bluuebunny/crossref_metadata_2025_split huggingface dataset:
Octreotide for Refractory Diarrhea Associated with Capecitabine
Authors: Tanvetyanon Tawee , Gaynor Ellen R 
Published: September 2013

Objective: To describe the effect of low-dose subcutaneous octreotide on refractory diarrhea associated with capecitabine. Case Summary: A 67-year-old white woman with recurrent metastatic breast cancer received monotherapy with capecitabine after failing docetaxel. The first 2 consecutive capecitabine cycles were well tolerated. The patient, however, developed severe watery diarrhea after the third cycle. Diphenoxylate, atropine, loperamide, and attapulgite, along with conventional supportive measures, did not significantly improve the diarrhea, resulting in prolonged hospitalization. Octreotide 100 μg every 8 hours was administered subcutaneously. Immediate relief in stool frequency was observed during the first day. The stool became more formed on the next day. The patient was ready for discharge after learning how to perform subcutaneous injections. Octreotide was continued at home for 3 more days. After discontinuation of octreotide, no recurrent diarrhea occurred. Capecitabine was not reinitiated. Discussion: Diarrhea is a potentially life-threatening complication from treatment with capecitabine, an oral fluoropyrimidine analog. Octreotide has shown efficacy for diarrhea from many conditions, including chemotherapy with irinotecan and intravenous fluoropyrimidines such as fluorouracil. Our report suggests that octreotide also is effective for diarrhea associated with capecitabine. The patient's rapid response shortened her hospital stay and improved her quality of life. Conclusions: In our patient, subcutaneous octreotide, along with other conventional antidiarrheal therapies, was associated with rapid resolution of refractory diarrhea attributed to capecitabine.
The Effects of β-Adrenergic Blockers in African Americans with Chronic Heart Failure
Authors: Veverka Angie , Carter D Brent , Crouch Michael A 
Published: September 2013

Objective: To review the available literature regarding the use of β-adrenergic blockers in African Americans with heart failure. Data Sources: Primary literature was located via MEDLINE (1966–January 2004). Key search terms were β-adrenergic blockers; heart failure, congestive; carvedilol; metoprolol; bisoprolol; and bucindolol. Data Synthesis: In African Americans, the prevalence of chronic heart failure (CHF) is nearly twice that of white people. African Americans exhibit symptoms of CHF at an earlier age, develop more marked functional decline after hospitalization for CHF, and have almost a twofold higher mortality rate compared with white patients. Sympathetic nervous system activation is a key pathophysiologic response in CHF; by attenuating this system, β-blockers have been shown to decrease mortality. Unfortunately, minority populations have been underrepresented in many of the trials evaluating β-blockers. Of the 4 β-blockers assessed in CHF, bucindolol has shown detrimental effects when used in African Americans. Metoprolol and bisoprolol have not been sufficiently evaluated to determine if response varies by race. Carvedilol has the best documented benefit in this population. Conclusions: Response to β-adrenergic blockers in CHF varies by race. Bucindolol has shown detrimental effects when used in African Americans. Further investigation is warranted to determine if metoprolol and bisoprolol are equally efficacious to carvedilol in African American patients with CHF.
Management of Cardiac Failure—Do Practitioners Follow Guidelines?
Authors: Suisted Philip , Seneviratne Sujith , Burgess Carl 
Published: September 2013

Objective: To assess the use of β-blockers, spironolactone, and the dose of angiotensin-converting enzyme (ACE) inhibitors in patients with congestive cardiac failure. Methods: The medical records of patients discharged with a diagnosis of congestive cardiac failure between January 1, 2001, and June 30, 2001, from the internal medicine and cardiology services at Capital and Coast District Health Board, Wellington, New Zealand, were identified and analyzed for cardiac drugs on admission and discharge. These records were also reviewed for New York Heart Association status and left-ventricular ejection fraction. Results: Two hundred ninety-two patients (146 from each service) were identified as having congestive cardiac failure; 84 were excluded due to death, admission being procedure related, notes being unavailable, or transfers from other services. The patients' mean age was 73 years. Four of 74 eligible patients were started on β-blockers, while 11 of 30 eligible patients were started on spironolactone. Sixteen patients were prescribed spironolactone inappropriately, and 27 were prescribed target recommended doses of ACE inhibitors. Conclusions: This study has shown that guidelines for the treatment of cardiac failure are difficult to follow in clinical practice. Adequate studies in older individuals with congestive cardiac failure are indicated.
Neuroleptic Malignant Syndrome: No Longer Exclusively a “Neuroleptic” Phenomenon
Authors: Wargo Kurt A , Gupta Rahul 
Published: September 2013

Objective: To review the literature concerning the incidence of neuroleptic malignant syndrome (NMS) associated with the use of atypical antipsychotics. Data Sources: Cases were identified through a search of MEDLINE (1986–March 2004) using the terms neuroleptic malignant syndrome, antipsychotic, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. Study Selection and Data Extraction: Case reports of possible NMS secondary to second-generation antipsychotics were selected for review. Reports meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for NMS were considered. Case reports in which 1 of the 2 major diagnostic criteria was met were also included in the analysis. Furthermore, at least one minor criterion was met. Case reports in which patients received traditional antipsychotics were excluded. Data Synthesis: NMS is a rare and sometimes fatal disease. Several theories exist as to how NMS develops, and an equally large amount of diagnostic criteria are available. However, the majority of available data are based on the first-generation neuroleptics and very few exist with regard to the second-generation antipsychotics. Conclusions: Although there are numerous case reports of NMS occurring secondary to the use of second-generation antipsychotics, the incidence has never been fully elucidated. While the reasons for this remain uncertain, not all cases of second-generation–induced NMS fulfill the diagnostic criteria established for traditional neuroleptics and therefore may not be reported as such.
The Need for a More Stringent LDL-C Goal in Patients with Diabetes
Authors: Altman Julie S , Kerr Jessica L , Thrower Margaret R 
Published: September 2013

Objective: To review relevant literature supporting the need for intensive lipid management in patients with diabetes mellitus. Data Sources: A literature search using MEDLINE (1975–March 2005) was conducted. The search terms coronary disease, diabetes mellitus, hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins), lipoproteins, and low-density lipoprotein cholesterol (LDL-C) were used to identify published trials comparing the effects of intensive LDL-C lowering and cardiovascular morbidity and mortality. Study Selection and Data Extraction: Primary literature was evaluated and included in this review if the study was a large randomized trial containing a significant number of diabetic patients receiving primary prevention. For trials including patients without diabetes, an available sub-analysis of the diabetic population in that trial must have been available. Data Synthesis: The incidence of diabetes mellitus is rising in dramatic proportions throughout the nation. In addition to the diagnosis of diabetes, many of these patients also have preexisting risk factors that increase their risk for cardiovascular morbidity and mortality. In 2004, the National Cholesterol Education Program issued a scientific statement proposing a newer and lower optimal LDL-C goal for high-risk populations. This article reviews pertinent findings from recent clinical trials and guidelines discussing the need to integrate more stringent LDL-C goals into clinical practice. Conclusions: Although data are limited, all patients with diabetes mellitus, regardless of cardiovascular status, may benefit from lipid-lowering therapy with an optimal LDL-C goal of < 70 mg/dL.
The Pharmacist's Role in Continuity of Care in Type 2 Diabetes: An Evaluation of a Model
Authors: Krass Ines , Taylor Susan J , McInman Adrian D , Armour Carol L 
Published: September 2013

Background: Evidence suggests that many patients with type 2 diabetes are not achieving current evidence-based therapeutic targets. Objective: To compare the impact of a clinic-only versus continuity-of-care model on clinical and humanistic outcomes of patients with type 2 diabetes. Methods: One hundred eighteen patients were recruited from 2 diabetes clinics and assigned to a clinic-only or continuity-of-care group. The clinic-only patients were assessed by the clinic pharmacist at the initial visit and attended their usual pharmacy until the follow-up clinic visit 6 months later. The continuity-of-care patients were referred to one of 20 participating pharmacies for ongoing care over 6 months. The evaluation used a repeated measures design and compared the clinic-only with the continuity-of-care groups. Results: Within the continuity-of-care group, there was a significant reduction in mean blood glucose over the 6 months (p = 0.04). Compared with the clinic-only group, the continuity-of-care model demonstrated a trend toward a greater improvement in glycemic control. The net benefit of the intervention was an additional 0.27% (95% CI −0.63% to 0.009%) reduction in hemoglobin A1c (p = 0.15). Improvements in negative attitude and understanding of diabetes were seen in both groups; however, improvements in positive attitude to diabetes were seen only in the continuity-of-care group. Conclusions: The continuity-of-care model had a significant impact on clinical and humanistic outcomes. Community pharmacists may enhance the care of patients with type 2 diabetes.
Two Approaches to Treatment of Complicated Candida Glabrata Urinary Tract Infection in Renal Failure
Authors: Kishel Joseph J , Arunkumar Punitha 
Published: September 2013

Objective: To report the treatment of 2 cases of Candida glabrata urinary tract infection (UTI) in the setting of renal failure. Case Summaries: A 37-year-old female in acute renal failure developed a complicated UTI due to C. glabrata. The organism was eradicated after treatment with caspofungin. The second patient, a 58-year-old woman also in acute renal failure, developed a complicated UTI due to C. glabrata. This patient failed to eradicate the organism after repeated courses of voriconazole. Discussion: UTI caused by non-albicans Candida in the setting of renal failure presents few therapeutic options for management. Caspofungin and voriconazole have excellent activity against Candida spp., but have poor elimination as active drug in the urine. Amphotericin B is less feasible in the setting of acute renal failure, in which return of renal function is expected. Lipid-associated amphotericin products poorly penetrate the kidney. Despite these facts, one patient cleared the organism after treatment with caspofungin and one patient had persistent positive cultures after receiving voriconazole. Conclusions: Despite poor penetration into the urine, caspofungin may be an option in the management of UTI when other modalities are not feasible or desired.
Impact of β-Blocker Dosage Changes during Heart Failure Exacerbation
Authors: Brouse Sara D , Hafezi Shideh 
Published: September 2013

Background: Although β-blockers are important life-saving medications in heart failure patients, studies evaluating β-blocker dosing in decompensated heart failure are limited. Objective: To determine the clinical outcomes in patients with severe decompensated heart failure receiving the same dose of β-blockers as well as those whose outpatient regimen was altered. Methods: A retrospective chart analysis was conducted in patients with severe decompensated heart failure receiving chronic β-blocker therapy who were admitted to the hospital for decompensated heart failure. Of 245 patients identified, 76 were included in the study: same dose (n = 26), decreased dose (n = 19), discontinued dose (n = 21), or increased dose (n = 10). χ2 Analysis for K-independent samples evaluated the incidence of proarrhythmic events, mortality, and the number of recurrent hospitalizations after the index admission. Stepwise forward linear regression analysis determined the variables correlated with morbidity and mortality in these patients. Results: New arrhythmias during hospital admission occurred in 19 (25%) patients. The discontinued dose group had the most proarrhythmic events (47.6%; n = 10) and the most deaths (50%) in 6 months. Arrhythmias developed 1.8 and 3 days following β-blocker discontinuation or dosage reduction, respectively. Conclusions: Patients who remained on their outpatient β-blocker dose upon admission for decompensated heart failure had better clinical outcomes than others whose β-blocker dose was changed. A prospective, randomized, controlled clinical trial is warranted to further explore the implications of this drug–disease state interaction.
Ursodeoxycholic Acid for the Treatment of Parenteral Nutrition–Associated Cholestasis in Pediatric Patients
Authors: Tejani Aaron M , Arbo Trudy C 
Published: September 2013

Objective: To determine the relative safety and efficacy of ursodeoxycholic acid (UDCA) in children and neonates with parenteral nutrition–associated cholestasis (PNAC). Data Sources: A comprehensive search (up to May 29, 2006) of the following databases was conducted to identify relevant prospective, randomized, double-blind clinical trials and systematic reviews: Ovid–MEDLINE, PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects, and the Centre for Reviews and Dissemination. In addition, reference lists from retrieved articles were searched to identify trials or systematic reviews not identified in the search of electronic databases. Also, the manufacturer of UDCA was contacted regarding access to any other unpublished trials that could be included in this review. Study Selection and Data Extraction: Prospective, double-blind, randomized, controlled trials of neonates (<36 wk gestational age) and/or children (0–18 y) who developed PNAC while receiving parenteral nutrition were included in the analysis. Articles were evaluated with specific focus placed on the following hierarchy of outcomes: mortality, nonfatal serious adverse events, liver failure, infection, sepsis, return of liver function test results to within normal ranges, and relief of pruritus. Data Synthesis: No prospective, double-blind, randomized, controlled trials assessing the efficacy and safety of UDCA for the treatment of PNAC in children and/or neonates were identified. Five retrospective chart reviews and/or case series were identified; however, the results of these studies were conflicting and do not provide sufficient evidence of the safety and efficacy of UDCA for the treatment of PNAC. Conclusions: There is no evidence from prospective, double-blind, randomized, controlled trials in neonates and/or children with PNAC regarding the relative safety and efficacy of UDCA therapy.
Physician Acceptance of a Hyperlipidemia Program's Adaptation of the National Cholesterol Education Program's Adult Treatment Panel III Update
Authors: Palmieri James 
Published: September 2013

Background: Physician acceptance of a disease management program is paramount to that program's success, particularly in a voluntary referral system. Physician satisfaction assessment is necessary as programs adapt to updated national guidelines that change the practice of care. Objective: To assess the level of knowledge and acceptance of the principles behind the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III update among physicians who refer to our telephone surveillance hyperlipidemia risk management program, assess their satisfaction with our program's educational efforts regarding clinical hyperlipidemia management, and ascertain the physicians' ongoing willingness to refer their patients to our program. Methods: Surveys were mailed to all physicians (n = 81) who had patients actively enrolled in our program at the time of the study. The survey consisted of 7 questions designed to discern the physicians' awareness and acceptance of the trend toward more aggressive cholesterol-lowering therapy in certain high-risk patient populations, as well as their future willingness to refer patients to our program now that more aggressive treatment targets have been established. Results: Of the 21 (26%) physicians who responded to our survey, all indicated that they were aware of the latest NCEP update. Most physicians (94%) received their knowledge of the update outside of our program's efforts to inform them, yet most (90%; p < 0.001) thought that our program kept them informed on the best practices for dyslipidemia management. Respondents were overwhelmingly in favor of the more aggressive targets (95% [p < 0.001 for highest-risk patients]; 100% [p < 0.001 for moderately high-risk patients]). Conclusions: Our referring physicians are aware of and support the NCEP ATP III update recommendations and the revisions to our standardized procedure that came as a result of these recommendations.
Implementation of an Algorithm for Intravenous Pantoprazole: Impact on Prescription Compliance in Quebec University Hospitals
Authors: Blouin Julie , Désaulniers Pierre-Louis , Tremblay Lydjie , Poitras Pierre , Dragomir Alice , Perreault Sylvie 
Published: September 2013

Background: Intravenous pantoprazole is used at Centre Hospitalier de l'Université de Montréal (CHUM) for the adjuvant treatment of nonvariceal upper gastrointestinal bleeding (UGB) and for inhibiting acid secretion among patients unable to tolerate oral intake (NPO). Since it was added to the CHUM formulary, the use of intravenous pantoprazole has steadily increased, and at times it has been used without endoscopic documentation of a nonvariceal UGB or even when the patient could have received a proton pump inhibitor orally. Objective: To assess the impact of an algorithm for intravenous pantoprazole on prescription compliance. Methods: Using a pre–post intervention specification, the use of pantoprazole was audited on a retrospective (January 1, 2002, to April 30, 2002) and prospective (January 1, 2003, to April 30, 2003) basis. We reviewed the medical records of all patients having received intravenous pantoprazole during these periods, assessing the compliance of prescriptions as specified by the algorithm. Cost of therapy and the step-down regimen were also reviewed. Results: In total, 150 patients were identified in the retrospective phase and 109patients in the prospective phase. The subjects were organized into 2 groups: UGB and NPO. In the UGB group, rates of compliance with indication, dose, and duration of treatment in the retrospective phase were 8.8%, 76.5%, and 58.8%, respectively; the corresponding rates for the prospective phase were 26.5% (p < 0.01), 80.9% (p = 0.53), and 69.1% (p = 0.78), respectively. The total rates of compliance (including indication, dose, and duration) were 4.4% in the retrospective phase and 11.8% in the prospective phase (p = 0.12). In the NPO group, the rate of compliance at the initiation of pantoprazole was 42.7% in the retrospective phase and 36.6% in the prospective phase (p = 0.51). The cost of noncompliance with the indication in the UGB group was estimated at $12 270 CDN (in the retrospective phase) and $7829 (in the prospective phase). In the NPO group, the cost figures were $8048 (retrospective phase) and $5929 (prospective phase). Conclusions: This study demonstrates that intravenous pantoprazole is being used in a suboptimal manner in our institution. Despite explicit criteria for use, in the prospective phase, we observed only 11.8% total compliance in the UGB group and 36.6% compliance at the initiation of pantoprazole in the NPO group. Even though these results were not statistically significant, in the prospective phase, we saw improvement in most compliance rates.
Association of Cardiac Drugs with Depression after Acute Coronary Syndrome
Authors: Corser William , Hanak Michael , Stommel Manfred , Olomu Ade , Yang Zhou , Dunn Susan , Holmes-Rovner Margaret 
Published: September 2013

Background: Depressive adverse effects of major cardiac medications in patients with cardiovascular disease have been suggested. Objective: To investigate the influence of the use of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and/or β-blockers on subsequent depressive symptoms in patients hospitalized for acute coronary syndrome. Methods: A sample of 521 patients was followed for 8 months during 1,340 observations. Data were collected from structured telephone interviews and medical record chart reviews. Pooled time series generalized estimating equations regression models were used to evaluate depressive symptom scores, controlling for major clinical and sociodemographic patient characteristics. Results: No significant independent or interactive effects were found linking the use of these medications to subsequent depressive symptoms, despite changes in depressive symptoms over time. Factors that did affect subsequent depression included sociodemographic (eg, increased age, less education) and clinical characteristics (eg, higher composite comorbidity, prior history of depression and/or first myocardial infarction, higher postdischarge pain levels). Conclusions: Our results suggest that potential depressive adverse effects should not be considered a contraindication to the use of recommended cardiac medications. Observed increases in depressive symptoms after an acute cardiac injury will more likely be attributed to other patient characteristics independent of the use of major drug therapy prescribed to prevent further acute cardiac events.