bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteoporosis and Vitamin D Deficiency in HIV-Positive Patients
Authors: Segarra-Newnham Marisel , Soffler Sarah L 
Published: September 2013

Objective: To review the epidemiology and pathophysiology of osteoporosis in patients with HIV infection and discuss vitamin D deficiency and the treatment of HIV-positive patients with osteoporosis. Data Sources: A search of PubMed (1980–June 2011) was conducted using the terms osteoporosis, HIV, vitamin D deficiency, and treatment. Study Selection and Data Extraction: Epidemiologic studies, clinical trials, and meta-analyses published in English were included. A manual review of the bibliographies of available literature was conducted and relevant articles were reviewed for inclusion. Data Synthesis: Patients with HIV infection are living longer with the use of potent antiretroviral therapy (ART) and are at increased risk for osteoporosis. Several studies have shown that HIV infection can affect bone health and increase the risk for osteoporosis. In addition, ART, and tenofovir in particular, may affect bone turnover. Studies and meta-analyses have shown an increased prevalence of osteopenia and osteoporosis in HIV-positive patients compared to noninfected controls. Recent reports also show increased prevalence of fractures and low vitamin D concentrations in HIV-positive patients. Osteoporosis treatments used in patients with HIV infection are similar to treatments for noninfected patients. HIV-positive patients should be monitored and treated to prevent the progression and complications of osteoporosis. Conclusions: HIV-positive patients are at increased risk for osteoporosis and vitamin D deficiency due to disease and treatment influences on bone health. These patients should be identified and treated to prevent the morbidity and mortality associated with osteoporosis.
Approved Uses of Dabigatran Etexilate as an Anticoagulant
Authors: Darnell Joshua B , Kleppinger Erika L 
Published: September 2013

Objective: To review, analyze, and critique dabigatran etexilate's approved uses as an anticoagulant. Data Sources: Literature searches were performed via MEDLINE, International Pharmaceutical Abstracts, and Google Scholar through February 2011, using the term dabigatran. Additional data were obtained from tertiary sources and prescribing information. Study Selection and Data Extraction: All published Phase 3 anticoagulation trials investigating dabigatran for currently approved indications were selected. Information from other anticoagulation trials investigating dabigatran was used for critiquing Phase 3 studies. Data Synthesis: Dabigatran etexilate has been evaluated in multiple clinical trials as an alternative to enoxaparin for prevention of venous thromboembolism in total hip and knee replacement surgeries. It has also been evaluated as an alternative to warfarin in stroke and systemic embolism prevention in patients with atrial fibrillation. Results have generally been positive, with few exceptions. The standard adult dose of dabigatran 150 mg twice daily, approved for use in the US for stroke prevention in nonvalvular atrial fibrillation, was found to be superior to warfarin in regard to occurrence rates of stroke or systemic embolism and hemorrhagic stroke. The occurrence rates of intracranial bleeding, life-threatening bleeding, and major or minor bleeding were lower with dabigatran 150 mg twice daily than with warfarin; however, the occurrence of gastrointestinal bleeding was significantly higher. Conclusions: With its numerous benefits, and despite its drawbacks, dabigatran remains a promising option for oral anticoagulation therapy.
Addressing the Controversial Use of Antipsychotic Drugs for Behavioral and Psychological Symptoms of Dementia
Authors: Ibrahim Farrah , Knight Seth R , Cramer Richard L 
Published: September 2013

Objective: To review relevant background information on behavioral and psychological symptoms of dementia (BPSD) and the antipsychotic drugs used to treat it, describe benefits versus risks of antipsychotic drugs for treatment of BPSD, and describe the latest management guidelines for patients with BPSD. Data Sources: A PubMed literature search (1998–October 2011) was conducted using the following MeSH search terms: dementia, elderly, antipsychotics, behavioral symptoms, and psychological symptoms. Tertiary references and prescribing information for included medications were used for pharmacology, adverse effects, and cost. Data Selection and Data Extraction: English-language reviews, tertiary references, and guidelines were reviewed; only articles that used pharmacotherapy in human models were included. Data Synthesis: There are no FDA-approved medications for treatment of BPSD; several classes of drugs are prescribed off-label, including selective serotonin reuptake inhibitors and certain anticonvulsants. Antipsychotics, particularly those from the atypical class, are also commonly used by clinicians as a pharmacologic intervention for dementia. Yet, since these are drugs with a wide array of potentially serious adverse effects, including increased risk for cerebrovascular accidents, clinicians treating patients with dementia must be especially cognizant of the benefits and risk of their use. Conclusions: Nonpharmacologic treatments should be first-line therapy for BPSD. When these approaches do not produce the desired results, clinicians must weigh the risks versus benefits of continued psychological disease and dangerous behavior with the use of an antipsychotic drug regimen.
Patient Perceptions of Pharmacist-Managed Clinics: A Qualitative Analysis
Authors: Gonzalvo Jasmine D , Papineau Emily C , Ramsey Darin C , Vincent Ashley H , Walton Alison M , Weber Zachary A , Wilhoite Jessica E 
Published: September 2013

Background: Pharmacist-managed clinics have consistently demonstrated improvement in patient outcomes. Quantitative research offers the benefit of objective outcomes to track progress toward therapeutic goals at pharmacist-managed clinics. While quantitative studies are readily available in the literature, there is a paucity of qualitative studies to capture the patients' perspectives of pharmacy services. Objective: To assess through the use of qualitative research methods patient perceptions of pharmacist-managed services within ambulatory care clinics that operate under a collaborative practice agreement. Methods: A semi-structured interview questionnaire was developed, pilot tested, and revised using a focus group of clinical pharmacists. The questionnaire was used to conduct face-to-face patient interviews at 6 pharmacist-managed clinics in central Indiana. English-speaking patients with a minimum of 2 visits with the clinical pharmacist were included in this study. Pharmacist-managed clinics without established collaborative practice agreements were excluded. Patient interviews were conducted by a trained research assistant, audio-recorded, and transcribed verbatim. The interview transcripts were analyzed to identify cross-cutting themes without predetermined definitions via inductive qualitative analysis. Four study investigators independently identified themes using a sample of the transcripts. Additional themes were identified and defined in a series of independent reviews and investigator meetings using the remaining transcripts until theme saturation. All themes were assigned to segments of the interview transcripts according to the consensus definitions. Results: A total of 30 interviews were conducted across the clinics. Ten themes from the interview transcripts emerged, including disease state management expertise, patient alliance, practice novelty, accessibility, increased sense of patient well-being, and compassion. Conclusions: Patient perceptions from qualitative interviews revealed that pharmacists are viewed as medication experts who provide patient-centered care. This study highlights unique in-depth perspectives from the patient that further support maintenance and expansion of pharmacist-managed services.
Rifabutin-Induced Thrombocytopenia from Concurrent Use of High-Dose Fluconazole
Authors: Frumin Jane , Yunker Nancy 
Published: September 2013

Objective: To report a case of—and review the literature supporting—rifabutin-induced thrombocytopenia from concurrent use of high-dose fluconazole. Case Summary: A 34-year-old man with AIDS, on a stable regimen that included rifabutin and fluconazole for the previous 3 months, was admitted to the hospital with symptoms of oropharyngeal candidiasis. He was treated with increased doses of fluconazole 200 mg to 800 mg daily over a 9-day hospital admission. During this time, his platelet count decreased from 441,000 cells/mm3 to 24,000 cells/mm3, with no signs of bleeding. He was discharged on day 9 and instructed to omit 1 dose of rifabutin and continue fluconazole 200 mg daily. On day 12, his platelet count was 118,000 cells/mm3. About 1 month after discharge, his platelet count was 151,000 cells/mm3. Discussion: Rifabutin is known to cause thrombocytopenia. Results from initial studies evaluating various doses of rifabutin were not conclusive as to whether rifabutin-induced thrombocytopenia is a dose-dependent effect. With increased use of rifabutin, often in combination with potentially interacting medications, reports of thrombocytopenia have gained frequency. One study showed that patients on higher doses of rifabutin experienced thrombocytopenia significantly more often than did those on lower doses. When rifabutin is administered with fluconazole, there is a clear pharmacokinetic interaction, showing a 76–82% increase in the rifabutin area under the concentration curve, with only uveitis and leukopenia reported. An objective causality assessment of this case classified the interaction between fluconazole and rifabutin, resulting in thrombocytopenia, as probable. Other causes of thrombocytopenia in our patient, including AIDS, Mycobacterium avium complex, fluconazole, famotidine, and ritonavir, are less likely. Conclusions: We describe the first case of rifabutin-induced thrombocytopenia from concurrent use of high-dose fluconazole. There is evidence to support this interaction and practitioners should be aware of this potential adverse effect.
Community Pharmacists' Impact on an Employer-Initiated Diabetes Disease Management Program
Authors: Sansgiry Sujit S , Agrawal Ruchika N , Patel Harshali K , Mhatre Shivani K , Hayes J David , Roberson Kim , James Clyde J 
Published: September 2013

Background: Diabetes is the third most expensive physical health condition for US employers. Thus, there is a need for employers to engage in disease management programs for their diabetic employees in order to ensure long-term benefits. Objective: To evaluate the clinical outcomes of successful implementation of an employer-initiated pharmacist-based disease management program for diabetic patients. Methods: This was a longitudinal retrospective study analyzing clinical indicators in diabetic employees after a community pharmacist-based diabetes disease management (DDM) program in a rural setting. The program involved comprehensive drug therapy assessment and individualized disease management education. Outcomes measured in this study were fasting serum glucose (FSG) levels, glycated hemoglobin (A1C) levels, diastolic blood pressure (DBP), systolic blood pressure (SBP), body mass index (BMI), and complete lipid profiles including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and total cholesterol (TC) levels. Results: A total of 137 patients were enrolled in this program. Significant improvement in mean clinical outcome scores was achieved for FSG (p = 0.004), DBP (p = 0.018), and SBP (p = 0.044). At the end of the 1-year intervention, targeted FSG and A1C goals were attained by 39.1% (p = 0.029) and 39.4% of patients, respectively. Also, targeted DBP, SBP, BMI, LDL, HDL, TG, and TC levels were achieved by 54.8% (p < 0.001), 38.5%, 38.3%, 56.8%, 38.2%, 37.5%, and 52.4% of patients, respectively. Conclusions: This study establishes a need for implementation of long-term employer-initiated pharmacist-based DDM programs that improve clinical outcomes for employees. Further studies evaluating outcomes for a longer time period would provide more conclusive results.
Inhaled Aztreonam Lysine for Cystic Fibrosis
Authors: Hoffman Lindsay E , Lowe Denise K 
Published: September 2013

Objective: To review the mechanism of action, indication, pharmacokinetics, clinical efficacy, safety and tolerability, dosing, availability, and place in therapy for aztreonam lysine in the chronic management of cystic fibrosis (CF). Data Sources: PubMed/MEDLINE (1966–December 2011) was searched to identify articles addressing aztreonam lysine use for CF using the terms aztreonam, cystic fibrosis, and inhaled antibiotics. Reference lists of review articles, guidelines, and unpublished data from the manufacturer were also utilized. Study Selection and Data Extraction: Limits were set for the English language and humans. Three placebo-controlled trials and 1 active-comparator trial evaluating the efficacy and safety of aztreonam lysine were reviewed for inclusion. Data were also extracted from review articles and the manufacturer's Web site. Data Synthesis: Pseudomonas aeruginosa is associated with significant morbidity and mortality in patients with CF; therefore, treatment is imperative. Current guidelines for chronic maintenance therapy recommend using chronic inhaled anti-pseudomonal antibiotics. Tobramycin (Tobi) is the only inhaled antibiotic approved by the FDA for management of CF patients with P. aeruginosa. Tobramycin treatment failures in P. aeruginosa infection have been increasing over the past decade; therefore, other treatment options are needed. Aztreonam lysine (Cayston) was approved by the FDA on February 22, 2010, as an inhaled antibiotic to help improve respiratory symptoms in patients 7 years of age or older with CF and known P. aeruginosa infection. Conclusions: Aztreonam lysine is a newer inhaled antibiotic that improves forced expiratory volume in 1 second, respiratory symptoms, and quality of life measures when used as maintenance therapy in patients with CF and chronic P. aeruginosa infection. Availability of aztreonam lysine only from specialty pharmacies may limit its use.
Health-Related Quality of Life in Patients Poststroke: Dapsone versus Placebo
Authors: Cruz-Cruz Copytzy , Altagracia-Martinez Marina , Kravzov-Jinich Jaime , Rios-Castañeda Camilo , Martinez-Nuñez Juan Manuel , Perez Mirza E 
Published: September 2013

Background: Stroke is the second leading cause of death in the world and the main cause of long-term disability in Western countries. Evaluating health-related quality of life (HRQOL) in patients who have survived a stroke provides a more complete picture of the effects of different interventions in a patient's condition. Dapsone has been shown to have neuroprotective effects during the acute phase of stroke. Objective: To evaluate HRQOL in patients who received dapsone versus placebo after stroke. Methods: This was an observational pilot study of 21 patients who randomly received dapsone or placebo during the acute phase of a stroke. HRQOL was evaluated with the Stroke-Specific Quality of Life (SSQOL) questionnaire 6 months after the stroke. Results: There was no significant difference in the total SSQOL score 6 months after a stroke between patients who received dapsone or placebo (3.41 vs 3.19; p = 0.434). Patients who received dapsone had higher mean values for 9 of the 12 domains of the SSQOL than patients who received placebo. However, the difference was not statistically significant. The highest score for the patients who received dapsone was in the self-care domain. Overall SSQOL scores were lower in women than in men (p < 0.01). Conclusion: SSQOL was slightly better for patients who received dapsone, showing a possible improvement in their functional level. More prospective, randomized, and placebo-controlled studies with a larger number of patients are needed to confirm these results.
Natural Health Product Utilization in Warfarinized Children; Prevalence and Knowledge
Authors: Bauman Mary E , Mack Gordon , Bruce Aisha K , Bauman Michelle L , Nolan Kyle , Massicotte M Patricia 
Published: September 2013

Background: The need for long-term thromboprophylaxis in children using warfarin therapy is increasing. Natural health products (NHPs) are administered to children by parents who perceive them to be useful and acceptable adjuncts or alternatives to conventional therapies. Interactions of NHPs with prescribed therapies may result in serious adverse events. NHP usage is underevaluated in children and there are no studies evaluating NHP usage in warfarinized children. Objectives: To explore NHP use in warfarinized children and their siblings to determine the prevalence, varieties, and reasons for NHP usage, as well as the potential effect on warfarinization (eg, time in therapeutic range [TTR]). Methods: This is a 3-phase cross-sectional cohort study that includes the (1) prevalence (2) NHP education and knowledge assessment, and (3) the follow-up NHP utilization phase. Results: Forty-six percent of warfarinized children consumed NHPs, with time in therapeutic range of 74%. The mean score for baseline knowledge of NHPs and warfarin following the education phase was 67%. Follow-up NHP use was 30%, and increased consistency of utilization with TTR was 83% (p < 0.05), consistent with education provided. Conclusions: The consistent prevalence rates over time of NHP usage in warfarinized children indicate the need for future studies. Education remains vital to combat the potential risks of NHP-warfarin interaction, encouraging patient disclosure and consistency.
Belatacept Post Kidney Transplantation
Authors: Bajjoka Iman , Makowski Charles , Churchill Dennis , Abouljoud Marwan 
Published: September 2013

Objective: To review the use of belatacept as an alternative to calcineurin inhibitor-based regimens for maintenance immunosuppression in renal transplant recipients. Data Sources: To provide an extensive overview of the pharmacology, pharmacokinetics, efficacy, and safety of belatacept, a MEDLINE/PubMed search (1980–December 2011) was performed for all articles evaluating belatacept's properties and patient outcomes, as well as abstracts from recent meetings, using key words belatacept, pharmacology, efficacy, pharmacokinetics, and safety. Study Selection/Data Extraction: Phase 2 and 3 studies in humans describing use, adverse reactions, pharmacology, pharmacokinetics, efficacy, and safety of belatacept were identified and reviewed. Other articles were identified through PubMed. Data Synthesis: Belatacept, a costimulation blocker, is a biologic recombinant fusion protein that has been shown to prevent acute cellular rejection in kidney transplant recipients and preserve renal function. It was recently approved by the FDA as an antirejection immunosuppressant agent for use in kidney transplant recipients. It is the first biologic agent used for maintenance immunosuppression. It acts as an antagonist to CD80 and CD86 receptors located on the surface of antigen presenting cells, thereby blocking CD28 T-cell activation and, thus, preventing acute rejection. In comparison with patients receiving other current therapies, patients on belatacept have demonstrated superior renal function with comparable outcomes in patient and graft survival. Conclusions: Belatacept has potential for use as an alternative to current maintenance immunosuppression regimens, with potentially fewer adverse effects.
Opportunity for Pharmacy Intervention on an Urban Teaching Hospital Rapid Response Team: A Pilot Study
Authors: Lasak-Myall Tracey , Peters Michael J , Mlynarek Mark 
Published: September 2013

Background: The role of a rapid response team (RRT) or medical emergency team is to bring the expertise of specialists trained in critical care to patients on general medicine and surgical wards who are rapidly deteriorating and to treat them accordingly. The involvement of pharmacists on cardiopulmonary resuscitation teams has been reported. However, the role of a pharmacist member of an RRT has not been extensively researched. Objective: To identify the role of a pharmacist on an RRT and categorize types of pharmacist interventions during cardiopulmonary resuscitation and initial patient assessments. Methods: This pilot study documented interventions made by the pharmacist on our RRT over a 1-month period. The pharmacist assisted the RRT with evaluations of patients during assessments and cardiopulmonary resuscitations and provided specialized medical information based on our current organizational standards of practice. Results: The pharmacist attended 34 consultations and 8 resuscitations during cardiopulmonary arrests. There were 96 interventions made during 34 RRT assessments—2.6 interventions per assessment. The most common interventions were treatment recommendations (29%), dosing recommendations (15%), and procuring medications for emergent use (12%). In both the treatment and dosing categories, antibiotic recommendations were the most common. Conclusions: The pharmacist member of the RRT had the opportunity for intervention on every patient seen by the team. The most common areas for intervention are treatment and dosing recommendations involving antibiotics, as well as providing and preparing emergent medications.
An Intervention to Increase Safety Feature Use on Smart Pumps: A Quality Improvement Initiative
Authors: Herring Holly , Ripley Toni L , Farmer Kevin C , St Cyr Mark 
Published: September 2013

Background: Medication errors due to intravenous administration are common. Metered infusion devices (MIDs) have reduced some administration errors, but the manual programming of these devices allows for continued risk. MIDs with safety features, smart pumps, have been shown to reduce intravenous medication errors, but usage rate of the safety features is reported to be low. Objective: To identify obstacles to the use of the smart pump safety feature and investigate the effectiveness of educational interventions to address these obstacles and improve safety feature use rates. Methods: This cross-sectional study was designed for quality improvement. A 10-question paper survey targeting potential obstacles was distributed to parttime and full-time nurses on the cardiovascular service of an academic hospital to ascertain the limitations to using the safety feature technology. Based on survey results, educational interventions were developed, which included a required educational active-learning, practical session, and optional didactic presentation. The primary end point was change in the rate of use during a prespecified month before (July 2010) and after (April 2011) targeted interventions. Descriptive analysis was performed on survey results. Student t test and χ2 analyses were used to compare usage rates. Results: Surveys were distributed to 60 nurses; 36 were returned and 1 was excluded, leaving 35 in the final analysis. Primary obstacles to using the safety features identified were education/training, technology burden, and drug library accuracy/content. After educational training sessions, usage rates of the smart pump safety feature increased significantly, 5.5 times from baseline (5.5% vs 30.5%; p < 0.001). Conclusions: Targeting education and providing hands-on training directed to nurses' perceived barriers to use of smart pumps was an effective method to improve use of safety features, although overall utilization can be improved.