Publication Records and Bibliometric Indices of Pharmacy School Deans.

Objective. To characterize the publication records and bibliometric indices of current CEO deans at pharmacy schools and colleges in the United States. Methods. Using the Web of Science database, the publication records of all CEO pharmacy deans in the US were collected. Bibliometric indices calculated included: lifetime publications, publications/year, h-index, m-quotient, lifetime citations, citations/year, average citations/paper, productivity, and creativity. The Kruskal-Wallis analysis of variance for nonparametric data was used to assess differences between groups. Results. All bibliometric parameters were different between pharmacy schools and colleges that were research-intensive vs teaching-intensive, academic health center-based vs non-academic health center-based, and public vs private. Additionally, the discipline and degree of each dean yielded significant differences. There were no significant differences in bibliometric parameters between male or female deans. Conclusion. Deans of current SCOP display a varied range of publication records and bibliometric indices.

A Review and Assessment of Drug-Induced Thrombocytosis.

OBJECTIVES: The purpose of this article is to review the current literature on drug-induced thrombocytosis with the goal of critically assessing causality and providing a comprehensive review of the topic. Thrombopoietic growth factors, such as thrombopoietin-receptor agonists (romiplostim and eltrombopag) and erythropoietin are not included in our review. DATA SOURCES: The literature search included published articles limited to the English language and humans in MEDLINE, EMBASE, and Web of Science databases. MEDLINE/PubMed (1966 to September 2018) was searched using the MeSH terms thrombocytosis/chemically-induced and thrombocytosis/etiology. EMBASE (1980 to September 2018) was searched using the EMTAGS thrombocytosis/side effect. Web of Science (1970 to September 2018) was searched using the search term thrombocytosis. References of all relevant articles were reviewed for additional citations and information. STUDY SELECTION AND DATA EXTRACTION: Review articles, clinical trials, background data, case series, and case reports of drug-induced thrombocytosis were collected, and case reports were assessed for causality using a modified Naranjo nomogram. DATA SYNTHESIS: Drug-induced thrombocytosis, a form of reactive thrombocytosis cannot be easily differentiated from more common etiologies of reactive thrombocytosis. In all, 43 case reports of drug-induced thrombocytosis from a wide variety of drugs and drug classes were reviewed using a modified Naranjo probability scale that included criteria specific for thrombocytosis. CONCLUSIONS: Drug-induced thrombocytosis is a relatively rare adverse drug reaction. The strongest evidence of causality supports low-molecular-weight heparins and neonatal drug withdrawal. Weaker evidence exists for all-trans retinoic acid, antibiotics, clozapine, epinephrine, gemcitabine, and vinca alkaloids.

Clinical Toxicology of Yew Poisoning.

OBJECTIVES: Yew plant materials contain highly toxic taxine alkaloids. Serious ingestions can result in life-threatening toxicity. The purpose of this article is to summarize the literature on the treatment of acute yew poisoning. DATA SOURCES: PubMed (January 1946 to November 2017) was searched using the search terms "taxus/po". EMBASE (1980 to November 2017) was searched using the search terms "taxus/to" and "yew.mp." Web of Science (1945 to November 2017) was searched using the text words taxus, taxine, and yew. STUDY SELECTION AND DATA EXTRACTION: Available English language articles involving case reports, epidemiology, treatment, and outcomes were included. DATA SYNTHESIS: Although not uncommon, unintentional yew poisoning rarely results in significant morbidity or mortality. A total of 26 case reports of yew poisoning were evaluated along with 4 case series articles (totaling 22 additional cases). Only 4 of the 48 total cases (8%) were accidental poisonings, the rest being deliberate ingestions. In 20 patients (42%), it resulted in fatalities. Severe, acute yew poisoning results in symptomatology largely resistant to pharmacotherapy intervention. CONCLUSIONS: Most nonintentional ingestions of yew plant constituents are asymptomatic and require little intervention. Severe poisoning can result in life-threatening cardiac toxicity and require aggressive supportive care. Therapeutic interventions, such as sodium bicarbonate, digoxin immune fab, and hemodialysis that have been utilized in case studies and case series in the literature have little proven benefit. Extracorporeal life support should be considered in severe yew poisoning.

Antibiotic-Induced Rash in Patients With Infectious Mononucleosis.

OBJECTIVE: To provide an extensive review of case reports, epidemiological data, and the underlying mechanism of antibiotic-induced skin rash in patients with concurrent infectious mononucleosis (IM). DATA SOURCES: A MEDLINE literature search inclusive of the dates 1946 to June 2016 was performed using the search terms anti-bacterial agents and infectious mononucleosis. EMBASE (1980 to June 2016) was searched using the terms mononucleosis and antibiotic agent and drug eruption. References of all relevant articles were reviewed for additional citations and information. STUDY SELECTION AND DATA EXTRACTION: We selected English-language, primary literature, review articles, and mechanistic articles that addressed antibiotic-induced skin rash in patients with concurrent IM. We assessed all case reports available for causality utilizing a modified Naranjo nomogram specifically designed for this subject. We assembled the available epidemiological data into tables to identify trends in incidence rates over the years. DATA SYNTHESIS: We identified 17 case reports of antibiotic-associated rash in patients with IM. The median Naranjo score was 6 (range = 1 to 8). The top 3 reported drugs were ampicillin, azithromycin, and amoxicillin. Incidence of this adverse effect was higher in the 1960s (55.6%, 45%, and 33%) than in 2013 (33% and 15%). The mechanism most commonly proposed is a transient virus-mediated immune alteration that sets the stage for loss of antigenic tolerance and the development of a reversible, delayed-type hypersensitivity reaction to the antibiotic. CONCLUSION: A reassessment of the long-held belief of the high incidence (80%-100%) of antibiotic-induced skin rash in patients with IM seems prudent. Additional studies will be necessary to clarify this issue.

Nebulized Fentanyl in Acute Pain: A Systematic Review.

OBJECTIVE: To provide a systematic review of the current role of nebulized fentanyl in acute pain and potentially other conditions. DATA SOURCES: A MEDLINE literature search inclusive of the dates 1946 to May 2016 was performed using the following search terms: fentanyl and administration, inhaled Excerpta Medica was searched from 1980 to May 2016 using the following search terms: exp fentanyl/inhalation drug administration Additionally, Web of Science was searched using the terms fentanyl and pain inclusive of 1945 to May 2016. STUDY SELECTION AND DATA EXTRACTION: We utilized the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to select English language, human primary literature, review articles, and supporting data assessing the efficacy of nebulized fentanyl in acute pain. DATA SYNTHESIS: Seven clinical trials have demonstrated no difference in efficacy between nebulized fentanyl and intravenous (IV) opioids. Few adverse effects were reported; however, the trials were of short duration. Nebulized fentanyl appeared to be a rapid-acting analgesic that does not require IV access. CONCLUSION: Evidence suggests that nebulized fentanyl is as effective as IV opioids in the treatment of acute pain, with relatively few adverse effects. However, questions remain about the extemporaneous preparation of fentanyl nebulized solution, the variability in nebulization devices, and ensuring consistent drug delivery to distal airways in the clinical setting. The abuse potential of nebulized fentanyl should also be considered.

Role of Clonidine in Neonatal Abstinence Syndrome: A Systematic Review.

OBJECTIVE: To provide a systematic review of the current role of clonidine in neonatal abstinence syndrome (NAS). DATA SOURCES: A MEDLINE literature search inclusive of the dates 1946 to November 2015 was performed using the search terms clonidine and abstinence syndromes, neonatal. Excerpta Medica was searched from 1980 to November 2015 using the search terms clonidine and newborn. Additionally, Web of Science was searched using the terms clonidine and neon* inclusive of 1945 to November 2015. STUDY SELECTION AND DATA EXTRACTION: We utilized the PRISMA guidelines to select English language, human primary literature, review articles, and supporting data assessing the efficacy of clonidine in the treatment of NAS. DATA SYNTHESIS: Three clinical trials and 5 observational studies demonstrated evidence of clonidine's effectiveness in NAS. Clonidine's therapeutic use as monotherapy and in combination with other agents was shown to reduce the time needed for pharmacotherapy treatment. Adverse reactions associated with clonidine in neonates, when reported, are mild. CONCLUSION: The American Academy of Pediatrics recommends opioids as first-line agents in the treatment of NAS when pharmacological treatment is indicated. Limited data suggest that clonidine, in combination with other agents or as monotherapy, may be as effective, with minimal adverse effects and reduced treatment time. Prospective clinical trials are necessary to clarify the ultimate role of clonidine in NAS and establish long-term safety.

A descriptive and historical review of bibliometrics with applications to medical sciences.

The discipline of bibliometrics involves the application of mathematical and statistical methods to scholarly publications. The first attempts at systematic data collection were provided by Alfred Lotka and Samuel Bradford, who subsequently established the foundational laws of bibliometrics. Eugene Garfield ushered in the modern era of bibliometrics with the routine use of citation analysis and systematized processing. Key elements of bibliometric analysis include database coverage, consistency and accuracy of the data, data fields, search options, and analysis and use of metrics. A number of bibliometric applications are currently being used in medical science and health care. Bibliometric parameters and indexes may be increasingly used by grant funding sources as measures of research success. Universities may build benchmarking standards from bibliometric data to determine academic achievement through promotion and tenure guidelines in the future. This article reviews the history, definition, laws, and elements of bibliometric principles and provides examples of bibliometric applications to the broader health care community. To accomplish this, the Medline (1966-2014) and Web of Science (1945-2014) databases were searched to identify relevant articles; select articles were also cross-referenced. Articles selected were those that provided background, history, descriptive analysis, and application of bibliometric principles and metrics to medical science and health care. No attempt was made to cover all areas exhaustively; rather, key articles were chosen that illustrate bibliometric concepts and enhance the reader's knowledge. It is important that faculty and researchers understand the limitations and appropriate uses of bibliometric data. Bibliometrics has considerable potential as a research area for health care scientists and practitioners that can be used to discover new information about academic trends, pharmacotherapy, disease, and broader health sciences trends.

Gabapentin therapy of hiccups.

OBJECTIVE: To determine whether gabapentin is effective in the treatment of persistent or intractable hiccups. DATA SOURCES: A search of MEDLINE (1966-March 2013) using the MeSH search terms gabapentin, hiccups, and hiccups/drug therapy was performed. Additional databases searched included Web of Science (1945-March 2013) and International Pharmaceutical Abstracts (1970-March 2013) using the text words gabapentin and hiccups. Bibliographies of relevant articles were reviewed for additional citations. STUDY SELECTION AND DATA EXTRACTION: All data sources were considered for inclusion. Preference was given for articles written in English, although one abstract in German was used. DATA SYNTHESIS: Because of the low incidence of persistent or intractable hiccups, few if any controlled clinical trials are conducted on the efficacy of drug treatment. Therefore, most of the data involve case reports or case series. We evaluated 17 case reports and 2 case series involving gabapentin therapy for persistent or intractable hiccups. Therapeutic outcomes with gabapentin were positive in all cases, with temporal evidence suggesting an effect, but outcomes often were obscured by combination therapy and comorbidities in some cases. Case reports suggest that gabapentin might be useful as a second-line agent in patients undergoing stroke rehabilitation or in the palliative care setting where chlorpromazine adverse effects are undesirable. Gabapentin was very well tolerated, with only a few minor adverse effects. CONCLUSIONS: Gabapentin has a similar body of evidence as other pharmacotherapeutic agents used to treat hiccups. Gabapentin is well tolerated and should be considered as a second-line agent in selected patients.

A review and assessment of drug-induced parotitis.

OBJECTIVE: To review the current literature on drug-induced parotitis. DATA SOURCES: Literature was accessed through MEDLINE/PubMed (1980-May 2012), using the search terms sialadenitis/chemically induced and parotitis/chemically induced. EMBASE (1980-May 2012) was searched using the terms parotitis/diagnosis, sialadenitis/side effect, and parotitis/side effect. International Pharmaceutical Abstracts (1970-May 2012) was searched using the search terms parotitis and sialadenitis. All searches were limited to articles on humans written in English. Inclusion criteria were published letters, case reports, reviews, and clinical trials involving drugs that may be associated with parotitis. Articles pertaining to parotitis induced by iodine-containing drugs were excluded. References of all relevant articles were reviewed for additional citations. STUDY SELECTION AND DATA EXTRACTION: Review articles, clinical trials, background data, and case reports of drug-induced parotitis were collected and case reports were assessed for causality. DATA SYNTHESIS: Parotitis is an uncommon adverse effect; however, signs and symptoms of parotitis have been noted in case reports as an adverse drug reaction related to various medications. Assessing causality of an adverse drug reaction such as parotitis is challenging. To help determine the probability of causality for these events, algorithms such as the Naranjo probability scale have been developed. Eighty-four case reports of drug-induced parotitis from 40 different drugs were reviewed using a modified Naranjo probability scale that included criteria specific for parotitis. Medications that met the criteria for establishing causality included l-asparaginase with 7 case reports, clozapine with 13 case reports, and phenylbutazone with 13 case reports. CONCLUSIONS: Drug-induced parotitis is a rare adverse drug reaction. Based on the quantitative and qualitative evidence collected from the case reports, medications that are associated with drug-induced parotitis include l-asparaginase, clozapine, and phenylbutazone. Many other drugs have been implicated in the development of parotitis; however, the evidence supporting this association is insufficient to determine causality at this time.

Pharmaceutical science faculty publication records at research-intensive pharmacy colleges and schools.

OBJECTIVE: To determine yearly (phase 1) and cumulative (phase 2) publication records of pharmaceutical science faculty members at research-intensive colleges and schools of pharmacy. METHODS: The publication records of pharmaceutical science faculty members at research-intensive colleges and schools of pharmacy were searched on Web of Science. Fifty colleges and schools of pharmacy were randomly chosen for a search of 1,042 individual faculty members' publications per year from 2005 to 2009. A stratified random sample of 120 faculty members also was chosen, and cumulative publication counts were recorded and bibliometric indices calculated. RESULTS: The median number of publications per year was 2 (range, 0-34). Overall, 22% of faculty members had no publications in any given year, but the number was highly variable depending on the faculty members' colleges or schools of pharmacy. Bibliometric indices were higher for medicinal chemistry and pharmaceutics, with pharmacology ranking third and social and administrative sciences fourth. Higher bibliometric indices were also observed for institution status (ie, public vs private) and academic rank (discipline chairperson vs non-chairperson and professor vs junior faculty member) (p<0.01 for each). The median number of cumulative publications per faculty member was 34 (range, 0-370). CONCLUSION: Significant differences exist in yearly and cumulative publication rates for faculty members and bibliometric indices among pharmaceutical science disciplines and academic ranks within research-intensive colleges and schools of pharmacy. These data may be important for benchmarking purposes.

Drug-induced black hairy tongue.

Black hairy tongue (BHT) is a benign, self-limiting disorder characterized by abnormally hypertrophied and elongated filiform papillae on the surface of the tongue. The prevalence of BHT is quite variable, ranging from 0-53.8% depending on the population. Many predisposing factors to BHT exist, and several drugs and drug classes have been implicated in causing this disorder. A modified Naranjo adverse drug reaction probability nomogram specific for BHT was used to rate causality for the available published case reports of drug-induced BHT. From the available data, antibiotics and drugs capable of inducing xerostomia are the drug classes that have modest evidence of causality and a rational mechanism. The presence of underlying predisposing factors in these cases along with the variable prevalence of BHT make drawing firm conclusions difficult. Treatment for BHT involves eliminating any predisposing issues and practicing scrupulous oral hygiene. Drug therapy and physical removal of the elongated filiform papillae are available for resistant cases. Clinicians should be aware of the prevalence, the predisposing factors and drug classes that may play a role in the development, and the treatment of BHT.

New indices in scholarship assessment.

Faculty members' contributions to research and scholarship are measured by a variety of indices. Assessment also has become an integral part of the Accreditation Council for Pharmacy Education's accreditation process for professional programs. This review describes some of the newer indices available for faculty scholarship assessment. Recently described metrics include the h-index, m-quotient, g-index, h(2) index, a-index, m-index, r-index, ar index, and the creativity index. Of the newer scholarship metrics available, the h-index and m-quotient will likely have the most widespread application in the near future. However, there is no substitute for thoughtful peer review by experienced academicians as the primary method of research and scholarship assessment.

The challenge of conflict of interest in medicine.

As the relationships between industry and medicine increase, the primary goals of medicine, -- high quality research, responsible patient care and excellent medical education -- are at risk of being compromised by the undue pursuit of financial gain. Conflict of interest policies and procedures are designed to reduce that risk. This article seeks to clarify the concept of conflict of interest, counter the most common objections to its use, and describe the various methods of regulating conflict of interest.

Publication metrics and record of pharmacy practice chairs.

BACKGROUND: Scholarship is an essential component of academic pharmacy. Department chairs are considered role models and mentors to junior faculty, but their publication record has not been documented. OBJECTIVE: To quantify publication patterns of pharmacy practice chairs in general and, specifically, at health sciences center (HSC)-based versus non-HSC-based and public versus private colleges of pharmacy. METHODS: Pharmacy practice chairs were identified using the 2006-2007 roster of faculty from the American Association of Colleges of Pharmacy. Of the 89 colleges of pharmacy in the roster, 11 listed no pharmacy practice chair and 5 listed more than one. Data were collected on the remaining 73 schools by searching each chair's name on PubMed and Web of Science (WoS). Data on total publications, publications per year, total citations, citations per article, h-index, and m quotient were collected. RESULTS: A total of 2394 papers published by 73 pharmacy practice chairs were found in a search of PubMed. The mean number of total publications per chair was 33 (95% CI 21 to 44). The mean number of publications per year was 1.4 using PubMed and 1.6 using WoS. Mean h-index was 8.0 (95% CI 6.3 to 9.6). Mean number of total citations was 410 (95% CI 252 to 568). Thirty-three percent (n = 24) had less than 10 lifetime publications and 18% had more than 50 lifetime publications. HSC-based chairs averaged 51.3 papers while non-HSC-based chairs averaged 19.1 (p < 0.01). Similar data were found for total citations (HSC = 673 vs non-HSC = 216; p < 0.001). Public school chairs had an average of 41.5 articles cited on PubMed, versus 15 for private school chairs (p < 0.01). Public school chairs had an average h-index of 9.7 versus 4.4 for private school chairs (p < 0.001), and an average of 9.2 citations per article compared with 5.2 for private school chairs (p < 0.001). CONCLUSIONS: These data provide a normative pattern of publication metrics and record for pharmacy practice chairs and demonstrate marked variability in scholarly productivity.

Identifying perceptions of professionalism in pharmacy using a four-frame leadership model.

OBJECTIVES: To determine whether professionalism in pharmacy education is addressed from Bolman and Deal's four-frame leadership model. METHODS: Students (N=624), faculty (N=57), preceptors (N=56), and academic administrators (N=8) at 6 colleges and schools of pharmacy were surveyed to assess professionalism. Using grounded theory methodology and a constant comparative process, common themes were identified for each question in each group. Themes were assigned to the four-frame model and the data were compared. RESULTS: Mechanisms of addressing professionalism consistent with all 4 frames of the Bolman and Deal's model were identified. Faculty assessment of student professionalism was significantly lower (P<0.05) than the student group, preceptors, and administrators. CONCLUSIONS: Mechanisms of addressing professionalism in pharmacy education span all four frames of Bolman and Deal's leadership model. The values students bring into a pharmacy program may play an important role in the process of professional socialization. Faculty members have a tremendous opportunity to enhance student professionalism with their daily verbal and nonverbal interactions with students.