bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wellness Programs With Financial Incentives Through Disparities Lens
Authors: Cuellar Alison , LoSasso Anthony T. , Shah Mona , Atwood Alicia , Lewis-Walls Tanya R. 
Published: December 2017

Purpose: To examine wellness programs with financial incentives and their effect on disparities in preventive care. Design: Financial incentives were introduced by 15 large employers, from 2010 to 2013. Setting: Fifteen private employers. Subjects: A total of 299 436 employees and adult dependents. Measures: Preventive services and participation in financial incentives. Analysis: Multivariate linear regression. Results: Disparities in preventive services widened after introduction of financial incentives. Asians were 3% more likely and African Americans were 3% less likely to receive wellness rewards than whites and non-Hispanics, controlling for other factors. Conclusion: Federal law limits targeting of wellness financial incentives by subgroups; thus, employers should consider outreach and culturally appropriate messaging.
Bereaved Parents’ Health Status During the First 6 Months After Their Child’s Death
Authors: Dias Nancy , Brandon Debra , Haase Joan E. , Tanabe Paula 
Published: December 2017

Purpose: To examine bereaved parents’ physical, mental, and social health during the first 6 months after their child’s (<12 years) death from a life-threatening illness. Background and Significance: Bereaved parents have higher mortality and morbidity rates when compared to nonbereaved parents. Acute illnesses, hospitalizations, and medication changes are highest in the first 6 months. An understanding of bereaved parents’ health risk indicators can help inform development of health promotion and disease prevention measures. Methods and Analysis: A prospective descriptive study examined 8 parent dyads. Parents completed health surveys (Patient-Reported Outcomes Measurement Information System–global, social, and sleep; Brief Symptom Inventory [BSI] 18), which are used to assess parents’ health at 3 and 6 months after their child’s death. Demographic data included a medical history, hospital or emergency department visits, and smoking and alcohol intake. Descriptive statistics were used to compare parents’ scores to US general population scores. Findings: Mothers’ and fathers’ physical, mental, and sleep health scores were typically within 1 to 2 standard deviations of the population norms. However, their social health scores were as low as 3 standard deviations and all parents’ scores were below population norms. Four (25%) of the 16 parents had new diagnosis during the first 6 months. Based on the BSI-18, 3 parents had their scores above population cutoffs, which warranted a need for further clinical evaluation. Conclusions: Health data highlight the “at-risk” health status of bereaved parents. Further validation of these data is required to support the development of health promotion and disease prevention programs.
An Aerosol Laboratory in a Hospital Pharmacy
Authors: Gallelli Joseph F. , Crossley Ray D. , Skolaut Milton W. 
Published: December 2017

An aerosol laboratory was established in the hospital pharmacy at The Clinical Center of the National Institutes of Health in late 1965. The need for such a laboratory was prompted by the requests of nurses and clinical investigators for pharmaceuticals in an aerosol dosage form. Specifically, physicians in the Dermatology Branch of the National Cancer Institute had requested the formulation of dermatological preparations in the form of aerosols for the possible treatment of patients with mycosis fungoides. It was hoped that aerosol therapy would be effective and lead to better patient care because of its ease of application, elimination of contamination or deterioration of product by contact, oxidation, moisture or light, and elimination of physical contact with a consequent reduction of pain and infection. Evaluation of the potential usefulness of an aerosol unit in a hospital pharmacy, and the advantages and disadvantages of such a unit, are reported. Selection of the basic equipment needed for the aerosol filling or packaging, principles of operation and control and evaluation procedures are discussed.
Investigational Drug Information
Authors: Kleinman Larry M. , Tangrea Joseph A , Gallelli Joseph F. 
Published: December 2017

The drug information appearing in this column is for investigational drugs studied in clinical research protocols being pursued in the Clinical Center at the National Institutes of Health. As with all investigational drugs, the drugs reported in this column have a Notice of Claimed Investigational Exemption for a New Drug (IND) assigned to them by the Food and Drug Administration (F.D.A.).
Investigational Drug Information
Authors: Kleinman Larry M. , Tangrea Joseph A. , Gallelli Joseph F. 
Published: December 2017

The drug information appearing in this column is for investigational drugs studied in clinical research protocols being pursued in the Clinical Center at the National Institutes of Health. This same information, in the form of an “Investigational Drug Fact Sheet,” is distributed, prior to its use, to the dispensing pharmacist and the appropriate nursing units involved in the administration of the drug As with all investigational drugs, the drugs reported in this column have a Notice of Claimed Investigational Exemption for o New Drug (IND) assigned to them by the Food and Drug Administration (F.D.A.).
A Review with a Case History on the Effect of Renal Failure
Authors: Kradjan Wayne A. 
Published: December 2017

Although the majority of individuals medicated with diphenylhydantoin require doses in the range of 4–6 mg/kg/day (300–400 mg/day), there are many people who are known to deviate from this average in their requirements. Other persons may be stablized on a given dose of diphenylhydantoin, yet develop toxic signs or demonstrate lack of therapeutic effect at a later time. This paper reviews basic pharmacokinetics and elimination data for diphenylhydantoin, as well as the various parameters recognized as influencing diphenylhydantoin dosing requirements. A case history is presented1 to illustrate the possible effects of renal failure and how one individual's requirements changed as his clinical status changed. Among the physiological factors considered are liver function, renal function, genetic influences on metabolic disposition, and alterations that occur in serum protein binding of diphenylhydantoin. Physical characteristics that are considered include variability in formulation of various solid oral dosage forms, hazards of oral suspensions of diphenylhydantoin, efficacy of intramuscular injections, and failure of diphenylhydantoin to obey first order elimination kinetics. Finally, interaction of other drug products with diphenylhydantoin is discussed and summarized.
Amiloride (Midamor®, Merck, Sharp and Dohme)
Authors: Macfie Helen L. , Colvin Carol L. , Anderson Philip O. , Jackson Eric A. , Cardoni Alex A. , Lebel Marc 
Published: December 2017

Amiloride is a potassium-sparing diuretic that is pharmacologically similar to triamterene. It has been widely used abroad for several years, alone and in combination with hydrochlorothiazide. As a potassium-sparing agent, amiloride appears to be approximately as effective as triamterene and spironolactone and to have a longer duration of action than triamterene, allowing once daily dosing. The diuretic effect of amiloride is mild, as are all agents that act at distal tubular sites. Amiloride appears to have an antihypertensive effect approximating that of the thiazides and spironolactone – an advantage over triamterene, which is devoid of antihypertensive effects. Amiloride will probably be most useful as a potassium-sparing agent in combination with the thiazide and loop diuretics. It should be kept in mind, however, that many patients on thiazide diuretics do not need supplemental potassium or potassium-sparing agents if they have no other complicating factors, such as digitalis therapy. When hypokalemia causes symptoms, a potassium-sparing agent may have advantages over oral potassium supplements in patient tolerance and compliance. Because of the possibility of tumorigenicity and estrogenic side effects, spironolactone's popularity has been decreasing in recent years. Amiloride will probably be a strong competitor of triamterene and spironolactone because of its longer duration of action than triamterene and, from early indications (cf. ticrynafen), more benign side effects than spironolactone. The drug should be used with great caution, if at all, in patients with impaired renal function, however. The benefits of amiloride will have to be weighed against the cost of the drug in individual patients.
Actinomycosis: The Disease and its Treatment
Authors: Robbins Terry S. , Scott Steven A. , Roy Myrella 
Published: December 2017

The diagnosis of actinomycosis is often missed because anaerobic cultures are difficult to obtain and the clinical presentation of actinomycosis often resembles several other disease states. The presence of external draining sinuses and/or yellow sulfur granules upon microscopic examination should direct the clinician toward a correct diagnosis. Therapeutic measures usually consist of several weeks of high dose intravenous penicillin followed by weeks to months of oral penicillin, tetracycline, clindamycin, or erythromycin. Abscesses and empyemas require surgical drainage in addition to antibiotic therapy. The prognosis is usually favorable with early detection and proper treatment. A case of pulmonary actinomycosis is described in a patient who presented with fever, weight loss, and a painful mass on his lower anterior left rib cage. Gram-stain and culture and sensitivity tests performed on the fluid drawn off the chest wall mass revealed Actinomyces israelii as the infecting organism. The patient was successfully treated with long-term penicillin therapy. A review of this rare bacterial disease is presented, emphasizing its treatment and its similarities and differences to other bacterial and fungal diseases.
Nalidixic Acid-Induced Photodermatitis after Minimal Sun Exposure
Authors: Boisvert Alain , Barbeau Gilles , Boisvert Alain 
Published: December 2017

More than 30 cases of bullous photodermatitis have already been associated with the administration of nalidixic acid. This reaction is reported in a 57-year-old woman whose sun exposure was minimal. Nalidixic acid-induced photoreactions generally occur in females; they affect mainly the dorsal surfaces of the hands, feet, and legs, and usually do not involve the face. Blistering is always reported, and erythema is common. Dosage regimen and duration of treatment have little influence on the onset and severity of the reaction, which is probably of allergic nature. Its duration may be long, from three to six weeks, and reexposure to the sun may trigger the reappearance of blistering for several months, even in the absence of a drug rechallenge.
Treatment of Nongonococcal Bacterial Septic Arthritis
Authors: Fraser Gilles L. 
Published: December 2017

Septic arthritis carries significant morbidity and mortality, necessitating prompt, appropriate therapy with joint fluid aspiration, intravenous antibiotics, and, occasionally, surgical intervention. The initial choice of antimicrobial agent is guided by the results of synovial fluid gram stain, by identification of the pathogenesis of the primary focus, or by epidemiologic factors. Adequacy of therapy is assessed by serial synovial fluid white blood cell counts and by determining antimicrobial concentrations in the joint space. The goal of treatment is a clinically normal and sterile joint. Factors that may affect antimicrobial joint penetration include the degree of joint tissue inflammation, the degree of drug protein binding, and the chemical characteristics of the drug. Perhaps most important in determining the extent of joint penetration are factors that may affect serum antibiotic concentrations, for example, dose, route of administration, volume of distribution, and rate of elimination.
A Suspected Case of Codeine-Induced Erythema Multiforme
Authors: Ponte Charles D. 
Published: December 2017

Erythema multiforme usually presents as an acute inflammatory reaction involving the skin and mucous membranes. Systemic symptoms and organ involvement also can occur. The disease is associated with many illnesses and drugs. A two-year-old child presented to the Family Practice Center with a probable codeine-induced episode of erythema multiforme. The patient had been treated with Actifed-C Expectorant for a suspected viral upper respiratory tract infection. The rash was characteristic of erythema multiforme, but there was no involvement of mucous membranes. The rash quickly abated after the discontinuation of the drug and the administration of hydroxyzine. A viral cause for the rash could not be ruled out. When erythema multiforme is precipitated by a particular drug, discontinuation of the offending agent is necessary. The rash should disappear quickly. Adjunctive use of antihistamines may offer some benefit for the patient. Systemic corticosteroids may be necessary for more severe cases.
Geriatrics & Gerontology: Pharmacists' Perceptions of Geriatric Pharmacy Practice
Authors: Lamy Peter P. , Simonson William , Pratt Clara C. 
Published: December 2017

Four hundred thirty-two pharmacists from two separate pharmacy organizations associated with geriatric practice were surveyed to determine their perceptions of 51 content areas in terms of their importance for inclusion in pharmacy curricula. The population surveyed was also asked to respond to the question: What do you believe is the most difficult aspect of geriatric pharmacy practice? Demographic and descriptive information was collected for each respondent, for statistical purposes. The most important content areas for inclusion in pharmacy curricula were the pharmacist's responsibility in long-term care, patient compliance, drug interactions, adverse drug reactions, and psychotropic medication use. The most difficult aspects of geriatric pharmacy practice identified included inadequate geriatric knowledge, patient compliance, physician overprescribing, communication with the elderly, and lack of professional and/or financial recognition.
Other NSAIDs of Choice for Rheumatoid Arthritis
Authors: Ehrlich George E. 
Published: December 2017

Aspirin is an effective anti inflammatory and analgesic agent. Pain relief is achieved with relatively modest doses, far below those necessary for inflammation control. The patient reacts to the need for pain relief and will take fewer aspirin than prescribed because the lower dosage is better tolerated and less expensive. This often obviates the wanted effects. This pain-inflammation gap does not exist for most nonsteroidal anti inflammatory drugs (NSAIDs), in which analgesic and anti inflammatory doses approximate each other. The range of toxic effects from aspirin is larger than that for nonsteroidal drugs. Gastric erosions and bleeding are far more prevalent with aspirin. Other organ systems are involved more by aspirin than by other drugs, and, in osteoarthritis, aspirin actually may militate against recovery by interfering with glycosaminoglycan synthesis.
Nonrheumatologic Uses of NSAIDS
Authors: Evens Ronald P. 
Published: December 2017

Nonsteroidal anti inflammatory drugs (NSAIDs) have several salient indications outside of their role in rheumatology. Two major uses are treatment of dysmenorrhea and patent ductus arteriosus. Other established roles encompass treatment of fever, pain, Banter's syndrome, and thromboembolic disorders. Animal and human studies are being done on the use of NSAIDs in cancer, diabetes, psoriasis, and shock, just to name a few investigative areas. NSAIDs are not a panacea nor are they wonder drugs to be used indiscriminately. When these drugs first were marketed in the 1970s, they were considered safe agents with little toxicity. However, the side-effect profile of the NSAIDs has been, and continues to be, better identified over the past few years and warrants judicious use of these drugs. Their adverse effects potentially include gastric distress (possibly hemorrhage), allergic urticaria or bronchospasm in asthma patients, azotemia, arrested labor, skin reactions, and water retention. NSAIDs are relatively safe agents with a growing list of new indications. Future clinical evaluation holds the key to the balance between their emerging toxicities and indications.
Major Issues Facing the Pharmaceutical Industry and Their Relationship to Clinical Pharmacy
Authors: Riddiough Michael A. 
Published: December 2017

There are two major issues that have potential for positive interactions between the industry and clinical pharmacy. These are drug selection and reimbursement, and clinical research. The first issue embodies the drug prescribing process, which has been, until recently, almost the sole purview of physicians. For this reason, pharmaceutical manufacturers have marketed their products primarily to this group. Changes are occurring; other licensed practitioners, including clinical pharmacists, are gaining prescribing authority. Schools of pharmacy have trained several thousand clinical pharmacists over the past decade, while the pharmacology component of medical education and the time devoted to clinical therapeutics either has stagnated or declined during the same period. Meanwhile, drug information has increased and the need to monitor drug selection to curtail costs has widened the opportunities for clinical pharmacists to exert an influence. The pharmaceutical industry needs to recognize the role clinical pharmacists play in drug selection. Drug selection decisions obviously influence drug reimbursement decisions, which influence drug sales, which influence profits. Clinical research is the backbone of a company's financial success and is becoming technologically sophisticated. Companies are becoming aware that many clinical pharmacists are able to collect and analyze clinical drug data as well as, or possibly better than, physicians. Clinical pharmacists can play a significant role in monitoring the safety and efficacy of marketed drugs. Good postmarketing surveillance data collection systems need to be developed.
AMA's Drug Information Data Base: Program Capabilities and Opportunities for Clinical Pharmacy
Authors: Weaver Ross H. 
Published: December 2017

The AMA drug information base (AMA-DIB) is reviewed and the impact of computerized drug data bases on the practice of clinical pharmacy is discussed. The AMA-DIB is an on-line data base derived from the fifth edition of AMA Drug Evaluations. Thus, it represents consensus information. The data base consists of individual drug records, pharmacologic class records, and therapeutic class records. It is accessed via commands using keyword searches. Computerized on-line drug data bases will have an impact on the practice of clinical pharmacy. Information resource services will either discontinue or proliferate, depending on the quality of the service and the ability of the directors to adapt to future needs. Patient monitoring services will discover that these data bases allow easier access to more information, but the computer will not be able to transfer the data to direct patient care. Thus, their professional roles will remain intact. Clinical pharmacy researchers, in contrast, will notice little or no impact on their practice.
Adverse Dermatologic Reaction to Transdermal Nitroglycerin
Authors: Letendre Peter W. , Barr Charles , Wilkens Kim 
Published: December 2017

The incidence of adverse effects from transdermal nitroglycerin systems is reported to be very low. A cutaneous reaction from Transderm-Nitro is described. The patient in this case was a 63-year-old male with a history of chronic obstructive lung disease, adult onset diabetes mellitus, peptic ulcer disease, congestive heart failure, and angina pectoris. Seven weeks after having used a Transderm-Nitro-5 patch daily, the patient was found to have two macular erythematous areas on his chest that corresponded to the exact sites of the nitroglycerin patch. Follow-up with the same patient, using a placebo Transderm-Nitro, elicited a reaction similar in appearance. The exact causative agent is unknown, but it is believed to be from the transdermal delivery system and not the nitroglycerin.
Lactulose-Induced Hypernatremia
Authors: Nanji Amin A. , Lauener Roland W. 
Published: December 2017

We describe severe hypernatremia in a patient with hepatic encephalopathy, who was treated with lactulose. Lactulose produces hypernatremia via its osmotic effect and its degradation to organic acids. We recommend that patients who receive large quantities of lactulose and who lack access to free water have their electrolytes monitored and the dose tapered as quickly as possible.
Doxorubicin: Alteration of Dose Scheduling as a Means of Reducing Cardiotoxicity
Authors: Lum Bert L. , Svec Jennifer M. , Torti Frank M. 
Published: December 2017

The long-term therapeutic potential of doxorubicin is often limited by the predictable development of a dose-related cardiomyopathy. Empiric limitations of cumulative doses to 450–550 mg/m2 minimize the incidence of this potentially fatal toxicity. This review presents recent studies performed to examine the potential for altered dose schedule to reduce or delay this toxicity and maintain therapeutic efficacy. Altering doxorubicin's dosing schedule from the standard three-weekly regimen to a continuous infusion or weekly schedule has been shown to delay cardiotoxicity. Data presented suggest that doxorubicin administered on a weekly schedule significantly reduces cardiotoxicity as compared with a three-weekly schedule and allows approximately 160 mg/m2 more of the drug to be administered to reach the same level of cardiotoxicity as measured by endomyocardial biopsy. This corresponds clinically to two additional months of therapy. Cumulated response data suggest that continuous infusion or weekly schedules of doxorubicin are equally efficacious as the standard three-weekly schedule.
Imipenem/Cilastatin: The First Carbapenem Antibiotic
Authors: McLeod Donald C. , Lyon James A. 
Published: December 2017

Imipenem/cilastatin is the first of a new class of β-lactam antibiotics called carbapenems. The antibacterial spectrum of imipenem exceeds any antibiotic investigated to date and includes gram-positive, gram-negative, and anaerobic organisms. Only methicillin-resistant organisms, Strep. faecium, Pseudomonas cepacia, and Pseudomonas maltophilia have been shown to be resistant. Imipenem is administered in a 1:1 ratio with cilastatin, which inhibits a renal enzyme (dehydropeptidase) and improves urinary recovery of imipenem. The elimination half-life of both compounds is 1.0 hours and recommended doses are 0.25–0.5 g iv q6h. Adverse events are similar in nature and incidence to β-lactam antibiotics, with phlebitis/thrombophlebitis, diarrhea, nausea, skin rash, and elevations of hepatic enzymes most common. Clinical studies in phase II and III trials have shown imipenem/cilastatin to be effective in soft tissue infections, endocarditis, obstetrics and gynecology, complicated urinary tract infections, mixed anaerobic-aerobic infections, osteomyelitis, bacteremias, and pneumonias. Several comparative clinical trials have shown imipenem/cilastatin to be equal in efficacy to combination therapy. Imipenem/cilastatin may prove to be an alternative to combination antibiotic therapy because of its extremely broad spectrum of activity.