bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacy-Based Intervention to Reduce Antibiotic Use for Acute Bronchitis
Authors: Hickman David E , Stebbins Marilyn R , Hanak John R , Guglielmo B Joseph 
Published: January 2017

BACKGROUND: Intervention programs can reduce inappropriate antibiotic use for the treatment of acute bronchitis in a closed health maintenance organization model. OBJECTIVE: To evaluate the impact of a pharmacy-based intervention program intended to reduce antibiotic use in the treatment of acute bronchitis in a community-based physician group model. SUBJECTS: Adult and pediatric patients with an office or urgent care visit for acute bronchitis during the baseline and study periods were included in the study. The clinicians were primary care physicians, nurse practitioners, and physician assistants in a suburban community-based physician group setting. METHODS: All patients treated for acute bronchitis from January 1 through June 30, 1998, were evaluated for initial receipt of antibiotics and use of clinic resources (office visits, additional antibiotics). From September through December of 1998, physicians were provided literature from the Centers for Disease Control and Prevention (CDC), cough and cold package inserts, and newsletters intended to educate the providers regarding the inappropriateness of antibiotics in the treatment of acute bronchitis. Patient-directed literature from the CDC was placed in the examination rooms and clinic waiting areas beginning September 1998. From January 1 through June 30, 1999, all patients treated for acute bronchitis were assessed for receipt of antibiotics and use of clinic resources. A separate geographic clinic site served as a control during both study periods. RESULTS: During 1998, 888 of 1840 patients (48.3%) received antibiotics for treatment of acute bronchitis; this total decreased to 924 of 2392 (38.6%; p ≤ 0.001) in 1999, a reduction of 20%. The rate of antibiotic prescribing in control patients was unchanged during the concomitant time periods (142/446, 31.8% vs. 102/321, 31.8%). The rate of subsequent physician visits was similar (8% vs. 9%) between patients receiving antibiotics and those who did not. However, significantly more patients initially receiving antibiotics required a subsequent antibiotic prescription (45/1812, 2.5% vs. 24/2420, 1.0%; p ≤ 0.001). CONCLUSIONS: A pharmacy-based intervention program reduces the incidence of inappropriate antibiotic use in the treatment of acute bronchitis. Reduced antibiotic prescribing does not increase consumption of healthcare resources; patients who receive antibiotics for acute bronchitis are more likely to subsequently require additional antibiotic prescriptions. While a significant decrease in antibiotic use was realized, other interventions are required to further reduce the prevalence of antibiotic use in acute bronchitis.
Serotonin Syndrome Induced by Low-Dose Venlafaxine
Authors: Pan Jan-Jhy , Shen Winston W 
Published: January 2017

OBJECTIVE: To report the case of a patient with serotonin syndrome induced by low-dose venlafaxine. CASE SUMMARY: A 29-year-old Taiwanese woman with major depressive disorder abruptly developed serotonin syndrome during low-dose (37.5 mg/d) venlafaxine monotherapy, with symptoms of restlessness, tremor, shivering, diarrhea, vomiting, ataxia, tachycardia, and myoclonus. The patient recovered in 2 hours after receiving prochlorperazine and lorazepam in the emergency department. Venlafaxine was discontinued, and she was discharged home. Two weeks later, the patient started to receive fluoxetine 20 mg/d and reported no adverse adverse effects during follow-up clinic visits. DISCUSSION: The clinical manifestations of this case meet Sternbach's criteria of serotonin syndrome. Its possible etiologic factors include panic attack, adverse drug reaction, pharmacodynamic interaction, and congenital absence of CYP2D6 enzyme activity. The Naranjo probability scale suggested a probable causality of venlafaxine treatment and serotonin syndrome. CONCLUSIONS: Clinicians should be aware of the risk of serotonin syndrome when the patient receives not only a combination of 2 antidepressants, but also the single potent serotonergic agent venlafaxine.
Fenofibrate Potentiates Warfarin Effects
Authors: Kim Karissa Y , Mancano Michael A 
Published: January 2017

OBJECTIVE: To describe 2 patients in whom the initiation of fenofibrate potentiated warfarin's anticoagulant effects. CASE SUMMARY: A 71-year-old white woman and an 80-year-old white woman with multiple medical conditions were both stabilized on long-term warfarin therapy. During the course of anticoagulation, both patients were prescribed fenofibrate and experienced threefold and twofold increases in international normalized ratio (INR), respectively, requiring total weekly warfarin dosage reductions of 30–40%. Before starting fenofibrate therapy, both patients' coagulation values were within the therapeutic range. When interviewed, patients and caregivers denied bleeding, bruising, changes in diet, alcohol ingestion, nonadherence with therapy, or changes in drug regimen except for the addition of fenofibrate. Upon chart review, evaluation of potentially contributory parameters, such as other changes in drug therapy, thyroid function, liver function, and drug–disease interactions, showed that these parameters remained stable and were ruled noncontributory. DISCUSSION: The addition of fenofibrate in 2 patients on stable and therapeutic doses of warfarin increased the anticoagulant response to warfarin. A clear temporal relationship with the addition of fenofibrate and the appearance of the interaction was seen. Fenofibrate is highly protein bound, with the potential to displace warfarin from its binding protein, leading to an enhanced hypoprothrombinemic effect. Fenofibrate is also a mild to moderate inhibitor of CYP2C9, the enzyme responsible for warfarin metabolism. The combination of these effects — displacement of warfarin by fenofibrate coupled with decreased metabolism of warfarin — may increase the anticoagulant response to warfarin. Using the Naranjo probability scale, these interactions were designated as probable. CONCLUSIONS: We suggest serial monitoring of INR and consider an empiric 20% reduction in warfarin dosage when fenofibrate is initiated, with the possibility for a greater warfarin dosage reduction based on INR results.
Lepirudin Use in a Neonate with Heparin-Induced Thrombocytopenia
Authors: Nguyen Thuy N , Gal Peter , Ransom J Laurence , Carlos Rita 
Published: January 2017

OBJECTIVE: To describe a case of heparin-induced thrombocytopenia (HIT) in a premature infant and the doses of danaparoid and lepirudin needed to achieve appropriate therapeutic endpoints. CASE SUMMARY: A 30-week gestational age infant was diagnosed with HIT with heparin antibodies. Danaparoid 2.0–2.4 units/kg/h achieved anti-Xa levels of 0.2–0.4 U/mL, but thrombocytopenia failed to resolve. Lepirudin was started in place of danaparoid. Lepirudin doses of 0.03–0.05 mg/kg/h achieved target activated partial thromboplastin time values of 1.5–2.0 times baseline. DISCUSSION: Dosing information for danaparoid in neonates is limited, and information for lepirudin appears only in German literature at this time. HIT is well documented in newborns, and lepirudin use in these situations is likely to increase. This report provides some guidance for optimal dosing. It also provides some guidance for HIT evaluation in preterm infants, in whom blood volume for laboratory tests is a major issue. CONCLUSIONS: HIT is an important and potentially fatal problem in neonates. Lepirudin may be the drug of choice, especially since danaparoid is now unavailable. Initial lepirudin dosing should not exceed 0.05 mg/kg/h.
Tamoxifen for Prevention of Breast Cancer
Authors: Cersosimo Robert J 
Published: January 2017

OBJECTIVE: To review data on the use of tamoxifen for primary prevention of breast cancer. DATA SOURCES: A literature search was performed through MEDLINE (1992–May 2002) using the key words tamoxifen, breast cancer, and prevention. DATA SYNTHESIS: Breast cancer is the most common malignancy detected in American women. Attempts to reduce morbidity and mortality include early detection programs and chemoprevention. Clinical trials of tamoxifen for reduction of breast cancer risk are reviewed. CONCLUSIONS: Tamoxifen may reduce the risk of primary breast cancer in women at increased risk. The benefit of tamoxifen in women who are not at risk is uncertain. The risks of developing thromboembolic disorders or endometrial cancer must be considered before tamoxifen is prescribed. Women should be given all of the information about the benefits and risks of tamoxifen use so that they can make an informed decision based on the best data available.
Association of HMG-CoA Reductase Inhibitors with Neuropathy
Authors: Backes James M , Howard Patricia A 
Published: January 2017

OBJECTIVE: To review the possible association between statins and peripheral neuropathy. DATA SOURCES: Literature was obtained from MEDLINE (1984–September 2002) and International Pharmaceutical Abstracts (1970–June 2002). Key search terms included statin, neuropathy, and HMG-CoA reductase inhibitor. DATA SYNTHESIS: Epidemiologic studies and case reports suggest an increased risk of peripheral neuropathy with statin drugs. Most patients were receiving long-term therapy, although the onset was highly variable. The majority of cases were at least partially reversible with drug cessation. Specific risk factors or mechanisms have not been identified. CONCLUSIONS: Observational data suggest a link between chronic statin use and increased risk of peripheral neuropathy. However, the risk appears to be small relative to the significant cardioprotective benefits.
Ivermectin for the Treatment of Resistant Scabies
Authors: Cook Aaron M , Romanelli Frank 
Published: January 2017

OBJECTIVE: To assess the clinical literature describing the use of ivermectin in cases of treatment-resistant scabies infestations. DATA SOURCES: Clinical literature accessed through a MEDLINE search (1966–July 2001) and the Cochrane Database. DATA SYNTHESIS: A limited number of case reports and case series describes successful intervention with ivermectin use in patients who have failed prior therapy. Ivermectin may serve as a viable alternative therapy as the incidence of resistant scabitic infestations increases. CONCLUSIONS: Ivermectin appears to be a safe and effective alternative for patients with treatment-resistant scabies. Larger, controlled clinical trials are required before this therapy can be recommended in the general population or as primary therapy.
Personal Digital Assistant Applications for the Healthcare Provider
Authors: Keplar Kristine E , Urbanski Christopher J 
Published: January 2017

OBJECTIVE: To review some common medical applications available for personal digital assistants (PDAs), with brief discussion of the different PDA operating systems and memory requirements. Key search terms included handheld, PDA, personal digital assistants, and medical applications. DATA SOURCES: The literature was accessed through MEDLINE (1999–August 2002). Other information was obtained through secondary sources such as Web sites describing common PDAs. DATA SYNTHESIS: Medical applications available on PDAs are numerous and include general drug references, specialized drug references (e.g., pediatrics, geriatrics, cardiology, infectious disease), diagnostic guides, medical calculators, herbal medication references, nursing references, toxicology references, and patient tracking databases. Costs and memory requirements for these programs can vary; consequently, the healthcare provider must limit the medication applications that are placed on the handheld computer. CONCLUSIONS: This article attempts to systematically describe the common medical applications available for the handheld computer along with cost, memory and download requirements, and Web site information. This review found many excellent PDA drug information applications offering many features which will aid the healthcare provider. Very likely, after using these PDA applications, the healthcare provider will find them indispensable, as their multifunctional capabilities can save time, improve accuracy, and allow for general business procedures as well as being a quick reference tool. To avoid the benefits of this technology might be a step backward.
Clinical Pharmacy Service Contributions on a Part-Time Basis
Authors: Self Timothy H. , Eoff James C. 
Published: January 2017

Staffing a majority of hospitals with full-time clinical pharmacists is an aim that will not be attainable for many years. In an effort to demonstrate an interim approach to clinical practice that could be applied to a large percentage of hospitals, a part-time clinical pharmacist's services were documented. Serving a teaching hospital with an average census of 97 patients, the pharmacist, with a 50 percent time allotment for clinical services, monitored 229 total admissions during an eleven week period. The majority of patients were on either a pulmonary medicine or urology service. The total number of actions taken as a result of pharmacy consultations was 106, with 70 percent of these being related to dosing problems. It was concluded that a pharmacist providing clinical services to a large patient population on a less than full-time basis can have a positive impact on drug therapy.
An Evaluation of Dosing Regimens for Insulin in Diabetic Ketoacidosis
Authors: Beck Diane E. , Yost Richard L. 
Published: January 2017

A review of the literature was performed to evaluate insulin dosing regimens used in the treatment of diabetic ketoacidosis. High-dose insulin therapy was demonstrated to be effective in the largest number of patients, but carries the added risks of a high incidence of hypokalemia and hypoglycemia. Low-dose insulin regimens are effective for most patients, and these regimens produce a lower incidence of hypokalemia and hypoglycemia than do the high-dose therapies. Continuous intravenous infusion appears to be preferable to intermittent intramuscular or subcutaneous administration of insulin. Low-dose insulin therapy is recommended unless the DKA patient presents with shock. Regardless of the dosing regimen or route of administration selected, careful patient monitoring and correction of electrolyte imbalances is most important in the prevention of any complications.
Predictability of Serum Digoxin Concentrations in Clinical Practice
Authors: Taketomo Robert T. , Dominguez Andres E. , Landes Robert A. 
Published: January 2017

A study was conducted to clarify the reliability of serum digoxin concentration (SDC) predictions in the absence of concurrent quinidine administration. The effects of age, sex, congestive heart failure (CHF), and the method used to estimate creatinine clearance were investigated. Data were collected from patients who were representative of those seen in clinical practice. Patients admitted to the study were required to have not received quinidine, to have stable renal function, to have been taking digoxin for ten consecutive days—the same dose and route of administration, and to have been categorized as having or not having CHF at the time of the SDC determination. There were 44 patients who qualified for admission to the study. SDCs were predicted on the basis of four methods for estimating creatinine clearance and four methods for estimating serum concentrations. After simple linear regression analysis, one method was found to have correlation coefficients ranging from 0.72 to 0.79, regardless of the method used to estimate creatinine clearance. In addition, analysis determined that age and presence of CHF were not factors affecting the reliability of predicted SDCs. Female patients had, on the average, a greater difference between measured and predicted SDCs; however, this was not statistically significant. Thus, in the absence of concurrent quinidine administration, SDCs may be estimated as long as the limitations of the method are acknowledged. Age, CHF, and the common methods used to estimate creatinine clearance do not significantly affect the reliability of predicted SDC values.
Cefaclor-Associated Serum Sickness-Like Disease: Eight Cases and Review of the Literature
Authors: Vial Thierry , Pont Jacqueline , Pham Emmanuel , Rabilloud Muriel , Descotes Jacques 
Published: January 2017

OBJECTIVE: To describe the clinical features of serum sickness-like diseases (SSLD) in cefaclor-treated patients. DESIGN: Analysis of a case series spontaneously reported to Lyons Pharmacovigilance Center. SETTING: General and hospital practitioners and the French Network of Regional Pharmacovigilance Centers (FNRPC). PATIENTS: All reported cases with a possible causative relationship between cefaclor treatment and SSLD. MAIN RESULTS: Eight cases of SSLD following cefaclor treatment are described. The clinical features included cutaneous reactions, arthralgias, and moderate hyperthermia. In 50 percent of the patients, hospitalization was required because of incapacitating symptoms. The outcome was benign in all cases following discontinuation of the offending drug. All eight cases were reported in children under five years of age. Among 137 cefaclor-associated drug reactions collected by FNRPC, 27 cases of SSLD have been reported; 23 of these patients were younger than five years of age. A literature survey confirmed the higher reporting of SSLD in children with cefaclor compared with other antibiotics and suggested an incidence of 0.024–0.2 percent of SSLD per drug course of cefaclor. CONCLUSIONS: The case reports and epidemiologic studies confirmed the presumed role of age (patients under five years of age) in cefaclor-induced SSLD and the benign outcome despite severe clinical presentations in some reports.
Evaluation of Medication Knowledge in Elderly Patients
Authors: O'Connell Mary Beth , Johnson June F. 
Published: January 2017

OBJECTIVE: To identify problems with medication knowledge, self-estimated compliance, and recall of medication education in a group of elderly patients. DESIGN: Survey. SETTING: Medicine and geriatric clinics at a county hospital. PATIENTS: Patients ≥60 years old and taking at least one prescription medication. MAIN OUTCOME MEASUREMENTS: Medication knowledge, self-estimated compliance, and recall of medication education. RESULTS: The percent of geriatric patients correctly stating 76–100 percent of their medication doses, uses, and frequencies was 30, 64, and 66 percent, respectively. Fifteen patients (34 percent) stated they never missed a medication dose and 27 (61 percent) remembered to take their medications by memory alone. Sixteen and 86 percent, respectively, of the patients from the medicine and geriatric clinics could not recall receiving verbal or written educational material. Only 27 percent of patients recalled having been told about possible adverse reactions. The most frequently cited providers of medication information were physicians. CONCLUSIONS: Specially designed multidisciplinary medication education programs with repeated written and verbal reinforcement for elderly patients may improve patients' knowledge about their medications, recognition and management of adverse reactions, and compliance.
Hypersensitivity Immune Reaction as a Mechanism for Dilevalol-Associated Hepatitis
Authors: Maria Vasco A.J. , Victorino Rui M.M. 
Published: January 2017

OBJECTIVE: To assess lymphocyte reactivity to dilevalol and to serum containing putative ex vivo dilevalol antigens or metabolites in a case of dilevalol-induced liver injury. PATIENT: A 58-year-old woman with a clinical diagnosis of dilevalol-induced liver injury. METHODS: Peripheral blood mononuclear cells collected from the patient were cultured in the presence of a solution of dilevalol and also with sera collected from a volunteer before and after dilevalol intake. A similar protocol was performed with lymphocytes from a healthy subject. RESULTS: No lymphocyte proliferation was observed either in the patient or in the healthy volunteer in the presence of dilevalol solutions. A significant proliferative response to serum collected after dilevalol intake was observed in the case of the patient compared with the proliferative response to the serum collected before the drug intake. No reactivity was found when lymphocytes from the healthy subject were tested under similar conditions. CONCLUSIONS: The methodology used allowed the detection of lymphocyte sensitization to sera containing ex vivo-prepared dilevalol antigens, suggesting the involvement of an immunologic mechanism in dilevalol-induced liver injury.
Treatment of Herpesvirus Infections in Hiv-Infected Individuals
Authors: Fletcher Courtney V. 
Published: January 2017

OBJECTIVE: To discuss strategies available for the treatment of herpesvirus infections in individuals infected with HIV. DATA SOURCES: Information was obtained from controlled and uncontrolled clinical trials, abstracts, conference proceedings, and review articles. STUDY SELECTION: Emphasis was placed on controlled investigations in subjects infected with HIV. DATA EXTRACTION: Data from human studies were extracted by the author and evaluated according to the patient population studied, sample size, dosage regimen, and therapeutic response. DATA SYNTHESIS: Herpes group viruses are common opportunistic pathogens in HIV-infected individuals. Zoster, caused by varicella-zoster virus (VZV), is an early indication of the loss of cell-mediated immunity and HIV disease progression. Anorectal mucocutaneous disease is the most common manifestation caused by herpes simplex virus (HSV). Acyclovir is the drug of choice for treatment of both VZV and HSV infections. Cytomegalovirus (CMV) is the most common life-threatening viral infection in patients with AIDS; retinitis is the most frequent clinical manifestation. The response rate of CMV retinitis to initial treatment with either ganciclovir or foscarnet is equivalent, approximately 60–90 percent. Recent data suggest that the survival benefit may be greater with foscarnet. CONCLUSIONS: Advances in the development and application of antiviral drugs for herpes group viruses have made treatment and, in some cases, prevention of infections possible. Future efforts, aimed at earlier intervention and suppression of latent virus, may offer additional improvement in quality of life for the HIV-infected individual.