bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bicycle accidents often cause disability –
Authors: Olkkonen Seppo , Lahdenranta Uolevi , Slätis Pär , Honkanen Risto 
Published: July 2017

Social and medical consequences of 278 children and 264 adults injured in bicycle accidents and seen in two hospitals in Helsinki in 1985–86 were analyzed. Information was collected from patient records, by means of a special questionnaire and by telephone interview. A child outpatient required 1.7 and a child inpatient 3.0 physician visits on an average, while adults required 2.2 and 4.9 visits, respectively. The average duration of hospital stay was 8 days for hospitalized adults and 6 days for children. Rehabilitative care outside the hospital was received by 6% of the adult outpatients and 25% of the inpatients, but none of the injured ***. The mean duration of work disability was 82 days among inpatients, 11 days among outpatients, 127 days among the inpatients injured in motor vehicle collisions and 65 days among inpatients injured in other bicycle accidents. Of inpatients 32% and of outpatients 5% reported persistent (>6 months) disability. Persistent disability was recorded in 11% of children, in 47% of adults and in 67% of elderly inpatients. Most serious consequences were due to intracranial injuries in motor vehicle - bicycle collisions. Of the hospitalized bicyclists 4% sufered from severe cognitive and behavioural changes or sense impairment and of adult inpatients 3% suffered from permanent work disability. The average costs of health and social services were about FIM 1000 per adult outpatient and FIM 13000 per adult inpatient. In prevention high priority should be given to motor vehicle collisions, head injuries and injuries among the elderly bicyelists.
The Synergistic Effect of Microwave Radiation and Hypergravity on Rats and the Intervention Effect of Rana Sylvatica Le Conte Oil
Authors: Sun Wei , Yang Yudan , Yu Hongmei , Wang Luowei , Pan Su 
Published: July 2017

Aim: The phenomena of hypergravity and microwave radiation are widespread, which cause more and more concern for the hazards to human health. The aim of this study was to investigate the synergistic effect of microwave radiation and hypergravity on rats and observe the protective effect of Rana sylvatica Le conte oil. Methods: Rats were exposed to microwave radiation and hypergravity, and the rat weight, the climbing pole height, serum enzyme activities, blood urea nitrogen concentration, and total antioxidant capacity were detected. Results: The climbing pole height, the activities of choline acetyl transferase and cholinesterase, and the total antioxidant capacity decreased, whereas the activities of alanine aminotransferase, aspartate aminotransferase, areatine kinase, isocitric dehydrogenase, hydroxybutyrate dehydrogenase, and the blood urea nitrogen concentration increased in the hypergravity irradiation group as compared with the others. Conclusion: These results imply that the motion and nervous system of rats might be affected critically by the synergistic effect of microwave radiation and hypergravity, and it causes damage to most rat organs, such as the bone, skeletal muscle, liver, heart, and kidney, and the antioxidant effect is also damaged, while the injury resulted from it could be protected by Rana sylvatica Le conte oil.
Costs Associated With Intravenous Darbepoetin Versus Epoetin Therapy in Hemodialysis Patients: A Randomized Controlled Trial
Authors: Woodland Andrea L. , Murphy Sean W. , Curtis Bryan M. , Barrett Brendan J. 
Published: July 2017

Background: Anemia of chronic kidney disease is associated with adverse outcomes and a reduced quality of life. Erythropoiesis-stimulating agents (ESAs) have improved anemia management, and 2 agents are available in Canada, epoetin alfa (EPO) and darbepoetin alfa (DA). EPO and DA are considered equally effective in achieving target hemoglobin (Hb), but it is not clear whether there is a cost difference. There have been few head-to-head comparisons; most published studies are observational switch studies. Objective: To compare the cost of DA and EPO and to determine the dose conversion ratio over a 12-month period. Design: Randomized controlled trial. Setting: Canadian outpatient hemodialysis center. Patients: Eligible patients were adult hemodialysis patients requiring ESA therapy. Measurements: The primary outcome was ESA cost (Can$) per patient over 12 months. Secondary outcomes included the dose conversion ratio, deviation from target ranges in anemia indices, iron dose and cost, and time and number of dose changes. Methods: An open-label randomized controlled trial of intravenous (IV) DA versus EPO was conducted in 50 hemodialysis patients. Participants underwent a minimum 6-week run-in phase followed by a 12-month active study phase. ESA and iron were dosed using a study algorithm. Results: The median cost was $4179 (interquartile range [IQR]: $2416-$5955) for EPO and $2303 (IQR: $1178-$4219) for DA with a difference of $1876 ( P = .02). The dose conversion ratio was 280:1 (95% confidence interval [CI]: 197-362:1) at the end of the run-in phase, 360:1 (95% CI: 262-457:1) at the 3-month point of the active phase, and 382:1 (95% CI: 235-529:1) at the 6-month point of the active phase. There were no significant differences between the 2 groups in weekly iron dose, Hb, serum ferritin, or transferrin saturation. The number of dose changes and the time to Hb stability were similar. Limitations: Results may not be generalizable to hemodialysis units without algorithm-based anemia management, with subcutaneous ESA administration, or to the nondialysis chronic kidney disease population. The effective conversion ratio between EPO and DA is known to increase at higher doses; the Hb targets used in the study were slightly higher than those recommended today so it is possible that the doses used were also higher. Because of this, the cost savings estimated for DA could differ somewhat from the savings realizable in current practice. Conclusions: In this study of hemodialysis patients with comparable anemia management, IV DA cost $1876 less per year per patient than IV EPO. The dose conversion ratio was greater than 350:1 by the 3-month point. Trial registration: ClinicalTrials.gov (NCT02817555).
The diagnostic accuracy of ultrasonography for soft tissue lipomas: a systematic review
Authors: Rahmani George , McCarthy Peter , Bergin Diane 
Published: July 2017

Background Ultrasound has been used in the diagnosis of soft-tissue lesions for well over a decade. Lipomas are the most common, benign, soft-tissue tumor and comprise adipose tissue. The sensitivity and specificity of diagnosing lipomas on ultrasound vary greatly in the literature. Purpose To perform a systematic review on ultrasonography in soft-tissue lipomas to better ascertain the true diagnostic value of this test. Material and Methods A systematic review of the diagnostic value of ultrasound in lipomas was performed where possible in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of the literature was conducted using several well-known databases Scopus®, PubMed®, Ovid® Medline, and Web of Science®. Results A total of 455 articles were identified in the initial literature search. Six papers were included in the final systematic review, which revealed an overall sensitivity and specificity of 86.87% (95% confidence interval [CI] = 82.14–90.73) and 95.95% (95% CI = 93.75–97.54), respectively. Conclusion Ultrasound is a useful tool in the diagnosis of superficial lipomas with good sensitivity and even better specificity and should continue to be the first line investigation in such cases.
Antithrombotic Therapy during and after Intracoronary Stenting
Authors: Panning Chad A 
Published: July 2017

Objective: To evaluate the impact on patient outcomes of antithrombotic therapy during and after intracoronary stenting. Data Sources: A MEDLINE search (1966-July 2000) for English-language clinical trials and review articles using the search terms stent and coronary with one or more of the following search terms: abciximab, tirofiban, orofiban, xemilofiban, eptifibatide, aspirin, heparin, enoxaparin, tinzaparin, dalteparin, hirudin, danaparoid, dipyridamole, cilostazol, dextran, warfarin, anticoagulant, ticlopidine, and Clopidogrel. References from these articles were reviewed for additional articles. Pharmaceutical companies were contacted to identify unpublished studies. A total of 177 sources were initially identified. Study Selection: Studies were selected through an unblinded individual review for prospective, randomized clinical trials evaluating patient outcomes related to antithrombotic therapy during or after intracoronary stent placement. Additional human and animal studies were included for background and introductory information. Data Extraction: Patient characteristics in each study were compared with those of the overall stent population. The primary end point measurements were defined. The completeness of follow-up and power analysis was assessed. Data Synthesis: Intracoronary stenting is now a common modality for maintaining patency of occluded arteries. Antithrombotic therapy during coronary artery stent placement is changing as knowledge about the pathophysiology of thrombus formation expands and new medications become available. Development of new stent placement techniques, new stent designs, and methods of restenosis irradiation or prevention have coincided with evolving antithrombotic regimens. Conclusions: The current antithrombotic regimen used in coronary artery stenting is complex, but has a lower incidence of hemorrhagic complications and thrombosis compared with previous anticoagulant regimens. Antithrombotic therapy may need to be tailored to individual patient contraindications.
The Role of Heparin in the Thrombolytic Treatment of Acute Myocardial Infarction
Authors: Stoneman David K. , Mauro Vincent F. 
Published: July 2017

Objective: To review the literature to determine the most appropriate role of heparin when using thrombolytic therapy. Data Sources: English-language journal articles published between 1985 and 1991. Study Selection: Ten trials comparing the effects of thrombolytic therapy with and without heparin. Desired outcomes that the authors were interested in were coronary vessel patency, reocclusion, recurrent ischemia, reinfarction, mortality, and bleeding complications. Data Extraction: Studies were assessed based on methodology. Data Synthesis: The concurrent use of heparin with tissue plasminogen activator (tPA) enhances coronary vessel patency without significantly increasing the risk of bleeding complications. The concurrent use of heparin with streptokinase enhances survival; however, the risk of bleeding associated with heparin use is unclear at present. Data are not currently available for anistreplase. Studies are underway to further address the role of heparin with thrombolytic therapy. Conclusions: Based on data currently available, it appears that beginning intravenous heparin during the first hour of the tPA infusion and continuing heparin for 24 hours appears most appropriate and has a minimal risk of bleeding. Delaying heparin for 9–12 hours after the streptokinase infusion appears to produce clinical benefits; however, it is not clear whether these benefits outweigh the potential risks of bleeding.
Albumin Audit Results and Guidelines for Use
Authors: Gales Barry J. , Erstad Brian L. 
Published: July 2017

Objective: To identify patients receiving albumin, develop guidelines for albumin use, and examine distribution and billing procedures. Design: Case series. Setting: Tertiary care center. Patients: All patients received albumin in a four-week period. Patients were identified concurrently using intensive care unit surveys and the pharmacy computer system, and retrospectively using billing statements. Data were analyzed from 73 of 79 patients (92.4 percent); 6 (7.6 percent) had no record of albumin being ordered or administered. Pediatric patient data were used only in the financial calculations. Data Collection: Demographics and albumin dosages were recorded for all patients. Prescribing service and indications for use were recorded in adults. Albumin administered was compared with the amount billed to each patient. Main Results: Sixty adult patients aged 14–91 y (median 62) received 1–69 units (median 4 units [1 unit=12.5 g albumin]) and 470 total units. Surgical services prescribed albumin in 73 percent and medical services in 27 percent of the patients. Common indications for albumin included volume expansion (65 percent), as intraoperative fluid (13 percent), and to increase urine output (10 percent). The pharmacy computer system identified 63 percent of the patients. Of these, 13 percent were not billed for albumin they received. Examinations of patient billing statements found that up to $17,740 a year (15 percent) of albumin administered is not billed. The floor-stock distribution system used in the intensive care units contributed to most errors. Conclusions: Recommendations addressing the problems identified in this audit were made to the pharmacy, medical, nursing, and billing departments. Guidelines for albumin use were formulated and approved by the hospital's pharmacy and therapeutics committee.
Application of Decision Analysis in Antibiotic Formulary Choices
Authors: Szymusiak-Mutnick Barbara , Mutnick Alan H. 
Published: July 2017

Objective: To introduce the reader to the fundamentals involved in using decision analysis as a tool in evaluating the associated costs and effectiveness of comparable therapeutic agents. Data Sources: Currently available literature citations were used to provide the reader with basic references whose purpose is to provide a step-by-step approach for using Decision Analysis in conducting a cost-effective comparison of three commonly used antibiotics. Data were gathered from a previously conducted retrospective chart review where the three antibiotics were used for either prophylactic, empiric, or documented infections. Although this study was limited by its retrospective nature, the reader can use the data to appreciate the fundamentals of decision analysis. Conclusions: The continually changing climate in healthcare and the added visibility of pharmacologic agents in the treatment and prevention of disease has increased pressure on pharmacy departments to provide therapeutic agents that are cost-effective. Decision analysis can be used to compare therapeutic agents, in terms of financial as well as clinical outcomes, in a structured fashion that all members of the health care team can understand. The application of Decision analysis is appropriate for many therapeutic agents, not just antibiotics.
Foscarnet-Associated Penile Ulcerations
Authors: Cadle Richard M. , Hamill Richard J. 
Published: July 2017

Objective: To report a case of foscarnet-induced penile ulcerations and review literature related to this adverse effect. Data Sources: Case reports and review articles identified by a computerized search (MEDLINE) and manual search (Index Medicus). Data Synthesis: Foscarnet is a pyrophosphate analog antiviral agent that is approved by the Food and Drug Administration for treating cytomegalovirus retinitis in patients with AIDS. It also is used investigationally for other indications and human herpesvirus infections. Adverse effects include nephrotoxicity, anemia, ionized calcium abnormalities, and penile ulcerations. The majority of penile ulcers have developed within two weeks following initiation of foscarnet therapy with dosages of 180–200 mg/kg/d. Most cases required discontinuation of foscarnet to resolve the penile lesions. A postulated mechanism for this effect is inflammatory contact dermatitis from exposure to urine with elevated concentrations of foscarnet. We report a case of foscarnet-induced penile ulcerations that resolved after discontinuing this agent. Conclusions: Foscarnet can induce penile ulcerations. Increased awareness of this phenomenon, along with meticulous genital hygiene and urination practices, are required for its prevention.
Aprotinin: No Justification for Current Use
Authors: Cooper Brad E 
Published: July 2017

Objective: To review the pharmacology, pharmacokinetics, clinical efficacy, and safety of aprotinin. Data Identification: A literature search using Grateful Med from 1991 to 1994 and the search term “aprotinin” was performed. Study Selection: Open and controlled trials were reviewed. Data Extraction: Studies evaluating aprotinin for use in primary and repeat coronary artery bypass graft (CABG) surgery were evaluated and results of the effects of aprotinin on decreasing transfusion requirements as well as adverse effects were summarized. Data Synthesis: Many European studies have shown that aprotinin reduces blood loss and transfusion requirements during CABG. More recently, two studies in the US and one in Canada have been published that confirm the effects of aprotinin on blood loss, but raise questions concerning its safety. Combined data indicate that aprotinin is associated with an increased incidence of renal failure, and there are trends toward increases in myocardial infarction, graft occlusion, and mortality. There is no question that aprotinin reduces blood loss during CABG. How much it will save depends on surgical skill and the use of other blood conservation techniques. There are many theoretical benefits to patients from this reduction in blood loss. Whether the benefits of aprotinin administration exceed the risks associated with its use has not been adequately assessed, and further multicenter trials are currently in progress. Whether the cost of aprotinin is counterbalanced by a reduction in transfusion requirements will vary, depending on the cost and amount of blood products used at the specific institution, but this type of analysis does not account for the cost of adverse effects of aprotinin or transfusions, and no pharmacoeconomic evaluations have been published. Conclusions: Until studies can demonstrate a positive benefit/risk ratio in terms of patient outcome, aprotinin should not be added to the formulary or used in patients undergoing CABG.
Use of Benchmarking Techniques to Justify the Evolution of Antibiotic Management Programs in Healthcare Systems
Authors: Schentag Jerome J , Paladino Joseph A , Birmingham Mary C , Zimmer Gabrial , Carr James R , Hanson Stephen C 
Published: July 2017

Objective: To apply basic benchmarking techniques to hospital antibiotic expenditures and clinical pharmacy personnel and their duties, to identify cost savings strategies for clinical pharmacy services. Design: Prospective survey of 18 hospitals ranging in size from 201 to 942 beds. Each was asked to provide antibiotic expenditures, an overview of their clinical pharmacy services, and to describe the duties of clinical pharmacists involved in antibiotic management activities. Specific information was sought on the use of pharmacokinetic dosing services, antibiotic streamlining, and oral switch in each of the hospitals. Results: Most smaller hospitals (<300 beds) did not employ clinical pharmacists with the specific duties of antibiotic management or streamlining. At these institutions, antibiotic management services consisted of formulary enforcement and aminoglycoside and/or vancomycin dosing services. The larger hospitals we surveyed employed clinical pharmacists designated as antibiotic management specialists, but their usual activities were aminoglycoside and/or vancomycin dosing services and formulary enforcement. In virtually all hospitals, the yearly expenses for antibiotics exceeded those of Millard Fillmore Hospitals by $2,000–3,000 per occupied bed. In a 500-bed hospital, this difference in expenditures would exceed $1.5 million yearly. Millard Fillmore Health System has similar types of patients, but employs clinical pharmacists to perform streamlining and/or switch functions at days 2–4, when cultures come back from the laboratory. Conclusions: The antibiotic streamlining and oral switch duties of clinical pharmacy specialists are associated with the majority of cost savings in hospital antibiotic management programs. The savings are considerable to the extent that most hospitals with 200–300 beds could readily cost-justify a full-time clinical pharmacist to perform these activities on a daily basis. Expenses of the program would be offset entirely by the reduction in the actual pharmacy expenditures on antibiotics.
Herbal Remedies
Authors: Tyler Varro E 
Published: July 2017

Objective: To provide an overview of basic information required by pharmacists to advise patients on the proper use of selected herbs and phytomedicines (“dietary supplements”) as therapeutic agents. Data Sources: The vast literature on this topic in the English, German, and French languages has been researched by the author over a period of many years. Databases that were used include NAPRALERT and MEDLINE. Study Selection: Articles and books dealing with the current popularity of botanical medicine and with laws and regulations covering so-called dietary supplements, as well as information on selected toxic herbs and a few of the most popular beneficial herbs used for treating common ailments and syndromes. Data Synthesis: Studies suggest that many herbal products currently available are both safe and effective drugs. A few products on the US market are definitely unsafe for human consumption and use. Conclusions: The increasing popularity of botanicals, coupled with regulations that prohibit definitive labeling, requires pharmacists to acquire accurate information based on scientifically and clinically acceptable data to advise patients on their use. Useful remedies for several common ailments and information concerning their safety and usefulness provide a starting point for an understanding of this complex field.
Ketoconazole in the Prevention of Acute Respiratory Distress Syndrome
Authors: Earl-Salotti Grace L , Ratzell Michelle D , Maldonado Ivan L 
Published: July 2017

Objective: To describe the pharmacology of ketoconazole and examine the use of ketoconazole in critically ill surgical patients to prevent the development of acute respiratory distress syndrome (ARDS). Data Source: An English-language literature search from 1985 to 1994 using MEDLINE-identified relevant articles. Search terms were adult, acute respiratory distress syndrome, ketoconazole, thromboxane, and leukotrienes. Study Selection: Two randomized, controlled, double-blind studies were identified that examined the use of ketoconazole in critically ill surgical patients. In vitro and animal studies were included to describe the mechanism of ketoconazole on inhibition of leukotriene and thromboxane synthesis. Data Extraction: Studies were evaluated for study design, efficacy, and toxicity. Data Synthesis: Two randomized, placebo-controlled clinical trials have been conducted in critically ill surgical patients. One study demonstrated a 6% incidence of ARDS in patients receiving ketoconazole 200 mg/d (n = 35) versus 31% on placebo (n = 36) (p < 0.01). Another study demonstrated a 15% incidence of ARDS in patients receiving ketoconazole 400 mg/d (n = 26) versus 64% on placebo (n = 28) (p < 0.002), and showed a statistically significant decrease in mortality in the ketoconazole group (15%) versus placebo (39%) (p < 0.05). There were no reports of serious adverse events, and patients in both treatment and placebo groups were discontinued for increased liver enzyme concentrations. Conclusions: Two studies conducted at single sites using prophylactic ketoconazole therapy in dosages of 200–400 mg/d in a small population of critically ill surgical patients at risk for ARDS have demonstrated a significant decrease in the incidence of ARDS. There are no ongoing multicenter trials that would provide the power to measure the true difference between the groups and minimize the selection bias inherent in these studies.