bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Atypical Antipsychotics on an As-Needed Basis
Authors: Demczar Dorothy , Levin Gary M 
Published: July 2017

Objective: To review the literature and determine whether atypical antipsychotics should be used on an as-needed (prn) basis. Data Sources: Pertinent English-language literature dealing with atypical antipsychotics, typical antipsychotics, phamacokinetics, and prn dosing strategies was retrieved from a MEDLINE search (1960–1995). Data Extraction: Articles that discussed either pharmacokinetic parameters or the rationale for using antipsychotics on a prn basis. Data Synthesis: Administration of typical antipsychotics on a prn basis, either alone or in combination with scheduled antipsychotics, is a common practice. However, it has recently been recognized that the atypical agents, clozapine and risperidone, are also being prescribed for prn dosing. Clozapine has a sedative component that may provide a therapeutic benefit when prescribed prn, but it is also associated with dose-related seizures and orthostatic hypotension. Risperidone does not appear to exhibit sedation, except at very high doses. Conclusions: The risk-to-benefit ratio is not acceptable in using the atypical antipsychotic agents on a prn basis. There are documented safety and efficacy data that support the use of the typical antipsychotic agents such as chlorpromazine, or haloperidol in combination with lorazepam, on a prn basis. These latter choices are also more cost-effective.
Community Pharmacists' Knowledge of Antioxidant Vitamins
Authors: Offricht Debra M , Malone Margaret 
Published: July 2017

Objective: The current interest in antioxidant vitamins has led consumers to seek advice from community pharmacists. The primary objective of this study was to evaluate community pharmacists' knowledge of antioxidant vitamins. Design: An interviewer-based questionnaire was developed to represent the questions most frequently asked by consumers in community pharmacies about antioxidant vitamins. Setting: Pharmacies in the Tri-cities area (Albany, Schenectady, and Troy, NY) were identified from the Yellow Pages of the Albany, NY telephone directory, and each was visited by the interviewer (DMO). Main Outcome Measures: Questions were divided into the demographic data and practice setting of the participant; the antioxidant vitamins, knowledge of supplements and foods containing antioxidants, dosage recommendations, and toxicities; and therapeutic claims attributed to their use. Results: Of 75 pharmacists approached, 70 agreed to participate in the study. The number of questions per week received from customers regarding antioxidant vitamins was estimated to be between 0 and 25. All pharmacists had heard of the terms “free radical” and “antioxidant,” but few were able to provide an adequate definition of either term. The majority of pharmacists knew which vitamins are considered to be antioxidants, but were unfamiliar with appropriate dosage recommendations. In keeping with current literature recommendations, the use of antioxidant supplements was generally not advocated. Conclusions: In this study, pharmacists provided inadequate information regarding antioxidant vitamins. Because antioxidants are rarely indicated according to the current literature, pharmacists have a responsibility to base their recommendations to customers on substantiated data.
Assessment of Drug-Prescribing Problems in a Multidisciplinary Primary Care Clinic
Authors: Otaguro Jill E , Kruse Leann E 
Published: July 2017

Objective: To identify drug classes prone to prescribing problems in a multidisciplinary primary care clinic in a Department of Veterans Affairs Medical Center. Methods: Over a 10-week study period, the ambulatory care pharmacists reviewed the prescription profiles and medical records of every patient with an appointment in the Comprehensive Health Care Unit primary care clinic. Based on this review, the pharmacists made patient-specific consultations to the providers. They were also available during clinic hours for additional consultations and patient referrals. A standard data collection form was used to document all consultations. Results: The pharmacists made 1,701 consultations concerning 1,665 patients. The most problematic drug classes identified included anticoagulants, lipid-lowering agents, antiulcer agents, antihypertensive/ cardiovascular agents, chronic obstructive pulmonary disease/asthma agents, oral antidiabetic agents, nonsteroidal antiinflammatory drugs, and anticonvulsants. Anticoagulants and lipid-lowering agents were the most problematic drug classes, with most of the consultations related to dosing and monitoring requirements. Consultations had an 88.6% acceptance rate and resulted in a total monthly drug cost avoidance of $1,525. Conclusions: As a result of identifying the most problematic drug classes, computer programs have been developed to streamline the pharmacist review process, and clinical practice guidelines, posters, and educational handouts have been developed to promote appropriate prescribing.
Octreotide in the Treatment of Pancreatic Pseudocysts
Authors: Lam Annie Y , Kracke Susan E 
Published: July 2017

Objective: To describe the potential use of octreotide in the treatment of pancreatic pseudocysts through a brief review of anecdotal case reports. Case Summary: Octreotide has been used in a few patients to effectively inhibit pancreatic secretions and shrink the size of persistently draining pseudocysts. The dosage of octreotide is 100–200 μg bid or tid sc, for up to 36 days or until resolution of the pseudocysts is achieved. Discussion: Persistent pancreatic pseudocysts of varying size and duration have been successfully treated with the use of octreotide. Larger pseudocysts, which are unlikely to resolve spontaneously, may remain unresolved with the use of octreotide and may still require conventional surgical intervention. The use of octreotide in such cases, however, may still be beneficial. Shrinkage of the pseudocysts, even without complete resolution, may result in reduction of pain and may prevent other complications that often accompany the unresolved pseudocysts. Conclusions: Anecdotal reports suggest that octreotide may be useful as a noninvasive alternative or adjunct to traditional surgical treatment of pancreatic pseudocysts. Further research with well-designed studies involving randomized comparative controls are necessary to correlate the degree of pseudocyst shrinkage with the dosage and duration of octreotide therapy. The apparent effectiveness of octreotide in reducing the size of persistent pancreatic pseudocysts and providing pain relief suggests that it may be a useful adjunct to surgical interventions. With smaller persistent pseudocysts, octreotide may be a treatment alternative to surgery.
Beliefs of Community Pharmacists on Prevention and Correction of Potential Drug Therapy Problems
Authors: Farris Karen B , Kirking Duane M 
Published: July 2017

Objective: To describe likelihood and affective evaluation ratings for salient beliefs of community pharmacists about trying to prevent and correct potential drug therapy problems, and to describe normative belief and motivation to comply ratings about trying to prevent and correct potential drug therapy problems. Design: Descriptive statistics from a self-administered mail survey. Participants: A convenience sample identified salient beliefs about trying to prevent and correct potential drug therapy problems, and a random sample of Michigan community pharmacists (n = 555) completed a self-administered mail survey regarding these beliefs. Main Outcome Measures: Likelihood and affective evaluation ratings of 22 salient beliefs and normative belief and motivation to comply ratings of six salient others. Results: Pharmacists believed that trying to prevent and correct drug therapy problems could lead to valuable consequences, regardless of whether the efforts were a success or a failure. The pharmacists also believed they could have a positive impact on the quality of drug therapy; however, they seemed less convinced that failure would lead to health complications in patients or unnecessary health expenditures. Pharmacists were most motivated to comply with the expectations of patients. Conclusions: Assisting community pharmacists in adopting pharmaceutical care can be accomplished by (1) providing programs where the process of trying to prevent and correct drug therapy problems can be experienced, (2) promoting an understanding of the relationships between drug product costs and healthcare costs due to patient morbidity, (3) devising mechanisms to increase patient demand for pharmaceutical care and drug utilization review, and (4) assisting community pharmacists to obtain reimbursement for time spent trying to prevent and correct drug therapy problems.
Benzodiazepine Utilization Review for Inpatients at a Tertiary Medical Center in Taiwan
Authors: Hsu Rou-Yee Chen , Tang Kwong-Yui 
Published: July 2017

Objectives: To examine benzodiazepine prescribing patterns by physicians for inpatients relative to indications and drug characteristics in a tertiary medical center. Design: Prescription pattern analysis was done by checking computer-based pharmacy records. Benzodiazepine utilization was evaluated through retrospective chart review. Results: A total of 2,195 inpatients were surveyed, of whom 945 were given benzodiazepines. Of these, 827 charts were available for review. The mean number of prescriptions written for benzodiazepines was 1.62 per patient. Of the benzodiazepines available, triazolam was most frequently prescribed. The use of benzodiazepines ranged from 38.7% in the internal medicine ward to 85.1% in the oncology ward. We found that 60% of prescriptions were appropriate, 24.9% were prescribed without documentation, and 15.1% were used inappropriately. Conclusions: Proper prescribing of benzodiazepines is essential in the management of the symptoms of mental illness. From both a diagnostic and treatment perspective, more education efforts are needed in the investigation, documentation, and treatment of mental illness symptoms.
Impact of Federal Law on Dispensing Activities in Hospital Pharmacies
Authors: Williams Karl G 
Published: July 2017

Objective: To review federal laws that have an impact on dispensing in hospital pharmacies. Data Synthesis: Information has been extracted from the Robinson-Patman Act, the Prescription Drug Marketing Act, the Internal Revenue Code, and associated regulations, policies, and court cases. Hypothetical situations are used to illustrate the application of federal law to routine dispensing functions. Conclusions: Each of these legal areas has a significant impact on dispensing by hospital pharmacies. Understanding these can simplify practice in many ways.
Heparin Dosing Order Form Use in an Academic-Affiliated Veterans Affairs Medical Center
Authors: Hoffman Nannette B , Frohnapple David J 
Published: July 2017

Objective: Because a drug utilization evaluation (DUE) showed poor intravenous heparin prescribing practice in our medical center, we developed a preprinted intravenous heparin order form for use by physicians to improve heparin administration. Methods: Two DUEs were performed, one prior to use of a weight-based heparin dosing order form and another after the introduction of the form. Indicators that were evaluated included dosing, laboratory monitoring, and intramuscular injections. DUE results before and after introduction of the order form were statistically compared using Fisher's exact text. Results: The initial DUE showed that only 3% of patients who were administered intravenous heparin received appropriate dosing, and only 60% had a therapeutic activated partial thromboplastin time (aPTT) ratio within the first 24 hours. Blood samples for the aPTTs were drawn at incorrect × in 27% of patients, and 9% of patients received intramuscular injections of other drugs. After implementation of the preprinted intravenous heparin order form, 73% of the patients received appropriate heparin dosing (p < 0.00001), and 79% of the patients had a therapeutic aPTT ratio within the first 24 hours (p = 0.08). The aPTTs were drawn at incorrect × in 12% of patients, and 3% of patients received intramuscular injections (NS for both). All patients receiving appropriate heparin dosing achieved a therapeutic aPTT ratio within the first 24 hours, whereas only 29% of patients on the acute wards and 50% of those in the intensive care units achieved a therapeutic ratio when dosing was inappropriate (p < 0.0001). Conclusions: We improved the intravenous heparin prescribing practice in an academic-affiliated tertiary Veteran's Affairs Medical Center using a preprinted intravenous heparin order form for physician use. The form was also effective in achieving the desired aPTT ratio within 24 hours.
Multidisciplinary Approach to Improving Antibiotic Turnaround Time in a Medical Intensive Care Unit
Authors: Watling Sharon M , Harter Phyllis J , Lee Susan M , Yanos John 
Published: July 2017

Objective: To improve the timeliness of antibiotic therapy. Setting: A 13-bed university hospital medical intensive care unit. Interventions: Inservice presentations regarding the importance of antibiotic administration time, preprinted antibiotic orders, and a rearrangement of the order processing system were implemented. Results: Overall antibiotic turnaround time decreased from a median of 2.2 hours (March–May 1993) to 1.4 hours (March–May 1994) (p = 0.001). Conclusions: A multidisciplinary team working together developed a system to significantly improve antibiotic turnaround time.
Quality of Prescribing at Primary Care Centers in Saudi Arabia
Authors: Khoja Tawfik A , Al-Shammari Sulaiman Ai , Farag Mohammad Kamel , Al-Mazrou Yagob 
Published: July 2017

Objective: To assess serious prescribing errors, prescribing rate per patient, and ranking of common illnesses and medications prescribed at primary care centers in Saudi Arabia. A proposal for improvement measures will be formulated. Methodology: A cross-sectional study of a randomly selected afternoon shift (4 working h) was carried out on November 1, 1994. All of the 367 physicians working in the health centers in Riyadh, Saudi Arabia participated. All prescriptions issued by physicians during this shift were entered into the study and examined with regard to a number of variables. The variables included patient demographic characteristics, vital signs, the physician's name and center, diagnosis, and prescription items. Demographic variables were excluded from analysis for purposes of confidentiality. Results: During the study period, 11,326 patients were seen, and 6,350 prescriptions were issued (for 20,320 drug entries). The average number of consultations per primary health care (PHC) physician was 30 ± 9. The average number of prescriptions per PHC physician was 17.3 ± 6, for a total of 0.56 prescriptions per patient. Of all prescriptions, 11.6% were found to have at least one error. The average number of drugs per prescription was 3.2 ± 0.4. The average number of drugs per patient was 1.8 ± 0.3. Of all patients, 73% had two or fewer drug items prescribed. Upper respiratory tract infection was the most frequent diagnosis, and accounted for 31.0% of the illnesses seen. Antibiotics, analgesics/antipyretics, and tonics/vitamins were the most common items prescribed (to 16.8%, 15.4%, and 11.8% of the patients, respectively). The most common errors were those considered type B (5.39%), where the pharmacist must contact the physician before dispensing the prescription, and type C (4.59%), where the pharmacist must make a professional decision before dispensing the prescription. Missing drug strength and missing quantity of medication and frequency of dosing were observed in relatively high proportions (3.8% and 3.2%, respectively). Frequency of the daily dose, generic name of the drug, and strength of the drug were the top three missing pieces of information (89.5%, 86%, and 76.3%, respectively). Conclusions: These results represented a challenge and justified setting standards and indicators to ensure the quality of these vital activities of prescribing and dispensing. There is a need to design and implement training programs to improve PHC team prescribing and dispensing skills and establish an accurate system of error reporting.
Sugar Paste for Treatment of Decubital Ulcers
Authors: Valls Laura Tuneu , Altisen Magdalena Trullás , Poblador Ramón Plá , Alvarez Angels Ciurán , Biosca Rosa Garriga 
Published: July 2017

Objective: To review the use of sugar paste in the treatment of decubital ulcers. Data Sources: A MEDLINE, IDIS, and current journal search of English-language articles published between 1978 and 1993 on sugar paste in the treatment of ulcers. Study Selection: Case reports, cohort, epidemiologic, in vivo, and in vitro studies were evaluated. Data Extraction: Reports using granulated sugar or derivatives in the treatment of refractory cutaneous ulcers were evaluated. Data Synthesis: All the studies show that sugar paste treatment has satisfactorily resolved decubital ulcers, although a wide variability in treatment length has been seen. Considering the likely mechanisms of action for sugar paste, this wide variability may be a result of dressing frequency. In other words, for sugar paste to be most effective it has to be applied in such a way that a continuous optimal sugar concentration in the ulcer is maintained. To achieve this, dressing frequency should not be standardized, but individualized according to ulcer type, depth, and exudate, as well as patient healing capacity. Healing could probably have been achieved earlier if dressing had been individualized. Besides effectiveness and low cost, sugar paste is also safe, with few adverse events associated with its use. Conclusions: In spite of difficulties in evaluating the use of sugar paste in treatment of decubital ulcers, it has been shown to be an effective therapy for this disorder. However, we recommend that length of treatment be individualized for each patient.
Recognition of Medication Adverse Effects in Female Veteran and Nonveteran Psychiatric Patients
Authors: Nand Surinder S , Grossman Linda S , Bailey LaGenia , Pater Debra M , Mian Rubeena H 
Published: July 2017

Objective: To provide information about knowledge of adverse effects of psychotropic medications in a group of female veteran and nonveteran psychiatric outpatients. Design: Questionnaire. Setting: Westside Veterans Affairs (VA) Medical Center and the University of Illinois at Chicago (UIC). Patients: Thirty-five female psychiatric outpatients, 17 from the VA Medical Center and 18 from UIC. Main Outcome Measure: Number of adverse effects patients were able to recognize. Results: Veterans demonstrated significantly more knowledge of adverse effects than did nonveterans for antipsychotic, antidepressant, and anxiolytic medications. Conclusions: The data support the provision of extensive personalized psychoeducation consisting of structured group programs for didactic lessons, discussion, and question and answer, such as those provided by the VA Medical Center studied here. As funding for mental services decreases, clinicians should recognize the ongoing benefits that personalized interactive patient education can provide.
Can Response to Bedtime Insulin with Daytime Sulfonylurea Be Predicted in Patients with Type 2 Diabetes Mellitus?
Authors: Oki Julie C , Tal Alexander , Graves Leland , Isley William L 
Published: July 2017

Objective: To determine characteristics predictive of response in patients with Type 2 diabetes mellitus (Type 2 DM) who demonstrate good or poor blood glucose control while receiving bedtime insulin with daytime sulfonylurea (BIDS) therapy. Methods: A retrospective chart review of patients with Type 2 DM receiving BIDS therapy was performed. The criterion for responders was the mean of two consecutively obtained glycosylated hemoglobin (Hb) concentrations being less than or equal to 10.2% (HbA1c ≤7.0%). Setting: A university-affiliated diabetes specialty clinic staffed consistently by a pharmacist diabetes educator, four endocrinologists, and a pharmacotherapy specialist. Patients: Thirty-one patients with Type 2 DM who were predominantly African-American and women who had documented regular follow-up examinations for more than 12 months while receiving BIDS therapy. Data Collection and Measurements: Gender, ethnicity, height, weight, calculated body mass index, age of onset of diabetes mellitus, duration of diabetes mellitus before BIDS therapy, pre-BIDS treatment regimen, dosages of NPH insulin and glyburide, glycosylated Hb concentration, fasting blood glucose concentration, and duration of BIDS therapy were recorded. Results: There were no differences in age of onset of diabetes mellitus, duration of diabetes mellitus before BIDS was initiated, duration of therapy with BIDS, or baseline glycosylated Hb concentration between responders (n = 15) and nonresponders (n = 16). Patients in the responder group weighed less, had a lower body mass index, required smaller dosages of both glyburide and NPH insulin, and achieved a lower fasting blood glucose concentration. Conclusions: In this study population, with the exception of body mass index, there was no difference in suggested clinical characteristics of response between responders and nonresponders.
Antimicrobial Liquid Formulations: A Blind Comparison of Taste of 13 Commonly Prescribed Medications
Authors: Chan Debora Schotik , Demers Denise M , Bass James W 
Published: July 2017

Objective: To rate the perception of taste, texture, smell, and aftertaste of 13 commonly prescribed liquid medications, including four new drugs: Zithromax, Cedax, Ceftin, and Biaxin. Design: Each category was scored on a scale of 1 to 5 by 30 volunteers in a blinded study. The order in which the drugs were sampled was randomized for 15 of the participants. The order was reversed for the remaining 15 participants. The drugs used in the study were Amoxil (amoxicillin), Biaxin (clarithromycin), Ceclor (cefaclor), Cedax (Ceftibuten), Ceftin (cefuroxime), Cefzil (cefprozil), Dynapen (dicloxacillin), Keflex (cephalexin), Suprax (Cefixime), Trimox (amoxicillin), Vantin (Cefpodoxime), VeeTids (penicillin VK), and Zithromax (azithromycin). Setting: A 537-bed US Army teaching hospital. Participants: Participants included 30 healthy adult volunteers from the Departments of Pediatrics, Nursing, and Pharmacy. Main Outcome Measures: Drugs received cumulative scores in each category as well as an overall total score ranking. The data were analyzed by using one-way ANOVA for repeated measures with a post hoc Duncan's multiple-range test to determine significant differences between individual means. The level of significance was set at a p value of 0.05 or less. Results: Overall, Trimox was better than all other drugs tested except Suprax; Dynapen was inferior to all except Biaxin and VeeTids. Zithromax scored higher than Biaxin in the texture, taste, and overall categories. Biaxin scored lower than all other drugs tested in the texture category. Ceftin was better than Cedax in the smell category, but Cedax was superior to Ceftin in the texture, taste, aftertaste, and overall categories. Conclusions: All of the new drugs tested were significantly different from each other (Cedax > Zithromax > Ceftin > Biaxin).