bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality Assessment of Pharmacoeconomic Abstracts of Original Research Articles in Selected Journals
Authors: Trakas Kostas , Addis Antonio , Kruk Dorothy , Buczek Yvona , Iskedjian Michael , Einarson Thomas R 
Published: May 2017

Objective To assess and compare the quality of pharmacoeconomic abstracts of cost-minimization analyses, cost–effectiveness analyses, cost–utility analyses, and cost-benefit analyses of original research articles in selected medical, pharmacy, and health economics journals. Methods MEDLINE was used to identify articles in selected medical, pharmacy, and health economics journals using the MeSH word “economic” and text words “cost” and “pharmacoeconomic”; the journal PharmacoEconomics was searched manually. All retrieved abstracts were evaluated. Original, comparative (at least one drug comparator) research articles (1990–1994) reporting both costs and clinical outcomes were included in the quality analysis. Abstract quality was assessed as a percentage by using a checklist with 29 objective criteria. Group consensus produced interrater reliability greater than 0.8. Results One thousand two published abstracts labeled with the above key words were identified. Of these, 951 were excluded from quality assessment because they were not original research (18%), were not pharmacoeconomic research (47%), lacked a drug comparator (35%), or did not report a clinical outcome (0.5%). Thus, the quality of 51 (5% of the total) remaining abstracts was assessed. Overall scores were 56% in 1990 and 58% in 1994 (p = 0.094). Medical articles scored highest (61.5%; n = 25), pharmacy articles were next (54.3%; n = 5), and health economics articles were lowest (53.4%; n = 21) (p = 0.091); structured abstracts scored significantly higher (62.5%; n = 20) than unstructured (53.3%; n = 31) (p = 0.003). Conclusions Abstract quality was generally poor, with no significant change in quality over time. Medical journals scored highest, probably because they use structured abstracts. Guidelines for structured pharmacoeconomic abstracts may assist in improving quality.
Acute Respiratory Distress Syndrome after Aprotinin Infusion
Authors: Vucicevic Zeljko , Suskovic Tomislav 
Published: May 2017

Objective To report a case of acute respiratory distress syndrome (ARDS) following first exposure to aprotinin. Case Summary A 24-year-old previously healthy white man was treated with aprotinin infusion because of bleeding following tonsillectomy. The patient had never been treated with aprotinin before, including local application of different hemostatics containing the aprotinin component. Two hours later, hypotension and severe ARDS developed. A full recovery was noted after discontinuation of the drug and prolonged ventilatory support. Discussion To our knowledge, this is the first reported case of ARDS following first administration of aprotinin, although serious adverse effects at first exposure have been reported. We propose two possible mechanisms for this adverse reaction: a nonallergic or anaphylactoid reaction with direct degranulation of mast cells and basophils by aprotinin, and microthrombosis of the small pulmonary arterioles precipitated by aprotinin. Conclusions Most clinicians consider aprotinin to be a safe drug, especially if it has not been administered before. Reexposure carries a high risk of allergic reactions because of possible sensitization. Nonimmunologic, toxic, or idiosyncratic adverse reactions can be expected at first exposure to any drug, as well as to aprotinin.
Pharmacotherapy of HIV Dementia
Authors: Melton Sarah T , Kirkwood Cynthia K , Ghaemi S Nassir 
Published: May 2017

Objective To review the clinical presentation and management of cognitive impairment associated with central nervous system HIV type 1 (HIV-1) infection. Data Sources A MEDLINE search pertaining to HIV-related dementia (HIV-D) and pharmacologic management was performed. Additional literature was obtained from reference lists of the identified articles. Study Selection and Data Extraction All clinical trials and case reports evaluating pharmacologic efficacy in terms of clinical response, cerebrospinal fluid (CSF) changes, and neuropathology were considered for inclusion. Selection was not restricted by study design because most information consists of open uncontrolled trials and case reports. Data Synthesis HIV-D is characterized by a triad of disturbances in cognition, motor performance, and behavior in adults. Children present with developmental delay, cognitive impairment, poor brain growth, and other neurologic symptoms. The exact pathophysiologic mechanisms of HIV-D are not known. Numerous pharmacologic agents (e.g., nucleoside reverse transcriptase inhibitors, pentoxifylline, nitroglycerin, memantine, nimodipine, peptide T) are under investigation for management of HIV-D. Zidovudine is the most thoroughly investigated medication, with patients developing HIV-D less frequently and showing improvement on neuropsychological, CSF, and neuropathologic evaluations. Sustained response to zidovudine lasts 6 months to 1 year and optimal response is achieved at higher, but less tolerated, dosages. HIV-D patients frequently have comorbid psychiatric disorders requiring psychopharmacologic agents and are sensitive to the adverse effects of these medications. Conclusions HIV-D is a devastating complication of HIV-1 infection. Zidovudine is the therapy of choice for prevention and management of cognitive impairment in symptomatic HIV-infected patients and patients with AIDS. Recommendations for other medications cannot be made secondary to lack of data. The management of HIV-D may include multiple agents as more data become available regarding combination therapy. Well-designed controlled trials are needed to evaluate the efficacy of established treatments and investigational medications in the management of HIV-D.
Metformin and Insulin: Is There a Role for Combination Therapy?
Authors: Daniel Jacqueline R , Hagmeyer Kathleen O 
Published: May 2017

Objective To review the literature on concomitant insulin and metformin therapy in patients with type 1 diabetes to determine the potential for combination therapy. Data Sources A MEDLINE and bibliographic search (1966–1996) of the literature pertaining to metformin and phenformin and their combined use with insulin in the treatment of patients with type 1 diabetes mellitus was performed. Study Selection All human studies using metformin with insulin were included in the analysis. Studies using phenformin with insulin were also included due to its similarities to metformin. Data Synthesis The recent availability of metformin provides some new options for treating diabetes mellitus. One possibility is the use of this medication in conjunction with insulin in patients with type 1 diabetes. Although this seems like a potentially beneficial combination, there is currently no recommendation for use in this manner. Experience with combination metformin and insulin therapy has consistently demonstrated a reduction in insulin requirements. Studies have not been of necessary size or duration to definitively prove the benefits of this insulin dose reduction or any other benefits of combination therapy. Conclusions When metformin is added to insulin therapy, insulin requirements are likely to decrease. Although one would anticipate benefits from reduction in circulating insulin concentrations, the studies do not provide data to determine if benefits of combination therapy outweigh risks. Further studies of larger size and longer duration are needed before the use of metformin with insulin can be routinely recommended in patients with type 1 diabetes.
Cost-Minimization Analysis of Intravenous Adenosine and Dipyridamole in Thallous Chloride ti 201 Spect Myocardial Perfusion Imaging
Authors: Hilleman Daniel E , Lucas B Daniel , Mohiuddin Syed M , Holmberg M Jeffrey 
Published: May 2017

ObjectiveTo conduct a cost-minimization analysis of intravenous adenosine and intravenous dipyridamole in thallous chloride TI 201 single-photon emission computed tomography (SPECT) myocardial perfusion imaging.DesignA retrospective, open-label, cost-minimization analysis.SettingUniversity hospital, outpatient nuclear medicine department.PatientsEighty-three patients undergoing dipyridamole TI 201 SPECT and 166 patients undergoing adenosine TI 201 SPECT.Main outcome MeasuresA cost-minimization analysis was conducted using a direct cost accounting approach estimating institutional costs. For the purpose of this study, sensitivity and specificity between adenosine SPECT and dipyridamole SPECT were assumed to be identical. Key costs evaluated included acquisition, administration, monitoring, treatment of adverse effects, follow-up care, and repeat tests.ResultsAdenosine increased heart rate and lowered blood pressure to a significantly greater extent than dipyridamole. The frequency of adverse reactions was not significantly different (p = 0.103) between adenosine (1.64 ± 1.32 per patient) and dipyridamole (1.36 ± 1.23 per patient). The frequency of prolonged and late-onset adverse effects was significantly greater for dipyridamole than for adenosine (p < 0.001). The frequency of adverse events requiring medical intervention was statistically greater for dipyridamole (24%) compared with adenosine (5%) (p < 0.00001). Total cost was significantly less for adenosine ($378.50 ± $128.20 per patient) compared with dipyridamole ($485.60 ± $230.40). Although adenosine had a significantly greater acquisition cost than dipyridamole (p < 0.0001), administration, monitoring, and adverse reaction costs were significantly less for adenosine than for dipyridamole.ConclusionsThe cost of using dipyridamole is significantly greater than the cost of using adenosine despite adenosine's high acquisition cost. Adenosine is less expensive to use because of lower administration costs, monitoring costs, and adverse effect costs. Adenosine should be the agent of choice for pharmacologic vasodilation in the setting of myocardial perfusion imaging.
Low Pharmacist Counseling Rates in the Kansas City, Missouri, Metropolitan Area
Authors: Fritsch Michelle A , Lamp Kenneth C 
Published: May 2017

Objective To quantify the percentage of patients counseled by community-based pharmacists. Methods Phase I consisted of a 15-minute observational period of pharmacist counseling in 50 randomly selected pharmacies in the Kansas City, MO, area. In phase II, a survey was mailed to the same pharmacies to obtain policies, self-reported rates of counseling, baseline workload, and personnel information, as well as perceived communication barriers. Results Forty-six of 50 pharmacies were observed in phase I after excluding 10 ineligible pharmacies and adding 6 replacement pharmacies. Pharmacists provided counseling in only 14 of the 46 pharmacies (30%). Nineteen percent (20/106) of all patients received pharmacist-initiated counseling. Pharmacists in independent pharmacies were observed counseling a significantly higher percentage of patients than were pharmacists in chain pharmacies (44% vs. 11%; p = 0.014). Technicians were observed counseling 5 patients in chain pharmacies. Detailed verbal counseling, defined as four or more of a group of major counseling components, was provided to only 8 of the 20 patients who were counseled by a pharmacist (40%; 8% of all patients). In phase II, 31 of 51 surveys (61%) were returned. During the requested survey time period, pharmacies estimated that approximately five prescriptions were filled every 15 minutes, 51.5% of which were new. Pharmacists in chain pharmacies reported dispensing greater numbers of prescriptions than did pharmacists in independent pharmacies. These data and the reported counseling rates indicated that 50% of all patient prescriptions should be counseled. This is a higher rate than actually observed. All pharmacies reported that pharmacists completed the counseling; however, 10% of the respondents reported that technicians also counseled patients. Contrary to the findings in phase I, slightly more than 50% of the pharmacists reported using detailed verbal counseling. Conclusions The overall observed rate of counseling in community pharmacies is low. In the Kansas City area, independent pharmacists counsel a greater than average percentage of their patients. Even if the national counseling rate is double what was observed, millions of patients are leaving pharmacies without the benefit of pharmacotherapeutic guidance. If pharmacists are slow to meet these challenges, other service providers will relieve pharmacists of that responsibility.
Ceftibuten: A New Expanded-Spectrum Oral Cephalosporin
Authors: Guay David RP 
Published: May 2017

Objective To review the antimicrobial activity, pharmacokinetics, clinical efficacy, and tolerability of ceftibuten, a new expanded-spectrum oral cephalosporin. Data Sources Literature was identified by a MEDLINE search (January 1983–June 1996) of the medical literature, review of English-language literature and bibliographies of these articles, and data on file. Study Selection Clinical efficacy data were selected from all published and unpublished trials and abstracts that mentioned ceftibuten. Additional information concerning in vitro susceptibility, safety, chemistry, and pharmacokinetic profile of ceftibuten also was reviewed. Data Synthesis Ceftibuten, an oral expanded-spectrum cephalosporin, has a broad spectrum of activity against many gram-negative and selected gram-positive organisms, including Streptococcus pneumoniae, Streptococcus pyogenes, Moraxella catarrhalis, and Haemophilus influenzae. Ceftibuten is stable to hydrolysis by many common p-lactamases. Ceftibuten is rapidly and almost completely absorbed from the gastrointestinal tract and is primarily eliminated renally as unchanged drug. The elimination half-life of ceftibuten is slightly longer than 2 hours. Efficacy has been demonstrated in a number of clinical trials in adults and children with upper and lower respiratory tract infections (e.g., acute otitis media, pharyngitis, sinusitis, bronchitis) and urinary tract infections. The adverse effect profile is equal to that of comparator agents. Conclusions Ceftibuten is an alternative to other antimicrobial agents with convenient once-daily dosing in the treatment of upper and lower respiratory tract infections. Similar to other oral expanded-spectrum cephalosporins, ceftibuten has antimicrobial activity against common pathogens of the respiratory tract and is stable in the presence of many β-lactamases. The clinical choice of an oral expanded-spectrum cephalosporin will be based on patient acceptance, frequency of administration, and cost.
Necrotizing Soft Tissue Infections Reported with Nonsteroidal Antiinflammatory Drugs
Authors: Kahn Laura H , Styrt Barbara A 
Published: May 2017

background: Recent reports of necrotizing fasciitis in children with varicella who received a nonsteroidal antiinflammatory drug (NSAID) recall earlier concerns regarding the possibility of relationships between infections and NSAIDs. We searched the Food and Drug Administration's Spontaneous Reporting System (SRS) for necrotizing soft tissue infections reported in conjunction with the use of NSAIDs, to identify common features. methods: A computer search of NSAID listings in the adverse event database recovered reports with codes for selected infection and necrosis-related diagnostic categories. From review of individual reports classified under these codes, cases were selected if the terms “necrotizing fasciitis,” “necrotic,” or “gangrenous” appeared in the adverse drug reaction description. Demographic, drug use, and disease course information were gathered. findings: Thirty-three cases were identified, of which 10 were fatal. Over two-thirds of the patients were younger than 40 years. Thirty (91%) had a possible portal of entry for infection. Most received NSAIDs for acute conditions including varicella, trauma, and postoperative or postpartum pain; 7 received an NSAID by intramuscular injection. Specific NSAIDs accounting for most reports were also among those likely to be most heavily used in the relevant populations. interpretation: Common features of these rare case reports of necrotizing soft tissue infections with NSAID use include characteristics such as age, portal of infection entry, indication for NSAID use, route of administration, and individual NSAIDs. The total number of SRS cases does not suggest that necrotizing infection is frequent with NSAIDs or likely without other risk factors. Controlled observational studies would help to define any causal contribution of these factors to the evolution of severe infection.
Acute Pain Management: Operative or Medical Procedures and Trauma
Authors: Follin Sheryl L , Charland Scott L 
Published: May 2017

ObjectiveTo review the topics presented in the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline for Acute Pain Management and provide updated information on therapeutic issues as necessary.Data SourcesAHCPR Clinical Practice Guideline for Acute Pain Management: Operative or Medical Procedures and Trauma. A MEDLINE search (1990 to June 1996) of English-language literature pertaining to pain assessment and management was performed. Reference lists from relevant articles also served as a literature source.Study Selection and Data ExtractionAll articles identified from the data sources were evaluated. Relevant information, as determined by the authors, was included in the review.Data SynthesisInadequate acute pain management continues to be recognized as a problem due to limited health professional education on the treatment of pain, inadequate patient empowerment, negative connotations associated with opioid analgesics (e.g., fear of “addiction”), federal regulations associated with prescribing opioid analgesics, and difficulty in assessing pain. The widespread inadequacy in pain management prompted the development of the AHCPR Clinical Practice Guideline for Acute Pain Management, which was published in 1992. In addition to reviewing the pain guideline, this article includes updated information on ketorolac tromethamine, tramadol, local anesthetics, sedation, regional anesthetic techniques, and the management of opioid adverse effects.ConclusionsThe AHCPR Clinical Practice Guideline for Acute Pain Management is a comprehensive, yet functional, review for clinicians. Most issues relating to acute pain assessment and management are adequately discussed. Overall, this guideline is a worthwhile general resource to clinicians. It is important, however, for clinicians managing acute pain issues to supplement this guideline with more detailed and current information.
Interdisciplinary implementation of tacrolimus intravenous standard concentration in hematopoietic stem cell transplantation recipients
Authors: Shank Brandon R , Deaver Melissa , Baker Angela , Myers Alan L , Zhang Yan-Ping , Anderegg Brent , Bassett Roland , Westmoreland Michael 
Published: May 2017

Purpose Reduction in waste of intravenous (IV) tacrolimus, an immunosuppressant used to prevent graft-versus-host disease in allogeneic hematopoietic stem cell transplantation recipients, was evaluated after standardizing the concentration. Methods A single-center, retrospective cohort study at a large academic comprehensive cancer center was performed comparing patient-specific intravenous tacrolimus doses (tacrolimus doses in 50, 100, or 250 mL of normal saline based on manufacturer’s recommended concentration) to tacrolimus intravenous standard concentration (tacrolimus 1 mg in 250 mL of normal saline) continuous intravenous infusion titrated to prescribed dose. The cohort study was performed on two hematopoietic stem cell transplantation nursing units consisting of a prepilot phase during which time patient-specific intravenous tacrolimus doses were compounded and administered, followed by the pilot phase during which patients received tacrolimus intravenous standard concentration. The primary endpoint was reduction in tacrolimus intravenous bags wasted. Secondary endpoints were drug cost savings, decreased intravenous infusion line supplies, decrease in time needed to execute dose changes, reduction in infusion pump alerts, and number of patient safety events. Results Compared to the prepilot phase, there was a 64% reduction in tacrolimus intravenous bags wasted during the pilot phase ( p = 0.029), resulting in a mean monthly total cost savings of $224.31 for pilot units. Intravenous pump line use was reduced by 18% ( p = 0.067), yielding a monthly total cost savings of $84.02 for pilot units. The median time needed to execute dose changes and intravenous pump overrides was significantly reduced ( p < 0.0001, p < 0.0001, respectively). Conclusion This interdisciplinary quality improvement initiative led to increased efficiency, reduction in waste, and decreased intravenous pump alerts utilizing tacrolimus intravenous standard concentration.
Modulation of Tryptophan/Serotonin Pathway by Probiotic Supplementation in Human Immunodeficiency Virus–Positive Patients: Preliminary Results of a New Study Approach
Authors: Corano Scheri Giuseppe , Fard Saeid Najafi , Schietroma Ivan , Mastrangelo Andrea , Pinacchio Claudia , Giustini Noemi , Serafino Sara , De Girolamo Gabriella , Cavallari Eugenio Nelson , Statzu Maura , Laghi Luca , Vullo Annamaria , Ceccarelli Giancarlo , Vullo Vincenzo , d’Ettorre Gabriella 
Published: May 2017

Background: To date, no data are available regarding the effects of probiotics on the pathway of tryptophan/serotonin metabolism among human immunodeficiency virus (HIV) 1–infected individuals. Because a condition of dysbiosis might be responsible for the altered use of tryptophan described in this population, the aim of this study was to investigate the link between probiotic supplementation and serotonin levels in combined antiretroviral therapy–treated patients and the subsistence of an interplay with inflammation. Methods: We conducted a pilot study that included 8 HIV-positive subjects. We collected blood and fecal samples before and after 6 months of probiotic supplementation, to measure the level of serotonin in serum and tryptophan in stool, the expression of CD38 and HLA-DR on peripheral CD4+ T lymphocytes (as immune activation markers), the expression of indoleamine 2,3-dioxygenase 1 messenger RNA (mRNA) and IFN-γ mRNA (as markers of tryptophan metabolism and systemic inflammation). Results: After probiotic supplementation, we observed a significant increase in concentration of serum serotonin ( P = .008) and a decreased level of tryptophan in plasma. Moreover, a significant reduction in CD38 and HLA-DR expression on the surface of peripheral CD4+ T cells ( P = .008) and a reduced expression of indoleamine 2,3-dioxygenase 1 mRNA on peripheral blood mononuclear cells ( P = .04) were observed. Conclusions: Considering that this probiotic (Vivomixx® in EU; Visbiome® in USA) has an influence on tryptophan metabolism, larger studies on this topic are needed.