bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benign Prostatic Hyperplasia: Diagnosis and Treatment Guideline
Authors: Lee Mary , Sharifi Roohollah 
Published: May 2017

ObjectiveTo critique the US Department of Health and Human Services Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline on Benign Prostatic Hyperplasia: Diagnosis and Treatment; and to provide an update on management and treatment of benign prostatic hyperplasia (BPH) since the Guideline was published.Data SourcesA review of the published medical literature in MEDLINE from 1994 to April 1996, limited in focus to drug treatment of BPH, English language, and human subjects, was performed.Study SelectionControlled clinical studies of drug treatment for symptomatic BPH that used objective parameters (e.g., urinary flow rate, prostatic volume, voiding symptom scores) were evaluated. A single reviewer assessed each study.Data ExtractionStudy methods, inclusion and exclusion criteria, and treatment outcomes were assessed for all studies. Independent extraction was performed by a single observer.Data SynthesisManagement of BPH is directed at ameliorating voiding symptoms. For moderate or severe BPH, medical or surgical therapy should be offered to the majority of patients. Medical therapy options include α-adrenergic antagonists and finasteride. The former offer the advantage of a more prompt onset of action (within weeks) when compared with finasteride. Finasteride produces a lower response rate and smaller improvement in voiding symptoms. Combination therapy of terazosin and finasteride has not been proven to be more effective than terazosin monotherapy.ConclusionsWhen medical therapy is indicated for moderate or severe BPH, α-adrenergic antagonists exhibit a faster onset of action and produce greater improvement of voiding symptoms than does finasteride.
Toleration of Intravenous Azithromycin
Authors: Luke David R , Foulds George 
Published: May 2017

Objective To study the toleration of various infusate concentrations of single intravenous doses of azithromycin. Design Randomized, double-blind, two-treatment, two-period, crossover. Setting Clinical pharmacology unit. Participants Twenty-four healthy men aged 19–41 years. Study Design All subjects were initially randomized to receive single 1-hour intravenous infusions of azithromycin 1 g at infusate concentrations of 1, 2, or 5 mg/mL (n = 6 each) compared with placebo (n = 6). Subjects who were randomized to receive 1 mg/mL concentrations were subsequently administered 5 mg/mL concentrations at least 2 weeks later, those given 2 mg/mL were crossed over to 4 mg/mL, and those in the 5-mg/mL group were crossed over to 1 mg/mL concentrations. Main outcome Measures Subjects recorded intravenous infusion toleration using visual analog scales ranging from 0 (no signs or symptoms) to 10 (poor toleration) for erythema, pain, swelling, and tenderness. Vascular Doppler recordings were obtained during and after infusion cephalad to the infusion site. Results Infusion site reactions increased in incidence and severity with infusion concentrations of 4 and 5 mg/mL; the most frequent reactions were tenderness and erythema. There were no apparent trends in Doppler readings. Conclusions Single doses of azithromycin 1 g at infusate concentrations up to 2 mg/mL were well tolerated when administered over 1 hour to healthy men.
Impact of a Vancomycin Restriction Policy on Use and Cost of Vancomycin and Incidence of Vancomycin-Resistant Enterococcus
Authors: Morgan Amy S , Brennan Patrick J , Fishman Neil O 
Published: May 2017

Objective To review the appropriateness of vancomycin therapy, changes in vancomycin use, and the incidence of vancomycin-resistant Enterococcus (VRE) after implementation of a limited restriction policy requiring approval from the Infectious Diseases Approval service to continue vancomycin therapy beyond 72 hours. Design A prospective chart review was conducted in April 1995. Pharmacy billing data and infection control data were compared before and after policy implementation. Setting A 725-bed university teaching institution. Patients All patients receiving vancomycin during April 1995. Main outcome Measures Appropriateness of use was based on the Centers for Disease Control and Prevention (CDC) recommendations for prudent vancomycin use. Results A total of 333 courses of vancomycin therapy were reviewed. Vancomycin use was appropriate in 219 (66%) courses. Of the 114 courses that did not meet the CDC guidelines, 76 (67%) were for empiric use, 35 (31%) were for prophylactic use, and 3 (3%) were for therapeutic use. Overall, the total number of grams used decreased 9%, grams per 1000 patient-days decreased by 10, and the total number of patients exposed to vancomycin decreased 0.5%. Several services had large decreases in vancomycin use. Vancomycin expenditures decreased by $15 788 for the 7-month time period. The incidence of VRE remained unchanged, at 30% of all enterococcal isolates 2 years after policy implementation. Conclusions The limited restriction policy was effective in decreasing the total grams of vancomycin used. However, one-third of vancomycin therapy was inappropriate and the incidence of VRE was unchanged. A more stringent restriction policy could potentially increase appropriate use, further decrease the amount of vancomycin used, and decrease the incidence of VRE.
Evaluation of a Sparse Sampling Strategy for Determining Vancomycin Pharmacokinetics in Preterm Neonates: Application of Optimal Sampling Theory
Authors: Burstein Aaron H , Gal Peter , Forrest Alan 
Published: May 2017

Objective To use optimal sampling theory to determine the fewest vancomycin concentrations required and the appropriate sampling times to calculate vancomycin pharmacokinetic parameters in neonates. Design Unblinded evaluation in neonates with presumed sepsis. Setting Level 3 community-based neonatal intensive care unit. Patients Eleven neonates with presumed sepsis. Interventions Twelve courses of intravenous vancomycin 20 mg/kg were administered. Blood samples were collected 3 and 9 hours after initiation of a 1-hour infusion of the first dose. Measurements and Main Results A two-compartment model was fit to vancomycin concentrations using iterative two-stage analysis. Pharmacokinetic parameter estimates were used for determination of optimal sampling times for two-, three-, and four-sample strategies with subsequent generation of two-, three-, and four-sample concentration data for 100 cases. Relative performance of strategies was compared through calculation and comparison of D efficiency for the determined strategies. Bias (median percent error) and precision (median percent absolute error) of pharmacokinetic parameter estimates for each strategy in the 100 simulated cases were determined. Conclusions For estimation of total clearance and volume in the central and peripheral compartments, all strategies performed similarly with no difference in efficiency or bias and precision of estimates. Our results suggest that for clinical evaluations two appropriately timed samples (0.5 h after a 1-h infusion, trough concentration) are adequate for estimation of vancomycin clearance in neonates.
Ursodeoxycholic Acid Improves Cholestasis in Infants with Cystic Fibrosis
Authors: Scher Herschel , Bishop Warren P , Mccray Paul B 
Published: May 2017

Objective To describe two infants with cholestatic jaundice treated with ursodeoxycholic acid (UDCA). Case Summary Two infants with cystic fibrosis (CF)-associated hepatobiliary disease, manifesting as cholestatic jaundice and elevated liver enzymes within the first 6 weeks of life, had improved biochemical indices of liver function following treatment with UDCA 20–40 mg/kg/d. Discussion To our knowledge, this is the first report of UDCA treatment in infants with CF-associated cholestatic jaundice. Infants and children require treatment with increased doses of UDCA to compensate for reduced intestinal absorption of bile acid and immaturity of the enterohepatic circulation. Conclusions UDCA appears to be a cost-effective treatment for CF-associated hepatobiliary disease in infants and children.
Zafirlukast: The First Leukotreene-Receptor Antagonist Approved for the Treatment of Asthma
Authors: Kelloway Judy Shepard 
Published: May 2017

Objective To review the pharmacology, pharmacokinetics, clinical efficacy, and adverse effects of zafirlukast. Therapeutic issues regarding the use of a leukotriene-receptor antagonist as prophylactic antiinflammatory therapy for asthma are also discussed. Data Sources A MEDLINE search was conducted to identify pertinent literature, including preclinical trials, clinical trials, and reviews. Pharmacokinetic and dosing information were abstracted from the product labeling. Study Selection All available published articles describing double-blind, placebo-controlled trials of both oral and aerosol zafirlukast in patients with asthma or rhinitis were reviewed. These included single-dose studies with zafirlukast against exercise, allergen, leukotriene D4 (LTD4), and platelet-activating factor (PAF) challenges, and 6- and 13-week trials in patients with asthma. Studies describing clinical trials with long-term use or comparisons with other asthma medications as reported in abstracts are also included. Data Extraction Information on the safety and efficacy of zafirlukast from single- and multiple-dose studies was evaluated on the basis of statistical significance relative to placebo treatment. Data Synthesis Zafirlukast, a potent and selective antagonist of the cysteinyl leukotriene receptor, blocks leukotriene-mediated pathologic events in both experimental animal and clinical disease models. Zafirlukast antagonizes LTD4-, PAF-, and exercise-induced bronchoconstriction, and blocks both early- and late-phase responses following allergen provocation in patients with atopic asthma. Greater efficacy is noted following oral administration than with aerosol dosing, presumably because of the enhanced delivery of drug when ingested rather than inhaled. Conclusions Zafirlukast is the first orally active leukotriene-receptor antagonist approved by the Food and Drug Administration for the prophylactic and chronic treatment of asthma. Since the leukotrienes play an important role in the underlying inflammatory processes of asthma, zafirlukast represents a new antiinflammatory option available in an oral dosage form. It is clear that this agent has therapeutic activity in patients with asthma, but its effectiveness relative to other antiasthma medications still needs confirmation. Data from clinical studies support the use of zafirlukast as first-line therapy in patients with mild-to-moderate asthma. Further research is needed to establish its role as an add-on agent for patients with severe asthma, aspirin-sensitive asthma, and both allergies and asthma. In addition to having a favorable safety and efficacy profile, zafirlukast has the advantage of being an oral agent with twice-daily dosing; these attributes offer the potential for greater patient adherence to pharmacotherapy and, thereby, improved control of asthma symptoms.
Hepatitis B Vaccine: Current Issues
Authors: Zannolli Raffaella , Morgese Guido 
Published: May 2017

ObjectiveTo review two main issues concerning the hepatitis B vaccine: (1) the management of unresponsive subjects and (2) the need for routine booster doses.Data SourcesPertinent literature identified via MEDLINE (1980–1996) search as well as references cited in published articles.Data SynthesisThe optimal procedure for management of subjects unresponsive to hepatitis B vaccine has not been well established. Most unresponsive subjects are not absolute nonresponders, since most of them can develop protective concentrations of antibodies to hepatitis B surface antigen (anti-HBsAg) after hepatitis B revaccination, consisting of a fourth or a fifth dose or a new complete course of immunization. In subjects who do not respond to the hepatitis B vaccine after four or more injections, the benefits of the combination of cytokines (e.g., interferon-alfa, interleukin-2 [aldesleukin]) and vaccine have not been clearly shown. There are two main opinions regarding the need for routine booster doses. Experts from the US, claiming long-term protection from immunologic memory, suggest delaying booster doses for at least a decade after vaccination in subjects with normal immune status. Furthermore, postvaccination antibody testing should be restricted only to high-risk subjects. Once a vaccinated subject has responded satisfactorily, further antibody tests are unnecessary. Only hemodialysis patients should be tested annually for adequate antibody concentrations and the booster dose administered when concentrations decline to less than 10 IU/L. Experts from Europe suggest that vaccine-induced antibody responses should be assessed in all subjects and booster doses administered at intervals, with the theory being that protection correlates with the presence of antibody. However, indications about appropriate timing for booster doses and target titers of anti-HBsAg remain controversial.ConclusionsIt is possible to obtain seroconversion in nonresponders by using variations in vaccination strategies (i.e., >3 doses, double amounts of HBsAg). Adjuvants such as interferon-alfa or aldesleukin are of limited use. The opinions of American experts regarding routine booster doses, as expressed by the statement of the Immunization Practices Advisory Committee, seem to be well defined and helpful to clinicians trying to resolve controversies for individual patients. The opinions of the European experts are not unanimous and are sometimes impractical. A consensus conference is needed.
Digoxin–Macrolide Drug Interaction
Authors: Bizjak Eric D , Mauro Vincent F 
Published: May 2017

Macrolide antibiotics appear to be able to enhance the oral bioavailability of digoxin by altering the gastrointestinal flora that metabolize digoxin to less active dihydro metabolites, thus leading to increased serum digoxin concentrations and possible digoxin toxicity in select patients stabilized on digoxin therapy. This interaction may be of clinical importance in up to 10% of the population. Currently, the orally administered erythromycin, clarithromycin, and roxithromycin have been implicated. Although realistically this interaction may be encountered rarely, when it does occur, it can be of clinical significance. Addendum Following acceptance of this manuscript, two additional reports of a digoxin–clarithromycin drug interaction have been published. Nawarskas et al.28 described clarithromycin-induced digoxin toxicity (digoxin-induced ST segment changes, non-sustained ventricular tachycardia, and a digoxin concentration of 4.4 ng/mL) due to 3 days of clarithromycin 500 mg bid in a 78-year-old woman stabilized on oral digoxin 0.25 mg/d. Laberge and Martineau29 observed a clinical presentation suggestive of digoxin toxicity and an elevated digoxin concentration of 3.9 ng/mL in a 78-year-old man stabilized on digoxin 0.25 mg/d who had received 4 days of clarithromycin 250 mg bid.
Combination Antiviral Therapy for Cytomegalovirus Disease in Patients with AIDS
Authors: Cline Julie J , Garrett Anna D 
Published: May 2017

Currently, combination therapy with ganciclovir and foscarnet should be reserved for patients with disease progression while receiving monotherapy or for those who are unresponsive to either agent alone. Although cidofovir and ganciclovir were shown to have synergistic activity against human CMV in vitro, there have been no in vivo studies to confirm this activity. Therefore, if a combination regimen is necessary to control CMV in a patient, foscarnet and ganciclovir should be used first. There are several advantages of the combination therapy regimen. For instance, lower doses of the individual agents can be used with superior efficacy to monotherapy and similar toxicities.5,10 Also, for neurologic CMV involvement, the combination therapy may be superior to monotherapy because of the variable CSF penetration of either drug alone. In addition, combined therapy may be beneficial in treating and/or preventing drug-resistant strains of CMV.13 Even though combination therapy has evidence of superior efficacy compared with monotherapy in the treatment of CMV, several issues must be considered. First, combination therapy has longer administration times because of the infusion of multiple drugs, which may be an inconvenience. Also, even though the toxic effects are similar with both combined therapy and monotherapy, the adverse effects associated with combination therapy may be less well tolerated and may negatively affect the patient's quality of life. Finally, combination therapy is more expensive than monotherapy with ganciclovir or foscarnet alone.10 Patients should be evaluated with these issues in mind before combination therapy is initiated.
Efficacy of direct hemoperfusion using polymyxin B-immobilized fiber column (PMX-DHP) in rapidly progressive interstitial pneumonias: results of a historical control study and a review of previous studies
Authors: Ichiyasu Hidenori , Horio Yuko , Masunaga Aiko , Migiyama Yohei , Sakamoto Yasumiko , Jodai Takayuki , Ideguchi Hideharu , Okabayashi Hiroko , Hamada Shohei , Yoshida Chieko , Hirosako Susumu , Okamoto Shinichiro , Kohrogi Hirotsugu 
Published: May 2017

Background: Direct hemoperfusion using polymyxin B-immobilized fiber column (PMX-DHP) therapy has been approved for sepsis-associated acute respiratory distress syndrome, but its efficacy for other rapidly progressive interstitial pneumonias (RPIPs) is unclear. The purpose of this study was to examine the efficacy of PMX-DHP therapy for acute respiratory failure in patients with RPIPs, when compared with a historical control receiving conventional treatment without PMX-DHP. Methods: This study comprised 77 patients with RPIPs in our institute between January 2002 and December 2015. The initial 36 patients between January 2002 and March 2007 were treated without PMX-DHP (historical control group), and the following 41 patients between April 2007 and December 2015 were treated with PMX-DHP (PMX-DHP group) once daily for two successive days concurrently with corticosteroids and/or immunosuppressive agents. The 90-day mortality and clinical factors were compared between the groups. Cox proportional hazards models were constructed to analyze 90-day mortality and identify predictors. Results: The 90-day mortality rate was significantly lower in the PMX-DHP group than in the controls (41.5% versus 66.7%, p = 0.019). PMX-DHP therapy was significantly associated with mortality (hazard ratio 0.505; 95% confidence interval, 0.270–0.904; p = 0.032). There were significant differences in the serial changes in the PaO2/FiO2 ratio, SOFA score, and blood neutrophil counts from days 0–5 after PMX-DHP between the survivor and non-survivor groups ( p = 0.015, p < 0.001, p = 0.035, respectively). The improved PaO2/FiO2 ratio on day 3 significantly correlated with the change in blood neutrophil counts (rs = −0.431, p = 0.006). Conclusions: PMX-DHP therapy may be effective in RPIPs patients accompanied by acute respiratory failure and is expected to reduce mortality rates.
Epidemiology of Shoulder Dislocations in High School and Collegiate Athletics in the United States: 2004/2005 Through 2013/2014
Authors: Kraeutler Matthew J. , Currie Dustin W. , Kerr Zachary Y. , Roos Karen G. , McCarty Eric C. , Comstock R. Dawn 
Published: May 2017

Background: Shoulder dislocations occur frequently in athletes across a variety of sports. This study provides an updated descriptive epidemiological analysis of shoulder dislocations among high school and college athletes and compares injury rates and patterns across these age groups. Hypothesis: There would be no difference in injury rates/patterns between high school and college athletes. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Methods: Shoulder dislocation data from the High School Reporting Information Online (RIO) and the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) databases were analyzed from the 2004/2005 through 2013/2014 (NCAA) or 2005/2006 through 2013/2014 (RIO) academic years in 11 different sports. Rate ratios (RRs) and injury proportion ratios (IPRs) were calculated to make comparisons between age groups. Results: During the study period, 598 shoulder dislocations were reported during 29,249,482 athlete-exposures (AEs) among high school athletes, for an overall shoulder dislocation rate of 2.04 per 100,000 AEs; 352 shoulder dislocations were reported during 13,629,533 AEs among college athletes, for an overall injury rate of 2.58 per 100,000 AEs. College athletes had a higher rate of shoulder dislocation than high school athletes (RR, 1.26; 95% CI, 1.11-1.44). However, the injury rate in football was lower in collegiate than high school athletes (RR, 0.52; 95% CI, 0.43-0.62). Surgery was performed to correct 28.0% of high school and 29.6% of college shoulder dislocations. Shoulder dislocations resulted in longer return-to-play times than other shoulder injuries. Conclusion: Overall, shoulder dislocation rates were higher among collegiate than high school athletes. This may be due to greater contact forces involved in sports at higher levels of play, although the increased rate in high school football warrants additional research. Clinical Relevance: Higher shoulder dislocation rates within collegiate athletics are likely due to the higher level of intensity at this level of play, with stronger and faster athletes resulting in more forceful collisions.
Cardiac Rehabilitation for the Elderly: Qi Gong and Group Discussions
Authors: Stenlund Therese , Lindström Britta , Granlund Marie , Burell Gunilla 
Published: May 2017

Background Over the last decade several studies have shown that patients with coronary artery disease even above the age of 70 can be successfully treated with advanced medical and surgical methods. Unfortunately, rehabilitation programmes for this group are rarely offered. It is important to develop forms of rehabilitation that are adapted to the specific needs of this increasing group of elderly patients. The aim of this randomized study was to investigate whether the combination of Qi Gong and group discussions would increase physical ability for elderly patients ≥ 73 years with coronary artery disease. Methods A total of 95 patients (66 men and 29 women), with documented coronary artery disease, were randomized to an intervention group (n = 48) mean age 77 ± 3 (73-82) or to a control group (n = 47) mean age 78 ± 3 (73-84). The intervention groups met weekly over 3 months. The control group got usual care. Physical ability was assessed at baseline and after the intervention. Results Patients in the intervention group increased their self-estimated level of physical activity (P = 0.011), and their performance in the one-leg stance test for the right leg (P = 0.029), co-ordination (P = 0.021) and the box-climbing test for right leg (P = 0.035). Conclusion A combination of Qi Gong and group discussions appear to be a promising rehabilitation for elderly cardiac patients in terms of improving self-reported physical activity, balance and co-ordination. This could be an option for elderly patients who do not participate in the ordinary cardiac rehabilitation. Eur J Cardiovasc Prev Rehabil 12:5-11 © 2005 The European Society of Cardiology