bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacists' Knowledge and Attitudes toward Herbal Medicine
Authors: Chang Ziba Gorji , Kennedy Daniel T , Holdford David A , Small Ralph E 
Published: June 2003

OBJECTIVE: The use and sales of herbal medications have increased dramatically over the past several years. Pharmacists are in an ideal position to educate patients about herbal medicines. This study was intended to determine the knowledge and attitudes of pharmacists regarding herbal medications. METHODS: A survey was distributed to pharmacists at several state and regional meetings in Virginia and North Carolina between August and October 1998. The survey evaluated demographic data, attitudinal scales, and a 15-item herbal medicine knowledge test. Pharmacists immediately returned the surveys to the distributor on completion. RESULTS: Of the 217 surveys distributed, 164 met the inclusion criteria for further evaluation. Of the pharmacists surveyed, 68.0 % practiced in a community pharmacy, 45.1% had previous continuing education on herbal medications, and 73.6% sold herbal medications in their practice settings. The average score on the herbal knowledge test was 6.3 (maximum score of 15). Pharmacists with previous continuing education scored significantly higher than those without prior continuing education (p < 0.001). Of the 15 questions, the five that pharmacists were most likely to answer correctly assessed the uses of herbal medications. Additionally, pharmacists with prior continuing education or with access to herbal medication information at their practice site were more likely to agree that providing information about herbal medication is a pharmacist's professional responsibility (p = 0.02 and p = 0.01, respectively). CONCLUSIONS: The findings from this study demonstrate that pharmacists were more likely to answer correctly about the uses of herbal medications than about drug interactions, adverse drug effects, and precautions of herbal medications. Additionally, pharmacists with previous continuing education on herbal medications were more knowledgeable about these products. With the increasing use of herbal medications, there is a greater need for pharmacy training programs in this area.
Miglitol: Assessment of its Role in the Treatment of Patients with Diabetes Mellitus
Authors: Campbell Lance K , Baker Danial E , Campbell R Keith 
Published: June 2003

OBJECTIVE: To evaluate miglitol, a new oral α-glucosidase inhibitor, and discuss its pharmacology, therapeutics, pharmacokinetics, dosing guidelines, adverse effects, drug interactions, and clinical efficacy. DATA SOURCES: A MEDLINE English-language only database search using the keywords miglitol, glyset, and Bay m 1099 (1985 to December 1999), was completed to identify relevant articles including reviews, recent studies, and abstracts; American Diabetes Association 1999 Annual Meeting abstracts; Pharmacia & Upjohn data on file and product information. STUDY SELECTION: The clinical trials that were selected to be reviewed in detail were randomized, double-blind studies with at least 100 patients in the intention-to-treat group. DATA EXTRACTION: All articles and abstracts were reviewed along with the product labeling from Pharmacia & Upjohn. DATA SYNTHESIS: Miglitol is an α-glucosidase inhibitor that exerts its effect through the delayed absorption of complex carbohydrates in the small intestine, resulting in a decrease in postprandial glucose concentrations that are directly correlated with the dietary carbohydrate content. Both small, short-term trials and large, clinical trials show a decrease in postprandial glucose concentrations and a modest decrease in glycosylated hemoglobin of approximately 0.5–1.0% as a result of miglitol's action. The adverse effects of miglitol are mild and transitory and include flatulence, diarrhea, and abdominal pain. The incidence of gastrointestinal problems may be reduced with a small initial dose, which is slowly titrated as tolerated. CONCLUSIONS: Miglitol is an effective and safe treatment option in patients with type 2 diabetes mellitus who are inadequately controlled with diet or oral sulfonylurea therapy. Miglitol is a good choice of therapy in Hispanic, African-American, and elderly patients, or any patients in whom hypoglycemia, weight gain, or lactic acidosis are risks. No published studies comparing miglitol with acarbose have been published, but there appears to be no major clinical or financial advantages to using one agent over the other.
Helicobacter Pylori Eradication in Clinical Practice: Retreatment Rates and Costs of Competing Regimens
Authors: Fairman Kathleen A , Motheral Brenda R 
Published: June 2003

OBJECTIVE: To measure outcomes for eradication regimens for Helicobacter pylori infection in routine clinical practice. DESIGN: Retrospective analysis of an integrated medical and pharmacy claims database identified patients treated from June 1, 1995 through May 31, 1996, and followed the patients' claims until December 31, 1996. SETTING: The database represented multiple health plans throughout the US. PATIENTS: Patients were ≥16 years old, continuously enrolled from April 1, 1995, to December 31, 1996, and met clinical (diagnostic or procedural) criteria. INTERVENTION: Patient cohorts were treated with bismuth-based triple (n = 98), proton-pump inhibitor (PPI)–based triple (n = 180), or PPI-based dual (n = 337) regimens. OUTCOME MEASURES: Retreatment; monthly postregimen medical expense, controlling for preregimen expense; and drug cost per successfully treated patient. Cox regression (retreatment analysis) and ANCOVA (postregimen expense analysis) adjusted for age, gender, diagnostic/procedural criteria met by patient, and specialty physician use. RESULTS: Retreatment rates were higher (p < 0.05) for PPI-based dual than bismuth-based or PPI-based triple-therapy cohorts. Retreatment rates for bismuth- and PPI-based triple-therapy cohorts were not significantly different. Total and follow-up (excluding the first 2 wk of treatment) expenses were higher for retreated than nonretreated patients (p < 0.01). Total expenses were higher for the PPI-dual cohort (p < 0.05) than for triple cohorts. Drug costs per successfully treated patient were $30 for bismuth-based, $172 for PPI-based triple, and $208 for PPI-based dual-therapy regimens. CONCLUSIONS: PPI-based dual-therapy regimens are not cost-effective in H. pyloritreatment. Further study should compare more costly (PPI-based) versus less costly (bismuth-based) triple-therapy regimens.
Long-Term Treatment with Warfarin in Chinese Population
Authors: Chenhsu Rou-Yee , Chiang Shu-Chiung , Chou Mei-Huei , Lin Ming-Fang 
Published: June 2003

OBJECTIVE: To estimate the incidence of and risks for bleeding and thromboembolic events after warfarin anticoagulation. We also explored the dosage and international normalized ratio (INR) among Chinese patients during long-term warfarin therapy. METHODS: The population in this retrospective study consisted of inpatients of the only medical center for northern Taipei City, whose initial course of warfarin therapy continued for more than four weeks. Enrollment began in June 1995 and ended in February 1996. Follow-up was completed in March 1998. Relevant data were collected by chart review. The rate of events was calculated using the Kaplan—Meier method, and risk factors were identified by the Cox proportional hazard model. RESULTS: During the study period, 226 patients were identified. The total follow-up time was 248.7 patient-years. Sixty-one patients (27.0%) received anticoagulation for mechanical prosthetic valve, but their duration of therapy accounted for 48.6% of the total patient-years of follow-up. The starting dosage (mean ± SD) was 3.4 ± 1.4 mg/d (range 1.3–10); the maintenance dosage was 3.1 ± 1.2 mg/d (range 1.2–7.7). There were 1060 dosing adjustments and 3398 INR measurements collected for these patients. The independent determinants of maintenance dosage were age, body weight, and indication of mechanical prosthetic valve. The INR was 1.9 ± 0.5 (range 1.0–3.7). The cumulative probabilities for hemorrhage at 12, 24, and 34 months were 24.5%, 32.3%, and 38.4%, respectively. The corresponding figures for thromboembolism were 8.5%, 10.7%, and 10.7%, respectively. Three hemorrhages were fatal. After adjusting for other patient characteristics, increasing age was the only independent risk factor identified for bleeding. CONCLUSIONS: Antithrombotic efficacy seemed to be maintained, although the mean INR was 1.9. Even so, the substantial incidence of bleeding, especially fatal bleeding, remains a concern. Low-intensity anticoagulation might be needed for Chinese patients during long-term warfarin therapy.
Angiotensin II Receptor Blockers in Patients with ACE Inhibitor–Induced Angioedema
Authors: Warner Kelly K , Visconti James A , Tschampel Marva M 
Published: June 2003

OBJECTIVE: To determine the safety of using angiotensin II receptor blockers in patients who have experienced angioedema following treatment with angiotensin-converting enzyme (ACE) inhibitors. DATA SOURCES: Clinical literature identified through MEDLINE (January 1966–August 1999). Key search terms included angioneurotic edema, angiotensin-converting enzyme inhibitors, receptors–angiotensin, and losartan. DATA SYNTHESIS: ACE inhibitor–induced angioedema occurs with an incidence of 0.1–0.5%. Alternative therapy is necessary for patients who experience this potentially life-threatening adverse effect. Since angiotensin II receptor blockers do not increase concentrations of bradykinin, the proposed mechanism of ACE inhibitor–induced angioedema, they were presumed to be safe alternatives. Recent case reports, however, document angioedema following therapy with angiotensin II receptor blockers; 32% of the reported patients experienced a prior episode of angioedema attributed to ACE inhibitor therapy. CONCLUSIONS: Until the exact cause of both ACE inhibitor– and angiotensin II receptor blocker–induced angioedema is determined, angiotensin II receptor blockers should be used with extreme caution in patients with a prior history of angioedema.
Combined Aspirin/ACE Inhibitor Treatment for CHF
Authors: Olson Kari L 
Published: June 2003

OBJECTIVE: To review the literature evaluating the interaction between angiotensin-converting enzyme (ACE) inhibitors and aspirin in patients with congesitve heart failure (CHF). DATA SOURCES: A literature search through MEDLINE (1966–March 2001) and EMBASE (1966–March 2001) identified randomized, double-blind, controlled trials evaluating the use of ACE inhibitors and aspirin in patients with CHF. DATA SYNTHESIS: No prospective study has evaluated the effects of aspirin and ACE inhibitors on clinical outcomes of patients with CHF. All have been short-term studies evaluating the effects on hemodynamic parameters only. CONCLUSIONS: While the potential for an interaction between ACE inhibitors and aspirin exists, the results from ongoing prospective trials will help determine the efficacy of using both agents in patients with CHF.
Bupropion-Induced Serum Sickness–Like Reaction
Authors: McCollom Robert A , Elbe Dean HT , Ritchie Alec H 
Published: June 2003

OBJECTIVE: To report three cases of serum sickness–like reaction (SSLR) associated with bupropion ingestion. CASE SUMMARY: A 27-year-old woman, a 46-year-old man, and a 43-year-old woman presented to our emergency department within a three-week period with symptoms consistent with SSLR. Symptoms consisted of pruritic skin rash, tongue swelling, and arthralgias. All three patients had initiated bupropion therapy within two to three weeks prior to arrival. DISCUSSION: This is the second published case describing SSLRs associated with bupropion. Reports of urticaria and rash with bupropion use are numerous and the incidence has been estimated at between 1% and 4%. Arthralgia and arthropathy with bupropion use are reported much less commonly. The onset of symptoms of SSLRs typically begins six to 21 days after administration of the causative agent. SSLRs are usually self-limiting, lasting four to 14 days. CONCLUSIONS: SSLRs following bupropion ingestion appear to be rare. However, the fact that this cluster of patients presented to our emergency department within a three-week period suggests that this reaction may be underreported.
Acute Profound Thrombocytopenia following Abciximab Therapy
Authors: Bishara Amira I , Hagmeyer Kathleen O 
Published: June 2003

OBJECTIVE: To report a case of acute, profound thrombocytopenia (APT), defined as an abrupt drop in platelet count to <20 000/mm3 that occurred within 24 hours of administration of an abciximab bolus, to summarize other abciximab-associated APT cases reported in the literature, to review the postulated mechanisms behind this reaction, and to emphasize the importance of periodically monitoring platelet counts after initiating abciximab therapy. DATA SOURCES: MEDLINE and Index Medicus searches restricted to English-language literature from 1993 through June 1999 were conducted. MeSH headings included abciximab, ReoPro, thrombocytopenia, and glycoprotein IIb-IIIa (GP IIb-IIIa) inhibitors. References of the articles obtained were also reviewed. DATA EXTRACTION: Search and evaluation were focused on published case reports and reviews of abciximab-induced APT, as well as the incidence of thrombocytopenia from the drug compared with that from other GP IIb-IIIa inhibitors. DATA SYNTHESIS: Platelet aggregation has been identified as the structural basis for coronary thrombosis. This may lead to ischemic complications during acute coronary syndromes or following coronary intervention procedures. The use of GP IIb-IIIa inhibitors such as abciximab as antiplatelet agents has been effective in reducing these ischemic complications. We summarize 15 published cases of abciximab-associated APT gathered from data on 2482 patients treated with the drug. Prior to suspecting abciximab, other potential causes of thrombocytopenia should be evaluated. It is important to monitor the platelet count at baseline, two hours after initiating abciximab, and 24 hours after initiation of therapy or prior to discharge, whichever comes first, to identify patients at risk for developing APT. If APT occurs and is left untreated, it can produce excessive hemorrhage and ischemia, potentially leading to death. Platelet transfusions have been more effective than immunoglobulin in the management of APT. CONCLUSIONS: Abciximab-induced APT has a low incidence of occurrence. If it does develop and is not recognized or treated promptly, it can lead to serious hemorrhagic complications. Consequently, monitoring the platelet count two hours after initiation of the infusion is essential. If APT develops, abciximab should be discontinued and a platelet transfusion should be considered.
Use of Gabapentin in the Treatment of Neuropathic Pain
Authors: Laird Michael A , Gidal Barry E 
Published: June 2003

OBJECTIVE: To evaluate the role of gabapentin for the treatment of neuropathic pain. DATA SOURCES: Clinical literature was identified through MEDLINE (from 1990 to October 1999). Key search terms were gabapentin and pain. DATA SYNTHESIS: Neuropathic pain can be a problematic, chronic syndrome that is frequently refractory to current drug treatments. Gabapentin is a newer generation antiepileptic drug that is commonly used in treatment of neuropathic pain. An evaluation of clinical trials using gabapentin to treat neuropathic pain was performed. CONCLUSIONS: Gabapentin appears to be effective in treating various neuropathic pain disorders. Gabapentin may have advantages over current therapies, such as a favorable safety profile and lack of drug interactions; however, cost issues and limited experience may limit the use of gabapentin as a first-line option.
Alatrofloxacin-Induced Seizures during Slow Intravenous Infusion
Authors: Melvani Sharmila , Speed Bryan R 
Published: June 2003

OBJECTIVE: To report a case of seizures associated with slow infusion (1–2 h) of alatrofloxacin, the prodrug of trovafloxacin. CASE SUMMARY: A 37-year-old Asian man was admitted to the hospital for a distal pancreatectomy and drainage of a pseudocyst. Postoperative complications developed, which included peritonitis and pneumonia, requiring intensive care admission. Cultures from peritoneal drainage fluid and sputum isolated Klebsiella pneumoniae and Pseudomonas aeruginosa, respectively. He was treated with multiple courses of antibiotics, including intravenous gentamicin, metronidazole, vancomycin, meropenem, and ceftazidime. After three weeks, the patient still had sepsis and began therapy with alatrofloxacin in addition to ceftazidime and vancomycin. Alatrofloxacin infusion was administered according to product information instructions. Fifteen minutes after the first dose was started, the patient developed generalized clonus. On rechallenge, infusing at half the initial rate, the seizure recurred; consequently, the infusion was discontinued and replaced with intravenous ciprofloxacin and metronidazole. The patient remained seizure free thereafter. DISCUSSION: Fluoroquinolones have been implicated in central nervous system adverse effects, including seizures, which have been reported with other fluoroquinolones but not with alatrofloxacin or trovafloxacin. In these reports, the patients often had preexisting risk factors such as increased age and electrolyte imbalances. The only apparent predisposition in this patient was mild hyponatremia. CONCLUSIONS: Alatrofloxacin may cause seizures even during slow infusion. This case highlights the need for caution when commencing parenteral fluoroquinolone therapy, particularly with a new agent.
New Competition in the Realm of Renin—Angiotensin Axis Inhibition; the Angiotensin II Receptor Antagonists in Congestive Heart Failure
Authors: Martineau Pierre , Goulet Jude 
Published: June 2003

OBJECTIVE: To critically review the studies comparing angiotensin II (AgII) receptor antagonists with placebo or angiotensin-converting enzyme (ACE) inhibitors in patients with congestive heart failure (CHF). DATA SOURCES: A MEDLINE search (1988 to January 2000) was used to identify pertinent literature. Additional references were also retrieved from selected articles. STUDY SELECTION: As most published CHF studies were performed with candesartan and losartan, these agents are the main focus of this article. However, all identified comparative clinical studies were reviewed and included, regardless of the agent used. DATA SYNTHESIS: AgII receptor antagonists inhibit the effects of AgII at its sub-type 1 receptor, independently of AgIIs synthesis pathway. They present a hemodynamic profile similar to that of ACE inhibitors, without reflex neurohormonal activation. They have been shown to be at least as effective as ACE inhibitors in improving symptoms, exercise capacity, and New York Heart Association functional class in CHF patients. Although the ELITE (Evaluation of Losartan in the Elderly) trial suggested that losartan improved survival compared with captopril, this study was not designed to look at mortality. ELITE-II, an adequately powered study, showed no difference in mortality rates between patients taking captopril and those taking losartan. The combination of AgII receptor antagonists and ACE inhibitors provides additional benefit on blood pressure lowering and prevention of ventricular remodeling. AgII receptor antagonists are well tolerated, with an incidence of adverse effects similar to or lower than that of ACE inhibitors. Their lack of effect on bradykinin degradation might explain their lower incidence of cough. CONCLUSIONS: The data cumulated thus far in patients with CHF highlight that ACE inhibitors must remain the treatment of choice and that AgII receptor antagonists may be considered as an acceptable alternative for patients who are intolerant to ACE inhibitors.
Documentation of Clinical Interventions by Pharmacy Faculty, Residents, and Students
Authors: Taylor Charles T , Church Chelsea O , Byrd Debbie C 
Published: June 2003

OBJECTIVE: To describe the influence of pharmacy faculty, residents, and students at a community hospital by documenting the number and types of interventions attributable to their involvement in patient-care activities. METHODS: Between September 1, 1997, and May 31, 1999, data were collected using a computerized documentation system to characterize the intervention type, significance, and value of services rendered by an education group composed of pharmacy faculty (n = 2), residents (n = 4), and students (n = 22). RESULTS: The number, nature, and outcome category for all interventions were documented using an existing computerized documentation system. The education group accounted for 13% (n = 2873) of total clinical activities documented (n = 21 817). The most common activities reported were discharge counseling/education (31%), consultation by physicians and therapeutic recommendations (15%), and route conversion (6%). Interventions documented by the education group were classified as medium or high significance 50% of the time. Sixteen percent ($172 655) of the estimated cost avoidance documented by the pharmacy department was attributed to the education group. CONCLUSIONS: This study demonstrates that educational activities by pharmacy faculty, residents, and students have a positive influence on patient care in a community hospital.
Sucrose Analgesia for Minor Procedures in Newborn Infants
Authors: Masters-Harte Lory D , Abdel-Rahman Susan M 
Published: June 2003

OBJECTIVE: T o evaluate the role of intraoral sucrose and other sweet-tasting solutions for the management of pain associated with minor procedures in newborns. DATA SOURCES: A search of MEDLINE articles from 1966 to August 1999 and an extensive review of journals was conducted. MeSH headings included analgesia, sucrose, and neonate. DATA SYNTHESIS: Newborn infants regularly undergo minor invasive procedures for which analgesics are not routinely used. Intraoral sucrose and other sweet-tasting solutions appear to diminish surrogate biomarkers of pain response as evidenced by a reduction in crying time, smaller increases in heart rate, and lower pain scale ratings. CONCLUSIONS: These studies appear to suggest that sucrose solution 0.5 g provides effective analgesia with no reported adverse effects.