bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physician‐Pharmacist Comanagement of Hypertension: A Randomized, Comparative Trial
Authors: Borenstein Jeff E. , Graber Geneen , Saltiel Emmanuel , Wallace Joel , Ryu Seonyoung , Jackson Archi , Deutsch Stephen , Weingarten Scott R. 
Published: May 2004

Objective. To compare the effectiveness of an evidence‐based, systematic approach to hypertension care involving comanagement of patients by primary care physicians and clinical pharmacists versus usual care in reducing blood pressure in patients with uncontrolled hypertension.Methods. Patients in a staff model medical group with uncontrolled hypertension were randomized to either a usual care (UC) or a physician‐pharmacist comanagement (PPCM) group. All physicians in the study received both group and individual education and participated in the development of an evidence‐based hypertension treatment algorithm. Physicians were then given the names of their patients whose medical records documented elevated blood pressures (defined as systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg for patients aged < 65 yrs, and systolic ≥ 160 mm Hg and/or diastolic ≥ 90 mm Hg for those aged ≥ 65 yrs). Patients randomized to the UC group were managed by primary care physicians alone. Those randomized to the PPCM group were comanaged by their primary care physician and a clinical pharmacist, who provided patient education, made treatment recommendations, and provided follow‐up. Blood pressure measurements, antihypertensive drugs, and visit costs/patient were obtained from medical records.Results. One hundred ninety‐seven patients with uncontrolled hypertension participated in the study. Both PPCM and UC groups experienced significant reductions in blood pressure (systolic −22 and −11 mm Hg, respectively, p<0.01; diastolic −7 and −8 mm Hg, respectively, p<0.01). The reduction in systolic blood pressure was greater in the PPCM group after adjusting for differences in baseline blood pressure between the groups (p<0.01). More patients achieved blood pressure control in the PPCM than in the UC group (60% vs 43%, p=0.02). Average provider visit costs/patient were higher in the UC than the PPCM group ($195 vs $160, p=0.02).Conclusions. An evidence‐based, systematic approach using physician‐pharmacist comanagement for patients with uncontrolled hypertension resulted in improved blood pressure control and reduced average visit costs/patient.
Bioterrorism: Pivotal Clinical Issues: Consensus Review of the Society of Infectious Diseases Pharmacists
Authors: Terriff Colleen M. , Schwartz Mike D. , Lomaestro Ben M. 
Published: May 2004

Objectives. To discuss specific facts regarding use as a bioweapon, epidemiology, microbiology, clinical manifestations, diagnosis, antimicrobial therapy, immunization, and isolation precautions for five most likely agents of bioterrorism; to review and provide recommendations for health care clinicians on the management of these bioterrorism agents; and to share information on the pharmacist's role in preparedness and response.Participants. The manuscript was drafted by the three authors, reviewed by a group of selected members of the Society of Infectious Diseases Pharmacists, and approved by its Board of Directors.Evidence. The primary focus was to review and summarize recent and key articles on bioterrorism. Preference was given to peer‐reviewed journal information and government‐sponsored journals, such as the MMWR, Morbidity and Mortality Weekly Report.Consensus Process. Written comments were requested from each reviewer. Comments were incorporated into the final draft.Conclusion. Pharmacists play an integral role in disaster preparedness and response and should be involved in planning committees. As drug information specialists, pharmacists can assist other health care providers and emergency personnel, as well as provide counseling to calm, comfort, and empower the public.
Integration of Population Pharmacokinetics, a Pharmacodynamic Target, and Microbiologic Surveillance Data to Generate a Rational Empiric Dosing Strategy for Cefepime against Pseudomonas aeruginosa
Authors: Tam Vincent H. , Louie Arnold , Lomaestro Ben M. , Drusano George L. 
Published: May 2004

Study Objective. To derive steady‐state pharmacokinetic profiles of cefepime against Pseudomonas aeruginosa.Design. Retrospective evaluation using a weighted approach based on a minimum inhibitory concentration distribution of cefepime in the United States.Setting. Medical and surgical intensive care units.Patients. One thousand patients with creatinine clearances of 120, 90, or 60 ml/minute.Intervention. Administration of a standard dosage of cefepime 2 g every 12 hours, each dose infused over 0.5 hour, and maximum dosage of 2 g every 8 hours, each dose infused over 0.5 hour; and a nonstandard dosage of 2 g every 12 hours, each dose infused over 6 hours, and continuous infusion of 4 g infused over 24 hours.Measurements and Main Results. The standard and maximum dosages achieved pharmacodynamic targets from 4–38% and 21–68%, respectively for the three groups. With extended infusion of the standard dosage, the probability of achieving the pharmacodynamic target increased to 18–63%. Continuous infusion over 24 hours offered the most promising pharmacodynamic target, attaining 65–81% (p<0.001).Conclusion. The recommended dosage of cefepime has a low probability of achieving a pharmacodynamic target predicting a favorable outcome for infections due to P. aeruginosa. The probability of attaining the target could be improved with higher dosages or extended infusion time.
Shifting from Inpatient to Outpatient Treatment of Deep Vein Thrombosis in a Tertiary Care Center: A Cost‐Minimization Analysis
Authors: Boucher Michel , Rodger Marc , Johnson Jeffrey A. , Tierney Mike 
Published: May 2004

Study Objective. To compare the cost of contemporary outpatient and historical inpatient management of proximal lower limb deep vein thrombosis (DVT) in adults.Design. Prospective, observational study with historical inpatient cases as controls.Setting. Ambulatory thrombosis clinic of a tertiary care teaching center in Canada.Patients. Forty‐nine inpatients with DVT from a previous study in 1996 at the same institution who would have been eligible for outpatient therapy if this option had been available, and 51 consecutive patients referred to the ambulatory thrombosis clinic for treatment of DVT between March 2000 and January 2001.Intervention. The 49 inpatients received unfractionated heparin, and the 51 outpatients received low‐molecular‐weight heparin (LMWH).Measurements and Main Results. A cost‐minimization analysis restricted to the hospital perspective was conducted. This design was justified based on the clinical equivalence of the two treatment strategies. All direct hospital costs for treating the 51 consecutive outpatients with LMWH were measured. These data were compared with the cost of treating the inpatients with unfractionated heparin. The analysis horizon was limited to 7 days, based on the duration of hospitalization and length of heparin therapy for DVT before conversion to oral warfarin. The mean cost (in Canadian dollars) per outpatient case was $248 (95% confidence interval $216–280) and was significantly different from the mean cost/inpatient case of $2826 (adjusted for the difference in fiscal years) (p<0.0005). A breakdown of the outpatient cost showed that nursing time contributed to 51% of the cost, monitoring laboratory tests 5%, drugs 2%, and other costs (diagnostic laboratory tests and medical imaging) 42%.Conclusion. Converting from inpatient to outpatient treatment of proximal DVT was associated with a significant cost savings for our institution. Accordingly, it is financially advantageous for hospitals to offer this service as it reduces direct costs and does not appear to compromise patient care.
Effect of Levofloxacin Coadministration on the International Normalized Ratios During Warfarin Therapy
Authors: Yamreudeewong Weeranuj , Lower Dennis L. , Kilpatrick David M. , Enlow Ann M. , Burrows Margo M. , Greenwood Mark C. 
Published: May 2004

Study Objective. To evaluate the effect of levofloxacin coadministration on the international normalized ratio (INR) in patients receiving warfarin therapy.Design. Prospective analysis.Setting. Outpatient clinic at a Veterans Affairs medical center.Patients. Eighteen adult patients receiving warfarin.Intervention. On the basis of clinical diagnosis and judgment, levofloxacin was prescribed to the 18 patients for treatment of various types of infection. The INR was measured before and at 2–8‐day intervals after the coadministration of levofloxacin therapy, and once after completing therapy. Warfarin dosages were adjusted when necessary.Measurements and Main Results. Warfarin dosages were changed in seven patients as a result of the first nontherapeutic INR values obtained after start of levofloxacin therapy. Owing to a concern regarding noncompliance and the adverse effect of bleeding, warfarin dosage was adjusted in one patient even though his first INR value was in the high end of the therapeutic range (2.98, therapeutic range 2–3). One patient withdrew from the study after the first INR measurement after levofloxacin coadministration. Because of a concern about the possible bleeding complication, warfarin dosage was also adjusted in this patient after obtaining his first INR value. Therefore, only the INR values obtained before and the first INR values obtained after levofloxacin administration were compared to evaluate the effect of levofloxacin on INR determination of warfarin therapy. The INR values obtained before levofloxacin administration did not differ significantly from the first INR values obtained after levofloxacin coadministration (mean ± SD 2.61 ± 0.44 vs 2.74 ± 0.83, 95% confidence interval −0.449–0.196, p=0.419).Conclusion. The INR values measured before and after concomitant levofloxacin therapy were not significantly different. However, the ability to detect a significant difference may be affected by the small number of patients studied. Further studies with a larger sample are required to better determine the effect of levofloxacin coadministration on INR monitoring during warfarin therapy.
Production of Interferon‐γ and Interleukin‐10 After Inactivated Hepatitis A Immunization
Authors: Hayney Mary S. , Buck Jessica M. , Muller Daniel 
Published: May 2004

Study Objective. To assess helper T cell function by measuring cytokine production over time after hepatitis A immunization.Design. Open‐label, single‐dose study.Setting. General clinical research center of a university hospital.Subjects. Twenty‐five healthy adults.Intervention. Each subject was immunized with inactivated hepatitis A vaccine; blood was drawn on day 0 (the day of immunization) and days 2, 5, 7, 10, and 28 after immunization.Measurements and Main Results. Production of interferon (IFN)‐γ and interleukin (IL)‐10 by peripheral blood mononuclear cells stimulated in culture with hepatitis A virus was measured by enzyme‐linked immunosorbent assay. Concentrations of hepatitis A antibody were measured on day 28. Both IFN‐γ and IL‐10 production peaked on day 10 after immunization (IFN‐γ day 0 median = 7.35 pg/ml, interquartile ratio [IQR] = 20.8 vs day 10 median = 22.35 pg/ml, IQR = 42.4, p<0.05; IL‐10 day 0 median = 1.00, IQR = 7.4 vs day 10 median = 11.75 pg/ml, IQR = 92.3, p<0.02, Wilcoxon signed rank test). The IL‐10:IFN‐γ ratio on day 10 correlated with antibody production (Pearson product moment correlation 0.46, p<0.05). This ratio was used as a measure of helper T cell phenotype.Conclusion. Both IFN‐γ and IL‐10 are produced in response to hepatitis A vaccine. The parallel production after immunization may contribute to the high efficacy of these vaccine preparations in inducing both cell‐mediated immune response and a protective antibody response.
Evaluation of P‐glycoprotein—Mediated Renal Drug Interactions in an MDR1‐MDCK Model
Authors: Karyekar Chetan S. , Eddington Natalie D. , Garimella Tushar S. , Gubbins Paul O. , Dowling Thomas C. 
Published: May 2004

Study Objective. To evaluate P‐glycoprotein (P‐gp)‐mediated renal drug interactions in an in vitro model of tubular secretion.Design. In vitro experiment.Setting. University‐affiliated pharmacokinetics laboratory.Cell Lines. Madin‐Darby canine kidney (MDCK), multidrug‐resistant‐1 (MDR1)‐MDCK, and human colon carcinoma (Caco‐2) cells.Intervention. Transepithelial transport (basolateral‐to‐apical and apical‐to‐basolateral) of cimetidine was assessed in the absence and presence of various concentrations of the P‐gp inhibitors itraconazole and PSC‐833 in a renal P‐gp cell culture model (MDR1‐MDCK).Measurements and Main Results. Apparent permeability of cimetidine was characterized, and level of P‐gp expression was determined by Western blot analysis, in MDCK (wild type), MDR1‐MDCK, and Caco‐2 cells (for relative comparison). In the presence of PSC‐833, cimetidine's apparent permeability value for basolateral‐to‐apical transport decreased from 2.96 to 1.15 times 10−6 cm/second, coupled with a decrease in efflux ratio from 2.36 to 1.80. The effect of itraconazole was concentration dependent, with cimetidine's apparent permeability value for basolateral‐to‐apical transport decreasing from 3.96 to 1.92 times 10−6 cm/second (p<0.05), resulting in a 50% decrease in efflux ratio. Expression of P‐gp was negligible in MDCK (wild‐type) cells, but high‐level expression was confirmed in both MDR1‐MDCK and Caco‐2 cells.Conclusion. P‐glycoprotein plays a significant role in the renal tubular secretion of organic cations such as cimetidine, and the high level of P‐gp expression in MDR1‐MDCK cells makes this a well‐suited model for evaluating mechanisms of renal drug interactions.
Lack of Economic Benefit with Basiliximab Induction in Living Related Donor Adult Renal Transplant Recipients
Authors: Crompton Jason A. , Somerville Troy , Smith Lonnie , Corbett Jacke , Nelson Edward , Holman John , Shihab Fuad S. 
Published: May 2004

Study Objective. To assess the effect of basiliximab (BAS) induction therapy on acute rejection rates and overall costs in adult living related donor (LRD) renal transplant recipients.Design. Retrospective chart review and cost‐effectiveness analysis of the first 12 months after transplantation.Setting. University hospital and outpatient renal transplant clinic.Patients. Sixty consecutive adult LRD renal transplant recipients.Intervention. The treatment group received BAS 20 mg intravenously on postoperative days 0 and 4. The control group received no induction agents. Both groups received cyclosporine microemulsion, azathioprine, and corticosteroids for maintenance immunosuppression.Measurements and Main Results. Six patients (three in each group) were excluded; three had received muromonab‐CD3 as an induction agent and three were lost to follow‐up. At 12‐months, the frequency of acute rejection episodes was 15% (4/27) in the control group and 22% (6/27) in the BAS group (NS). Renal function, as measured by average serum creatinine level, was similar at months 1, 2, 3, 6, and 12 for both groups. The frequency of infectious complications was similar in both groups. No adverse effects were associated with BAS. Mean initial hospitalization charges were $51,970.01 and $68,093.90 in the control and BAS groups, respectively (p<0.05). The control group had more readmissions (18 vs 14 in the BAS group), but the average charge/readmission was lower ($10,148.50 vs $21,952.58 in the BAS group; NS). All costs were adjusted to 2000 dollars (US).Conclusion. Basiliximab induction therapy did not provide clear clinical efficacy benefit or prove to be cost‐effective compared with no induction in LRD recipients.
Use of Herbal Medicine by Elderly Hispanic and Non‐Hispanic White Patients
Authors: Zeilmann Carla A. , Dole Ernest J. , Skipper Betty J. , McCabe Melvina , Dog Tieraona Low , Rhyne Robert L. 
Published: May 2004

Study Objectives. To determine the types and prevalence of herbal medicines used by Hispanic and non‐Hispanic white individuals aged 65 years and older. Secondary objectives were to compare herbal medicine use according to ethnicity, sex, age, socioeconomic status, and education level, and to determine patients' beliefs about herbal medicines. Use of nonphysician health care providers such as acupuncturists and chiropractors also was assessed.Methods. Data for a cross‐sectional, interviewer‐administered survey were collected at the University of New Mexico Senior Health Center, an ambulatory health care clinic, in Albuquerque, New Mexico, from February 1996‐January 1997. To participate in the study, patients had to be at least 65 years of age, established patients at the clinic, and live independently in a community dwelling. They were excluded if they had dementia, lived in an institution, or belonged to any ethnic group other than Hispanic or non‐Hispanic white. Ethnicity was determined by asking the patients in which ethnic group they identified themselves.Results. A total of 186 patients were surveyed: 84 Hispanic (34 men, 50 women) and 102 non‐Hispanic white (47 men, 55 women). Of the 186 patients, 91 (49%) admitted to having taken herbal medicines in the previous year. The most common were spearmint, chamomile, aloe vera, garlic, brook‐mint, osha, lavender, ginger, ginseng, and camphor. Most of the patients who used herbal medicines were 65–74 years of age and took them primarily for health care maintenance or self‐perceived problems.Conclusion. As approximately half of the elderly patients stated that they used herbal medicines, health care providers should be knowledgeable about herbal remedies and provide reliable information to their patients about them in a nonjudgmental manner.
Aspirin Dosage and Thromboxane Synthesis in Patients with Vascular Disease
Authors: Hart Robert G. , Leonard Anne D. , Talbert Robert L. , Pearce Lesly A. , Cornell Elaine , Bovill Edwin , Feinberg William M. 
Published: May 2004

Study Objective. To determine whether urinary 11‐dehydrothromboxane B2 (d‐TXB2) is a marker of aspirin resistance and define the relationship between aspirin dosage and concentrations of this thromboxane metabolite.Design. Randomized, crossover study.Setting. Two outpatient clinical centers.Patients. Forty‐eight patients (mean age 70 yrs) with vascular disease (52% clinical coronary artery disease, 29% cerebrovascular disease, 46% atrial fibrillation).Intervention. Levels of serum thromboxane B2 and d‐TXB2 were measured after patients were treated initially with aspirin 325 mg/day for 4 weeks, then again after random assignment to receive aspirin 81, 325, or 1300 mg/day for 4 weeks, and then again after resumption of 325 mg/day for 4 weeks.Measurements and Main Results. During treatment with aspirin 325 mg/day, the mean ± SD serum thromboxane B2 level was 0.9 ± 1.2 ng/ml and median (interquartile range) was 0.4 (0.2–0.9) ng/ml. Mean urinary d‐TXB2 was 16 ± 7.9 ng/mmol creatinine, with a median of 15 (9.9–23) ng/mmol creatinine with aspirin 325 mg/day. After 4 weeks of aspirin 81 mg/day, levels of serum thromboxane B2 (p<0.01) and urinary d‐TXB2 (p=0.04) were both significantly higher compared with aspirin 325 mg/day; for urinary d‐TXB2, the median increase was 3.0 ng/mmol creatinine. After 4 weeks of treatment with aspirin 1300 mg/day, levels of serum thromboxane B2 (p<0.01) and urinary d‐TXB2 (p<0.01) were both significantly lower compared with aspirin 325 mg/day; the median decrease in urinary d‐TXB2 was 4.4 ng/mmol creatinine.Conclusion. Different aspirin dosages significantly affect serum and urinary markers of thromboxane synthesis.
A Gentamicin Pharmacokinetic Population Model and Once‐Daily Dosing Algorithm for Neonates
Authors: DiCenzo Robert , Forrest Alan , Slish Judianne C. , Cole Carol , Guillet Ronnie 
Published: May 2004

Study Objective. To develop a gentamicin pharmacokinetic population model and once‐daily dosing algorithm for neonates younger than 10 days.Design. Prospective, open‐label study.Setting. Neonatal intensive care unit.Patients. One hundred thirty‐nine neonates prescribed gentamicin.Measurements and Main Results. Gentamicin peak and trough serum concentrations were collected from 139 neonates divided into three groups who were receiving one of the following intravenous 24‐hour gentamicin regimens during the first 10 days of life, based on gestational age and birth weight (group 1, < 28 wks, 2.5 mg/kg; group 2, 28–34 wks, 3 mg/kg; and group 3, > 34 wks, 4 mg/kg). A structural model was developed in ADAPT II software using a MAP Bayesian approach. Final population parameter estimates were calculated using iterative two‐stage analysis. The median (range) gestational age and birth weight, respectively, were 32 weeks (23–42 wks) and 1.92 kg (0.47–5.00 kg). The final one‐compartmental linear model had a median (range) gentamicin total clearance, half‐life, and volume of distribution of 0.0709 L/hour (0.0151–0.246 L/hr), 8.59 hours (4.88–16.9 hrs), and 0.262 L (0.0903–0.929 L), respectively. Total clearance increased as gestational age increased (p<0.001). Group 1 (10.2 hrs) had a significantly longer half‐life than either group 2 (8.89 hrs, p<0.01) or group 3 (6.98 hrs, p<0.01). Total clearance was associated with gestational age and birth weight: clearance (L/hr) = (0.00504 + [0.00108 · gestational age]) · birth weight (coefficient of determination [r2] = 0.897), and volume of distribution was associated with birth weight (r2 = 0.700). The following dosing algorithm was designed to reach a therapeutic 24hour area under the curve (87.5 mg/L·hr) in neonates during the first 10 days after birth: 24‐hour gentamicin dose (mg) = (0.441 + [0.0945 · gestational age]) · birth weight.Conclusion. This dosing algorithm provides a new approach for determining initial gentamicin dosing regimens in neonates; however, clinical validation is required.
Assessment of Differences in Antimicrobial Effect Determined with Two In Vitro Pharmacodynamic Models: Impact of Surface Area to Volume Ratio
Authors: White Roger L. , Bonapace Charles R. , Friedrich Lawrence V. , Rybak Michael J. , Cappelletty Diane M. , Mercier Renee‐Claude , Houlihan Heather H. , Aeschlimann Jeffrey R. , Bosso John A. 
Published: May 2004

Study Objective. To measure the influence of different surface area:volume ratios (SA:Vs) on antibiotic penetration and subsequent antibacterial effect.Design. In vitro laboratory experiment.Setting. Two academic research laboratories.Intervention. The two models with effective SA:Vs of 5.34 and 4.80 cm−1 were evaluated by conducting a time‐kill experiment with Pseudomonas aeruginosa ATCC 27853 and ceftazidime.Measurements and Main Results. Ceftazidime was administered by constant infusion into the central compartment. Its penetration into the peripheral compartment and bacterial counts were determined over 24 hours, and antibacterial effect was quantified. Antibiotic penetration, calculated using central compartment and peripheral compartment area under the concentration‐time curves, and effect, quantified as the relationship between the areas under growth and kill curves, differed between the models. Antibiotic penetration into the peripheral compartment was 53% greater over the first 4 hours of the experiment in the model with the larger SA:V. This was associated with antibacterial effects that were 64% and 38% greater in the 0–4‐hour and 0–24‐hour time periods, respectively.Conclusion. Differences in antibiotic penetration and effect observed between these models are likely explained by differences in SA:V.