bluuebunny/crossref_metadata_2025 huggingface dataset:
The Uyghur Terrorism: Phenomenon and Genesis
Authors: Soloshcheva Maria A.
Published: December 2017

The aim of this paper is 1) to analyse the historical and political roots of the current situation in Xinjiang; 2) to identify the boundaries that separate the legal opposition from what is usually called non-system opposition; and 3) to study a set of preconditions that have affected the emergence of the phenomenon of the Uyghur terrorism. In a broader sense, the engagement of the Uyghur population in separatist activities under the slogan of the most radical Islamic religious-political movements (Jabhat an-Nusra (alias Jabhat Fateh al-Sham), ISIL, Al Qaeda, the Taliban, etc.) is addressed. Generally, the author tries to answer the following questions: What are the motives and methods of Uyghur terrorists? What dynamics of their violent acts may we consider in the People’s Republic of China and abroad? What legal and terrorist organisations have Chinese Uyghurs as members? And what distinguishes legal and the so called non-system Uyghur opposition?
Pirating Mare liberum (1609)
Authors: Somos Mark , Margócsy Dániel
Published: December 2017

Two pirated editions form a vital but neglected part of the printing and reception history of the first edition of Grotius’s Mare liberum.
The Esipov Chronicle and the Creation of the Concept of Siberia as a Special Sacred Space
Authors: Thyrêt Isolde
Published: December 2017

The conquest of Siberia and the conversion of its peoples to Russian Orthodoxy are generally seen as the outcome of a successful Muscovite imperial policy, which aimed at the political subordination of the area east of the Urals to the tsar’s will and at Siberia’s economic exploitation. While scholars tend to view even the definition of a Siberian identity as an outgrowth of Muscovite political and religious thought, this article explores how the Esipov Chronicle, composed in 1636 by Savva Esipov, a deacon of the Sophia Cathedral in Tobolsk, articulated the Siberian hierarchs’ view on the importance of their border diocese to their Muscovite homeland. The Esipov Chronicle achieved this purpose by presenting Ermak’s expedition into Siberia and the defeat of the pagan tsar Kuchum as an important chapter in the Christian salvation drama. Portraying the land beyond the Urals as a place with its own local religious traditions, the Esipov Chronicle created the notion that Siberia was a unique sacred space that needed to be respected. In the early seventeenth century, the Muscovite agenda regarding Siberia was seemingly not yet fully developed, allowing the Siberian hierarchs to formulate their own regional perspective on their outpost diocese.
Unraveling Climatic Wind and Wave Trends in the Red Sea Using Wave Spectra Partitioning
Authors: Langodan Sabique , Cavaleri Luigi , Pomaro Angela , Portilla Jesus , Abualnaja Yasser , Hoteit Ibrahim
Published: December 2017

The wind and wave climatology of the Red Sea is derived from a validated 30-yr high-resolution model simulation. After describing the relevant features of the basin, the main wind and wave systems are identified by using an innovative spectral partition technique to explain their genesis and characteristics. In the northern part of the sea, wind and waves of the same intensity are present throughout the year, while the central and southern zones are characterized by a marked seasonality. The partition technique allows the association of a general decrease in the energy of the different wave systems with a specific weather pattern. The most intense decrease is found in the northern storms, which are associated with meteorological pulses from the Mediterranean Sea.
The Importance of Ocean Dynamical Feedback for Understanding the Impact of Mid–High-Latitude Warming on Tropical Precipitation Change
Authors: Yoshimori Masakazu , Abe-Ouchi Ayako , Tatebe Hiroaki , Nozawa Toru , Oka Akira
Published: December 2017

It has been shown that asymmetric warming between the Northern and Southern Hemisphere extratropics induces a meridional displacement of tropical precipitation. This shift is believed to be due to the extra energy transported from the differentially heated hemisphere through changes in the Hadley circulation. Generally, the column-integrated energy flux in the mean meridional overturning circulation follows the direction of the upper, relatively dry branch, and tropical precipitation tends to be intensified in the hemisphere with greater warming. This framework was originally applied to simulations that did not include ocean dynamical feedback, but was recently extended to take the ocean heat transport change into account. In the current study, an atmosphere–ocean general circulation model applied with a regional nudging technique is used to investigate the impact of extratropical warming on tropical precipitation change under realistic future climate projections. It is shown that warming at latitudes poleward of 40° causes the northward displacement of tropical precipitation from October to January. Warming at latitudes poleward of 60° alone has a much smaller effect. This change in the tropical precipitation is largely explained by the atmospheric moisture transport caused by changes in the atmospheric circulation. The larger change in ocean heat transport near the equator, relative to the atmosphere, is consistent with the extended energy framework. The current study provides a complementary dynamical framework that highlights the importance of midlatitude atmospheric eddies and equatorial ocean upwelling, where the atmospheric eddy feedback modifies the Hadley circulation resulting in the northward migration of precipitation and the ocean dynamical feedback damps the northward migration from the equator.
The Dynamics of Quasigeostrophic Lens-Shaped Vortices
Authors: Storer Benjamin A. , Poulin Francis J. , Ménesguen Claire
Published: December 2017

The stability of lens-shaped vortices is revisited in the context of an idealized quasigeostrophic model. We compute the stability characteristics with higher accuracy and for a wider range of Burger numbers (Bu) than what was previously done. It is found that there are four distinct Bu regions of linear instability. Over the primary region of interest (0.1 < Bu < 10), we confirm that the first and second azimuthal modes are the only linearly unstable modes, and they are associated with vortex tilting and tearing, respectively. Moreover, the most unstable first azimuthal mode is not precisely captured by the linear stability analysis because of the extra condition that is imposed at the vortex center, and accurate calculations of the second azimuthal mode require higher resolution than was previously considered. We also study the nonlinear evolution of lens-shaped vortices in the context of this model and present the following results. First, vortices with a horizontal length scale a little less than the radius of deformation (Bu > 1) are barotropically unstable and develop a wobble, whereas those with a larger horizontal length scale (Bu < 1) are baroclinically unstable and often split. Second, the transfer of energy between different horizontal scales is quantified in two typical cases of barotropic and baroclinic instability. Third, after the instability the effective Bu is closer to unity.
Angular Momentum Eddy Detection and Tracking Algorithm (AMEDA) and Its Application to Coastal Eddy Formation
Authors: Le Vu Briac , Stegner Alexandre , Arsouze Thomas
Published: December 2017

Automated methods are important for the identification of mesoscale eddies in the large volume of oceanic data provided by altimetric measurements and numerical simulations. This paper presents an optimized algorithm for detecting and tracking eddies from two-dimensional velocity fields. This eddy identification uses a hybrid methodology based on physical parameters and geometrical properties of the velocity field, and it can be applied to various fields having different spatial resolutions without a specific fine-tuning of the parameters. The efficiency and the robustness of the angular momentum eddy detection and tracking algorithm (AMEDA) was tested with three different types of input data: the 1/8° Archiving, Validation, and Interpretation of Satellite Oceanographic Data (AVISO) geostrophic velocity fields available for the Mediterranean Sea; the output of the idealized Regional Ocean Modeling System numerical model; and the surface velocity field obtained from particle imagery on a rotating tank experiment. All these datasets describe the dynamical evolution of mesoscale eddies generated by the instability of a coastal current. The main advantages of AMEDA are as follows: the algorithm is robust to the grid resolution, it uses a minimal number of tunable parameters, the dynamical features of the detected eddies are quantified, and the tracking procedure identifies the merging and splitting events. The proposed method provides a complete dynamical evolution of the detected eddies during their lifetime. This allows for identifying precisely the formation areas of long-lived eddies, the region where eddy splitting or merging occurs frequently, and the interaction between eddies and oceanic currents.
An Observing System Simulation Experiment for the Calibration and Validation of the Surface Water Ocean Topography Sea Surface Height Measurement Using In Situ Platforms
Authors: Wang Jinbo , Fu Lee-Lueng , Qiu Bo , Menemenlis Dimitris , Farrar J. Thomas , Chao Yi , Thompson Andrew F. , Flexas Mar M.
Published: December 2017

The wavenumber spectrum of sea surface height (SSH) is an important indicator of the dynamics of the ocean interior. While the SSH wavenumber spectrum has been well studied at mesoscale wavelengths and longer, using both in situ oceanographic measurements and satellite altimetry, it remains largely unknown for wavelengths less than ~70 km. The Surface Water Ocean Topography (SWOT) satellite mission aims to resolve the SSH wavenumber spectrum at 15–150-km wavelengths, which is specified as one of the mission requirements. The mission calibration and validation (CalVal) requires the ground truth of a synoptic SSH field to resolve the targeted wavelengths, but no existing observational network is able to fulfill the task. A high-resolution global ocean simulation is used to conduct an observing system simulation experiment (OSSE) to identify the suitable oceanographic in situ measurements for SWOT SSH CalVal. After fixing 20 measuring locations (the minimum number for resolving 15–150-km wavelengths) along the SWOT swath, four instrument platforms were tested: pressure-sensor-equipped inverted echo sounders (PIES), underway conductivity–temperature–depth (UCTD) sensors, instrumented moorings, and underwater gliders. In the context of the OSSE, PIES was found to be an unsuitable tool for the target region and for SSH scales 15–70 km; the slowness of a single UCTD leads to significant aliasing by high-frequency motions at short wavelengths below ~30 km; an array of station-keeping gliders may meet the requirement; and an array of moorings is the most effective system among the four tested instruments for meeting the mission’s requirement. The results shown here warrant a prelaunch field campaign to further test the performance of station-keeping gliders.
Potential Influence of the East Asia–Pacific Teleconnection Pattern on Persistent Precipitation in South China: Implications of Atypical Yangtze River Valley Cases
Authors: Li Hui , Zhai Panmao , Chen Yang , Lu Er
Published: December 2017

In this study, cases of the East Asia–Pacific (EAP) teleconnection pattern not responsible for persistent precipitation processes in the Yangtze River valley (YRV) have been investigated. The results suggest that such a type of EAP pattern has some linkage with persistent precipitation processes in south China (SC) with the following properties: 1) in response to the negative SSTAs and anticyclone near the Philippines, the meridional energy propagates from the low latitudes over the north of the Philippines; 2) the western Pacific subtropical high (WPSH) then intensifies and extends westward; 3) a meridional triple structure of the EAP teleconnection pattern is established; 4) at the same time, the cyclonic circulation over northeastern China introduces cold and dry air to the lower latitudes, merging with the water vapor into SC and leading to heavy precipitation from the fringe of the WPSH, the South China Sea, and the Bay of Bengal and the combination of systems persists for at least 3 days, leading to the persistent precipitation processes in SC; and 5) compared with the EAP teleconnection responsible for the precipitation in YRV, the positions of the three centers in the mid- and low latitudes are more southerly located than the YRV EAP centers. Further study indicates that the ocean surface heat conditions in the areas near the Philippines seem to be important in affecting the EAP teleconnection pattern for persistent precipitation processes in SC. Finally, all of the cases with persistent precipitation in SC during 1961–2010 linked with the EAP pattern have been investigated; the results are consistent with the above conclusions.
Lightning-Related Fatalities in Romania from 1999 to 2015
Authors: Antonescu Bogdan , Cărbunaru Felicia
Published: December 2017

Lightning-related fatalities in Romania are analyzed and presented for the first time using data from the Romanian National Institute of Statistics. The database contains 724 lightning fatalities that occurred between 1999 and 2015 in Romania, corresponding to an average of 42.6 fatalities per year. The annual number of lightning fatalities decreased from 65 fatalities per year between 1999 and 2003 to 23.2 fatalities per year between 2011 and 2015. The majority of fatalities occurred in May–August (42% of all fatalities) with a peak in June (31%) and July (28%). The highest fatality rates (>2.6 fatalities per million inhabitants per year) are observed over southwestern Romania, a region characterized by high values of cloud-to-ground lightning density (>2 flashes per square kilometer per year) and by a relatively high percentage (>40%) of the population living in rural areas. The majority of fatalities (78%) were reported in rural areas. Approximately 78% of the victims were male. The most vulnerable group was males between the ages of 10–39 living in rural areas. To further reduce the lightning fatality rate in Romania, currently one of the highest in Europe, the authors argue that lightning mitigation activities and information campaigns about the risks associated with lightning should be initiated in Romania.
A Mighty River Flowing Eastward
Authors: Guanghao Hou
Published: December 2017

This article attempts to interpret the narratives presented in the autobiography of Situ Hua (Szeto Wah, 1931–2011), well-known activist and leader of pressure-group movements in modern Hong Kong, in order to understand his ethnic and national identities. This exploration can illustrate the interaction between collaborative nationalism, critical nationalism and colonialism that is ongoing and constantly changing in modern Hong Kong. The article suggests that during his childhood and youth, Situ ethnically identified himself as being Chinese and, in terms of his national identity, he longed for a strong communist Chinese state. Second, it argues that Situ’s national identity was hollowed out by the Chinese Communist Party while his ethnic identity remained unchanged from his youth. Finally, Situ’s success in promoting pressure-group movements in Hong Kong led him to believe in democracy. His belief in democracy resulted in the convergence of his ethnic and national identities. He still wanted to build a strong Chinese state, but believed that this state should be democratic. It was his democratic Chinese nationalism that propelled him to embark on such a political pursuit.
Heparin-Induced Thrombocytopenia; Hepatotoxicity with Newer Diabetes Agent; Acute Myocardial Infarction Associated with Albuterol; Olanzapine-Induced Hyperglycemic Hyperosmolar Nonketotic Coma; Paronychia and Skin Hyperpigmentation Due to Gefitinib; Selective Serotonin Reuptake Inhibitor-Induced Enuresis; Do Antidepressants Confer a Decreased Risk for Myocardial Infarction?; Recent Adverse Event Reviews; An Online Interview Discussing the Reduction of ADRs
Authors: Shuster Joel
Published: December 2017

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Intravesical Doxorubicin for Superficial Bladder Carcinoma
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: December 2017

The increasing complexity of cancer chemotherapy increases the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It also reviews various agents, both commercially available and investigational, that are used to treat malignant diseases.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Department of the Army or Department of Defense.
Modafinil: Sedation (Drug Induced)
Authors: Generali Joyce , Cada Dennis J.
Published: December 2017

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Low Literacy and Medication Safety: Spreading the Word
Authors: Brown Timothy
Published: December 2017

Patient education decreases the incidence of medication errors. However, the barrier to education is the level of comprehension of the patient. Studies show that even those with a college degree function at an eighth grade reading level when provided with medical educational materials. This level almost becomes nonexistent if the patient is considered low literate or a first time reader. This functional illiteracy has been reported to lead to approximately $73 billion in additional health care expenditures annually.1

Methods

The Ohio Patient Safety Institute (OPSI), Project: LEARN of Summit County, and the Ohio Society of Health-System Pharmacists (OSHP) collaborated to create and implement a medication safety brochure that could be used by patients at varying reading levels. The partners in this project initiated the development of the brochure after an extensive search for standardized graphics used to relate medical answers to common questions yielded no results. Development of pictures and graphics that were considered universal were keys to the success of the project. The design of the brochure encompassed major problems encountered with medications. Implementation took several routes that led to distribution throughout the state.

Results

At this point more than 65,000 brochures have been circulated throughout Ohio, as well as mailed to interested parties outside the state.

Conclusions

By implementing this type of brochure, we are one step closer to ensuring the education of the entire community regarding medications and their dangers, as well as building relationships that maintain the trust in the medical community.
Medication Safety
Authors: Generali Joyce
Published: December 2017

Hospital Pharmacy presents a new feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest will be abstracted monthly regarding a broad scope of topics.
How to Prevent Errors – Safety Issues with Patient-Controlled Analgesia (Part 2); Potential for Confusing Dakin's Solution with Sterile Water
Authors: Cohen Michael R.
Published: December 2017

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.
Azacitidine; Erlotinib
Authors: Solimando Dominic A. , Russell Martin A. , Waddell J. Aubrey
Published: December 2017

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Department of the Army or the Department of Defense.
Tadalafil: Pulmonary Hypertension (Adults)
Authors: Generali Joyce , Cada Dennis J.
Published: December 2017

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Information Technologies Relevant to Pharmacy Practice in Hospitals: Results of a Statewide Survey
Authors: Warner April , Menachemi Nir , Brooks Robert G.
Published: December 2017

Purpose

To evaluate the extent that Florida hospitals are utilizing a variety of pharmacy-related information technology (IT) applications and contrast these results with nationwide studies regarding IT.

Methods

Chief Information Officers of Florida acute care hospitals were surveyed from May through October 2003. Facilities were questioned on the utilization of clinical and other IT applications, priorities, and barriers. The results of the questionnaire along with differences between small and large hospitals were examined.

Results

Overall, few hospitals have adopted computerized physician order entry (CPOE) and bar coded medication management (15.8% and 12.6% respectively), and only slightly more than half (50.5%) have adopted a computer-based patient record (CPR) system. Although utilization of these did not differ between small and large hospitals, larger hospitals were more likely to have a pharmacy information system (100% vs 69.6%, P = 0.004) and an automated pharmacy dispensing system (82.6% vs 30.4%, P < 0.001). Larger hospitals were also more likely to utilize most medical information retrieval services. Implementing technology to reduce medical errors and promote patient safety was cited by facilities as their number one IT priority, and lack of adequate financial support was cited as the single most important barrier to implementing IT. These results were comparable with other nationwide studies.

Conclusions

Florida hospitals, similar to previous hospitals studied nationwide, were found to have a slow rate of adoption of pharmacy-related IT. As a result, pharmacists are encouraged to play a more active role in collaborating with hospital leaders in order to implement these technologies at their facilities in an effort to reduce medication errors and improve the quality of care delivered to patients.
The Open Abdomen: Enteral Access Results in Cost Savings
Authors: Tsuei Betty J. , Clifford Timothy M. , Magnuson Barbara L. , Kearney Paul A.
Published: December 2017

Purpose

To evaluate the cost savings of using enteral access for drug and nutrition delivery in patients requiring open peritoneal cavity management (laparosotomy).

Methods

A review of 14 patients who required laparostomy and received at least 4 consecutive days of enteral nutrition treated at our tertiary care facility between January 1999 and May 2001. Data collected included age, sex, reason for laparostomy, enteral formulation, medications, and side effects (diarrhea and gastric reflux). Cost savings were calculated as the difference between the cost of intravenous (IV) and enteral nutritional formulation and drug dosage costs.

Results

Patients were fed via nasojejunal feeding tube. Average duration of enteral nutrition (EN) was 19.1 ± 12.3 days. Gastric reflux and diarrhea occurred in five (36%) and six (42%) patients, respectively. These were easily treated and did not require conversion to IV nutrition or medications. Drug and electrolyte levels were therapeutic at appropriate enteral doses. A total of 267 days of EN were utilized in these 14 patients. The cost difference between the parenteral nutrition that would have been used during that time and the actual enteral formula utilized was $25,373. The use of enteral rather than IV medications also resulted in a cost savings of $7,058. Thus, the combined cost savings of enteral medication and nutrition therapy for the 14 patients was $32,431.

Conclusion

EN and drug therapy can be utilized in patients requiring open peritoneal cavity management. The resultant cost savings can be substantial, and these methods of cost reduction can also be applied to other patients.
A Case of Hyperammonemic Encephalopathy Secondary to a Combination of Valproic Acid and Topiramate
Authors: Wargo Kurt A. , Wavra M. Georgia
Published: December 2017

Purpose

To report a case of hyperammonemic encephalopathy induced by a combination of valproic acid and topiramate.

Case Summary

A 30-year-old male was admitted to our institution after experiencing headaches, decreasing mental capacity and increasing somnolence over the previous 3 days. Past medical history was significant for generalized tonic-clonic seizure disorder and mild mental retardation for which he had been regularly taking valproic acid, topiramate, and lorazepam. The patient was seizure free for the past 9 months prior to his seizure 2 weeks prior to admission. Upon presentation, an electroencephalogram revealed excessive slowing in the left more than right, with a differential consistent with a metabolic encephalopathy, head injury, or postictal state. Laboratory workup revealed a valproic acid level that was slightly elevated, but still within normal limits, at 92.5 mcg/mL (normal = 50 to 100 mcg/mL). Furthermore, the patient's ammonia level was found to be elevated at 72 mcg/dL (normal = 14.7 to 55.3 mcg/dL). On hospital day 3, after discovering these findings, valproic acid was discontinued and lactulose 20 g three times daily was started. Five days after admission, the patient's mental status changes were resolved, and he was discharged with an ammonia level of 57 mcg/dL.

Conclusion

Hyperammonemic encephalopathy is rare, but a serious and sometimes fatal disorder can occur in patients receiving valproic acid therapy. The incidence of hyperammonemia may be increased in patients receiving concomitant valproic acid and topiramate therapy. In patients on valproic acid and topiramate who present with altered mental status, an ammonia level in addition to a serum valproate level should be ascertained to rule out this potentially serious adverse drug reaction.
Recent Publications on Medication and Pharmacy
Authors: Generali Joyce
Published: December 2017

Hospital Pharmacy presents a new feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest will be abstracted monthly regarding a broad scope of topics.
Dose Dense Doxorubicin and Cyclophosphamide Followed by Paclitaxel (Dose Dense AC Followed by T) Regimen for Breast Cancer
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: December 2017

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases.
Tamsulosin: Ureteral Stones
Authors: Generali Joyce , Cada Dennis J.
Published: December 2017

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Weight Variability of Scored and Unscored Psychotropic Drug Tablets Split by a Uniquely Designed Tablet Splitting Device
Authors: Nolly Robert J. , Rodrigues Patrick , Thoma Laura
Published: December 2017

Tablets of three psychotropic drugs were split using a uniquely designed tablet splitting device, the Tru-Cut Multi-Tablet Cutter, and evaluated for weight variation utilizing criteria based on the United States Pharmacopeia (USP) <27> Uniformity of Dosage Units Content Uniformity Criteria. Whole tablets of Risperdal 2 mg and 4 mg, Paxil 20 mg and 40 mg, and Zoloft 100 mg were split by a device that positioned tablets in tablet specific disposable trays for splitting. Each half tablet weight was recorded utilizing a digital electronic balance. Weight variability was determined by comparing actual half tablet weight to theoretical half tablet weight and calculation of the relative standard deviation. Results showed half tablets of all drugs met the weight variation criteria resulting in uniform half tablet dosages as defined by the criteria.
Eptifibatide Cost Containment/Waste Minimization Strategy
Authors: Peppers Michael P. , Ritter Jeff
Published: December 2017

Des Peres Hospital is a community teaching hospital that performs approximately 77 percutaneous coronary interventions (PCI) per month. Eptifibatide is the primary glycoprotein IIb/IIIa inhibitor used at Des Peres Hospital. The hospital spent approximately $340,598 on eptifibatide for use in the Cath Lab in 2003. A review was performed and found that patients were being dosed appropriately for the interventions performed. The Pharmacy was challenged to find a method to reduce the cost of this class of drug without adversely affecting patient outcomes. Further analysis revealed that the average patient needed approximately 207 mg of eptifibatide to initiate and complete the therapy, according to established dosing guidelines. We determined that a significant amount of eptifibatide was being wasted due to both the available dosage forms and the amount of fluid left in the intravenous tubing after therapy completion. An educational effort and the Eptifibatide Cost Containment/Waste Minimization Strategy was undertaken. Calculating the exact amount of drug needed for initiating and completing eptifibatide therapy following PCI now allows the Des Peres Hospital pharmacy to save approximately $34,188 per year by compounding a final infusion bag to be hung and flushed with normal saline. We describe our methods for doing such.
Natalizumab
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: December 2017

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The April 2005 omega-3-acid ethyl esters capsules, iloprost inhalation solution, clofarabine, pegaptanib, and meningococcal conjugate vaccine. The DUE is on omega-3-acid ethyl esters capsules.
Wireless Communications in Health Systems: Is There a Danger?
Authors: Young Marc , Fox Brent I.
Published: December 2017

With the introduction of cellular phones and other wireless radio communications, a fear of interfering with medical devices began to surface in health system environments. Modern hospitals have always been electromagnetic environments with their electric equipment; it is only recently that this environment has become much more complex. This article discusses basic principles a pharmacist should be aware of when navigating through the often delicate field of electromagnetic communications.
Behavioral Effects of ICU Medications
Authors: Fraser Gil , Riker Richard R.
Published: December 2017

This feature examines the impact of pharmacologic interventions on the treatment of the critically ill patient — an area of health care that has become increasingly complex. Recent advances in drug therapy for adult ICU patients (including evolving and controversial data) will be reviewed and assessed in terms of clinical, humanistic, and economic outcomes. Direct questions or comments to Gil Fraser, PharmD, at fraseg@mmc.org .
Fluorouracil, Leucovorin and Irinotecan (FOLFIRI) Regimen for Colorectal Cancer
Authors: Solimando Dominic A. , Louis-Charles Erminthe , Waddell J. Aubrey
Published: December 2017

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases.
Topiramate: Alcohol Dependence
Authors: Generali Joyce , Cada Dennis J.
Published: December 2017

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
“Concealed Renal Insufficiency” Leading to ADRs in the Elderly; Vincristine-Induced Peripheral Neuropathy – Worse after Drug Discontinuation; Gadolinium Encephalopathy in a Patient with Renal Failure; Herbal Preparation Causes Retinal Vein Thrombosis; Sweet Syndrome Associated with Imatinib Therapy; Risperidone-Induced Morning “Pseudoneutropenia”; Venlafaxine-Associated Interstitial Pneumonitis
Authors: Shuster Joel
Published: December 2017

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medwatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medwatch, please consider sharing the account with our readers.
Methotrexate, Cisplatin, and Fluorouracil (MPF Regimen) for Head and Neck Cancer
Authors: Neigh Jeffrey J. , Sano Harold S , Murak Elizabeth M. , Waddell J. Aubrey , Solimando Dominic A.
Published: December 2017

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases.
Safety Issues: Anticoagulation and Neuraxial Blockade
Authors: Dalton Mazie F. , Schoenekase Steve
Published: December 2017

Neuraxial blockade includes techniques of spinal or epidural anesthesia and continuous epidural analgesia. A rare but potentially catastrophic complication of neuraxial blockade is spinal hematoma and subsequent paraplegia. The risk of this complication is increased with patient specific risk factors, and with the concomitant use of antithrombotic drugs.1

The American Society of Regional Anesthesia and Pain Medicine have provided guidelines on the management of patients receiving neuraxial anesthesia and anticoagulation. While the anesthesia staff may be familiar with these guidelines, other practitioners may not be aware of them.

In a retrospective review, we found that only eight of 69 (12%) patients with an indwelling epidural catheter over a 12-month period received no concomitant medications that may affect the coagulation system. Two patients received medications, which the guidelines recommend against. Patients receiving neuraxial anesthesia are at high risk to be prescribed medications that may affect coagulation. The pharmacy needs to assume vigilance and responsibility to notify anesthesiology or develop some fail-safe method for these orders to be screened and evaluated. Pharmacy software vendors could assist in this challenge by developing the software to effectively contend with this therapeutic issue.
Clonidine: Postanesthesia Shivering
Authors: Generali Joyce , Cada Dennis J.
Published: December 2017

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Retrospective Cohort Study of Granisetron Administration for PONV Prophylaxis and Treatment
Authors: Shillington Alicia , Farley P. Anne , Varkey Jerry A. , Dempsey Cindy , Coop Andrew , Harshaw Qing , Murdakes Christopher
Published: December 2017

Postoperative nausea and vomiting (PONV) frequently complicates surgical recovery and is considered to be one of the least desirable surgical side effects. Granisetron (Kytril) 1 mg intravenously (IV) was approved by the FDA for the prevention and treatment of PONV in August 2002.

Objective

This cohort study evaluated outcomes and utilization associated with granisetron use for PONV prevention and treatment.

Methods

This was a retrospective cohort study of 400 patient records from 10 US hospitals. Patients included were those greater than or equal to 18 years of age having elective surgery under general anesthesia with granisetron administered IV for prevention or treatment of PONV. Excluded were those with concurrent radiation or chemotherapy, or those observed less than 2 hours in the post anesthesia care unit.

Results

Mean age was 50 y ± 17 with 272 females (68%). The majority was at moderate-high (n = 230; 58%) or mild-moderate risk of PONV (n = 155; 39%). Granisetron was administered predominantly perioperatively and at 0.1 mg dose (n = 382; 96%) from prefilled syringes extemporaneously prepared from 4 mg/4 mL vials. Total control (absence of nausea and vomiting) was experienced in 330 patients (83%), with 16 (4%) having a vomiting episode. In 167 patients at lower risk of PONV, symptoms were prevented in 148 (less than 90%). Regression analysis indicates that, in addition to absence of key risk factors, combination antiemetic prophylaxis was highly associated with optimal outcome. Granisetron dose did not impact outcome.

Conclusion

The majority of granisetron use for PONV was prophylactic, administered perioperatively at a 0.1 mg dose. Most patients experienced excellent control, even in the highest risk groups, particularly when granisetron was administered in combination with dexamethasone or metoclopramide.
Pramlintide Acetate
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: December 2017

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The July 2005 monograph topics are exenatide injection, inhaled insulin, fluocinolone acetonide intravitreal implant, tigecycline, and medroxyprogesterone acetate injectable suspension. The DUE is on exenatide injection.
Tiagabine: Bipolar Disorders
Authors: Generali Joyce , Cada Dennis J.
Published: December 2017

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .