Search PubMed⌕ Search

Biomedical subjects

Robert L Talbert

Publications and source records attributed to Robert L Talbert.

31 records · Page 2Linked to original sources
PubMed2003

Impact of atypical coverage for patients with community-acquired pneumonia managed on the medical ward: results from the United States Community-Acquired Pneumonia Project.

STUDY OBJECTIVE: As current guidelines for treatment of community-acquired pneumonia (CAP) recommend empiric antimicrobial coverage for atypical pathogens, we evaluated the need for atypical coverage by examining length of hospital stay (LOS) and mortality in patients with CAP who were managed on the medical ward. METHODS: Medical records of patients with CAP admitted from January 1, 1997-December 31, 2001, from 176 United States nonteaching community hospitals were reviewed. Patients were divided into one of three mutually exclusive groups on the basis of intravenous antimicrobials received on days 1 or 2 of hospital stay: ceftriaxone monotherapy, ceftriaxone plus a macrolide, or levofloxacin. Variables evaluated for their ability to predict outcome were patient age, year of hospital admission, geographic region, preadmission setting, preadmission antimicrobial treatment, timing of antimicrobial administration, comorbid disease, and duration of intravenous antimicrobial treatment. The impact of initial antimicrobial regimen on LOS and mortality was evaluated in regression models while controlling for significant predictors of outcome. RESULTS: Of 8975 patients evaluated, 2453 met the inclusion criteria. Significant differences were noted among patients who received ceftriaxone (932 patients), ceftriaxone plus a macrolide (872), and levofloxacin (649) with respect to mean +/- SD age (72 +/- 16, 67 +/- 18, and 70 +/- 17 yrs, respectively; p<0.0001), admission from a nursing home (21%, 11%, and 15%, respectively; p<0.0001), and duration of intravenous antimicrobial treatment (4.4 +/- 2.7, 4.0 +/- 2.6, and 3.6 +/- 2.5 days, respectively; p<0.0001). The LOS predictors were age, geographic region, coexisting heart failure, and duration of intravenous antimicrobial therapy. Mortality predictors were age, admission from a nursing home, coexisting heart failure, and coexisting cancer. After controlling for these predictors of outcome, no significant differences were noted among the three groups for LOS (5.5 +/- 3.5, 4.8 +/- 2.9, and 4.8 +/- 2.9 days, respectively; p=0.2791) or mortality (3.1%, 2.0%, and 2.6%, respectively; p=0.8461). CONCLUSION: Initial coverage for atypical pathogens does not affect LOS or mortality among patients with CAP managed on the medical ward.

Aged↗
PubMed2003

Aspirin dosage and thromboxane synthesis in patients with vascular disease.

STUDY OBJECTIVE: To determine whether urinary 11-dehydrothromboxane B2 (d-TXB2) is a marker of aspirin resistance and define the relationship between aspirin dosage and concentrations of this thromboxane metabolite. DESIGN: Randomized, crossover study. SETTING: Two outpatient clinical centers. PATIENTS: Forty-eight patients (mean age 70 yrs) with vascular disease (52% clinical coronary artery disease, 29% cerebrovascular disease, 46% atrial fibrillation). INTERVENTION: Levels of serum thromboxane B2 and d-TXB2 were measured after patients were treated initially with aspirin 325 mg/day for 4 weeks, then again after random assignment to receive aspirin 81, 325, or 1300 mg/day for 4 weeks, and then again after resumption of 325 mg/day for 4 weeks. MEASUREMENTS AND MAIN RESULTS: During treatment with aspirin 325 mg/day, the mean +/- SD serum thromboxane B2 level was 0.9 +/- 1.2 ng/ml and median (interquartile range) was 0.4 (0.2-0.9) ng/ml. Mean urinary d-TXB2 was 16 +/- 7.9 ng/mmol creatinine, with a median of 15 (9.9-23) ng/mmol creatinine with aspirin 325 mg/day. After 4 weeks of aspirin 81 mg/day, levels of serum thromboxane B2 (p<0.01) and urinary d-TXB2 (p=0.04) were both significantly higher compared with aspirin 325 mg/day; for urinary d-TXB2, the median increase was 3.0 ng/mmol creatinine. After 4 weeks of treatment with aspirin 1300 mg/day, levels of serum thromboxane B2 (p<0.01) and urinary d-TXB2 (p<0.01) were both significantly lower compared with aspirin 325 mg/day; the median decrease in urinary d-TXB2 was 4.4 ng/mmol creatinine. CONCLUSION: Different aspirin dosages significantly affect serum and urinary markers of thromboxane synthesis.

Aged↗
PubMed2002

Effect of fluvastatin and pravastatin, HMG-CoA reductase inhibitors, on fluconazole activity against Candida albicans.

Synergy between fluvastatin, at clinically unachievable concentrations, and fluconazole against Candida albicans has been reported. The purpose of the present study was to evaluate the in-vitro activity of fluconazole alone and in combination with clinically achievable concentrations of pravastatin and fluvastatin against C. albicans. In-vitro susceptibility and synergy testing were performed against clinical isolates of C. albicans with fluconazole, pravastatin and fluvastatin. Both checkerboard method and time-kill studies were performed. MICs for fluconazole ranged from 0.5 (susceptible) to >256 mg/L (resistant) at 24 h. All isolates had MICs >2 mg/L for both statins. No synergy or antagonism was observed with fluconazole in combination with either agent against any isolate of C. albicans by the checkerboard assay or time-kill studies. Clinically achievable concentrations of pravastatin and fluvastatin did not affect the in-vitro activity of fluconazole against C. albicans.

Antifungal Agents↗
PubMed2002

A review of vasopeptidase inhibitors: a new modality in the treatment of hypertension and chronic heart failure.

Vasopeptidase inhibitors are a group of agents capable of inhibiting neutral endopeptidase and angiotensin-converting enzymes, which leads to potentiation of natriuretic peptide actions and suppression of the renin-angiotensin-aldosterone system. With this distinctively characteristic mechanism, these agents have emerged as a new drug class for management of hypertension and heart failure. Several vasopeptidase inhibitors are under clinical investigation. Omapatrilat is the most studied agent in this class. Clinical studies of omapatrilat in hypertension have consistently shown the agent's effectiveness in a variety of patient populations. In patients with heart failure, omapatrilat significantly improved neurohormonal and hemodynamic status. Long-term effects of omapatrilat in patients with heart failure recently were compared with those of conventional therapy in a large phase II trial. Results of the study appear promising. Large clinical trials are ongoing, and additional information regarding safety and efficacy from these studies may help define the place in therapy for this agent.

Amlodipine↗
PubMed2002

Combination antiplatelet therapy: implications for pharmacists.

OBJECTIVES: To present two case reports of patients who received suboptimal oral antiplatelet therapy and to review recent changes in national guidelines for management of acute coronary syndromes. DATA SOURCES: Personal observation by the authors, and clinical practice guidelines and related clinical trials of the American Heart Association and the American College of Cardiology. SUMMARY: The American College of Cardiology and the American Heart Association revised the guidelines for administration of antiplatelet and anticoagulant therapy in patients with unstable angina and non-ST-segment elevation myocardial infarction in March 2002. Two cases observed by the authors illustrate the consequences of suboptimal antiplatelet therapy when a combination of two antiplatelet drugs should have been administered. CONCLUSION: Evidence from recent randomized controlled trials led to changes in the national guidelines for administration of oral antiplatelet therapy in patients with acute coronary syndromes. Pharmacists should be aware of these changes and counsel patients about appropriate administration of antiplatelet drugs.

Adult↗
PubMed2002

Modification of high-density lipoprotein cholesterol in the management of cardiovascular risk.

Although several clinical trials clearly demonstrate a decrease in mortality and morbidity rates for various patient populations with cardiovascular disease, this disease continues to be the leading cause of death in the United States. Based on various practice surveys and descriptive reports, clinicians apparently are not identifying patients at risk or not treating them to established goals set by national guidelines. Most evidence, including the updated National Cholesterol Education Program Adult Treatment Panel III guidelines, support low-density lipoprotein cholesterol (LDL) as the principal target for intervention. The guidelines also emphasize that a low level of high-density lipoprotein cholesterol (HDL) alone or in association with hypertriglyceridemia increases the risk of cardiovascular disease; also, epidemiologic data taken as a whole signify that a 1% decrease in HDL levels is associated with a 2-3% increase in risk of coronary heart disease. Low HDL levels occur more frequently than once thought, especially in selected populations such as patients with type 2 diabetes and men. Therapeutic lifestyle changes should be implemented first for any lipid disorder. In patients for whom this approach is not adequate, LDL levels need to be lowered to goals based on risk assessment. In addition, low HDL levels and/or hypertriglyceridemia should be managed with a niacin or fibrate product. However, increases in HDL levels and reductions in triglyceride levels are modest with fibrates compared with the dose-related changes seen with niacin products. Reformulation of niacin into an extended-release form minimizes common adverse effects seen with crystalline or sustained-release niacin, and the beneficial effects on the lipid profile are maintained.

Cardiovascular Diseases↗
PubMed2002

New therapeutic options in the National Cholesterol Education Program Adult Treatment Panel III.

Coronary heart disease (CHD) is a common, costly, and undertreated disorder in the United States, and dyslipidemia is one of its most important modifiable risk factors. Recently, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) published updated guidelines for the treatment of lipid disorders, greatly expanding the number of patients eligible for therapy. In the new recommendations, several significant changes have been made in the identification and management of patients at risk for CHD. Although ATP III maintains that low-density lipoprotein (LDL) cholesterol should be the primary target of lipid-lowering therapy, it identifies non-high-density lipoprotein (HDL) cholesterol (total cholesterol minus HDL cholesterol) as a secondary target in patients with elevated triglycerides. Patients with > or = 2 CHD risk factors should now be assessed for 10-year absolute CHD risk based on the Framingham Point Scale to identify those who require more aggressive treatment. The guidelines also designate a new category, CHD risk equivalent, which recognizes that certain patients have the same high risk as those with established CHD. Diabetes is now identified as a CHD risk equivalent, as are other forms of atherosclerotic disease and multiple risk factors comprising a CHD 10-year risk of > 20%. New lipoprotein classifications are given, and increased emphasis is placed on the metabolic syndrome, a constellation of metabolic risk factors, as a marker for CHD risk. Since adherence poses a major challenge in the management of patients with or at risk for CHD, the new guidelines provide physicians with several strategies for increasing patient compliance. The new guidelines should help physicians better identify and manage patients at risk for CHD, help more patients reach their lipid goals, and thereby decrease cardiovascular morbidity and mortality.

Adult↗
PubMedDate not supplied

The COMET trial.

Explore the source record for details and available documents.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Combination antiplatelet therapy: implications for pharmacists.

OBJECTIVES: To present two case reports of patients who received suboptimal oral antiplatelet therapy and to review recent changes in national guidelines for management of acute coronary syndromes. DATA SOURCES: Personal observation by the authors, and clinical practice guidelines and related clinical trials of the American Heart Association and the American College of Cardiology. SUMMARY: The American College of Cardiology and the American Heart Association revised the guidelines for administration of antiplatelet and anticoagulant therapy in patients with unstable angina and non-ST-segment elevation myocardial infarction in March 2002. Two cases observed by the authors illustrate the consequences of suboptimal antiplatelet therapy when a combination of two antiplatelet drugs should have been administered. CONCLUSION: Evidence from recent randomized, controlled trials led to changes in the national guidelines for administration of oral antiplatelet therapy in patients with acute coronary syndromes. Pharmacists should be aware of these changes and counsel patients about appropriate administration of antiplatelet drugs.

Adult↗
PubMedDate not supplied

National survey of pharmacists about coronary heart disease, hypercholesterolemia, nonprescription statintherapy, and pharmacists' services.

OBJECTIVE: To determine the beliefs and attitudes of pharmacists about the significance of high blood cholesterol, coronary heart disease (CHD), nonprescription statin therapy for patients at moderate risk for CHD, and their role in support of cholesterol-lowering treatments in patients. DESIGN: Cross-sectional survey. SETTING: Nationwide sample of licensed pharmacists in ambulatory practice in the United States drawn randomly from databases of the American Pharmacists Association. PARTICIPANTS: 104 independent pharmacists and 169 chain pharmacists. INTERVENTION: Web-based survey. MAIN OUTCOME MEASURE: Respondents' indication of strong agreement with questionnaire statements (selecting 8, 9, or 10 on a 10-point scale). RESULTS: The survey found that 75% and 61% of pharmacists believed strongly that CHD and high blood cholesterol levels, respectively, are significant health problems facing Americans, and 60% believed that not enough is currently being done to reduce this risk. Pharmacists indicated that they very regularly advised patients about prescription and nonprescription treatments (75%) and encouraged adherence to them (78%); a smaller but substantial proportion regularly monitored patient response to prescription (33%) and nonprescription therapies (15%) and provided point-of-care cholesterol testing (7%). The survey also revealed that the majority of pharmacists (68%) would support consumers interested in purchasing a nonprescription statin product and 82% believed such a product would be more effective than currently available cholesterol-lowering dietary supplements. Pharmacists were concerned that patients pursuing nonprescription statins might discontinue their prescription cholesterol-lowering medications (79%), experience adverse effects (79%), and not be able to self-manage their use of a nonprescription statin product (78%). CONCLUSION: Community pharmacist members of APhA believe that CHD and cholesterol are important problems facing many people, routinely provide services that support patients who wish to self-administer nonprescription therapies, and would be interested in supporting consumers who wish to carry out therapy with a nonprescription statin.

Attitude of Health Personnel↗
PubMedDate not supplied

Treatment of acute and chronic heart failure.

Heart failure is a common, costly, and generally fatal condition that most often results from coronary artery disease or hypertension. All patients with heart failure need education about the importance of sodium restriction and daily weight monitoring. Most patients with heart failure require combination therapy that includes a diuretic, an ACE inhibitor, a beta-blocker, and digoxin. Selected patients may benefit from alternative or additional medications, such as anticoagulants in individuals with atrial fibrillation or ARBs in those who cannot tolerate ACE inhibitor therapy. Investigational medications and devices for heart failure are under active study.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Safety issues with statin therapy.

OBJECTIVE: To describe the most important potential adverse effects related to statin therapy, discuss mechanisms of toxicity and drug interactions, and suggest approaches for enhancing safety with statin therapy. DATA SOURCES: Large-scale clinical trials, government databases and papers, and recent studies of statin safety. STUDY SELECTION: By the author. DATA EXTRACTION: By the author. DATA SYNTHESIS: The number of patients requiring intensive therapy with statins to achieve lipid goals is climbing, and as the number grows, so does the potential for adverse effects with these agents. The most detrimental adverse effects of statins are hepatotoxicity and myopathy. Liver dysfunction induced by statins is rare and usually mild, with asymptomatic transaminase elevation or acute cholecystitis. Progression to liver failure is exceedingly rare, and transaminase elevations is usually reversible with dose reduction. Statin-associated myopathy is generally a concern when patients have more than one risk factor for muscle syndromes, such as an elderly patient with poor renal function. Drug interactions represent an additional concern, especially for atorvastatin, lovastatin, and simvastatin, all of which are metabolized by the important 3A4 isoenzyme of the cytochrome P450 system of the liver. CONCLUSION: The benefits of all available statins for the treatment or prevention of cardiovascular disease outweigh any potential risks of therapy. For patient groups most susceptible to adverse effects, such as the elderly and those on multiple medications, clinicians should consider the use of statins that are least likely to interact with other medications.

Chemical and Drug Induced Liver Injury↗