bluuebunny/crossref_metadata_2025_split huggingface dataset:
Significant Bleeding in Elderly Patient with Atrial Fibrillation Due to Probable Interaction between Dabigatran and Amiodarone
Authors: Neuffer Elizabeth M , Tofade Toyin S , Galpin Lauren E , Ritchey Amanda J , Roma Domenick J 
Published: September 2013

Objective: To present the case of an elderly patient who developed significant bleeding while receiving a standard dose of dabigatran with concomitant amiodarone therapy. Case Summary: A 77-year-old man was admitted for upper gastrointestinal bleeding that presented as coffee ground emesis. A coronary artery bypass graft had been performed 4 weeks earlier, which was well tolerated, except that his postoperative course was complicated by atrial fibrillation, for which amiodarone was initiated; dabigatran was added subsequently. Upon his admission to the hospital, dabigatran was stopped. The patient's bleeding was stabilized and dabigatran 150 mg twice daily was restarted after amiodarone was discontinued. The laboratory was not equipped to measure thrombin clotting time or ecarin clotting time; therefore, the team relied on the measurement of international normalized ratio (INR) and activated partial thromboplastin time to guide therapy based on pharmacokinetic and pharmacodynamic studies of therapeutic dabigatran concentrations. Based on laboratory values the following morning, the team maintained dabigatran 150 mg once daily. Subsequent INR and partial thromboplastin time values were within the desired range. He remained stable, without further evidence of bleeding even after anticoagulation with dabigatran was restarted for atrial fibrillation. Discussion: Dabigatran received FDA approval in October 2010 to reduce the risk of stroke and systemic embolization in patients with nonvalvular atrial fibrillation. It has a favorable monitoring profile compared to warfarin. The manufacturer acknowledges the potential for amiodarone to increase the effective concentration of dabigatran because of its inhibition of P-glycoprotein. An objective causality assessment using the Horn Drug Interaction Probability Scale revealed that the interaction was probable. Conclusions: A probable interaction suggests that providers should use caution with the coadministration of amiodarone with dabigatran; dose adjustment in the setting of concomitant administration in elderly patients with atrial fibrillation should be considered.
The Patient-Centered Medical Home and Community Pharmacists' Perceptions
Authors: Hohmeier Kenneth C , Mangan Michelle N , Powers Mary F , Lengel Aaron J 
Published: September 2013

Background: As new models of health care delivery are being discussed, it is important to determine the pharmacist's role within each care model to assist in the provision of clinical services. Recent literature suggests that pharmacists are integral members of the patient-centered medical home (PCMH) and should be included as members of the health care team. As the most accessible health care professionals, community pharmacists are uniquely positioned to play a prominent role within the PCMH, as enhanced access is one of the joint principles of the PCMH care model. To date, no studies have described the barriers to community pharmacists' participation in the PCMH model or their acceptance as members of the PCMH team. Objective: To evaluate community pharmacists' perceptions of barriers to participation and acceptance within the PCMH in a community pharmacy chain. Methods: Online surveys were made available to 244 community pharmacists working for a supermarket pharmacy chain in Ohio. Pharmacists completed the survey anonymously and indicated their opinions on preparedness to participate in the PCMH, their relationship with other health care providers, their relationship with patients, and their perceived barriers to participation in a PCMH. Results: Of the 244 pharmacists contacted, 129 completed the survey (52.9%). In total, 32.6% of responding pharmacists were familiar with the PCMH before the survey. A majority of respondents agreed that pharmacists are sufficiently trained and have the skills required to participate within the PCMH (79.8%, 93.8%, respectively). Only 36.4% of pharmacists agreed that physicians are willing to work closely with community pharmacists. Pharmacists also indicated that they do not have adequate opportunities to meet with other members of their patients' health care team (68.5%). Conclusions: Most community pharmacists are still unfamiliar with the concept of the PCMH. Once they were made aware of what a PCMH is, the pharmacists surveyed indicated that they want to be members of a PCMH. Before pharmacists participate in this model of care within the community setting, it is important that they first understand and address the barriers identified from this survey in order to facilitate a smooth transition of pharmacy services into the PCMH.
Outpatient Perceptions of the Medtable: A Medication Scheduling Tool
Authors: Conner-Garcia Thembi , Morrow Daniel , Graumlich James , Ellison Jennifer , Wang Huaping 
Published: September 2013

Background: Health literacy is the ability of patients to obtain, process, and understand information needed to make health decisions. Health literacy is a stronger predictor of a person's health than is age, income, employment status, educational level, or race. The Medtable is a paper-based tool that is designed to support comprehension of medication information by patients. A collaborative tool such as the Medtable might facilitate the comprehension of medication information by low-literacy patients and increase communication regarding medications between healthcare pers and their patients. Before evaluating the efficacy of the Medtable to improve health outcomes, it is important to confirm that patients find the tool easy to use and helpful in relevant clinical settings. Objective: To investigate whether patients think that the Medtable is a helpful and easy-to-use tool for organizing daily medication regimens. Methods: Sixty outpatients participated in this usability study. Patients filled in the Medtable with a healthcare provider. Opinions regarding the usability of the Medtable were elicited with a brief questionnaire afterward. Results: Fifty-five of the 60 (92%) patients thought the Medtable would be very or somewhat helpful when figuring out when to take their medications and would be very or somewhat helpful for assisting them with taking their medications at home. Fifty-nine of the 60 (98%) patients thought the Medtable would be very or somewhat easy to fill in with the assistance of their health care provider. Conclusions: Patients think that the Medtable is a helpful and easy-to-use tool for organizing their daily medication regimens. Future studies should evaluate Medtable's efficacy to improve patient medication knowledge and adherence.
Salvage Options for Eradication of Helicobacter pylori During Tetracycline Backorder
Authors: Segarra-Newnham Marisel , Coakley Christina 
Published: September 2013

Objective: To review salvage options for Helicobacter pylori eradication regimens during a tetracycline backorder for patients with triple-therapy failure. Data Sources: A search of PubMed (1980-June 2012) was conducted using a combination of the terms H. pylori or Helicobacter pylori, salvage therapy, and eradication or treatment as text word searches. Study Selection and Data Extraction: Clinical trials and meta-analyses published in English were included. A manual review of the bibliographies of available literature was conducted and relevant articles were reviewed for inclusion. Data Synthesis: Treatment of H. pylori consists of a triple-drug regimen that includes a proton pump inhibitor (PPI), amoxicillin or metronidazole, and clarithromycin. Failure with this therapy is becoming increasingly common due to macrolide resistance. Upon failure with this regimen, it is recommended that a quadruple regimen with bismuth subsalicylate, metronidazole, tetracycline, and a histamine2 receptor antagonist or a PPI be used. Recent backorders by the 2 manufacturers for tetracycline restrict the use of this regimen. Options that can be considered include minocycline or doxycycline in place of tetracycline, levofloxacin- or moxifloxacin-based regimens, a tinidazole-based regimen, or a rifabutin-based regimen. This article includes a review of 1 study each of minocycline and doxycycline, 5 levofloxacin studies (including meta-analyses), 2 moxifloxacin studies, 1 rifabutin study, and 1 tinidazole study. There are limited data with other tetracyclines; however, given the resistance to quinolones in some areas and possible drug interactions and adverse effects from rifabutin, minocycline or doxycycline regimens may be a better second-line regimen option. Conclusions: Given the current tetracycline shortage, minocycline and doxycycline are options to be considered in patients with a macrolide-based treatment failure. Fluoroquinolones may be an option for patients who have not received these drugs for other indications in the recent past or in areas where resistance is low.
Pharmacotherapeutic Options for the Treatment of Patients with Obesity
Authors: Debellis Lindsay R , Wrobel Mark J 
Published: September 2013

Objective: To assess the safety and efficacy of FDA-approved and in-development antiobesity agents. Data Sources: Literature was accessed through MEDLINE (1950-current) and EMBASE using the terms antiobesity agent, diethylpropion, phentermine, orlistat, topiramate, lorcaserin, bupropion, and naltrexone. In addition, reference citations from publications identified were reviewed. Files related to FDA expert panel hearings were retrieved from the FDA website. Study Selection and Data Extraction: Randomized double-blind trials assessing the efficacy and safety of antiobesity agents compared with placebo in the treatment of overweight and obese adults were reviewed. Only English-language or English-translated literature was reviewed. Medications were selected based on FDA approval status. Data Synthesis: Ten double-blind clinical trials were reviewed. There are currently 5 FDA-approved antiobesity agents and 1 agent recently rejected by the FDA. Study results for all agents showed statistically significant weight loss compared with placebo, but with varying adverse effects. The combination of phentermine and topiramate is the most efficacious antiobesity agent approved by the FDA. However, this combination has various neurologic, cardiovascular, and teratogenic safety risks that may limit its use. Based on its safety profile, orlistat is the preferred antiobesity medication, despite the lesser extent to which it induces weight loss versus newer agents. The incidence of unwanted gastrointestinal adverse effects limits its use. Conclusions: Despite a glaring medical need for options to treat obesity, available medications are limited. No current drug option is ideal; each has either safety risks or efficacy concerns. Safe agents that meet FDA efficacy standards are needed to help treat the obesity epidemic.
Quetiapine-Induced Leukopenia and Neutropenia in an Intensive Care Unit Patient with Delirium
Authors: Shewmaker Justin 
Published: September 2013

Objective: To report a case of neutropenia in a critically ill trauma patient who was receiving quetiapine for hyperactive delirium. Case Summary: A 30-year-old white female was admitted to the neurosurgical intensive care unit following a motor vehicle crash. During her recovery in the intensive care unit, she received quetiapine for hyperactive delirium. The patient was initially started on quetiapine 50 mg/day, which was eventually increased to 100 mg/day. Her white blood cell count and neutrophil count were both noted to be decreasing, eventually reaching a nadir of 2.29 × 109/L and 0.89 × 109/L, respectively. Quetiapine was discontinued and her white blood cell count and neutrophil count returned to normal. Discussion: Quetiapine-induced neutropenia has rarely been reported. A MEDLINE search (1991-August 2012) revealed 12 case reports; however, in none of them had neutropenia occurred in critically ill patients. The available case reports reveal a wide variety of doses and durations of treatment with quetiapine-associated neutropenia. A definite mechanism for quetiapine-induced neutropenia is unknown. Quetiapine is structurally related to clozapine, known to cause neutropenia, and it may share a similar mechanism. The Naranjo probability scale revealed possible neutropenia associated with quetiapine. Conclusions: With the increased use of quetiapine for hyperactive delirium in intensive care unit patients, health care professionals should be cognizant of the potential for quetiapine to induce neutropenia.
Management of Xerostomia in Older Adults: A Systematic Review
Authors: Daniels Betty , McNally Mary , Matthews Debora , Sketris Ingrid , Hayden Jill A 
Published: September 2013

Background: Xerostomia (dry mouth) is a common adverse effect of many medications and can severely diminish quality of life for older adults. Objective: To assess the effectiveness of 3 categories of interventions used to manage drug-induced xerostomia and xerostomia secondary to Sjögren syndrome and radiation treatment for head and neck cancer in older adults: saliva substitutes, saliva stimulants, and topical fluoride. Data Sources: The Cochrane Library, PubMed, EMBASE (to July 2009) and CINAHL (to February 2010) were searched for randomized or quasi-randomized studies involving older adults with drug- or radiation-induced xerostomia or Sjögren syndrome. Study Selection and Data Extraction: An updating search focusing on systematic reviews (to June 2012) was conducted prior to publication. Outcomes included perceived dryness of the mouth, reduced sialometry, or increased root caries. Duplicate study selection and data extraction were conducted. Risk of bias was assessed. A random effects meta-analysis was employed. Data Synthesis: Four studies of saliva substitutes (N = 116), 3 studies of saliva stimulants (N = 361), and 1 of fluoride treatment (N = 334) met selection criteria. Saliva substitutes were more effective than other treatments at improving perceived dryness of the mouth as determined on a 10-point visual analog scale (weighted mean difference [WMD] −1.91 [95% CI −2.54 to −1.29]) but less effective than placebo (WMD 0.26 [95% CI 0.51–1.02]). Parasympathetic stimulants were more effective than placebo in improving oral dryness (OR = 0.37 [95% CI 0.19–0.72]). Due to lack of data, quantitative synthesis of results for topical fluoride was not possible. Conclusions: There is evidence to suggest that saliva substitutes improve symptoms but the clinical significance is minimal. The evidence more strongly supports the effect of saliva stimulants, although the quality of evidence is poor and adverse effects from these medications cannot be overlooked. Evidence demonstrating efficacy of topical fluoride in disease prevention was inconclusive. Addressing underlying causes of xerostomia, including drug choices, may help mitigate the burden of illness and effects on quality of life.
Orthostatic Hypotension in the Patient with Diabetes: A Broad Review of Pharmacologic Treatment Options
Authors: Smith Nicole D 
Published: September 2013

Objective: To provide an evidence-based broad review of the pharmacologic management of orthostatic hypotension (OH) in the patient with diabetes. Data Sources: A search of PubMed, MD Consult, International Pharmaceutical Abstracts, and the Cochrane Register of Clinical Trials and Systematic Reviews was performed using the key words diabetes, autonomic neuropathy, orthostatic hypotension, midodrine, fludrocortisone, pyridostigmine, xamoterol, octreotide, pindolol, dihydroergotamine, erythropoietin, clonidine, acarbose, desmopressin, and droxidopa. Literature published between 1976 and August 2012 was included. Study Selection and Data Extraction: All articles in English and studies in humans including clinical trials, meta-analyses, practice guidelines, randomized controlled trials, and review articles were identified and evaluated. Studies not including patients with diabetes were excluded. The selection of materials was focused on those that would aid the pharmacist in caring for patients with orthostatic hypotension resulting from diabetic neuropathy. Data Synthesis: Definitive guidelines on the pharmacologic management of OH in the patient with diabetes are not available and recommendations must be assessed from available evidence-based sources. Ten trials of medications used in the patient with diabetes were assessed for efficacy and safety. From these trials, evidence-based therapy options were recommended. If nonpharmacologic measures are insufficient in ameliorating symptoms, fludrocortisone or midodrine should be considered as first-line agents in the absence of contraindications. Pyridostigmine, octreotide, or recombinant erythropoietin may be useful as adjunct or alternative agents. Combination therapy may be considered, based on coexisting conditions or response. When recommending both nonpharmacologic and pharmacologic therapy, careful attention should be paid to comorbid conditions such as congestive heart failure, supine hypertension, and kidney disease. Conclusions: There is insufficient evidence to recommend the routine use of medications other than the first-line agents fludrocortisone or midodrine in this patient population. Further trials with existing and new therapeutic options in patients with diabetes are warranted.
Effect of Group Diabetes Self-Management Education Classes on Clinical Outcomes and Patient Satisfaction in a Family Medicine Clinic
Authors: Shrader Sarah P , Martin Alison , Cogdill Brittany 
Published: September 2013

Background: The American Diabetes Association (ADA) has emphasized the need for patients to receive diabetes self-management education (DSME) as a standard of care. Various DSME models have been described, including individual or group sessions. There is no preferred method reported in the literature. Objectives: To determine the effect of group DSME classes on patients' hemoglobin A1c (A1C), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C). Patient satisfaction was also assessed. Methods: Pharmacists offered 4 group education classes to patients over the course of 1 year using the ADA Diabetes Conversation Maps. Patients were encouraged to attend all sessions to cover the entire curriculum; however, many attended only 1 class. Patient A1C, BP, and LDL-C were monitored before the first class and after the last class attended. The Wilcoxon signed-rank test and descriptive statistics were used for data analysis. Results: Thirty-two patients attended at least 1 of the group classes, and 9 returned for more than 1 class. Baseline characteristics included a mean age of 58 years, baseline A1C of 9.4%, systolic BP of 140.6 mm Hg, diastolic BP of 77.2 mm Hg, and LDL-C of 99.1 mg/dL. An average decrease of 1.1% in A1C, 5.1 mm Hg in systolic BP, 1.9 mm Hg in diastolic BP, and 4.6 mg/dL in LDL-C was seen from baseline after class participation. For patients who attended more than 1 class, a statistically significant decrease of 3.6% occurred in A1C (p < 0.05). The majority of patients (84%) reported greater satisfaction with the group DSME as compared with individual diabetes education. Conclusions: Data from this study support offering group DSME classes as a method of patient education at a family medicine clinic.
The Role of Pictograms for Enhancement of Patient Prescription Medication Information in the US
Authors: Advani Ashish A , Lopez Juan , Jones Jessica , Patel Shreena 
Published: September 2013

Background: Approximately half of American adults have trouble understanding and acting on health information. United States Pharmacopeia (USP) pictograms are standardized graphic images that help convey medication instructions, precautions, and/or warnings to patients and consumers. No published literature exists regarding USP pictogram-based prescription instructions for adults in the US. Objective: To gauge the perceived effect of USP pictograms included within patient information handouts in community pharmacy settings in the US. Methods: Two sets of patient information handouts were made for each of 2 community pharmacies' self-reported top 20 medications: one containing USP pictogram-based patient information and the other containing the same text without pictograms. Over a 6-week period, patients filling or refilling a prescription for one of the 20 medications were offered counseling using either a pictogram- or non-pictogram-based handout, selected at random. A patient-administered survey assessed 4 criteria of the handout received: user-friendliness, long-term comprehension, likelihood of referring to the handout in the future, and effectiveness. Results: The addition of pictograms significantly increased only the likelihood of the patient referring to the handout in the future. Conclusions: Results suggest a potential role for USP pictograms that should be evaluated on a larger scale in the future.
Treatment and Management of Postmenopausal Osteoporosis within an Ambulatory Care Network
Authors: Romanelli Robert J , Leahy Angela , Jukes Trevor , Ishisaka Denis Y 
Published: September 2013

Background: Postmenopausal osteoporosis (PMO) is associated with substantial morbidity and mortality. Despite established guidelines for the care of PMO, the treatment and management of this disease remain suboptimal. Objective: To examine the treatment and management of PMO in a community-based ambulatory care setting. Methods: Women with a new diagnosis of PMO (International Classification of Diseases, 9th Revision, code 733.01) were identified through the electronic health records (EHR) of a community-based ambulatory care network in northern California between January 1, 2007, and December 31, 2008. Patients were included if they were 65 years of age or older and had EHR activity 26 months or more after diagnosis. They were excluded if they had a diagnosis of osteoporosis (ICD-9:733.xx) prior to the study period. A retrospective review of the EHR and medical charts was performed to identify patients who were prescribed FDA-approved pharmacotherapy, who received bone mineral density (BMD) testing via dual-energy X-ray absorptiometry (DXA), and who experienced a fracture. Results: One hundred thirty-one PMO patients were identified who met study eligibility criteria. Fifty-nine patients (45%) were prescribed FDA-approved pharmacotherapy at diagnosis. Ninety patients (69%) were prescribed pharmacotherapy at any point during follow-up. Sixty-four patients (49%) had a baseline DXA scan and 95 patients (73%) had 1 or more DXA scans during follow-up. Seventeen of 90 patients (19%) who received pharmacotherapy had 2 DXA scans within 2 years of follow-up. Nineteen fractures were reported among 16 patients during the study period. Conclusions: The proportion of patients with PMO who received pharmacologic treatment at diagnosis and had a baseline DXA scan was relatively low; however, the majority of these patients received treatment and had 1 or more DXA scans at some point during the 26-month follow-up period. Future studies should be conducted to assess the role of early BMD testing and pharmacologic intervention in optimizing outcomes among women with PMO.