rental units currently in jeopardy. The National Conference of State Legislatures report identifies a number of state strategies for making housing affordable to low-income families. The broad coverage, up-to-date analyses, and provocative suggestions make these reports an important resource for planners and policymakers.
Community Detection in Political Discussions on Twitter
Authors: Guerrero-Solé Frederic
Published: November 2015

In November 9, 2014, the Catalan government called Catalan people to participate in a straw poll about the independence of Catalonia from Spain. This article analyzes the use of Twitter between November 8 and 10, 2014. Drawing on a methodology developed by Guerrero-Solé, Corominas-Murtra, and Lopez-Gonzalez, this work examines the structure of the retweet overlap network (RON), formed by those users whose communities of retweeters have nonzero overlapping, to detect the community structure of the network. The results show a high polarization of the resulting network and prove that the RON is a reliable method to determinate network community structures and users’ political leaning in political discussions.
Systemic Radionuclide Palliative Therapy for Metastatic Carcinoma with Strontium 89
Authors: Papatheofanis Frank J. , Windisch Paul A. , Matuszewski Karl A.
Published: November 2015

Metastatic carcinoma is the most common neoplasm involving the skeletal system. It is estimated that 30% to 70% of newly diagnosed cancer patients develop osseous metastases, causing intractable bone pain. A variety of treatments have been used to control bone pain associated with skeletal metastases, including analgesics, cytotoxic chemotherapy, external beam radiotherapy and systemic radio-nuclide therapy. Strontium 89 (89Sr) is a systemic radionuclide and calcium analog that has been extensively used for pain control in advanced skeletal metastatic disease. Strontium 89 offers advantages over other treatment modalities, including repeated treatments if necessary, less bone marrow suppression and toxicity and potential for cost effectiveness.
The Role of the Pharmacist in Developing Critical Pathways with Warfarin Therapy
Authors: LaCalamita Stephanie
Published: November 2015

The pharmacist can play a key role in the development of critical pathways for disease states with warfarin as a component of therapy. The pharmacist must be familiar with the complex therapeutic considerations involved with warfarin therapy. This paper will briefly review warfarin therapeutics and will discuss strategies for pharmacist involvement in development of critical pathways including warfarin therapy. Participation in the multidisciplinary planning of critical pathways provides an excellent opportunity to contribute to the efficient, safe, and cost-effective use of warfarin.
The Biotechnology Industry
Authors: Evens Ronald P.
Published: November 2015

Growth and change are the hallmarks of the developing biotechnology industry. Since the first approval of a biological product in 1982, over 40 biologicals, many of them medical breakthroughs, have been brought to market. The majority of biotechnology companies focus on developing human therapeutic agents, but about 25 percent of biotechnology companies focus on the diagnostic area, using monoclonal antibody technology, polymerase chain reaction (PCR) technology, and genetics to provide advances in diagnosis and disease monitoring. Structurally, few biotechnology firms are fully integrated companies with full capabilities in research, development, manufacturing, and sales and marketing. Many pursue strategic alliances with other companies to enhance their capabilities in research, development, and sales and marketing. Research alliances between companies and universities are also frequently used to enhance research capabilities. As the industry has matured, consolidation has occurred, with major pharmaceutical companies purchasing biotechnology companies and biotechnology companies merging to expand their capabilities. Research investment, as a percentage of gross sales, continues to be very high for biotechnology companies compared with traditional pharmaceutical companies. The cost of drug development is high, but the probability of approval appears to be somewhat better in the biotechnology field compared with traditional pharmaceuticals. Today, the biotechnology product pipeline is rich, with between 400 to 700 products in various stages of clinical development. Technology developments beyond recombinant DNA technology and monoclonal antibodies, such as antisense, genomics, and combinatorial chemistry, will lead to additional therapeutic and diagnostic breakthroughs.
Practical Issues in Handling Biotechnology Products
Authors: Jones Suzanne F.
Published: November 2015

The unique nature of biotechnology products requires specific additional education and training for pharmacists. To understand how these products were developed and their mechanism of action, expanded knowledge in molecular biology, immunology, genetics, and the techniques of biotechnology is essential. Since these products are often used for disease states that were not previously treated with drug therapy, a basic understanding of the pathophysiology of the disease being treated is essential. Many biotechnology products are administered parenterally, and pharmacists must be familiar with these methods of administration to provide proper equipment, guidance, and counseling for patients. Stability and compatibility issues frequently arise with biotechnology products as many require refrigeration, special diluents, and are susceptible to compatibility problems. Because these products are often used in chronic disease settings and because patients may be expected to self-administer using a parenteral route, drug therapy monitoring and patient education needs are often substantial. The patient education role, in particular, may be the most important responsibility for pharmacists providing care to patients undergoing treatment with biotechnology products.
Understanding Statistical and Clinical Significance: Hypothesis Testing
Authors: Anderson H. Glenn , Kendrach Michael G. , Trice Shana
Published: November 2015

This primer reviews a number of statistical concepts integral to the hypothesis testing process and its role in decision making. Concepts of variables, scales of measure, and measures of central tendency and dispersion are discussed, and a 5-step process of hypothesis testing is presented. Finally, a discussion of the statistical and clinical significance of research results is presented, along with the concept of confidence intervals as a method of conveying information about the effect size as well as the statistical significance of a difference between groups.
Evidence-Based Practice in Health Care
Authors: Moores Kevin G.
Published: November 2015

Health care practice requires managing large amounts of information. Rapid advances are occurring in available evidence regarding effectiveness and efficiency of various health care services. The health care practitioner must have information management skills plus access to resources and technology. Evidence-based medicine is a philosophy of practice and an approach to decision making that values systematic evidence. There are many similarities in evidence-based practice and the systematic approach to drug information. New information resources and informatics technologies are available, and changes are occurring in health professional education that support an evidence-based practice. Implementation of principles and tools of evidence-based medicine are expected to improve the quality, effectiveness, and efficiency of care.
Contemporary Practice: Treatment Gap in Lipid-Lowering Therapy
Authors: Evers Laurel B. , Raasch Ralph H.
Published: November 2015

Pharmacists can play a key role in preventing many adverse sequelae from improperly treated hypercholes-terolemia through treatment and monitoring strategies. Simvastatin and lovastatin utilization in an outpatient population was evaluated in this retrospective chart review. A dose-response effect for total cholesterol reduction was observed. Only 33% (13/40) of patients achieved consensus National Cholesterol Education Program (NCEP) therapy goals. Of those not meeting NCEP guidelines, 11% (3/27) were on maximum doses. Dosage adjustment occurred for 56% (15/27) but 27% (4/15) had no follow-up level. These results suggest that more aggressive lipid-lowering treatment and monitoring are necessary if guidelines are to be met.
Pantoprazole: A New Proton-Pump Inhibitor
Authors: Dombrower Paul M.
Published: November 2015

Pantoprazole, a new substituted benzimidazole, is reviewed for its use in the treatment of gastroesophageal reflux disease (GERD). In the intravenous form, pantoprazole has a rapid onset of antisecretory effect. The oral formulation has good oral bioavailability and chemical stability in mild to moderate acid conditions. Other positive attributes include lack of significant adverse effects and drug interactions, minimal effect of renal and hepatic impairment on drug disposition, and its ability to control gastric pH > 4.0. In comparative studies, it has been shown to be more effective than H2RAs in the treatment of erosive esophagitis, comparable to omeprazole, but less effective than lansoprazole.
REFORMS AND THE CORPORATE WORLD
Authors: Raipuria Kalyan
Published: November 2015

There is a world-wide wave for reforms. The corporate sector is expected to be in the forefront. But, presently, it appears to be in the grip of paradoxes of ever-growing need for liquidity in the grip of low own savings; apprehension of foreign investors in the face of foreign flows and technology; little attention to cost and price competitiveness and R&D in the face of the lauded objective of $100 billion exports by the turn of the century and the like. The growth rate of the country has much to do with structural, allocational and efficiency or productivity factors than larger and larger credit alone. Cost of money is coming down. Indeed, the initial phase did receive expected responses from the corporate sector all to its own benefit. But, the new factors of competitiveness are yet to be faced. Unlike the winning Japanese, the Korean and the Chinese styles of corporate enterprises, none seems to be discussing the Indian styles of enterprise. The defensive and suspicions style of Indian enterprises seems to be making them the lasting looser.
FISCAL DEFICIT CONTAINMENT NOT AN EXCUSE FOR NEGLECT OF POOR
Authors: Ramachandran K.S.
Published: November 2015

The paper holds the view that while fiscal discipline is important this must be achieved through good management of resources. The magnitude of poverty does not justify slackness. The poor should not be asked to pay the price for the mistakes and inadequacies of politicians and bureaucrats. If there is inefficiency in economic management, this is not the fault of those who cannot afford a square meal a day. Those who are inept or inefficient must look for other scapegoats than people who are barely surviving.
MEASURING QUALITY OF WORK LIFE - A SIMPLE APPROACH
Authors: Karrir Naval , Khurana Amulya
Published: November 2015

The study through survey of literature finds that there is neither a consensus on what are to be the dimensions for Quality of Worklife nor there is a standard definition. An analysis of background and motivational variables of 491 managers from 30 organisations in public, private and cooperative sectors of Indian industry, at all the three levels of managerial hierarchy (top, middle and bottom), has been done to simplify measurement of Quality of Worklife (QWL) of managers.

Stepwise multiple regression analysis has been done to reach at near efficient predictors for QWL of managers among background and motivational variables.
INDIAN MANAGERS FOR A GLOBAL ECONOMY
Authors: Atmanand
Published: November 2015

The paper attempts to present the various dimensions of management in the changing recnario of globalisation and liberalisation. The Indian manager has to be prepared with the qualities required for being successful in a global economy. In this context, the role of management education, management institutions and information technology becomes very important.
CASE STUDY I LUCENT PAINTS PVT. LTD. REENGINEERING “BODY” ON QUALITY “WHEELS”
Authors: Bhalla Aditya
Published: November 2015

Lucent Paints Pvt. Ltd., established in 1975, is a paint and enamel manufacturer with a market share of 20 per cent. With the changing environment, increasing competition and the threat of MNCs looming large the company's management decides to undertake reengineering of its processes. Ms. Anjali Parmar, a sales manager, with an engineering background and a star performer is considered to be the right candidate for this project. Parmar accepts the responsibility enthusiastically and sets about the task with full vigour. In eight months she submits the report recommending radical proposals with another ongoing quality control project being implemented under the guidance of Mr. Tikoo for obtaining ISO 9001 certification. Ms. Parmar and Mr. Tikoo get down to the new task. However, things start going wrong between them from the beginning itself. The team is plagued with disagreements and arguments. Things take such a turn that the top management has to intervene...
Power Sector Financing in India
Authors: Chaudhuri S.K.
Published: November 2015

The huge sum of capital required to finance the power development plan in India to achieve a target GDP growth of 7-8 per cent calls for heavy private investments-domestic and foreign. Private capital flow to the power sector can be induced by developing industry-market and regulatory utility to function as financially sound and commercially responsible entities.
Managing Quality Improvement
Authors: Chalapathi R.S.
Published: November 2015

Knowledge of “theory of variation” is one of the most powerful tools a company can develop in its quest for quality. It can improve manager's effectiveness and create opportunities for continuous improvement. It is part of the foundation of Deming's management philosophy, each of his 14 points is based partly on the desire to reduce variation.
Job Attitudes and Learned Helplessness: Implications for Individual Competitiveness in Indian Industries
Authors: Petre Sanjyot , Chaudhari Sushama
Published: November 2015

In the era of change, restructuring, learning and growth, and above all uncertainty, organizations face dual challenge. On one end is tile challenge of ensuring continued performance of employees, their motivation, their ability enhancement and their career growth. On the other hand is separation of non-performing employees, less job security, constant pressure of the environment and search for stability and predictability. Employee attitudes are therefore very relevant to increasing competitiveness. The present study is an attempt to empirically analyze how environmental commitment in terms of their controllability influence job involvement and organizational commitment in organizations. The present work has been undertaken as a preliminary study to understand the relationship between learned helplessness and job attitudes in terms of organizational commitment and job involvement of the employees of heavy engineering plant and that of a bank. The result is discussed with implications for increasing competitiveness.
Attractiveness Of The Indian Market In Comparison To Chinese Market: A Critical Analysis
Authors: Roy Dilip , Mandal Kaushik
Published: November 2015

This paper examines the attractiveness of Indian market keeping in mind the competitive role of the Chinese market. For doing so, multi-dimensional study has been undertaken covering economic, socio-human, infrastructure, communication, political and ethical aspects of these two countries. We further present SAW analysis for Indian market to depict the attractiveness potential and indicate the future path for strategic action.
Key Issues And A Framework For Managing Global Supply Chains
Authors: Mitra Subrata
Published: November 2015

Managing global supply chains has become important due to an accelerated growth in world trade in the last few years. In this paper, the operational, organizational and socio-economic and political issues in the context of global supply chains are discussed, and a framework for managing global supply chains is constructed.
Women In Indian Advertising: A Study Of Consumer Liking For Different Role Portrayals
Authors: Singh Raghbir , Bhullar Prima
Published: November 2015

Most advertisements, in order to attract audience, use illustrations depicting women. Women are often shown in Indian print advertisements in different roles ranging from that of a mother to that of a sexy siren. However, very little is known about the preference for different depictions. The changing role of woman in society has created a challenging task for advertisers, that is, how to portray women in advertisements. In the present paper, an effort has been made to identify and examine the liking of the respondents towards different roles portrayed by women in advertisements.
Information Modeling for Achieving Integrity in Data Bases for Open Systems
Authors: Khurana Reema
Published: November 2015

For a complex and changing business environment this paper addresses the research issue of developing a comprehensive information base with integrity and also stresses on the fact that the traditional view of schema is not enough in the current business environment. The paper begins with identifying every generic business process with a physical and informational work system and the fact that each of these are represented by closed loop information and control system, backed by a information base. The paper identifies the fact that the information base functions in a complex information and control system delivering support for flexible decision making. It also enhances the fact that operable goal setting w.r.t defining ‘many’ factors, ‘multiple’ criteria characterized by problem system complexity needs to be reflected in developing an Information base model with integrity. Finally the paper proposes that an information base design model needs to be identified which preserves integrity of information through an ever evolving schema open to the environment.
Genetic Algorithm & Tabu Search Attack on The Mono-Aiphanetic Substitution Cipher
Authors: Garg Poonam , Sherry A.M.
Published: November 2015

With the exponential growth of networked system and application such as Commerce, the demand for effective internet security is increasing. Cryptology is the science and study of systems for secret communication. It consists of two complementary fields of study: cryptography and cryptanalysis. In this paper, we propose a cryptanalysis method based on Genetic Algorithm and Tabu Search to break a Mono-Alphabetic Substitution Cipher. We will also compare and analyze the performance of these algorithms in automated attacks on a Mono-Alphabetic Substitution Cipher. The use of Tabu Search is a largely unexplored area in the field of Cryptanalysis. A generalized version of these algorithms can be used for attacking other cipher as well.
Dynamics Of Composite Work Groups & It's Impact On An Organization
Authors: Agarwal V.K. , Sharma Nitika
Published: November 2015

Groups are everywhere; in industry, in business, in government, in schools, any professional associations-it is omnipresent wherever people go together to get things done. Indeed, the peoples' management approach has made the collaborative group work as one of the inevitable feature that has swept through organizations during the last two decades of the twentieth century. Organizations have sold on the value of collaborative group work. One issue, which usually remains unaddressed, is how these performing groups are able to bring about drastic change, bringing good to the organizations' bottom line. Much has been written and said about the after results of the performing group. However, what is important to study is ultimately, what is the processes intervention that takes place from the formation to the working of a performing group. These are the dynamics that when left unattended; only widen the gap between what is promised and what can be accomplished. To gain further insight, authors have taken a case of a T.V. Glass manufacturing plant, a retrospective study to underneath the process of interventions and especially the various processes and their impact on the group, its members and on the overall performance of the group.