bluuebunny/crossref_metadata_2025_split huggingface dataset:
Zidovudine Compliance as Measured by Different Methods in an HIV Ambulatory Clinic
Authors: Geletko Sandra M , Segarra Marisel , Ravin Donna S , Babich Mark P 
Published: July 2017

Objective: To measure and compare medication compliance by patient reports, pill counts, physician assessments, and electronic monitoring with the Medication Event Monitoring System (MEMS) in patients infected with HIV. Methods: Five patients monitored in a Veterans Affairs Medical Center HIV clinic were dispensed zidovudine for 3 months in MEMS vials. Zidovudine was refilled every month, at which time MEMS data were retrieved and pill counts were performed. Medication compliance surveys requesting the number of missed doses were also administered to patients and their physicians every month for 3 months. Results: Compliance assessments were as follows: patient report 80–100%, physician assessment less than 30–100%, pill counts 50–100%, and MEMS 9–100%. MEMS identified one patient's misunderstanding of zidovudine dosing. Three patients removed zidovudine from MEMS vials and placed the medication in a smaller vial for easy transport, thereby decreasing the usefulness of MEMS data. Conclusions: A combination of compliance assessment tools produces a more accurate representation of zidovudine dosing and facilitates identification of patient dosing errors. Use of multiple compliance tools, including MEMS data, during patient counseling may be an effective strategy for enhancing medication compliance.
Diuretic Drug Utilization Study
Authors: Torelló Jaime , Durán José A , Serrano María I 
Published: July 2017

Objective: To evaluate the present use of diuretics in our institution, and determine the appropriateness of that use and the incidence of adverse reactions and interactions. Design: This retrospective study describes the indications for use of an identified drug or combination of drugs. By the time the data were collected, some patients had been discharged or had died. Setting: The study was carried out in a referral center, the University Hospital “Virgen Macarena,” Seville, Spain. Patients: All patients receiving diuretic therapy. Those undergoing hemodialysis or receiving home care were excluded from the study. Intervention: A therapeutic audit was performed using specific standards of reference. Two models were used — one for each of the most frequent indications, ascites and congestive heart failure (CHF). Main Outcome Measures: A structured protocol gathered data on (1) demographic characteristics, (2) causes of admission and pathologic antecedents, (3) diuretic treatment, (4) basic controls (24-h diuresis and daily basal weight), (5) clinical evolution, and (6) concurrent complementary studies. The protocol included a checklist of the most frequent adverse drug reactions and interactions whose degree of causality was determined by applying the modified algorithm of Karch-Lasagna, used in the World Health Organization voluntary reporting system of adverse drug reactions. Results: One hundred twenty-six patients (16% of total admissions) received diuretic therapy. Of these, 71% were analyzed; information in the medical records was incomplete for the rest (29%). Fifty-one percent of the patients were more than 60 years old. The most frequent admission diagnoses were cardiovascular (51.5%), followed by digestive (16.7%) diseases. A total of 134 cardiac symptoms was seen in 50 patients. The most notable were acute pulmonary edema (26%), ischemic cardiopathy (12%), and cardiogenic shock (8%). Most patients receiving diuretic therapy (47.3%) were admitted to the internal medicine service. The most-prescribed diuretic was furosemide (59%), followed by spironolactone (27%). The combined use of furosemide and spironolactone occurred in all but 1 of the patients with hepatic ascites (92%), whereas in those with CHF the figure for the combined use of furosemide and spironolactone fell to 38% (p = 0.001). In 63% of the patients with ascites, the spironolactone dosage was changed in the first 48 hours of treatment. There was a high percentage of deaths (21%) in the study patients. Conclusions: Therapeutic strategy often does not follow the guidelines laid down in the standards of reference on diuretic use in serious CHF and/or ascites in this institution.
Impact of Pharmacy Efforts to Promote the Optimal Use of Ranitidine in a University Teaching Hospital
Authors: Sterné Sharette C , Hayward Shelly L , Ferrill Mary J , Iteen Scott A 
Published: July 2017

Objective: To determine whether the development, implementation, and outcome of a hospital-wide, pharmacy-initiated, educational and intervention program impacted ranitidine prescribing patterns specific to institution guidelines. Methods: The development of a standardized ranitidine medication utilization guideline (R-MUG) form was established by the departments of pharmacy and gastroenterology in conjunction with the pharmacy and therapeutics committee at the University of California, Irvine. Using this standardized R-MUG form, all hospitalized patients (excluding pediatric, mental health, and labor and delivery) receiving ranitidine during their hospitalization were identified and evaluated for appropriate ranitidine use patterns. A baseline evaluation phase that included 240 patients was conducted, and diagnosis, dosage, and dosage form were recorded. This was followed by an educational program and subsequently a posteducational pharmacist intervention phase involving 210 patients, in which data were collected over a 3-week period. From these data, projected ranitidine cost savings were calculated. Results were used to determine the impact the educational process had on modifying ranitidine prescribing patterns. Results: Initially, ranitidine was prescribed according to the guidelines in 74% of the patients. After educational inservice sessions this number rose to 96% (p < 0.001). The 3-week intervention phase saved approximately $930 compared with the baseline period by limiting the amount of ranitidine used. The optimal choice of ranitidine dosage form increased significantly from baseline (87%) to the posteducational data collection period (94%) (p < 0.01). Targeted intervention of high-need areas of the hospital (surgical and burn intensive care units) resulted in a significant decrease (p < 0.001) in the percentage of inappropriate dosing with continuous ranitidine infusion, but not with intravenous piggyback or syrup. Conclusions: This program was an effective method of educating healthcare professionals regarding ranitidine prescribing, improving the pattern of use of ranitidine, and decreasing costs to the institution. It may serve as a model for addressing other medication usage concerns.
Dalteparin, a Low-Molecular-Weight Heparin: Review of Pharmacology and Pharmacotherapy
Authors: Kandrotas Robert J 
Published: July 2017

Objective: To review the current literature concerning the use of dalteparin in thromboembolic disease. The chemistry, pharmacokinetics, pharmacodynamics and clinical efficacy for approved and nonapproved uses, and adverse effects are presented. Data Sources: A MEDLINE search of the English-language literature between 1980 and 1996. Data Extraction: The data presented are primarily from controlled studies of dalteparin in humans. Some of the pharmacokinetic/pharmacodynamic and basic pharmacologic data are from animal studies. The majority of the clinical investigations were blind. Data Synthesis: Dalteparin sodium is approved for use in the prophylaxis of thromboembolic disease after major abdominal surgery. Dalteparin is a low-molecular-weight heparin (LMWH) with a mean molecular weight of 5,000 Da. It produces its antithrombotic effect through the inhibition of activated factor X and, to a lesser extent, activated factor II. Conclusions: Thromboembolic disease may occur in patients such as those over 40 years of age undergoing major surgical procedures lasting longer than 30 minutes. In addition, prolonged bed rest may result in development of thromboembolism due to immobilization and venous stasis. Anticoagulant prophylaxis for deep-vein thrombosis is warranted in these patients. As with other LMWHs, laboratory monitoring of coagulation parameters (e.g., activated partial thromboplastin time and activated coagulation time) is unnecessary. Dalteparin sodium has been demonstrated to be efficacious and safe for the prophylaxis of thromboembolic disease after major abdominal surgery and is a reasonable alternative to unfractionated heparin in these patients. The use of dalteparin for other indications, such as treatment of thromboembolic disease, hemodialysis, and unstable coronary artery disease, also appears to be promising.
Office-Based Cholesterol Testing: Impact on Process-of-Care in Patients with Hypercholesterolemia a Pilot Study
Authors: Ruffin David M , McKenney James M 
Published: July 2017

Objective: To determine whether providing cholesterol results during a patient-physician office encounter would affect the process-of-care in patients with hypercholesterolemia. Methods: We used a randomized, parallel-group, control design to conduct the study. Thirty-five participants had a lipoprotein analysis performed using the L.D.X. cholesterol analyzer. Patients randomly assigned to the intervention group (n = 19) had their results provided to the physician during the office visit; the results of those in the control group (n = 16) were not made available to the physician. Each participant's medical record was reviewed to determine the physican's process-of-care with respect to cholesterol management. The indicators of the process-of-care for which we sought documentation included therapeutic interventions and the physician's assessment of risk for coronary heart disease. We used Fisher's exact test to determine statistical significance of the intervention. Descriptive analysis was also performed. Results: We were unable to detect a statistically significant difference in therapeutic interventions (p = 0.183). However, we did observe a statistically significant difference in the physician's assessment of risk for coronary heart disease (p = 0.0001). Conclusions: Our data suggest that providing a cholesterol test result during a patient-physician office encounter positively affects the process-of-care in patients with hypercholesterolemia. Future studies should include larger numbers of patients and longer follow-up periods.
Well-Being and Functional Status of Pharmacy Students: A Preliminary Assessment
Authors: Edgell Eric T , Caplette Michael D , Gregor Karl J , Flynn Mark T , Coons Stephen Joel 
Published: July 2017

Objective: To initiate the research process of investigating how pharmacy education affects the health status of pharmacy students. Design: Student functioning and well-being were assessed within two pharmacy classes at two points in time. Setting: College of Pharmacy, The University of Arizona, Tucson, AZ. Participants: Students enrolled in either their first (class of 1997) or third (class of 1995) professional year of The University of Arizona's 4-year Doctor of Pharmacy degree program. Main Outcome Measure: The RAND 36-Item Health Survey 1.0. Results: No significant mean score differences were found between the classes, and the mean scores for the first-year class remained stable during the semester. The third-year class's mean scores for the emotional well-being and emotional problem-related role functioning scales decreased significantly during the semester. Conclusions: Pharmacy school may affect students' functioning and well-being in different and unique ways compared with medical school. Additional research should be conducted to assess changes in pharmacy student health status and to develop mechanisms to help counter any negative impact that may occur during pharmacy school.
Predictive Performance of Estimated Creatinine Clearance in HIV-Infected Individuals
Authors: Noormohamed Saleem E , Flanigan Michael J 
Published: July 2017

Objective: To evaluate the predictive performance of published creatinine clearance (Clcr) predictor equations in individuals infected with HIV. Methods: A retrospective review of medical records of patients with a 24-hour urine collection to determine Clcr was conducted. Clcr was estimated with each of six published equations. Estimated Clcr was compared with actual values, and bias and precision were calculated. Results: Clcr determined using the 24-hour urine collections were only moderately related to various patient factors such as weight and serum creatinine. The Cockcroft—Gault method significantly overestimated Clcr in patients with HIV (ANOVA; p = 0.0087) and demonstrated greatest bias (mean percentage prediction error, 52; 95% CI 18 to 87) and least precision (percentage root mean-squared error, 76; 95% CI −26 to 177) of the estimator methods. Conclusions: None of the six equations evaluated were precise predictors of Clcr in individuals with HIV. Using these equations, particularly the Cockcroft—Gault method, to predict renal function in patients with HIV could lead to overdosing renally eliminated medications in this population. Accurate assessment of renal function in these patients warrants a 24-hour urine collection or isotopic clearance measurement.
Amiodarone-Associated Depression
Authors: Maidment Ian D , Helme Tim 
Published: July 2017

Objective: To report a case of depression secondary to or aggravated by amiodarone-induced hypothyroidism. Case Summary: An 84-year-old white man was admitted to a psychiatric unit with severe depression approximately seven months after amiodarone had been initiated to treat paroxysmal supraventricular tachycardia. On admission, the thyroid-stimulating hormone (TSH) concentration was 11.50 μU/mL (normal 0.17–4.00) and the total thyroxine concentration was 3.9 μg/dL (4.0–11.0). About 21 months before initiation of amiodarone therapy, the TSH concentration was 2.4 μU/mL; this was the only previous TSH result available. Seven days after admission, thyroxine (levothyroxine) 25 μg/d was started. Twenty-eight days after admission, the patient's mood had improved, and the TSH concentration (2.67 μU/mL) was within normal range. The patient was discharged four days later. Discussion: Amiodarone contains 37.2% iodine. This is a greatly increased iodine load compared with normal intake. Amiodarone may therefore have three possible effects on thyroid function: (1) the serum concentration of thyroid hormones in clinically euthyroid patients may change, complicating assessment; (2) hyperthyroidism may occur (1–5% of patients); and (3) hypothyroidism may occur (6–10% of patients). Thus, thyroid function should be checked at least every six months. The elevated TSH concentration could indicate mild hypothyroidism or possibly be a symptom of the depressive illness. Furthermore, our patient's mood appeared to improve after he had received six to seven weeks of treatment with fluoxetine; he had also experienced depressive episodes throughout his life. Thus, particularly because the TSH concentration was only moderately raised, it is possible that amiodarone-induced hypothyroidism worsened rather than caused the depressive episode. The usual treatment for amiodarone-induced hypothyroidism is continuation of amiodarone and initiation of thyroxine at a dosage of 25–50 μg/d. Conclusions: This case illustrates the need to be vigilant for amiodarone-induced hypothyroidism, which may cause depression or exacerbate an underlying depressive illness. Supplemental treatment with levothyroxine may effect a rapid mood response.
TMP/SMX Dosage Adjustment in a Renally Impaired Patient with Presumed Trimethoprim-Induced SCr Elevations
Authors: Fellenzer Margery M , Timm Edward G , Briceland Laurie L 
Published: July 2017

Objective: To report a case of drug-induced elevated serum creatinine (SCr) concentrations in a renally impaired patient treated with trimethoprim/sulfamethoxazole (TMP/SMX) for presumed Pneumocystis carinii pneumonia (PCP), and to discuss important dosage adjustment considerations. Case Summary: A patient with steroid-dependent glomerulonephritis was admitted with subarachnoid hemorrhage; on day 17 he developed pneumonia of uncertain origin. He was treated empirically with ampicillin/sulbactam for two days, followed by two doses of oxacillin for Staphylococcus aureus isolated from sputum. On day 20, based on a subsequent sputum culture showing no organisms, the patient's immunocompromised status, and the patient's deteriorating clinical state, oxacillin was discontinued, and erythromycin and TMP/SMX 15 mg/kg/d were initiated for empiric treatment of atypical pneumonia and PCP. On day 22, his SCr had increased to 2.2 mg/dL from a baseline value of 1.4 mg/dL. Estimated creatinine clearance was <30 mL/min, prompting a dosage reduction of TMP/SMX to 8 mg/kg/d, after which the SCr concentration decreased. On the basis of results of an open-lung biopsy, PCP was ruled out, and TMP/SMX was discontinued on day 25. Four days later, the patient's SCr returned to its baseline value. Discussion: TMP/SMX was used at a dosage of approximately 15 mg/kg/d. When the patient's SCr rose to 2.2 mg/dL, dosage adjustment of TMP/SMX to 8 mg/kg/d was based on the patient's estimated creatinine clearance. However, trimethoprim has been reported to cause elevations in SCr by inhibiting tubular secretion of creatinine, without affecting glomerular filtration rate. This potential elevation in creatinine confounds the clinician's ability to estimate renal function and must be considered when making dosage adjustments based on creatinine clearance. After the TMP/SMX dosage reduction, a trimethoprim-induced elevation in SCr was suspected on the basis of a temporary rise in creatinine in relation to TMP/SMX dosing. Thus, the reduced TMP/SMX dosage may have provided subtherapeutic serum concentrations in the presumed PCP case. However, more careful examination revealed that the rise in creatinine was most likely induced by multifactorial causes as opposed to being induced solely by trimethoprim. A combination of ischemic events caused by hypoperfusion due to hypovolemia and a significant drop in blood pressure, coupled with the addition of trimethoprim, were most likely responsible for the rise in SCr in this patient. Conclusions: The potential of trimethoprim to cause an elevation in SCr, especially in patients with chronic renal insufficiency, must be considered when making dosage adjustments in patients with SCr elevations who are taking TMP/SMX. Further investigation of other potential causes of renal failure, such as hypoperfusion, hypovolemia, and hypotension, should also be considered and weighed against trimethoprim's potential to block tubular secretion of creatinine.
Proteomic profile of cystic fibrosis sputum cells in adults chronically infected withPseudomonas aeruginosa
Authors: Pattison Sally H. , Gibson David S. , Johnston Elinor , Peacock Samantha , Rivera Keith , Tunney Michael M. , Pappin Darryl J. , Elborn J. Stuart 
Published: July 2017

Lung disease is the main cause of morbidity and mortality in cystic fibrosis (CF), and involves chronic infection and perturbed immune responses. Tissue damage is mediated mostly by extracellular proteases, but other cellular proteins may also contribute to damage through their effect on cell activities and/or release into sputum fluid by means of active secretion or cell death.We employed MudPIT (multidimensional protein identification technology) to identify sputum cellular proteins with consistently altered abundance in adults with CF, chronically infected withPseudomonas aeruginosa, compared with healthy controls. Ingenuity Pathway Analysis, Gene Ontology, protein abundance and correlation with lung function were used to infer their potential clinical significance.Differentially abundant proteins relate to Rho family small GTPase activity, immune cell movement/activation, generation of reactive oxygen species, and dysregulation of cell death and proliferation. Compositional breakdown identified high abundance of proteins previously associated with neutrophil extracellular traps. Furthermore, negative correlations with lung function were detected for 17 proteins, many of which have previously been associated with lung injury.These findings expand our current understanding of the mechanisms driving CF lung disease and identify sputum cellular proteins with potential for use as indicators of disease status/prognosis, stratification determinants for treatment prescription or therapeutic targets.
Cardiometabolic correlates of sleep disordered breathing in Andean highlanders
Authors: Pham Luu V. , Miele Catherine H. , Schwartz Noah G. , Arias Rafael S. , Rattner Adi , Gilman Robert H. , Miranda J. Jaime , Polotsky Vsevolod Y. , Checkley William , Schwartz Alan R. 
Published: July 2017

Associations between sleep disordered breathing (SDB) and cardiometabolic outcomes have not been examined in highlanders.We performed nocturnal polygraphy in Peruvian highlanders (3825 m). Multivariable linear regression models examined associations between SDB metrics and haemoglobin, glucose tolerance (haemoglobin A1c (HbA1c)), fasting glucose, homeostatic model-based assessments of insulin resistance and β-cell function (HOMA-IR and HOMA-β, respectively), blood pressure, and lipids, while adjusting for age, sex, body mass index (BMI) and wake oxygenation.Participants (n=187; 91 men) were (median (interquartile range)) 52 (45–62) years old, and had a BMI of 27.0 (24.3–29.5) kg·m−2and 87% (85–88%) oxyhaemoglobin (arterial oxygen) saturation during wakefulness. In fully adjusted models, worsening nocturnal hypoxaemia was associated with haemoglobin elevations in men (p=0.03), independent of wake oxygenation and apnoea–hypopnoea index (AHI), whereas worsening wake oxygenation was associated with haemoglobin elevations in older women (p=0.02). In contrast, AHI was independently associated with HbA1c elevations (p<0.05). In single-variable models, nocturnal hypoxaemia was associated with higher HbA1c, HOMA-IR and HOMA-β (p<0.001, p=0.02 and p=0.04, respectively), whereas AHI was associated with HOMA-IR, systolic blood pressure and triglyceride elevations (p=0.02, p=0.01 and p<0.01, respectively). These associations were not significant in fully adjusted models.In highlanders, nocturnal hypoxaemia and sleep apnoea were associated with distinct cardiometabolic outcomes, conferring differential risk for excessive erythrocytosis and glucose intolerance, respectively.
Pulmonary artery to aorta ratio and risk of all-cause mortality in the general population: the Rotterdam Study
Authors: Terzikhan Natalie , Bos Daniel , Lahousse Lies , Wolff Lennard , Verhamme Katia M.C. , Leening Maarten J.G. , Felix Janine F. , Gall Henning , Ghofrani Hossein A. , Franco Oscar H. , Ikram M. Arfan , Stricker Bruno H. , van der Lugt Aad , Brusselle Guy 
Published: July 2017

A pulmonary artery to aorta ratio (PA:A) >1 is a proxy of pulmonary hypertension. It is not known whether this measure carries prognostic information in the general population and in individuals with chronic obstructive pulmonary disease (COPD).Between 2003 and 2006, 2197 participants from the population-based Rotterdam Study (mean±sdage 69.7±6.7 years; 51.3% female), underwent cardiac computed tomography (CT) scanning with PA:A quantification, defined as the ratio between the diameters of the pulmonary artery and the aorta. COPD was diagnosed based on spirometry or clinical presentation and obstructive lung function measured by a treating physician. Cox regression was used to investigate the risk of mortality.We observed no association between 1-sdincrease of PA:A and mortality in the general population. Larger PA:A was associated with an increased risk of mortality in individuals with COPD, particularly in moderate-to-severe COPD (hazard ratio 1.36, 95% CI 1.03–1.79). We demonstrated that the risk of mortality in COPD was driven by severe COPD, and that this risk increased with decreasing diffusing capacity.Larger PA:A is not associated with mortality in an older general population, but is an independent determinant of mortality in moderate-to-severe COPD. Measuring PA:A in CT scans obtained for other indications may yield important prognostic information in individuals with COPD.