Skolnik A.B.,Banner Good Samaritan Medical Center |
Ewald M.B.,Harvard University
Pediatric Emergency Care | Year: 2013
In the Southwestern United States, the venom of the scorpion Centruroides sculpturatus (common name bark scorpion) can cause serious and potentially fatal neurotoxicity, with young children most vulnerable to its effects. Historically, advances in the quality of supportive care have made significant improvements in morbidity and mortality. In recent years, the development of effective antivenom therapies has changed the landscape of caring for these patients. This article reviews the background, pathophysiology, diagnosis, and treatment options for C. sculpturatus envenomation. Recent advances in immunotherapy and subsequent implications for pediatric emergency care providers are discussed. Copyright © 2013 by Lippincott Williams & Wilkins.
Buckley M.S.,Banner Good Samaritan Medical Center
International journal of clinical practice. Supplement | Year: 2013
Pulmonary arterial hypertension (PAH) is a progressive disease without a cure, which can lead to right heart failure and death. Over the past decades, several therapeutic advances have been developed for the management of PAH. Although these agents have demonstrated clinical safety and efficacy, some patients may require additional drug therapy due to a lack of response or disease progression. The purpose of this review was to evaluate the safety and efficacy of various combination PAH therapies. A systematic search was conducted using the MEDLINE database (1966 and June 2012) for relevant clinical studies. Searches were limited to English, human and clinical trial using the terms sildenafil, tadalafil, vardenafil, phosphodiesterase inhibitor, prostacyclin, prostaglandin, epoprostenol, treprostinil, iloprost, beraprost, endothelin receptor antagonist, bosentan, ambrisentan, sitaxsentan and pulmonary hypertension. Overall, 22 studies met inclusion criteria. Overall, the majority of trials demonstrated clinical efficacy in improving functional class, reducing pulmonary pressure, or increasing exercise capacity. Most trials were uncontrolled with small sample sizes investigating the acute effects of combination therapy and lacking long-term clinical outcomes. Adjunctive therapy was well tolerated by most patients. Overall, combination therapy is relatively safe and well tolerated. Published guidelines provide evidence-based recommendations for monotherapy. However, suggestions for combination therapy in refractory PAH patients are lacking. Several studies evaluating several combination therapies have been published. The preferred combination treatment among several PAH drug therapies remain controversial. Therefore, clinicians should consider ease of administration, cost, and tolerability when choosing specific combination therapies. Combination therapy appears promising for patients who are refractory to treatment or whose disease progression is not well controlled with monotherapy. An optimal combination drug therapy regimen remains debatable and should be customized for individual PAH patients. Further studies are needed to determine the optimal combination therapy in PAH based upon efficacy, safety and cost. © 2013 Blackwell Publishing Ltd.
Goldenberg M.,Banner Good Samaritan Medical Center |
Danovitch I.,Cedars Sinai Medical Center |
IsHak W.W.,Cedars Sinai Medical Center
American Journal on Addictions | Year: 2014
Background and Objectives Smoking tobacco is the leading cause of preventable illness in the United States and around the world. However, much remains unknown about the factors that motivate individuals to smoke. Quality of life (QoL) has become an important measure of outcomes across all medical specialties, in both research and clinical settings. To date, there has not been a critical review of the research relevant to QoL in smokers. In this review, we describe which scales are used to quantify the QoL of smokers, the relationship between smoking and QoL and the positive impact of smoking cessation. Methods Fifty-four relevant studies are included in our review. Results Low QoL and depression are associated with higher odds of smoking initiation and lower odds of successful smoking cessation. There is a negative relationship between smoking and QoL and the magnitude of this association is related to the number of cigarettes smoked. Secondhand smoke also appears to be negatively associated with QoL. Smoking cessation significantly improves QoL. These findings have been replicated across populations with diverse socioeconomic and cultural groups around the world. Discussion and Conclusions QoL data promotes smokers and practitioners to become more sensitive to the sub-clinical adverse effects of cigarette smoking, thereby improving motivation to quit, cessation rates, and treatment outcomes. Scientific Significance Understanding the relationship between QoL and tobacco smoking is important for patients, clinicians, and researchers. (Am J Addict 2014;23:540-562) © American Academy of Addiction Psychiatry.
Buckley M.S.,Banner Good Samaritan Medical Center |
Feldman J.P.,Arizona Pulmonary Specialists Ltd
Pharmacotherapy | Year: 2010
Pulmonary arterial hypertension (PAH) is a progressive disease without a cure. The primary treatment goal for patients with this disease is improving pulmonary blood flow through vasodilation of the pulmonary arteries. Several drugs are available that ameliorate walk distance and hemodynamics, but their maximum tolerated doses are limited in critically ill patients with PAH because of systemic vasodilation resulting in hypotension. The ideal vasodilator would be cost-effective, safe, and selective to the pulmonary vasculature; no such agent currently exists. Inhaled nitric oxide selectively reduces pulmonary pressures without systemic hypotension. However, it is expensive, potentially toxic, and requires complex technology for monitoring and administration. Inhaled epoprostenol may be an alternative therapy to minimize systemic hypotension, which often accompanies rapid intravenous titration. To evaluate the safety and efficacy of inhaled epoprostenol in critically ill patients with PAH, we conducted a literature search by using the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases (1966-August 2009) for relevant studies. Case reports and in vitro studies were excluded. Overall, 11 studies met the inclusion criteria. The PAH population included patients requiring cardiac surgery, lung or heart transplantation, or nonspecific intensive care. All trials showed that inhaled epoprostenol significantly decreased pulmonary pressures without lowering systemic blood pressure. The duration of therapy in most studies was 10-15 minutes, with one study evaluating its effects up to an average of 45.6 hours. Pulmonary pressures returned to baseline soon after drug discontinuation. Minimal adverse events were reported. Thus, inhaled epoprostenol in various subgroups of critically ill patients was effective in reducing pulmonary pressures. However, the significance of these effects on improving clinical outcomes remains unknown. Further studies are needed to determine the role of inhaled epoprostenol in critically ill patients with PAH.
Harvey S.A.,Director of Learning Resources |
Wandersee J.R.,Banner Good Samaritan Medical Center
Journal of the Medical Library Association | Year: 2010
Objectives: This study sought to ascertain the publication rate of abstracts presented at the annual meetings of the Medical Library Association (MLA) for the years of 2002 and 2003. The secondary objectives were to examine possible reasons for non-publication and factors influencing publication. &Methods: A total of 442 abstracts from both meeting years, consisting of presented papers and posters, were examined. The 2 methods used to obtain a publication rate were literature searches and an online questionnaire sent to first authors. The questionnaire also asked abstract authors about reasons for non-publication and other factors that might have influenced their decisions about whether or not to submit the project for publication. &Results: The overall publication rate from the survey was 26.5%, and the publication rate found via literature searching was 27.6%. The most common reason given for non-publication was time restrictions. Also notable was the large proportion of abstracts written by librarians working at universities and those having 25 or more years in the library profession. &Discussion: Publication rates for abstracts presented at the Medical Library Association meetings for the years studied rank at the low end in comparison with other medical professional associations. Further research into factors affecting publication may reveal ways to increase this rate.