bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pattern of Medication Use and Errors in a Tertiary Care Children's Hospital Intensive Care Unit
Authors: Burny Ilyas , Lieh-Lai Mary W , Gaynor Ken N , Thomas Ronald L , Sarnaik Ashok P 
Published: September 2013

Background: Children are at increased risk for medication errors because of weight-based dosing and the need for diluting stock solutions, both of which may lead to calculation errors. Medication errors are reported in 0.15% to almost 6% of medication orders for children. Critically ill children may be at the greatest risk because of hemodynamic and respiratory instability, drug–drug interactions, disease-related abnormalities in drug clearance and volume of distribution, and renal or hepatic insufficiency. Objective: To describe the pattern of medication use in a tertiary care children's hospital intensive care unit (ICU), to determine the status of FDA labeling for the drugs used in the same ICU, and to determine the rate and types of medication errors reported in our ICU and whether the errors were related to factors such as length of ICU stay and the number of medications received. Methods: This prospective, observational study was conducted over a 6 month period in the 20 bed medical–surgical ICU of a free-standing children's hospital. Data collected included all medications prescribed, total number of admissions, patient's age, length of ICU stay, the number of drugs prescribed per patient, and the number of medication errors reported through a computerized database named Dr. Quality. Medication errors were categorized according to the National Coordinating Council for Medication Errors Reporting and Prevention Medication Errors Categories. In addition, the status of pediatric labeling for each drug was determined. Results: Six hundred thirty-nine patients were admitted to the ICU during the study period. The average length of stay was 4 days. Two hundred seven (32%) patients stayed for one day, while the longest stay was 62 days (1 patient). The total number of prescriptions ordered and dispensed during the study period was 8,025. Each patient received an average of 13 medications (49 drugs were given to one patient). The 3 most commonly prescribed medication groups in the ICU were analgesics/sedatives, antimicrobials, and gastrointestinal preparations. Five hundred fifty-seven (87%) patients received one or more analgesic or sedative drug. Eighty-one percent received at least one antimicrobial. Of the 8,025 medication orders, 17 (0.21%) medication errors were reported. One hundred different medications were dispensed during the study period, with only 33% labeled for use in children 0–18 years. The effects of ICU length of stay and number of medications prescribed per patient on the occurrence of medication errors could not be determined due to the small sample size. Conclusions: Patients in this ICU received a significant number of medications, of which only 33% were labeled for use in children. The rate of medication errors was 0.21%.
Therapeutic Interventions for the Treatment and Control of Influenza
Authors: Patel Gourang P , Crank Christopher W , Black Stephanie 
Published: September 2013

Objective: To review antiviral management of influenza and discuss recent developments in antiviral resistance. Data Sources: Literature retrieval was accessed through MEDLINE/PubMed (1977–February 2007) using the terms influenza, resistance, adamantanes, and neuraminidase inhibitors, treatment, and prevention. In addition, reference citations from identified publications were reviewed. Study Selection and Data Extraction: All articles in English identified from the data sources were evaluated. Data Synthesis: Infection with influenza is associated with 36,000 deaths and more than 200,000 hospitalizations in the US each year and results in a large economic burden on society. We reviewed 7 trials describing management of influenza; the results showed that 92% of influenza cases demonstrated adamantane resistance in 2005. Selection of treatment for influenza with a neuraminidase inhibitor should be based on patient preference, past medical history, and managed care restrictions since one agent has not demonstrated superiority. Early initiation of treatment, within 12 hours of symptom onset (compared with 48 h), has resulted in illness being shortened by more than 3 days. Conclusions shown in the trials reviewed here regarding the consequences of increasing incidence of influenza A resistance include: viral surveillance cultures are important, influenza has a significant global impact, and inappropriate use of antiinfective agents results in local and global resistance. Conclusions: Therapeutic options for the management of influenza include the neuraminidase inhibitors, zanamavir and oseltamivir. Unfortunately, new classes of antiviral drugs for influenza will not be forthcoming in the near future. Adamantane resistance is now commonly demonstrated in influenza. At this time, efforts should be made to minimize patient risk for infection.
Evaluation of a Standardized Sliding Scale Insulin Preprinted Order
Authors: Wilbur Kerry , Yu Christine 
Published: September 2013

Background: Poor glycemic control is associated with negative outcomes in hospitalized patients with diabetes, both during and beyond their hospital stay. Despite its limitations, adjunct sliding scale insulin (SSI) is often prescribed to manage glucose levels, but the regimens are subject to wide variability and may contribute to medication error. Objective: To evaluate diabetic patients' glycemic control and staff acceptability following development and implementation of an SSI preprinted order (PPO). Methods: A retrospective chart review of diabetic patients admitted to the adult internal medicine service at a major Canadian teaching hospital was conducted. A convenience sample of patients who received SSI before (n = 60) and after (n = 60) PPO implementation was evaluated for episodes and management of hypo- and hyperglycemia. A survey also was conducted to determine staff perspectives regarding SSI PPO use. Results: Thirty-five SSI regimens were identified among the 60 patients in the pre-PPO group. Although no significant difference in the incidence of hypoglycemia was found between groups, more hyperglycemia episodes occurred in the post-PPO group. Glycemic control was poor regardless of the SSI prescribing strategy employed; only half of the measurements in either group were within a 72–198 mg/dL target range. One-third of medical students reported receiving no prior teaching for devising an SSI regimen. Both medical and nursing staff reported increased clarity and ease in administering SSI with use of a PPO. Half of the respondents believed that the potential for medication error was diminished. Conclusions: A PPO decreased variability in SSI prescribing but did not improve glycemic control in diabetic patients admitted to internal medicine. Revisions to our documents have been made to address hyperglycemia events and appropriate SSI use to further promote patient safety through standardized prescribing.
Consumers' Risk Perceptions of Prescription and Over-the-Counter Medications
Authors: Droege Marcus , Maniscalco Maria , Daniel Karen L , Baldwin H John 
Published: September 2013

Background: Flawed judgments about medication risks potentially jeopardize efforts to protect the public. It has been shown that positive risk/benefit perceptions by patients and providers lead to better patient outcomes, higher acceptance of drug therapy, and higher adherence rates. Objective: To explore consumers' level of familiarity with 10 best-selling over-the-counter (OTC) and prescription drug products, correlate familiarity with risk perceptions regarding those agents, and ascertain common sources of information regarding the medications studied. Methods: A cross-sectional study was conducted in the major metropolitan tri-county area of south Florida using a facilitator-administered survey instrument. Data collection involved asking consumers about the extent to which they agreed with statements related to risk perceptions, familiarity, and sources of information for 10 best-selling medications. Participants were recruited from a convenience sample of 1,035 south Florida residents. Results: When ranking the drugs by familiarity, 972 respondents reported a higher level of familiarity with OTC than prescription medications. Overall, prescription agents were perceived to be riskier than OTC products (p < 0.01); however, individual respondents tended to perceive the listed drugs as either risky or not regardless of their OTC or prescription status. Direct-to-consumer advertisements were mentioned most frequently as information sources. Conclusions: As shown in this study, marketing status, provider interaction, and effects of an undefined health risk are variables that contribute to consumers' decision-making regarding the medication use process.
Leukopenia Associated with Paroxetine Use
Authors: Trewet CoraLynn B , Galioto Nicholas J , Payne Thomas J 
Published: September 2013

Objective: To report a case of leukopenia associated with paroxetine treatment. Case Summary: A 44-year-old white female with a history of anemia secondary to heavy menses, anxiety, depression, and current tobacco dependence presented with general symptoms of fatigue and blurred vision. The patient's medications at the time of the initial visit were ferrous sulfate 325 mg twice a day and paroxetine 20 mg/day. Three years prior to the initiation of paroxetine, the patient's documented white blood cell (WBC) count was 7.4 × 103/ μL with normal differential and hemoglobin was 10.5 g/dL; on presentation, laboratory test results were WBC count 1.3 × 103/ μL, red blood cell count 1.78 × 106/ μL, hemoglobin 4.5 g/dL, hematocrit 15.1%, and platelets 248 × 103/ μL. Three months after discontinuation of paroxetine, the patient's WBC count was 4.4 × 103/ μL. Discussion: Paroxetine and other antidepressants have not been known to cause adverse hematologic effects that can be seen with other antipsychotics, namely, clozapine. The use of the Naranjo probability scale indicated a probable relationship between leukopenia and paroxetine therapy in this patient. Based on a MEDLINE search (February 12, 2007), there are limited data on leukopenia as an adverse event of paroxetine. We found this to be a unique case of leukopenia suspected to be secondary to extended use of low-dose paroxetine. Conclusions: Although leukopenia caused by paroxetine and other medications with serotonergic effects appears to be uncommon, physicians and pharmacists should be aware of this rare but potentially serious adverse event.
Robustness of Palm Kernel Oil Blend in Suppository Preparation Using Acetaminophen as a Model Drug
Authors: Noordin Mohamed Ibrahim , Chung LY 
Published: September 2013

Background: Theobroma oil suppository base has good characteristics for the delivery of most drugs, but its polymorphism renders it a difficult medium with which to work. Preparation of suppositories using theobroma oil must be carried out at a temperature below 36 °C to avoid formation of metastable polymorphs. Substitutes for theobroma oil are therefore desirable. Objective: To compare the characteristics of theobroma oil- and palm kernel oil blend (PKOB)-based suppositories, each produced by 2 different techniques of preparation. Methods: Theobroma oil and PKOB (consisting of hydrogenated palm kernel oil and hydrogenated palm kernel stearin in an 8:2 ratio, with 5% stearic acid and 5% glyceryl monostearate) were used as a base. Suppositories were prepared by 2 different techniques, with acetaminophen used as the model drug. The standard technique used a water bath to melt the base preparation at 36 °C before incorporation of acetaminophen, while the second technique involved melting the base in an oven at 60 °C. The 2 types of suppositories produced by these techniques were then tested physically for appearance, hardness, liquefaction time, and melting characteristics using differential scanning calorimetry. Results: Satisfactory theobroma oil–based suppositories were produced by the water bath technique at 36 °C, but the oven technique at 60 °C failed to produce a good product. On the other hand, both techniques produced satisfactory PKOB-based suppositories that were similar in both physical and thermal characteristics. Conclusions: PKOB constituted with the above-mentioned ingredients can be exposed to a wider range of temperatures without risk of polymorphism.
High Initial Dosing of Olanzapine for Stabilization of Acute Agitation: A Retrospective Case Series
Authors: Brooks John O , Karnik Niranjan , Hoblyn Jennifer 
Published: September 2013

Background: There are several possible dosing strategies for the use of atypical antipsychotics for acute agitation, such as the rapid initial dose escalation protocol (olanzapine) or starting at the maximum recommended dose (aripiprazole). There can be challenges to dose escalation as compared with “loading” patients with an atypical antipsychotic. Objective: To describe an effective loading dose protocol for olanzapine used to enhance control of acute psychotic and manic symptoms. Methods: A retrospective case series was constructed from the records of inpatients treated on an acute psychiatry unit. Records from 8 patients who were diagnosed with bipolar disorder or schizophrenia and who received an initial dose of olanzapine 40 mg for 2 days, 30 mg for 2 days, and 20 mg for 2 days were retrieved and examined. Scores on the Brief Psychiatric Rating Scale (BPRS) and the Young Mania Rating Scale (YMRS) were assigned retrospectively on the basis of chart review. Results: The dosing regimen was associated with average reductions of 9.2 points per day on the BPRS and 9.1 points per day on the YMRS over the first 4 days of treatment. None of the patients in this series experienced serious adverse events, and the only adverse effect observed was mild sedation. Conclusions: High initial dose olanzapine, used in a scheduled loading dose regimen, was associated with rapid reduction of psychotic and manic symptoms. Our conclusions are limited by the small sample size, the lack of random assignment, and the retrospective approach. The results of this series suggest the need for additional studies of the efficacy and safety of this olanzapine loading dose protocol.
Ceftobiprole: A Novel Broad-Spectrum Antiinfective
Authors: Dixon Tripp , Eiland Edward H 
Published: September 2013

Objective: To review the efficacy, safety, pharmacology, pharmacokinetics, pharmacodynamics, and in vitro microbiology susceptibilities of ceftobiprole, a new broad-spectrum cephalosporin. Data Sources: A PubMed and Internet search (2000–September 2007) was conducted, using the key words ceftobiprole, Ro 63–9141, BAL5788, and BAL9141. Cochrane Library and International Pharmaceutical Abstracts (2000–September 2007) were accessed and reference citations from publications identified were reviewed. Study Selection and Data Extraction: All English-language articles identified from the data sources were reviewed. Phase 3 studies were included in the evaluation. Data Synthesis: Two multinational, double-blind, pivotal Phase 3 studies involving more than 1,600 patients have shown ceftobiprole to have in vitro activity against penicillin-resistant Streptococcus pneumoniae, Pseudomonas spp., and methicillin-resistant Staphylococcus aureus (MRSA). In addition, the cure rates associated with ceftobiprole for complicated skin and skin structure infections (cSSSI) were comparable with those of a single drug or a 2-drug comparator combination. Adverse effects included nausea, vomiting, taste disturbance, headache, and diarrhea. Conclusions: Ceftobiprole is an essential addition to the antimicrobial armamentarium for use against MRSA and/or multidrug-resistant gram-negative infections. Ceftobiprole is approved for the treatment of cSSSI, including diabetic foot infections; however, studies related to the treatment of hospital-acquired and community-acquired pneumonia requiring hospitalization are ongoing. The safety profile is consistent with that of the cephalosporin class of antibiotics. Ceftobiprole will serve as empiric or definitive antimicrobial therapy for resistant gram-negative and gram-positive pathogens. The challenge will be to maintain judicious use through antibiotic stewardship programs and deescalation strategies.
Phlegmasia Cerulea Dolens in a Patient with Heparin-Induced Thrombocytopenia
Authors: Wetz R Colin , Stroup Jeffrey S , Roberts Montgomery L 
Published: September 2013

Objective: To report a case of the venous obstructive condition known as phlegmasia cerulea dolens (PCD) in the presence of heparin-induced thrombocytopenia (HIT). Case Summary: A 50-year-old white female presented to the emergency department with a 2-day history of a bluish discoloration of her toes and hands accompanied by chest pain and shortness of breath. The evident edema, tenderness on palpation, and cyanosis of the extremities were suggestive of PCD. She had been hospitalized approximately one month previously due to a fibular fracture and again within the past 2 weeks for intractable abdominal pain and nausea. During her current hospital stay, she was diagnosed with multiple venous thromboembolisms (VTEs); at the time of admission, an unfractionated heparin (UFH) drip was initiated to treat her VTEs. Due to a decreased platelet count on admission, a platelet factor 4 (PF4) antibody assay was performed and found to be positive. After discontinuation of UFH, her platelet count slowly returned to normal range. Discussion: The pathogenesis of HIT is due to formation of antibodies against the complex of heparin and PF4. HIT is characterized by a reduction in the platelet count approximately 4–14 days after the initiation of heparin therapy plus a paradoxical prothrombotic state. The typical diagnostic clues are a drop in platelet count of 50% from baseline with the initiation of heparin and a positive assay for heparin-PF4-immunoglobulin G. This condition may result in PCD, which presents as the triad of pain, edema, and cyanosis. This condition often results in venous or arterial thrombus formation. The treatment for PCD includes immediate discontinuation of heparin products and anticoagulation with a direct thrombin inhibitor. Conclusions: Thromboembolic complications such as PCD are often observed as a presenting feature of HIT. To avoid these potentially limb- and life-threatening complications, clinicians must be vigilant in their monitoring of platelets and clinical signs and symptoms of HIT while patients are on heparin therapy.
Hospital Pharmacist Familiarity with Patient Discharge Medication Costs
Authors: Wilbur Kerry 
Published: September 2013

Background: Drug therapy poses a financial burden for many individuals. Cost-related medication nonadherence is ultimately associated with increased healthcare resource utilization and poor patient outcomes. Physicians are often unaware of the costs associated with their prescribed therapy, but little is documented regarding familiarity of hospital pharmacists with out-of-pocket medication expenses borne by patients in the community setting. Objective: To evaluate how familiar hospital pharmacists are with prescribed medication costs for discharged patients. Methods: Hospital pharmacists within a specific healthcare organization were invited to participate in an online survey. Ten brief patient case scenarios and associated discharge therapeutic regimens were outlined and respondents were asked to identify the costs that discharged patients would incur when having the prescriptions filled. The total number and proportion of estimates either above or below the actual medication cost as determined from community pharmacies were calculated. Results: Thirty-one pharmacists completed the survey. For the therapeutic regimens described, 47% of medication costs were underestimated, 33% were overestimated, and 20% were correctly estimated (within 10% of the actual value). Incorrect estimates were evident across all therapeutic classes and medical indications presented in the survey. The greatest mean absolute cost differences were underestimation of a linezolid treatment course for skin and soft tissue infection ($384.18 below the mean absolute cost) and overestimation of monthly bisoprolol heart failure therapy ($22.42). Conclusions: Hospital pharmacists are often unfamiliar with what discharged patients must pay for drug therapy.
Pharmacy Technology Clubs: A Great Way to Enhance Your Students' Educational Experience
Authors: Davis Karen D 
Published: September 2013

Background: Past experience of starting and continuing a pharmacy technology club has shown that the students who participated have been able to surpass the normal boundaries of technician training and accomplish many extra activities, including community service and awareness, which were done in addition to the competencies required in an ASHP-accredited program. Objective: To discuss the role that a pharmacy technology club can play in enhancing and improving students' experience in a technician training program. Methods: The information presented was collected from past experiences of a successful organization and include ways to start such a club, the benefits a club can provide, and the actual results from an existing club. Results: The Pharmacy Technology Club at Southeastern Technical College in Vidalia, GA, was established 2 years ago and has provided 3 classes of technicians with an enhanced training experience by providing additional viable skills for the field, job opportunities before graduation, and the opportunity to take and pass the Pharmacy Technician Certification Board examination. Conclusions: The standard curriculum for technician training programs used across the country is very successful in training technicians for entry-level employment in pharmacy through didactic, experiential, and laboratory experiences. An organized club can provide students with additional skills that will aid in communication, cultural diversity, leadership qualities, and better work ethics. This will give students who complete such a program the additional understanding of how important their role in patient care is today and enable them to adapt to continuous changes in the field.