bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-Dose Intravenous Immune Globulin in the Management of Severe Guillain-Barre Syndrome
Authors: Urtasun Miguel , de Murrain Adolfo López , Carrera Nieves , Martí-Massó José F. , de Dicastillo Gonzalo López , Mozo Carmela 
Published: January 2017

OBJECTIVE: To evaluate the efficacy of high-dose intravenous gammaglobulin (IGIV) versus plasmapheresis in patients with severe Guillain-Barré syndrome (GBS) and compare the costs of both treatments. DESIGN: Retrospective review of all severely disabled GBS patients admitted between January 1 and December 31, 1990. SETTING: Neurologic unit of a tertiary-care center. PATIENTS: Six patients fulfilling the criteria for the diagnosis of GBS agreed upon by the ad hoc National Institute of Neurological and Communicative Disorders and Stroke committee. INTERVENTION: Four patients treated with plasmapheresis underwent three to six sessions of plasma exchange. Two patients received IGIV 0.4 g/kg/d administered over a five-day period. MAIN OUTCOME MEASURES: Recovery time, functional assessment (performed according to the grading scale used in the North American trial) at 30, 60, and 90 days after treatment. Cost of plasmapheresis, IGIV, and bed/day were compared. RESULTS: Clinical recovery appeared to be faster and more complete in the IGIV group than in the plasmapheresis group. No adverse reactions related to IGIV treatment appeared. The total cost was greater in the plasmapheresis group. CONCLUSIONS: These preliminary results suggest that IGIV may be more beneficial and less expensive than plasmapheresis in treatment of GBS. Definitive conclusions regarding the efficacy of IGIV in GBS will need to await the final analysis of the Ducht randomized multicenter trial comparing IGIV with plasmapheresis.
Nephrotoxicity of Contrast Media following Cardiac Angiography: Pathogenesis, Clinical Course, and Preventive Measures, Including the Role of Low-Osmolality Contrast Media
Authors: Spinier Sarah A. , Goldfarb Stanley 
Published: January 2017

OBJECTIVE: To review the incidence, definition, clinical course, risk factors, pathogenesis and prevention of contrast-associated nephropathy (CAN) following cardiac angiography with emphasis on differences between high-osmolality contrast media (HOCM) and low-osmolality contrast media (LOCM). DATA SOURCES: Investigations in animal models and in patients following cardiac angiography. DATA EXTRACTION: Animal models of the pathogenesis of CAN are presented. Human studies describing the incidence, clinical course, risk factors, and prevention of CAN are reviewed. Comparative clinical trials of HOCM (diatrizoate, metrizoate) and LOCM (iohexol, iopamidol, ioxaglate) nephrotoxicity following cardiac angiography are critically evaluated. DATA SYNTHESIS: All clinical studies comparing CAN of HOCM versus LOCM following cardiac angiography have some methodologic limitations (e.g., small sample size, lack of control for other factors) that may affect renal function, lack of stratification for other reported risk factors, and variable or short follow-up periods. CONCLUSIONS: Whether the incidence of CAN following cardiac angiography is reduced with LOCM remains controversial. The incidence of CAN in patients with normal renal function does not appear to differ in patients treated with LOCM versus HOCM because few patients in each group develop renal failure. Additional controlled clinical trials comparing CAN of LOCM and HOCM in patients with renal dysfunction are needed. Because of greater product cost and scarcity of documented benefit compared with HOCM, selection of LOCM based on the presence of renal dysfunction cannot be recommended at this time.
Beta-Adrenergic Agonists for Acute, Severe Asthma
Authors: Kelly H. William , Murphy Shirley 
Published: January 2017

OBJECTIVE: To critically review the use of beta-adrenergic agonists in acute, severe asthma with particular focus on aerosol administration. DATA SOURCES: English language articles published since 1971 on the use of beta-agonists for acute asthma. Studies were identified from bibliographies of book chapters, review articles, and other research articles. STUDY SELECTION: All studies (21 total) comparing systemic with inhaled beta-agonists were reviewed, regardless of their design or outcome. Selected studies highlighting specific aspects of beta-agonist use in acute asthma such as beta-agonists versus other bronchodilators, aerosol delivery, and intravenous beta-agonists were also reviewed. DATA EXTRACTION: Performed subjectively by the authors with specific aspects of quality discussed within the body of the article. DATA SYNTHESIS: The beta-agonists provide superior bronchodilation in acute severe asthma compared with either the methylxanthines and/or anticholinergics. The majority of studies found aerosolized beta-agonists to be either as effective as or more effective than parenteral beta-agonists and to produce fewer adverse cardiovascular effects. Studies showing preference for parenteral therapy have either been of poor design or used low doses of an aerosolized beta-agonist. Based on studies of aerosol delivery, there is no advantage of jet nebulization over metered-dose inhalers; however, other aspects, including ease of administration, favor nebulization as the delivery method of choice. The articles recommending intravenous beta-agonists consist of a series of uncontrolled cases. CONCLUSIONS: Aerosolized selective beta2-agonists are the bronchodilator treatments of choice for acute, severe asthma. Attention to the details of dosing and delivery are required for optimal results. The final dose and dosing interval are determined by the patient's response. Intravenous beta-agonists are hazardous and cannot be recommended.
Metered-Dose Inhalers and Nebulizers in the Acute Setting
Authors: Kisch Glenn L. , Paloucek Frank P. 
Published: January 2017

OBJECTIVE: This article evaluates the current literature comparing beta-adrenergic agonists administered via metered-dose inhalers (MDIs) with nebulizer devices in adult and pediatric patients. These studies focus on the acute treatment of asthma or chronic obstructive pulmonary disease in the emergency department and other acute care settings. DATA SOURCES: English-language journal articles published between 1980 and 1991. STUDY SELECTION: Eight studies that compared beta-adrenergic agonists administered via an MDI or an MDI with a spacing device versus a nebulizer were identified. All of the studies were either poorly designed or had few subjects. By consensus of the authors, all were included in the review. DATA EXTRACTION: Studies were assessed according to methodologic strength (e.g., prospective, comparative). DATA SYNTHESIS: Five studies found no differences between administration methods, one study found metered-dose inhalation to be superior, and another found nebulization to be superior based on observed improvements in pulmonary function tests. There were no significant differences in adverse-reaction rates. When surveyed, subjects preferred MDIs to nebulizers. There were marked variations in doses administered within and between studies. There was no consideration given to doses potentially delivered to the lungs. CONCLUSIONS: There is no significant difference between nebulizers and MDIs plus a spacer with regard to the administration of beta-agonists in the treatment of acute asthma. There are insufficient data to conclusively support the role of spacers in this setting. The choice of a specific delivery method at this time must be determined on an individual basis, taking into account the issues of cost, timeliness of administration, and personnel availability.
Massive Theophylline Dosing in a Heavy Smoker Receiving Both Phenytoin and Phenobarbital
Authors: Nicholson James P. , Basile Sharon A. , Cury James D. 
Published: January 2017

OBJECTIVE: To report unusually high theophylline dosing requirements in a smoker receiving concomitant therapy with phenytoin and phenobarbital. DESIGN: Single case report. SETTING: 517-bed, university teaching hospital. PATIENT: 29-year-old woman with newly diagnosed asthma, heavy smoking history, and a seizure disorder. RESULTS: The additive influence of smoking, phenytoin, and phenobarbital greatly increased the theophylline dosing requirements. Doses of up to 4 g/d (59 mg/kg/d) were required to achieve adequate symptomatic relief of her asthma as well as to provide therapeutic serum theophylline concentrations. CONCLUSIONS: Multiple polymorphisms may additively influence theophylline metabolism and exceptionally large theophylline doses may be required in some patients who smoke and are comedicated with phenytoin and phenobarbital.
Cefotaxime and Metabolite Disposition in Two Pediatric Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Paap Christopher M. , Nahata Milap C. , Mentser Mark A. , Mahan John D. , Puri Surendra K. , Hubbard John A. 
Published: January 2017

OBJECTIVE: To characterize the pharmacokinetics of cefotaxime and desacetylcefotaxime in pediatric patients undergoing continuous ambulatory peritoneal dialysis (CAPD) after intraperitoneal administration of cefotaxime. DESIGN: Case series. SETTING: Ambulatory children from Children's Hospital nephrology clinic, Columbus, Ohio. PATIENT POPULATION: Two adolescents without peritonitis. METHODS: A single intraperitoneal dose of cefotaxime 500 mg per 1 L dianeal was given during CAPD. Cefotaxime and desacetylcefotaxime were measured in plasma, urine, and dialysate by HPLC. RESULTS: Maximum plasma concentration (Cmax,) of cefotaxime was 11.94 and 13.08 mg/L and that of desacetylcefotaxime 5.73 and 5.33 mg/L. Time to reach maximum concentration (Tmax) of cefotaxime was 2.22 and 4.08 h, and that of desacetylcefotaxime was 5.33 and 5.73 h after instillation of the intraperitoneal cefotaxime dose. Systemic absorption of cefotaxime was 56.6 and 64.8 percent. Total clearance of cefotaxime was 62 and 79 mL/min/1.73 m2. Nonrenal clearance accounted for nearly 95 percent; renal and CAPD clearance contributed approximately 5 percent of the total clearance. Renal and CAPD clearance measurements of desacetylcefotaxime were similar to those for cefotaxime. Cefotaxime half-life was 1.83 and 2.49 h and desacetylcefotaxime half-life was 8.14 and 11.0 h. CONCLUSIONS: Cefotaxime was well absorbed and therapeutic serum concentrations were achieved after intraperitoneal administration. Renal and CAPD clearances for cefotaxime and desacetylcefotaxime were low. Cefotaxime nonrenal clearance was unaffected. Further studies are needed to establish appropriate intraperitoneal dosing guidelines of cefotaxime in pediatric CAPD patients.
Gallium Nitrate
Authors: Hughes Thomas E. , Hansen Lea Ann 
Published: January 2017

OBJECTIVE: To evaluate the therapeutic role of gallium nitrate in the treatment of hypercalcemia associated with malignancy and related disease states. DATA SOURCES: A literature search of English-language studies involving gallium nitrate for the period 1966–1991 using MEDLINE and the bibliographies of relevant articles. STUDY SELECTION: Because of the limited number of studies, all clinical trials were reviewed, with particular emphasis on Phase III comparative trials. Related investigative studies on the pharmacology, pharmacokinetics, and toxicity of gallium nitrate were also reviewed. DATA EXTRACTION: Two appraisers independently abstracted data from available clinical trials and evaluated trial quality. RESULTS OF DATA SYNTHESIS: Two Phase III comparative trials evaluating gallium nitrate in the treatment of hypercalcemia of malignancy have been completed. Gallium nitrate was shown to be superior to both calcitonin and etidronate disodium, based on the comparative percentage of patients achieving normocalcemia and the subsequent duration of normocalcemia. Both trials employed similar methodology. Positive therapeutic effects of gallium nitrate have also been demonstrated in small, noncomparative trials for hypercalcemia associated with parathyroid carcinoma, Paget's disease of bone, and osteolytic bone metastases. CONCLUSIONS: Gallium nitrate is effective in the treatment of hypercalcemia associated with malignancy and is appropriate for formulary addition. In certain clinical situations, it may be clearly advantageous over such agents as calcitonin, plicamycin, and etidronate. Further investigation is needed to define the limitations of nephrotoxicity and the therapeutic potential for other indications. Further comparative clinical trials of gallium nitrate versus bisphosphonates and plicamycin could also help define its relative clinical benefit.
Long-Term Use of Neuroleptics among Elderly in a Swedish Community
Authors: Stewart Ronald B. , Isacson Dag G.L. , Bingefors Kerstin A.L. , Antonov Karolina I.M. 
Published: January 2017

OBJECTIVE: Analysis of long-term use of neuroleptics among the elderly in a Swedish community. DESIGN: Cohort study, three-year follow-up period. SETTING: Primary care. PATIENTS: All people aged 65 years or older who used neuroleptics in 1984. RESULTS: Neuroleptic use was fairly common among elderly and continued long-term use was relatively frequent. One third of long-term users obtained doses exceeding a recommended dosage range. Prescribed doses were seldom changed during the study period. CONCLUSIONS: The high proportion of long-term users and the stability of the prescribed doses indicate that there is a need for more information to be made available to prescribers regarding the risks of long-term use of neuroleptics in primary care.
Feasibility Study of Surveying the Adverse Drug Reaction Surveillance Systems in a Large Community of Hospitals
Authors: Hartzema Abraham G. , Porta Miquel S. , Tilson Hugh H. , Herrera Carlos R. , Moss Jeffrey T. , Reves Randall R. , Buffler Patricia A. 
Published: January 2017

OBJECTIVE: To determine the feasibility of accurately assessing the types of hospital adverse drug reaction (ADR) surveillance systems. DESIGN: Cross-sectional survey by mailed, self-administered questionnaire followed by selected verification interviews. SETTING: Harris County, Texas. PARTICIPANTS: All hospitals in the county with different pharmacy directors. MAIN OUTCOME MEASURE: Self description of surveillance system and number of ADRs reported. RESULTS: Forty-nine of 61 hospitals (80 percent) responded to a questionnaire. Forty-seven (96 percent) of the responding hospitals collected information on ADRs with 11 (22 percent) describing their surveillance system as active. Those individuals most often cited as responsible for ADR surveillance included pharmacists, quality assurance personnel, and nurses. Data were verified by personal interviews for 10 hospitals. The number of ADRs reported during the interviews was significantly lower than that reported in the questionnaires. Overall, the reporting of fatal and severe ADRs were more reliable than the reporting of moderate ADRs. These differences were the result of inadequate documentation and the lack of a uniform definition of ADRs. CONCLUSIONS: These data suggest that a large-scale ongoing survey of surveillance systems and reported adverse event rates has limitations and the reliability of data derived from a questionnaire should be verified. To improve the accuracy of surveys used to monitor hospital ADR surveillance systems, it is essential to develop reliable definitions for classifying ADRs and surveillance methods, as well as accurate measures of ADR documentation procedures.
Information Systems for Evaluating the Quality of Prescribing
Authors: Fish Catherine A. , Kirking Duane M. , Martin James B. , De Almentero Daisy Rivera 
Published: January 2017

OBJECTIVE: An important purpose of drug usage evaluation (DUE) is to provide feedback to physicians on population-based prescribing patterns and problems. This article has four objectives: (1) to outline prescribing information requirements for a computerized information system in terms of the variables needed for DUE, (2) to describe existing computerized information systems that collect and organize prescribing data, (3) to assess existing systems in terms of their capacity to provide the requirements outlined in our first objective, and (4) to suggest design changes to existing systems that would improve the DUE process. ANALYSIS: There are several existing DUE information systems that have some capacity to evaluate the quality of prescribing in specific populations (e.g., veterans, public and private insured groups, hospital service areas). Shortcomings of most DUE information systems include patient identification problems, defects in database design, and lack of software to identify prescribing problems and perform statistical analysis. CONCLUSIONS: DUE information systems could be used and upgraded to enable physicians to develop more rational prescribing rules from population data that would improve the quality of prescribing.
Enalapril to Lisinopril: Economic Impact of a Voluntary Angiotensin-Converting Enzyme-Inhibitor Substitution Program in a Staff-Model Health Maintenance Organization
Authors: McGhan William F. , Bootman J. Lyle , Townsend Raymond J. , McDonough Kimberly P. , Weaver Ross H. , Viall Gary D. 
Published: January 2017

OBJECTIVE: The cost-effectiveness of a voluntary program that switched enalapril to lisinopril therapy in patients with benign essential hypertension in a staff-model health maintenance organization (HMO) was evaluated. DESIGN: The one-year nonrandomized, controlled trial was performed from November 1989 through October 1990. PARTICIPANTS: One hundred twenty-seven patients were entered into the study: 75 who converted from enalapril to lisinopril and 52 who remained on enalapril throughout the study period. Patients were excluded from analysis because of diagnosis (not benign essential hypertension) or insufficient data collection. INTERVENTIONS: Patients taking enalapril were asked by staff pharmacists if they were willing to consider switching from enalapril to lisinopril. To encourage patients, the HMO agreed to waive the drug rider copayment for three months. If patients were willing, their physicians were contacted and they established the lisinopril dosage. MAIN OUTCOME MEASURES: Total direct cost and savings resulting from converting patients from enalapril to lisinopril were measured and compared with costs of therapy for patients who remained on enalapril. RESULTS: The control and study groups were evenly matched according to demographics and concomitant drug therapy. Drug acquisition costs, costs associated with waiving drug rider copayment, pharmacy administrative costs, costs of managing adverse events, costs of visits to physicians, and laboratory test costs were assessed. Depending on the cost of capital assumed, net savings ranged from $85 to $110 per patient converted from enalapril to lisinopril. Monthly net savings that ranged from $2.04 to $2.61 per patient were required to result in overall net savings within the first two years. CONCLUSIONS: In a regular practice setting, a net savings is realized in less than 12 months when patients are converted from enalapril to lisinopril for treatment of benign essential hypertension. The voluntary therapeutic interchange program provided a good means for achieving cost controls for pharmacy expenses.
European Survey of Independent Drug Information Centers
Authors: Taggiasco Nadine , Sarrut Bernard , Doreau Christian G. 
Published: January 2017

OBJECTIVE: The purpose of our survey was to ascertain the activities of the independent drug information centers (DICs) in Europe and to contact the person in charge of these services to establish a European network of DICs in the future. DATA SOURCES: The survey was conducted in 32 European countries. We contacted 2026 people in DICs and official healthcare organizations by mail. On request, we returned our questionnaire including 167 closed questions on the means and activities of a DIC. Data were collected and analyzed on a personal computer using dBASE III PLUS (Ashton-Tate). RESULTS: Of the 110 questionnaires received, 88 answered the question pertaining to the number of queries asked of the DIC per year and were analyzed (1 from West Germany, Denmark, Finland, Sweden, Portugal, Poland; 2 from Italy; 3 from Switzerland; 6 from Spain; 8 from The Netherlands; 16 from France; and 47 from the United Kingdom). We recorded data on their location, their means (e.g., staff, information), their users (e.g., health professionals), and activities. CONCLUSIONS: The DICs were located in healthcare structures, managed by pharmacists or physicians, and open to other health professionals. Only the United Kingdom maintains a national organized network. Most of the participants showed interest in cooperating with each other to establish a list of the centers, guidelines on good information practices, a database, and a European network.
The Mobility of the Proximal Tibio-Fibular Joint. A Roentgen Stereophotogrammetric Analysis on Six Cadaver Specimens
Authors: Soavi Raffaella , Girolami Mauro , Loreti Ivano , Bragonzoni Laura , Monti Carlo , Visani Andrea , Marcacci Maurilio 
Published: January 2017

In six cadaver specimens the mobility of the proximal fibula in relation to the tibia was investigated during plantar/dorsiflexion of the ankle, using Roentgen Stereophotogrammetric Analysis (RSA). The role of the ankle joint, and of the calcaneofibular and talofibular ligaments was also evaluated. The greatest movements were observed along the medio-lateral and anterior-posterior axes, resulting in an anterolateral displacement of the fibula head during dorsiflexion and in a postero-medial displacement during plantarflexion. This study demonstrated a limited mobility of the proximal tibiofibular joint. Moreover, the ligament cutting and the presence of constraints in the ankle region did not show any effect on the fibular movement.
Insertional Achilles Tendinosis: Surgical Treatment Through a Central Tendon Splitting Approach
Authors: McGarvey William C. , Palumbo Robert C. , Baxter Donald E. , Leibman Bryan D. 
Published: January 2017

Twenty-two heels in 21 patients treated surgically for a primary diagnosis of insertional Achilles tendinosis were reviewed on the basis of preoperative and postoperative examinations, office records, and a comprehensive questionnaire administered to each subject. Each patient underwent surgical treatment using a midline-posterior skin incision combined with a central tendon splitting approach for debridement, retrocalcaneal bursectomy, and removal of the calcaneal bursal projection as necessary. The findings at surgery revealed involvement of the middle third of the insertion in 21 of 22 cases with only one patient manifesting isolated lateral involvement. Thirteen of 22 had an associated prominent calcaneal bursal projection and four of 22 a superficially inflamed bursa. Three patients required reinsertion of the tendo Achilles via drill holes and one underwent augmentation with a plantaris tendon. Operative findings and complications were reported. Eight male and 13 female patients underwent 22 procedures (one case bilaterally) with an average follow-up of 33 months. Preoperative symptoms include presence of symptoms over a range of three months to two years and pain associated with activities of daily living (17 of 22), limitation of regular activities (six of 22), and pain present at rest in six of 22. Postoperatively, 20 of 22 patients were able to return to work or routine activities by three months; only 13 of 22 were completely pain free. Only 13 of 22 also claimed that they were able to return to unlimited activities. Overall, there was an 82% (18 of 22) satisfaction rate with surgery and 77% (17 of 22) stated they would have the surgery again.