bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rifapentine: Its Role in the Treatment of Tuberculosis
Authors: Temple Mary E , Nahata Milap C 
Published: July 2017

Objective: To review the pharmacokinetics, efficacy, adverse effects, and cost of the newest antitubercular drug, rifapentine. Data Sources: A MEDLINE search using key terms such as rifapentine, rifampin, isoniazid, Mycobacterium tuberculosis, and pyrazinamide was conducted for the time period 1966-November 1998. Study Selection: Animal data were used for basic information and human studies were selected for inclusion if they were randomized, controlled studies assessing efficacy, or if they were single- or multiple-dose studies assessing the pharmacokinetics of rifapentine. Background articles on the pathophysiology of tuberculosis and cost of care and noncontrolled studies assessing drug interactions were also included. Data Synthesis: Compared with an oral solution, the relative bioavailability of rifapentine is 70% following oral administration of tablets. Food increased bioavailability by 55%. Rifapentine accumulated significantly in human macrophages, and its elimination half-life was longer than that of rifampin. Comparative studies of rifapentine and rifampin in humans during intensive- and continuation-phase treatment of tuberculosis suggest that at currently accepted doses, rifapentine was slightly less effective than rifampin. The most significant drug interaction with rifapentine involves indinavir. Adverse events of rifapentine may occur less frequently at the currently recommended 600-mg dose compared with rifampin; however, the difference was not statistically significant. If only drug costs were evaluated during the six-month treatment of tuberculosis, rifapentine is more expensive than rifampin. Conclusions: Rifapentine can be administered twice weekly during the intensive phase of tuberculosis treatment and then once weekly during the continuation phase of treatment. This may improve patient adherence over some other treatments and possibly reduce costs of treatment by preventing development of resistant tubercular strains due to non-adherence. Rifapentine is well tolerated, with most patients experiencing adverse effects at a similar rate as rifampin. Rifapentine induces cytochrome P450 somewhat less than rifampin, although few drug interaction studies have been done with rifapentine. Its efficacy at the currently approved dosage of 600 mg may be slightly lower than that of rifampin. Studies are needed to determine whether equal or greater efficacy can be achieved with higher doses of rifapentine. Rifampin is less expensive than rifapentine. Further pharmacoeconomic studies are needed to evaluate costs of relapse and failure in patients receiving these agents.
Economic Outcomes of Risperidone in Comparison to Typical Neuroleptic Agents for Treatment-Resistant Psychosis: A Community-Based Study
Authors: Ghaemi S Nassir , Kirkwood Cynthia K , Sambur Marinie R , Ko James Y , Howden Kimberly L , Duong Quynh-Van , Goodwin Frederick K 
Published: July 2017

Objective: To compare the costs of treatment for psychosis with risperidone and typical neuroleptics in severely ill outpatients treated in a community mental health setting. Methods: This was an open, retrospective, controlled cohort comparison of actual costs of psychiatric treatment in a group of 17 patients treated with risperidone for psychotic disorders and 15 typical neuroleptic-treated controls matched for severity of illness. Assignment to the two groups was nonrandomized, and outcome data were gathered for the duration of the study for each subject, with dropouts included. Results: Risperidone use did not lead to increased treatment expenses compared with typical neuroleptic use in a mean of approximately nine months follow-up. The median overall cost per patient per year was $2,703 in the risperidone group, compared with $2,551 in the typical neuroleptic group (p = 0.64). Increased drug costs (mean expenses per patient per year: $1,631 for risperidone vs. $357 for typical neuroleptics; p = 0.005) were offset by reduced expenses due to decreased hospitalization rates (mean expenses per patient per year: $1,379 for risperidone vs. $3,920 for typical neuroleptics; p = 0.04). Use of other outpatient services did not significantly differ between the two groups. Conclusions: Use of risperidone led to lower hospitalization rates in this severely ill sample and did not lead to greater overall expense than typical neuroleptic use.
Potential for Microbial Contamination of ADD-Vantage Admixtures
Authors: Hudson Teresa J. , Ambroziak Ellen M. , Coley Rebecca M.R. 
Published: July 2017

Objective: To test for potential bacterial contamination of the ADD-Vantage system when the components are assembled in various hospital environments. Study Design: One hundred fifty ADD-Vantage units were assembled by three different people in three separate locations within a hospital. Each person assembled ten units per day; the study spanned five days. After 72 hours of incubation, units were inspected for evidence of contamination. Setting: ADD-Vantage units were assembled by a pharmacist in a laminar-flow hood, a pharmacy student using the pharmacy counter, and a nurse at a patient's bedside table. Personnel at each site wore their regular work attire. Each person observed handwashing techniques normally used during routine working hours. Data Extraction: Positive results were sent to the hospital microbiology laboratory for determination of growth type. Results: After 72 hours, none of the systems exhibited microbial growth on visual inspection. No differences in microbial contamination of the ADD-Vantage systems relative to assembly site, day of assembly, or person performing the assembly were observed. The incidence of contamination was calculated at less than seven percent. Conclusions: There is minimal risk of bacterial contamination when ADD-Vantage systems are compounded either on a pharmacy counter or at a patient's bedside. Larger samples must be studied in order to detect differences in the incidence of contamination among assembly sites.
Buspirone and Sertraline in the Treatment of a Patient with Refractory Obsessive-Compulsive Disorder
Authors: Veivia Amy J. , Levin Gary M. , Powell Hannah S. 
Published: July 2017

Objective: To describe a hospitalized patient with refractory obsessive-compulsive disorder (OCD) and to briefly review the supporting literature. Case Summary: A 33-year-old man was admitted with a diagnosis of depression and OCD. Prior drug therapy included numerous medications, but none improved the OCD. Clonazepam therapy was initiated for treatment of anxiety and propranolol was begun to treat his headaches. Sertraline and buspirone were added sequentially to control the symptoms of depression and OCD. Subjective improvement was noted within a few weeks after the combination therapy was begun. Six and four weeks after starting sertraline and buspirone, respectively, the patient's symptoms remain improved. Discussion: Fluoxetine has been shown to be effective in the management of OCD. Sertraline, another selective serotonin-reuptake inhibitor, also looks promising for OCD therapy. Buspirone is a serotonin1A-receptor agonist, and theoretically could augment the effect of selective serotonin-reuptake inhibitors in the treatment of OCD. Conclusions: This patient's OCD symptoms responded to a combination of sertraline and buspirone therapy. It is difficult to confirm whether buspirone augmented the effects of sertraline in this patient. Clinical trials should be developed to determine whether these regimens are, in fact, beneficial in patients with refractory OCD.
Interactions of Acetaminophen, Opiates, and Their Combinations with Warfarin and other Oral Anticoagulants
Authors: Chan Thomas YK 
Published: July 2017

Objective: To determine whether acetaminophen, opiates, or acetaminophen–opiate combinations potentiate the effect of warfarin. Data Sources: Previous studies or reports of interactions between warfarin and acetaminophen, opiates, or acetaminophen–opiate combinations (MEDLINE search, January 1976 to January 1996). Study Selection: All articles were included in the review. Pertinent information was selected for discussion. Data Synthesis: Studies of the effects of acetaminophen on anticoagulation with warfarin and other oral anticoagulants have yielded conflicting results. In three placebo-controlled studies of patients or healthy men, acetaminophen 2–4 g/d for 2–3 weeks potentiated the anticoagulant effect of warfarin and other related drugs compared with placebo. Similar findings were seen in one uncontrolled study of patients taking acetaminophen 2.6 g/d for 4 weeks, but not in another in which patients took acetaminophen 3.25 g/d for 14 days. Other studies showed that two doses of acetaminophen 650 mg for 1 day did not influence the prothrombin time. There were six reports of adverse interactions between warfarin and acetaminophen–opiate combinations. Of five patients who were given an acetaminophen–propoxyphene combination, the equivalent daily doses of acetaminophen and propoxyphene were specified for four and ranged from 1.95 to 6.5 g and from 195 to 1,000 mg, respectively. The duration of therapy in the five patients ranged from less than 1 day to 10 days. One of these patients also received ibuprofen. Another patient took an unspecified acetaminophen–codeine product equivalent to acetaminophen 1.56 g/d. The exact mechanism underlying such interactions is not clear. Conclusions: During the combined use of warfarin and acetaminophen (in high daily doses for 2–3 wk) or acetaminophen–propoxyphene combinations, patients should be closely monitored for anticoagulant control and bleeding complications.
Vocal Cord Dysfunction Presenting as “Steroid-Dependent” Asthma
Authors: Knoell Daren L , Marsh Clay B 
Published: July 2017

Objective: To describe a case of paroxysmal vocal cord dysfunction (PVCD) in a patient presenting with an initial diagnosis of severe asthma. Case Summary: A 42-year-old obese white woman with a 5-year history of severe asthma symptoms was referred to The Ohio State University Comprehensive Asthma Outpatient Clinic. The patient said she had experienced frequent “asthma attacks” despite increased use of multiple asthma medications. Additionally, she often required nebulization therapy with bronchodilators and supplemental oxygen, and had a variable response. During the clinic visit, the patient presented with clear airways uncharacteristic of a person with severe asthma. A diagnosis of PVCD was made on the basis of results of videolaryngostroboscopy, and asthma medications were gradually discontinued. Setting: The Ohio State University Comprehensive Asthma Outpatient Clinic. Discussion: Patients with PVCD often present with symptoms characteristic of asthma. As a result, misdiagnosis of severe asthma often occurs, and the patient undergoes unnecessary treatment. The cornerstone for diagnosis of PVCD is laryngoscopic viewing of the adducted vocal cord during an acute attack. Following diagnosis, treatment for PVCD includes a multidisciplinary approach that includes speech therapy and psychiatric counseling. Pharmacologic therapy in patients with pure PVCD is not required, thus preventing medication-related morbidity and associated costs. Conclusions: PVCD must be considered in patients who are refractory to asthma therapy and have dyspneic symptoms out of proportion to observed clinical findings. We suggest that all patients with episodes of acute asthma undergo objective testing to document acute airway obstruction. Oral corticosteroid therapy and treatment-associated morbidity can be avoided in patients with PVCD if the appropriate diagnosis is made early.
Multiple Episodes of Phenytoin Toxicity in an Elderly Patient
Authors: Namjoshi Anjali A , Aruna Augustine S 
Published: July 2017

Objective: To describe a case involving multiple episodes of phenytoin toxicity leading to hospitalization over a period of 13 months in an elderly man and to review the risk factors contributing to drug toxicity in this individual. Case Summary: A 70-year-old African-American man presented four times with phenytoin toxicity manifested as ataxia and bilateral nystagmus, leading to multiple hospitalizations over 13 months. Each time the phenytoin concentration was dangerously high, and each time the symptoms of toxicity resolved without serious consequences when phenytoin therapy was temporarily stopped. Each toxicity episode was characterized by a variety of risk factors. Discussion: The risk factors contributing to the drug toxicity in this elderly individual are discussed. Conclusions: This case illustrates that age is not an independent risk factor for adverse drug reactions and that appropriate and comprehensive geriatric pharmaceutical care approaches are necessary to prevent and/or reduce the incidence of these reactions.
Emesis after Intravenous Meperidine Administration to Emergency Department Patients
Authors: Watson William A , Pauls Scott W , Schwab Robert A 
Published: July 2017

Objective: To determine the frequency of emesis after intravenous administration of meperidine, with and without concurrent intravenous antiemetics, in emergency department (ED) patients. Design: Record review of consecutive patients who received intravenous meperidine in the ED. Setting: The ED of an urban teaching hospital. Patients: All patients who received intravenous meperidine during a 5-month period. Main Outcome Measures: Documentation of emesis and therapeutic measures commonly used to treat emesis. Results: Meperidine was administered intravenously at 173 patient visits; at 81 visits, meperidine was administered alone, and at 92 visits, concurrent antiemetics were administered. The prevalence of emesis was similar in both treatment groups (8.6%; p = 0.79). Conclusions: The prevalence of emesis associated with intravenous administration of meperidine is relatively infrequent in ED patients and generally associated with abdominal signs and symptoms at presentation. The concurrent administration of an intravenous antiemetic did not decrease the frequency of meperidine-associated emesis.
The ExACT CM Microprocessor-Based Compliance Recording Device: Product Description and Field Testing Results
Authors: Bealmear Brackett K , Draugalis JoLaine R , Coons Stephen Joel , Jones William N , Barreuther Christine 
Published: July 2017

Objective: To conduct field testing of the ExACT CM compliance monitoring device and provide results to the manufacturer. Design: Questionnaires, interviews, and patient diaries were used to collect data on targeted product attributes of interest. Setting: The Veterans Affairs Medical Center outpatient anticoagulation clinic in Tucson, AZ. Subjects: A convenience sample of 31 ambulatory male patients (average 68 ± 0.5 y) who had been stabilized on warfarin therapy for at least one month. Main Outcome Measures: Scaled attitudinal scores and open-ended comments on device attributes. Results: Data were collected for 28 days per patient. The device was determined to be both functional and acceptable to patients. Conclusions: Results suggest that it is feasible to market ExACT CM for use by the pharmaceutical industry in clinical research.
Ohio Institutional Pharmacy Technicians' Demographics and Attitudes toward National Voluntary Pharmacy Technician Certification: An Exploratory Analysis
Authors: Mott David A , Vanderpool William H , Smeenk David A 
Published: July 2017

Objective: To collect demographic information from pharmacy technicians working in Ohio hospitals and to determine their attitudes toward national voluntary pharmacy technician certification. Methods: A survey was developed and sent to directors at 58 hospitals in Ohio for distribution to an exploratory sample of 735 technicians. Results: The response rate was 19.9%. Men comprised the majority of certified technicians and had been in their current job fewer years than the women surveyed. Technicians' attitudes toward certification differed depending on certification status. More certified technicians than uncertified technicians agreed with the beneficial aspects of certification. All technicians agreed that certification is not a substitute for on-the-job training and that certified technicians will not replace pharmacists. Technicians unsure of certification questioned its impact on improving qualifications, skills, likelihood of being hired, and opportunities for promotion. Conclusions: The use of technical personnel in pharmacies likely will increase because of pressures from the healthcare system to control costs. Future research should continue to document the characteristics of technicians and the benefits and costs of certification to technicians, employers, and pharmacists.
The Role of Chlamydia Pneumoniae in the Pathogenesis of Coronary Heart Disease
Authors: Olson Kari , Marra Fawziah , Sunderji Rubina 
Published: July 2017

Objective: To review the role of Chlamydia pneumoniae in the pathogenesis of coronary heart disease (CHD). Data Sources: Articles indexed in MEDLINE from 1966 to April 1998 as well as references identified in these articles were searched. Data Extraction: Studies investigating seroepidemiologic and pathologic evidence for an association of C. pneumoniae with CHD and randomized clinical trials evaluating the effectiveness of antibiotic therapy on cardiovascular outcomes are presented. Data Synthesis: Seroepidemiologic and pathologic studies provide circumstantial evidence of an association between C. pneumoniae and CHD. Results of initial small trials suggest a reduction in CHD events in patients treated with macrolide antibiotics. Conclusions: Direct evidence implicating chlamydial infection in CHD is lacking. Formal recommendations for antimicrobial therapy should not be made until results of additional clinical trials are available.
Defining asthma and assessing asthma outcomes using electronic health record data: a systematic scoping review
Authors: Al Sallakh Mohammad A. , Vasileiou Eleftheria , Rodgers Sarah E. , Lyons Ronan A. , Sheikh Aziz , Davies Gwyneth A. 
Published: July 2017

There is currently no consensus on approaches to defining asthma or assessing asthma outcomes using electronic health record-derived data. We explored these approaches in the recent literature and examined the clarity of reporting.We systematically searched for asthma-related articles published between January 1, 2014 and December 31, 2015, extracted the algorithms used to identify asthma patients and assess severity, control and exacerbations, and examined how the validity of these outcomes was justified.From 113 eligible articles, we found significant heterogeneity in the algorithms used to define asthma (n=66 different algorithms), severity (n=18), control (n=9) and exacerbations (n=24). For the majority of algorithms (n=106), validity was not justified. In the remaining cases, approaches ranged from using algorithms validated in the same databases to using nonvalidated algorithms that were based on clinical judgement or clinical guidelines. The implementation of these algorithms was suboptimally described overall.Although electronic health record-derived data are now widely used to study asthma, the approaches being used are significantly varied and are often underdescribed, rendering it difficult to assess the validity of studies and compare their findings. Given the substantial growth in this body of literature, it is crucial that scientific consensus is reached on the underlying definitions and algorithms.
Solar ultraviolet B exposure and global variation in tuberculosis incidence: an ecological analysis
Authors: Boere Tjarda M. , Visser Douwe H. , van Furth A. Marceline , Lips Paul , Cobelens Frank G.J. 
Published: July 2017

Epidemiological evidence supports vitamin D deficiency as a risk factor for tuberculosis. Differences in solar ultraviolet B (UV-B) exposure, the major source of vitamin D, might therefore partially explain global variation in tuberculosis incidence.In a global country-based ecological study, we explored the correlation between vitamin D-proxies, such as solar UV-B exposure, and other relevant variables with tuberculosis incidence, averaged over the period 2004–2013.Across 154 countries, annual solar UV-B exposure was associated with tuberculosis incidence. Tuberculosis incidence in countries in the highest quartile of UV-B exposure was 78% (95% CI 57–88%, p<0.001) lower than that in countries in the lowest quartile, taking into account other vitamin D-proxies and covariates. Of the explained global variation in tuberculosis incidence, 6.3% could be attributed to variations in annual UV-B exposure. Exposure to UV-B had a similar, but weaker association with tuberculosis notification rates in the multilevel analysis with sub-national level data for large countries (highestversuslowest quartile 29% lower incidence; p=0.057).The potential preventive applications of vitamin D supplementation in high-risk groups for tuberculosis merits further investigation.
Home monitoring improves endpoint efficiency in idiopathic pulmonary fibrosis
Authors: Johannson Kerri A. , Vittinghoff Eric , Morisset Julie , Lee Joyce S. , Balmes John R. , Collard Harold R. 
Published: July 2017

The objective of this study was to investigate the reliability, feasibility and analytical impact of home-based measurement of forced vital capacity (FVC) and dyspnoea as clinical endpoints in idiopathic pulmonary fibrosis (IPF).Patients with IPF performed weekly home-based assessment of FVC and dyspnoea using a mobile hand-held spirometer and self-administered dyspnoea questionnaires. Weekly variability in FVC and dyspnoea was estimated, and sample sizes were simulated for a hypothetical 24-week clinical trial using either traditional office-based interval measurement or mobile weekly assessment.In total, 25 patients were enrolled. Mean adherence to weekly assessments over 24 weeks was greater than 90%. Compared with change assessment using baseline and 24-week measurements only, weekly assessment of FVC resulted in enhanced precision and power. For example, a hypothetical 24-week clinical trial with FVC as the primary endpoint would require 951 patients using weekly home spirometry compared with 3840 patients using office spirometry measures at weeks 1 and 24 only. The ability of repeated measures to reduce clinical trial sample size was influenced by the correlation structure of the data.Home monitoring can improve the precision of endpoint assessments, allowing for greater efficiency in clinical trials of therapeutics for IPF.