bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Patient Care and Pharmacy Management: The Effect of Hospital Formularies
Authors: Plumridge Richard J. , Stoelwinder Johannes U. , Berbatis Con G. 
Published: May 2016

A study of the organizational features and implementation procedures associated with formulary use in major acute-care hospitals throughout Australia was undertaken. Data were collected via a questionnaire mailed to 57 directors of pharmacy. An 86-percent response was obtained. A high proportion of formularies was found to rate poorly in terms of organizational features (e.g., content, compilation methods, format) and process variables (e.g., effectiveness as a communication document, prescribing aid, or management tool). Methods of improving formulary effectiveness are outlined in the context of practical and normative research, including improving the quality of drug therapy, use of formularies in cost control, and improving user acceptance. The results confirm previous research showing that methods of improving organizational features and implementation procedures associated with formulary compilation and use are neither widely applied nor widely known. There is an urgent need to reassess the usefulness of formularies and improve their effectiveness by adopting recommendations resulting from past research.
Bacterial Contamination of Pressurized Inhalers
Authors: Levesque Katherine A. , Johnson Cary E. 
Published: May 2016

The objective of this project was to determine the incidence, location, and potential transmission of bacteria from pressurized inhalers contaminated during normal use by pediatric patients. Patients' inhaler usage and cleaning patterns also were evaluated. Fifteen inhalers from 12 children were cultured at three separate sites: the mouthpiece, spray portal, and the spray itself. The patient and/or parent were interviewed to determine usage and cleaning patterns. No bacterial growth was found from any of the cultured sites or aerosol of the control inhalers. All of the mouthpieces and portals of the patient-used inhalers were positive for growth, which is significant (p < 0.01). One patient-used inhaler was positive for bacterial growth from the aerosol, which is not significant (p > 0.05). These results demonstrate that despite inhaler contamination, bacteria are not significantly transmitted by the aerosol. Routine cleaning of inhalers to remove accumulated debris is recommended to prevent disruption of drug delivery.
Counseling the Oncology Patient
Authors: Vall Emily Du , Lash Stephen D. 
Published: May 2016

The clinical pharmacist of today has developed a broad knowledge base in the areas of cancer chemotherapy and the associated ancillary therapies. In spite of this expertise, most are ill-prepared for a face-to-face interaction with the cancer patient. Difficult situations may tempt the pharmacist to avoid contact with the cancer patient and confine his talents to areas in which he feels more comfortable. However, the pharmacist is in a unique situation in that he is accessible, informed, and respected by the patient. Pharmacists must assume the responsibility of ensuring that the cancer patient receives the full benefit of this expertise, which can only be accomplished through appropriate communication skills. This editorial explores some of the techniques and common pitfalls that await the pharmacist in his day-to-day practice.
The Adult Respiratory Distress Syndrome
Authors: Boucher Bradley A. , Foster Thomas S. 
Published: May 2016

The adult respiratory distress syndrome (ARDS) is a common form of acute respiratory failure that has been increasingly reported as associated with a wide variety of medical conditions. Unlike other identifiable pathological events causing severe lung injury, it is now recognized that ARDS is not a single disease, but a complex interaction of pathophysiological events that result in diffuse injury to lung parenchyma. Only through a thorough understanding of ARDS pathophysiology, pathogenesis, and clinical course can medical intervention be instituted in a judicious and timely manner. This review article is intended to provide an overview of the suspected precipitating causes, discrete pathophysiologic changes, and monitorable clinical events associated with ARDS. With mortality from ARDS high, significant attention is being given to improving therapeutic intervention with such conventional measures as mechanical ventilation, positive end-expiratory pressure, and fluid management, along with corticosteroids and several new experimental pharmacologic approaches.
Warfarin Dosage following Prosthetic Valve Replacement: Effect of Smoking History
Authors: Weiner Bruce , Faraci Philip A. , Fayad Rene , Swanson Larry 
Published: May 2016

Warfarin currently is the most widely used agent in the prevention of thrombosis and embolism after prosthetic cardiac valve replacement. Since smoking has been shown to increase the requirement for medications undergoing hepatic metabolism, this study was designed to determine if a correlation exists between smoking history and warfarin daily maintenance dose (DMD) in patients undergoing cardiac valve replacement. Of 200 charts retrospectively reviewed at the New England Medical Center, 174 satisfied the criteria for inclusion in the study (normal hepatic, renal, and hematologic function, and absence of complicating medications). The study population included aortic, mitral, and combined valve replacement. Study groups consisted of 117 nonsmokers (Group A), 23 light smokers (Group B), and 34 heavy smokers (Group C). Thirty-three percent of patients required a low DMD of warfarin (≤2.5 mg), 43 percent required a moderate DMD (>2.5–7.5 mg), and 24 percent required a high DMD (>7.5 mg). Each of the subgroups followed a similar pattern. In Group A, there were 31 percent low, 44 percent moderate, and 25 percent high-dose requiring patients. In Group B, there were 48 percent low, 39 percent moderate, and 13 percent high-dose requiring patients and in Group C there were 29.5 percent low, 41 percent moderate, and 29.5 percent high-dose requiring patients. Chi-square analysis did not demonstrate any statistically significant difference between smokers and nonsmokers in regard to daily maintencance warfarin dose (p = 0.5). The study population followed a normal pattern of distribution in regard to warfarin dosage. On the basis of these data we conclude that smoking history does not affect warfarin dose requirement.
The Intensive Care Unit Syndrome: Causes, Treatment, and Prevention
Authors: Dasta Joseph F. , Weber Robert J. , Oszko Michael A. , Bolender Barbara J. , Grysiak Deborah L. 
Published: May 2016

The psychological assessment and management of the critically ill patient is often overlooked as a part of the patient care plan. The intensive care unit (ICU) syndrome is a type of organic brain syndrome manifested by a variety of psychological reactions, including fear, anxiety, depression, hallucinations, and delirium. Causes, treatment modalities, and a multidisciplinary approach to preventing the ICU syndrome are presented. Causative factors that should be assessed in the psychological evaluation of ICU patients include: (1) preadmission history; (2) past ability to adapt to stress; (3) past and current medications; (4) current clinical status; and (5) environmental factors. The treatment of the ICU syndrome includes: (1) the correction or elimination of causative factors; (2) the appropriate choice, dose, and route of administration of anxiolytic and antipsychotic agents; (3) reduction or elimination of sources of environmental stress; and (4) frequent patient and family communication. Finally, the prevention of the ICU syndrome through the involvement of physicians, nurses, and pharmacists is stressed.
Psychotropic Drug use by Women: Demographic, Lifestyle, and Personality Correlates
Authors: Marinier Raymonde L. , Pihl Robert O. , Wilford Colleen , Lapp Janet E. 
Published: May 2016

From initial telephone interviews with a random population of 1187 francophone women, 179 women participated in a further three-hour person-to-person interview focusing on the use of psychotropic medications. Psychotrope users typically were older, in poorer health, and had a lower level of education than abstainers. They showed an increased prevalence of nervousness, anxiety, depression, and restlessness. Initial contact with psychotrope use was through their general practitioners after presentation of vague and ill-defined symptoms. Psychotropic drug use was found among housewives, especially those with children, and among those unemployed but desiring work. Personality profiles of psychotrope users showed that they think of themselves as failures and are more distressed, with significantly greater life changes. Users scored higher on “femininity” subscales, apparently reflecting dependent and nondefensive personality types. In addition, personality measures defined psychotrope users as precise, methodical, cautious, serious, unassertive, and modest. The incompleteness of present unidirectional models of psychotropic drug use are discussed. Suggestions for future research include encompassing the cognitive organization of the psychotrope user within the context of social, affective, and physician influences on this form of coping style.
Impact of Clinical Pharmacy Services on Prescribing on a Cardiothoracic/Vascular Surgical Unit
Authors: Herfindal Eric T. , Bernstein Linda R. , Kishi Donald T. 
Published: May 2016

A multi-faceted approach was used to study the impact of clinical pharmacy services on the cost of drug therapy on a cardiothoracic and vascular surgical service. Physician and nursing attitudes about the usefulness and likely effect of clinical pharmacist recommendations were also assessed. A cross-sectional design with a temporal factor was used to study physician prescribing of all pharmacologic classes, and particularly of antibiotics. Measurements were taken for nine months before the institution of clinical pharmacy services, 12 months during a clinical pharmacy service period, and for six months after the cessation of the services. A trend toward reduction in drug costs per patient day was observed on both services. This was observed for all pharmacologic classes, and when antibiotics were analyzed alone. The difference was significant when antibiotics were specifically analyzed on the vascular surgical service. The pharmacist's log and a survey of physicians' and nurses' attitudes toward clinical pharmacy services supported the above results.
Nitroglycerin Adsorption to a Combination Polyvinyl Chloride, Polyethylene Intravenous Administration Set
Authors: Schaber Daniel E. , Uden Donald L. , McCoy Harry G. 
Published: May 2016

Loss of nitroglycerin (NTG) from intravenous solutions to intravenous bags and administration sets has been well documented. This study was designed to examine a commercially available low adsorption administration set that was compatible with a volumetric infusion pump. A solution of NTG 100 μg/ml in dextrose 5% in glass bottles was used. Six study administration sets were tested. The infusion sets were connected to the NTG-containing glass bottles, filled as rapidly as possible, placed in the infusion pump, and set at the appropriate rate. Effluent was collected for NTG assay initially, and at 20 and 40 minutes, and 1, 1.5, 2, 3, 6, and 24 hours. The effects of flow rate were studied at 0.2 and 1.0 ml/min. The tubing performed similarly to other polyvinyl chloride (PVC)-containing sets at 0.2 ml/min and similar to non-PVC sets at 1.0 ml/min. The effect of an initial flush with 20–100 ml of 100 μg/ml NTG was also examined. An initial flush of 20 ml of 100 μg/ml NTG solution was found to enhance delivery of NTG immediately. NTG aliquots were stored frozen in glass vials prior to assay by high performance liquid chromatography.
Cost-Justification of a Clinical Pharmacist-Managed Anticoagulation Clinic
Authors: Gray David R. , Garabedian-Ruffalo Susan M. , Chretien Steven D. 
Published: May 2016

A cost-benefit evaluation of a clinical pharmacist-managed anticoagulation clinic (AC) was performed. Outpatient and hospital records were examined for 26 patients in the treatment group with an AC clinic and 26 patients in the control group. Therapeutic prothrombin times were maintained within the treatment group to a significantly greater extent than within the control group (p < 0.001). The AC was successful in preventing hospitalizations resulting from hemorrhage or thromboembolism (p < 0.01). The abnormal prothrombin times on admission in the control group correlated with hemorrhagic and thromboembolic admissions (p < 0.05, p < 0.005, respectively). Patients were hospitalized 3.22 days and .048 days per patient-treatment-year in the control and treatment groups, respectively. The net savings in reduced hospitalization costs per year in the treatment group was $211776. The benefit:cost ratio (B:C) was 6.55, suggesting the program is socially valuable. This clinical pharmacist-managed AC was effective in maintaining therapeutic prothrombin times, and reducing the incidence of hospitalizations resulting from anticoagulation complications, and can be cost-justified based on a cost-benefit analysis.
Review of the Etiology and Treatment of Premenstrual Syndrome
Authors: True Bev Lorraine , Goodner Susan M. , Burns Elizabeth A. 
Published: May 2016

Premenstrual syndrome (PMS) is a diagnostic enigma that causes significant morbidity in many woman. Numerous theories have been proposed in an attempt to explain the varied symptoms that occur cyclically in women with PMS. Suggested etiologic theories of PMS include psychological abnormalities, nutritional deficiencies, aberrations in the renin-angiotensin-aldosterone axis, altered prostaglandin activity, hormonal imbalances, and changes in endogenous opioid peptide activity. Because of the lack of standardized diagnostic criteria, clinical drug trials for PMS have been severely compromised. For every proposed cause of PMS, there exists a drug or drug class that has been investigated for treatment of the associated symptoms. Many clinical studies are uncontrolled, a significant deficiency in study design for a disorder that is associated with a high placebo response rate. At the present time, no definitive treatment for PMS exists and therapy must be individualized according to clinical response. This review article defines PMS, describes one of the current approaches to the diagnostic work-up, discusses the proposed etiologies of PMS, and reviews the various proposed treatment modalities.
Severe Withdrawal Syndrome after Substitution of a Short-Acting Benzodiazepine for a Long-Acting Benzodiazepine
Authors: Bond William S. , Berwish Neil J. , Swift Brian 
Published: May 2016

A severe withdrawal syndrome occurred in a patient after oxazepam 10 mg bid was substituted for diazepam 5 mg bid. The onset of symptoms was consistent with the rate of decline of diazepam and its active metabolite, desmethyldiazepam. Reintroduction of diazepam produced prompt symptom remission. This report and others suggest the need for caution when substituting a short-acting drug for a long-acting one, even when usual doses of each are used. The chronic use of benzodiazepines for eight months or longer prior to substitution or withdrawal appears to place the patient at a higher risk of incurring withdrawal phenomena. Slow and careful tapering of drug is required in such patients to reduce the risk of withdrawal symptoms.
Variation in Prophylactic Antibiotic Use in Pediatric Orthopedic Surgery
Authors: Nahata Milap C. , Winters Cora B. , Powell Dwight A. 
Published: May 2016

Fifty-two pediatric patients undergoing orthopedic surgery were evaluated to determine the pattern of prophylactic antibiotic use. Of the 50 patients receiving antibiotics, 43 patients were given the antibiotic prior to surgery; 38 patients received the drug within two hours prior to surgery. All patients received the postoperative antibiotic for a duration ranging from 2 to 14 days. Thirty-one patients received the postoperative antibiotic for longer than 48 hours without documentation of infection. Cephapirin and/or cefazolin were the most common antibiotics used. Due to fixed postoperative doses (0.5–2 g), the dose/kg/d exceeded the maximum recommended therapeutic doses in one-third of the patients. The results of this study illustrate that the use of prophylactic antibiotics in pediatric orthopedic surgery can be improved to maximize benefits and minimize costs and the potential for adverse effects. Until data from controlled studies become available, it seems appropriate to follow the Centers for Disease Control guidelines in establishing hospital policy for surgical prophylaxis.
Pharmaceutical Services at Sint Radboud Hospital
Authors: McLeod Donald C. , Van Der Kleijn Eppo 
Published: May 2016

This article describes a contemporary pharmaceutical and clinical pharmacy program at a major university medical center in The Netherlands. The service components described illustrate practice concepts on an international basis. The number of professional personnel and their training vary considerably among the nations, and this requires imagination in adapting practice concepts in various countries. Several types of technical persons are used to support the professional role of the pharmacist at Sint Radboud Hospital. Pharmaceutical research and international liaison are high priorities in the department of clinical pharmacy. Primary differences at Sint Radboud, as compared with U.S. hospitals, are the use of various supportive personnel and a continuing drug analysis/quality control program for commercial pharmaceuticals.
Individualized Adjustment of Vancomycin Dosage: Comparison with Two Dosage Nomograms
Authors: Rybak Michael J. , Boike Steven C. 
Published: May 2016

An individualized method of vancomycin dosage adjustment using steady-state serum concentrations was assessed in 50 patients (86 sets of vancomycin serum concentrations). The predictive accuracy of this method was compared with that of two published nomograms (Moellering, Matzke). Peak and trough serum concentrations predicted from previously drawn vancomycin serum concentrations (individualized method) using a one-compartment pharmacokinetic model were compared with measured steady-state peak and trough serum concentrations. Predicted peak and trough serum concentrations were also generated for both the Moellering and Matzke nomograms by using the elimination rate constant derived from each of the respective nomograms and the fixed volume of distribution (0.9 L/kg) assumed by the nomograms, and the actual administered vancomycin dose and dosage interval. These predicted concentrations were also compared with the measured peak and trough concentrations. Statistical measures of bias and precision indicated that the individualized method of dosage adjustment more closely predicted vancomycin serum concentrations following a dosage change than did either of the nomograms. Overall, the Moellering nomogram was the least accurate of the three methods in predicting vancomycin serum concentrations, and this nomogram should not be used to titrate vancomycin dosages in a clinical setting. Adjustment of vancomycin dosages should be individualized based on pharmacokinetic data derived from measured serum concentrations. In situations where quantitative analysis of vancomycin concentrations is not available, the Matzke nomogram appears to be a reasonable method of adjusting vancomycin dosages.
Aspirin and Reye's Syndrome: The Change in Prescribing Habits of Health Professionals
Authors: Rahwan Gary L. , Rahwan Ralf G. 
Published: May 2016

Epidemiological studies demonstrate the possible increased risk of Reye's syndrome after aspirin ingestion in children suffering from viral influenza or chicken pox. This study was conducted to determine whether the possible association between aspirin and Reye's syndrome in viral influenza and chicken pox deterred pediatricians and pharmacists in a large American city (Columbus, Ohio) from prescribing or recommending aspirin to their pediatric patients suffering from other causes of fever or pain. The results indicate that 90.6 percent of pediatricians and 97.8 percent of pharmacists no longer recommend aspirin to their pediatric patients, and an almost identical percentage recommend acetaminophen instead of aspirin. This change in prescribing habits of health professionals is reflected in a drop in sales of pediatric aspirin products with a simultaneous rise in sales of pediatric acetaminophen products reported by 93.3 percent of pharmacies. However, only 69.8 percent of pediatricians and 86.7 percent of pharmacists noted that their abstention from prescribing or recommending aspirin to children was rooted in a belief in a possible association between aspirin and Reye's syndrome.
Mexiletine: A New Type I Antiarrhythmic Agent
Authors: Schrader Bruce J. , Bauman Jerry L. 
Published: May 2016

Mexiletine is a type I antiarrhythmic drug that is structurally similar to lidocaine. Mexiletine has considerable potential for causing neurologic, cardiac, or gastrointestinal side effects. However, mexiletine does not undergo clinically significant first-pass metabolism and, thus, has good oral bioavailability. Mexiletine has a large and variable volume of distribution and an elimination half-life ranging from 6 to 12 hours. Mexiletine disposition is probably altered in patients with heart failure, liver disease, and severe renal dysfunction. Efficacy and toxicity are not well correlated with mexiletine serum concentrations. Mexiletine is as effective as traditional antiarrhythmics in the treatment of premature ventricular contractions. However, in patients with drug-refractory inducible ventricular tachycardia, mexiletine is usually ineffective when used alone. When mexiletine is combined with other antiarrhythmic agents, a significantly higher percentage of patients with this difficult arrhythmia have a good response. Mexiletine is a potentially important addition to the existing antiarrhythmic drugs currently available, but its place in the clinical setting and in therapeutic drug monitoring is not well defined at this time.
Nausea and Vomiting Possibly Associated with Intravenous Acyclovir
Authors: Lisby Susan M. , Nahata Milap C. , Powell Dwight A. 
Published: May 2016

Nausea and vomiting have not been clearly associated with parenteral acyclovir. We report a pediatric patient who developed nausea and vomiting apparently associated with intravenous acyclovir therapy. The child received acyclovir (1500 mg/m2/d) for treatment of recurrent varicella zoster with possible dissemination. Nausea and vomiting could be attributed only to acyclovir therapy. Discontinuing the drug resulted in a resolution of the adverse symptoms. Adverse effects of parenteral acyclovir can mimic the early manifestations of Reye's syndrome, which is an important consideration in children with viral infections. It is necessary to distinguish the cause of nausea and vomiting for proper management of patients. Nausea and vomiting are important side effects of parenteral acyclovir that have not been reported in children. These side effects are of special concern in the pediatric population because they can mimic the early clinical manifestations of Reye's syndrome. It is necessary to distinguish the cause of these symptoms in order to institute proper measures. Nausea and vomiting may be related to the hydration status of the patient during acyclovir therapy. Maintenance intravenous therapy or assurance of good oral intake may help in reducing this side effect. Evaluation of the relationship between nausea and vomiting and acyclovir therapy is needed in a prospective study involving a large number of patients so that therapy with this drug can be optimized.