bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clopidogrel Adherence following Percutaneous Coronary Intervention with a Drug-Eluting Stent in a VA Medical Center
Authors: Shroff Adhir , Ali Ambreen , Groo Vicki L 
Published: September 2013

Background: Antiplatelet therapy with aspirin and a thienopyridine is the standard of care for prevention of thrombosis following coronary stent implantation. Recent evidence suggests a prolonged risk of stent thrombosis; therefore, clopidogrel therapy for at least 1 year is recommended following implantation of a drug-eluting stent. Premature discontinuation of clopidogrel is a well-recognized risk factor for stent thrombosis. Objective: To identify the rate of adherence to clopidogrel therapy among patients who have undergone percutaneous coronary intervention (PCI). Methods: We queried the central Veteran Affairs (VA) pharmacy database for each patient who underwent PCI with a drug-eluting stent between September 2004 and August 2005 at a single VA medical center. Based on pharmacy refill records, patients were considered adherent to clopidogrel if they filled more than 80% of the clopidogrel prescriptions. Results: We observed that 20.3% of patients were nonadherent to clopidogrel therapy for the course that they were assigned. Shorter duration of therapy was the only factor that predicted increased adherence. Race, polypharmacy, marital status, prior clopidogrel use, and age did not have a significant impact on adherence. Multivariable analysis did not demonstrate any other significant relationships. Conclusions: In this high-risk cohort of patients who have undergone PCI, we observed a 20% incidence of nonadherence to clopidogrel therapy. Shorter duration of therapy had a significant impact on improving rates of adherence in our analysis. This observation is of particular concern given the recent recommendations to prolong antiplatelet therapy to at least 1 year following PCI with a drug-eluting stent.
Comparison of Immediate-Release and Controlled-Release Paroxetine Ingestions Reported to Texas Poison Control Centers between 2002 and 2008
Authors: Forrester Mathias B 
Published: September 2013

Background: Controlled-release (CR) paroxetine was created to improve the tolerability of immediate-release (IR) paroxetine while maintaining therapeutic benefits. There is limited information comparing the toxicity of the 2 paroxetine formulations. Objective: To compare the toxicity and management of paroxetine IR and paroxetine CR ingestions reported to poison control centers. Methods: Cases of ingestion of paroxetine that were reported to Texas poison control centers between 2002 and 2008, in which the final medical outcome and dose were known, were retrospectively reviewed. The rates for selected variables were determined for paroxetine IR and paroxetine CR and comparisons between the 2 were made by calculating the ratio of the drug's CR rate to the IR rate and 95% confidence interval. Compliance with simplified algorithms of triage management guidelines was determined for both formulations. Results: Included in the analysis were 405 cases of paroxetine IR ingestion and 169 cases of paroxetine CR ingestion for which a reported dose and final medical outcome were known. There were no statistically significant differences between the paroxetine CR and paroxetine IR formulations with respect to serious medical outcomes (ratio 0.69, 95% CI 0.34 to 1.31), self-harm or malicious intent (ratio 0.82, 95% CI 0.60 to 1.12), or referral to a healthcare facility (ratio 1.18, 95% CI 0.76 to 1.83). The rate of compliance with the triage algorithm for cases not already en route to or at a healthcare facility when the poison control center was contacted was 87% for paroxetine IR and 89% for paroxetine CR. Conclusions: The toxicity and management of paroxetine IR and paroxetine CR ingestions reported to Texas poison control centers were similar after adjusting for differences in dosage.
Eltrombopag: A Thrombopoietin Receptor Agonist for Idiopathic Thrombocytopenic Purpura
Authors: Zhu Min 
Published: September 2013

Objective: To review the pharmacology, pharmacokinetics, safety, and efficacy of eltrombopag in previously treated patients with chronic idiopathic thrombocytopenic purpura (ITP). Data Sources: Articles were identified through a search of the MEDLINE (1950–December 2008) database for English-language articles containing the key words eltrombopag, SB-497115, idiopathic thrombocytopenic purpura, and immune thrombocytopenic purpura. References from publications identified in this search were reviewed for relevant information. Unpublished data received from the manufacturer was also included in this review. Study Selection and Data Extraction: All articles identified from the data search were reviewed for relevant information. Applicable information was included in this review. Data Synthesis: Eltrombopag is a new oral thrombopoietic receptor agonist approved by the FDA in November 2008 as second-line treatment of chronic ITP. It stimulates human megakaryocyte differentiation and proliferation, leading to increased platelet production. Eltrombopag has been shown in clinical trials to increase platelet counts in a dose-dependent manner regardless of splenectomy status, baseline platelet counts, and concurrent ITP therapy. Available data show a statistically significant decrease in the incidence of any bleeding (World Health Organization Grades 1–4) and clinically significant bleeding (Grades 2–4). Common adverse effects are mild and typically do not lead to treatment discontinuation. Results from clinical studies demonstrated significant increase in platelet counts with minimal adverse effects. Conclusions: Eltrombopag treatment provides a potential new resource for clinicians to use in the pharmacotherapy of ITP. Further studies are needed to explore its long-term safety and efficacy in patients with chronic ITP. ACPE Universal Program Number: 407-000-09-054-H01-P (Pharmacists)
An Update of Recent Trials with Vildagliptin, a Dipeptidyl Peptidase-4 Inhibitor for the Treatment of Type 2 Diabetes
Authors: Johnson John T , Golden Kish L , Braceras Rogelio 
Published: September 2013

Objective: To review the clinical efficacy and tolerability of vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, for the treatment of type 2 diabetes, based on recent Phase 3 trials. Data Sources: Primary literature and review articles were obtained via a MEDLINE search (2005–November 2007) using the search terms diabetes, vildagliptin, and LAF-237. Additional data from abstracts presented at clinical meetings were included when appropriate. Study Selection: Nine double-blind, randomized, multicenter, parallel-group trials and vildagliptin studies were identified and reviewed. Data Synthesis: Vildagliptin, a selective DPP-4 inhibitor, has been shown to produce clinically significant reductions in hemoglobin A1c (A1C) levels when used as monotherapy (0.6–1%) or in combination with other glucose-lowering agents (mean decrease 0.7%). Phase 3 trials indicated a 24- to 52-week sustained effect on reduction of blood glucose in patients with type 2 diabetes. The primary endpoint for all trials was change from baseline A1C. In the intent-to-treat population, baseline A1C was compared with end-of-study A1C. More than 2,500 patients with type 2 diabetes enrolled in monotherapy trials; an additional 2,119 participated in combination therapy trials. Males outnumbered females, and all groups included obese patients. The most common adverse effects reported were nasopharyngitis, headache, and dizziness. Vildagliptin was weight-neutral and produced a rate of hypoglycemia similar to that of placebo. Conclusions: Vildagliptin appears to be a promising agent for the management of type 2 diabetes.
The Effect of Pharmaceutical Care Programs on Blood Pressure Control in Individuals with Hypertension: A Meta-Analysis
Authors: Ni Yongbing , Chen Yongfa , Huang Wenlong 
Published: September 2013

Objective: To evaluate the effect of pharmaceutical care (PC) programs on blood pressure control in individuals with hypertension. Methods: Studies were retrieved by searching MEDLINE, EMBASE, Cochrane, CNKI, and CBM databases from 1999 to February 2008. Randomized controlled trials (RCTs) on the association of pharmaceutical care programs with blood pressure control in individuals with hypertension were included in this study. Moreover, the studies were selected independently by 2 authors. The analysis was conducted by using Review Manager version 4.2 software. Results: Five RCTs with a total of 585 patients with hypertension were included in this meta-analysis. Compared with the control group, the PC program intervention group had significantly lower endpoint systolic blood pressure (SBP) and diastolic blood pressure (DBP). Moreover, SBP and DBP were significantly improved in the intervention group relative to the control group. Conclusions: PC programs appear to be an effective tool in helping to control blood pressure in hypertensive patients.
Pill Burden in Low-Income Patients with Metabolic Syndrome and Diabetes
Authors: Boyd Steven T , Scott David M , Pick Amy M 
Published: September 2013

Background: While pill burden can harm or overwhelm patients, very little is known about pill burden in patients with diabetes or metabolic syndrome. Objective: To determine the pill burden level in low-income patients with metabolic syndrome who were enrolled in a diabetes study that was trying to achieve recommended targets of therapy. Methods: A prospective chart review was performed on 145 patients enrolled in a diabetes study at Siouxland Community Health Center. Patients were considered to have metabolic syndrome if they had 3 or more of the following clinical risk factors: (1) type 2 diabetes mellitus; (2) dyslipidemia (triglycerides >150 mg/dL or high-density lipoprotein cholesterol <40 mg/dL for men and <50 mg/dL for women); (3) hypertension (blood pressure <130/80 mm Hg or receiving antihypertensive medication); and (4) obesity (body mass index >30 kg/m2). Pill burden was defined as the average number of prescribed administrations per day. Inhalers, ophthalmics, and glucose meters were counted by number of puffs, drops, or finger sticks per day. Average hemoglobin A1C (A1C) level was collected at baseline and at 12 months. Results: The results showed that 85.5% of patients in the diabetes study were classified as having metabolic syndrome. The total number of administrations per day was analyzed for 124 eligible patients. Patients had an average baseline pill burden of 8.5 and A1C of 8.6%. After being enrolled in the study for 12 months, patients' average pill burden endpoint increased to 13.1 and A1C was reduced to 7.0%. At the end of the study, 37.9% of patients were prescribed dual therapy for glucose control: 79% on antihypertensives, 70% on lipid-lowering agents, and 65% taking aspirin. Conclusions: Diabetes patients with metabolic syndrome are prescribed multiple drug therapies to control diabetes and other metabolic abnormalities. In this study, we concluded that the average pill burden was 13.1 in patients with glucose-controlled diabetes and metabolic syndrome.
Licensed Vaccines for Rotavirus Prevention in the US: A Review
Authors: Hale Katherine S , Brown Sherrill J 
Published: September 2013

Objective: To review the pharmacology, efficacy, safety, and tolerability of RotaTeq and RotaRix, 2 rotavirus vaccines. Data Sources: English-language articles were obtained via MEDLINE (1966-August 2009) and EMBASE (1980-August 2009) searches using the key words rotavirus vaccine, epidemiology, diarrhea, intussusception, RotaShield, RotaTeq, and RotaRix. Bibliographies of selected articles were used to identify additional sources. Study Selection and Data Extraction: Available published articles reporting the results of human studies of rotavirus vaccines were reviewed for inclusion in this article. Additional information regarding clinical trials and adverse events was obtained from the manufacturer's prescribing information for each vaccine. Data Synthesis: RotaTeq is a live, attenuated human-bovine pentavalent vaccine, and RotaRix is a live, attenuated human vaccine. Both vaccines are approved for the prevention of rotavirus infection and recommended for routine immunization in healthy infants aged 14 weeks to 8 months. The vaccines differ in virologic characteristics, but clinical trials indicate similar efficacy and safety. Each vaccine is more than 70% effective in preventing any severity of rotavirus gastroenteritis and more than 98% effective in preventing severe disease through one full season of rotavirus exposure postvaccination. Efficacy begins to wane during the second season of rotavirus exposure. Post hoc analyses of clinical trials indicated an 85–100% reduction in hospitalizations and emergency department visits following vaccination. Both vaccines have been well tolerated. Fever, vomiting, and diarrhea are the most reported adverse events. Intussusception and Kawasaki syndrome have been reported, but occurrence of these events has not been shown to be significant in comparison with the background rate for each adverse event. Conclusions: RotaTeq and RotaRix are effective for the prevention of rotavirus infection in the US, Europe, and Latin America. Additional studies are needed to assess their duration of protection, worldwide efficacy, effect on the reduction of healthcare resource utilization, and adverse event monitoring.
Pharmacists' Perceptions of Barriers to Implementing Medication Therapy Management and the Role of Pharmacy Technicians in Overcoming the Barriers
Authors: Bright David R , Lengel Aaron J , Powers Mary F 
Published: September 2013

Background: Recent literature supports the value of clinical pharmacy services in the outpatient setting, but pharmacists must overcome barriers to the implementation of clinical services to establish an effective and efficient program. Objective: To identify pharmacists' perceptions of barriers to the implementation of medication therapy management (MTM) and perceptions of collaboration with pharmacy technicians. Methods: Surveys were sent to all 415 community pharmacists in a supermarket pharmacy chain marketing area in Ohio. Pharmacists completed the anonymous survey to indicate their opinions regarding a series of potential barriers to the implementation of MTM, including education and training, current and desired roles of pharmacy technicians, and support from store management. Results: Of responding pharmacists, 16.2% reported that they had personally participated in an MTM encounter, with an average number of encounters per pharmacist of 1.4. Pharmacists reported a desire for additional training in disease states commonly addressed in MTM, MTM systems, and MTM service elements, but 50.5% felt comfortable as a provider of MTM without additional training. More than 90% of pharmacists reported that sufficient staffing and overlap affords the opportunity for 0–5 MTM encounters per week. Pharmacists reported that few technicians are trained to assist with MTM, but more than 70% of pharmacists would seek technician assistance with scheduling, billing, and patient correspondence. Conclusions: Although technician assistance may help to reduce pharmacist staffing and training needs, few technicians are trained for clinical support roles. Incorporation of clinical pharmacy technicians into the MTM process may improve the economics and efficiency of MTM and reduce barriers to the implementation of MTM.
Overview of the Pharmacologic Options for Rosacea
Authors: Segarra-Newnham Marisel , Karimi Sahar 
Published: September 2013

Objective: To review available therapies for rosacea. Data Sources: A PubMed literature search (1985-July 2009) was conducted. Search terms included rosacea, antibiotics, and treatment. Study Selection and Data Extraction: English-language reviews, comparative clinical trials, and guidelines for treatment of rosacea were reviewed. Seven comparative trials were identified. Data Synthesis: Rosacea is a common dermatologic disease that affects about 10% of the adult population, usually before age 50. The etiology of the disease is unknown. There are 4 subtypes of rosacea: erythematotel-angiectatic (frequent flushing and redness), papulopustular (early telangiectasias, classic rosacea), phymatous (thickened skin with prominent pores), and ocular. Severity of each subtype is classified as mild, moderate, or severe. The goal of therapy is symptomatic control versus cure. For papulopustular rosacea, topical metronidazole is the first line of therapy. Azelaic acid is a newer preparation that patients have preferred over topical metronidazole in head-to-head trials. Topical sodium sulfacetamide/sulfur is another alternative. Systemic agents may be needed for nonresponders or patients with severe disease. Oral alternatives include a 40–mg dose of doxycycline, which costs significantly more than generic doxycycline 100 mg. The lowest effective oral dose should be used to reduce the possibility of bacterial resistance. Telangiectasias may require laser surgery. Conclusions: Several alternatives are available for the treatment of rosacea, depending on the subtype, severity of disease, and patient response. In addition to pharmacologic therapy, patients with rosacea need to be counseled about identification and avoidance of triggers that can exacerbate their symptoms, the use of broad-spectrum sunscreens, and the use of mild cleansers.
Autoimmune Hepatitis Induced by Interferon Beta Therapy in a Patient with Multiple Sclerosis: A Case Report
Authors: Benmousa Ali , Helmy Ahmed , Sanai Faisal M , Ghandour Zuhal M 
Published: September 2013

Objective: To report a case of a woman who had multiple sclerosis and developed autoimmune hepatitis (AIH) induced by interferon beta therapy. Case Summary: A 35–year-old woman with multiple sclerosis was being treated with interferon beta when she presented with fatigue and jaundice. Liver biochemistry testing revealed acute hepatitis (alanine and aspartate aminotransferase values >10 times the upper limit of normal) that was histologically consistent with AIH. Our patient had a score of 9 on the Roussel Uclaf Causality Assessment Method scale, indicating a high probability that hepatotoxicity in this case was related to interferon beta therapy. The patient had spontaneous clinical and biochemical improvement after stoppage of treatment. However, when she resumed interferon beta therapy, derangement of liver function reappeared, which again responded well to discontinuation of interferon. Discussion: Interferons can induce many autoimmune diseases due to their immunomodulatory effects. Autoimmune thyroid diseases and, to a lesser extent, skin and pulmonary involvement, are frequently reported during interferon alfa treatment for chronic hepatitis C. Several different forms of hepatotoxicity have also been described with interferon alfa and beta therapy, but few cases of AIH induced by interferon are reported in the literature. AIH has been described in association with interferon alfa therapy; however, this association with interferon beta therapy is extremely rare, and only a handful of cases have been described. Moreover, reports of previous cases were not rechallenged with the same medication, thereby failing to demonstrate firm evidence of causality. This is the first report of the disease reappearing upon drug rechallenge. In addition, we have shown that interferon-induced AIH can be suitably treated by drug withdrawal rather than by institution of steroid therapy. Conclusions: Practitioners need to be aware of the potential complication of AIH induced by interferon beta; this condition occurs independently of the typically benign enzyme elevations frequently reported with this drug.
Survey of Hospital Pharmacy Directors: Assessment of the Current State of Unit-Dose Acquisition
Authors: Mason Scott J , Meller Russell D , Thomas Lisa M , Pazour Jennifer A , Root Sarah E 
Published: September 2013

Background: Many hospitals are in the planning stage of barcode point-of-care (BPOC) implementation. One of the challenges that hospital pharmacies face in BPOC implementation is unit-dose acquisition. Objective: This article presents the results of a survey of hospital pharmacy directors to assess the current state of unit-dose acquisition to support bedside barcode-enabled dispensing practices. Methods: An online survey was administered over 2 months and was available from September to November 2008. The University of Arkansas Institutional Review Board approved the survey before it was disseminated. The survey was developed in collaboration with 2 hospital pharmacy directors. Ninety-one valid survey responses were representative in terms of the distribution of hospital size compared with previous surveys of the American Society of Health-System Pharmacists. Though there were 91 total respondents, not all provided responses to all of the survey questions. Thus, some of the figures, tables, and text refer to fewer than 91 respondents. Results: The results of interest to pharmacy technicians indicated that most hospitals today are able to purchase at least 40% of their medications in unit-dose packaging directly from the manufacturer. For medications that cannot be acquired in unit-dose packaging, 85% of the hospitals surveyed perform repackaging operations in-house. However, 87% of the hospitals that use a high-speed oral solid repackager only use this equipment, at most, 4 hours per day. Our survey results showed that only 8% of the hospitals surveyed used a third-party repackager to acquire unit-dose medications, compared with 85% of hospitals that are either currently using or in the planning phase of using BPOC. Conclusions: The survey found that most hospital pharmacy directors choose to repackage medications in-house, despite the high cost of repackaging equipment and a relatively low utilization of that equipment. Hospitals indicated that cost and turnaround time were the 2 issues of greatest concern when considering outsourcing unit-dose medication repackaging to a third-party repackager.
Doripenem: The Newest Addition to Carbapenem Antibiotics
Authors: Willett Kristine , Raman Kirthana , Nichols Jessica , Durand Cheryl 
Published: September 2013

Objective: To review the pharmacology, pharmacokinetics, microbiology, and clinical efficacy and safety data of doripenem for the management of complicated and nosocomial infections. Data Sources: Literature searches were conducted using MEDLINE (1996-September 2009, week 2) and EMBASE (1996–2009, week 38) with the term doripenem. References from articles obtained from the search were evaluated for other relevant citations. Study Selection and Data Extraction: All articles in English evaluating the efficacy, adverse effects, pharmacology, microbiologic spectrum of activity, and pharmacokinetic profile of doripenem were selected. Data Synthesis: Doripenem is the newest addition to the carbapenem class of antibiotics and has been studied for a variety of indications. It is approved by the FDA for the treatment of complicated urinary tract infections and complicated intraabdominal infections. The manufacturer is also seeking an indication for the treatment of nosocomial pneumonia. Efficacy studies evaluating doripenem's use for these indications were conducted as noninferiority studies comparing doripenem with standard treatment options. Results showed that doripenem is noninferior to levofloxacin in the treatment of complicated urinary tract infections, noninferior to meropenem in the treatment of complicated intraabdominal infections, and noninferior to both piperacillin/tazobactam and imipenem/cilastatin for the treatment of nosocomial pneumonia. The adverse effect profile for doripenem is similar to that of other carbapenems, with the most commonly reported effects being headache, nausea, diarrhea, rash, and phlebitis. Conclusions: Doripenem has been shown to be an effective and well-tolerated carbapenem antibiotic for the treatment of complicated urinary tract infections and complicated intraabdominal infections. It has also exhibited promising results in studies evaluating its use in patients with nosocomial pneumonia.