bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Granulocyte Colony-Stimulating Factor in the Treatment of Pancytopenia Secondary to Colchicine Overdose
Authors: Katz Roya , Chuang Linda C. , Sutton Jacqueline D. 
Published: January 2017

OBJECTIVE: To report a case of pancytopenia following colchicine overdose and to discuss the use of granulocyte colony-stimulating factor (G-CSF) for treating this severe complication. CASE SUMMARY: A 19-year-old man developed pancytopenia four days after ingestion of approximately 50–60 0.6-mg colchicine tablets in a suicide attempt. His pancytopenia resolved after subcutaneous administration of one 300-μg dose of G-CSF. The patient recovered from his other multiorgan disturbances during his hospitalization and was discharged from the hospital with elevated liver enzyme concentrations. CONCLUSIONS: Colchicine overdose is rare, but can be fatal. The use of G-CSF appears to be beneficial in alleviating bone marrow depression in colchicine overdose situations.
Antibiotic Prescribing Patterns in Italian Hospital Inpatients with Pneumonia, Chronic Obstructive Pulmonary Disease, and Urinary Tract Infections
Authors: Guglielmo Luigi , Leone Roberto , Moretti Ugo , Conforti Anita , Spolaor Alvise , Velo Giampaolo 
Published: January 2017

OBJECTIVE: The primary objective of this study was to describe the antibiotic prescribing patterns in hospital inpatients with pneumonia (PN), exacerbations of chronic obstructive pulmonary disease (COPD), and urinary tract infections (UTIs). A second objective was to verify if some selected variables (i.e., risk factors, patient age, size of hospitals) were affecting the therapeutic choice. DESIGN: Survey was performed on 1609 patients. The data were collected by physicians using a special form, covering a six-month period. SETTING: Twenty-six medical wards and 8 geriatric wards in 24 acute-care hospitals in the Veneto Region in Northern Italy. PATIENTS: A consecutive sample of PN, COPD, and UTI patients treated with antibiotics. MAIN OUTCOME MEASURES: The following information was collected: patient and hospital demographics, risk factors, diagnoses, and antibiotic regimens. RESULTS: Sixty-three antimicrobial agents used, with 2115 administrations, 1227 of which were single-drug therapy. The most frequently used drugs were third-generation cephalosporins (24.6 percent), fluoroquinolones (15.4 percent), aminopenicillins (15.0 percent), and ureidopenicillins (9.7 percent). There is great variability of therapeutic regimens in the various hospitals for the same disease. However, this variability is not explained by the different types of hospitals or by the patients' characteristics (e.g., age, risk factors). CONCLUSIONS: Our results show that the use of broad-spectrum antibiotics probably is excessive. Moreover, the treatment seems to be based more on the opinion of the treating physician and the local habits rather than objective criteria. These factors may have negative repercussions not only in economic terms, but also in terms of alteration of the bacterial ecology.
Calcium-Channel Antagonists for Prevention of Atherosclerosis
Authors: Borcherding Shawn M. , Meeves Suzanne G. , Klutman Neil E. , Howard Patricia A. 
Published: January 2017

OBJECTIVE: To critically evaluate the current literature regarding the role of calcium-channel antagonists in preventing atherosclerosis. DATA SOURCES: English language clinical studies, abstracts, conference proceedings, and review articles pertaining to calcium-channel antagonists and atherosclerosis. STUDY SELECTION: Relevant animal and human studies examining the role of calcium-channel antagonists in atherosclerosis prevention and treatment. DATA EXTRACTION: Potential mechanisms for the development of atherosclerosis and the use of calcium antagonists for preventing and treating coronary artery disease are discussed. Animal studies are summarized; next, significant data from human clinical studies are presented. DATA SYNTHESIS: Available studies are described and discussed. CONCLUSIONS: Results from animal and clinical trials in humans suggest that calcium antagonists may retard the development and progression of atherosclerosis. However, most clinical trials to date have been conducted in patients with proven atherosclerotic plaques. Further studies examining the role of calcium-channel antagonists in preventing and treating atherosclerosis are needed, but may be difficult to conduct because of the large numbers of patients required, long trial duration, and associated costs.
Assessing the Quality of Pharmaceutical Care I. One Perspective of Quality
Authors: Farris Karen B. , Kirking Duane M. 
Published: January 2017

OBJECTIVE: To evaluate the concept of pharmaceutical care (PC) as a standard of quality care for ambulatory pharmacy practice. DATA SOURCES: Donabedian's article on the seven pillars or characteristics of quality provides a framework for a discussion of the merits of PC as a definition of quality. A MEDLINE search augmented by a manual review of International Pharmacy Abstracts was also used to identify pertinent English-language pharmacy literature; indexing terms included quality, community pharmacy services, ambulatory, pharmacy services, and pharmacist(s). STUDY SELECTION: Representative articles and studies promoting PC were considered. DATA EXTRACTION: The literature was independently reviewed by the primary author. DATA SYNTHESIS: An interpretation of the principles of Donabedian's article was applied to PC. PC appears to be consistent with the quality characteristics of efficacy and acceptability. The effectiveness, cost-effectiveness, and efficiency of PC should be firmly established by its practitioners as barriers are eliminated and/or overcome. The pillars of optimality, equity, and legitimacy seem to be overlooked under the current definition of PC. This article contends that PC assumes an individualist definition of quality, by definition, because of its covenantal relationship with the patient. CONCLUSIONS: Quality is defined in terms of the values of individuals and society. For now, PC appears to be the appropriate standard for defining quality in pharmacy because of the importance of individual maximal benefits within our society.
Impact of Pharmacist Interventions on Medication Management by the Elderly: A Review of the Literature
Authors: Tett Susan E. , Higgins Gwen M. , Armour Carol L. 
Published: January 2017

OBJECTIVE: To review the impact of pharmacist interventions designed to assist older people in managing their medication regimens. DATA SOURCES: A computer search of literature published between 1975 and 1990 was conducted using MEDLINE. References were also identified from the bibliographies of pertinent articles. STUDY SELECTION: Studies included in the review were those evaluating pharmacist interventions that were designed to assist in medication management by people over 65 years of age. Only nine studies were identified by these criteria. Interventions that have not been evaluated are discussed briefly. The studies included were chosen by consensus of the authors. DATA EXTRACTION: A data extraction form was used to summarize the information in each study. RESULTS: This was a qualitative review. Some studies evaluating the effects of short verbal medication counseling episodes showed positive benefits; others showed no benefit. Written medication information, some memory devices, and audiovisual techniques have also been found to be of limited use. Self-medication programs for hospitalized elderly people need to be evaluated. CONCLUSIONS: This review identified the lack of published evaluations of pharmacist interventions in medication management by elderly people. Well-designed studies need to be performed to determine the effects of individualized advice and counseling. The cost-effectiveness of such interventions should be assessed, with consideration of long-term outcomes, such as readmission rates to the hospital and cost savings accruing from increased duration of independent living.
Hydrazine Production in Children Receiving Isoniazid for the Treatment of Tuberculous Meningitis
Authors: Donald Peter R. , Seifart Heiner I. , Parkin Donald P. , van Jaarsveld Pieter P. 
Published: January 2017

OBJECTIVE: To study the generation of the hepatotoxin hydrazine in 32 malnourished children receiving isoniazid for the treatment of tuberculous meningitis. DESIGN AND SETTING: This observational study was undertaken in the pediatric ward of a teaching hospital admitting children with advanced forms of tuberculous meningitis for treatment and management of complications. METHODS: Thirty-two children (mean age 2.28 years) receiving isoniazid 20 mg/kg/d were studied. Plasma isoniazid, acetylisoniazid, and hydrazine concentrations were determined by an HPLC method. Fourteen children were studied at weekly intervals for the first month of treatment and again after six months of therapy; 18 additional children were studied on one or more occasions during the first month of treatment only. RESULTS: The area under the curve for hydrazine two to five hours after the isoniazid dose correlated with the isoniazid elimination rate and with acetylisoniazid generation. Hydrazine production increased significantly during the first month of treatment, but decreased to approximate initial values at six months. No correlation was found between any clinical or biochemical indicator of liver dysfunction and hydrazine production. CONCLUSIONS: Hydrazine is formed in significant concentrations during the metabolism of isoniazid in young children. However, additional factors such as preexisting liver damage (e.g., from viral hepatitis) may be necessary for it to reach its toxic potential.
Acute Pulmonary Edema Associated with Ocular Metipranolol Use
Authors: Johns Melanie D , Ponte Charles D 
Published: January 2017

Objective: To report a case of pulmonary edema associated with the use of ocular metipranolol, a nonselective beta-blocker. Case Summary: A 72-year-old woman with no history of pulmonary or cardiac disease presented to the emergency room with signs and symptoms consistent with cardiogenic pulmonary edema. The patient had used metipranolol eyedrops approximately 1 hour before becoming symptomatic. When rechallenged inadvertently while hospitalized, the patient again became symptomatic. The patient's metipranolol eyedrops then were substituted with betaxolol eyedrops. She continued to be free of symptoms of pulmonary edema at subsequent clinic visits 1,4, and 6 weeks following discharge. Discussion: This is the first reported case of pulmonary edema associated with metipranolol. There was a reasonable temporal association between use of the eyedrops and the onset of symptoms. Beta-blockers may cause cardiogenic pulmonary edema secondary to their negative inotropic and negative chronotropic effects. The drug's lipid solubility or a deficiency in the enzyme responsible for its metabolism may have allowed the drug to accumulate to a critical concentration over the 6-week period of use. Conclusions: Ocular beta-blockers must be used with caution in patients with relative contraindications to beta-blockade. This case illustrates that these agents must be used prudently even in patients with no history of symptomatic congestive heart failure.
Bone and Tissue Changes following Prostaglandin Therapy in Neonates
Authors: Kaufman Michele B , El-Chaar Gladys M 
Published: January 2017

OBJECTIVE: To review case reports describing prostaglandin-induced bone changes and tissue swelling in neonates. DATA SOURCES: An Index Medicus and bibliographic search of the English-language literature pertaining to prostaglandin-induced bone changes and tissue swelling in neonates. DATA SYNTHESIS: Short- and long-term prostaglandin infusion in neonates is associated with cortical proliferation throughout the skeletal system. Total resolution of these changes has occurred in seven patients described to date; other reports did not note either the time or the regression of these changes. Skeletal changes may occur within 9 days of initiation of prostaglandin therapy and include widened fontanelles, pretibial and soft-tissue swelling, and swelling of the upper and lower extremities. These reactions may last up to 38 weeks following discontinuation of therapy. Alkaline phosphatase (AP) concentrations have been shown to be increased in four cases, as well as in one retrospective analysis. Although these were not prospective studies, evaluation of AP may provide a means to monitor neonates receiving prostaglandin therapy. CONCLUSIONS: Pharmacists need to be aware of the potentially serious skeletal changes, encourage dosage titration as soon as possible, and limit the duration of time neonates are exposed to prostaglandin therapy. Monitoring of AP concentrations during therapy with prostaglandins may be beneficial in predicting or preventing further complications.
A Method to Produce Sedation in Critically Ill Patients
Authors: Watling Sharon M , Johnson Melissa , Yanos John 
Published: January 2017

OBJECTIVE: To evaluate a protocol based on continuous infusion of a benzodiazepine and morphine to produce apnea/decreased respiratory effort as an adjunct to complex mechanical ventilation in patients with respiratory failure. DESIGN: Observational report of consecutive patients. SETTING: University medical intensive care unit. PATIENTS: Seventeen consecutive patients with acute respiratory failure requiring high levels of sedation and/or paralysis to facilitate mechanical ventilation were studied. INTERVENTIONS: Patients were started on a continuous infusion of a benzodiazepine and morphine soon after mechanical ventilation was instituted. The dosages of the benzodiazepine and morphine were increased to the end point of diminished respiratory effort or apnea depending on the clinical status of the patient and ventilatory mode. This regimen was supplemented with single doses of neuromuscular blocking agents (NMBAs) only as the dosages of benzodiazepine/narcotic were being titrated. The benzodiazepine/narcotic agents were then gradually reduced as the patient's condition improved, often using an oral route of administration. MEASUREMENTS AND RESULTS: The benzodiazepine/morphine combination produced apnea and diminished respiratory effort in patients requiring sedation from 2 to 50 days, including those with hemodynamic instability, hepatic dysfunction, renal dysfunction, and sepsis. The combination allowed the use of NMBAs to be minimized. There was no evidence of worsened hemodynamic instability as a result of the administration of these agents. The gastrointestinal tract could be used for nutrition in 8 of the 17 patients. CONCLUSIONS: Continuous infusion of a benzodiazepine and morphine controlled the respiratory rate in patients with severe respiratory failure requiring complex mechanical ventilatory support.
Prevention and Regression of Atherosclerosis: Effects of Hmg-CoA Reductase Inhibitors
Authors: Bjelajac Aleksandra , Goo Alvin KY , Weart C Wayne 
Published: January 2017

OBJECTIVE: TO review the current literature on the effects of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors in secondary prevention and regression of atherosclerosis. DATA SOURCES A MEDLINE and journal search of recent studies evaluating the effects of lipid lowering with HMG-CoA reductase inhibitors on serum cholesterol as well as progression and regression of atherosclerotic coronary or carotid disease in patients with established atherosclerotic disease was conducted. Articles addressing the pathophysiology of atherosclerotic disease were identified by using the same sources. STUDY SELECTION: All available studies evaluating the use of HMG-CoA reductase inhibitors in the progression and regression of coronary and carotid atherosclerosis were reviewed. DATA SYNTHESIS: Lowering of total serum cholesterol, low-density lipoprotein cholesterol, and triglycerides, as well as increasing high-density lipoprotein cholesterol can be achieved with HMG-CoA reductase inhibitors. Aggressive lipid lowering has been demonstrated to alter progression of established atherosclerotic disease and, in some patients, actually induce regression of the atheroma. An unexpected finding of several trials was the early and significant reduction in clinical cardiac events. Other mechanisms by which clinical event reduction may be explained include plaque stabilization and restoration of endothelium vasodilation. CONCLUSIONS: Aggressive lipid-lowering therapy using HMG-CoA reductase inhibitors appears to alter the natural progression and promote regression of atherosclerosis in selected patients with established coronary or carotid atherosclerosis. However, it is unlikely that regression of atherosclerosis alone is responsible for the marked reduction in clinical cardiac events seen in these trials.
Rational use of rasburicase for the treatment and management of tumor lysis syndrome
Authors: Shaikh Suhail A , Marini Bernard L , Hough Shannon M , Perissinotti Anthony J 
Published: January 2017

Purpose There is a lack of high-level evidence identifying meaningful outcomes and the optimal place in therapy of rasburicase in patients with, or at high risk for tumor lysis syndrome. The primary objective of this study was to evaluate and characterize outcomes resulting from an institution-specific guideline emphasizing supportive care, xanthine oxidase inhibitors, and lower doses of rasburicase. Methods In this retrospective chart review, we compared conservative rasburicase dosing, in accordance with newly developed UMHS tumor lysis syndrome guidelines, with aggressive rasburicase in adult patients (≥ 18 years of age) with hematological or solid tumor malignancies, and a uric acid level between 8 and 15 mg/dL. The primary efficacy outcome assessed the difference in the proportion of patients achieving a uric acid level <8 mg/dL within 48 h using a one-sided noninferiority test. The principle safety outcomes analyzed included incidence of acute kidney injury and hemodialysis requirement. Results One hundred sixty-one patients met inclusion criteria and were included in the study. Within 48 h of an elevated uric acid level, treatment was successful in 97.03% of patients in the conservative group, as compared with 98.33% in the aggressive group (difference, 1.3 percentage points; 95% confidence interval [CI], −3.33 to 5.93). Furthermore, there was no difference in the proportion of patients requiring hemodialysis (2.97% vs. 10.0%, p-value 0.079), or incidence of acute kidney injury (4.0% vs. 12.5%, p-value 1.00) between the treatment group and control group, respectively. Conclusions Conservative rasburicase use was noninferior to aggressive rasburicase use in patients with or at high risk for tumor lysis syndrome.
Results and Future of Carotid Endarterectomy in a Medium-Sized Finnish Central Hospital
Authors: Jokinen J. J. , Huusari H. M. T. , Lehtonen J. Y. , Korpela A. A. 
Published: January 2017

Background and Aims: Carotid endarterectomies (CEA) should, by general agreement, be performed only at specialised institutions and on patients who are expected to have a low rate of complications, i.e., a 6% surgical risk for patients with symptomatic and a 3% risk for patients with asymptomatic carotid artery disease. We have reviewed the midterm results after CEA in amedium-sized Finnish central hospital to audit whether our results fulfil current quality standards. Patients, Materials and Methods: There were 116 consecutively operated patients at the Päijät-Häme Central Hospital during the years 1999–2003 on whom 122 CEAs were made. All CEAs were performed by conventional methods and shunts and patches were used when necessary. Results: The overall survival rate was 81.0% during the 3.6 ± 1.5 years [range 1.3–6.3 years] follow-up. The incidence of early major stroke was 2.5% and of late major stroke 1.6%. Other complications included cranial nerve deficit (2.5%), wound haematoma (3.3%) and postoperative hypertension (3.3%) or hypotension (2.5%). Significant changes in medication were needed after surgery in several patient subgroups. Conclusions: The results of CEA at the Päijät-Häme Central Hospital are at least acceptable. The primary prevention of strokes with pharmacotherapy needs aggressive improvement.
Service Comparison between Vascular and General Surgery in the Treatment of Chronic Venous Insufficiency with Special Reference to Preoperative Doppler Techniques
Authors: Oinonen A. , Sugano N. , Lehtola A. , Suokas N. , Keränen U. , Lepäntalo M. 
Published: January 2017

Aims: To compare the ability of vascular and general surgical services to abolish reflux in superficial venous system with aspecial reference to preoperative use of Doppler techniques. Materials and Methods: 68 lower limbs operated on for venous insufficiency based on either preoperative Duplex evaluation and Doppler marking in avascular surgical unit (Vascular Surgical Service, VSS: 33 limbs, clinical class C2–C6) or clinical findings in a general surgical unit (General Surgical Service, GSS: 35 limbs, clinical class C2–C4) were re-examined clinically and with duplex scanning for reflux some three years postoperatively. Results: Marked superficial or perforator vein reflux was observed in 27 of 68 (39.7 %) operated limbs, thirteen of which in VSS and fourteen in GSS. However, axial reflux at saphenofemoral or thigh level was observed significantly less in VSS compared to GSS (3 vs 13, p = 0, 006). Conclusion: Total ablation of any reflux appeared difficult irrespective of the preoperative assessment. Preoperative Duplex examination, however, aided in identifying and treating axial reflux at thigh level.
Unrestricted Weight Bearing and Intensive Physiotherapy after Uncemented Total Hip Arthroplasty
Authors: Ström H. , Huss K. , Larsson S. 
Published: January 2017

Background and Aims: The effectiveness of partial weightbearing after hip surgery has been questioned as well as the need of intensive physiotherapy. Material and Methods: 36 patients (average age 54.4, 19 women) operated with uncemented hip arthroplasty were randomized either to unrestricted weightbearing (UWB) combined with intensive physiotherapy or to partial weightbearing (PWB) for 3 months combined with a short self-training program. The load during walking and the muscle strength (MS) in abduction was measured preoperative and subsequent up to 12 months. Results: The average peak load on the operated leg at one week was 39.0 kg for the UWB and 25.8 for the PWB group (P = 0.009) while at three months 70.0 and 31.7 (P = 0.001) respectively. At 6 and 12 months there were no differences between the groups. The muscle strength increased in both groups up to six months but there were no differences between the groups. Conclusions: Even though patients applied more load than the recommended 15 kg most patients were able to comply with partial weightbearing fairly well. The effect of intensive physiotherapy on the muscle strength after hip arthroplasty is questionable.