Air Medical Blood Transfusion as a Trigger of Massive Transfusion Protocol.

Air medical services can improve access to blood products at the point of injury. Studies have shown that early activation of mass transfusion protocols (MTPs) can improve the survival of trauma patients by up to 25%. There are several scoring systems to guide early activation, but the use of a single criterion has been elusive. Our study sought to determine if air medical administration of blood products was a risk factor for massive transfusion activation and utilization of prehospital vital signs for calculation of the shock index. In our retrospective study, we evaluated adult trauma patients transfused by helicopter emergency medical services (HEMS) and as a control all patients in our institution receiving the MTP. Our study found HEMS blood transfusion was not a reliable trigger for MTP, although the sample size may have limited our findings. We found that HEMS care resulted in an overall reduction in the volume of transfusion and an improvement in hemodynamic parameters upon trauma center arrival. HEMS transfusion and a higher rate of tranexamic acid administration may have contributed to these findings. Of note, the assessment of blood consumption score and shock index were nonspecific in the study populations.

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.

The fingerprint nature of PCDD in iron ore sinter strand emissions, the effect of suppressants and alternative fuels, and the potential for comparison with the isomer profile of PCDF.

It has been previously shown that the isomer profile of PCDF emissions from iron ore sinter plant only varies within limits even when suppressants or alternative fuels are added, to the extent that it can be said to have a 'fingerprint'. The isomer profiles of PCDD from tetra- to hexacholrodibenzo-p-dioxin from the same samples examined for PCDF emissions have been obtained, and show the same tendency for a 'fingerprint ' isomer distribution to occur. Occasional exceptionally high isomer abundances are observed, but these are uncommon. The potential for comparison of the abundances of PCDF and PCDD isomers with similar chlorination patterns to determine whether the same formation process is involved has been examined. It is found that co-elutions prevent extensive comparisons irrespective of whether the SP2331 or DB5ms column is used in the analyses for separation of isomers to provide the results used for comparisons, although they allow limited results to be obtained. It is suggested that analyses using the two chromatography columns to analyse the same sample in parallel could provide more resolution of the isomer profiles for use in comparisons. A pilot study using samples analysed using each column is limited because of detailed differences in the emissions profiles, but demonstrates that greater resolution is possible if the two columns are used to analyse one sample.

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.

Coping Strategies and Depression Among College Students Following Child Sexual Abuse in Turkey.

The objective of this study was to investigate the relationship between type of coping style and depression in college students with child sexual abuse experience. A total of 1,055 college students completed self-report measures to assess depressive symptoms, coping strategies, and child sexual abuse history. This study was conducted with a subset of 125 college students who reported that they had been sexually abused in childhood. They were divided into depressive and nondepressive groups according to their depressive symptoms. Data was collected with the Childhood Sexual Abuse Measurement, the Beck Depression Inventory, and the Coping Styles of Stress Scale. Family characteristics were measured with a demographic questionnaire. Analyses involved multiple regression to test for predictive effects. Among college students with child sexual abuse histories, parental education level and both problem-focused and emotion-focused strategies significantly explained depression scores.

Developmental Psychology in the 1920s: A Period of Major Transition.

A 1918 survey (H. E. Jones, 1956 ) indicated that only 3 psychologists in the United States expressed an interest in conducting research on child development. By the end of the 1920s there were more than 600 who expressed such an interest, and their areas of inquiry encompassed not only child development but also adolescence, the lifespan, and old age. The author explores the factors and people that contributed to this remarkable transition and highlights some of the major contributions that resulted from their work.

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.

The polychlorinated dibenzofuran fingerprint of iron ore sinter plant: Its persistence with suppressant and alternative fuel addition.

An earlier demonstration that the relative concentrations of isomers of polychlorinated dibenzofuran do not vary as the flamefront of an iron ore sinter plant progresses through the bed, and profiles are similar for two sinter strands has been widened to include studies of the similarity or otherwise between full scale strand and sinter pot profiles, effect of addition of suppressants and of coke fuel substitution with other combustible materials. For dioxin suppressant addition, a study of the whole of the tetra- penta- and hexaCDF isomer range as separated by the DB5MS chromatography column, indicates no significant change in profile: examination of the ratios of the targeted penta- and hexaCDF isomers suggests the profile is similarly unaffected by coke fuel replacement. Addition of KCl at varied levels has also been shown to have no effect on the 'fingerprint' and there is no indication of any effect by the composition of the sinter mix. The recently published full elution sequence for the DB5MS column is applied to the results obtained using this column. It is confirmed that isomers with 1,9-substitution of chlorine atoms are invariably formed in low concentrations. This is consistent with strong interaction between the 1 and 9 substituted chlorine atoms predicted by DFT thermodynamic calculations. Non-1,9-substituted PCDF equilibrium isomer distributions based on DFT-derived thermodynamic data differ considerably from stack gas distributions obtained using SP2331 column separation. A brief preliminary study indicates the same conclusions (apart from the 1,9-interaction effect) hold for the much smaller content of PCDD.

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.

Amino acid quantification in bulk soybeans by transmission Raman spectroscopy.

Soybeans are a commodity crop of significant economic and nutritional interest. As an important source of protein, buyers of soybeans are interested in not only the total protein content but also in the specific amino acids that comprise the total protein content. Raman spectroscopy has the chemical specificity to measure the twenty common amino acids as pure substances. An unsolved challenge, however, is to quantify varying levels of amino acids mixed together and bound in soybeans at relatively low concentrations. Here we report the use of transmission Raman spectroscopy as a secondary analytical approach to nondestructively measure specific amino acids in intact soybeans. With the employment of a transmission-based Raman instrument, built specifically for nondestructive measurements from bulk soybeans, spectra were collected from twenty-four samples to develop a calibration model using a partial least-squares approach with a random-subset cross validation. The calibration model was validated on an independent set of twenty-five samples for oil, protein, and amino acid predictions. After Raman measurements, the samples were reduced to a fine powder and conventional wet chemistry methods were used for quantifying reference values of protein, oil, and 18 amino acids. We found that the greater the concentrations (% by weight component of interest), the better the calibration model and prediction capabilities. Of the 18 amino acids analyzed, 13 had R(2) values greater than 0.75 with a standard error of prediction c.a. 3-4% by weight. Serine, histidine, cystine, tryptophan, and methionine showed poor predictions (R(2) < 0.75), which were likely a result of the small sampling range and the low concentration of these components. It is clear from the correlation plots and root-mean-square error of prediction that Raman spectroscopy has sufficient chemical contrast to nondestructively quantify protein, oil, and specific amino acids in intact soybeans.

Infections in outpatient surgery.

In the plastic surgery patient population, outpatient surgery is cost effective and will continue to grow as the preferred arena for performing surgery in healthy patients. Although there is a widespread myth that outpatient surgery centers may suffer from increased infection rates due to lax infection control, the data presented from American Association for Accreditation of Ambulatory Surgery Facilities-accredited facilities prove the contrary. There is a lack of data investigating infection prevention in the perioperative period in plastic surgery patients. As data collection becomes more refined, tracking the postoperative care environment should offer additional opportunities to lower the incidence of postoperative infections.

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.