bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Survey of Herbal Use in Children with Attention‐Deficit—Hyperactivity Disorder or Depression
Authors: Cala Suzanne , Crismon M. Lynn , Baumgartner Jennifer 
Published: May 2004

Objective. To examine whether herbal medicines were given to children or adolescents receiving care for attention‐deficit‐hyperactivity disorder or depression.Methods. Between October 2000 and July 2001, a 23‐item questionnaire was administered in five community mental health centers in Texas. Parents or primary caregivers of children who received a psychiatric assessment were sought for participation. One hundred seventeen caregivers completed a questionnaire. The main outcome measure was primary caregivers' self‐report of the use of herbal therapy in their children.Results. The lifetime prevalence of herbal therapy in patients was 20% (23 patients). Eighteen patients (15%) had taken herbal medicines during the past year. Recommendations from a friend or relative resulted in the administration of herbal medicines by 61% of 23 caregivers. Herbal medicines were given most frequently for a behavioral condition, with ginkgo biloba, echinacea, and St. John's wort most prevalent. Almost 83% of caregivers gave herbal medicines alone, whereas 13% gave herbal medicines with prescription drugs. Most caregivers (78%) supervised the administration of herbal therapy in their children; the children's psychiatrists (70%), pediatricians (56%), or pharmacists (74%) typically were not aware of the use.Conclusions. Most caregivers supervised herbal therapy in their children, without communication with a health professional. A need exists for better communication between health professionals and caregivers regarding the use of herbal therapy.
Disposition of Cefepime in the Central Nervous System of Patients with External Ventricular Drains
Authors: Rhoney Denise H. , Tam Vincent H. , Parker Dennis , McKinnon Peggy S. , Coplin William M. 
Published: May 2004

Study Objective. To assess central nervous system (CNS) penetration of cefepime in adults with external ventricular drains and to compare the achieved cerebrospinal fluid (CSF) concentrations with the usual minimum inhibitory concentrations (MICs) of common pathogens.Design. Open‐label, prospective study.Setting. University‐affiliated medical center.Patients. Seven patients with external ventricular drains and normal renal function (documented creatinine clearance > 60 ml/min) who received cefepime 2 g intravenously every 12 hours for treatment of nosocomial pneumonia.Intervention. Serial serum and CSF samples were obtained concurrently after the fourth dose during one dosing interval.Measurements and Main Results. The concentration‐time profiles in serum and CSF were comodeled by using a two‐compartment model with zero‐order infusion to the central compartment. The CSF concentration‐time profiles of the individual patients were compared with published MIC90 of common pathogens isolated in nosocomial meningitis. Our model reasonably characterized the disposition of cefepime in serum and CSF. Penetration into the CNS was 4–34% based on area under the curve and was 5–58% based on minimum concentration.Conclusion. Penetration of cefepime into the CNS was variable among the patients (4–34%) but appeared similar to that reported for other cephalosporins given to treat meningitis. The concentrations attained by most patients in this study were above the MIC90 of many common nosocomial organisms.
Evaluation of the Clinical and Economic Impact of a Brand Name—to‐Generic Warfarin Sodium Conversion Program
Authors: Witt Daniel M. , Tillman Donald J. , Evans Christy M. , Plotkin Tatyana V. , Sadler Melanie A. 
Published: May 2004

Background. Substitution of generic warfarin initially was discouraged because of concerns regarding therapeutic failure or toxicity. Although subsequent research with AB‐rated (i.e., bioequivalent) warfarin did not confirm initial concerns, the issue is not settled for all clinicians.Objectives. We sought to provide additional information regarding the clinical and economic impact of warfarin conversion by analyzing a real‐life sample of patients receiving long‐term anticoagulation therapy who were switched from brand name to generic warfarin.Methods. Patients who had been taking warfarin for at least 180 days and had received uninterrupted oral anticoagulation 90 days before and 90 days after switching to generic warfarin were included. The switch date was based on the first time generic warfarin was dispensed from our pharmacies. The primary end point was the calculated amount of time each patient's international normalized ratio (INR) values were within the patient‐specific target INR range in the 90 days before and after the switch. Data regarding adverse events and medical resource utilization were also collected. Pharmacoeconomic analyses were performed.Results. The analysis included 2299 patients. The overall difference in calculated time INR values were below (22.6% before vs 26.1% after switch, p<0.0001) and within (65.9% before vs 63.3% after switch, p=0.0002) the therapeutic INR range was statistically but not clinically significant. Only 28.0% of patients experienced a change in therapeutic INR control of 10% or less, 33.1% experienced INR control that improved by greater than 10%, and 38.9% experienced INR control that worsened by more than 10%. The difference in total treatment costs associated with brand name and generic warfarin was $3128/100 patient‐years in favor of the generic product. Sensitivity analyses revealed that cost savings associated with warfarin conversion in this health care system were highly dependent on the difference between warfarin costs and cost of treating anticoagulation‐related adverse events.Conclusions. Most of these patients were successfully switched from brand name to generic warfarin. However, supplemental INR monitoring is warranted when one warfarin product is substituted for another to allow timely detection of those patients who experience significant changes in anticoagulation response.
High‐Dose Hepatitis B Vaccine in Patients Waiting for Lung Transplantation
Authors: Hayney Mary S. , Welter Deborah L. , Reynolds Ann Marie , Francois Mary , Love Robert B. 
Published: May 2004

Study Objective. To increase the response rate to hepatitis B vaccine in patients awaiting lung transplantation.Design. Historically controlled, open‐label study.Setting. Lung transplant clinic at a university hospital.Subjects. Twenty‐seven consecutive individuals with end‐stage pulmonary disease who were enrolled to accrue 15 subjects who would complete the vaccine series before transplantation; and 27 lung transplant recipients who were immunized with the conventional dose before the study and served as historical controls.Intervention. Intramuscular injection of high‐dose hepatitis B vaccine 40 μg at 0, 1, and 6 months.Measurements and Main Results. Hepatitis B surface antibody (anti‐HBs) concentrations were measured 1–2 months after completing the high‐dose series. Individuals with undetectable anti‐HBs received additional vaccine to a maximum of six doses. The response rate to the series was compared with that in the control group. Seventeen individuals in the high‐dose group and 14 controls met the study criterion of complete vaccine series before transplantation. The former had a much higher response rate than the latter (9 [53%] vs 1 [7%], p<0.01). Four of six patients who received additional doses of vaccine seroconverted. Two of them underwent transplantation shortly after completing the three‐dose series.Conclusion. The high‐dose hepatitis B vaccine series produced a protective immune response in lung transplant recipients; however, the response was suboptimal, and alternative immunization strategies should be studied.
Estradiol in Premenstrual Asthma: A Double‐Blind, Randomized, Placebo‐Controlled, Crossover Study
Authors: Ensom Mary H. H. , Chong Gina , Zhou Danyi , Beaudin Bev , Shalansky Stephen , Bai Tony R. 
Published: May 2004

Study Objectives. To characterize asthma symptoms and pulmonary function throughout two menstrual cycles, with and without exogenous estradiol administration, in women with premenstrual asthma, and to determine the effect of estradiol administration on asthma symptoms, pulmonary function, quality of life, and biomarkers of airway inflammation.Design. Double‐blind, randomized, placebo‐controlled, crossover study.Setting. Respiratory clinic and clinical research center.Subjects. Twelve women with documented premenstrual asthma ( 20% premenstrual worsening of asthma symptoms and/or of peak expiratory flow [PEF] during a 1‐month screening phase).Intervention. Each woman received either estradiol 2 mg or placebo orally between cycle days 23 and 28 (i.e., premenstrually, or before the onset of menses) in the first cycle and then crossed over to the other arm in the second cycle. Throughout both cycles, the women recorded daily morning and evening PEF readings and asthma symptoms.Measurements and Main Results. Spirometry testing and measurement of serum estradiol and biomarkers of airway inflammation were performed on days 8 (follicular phase), 22 (luteal phase), and 28 (premenstrually) of both the estradiol and placebo cycles. During the two premenstrual visits, the Asthma Quality of Life Questionnaire was administered. No notable differences were observed between the estradiol and placebo cycles in daily PEF recordings or composite asthma symptoms scores. The area under the curve (AUC) for the composite asthma symptoms versus time profile was numerically, but not statistically, lower (denoting less severe symptoms) during the estradiol cycle than during the placebo cycle. Likewise, no significant difference in AUC values for morning PEF or evening PEF was found between the estradiol cycle and the placebo cycle. Despite differences (p<0.05) in day‐28 estradiol concentrations for estradiol and placebo cycles, no significant differences were found in forced expiratory volume in 1 second, serum endothelin‐1, serum and urine eosinophil protein X, urine leukotriene E4, or quality‐of‐life scores.Conclusion. Exogenously administered estradiol did not have a significant effect in women with premenstrual asthma whose asthma was classified predominantly as mild and under excellent control. As in the case of premenstrual syndrome, the placebo effect may be prominent in premenstrual asthma. Further trials, involving women with more severe asthma under poorer control, are warranted to discern underlying mechanisms for the worsening of asthma in relation to menstruation.
Enteral Fluconazole Population Pharmacokinetics in Patients in the Surgical Intensive Care Unit
Authors: Rajagopalan Prabhu , Pelz Robert K. , Lipsett Pamela A. , Swoboda Sandra M. , Rinaldi Michael G. , Hendrix Craig W. 
Published: May 2004

Study Objective. To determine the population pharmacokinetic parameters of enterally administered fluconazole in patients in a surgical intensive care unit (SICU).Design. Population pharmacokinetics component of a prospective, randomized clinical study.Setting. The SICU at a university hospital.Patients. One hundred ten patients with an expected length of stay in the SICU of 3 or more days and a need for intubation, in whom at least one fluconazole plasma concentration‐time measurement was available.Intervention. Patients received fluconazole as an 800‐mg loading dose and as a 200‐ or 400‐mg (depending on renal function) daily maintenance dose. Fluconazole suspension was administered enterally followed by a 30‐ml free water flush.Measurements and Main Results. Plasma samples were collected, and population pharmacokinetic analysis was performed with NONMEM software; a one‐compartment pharmacokinetic model was used. Fluconazole clearance was dependent on creatinine clearance, and volume of distribution was dependent on body weight and age. In patients with creatinine clearance values greater than 80 ml/minute, between 30 and 80 ml/minute, and less than 30 ml/minute, geometric mean (percentage coefficient of variation) fluconazole clearance was 14.39 ml/minute (21%), 10.53 ml/minute (28%), and 5.47 ml/minute (30%), respectively. The geometric mean (percentage coefficient of variation) volume of distribution in all patients was 1.27 L/kg (28%) and decreased with increasing age.Conclusions. Fluconazole clearance values in patients in the SICU who had normal renal function and in those with renal impairment were in agreement with previously reported data. Fluconazole volume of distribution was larger and half‐life was longer in the SICU population than in healthy subjects.
The Effect of an Antimicrobial Restriction Program on Pseudomonas aeruginosa Resistance to β‐Lactams in a Large Teaching Hospital
Authors: Regal Randolph E. , DePestel Daryl D. , VandenBussche Heather L. 
Published: May 2004

Study Objectives. To compare the use of β‐lactams and subsequent Pseudomonas aeruginosa sensitivity patterns before and after implementation of a clinical pharmacist‐facilitated antimicrobial restriction program in August 1997.Design. Retrospective consecutive data collection.Setting. Large university‐affiliated medical center.Intervention. The study results are the accumulation of the daily intervention activities of the antimicrobial restriction program. Data on antimicrobial grams purchased/1000 patient‐days and susceptibility patterns were collected and analyzed retrospectively.Measures and Main Results. Annual grams of ceftazidime, piperacillin, piperacillin‐tazobactam, and other antipseudomonal β‐lactams purchased/1000 patient‐days were compared during the 2 full calendar years before the antimicrobial restriction program (1995–1996) with the 4 full calendar years after the program was implemented (1998–2001). Pseudomonas aeruginosa resistance trends for the antipseudomonal β‐lactams, ciprofloxacin, and tobramycin also were compared for the 2 years before the program (1995–1996) with the last 2 years of the program (2000–2001). A 44% reduction in ceftazidime use was documented; ostensibly, minimal changes occurred in the overall use of piperacillin and piperacillin‐tazobactam. During the same time period, ceftazidime resistance fell from 24% to 11.8% (p<0.001), whereas piperacillin resistance fell from 32.5% to 18.5% (p<0.001). Imipenem resistance declined from 20.5% to 12.3% (p<0.001) with an 18% reduction in use. Aztreonam resistance declined from 29.5% to 16.5% (p<0.001) despite a 57% increase in use. No changes in resistance to either ciprofloxacin or tobramycin were found.Conclusion. Through an antimicrobial restriction program, a dramatic reduction in ceftazidime use was achieved with judicious use of other antipseudomonal antimicrobials, which resulted in reduced resistance of P. aeruginosa to other β‐lactams.
Mississippi Mud No More: Cost‐Effectiveness of Pharmacokinetic Dosage Adjustment of Vancomycin to Prevent Nephrotoxicity
Authors: Darko William , Medicis Joseph J. , Smith Adrienne , Guharoy Roy , Lehmann David F. 
Published: May 2004

Objective. To determine the cost‐effectiveness of pharmacokinetic dosage adjustment of vancomycin to prevent nephrotoxicity. An analysis was performed for subpopulations of patients receiving nephrotoxic agents (aminoglycosides, amphotericin, and acyclovir), those in the intensive care unit, and those on the oncology service.Methods. Decision analysis was used to model the cost‐effectiveness of pharmacokinetic dosage adjustment of vancomycin. The reference case was determined, in part, by a retrospective review of 200 patients randomly selected from our clinical pharmacology consultation service. Patients were aged 18 years or older and had received intravenous vancomycin for at least 48 hours, with at least two—one peak and one trough—vancomycin serum concentrations obtained during therapy. Results of published clinical trials were used to determine the probability of vancomycin‐induced nephrotoxicity.Results. The mean cost of treating nephrotoxicity was $11,233 at our institution. The mean cost for all patients was $25,166 (sensitivity analysis $15,000–27,500)/nephrotoxic episode prevented. The subgroup analysis revealed a cost of $8363 (sensitivity analysis $4368–10,500)/nephrotoxic episode prevented in intensive care patients, $5000 (sensitivity analysis $1687–13,250) in oncology patients, and a dominant strategy showing a cost savings of $5564 (sensitivity analysis $2724–12,428) in those receiving concomitant nephrotoxins.Conclusion. Although pharmacokinetic monitoring and dosage adjustment are effective methods for reducing the toxicity of many drugs, controversy exists regarding the necessity of such monitoring with vancomycin. Evaluation by decision analysis over a range of assumptions, varying probabilities, and costs reveals that pharmacokinetic monitoring and vancomycin dosage adjustment to prevent nephrotoxicity are not cost‐effective for all patients. However, such dosage adjustment demonstrates cost‐effectiveness for patients receiving concomitant nephrotoxins, intensive care patients, and probably oncology patients.
Risperidone‐Associated Diabetes Mellitus: A Pharmacovigilance Study
Authors: Koller Elizabeth A. , Cross James T. , Doraiswamy P. Murali , Schneider Bruce S. 
Published: May 2004

Study Objective. To explore the clinical characteristics of hyperglycemia in patients treated with risperidone.Design. Pharmacovigilance survey of spontaneously reported adverse events in risperidone‐treated patients, with reports of haloperidol‐associated hyperglycemia used as a control.Setting. Government‐affiliated drug evaluation center.Intervention. The Food and Drug Administration MedWatch surveillance program was queried (risperidone, 1993‐February 2002; haloperidol, late 1970s‐February 2002) and results pooled with published cases.Measurements and Main Results. We identified 131 reports of risperidone‐associated hyperglycemia in addition to seven reports of patients with hyperglycemia who received combined risperidone‐haloperidol therapy and six reports of acidosis that occurred in the absence of hyperglycemia. We found 13 reports of haloperidol‐associated hyperglycemia and 11 reports of acidosis without hyperglycemia. Of the reports of risperidone‐associated hyperglycemia (monotherapy), 78 patients had newly diagnosed hyperglycemia, 46 had exacerbated preexisting diabetes, and 7 could not be classified. Mean ± SD age was 39.8 ± 17.4 years (range 8–96 yrs). Patients with new‐onset diabetes (mean ± SD age 34.8 ± 15.7 yrs) were younger than those with preexisting diabetes (mean ± SD age 48.8 ± 17.5 yrs). The overall male:female ratio was 1.5. In most patients, hyperglycemia appeared within 3 months of the start of risperidone therapy. Severity of disease ranged from mild glucose intolerance to diabetic ketoacidosis or hyperosmolar coma. Twenty‐six patients with acidosis or ketosis were reported. Four patients died.Conclusion. Atypical antipsychotic treatment may unmask or precipitate hyperglycemia. Although such cases attributed to clozapine or olanzapine are more numerous than those associated with risperidone, the number for risperidone‐associated hyperglycemia is relatively higher than that observed with the conventional neuroleptic haloperidol.
Genetics and alcoholism among at‐risk relatives II: Interest and concerns about hypothetical genetic testing for alcoholism risk
Authors: Gamm Jennifer L. , Nussbaum Robert L. , Bowles Biesecker Barbara 
Published: May 2004

AbstractOne purpose of this study was to examine hypothetical interest in genetic predisposition testing for alcoholism among at‐risk relatives. Qualitative interviews and several quantitative tools were administered to 27 individuals who had at least one first‐degree relative affected by alcoholism. Data analysis revealed that participants' interest in genetic testing for susceptibility to alcoholism was moderate. Lower educational level and a stronger belief in ‘others’ influencing health were related to participants' having a stronger interest in genetic testing. Participants' concerns about future use of genetic testing ranged from doubts about its usefulness in affecting behavior to apprehension regarding detrimental societal effects such as breaches in confidentiality and fear of being labeled an ‘alcoholic.’ Younger age and stronger interest in genetic testing were associated with deterministic or fatalistic beliefs, while drinking behaviors, gender, and other demographics were not. Participants questioned the utility of this type of testing. Their interest in testing and concerns about its hypothetical use may prove important for at‐risk relatives who may face decisions about genetic testing in the future. Data from this study can provide direction for researchers and health care providers as genetic testing for this and other behavioral conditions emerges. Scientists and the public should address the social concerns expressed by participants, including the fear of labeling. Also, we can begin to anticipate characteristics common in those who may have fatalistic responses, and who may possibly make adverse behavior choices, to results from alcoholism susceptibility testing. Published 2004 Wiley‐Liss, Inc.
Superficial siderosis: A potentially important cause of genetic as well as non‐genetic deafness
Authors: Dodson Kelley M. , Sismanis Aristides , Nance Walter E. 
Published: May 2004

AbstractSuperficial siderosis is an important disease that is increasingly being recognized as a cause of sensorineural hearing loss. Hemosiderin, resulting from repeated episodes of subarachnoid bleeding, is deposited preferentially on the surface of the eighth nerve, cerebellum, and brain stem as a consequence of glial catabolism of ferritin within those structures. This deposition eventually results in destruction and demyelination within the central nervous system, leading to the cardinal clinical findings of superficial siderosis: hearing loss, ataxia, and myelopathy. This mechanism may contribute to the pathogenesis of several forms of genetic deafness, and should be considered as a diagnostic possibility in cases of late onset deafness even in the absence of an overt history of subarachnoid bleeding. © 2004 Wiley‐Liss, Inc.
Genetics and alcoholism among at‐risk relatives I: Perceptions of cause, risk, and control
Authors: Gamm Jennifer L. , Nussbaum Robert L. , Biesecker Barbara Bowles 
Published: May 2004

AbstractGenetic factors influence a person's risk for developing alcoholism. In other common disorders with a genetic component, a belief in a genetic cause can lead to less perceived control or fatalism among those at risk that may adversely affect undertaking health‐promoting behaviors. This study explores beliefs about the cause of alcoholism and risk perception among individuals with affected relatives. In‐depth interviews including both open‐ended questions and several quantitative measures were conducted with participants to explore the relationships between causal beliefs and perceptions of personal risk and control. Twenty‐seven individuals with at least one first‐degree relative affected with alcoholism participated. Transcript analysis of interviews revealed that all participants attribute multiple factors to the cause of alcoholism in their families, often as a combination of biological, genetic, environmental factors, and personal characteristics. Many perceived themselves as being ‘at‐risk,’ and this concern often stemmed from a belief in a genetic or biological cause of alcoholism. However, participants also had a strong sense of personal control, rooted in beliefs about environmental causes or personal characteristics influencing alcoholism risk. A participant's strong belief in a genetic cause was associated with a significantly increased risk perception, but not a fatalistic outlook towards developing alcoholism. Published 2004 Wiley‐Liss, Inc.