bluuebunny/crossref_metadata_2025_split huggingface dataset:
Amantadine Therapy in Traumatic Brain Injury Patients
Authors: Villareal Carolyn L 
Published: September 2013

Objective: To review literature on amantadine therapy in patients with traumatic brain injury (TBI). Data Sources: MEDLINE (1966–March 2006), EMBASE (1974–March 2006), BIOSIS (1969–March 2006), and International Pharmaceutical Abstracts (1970–March 2006) were searched to identify papers on the clinical outcomes of patients with TBI treated with amantadine. A bibliographic search was also performed. Study Selection and Data Extraction: Papers were excluded if they were not published in English, if they included patients less than 16 years old, or if they included patients in whom the effects of multiple medications, rather than amantadine alone, were studied. Reports were categorized according to the time of initiation of amantadine following the injury. Data Synthesis: Reports examining early initiation of amantadine suggest a possible benefit for treatment of decreased responsiveness and functional recovery. One report examining late initiation of amantadine failed to demonstrate benefit in the treatment of motor impairment, while 2 reports suggested possible improvement of functional recovery. Finally, reports examining late initiation of amantadine in the treatment of cognitive and behavioral therapy demonstrated possible benefit. Conclusions: Further investigation is needed before either early or late initiation of amantadine can be recommended for treatment of decreased responsiveness and functional recovery. However, while additional research is conducted, late initiation of amantadine can be considered an option for the treatment of cognitive and behavioral impairments in patients with TBI.
Probable Elevation in International Normalized Ratio from Cranberry Juice
Authors: Welch Justin M , Forster Keith 
Published: September 2013

Objective: To report a case in which cranberry juice interacted with warfarin, resulting in an elevated international normalized ratio (INR). Case Summary: A 77-year-old male had maintained stable INR values for 6 months while on a warfarin maintenance dose of 24 mg/wk. On a routine follow-up examination, the INR was 5.9; one month prior to presentation, the INR had been 2.4. The patient reported several recent nosebleeds and a red mark on his left eye. He stated he had been adherent to therapy and denied any changes in medications or recent illnesses such as fever, flu, or diarrhea. His physical activity level and diet had been consistent, with no alcohol intake. The only change identified was the addition of daily cranberry juice (1–3 cups/day) for the last month. Cranberry juice was stopped, and the dose of warfarin was decreased to 22 mg/wk. Subsequently, the INR stabilized at the low end of the therapeutic range. Discussion: Whether cranberry juice interacts with warfarin is unclear. Three previously published case reports suggested a possible interaction. In at least 2 of these cases, confounding factors and incomplete information make assessing the influence of cranberry juice difficult. The interaction in our patient was scored as probable by the Naranjo probability scale, based on the temporal relationship, return to the therapeutic INR range after discontinuing cranberry juice, and elimination of alternative causes for the INR elevation. Conclusions: This case suggests that cranberry juice may interact with warfarin, leading to an elevated INR.
Long-Term Glycemic Control after a One Week Hospital Education Program for Inpatients with Type 2 Diabetes
Authors: Akabane Michiya , Konishi Hiroki , Nishio Yoshihiko , Yamaji Akira 
Published: September 2013

Background: Clinical usefulness of short-term education for long-term glycemic control has been unclear in patients with type 2 diabetes. Objective: To conduct a one week education program, incorporating a clinical path with group education and a team approach, for inpatients with type 2 diabetes and assess the effect of our program on short- and long-term glycemic control in these patients. Methods: Changes in hemoglobin A1c (A1C) values of 29 patients were serially examined for 3 years after discharge at completion of the education program, and findings were compared with those of 22 patients with diabetes who did not participate in the program. Results: A1C values of patients in the education group at the first and third year after discharge were maintained at lower levels than those of patients in the control group. The proportion of patients with A1C values less than 7% was greater in the education group than in the control group during the first and third years. No significant differences in the number of hospital visits were noted over 3 years, and no significant difference between the 2 groups was found in the ratio of patients receiving drug therapy to those supported by a diet/exercise regimen only. Conclusions: Our findings suggest that a one week in-hospital education program contributes to improvement of short- and long-term glycemic control in patients with type 2 diabetes.
Telepharmacy in Mental Health Outpatient Case Management
Authors: Nieves J Edwin , Stack Kathleen M , Cruz Martin 
Published: September 2013

Objective: To describe the use of videophones to augment community-based case management medical services, particularly for in-home pharmacy consultations. Discussion: Despite recent technologic advances, telepharmacy image applications, in which a patient and a pharmacist can see each other, are rather limited in number and variety. However, videophone technology can fill this role well, given its portability, low cost, reliability, privacy, ease of use, and minimal technologic requirements. Videophone deployment in our psychiatry community case-management program has improved both medical and pharmacist access to a population of seriously mentally ill patients. Specifically, the ability to reach a hospital-based pharmacist through videophone, while making home visits, has allowed clarification of medication preparation and authorization of refills as well as improving treatment adherence. In short, despite minor technical limitations, videophones provide a simple and, in our case, reliable solution for in-home care. To date, both patients and case managers have responded with satisfaction to this treatment adjunct. Conclusions: Despite some limitations, videophone technology can increase patient access to health care, particularly pharmacy consultations. Expanded use of this technology would allow for systematic studies to support or refute the successes documented at our institution.
The Effects of Androstenedione Supplementation on Serum Gonadal Hormones
Authors: Weber Cynthia A , Wood Heidi M , Ernst Michael E 
Published: September 2013

Objective: To review the effects of androstenedione supplementation on serum gonadal hormones. Data Sources: Biomedical literature was accessed via PubMed through September 2007; MeSH terms included androstenedione and gonadal hormones. Study Selection and Data Extraction: Studies were limited to those published in English, with the primary outcome of change in serum gonadal hormone concentrations following multiple-dose oral androstenedione supplementation. Articles that reported only effects on muscle strength were excluded because our review focuses on the biochemical, not physiological, effects of androstenedione. For studies that evaluated multiple outcomes of therapy that were published in more than one journal, only the article reporting serum gonadal levels was selected for this review. Data Synthesis: We reviewed 8 unique studies that evaluated the effect of oral androstenedione supplementation on serum gonadal hormone concentrations. Critical comparison of the studies is challenging due to heterogeneity in methodology and outcomes measured, small sample sizes and short durations, and lack of complete data. The timing of serum gonadal hormone measurements, which is of critical importance, is not standardized among the studies. Subjectively evaluated, these studies suggest that androstenedione supplementation may cause a small, transient increase in serum testosterone. However, this effect is very short (<24 h) and may be completely negated by conversion to estrogens and through feedback inhibition of endogenous testosterone production with long-term use (≥28 days). Conclusions: The findings of the studies reviewed suggest that androstenedione supplementation may cause a small, transient increase in serum testosterone levels. More importantly, estrogen-related hormones were also increased. Although androstenedione supplements are no longer available in the US without a prescription, they are available in other countries and potentially via the Internet. Clinicians should be aware of the potentially harmful effects of androstenedione on gonadal hormones in the event that they are involved in the care of a patient who may be using an androstenedione-containing product.
Evaluation of State Schedule II Controlled Substance Laws
Authors: Fass Jennifer A , Seamon Matthew J 
Published: September 2013

Background: States have the authority to mandate laws that are more stringent than federal law, which often results in important differences in prescribing and dispensing patterns throughout the country. Objective: To evaluate schedule II controlled substance laws in all 50 states, the District of Columbia, and Puerto Rico to identify important differences. Methods: The current state laws and regulations regarding controlled substances were evaluated using the following criteria: whether prescription expirations dates are mandated, whether partial fills are permitted, whether changes can be made to prescriptions after consulting with a physician, whether maximum days' supplies are mandated, and whether pharmacists can dispense emergency oral prescriptions. Results: Thirty-nine states and Puerto Rico (77%) mandate prescription expiration dates. Partial filling is permitted in all states, the District of Columbia, and Puerto Rico (100%). All 50 states and the District of Columbia (98%) permit pharmacists to make prescription changes after consulting with the physician. Nine states (17%) have mandated maximum days' supplies that a physician may prescribe. All 50 states, the District of Columbia, and Puerto Rico (100%) permit pharmacists to dispense drugs in an emergency situation with verbal prescription. Conclusions: Pharmacists should be aware that differences exist among the states, the District of Columbia, and Puerto Rico regarding Schedule II controlled substance laws. Understanding these differences is fundamental to the profession.
Assessment of Vitamin K Use in the Inpatient Treatment of Excessive Anticoagulation
Authors: Hansen Lizbeth A , Jennings Douglas L , Pallares Maria-Jose , Thompson Amy N , Garrison Kelli L , Wessell Andrea M 
Published: September 2013

Background: Guidelines from the Seventh American College of Chest Physicians (ACCP) Conference on Antithrombotic and Thrombolytic Therapy provide specific recommendations for the management of patients with supratherapeutic international normalized ratios (INRs). Objective: To assess the appropriateness of vitamin K administration in inpatients with excessive anticoagulation, according to existing guidelines. Methods: A retrospective chart review was performed for randomly selected patients on warfarin therapy who received vitamin K during hospitalization. Data were collected on patient demographics, vitamin K dose and route of administration, warfarin dose, alternative therapies, and INR values before and after vitamin K administration. The appropriateness of vitamin K use was evaluated based on indication, route, and dose. Results: A total of 136 patient charts were reviewed. The majority (71%, n = 97) of patients had a baseline INR of less than 5, with a mean INR of 4.4 ± 2.9 SD. Seventy-five patients had documented bleeding events on admission, 49% of which were considered major. Average time to repeat INR was 9.7 ± 6.8 SD hours. Seventy-one percent of patients had a documented appropriate indication for vitamin K, 42% received an appropriate dose, and 27% received vitamin K via the appropriate route of administration. Only 21% of patients received vitamin K for an appropriate indication, at an appropriate dose, via an appropriate route. Conclusions: At our institution, the current use of vitamin K for excessive anticoagulation is inconsistent and suboptimal with regard to route, dose, and monitoring parameters. Education of both medical and pharmacy staff is essential to improving compliance with ACCP recommendations.
Pharmaceutical Care: What's in a Name? A Qualitative Analysis of Patient Perceptions of Pharmacy Practice
Authors: Franic Duska M , Tucker Leslie Tootle , Haddock Sarah M 
Published: September 2013

Background: Pharmaceutical care has been integrated into the mission statement of every major pharmacy school and the profession of pharmacy in the US. Objective: To evaluate patients' awareness and understanding of pharmacy practice, pharmacy services, and pharmaceutical care. Methods: A cross-sectional study was conducted involving completion of a self-administered questionnaire by participants frequenting community pharmacies (independent, chain, discount, and grocery) in Georgia. Content analyses were performed to assess participants' knowledge and perception of available pharmacy services and pharmaceutical care. Results: Approximately half of the study participants were unfamiliar with pharmaceutical care despite its integration into pharmacy education. One percent described pharmaceutical care as the compounding phase of pharmacy, 2% described it as the early clinical practice model, 45.3% equated pharmaceutical care with dispensing (ie, the “professional shopkeeper”), and approximately 52% described pharmaceutical care accurately. Forty-three percent described at least one of the subcomponents of basic pharmaceutical care (ie, pharmacist commitment, definite outcomes, or process of care [eg, counseling, drug utilization review]) and 8% described true or enhanced pharmaceutical care (ie, quality of life). Conclusions: The practice of pharmaceutical care is not widely understood by patients. Furthermore, many patients were unaware of the cognitive and clinical services that pharmacists provide. In the future, we expect the pharmacy profession to educate not only its pharmacists, but also its patients, about pharmaceutical care. Patients may not be seeking or demanding available services from their pharmacists because they are uninformed.
Intracoronary Vasodilators for the No-Reflow Phenomenon
Authors: Montarella Kristin E , Gales Mark A 
Published: September 2013

Objective: To review the literature relating to the use of intracoronary vasodilators to prevent and/or treat the no-reflow phenomenon in patients undergoing percutaneous coronary intervention (PCI). Data Sources: A literature search was conducted using MEDLINE (1966–March 2008) and Science Citation Index (1945–March 2008) using the search terms vasodilators, no-reflow, and intracoronary. Study Selection and Data Extraction: English-language clinical trials and case series were selected from articles retrieved. References of reviewed articles were examined for additional sources. Studies relating to the use of intracoronary vasodilators in the prevention and/or treatment of no-reflow in PCI were evaluated for safety and efficacy data. Articles relating to agents not available in the US were excluded. Data Synthesis: Evidence of intracoronary adenosine's utility in no-reflow treatment is limited. Its use in no-reflow prevention was associated with outcomes ranging from no difference to nearly an 88% reduction in no-reflow development; the drug was generally well tolerated. No-reflow treatment with intracoronary verapamil improved flow in 87–100% of cases. Preventive trials with verapamil failed to demonstrate efficacy. Atrioventricular block requiring treatment was the most commonly reported adverse event with intracoronary verapamil. Literature on intracoronary diltiazem and intracoronary nicardipine is limited. Both agents produced greater than 95% efficacy in no-reflow treatment, while prevention studies found no-reflow developing in less than 4% of patients. Although adverse event reporting was limited, hemodynamic instability was noted in patients receiving diltiazem. Response rates ranged from 73% to 100% when intracoronary nitroprusside was studied as treatment for no-reflow associated with acute myocardial infarction (AMI). Systemic hypotension was noted with nitroprusside administration. Conclusions: The available data are predominately from case series and retrospective reviews. Prevention of no-reflow with intracoronary vasodilators in elective PCI is not warranted. Nitroprusside should be considered first-line treatment in no-reflow associated with AMI.
Safety of Proton Pump Inhibitors in Community-Dwelling Older Adults
Authors: Lindblad Adrienne J , Sadowski Cheryl A 
Published: September 2013

Objective: To describe proton pump inhibitor (PPI)–related adverse effects in community-dwelling older adults. Data Sources: Articles were identified via PubMed (1966–March 2008) using the terms proton pump inhibitor, adverse drug effects, safety, pneumonia, fractures, Clostridium difficile, and vitamin B12. Clinical trials, meta-analyses, and drug evaluations published in English were selected. Articles excluding patients over 65 years of age or those involving solely institutionalized patients were excluded. Study Selection and Data Extraction: Twelve studies were selected, 10 of which were case–control or population-based studies. Three of 4 studies investigating the association of PPI use with C. difficile infection found a positive association. Many participants in these studies had no history of antibiotic exposure prior to infection. Three studies found a significant relationship between community-acquired pneumonia and PPI therapy, with a possible dose–response relationship. Two studies found an increased risk of fracture with PPI use, with a possible dose–response relationship. Two of 3 included studies found an association between vitamin B12 deficiency and PPI therapy. Data Synthesis: The majority of studies found significant associations between PPI use and the development of C. difficile infection, pneumonia, fractures, and vitamin B12 deficiency, all of which are plausible based on the mechanisms of action of PPIs. With a lack of randomized controlled trials, the underlying causes of these adverse effects remain controversial. Conclusions: Cause and effect between PPI use and C. difficile infection, pneumonia, fractures, and vitamin B12 deficiency has not been established. Well-designed, prospective, randomized studies are required to confirm whether there are risks associated with long-term PPI use. Until the results of such studies become available, PPI use should be reviewed for appropriateness at regular intervals in individual patients, as the consequences of these complications in the elderly could be devastating.
Evaluation of INR Monitoring Frequency and Time in Therapeutic Range
Authors: Snyder Christin M , Helms Bethany E , Hall Deanne L 
Published: September 2013

Background: Although anticoagulant therapy has been used for more than 50 years, the optimal interval between international normalized ratio (INR) measurements in patients who demonstrate a stable dose response remains unsettled. Based on the results of observational studies, the American College of Chest Physicians currently recommends that patients receiving a stable dose of warfarin undergo INR testing at least once every 4 weeks.1 Objective: To determine whether an increased frequency of INR monitoring impacts time in therapeutic range (TTR) among patients receiving maintenance warfarin therapy managed by an anticoagulation clinic. Methods: A total of 2,222 INR results belonging to more than 700 adults who were followed by the anticoagulation service at the University of Pittsburgh Medical Center and who were receiving maintenance warfarin therapy between April 1, 2006, and September 30, 2006, were retrospectively reviewed. INR measurements were categorized as having been determined fewer than 21 days or 21 or more days after the previous measurement, and the percentage of INRs within the therapeutic range was calculated for each interval. Results: During the evaluation period, INRs measured within 21 days of the preceding test were within the therapeutic range 75.1% of the time, whereas INRs obtained at least 21 days after the antecedent INR test were within the therapeutic range 79.9% of the time (p < 0.001). Additionally, the proportion of INRs below 1.5 or above 5.0 was not significantly different between the 2 groups, representing only 0.04% of all results at either interval (p > 0.05). Conclusions: Our evaluation suggests that more frequent INR monitoring among patients receiving maintenance warfarin does not impact TTR to a clinically meaningful extent. Moreover, these findings support the reevaluation of the anticoagulation service management algorithm to reduce the frequency of INR measurements among patients within the maintenance phase of therapy.
Pharmacy Technicians and Medication Therapy Management
Authors: Powers Mary F , Bright David R 
Published: September 2013

Background: Although cognitive services have become more widely accepted among pharmacists since Medicare Part D provided a benefit to allow for billing of services, not all pharmacists have incorporated services into their practices. Objective: To identify opportunities for pharmacy technicians to aid pharmacists in medication therapy management (MTM). Methods: Articles were identified through searches of MEDLINE/PubMed (1950–July 2008) and review of MTM resources from the American Pharmacists Association. Articles describing medication therapy management and pharmacy technicians were included. Results: As the pharmacy profession embraces extensive patient counseling in the form of MTM, many aspects of the practice of pharmacy need to evolve to ensure MTM program success. Time constraints limit the ability of pharmacists to handle administrative tasks and represent a major barrier to MTM program implementation. Technicians can do some of the work to reduce this barrier. With proper training, technicians can assist pharmacists in the tasks that do not require the professional judgment of a pharmacist, freeing pharmacists to focus on clinical activities and enabling an MTM program to be more sustainable. For example, technicians can help in areas such as scheduling and patient reminders through phone calls. Medication histories and health histories can also be documented by technicians, as can chart construction, filing, and the documentation of release forms and health histories. Additional steps can be taken to further increase efficiency in the MTM process and include creation of a flow map and cross training of all pharmacy staff. Conclusions: Through developing new roles, technicians can help pharmacists provide pharmaceutical care and develop a successful MTM program.