bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening Status in Relation to Biological and Chronological Characteristics of Breast Cancers: A Cross Sectional Survey
Authors: Alexander Freda E , Anderson Thomas J , Hubbard Alexandra L 
Published: January 2017

Objective— To determine the pathological and biological characteristics of breast cancers diagnosed by screening and examined at the Edinburgh University pathology department. Methods— These cancers were classified by screening status: never screened (n=111), prevalence screen detected (n=105), and previously screened (n=74). The last category arose in women who had been regularly screened during the trial; the cancers were diagnosed as interval cases before the first invitation to service screening (n=33) or were incidence screen detected at that time (n=41). Results— Association (for operable invasive cancers, n=250) of cancer characteristics with screening status reflects influences of biology (aggressiveness) or chronology (time of diagnosis), or both. The prognostic indicators tumour grade, histological type, and oestrogen receptor status were found in a smaller percentage of the patients with poor prognosis among the prevalence screen detected cases (9%, 77%, 18%) than among those previously screened (29%, 84%, 35%). The chronological factors size and node status were found in a smaller percentage of patients with poor prognosis among women previously screened (31%, 24%) than among those never screened (62%, 39%)). Apart from these two, no other factors improved the diagnosis in the previously screened group compared with the never screened group. Conclusions— These results suggest that favourable characteristics of screen detected cases are often due to the effects of length bias on “biological factors” and fail to show that current local screening practice has succeeded in advancing the diagnosis of breast cancers to a less aggressive phase.
Prospective Trial on Captopril-Related Cough
Authors: Lefebvre Jean , Poirier Luc , Lacourcière Yves 
Published: January 2017

OBJECTIVE: Quantify and characterize cough as an adverse reaction secondary to captopril. DESIGN: Cohort analytic study: six-month prospective trial including two-week, placebo, run-in period; five-month, single-blind, active treatment; and two-week, dechallenge period. SETTING: Outpatient clinic. PATIENTS: 199 previously treated or newly diagnosed untreated patients with mild to moderate hypertension. INTERVENTIONS: Captopril 50 mg/d during five months. OUTCOME MEASURES: Self-questionnaires, interviews, dechallenge, and rechallenge periods, Naranjo's algorithm. RESULTS AND CONCLUSIONS: (1) Cumulative incidence of captopril-induced cough over a five-month period was 7.1 percent (95 percent C.I., 6.8–7.4 percent). Incidence of drug withdrawal secondary to severe cough was 1.0 percent; this figure is somewhat similar to first reports about the reaction. (2) Cough was a generally mild to moderate symptom, present day and night in 71.4 percent of patients and resistant to antitussive agents. Cough was not statistically related to sex, age, or smoking habit; however, the female gender and the development of a common cold may be predisposing factors.
Lovastatin-Induced Rhabdomyolysis in the Absence of Concomitant Drugs
Authors: Wallace Carla S. , Mueller Bruce A. 
Published: January 2017

OBJECTIVE: Presentation of a case of lovastatin-induced rhabdomyolysis in the absence of other medications known to potentiate this adverse effect. METHODOLOGY: Case report. RESULTS: A 60-year-old black man developed rhabdomyolysis after receiving lovastatin for 14 months. Rhabdomyolysis developed in the absence of other medications previously reported to cause this adverse effect when administered concomitantly with lovastatin. Adverse drug reaction causality algorithms categorized this reaction as either possible or probable. CONCLUSIONS: Rhabdomyolysis is an uncommon adverse effect associated with lovastatin therapy. Although reported cases of lovastatin-induced rhabdomyolysis were associated with the coadministration of cyclosporine, erythromycin, gemfibrozil, or nicotinic acid, this adverse effect may occur in the absence of these agents.
Predictive Performance of Equations to Estimate Creatinine Clearance in Hospitalized Elderly Patients
Authors: O'Connell Mary Beth , Dwinell Andrea M. , Bannick-Mohrland Susan D. 
Published: January 2017

OBJECTIVE: To ascertain the clinical accuracy of equations that estimate creatinine clearance to predict the correct drug doses in hospitalized elderly patients DESIGN: Single 24-hour creatinine clearance measurement compared with estimated creatinine clearances derived from eight equations using total and modified ideal body weight SETTING: Nonintensive care medical and surgical units at a county hospital PATIENTS: 15 patients with urethral catheters were enrolled in each of three age groups: 65–75, 76–85, and ≥86 years MAIN OUTCOME MEASUREMENTS: Drug–dose predictions, bias, precision, and absolute errors RESULTS: The bias for all equations was −4.0−42.0 mL/min (–0.07–0.70 mL/s) and the precision was 10.8−47.4 mL/min (0.18–0.88 mL/s). The Jelliffe 1973, Hull et al., and Mawer et al. equations were the least biased and the Jelliffe 1973 was the most precise, followed by the Mawer et al., Hull et al., and Cockcroft-Gault equations. The percent of patients with absolute percent errors >20 percent were 38 percent for Jelliffe 1973, 36 percent for Mawer et al., 40 percent for Hull et al., and >50 percent for the other equations. The percent of patients receiving correct drug doses was 67 percent for Jelliffe 1973, 58 percent for Gates, 51 percent for Mawer et al. and Hull et al., and <50 percent for the other equations. Within various age, renal function, serum creatinine, and albumin subgroups, the Jelliffe 1973 estimates were least biased and most precise, followed by the Cockcroft-Gault estimates. Generally, estimates using modified lean body weight performed better than did those using total body weight. CONCLUSIONS: The Jelliffe 1973 equation with modified lean body weight was the best equation, followed by the Cockcroft-Gault equation. Even with the best equation, 33 percent of the patients would have received an incorrect drug dose. Therefore, some elderly patients may still require a measured creatinine clearance.
A Nationwide Investigation of a Possible Protamine Drug-Product Defect
Authors: Herrera Carlos R. , Grasela Thaddeus H. , Walawander Cynthia A. 
Published: January 2017

OBJECTIVE: To follow-up a report submitted to FDA Spontaneous Reporting System, we investigated the hypothesis that there was not a striking increase in unexpected deaths within four hours after elective coronary artery bypass surgery associated with protamine sulfate use. DESIGN: Surveys were mailed to clinical pharmacists at 521 hospitals participating in the Drug Surveillance Network. Questionnaires were to be completed with the assistance of cardiac surgeons and anesthesiologists. Hospitals responding with a suspected problem with protamine were contacted via telephone. RESULTS: Surveys were received from clinical pharmacists at 380 hospitals (73 percent response rate) and 29 hospitals reported the occurrence of potential problems associated with protamine during coronary artery bypass graft surgery. Telephone interviews of the positive responders yielded six cases of possible myocardial decomposition potentially associated with protamine. There was no association with a specific distributor, however, and none of the hospitals reported a dramatic increase in serious adverse events around the time of index cases. CONCLUSIONS: There was no evidence of a widespread public health problem with protamine and a product recall was not necessary. The high response rate and the ability to follow-up with telephone interviews suggests that the Drug Surveillance Network is an effective mechanism for investigating possible outbreaks of serious adverse events in the hospital setting.
The Effect of Physician Education on Knowledge of Drug Therapeutics and Costs
Authors: Sumpton Janice E. , Frewen Timothy C. , Rieder Michael J. 
Published: January 2017

OBJECTIVE: To determine if a clinical pharmacist-sponsored education program regarding physician knowledge of drug costs and therapeutics would change drug utilization and costs for specific high-cost groups of drugs in a pediatric critical care unit (PCCU). STUDY DESIGN: Prescribers within the PCCU completed a questionnaire addressing drug costs and therapeutic issues. Subsequent to the questionnaire the PCCU liaison pharmacist implemented a visual display of monthly drug costs, an education program that included the presentation of questionnaire results, and drug information lectures discussing controversial therapeutic issues. After the education program participants again completed the questionnaire. SETTING/PARTICIPANTS: The study was conducted in a 13-bed PCCU in a regional children's hospital. The participants were postgraduate trainees in pediatrics and critical care medicine as well as attending staff in the PCCU. OUTCOME MEASURES: The main outcome measure was the score on a test addressing drug costs and therapeutic issues. RESULTS: The mean overall posteducation score (52.5 percent) improved significantly from the preeducation score (46.4 percent). The preeducation questionnaire results indicated increased knowledge of costs by residents and increased knowledge of therapeutics by attending physicians. The number of educational sessions attended appeared to be associated with improvement in overall questionnaire scores. CONCLUSIONS: There was improvement in knowledge of drug costs and therapeutics associated with the educational program. Although this relationship did not reach statistical significance, this may be related to the relatively small sample size of our study. Our results suggest that clinical pharmacists can positively influence physicians' knowledge on drug costs and therapeutics.
Treatment of Type I Diabetes with a Combination of Glyburide and Insulin
Authors: Gums John G. , Curry R. Whitney , de Oca Gelcys Montes , Skluth Hilary A. , Reynolds L. Raymond 
Published: January 2017

OBJECTIVE: To assess the ability of a combination of insulin and an oral hypoglycemic agent (glyburide) to improve the overall glycemic control in a population of patients with type I diabetes. DESIGN: Randomized, placebo-controlled, double-blind trial. SETTING: Community-based, university-affiliated, family medicine group. PATIENTS: Men and women between 18 and 68 years of age with type I diabetes. INTERVENTIONS: Subjects were observed and titrated on an insulin only regimen for 12 weeks (phase I). Subjects were then randomized to receive either placebo or glyburide 10 mg/d for an additional 12 weeks (phase II). MAIN OUTCOME MEASURES: Glucose measurements were taken at breakfast, lunch, supper, and bedtime. Each patient also was followed sequentially for serum lipids, glycosylated hemoglobin, (Hb A1c) and daily insulin utilization. RESULTS: Average fasting blood glucose (FBG) measurements were significantly lower in the glyburide-treated group during phase II (9.22 ± 0.55 mmol/L) compared with baseline (10.27 ± 0.93 mmol/L) and phase I (10.41 ± 0.55 mmol/L). A decrease in the average Hb A1c concentration in the glyburide group was evident by week 4 and was sustained for the duration of the study. The average daily insulin dose rose significantly in the glyburide but not the placebo group compared with baseline. Total cholesterol, triglycerides, and low-density lipoprotein cholesterol did not change significantly in either group over the course of the study. High-density lipoprotein cholesterol increased significantly over baseline in the glyburide group during phase II. Several patients experienced dramatic improvements in glycemic parameters after the addition of glyburide to their insulin regimens. CONCLUSIONS: Improvements were observed in the FBG and Hb A1c measurements of this heterogeneous population of patients with type I diabetes after the addition of glyburide to their insulin regimens. The study failed to find consistent trends in glycemic control when evaluating mean changes in FBG measurements.
Isradipine—Another Calcium-Channel Blocker for the Treatment of Hypertension and Angina
Authors: Lopez Larry M. , Santiago Tamara M. 
Published: January 2017

OBJECTIVE: To review the pharmacology, pharmacokinetic disposition, dose recommendations, adverse effects, drug interactions, and efficacy of isradipine in patients with hypertension or ischemic heart disease. DATA SOURCES: Data from scientific literature were extracted, evaluated, and summarized for presentation. A MEDLINE search was conducted using the following indexing terms: isradipine, calcium-channel blockers, hypertension, and angina pectoris. Experiences from studies evaluating isradipine reported in the form of articles, abstracts, or proceedings involving patients or healthy subjects were considered for inclusion. STUDY SELECTION: Special consideration was given to clinical studies that had been designed in a blind, randomized fashion. Studies that compared the effectiveness and safety of isradipine with another antihypertensive or antianginal agent or placebo were included. DATA EXTRACTION: Data from human studies published in the English language were evaluated. Trials were evaluated according to sample size, design, and adequacy of description of therapeutic response. DATA SYNTHESIS: Isradipine is a new dihydropyridine calcium-channel blocker that appears to exert less negative inotropic activity than nifedipine and to selectively inhibit sinoatrial conduction. Pharmacokinetic parameters are quite variable and considerably more work is needed to better describe the kinetic disposition of isradipine. Antihypertensive efficacy has been demonstrated extensively in a number of short-term trials. Antianginal efficacy also has been observed in a few short-term trials and is comparable to that of isosorbide dinitrate and nifedipine. Extensive experience with isradipine is minimal and no clear-cut advantages over existing compounds have been noted thus far. CONCLUSIONS: The place of isradipine in the therapy of hypertension and myocardial ischemia is unclear and its routine use cannot yet be recommended based solely on clinical grounds.
Hospital Nuclear Pharmacy—A Comparison of Physician and Pharmacist Practice
Authors: Dansereau Raymond N. , Dansereau Richard J. 
Published: January 2017

OBJECTIVE: Nuclear pharmacy is practiced in every hospital with a nuclear medicine clinic. Pharmacists control this practice in fewer than four percent of these institutions. The authors wish to bring to the attention of hospital pharmacists an area of practice in which they can make a significant contribution to the state of pharmacy practice. METHOD: The current state of the physician practice of nuclear pharmacy is described and compared with the accepted standards of pharmacy practice. CONCLUSIONS: Hospital pharmacists can improve pharmaceutical care administered in nuclear medicine by their participation in nuclear pharmacy practice and by the application of hospital pharmacy practice standards. It is also suggested that nuclear pharmacy should be integrated into the pharmacy curriculum at schools of pharmacy.
Prediction of Glomerular Filtration Rate Using Aminoglycoside Clearance in Critically Ill Medical Patients
Authors: Zarowitz Barbara J. , Robert Sylvie , Peterson Edward L. 
Published: January 2017

OBJECTIVE: The aim of this preliminary investigation was to evaluate the use of aminoglycoside serum concentrations as a surrogate measure of the glomerular filtration rate (GFR) in comparison with other measured and empiric methods against inulin, the criterion standard measure of GFR. DESIGN: A consecutive sample of all eligible patients. SETTING: An eight-bed medical intensive care unit in a university-affiliated tertiary-care teaching hospital. PATIENTS: Ten critically ill medical patients receiving gentamicin or tobramycin for presumed or documented gram-negative bacillary infection were enrolled in the study. The patients were mechanically ventilated and had underlying organ system dysfunction. All ten patients completed the study. INTERVENTION: Patients underwent renal functional assessment by measured inulin (Clin) and 24-hour urinary creatinine clearance (Clcr). Aminoglycoside serum concentrations were used to estimate GFR and were compared with the two measured methods and a creatinine clearance calculated with the Cockcroft-Gault method (ClCG). All evaluations were performed the same day. RESULTS: Clin averaged 51.6 ± 35.0 mL/min and serum creatinine ranged from 0.3 to 5.4 mg/dL (26.5 to 477.3 μmol/L). Steady-state peak and trough aminoglycoside concentrations were 6.1 ± 1.4 and 1.3 ± 0.9 μg/mL, respectively. There were no statistically significant differences between the various methods, although the aminoglycoside-calculated GFR (Clamg) 95 percent confidence intervals were smaller man Clcr and ClCG compared with Clin. Mean absolute errors were smaller with Clamg than with Clcr and ClCG. Regression results indicated that only Clang and ClCG demonstrated agreement with Clin (lines not different from y=x). However, the Clamg showed closer agreement, with a mean square error almost half that of ClCG (9.6 vs. 18.1). CONCLUSIONS: Clamg can be used routinely as an estimate of GFR in critically ill patients, with less error man empiric methods.
Pamidronate
Authors: Kellihan Michael J. , Mangino Paul D. 
Published: January 2017

OBJECTIVE: The primary objective of this article is to introduce readers to the use of a new agent, pamidronate. The article discusses its use in hypercalcemia of malignancy (HCM), osteolytic lesions, and Paget's disease. Pharmacokinetic data and clinical trials are reviewed, as well as adverse effects and dosage guidelines. DATA SOURCES: A MEDLINE search was used to identify English-language studies involving pamidronate for the period from 1970 to 1992. STUDY SELECTION: As comparative trials were few in number, trials using pamidronate as a single agent were also reviewed. DATA EXTRACTION: Sparse pharmacokinetic data were obtained from clinical trials. All clinical trials available at the time of publication that met the following criteria were reviewed: (1) allowed for adequate rehydration prior to drug therapy; (2) reported standardized and corrected serum calcium concentrations; (3) separated data obtained from patients who received pamidronate alone from those who received pamidronate and concurrent chemotherapy. RESULTS: Pamidronate has a pharmacologic profile similar to that of etidronate, but pamidronate is more potent and has a longer duration of effect. It has been investigated primarily in the treatment of HCM as well as in the treatment of osteolytic bone metastases and Paget's disease. In hypercalcemia of malignancy it appears to be as effective as established agents with the advantage that a single dose of pamidronate 90 mg iv provides a durable response. In Paget's disease chronic oral administration has also been shown to be effective in relieving bone pain. Adverse reactions with intravenous administration are transient and self-limiting and usually occur with the first dose. The most common adverse effect is a transient and self-limiting fever. Chronic oral administration of doses >600 mg/d is associated with gastrointestinal toxicities. CONCLUSIONS: Although more well-designed clinical trials comparing pamidronate with standard therapies and other available agents are necessary, initial results indicate that pamidronate is an effective and promising alternative for use in the treatment of HCM.
Renal Insufficiency Associated with Intramuscular Administration of Ketorolac Tromethamine
Authors: Corelli Robin L. , Gericke Kristin R. 
Published: January 2017

OBJECTIVE: To evaluate reports of renal toxicity associated with intramuscular ketorolac tromethamine. Medical charts were reviewed for all cases of renal toxicity associated with ketorolac therapy. METHODS: Patients with possible ketorolac-associated nephrotoxicity were identified through our institution's adverse drug reaction reporting program. Patients were included in this report if: (1) renal insufficiency was temporally related to ketorolac administration; (2) resolution of renal insufficiency occurred after discontinuation of ketorolac; and (3) no other causes of renal insufficiency, including other medications, could be identified. RESULTS: Six patients had renal insufficiency secondary to ketorolac administration. The mean age of the patients was 58 years and cardiovascular disease was present in five. Serum creatinine values increased from a mean of 106 ± 26 μmol/L (1.2 ± 0.3 mg/dL) to a mean peak value of 256 ± 195 μmol/L (2.9 ± 2.2 mg/dL). Recovery of renal function was observed after a mean of 2.3 ± 0.5 days. CONCLUSIONS: Short-term administration of ketorolac can be associated with reversible oliguric renal insufficiency. Indiscriminate use of ketorolac for pain management in place of narcotic analgesics should be avoided, especially in patients at high risk for toxicity induced by nonsteroidal antiinflammatory drugs.
Felbamate
Authors: Graves Nina M. 
Published: January 2017

OBJECTIVE: To provide an up-to-date review of the current literature on felbamate (FBM) and its use as an antiepileptic medication (AEM). DATA SOURCES: All published literature (manuscripts and abstracts) on FBM was reviewed. The initial bibliography (up to September 1992) was provided by the manufacturer (Carter-Wallace Laboratories); subsequent literature was obtained from American Epilepsy Society presentations in December 1992 and manuscripts published up to January 1993. STUDY SELECTION/DATA EXTRACTION: All pertinent literature was reviewed. Information from the publications was abstracted and organized by the author. DATA SYNTHESIS: FBM is effective in complex partial seizures either as monotherapy or as an adjunct in patients receiving other AEMs. In addition, it has shown efficacy in some seizures associated with the Lennox-Gastaut syndrome. Adverse effects appear to be mild. When FBM is given as monotherapy, the primary adverse effects are insomnia and weight loss. Patients receiving multiple AEMs may have increased adverse effects. CONCLUSIONS: FBM appears to be an effective new AEM. Additional studies as to its role in newly diagnosed and pregnant patients are needed. Pharmacokinetic studies in children, patients with renal failure, and patients on nonepilepsy drugs also are needed.