bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clomipramine-Induced Urinary Dysfunction in an Obsessive-Compulsive Adolescent
Authors: Hermesh Haggai , Aizenberg Dov , Weizman Abraham , Lapidot Margo , Munitz Hanan , Rivera Giselle C. , Dion Pierre 
Published: May 2016

Two episodes of urinary retention occurred in a 15-year-old male following administration of clomipramine given for obsessive-compulsive disorder. Improvement of behavioral symptoms along with side effects was clearly correlated with clomipramine dosage. Severity of side effects, and their resistance to bethanechol and to phenoxybenzamine, necessitated a complete withdrawal of clomipramine. This case demonstrates that clomipramine-induced urinary retention is not limited to older individuals. Possible involvement of noncholinergic and nonadrenergic mechanisms in this adverse drug reaction is suggested. Extracto Se reportan dos episodios de retención urinaria en un paciente varón de 15 años de edad luego de la administración de clomipramina (CMI) para el tratamiento de un desorden obsesivo-compulsivo. Tanto la mejoría en los s***intomas del comportamiento como los efectos adversos correlacionaron con la dosis de CMI. La severidad de la retención urinaria y su resistencia al tratamiento con betanecol y fenoxibenzamina requirieron que se descontinuara el medicamento. Los autores concluyen que este caso demuestra que la retención urinaria inducida por CMI no está limitada a pacientes envejecientes sino que se puede observar también en adolescentes. Sugieren, además, mecanismos no-colinérgicos y no-adrenérgicos como posibles causas de este efecto adverso. Resume Deux épisodes de rétention urinaire furent observés chez un jeune homme de 15 ans après l'administration de clomipramine (CMI). La CMI était utilisée pour traiter un désordre obsessif-compulsif (DOC). Une corrélation fut établie entre les dosages de CMI, l'amélioration des symptômes du comportement et les effets secondaires. La sévérité de ces effets secondaires et l'absence de réponse au béthanechol et à la phenoxybenzamine auront nécessité l'arrêt de la thérapie à la CMI. Ce cas démontre que l'induction d'une rétention urinaire avec la CMI n'est pas limitée aux personnes âgées, mais qu'elle peut aussi survenir chez les adolescents. Des mécanismes non-cholinergiques et non-adrénergiques seraient suggérés pour expliquer cet effet secondaire.
A Clinical Pharmacy-Oriented Drug Surveillance Network: II. Results of a Pilot Project
Authors: Grasela Thaddeus H. , Edwards Blake A. , Raebel Marsha A. , Sisca Thomas S. , Zarowitz Barbara J. , Schentag Jerome J. 
Published: May 2016

A nationwide network of clinical pharmacists has been organized for the purpose of collecting drug experience data generated during the routine clinical care of patients. In order to assess the utility of this network a pilot project was performed to obtain a cross-sectional view of antibiotic utilization in the U.S. and to identify potential problems with a more widespread implementation of this program. One hundred eleven pharmacists enrolled in the drug surveillance network participated in this survey and collected information on more than 2000 patients treated with antimicrobial agents over approximately a three-month period (February-April 1987). The most common sites of infection were the lung, genitourinary tract, skin and soft tissue, and the abdomen, and accounted for approximately 75 percent of infections. Overall, the aminoglycosides, the first-generation cephalosporins, and the aminopenicillins remain the most commonly used antibiotics and represent approximately 50 percent of antimicrobials used in the surveyed population. The results of this pilot project suggest that the use of a nationwide network of clinical pharmacists is a promising source of clinically relevant drug experience data. The ability to concurrently evaluate patients and link information regarding patient demographics, drug therapy regimens, diagnosis, and clinical outcomes fills an important gap in our knowledge of clinical drug utilization.
Adverse Drug Events: Identification and Attribution
Authors: Hartzema Abraham G. , Porta Miquel S. , Tilson Hugh H. , Rogers Audrey Smith 
Published: May 2016

The definition of an adverse drug event should be tailored to one's purpose in examining the incident. Although the more specific of these definitions is required for scientific evaluation of the link between drug and event, other less stringent definitions are usually adequate for clinical purposes. Knowledge about the safety profile of a drug in humans is limited at the time of marketing. The mechanisms for supplementing safety data during postmarketing include (1) the Spontaneous Reporting System maintained by the Food and Drug Administration, (2) formal projects to assemble safety data on larger or more complex populations, and (3) formal projects designed to answer specific research questions. Judgments about attribution can be no better than the data that support them. The criteria applied by the clinician to the individual adverse drug experience to determine association differ from those required to establish causation based on epidemiologic evidence. In most situations, regulatory action on drug recall should be based on epidemiologic evidence. This article will discuss the choice of a definition for an adverse drug event, examine the extent and nature of the safety data assembled on a drug at the time it is marketed, propose the best methods for collecting additional information after marketing, and designate factors to be considered in judging a drug to be causally related to an adverse event.
Nonsteroidal Antiinflammatory Drug-Induced Renal Dysfunction Related to Inhibition of Renal Prostaglandins
Authors: D'Angio Richard G. 
Published: May 2016

This article reviews the role of prostaglandins (PG) in maintaining renal function in the face of vasoconstrictive substances and decreased renal blood flow. Inhibition of the synthesis of renal PG by nonsteroidal antiinflammatory drugs (NSAID) may lead to the development of hemodynamically induced renal dysfunction in patients with a decreased effective plasma volume or chronic renal insufficiency. The importance of stimulation of renal PG activity to the action of diuretics and a pharmacodynamic mechanism for NSAID-induced diuretic resistance are presented. Evidence for the relative selectivity of sulindac in inhibiting systemic PG without inhibiting renal PG is also reviewed. Inhibition of renal PG synthesis has been postulated to be a contributing factor for other forms of NSAID-induced renal dysfunction (interstitial nephritis, analgesic-associated nephropathy). The relationship between renal PG inhibition by NSAID and these syndromes is briefly discussed. Considering the frequent use of NSAID, it is important that practitioners are aware of the mechanisms whereby patients may develop NSAID-induced renal dysfunction and that they are able to identify patients at risk.
Cromolyn Sodium: A Review of Mechanisms and Clinical Use in Asthma
Authors: Murphy Shirley , Kelly H. William 
Published: May 2016

The cellular and clinical pharmacology of cromolyn sodium are reviewed. Cromolyn sodium inhibits the release of mediators of inflammation, induced by specific antigens as well as nonspecific mechanisms, such as exercise, from mast cells. Cromolyn may also inhibit the activity of other cell types that produce inflammation. It is the only antiasthmatic that blocks both early and late asthmatic responses induced by allergen inhalation and exercise. Consequently, cromolyn therapy can block the increase in bronchial hyperreactivity induced by chronic allergen exposure. Cromolyn is effective for controlling the symptoms of mild to moderate chronic asthma in 60 to 70 percent of patients. In comparative studies, cromolyn has been as effective as theophylline for controlling symptoms of chronic asthma with fewer side effects, and may be particularly suited for asthmatic patients with learning or behavioral problems. The combination of theophylline and cromolyn is often more effective than either agent alone. Because of the convenience of administration, cromolyn is preferred over theophylline for exercise-induced asthma. Cromolyn may allow the corticosteroid dosage to be reduced in severe steroid-dependent asthmatics, but it is primarily indicated for the prophylaxis of mild to moderate disease. Adverse reactions to cromolyn are uncommon to rare. Cromolyn is now available in a Spinhaler, a metered-dose aerosol, and a nebulizer solution. If taken properly all preparations appear to be equally effective. Attention to proper inhalation technique and appropriate education of the patient is essential to ensure a good outcome with cromolyn.
Atenolol vs. Amiloride-Hydrochlorothiazide in the Treatment of Mild to Moderate Hypertension: A Double-Blind, Crossover, Placebo-Controlled Study
Authors: Lischner Michael , Lang Ruth , Jutrin Itzhak , Ravid Mordchai 
Published: May 2016

The antihypertensive effect of atenolol 100 mg was compared to that of amiloride HCl 5 mg + hydrochlorothiazide 50 mg (AHCZ) in a double-blind, crossover, placebo-controlled study of 128 patients. Both drugs were given once daily. Atenolol produced a significant decline in lying, standing, and postexercise blood pressure and pulse rate values. The corresponding values on AHCZ were not significantly different from placebo. Both the beta-blocking agent and the thiazide diuretic with amiloride were relatively well tolerated. More than half of all adverse effects were nonspecific and also observed in patients on placebo. In the population studied, atenolol proved to be a superior antihypertensive agent to AHCZ. MICHAEL LISCHNER, M.D., is Senior Resident, Instructor in Medicine; RUTH LANG, M.D., is Physician, Lecturer in Medicine; ITZHAK JUTRIN, M.D., is Senior Physician; and MORDCHAI RAVID, M.D., is Head, Department of Medicine, Associate Professor of Medicine, Meir Hospital, Kfar Saba, and Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.
Improving the effectiveness and efficiency of outpatient services: a scoping review of interventions at the primary–secondary care interface
Authors: Winpenny Eleanor M , Miani Céline , Pitchforth Emma , King Sarah , Roland Martin 
Published: May 2016

Objectives Variation in patterns of referral from primary care can lead to inappropriate overuse or underuse of specialist resources. Our aim was to review the literature on strategies involving primary care that are designed to improve the effectiveness and efficiency of outpatient services. Methods A scoping review to update a review published in 2006. We conducted a systematic literature search and qualitative evidence synthesis of studies across five intervention domains: transfer of services from hospital to primary care; relocation of hospital services to primary care; joint working between primary care practitioners and specialists; interventions to change the referral behaviour of primary care practitioners and interventions to change patient behaviour. Results The 183 studies published since 2005, taken with the findings of the previous review, suggest that transfer of services from secondary to primary care and strategies aimed at changing referral behaviour of primary care clinicians can be effective in reducing outpatient referrals and in increasing the appropriateness of referrals. Availability of specialist advice to primary care practitioners by email or phone and use of store-and-forward telemedicine also show potential for reducing outpatient referrals and hence reducing costs. There was little evidence of a beneficial effect of relocation of specialists to primary care, or joint primary/secondary care management of patients on outpatient referrals. Across all intervention categories there was little evidence available on cost-effectiveness. Conclusions There are a number of promising interventions which may improve the effectiveness and efficiency of outpatient services, including making it easier for primary care clinicians and specialists to discuss patients by email or phone. There remain substantial gaps in the evidence, particularly on cost-effectiveness, and new interventions should continue to be evaluated as they are implemented more widely. A move for specialists to work in the community is unlikely to be cost-effective without enhancing primary care clinicians’ skills through education or joint consultations with complex patients.
Ultrasound for confirmation of thoracostomy tube placement by emergency medicine residents
Authors: Nakitende Damali , Gottlieb Michael , Ruskis Jennifer , Kimball Deborah , Christian Errick , Bailitz John 
Published: May 2016

Introduction Thoracostomy tubes are placed in the Emergency Department for numerous indications, including hemothoraces, pneumothoraces, and empyemas. After insertion, a portable single view chest radiograph is typically performed minutes later to confirm thoracostomy tubes position. However, up to 2.6% of thoracostomy tubes are ultimately determined to be misplaced. Failure to adequately drain the chest in a timely manner may have disastrous consequences. Ultrasonography by expert sonographers has been previously described to evaluate thoracostomy tubes position. The purpose of this study was to assess the accuracy of ultrasound for confirmation of thoracostomy tubes placement by Emergency Medicine residents. Methods We conducted a prospective, randomized, blinded study using a cadaveric model for ultrasound confirmation of thoracostomy tube placement by resident physicians. Thirty-five Emergency Medicine residents performed a total of 140 confirmations. The primary outcome of the study was the sensitivity and specificity of EM resident-performed ultrasonography to correctly confirm thoracostomy tube placement. Secondary outcomes included time to identification, operator confidence, and subgroup analysis by resident training level. Results The study demonstrated an overall sensitivity of 100% (95% CI 94–100%) and specificity of 96% (95% CI 87–99%) for intrathoracic placement. Post-graduate year (PGY) 1 EM residents demonstrated 100% (95% CI 76–100%) sensitivity and 100% (95% CI 76–100%) specificity. PGY 2 EM residents demonstrated 100% (95% CI 87–100%) sensitivity and 94% (95% CI 79–99%) specificity. PGY 4 EM residents demonstrated 100% (95% CI 80–100%) sensitivity and 95% (95% CI 75–100%) specificity. The total time to identification was 16 seconds (95% CI 13–19). Overall operator confidence was 4.0/5.0 (95% CI 3.8–4.1). Conclusion Emergency medicine residents were able to quickly identify thoracostomy tube location using ultrasound with a high degree of accuracy in a cadaveric model after a brief educational session.
Worry and time: the unseen costs of informal care
Authors: Jowsey Tanisha , Strazdins Lyndall , Yen Laurann 
Published: May 2016

Objectives The objective of this study is to examine the experiences of informal carers in terms of how their time spent caring is related to worry. Is worry about a care recipient a care practice, and if so, to what extent it can be understood temporally? Methods Classical phenomenology underpinned this study. Three qualitative studies of people living with chronic illness in Australia were conducted between 2009 and 2013. Semi-structured interviews were conducted. Interviews were audio recorded and transcribed verbatim. Phenomenological thematic analysis of the data was undertaken. Results Twenty-five informal carers participated. The findings pivot around three interconnected themes: time, worry and cost. Worry was identified as a temporally bound unseen cost to carers that informs carer identity irrespective of culture, ethnicity, or social status. Discussion Worry is a practice that most carers report engaging in and it is one that comes with a temporal cost—it keeps people busy looking after the needs of others during the day and it keeps some people awake when they would rather be sleeping. Worry takes time and effort, it informs people’s construction of their own sense of self, motivates acts of care, and informs carers’ imaginings of what their future and that of their loved one(s) may entail.
A preliminary investigation of the suitability of aquatics for people with severe and profound intellectual disabilities
Authors: Aherne Cian , Coughlan Barry 
Published: May 2016

Background: Aquatics is an under-researched but possibly appropriate form of activity for people with severe to profound intellectual disabilities (SPIDs). Aim: The current pilot study investigates the suitability of an aquatics programme for service users with SPIDs. Method: Four service users with SPID completed an 8–12-session aquatics programme. Front-line staff ( N = 6) were interviewed after the programme to explore its suitability. A thematic analysis of the interviews was utilized. Results: The thematic analysis unearthed main themes of effects, facilitators, barriers, strengths and needs. Conclusion: Aquatics can be an appropriate and beneficial form of physical activity for people with SPIDs, but there are many barriers to participation. Tailored programmes are required. Further investigation of the experiences of people with SPIDs in relation to physical activity is recommended.
Ultrasound imaging of the distal radioulnar joint: a new method to assess ulnar radial translation in forearm rotation
Authors: Oldfield C. E. , Boland M. R. , Greybe D. , Hing W. 
Published: May 2016

A cross-sectional reliability study was conducted with 23 normal participants to establish normal values, and the repeatability and validity of distal radioulnar joint translation measurements using ultrasound imaging. Static transverse images of maximal supination, neutral and maximal pronation were examined to assess translation, using a method consistent with the rheumatoid arthritis subluxation ratio. Translation while gripping a 1 kg weight in supinated and pronated positions was then compared with non-gripping translation. There was significantly more ulnar radial translation found with pronation than supination, when compared with neutral. Gripping in pronation did not produce statistically significant changes in translation, whereas the changes produced by gripping in supination were significant. Internal consistency was deemed very high and the rheumatoid arthritis subluxation ratio values measured using ultrasound imaging were consistent with previously documented values measured by computerized tomography. This study demonstrated that translational movement of the distal radioulnar joint can be reliably detected in healthy participants using ultrasound imaging. This may reduce dependency on other imaging modalities to diagnose distal radioulnar joint instability. Level of Evidence: 2.
One-Year Results of an Educational Program on Osteoarthritis
Authors: de Rezende Marcia Uchoa , Hissadomi Marcelo Issao , de Campos Gustavo Constantino , Frucchi Renato , Pailo Alexandre Felício , Pasqualin Thiago , Brito Nadia Lucila Rocha , Santana Olga Fugiko Magashima , Moreira Merilu Marins , Strutz Carolina Guimarães , Matos Natalia Beraldo dos Santos , de Camargo Olavo Pires , Hernandez Arnaldo José 
Published: May 2016

Introduction: Knee osteoarthritis (KOA) is the most prevalent form of osteoarthritis. Low socioeconomic level, age, and obesity are directly correlated with the incidence of the disease. Education, exercise, and diet are the core recommendations of all KOA treatment guidelines. Objective: To evaluate the impact of a multiprofessional educational program on patients with KOA. Methods: Of a total of 198 participants, 150 patients with KOA attended 2 days of lectures (at 1- to 3-month intervals) and received educational material on osteoarthritis, and a control group (48 patients) received educational materials only. Body mass index (BMI), frequency, and intensity of physical activity, pain, function, and quality-of-life scores were assessed at baseline and at 4 and 12 months after the educational program. Bimonthly telephone calls were made to half of the participants. Correlations between BMI, level of education, coping skills, functional, and pain results was procured. Results: The groups were similar in terms of race, gender, affected side, and osteoarthritis severity. The results were not affected by the telephone calls or the patients’ level of education. At baseline, 25 performed physical activity, whereas 123 performed at 1 year. Seventy-two (36.36%) patients decreased BMI (45 by 1 point and 27 by more than 2 points). There were some weak correlations such as BMI reduction with pain and functional improvements and with coping results. Significant improvements in function and quality of life were found at 4 months. Quality of life remained improved at 1 year. Conclusion: The effect of this educational program in function and quality of life of patients with KOA is very subtle. Interval between classes (1, 2, or 3 months) is not an important issue.
Arresting Dentine Caries with Different Concentration and Periodicity of Silver Diamine Fluoride
Authors: Fung M.H.T. , Duangthip D. , Wong M.C.M. , Lo E.C.M. , Chu C.H. 
Published: May 2016

Different regimens of silver diamine fluoride (SDF) have been used to manage early childhood caries. So far, there is limited information regarding the concentrations and frequency of applications for effective caries control in primary teeth. This study aimed to compare the efficacy of 2 commercially available SDF solutions at preprepared concentrations of 38% and 12% when applied annually or biannually over 18 mo in arresting dentine caries in primary teeth. This randomized double-blinded clinical trial recruited kindergarten children aged 3 to 4 y who had at least 1 tooth with dentine caries. The children were randomly allocated to receive 4 treatment protocols: group 1, annual application of 12% SDF; group 2, biannual application of 12% SDF; group 3, annual application of 38% SDF; and group 4, biannual application of 38% SDF. Clinical examinations at 6-mo intervals were conducted to assess whether active carious lesions became arrested. Information on the children’s background and oral hygiene habits was collected through a parental questionnaire at baseline and follow-up examinations. A total of 888 children with 4,220 dentine carious tooth surfaces received treatment at baseline. After 18 mo, 831 children (94%) were examined. The caries arrest rates were 50%, 55%, 64%, and 74% for groups 1, 2, 3, and 4, respectively ( P < 0.001). Lesions treated with SDF biannual application had a higher chance of becoming arrested compared with those receiving SDF annual application (odds ratio, 1.33; 95% confidence interval, 1.04–1.71; P = 0.025). The interaction between concentration and lesion site was statistically significant ( P < 0.001). Compared with 12% SDF, the use of 38% SDF increased a chance of becoming arrested ( P < 0.05), except lesions on occlusal surfaces. Based on the 18-mo results, SDF is more effective in arresting dentin caries in the primary teeth of preschool children at 38% concentration than 12% concentration and when applied biannually rather than annually. Knowledge Transfer Statement: The results of this study can be used by clinicians and dental public health professionals when deciding which concentrations and frequency of application of silver diamine fluoride solution should be adopted for arresting dentine caries. With consideration of caries arrest treatment with silver diamine fluoride, which is painless, simple, and low cost, this information could lead to more appropriate therapeutic decisions for caries control in young children or those who lack access to affordable conventional dental care.