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PubMed2005

Validity of retrospective assessments of nicotine dependence: a preliminary report.

Information about levels of nicotine dependence in ex-smokers when they smoked, or in current smokers at an earlier date, is useful for clinical and research purposes. To estimate the accuracy of retrospective reports of dependence, 28 individuals who completed either the Fagerström Tolerance Questionnaire (FTQ) or Fagerström Test for Nicotine Dependence (FTND) in smoking cessation trials conducted 5 to 12 years earlier were asked to respond again to the same questions, thinking back to their smoking behavior just prior to their on-study quit attempt. Concordance and Kappa values for the items ranged from 50.0% to 95.0% and 0.00 to 0.92, respectively. The mean difference between the baseline and follow-up total scale scores was 0.05 for the FTQ and 0.38 for the FTND, and the correlation between these assessments was 0.62 for the FTQ (p<0.005) and 0.72 for the FTND (p<0.05). These preliminary results suggest that retrospectively assessed FTQ/FTND scale scores have acceptable reliability.

Adult↗
PubMed2005

Identity development and alcohol consumption: current and retrospective self-reports by college students.

First-year college students were asked to complete alcohol consumption and identity status questionnaires-currently and retrospectively. Trend analyses of the retrospective data and current data revealed somewhat similar inverse linear trends for identity status on absolute annual alcohol consumption. In both cases, identity sophistication was associated with lower levels of consumption. Of the students who reported an increase in consumption from the junior year of high school to the first year of college, those displaying progressive identity development reported a relatively lower increase in consumption than those displaying stable identity status. This difference approached the conventional level of significance. The implications of these findings are explored.

Adolescent↗
PubMed2005

A retrospective study of endophtalmitis rates comparing quinolone antibiotics.

PURPOSE: To compare endophthalmitis rates between topical quinolone antibiotics over a four-year period in a university setting. DESIGN: Retrospective, cross-sectional (prevalence) study. METHODS STUDY POPULATION: Nine thousand seventy-nine patients who underwent a phacoemulsification procedure at a University Eye Center. INTERVENTIONS: The following interventions were conducted: use of a nosocomial infectious reporting database retrospective analysis of prospectively collected data to establish endophthalmitis rates; prevalence analysis of postoperative quinolone antibiotics; analysis of endophthalmitis rate vs postoperative quinolone prescribed. MAIN OUTCOME MEASURES: Occurrence of endophthalmitis after cataract surgery. RESULTS: During a four-year period involving 9079 phacoemulsification procedures, 26 cases of bacterial postoperative endophthalmitis were reported (rate = 0.286%). Eight of the 26 cases were considered complicated; 18 cases were uncomplicated. Among cases performed during this period, postoperative prescription volumes for ciprofloxacin (Ciloxan, Alcon Laboratories, Inc., Fortworth, Texas) and ofloxacin (Ocuflox, Allergan, Inc., Irvine, California) antibiotic drops were nearly identical, with 4538 patients receiving ciprofloxacin (49.98%) and 4541 patients receiving ofloxacin (50.02%). There were 22 endophthalmitis patients (85%) who had used topical ciprofloxacin and 4 patients (15%) who had used topical ofloxacin postoperatively. The difference in infectious rates between antibiotics was highly significant (P < .00026). For uncomplicated cases, 14 patients received ciprofloxacin and 4 patients received ofloxacin. This difference was also significant (P < .015). CONCLUSIONS: Differences in pharmacokinetic and pharmacodynamic properties exist among quinolone antibiotics, which may affect endophthalmitis incidence following cataract surgery.

Administration, Topical↗
PubMed2004

Efficacy of exclusively oral antibiotic therapy in patients hospitalized with nonsevere community-acquired pneumonia: a retrospective study and meta-analysis.

PURPOSE: To assess the efficacy of oral antibiotics in patients hospitalized with community-acquired pneumonia and to identify factors precluding oral therapy. METHODS: In a meta-analysis, we compared inpatient oral and parenteral therapy in community-acquired pneumonia. Studies were reviewed independently and rated by two reviewers, and results were summarized. We also performed a retrospective cohort study of hospitalized patients with community-acquired pneumonia and compared outcomes in patients treated with oral versus parenteral therapy. RESULTS: For the meta-analysis, we identified seven studies involving 1366 patients. Study exclusions included severe pneumonia or impaired oral absorption. There was no significant difference in the relative risk of mortality at the end of treatment or at follow-up. Mean length of hospital stay was shorter (6.1 days vs. 7.8 days) in patients taking oral antibiotics than in those taking the parental form. In the retrospective cohort, 18% (124/698) of patients received oral-only therapy; these patients were younger (median age, 75 vs. 78 years, P = 0.01) and had lower mean pneumonia severity index scores (101 vs. 119, P <0.0001) than those who received parenteral therapy. In multivariable models, oral-only patients had a median length of stay that was 1.3 days shorter (95% CI: 0.4% to 2.2% days; P = 0.008) and a median antibiotic cost that was 56 dollars lower (95% CI: 53 dollars to 58 dollars; P <0.0001) than that of patients in the parenteral group, but mortality was similar. CONCLUSION: Although prospective data are limited, oral antibiotics in certain hospitalized patients with community-acquired pneumonia are effective. More data are needed to identify appropriate candidates for exclusively oral antibiotic therapy.

Administration, Oral↗
PubMed2006

Potentially inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis.

BACKGROUND: Previous medication management research has focused on hospital and long-term care facility settings, where drug-utilization reviews are used to reduce medication errors. Patients receiving home health care (HHC) are without the benefit of systematic drug-utilization reviews. OBJECTIVE: The purpose of this study was to review medication use in elderly patients receiving HHC to identify the prevalence of potentially inappropriate medication (PIM) use, dangerous drug interactions (DDIs), and other patterns of medication use. METHODS: This retrospective chart review was conducted using data from Medicare recipients aged > or =65 years who were patients of Scott & White Memorial Hospital and Clinic, Scott, Sherwood and Brindley Foundation, Temple, Texas, in 2002. Pharmacists compiled medication profiles based on admissions data. PIM use was identified using the Beers criteria. DDIs were identified using the Multidisciplinary Medication Management Project criteria. Polyphsarmsacy was identified in patients receiving > or =9 medications. RESULTS: Data from 786 patients were included (mean [SD] age, 78 [7] years [range, 65-100 years; median, 78 years]; 36% men; 86% white; and 53% admitted to HHC after a hospital stay). The mean (SD) number of medications was 8.0 (3.7), with 39% of patients receiving polypharmacy. PIM use was identified in 31% of patients. DDIs were identified in 10% of patients, with a significantly higher prevalence in men (P < 0.01). Rates of PIM use and DDIs were 37% and 20%, respectively, in patients receiving polypharmacy. CONCLUSION: In this retrospective data analysis in this population of elderly patients receiving HHC in 2002, PIM and DDI were prevalent, and polypharmacy was associated with increased rates of PIM use and DDIs.

Aged↗
PubMed2004

Use of free flaps for reconstruction in head and neck surgery: a retrospective study of 182 cases.

OBJECTIVE: In order to clarify the factors affecting the survival of flaps, we performed a retrospective study on free flaps (187) used for reconstruction in head and neck surgery in 182 patients. METHODS: Free jejunum flaps were used on 68 occasions, rectus abdominus myocutaneous flaps on 67, radial forearm flaps on 49, scapular osteocutaneous flaps on 2 and latissimus dorsi myocutaneous flap on ones occasion, during the period from May 1996 to April 2003. Post-operative circulatory complications at the recipient site were analyzed mainly in relation to a history of previous surgery, radiotherapy and chemotherapy. RESULTS: Circulatory crisis was observed in seven cases and circulation was restored in two of them after emergency exploration, whereas the other five flaps failed to survive. The overall failure rate of free flaps was 2.7%. Wound infection at the recipient site was frequent in patients with a history of previous local cervical surgery. Flap failure was significantly more frequent in patients with a history of previous surgery and infection, except for 2 patients in whose case the microsurgical technique was inadequate. Flap failure was not observed in those patients whose irradiation field could be analyzed, or in the patients who received chemotherapy. Although the incidence of circulatory crisis as a consequence of inadequate microsurgical technique was observed in the early period of this retrospective study, their frequency has diminished in the last 2 years. CONCLUSION: The survival of flaps was affected by a history of previous surgery following wound infection, although a history of irradiation and chemotherapy would have no effects on flap failure. The appropriate choice of vessels and surgical skill are crucial for the success of free flaps from our experience. Emergency exploration was also crucial for the survival of the flap in the case of circulatory crisis.

Adult↗
PubMed2004

[Evaluation of varicella complications through a retrospective hospital survey in a paediatric center over 16 years in France].

OBJECTIVE: Evaluation of the varicella severity through a prevalence study of hospital admissions justified by a complication directly related to the onset of an acute episode of varicella. METHODS: Retrospective study in one paediatric center in France with a follow-up of a paediatric cohort from April 1987 to December 2002. This general paediatric hospital recruits children from a 400,000 inhabitants area. Inclusion criterion: diagnosis main or associated of varicella. EXCLUSION CRITERIA: congenital or acquired immunodepression, including long-term oral high dosage steroid therapy. RESULTS: Three hundred and forty-three (343) complications of varicella were reported in 309 children hospitalised for a symptom in relationship with varicella. Most of children (75%) were <2 years of age. The annual number of hospitalisations varied with a maximum of 44. An increase of the number of hospitalisations was reported since 1997 but particularly since 2000. Main complications were gastro-intestinal (75), neurological (68), bronchopulmonary (52), and skin and soft tissue infections (52). Superinfections of soft tissues such as Streptococcus pyogenes cellulitis and life-threatening complications, which occurred in children treated by a short-course of corticosteroïds for an acute episode such as an asthma crisis, were mostly noticed since 1995. Two deaths occurred. CONCLUSION: These data collected over 16 years as part of a retrospective survey of a paediatric cohort show that varicella, often considered as a mild disease, can be responsible for severe complications in young immunocompetent children. The digestive complications (30%) are the main complication in our study with existence of gingivitis-stomatitis but also lower digestive manifestations (erosive gastritis aspect through endoscopy). These data have all the more to be taken into account because a vaccine, developed for healthy children, is now available in France. A national survey of hospitalised varicella has been set up since March 2003.

Adolescent↗
PubMed2004

Large cell neuroendocrine carcinoma of the lung: a 10-year clinicopathologic retrospective study.

BACKGROUND: Large cell neuroendocrine carcinoma is a recently recognized histologic entity whose clinical features and optimal treatment have not yet been well defined and are still being assessed. We report our retrospective assessment of cases of large cell neuroendocrine carcinoma observed from 1989 to 1999 in terms of survival. METHODS: Cases of large cell neuroendocrine carcinoma diagnosed between 1989 and 1999 were reassessed retrospectively according to the World Health Organization classification. The clinical outcome and pathologic features of all cases are described. Survival rates of patients with large cell neuroendocrine carcinoma are compared with those patients with small cell lung cancer treated in the same period. RESULTS: Patients were 41 men and 7 women with an average age of 63.7 years. Twenty-nine patients (60.4%) had pathologic stage I disease, 11 patients (22.9%) had pathologic stage II disease, and 7 patients (14.6%) had pathologic stage IIIA disease. One patient (2.1%) had pathologic stage IIIB disease. No patient underwent induction chemotherapy. Two patients underwent adjuvant chemotherapy and 2 underwent mediastinal radiotherapy for N2. No death was reported in the perioperative period. The median follow-up was 5 years. The actuarial survival for the entire group was 60.4% at 1 year, 27.5% at 3 years, and 21.2% at 5 years. The actuarial survival of accurately staged, stage I patients at 5 years was 27%. CONCLUSIONS: The findings suggest that treating large cell neuroendocrine carcinoma by means of applying treatment for nonsmall cell lung cancer leads to a prognosis that is worse than that for nonsmall cell lung cancer, even in terms of low pathologic stages.

Adult↗
PubMed2005

Clinical outcome of patients with deep sternal wound infection managed by vacuum-assisted closure compared to conventional therapy with open packing: a retrospective analysis.

BACKGROUND: It is suggested that the vacuum technique is a promising new method for the therapy of mediastinitis, but reliable investigations are currently almost completely lacking. We therefore compared clinical outcome of patients whose sternal infection was managed with the vacuum-assisted closure system or with the conventional procedure of open packing. METHODS: We performed a retrospective analysis in 68 cases of sternal wound infection that were identified at our Heart Center between September 1998 and September 2003. Thirty-five patients could be allocated to the vacuum group and 33 patients to the conventional group. We compared the time interval from sternal infection until freedom of microbiological cultures, in-hospital stay, the status at discharge (rewired or open sternum), the time interval until wound healing was achieved, and survival rates. Moreover, we compared serum levels of C-reactive protein and blood leukocyte counts on admission, at diagnosis of sternal infection, and at different points of time until discharge. RESULTS: Baseline characteristics and blood factors did not differ between the two study groups at diagnosis of sternal infection. Moreover, the number of prescribed antibiotics was similar, and the C-reactive protein level and blood leukocyte counts at discharge were comparable in both groups. However, freedom from mediastinal microbiological cultures was achieved earlier (p < 0.01), C-reactive protein levels declined more rapidly (p < 0.025), in-hospital stay was shorter (p < 0.01), rewiring was earlier (p < 0.01), and survival tended to be higher (p < 0.15) in the vacuum group compared to the conventional group. CONCLUSIONS: This retrospective analysis could demonstrate that the vacuum technique improves the medical outcome of patients with mediastinitis compared with the conventional technique of open packing.

Adult↗
PubMed2004

Cyclosporine in patients with steroid-resistant nephrotic syndrome: an open-label, nonrandomized, retrospective study.

BACKGROUND: Steroid-resistant nephrotic syndrome (SRNS) with focal segmental glomerulosclerosis has emerged as a leading cause of end-stage renal failure (ESRF) in children and adults. In the past decade, immunosuppressive drugs such as cyclosporine (CsA) and cyclophosphamide have been introduced for the treatment of SRNS, but data on long-term clinical outcome (over years) are lacking. OBJECTIVE: The current study considered the clinical outcome of patients with SRNS who had been treated with CsA for >2 years. The primary objective was to evaluate renal function after years of treatment compared with nontreated or CsA-resistant patients. A secondary objective was to identify renal effects related to the use of CsA, with a major emphasis on renal fibrosis. METHODS: In this open-label, nonrandomized, retrospective study, the outcomes of patients of all ages with sporadic SRNS who had been followed up for >2 years (between 1970 and 2002) at 4 Italian clinical institutions were evaluated. Preliminary molecular screenings for genes encoding proteins of the slit-diaphragm (eg, podocin, nephrin, alpha-actinin) were performed to exclude inherited forms of sporadic SRNS. RESULTS: A total of 157 patients were studied; mutations were found in 18 patients (11%). Of the remaining 139 patients (84 men, 55 women; median [interquartile range (IQR)] age at onset of proteinuria, 12 [4-32] years), 84 (60%) were nontreated and 55 (40%) were treated with CsA. Of these 55 treated patients, 35 (64%) were found to be resistant (ie, persistence of proteinuria after 2 months) or intolerant (ie, malignant hypertension or worsening of renal function), and CsA was withdrawn. The median (IQR) durations of follow-up for CsA-resistant and nontreated patients were 41 (23-92) and 48 (28-106) months, respectively. Twenty patients (36%) were responsive to CsA and were followed up for a median (IQR) of 81 (47-115) months. Progression Lo ESRF occurred in 10% of CsA-responsive patients versus 60% of CsA-resistant patients and 62% of nontreated patients (P = 0.002). No sign of renal fibrosis related to drug toxicity was observed in renal biopsies performed at 5-year intervals. CONCLUSIONS: This retrospective analysis of SRNS documented a persistent antiproteinuric effect of long-term CsA (>2 years) in the absence of renal fibrosis. Although sensitivity to CsA was associated with normal renal function, resistance or intolerance was associated with progression to ESRF These data suggest that CsA may have a role in the treatment of patients with SRNS.

Adolescent↗
PubMed2004

Association between congestive heart failure and hospitalization in patients with type 2 diabetes mellitus receiving treatment with insulin or pioglitazone: a retrospective data analysis.

BACKGROUND: Thiazolidinediones (TZDs) are widely used oral antihyperglycemic drugs that facilitate insulin action and increase insulin-stimulated glucose metabolism, thereby decreasing insulin resistance. However, concerns have been raised regarding the association between TZD use and a heightened risk for congestive heart failure (CHF). OBJECTIVE: This study used claims data to conduct a retrospective examination of the CHF risk in patients with type 2 diabetes mellitus and to compare the association with CHF in those receiving the TZD pioglitazone and those receiving insulin. METHODS: Patients with type 2 diabetes aged > or =18 years who had begun treatment with pioglitazone or insulin between January 1999 and December 2001 were identified using the PharMetrics Patient-Centric database. The sample was restricted to patients for whom there were > or =12 months of data before the index date (date of the first prescription for pioglitazone or insulin) and > or =3 months of follow-up data. Patients receiving a diagnosis of CHF before the index date were excluded. The propensity score for receiving pioglitazone was estimated using logistic regression based on available observed patient characteristics. Patients receiving insulin were matched in a 1:1 ratio with patients receiving pioglitazone based on a difference of no more than +/-0.01 in the estimated propensity score for receiving pioglitazone therapy. CHF risk was examined using the Cox proportional-hazards model. RESULTS: After exclusion of ineligible patients, 1668 matched pairs of patients receiving pioglitazone or insulin were identified (50.9% men, 49.1% women; mean [SE] age, 51.2 [0.2] years). The 2-year crude incidence rate of CHF was significantly lower in the pioglitazone group compared with the insulin group (primary/secondary diagnosis of CHF, 2.0% vs 4.0%, respectively; P < 0.001; inpatient hospitalization for CHF, 0.7% vs 2.5%; P < 0.001). The hazard ratio for pioglitazone versus insulin was 0.501 (95% CI, 0.331-0.758; P = 0.001) for a primary or secondary diagnosis of CHF in any setting and 0.263 (95% CI, 0.135-0.511; P < 0.001) for any occurrence of an inpatient hospitalization for CHF. CONCLUSIONS: In this retrospective analysis of data from patients with type 2 diabetes, pioglitazone therapy was associated with significantly lower incidence rates of CHF and inpatient hospitalization compared with insulin therapy.

Cohort Studies↗
PubMed2005

Equipotent doses of transdermal fentanyl and transdermal buprenorphine in patients with cancer and noncancer pain: results of a retrospective cohort study.

BACKGROUND: The equipotency ratio of transdermal (TD) fentanyl to oral morphine has been established as 1:100; for buprenorphine TD, a ratio of 1:75 has been proposed, although this ratio has not been confirmed in clinical studies. Growing evidence from clinical practice, in which much lower doses of buprenorphine are used, suggests that this conversion ratio may be too high. OBJECTIVE: The aim of this study was to compare calculated equipotent oral morphine doses of fentanyl TD with equipotent oral morphine doses of buprenorphine TD prescribed in clinical practice. METHODS: This retrospective study identified patients with cancer and noncancer pain who had received > or =1 prescription for fentanyl TD or buprenorphine TD (the all-patients groups) from the German IMS Disease Analyzer-mediplus database, which contains all relevant data concerning drug prescriptions from 400 practices in Germany. Also identified were subgroups of the all-patients groups who had received long-term treatment with fentanyl TD or buprenorphine TD and were considered to have similar pain intensity, as they had previously received similar analgesic medication (the identical-cohort groups). Mean prescribed daily doses for the all-patients and identical-cohort groups were calculated based on the distribution of prescribed patch strengths. Because patients could have applied >1 patch, mean prescribed daily doses were also calculated based on an assumption of double application when appropriate. Equipotent oral morphine doses were estimated using equipotency ratios of 1:100 for fentanyl TD and 1:75 for buprenorphine TD. RESULTS: The all-patients groups consisted of 2198 patients with noncancer pain and 2544 patients with cancer pain; the identical-cohort groups consisted of 380 patients with noncancer pain and 496 patients with cancer pain (529 women, 347 men; mean age, 74 years [range, 25-101 years]). Equipotent doses of oral morphine were significantly lower in patients receiving buprenorphine TD compared with those receiving fentanyl TD (P < 0.001). In cancer patients, the equipotent oral morphine doses of fentanyl TD and buprenorphine TD were 130.9 to 138.9 mg and 85.2 to 88.8 mg, respectively; in noncancer patients, the corresponding values were 117.0 to 118.3 mg and 80.2 to 80.9 mg. Based on these results, an equipotency ratio of 1:110 to 1:115 for buprenorphine TD would appear to be more appropriate than the proposed ratio of 1:75. CONCLUSIONS: The fact that this retrospective analysis conducted in identical cohorts showed lower calculated equipotent oral morphine doses in the buprenorphine TD groups compared with the fentanyl TD groups calls into question the proposed 1:75 ratio for conversion of buprenorphine TD to equipotent oral morphine doses. Based on the findings of the present study, an equipotency ratio of 1:110 to 1:115 may be more appropriate. However, confirmative data from prospective randomized clinical trials are needed.

Administration, Cutaneous↗
PubMed2005

A retrospective chart review of the clinical effects of atypical antipsychotic drugs on glycemic control in institutionalized patients with schizophrenia and comorbid diabetes mellitus.

BACKGROUND: The association between schizophrenia and onset of type 2 diabetes mellitus (DM) is well documented. It is unclear whether this association is due to inherent risk factors in individuals with schizophrenia or to treatment with antipsychotic drugs, particularly atypical antipsychotic agents. OBJECTIVES: The goals of this retrospective, observational study were the following: (1) to determine whether adequate glycemic control could be achieved in patients with schizophrenia and comorbid DM who were undergoing treatment with atypical antipsychotic drugs, (2) to identify inherent risk factors that may affect glycemic control in this patient population, and (3) to consider the possibility that combined medication and inherent risk factors may affect glycemic control. METHODS: This was a retrospective, observational chart review that evaluated institutionalized patients in a New Jersey mental institution with concurrent diagnoses of schizophrenia and type 1 or 2 DM who were being treated with atypical antipsychotic agents (ie, olanzapine, risperidone, clozapine, or quetiapine) and were referred by their hospital internists to a weekly, half-day, in-hospital DM clinic. All patients with initial and end-point data for the efficacy measure (ie, change in glycosylated hemoglobin [HbA(1c)]) were included in the analysis. Mixed-effects linear and least-squares models were used to test whether a specific comorbidity had an effect on the change in HbA(1c) adjusted for the duration of the observation. RESULTS: A total of 72 patients met entry criteria. Among the 38 patients with baseline and end-point data (20 treated with olanzapine and 18 treated with risperidone), mean (SD) HbA(1c) decreased from 8.21% (2.4%) to 7.62% (1.7%). The only baseline demographic characteristic or comorbidity that predicted significant worsening in the adjusted HbA(1c) change was hepatitis (P = 0.003). CONCLUSIONS: Using appropriate, aggressive antidiabetic therapy, glycemic control was achieved in this group of patients with schizophrenia and comorbid DM who were treated with atypical antipsychotic agents.

Adult↗
PubMed2005

Changes in the prescribed daily doses of transdermal fentanyl and transdermal buprenorphine during treatment of patients with cancer and noncancer pain in Germany: results of a retrospective cohort study.

BACKGROUND: During long-term therapy with strong opioids (step III opioids according to the World Health Organization [WHO] analgesic ladder), dose increases are often necessary because of deterioration of the primary disease or development of tolerance. OBJECTIVE: The purpose of this study was to compare changes in dosages of transdermal (TD) fentanyl and TD buprenorphine in patients with cancer and non-cancer pain. METHODS: In a retrospective study, patients with cancer and noncancer pain being treated with TD fentanyl or TD buprenorphine for at least 3 months between January 2001 and December 2003 were identified from the IMS Disease Analyzer-mediplus database, which contains all patient-related data documented from 400 medical practices in Germany. The indications for treatment were defined according to the International Classification of Diseases, 10th Revision, and included neoplasm (cancer groups), and osteoarthritis, low back pain, and osteoporosis (noncancer groups). The cohort patients were considered to have comparable pain intensity because they had received similar analgesic premedication classified according to steps I to III of the WHO analgesic ladder (cohort groups). The mean prescribed daily doses on first and last prescription were documented, and the mean percentile increases were calculated over the whole treatment duration and per day. Additionally, the mean percentile intraindividual increases (on a per-patient basis) were estimated. RESULTS: The cohort groups consisted of 448 patients with noncancer pain and 446 patients with cancer pain (552 women and 342 men; mean age, 74 years; range, 25-101 years). The mean percentile increases in dosages over the whole treatment duration and adjusted per day were significantly higher in patients taking TD fentanyl (P < 0.05). Differences were even greater for the mean percentile intraindividual increases per day, which totaled 0.42%and 0.17% for cancer patients taking TD fentanyl and TD buprenorphine, respectively; corresponding values were 0.25% and 0.09%in noncancer patients (P < 0.001). CONCLUSIONS: This retrospective analysis showed a significantly higher increase in the mean daily doses of TD fentanyl as compared with TD buprenorphine. The results must be verified in prospective, randomized clinical studies.

Administration, Cutaneous↗
PubMed2005

A retrospective Evaluation of fluconazole for the treatment of Candida glabrata fungemia.

BACKGROUND: Candida glabrata accounts for 21% of Candida bloodstream isolates in the United States and ranges from susceptible-dose-dependent to resistant to fluconazole. A fluconazole dose of 800 mg/d ( approximately 12 mg/kg per day) is predicted to produce peak plasma concentrations that surpass the susceptible-dose-dependent MIC breakpoint of 16 to 32 mug/mL. Accordingly, the Infectious Diseases Society of America treatment guidelines for candidiasis recommend fluconazole 12 mg/kg per day as an alternative option for treatment of C glabrata fungemia. OBJECTIVE: The main objective of this study was to evaluate fluconazole retrospectively as a treatment for C glabrata fungemia. METHODS: Data were collected through a database that stores patient information electronically and can be accessed and queried, and chart review at Barnes-Jewish Hospital (St. Louis, Missouri) from January 1999 to August 2002. Eligible patients who had at least 1 positive blood culture for C glabrata and received at least 1 dose of fluconazole were identified through the electronic query. Chart reviews of these patients followed. The primary outcomes were fungemia eradication and in-hospital mortality. RESULTS: Of the total 124 cases of C glabrata fungemia identified, 54 patient charts were evaluable. Chart review revealed that 65% (17/26) of patients receiving fluconazole as the sole antifungal therapy had successful bloodstream eradication of C glabrata, whereas approximately 54% (15/28) of patients who were changed from fluconazole to an amphotericin B formulation had successful bloodstream eradication. Although no association was found between fluconazole dose and fungemia eradication in the entire study population, higher doses of fluconazole (> or =400 mg/d) were more likely to achieve fungemia eradication than lower doses (< or =400 mg/d) in the subset of patients who received only fluconazole (P = 0.042). Mortality rates were approximately 24% (4/17) and 40% (6/15) in patients having successful bloodstream eradication with fluconazole alone and with fluconazole followed by amphotericin B, respectively, compared with 38% (3/8) in patients with persistent fungemia who received fluconazole alone. CONCLUSIONS: Fluconazole was a viable therapy for C glabrata fungemia, with bloodstream eradication in 65% of patients and mortality rates of 24% to 40% in this retrospective chart review.

Algorithms↗
PubMed2005

The long-term course of low-density lipoprotein cholesterol after initiation of statin treatment: retrospective database analysis over 3 years in health maintenance organization enrollees.

OBJECTIVES: Our primary objective was to obtain robust estimates of the low-density lipoprotein cholesterol (LDL-C) decrease from baseline over a long period (ie, 3 years) after initiation of statin treatment in a usual-care setting. Our secondary objective was to investigate the predictors of the LDL-C time course. METHODS: We retrospectively analyzed the data for a sample of enrollees in a health maintenance organization (HMO) who started statin treatment between October 1, 1995, and December 31, 1998. Using the HMO's claims database, we examined the LDL-C change from baseline (as measured at the prescribing physicians' discretion) and computed mean estimates every 6 months up to 3 years. We investigated potential predictors of the LDL-C time course (ie, age, sex, baseline LDL-C, previous treatment, prescribing physician's specialty, and most recent treatment) with a mixed model applied to longitudinal data. This model enabled us to impute missing data for all enrollees still being followed, including those who had stopped treatment, and to discuss the robustness of our findings. We applied 2 methods of imputation, assuming either of the following: (1) data were missing at random but could be estimated from the parameters in the mixed model, or (2) LDL-C returned to the baseline value > or =15 days after treatment cessation. RESULTS: We examined data from 3193 individuals. In most cases, the statin used was fluvastatin or pravastatin. The observed mean (95% CI) LDL-C decrease from baseline widened progressively from 23.6% (23.0%-24.3%) at 6 months to 28.0% (27.1%-28.9%) at 18 months and 30.2% (28.7%-31.7%) at 36 months after treatment initiation. These results remained robust after the imputation of missing data, with mean LDL-C reduction consistently >20% at each 6-month time point during the 3 years after treatment initiation. Variations as a function of baseline characteristics were limited (demographics) or explicable by extraneous factors (baseline LDL-C). There were predictable variations as a function of the most recent treatment. CONCLUSIONS: This analysis indicates a long-term reduction in LDL-C among a sample of HMO enrollees who initiated statin treatment in a usual-care setting. The results were robust after imputation of missing data, with mean decrease from baseline consistently >20% over 3 years. However, given the retrospective design of our study and the absence of a control group, we cannot determine how much of the decrease was attributable to treatment.

Aged↗
PubMed2005

Preventive drug use in patients with a history of nonfatal myocardial infarction during 12-year follow-up in The Netherlands: a retrospective analysis.

BACKGROUND: Myocardial infarction (MI) is a common cause of death in developed countries. Long-term preventive pharmacotherapy has been shown to decrease mortality and morbidity after MI. Based on a literature search, studies of these therapies to date have estimated the use of monotherapy, whereas many patients are prescribed combination therapy. Thus, assessment of long-term combination drug use after MI is timely. OBJECTIVE: The aim of this study was to assess the use of oral antithrombotics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, hydroxymethyl-glutaryl coenzyme A reductase inhibitors ("statins"), and their combinations after MI at discharge and during 12-year follow-up. METHODS: This community-based, retrospective data analysis was conducted at Utrecht University, Utrecht, The Netherlands. Data from patients aged > or =18 years at hospital admission who experienced nonfatal acute MI between 1991 and 2000 and had a duration of follow-up > or =30 days were included in the analysis. Data were retrieved from the Pharmo Record Linkage System database, which links pharmacies' dispensation records to hospitals' discharge records on an individual patient level, allowing the investigator to observe individual patients' medication use over time. Primary outcome measures were the use of preventive medicines (oral antithrombotics, beta-blockers, ACE inhibitors, and statins) at discharge, overall use, and persistence during 12-year follow-up. RESULTS: Of 330,000 patients in the database, 4007 were included in the analysis (2828 men, 1179 women; mean [SD] age, 63.5 [12.5] years). Use at discharge and overall use of oral antithrombotics and statins increased significantly between 1991 and 2000, whereas use of beta-blockers and ACE inhibitors increased mainly in patients discharged in the latter years of the follow-up period. Therapy with any combination of drugs increased strikingly from 1991 to 2000, from 47% to 90%. At 1 year after discharge, 32% of patients had discontinued their first-prescribed combination treatments. At 5 years after discharge, this rate increased to 57%, suggesting a low rate of persistence CONCLUSIONS: Based on the results of this retrospective data analysis, the use of MI-preventive drug treatment at and after discharge increased significantly in this population in The Netherlands during the 1990s. Combination therapy increased strikingly. However, persistence with combination therapy was low.

Adrenergic beta-Antagonists↗
PubMed2006

Effectiveness and tolerability of prolonged linezolid treatment for chronic osteomyelitis: a retrospective study.

BACKGROUND: Linezolid is an oxazolidinone agent which is apparently well designed for treating chronic osteomyelitis, but data on effectiveness and tolerability as prolonged therapy is currently lacking. OBJECTIVE: The purpose of this study was to assess the effectiveness and tolerability of linezolid in the treatment of chronic osteomyelitis. METHODS: The charts of hospitalized patients who had been treated with linezolid for >4 weeks because of chronic osteomyelitis and were followed up for > or =12 months after the end of treatment were retrospectively reviewed for clinical outcome and tolerability. Cure was defined as the absence of clinical, biological, or radiological evidence of infection throughout the posttreatment follow-up. Linezolid tolerability was assessed on the basis of hematologic properties during treatment. RESULTS: Of the 66 patients included, all were white (mean [SD] age, 67.7 [18.1] years; 41 men and 25 women; mean [SD] weight, 80.7 [18.6] kg). Thirty-seven (56.1%) patients had infection due to implants including 27 prosthetic joints. Pathogens were predominantly methicillin-resistant staphylococci (49/72 strains, 68.1 %). Every patient was administered N linezolid (600 mg BID) treatment for 6 to 8 days as inpatients, and then, as outpatients, they were switched to PO treatment. Fifty (75.8%) patients received a combination of linezolid and other antimicrobial agents, including rifampin (32 [48.5%]). Surgery was performed in 52 (78.8%) patients. The median hospital stay was 14 days (mean [SD], 19 [11.4] days [range, 7-70 days] ). The median duration of treatment was 13 weeks (mean [SD], 14.3 [8.2] weeks [range, 5-36 weeks]). At the end of treatment, 56 (84.8%) patients were cured, and during the post-treatment follow-up (median duration, 15 months [range, 12-36 months]), 4 relapses occurred, resulting in an overall successful cure for 52 (78.8%) patients. Reversible anemia was reported in 21 patients (31.8%), of whom 16 (24.2%) required blood transfusions. Median time from treatment initiation to anemia onset was 7.3 weeks (range, 4-12 weeks). Peripheral neuropathy was reported in 6 (9.1%) patients, of whom 4 remained symptomatic for up to 24 months after linezolid discontinuation. Other reported adverse events included nausea (6 [9.1%]), diarrhea (1 [1.5%]), and headache (2 [3.0%]), although none of these patients discontinued treatment. CONCLUSIONS: In this retrospective chart review, treatment with linezolid as monotherapy or in combination with antimicrobials and/or surgery was associated with cure of chronic osteomyelitis in 84.8% of subjects at 12 weeks after the end of treatment and 78.8% at follow-up. Adverse events were reported in 51.5% of subjects, and 34.8% of subjects discontinued the study because of adverse events. The potential for severe complications justifies close monitoring of these patients.

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