bluuebunny/crossref_metadata_2025_split huggingface dataset:
Participation in Faecal Occult Blood Screening for Colorectal Cancer in a Well Defined French Population: Results of Five Screening Rounds from 1988 to 1996
Authors: Tazi M A , Faivre J , Dassonville F , Lamour J , Milan C , Durand G 
Published: January 2017

Objective— To evaluate the influence on compliance of demographic variables and of the way of proposing a faecal occult blood test in a colorectal cancer mass screening programme. Setting— Well defined population in Burgundy (France). Methods— From 1988 to 1996 five screening rounds were conducted in people aged 4S to 74 on entering the study. The screening test was provided free of charge by primary care physicians over a four month period, then mailed to non-consultants, followed by a potential reminder letter. The whole population was invited to participate in each screening campaign. Results— During the five successive rounds, compliance was 52.8%, 54.0%, 57.3%, 58.3%, and 56.2%. It was higher in women than in men, in those initially aged 50 to 69 than in the extreme age groups, and in urban than in rural areas. Overall, 68.7% of the invited population completed at least one screening test and 37.2% completed the five rounds. Among those who participated once in a screening campaign, between 79.6% and 87.6% participated in the succeeding ones. Compliance was higher when the test was proposed by GPs (varying between 85.2% and 94.0% according to the screening campaign) than when it was sent by post (varying between 26.0% and 33.7%). Conclusion— In France, a participation rate of over 50% can be achieved in colorectal cancer screening by means of a faecal occult blood test. To achieve this, primary care physicians have to play an active part in the programme and the test must be mailed to non-consultants.
Possible Short-Term Memory Loss Associated with Nafarelin Acetate
Authors: Kortepeter Cindy , MacMillan Mary , Ferrell Richard 
Published: January 2017

OBJECTIVE AND DESIGN: A survey was conducted to determine the occurrence of short-term memory loss in patients using nafarelin acetate nasal spray. SETTING AND PATIENTS: A list of all patients receiving nafarelin acetate from our pharmacy over a four-month period was generated. We contacted and surveyed 16 women. INTERVENTIONS: Each patient was asked to repeat three words at the beginning of the survey and after a series of questions, each patient was asked to recall the three words. Patients were also asked if they believed that their memory was affected by nafarelin acetate nasal spray. RESULTS: Eleven patients (69 percent) recalled three words, 3 (19 percent) recalled two words, and 2 (13 percent) recalled one word at the conclusion of the survey. Nine of 16 patients (56 percent) reported some type of memory difficulty. CONCLUSIONS: Nafarelin acetate nasal spray may adversely affect short-term memory. This effect is not documented in current literature and further investigation is warranted in the possible relationship between gonadotropin releasing hormone agonists, estrogen deficiency, menopause, and short-term memory. Our survey also demonstrates the significance of communication between pharmacists and patients on newly marketed medications.
Adverse Drug Events and the Freedom of Information Act: An Apple in Eden
Authors: Stang Paul E. , Fox Janet L. , Hartzema Abraham G. , Porta Miquel S. , Tilson Hugh H. 
Published: January 2017

OBJECTIVE: To review some of the abuses and proper uses of the Food and Drug Administration's (FDA's) spontaneous adverse-reaction reporting system, as a way of educating the reader to its strengths and limitations. DATA SOURCE: Published literature and reports based on information obtained from the FDA's database of spontaneous adverse drug-event reports. DATA SYNTHESIS: The Freedom of Information Act has increased public access to the FDA's database of spontaneous adverse drug reaction reports. As these reports are voluntarily received and reported to the FDA, their use for comparisons of drug safety is severely limited. Despite these limitations and the FDA's caveats for use of these data, consumer advocacy groups, researchers, and various pharmaceutical marketing groups have used this source to project the incidence of adverse drug reactions. CONCLUSIONS: The FDA's spontaneous adverse-event reporting system is designed to generate signals of unexpected adverse drug events. Use of the data gathered by this system to make drug safety comparisons is beyond their credible scope because many factors influence the reporting of adverse events. Researchers and peer reviewers should place these data in the proper perspective and support sound research into questions of drug safety.
Rxpert: A Prototype Expert System for Formulary Decision Making
Authors: Greer Marianne L. 
Published: January 2017

OBJECTIVE: RXPERT, a prototype, computer-based, expert system that models the decision-making processes for an ambulatory (non-hospital) formulary, is described as an example of how expert systems may be used to support pharmacy decision making. Basic information about expert-system technology is provided through this example. BACKGROUND: Computer-assisted decision making is becoming an important and accepted aspect of complex, health-related decisions. Because expert-system support may become an integral component of future, complex, pharmacy decision making, it is important for pharmacists to become familiar with this technology and its possibilities for supporting pharmacy decisions. METHOD: Expert systems offer the potential advantages of making the human decision-making process explicit, more consistent, easily duplicated in many locations simultaneously, and easy to update and document. Although an expert system is seldom intended to replace human decision makers, it can provide valuable support for complex, multivariable decisions. Typical knowledge-acquisition and knowledge-engineering techniques, as well as the characteristics and structure of expert systems, are described, relative to the development of the RXPERT prototype. CONCLUSIONS: Although RXPERT is not yet in use, the process for using an expert system to support an individual committee member's personal assessment of a drug product is described. Decision-support expert systems are potentially useful to pharmacists in complex decision-making tasks.
Prevalence of Invasive Cytomegalovirus Disease with Administration of Muromonab Cd-3 in Patients Undergoing Orthotopic Liver Transplantation
Authors: Hooks Michael A. , Perlino Carl A. , Henderson J. Michael , Millikan William J. , Kutner Michael H. 
Published: January 2017

OBJECTIVE: To assess the association of cytomegalovirus (CMV) disease with the administration of muromonab CD-3 (OKT-3) in patients undergoing liver transplant; specifically, to assess the risk of OKT-3 use as an agent for rejection prophylaxis and as an agent for therapy of rejection. DESIGN: Retrospective review of medical records. STUDY POPULATION: 83 liver transplant recipients (43 men, 40 women) with a mean age of 41.5 years (range 16–62). DATA EXTRACTION: The medical record for each liver transplant recipient was reviewed and analyzed for the following variables: (1) preoperative recipient CMV serology, (2) donor CMV serology, (3) incidence of invasive CMV disease, (4) administration of OKT-3, (5) postoperative administration time of OKT-3, and (6) the relationship between the administration of OKT-3 and the prevalence of invasive CMV disease. RESULTS: OKT-3 was administered to 34 of 83 (40.9 percent) liver recipients, 7 of whom received OKT-3 as rejection prophylaxis; the remainder received OKT-3 as rejection rescue. All patients received OKT-3 5 mg iv for 14 days. Seventeen of the 34 patients receiving OKT-3 (50 percent) developed invasive CMV disease; 58.8 percent of the patients (20/34) receiving OKT-3 were given the agent within the first 14 postoperative days. Sixteen of these 20 patients (80 percent) developed invasive CMV disease. One of 14 patients (7.1 percent) who received OKT-3 after the first 14 postoperative days developed invasive CMV disease. Of those patients 94 percent (16/17) received OKT-3 in the first 14 postoperative days. This prevalence differed significantly from those receiving OKT-3 after the 14th postoperative day and those who did not receive OKT-3 at any time during their hospital course. CONCLUSIONS: The patients who received early administration of OKT-3 in our study had a greater risk of invasive CMV disease than did those who received OKT-3 later in the hospital course.
Loss of Seizure Control Associated with Generic Substitution of Carbamazepine
Authors: Welty Timothy E. , Pickering Patricia R. , Hale Bradford C. , Arazi Richard 
Published: January 2017

OBJECTIVE: We report two cases of lost seizure control associated with the generic substitution of carbamazepine, review pertinent literature, and discuss the impact of this substitution on patient care. DATA SOURCES: Case studies, abstracts, and research publications identified in MEDLINE and bibliographic review. DATA EXTRACTION: One author reviewed cases supplied by the other authors and abstracted information from published literature sources. DATA SYNTHESIS: The first case describes a 15-year-old boy who received valproic acid and carbamazepine for partial seizures. A change in government program policies caused him to receive generic carbamazepine. This resulted in loss of seizure control and a decrease in his serum carbamazepine concentration from 12.4 to 6.7 μg/mL. When his carbamazepine concentration returned to previous levels, seizure control was not reestablished. A second case involves a 21-year-old woman who substituted generic carbamazepine because of financial problems. After being seizure-free for at least five years on phenobarbital and carbamazepine, she experienced seizures related to the product change. Her carbamazepine concentration decreased from 11.8 to 8.5 μg/mL; she also became pregnant at that time. Seizure control was not reestablished. At least three other studies do not support these observations, but the tightly controlled conditions in these studies may not have simulated actual clinical practice. CONCLUSIONS: When generic substitution of carbamazepine is required, serum concentrations should be carefully monitored. The extra care required may negate the financial advantages of the substitution.
Antibiotic Use in Urban Whites and Blacks: The Minnesota Heart Survey
Authors: Melnick Sandra L. , Sprafka J. Michael , Laitinen David L. , Bostick Roberd M. , Flack John M. , Burke Gregory L. 
Published: January 2017

OBJECTIVE: To assess racial differences in the use of antibiotics, including penicillins, erythromycins, tetracyclines, sulfas, and cephalosporins. DESIGN: Population-based surveys, conducted from 1985 to 1987. SETTING: The seven-county metropolitan area of Minneapolis-St. Paul, MN. PARTICIPANTS: 3127 whites (response rate 68 percent) and 1047 blacks (response rate 65 percent), aged 35–74 years. RESULTS: White women (26 percent of 1625) were more likely to report having taken an antibiotic in the past year than were white men (18 percent of 1502), black women (18 percent of 590), or black men (15 percent of 457). Reported antibiotic usage decreased with increasing age. Black men were more likely than white men to report the use of tetracyclines or sulfas; otherwise, white men reported higher usage prevalences. White women reported higher usage prevalences of all drug classes than black women. CONCLUSIONS: Significant independent predictors of antibiotic use were younger age, white race, and female gender. Potential explanations for these differences include differences in patient access, physician-prescribing behaviors, or both.
Anaphylactoid Reactions with Intraperitoneal Cisplatin
Authors: Hebert Mary E. , Blivin Janye L. , Kessler John , Soper John T. , Oleson James R. 
Published: January 2017

Objective: To report the occurrence of anaphylactoid reactions to intraperitoneal cisplatin in 3 patients. Case Summaries: While conducting a protocol evaluating the efficacy of intraperitoneal cisplatin and hyperthermia in the treatment of recurrent ovarian cancer, 3 patients were noted to exhibit anaphylactoid reactions. A 43-year-old woman received cisplatin 60 mg/m2 in 15 minutes during her sixth cycle of therapy. She developed pruritus, edema, and urticaria over both hands. The reaction subsided after treatment with diphenhydramine and dexamethasone. A 57-year-old woman received 400 mL (62.4 mg) of a cisplatin solution concentrated to deliver cisplatin 100 mg/m2 during her first attempted therapy. At this point, she developed whole body urticaria and pruritus with edema of the extremities. The reaction was aborted with diphenhydramine and dexamethasone. Despite premedication with dexamethasone prior to a second attempt at therapy, she again experienced similar symptoms after receiving 500 mL (78 mg) of cisplatin solution. A 55-year-old woman received 2 cycles of therapy with cisplatin 100 mg/m2 without difficulty. During her third cycle, she again received cisplatin 100 mg/m2 over 30 minutes and developed palmar pruritus, urticaria, and edema. Symptomatology resolved with diphenhydramine. Despite premedication with diphenhydramine and dexamethasone, she experienced generalized pruritus and urticaria, as well as headache and chest pain/tightness, after her next infusion. For both the second and third patients, symptomatology failed to resolve until the intraperitoneal cisplatin solution was withdrawn. Discussion: Anaphylactoid reactions have been described previously with cisplatin administration. No dose–rate effect has been reported, however. We observed 5 reactions in 3 patients that appear to be related to a high dose–infusion time ratio, indicating that dose and rate of infusion may be important factors in precipitating anaphylactoid reactions with cisplatin. Conclusions: We conclude that a high dose combined with a short infusion time increases the risk of anaphylactoid reactions with the administration of intraperitoneal cisplatin. There was no indication that the increase in anaphylactoid reactions was associated with the use of hyperthermia.
Apomorphine for Motor Fluctuations and Freezing in Parkinson's Disease
Authors: Corboy Dannielle L. , Wagner Mary L. , Sage Jacob I. 
Published: January 2017

Objective: To review the pharmacokinetics and use of apomorphine in patients with Parkinson's disease; to report a case of beneficial outcome with apomorphine in a patient with Parkinson's disease with severe levodopa “on-off” fluctuations and freezing; and to outline the types of patients or situations where apomorphine may be useful. Data Sources: Case reports, review articles, and relevant clinical studies identified by a MEDLINE search of the English-language literature published between 1975 and October 1994. Study Selection: Because all but 2 reports were of open-label design with small sample sizes, all studies identified were evaluated. Data Extraction: The following data were extracted from each study: apomorphine treatment duration, dosing, onset, duration, and adverse effects. The following efficacy variables were extracted: percent decrease in off periods, improvement in parkinsonian symptoms, and percent decrease in levodopa dosage. Data Synthesis: Efficacy of apomorphine following subcutaneous, rectal, sublingual, and intranasal dosage forms are evaluated. We also describe the use of apomorphine in a patient with Parkinson's disease who experienced on-off fluctuations and freezing. Based on these reports, recommendations for patient selection, product selection, and apomorphine dosing guidelines are presented. Conclusions: Apomorphine decreases off time, freezing, and levodopa requirements in patients with Parkinson's disease. It can be administered via a number of different nonoral routes; however, subcutaneous apomorphine is the most extensively studied. Rectal, sublingual, and intranasal routes also have been shown to provide benefit in motor fluctuations, but differ from the subcutaneous route in onset of action, duration of effect, and adverse effect profile.
Comparison of Tobramycin Pharmacokinetics After Administration by Cris and a Traditional Intravenous Piggyback Infusion
Authors: Mauro Vincent F , Jacobs Lori R , Mauro Laurie S , MacArthur Rodger D , White Donald B 
Published: January 2017

Objective: To compare the administration pharmacokinetics of a 30-minute intravenous piggyback (ivpb) infusion of tobramycin with those of controlled-release infusion system (CRIS) using a 20-mL vial at rates of 60 and 120 mL/h. Design: Randomized, controlled, crossover, prospective, open-label trial. Setting: Medical college-affiliated hospital. Participants: Eight healthy volunteer men between the ages of 22 and 24 years weighing between 60 and 90 kg. Interventions: Volunteers received, in random order, tobramycin sulfate 2 mg/kg iv on 3 occasions separated by 1 week. The drug was administered using a 50-mL ivpb infusion at 100 mL/h for 30 minutes, and with the CRIS using a 20-mL vial with flow rates of 60 mL/h for 1 hour (slow) and 120 mL/h for 1 hour (fast). Main Outcome Measures: Primary endpoints were area under the time–concentration curve (AUC), time to reach maximum concentration (tmax), and maximum concentration (Cmax). Secondary endpoints were elimination rate constant (ke), clearance (Cl), and half-life (t1/2). Results: Six volunteers successfully completed the trial. The tmax values observed following fast CRIS and ivpb were 28 ± 8 and 32 ± 4 minutes, respectively, and not significantly different from each other. Both occurred significantly earlier than the tmax associated with slow CRIS (44 ± 7 min). The Cmax values observed following ivpb (11.2 ± 1.5 mg/L) and slow CRIS (10.9 ± 0.9 mg/L) administration were not significantly different from each other, but both were significantly lower than that of fast CRIS (13.4 ± 1.5 mg/L). The AUCs of slow and fast CRIS were 29.8 ± 4.8 and 31.2 ± 3.8 mg/L•h, respectively, and were not significantly different from each other. The AUC of fast CRIS was significantly greater than that observed with ivpb (27.4 ± 4.3 mg/L•h). No significant difference in ke (fast CRIS 0.32 ± 0.03 h-1; slow CRIS 0.33 ± 0.04 h-1; ivpb 0.34 ± 0.0 h-1) was observed among any of the methods. Conclusions: CRIS administration of tobramycin resulted in higher AUCs than did ivpb administration. Compared with ivpb, fast CRIS resulted in a higher Cmax, but the tmax values of fast CRIS and ivpb administration were not statistically different. Compared with ivpb, slow CRIS resulted in a more delayed tmax, but the Cmax values of slow CRIS and ivpb were not statistically different.
Gaucher's Disease: A Review
Authors: Morales Laura E 
Published: January 2017

OBJECTIVE: To review the epidemiology, pathophysiology, clinical features, diagnosis, and treatment of Gaucher's disease, focusing on the role of enzyme replacement therapy. DATA SOURCES: a MEDLINE search (from 1984 to July 1995) of English-language literature pertaining to the treatment of Gaucher's disease was performed. Additional references were obtained by reviewing the references of pertinent articles identified through the search. Tertiary sources were also used. STUDY SELECTION AND DATA EXTRACTION: Articles with information on enzyme treatment were selected for review. Articles containing other interesting aspects of the disease or its treatment were also included. DATA SYNTHESIS: Gaucher's disease is the most common lipid storage disorder known and results from a genetic deficiency of the enzyme glucocerebrosidase (glucosylceramidase). Enzyme deficiency results in accumulation of glucocerebroside within the reticuloendothelial system. If may present with hepatosplenomegaly, bone marrow suppression, and bone lesions. The most common of the three subtypes, type 1, is non-neuronopathic. In the rare neuronopathic subtypes, type 2 or 3, there may also be nerve cell destruction within the central nervous system with acute brainstem dysfunction or progressive neurologic deterioration, respectively. In 1991, enzyme treatment became available with the marketing of alglucerase, a placentally derived modified form of glucocerebrosidase. In 1994, a recombinant DNA modified form of glucocerebrosidase, known as imiglucerase, was developed to replace alglucerase. Most published data on enzyme therapy are with alglucerase in patients with type 1 disease. A dosage regimen of 60 units/kg every 2 weeks for moderately to severely ill patients has been effective in reducing hepatosplenomegaly, improving anemia and thrombocytopenia, as well as improving weight gain and growth in children and increasing vigor and self-esteem in adults. Bone involvement is often slow to respond to therapy although pain is frequently improved. Controversy exists as to whether lower dosage regimens are as effective. The role of enzyme therapy in the rarer neuronopathic subtypes remains to be determined, but initial reports have been disappointing. CONCLUSIONS: Enzyme replacement therapy is available for the treatment of type 1 Gaucher's disease, resulting in clinical improvement with enhanced quality of life within the first year of treatment, although improvement in bone disease can take longer. Doses of 60 units/kg every 2 weeks are of clinical benefit to patients with moderate to severe disease. A number of lower dosage regimens have been evaluated in small groups of patients, with satisfactory clinical responses occurring in some of these patients.
Rhabdomyolysis Induced by Epsilon-Aminocaproic Acid
Authors: Seymour Beverly D , Rubinger Morel 
Published: January 2017

OBJECTIVE: To report a case of rhabdomyolysis associated with epsilon-aminocaproic acid (epsilon-ACA). CASE SUMMARY: A 33-year-old female patient with chronic granulocytic leukemia was treated with epsilon-ACA for approximately 3.5 months for thrombocytopenic bleeding. The initial dosage was 4 g po q6h. One month after an increase in dosage to 5 g po q4h the patient developed severe lower extremity myalgia and marked weakness. Laboratory investigations revealed an elevated creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and myoglobinemia. Epsilon-ACA was thought to be the causative agent and was discontinued. The patient received intravenous fluids to minimize renal damage due to myoglobin. Serum enzyme concentrations did not return to normal. The patient died of a central nervous system hemorrhage 1 week after the epsilon-ACA was discontinued. DISCUSSION: There were 31 cases of epsilon-ACA-induced myopathies published in the literature (MEDLINE) from 1972 to June 1995. Of these, 10 cases were reviewed. In all cases, patients received epsilon-ACA in doses ranging from 16 to 36 g/d for more than 28 days. Clinical findings varied from extreme muscle weakness to myopathic changes in electromyelograms. All patients recovered following discontinuation of epsilon-ACA. CONCLUSIONS: Long-term therapy with high-dose epsilon-ACA may produce muscle weakness or rhabdomyolysis. Patients who require long-term, high-dose epsilon-ACA therapy should be monitored for myoglobinuria and changes in serum CK, LDH, and AST, for myoglobinemia, for decreases in muscle strength, and/or for myalgia. Significant changes in these parameters compared with baseline values should suggest a need to discontinue epsilon-ACA therapy.
Painful Idiopathic Rigid Flatfoot in Children and Adolescents
Authors: Luhmann Scott J. , Rich Margaret M. , Schoenecker Perry L. 
Published: January 2017

Nine patients (13 feet) were identified whose primary complaints were of atraumatic-onset, chronic pain in the hindfoot exacerbated with increased activity and who had the diagnosis of idiopathic rigid flatfeet. Eight of 11 were greater than the 95th percentile in weight for their age. Exam under anesthesia showed moderate to significant improvement in hindfoot motion in 9 feet; 4 feet required fractional peroneal lengthenings. Only 5 of 11 patients have had sustained relief of pain and report unlimited activity level. Children and adolescents with painful idiopathic rigid flatfeet without known causation can have significant, persistent, disability and do not uniformly respond well to traditionally-described nonoperative interventions.