bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Benign Prostatic Hyperplasia
Authors: Thapa Sraddha , Kourlas Helen 
Published: September 2013

Objective: To review the physiology and pathophysiology of benign prostatic hyperplasia, as well as current medical strategies for the management of the disease. Data Sources: A MEDLINE search (1992–September 2004) was conducted using benign prostatic hyperplasia (BPH), α-receptor antagonists, and 5 α-reductase inhibitors as MeSH search terms to identify clinical trials and review articles. Study Selection/Data Extraction: Primary literature and tertiary review articles evaluating the safety and efficacy of pharmacotherapeutic options in the management of benign prostatic hyperplasia were retrieved and included. Data Synthesis: Pharmacotherapeutic management of symptoms associated with benign prostatic hyperplasia has become the hallmark of therapy. Therapeutic agents evaluated include α-adrenergic antagonists (prazosin, terazosin, doxazosin, alfuzosin, tamsulosin) and 5-α-reductase inhibitors (finasteride, dutasteride). α-Adrenergic antagonists are more popular for therapy of BPH. This group of drugs is generally the first line of therapy, with growing popularity of tamsulosin and alfuzosin due to their decreased incidence of adverse effects. Conclusions: Understanding the pathophysiology of the disease can play an integral part in the selection of a pharmacotherapeutic agent. Patients who require pharmacologic intervention can benefit greatly by the number of agents available.
Duloxetine in the Treatment of Stress Urinary Incontinence
Authors: Osborne Kristie L , Davis Steven M 
Published: September 2013

Objective: To review the available literature regarding the use of duloxetine in the treatment of stress urinary incontinence. Data Sources: Clinical trials were obtained through a PubMed search (1966–December 2004) with the key words duloxetine, urinary incontinence, and stress. Data Synthesis: This article analyzes 5 clinical studies comparing duloxetine with placebo. The randomized, double-blind, multicenter trials were performed in the US and throughout the world and had strict inclusion criteria to enroll only patients with confirmed stess urinary incontinence. All trials showed a statistically significant decrease in incontinence episode frequency of 50–60% for duloxetine compared with a placebo response of 27–40%. Conclusions: Duloxetine appears to be an effective treatment for stress urinary incontinence. Additional trials comparing duloxetine with pelvic floor muscle training would better define duloxetine's place in therapy.
Risk for Osteoporosis and Antiresorptive Therapies in Patients with Crohn's Disease
Authors: Makhzoum Josette , Jobin Gilles , Dagenais Pierre , Makhzoum Sylvie , Perreault Sylvie 
Published: September 2013

Background: The risk of osteoporosis is greater in patients with inflammatory bowel disease (IBD) because of several related risk factors such as the prolonged use of corticosteroids, the malabsorption of calcium and vitamin D following small-bowel disease or small-bowel resections, and the inflammatory process resulting from the illness. A reduction in bone mineral density (BMD) has been reported in 30–75% of patients with IBD (Crohn's disease or ulcerative colitis). An evaluation of the risk factors of osteoporosis should be performed to identify those in need of antiresorptive drug therapies (ART) and/or calcium and vitamin D supplements. Objective: To determine whether patients with Crohn's disease at risk for osteoporosis or already having decreased BMD were identified as such and treated with appropriate therapy. Methods: A cross-sectional study was performed among 54 white patients with Crohn's disease who attended a gastroenterology specialized clinic between January and March 2002. All patients with Crohn's disease having an outpatient medical visit were asked to participate in the study. Patients who agreed to the study were questioned for Crohn's disease activity index (CDAI) and osteoporosis risk factors such as nutrition, lifestyle, and corticosteroid therapy. Serum bone-specific markers and nutritional status were assessed. BMD test of the lumbar vertebrae (L2–L4) and the nondominant hip were assessed with dual-energy X-ray absorptiometry if the participants did not have a BMD test in the year prior to the study. ART and calcium/vitamin D use were assessed through a questionnaire and on community pharmaceutical drug services in the 2 year period prior to the evaluation. Results: Mean age and CDAI severity score were 41.5 years and 145, respectively. None of the patients was evaluated for BMD in the year prior to the study. Osteopenia at the nondominant hip and/or lumbar vertebrae was seen in 29 patients. Eighty-two percent of patients with a T score under −2 SD had not been exposed to ART; 84% of patients with more than 4 risk factors for osteoporosis and a T score less than −1.5 SD had not received ART. Moreover, 88% of patients with a T score less than −1.5 SD and receiving corticosteroid therapy had not been treated with ART. Conclusions: The presence of osteoporosis risk factors and osteopenia had not been recognized and treated in our population. Adequate osteoporosis management should be implemented in patients with Crohn's disease to reduce the occurrence of osteoporotic fractures.
A Survey of the Medication Error Experiences of Pharmacy Technicians
Authors: Kennedy Amanda G , Aiken Cheryl A 
Published: September 2013

Background: Little is known about pharmacy technicians and their experiences with medication errors in community pharmacies. Objective: To document the opinions and self-reported experiences of medication errors in a sample of community pharmacy technicians. Methods: A telephone survey of one self-identified pharmacy technician from each Vermont community pharmacy was conducted between August and October 2004. Surveys were administered using a standard script. Descriptive statistics were used to summarize quantitative data, and qualitative data were organized into similar categories. Results: Of 128 operating community pharmacies, 72 (56.3%) responded by providing a technician interview. Approximately 70% of technicians reported receiving training in medication errors. Nearly all (93.1%) respondents stated they had come into contact with prescribing errors; 62.7% of technicians cited illegible prescriptions or poor handwriting as examples. Two-thirds (66.7%) of all respondents stated they personally had detected a medication error. Only 2 (2.8%) technicians responded that they had ever completed a medication error report; both submitted the report to their corporate reporting programs. Conclusions: Most technicians are aware of medication errors in their practice, and the majority had personally detected errors. However, nearly one-third of technicians responded that they had never received any training in medication errors. Further research exploring pharmacy technicians' level of training, job experience, and understanding of and ability to report medication errors in a larger, more diverse sample is warranted.
Stability of Omeprazole Sodium and Pantoprazole Sodium Diluted for Intravenous Infusion
Authors: Carpenter Jane F , McNulty Margaret A , Dusci Leon J , Ilett Kenneth F 
Published: September 2013

Background: Proton-pump inhibitors are often administered by intravenous infusion to raise intragastric pH and prevent rebleeding following endoscopic treatment of bleeding ulcers. Currently, the manufacturers of omeprazole and pantoprazole injections recommend that infusions prepared by dilution in NaCl 0.9% should be used within 12 or 3 hours, respectively. Administration at the ward level would be facilitated if these drugs were known to be stable for up to 24 hours. Objective: To determine whether omeprazole and pantoprazole diluted for infusion in NaCl 0.9% or dextrose 5% are sufficiently stable to allow preparation of 24 hour infusion bags. Methods: Intravenous 500 mL bags of NaCl 0.9% or dextrose 5% containing 200 mg of either omeprazole or pantoprazole were prepared. While stored at 22 °C, samples were withdrawn at intervals up to 10 days, and pH and drug content were measured. ANOVA was used to compare drug concentrations at preparation with those after storage. Results: The pH of the infusions did not alter by more than 0.2 units over 48 hours, but decreased subsequently. The measured concentrations of both omeprazole and pantoprazole decreased during storage. The decrease in concentration was greater in dextrose 5% than in NaCl 0.9% and was related to storage time. However, for both drugs, the mean decrease did not exceed 6% over the first 48 hours. Conclusions: Infusions of omeprazole or pantoprazole can be maintained for up to 48 hours without significant loss of active drug content. Maintaining the same bag for 48 hours may provide cost savings compared with the present practice of replacing bags more frequently.
Use of Pharmacy Database to Investigate Patterns of Physician Practice as Related to Patient Outcomes
Authors: Cerrito Patricia B , Cerrito John C 
Published: September 2013

Background: It has been observed that physicians vary considerably in their dose prescribing in the cardiac catheterization laboratory. Objective: To investigate the relationship between heparin dose and patient outcome and demonstrate the effectiveness of data mining in investigating variation in physician practice. Methods: The pharmacy database containing information about heparin dose prior to angioplasty was merged with a clinical database containing information about patient weight and length of hospital stay. The data were analyzed using data mining and kernel density estimation. Results: Cardiologists practice differing methods for administering heparin doses. This variability has impact on patient length-of-stay. Patients receiving heparin doses greater than 80 mg/kg stayed in the catheterization lab longer than patients receiving less (p < 0.001). This was independent of the number of vessels treated during angioplasty. Conclusions: Length of stay related to angioplasty is significantly related to physician decisions concerning the heparin dose prescribed. Data mining is an effective tool that can be used to exploit the pharmacy database for research into physician practice.
Reasons Why Herbal Users Do or Do Not Tell Their Physicians about Their Use: A Survey of Adult Ohio Residents
Authors: Shah Bupendra K , Lively Buford T , Holiday-Goodman Monica , White Donald B 
Published: September 2013

Background: Several studies have reported lack of patient–physician communication regarding herbal use. However, reasons for this lack of communication are not well understood. Objective: To determine, explore, and identify reasons for lack of patient–physician communication about herbal use. Methods: Using a cross-sectional design, a systematic sample of 1,000 adult Ohio residents was surveyed through a 29 item questionnaire. Survey items were adapted from earlier instruments evaluating complementary and alternative use. Descriptive and univariate statistics were run using SPSS version 10.0. Results: Of 210 usable responses, almost half (47.6%) of the participants reported that they were either currently using herbal products or had used them in the past, with 1 in 16 using herbal products daily. Forty-eight percent of these respondents indicated that they had never had a discussion with their physician about using herbal medicines. A similar percentage (45%) of individuals using herbal agents had not told their physicians about any of the products they used. The top 3 reasons for informing physicians of herbal use were that the physician needs to be aware of all of the products used, the physician may know whether herbals work, and the physician understands the interactions of herbals with prescribed drugs. The main reason that patients did not supply the information was that the physician did not ask them about it. Conclusions: Many patients do not inform their physicians about their use of herbal products unless asked. Physicians and other healthcare providers should therefore integrate inquiry about herbal product use as part of medication history.
The Role of Technicians in Managing Computerized Drug–Drug Interaction Alerts in Community Pharmacies and the Relationship to Pharmacist Managers' Attitudes
Authors: Murphy John E , Malone Daniel C , Skrepnek Grant H , Armstrong Edward P , Abarca Jacob , Grizzle Amy J , Rehfeld Rick A , Woosley Raymond L 
Published: September 2013

Background: Community pharmacies are where identification and prevention of drug–drug interactions (DDIs) typically occur. Technicians have been shown to play some role in the initial screening of DDIs in community pharmacies. Objectives: To examine the role of technicians in the management of DDI alerts in community pharmacies and the possible relationship to the attitudes of pharmacy managers toward DDI alerts. Methods: A national survey of pharmacist managers in 3,000 community pharmacies was conducted. Data collected included demographics, workload issues, handling of DDIs, and pharmacists' attitudes toward computerized DDI alerts. Results: Of questionnaires returned, 736 could be used. Technicians were more often allowed or sometimes allowed to override lower level DDI alerts without prior review by a pharmacist. However, some pharmacies (2.1%) allowed or sometimes allowed technicians to override interactions with the highest potential clinical significance. Stores with the highest use of technology were less likely to allow technicians to override insignificant interactions. Stores that allow technicians to override clinically significant interactions were less confident in their program's ability to provide meaningful alerts and more likely to agree that alerts are a waste of time and that the volume of alerts makes differentiating important from unimportant DDIs more difficult. Conclusions: Pharmacy technicians play a limited role in the management of DDI alerts, but could be used to help ensure that a patient's profile of medications is up-to-date and determine whether the patient had already been receiving the combination without notable problem.
An Audit of Lipid Management in Patients with Diabetes in an Academic Internal Medicine Practice
Authors: Adigun Adegboyega Q , Lloyd Benjamin J , Donato Anthony A 
Published: September 2013

Background: There is increasing pressure from health insurers that clinicians meet nationally accepted standards of care for patients with diabetes. How quality improvement initiatives will be implemented in the ambulatory care setting remains unclear. Objective: To conduct an audit of lipoprotein management in patients with diabetes in a single academic internal medicine practice, using low-density lipoprotein cholesterol (LDL-C) as the primary measurement, and compare results to nationally reported data. Methods: A retrospective, cross-sectional study involving all patients with diabetes seen in an internal medicine faculty practice from January 1, 2004, to December 31, 2004, was performed. Data collected included results of lipid tests performed within the past year, medications to lower cholesterol, and markers of diabetes control. Results: Two hundred eight patients with diabetes were eligible for the study. Forty-two percent were at the LDL-C goal of less than 100 mg/dL. Sixty-five percent were taking a hydroxymethylglutaryl coenzyme A reductase inhibitor (statin), while 6.6% were taking 2 or more lipid-lowering drugs. Twenty-four patients (12%) had high LDL-C levels (>130 mg/dL) but were not taking lipid-lowering agents; these patients were older compared with the population with an LDL-C level at the goal (mean ± SD 66 ± 15 vs 59 ± 15 y; p < 0.05) and less likely to have coronary artery disease (8.7% vs 33%; p < 0.05). Thirty-six percent of patients were above the goal LDL-C despite use of statins at moderate or higher doses. Conclusions: Achieving goal LDL-C levels remains a challenge, even in this era of powerful, proven pharmacotherapy. Strategies to improve lipid management may need to address issues of patient acceptance of and adherence to cholesterol-lowering drug therapy. Audits are helpful to compare practice data with accepted benchmarks, but confounders must be considered if the audit data are used for high-stakes decisions.
Chronic Stable Angina: Angiotensin-Converting Enzyme Inhibitor Therapy and/or Calcium-Channel Blocker Therapy—When is it Indicated?
Authors: Marrs Joel C , Saseen Joseph J 
Published: September 2013

Objective: To discuss outcomes data assessing the use of angiotensin-converting enzyme (ACE) inhibitors and calcium-channel blockers (CCBs) in the prevention of cardiovascular events in patients with chronic stable angina that have been published since the 2002 American College of Cardiology/American Heart Association (ACC/AHA) updated guidelines for the treatment of chronic stable angina. Data Sources: A MEDLINE search (2002–April 2006) identified 60 primary, review, and meta-analysis articles. The inclusion criteria were: patients with stable coronary artery disease, chronic stable angina, or coronary heart disease; evaluation of long-term therapy with either ACE inhibitor or CCB therapy; prospective, randomized, controlled clinical trials; cardiovascular events as the primary endpoint of the study; and date of publication after the 2002 ACC/AHA guidelines. Study Selection and Data Extraction: All articles identified from the literature search were evaluated, and all clinical trials deemed relevant were included in this review. Six randomized trials met inclusion criteria and evaluated the utility of ACE inhibitor and CCB therapy in reducing cardiovascular events in patients with coronary artery disease and/or chronic stable angina. Data Synthesis: Patient populations, background therapy, and the study endpoints of all 6 trials varied. However, all primary endpoints assessed cardiovascular events. Two of the 3 ACE inhibitor trials demonstrated a significant reduction in the primary endpoint and 1 of the 3 CCB trials demonstrated a significant reduction in the primary endpoint. Conclusions: Newer evidence cumulatively supports the addition of an ACE inhibitor to standard antianginal pharmacotherapy to reduce the risk of cardiovascular events. However, benefit is influenced by severity of illness and use of additional cardiovascular risk reduction pharmacotherapy. The level of supporting evidence for ACE inhibitor therapy in chronic stable angina is higher than that cited in the 2002 ACC/AHA guidelines. Newer evidence evaluating the use of CCBs to prevent cardiovascular events in patients with stable coronary artery disease is controversial and remains consistent with the 2002 guidelines.
Active Communication of a Pharmacy Discharge Plan for Patients with Respiratory Diseases: A Pilot Study
Authors: Beauchesne Marie-France , Nenciu Laura M , Dinh Thanh-Ha , Tassé Michel , Fillion Anne , Labrecque Manon , Blais Lucie 
Published: September 2013

Background: Drug-related problems (DRPs) are common following hospital discharge. Active communication of a written pharmacy discharge plan may increase the number of community pharmacists' interventions. Objective: To assess the impact of the active communication of a written pharmacy discharge plan. Methods: This was a pilot study comparing 2 groups of pharmacists over a period of 6 weeks. Participating community pharmacists were assigned to either the control group (those who provided usual patient care during hospital stay and transmission of a standard written pharmacy discharge plan) or the active communication group (those who, in addition to the usual care provided in the control group and the written pharmacy discharge plan, included a list of up to 3 DRPs with proposed interventions to resolve them and a telephone call from the hospital pharmacist to the community pharmacist to facilitate the transfer of information). The patients enrolled were adults admitted to the respiratory unit of our hospital who were returning home following their discharge. Patients were assigned to the control or the active communication group based on the community pharmacy where they usually filled their prescriptions. Results: Overall, 36 community pharmacists were included in the study and assigned to either the active communication (n = 17) or control group (n = 19). A total of 22 patients were assigned to either the control group (n = 8) or the active communication group (n = 14). The mean number of community pharmacist interventions per patient was 4.2 in the active communication group and 0.9 in the control group (p = 0.0004). The mean number of DRPs per patient for which there was at least one intervention made by the community pharmacist was 2.8 in the active communication group and 0.6 in the control group (p = 0.0001). Conclusions: Results of this pilot study demonstrate that the active communication of a written discharge plan may increase the number of interventions by community pharmacists.
Pharmacists' Self-Assessments regarding Emergency Preparedness Activities in Kansas
Authors: Fromer Deborah B , Ablah Elizabeth , Schrater Suzanne R , Molgaard Craig A , Cook David J 
Published: September 2013

Background: In an emergency, the pharmacists' role lies in obtaining access to pharmaceuticals and other crucial supplies necessary to ensure that injured or ailing people are treated quickly and effectively. Objective: To assess pharmacist reactions regarding the emergency preparedness program, “Can it Happen in Kansas: Response to Terrorism and Emerging Infections,” before and after training. Methods: A terrorism preparedness questionnaire was developed to self-assess changes in participants' confidence. These were measured before, immediately after, and 3 and 10 months after training. Results: At pretest, pharmacists reported feeling more alert to agroterrorist attacks in Kansas, better able to describe their roles in incident response, more alert to symptoms of emerging infections, and better able to recognize radiation symptoms than at posttest (all p < 0.001). Similar statistical patterns can be found in almost all content areas covered. Conclusions: It is difficult to measure competencies and skills needed in emergency preparedness training. Future training will involve more objective measures. Since pharmacists are well positioned to detect emerging and unusual patterns of disease or medical conditions, it is imperative that they are included among professionals who are trained to recognize symptoms of exposure to biological, nuclear, or chemical agents.