bluuebunny/crossref_metadata_2025_split huggingface dataset:
Individualized Pharmacokinetic Monitoring Results in Less Aminoglycoside‐Associated Nephrotoxicity and Fewer Associated Costs
Authors: Streetman Daniel S. , Nafziger Anne N. , Destache Christopher J. , Bertino Joseph S. 
Published: June 2004

Study Objective. To examine the impact of individualized pharmacokinetic monitoring (IPM) on the development of aminoglycoside‐associated nephrotoxicity (AAN).Design. Retrospective case‐control study.Setting. Two teaching hospitals.Subjects. Two thousand four hundred five patients who received aminoglycosides.Intervention. Aminoglycoside therapy dosed by either IPM or physicians' directions.Measurements and Main Results. Patients receiving IPM were significantly less likely to develop AAN by both univariate (7.9% vs 13.2%, p=0.02) and multivariate methods (odds ratio 0.42, p=0.002). Female sex was protective against AAN. Age 50 years and above, high initial aminoglycoside trough, long duration of therapy, and concurrent piperacillin, clindamycin, or vancomycin increased risk of AAN. We estimated that IPM decreased AAN costs by $90,995/100 patients.Conclusion. Individualized pharmacokinetic monitoring significantly decreased the frequency of AAN and its associated economic costs.
Fludarabine Pharmacokinetics after Subcutaneous and Intravenous Administration in Patients with Lupus Nephritis
Authors: Kuo Grace M. , Boumpas Dimitrios T. , Illei Gabor G. , Yarboro Cheryl , Pucino Frank , Burstein Aaron H. 
Published: June 2004

Study Objective. To compare the pharmacokinetics of subcutaneous and intravenous fludarabine in patients with lupus nephritis.Design. Open‐label, randomized, crossover trial conducted with a phase I‐II trial.Setting. Government research hospital.Patients. Five patients with lupus nephritis.Intervention. Fludarabine 30 mg/m2/day was administered either subcutaneously or as a 0.5‐hour intravenous infusion for 3 consecutive days. All patients received oral cyclophosphamide 0.5 g/m2 on the first day of each cycle.Measurements and Main Results. Plasma samples were collected before and 0.5, 1, 1.5, 2, 4, 8, and 24 hours after the first dose. Urine was collected at 6‐hour intervals for 24 hours. Plasma and urine were analyzed for fluoro‐arabinofuranosyladenine (F‐ara‐A), fludarabine's main metabolite, using high‐performance liquid chromatography. Compartmental techniques were used to determine the pharmacokinetics of F‐ara‐A; a linear two‐compartment model best described them. Comparison of the pharmacokinetics between subcutaneous and intravenous administration was done by using a Wilcoxon signed rank test. No significant differences were found between subcutaneous and intravenous administration in median (interquartile range) maximum concentrations of 0.51 (0.38‐0.56) and 0.75 (0.52‐0.91) mg/L, respectively, or in fitted area under the concentration‐time curves from 0–24 hours of 4.65 (4.17‐4.98) and 4.55 (3.5‐4.94) mg•hour/L, respectively. Bioavailability of F‐ara‐A after subcutaneous dosing was approximately 105% of the bioavailability after intravenous administration. Differences in renal clearance and percentage of dose excreted in urine for subcutaneous and intravenous administration were nonsignificant. No injection site reactions were seen with subcutaneous dosing.Conclusion. Subcutaneous and intravenous administration of fludarabine appear to have similar pharmacokinetics in patients with lupus nephritis. Subcutaneous injection may offer a convenient alternative to intravenous administration.
In Vitro Characteristics of Tobramycin Aerosol from Ultrasonic and Jet Nebulizers
Authors: Asmus Michael J. , Milavetz Gary , Tice Angela L. , Teresi Mary E. 
Published: June 2004

Study Objective. To compare the in vitro performance of an ultrasonic nebulizer and a jet nebulizer in producing a respirable aerosol of tobramycin solution for injection.Design. In vitro observational study.Devices. Ultrasonic and jet nebulizers.Intervention. Output was determined by measuring the difference in nebulizer weight before and after nebulizing 3 ml of tobramycin injection solution. Mass median aerodynamic diameter (MMAD) and respirable mass were determined by sampling tobramycin aerosol into a cascade impactor.Measurements and Main Results. Mean (SD) output was 1.14 (0.09) ml/minute for the ultrasonic nebulizer and 0.64 (0.08) ml/minute (p<0.001) for the jet nebulizer. Mean MMAD for the jet nebulizer (2.31 [0.10] μm) was less than that of the ultrasonic nebulizer (2.81 [0.17] μm, p<0.001). The majority of tobramycin aerosol produced was in the respirable range for both the ultrasonic (65.1% [4.10%]) and jet (60.6% [0.73%], p=0.008) nebulizers.Conclusion. Despite small, clinically unimportant differences in aerosol size and respirable fraction, either device would be acceptable to administer tobramycin injection solution.
Impact of Antiemetic Selection on Postoperative Nausea and Vomiting and Patient Satisfaction
Authors: Darkow Theodore , Gora‐Harper Mary Lea , Goulson Daniel T. , Record Kenneth E. 
Published: June 2004

Study Objective. To determine the impact of antiemetic selection on postoperative nausea and vomiting (PONV) and patient satisfaction after ambulatory surgery.Design. Prospective, observational study.Setting. Ambulatory surgery center in an academic medical center.Patients. Five hundred fifty‐four consecutive patients undergoing ambulatory surgical procedures of any kind.Intervention. Data on antiemetic utilization, occurrence of PONV, and patient satisfaction were collected perioperatively. Multiple regression analyses for antiemetic choice were performed.Measurements and Main Results. Prophylactic antiemetic therapy was administered to 292 (52.7%) patients, most often with droperidol (200 patients), metoclopramide (134), or dexamethasone (55). Forty‐one (7.4%) patients had an episode of emesis in the postanesthesia care unit. Choice of antiemetic was not a significant predictor of PONV. Patient satisfaction for all patients was 9.5 on a 10‐point scale, with no agent more or less successful than any other.Conclusion. As choice of antiemetic drug given for prophylaxis had little impact on clinical outcome or patient satisfaction, traditional agents should form the core of antiemetics used for PONV prophylaxis in ambulatory surgery patients.
Cost‐Effectiveness of Ceftazidime by Continuous Infusion versus Intermittent Infusion for Nosocomial Pneumonia
Authors: McNabb JoCarol J. , Nightingale Charles H. , Quintiliani Richard , Nicolau David P. 
Published: June 2004

Study Objective. To determine if continuous‐infusion ceftazidime is more cost‐effective and efficacious than intermittent infusion in patients with nosocomial pneumonia.Design. Prospective, open‐label, randomized trial.Setting. Large, community teaching hospital.Patients. Intensive care unit (ICU) patients with nosocomial pneumonia.Interventions. Ceftazidime 3 g/day was administered as a continuous infusion or as 2 g 3 times/day by intermittent infusion to treat nosocomial pneumonia in the ICU. Patients also received tobramycin 7 mg/kg once/day.Measurements and Main Results. Thirty‐five patients were evaluable; 17 received continuous infusion and 18 intermittent infusion. Clinical efficacy (94% and 83% successful outcomes with continuous and intermittent infusion, respectively), adverse events, and length of stay did not vary significantly between groups. Costs associated with continuous infusion, $627 ± 388, were significantly lower (p≤0.001) than with intermittent infusion, $1007 ± 430.Conclusions. Continuous infusion of ceftazidime is a cost‐effective alternative to intermittent infusion for nosocomial pneumonia in the ICU.
An Evaluation of the Hemostatic Effects of Hydrophilic, Alcohol, and Lipophilic Extracts of Notoginseng
Authors: White C. Michael , Fan Chengde , Song Jessica , Tsikouris James P. , Chow Moses 
Published: June 2004

Study Objective. To compare the hemostatic effects of hydrophilic, alcohol, or lipophilic extract of notoginseng with those of the control and placebo.Design. Hemorrhagic rat model.Setting. Hartford Hospital, Hartford, Connecticut; animals were housed at the Hartford Hospital animal facility.Animals. Sixty‐two male Wistar rats.Intervention. Administration of placebo (wheat flour), and alcohol, hydrophilic (water), and lipophilic (hexane) extracts of notoginseng.Methods. Rats were divided into five groups, and their tails were transected 5 mm from the tip. Group 1 received no treatment (control), group 2 received placebo, group 3 received alcohol extract, group 4 received hydrophilic extract, and group 5 received lipophilic extract. Total bleeding time was determined and compared among the groups.Main Results. Bleeding time was shorter for the placebo group than the control group (p=0.035). The alcohol extract group had the shortest bleeding time, which was significantly shorter than that of the control (p<0.0001), placebo (p=0.0124), and lipophilic extract groups (p=0.002). The hydrophilic extract group had a shorter bleeding time than the control group (p=0.0058) and showed a trend toward shorter bleeding time than the lipophilic extract group (p=0.068).Conclusions. The alcohol extract of notoginseng results in the shortest bleeding time and provides better hemostatic effects than no treatment, placebo treatment, and treatment with lipophilic extract.
Role of Coenzyme Q10 in Chronic Heart Failure, Angina, and Hypertension
Authors: Tran Mongthuong T. , Mitchell Tina M. , Kennedy Daniel T. , Giles Joel T. 
Published: June 2004

Purpose. Coenzyme Q10 (CoQ10) has a pathophysiologic role in many disease states. The purpose of this review is to provide recommendations regarding the safety, efficacy, and dosing of CoQ10 in the management of chronic heart failure (CHF), angina, and hypertension.Data Sources. Literature pertaining to the safety and efficacy of CoQ10 specifically in cardiovascular indications was reviewed. We used relevant clinical trials, articles, reviews, and letters that were selected from a literature search of the MEDLINE database (1974–2000), Micromedex Healthcare Series, and the Natural Medicines Comprehensive Database.Findings. Coenzyme Q10 administered orally has favorable actions in the described cardiovascular conditions and appears to be safe and well tolerated in the adult population. Issues concerning optimum target dosages, potential interactions, monitoring parameters, and the role of CoQ10 as a monotherapeutic agent need to be investigated further. Favorable effects of CoQ10 on ejection fraction, exercise tolerance, cardiac output, and stroke volume are demonstrated in the literature; thus, the use of CoQ10 as adjuvant therapy in patients with CHF may be supported.Conclusions. Coenzyme Q10 therapy in angina and hypertension cannot be substantiated until additional clinical trials demonstrate consistent beneficial effects. However, CoQ10 may be recommended as adjuvant therapy in selected patients with CHF. At this time, CoQ10 should not be recommended as monotherapy or first‐line therapy in any disease state.
Patient‐Reported Adherence to Guidelines of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Authors: Cheng Judy W. M. , Kalis Michelle M. , Feifer Stanley 
Published: June 2004

Objectives. To compare antihypertensive drug compliance with treatment guidelines established by the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), and to identify patient adherence to antihypertensive drugs and factors affecting prescribing patterns.Methods. Patients filling antihypertensive drug prescriptions in metropolitan New York area pharmacies were enrolled. Pharmacy externs collected patient‐reported demographics, medical and drug histories, and blood pressure measurements. Compliance with JNC VI guidelines was assessed.Results. Eight hundred twenty‐one patients from 102 pharmacies participated. Blood pressure was controlled in 61% of patients at the time of the study. The most prescribed class of antihypertensive agents was angiotensin‐converting enzyme inhibitors, followed by diuretics and β‐blockers. Over the study period, compliance with JNC VI guidelines decreased significantly from 85% to 64% (p<0.05). Thirty‐seven percent of patients reported consistent adherence to their antihypertensive regimens. Patients' education level was the only factor found to correlate positively with the appropriateness of antihypertensive agents prescribed.Conclusion. Compliance with JNC VI guidelines decreased over time, and patient adherence to drug therapy was suboptimal. Continuing‐education efforts to reinforce optimal blood pressure management are necessary.
Clinical and Microbiological Evaluation of the Periodontal Status of Children with Unilateral Complete Cleft Lip and Palate
Authors: Costa Beatriz , de Oliveira Lima JoséEduardo , Gomide Marcia Ribeiro , Pereira da Silva Rosa Odila 
Published: June 2004

Objective To compare periodontal conditions in children with and without cleft. Design Clinical examinations and microbiological analysis of 57 selected children, including 30 with unilateral complete cleft lip and palate (experimental group) and 27 without clefts (control group). Setting Hospital of Rehabilitation of Craniofacial Anomalies (HRCA) in Bauru, Sao Paulo, Brazil. Patients, Participants All children examined were healthy and between the ages of 5 and 6 years. Results The mean plaque index (PI) in the experimental group was higher (1.82 ± 0.3) than in the control group (1.63 ± 0.38), although this difference was not statistically significant. The mean gingival index (GI) in the experimental group (1.82 ± 0.38) was found to be significantly higher (p < .05) than that of the control group (0.79 ± 0.33). The cleft area in the experimental group, with a mean PI of 2.04 ± 0.58 and mean GI of 1.11 ± 0.26, compared with the posterior area, with a mean PI of 1.74 ± 0.37 and mean GI of 1.04 ± 0.26, showed a statistically significant difference only in the PI. Most of the children in both experimental and control groups presented a moderate PI degree (73.33% and 81.48%, respectively) and a high prevalence of mild gingivitis (53.33% and 70.37%, respectively). Analysis of the organisms showed that Prevotella nigrescens was detected in 16.67% of the experimental group and 11.11% of the control, whereas Porphyromonas gingivalis and Treponema denticola were not detected. Conclusion Children with clefts showed greater gingival inflammation, despite the same amount of plaque and prevalence of microorganisms.
Growth of Children with Isolated Robin Sequence Treated by Nasopharyngeal Intubation: Importance of a Hypercaloric Diet
Authors: Marques Ilza Lazarini , de Barros Almeida Peres Suely Prieto , Bettiol Heloisa , Barbieri Marco Antonio , Andrea Mauro , de Souza Luiz 
Published: June 2004

Objective To compare the growth curves (weight and length) of two groups of infants with isolated Robin sequence (RS) treated with nasopharyngeal intubation (NPI), one group receiving a hypercaloric diet and the other receiving a normal diet for age, and compare the growth rates and duration of NPI between the two groups. Design Prospective longitudinal study. Setting Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, Brazil, 1998 to 2000. Patients Twenty-three children with isolated RS treated by prolonged NPI. Interventions Nine children received a milk formula supplemented with 5% to 7% glucose polymers and 3% to 5% medium chain triglycerides (group 1), and 14 children received a milk formula only (group 2). Weight and length were measured at birth and every month up to 6 months of life for the construction of weight and length growth curves. The time of use of the nasogastric tube, age at the beginning of NPI, and duration of NPI were also determined. Results No significant difference in length was observed between the two groups. The mean weight curves obtained for the two groups were below the 50th percentile of the National Center for Health Statistics, but weight gain was higher in group 1. The duration of NPI was shorter in this group. Conclusions The hypercaloric diet led to an improvement in nutritional status, which in turn contributed to improved respiratory conditions in isolated RS.
Pierre Robin Sequence in Denmark: A Retrospective Population-Based Epidemiological Study
Authors: Printzlau Andreas , Andersen Mikael 
Published: June 2004

Objective To give an epidemiological description of the clinical entity given the name Pierre Robin sequence, defined by retro- and micrognathia, cleft palate, and respiratory distress and describe other malformations and possible intrauterine impairment. Methods Using the inclusion criteria of micrognathia, cleft palate, and neonatal respiratory distress, a retrospective population-based study of all Danish live births during 1990 through 1999 were carried out. We found 50 children, 25 boys and 25 girls, fulfilling the inclusion criteria, giving an incidence of 1 in 14,000 live births. Results Two-thirds (n = 33) of the children had the classical U-shaped cleft palate. More than one-third (n = 19) had one or several other malformations, and in five patients the triad of Pierre Robin was a minor feature of a complex syndrome. The most common noncomplex syndrome was the Stickler syndrome found in 6 of the 50 patients. More than one-fourth (n = 17) had some kind of intrauterine impairment, with no specific obstetric diagnosis predominant. Consistent with this, the average birth weight was well below normal. Conclusions Several authors have stated that the triad of Pierre Robin is not a nosological entity, in that it has diverse etiology and diverse pathogenesis. We conclude that the triad of Pierre Robin still can be regarded as a clinical entity, readily defined at birth, experiencing the same neonatal problems in varying degrees and hence the possibility of designing treatment protocols for later scientific evaluation.
Cost-Effectiveness of Infant Orthopedic Treatment regarding Speech in Patients with Complete Unilateral Cleft Lip and Palate: A Randomized Three-Center Trial in the Netherlands (Dutchcleft)
Authors: Konst Emmy M. , Prahl Charlotte , Weersink-Braks Hanny , De Boo Theo , Prahl-Andersen Birte , Kuijpers-Jagtman Anne M. , Severens Johan L. 
Published: June 2004

Objective To investigate the cost-effectiveness of infant orthopedic treatment (IO), compared with no such treatment in children with complete unilateral cleft lip and palate (UCLP) focusing on the effects on speech development at age 2.5 years. Design In a three-center prospective, randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally: one group was treated with IO based on a modified Zurich approach in the first year of life (IO group) and the other group did not receive this treatment (non-IO group). Patients The participants had complete UCLP without soft tissue bands or other malformations. They were born at term and their parents were native Dutch speakers. Outcome Measures The effect of IO on speech development at age 2.5 years was measured blindly by five expert listeners judging the “total impression of speech quality” on a 10-point equal-appearing interval scale. Costs were measured from a societal viewpoint in Euro. Results and Conclusion The IO group (n = 10) obtained a statistically significant higher rating, compared with the non-IO group (n = 10). The effect size was large, indicating that the improvement may be considered a clinically important change. The cost for treatment by the orthodontist was higher in the IO group. For both groups, the mean cost was related to the mean rating for “total impression of speech quality.” The resulting cost-effectiveness for IO, compared to non-IO was €1041 for 1.34 point speech quality improvement. The financial investment that is necessary to obtain this improvement seems limited. Thus, from the perspective of speech development, the cost-effectiveness of IO over non-IO seems acceptable at this point in time.
Alveolar Ridge Notching as a Predictor for Secondary Bone Grafting in Incomplete Alveolar Clefts
Authors: Kita Hiroki , Kochi Shoko , Kamiya Noriaki , Yamada Atsushi , Mitani Hideo 
Published: June 2004

Objectives To clarify the need for secondary alveolar bone grafting (ABG) in incomplete alveolar clefts identified clinically from its appearance and test the usefulness of alveolar ridge notching in the edentulous stage as a predictor for ABG. Design A prospective, cross-sectional study comparing three groups of patients at two stages. Patients Twenty-four patients with unilateral incomplete cleft of primary palate who underwent either no surgery or cheiloplasty only. Methods Cleft severity was assessed at two stages. Initially, the appearance of untreated clefts was assessed before cheiloplasty or at 3 months of age in the patient without cheiloplasty and graded by severity into three groups. Later alveolar bone defects were assessed with computed tomography in the primary or mixed dentition period. A decision regarding the requirement for ABG was then made. Finally, the relationship between untreated clefts and the need for ABG was determined. Main Outcome Measures Nine (75%) of 12 patients with alveolar ridge notching in the edentulous stage were diagnosed as fulfilling the criteria for ABG. Results The alveolar bone defects correlated with the severity of untreated cleft conditions (Spearman r = 0.65, p = .002). The need for ABG was greater in patients with alveolar ridge notching, compared with those without notching (9/12 versus 0/12, p = .00034). Conclusions Most patients with incomplete alveolar clefts clinically identified in the edentulous stage required ABG, and alveolar ridge notching in the edentulous stage could therefore serve as a predictor for ABG.
Choanal Atresia and Rare Craniofacial Clefts: Report of Three Cases with a Review of the Literature
Authors: Bonafos G. , Capon-Degardin N. , Fayoux P. , Pellerin P. 
Published: June 2004

Objective This retrospective study reports three cases associating choanal atresia (CA) and rare craniofacial clefts (RCFCs) described in Tessier's classification. Although still discussed, these two malformations could derive from the same embryopathogenic context, with an anomaly of migration of the neural crest cells as a common factor. In two of the three cases presented, the RCFC was diagnosed during the neonatal period, and the third case (case 3) was diagnosed at the age of 12 years. The knowledge of this malformative association must permit the diagnosis of CA as early as the neonatal period or through the thorough and directed examination of the children as part of the follow-up.