bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fentanyl Remaining in a Transdermal System Following Three Days of Continuous Use
Authors: Marquardt Kathy A , Tharratt R Steven , Musallam Nabil A 
Published: July 2017

Objective: To determine whether there was a sufficient amount of fentanyl remaining in a patch that had been used continuously for 3 days to warrant establishment of disposal policies to prevent diversion of fentanyl. Design: Nine patches were applied and removed by hospice nurses after 3 days of continuous use on hospice patients with cancer. Patches were analyzed for the remaining fentanyl contents using the Coat-A-Count Fentanyl radioimmunoassay. Five 2.5-mg patches and four 10.0-mg patches were opened, solubilized with methanol, diluted with water, and analyzed in duplicate. An unused 2.5-mg patch also was analyzed as a control and showed a 94% recovery of fentanyl. A methanol blank was negative for fentanyl. Main Outcome Measures: The study determined the amount of fentanyl in milligrams remaining in a used patch. Using pharmacokinetic principles, this quantity was compared with a potential lethal dose of fentanyl. Results: Analysis showed 0.7–1.22 mg remaining in the 2.5-mg patches and 4.46–8.44 mg remaining in the 10.0-mg patches. These numbers represent 28–84.4% of the original contents. Using the pharmacokinetic values of the volume of distribution of 4 L/kg and a potential lethal blood concentration of 3.7 μg/L, one can calculate the potential lethal dose for a 70-kg person to be 1036 μg. This is well within the amount remaining in the patch. This study also demonstrated that a wide patient variability exists in the absorption of fentanyl from the patch. Conclusions: There is a sufficient amount of fentanyl available for abuse and misuse after 3 days of therapeutic use. Adequate disposal policies currently are not established and need to be implemented.
Acute Respiratory Distress Syndrome
Authors: Watling Sharon M , Yanos John 
Published: July 2017

Objective: To review the pathophysiology, epidemiology, and therapy of patients with acute respiratory distress syndrome (ARDS). Data Sources: Articles pertaining to the pathophysiology, epidemiology, and supportive therapy of ARDS were chosen from a computerized literature search. Recent review articles addressing the specifics of treatment in an intensive care unit are cited rather than restating these specific aspects. Data Extraction: Primary literature was chosen in reference to the pathophysiology, epidemiology, and supportive therapy of ARDS. Both human and animal studies were included. Review articles were cited regarding areas of ARDS supportive therapy rather than citing the primary literature. Study Selection: Only peer-reviewed primary literature sources were chosen to describe the specifics of pathophysiology and epidemiology. When human data were unavailable, animal studies were cited. Recent review articles were cited for specifics on supportive therapy. Data Synthesis: Consensus regarding the definition of ARDS and the difficulties of performing large controlled trials in patients with ARDS has made development of new modalities problematic. Understanding the underlying pathophysiology and risk factors for mortality are key to supportive therapy. Although many pharmacologic agents are being tested in patients with ARDS, attention to the aspects of supportive therapy is the only method to decrease mortality. Conclusions: The mortality of ARDS continues to be 70%. Pharmacists can play an active role in the supportive therapy of patients with ARDS, which is currently the only way to impact mortality.
The Role of Continuous Infusion Loop Diuretics
Authors: Yelton Shannon L , Gaylor Melissa A , Murray Kim M 
Published: July 2017

Objective: To evaluate the role of continuous infusion loop diuretics in selected patient populations, discuss the advantages and disadvantages associated with continuous infusion, and recommend monitoring parameters for the use of continuous infusion therapy. Current dosing guidelines for continuous infusion of loop diuretics have not been established, but a summary of previously studied doses is provided. Data Sources: A literature search using MEDLINE, International Pharmaceutical Abstracts, as well as additional references found in pertinent articles. Study Selection and Data Extraction: Clinical studies concerning the use of loop diuretics administered by continuous infusion were evaluated in selected patient populations. All articles and clinical studies were considered for possible inclusion in the review. Information judged to be pertinent by the authors was selected for discussion. Data Synthesis: Comparative studies in the congestive heart failure (CHF), renal-insufficient, and postcardiac surgery patient populations have shown that loop diuretics administered by continuous infusion are more beneficial than those given by intermittent bolus administration. In adult patients with CHF, furosemide 3–4 mg/h is recommended. In adult and pediatric postcardiac surgery patients, furosemide dosages of 0.05 and 0.1 mg/kg/h have produced diuresis. In patients with renal insufficiency, bumetanide 0.912 mg/h has produced diuresis. Intravenous bolus doses were used in all studies reviewed except 1. These studies have indicated that continuous infusion of the loop diuretics yields diuresis without increasing toxicity. Conclusions: The use of continuous infusion loop diuretics is a therapeutic alternative for patients requiring diuresis. This form of administration has provided more consistent urine flow, fewer alterations in fluid balances, fewer urinary losses of electrolytes as well as decreased dosage of the diuretic requirements. The disadvantages have not been fully elucidated because of the limited evaluation of this administration method. Few studies have used this method of administration; however, the few data available indicate that continuous infusion of loop diuretics is an efficacious alternative to conventional therapy.
The Long-Term Treatment of the Aged: An Assessment Method
Authors: Simonen Helena , Apajalahti Antti , Ferm Liisa , Tötterman Lars Emil 
Published: July 2017

The aim of this investigation was to construct three parameters and assess their value as admission criteria for long-term institutional care of the aged, viz. medical dependence, nursing dependence, and dementia. The material consisted of 200 applicants, of whom 150 were admitted to institutions. The need for personal care was measured by means of a test method developed at the Wasa Hospital, Gothenburg, Sweden, and the dementia test comprised five subtests, each of which measures a distinct field of mental function. Both dementia and nursing dependence were found to increase with age, and there was a highly significant correlation between nursing dependence and age. There was also a highly significant correlation between nursing dependence and degree of dementia. The changes in nursing dependence 3 and 6 months after admission showed a significant correlation with the test scores for dementia. The nursing dependence of the moderately or severely demented persons had increased in 6 months after admission by approximately 100%. The test results of dementia were used as the sole, decisive criterion in 24% of admissions; medical dependence alone decided the choice of institution in 22% and nursing dependence in 15%. Two or three parameters were used in 39% of admissions—all indicating the same type of institutional care. The simultaneous use of the three assessment criteria provides an extensive body of information as to the general need of care, and by means of this information the appropriate placement of the old will be made possible.
Some Methodologic Problems Encountered in Occupational Health Research
Authors: Olsen Jam 
Published: July 2017

The sources of error encountered in occupational health epidemiology present unique and difficult problems. Knowledge of these possible sources of error is essential for the proper design of studies and interpretation of study results. This article describes important sources of bias in occupational health research including healthy worker selection, information bias and the differential distribution of workplace health services. The paper emphasizes that reference groups must be chosen with extreme care in order to avoid potential problems of healthy worker selection. In addition, knowledge of the process by which diseases are diagnosed is important in planning appropriate study designs.
Understanding untreated hypertension from patients’ point of view: A qualitative study in rural Yogyakarta province, Indonesia
Authors: Rahmawati Riana , Bajorek Beata 
Published: July 2017

Objectives This study aimed to explore perspectives about hypertension from patients who do not take anti-hypertensive medications. Factors that shape their perspectives as well as patients’ expectations were also canvassed. Method Individual, face-to-face interviews were conducted with 30 people (≥45 years old) living in rural villages, diagnosed with hypertension, who had not taken any anti-hypertensive medications for at least one year. Interviews were audiotaped, transcribed verbatim and thematically analysed. Results Four themes emerged: (1) alternative medicines for managing high blood pressure; (2) accessing health care services; (3) the need for anti-hypertensive medications; and (4) existing support and patients’ expectations. Reluctance to take anti-hypertensive medications was influenced by patients’ beliefs in personal health threats and the effectiveness of anti-hypertensive medications, high self-efficacy for taking alternative medicines, the lack of recommendation regarding hypertension treatment, and barriers to accessing supplies of medicines. Conclusion Despite their awareness of being diagnosed with hypertension, patients undervalued visiting a health professional to control their high blood pressure. Health strategies need to consider patients’ beliefs, concerns and expectations. Providing an accessible, affordable and adequate supply of hypertension medication is also key to any programs designed to optimise hypertension management.
Parenteral Histamine2-Receptor Antagonists in the Pediatric Population
Authors: O'Mara Neeta Bahal , Nahata Milap C. 
Published: July 2017

Objective: To provide a review of the use of parenteral histamine2 (H2)-receptor antagonists cimetidine, ranitidine, and famotidine in the pediatric population. Data Sources: Information was identified by MEDLINE and a review of journals. References cited in published articles and manufacturers' product information also were used. Study Selection: Information was selected for review if it addressed the parenteral administration of H2-receptor antagonists in the pediatric population. Data Extraction: Data were extracted from references pertaining to the topic. Data Synthesis: Despite the lack of Food and Drug Administration pediatric labeling, the H2-receptor antagonists often are used for a variety of indications in infants and children. Although these agents differ somewhat in chemical structure, potency, and pharmacokinetics, the most important differences exist in their drug interactions and adverse effect profiles. Further, administration methods, compatibility, and stability data differ slightly among the agents. Conclusions: Parenteral H2-receptor antagonists are used for a variety of indications in infants and children. Despite their widespread use, additional studies are needed to define the optimal dosage regimens in this population.
Diagnosis and Treatment of Bacterial Vaginosis: Survey of Family Physicians in West Virginia
Authors: Ponte Charles D. , Martinec Cindy L. 
Published: July 2017

Background: Vulvovaginitis is a common gynecologic complaint with millions of women seeking medical attention for this disorder. Bacterial vaginosis (BV) is the most common form of vaginal infection. Its nonspecific symptomatology and its diagnostic and therapeutic controversies pose many challenges. Methods: A 10-question self-administered survey was mailed to family physicians in West Virginia. The survey assessed the occurrence of BV, diagnostic criteria, and treatment options. The results were reported as descriptive statistics. Results: Overall, 107 physicians responded to the survey. Seventy-nine surveys were used in the tabulation of results. All respondents diagnosed vaginitis on a weekly basis. On average, BV is diagnosed in 25 percent of women with vaginal problems. Discharge, odor, and irritation were the most common signs/symptoms. History, physical examination, and microscopic examination of vaginal secretions were employed routinely for diagnosis. A detectable odor, a homogeneous discharge, and vaginal pH >4.5 were inconsistent objective clinical findings. However, the presence of clue cells was noted in the majority of patients. The preferred drug for the treatment of BV was metronidazole, usually administered in a dosage of 500 mg/d po bid for seven days. Fifty percent of the respondents treat men partners, and again, the drug of choice was metronidazole. The majority do not treat asymptomatic BV during pregnancy nor asymptomatic nonpregnant women during routine gynecologic examination. Recurrence was noted in fewer than 30 percent of treated women. Conclusions: On the basis of the results, BV is a common gynecologic diagnosis. Classic signs/symptoms were universally present and the diagnostic approach was consistent with established medical norms. The usual objective clinical findings were not always evident, although the presence of clue cells was a frequent finding. The therapeutic approach to the patient with BV was also consistent with contemporary medical practice in 1991. Whether the small sample size or inconsistent reporting affected the study results remains indeterminate. Future research will be directed toward larger patient populations and assessment of newer therapeutic modalities and their costs.
Atypical Presentation of Angioedema Associated with an Angiotensin-Converting Enzyme Inhibitor
Authors: Hamilton John D. , Raymond Claire H. 
Published: July 2017

Objective: To report a case of atypical angioedema associated with the use of lisinopril, an angiotensin-converting enzyme (ACE) inhibitor. Data Synthesis: Literature evaluating ACE inhibitor-induced angioedema was selected from a topical search in MEDLINE. Information regarding the case report was obtained from a review of the medical chart. Summary: A 23-year-old man presents with lisinopril-induced angioedema confined to the left pectoral area. Angioedema associated with ACE inhibitors has been described in the literature, manifesting primarily as edema of the face, throat, and mucous membranes. A review of the possible mechanism, cross-reactivity within the drug class, and treatment of ACE inhibitor-induced angioedema is also discussed. Conclusions: The use of ACE inhibitors in the treatment of hypertension and congestive heart failure is expected to increase, given their proven efficacy and favorable adverse effect profile. Clinicians need to be aware that, although the frequency of ACE inhibitor-induced angioedema is low, it may present in an atypical fashion. J Pharm Technol 1994;10:255–7.
Rifabutin Hepatotoxicity in a Pediatric Liver Transplant Patient
Authors: Ascher David P. , Jaffers Gregory J. , Davis Steven G. 
Published: July 2017

Objective: To report a case of hepatotoxicity associated with administration of rifabutin in a pediatric liver transplant patient. Case Summary: A child developed disseminated Mycobacterium avium-intracellulare eight years after liver transplantation, requiring a reduction in immunosuppression and concomitant therapy with amikacin, azithromycin, ciprofloxin, ethambutol, and clofazimine. Despite clinical improvement, rifabutin was added because of residual sterile hepatic and pulmonary granuloma identified during preparation for retransplantation. She developed acute hepatic decompensation upon initiation of rifabutin, which resolved after discontinuation of this antibiotic. Conclusions: This case demonstrates the potential for serious hepatotoxicity with the use of rifabutin in complicated medical patients with hepatic insufficiency.
Comparison of Methods Used for Estimating Pharmacist Counseling Behaviors
Authors: Schommer Jon C. , Sullivan Donald L. , Wiederholt Joseph B. 
Published: July 2017

Objective: To compare the rates reported for provision of types of information conveyed by pharmacists among studies for which different methods of estimation were used and different dispensing situations were studied. Data Sources: Empiric studies conducted in the US, reported from 1982 through 1992, were selected from International Pharmaceutical Abstracts, MEDLINE, and noncomputerized sources. Study Selection: Empiric studies were selected for review if they reported the provision of at least three types of counseling information. Data Extraction: Four components of methods used for estimating pharmacist counseling behaviors were extracted and summarized in a table: (1) sample type and area, (2) sampling unit, (3) sample size, and (4) data collection method. In addition, situations that were investigated in each study were compiled. Data Synthesis: Twelve studies met our inclusion criteria. Patients were interviewed via telephone in four studies and were surveyed via mail in two studies. Pharmacists were interviewed via telephone in one study and surveyed via mail in two studies. For three studies, researchers visited pharmacy sites for data collection using the shopper method or observation method. Studies with similar methods and situations provided similar results. Conclusions: Data collected by using patient surveys, pharmacist surveys, and observation methods can provide useful estimations of pharmacist counseling behaviors if researchers measure counseling for specific, well-defined dispensing situations.
Cost Implications of Using Inhaled Nitric Oxide Compared with Epoprostenol for Pulmonary Hypertension
Authors: Petros Andy J , Turner Sean C , Nunn Anthony J 
Published: July 2017

Objective: To compare the cost of using intravenous epoprostenol with that of inhaled nitric oxide (NO) for treating episodes of pulmonary hypertension in children with congenital heart disease. Design: An analysis of the cost of epoprostenol and NO use over the previous 18 months was performed. Three 6-month periods were identified, two in which epoprostenol was used and the third in which inhaled NO was introduced for the treatment of pulmonary hypertension. Setting: A 10-bed pediatric cardiac intensive care unit, Royal Liverpool Children's Hospital, Alder Hey, Liverpool, England. Subjects: Children with congenital heart disease and persistently elevated pulmonary artery pressure following cardiac surgery. Main Outcome Measures: The total duration of use of epoprostenol and inhaled NO was documented. The costs per hour for epoprostenol and inhaled NO were calculated and the annual cost of each agent was estimated. Results: In the two 6-month periods prior to the introduction of inhaled NO, epoprostenol was used on 14 occasions (5 in the first period, 3 in the second). In the last 6-month period, nine children required pulmonary vasodilator therapy on 14 occasions. All nine children were treated successfully with inhaled NO; none were given or needed epoprostenol, as NO always was effective in providing pulmonary vasodilatation. For resistant pulmonary hypertension, increasing the concentration of NO would have been the next therapeutic option. The cost for the two 6-month periods using epoprostenol was $19,483.48 for the drug and $283.25 for equipment costs (total cost $19,766.73). There was no expenditure on epoprostenol in the final 6-month period. The cost of NO was $465. However, the total expenditure, including the delivery and monitoring system, was $4,722.85. Conclusions: Using inhaled NO in our pediatric cardiac intensive care unit abolished the use of epoprostenol during the reported monitoring period. The cost savings were significant, amounting to 12% of the annual drug budget for the unit. The cost of setting up the inhaled NO delivery system is recouped rapidly. The ease of delivery and measurement of inhaled NO also may have contributed to its increased clinical use.
Digestive Enzyme Adjunct to Oral Headache Medication to Improve Absorption and Reduce Vomiting
Authors: Detweiler Mark B 
Published: July 2017

Objective: To report a case in which a digestive enzyme complex (Nature's Plus Digestive Enzymes: pancreatin, pepsin, ox bile extract, malt diatase, and papain) apparently improved the absorption and efficacy of an oral headache medication and alleviated vomiting associated with the headache. Case Summary: A 47-year-old white woman with a history of adverse drug reactions and allergies had been experiencing one to four disabling headaches per week for 2 years. One or two headaches each week would be accompanied by vomiting. This patient experienced adverse effects with most standard headache medications. For 40 months since taking a complex of digestive enzymes as an adjunct to her headache medication, the patient's vomiting has been eliminated, and her postheadache symptoms have been reduced. Discussion: Altered digestive processes are a common finding in severe headache episodes. Exogenous digestive enzymes may facilitate the absorption of oral medication during gastric disruption and consequently increase drug efficacy and the relief of symptoms. Conclusions: Digestive enzymes merit further study to ascertain their effectiveness in increasing the absorption and efficacy of oral medications prescribed for headaches accompanied by emesis.
Bioequivalence Study Between Two Extended-Release Formulations of Theophylline Using Saliva
Authors: Payssé Helena M , Vázquez Marta , Fagiolino Pietro L 
Published: July 2017

Objective: To assess the bioequivalence between two extended-release formulations of theophylline using saliva as the biologic fluid. Design: Randomized two-way crossover design. Participants: Eight healthy, nonsmoking volunteers (7 women, 1 man) between 23 and 41 years of age took a single dose (250 mg) of two extended-release formulations of theophylline (form A, tablet; form B, capsule). Results: Significant differences were found at 2, 4, 6, and 8 hours (p < 0.001), with the in vitro dissolution test between both formulations. ANOVA for AUC, maximum concentration (Cmax), average concentration, and %Cmax – 100 showed significant differences between both formulations in the in vivo trial. Conclusions: The tablet and capsule formulations of extended-release theophylline are bioinequivalent when saliva is used as the biologic fluid for performing these studies.
Effectiveness of Two-Step Tuberculin Skin Testing in Hospital Employees
Authors: Tran Jennifer H , Seeger John D 
Published: July 2017

Objective: To review the literature discussing the use of two-step tuberculin skin testing for hospital employees. Data Sources: English-language journal articles involving human subjects. Study Selection: Selected articles describing the use of two-step tuberculin skin testing. Data Extraction: Information relevant to the topic was extracted from the articles and synthesized into this report. Data Synthesis: People infected with tuberculosis exhibit a skin-test reaction to tuberculin, but this reaction can diminish over time. A two-step tuberculin skin test involves the administration of a second injection of tuberculin 1–3 weeks after the initial injection. The rationale for the use of the two-step tuberculin skin test is to help differentiate between individuals with new tuberculosis infections and those with previous infections whose immune response to tuberculin had decreased to levels not detectable with a single skin test. Conclusions: Two-step tuberculin skin testing is effective at detecting a booster effect. Despite the recent mandate by the Occupational Safety and Health Administration to use two-step tuberculin testing in all healthcare facilities, such testing may not be cost-effective in institutions with young employees, high employee turnover, and a low risk of tuberculosis. The requirements for universal two-step tuberculin testing may need to be reevaluated to account for these factors.