bluuebunny/crossref_metadata_2025_split huggingface dataset:
On Factors Complicating Rehabilitation of Psychiatric Patients
Authors: Sakki Pekka , Sorri Pentti , Virkkunen Matti 
Published: July 2017

Judging by previous studies, the factors most seriously complicating the rehabilitation of psychiatric patients include the underdeveloped state of society, the symptoms and detrimental consequences of the patients' disorders, the harmful consequences of prolonged institutionalization and the problems associated with home and family. The sample of this study consisted of 104 patients who were under treatment at the University Psychiatric Clinic, Helsinki, on November 30, 1971. No old people or children were included. The subjects' educational and intellectual levels were above average, and the proportion of patients with grave disorders in the sample was smaller than in psychiatric hospitals in general. The sample included no addicts. The attending doctor filled out, for each subject, a questionnaire, on which information was provided about the subject's psychosocial background, recommendations made for his treatment and rehabilitation, and the most serious obstacles to his rehabilitation were assessed. A number of “recommendation” and “obstacle” alternatives were listed in the form, from which 4 and 5 respectively of the most important were chosen. The patients' psychic disorders, problems associated with their families and homes, unrealistic hopes and expectations, and lack of motivation proved the most serious obstacles to rehabilitation. Typical of all these is their somewhat individual-centred nature. They were apparently linked with the reasons why the patients had come to hospital for treatment and with the rehabilitational goals the respondents had had in mind. Obstacles that can be characterized as social were of little significance, housing problems being the only exception here. The authors feel that caution should be observed in drawing generalized conclusions from these results, because the results of studies on rehabilitation are in general closely tied up with the population or sample studied as well as the environment and society.
Pharmacy Technician Educators' Attitudes toward Education and Training Requirements for Pharmacy Technicians
Authors: Moscou Kathy D 
Published: July 2017

Objective: To poll members of the Pharmacy Technician Educators Council (PTEC) to determine their attitudes toward the level of education and training necessary for pharmacy technicians to perform current and expanded duties. Methods: A convenience survey was developed and sent to 130 PTEC member training programs. PTEC members include directors of college, vocational, and on-the-job training programs. Results: Thirty-seven PTEC members responded, yielding a response rate of 28.5%. Responses reflected the opinions of directors of pharmacy technician programs from 19 states. All respondents agreed that the length of training for pharmacy technicians should be standardized. They also agreed that minimum competencies should be established for pharmacy technicians and that examination should be required to obtain certification or licensure that would then enable the technician to be employed in the field. Conclusions: The use of pharmacy technicians will likely increase, as will the duties pharmacy technicians perform. Expansion of the role of pharmacy technicians, however, must be in tandem with standardizing training and establishment of competencies for pharmacy technicians. Increased responsibilities should be commensurate with increased education and national examination should be required to determine competency.
Sustained Manic Delirium
Authors: Schwartz Thomas L , Dewan Mantosh J , Armenta Wendy A 
Published: July 2017

Objective: To report a case of bipolar I disorder with psychotic features that resembled a sustained episode of delirium. Case Summary: A 54-year-old white woman with bipolar I disorder developed severe, sustained psychosis resembling delirium. These symptoms resolved following several pharmacologic interventions. Discussion: Manic delirium is an extreme manifestation of bipolar disorder. The primary symptoms of manic delirium are confusion, agitation, altered levels of consciousness, and perceptual disturbances. Our patient developed typical symptoms of manic delirium; however, this case differed in terms of increased duration of symptoms and decreased treatment efficacy. Conclusions: Bipolar disorder with psychotic features may present as a delirious episode. Combination therapy may be an appropriate intervention when pharmacologic monotherapy fails.
Inhaled Corticosteroids in Young Asthmatic Children: Association with Hypercalciuria
Authors: Bentur Lea , Bibi Haim , Bentur Yedidia 
Published: July 2017

Introduction: The use of inhaled corticosteroids (ICS) via infant aerochamber in young, asthmatic children is increasing. However, concern has been raised about its long-term impact. Hypercalciuria is a known adverse effect of systemic corticosteroids. Objective: To determine whether ICS-induced hypercalciuria occurs in young, asthmatic children. Setting: Two outpatient clinics. Methods: Urinary calcium/creatinine ratio (UCa/Cr) was determined in 32 asthmatic children (age 6–36 mo) who were receiving inhaled budesonide or beclomethasone 200–600 μg/d for two to three months. A control group of asthmatic children within the same age range (n = 23) who did not receive ICS was included. None of the children were receiving oral corticosteroids, diuretics, antibiotics, or theophylline. Statistics: Student's t-test and χ2 analysis. Results: The treated and control groups were similar with regard to age and male/female ratio. Mean ± SD UCa/Cr was significantly higher in the asthmatic children receiving ICS (0.23 ± 0.19 vs. 0.09 ± 0.07, respectively; p = 0.002). Fourteen (43.75%) of the treated patients had hypercalciuria (UCa/Cr >0.2) compared with only one (4.35%) in the control group (p = 0.002). Renal ultrasonography failed to demonstrate nephrocalcinosis in eight of the treated hypercalciuric patients. Conclusions: Treatment of young, asthmatic children with ICS may be associated with hypercalciuria. More studies are needed to evaluate the clinical significance of this finding.
Methemoglobinemia: A Recurring Complication of Topical Benzocaine Spray
Authors: Shaw Robert F , Mathew Anitha 
Published: July 2017

Objective: To report a case of acute methemoglobinemia in a patient undergoing a transesophageal echocardiogram (TEE) after administration of topical benzocaine spray. Case Summary: An 80-year-old white man with a history of coronary heart disease developed severe cyanosis one hour after a TTE. The patient was taken to the intensive care unit where he was diagnosed with acute methemoglobinemia. The patient was treated with methylene blue and successfully resuscitated. He recovered and was transferred out of the intensive care unit. Discussion: Acute methemoglobinemia is a problem that is infrequently encountered in clinical practice and, unless the practitioner is alert to the possible diagnosis, methemoglobinemia is capable of producing a potentially fatal outcome. The rise in bronchoscopies, endoscopies, and TEEs has resulted in an accompanying increase in reporting of acquired methemoglobinemia from benzocaine spray as well as other local anesthetics and medications. The drug of choice for treatment of methemoglobinemia is methylene blue administered at 1–2 mg/kg. Conclusions: Quick recognition, diagnosis, and prompt treatment with methylene blue are keys to a successful outcome.
Demystifying the Cardiopulmonary Code Team Response
Authors: Bardas Sandra L. 
Published: July 2017

Objective: To familiarize the reader with the sequence of events in a hospital-based cardiopulmonary resuscitation. Data Sources: The American Heart Association's Textbook of Advanced Cardiac Life Support and the Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. Data Extraction: The roles and responsibilities of members of the cardiopulmonary code team are discussed. Data Synthesis: A typical code sequence is described, with emphasis on drug therapy. Conclusions: This information will provide a better understanding of the cardiopulmonary resuscitation team response and, in particular, the role of the pharmacist as an integral team member.
A Primer of Drug Safety Surveillance: An Industry Perspective
Authors: Allan Marjorie C. 
Published: July 2017

Objective: To place the fundamentals of clinical drug safety surveillance in a conceptual framework that will facilitate understanding and application of adverse drug event data to protect the health of the public and support a market for pharmaceutical manufacturers' products. Part I of this series provides a background for the discussion of drug safety by defining the basic terms and showing the flow of safety information through a pharmaceutical company. The customers for adverse drug event data are identified to provide a basis for providing quality service. The development of a drug product is briefly reviewed to show the evolution of safety data. Drug development and safety are defined by federal regulations. These regulations are developed by the FDA with information from pharmaceutical manufacturers. The intent of the regulations and the accompanying guidelines is described. An illustration from the news media is cited to show an alternative, positive approach to handling an adverse event report. Data Sources: This review uses primary sources from the federal laws (regulations), commentaries, and summaries. Very complex topics are briefly summarized in the text and additional readings are presented in an appendix. Secondary sources, ranging from newspaper articles to judicial summaries, illustrate the interpretation of adverse drug events and opportunities for drug safety surveillance intervention. Study Selection: The reference materials used were articles theoretically or practically applicable in the day-to-day practice of drug safety surveillance. Data Synthesis: The role of clinical drug safety surveillance in product monitoring and drug development is described. The process of drug safety surveillance is defined by the Food and Drug Administration regulations, product labeling, product knowledge, and database management. Database management is subdivided into the functions of receipt, retention, retrieval, and review of adverse event reports. Emphasis is placed on the dynamic interaction of the components of the process. Suggestions are offered to facilitate communication of a review of adverse event data for various audiences. Conclusions: Careful drug safety surveillance is beneficial to the health of the public and the commercial well-being of the manufacturer. Attention to basic principles is essential and, as illustrated, may be sufficient to resolve some problems.
Variability in Drug Administration Times among Patients with Coronary Artery Disease
Authors: Bleske Barry E. , Cornish Laura A. , Boyd Eddie L. , Shimp Leslie A. , Shea Michael J. 
Published: July 2017

Objective: Previous studies have shown that cardiac disease is influenced by circadian rhythms, resulting in a high incidence of cardiac events occurring in the morning hours. Before determining if adjusting drug administration times will influence the effect of these circadian rhythms, it is necessary to know when patients take their medication. Therefore, the objective of this study was to determine when patients take their anti-ischemic medication in relationship to their sleep/wake cycle. Design: Patients with a history of coronary artery disease were identified by screening consecutive medical charts from a cardiology outpatient clinic at a university teaching hospital. Data were collected by telephone interview with a survey instrument. Participants: A total of 57 patients were included in the study (41 men, mean age 61.8 ± 10 years; and 16 women, mean age 62.8 ± 10.4 years). Outcome Measures: The survey addressed the relationship between sleep/wake cycle and medication administration times, along with activities performed prior to taking morning medication. Results: Approximately 46 percent of the patients took their anti-ischemic medication upon awakening and 28 percent of the patients took their anti-ischemic medication more than 30 minutes after awakening. Of the 31 patients requiring evening dosing of their anti-ischemic medication, 45 percent took their medication at bedtime and 39 percent of the patients took their medication more than three hours before bedtime. Major activities patients undertook prior to taking their morning medications included urination/defecation, eating breakfast, and getting dressed. Conclusions: This study showed that there is variability in the time of drug administration among cardiac patients, which may be important regarding circadian variation and cardiac disease. Additional counseling by pharmacists in regard to drug administration times and circadian rhythms may be warranted following further studies.
Apparent Hemolysis in an AIDS Patient Receiving Trimethoprim/Sulfamethoxazole: Case Report and Literature Review
Authors: Reinke C Michael , Thomas Jennifer K , Graves Allen H 
Published: July 2017

Objective: To describe a case of acute hemolysis associated temporally with administration of trimethoprim/ sulfamethoxazole (TMP/SMX) in a patient with AIDS, review the available literature on TMP/SMX-induced hemolytic anemia, and discuss possible drug- and disease-related factors that may have contributed to the episode of hemolysis. Case Summary: A precipitous decrease in red blood cell count, hemoglobin, and hematocrit occurred shortly after a black woman with AIDS received a single intravenous dose of TMP/SMX for Pneumocystis carinii pneumonia. Following drug discontinuation and repeated transfusions, the patient's hematologic indices returned to baseline. Literature Sources: References were obtained using MEDLINE searches, the bibliographies of articles identified during the searches, review articles, and standard textbooks. Data Synthesis: Of the two different mechanisms of TMP/SMX-induced hemolytic anemia, the reaction is most likely to occur via dose-related oxidative disruption of the erythrocyte membrane in subpopulations deficient in glucose-6-phosphate dehydrogenase (G6PD) activity. In the US, G6PD deficiency most frequently is encountered among blacks. The potential for hemolysis may be further increased in G6PD-deficient AIDS patients, who also appear to lack adequate intracellular glutathione, which is essential for protecting the erythrocyte membrane from oxidative damage. Although an assay for G6PD activity was not conducted, the case circumstances were consistent with TMP/SMX-induced hemolysis in a G6PD-deficient patient. Conclusions: Black patients with AIDS who are receiving relatively high (≥50 mg/kg/d) dosages of TMP/SMX should be monitored closely for signs and symptoms of hemolytic anemia.
Effect of Low-Dose Fluconazole on Theophylline Serum Concentrations in Healthy Volunteers
Authors: Feil Rebecca A , Rindone Joseph P , Morrill Gregory B , Habib Michael P 
Published: July 2017

Objective: To determine whether fluconazole alters theophylline serum concentrations at steady-state in healthy volunteers. Design: Ten healthy subjects were administered controlled-release theophylline 150 mg bid for 10 days. Theophylline serum concentrations were measured at steady-state on day 4 to establish a baseline concentration. Fluconazole 100 mg/d was then administered beginning on day 4 through day 10. Theophylline serum concentrations also were measured on days 7, 9, and 11 of the study. Mean theophylline serum concentrations were compared before and during fluconazole administration. Statistical analysis was performed using repeated measures ANOVA. Setting: This study was undertaken in the outpatient department at the Tucson Veterans Affairs Medical Center. Results: No statistically significant differences in mean theophylline serum concentrations were noted on days 7, 9, and 11 compared with baseline. Conclusions: These data show that fluconazole 100 mg/d had no significant effect on theophylline serum concentrations in healthy volunteers.
Phenytoin Prophylaxis in Posttraumatic Head Injury
Authors: Ohimor Stephen O , Falcone Robert E 
Published: July 2017

Objective: To identify the effectiveness of prophylactic phenytoin in preventing posttraumatic epilepsy. Design: Retrospective cohort study. Setting: Urban tertiary-care hospital and trauma center. Subjects: Patients admitted to the trauma service in 1989 with moderate to severe head injury surviving to discharge. Interventions: Divided into two groups based on prophylaxis with phenytoin. Measurements and Main Results: Ninety-one patients with moderate to severe head injury were admitted during the study period; 6 were excluded from analysis for prehospital seizure activity. Forty-one patients received no anticonvulsants; 44 received phenytoin alone or in combination with other agents. None of the patients experienced a seizure during hospitalization. Seventy-four percent of all phenytoin concentrations were subtherapeutic (serum phenytoin 10–20 μg/mL). Conclusions: The lack of seizure activity in the face of absent or subtherapeutic phenytoin concentrations brings into question the benefit of prophylactic therapy.
Vitamin K1-Induced Anaphylactic Shock
Authors: Aziz Noorizan Abdul , Kamaruddin Zaitun , Hassan Yahaya , Jaalam Kamarudin 
Published: July 2017

Objective: To report a case of anaphylactic shock induced by the rapid intravenous administration of vitamin K1 in a patient in the intensive care unit (ICU). Case Summary: A 9-year-old Malay girl was admitted to the ICU and was diagnosed with Guillain-Barré syndrome. She developed an allergy to atropine that was manifested by a symmetric generalized transient macular rash over the trunk; it subsided 10 minutes after the drug was stopped. About 7 hours later, vitamin K1 10 mg iv was administered over 3 minutes due to the slight prolongation of prothrombin time and activated partial thromboplastin time. Immediately after the drug was administered, the patient developed a generalized transient macular rash, cyanosis, and shock. Her blood pressure and heart rate could not be detected. She responded well, however, after resuscitation. Discussion: Anaphylactic shock in this patient was most probably caused by the intravenous administration of vitamin K1, because this event occurred immediately after its administration. There have also been a few reported cases of severe reaction and death associated with intravenous administration of vitamin K1. The likelihood that the incident was drug-related could be classified as “probable” based on Naranjo's causal relationship algorithm. Conclusions: Rapid intravenous administration of vitamin K1 may induce anaphylactic shock in a critically ill patient with hemodynamic instability. If vitamin K1 is required, oral administration is preferred because it is rarely associated with severe reactions. Intravenous administration of vitamin K1 should be considered only in an emergency situation and the rate of administration should not exceed 1 mg/min.
Copper Deficieny in a Patient with AIDS Cholangiopathy and Cryptosporidium Diarrhea
Authors: Odell Timothy W , Cerveny Joli D 
Published: July 2017

Objective: To report a case of leukopenia caused by copper deficiency in a patient with AIDS cholangiopathy and Cryptosporidium diarrhea who required total parenteral nutrition (TPN). Case Summary: A 36-year-old white man with AIDS had Cryptosporidium diarrhea, and produced a daily stool volume of 3–5 L. He also had AIDS cholangiopathy, with intra- and extrahepatic biliary dilation and an alkaline phosphatase concentration of 3,000 U/L. He required TPN. Since copper is excreted primarily through the bile, it was omitted from his TPN. The patient then developed progressive leukopenia. His plasma copper concentration dropped to 10.2 μg/dL. Copper was subsequently added to the TPN, and the white blood cell count returned to normal. Discussion: A review of the literature showed that neither HIV infection nor AIDS is associated with copper deficiency. Copper deficiency has been reported as a rare complication of TPN or malabsorption, but it was not expected as a result of AIDS cholangiopathy. Conclusions: Copper supplementation is required in TPN in patients with chronic diarrhea and AIDS cholangiopathy. Additionally, copper deficiency is a potential cause of leukopenia in patients with AIDS who are receiving TPN or who have chronic diarrhea.
Risperidone for Treatment-Resistant Schizophrenia: Initial Clinical Experience in a State Hospital
Authors: Buckley Peter F , Donenwirth Karl , Bayer Kenneth E , Lys Christine , Ibrahim Zafar , Schulz S Charles 
Published: July 2017

Objective: To examine the efficacy of risperidone, a new antipsychotic with combined serotonergic-dopaminergic antagonism, in patients with treatment-resistant schizophrenia in state facilities. Methods: Brief Psychiatric Rating Scale (BPRS) evaluations were performed on 21 patients with schizophrenia who had received risperidone therapy for 10 weeks in a state facility. Results: Five patients showed a 20% reduction on their pretreatment BPRS score. A corresponding number of patients showed an increased BPRS score during treatment, and the remainder attained a modest reduction (2–17%) in symptoms on the BPRS. Conclusions: Although risperidone was an effective antipsychotic for patients with chronic treatment-resistant schizophrenia, only a subgroup of these patients achieved substantial clinical improvement over a 10-week period.
Suggested Transition from Oral to Intravenous Amiodarone Therapy
Authors: Korth-Bradley Joan M 
Published: July 2017

Objective: To provide clinicians with a basis from which to decide the appropriate intravenous dosage of amiodarone in patients who are currently taking oral amiodarone. Data Sources: English-language articles describing the pharmacokinetics of amiodarone were collected through literature searches of the Index Medicus database over a period of approximately 4 years. Reference lists from the publications were reviewed to search further for original articles. Study Selection: Data were rejected only if there was reason to doubt the validity of the pharmacokinetic parameters reported. For example, dose administration, sample collection times, and pharmacokinetic analysis procedures had to be clearly stated. Data Extraction: Data describing the pharmacokinetics, particularly the half-life, of amiodarone after discontinuation of long-term oral treatment were extracted from the articles. Data Synthesis: No formal methods were used to combine the data. Conclusions: Based on pharmacokinetic considerations, no intravenous replacement treatment is necessary in patients for whom oral administration is contraindicated for less than 2 weeks and who have received adequate loading doses of amiodarone. Intravenous amiodarone may be administered at half the dosage of oral amiodarone, assuming a bioavailability of 50%, to patients for whom oral administration is contraindicated for an undetermined time or in whom a steady-state concentration is unlikely to have been reached.