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Biomedical subjects

Kelly M Smith

Publications and source records attributed to Kelly M Smith.

At least 55 records · Page 3Linked to original sources
PubMed2005

The Canadian off-pump coronary artery bypass graft registry: a one-year prospective comparison with on-pump coronary artery bypass grafting.

BACKGROUND: The authors sought to examine in-hospital and one-year outcomes of off-pump coronary artery bypass grafting (CABG) and to determine the subgroups of patients most likely to benefit from the off-pump procedure in a regular surgical practice. METHODS: From March 2001 to December 2002, 1657 consecutive patients were treated with off-pump CABG and 1693 consecutive patients were treated with on-pump CABG. Propensity score modelling was performed to control for treatment and selection bias. A propensity-matched analysis was performed to identify factors associated with survival benefit from the off-pump procedure. RESULTS: The mortality was similar postoperatively and at one year after surgery. The rate of stroke was decreased in the off-pump group postoperatively (OR=0.49, 95% CI 0.23 to 1.06) and significantly at one year after surgery (OR=0.49, 95% CI 0.27 to 0.90). A significant reduction in acute renal dialysis and a significant increase in myocardial infarction rates were seen in off-pump patients during the initial hospitalization but these differences disappeared during the follow-up period. The number of grafts completed was significantly lower in off-pump CABG than in on-pump CABG (2.62+/-1.00 versus 3.36+/-0.92, respectively; P<0.001). Hospital length of stay and the percentage of patients who required mechanical ventilation were significantly lower in the off-pump group than in the on-pump group. At one year after surgery, the adjusted rate of coronary angiogram and revascularization was similar between the two groups, and the adjusted rate of self-reported angina and memory status was significantly better in the off-pump CABG group. Almost all subgroups of patients had a neutral effect or a survival benefit with the off-pump technique. CONCLUSIONS: The results from a Canada-wide multicentre registry showed the safety and effectiveness of off-pump CABG in most subgroups of patients in a regular surgical practice.

Canada↗
PubMed2004

Pharmacy residency training in academic medical centers.

PURPOSE: A survey of U.S. academic medical centers (AMCs) was conducted to identify the most important and challenging issues in pharmacy residency training. METHODS: A questionnaire addressing program characteristics and residency training concerns was sent electronically to pharmacy directors at 130 AMCs that are members or associate members of the University HealthSystem Consortium (UHC). Residency coordinators for both pharmacy practice and specialized programs were asked to complete the questionnaire, with input from other pharmacists involved in the residency program. Respondents were asked to rate the importance and degree of challenge for all issues on a 5-point Likert scale, where 1 = least important or least challenging and 5 = most important or most challenging. RESULTS: Responses were received from hospitals representing over 60% of all residency positions offered by UHC member hospitals. Recruitment was rated the most important issue (mean importance score, 4.8) facing residency programs in AMCs, but with over 85% of budgeted positions filled, programs appear to be successful in overcoming this concern. The most challenging issue (mean challenge score, 4.2) was compliance with the evaluation and documentation elements of the ASHP Residency Learning System (RLS), a system often used to meet requirements for pharmacy practice residency accreditation. The completion of resident research requirements was ranked as both an important and a challenging issue (mean importance score, 4.5; mean challenge score, 3.9). CONCLUSION: A survey of AMCs showed that they offered a wide variety of pharmacy residency programs and filled most budgeted resident positions. Resident recruitment, the RLS, and research requirements are the most important and challenging residency concerns facing the respondents.

Academic Medical Centers↗
PubMed2004

Recreational use of sildenafil by HIV-positive and -negative homosexual/bisexual males.

OBJECTIVE: To conduct an epidemiologic review of sildenafil in homosexual and bisexual males focusing on concurrent use with club drugs and/or antiretroviral medications. DATA SOURCES: A search of MEDLINE was conducted (1966-September 2003), and an extensive manual review of journals was performed using the key search terms club drugs, sildenafil, antiretrovirals, and HIV. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated and information deemed relevant was included. DATA SYNTHESIS: Several epidemiologic studies have reported that sildenafil is abused in a recreational fashion, typically with agents commonly known to be "club drugs." In this setting, sildenafil may reverse the impotence-inducing effects of the club drugs and restore sexual capabilities. Many implications of both recreational and nonrecreational use of sildenafil exist in relation to HIV disease. Concern has been raised regarding the potential effects on high-risk sexual practices. Also, several researchers have documented interactions between sildenafil and various club drugs, as well as with antiretrovirals intended for HIV disease. CONCLUSIONS: Serious concerns exist regarding the concurrent use of sildenafil with antiretrovirals and/or club drugs. Clinicians prescribing sildenafil to patients receiving protease inhibitor-containing antiretroviral regimens should be aware of the potential for reduced sildenafil metabolism with resultant adverse effects. Additionally, untoward effects may also occur when sildenafil is used concurrently with various club drugs including amyl and butyl nitrites ("poppers").

Anti-HIV Agents↗
PubMed2004

Isotretinoin in the treatment of granuloma annulare.

OBJECTIVE: To assess the utility and safety of isotretinoin in the treatment of granuloma annulare (GA). DATA SOURCES: Searches of MEDLINE (1966-January 2003), EMBASE (1989-January 2003), International Pharmaceutical Abstracts (1970-2002), and Allied and Complementary Medicine Database (1985-2002) were conducted. Key terms included granuloma annulare, isotretinoin, retinoids, and antioxidants. DATA SYNTHESIS: Isotretinoin may have proliferative and inhibitory effects on collagen synthesis that improve GA symptoms. Cases reporting use of isotretinoin in the treatment of GA were reviewed. Several reports detail the successful use of isotretinoin 0.5-1 mg/kg/day, primarily in the disseminated form of the disease. However, some patients required dosage decreases in response to drug-related liver function test elevations, and 2 instances of drug failure were identified. CONCLUSIONS: Isotretinoin should be reserved for patients with disseminated or refractory GA. Potential serious adverse effects associated with its use require careful monitoring.

Adult↗
PubMed2004

Differences in sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation.

BACKGROUND: Home-based cardiac rehabilitation (CR) has been demonstrated to be as effective as institution-based CR in post-coronary artery bypass graft surgery (CABG) patients in terms of short-term physical and psychosocial outcomes. The sustainability of these effects is less well studied. The aim of this study was to examine the sustainability of observed changes in physical, quality of life (HRQL), and social support (SS) outcomes in patients 12 months after discharge from a randomized controlled trial (RCT) of 6 months of monitored home-based versus supervised hospital-based CR. DESIGN: Two-hundred and twenty-two (n=222) patients were followed-up 12 months after discharge from a RCT of 6 months of monitored 'Home' versus supervised 'Hospital' CR after CABG. METHODS: At discharge from the 6-month RCT, participants who consented to the 12-month follow-up study, were given individualized guidelines for ongoing exercise, and were not contacted for 1 year. The primary outcome was peak oxygen uptake (VO2). Secondary outcomes were: HRQL, SS and habitual physical activity. RESULTS: One hundred and ninety-eight patients (89.2%), 102 'Hospital' and 96 'Home', returned for follow-up 12-months after discharge from CR. Both groups had similar medical and socio-demographic characteristics. Peak VO2 declined in 'Hospital' but was sustained in 'Home' patients 12 months after discharge from CR (P=0.002). Physical HRQL was higher in the 'Home' group at the 12-month follow-up (P<0.01). Mental HRQL showed general, minor deterioration over time in both groups (P=0.019). Twelve months after discharge from CR, physical and mental HRQL remained higher than at entry to CR in both groups. 'Home' patients had higher habitual physical activity scores compared to 'Hospital' patients. CONCLUSIONS: This follow-up study suggests that low-risk patients whose CR is initiated in the home environment may be more likely to sustain positive physical and psychosocial changes over time than patients whose program is initially institution-based.

Aged↗
PubMed2004

Poppers: epidemiology and clinical management of inhaled nitrite abuse.

Commonly referred to as "poppers," inhaled nitrites have a long history of abuse. Poppers are rapid-onset, short-acting potent vasodilators that produce a rush characterized by warm sensations and feelings of dizziness. Poppers sometimes are used to facilitate anal intercourse because of their actions on the anal sphincter. Epidemiologically, the frequent use of nitrites by men who have sex with men has led some experts to implicate these chemicals in the pathogenesis of Kaposi's sarcoma and acquired immunodeficiency syndrome. Controlled clinical trials to examine this potential correlation have not been conducted, and the use of nitrites simply may be a marker for other high-risk behaviors such as unprotected sex. Although regulated in the United States, many nitrite compounds and isomers are sold at various venues including bars, bookstores, and over the Internet. Adverse effects associated with these products vary from mild allergic reactions to life-threatening methemoglobinemia. The potential for drug-drug interactions and a propensity toward unsafe sex also exist. Clinicians should be familiar with the populations most likely to abuse these agents and with the clinical effects and management guidelines for acute ingestions.

Administration, Inhalation↗
PubMed2004

Board of Pharmaceutical Specialties-certified faculty: a survey of United States colleges of pharmacy.

Board certification of pharmacists has been a reality in the United States since 1976, when the Board of Pharmaceutical Specialties (BPS) was founded. Little has been reported about the effects of board certification of pharmacists, particularly pharmacy practice faculty, since 1992, when the BPS administered its first certification examination. We developed and pretested a survey to describe and measure the effect of BPS certification on the realm of academia as perceived by deans of colleges of pharmacy in the United States. Deans or other appropriate officials at all 84 colleges of pharmacy in the United States were asked to complete and submit this 13-question survey, which was administered through the Web and maintained respondents' anonymity. Officials from 35 of the 84 colleges completed the survey, for a response rate of 42%. No college reported that board certification was a condition for employment. Eight schools (23%) anticipated a certification requirement in the future. The most commonly reimbursed items associated with certification were fees for the American College of Clinical Pharmacy preparatory course and the BPS examination. Twelve schools (34%) provided no reimbursement toward certification. The most common incentive for faculty to obtain certification was consideration in promotion and tenure (66%). We believe that this information will facilitate efforts to gauge the effects of BPS certification on colleges of pharmacy. We also anticipate that it will assist colleges as they attempt to recruit and retain the most qualified faculty members possible, particularly in light of the national pharmacist shortage.

Certification↗
PubMed2004

Chloroquine and hydroxychloroquine as inhibitors of human immunodeficiency virus (HIV-1) activity.

Recent advances in the development of antiretrovirals have significantly extended life-spans and positively impacted morbidity of HIV-seropositive patients. While effective, antiretrovirals are associated with complex medication regimens, large pill burdens, and significant side effects which may impact quality of life. Researchers continue to examine various chemical entities in their search for agents with anti-HIV activity. Ideal agents would be efficacious, easily dosed and administered, inexpensive, and with few adverse effects. Chloroquine and its analog hydroxychloroquine are two inexpensive agents that are widely used for the treatment of malaria and have been shown to achieve some level of anti-HIV activity. The exact mechanism of chloroquine and hydroxychloroquine's anti-HIV activity has not yet been discerned but may be related to effects on HIV's surface envelope glycoprotein 120. If found efficacious, both drugs would offer significant advantages to current therapy including a unique mechanism of action, lack of cross-resistance with other antiretrovirals, and low cost. Early and limited in vitro and in vivo data have demonstrated modest anti-HIV efficacy as indicated by measures of viral burden. Effects on CD4+ cell counts have not been as pronounced. It is premature to advocate the use of either of these agents in the management of routine HIV disease; however; the drugs should be further studied to determine their benefit in the treatment of patients who have exhausted all standard treatments. Larger, well-controlled trials are needed to discern the potential role of chloroquine and hydroxychloroquine in the management of HIV.

Animals↗
PubMed2004

Is this patient penicillin-allergic?

Increased claims of hypersensitivity reactions are being reported due to the inability to differentiate between the terms "allergic reaction" and "adverse effect."

Anti-Bacterial Agents↗
PubMed2004

Low-molecular-weight heparin use in special populations.

Because many obese patients and patients with underlying renal dysfunction require surgical intervention, it is important to examine the dosage recommendations and monitoring required with low-molecular-weight heparins.

Anticoagulants↗
PubMed2003

Evolution and operation of a pharmacy residency on-call program.

A pharmacy residency on-call program designed to contribute to residents' competence in patient care and to extend the functions of the pharmacy department is described. The program, which was begun at the University of Kentucky Chandler Medical Center in 1984, offers a supportive environment in which the resident is held accountable for pursuing optimal outcomes of drug therapy. The program provides opportunities for the resident to engage in independent decision-making, care for a wide variety of patients, and manage acute illness. On-call services are provided in single 24-hour shifts beginning at 0800 each day. Residents assess and respond to supratherapeutic serum drug concentrations, perform pharmacokinetic monitoring, provide drug information, evaluate patients for specific drug therapy, obtain medication histories for HIV-seropositive patients, and participate in emergency patient management. Residents provide services in the absence of the primary pharmacist on nights, weekends, and holidays and devote a four-hour period to drug distribution. Each pharmacy resident participates in the on-call program, regardless of the chief focus of his or her residency. Residents' activities are documented electronically, and preceptors give feedback via e-mail. The program and its activities have evolved over the years to reflect changes in pharmacy practice. An on-call program for pharmacy residents provides a valuable learning experience while enhancing patient care.

Education, Pharmacy, Graduate↗
PubMed2003

Patient acceptance of fluorescent and reflective spectroscopy as a replacement test for the pap smear.

OBJECTIVE: To determine women's acceptance of fluorescent and reflective spectroscopy (FRS) as a potential replacement test for the Pap smear. MATERIALS AND METHODS: Women scheduled for a colposcopic examination, or a colposcopic and FRS examination, completed a 22-item questionnaire that included demographic data, medical history, and preference-type questions. Data were compared using chi and Wilcoxon's rank sum tests. RESULTS: Women considered accuracy, comfort, and quick results to be the most important characteristics for new cervical cancer tests. Immediate test results were preferred strongly by both groups (control, 84.5%; scanned, 88.6%). Provided FRS was more accurate than the Pap smear, most women (control, 74.7%; scanned, 68.2%) would rather have FRS if it cost the same as a Pap smear. CONCLUSIONS: Women consider accuracy, comfort, and time critical issues with respect to FRS used as a primary screening test. Acceptance of this new technology will be facilitated by designing equipment accordingly to satisfy the concerns of women.

Journal Article↗
PubMed2003

Women's responses to cervical interrogation by fluorescent and reflective spectroscopy.

OBJECTIVE: To determine women's responses to cervical interrogation by fluorescent and reflective spectroscopy (FRS). MATERIALS AND METHODS: A convenience sample of women scheduled for a colposcopic examination was interrogated by a cervical FRS system. Thereafter, women completed a 24-item questionnaire that assessed their responses to the spectroscopic test. Likert-scale responses were compared among subgroups using the chi test for trend. RESULTS: Most women favored FRS used for locating (97.7%; 170/174) and selectively sampling (96.6%; 168/174) cervical neoplasia. Fewer women (81.0%; 141/174) wanted FRS to replace the Pap smear. Most women were neither nervous (73.6%; 128/174) nor bothered (89.1%; 155/174) by the extra time for the FRS assessment. Women's acceptance was substantiated by 84.9% (146/174) and 90.8% (157/173) wanting their doctor to have and insurance company to pay for FRS, respectively. CONCLUSIONS: Use of FRS as a colposcopic adjunct was supported very favorably by women. Fewer women supported FRS replacing Pap smears. These high rates of approval by women should help the implementation of FRS technology.

Journal Article↗
PubMed2003

The effect of oxygenator membranes on blood: a comparison of two oxygenators in open-heart surgery.

Open-heart surgery (OHS) requires cardiopulmonary bypass (CPB) in most patients. Membrane oxygenators are a critical component of the CPB system. Despite advancements in CPB technology, injury to blood components during CPB still occurs and may result in complications after surgery. The purpose of the present study was to evaluate the performance of the Medtronic Affinity NT with Trillium coating and the Cobe Optima XP oxygenators and compare their influence on blood components. Two hundred and fifty-six male and female patients scheduled for urgent or elective cardiac surgery with CPB were randomly assigned to either the Affinity NT or the Optima XP oxygenators. Outcomes included platelets, hemoglobin, leukocyte counts, and O2 transfer, measured preoperatively and at 15, 45 and 75 min of CPB time. Blood loss was measured at six and 12 hours postoperatively. A modified intention-to-treat analysis was conducted. The two groups were similar for age, sex, height, weight, body surface area, and blood components at baseline. There were no differences between the Affinity NT and Optima XP for any outcome measure, although a significant change with time was seen in platelets, hemoglobin, hematocrit and leukocytes, as well as O2 transfer for both groups (p < 0.001). The Affinity NT oxygenator had a significantly lower difference in pressure across the membrane (p < 0.001) compared with the Optima XP. In conclusion, the two oxygenators performed similarly with respect to their impact on blood components, O2 transfer, and blood loss postoperatively during OHS with CPB. The Affinity NT had the smaller transmembrane pressure drop of the two.

Aged↗