bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cholesterol: Point-of-Care Testing
Authors: Taylor James R , Lopez Larry M 
Published: June 2004

OBJECTIVE: To review the literature regarding point-of-care (POC) cholesterol monitors and describe their role in pharmacy practice. DATA SOURCES: Primary articles were identified by a MEDLINE search (1966–May 2003); references cited in these articles provided additional resources. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified from this search were reviewed, and all information deemed relevant was included. DATA SYNTHESIS: Hyperlipidemia is a well-established risk factor for coronary artery disease, which is the leading cause of death in the US. The use of POC cholesterol monitors may help to improve the identification and management of this disease. Pharmacists may use many of these devices in their practice and are also in an ideal position to provide patient education on selection and use of these monitors and interpretation of the results. CONCLUSIONS: The availability of POC cholesterol monitors has increased in recent years. Based on currently available data, these monitors are best suited for screening purposes and to assist in the management of hyperlipidemia. There is not enough evidence to support the notion that POC cholesterol monitors can replace laboratory or office monitoring. Their application in the diagnosis of hyperlipidemia is also currently limited.
Effects of Continuous Vasopressin Infusion in Patients with Septic Shock
Authors: Obritsch Marilee D , Jung Rose , Fish Douglas N , MacLaren Robert 
Published: June 2004

BACKGROUND: Small studies have reported that vasopressin improves hemodynamic instability in patients with septic shock. OBJECTIVE: To determine whether vasopressin infusion increases blood pressure, decreases catecholamine vasopressor use, and improves renal function in a large patient population with septic shock when used in a clinical setting. METHODS: A retrospective chart audit was conducted of critically ill patients who received vasopressin infusion for septic shock from January 2000 through September 2002. Demographic, hemodynamic, laboratory, vasopressor, and adverse event data were collected. Statistical methods included ANOVA with Tukey's test for post hoc analysis. RESULTS: A total of 102 of 353 patients met study criteria. The mean ± SD vasopressin dosage regimen was 0.11 ± 0.17 units/min for 53.8 ± 71.5 hours. Compared with baseline, vasopressin infusion improved mean arterial pressure (MAP) by 15% within one hour (p < 0.05), reduced heart rate by 9% within 4 hours (p < 0.05), and reduced hourly dopamine dosage by 25% within 8 hours (p < 0.05). These effects persisted through 96 hours. Other hemodynamic variables and catecholamine vasopressor usage parameters were not statistically different from baseline. Urine output, serum creatinine, and serum sodium concentrations were not statistically changed from baseline. Adverse events possibly associated with vasopressin infusion included ischemic digits/extremities, myocardial infarction, and hyponatremia. CONCLUSIONS: Vasopressin infusion was effective in increasing MAP and reducing heart rate while decreasing the dopamine dosage in patients with septic shock. Comparative studies with catecholamine vasopressors are needed to define the optimal role of vasopressin in septic shock therapy. In the meantime, vasopressin infusion at ≤0.03 units/min should be considered only if response to 1 or 2 catecholamine vasopressors is inadequate or as a method to reduce the dose of these therapies.
Using a Computerized Drug Prescription Screening System to Trace Drug Interactions in an Outpatient Setting
Authors: Morera Tomas , Gervasini Guillermo , Carrillo Juan A , Benitez Julio 
Published: June 2004

BACKGROUND: Drug—drug interactions are one of the main causes of adverse effects. These events have been studied most often in hospital settings; however, investigations on prescribing based on community practice have shown a high prevalence rate of potential drug interactions. OBJECTIVE: To develop a computerized system able to trace drug interactions quickly through the identification of clinicians issuing potentially unsafe prescriptions. METHODS: We retrospectively evaluated hazardous concomitant prescriptions of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) and azole antifungals, which were invoiced through 9 months of 2001 within an outpatient setting. The study was conducted in Badajoz, a southern Spanish province, and was divided in three 3–month periods according to the release of 2 warning notes on this drug combination by the Spanish Drug Agency. Prescriptions written during this period were optically scanned each month, and the resulting information, including data from patients, physicians, and drugs involved, was converted to a database and searched for potentially unsafe coprescriptions. RESULTS: A total of 8 342 711 prescriptions were invoiced in the period of study, 174 of which were for a statin—azole combination. The number of these prescriptions remained fairly constant during periods I and II (63 and 71, respectively), decreasing to 40 in period III. Some clinicians (12.6%) repeatedly prescribed a hazardous drug combination at some point in this study, whereas 18 of 171 patients who received the hazardous coprescription at any time did so repeatedly within a given period. The impact of drug alerts was remarkably deeper in urban rather than rural care centers. CONCLUSIONS: The computerized drug prescription handling system described here is able to readily identify physicians and patients who issue/consume hazardous drug combinations, thus allowing both the possibility of individually informing the healthcare professionals involved and early detection of adverse effects.
Comparing Dexmedetomidine Prescribing Patterns and Safety in the Naturalistic Setting Versus Published Data
Authors: Dasta Joseph F , Kane-Gill Sandra L , Durtschi Amy J 
Published: June 2004

BACKGROUND: In clinical practice, new drugs may be used differently than the product labeling recommends. Furthermore, it often takes several years of use before adverse drug reactions (ADRs) are reported. OBJECTIVE: To compare prescribing patterns and safety of the newly released drug dexmedetomidine as observed in clinical practice with published data on the drug. METHODS: Information from a convenience sample of adults receiving dexmedetomidine as part of routine patient care at 10 institutions was retrospectively collected from June 27, 2001, to May 31, 2002. Investigators reviewed medical records daily and entered dosing information, patient demographics, and predefined categories of ADR severity and probability anonymously via the Internet on a secure server. RESULTS: Only 33% of the total sample (n = 136) of patients received a loading infusion of dexmedetomidine; however, maintenance dosing was usually within product labeling guidelines. Of note, 27.2% of patients received dexmedetomidine above the maximum dose and 33.8% received the drug beyond 24 hours. Some patients (15.4%) were never mechanically ventilated, while 59.5% received dexmedetomidine following extubation for an average of 11.3 hours. ADRs were reported in 30% of patients: 20% of the reactions required treatment or increased length of stay. Hypotension was the most common ADR, occurring in 22.7% of patients. Bradycardia was reported in 4.4% of patients. The rate and type of ADRs were similar in patients receiving dexmedetomidine >24 hours compared with the total population. CONCLUSIONS: Dexmedetomidine is prescribed within product labeling guidelines except for low use of a loading dose, some patients received the drug at doses above the maximum, and others received it for longer than 24 hours. Since ADR rates are similar to those of other published reports, dexmedetomidine maintained its expected safety profile in our patients.
Amantadine in the Akinetic-Rigid Variant of Huntington's Disease
Authors: Magnet Markus K , Bonelli Raphael M , Kapfhammer Hans-Peter 
Published: June 2004

OBJECTIVE: To report the effects of amantadine on an akinetic-rigid variant of Huntington's disease (HD). CASE SUMMARY: We describe a 36-year-old woman with HD who was treated with intravenous amantadine for 5 days. The woman was evaluated with the Unified Huntington's Disease Rating Scale before and after treatment. Parkinsonism, bradykinesia, and dystonia improved significantly. DISCUSSION: Amantadine is a noncompetitive N-methyl D-aspartate receptor antagonist. It is mainly used in the treatment of Parkinson's disease, as it increases dopamine levels in the brain. This effect is said to ameliorate akinesia. Although the effect of amantadine on choreatic dystonia in HD has been reported in several studies, to the best of our knowledge, this is the first report of the ameliorative effects of amantadine on the rigid form of HD. Our patient showed improvements of gait, parkinsonism, and dystonia. Fine-motor tasks and eye movement did not change significantly. CONCLUSIONS: We suggest that amantadine treatment might be of value to patients with the akinetic-rigid variant of HD.
Etomidate for Procedural Sedation in the Emergency Department
Authors: Falk Jamie , Zed Peter J 
Published: June 2004

OBJECTIVE: To review the current efficacy and safety evidence for the use of etomidate for procedural sedation in the emergency department (ED). DATA SOURCES: MEDLINE (1966—December 2003), EMBASE (1980—December 2003), PubMED (1966—December 2003), and Cochrane Database of Systemic Reviews (up to December 2003) were searched for full-text reports published in English on the use of etomidate in humans. Search terms included etomidate, procedural sedation, conscious sedation, relocation, dislocation, abscess incision, abscess drainage, and cardioversion. STUDY SELECTION AND DATA EXTRACTION: Prospective and retrospective studies evaluating efficacy or safety endpoints using etomidate for procedural sedation in the ED were included. All studies were evaluated independently by both authors. For clinical outcomes (efficacy, safety), the definitions specified by each study were used. DATA SYNTHESIS: Three observational studies and 5 prospective, randomized controlled trials were included in this review. Onset of action and time to recovery following etomidate were rapid and found to be comparable to that of propofol and thiopental but significantly faster than that of midazolam. The dose of etomidate for procedural sedation ranged from 0.15 to 0.22 mg/kg. No significant hemodynamic effects were observed; however, respiratory depression resulting in oxygen desaturation to <90% or apnea appears to occur in approximately 10% of patients undergoing procedural sedation with etomidate with or without analgesia. The most prominent adverse effect reported with etomidate was myoclonus, occurring in 20–45% of patients. CONCLUSIONS: Etomidate is an appropriate and valuable agent for performing procedural sedation in the ED. The rapid onset and recovery time and relative lack of significant hemodynamic and respiratory effects may facilitate optimal and safe conditions for procedural sedation in the ED.
Acute Onset of Severe Dilated Cardiomyopathy During Bromocriptine Therapy
Authors: Kaushik Prashant , Vatsavai Sundararama R , Banda Venkatramana R , Sanghi Pramod K , Ahmad Masood , Kaushik Richa 
Published: June 2004

OBJECTIVE: To report a case of severe dilated cardiomyopathy (DCMP) in a patient on bromocriptine therapy for a microprolactinoma. CASE SUMMARY: A 31-year-old African American female, who had been receiving bromocriptine 5 mg orally daily for a microprolactinoma during the preceding month, developed severe DCMP. An echocardiogram showed a markedly dilated left ventricle with severe reduction in the left-ventricular ejection fraction in the absence of any other identifiable causes of DCMP such as a peripartum state, ethanol use, preceding systemic viral illness, chronic hypocalcemia, chronic hypophosphatemia, or chronic uncontrolled tachycardia. She improved substantially (both symptomatically and echocardiographically) after cessation of bromocriptine therapy and initiation of supportive treatment of congestive heart failure (CHF). She showed no recurrence of CHF at a follow-up visit 2 months after withdrawal of the supportive care. The patient was not rechallenged with bromocriptine due to the clinical/ethical gravity of this probable adverse effect. DISCUSSION: Although cardiopulmonary adverse effects have been reported with the use of cabergoline (another dopamine agonist), to the best of our knowledge, this is the first case report of severe life-threatening DCMP associated with bromocriptine therapy. Causality assessment using the Naranjo probability scale revealed that the adverse drug event was probable. CONCLUSIONS: Bromocriptine was probably associated with DCMP in a patient being treated for a microprolactinoma. Severe DCMP needs to be considered a potentially life-threatening but reversible adverse effect of bromocriptine therapy for microprolactinoma of the pituitary gland.
A model of narrative development: Implications for understanding psychopathology and guiding therapy
Authors: Salvatore Giampaolo , Dimaggio Giancarlo , Semerari Antonio 
Published: June 2004

Story‐telling is one of the psyche's basic functions. All of us organize our experience in the form of narratives in order to give meaning to events, make forecasts about how situations will evolve, guide our actions in relationships and make our self‐experience coherent. Here we present a theoretical model which starts out from the hypothesis that, when they are created, the narratives we continuously relate to ourselves and others do not have a pre‐existing form. We propose a model for understanding the way each organizational level is formed in the mind, and works and interacts with other levels; and what psychological disorders could affect it, ranging from the basic, where there are simple aggregates of mental images, to the more complex, where there are true and proper stories, in which the characters of the internal scenario interact with each other. According to our model, it is possible to hypothesize the existence of:

a pre‐narrative level, and
a proto‐narrative level, followed by three extended narrative levels:
a procedural unconscious narrative level
a conscious propositional narrative level, and
a verbal interactive narrative level.

Our hypothesis is based on:

a review of various theories from different fields of research; and
illustrative clinical material obtained by recording psychotherapy sessions with severely personality‐disordered patients.
Identification of CYP2B6 Sequence Variants by Use of Multiplex PCR with Allele-Specific Genotyping
Authors: Jacob Robyn M , Johnstone Elaine C , Neville Matt J , Walton Robert T 
Published: June 2004

AbstractBackground: Cytochrome P450 2B6 (CYP2B6) has a role in the metabolism of many clinically important substances, but the variation within the CYP2B6 gene has not been fully characterized. The aim of the present study was to develop a reliable and robust assay for determining genotypic variants.Methods: We used a two-stage procedure. An initial multiplex PCR reaction amplified the relevant gene fragments in exonic and regulatory regions to ensure isolation of CYP2B6 from its similar pseudogene (CYP2B7). This product was then genotyped by allele-specific PCR.Results: The assay detected the following published single-nucleotide polymorphisms: C64T (Arg22Cys), C78T, G216C, G516T (Gln172His), C777A (Ser259Arg), A785G (Lys262Arg), and C1459T (Arg487Cys), as well as additional loci found within the single-nucleotide polymorphism (SNP) databases: A1190G, C1268A, C1330T, A1382G, A1402T, and an A/T SNP in intron 2 (A12917T). This approach detected all common, previously reported alleles and identified a new allele (CYP2B6*4C) present in 2.2% of a Caucasian population. Genotypic frequencies obtained were consistent with previously published results.Conclusions: This method is simple, reliable, rapid, and amenable to automation and could facilitate the large-scale genotypic analysis of CYP2B6.
Factors Influencing Rearing Success of Atlantic Salmon Stocked as Fry and Parr in Lake Ontario Tributaries
Authors: Stanfield Les , Jones Michael L. 
Published: June 2004

Abstract
From 1995 to 1999, we evaluated the suitability of various stream conditions for rearing juvenile Atlantic salmon Salmo salar in the Lake Ontario watershed. As part of an ongoing initiative to reestablish this species in Lake Ontario, fry and parr were stocked into sites with contrasting amounts of rock and wood cover, fine materials in the substrate, and densities of rainbow trout Onchorhynchus mykiss. Resulting Atlantic salmon densities exceeded the target density of five age-0 fall fingerlings/100 m2 at 52% of the site-years surveyed. Atlantic salmon stocked as parr (fed in hatchery before stocking; annual mean weights, 0.45-0.95 g) consistently had greater survival to the age-0 fall fingerling stage than those stocked as fry (not fed before stocking, annual mean weights, 0.13-0.20 g). The percentage of rock cover at a site was the best predictor of high densities of fall fingerling Atlantic salmon for the parr stocking strategy. For Atlantic salmon stocked as fry, the density of rainbow trout was the most influential variable, exhibiting a negative correlation, whereas the percentage of rock cover was also influential in discerning Atlantic salmon densities in a positive way. Our study also found that densities of fall fingerling Atlantic salmon at sites with high densities of rainbow trout (&gt;1.5/m2) were greater than at sites where rainbow trout were present at lower densities, suggesting that habitat influenced the outcome of competitive interactions. High-quality habitat supported high densities of both species. The results of this study indicate that both above and below barriers in the north shore tributaries of Lake Ontario, sites exist with conditions suitable for rearing Atlantic salmon from the fry to the fall fingerling stage.
Contribution and Relative Survival of Age-0 Walleyes Stocked at Two Sizes in Six Eastern Ontario Lakes
Authors: Pratt Thomas C. , Fox Michael G. 
Published: June 2004

Abstract
Size at stocking is believed to be a critical factor in determining the success of stocking events for many species. We examined the relative performance of summer (reared extensively, planted in June, average weight &lt; 1 g) and fall (reared intensively, planted in September, average weight ∼ 10 g) walleye Stizostedion vitreum fingerlings stocked at a 5:1 summer-to-fall fingerling ratio into six small lakes in Eastern Ontario. One lake was stocked concurrently during 1990-1993, and three lakes were given paired plants in 1992 and 1993; stocking assessments occurred at age 1 and as adults in 1997. Two additional lakes were stocked in 1998; in one the stocking failed, and in the other the stocking was assessed at age 1. Walleyes planted as summer fingerlings were significantly larger at first annulus formation than those planted as fall fingerlings, but these size differences disappeared in the adult fish recovered 4-7 years after the paired plants. By the time the fish were adults, summer fingerlings were more abundant in the samples of all four lakes assessed to that stage. After accounting for the difference in stocking ratios, the relative survival to adulthood did not differ between the two fingerling types, except in Warrens Lake where summer fingerlings had a greater probability of survival. Given the relatively high cost of raising walleyes to the fall fingerling stage, we recommend that summer fingerlings be used when stocking walleyes into small, inland lakes.
Effect of Rewards on Lake Trout Tag Returns in Northwestern Lake Michigan
Authors: Schmalz Patrick J. , Hansen Michael J. , Holey Mark E. , McKee Patrick C. , Toneys Michael L. 
Published: June 2004

Abstract
We determined the effect of a reward of one free case of Stroh's beer (retail value of US$7.50 in 1986 dollars) on lake trout Salvelinus namaycush tag returns made by two voluntary-return fisheries (recreational and commercial) in northwestern Lake Michigan during 1984–1990. To examine the effect of the reward, which was offered in 1986 and 1987, we determined the proportion of tags that were returned by assessment, recreational, and commercial fisheries. We used the log-likelihood G-statistic to test for homogeneity of recapture rates among years for the three fisheries. Comparison of individual G-statistics in the reward years versus the nonreward years yielded the impact of the reward. Recapture rates varied significantly among years for assessment, recreational, and commercial fisheries, and were also significantly different among the three fisheries. The reward of a free case of Stroh's beer increased the recapture rate in both of the voluntary tag-return fisheries (recreational and commercial), but the impact was greater in the commercial fishery. Despite the poor design of the reward program, recapture rates increased with the reward. However, we believe that increased recapture rates can be as much harmful as beneficial without careful a priori consideration of the impact of various types of rewards on response rates.
Impacts of Daily Bag Limit Reductions on Angler Effort in Wisconsin Walleye Lakes
Authors: Beard T. Douglas , Cox Sean P. , Carpenter Stephen R. 
Published: June 2004

Abstract
Angler effort is an important factor affecting recreational fisheries. However, angler responses are rarely incorporated into recreational fisheries regulations or predictions. Few have attempted to examine how daily bag limit regulations affect total angling pressure and subsequent stock densities. Our paper develops a theoretical basis for predicting angler effort and harvest rate based on stock densities and bag limit regulations. We examined data from a management system that controls the total exploitation of walleyes Sander vitreus (formerly Stizostedion vitreum) in northern Wisconsin lakes and compared these empirical results with the predictions from a theoretical effort and harvest rate response model. The data indicated that higher general angler effort occurs on lakes regulated with a 5-walleye daily limit than on lakes regulated with either a 2- or 3-walleye daily limit. General walleye catch rates were lower on lakes with a 5-walleye limit than on lakes with either a 2- or 3-walleye daily limit. An effort response model predicted a logarithmic relationship between angler effort and adult walleye density and that an index of attractiveness would be greater on lakes with high bag limits. Predictions from the harvest rate model with constant walleye catchability indicated that harvest rates increased nonlinearly with increasing density. When the effort model was fitted to data from northern Wisconsin, we found higher lake attractiveness at 5-walleye-limit lakes. We conclude that different groups of anglers respond differently to bag limit changes and that reliance on daily bag limits may not be sufficient to maintain high walleye densities in some lakes in this region.