bluuebunny/crossref_metadata_2025_split huggingface dataset:
Women's Health Issues and Counseling Behaviors: A Pilot Survey of West Virginia Pharmacists
Authors: Ponte Charles D 
Published: July 2017

Objective: To assess the counseling behaviors of pharmacists concerning women's health issues. Design: A 14-item survey was mailed to 1,050 pharmacists. Data were analyzed using descriptive statistics (frequency and cross-tabulation). An IBM-compatible microcomputer program, Epi Info Version 5, was used for data analysis. Stratified analysis of the data was conducted using chi-square testing. Correlation between selected variables was determined using statistical analysis software. Setting: West Virginia. Participants: Two hundred seven practicing West Virginia pharmacists who completed or partially completed the questionnaire. Outcome Measures: The degree and nature of counseling by West Virginia pharmacists pertaining to women's health issues. Results: Almost 77% of the pharmacists were engaged in community practice. Seventy-four percent (151/203) of pharmacists counsel women about healthcare issues at least sometimes during a typical week. Women most often initiate the interaction. Sixty-nine percent were somewhat comfortable counseling women. The most common topics discussed were vaginal infections and estrogen replacement therapy. The most common barriers to effective counseling were time constraints and lack of patient requests. Almost 33% of the pharmacists (n = 68) agreed that academic curricula inadequately prepared them to counsel women. If reimbursement mechanisms were available, 36% of pharmacists (n = 70) would charge up to $5 per session. Sixteen percent (n = 32) would charge no fee. Conclusions: The small sample size and design of the survey could affect interpretation of the study results. Future research should address the specific types of counseling performed and the methods used, the practice setting and its influence on counseling, curricular influences on counseling, and pharmacist reimbursement philosophy.
Can Valproate Prevent Migraine Headaches?
Authors: Tran Binh N , Vivian Virginia S , Burch Kelly J 
Published: July 2017

Objective: To investigate the effectiveness of valproate in the prevention of migraine headaches. The drug has been approved by the FDA for migraine prophylaxis in addition to its primary use in seizure control. Data Sources: A MEDLINE search (1988–1995) of the English-language literature pertaining to the use of valproate for prophylaxis of migraine headaches was performed. Additional literature was obtained from reference lists of pertinent articles identified through the search. Study Selection and Data Extraction: All articles were considered for possible inclusion in the review. Pertinent information was selected for discussion. Data Synthesis: Results of five clinical studies carried out worldwide were reviewed: a historical study of 22 patients from Denmark and studies of 32 patients in Israel, 43 patients in Denmark, 75 patients in California, and 117 patients in the US. Eleven patients (50%) were free of headache in the first study. The number of migraine attacks decreased from 15.5 to 8.8 in the second study, whereas patients treated with valproate reported 3.5 days with migraine versus 6.1 for patients receiving placebo in the third study. Efficacy rates of 85% and 61% were seen for patients with frequent migraine and transformed migraine, respectively, in the fourth study, and 48% of patients treated with divalproex compared with 14% of patients receiving placebo showed at least a 50% reduction in migraine headache frequency in the fifth study. Conclusions: Approximately half of the patients were shown to experience roughly a 50% reduction in the number of migraine attacks or days with migraine headaches; thus, valproate appears to provide a therapeutic alternative for patients who do not respond to or cannot tolerate beta-receptor blockers, tricyclic antidepressants, or calcium-channel blockers for prophylaxis of migraine headaches.
Theophylline and Verapamil: Clinically Significant Drug Interaction
Authors: Bangura Luella , Malesker Mark A , Dewan Naresh A 
Published: July 2017

Objective: To report and describe a case of verapamil interacting with theophylline. Case Summary: A 33-year-old white man with bronchial asthma was admitted for evaluation of sudden onset of chest pain. During hospitalization, verapamil 120 mg/d was added to the theophylline regimen (600 mg bid). The patient's requirement for theophylline decreased by 50% after the initiation of verapamil. Discussion: A review of the literature indicated that concomitant verapamil may reduce theophylline clearance by 12–23%. Other reports suggest that the degree of this interaction is of much smaller magnitude and clinically insignificant. Conclusions: Although the most recent FDA labeling guidelines for theophylline mention verapamil as a documented source of drug interaction with theophylline, many clinicians may not realize the potential clinical significance. Therefore, theophylline concentrations should be monitored in patients receiving both theophylline and verapamil, even in the absence of adverse effects.
Reevaluating the Safety of Concurrent Warfarin and Ibuprofen Therapy: A Case Report
Authors: Ernst Michael E , Buys Lucinda M 
Published: July 2017

Objective: To describe a case of subclinical bleeding and elevated international normalized ratio (INR) associated with the concomitant use of ibuprofen and warfarin. Case Summary: A 74-year-old white woman receiving warfarin for a history of cerebrovascular accident and deep-vein thrombosis with concomitant chronic obstructive pulmonary disease, hypertension, congestive heart failure, coronary artery disease, osteoarthritis, and erosive esophagitis developed significant elevation of the INR after the addition of ibuprofen to her medication regimen. The patient experienced a decrease in hemoglobin concentration, asymptomatic hypotension, and increased blood urea nitrogen/creatinine ratio. Limited physical examination failed to locate a source of bleeding. Discussion: The pharmacokinetic and pharmacodynamic interactions involving nonsteroidal antiinflammatory agents and warfarin are well documented. Limited data from healthy volunteers and patients without complex medical problems suggest that ibuprofen and warfarin may be given concomitantly with relative safety. This report describes an elderly patient with multiple medical problems, treated with numerous medications, including warfarin, who developed signs suggestive of subclinical bleeding and an INR of 14.3 after the addition of low-dose ibuprofen. Conclusions: Concomitant use of ibuprofen and warfarin should be avoided in elderly patients with complex medical problems treated with multiple medications.
Use of Erythropoietin in the Severely Anemic Jehovah's Witness Patient: Case Report and Review of the Literature
Authors: Rogers P David , Volles David F 
Published: July 2017

Objective: To describe and discuss the use of erythropoietin as a therapeutic option for treatment of severe anemia in a patient whose religious beliefs preclude the use of blood products. Case Summary: A 23-year-old male Jehovah's Witness patient presented to the emergency department with multiple fractures and significant blood loss secondary to trauma experienced in a motor vehicle accident. The patient refused transfusion because of his religious beliefs. He was given oxygen and lactated Ringer's solution, and phlebotomy was kept to a minimum. Erythropoietin was recommended to increase production of red blood cells. Review of the product information revealed that all available erythropoietin products contain human albumin as a stabilizer. After discussion with the clinical pharmacist, the patient and his family agreed to the use of erythropoietin. The patient's hematocrit and hemoglobin improved sufficiently for him to be taken to surgery on hospital day 12, and on hospital day 23 he was discharged. Discussion: Because Jehovah's Witnesses refuse to receive blood products, alternative methods for treatment of severe anemia must be used. Although some options are clearly unacceptable, certain volume expanders can be used in conjunction with oxygen and intravenous or oral iron that do not violate the patient's religious convictions. Erythropoietin is acceptable to most Jehovah's Witnesses; however, it contains human album (2.5 mg/mL), which may be of concern to some of these patients. Conclusions: Effective communication with the patient and the patient's family regarding all treatment options is required for treatment of severe anemia in the Jehovah's Witness patient. Erythropoietin, in conjunction with iron, adequate oxygenation, and good nutritional support, sometimes is an acceptable alternative in Jehovah's Witnesses.
Evaluation of ACE Inhibitor Therapy for Congestive Heart Failure in an Outpatient Setting
Authors: Bleske Barry E , Cornish Laura A , Erickson Steven R , Nicklas John M 
Published: July 2017

Objective: Angiotensin-converting enzyme (ACE) inhibitor therapy is considered the standard of care for the treatment of congestive heart failure. Despite this, clinical experience suggests that not all patients may be receiving ACE inhibitor therapy or may be receiving low dosages. This study was performed to better understand the use of ACE inhibitor therapy in clinical practice. Design and Participants: We reviewed the medical therapy of 110 patients with a history of congestive heart failure referred to an outpatient heart failure clinic at a university teaching hospital. Outcome Measures: This observational study evaluated the use of ACE inhibitors, including dosage, as well as other drugs to treat congestive heart failure. Results: Approximately 85% (93/110) of patients were receiving an ACE inhibitor. Twenty percent (22/110) were receiving enalapril 20 mg/d or more, captopril 150 mg/d or more, lisinopril 20 mg/d or more, or quinapril 40 mg/d or more. The remaining patients (n = 71) were receiving these drugs at lower dosages. However, 21 of the remaining patients (19% of all patients) were receiving lower dosages based on patient-specific parameters; 47 of the remaining patients (43% of all patients) were eligible to have their dosage increased. Ten eligible patients were not receiving an ACE inhibitor. The majority of patients were also receiving digoxin (70%) and loop diuretic (80%) therapy. Conclusions: Approximately 85% of patients were receiving ACE inhibitor therapy, with 9% of eligible patients not receiving an ACE inhibitor. In the patients receiving ACE inhibitor therapy, approximately 50% (47/93) were receiving dosages below those suggested in the guidelines. Overall, the use of ACE inhibitor therapy is varied and intervention appears required to ensure that all patients receive appropriate therapy for the treatment of congestive heart failure.
Once-Daily Aminoglycosides: A Meta-Analysis of Nonneutropenic and Neutropenic Adults
Authors: Kale-Pradhan Pramodini B , Habowski Suzette R , Chase Heather C , Castronova Frank C 
Published: July 2017

Objective: To compare the efficacy, nephrotoxicity, and ototoxicity of once-daily dosing of aminoglycosides versus conventional dosing. Design: Meta-analysis of 14 randomized trials identified through a MEDLINE search (January 1965-May 1996). Patients: Neutropenic and nonneutropenic adults. Interventions: Patients were randomly selected to receive an aminoglycoside once daily or in multiple daily doses. Measurements and Main Outcomes: The outcomes considered were clinical cure, bacteriologic cure, nephrotoxicity, auditory toxicity, and vestibular toxicity. The data were analyzed in the following subgroups: (1) all trials, (2) nonneutropenic patients, (3) neutropenic patients, and (4) patients with undefined neutrophil status. For all trials the pooled risk ratio was 1.268 (95% CI 0.828 to 1.939) for clinical cure, and was 1.390 (95% CI 1.350 to 1.392) for bacteriologic cure. Nephrotoxicity had a pooled risk ratio of 0.765 (95% CI 0.468 to 1.252), that for auditory toxicity was 1.117 (95% CI 0.151 to 5.636), and that for vestibular toxicity was 1.155 (95% CI 0.221 to 6.039). Analysis of the subgroups, including a separate analysis of neutropenic patients, demonstrated similar results. Conclusions: When all trials were considered, once-daily administration of aminoglycosides had similar efficacy and no increase in nephrotoxicity or ototoxicity compared with conventional aminoglycoside dosing.
Impact of Targeted Antibiotic Restriction on Usage and Cost in a Community Hospital
Authors: Mercer Kenneth A , Chintalapudi Srinivasa R , Visconti Ernest B 
Published: July 2017

Objective: To determine whether antibiotic restriction can produce savings. Design: Cost comparative analysis before and after antibiotic control. Methods: Cost control policy included removal of nonessential antibiotics from the emergency department and the operating room, the use of a clinical pathway protocol for pneumonia, and approval from the infectious disease consultant for certain high-cost antibiotics. Setting: Lutheran Medical Center, a community hospital in Brooklyn, New York. Results: Between the two 12-month periods analyzed (March 1995-February 1996 vs. March 1996-February 1997), we found a cost reduction of approximately 26% among intravenous antibiotics with a concomitant 10% cost reduction in oral antibiotics. Intravenous antibiotic use decreased by more than 22%, especially with regard to higher priced agents. Furthermore, we documented a 24% reduction in cost per patient. Hospital admission rates declined only 2.5% during the second 12-month period. Conclusions: Appropriate restriction of antibiotics can be done effectively and simply in a local hospital with no additional funding and achieve considerable cost savings.
Simvastatin and Rhabdomyolysis — A Case Report and Brief Review
Authors: Pershad Ashish , Cardello Frank P 
Published: July 2017

Objective: To report an unusual case of simvastatin-induced rhabdomyolysis and to discuss the occurrence of this potentially fatal adverse effect. Case Summary: A 61-year-old white man was admitted to the hospital with angina and myalgia. Laboratory data obtained on admission confirmed the clinical diagnosis of simvastatin-induced rhabdomyolysis. The medication was discontinued, and the patient's rhabdomyolysis resolved. Three months later, a rechallenge with simvastatin resulted in the recurrence of myalgia and elevation of the creatine kinase concentration. Discontinuation of the medication resulted in improvement of symptoms and return of the creatine kinase concentration to within normal limits. Discussion: Although simvastatin-induced rhabdomyolysis is a well-described entity, the occurrence of rhabdomyolysis at the lowest prescribed dose in the absence of concomitant interacting drugs is rare. The mechanism of this adverse effect is postulated to be related to mitochondrial dysfunction due to a relative deficiency of skeletal muscle Co Q10 induced by the drug. Conclusions: Simvastatin, even at the lowest prescribed dose and in the absence of drugs known to interact adversely with it, can cause potentially life-threatening rhabdomyolysis. This case report shows that cautioning all patients about this rare yet serious adverse effect is critical.
Data-Derived Treatment Duration Goal for Cervical Cancer: Should 8 Weeks Remain the Target in the Era of Concurrent Chemoradiation?
Authors: Hong Julian C. , Foote Jonathan , Broadwater Gloria , Sosa Julie A. , Gaillard Stephanie , Havrilesky Laura J. , Chino Junzo P. 
Published: July 2017

Purpose Prior studies have demonstrated the importance of treatment duration (TD) in radiation therapy (RT) for cervical cancer, with an 8-week goal based primarily on RT alone. This study uses a contemporary cohort to estimate the time point by which completion of chemoradiation therapy is most critical. Patients and Methods The National Cancer Database was queried for women with nonmetastatic cervical cancer diagnosed from 2004 to 2012 who underwent chemotherapy, external beam RT, and brachytherapy. Data-derived TD cut points for overall survival (OS) were computed by using recursive partitioning analysis with bootstrapped aggregation (bagging) and 10-fold cross-validation. Models were independently trained with 70% of the population and validated on 30% of the population by log-rank test with and without propensity matching. Multivariable Cox proportional hazards regression was performed for the entire cohort. Results In all, 7,355 women were identified with a median TD of 57 days. Bagged recursive partitioning analysis converged to a mean cut point of 66.6 days (median, 64.5 days; interquartile range, 63.5 to 68.5 days). Cross-validation yielded a cut point of 63.3 days. Both cut points differentiated OS in validation. Younger age, recent diagnosis, geographic region, nongovernment insurance, shorter distance to treatment facility, metropolitan location, lower comorbidity, squamous cell carcinoma, lower stage, negative lymph nodes, and shorter TD were independently associated with longer OS. With adjustment, TD within the mean cut point (64.9 days; hazard ratio, 0.79; 95% CI, 0.73 to 0.87) and 56 days (hazard ratio, 0.87; 95% CI, 0.80 to 0.95) were associated with longer OS. Exploratory stratification suggested increasing OS detriment beyond 64 days. Conclusion Shorter chemoradiation TD in cervical cancer is associated with longer survival, and TD should be minimized as much as possible. The data-derived cut point was distributed around 64 days, with a continuous relationship between shorter TD and longer OS.
Implementation and Clinical Utility of an Integrated Academic-Community Regional Molecular Tumor Board
Authors: Burkard Mark E. , Deming Dustin A. , Parsons Benjamin M. , Kenny Paraic A. , Schuh Marissa R. , Leal Ticiana , Uboha Nataliya , Lang Joshua M. , Thompson Michael A. , Warren Ruth , Bauman Jordan , Mably Mary S. , Laffin Jennifer , Paschal Catherine R. , Lager Angela M. , Lee Kristy , Matkowskyj Kristina A. , Buehler Darya G. , Rehrauer William M. , Kolesar Jill 
Published: July 2017

Purpose
Precision oncology develops and implements evidence-based personalized therapies that are based on specific genetic targets within each tumor. However, a major challenge that remains is the provision of a standardized, up-to-date, and evidenced-based precision medicine initiative across a geographic region.

Materials and Methods
We developed a statewide molecular tumor board that integrates academic and community oncology practices. The Precision Medicine Molecular Tumor Board (PMMTB) has three components: a biweekly Web-based teleconference tumor board meeting provided as a free clinical service, an observational research registry, and a monthly journal club to establish and revise evidence-based guidelines for off-label therapies. The PMMTB allows for flexible and rapid implementation of treatment, uniformity in practice, and the ability to track outcomes.

Results
We describe the implementation of the PMMTB and its first year of activity. Seventy-seven patient cases were presented, 48 were enrolled in a registry, and 38 had recommendations and clinical follow-up. The 38 subjects had diverse solid tumors (lung, 45%; GI, 21%; breast, 13%; other, 21%). Of these subjects, targeted therapy was recommended for 32 (84%). Clinical trials were identified for 24 subjects (63%), and nontrial targeted medicines for 16 (42%). Nine subjects (28%) received recommended therapy with a response rate of 17% (one of six) and a clinical benefit rate (partial response + stable disease) of 38% (three of eight). Although clinical trials often were identified, patients rarely enrolled.

Conclusion
The PMMTB provides a model for a regional molecular tumor board with clinical utility. This work highlights the need for outcome registries and improved access to clinical trials to pragmatically implement precision oncology.
Plasma DNA-Based Molecular Diagnosis, Prognostication, and Monitoring of Patients With EWSR1 Fusion-Positive Sarcomas
Authors: Shukla Neerav N. , Patel Juber A. , Magnan Heather , Zehir Ahmet , You Daoqi , Tang Jiabin , Meng Fanli , Samoila Aliaksandra , Slotkin Emily K. , Ambati Srikanth R. , Chou Alexander J. , Wexler Leonard H. , Meyers Paul A. , Peerschke Ellinor I. , Viale Agnes , Berger Michael F. , Ladanyi Marc 
Published: July 2017

Purpose Ewing sarcoma (ES) and desmoplastic small round cell tumors (DSRCTs) are aggressive sarcomas molecularly characterized by EWSR1 gene fusions. As pathognomonic genomic events in these respective tumor types, EWSR1 fusions represent robust potential biomarkers for disease monitoring. Methods To investigate the feasibility of identifying EWSR1 fusions in plasma-derived cell-free DNA (cfDNA) from patients with ES and DSRCT, we evaluated two complementary approaches in samples from 17 patients with radiographic evidence of disease. The first approach involved identification of patient-specific genomic EWSR1 fusion breakpoints in formalin-fixed, paraffin-embedded tumor DNA using a broad, hybridization capture-based next-generation sequencing (NGS) panel, followed by design of patient-specific droplet digital polymerase chain reaction (ddPCR) assays for plasma cfDNA interrogation. The second approach used a disease-tailored targeted hybridization capture-based NGS panel applied directly to cfDNA, which included EWSR1 as well as several other genes with potential prognostic use. Results EWSR1 fusions were identified in 11 of 11 (100%) ES and five of six (83%) DSRCT cfDNA samples by ddPCR, whereas 10 of 11 (91%) and four of six (67%) were identified by NGS. The ddPCR approach had higher sensitivity, ranging between 0.009% and 0.018%. However, the hybrid capture–based NGS assay identified the precise fusion breakpoints in the majority of cfDNA samples, as well as mutations in TP53 and STAG2, two other recurrent, clinically significant alterations in ES, all without prior knowledge of the tumor genotype. Conclusion These results provide a compelling rationale for an integrated approach using both NGS and ddPCR for plasma cfDNA-based biomarker evaluations in prospective cooperative group studies.