bluuebunny/crossref_metadata_2025_split huggingface dataset:
Selection of Atypical Antipsychotics for the Management of Schizophrenia
Authors: Sprague Denise A , Loewen Peter S , Raymond Colette B 
Published: January 2004

OBJECTIVE To review the evidence for selecting one atypical antipsychotic agent over another for management of schizophrenia. DATA SOURCES A literature search of MEDLINE (1966–June 2003), EMBASE (1998–June 2003), and the Cochrane Library was conducted using the following terms: schizophrenia, quetiapine, ziprasidone, olanzapine, aripiprazole, and risperidone. Bibliographies of relevant articles were hand-searched for additional references. STUDY SELECTION AND DATA EXTRACTION Prospective, randomized, blinded trials and meta-analyses that directly or indirectly compared ≥2 atypical antipsychotic agents in the management of schizophrenia are included in this review. Studies comparing an atypical agent with clozapine are not included. DATA SYNTHESIS A small number of prospective, randomized, blinded trials that compare efficacy and tolerability of olanzapine and risperidone have been published. These trials did not reveal clinically meaningful differences in efficacy but did confirm that their adverse effect profiles are slightly different (more weight gain with olanzapine and more extrapyramidal reactions with risperidone). Direct comparisons between other atypical antipsychotics are not available. Systematic reviews (indirect comparisons) of placebo-controlled or traditional antipsychotic-controlled trials suggest similar efficacy for quetiapine, olanzapine, and risperidone when placebo is the comparator and inferior efficacy of quetiapine compared to olanzapine and risperidone when haloperidol is the comparator. The few available economic analyses are difficult to interpret in light of current practice. CONCLUSIONS Additional randomized, blinded clinical trials directly comparing efficacy, tolerability, and cost-effectiveness are needed to confirm the proposed differences among atypical antipsychotic agents before recommendations can be made with confidence.
β-Blocker Underuse in Secondary Prevention of Myocardial Infarction
Authors: Everly Matthew J , Heaton Pamela C , Cluxton Robert J 
Published: January 2004

OBJECTIVE To review the clinical benefits of β-blockers as secondary prevention following a myocardial infarction (MI) and to address the reasons that clinicians are reluctant to use β-blockers in specific patient populations. DATA SOURCES MEDLINE was searched for articles published from January 1966 to October 2002. Relevant studies were identified by systematic searches of the literature for all reported studies of associations between β-blocker underuse and secondary prevention of MI. Additional studies were identified by a hand search of references of original or review articles. STUDY SELECTION AND DATA EXTRACTION English-language human studies were selected and analyzed. DATA SYNTHESIS Associations were observed in studies of β-blocker use as secondary prevention of MI. A lower rate of β-blocker treatment occurred in older patients and in patients with comorbid conditions such as diabetes, heart failure, chronic obstructive pulmonary disease, asthma, and peripheral arterial disease. In addition, underuse was attributed to the perception of high rates of adverse events associated with β-blockers. β-Blocker use as secondary prevention of an MI can lead to a 19–48% decrease in mortality and up to a 28% decrease in reinfarction rates. Nonetheless, β-blockers are significantly underused in many patient populations due to concomitant disease states. Due to their normal physiologic deterioration, the elderly are at an increased risk of low cardiac output and bradycardia when given a β-blocker; therefore, they should be started on a low dose that is then slowly titrated. In diabetic patients, β-blockers can impair glucose control leading to hypoglycemia; therefore, post-MI diabetic patients must routinely monitor their blood glucose levels. In patients with decompensated heart failure, β-blocker use can lead to further cardiac depression, but lower oral starting doses with slow titration can reduce this risk. β-Blockers can induce bronchospasm in patients with chronic obstructive pulmonary disease or asthma, but cardioselective β-blockers and appropriate use of medications such as albuterol can minimize these effects. Finally, in patients with peripheral arterial disease, with the exception of hypertensive patients with Reynaud's phenomenon, β-blockers can be used safely. The only absolute contraindications to β-blockers are severe bradycardia, preexisting sick sinus syndrome, second- and third-degree atrioventricular block, severe left ventricular dysfunction, active peripheral vascular disease with rest ischemia, or reactive airway disease so severe that airway support is required. CONCLUSIONS Overall, the cardiovascular benefits of β-blockers as secondary prevention of MI significantly outweigh the risks associated with their use.
Vascular Neurotoxicity Following Chemotherapy with Cisplatin, Ifosfamide, and Etoposide
Authors: Dietrich Jörg , Marienhagen Jörg , Schalke Berthold , Bogdahn Ulrich , Schlachetzki Felix 
Published: January 2004

OBJECTIVE To report a case of acute central nervous system (CNS) toxicity with multiple hemorrhages restricted to the corpus callosum associated with combination therapy of cisplatin, ifosfamide, and etoposide. CASE SUMMARY A 38-year-old white man with a testicular germ cell tumor received a cisplatin-based chemotherapy consisting of cisplatin 45 mg (20 mg/m 2 ), etoposide 570 mg (250 mg/m 2 ), and ifosfamide 4600 mg (2000 mg/m 2 ) given on 5 consecutive days during each course. After the first course of chemotherapy, the patient appeared to be neuropsychologically impaired with episodes of decreased alertness and features of a depressive syndrome. He became severely diminished in mental function, orientation, and psychomotor activity after a second course of treatment. In addition, he showed transient urinary incontinence. Motor and sensory deficits could not be detected. Magnetic resonance imaging demonstrated multiple hemorrhages restricted to the corpus callosum. An objective causality assessment revealed that an adverse drug reaction was probable. DISCUSSION Neurotoxicity has been associated with the administration of various antineoplastic agents. In particular, cisplatin and ifosfamide can cause both acute and delayed CNS toxicity. While ifosfamide neurotoxicity has been predominantly associated with neuropsychological impairment without evidence of structural abnormalities in neuroimaging studies, cisplatin has been shown to cause cerebrovascular complications. Various pathophysiologic conditions may contribute to these complications including thrombosis secondary to vascular endothelial injury or thromboembolic events. To our knowledge, as of December 2, 2003, vascular lesions restricted to the corpus callosum have not been reported as a complication of cisplatin- or ifosfamide-based chemotherapy. CONCLUSIONS Clinicians should be aware of the potential neurovascular adverse effects of cisplatin-based protocols. This is especially true in patients with subtle neurologic or neuropsychological symptoms. Chemotherapy-induced neurotoxicity should be considered in the differential diagnosis.
Single Versus Combined Antibiotic Therapy for Gram-Negative Infections
Authors: Klibanov Olga M , Raasch Ralph H , Rublein John C 
Published: January 2004

OBJECTIVE To evaluate the available clinical data regarding single versus combination antimicrobial therapy for treatment of gram-negative infections, focusing on the more recent data in predominantly nonneutropenic hosts. In vitro and in vivo data regarding various antimicrobial combinations are also discussed. DATA SOURCES Clinical trials, review articles, and meta-analyses were identified from a MEDLINE search (1960–July 2003). Special attention was given to clinical outcome trials performed since 1989. Search terms included gram-negative infections, drug synergism, Pseudomonas aeruginosa, monotherapy, combination therapy, carbapenems, β-lactams, cefepime, aminoglycosides, and fluoroquinolones. DATA SYNTHESIS Although most of the studies were not randomized, double-blind, or controlled, the most recent literature indicates that monotherapy with agents that are active against isolated organisms, including P. aeruginosa, may be appropriate for most patients. Efficacy outcomes, including mortality, did not significantly differ in most studies comparing single and combination therapies. Some trials suggest that combination therapy may be preferred in neutropenic patients and those with pseudomonal infections. CONCLUSIONS Hospitalized patients with gram-negative infections are often treated with combination antimicrobial agents; however, some of the recently available data, although limited, suggest that administration of monotherapy is a feasible alternative in certain patient populations.
Trimethoprim/Sulfamethoxazole for Treatment of Severe Staphylococcus aureus Infections
Authors: Adra May , Lawrence Kenneth R 
Published: January 2004

OBJECTIVE To evaluate the role of trimethoprim/sulfamethoxazole (TMP/SMX) as an alternative to vancomycin for the treatment of severe Staphylococcus aureus infections. DATA SOURCES Clinical literature was accessed through MEDLINE (1966–February 2003) and EMBASE (1980–February 2003). Key search terms included trimethoprim/sulfamethoxazole combination and Staphylococcus aureus. DATA SYNTHESIS An evaluation of case reports, case series, and clinical studies focusing on the use of TMP/SMX for treatment of severe S. aureus infections was conducted. The majority of the reports indicate that TMP/SMX may be effective for the treatment of infections due to low bacterial burdens of susceptible strains of S. aureus. CONCLUSIONS In select infections, TMP/SMX may be a useful alternative to vancomycin for treatment of severe S. aureus infections. Additional randomized studies should be conducted comparing this agent with vancomycin and linezolid.
Drug Control Authorities in China
Authors: Zhen Li Hui 
Published: January 2004

OBJECTIVE To provide an overview of China's drug control authorities. DATA SOURCES South Pharmaceutical Economy Institute. DATA SYNTHESIS China's drug control authorities include the State Food and Drug Administration (SFDA), which primarily oversees drug administration; the State Development and Reform Commission (SDRC), which is responsible for the drug price administration; and the Provincial Administration for Industry and Commerce, cooperating with the Provincial Food and Drug Administration, to regulate drug advertisements. Although the drug control authorities presented here have played important roles in drug administration and have obtained outstanding achievements in the past several years, they are also hindered by their respective problems and try to explore the solutions. CONCLUSIONS Other countries may confront the problems described here. It is therefore necessary to learn the current situation of drug control authorities in China, as well as the measures being taken to improve the situation. This understanding will aid countries seeking to enter China's pharmaceutical market.
Tracking Trends in Secondary Stroke Prevention Strategies
Authors: Carswell Jody L , Beard Kemberley A , Chevrette Michele M , Pardue Carol N , Hess David C , Fagan Susan C 
Published: January 2004

BACKGROUND Stroke is defined as a rapid onset of isolated neurologic dysfunction and is the leading cause of disability in adults, as well as the third-leading cause of death in the US. Nearly 600 000 cases of stroke are reported annually. OBJECTIVE To quantify the impact of emerging evidence on the use of secondary stroke prevention strategies in patients discharged from a specialized stroke center in 2002 compared with those discharged in 2000. METHODS Using a retrospective approach, data were collected on the first 100 patients cared for by the stroke service from July 1, 2000, to December 31, 2000. Using a prospective approach, the goal was to enroll 100 patients with a diagnosis of ischemic stroke and telephone the patients 1 and 3 months after discharge to determine patient adherence and persistence rate of medications. This is an interim report of the first 20 patients enrolled. RESULTS Both studies resulted in populations of 55% women and 45% men. The most common risk factor was hypertension, with 59% on admission in 2000 and 75% in 2002. Use of antithrombotics (98% in 2000 to 100% in 2002) and antihypertensives (67% in 2000 to 90% in 2002) was high in both studies and not significantly different. The 2 most significant changes in prescribing were increased use of statins (13% in 2000 to 50% in 2002, p = 0.0007) and combination clopidogrel and aspirin use (0% in 2000 to 20% in 2002, p = 0.001). At 3 months, 66.7% of patients were on the same antithrombotic medication as at discharge. CONCLUSIONS The dedicated stroke service was able to effectively translate emerging evidence and guidelines into practice and significantly change the use of prescribed medications for secondary stroke prevention.
Severe Dermatologic Reactions at Multiple Sites After Paclitaxel Administration
Authors: Beri Rakesh , Rosen Fred R , Pacini Michael J , Desai Swati R 
Published: January 2004

OBJECTIVE To report a case of a severe dermatologic reaction at the infusion site, as well as at multiple distant sites, after paclitaxel administration. CASE SUMMARY A 53-year-old white male with cancer of the base of the tongue was treated with paclitaxel 100 mg/m 2 infused over 3 hours and carboplatin dosed at an AUC of 6 mg/mL•min infused over 30 minutes via a peripheral vein on the left arm. After 4 doses of paclitaxel, the patient developed erythematous patches on both forearms and both thighs. The lesions on the left arm worsened into a necrotic ulcer, exposing underlying tissues. All of the lesions healed after paclitaxel was withheld from subsequent cycles. Based on the Naranjo probability scale, it is probable that paclitaxel was the causative agent for these lesions. DISCUSSION Most of the previously reported paclitaxel-induced dermatologic reactions occurred following extravasation. There are few reports of generalized dermatologic rashes. These rashes are thought to be due to delayed hypersensitivity either to paclitaxel or the solubilizing agents. Our patient had dermatologic toxicity at the infusion site, as well as at multiple other sites, that developed about 6 weeks after the first paclitaxel infusion. CONCLUSIONS Generalized dermatologic toxicity after paclitaxel administration is uncommon and seems to be immunologically mediated. This toxicity could be secondary to paclitaxel or the additives. The use of paclitaxel is increasing in various malignancies. Newer formulations are under development. Until these formulations are available, clinicians should report any dermatologic reactions in order to identify the cause of toxicity and develop safer administration technique.
Acetylcysteine Treatment for Non–Acetaminophen-Induced Acute Liver Failure
Authors: Sklar Grant E , Subramaniam Malar 
Published: January 2004

OBJECTIVE To evaluate the effectiveness of intravenous acetylcysteine in the treatment of non–acetaminophen-induced acute liver failure (ALF). DATA SOURCES A search of MEDLINE (1966–March 2003), International Pharmaceutical Abstracts (1970–2003), and Cochrane Library (2003, issue 3) databases was conducted, using the search terms acetylcysteine, non–acetaminophen-induced hepatic failure, liver failure, intravenous, and treatment. DATA SYNTHESIS All of the studies found were small and do not provide conclusive evidence that acetylcysteine benefits this subgroup of patients. Microvascular regional benefits were seen, but clinical outcomes have not been studied. CONCLUSION Intravenous acetylcysteine should not be used routinely for treatment of non–acetaminophen-induced ALF. Further large-scale studies are needed to evaluate clinical outcomes.
Urinary-Based Ovulation and Pregnancy: Point-of-Care Testing
Authors: Eichner Samantha F , Timpe Erin M 
Published: January 2004

OBJECTIVE To review the literature concerning ovulation prediction devices and pregnancy detection tests for home use. DATA SOURCES Articles were identified through searches of the MEDLINE (1966–May 2003), EMBASE (1980–May 2003), and International Pharmaceutical Abstracts (1970–May 2003) databases using the key words ovulation, ovulation detection, pregnancy test, diagnostic reagent kit, and diagnostic test. Additional references were located through review of the bibliographies of the articles found in the literature search. Searches were not limited by time restriction, language, or use of human or animal subjects. STUDY SELECTION AND DATA EXTRACTION Review articles, textbook chapters, and experimental and observational studies on home use ovulation and pregnancy tests were selected. DATA SYNTHESIS Luteinizing hormone (LH)-based ovulation tests have demonstrated accurate and superior ovulation detection when compared to basal body temperature charting, calendar calculation, salivary ferning, or observation of vaginal or cervical discharge changes. Systems using LH and estrone-3-glucuronide (E3G) have also demonstrated accurate detection of the fertile period. Literature evaluating home use of pregnancy tests has demonstrated accurate use by lay persons. CONCLUSIONS Urinary-based ovulation prediction and pregnancy detection tests available for use by nonprofessionals enable women and couples to take an active role in the family planning process. Numerous products are available at reasonable costs to the consumer.
HMG-CoA Reductase Inhibitors for the Prevention of Nephropathy
Authors: Maisch Nicole M , Pezzillo Kara K 
Published: January 2004

OBJECTIVE To evaluate the literature to determine whether hydroxymethylglutaryl coenzyme A reductase inhibitors are effective for the prevention of nephropathy. DATA SOURCES MEDLINE (1966–April 2003) and International Pharmaceutical Abstracts (1970–April 2003), as well as bibliographic searches, were conducted. DATA SYNTHESIS Although the statins are widely used for the prevention of coronary heart disease, non–lipid-lowering effects are also being investigated, namely their potential role in the prevention of nephropathy. Five trials of the statins used in this manner are reviewed, most of which included patients with dyslipidemias, making it difficult to determine whether the renoprotective effects were independent of the lipid-lowering effects. CONCLUSIONS Adequate evidence does not currently exist to support the widespread use of statins as alternatives to strategies known to prevent the progression of renal disease, but statins may be used to complement other therapies in patients with additional indications.
The Metabolic Syndrome: Pathophysiology, Clinical Relevance, and Use of Niacin
Authors: Ito Matthew K 
Published: January 2004

OBJECTIVE To review the pathophysiology and clinical relevance for using niacin to treat the metabolic syndrome. DATA SOURCES Primary articles were identified through a MEDLINE search (1966–January 2003), and recommendations for treatment were obtained from the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III guidelines. STUDY SELECTION AND DATA EXTRACTION Published studies showing the effects of the metabolic syndrome, atherogenic dyslipidemia, and niacin were evaluated and reviewed. DATA SYNTHESIS The metabolic syndrome is a highly prevalent condition that affects 24% of American adults and significantly increases the risk of coronary heart disease (CHD). Most patients with metabolic syndrome have atherogenic dyslipidemia characterized by elevated triglycerides, low high-density-lipoprotein cholesterol (HDL-C), and small, dense low-density-lipoprotein cholesterol (LDL-C) particles. The NCEP-ATP III identifies patients with the metabolic syndrome as candidates for intensified therapy. Lifestyle modifications and drug therapy are recommended. Niacin represents a good option for treating the triad of lipid abnormalities seen in the metabolic syndrome because it raises HDL-C, lowers triglycerides, and increases LDL-C particle size. CONCLUSIONS Treatment of the metabolic syndrome is recommended by NCEP-ATP III to further reduce CHD risk after the LDL-C target has been met. Prospective clinical studies are needed to define the impact of niacin and other lipid-modifying agents on CHD morbidity and mortality in patients with the metabolic syndrome.
Purified Poloxamer 188 for Sickle Cell Vaso-Occlusive Crisis
Authors: Gibbs Winter J , Hagemann Tracy M 
Published: January 2004

OBJECTIVE To review available literature on the pharmacology, pharmacokinetics, efficacy, toxicology, adverse effects, drug interactions, and dosage guidelines for purified poloxamer 188, a product in Phase III trials. DATA SOURCES Reviewers searched the following databases for English-language studies: MEDLINE (1966–November 2003), International Pharmaceutical Abstracts (1970–November 2003), and the Cochrane Library Database (3rd quarter 2003). Key search terms included purified poloxamer 188, Flocor, CRL-5861, poloxamer 188, RheothRx, and pluronic F-68. STUDY SELECTION AND DATA EXTRACTION Data on efficacy, adverse effects, and pharmacokinetics were obtained from randomized, open-label, and blinded clinical trials. Toxicology data were obtained from unpublished studies with purified poloxamer 188 and from available data on poloxamer 188 (nonpurified form). DATA SYNTHESIS Purified poloxamer 188 is a highly purified form of the nonionic block copolymer poloxamer 188. It lowers blood viscosity, decreases red blood cell (RBC) aggregation, and decreases friction between RBCs and vessel walls to increase microvascular blood flow and decrease cell injury. In clinical trials, purified poloxamer 188 demonstrated safety, but little efficacy for the treatment of sickle cell vaso-occlusive crisis. Increased efficacy has been shown in patients on concurrent hydroxyurea therapy and those <15 years of age. CONCLUSIONS Purified poloxamer 188 represents a new approach to the management of the sickle cell vaso-occlusive crisis. Children and patients on hydroxyurea may benefit most from purified poloxamer 188 therapy. Further studies are needed to confirm its efficacy and to determine whether the drug decreases sickle cell disease severity and complications.