bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying and Communicating Clinically Meaningful Drug–Drug Interactions
Authors: Nelson Scott D. , LaFleur Joanne , Hunter Emily , Archer Melissa , Steinvoort Carin , Maden CarrieAnn , Oderda Gary M. 
Published: August 2014

Objective: Providing care to patients with comorbid medical problems may result in complicated, multiple drug therapy regimens, increasing the risk of clinically meaningful drug–drug interactions (DDIs). The purpose of this article is to describe the prevalence of DDIs and provide examples on how to identify and intervene on DDIs. Methods: We described DDI data from the Utah Drug Regimen Review Center, where adult Medicaid patients were reviewed by pharmacists from 2005 to 2009. Patients were selected by the number of prescriptions filled per month (>7) or having a high RxRisk score. Summary: A total of 8860 patients were reviewed, and 16.6% had at least 1 clinically meaningful DDI. Patients with DDIs were slightly younger (mean age 45.2 vs 48.2), more likely to be female (75.0% vs 68.9%), and had more prescriptions per month (13.4 vs 12.5) compared to patients without ( P < .001). Pharmacodynamic DDIs were more prevalent (80.2%) than pharmacokinetic. Pharmacodynamic DDIs mainly occurred with drugs used to treat psychiatric/seizure/sleep disorders (69.4%) and pain/migraine (56.6%). Pharmacokinetic DDIs mainly occurred with drugs used to treat psychiatric/seizure/sleep disorders (53.2%), cardiovascular diseases (46.3%), and infectious diseases (29.6%). Conclusions: Clinically meaningful DDIs are common in patients with complex medication regimens. A systematic approach for identifying DDIs, determining clinical significance, formulating patient-specific recommendations, and communicating recommendations is important in pharmacy practice.
Pharmacists as Members of the Rapid Response Team
Authors: Groth Christine M. , Acquisto Nicole M. 
Published: August 2014

Purpose: Rapid response teams (RRTs) have been developed to provide early therapy to patients with risk factors for cardiopulmonary arrest. We sought to investigate the role a pharmacist could have as a member of the RRT. Methods: Two pharmacists trained in critical care and emergency medicine proposed a pilot program to determine whether a pharmacist as a member of the RRT could help to optimize pharmacotherapy and facilitate medication administration. During response, 1 pharmacist was at the bedside with the RRT for patient evaluation, consult, chart review, and to facilitate medication administration. The responding RRT pharmacist collected patient demographics, medications administered, pharmacotherapy recommendations, and time commitment. Results: The pharmacists responded to 32 RRT alerts. A majority (65.6%) of patients required at least 1 medication, and a total of 45 medications were administered. The pharmacists performed 49 pharmacotherapy-related interventions in 21 patients. These included medication facilitation (15), dose (15) or therapy (8) recommendations, and adding (6) or discontinuing (5) a medication. The pharmacists spent a median time of 15 minutes (interquartile range [IQR] 15, range 2-70) for each RRT alert and a total of 612 minutes (10.2 hours). Conclusion: With a minimal time commitment, pharmacists can be valuable members of the RRT.
Aripiprazole-Associated Hiccups
Authors: Silverman Melissa A. , Leung Jonathan G. , Schak Kathryn M. 
Published: August 2014

Aripiprazole’s pharmacologic properties (including dopamine 2 and 5-hydroxytryptamine 1A [5HT1A] receptor partial agonism and 5HT2A receptors antagonism) may be associated with the onset of hiccups. Case Description: A 21-year-old, antipsychotic-naive patient with bipolar I disorder and remote brain trauma developed persistent hiccups following aripiprazole titration. Despite trials of metoclopramide and chlorpromazine, hiccups continued. Remission of hiccups occurred with discontinuation of aripiprazole. Discussion: The exact etiology of hiccups is unknown but likely involves dopamine and/or γ-butyric acid. Highlighting the uncertainty related to drug-induced hiccups is the fact that multiple antipsychotics have been reported to not only induce hiccups but also to alleviate them. As the development of persistent hiccups may result in extensive medical workup, clinicians should be aware of drug-associated causes including aripiprazole.
Comparison of 2 Methods of Local Anesthetic-Based Injection as Part of a Multimodal Approach to Pain Management After Total Knee Arthroplasty
Authors: Tietje Teya , Davis Andrew B. , Rivey Michael P. 
Published: August 2014

Background: It is estimated that up to 50% of patients undergoing total knee arthroplasty (TKA) receive suboptimal postoperative pain management. Methods: In a retrospective study, 224 patients who underwent TKA between January 1, 2011, and September 30, 2012, were identified by surgical records for 2 surgeons at Community Medical Center in Missoula, Montana. Patient records were reviewed and data collected for patient hospital length of stay (LOS), postoperative opioid use, opioid-associated adverse events, and nonopioid analgesic use. Data were analyzed for differences in outcomes between patients who received an intraoperative intra-articular (IOIA) injection followed by a postoperative infusion (0.25%-0.5% bupivacaine) or an intraoperative periarticular (IOPA) injection (ropivacaine, ketorolac, epinephrine, and clonidine) for sustained analgesia after TKA. Results: Patients who received an IOPA injection had a statistically significant decrease in hospital LOS (67.0 vs 75.9 hours; P = .027) and postoperative nausea and vomiting (39.3% vs 54.9%; P = .023) when compared to patients who received an IOIA infusion. The incidence of having either oversedation or pruritus did not differ between groups (9.8% vs 9.8%; P = 1.00). Conclusion: The use of IOPA injections containing ropivacaine, epinephrine, ketorolac, and clonidine during TKA offered some benefit over IOIA infusions containing 0.25% to 0.5% bupivacaine at our institution.
Anti-ribosomal P antibodies are associated with elevated circulating IFNα and IL-10 levels in systemic lupus erythematosus patients
Authors: Mozo L , López P , Caminal-Montero L , Rodríguez-Carrio J , Suárez A 
Published: August 2014

Objective The objective of this paper is to analyze the relationship of anti-protein ribosomal P (RibP) antibodies with circulating levels of IFNα, TNFα, IFNγ, IL-17 and IL-10 in SLE. Disease activity and other systemic lupus erythematosus (SLE) features were also analyzed. Methods Anti-RibP and other SLE-related antinuclear antibodies (ANA) were determined by fluoro-enzyme immunoassay in the sera of 107 SLE patients. Circulating cytokines were quantified by flow cytometry (IFNα, IL-10 and IL-17) or ELISA (TNFα and IFNγ). Results Anti-RibP-positive patients (14.9%) displayed significantly higher serum levels of IFNα ( p = 0.023) and IL-10 ( p = 0.016) than their negative counterparts. This cytokine upregulation was independent of the presence of other ANA even though, in our patient cohort, anti-dsDNA was found to be associated with anti-RibP (OR, CI 95%: 6.03, 1.32–27.93, p = 0.021) and to correlate with IL-10 levels ( r = 0.204, p = 0.036). In fact, patients positive for anti-RibP but negative for anti-dsDNA exhibited the highest amounts of both IL-10 and IFN-α that were not related to disease activity since these patients showed lower SLEDAI than patients also positive for anti-dsDNA ( p = 0.018). Anti-RibP positivity was also associated with early diagnosis, hypocomplementemia and leukopenia. Conclusions Presence of anti-RibP was found to be related to increased serum IFNα and IL-10 levels independently of both antibody status and disease activity.
Student nurses’ experiences of undignified caring in perioperative practice – Part II
Authors: Willassen Elin , Blomberg Ann-Catrin , von Post Iréne , Lindwall Lillemor 
Published: August 2014

Background: In recent years, operating theatre nurse students’ education focused on ethics, basic values and protecting and promoting the patients' dignity in perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient’s care during surgery. Objective: The objective of this study was to present what operating theatre nursing students perceived and interpreted as undignified caring in perioperative practice. Research design: The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan’s critical incident technique. Participants and research context: Operating theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation. Ethical considerations: The study was approved by the Karlstad University's Research Ethics Committee. Findings: The findings show careless behaviour and humiliating actions among health professionals. Health professionals commit careless acts by rendering the patient invisible, ignoring the patient’s worry and pain and treating the patient as an object. They also humiliate the patient when speaking in negative terms about the patient’s body, and certain health professionals blame the patients for the situation they are in. Health professionals lack the willingness and courage to protect the patient’s dignity in perioperative practice. Discussion: In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act. Conclusion: The findings reveal that patients were exposed to unnecessary suffering; furthermore, the operating theatre nurse students suffered an inner ethical conflict due to the undignified caring situations they had witnessed.
Intraosseous Fixation Compared to Plantar Plate Fixation for First Metatarsocuneiform Arthrodesis
Authors: Roth Klaus Edgar , Peters Jennifer , Schmidtmann Irene , Maus Uwe , Stephan Daniel , Augat Peter 
Published: August 2014

Background: Metatarsocuneiform (MTC) fusion is a treatment option for management of hallux valgus. We compared the biomechanical characteristics of an internal fixation device with plantar plate fixation. Methods: Seven matched pairs of feet from human cadavers were used to compare the intramedullary (IM) device plus compression screw to plantar plate combined with a compression screw. Specimen constructs were loaded in a cyclic 4-point bending test. We obtained initial/final stiffness, maximum load, and number of cycles to failure. Bone mineral density was measured with peripheral quantitative computed tomography. Performance was compared using time to event analysis with number of cycles as time variable, and a proportional hazard model including shared frailty model fitted with treatment and bone mineral density as covariates. Results: On average the plates failed after 7517 cycles and a maximum load of 167 N, while the IM-implants failed on average after 2946 cycles and a maximum load of 69 N. In all pairs the 1 treated with IM-implant failed earlier than the 1 treated with a plate (hazard ratio for IM-implant versus plate was 79.9 (95% confidence interval [6.1, 1052.2], P = .0009). The initial stiffness was 131 N/mm for the plantar plate and 43.3 N/mm for the IM implant. Initial stiffness ( r = .955) and final stiffness ( r = .952) were strongly related to the number of cycles to failure. Bone mineral density had no effect on the number of cycles to failure. Conclusion: Plantar plate fixation created a stronger and stiffer construct than IM fixation. Clinical Relevance: A stiffer construct can reduce the risk of nonunion and shorten the period of non-weight-bearing.
Implementation of transcatheter aortic valve insertion (TAVI) in clinical practice: An ethical analysis
Authors: Ohldieck Annabel Eide , Nordrehaug Jan Erik , Vandvik Per Olav , Schaufel Margrethe , Norheim Ole Frithjof 
Published: August 2014

Objective The objective of this article is to provide an ethical analysis of a high-risk, advanced treatment case where the patient received transcatheter aortic valve insertion (TAVI), for aortic valve stenosis. Particular emphasis will be placed upon the significance of evidence and the implications for priority setting. Method One paradigmatic case involving a TAVI patient from a large university hospital in Norway is described and analysed. The method used was ethical case analysis modified after Kymlicka by Miljeteig et al. Perioperative mortality risk was estimated using the Euroscore risk-logarithm and the Society of Thoracic Surgeons’ risk model, STS. These predict the risk of operative mortality and morbidity associated with adult cardiac surgery. GRADE, the Grading of Recommendations Assessment, Development and Evaluation, was used to evaluate the evidence. Results In the case analysis, we found that it would be ethically justifiable not to recommend TAVI treatment for this patient. Although the patient had a severe condition in need of treatment, the expected improvement was marginal, the quality of evidence was low and the opportunity costs for other patients and society were higher than usually deemed appropriate. Conclusions Decision-making in the absence of high quality evidence from randomized trials is a complex process involving difficult ethical judgments. Novel high-risk devices often enter the European market with limited clinical evidence. Transparency and improved clinical evaluation are required so patient safety is not jeopardized. We argue that implementation of high risk, high cost interventions should be better regulated at a national level. Background All clinical decisions imply priority setting and therefore indirectly affect other patients and other patient groups. The use of expensive, innovative health technologies has an affect on individual patients as well as on other patient groups competing for the same resources.
Correlates of Pain Intensity in Community-Dwelling Individuals With Mild to Moderate Dementia
Authors: Breland Jessica Y. , Barrera Terri L. , Snow A. Lynn , Sansgiry Shubhada , Stanley Melinda A. , Wilson Nancy , Amspoker Amber B. , Kunik Mark E. 
Published: August 2014

Objectives: To identify correlates of participant-reported pain in community-dwelling individuals with mild to moderate dementia. Methodology: Associations among participant-reported pain intensity and depressive symptoms, mental health diagnoses, pain diagnoses, pain medications, level of functional ability, and cognitive impairment were assessed in 136 community-dwelling veterans with mild to moderate dementia and pain. Univariate and multiple regressions were used to assess relationships among the independent variables and participant-reported pain. Results: Pain diagnoses (β = .23, t132 = 2.65, P < .01) and pain medications (β = .21, t132 = 2.48, P < .05) were correlated with participant-reported pain intensity in univariate regression models. Only pain diagnoses (β = .20, t132 = 2.17, P < .05) remained a significant predictor in adjusted models. Conclusion: Participant-reported pain in individuals with dementia appears to be a unique construct for which other psychosocial indicators cannot be substituted. Therefore, directly asking community-dwelling individuals with mild to moderate dementia about their pain is a critical component of assessment.
The effectiveness of student-run organizations within global health promotion initiatives
Authors: Byron Yoni , West Henry , Wood Benjamin , Murray Linda , Cooling Nick 
Published: August 2014

Introduction: This commentary describes a student-led project that distributed long-lasting insecticide-treated nets in Masaka, Uganda. The role of student-led initiatives in global health promotion projects is also discussed. Methods: A survey of 213 net recipients was conducted after a 12-month period to evaluate malaria prevention knowledge, and net use and maintenance. Results: Only 4.7% of recipients could not recall any malaria prevention methods. Seventy percent of pregnant women and 86.5% of children under five slept under a net the previous night. Only two households (0.9%) no longer possessed a net, and nets were not used in 2.3% of houses. Household observation revealed 17.4% of nets had at least one problem that would compromise effectiveness. Conclusions: Student-led projects can play an important role in effectively preventing malaria. However coordination with existing programs, targeting hard-to-access groups, and training of students overcomes some common limitations of such student-led initiatives.
Clinical assessment of the glenoid labrum
Authors: Arnander Magnus , Tennent Duncan 
Published: August 2014

Background The glenoid labrum is integral to shoulder stability and can be difficult to assess clinically. Whilst it is a single anatomical structure, damage to different regions results in very different clinical manifestations. A large number of provocative tests have been described, all of which initially purport to have excellent diagnostic accuracy. Clinical experience suggests that this is not the case and decision making can be difficult for the non-expert. The purpose of this study is to review the current evidence for the most commonly used tests and to provide suggestions for tests which have the most evidence for efficacy. Methods The glenoid labrum was divided into anterior, superior and posterior regions. The English language literature describing labral tests was reviewed. The evidence provided by the authors and any subsequent studies was analysed. Results Whilst a large number if tests have been described with the primary authors reporting excellent results the evidence for most is poor when later tested critically. Discussion No single test will accurately diagnose labral pathology. The clinician must use evidence from the clinical history combined with selective use and interpretation of tests with which they are familiar.
Medial Patellofemoral Ligament Reconstruction for Patellar Dislocation
Authors: Mackay Nicola D. , Smith Nicholas A. , Parsons Nick , Spalding Tim , Thompson Peter , Sprowson Andrew P. 
Published: August 2014

Background: With improved understanding of the biomechanical importance of the medial patellofemoral ligament (MPFL), its reconstruction for patellar dislocation has become increasingly popular. The aim of this systematic review was to critically determine the effectiveness of MPFL reconstruction for patellar dislocation. Hypothesis: MPFL reconstruction for patellar dislocation leads to a low redislocation rate with improved Kujala scores. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed using Embase and Medline (Ovid) databases. Inclusion criteria included first-time and recurrent patellar dislocation, subluxation, or persistent instability with a minimum follow-up of 12 months and documentation of postoperative redislocation rate or Kujala score. The studies were systematically appraised, and a meta-analysis was performed. Results: Twenty-two studies were included: 2 randomized controlled trials, 3 parallel case series, and 17 case series. There were a total of 655 knees in the review, with an age range at time of surgery from 11 to 52 years. The pooled postoperative redislocation rate from all 17 case series showed a mean of 2.44%. The pooled preoperative Kujala scores from 12 case series showed a mean of 51.6 (95% CI, 46.71-56.49). The pooled postoperative Kujala scores from 16 case series showed a mean of 87.77 (95% CI, 85.15-90.39). Conclusion: Although the studies were of low quality, the meta-analysis of 17 case series shows that MPFL reconstruction for recurrent patellar dislocation results in a significant improvement in Kujala scores, a low redislocation rate, and acceptable complication rate. Randomized trials would be needed to draw influences on the superiority of MPFL reconstruction compared with other treatments.
Dietary guideline adherence for gastroesophageal reflux disease
Authors: Kubo Ai , Block Gladys , Quesenberry Charles P , Buffler Patricia , Corley Douglas A 
Published: August 2014

AbstractBackgroundGastroesophageal reflux disease (GERD) is the most common gastrointestinal disease, and the cost of health care and lost productivity due to GERD is extremely high. Recently described side effects of long-term acid suppression have increased the interest in nonpharmacologic methods for alleviating GERD symptoms. We aimed to examine whether GERD patients follow recommended dietary guidelines, and if adherence is associated with the severity and frequency of reflux symptoms.MethodsWe conducted a population-based cross-sectional study within the Kaiser Permanente Northern California population, comparing 317 GERD patients to 182 asymptomatic population controls. All analyses adjusted for smoking and education.ResultsGERD patients, even those with moderate to severe symptoms or frequent symptoms, were as likely to consume tomato products and large portion meals as GERD-free controls and were even more likely to consume soft drinks and tea [odds ratio (OR) = 2.01 95% confidence interval (CI) 1.12-3.61; OR = 2.63 95% CI 1.24-5.59, respectively] and eat fried foods and high fat diet. The only reflux-triggering foods GERD patients were less likely to consume were citrus and alcohol [OR = 0.59; 95% CI: 0.35-0.97 for citrus; OR = 0.41 95% CI 0.19-0.87 for 1 + drink/day of alcohol]. The associations were similar when we excluded users of proton pump inhibitors.ConclusionsGERD patients consume many putative GERD causing foods as frequently or even more frequently than asymptomatic patients despite reporting symptoms. These findings suggest that, if dietary modification is effective in reducing GERD, substantial opportunities for nonpharmacologic interventions exist for many GERD patients.