bluuebunny/crossref_metadata_2025_split huggingface dataset:
Access to Health Care and Hearing Evaluation in US Adults
Authors: Crowson Matthew G. , Schulz Kristine , Tucci Debara L. 
Published: May 2016

Objectives: To explore self-reported hearing testing access for adults in a nationally representative survey. Methods: Demographic and audiologic adult survey respondent variables in the National Health and Nutrition Examination Survey (NHANES) database 2011-2012 cohort were examined. Logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI). Results: In all, 5864 adult respondents were analyzed. Two-thirds (65.6%) of respondents reported having hearing tested 10 or more years ago or never tested at all. Male gender (OR = 2.27; 95% CI, 1.31-3.94), having a health care visit less than 3 years ago (OR = 8.19; 95% CI, 2.09-32.2), and having health insurance (OR = 1.73; 95% CI, 1.08-2.77) were significantly associated with respondents reporting having a hearing test less than 10 years ago. Mexican American race (OR = 0.41; 95% CI, 0.20-0.83) and respondent age 40 to 59 (OR = 0.52; 95% CI, 0.33-0.81) were significantly associated with respondents reporting having a hearing test 10 or more years prior or never. Conclusion: A significant proportion of the adult population reports having hearing tested 10 or more years prior or never at all. Effort will be required to identify adults who have hearing loss and may benefit from auditory rehabilitation such as hearing aids or the cochlear implant.
The Use of Ibuprofen in Posttonsillectomy Analgesia and Its Effect on Posttonsillectomy Hemorrhage Rate
Authors: Pfaff Julia A. , Hsu Kevin , Chennupati Sri Kiran 
Published: May 2016

ObjectiveTo determine the effect of ibuprofen on posttonsillectomy bleeding when compared with codeine in posttonsillectomy analgesia.Study DesignCase series with chart review.SettingTertiary care children’s hospital, Philadelphia, Pennsylvania.Subjects and MethodsOn July 1, 2012, our institution transitioned from acetaminophen with codeine to ibuprofen for posttonsillectomy analgesia. Pediatric patients (0‐18 years old) who underwent surgery from July 1, 2010, to June 30, 2012, were placed in the codeine cohort, and those who underwent surgery from July 1, 2012, to June 30, 2014, were placed in the ibuprofen cohort.ResultsA total of 6014 patients underwent tonsillectomy between July 1, 2010, and June 30, 2014, and 211 patients presented for posttonsillectomy hemorrhage during the same period. The incidence of readmission for posttonsillectomy hemorrhage was 3.4% and 3.6% (P =. 63; odds ratio [OR] = 1.07; 95% confidence interval [95% CI]: 0.811‐1.410) for the codeine and ibuprofen groups, respectively, and the incidence of second operation for control of posttonsillectomy bleeding for the codeine and ibuprofen groups was 1.9% and 2.2% (P =. 54; OR = 1.117; 95% CI: 0.781‐1.600), respectively. Patients aged 11 to 18 years demonstrated a higher incidence of posttonsillectomy bleeding events overall. When age is controlled, multivariate logistic regression demonstrated no statistically significant increase in posttonsillectomy bleeding events among pediatric patients treated with ibuprofen versus patients treated with codeine (readmission: P =. 617; OR = 0.932; 95% CI: 0.707‐1.228; reoperation: P =. 513; OR = 0.887; 95% CI: 0.618‐1.272).ConclusionAge is an independent risk factor for posttonsillectomy bleeding. When age is controlled, there is no statistically significant increase in the incidence of posttonsillectomy bleeding events among patients treated with ibuprofen when compared to patients treated with codeine.
Chemosensitivity enhancement toward arsenic trioxide by inhibition of histone deacetylase in NB4 cell line
Authors: Li Xiaofan , Guan Xiaoyan , Li Fang , Chen Yuanzhong , Li Nainong 
Published: May 2016

Objective To investigate the cytotoxic effects of suberanilohydroxamic acid (vorinostat) in combination with arsenic trioxide (ATO) on the human NB4 cell line in vitro. Methods The rates of cell proliferation following treatment with vorinostat with or without ATO were measured. Flow cytometry of Annexin-V/propidium iodide double-stained cells was used to measure apoptosis. Acridine Orange and ethidium bromide staining was used to observe morphological changes characteristic of apoptosis. Western blot analysis was used to measure protein levels. Results Vorinostat and ATO, alone and in combination, inhibited the proliferation of NB4 cells in a time- and dose-dependent manner and the effect was additive. NB4 cells treated with vorinostat + ATO demonstrated greater levels of apoptosis compared with cells treated with either drug alone. Both vorinostat and ATO alone and in combination resulted in lower levels of promyelocytic leukaemia/retinoic acid receptor alpha fusion protein and increased levels of acetyl-histone H3 and acetyl-histone H4 proteins compared with controls. Vorinostat + ATO resulted in lower levels of Akt protein compared with either drug alone. Conclusion The combination of vorinostat and ATO inhibited cell proliferation, induced apoptosis, and enhanced the chemosensitivity of NB4 cells. The mechanism might be associated with increasing histone acetylation levels as well as downregulation of the Akt signalling pathway.
Population Pharmacokinetics: Development of a Medical Intensive Care Unit-Specific Gentamicin Dosing Nomogram
Authors: Watling Sharon M. , Kisor David F. 
Published: May 2016

Objective This study was designed to develop a population-specific dosing nomogram for gentamicin in medical intensive care unit (MICU) patients using the population pharmacokinetic program nonparametric expectation maximization (NPEM). Design Observational clinical gentamicin dosing data were collected, entered into the USC*PACK database program PASTRX, and downloaded into the population pharmacokinetic program NPEM. NPEM generated population pharmacokinetic parameter values that were used to develop a gentamicin dosing nomogram. The nomogram was tested in the next 15 patients admitted to MICU to determine accuracy. Doses given per the MICU and the Hull-Sarubbi nomograms were compared with doses based on actual patient-specific pharmacokinetic parameter values. Reliability coefficients (intraclass correlation coefficients) were calculated to assess the agreement between observations. Setting Data were gathered from patients receiving gentamicin therapy in the MICU, Presbyterian University Hospital, Pittsburgh. Patients Baseline population pharmacokinetic parameter values were determined in 36 MICU patients receiving gentamicin therapy. Patients with renal failure receiving hemodialysis or another mechanical method of blood clearance or fluid removal were excluded. The population parameter values in the form of a dosing nomogram were then used prospectively to dose gentamicin in 15 patients. Results NPEM generated population parameter values similar to those previously published using the Sawchuk-Zaske method in ICU patients. The mean volume of distribution generated using NPEM was 0.34 ± 0.12 L/kg. The relationship between creatinine clearance (Clcr) and elimination rate constant (Ke) was: Ke = 0.00218 x Clcr + 0.007. The nomogram-derived doses correlated with doses determined by using actual patient-specific pharmacokinetic values (p<0.05). The Hull-Sarubbi derived doses, however, did not correlate with patient-specific doses (p>0.05). Only one patient had a peak concentration <6 mg/L. Two of 15 patients had trough concentrations prior to the first maintenance dose >2 mg/L. Conclusions The use of NPEM to generate population-specific pharmacokinetic parameter values has been previously described. Application of population-specific dosing nomograms can improve initial dosing regimens such that conventional therapeutic concentrations can be achieved early in therapy. This nomogram, however, does not preclude follow-up patient-specific pharmacokinetic analysis.
Inappropriate Use of High-Dose Glyburide to Treat Uncontrolled Type 2 Diabetes Mellitus
Authors: Rae Charlesworth E. , Ewing Robert C. , Cook Dee Dee 
Published: May 2016

Objective To report a case of chronic glyburide overdose. Case Summary A patient with noninsulin-dependent diabetes mellitus (NIDDM) who had previously developed secondary failure while taking a maximal dosage of glipizide was switched to glyburide 5 mg/d. The patient initially experienced adequate glycemic control while taking glyburide, but subsequently experienced deterioration in glycemic control. This necessitated gradual increases in the dosage of glyburide until the maximum dosage of 20 mg/d was reached. Because the patient's diabetic control did not improve with this dosage of glyburide, she decided independently to increase the dosage further. She ingested an average daily dose of 37.7 mg of glyburide over the 18 days that preceded her clinic visit without experiencing any glyburide-related adverse effects. Discussion Progression of NIDDM may be responsible for the development of secondary sulfonylurea failure in NIDDM patients treated with oral sulfonylurea drugs. Consequently, these patients should be treated as patients dependent on insulin. Conclusions NIDDM patients treated with oral sulfonylurea drugs require long-term blood glucose monitoring to detect the development of secondary sulfonylurea failure. Patients who experience secondary failure to a particular sulfonylurea drug do not appear to develop long-term blood glucose control when switched to a different oral sulfonylurea drug. These patients should be treated with insulin therapy.
Suspected Nafcillin-Induced Interstitial Nephritis
Authors: Guharoy Sudip Roy , Kar Sheila , Mcgalliard James 
Published: May 2016

Objective To present a case of nafcillin-induced interstitial nephritis. Methodology Case report and literature review. Setting Hospital. Results Three days following initiation of nafcillin therapy for staphylococcal pneumonia, an 80-year-old woman developed allergic manifestations and progressive renal impairment suggestive of acute allergic interstitial nephritis. These manifestations were completely reversed within 96 hours of cessation of nafcillin therapy. Conclusions In the clinical setting of acute renal failure in a patient on nafcillin therapy, acute interstitial nephritis should be considered. Prompt cessation of nafcillin therapy has generally been associated with reversal of symptoms and an improvement in renal function.
Retroperitoneal Abscess Caused by Mycobacterium Chelonae and Treatment
Authors: Idemyor Vincent , Cherubin Charles E. 
Published: May 2016

Objective To report a case of retroperitoneal abscess caused by Mycobacterium chelonae and treatment. Design Case report. Setting Private community teaching hospital. Patients A patient was admitted to the hospital following a gunshot to the flank. The bullet passed through the iliac crest and lodged in the abdomen. Intervention The patient was treated with cefazolin, trimethoprim/sulfamethoxazole, and amikacin at different times. Outcome The patient responded well to pharmacologic treatment and at 18-month follow-up, he is disease free. Conclusions Antimicrobial agents with in vitro activity against M. chelonae, especially amikacin-containing regimens, are recommended for treating M. chelonae infection.
Labetalol: Response and Safety in Critically Ill Hemorrhagic Stroke Patients
Authors: Patel Rakesh V. , Kertland Heather R. , Jahns Brian E. , Zarowitz Barbara J. , Mlynarek Mark E. , Fagan Susan C. 
Published: May 2016

Objective To observe and characterize the blood pressure (BP)-lowering and adverse hemodynamic and/or central nervous system effects of intravenous bolus doses of labetalol in hemorrhagic stroke patients. Design Observational, prospective, pilot survey conducted over an eight-week period. Setting Surgical intensive care unit. Participants Patients admitted with an intracerebral or subarachnoid hemorrhage. Main Outcome Parameters Absolute decline in systolic BP (SBP) and diastolic BP (DBP), time to peak reduction in SBP and DBP, and adverse hemodynamic and mental status changes. Results Labetalol at doses between 5 and 25 mg lowered SBP by 6–19 percent (baseline 152–184 mm Hg) and DBP by 3–26 percent (baseline 50–99 mm Hg). Adverse hemodynamic or mental status changes were not detected following labetalol administration. Conclusions Small (≤25 mg) intravenous bolus doses of labetalol produce mild decreases in BP in hemorrhagic stroke patients.
Use of Clonidine to Treat Hot Flashes Secondary to Leuprolide or Goserelin
Authors: Bressler Linda R. , Murphy Christine M. , Shevrin Daniel H. , Warren Richard F. 
Published: May 2016

Objective To determine the effects of clonidine, a centrally acting adrenergic agonist, in abating symptoms of hot flashes in men receiving either leuprolide or goserelin for prostate cancer. Design Patients were administered transdermal or oral clonidine 0.1–0.2 mg/d. Dosages were increased in increments of 0.1–0.3 mg/d every two to four weeks if symptoms persisted or until adverse effects developed. Setting Medical oncology clinic at the University of Illinois and the hypertension clinic at the Veterans Affairs West Side Medical Center. Participants Consenting male patients were eligible for the study if they were receiving leuprolide or goserelin for prostate cancer and were experiencing hot flashes. Exclusion criteria included diastolic blood pressure of 75 mm Hg or below or a history of adverse reactions to clonidine. Main Outcome Measures Effectiveness of clonidine was determined by questioning patients about frequency, severity, and duration of hot flashes at baseline and at two- to four-week intervals. Results All four patients receiving clonidine experienced a partial response within two weeks of starting treatment. No dose-dependent response was observed. Adverse effects were noted in one patient but did not result in discontinuation. Conclusions Our results document the first report of the use of clonidine to treat hot flashes secondary to leuprolide or goserelin therapy. Symptomatic improvement was noted in all four patients. Further evaluation of clonidine as well as other centrally acting adrenergic agonists is needed.
Vigabatrin
Authors: Connelly Julie Faulkner 
Published: May 2016

Objective To introduce the reader to the use of a new agent, vigabatrin, in the treatment of refractory complex partial seizures. Clinical trials and pharmacokinetic data are reviewed, as well as neuropathology, adverse effects, drug interactions, and dosage guidelines. Data Sources A MEDLINE search through March 1992 was used to identify pertinent English-language literature, including clinical trials, reviews, abstracts, and conference proceedings. Indexing terms included vigabatrin and anticonvulsants. Study Selection All clinical trials (total of 21) were reviewed, as were all pharmacokinetic studies (total of 8). Selected studies highlighting chemistry, pharmacology, neuropathology, and adverse effects were also reviewed. Data Extraction Performed subjectively by the author. Trials were assessed by design, sample size, types of seizures of the subjects, and clinical response. Data Synthesis Vigabatrin represents the first of a new class of antiepileptic drugs (AEDs)—the gamma-aminobutyric acid transaminase (GABA-T) inhibitors. Vigabatrin works by selective, irreversible inhibition of GABA-T, thus preventing the breakdown of GABA. It has been shown to produce dose-dependent increases in cerebrospinal fluid GABA concentrations, and decreases in GABA-T activity. Vigabatrin may also cause a decrease in excitation-related amino acids. It is well absorbed, is not protein bound, and is eliminated by glomerular filtration. However, even with a short half-life (5–7 h), vigabatrin may be given once or twice daily because of its mechanism of action. Few drug interactions have been reported with this agent, although decreases in phenytoin concentration may reach clinical significance. Concern over neuropathologic findings (microvacuolization of white matter) in animals caused trials of vigabatrin to be halted in 1983, but trials have now resumed as there is no evidence of toxicity in humans. Clinical efficacy of vigabatrin has been evaluated in controlled trials and appears to be most effective in complex partial seizures, producing a 50 percent or greater reduction in seizure frequency in approximately 50 percent of the adult patients studied. Efficacy in children with partial seizures also appears promising, and one uncontrolled study suggests that further study of vigabatrin in infantile spasms may be warranted. Conclusions Vigabatrin appears to be effective in treating refractory complex partial seizures in adults and refractory partial seizures in children. Its relatively benign adverse-effect profile and few known drug interactions may give this agent an advantage over existing anticonvulsants. However, definitive conclusions about the role of vigabatrin in epilepsy treatment should await the completion of ongoing Phase II and Phase III trials.
Renal Functional Alterations Induced by Angiotensin-Converting Enzyme Inhibitors in Heart Failure
Authors: Munger Mark A. 
Published: May 2016

Objective To review the effects of angiotensin-converting enzyme (ACE) inhibitors on renal pathophysiology and the compensatory mechanisms involved in heart failure. A clinical application of the use of these agents in the setting of concomitant heart failure and renal insufficiency also is presented. Data Sources A MEDLINE search was conducted using the terms heart failure, congestive; renal insufficiency; and angiotensin-converting enzyme inhibitors. Study Selection All applicable animal and human trials were reviewed. Data Synthesis Advances in the management of heart failure have led to new insights into the complex pathophysiology of this condition, particularly the favorable clinical effects noted with the ACE inhibitors. The net effect of ACE inhibitors on the renin-angiotensin system in patients with heart failure is to augment renal blood flow to a greater extent than cardiac output. Glomerular filtration rate is either unchanged or decreased by ACE inhibition. Sodium excretion is augmented primarily by alterations in glomerular hemodynamic parameters. ACE inhibitors may alter renal tubular function, both directly and indirectly, leading to increased diuresis and natriuresis. Conclusions Although ACE inhibitors exert beneficial pharmacodynamic effects on the renal bed in patients with heart failure, clinical consideration of volume and neurohormonal status prior to institution of therapy is prudent.
Use of Trans-Retinoic Acid in the Treatment of Acute Promyelocytic Leukemia
Authors: Dulaney Alice M. , Murgatroyd Rebecca J. 
Published: May 2016

Objective To discuss acute promyelocytic leukemia (APL) and review the literature concerning differentiation treatment of APL with trans-retinoic acid (t-RA). Data Sources English-language articles concerning APL or its treatment with t-RA were identified with a MEDLINE search. Study Selection All studies available at the time of article preparation, which addressed t-RA treatment in APL, were selected. Data Extraction Data extraction and assessment were performed subjectively by the authors. An extensive discussion of specific study details is included in the article. Data Synthesis APL is a unique subset of acute myelogenous leukemia and is typified by an accumulation of malignant promyelocytes in the bone marrow. Within the granulocyte cell cycle of a patient with APL, differentiation has been halted at the level of the promyelocyte, preventing formation of mature granulocytes. Upon treatment with traditional cytotoxic chemotherapy, complete remission rates of approximately 70 percent, with a five-year survival ranging from 25 to 40 percent have been achieved. In most patients with APL, a characteristic chromosomal t(15q+;17q-) translocation has been found, which may be responsible for the production of an aberrant retinoic acid receptor-alpha. Therefore, t-RA induction therapy has been investigated and has produced promising results. Administration of t-RA in dosages of 45–100 mg/m2/d has induced complete remissions. The apparent mechanism of t-RA is the induction of promyelocyte differentiation and maturation. The most common adverse effects noted have been dry skin, cheilitis, and headaches. Conclusions Upon consideration of the initial trials, t-RA appears to be a promising and unique treatment for APL.
Assessing the Quality of Pharmaceutical Care II. Application of Concepts of Quality Assessment from Medical Care
Authors: Farris Karen B. , Kirking Duane M. 
Published: May 2016

Objective To present a framework that facilitates quality assessment of pharmaceutical care (PC) so that the profession and the public may identify pharmacists in ambulatory settings who provide quality care in all aspects of their practices. Data Sources A MEDLINE search augmented by a review of International Pharmacy Abstracts was used to identify pertinent quality assessment and pharmacy practice literature; indexing terms included quality assurance, healthcare, pharmacists, community pharmacy services, ambulatory, pharmacy, and process and outcome assessment. Study Selection All identified quality assessments of community pharmacy practice were considered. Studies that documented the effectiveness of specific pharmacist activities and patient satisfaction were also included. Data Extraction The literature was independently reviewed by the primary author. Data Synthesis The structure–process–outcome paradigm is presented as a framework for quality assessment of PC. Structure should be assessed at periodic intervals because it identifies the potential for the provision of quality care. Process, the care that pharmacists provide, must be documented and linked to outcomes before either structure or process can be used to make inferences about the quality of PC. Technical and interpersonal processes should be examined. Outcomes require an interdisciplinary approach that not only considers other medical care inputs but also recognizes the psychologic, economic, and social factors that affect health status and quality of life. Process and outcome must both be assessed to distinguish the contribution of pharmacists from that of other healthcare providers. Examples of criteria are provided and a model to integrate PC within the healthcare system is discussed. Conclusions It is pharmacists’ duty to ensure that patients receive an acceptable level of PC. The structure-process-outcome paradigm provides a framework to identify and link pharmacists’ processes with patients’ outcomes.