Desk Reference Research Articles

The Professional counselor's desk reference

The Professional counselor's desk reference

Technetium-99m Pharmaceuticals: Preparation and Quality Control in Nuclear Medicine

I. Zolle, ed. New York, NY: Springer, 2007, 345 pages, $169 Written by a panel of 21 experts in the field and edited by Ilse Zolle, this hardbound volume is the current authoritative desk reference for those working with 99mTc-labeled radiopharmaceuticals. The 11 chapters of part 1 provide

An update on the genotoxicity and carcinogenicity of marketed pharmaceuticals with reference to in silico predictivity

Information from the 1999 through 2008 Physicians' Desk Reference (PDR) was used to evaluate the genotoxicity of marketed drugs. Where available, data regarding the rodent carcinogenicity results were included (PDR and Gold potency database). In addition, computational predictivity of genotoxicity (DEREK, MC4PC) is included and expanded upon from two previous reviews. The present paper contains genotoxicity data on 545 marketed drugs. Excluded from analysis were most cytotoxic anti-cancer and antiviral drugs, nucleosides (all with known mechanistic genotoxicity), steroids with class-specific genotoxicity and biologicals or peptide-based drugs. Per assay type, the percentage of positive drugs was: Bacterial mutagenesis assay: 38/525 (7.1%), in vitro chromosome aberrations: 88/380 (26.1%); mouse lymphoma assays (MLA): 32/163 (19.1%), in vivo cytogenetics: 49/438 (11.1%). The relationship among positive genetic toxicity findings, rodent carcinogenicity, and in silico prediction is discussed. Finally, supporting evidence is presented for the idea that the presence of an N-dialkyl group or piperidine aryl ketone may somehow be associated with genotoxicity, perhaps through DNA intercalation and consequent DNA topoisomerase II inhibition.

Access to prescribing information for paediatric medicines in the USA: post‐modernization

The aims of the present study were to examine the Physicians' Desk Reference (PDR) for changes in the listing of medicines licensed for children in the USA over a 10-year period (1998-2007). The USA PDR was used to identify products listed in 1998, 2002 and 2007. Information about generic name (active agent), salt, strength, brand name, suitability of formulation, paediatric licensing information and the lowest age of licensing was extracted. Prescription products were collapsed down to chemical entities/fixed-dose combinations. Of the prescription entities listed in the PDR, 538 (55.9%), 488 (54.3%) and 394 (51.3%) were licensed for children in 1998, 2002 and 2007, respectively. There was a 39% decrease in the number of entities licensed for the newborn and a 34% decrease for children aged 2-6 years between 1998 and 2007. Formulations suitable for children were listed for 611 (63.4%), 550 (61.2%) and 430 (60.6%), respectively. Prescription entities with both a suitable oral formulation and licensing for children numbered 161 (16.7%), 148 (16.5%) and 100 (14.1%) in 1998, 2002 and 2007, respectively. The listings in the PDR suggest that overall access to prescribing information about drugs in the paediatric population has not shown an increase over the decade. This particularly affected the neonatal age group.

Tinnitus Evaluation and Intervention

You have accessThe ASHA LeaderBottom Line1 Mar 2009Tinnitus Evaluation and Intervention Steven WhitePhD, CCC-A Steven White Google Scholar More articles by this author , PhD, CCC-A https://doi.org/10.1044/leader.BML.14032009.3 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Audiologists often call ASHA with questions on coding and reimbursement for audiological services involving tinnitus evaluation and intervention. The following Q&A answers the most common questions. Q: Which International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes should be used for tinnitus? ICD-9-CM 2009 codes for tinnitus are 388.30: tinnitus, unspecified; 388.31: subjective tinnitus; and 388.32: objective tinnitus. Q: Which Current Procedural Terminology (CPT)® code should be used for tinnitus assessment? Use CPT code 92625: assessment of tinnitus (includes pitch, loudness matching, and masking). Q: What are these tinnitus assessment components? Pitch (frequency) matching is intended to match the stimulus closest in pitch to the patient’s tinnitus. Loudness matching testing is performed to obtain loudness matches between the audiometric stimulus and the patient’s tinnitus. The masking procedure involves determination of the minimum masking level (MML) and testing for tinnitus suppression (residual inhibition). If only one ear is tested using the tinnitus assessment procedure, the modifier -52 (reduced service) should be applied. This modifier would also be used if only part of the tinnitus assessment battery is performed. Q: Which CPT code should be used when evaluating a client with a tinnitus masker? You can consider using CPT 92590 (hearing aid examination and selection: monaural) or 92591 (hearing aid examination: binaural). Q: How do I code the masker itself? A tinnitus masker could be coded using Level II Health Care Procedure Coding System National Codes (HCPCS), which are required for reporting most medical services and supplies provided to Medicare and Medicaid patients and by most private payers. There is not a code for a tinnitus masker, but V5299 is for hearing service, miscellaneous. HCPCS instructions note that this code should be used only if a more specific code is unavailable. Hearing services fall under V5000–V5999. Q: Can the various interventions used for the treatment of tinnitus be reimbursed? Most third-party payers view tinnitus treatment claims based on the procedure. For example, Aetna’s Clinical Policy Bulletin 0406 states that Aetna considers transcutaneous electrical nerve stimulation (TENS) medically necessary durable medical equipment (DME) for members with severe tinnitus when all of the following criteria are met: “(1) Member has experienced severe tinnitus for more than 6 months, and (2) Medically correctable causes of tinnitus have been ruled out, and (3) Member has tried and failed conservative tinnitus treatments, including counseling and reassurance, dietary modifications, and drug therapy.” Aetna limits coverage to no more than 10 TENS sessions per year “because of a lack of evidence that more frequent TENS treatments provides additional clinically significant benefits for this condition.” Aetna denies coverage for tinnitus instruments, ear canal magnets and electromagnetic stimulation, and tinnitus retraining therapy because they are experimental, investigational, or the effectiveness has not been established. Medicare will cover a tinnitus evaluation performed by an audiologist if the patient is referred by a physician. However, Medicare states in its Coverage Issues Manual that tinnitus masking is considered “an experimental therapy” and does not cover that procedure. Q: Is there no specific CPT code for tinnitus intervention? That’s correct. There is no such code. For tinnitus intervention you can consider using 92507: treatment of speech, language, voice, communication, and/or auditory processing disorder, individual. CPT code 92633: auditory rehabilitation, postlingual hearing loss, does not include tinnitus intervention. Q: Where can I find more information about CPT codes and HCPCS? A good place to start is the ASHA Web page on billing and reimbursement; it includes a specific section on coding. The American Medical Association (AMA) CPT and HCPCS books are available through the AMA Press. The Coders’ Desk Reference, designed for the lay person, is available through Ingenix Companies (800-765-6588). ASHA’s Private Health Plans Handbook also has a list of the CPT codes commonly used by members, and is available through ASHA Product Sales. Author Notes Steven White, PhD, CCC-A, director of health care economics and advocacy, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 14Issue 3March 2009 Get Permissions Add to your Mendeley library History Published in print: Mar 1, 2009 Metrics Current downloads: 2,158 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2009 American Speech-Language-Hearing AssociationLoading ...

Desk Reference of Clinical Pharmacology, 2nd Edition

Desk Reference of Clinical Pharmacology, 2nd Edition

Management accountant's standard desk reference

Management accountant's standard desk reference

An analysis of the high psychotropic off-label use in psychiatric disorders: The majority of psychiatric diagnoses have no approved drug

Objective The authors’ goals were to determine the extent of unapproved indications in the DSM-IV-TR, to highlight common off-label uses of psychotropic medications and offer insights into the rationale of the widespread off-label prescribing in psychiatry. Method Indications for approved psychotropic agents, obtained from the Physicians Desk Reference and the Drug Information Handbook, Clinical Handbook of Psychotropic Drugs, 15th edition, and the Drugs@FDA online database were analyzed in the context of the DSM-IV-TR to determine the percent of DSM-IV-TR disorders that are indications for psychotropic agents. A literature search was performed to determine common off-label uses of major classes of psychotropic medications. Results 88.5% of all DSM-IV-TR categorized disorders lack an approved medication for their treatment. Atypical Antipsychotics had the most extensive off-label use for DSM-IV-TR categorized disorder, whereas Mood Stabilizers showed the greatest off-label use with regards to disorders and symptoms that are not DSM-IV classified. For each class of medications, more off-label uses exist than FDA-approved uses. Conclusions The vast majority of DSM-IV-TR categorized disorders lack approved medications for their treatment. The large unmet need for approved psychiatric indications may explain the widespread off-label use of psychotropic medications in clinical practice.

Effect of Tamsulosin on Systemic Blood Pressure and Nonneurogenic Dysfunctional Voiding in Children

A number of therapies for dysfunctional voiding in children have been proposed after conservative measures have failed. Prior studies have shown significant improvement in lower urinary tract symptoms with alpha1-adrenergic antagonists. Nonselective alpha1-adrenergic antagonists can result in systemic vasodilatation and hypotension. We examined the effects of tamsulosin, a uroselective alpha1A-adrenergic antagonist, on blood pressure, as well as its safety and efficacy in the treatment of dysfunctional voiding in a pediatric population. A total of 23 children without anatomical or neurogenic abnormalities presented with lower urinary tract symptoms refractory to conservative measures. All children had increased post-void residual urine or abnormal uroflowmetry in the absence of pelvic floor activity suggestive of bladder neck dysfunction. All patients were administered tamsulosin daily. Voiding diaries, blood pressure, uroflowmetry studies and patterns along with assessment of post-void residual urine were obtained before and after beginning tamsulosin in all children. Median duration of tamsulosin therapy was 7 months, and patient followup was 20 months. The number of voiding and incontinent episodes significantly decreased during treatment compared to baseline (p <0.05). Mean blood pressures before and during tamsulosin treatment were 98/55 mm Hg and 110/61 mm Hg, respectively. Significant increases in average and maximum urinary flow rates along with reduction in post-void residual urine were observed during tamsulosin therapy compared to baseline values (p <0.01). A 50% reduction in the number of abnormal uroflow patterns was observed with tamsulosin therapy. Tamsulosin demonstrated no clinically significant effect on blood pressure, while proving to be a safe and effective treatment option for lower urinary tract symptoms in a select pediatric population.

Ethics desk reference for psychologists

The Ethics Desk Reference for Psychologists is an easy-to-use pocket guide that aides psychologists in identifying and avoiding ethical dilemmas. Editors Barnett and Johnson provide a jargon-free summary of each section of the APA Ethics Code (2002), note common dilemmas and conflicts that are associated with each section, and offer practical suggestions for preventing conflict and promoting positive practice. Additional resources are provided that will help psychologists to respond to ethical conflicts effectively if they do arise. These include a model for ethical decision making, a detailed checklist of what to do if you are facing an ethics complaint, and a list of ethics resources. This compact desk reference is an essential resource for all psychologists, trainees, and graduate students.

Desk Reference of Clinical Pharmacology

Desk Reference of Clinical Pharmacology

Risperidone Therapy in Two Successive Pregnancies

Risperidone Therapy in Two Successive Pregnancies

Which water for alendronate administration?

Dear Editors, Very likely some clinical trials on alendronate in tablets, taken with tap water (the possibility of using distilled water was not envisaged), do not report the real activity of the product, for the following reasons. In the Physician's Desk Reference [1], it is stated that Fosamax must be taken with tap water only and not with mineral water (the word “not” is printed in bold type) since other beverages, including mineral water, are likely to reduce its absorption by as much as 60% due to their content of calcium and other cations [2, 3]. The package insert of Fosamax in Italy, but most probably not only in Italy, has integrally reproduced this statement, saying that the product “must be taken with tap water only and not with mineral water.” The most authoritative Martindale [4] writes that “absorption is decreased by food, especially by products containing calcium or other polyvalent cations”. These other cations are, however, not specified, thus implying that calcium is the main negative substance, an assumption confirmed further on where it writes that “mineral water with a high concentration of calcium should be avoided” without mentioning other unfavourable water components. Now, the aforementioned formulation of the package insert is practically a nonsense, owing to the well-known huge differences among waters, both tap and mineral, as to their mineral content. For example, while in some areas of Italy the calcium content of tap water is rather low, in other areas, e.g. in Rome and in some parts of Milan, it is significantly high, namely 100–110 mg/l, which means up to 100 times higher than that in some commercially available bottled waters with a calcium content of 1 or 2 mg/l. And practically nobody knows what they are drinking when a tap water is used, while all bottles of mineral water are by law (at least in Italy) labelled with the specification of all the single components. The conclusion is that, following the instructions of the package inserts of all the products containing alendronate, many patients may miss up to 60% of its therapeutic activity, damaging not only their health but also their finances. And , while waiting for improbable amendments from the pharmaceutical companies and/or the regulatory authorities, it would be wise to follow Azoulay et al. [5] who conclude:“ physicians should encourage patients to check the mineral content of their drinking water, whether tap or bottled, and choose water most appropriate for their needs”.

Risperidone Therapy in Two Successive Pregnancies

There is very limited information available on the use of psychotropic drugs in consecutive pregnancies. The authors report a case of a woman with schizophrenia wherein risperidone was used successfully in two consecutive pregnancies. This is only the second known report in the existing literature in which atypical antipsychotic was used successfully in two successive pregnancies.

Virtual reference services: Evaluation of online reference services

Virtual reference services: Evaluation of online reference services

Commentary: Regulatory Toxicology and the Critical Path: Predicting Long-term Outcomes from Short-term Studies

Much attention and angst have been focused on the decline in new drug approvals, the increased failure rate of drug candidates in late stage development, and the soaring costs of developing new drugs. The causes for this crisis have been much discussed and debated. Oft cited are the following: consolidation in the pharmaceutical industry; more complicated multigenic diseases such as cancer, diabetes, and obesity; competition with generics; and perhaps a lower tolerance for adverse side effects. It is abundantly clear however that advances in applied science have not kept pace with the frenetic speed of developments in basic sciences (http://www.fda.gov/oc/initiatives/criticalpath/whitepaper.pdf). This discrepancy is especially true for the discipline of regulatory toxicology. In spite of the tremendous advances in our ability to assess xenobiotic-induced changes in gene expression, protein and metabolite levels, the tools that are routinely employed in preclinical safety testing have changed little in the last quarter of a century. Many of the endpoints we routinely evaluate are subjective and only semiquantitative such as clinical signs, functional observations, gross pathology, and histopathology. This article is designed to identify specific advances in applied regulatory toxicology that could help facilitate the movement of new drugs from discovery to the clinic. It is instructive to consider which advances in toxicology would provide the greatest benefit in advancing drug development. While nonclinical studies still comprise a relatively small percentage of overall drug development costs, the rate of increase for this aspect of drug development is rising dramatically along with other development costs (http://csdd.tufts.edu/InfoServices/ OutlookPDFs/Outlook2008.pdf). This is especially true for biologics, which frequently rely on costly nonhuman primate studies. For small molecules, the costliest studies, in terms of time and resources are chronic studies which have in-lives of 6 to 24 months. Clearly, a major contribution to the field of regulatory toxicology would be the ability to predict chronic outcomes from relatively shortterm studies. Arguably, this would be the most important contribution of the new ‘‘omics’’ endpoints. One of the costliest, and certainly the most timeconsuming requirement in nonclinical safety testing is the 2-species, 2-year chronic bioassay for carcinogenicity. In addition to the time and resource requirements, cancer bioassays are often criticized as being overly sensitive (subject to false positives), especially for drugs that induce tumors at only 1 site, in 1 sex or in 1 species. Perhaps the most frustrating aspect of this assay is its lack of mechanistic information. Often when drugs are found to induce tumors, the basis for the result is not known, and therefore little useful information is provided for designing the next generation drug that does not induce tumors. Shorter drug development timelines in the pharmaceutical industry have resulted in the need to start these studies earlier in the development cycle. Since many drugs will fail in phase 1 and phase 2 clinical trials, early initiation of cancer bioassays can result in wasted resources and needless use of animals. Predicting carcinogenicity from short-term assays is a challenge. It was both a surprise and disappointment when in the late 1980s it was learned that while most mutagens are carcinogens, the opposite is often not true, especially for pharmaceuticals. Pharmaceutical companies screen drug candidates early in development and generally discard genotoxic molecules except for life-threatening indications such as oncology. Nevertheless, approximately one third of the drugs in the Physicians’ Desk Reference (PDR) for which carcinogenicity data are

Gone (from the Pdr) but Not Forgotten

Purpose: While no longer listed in the Physicians' Desk Reference, PTU is still commonly used in the management of hyperthyroidism around the world. Serious complications of PTU include agranulocytosis, vasculitis, and hepatotoxicity. We report a case of PTU-associated ALF in a patient whose liver tests were not monitored while on therapy, reflecting U.S. guidelines written in 1995. Methods: Results: A 19 year old female was diagnosed with Graves' disease in August 2007 and treated with PTU. Pre-Tx CBC and LFTs were normal, but no further LFTs were obtained. Three months later she presented with nausea, vomiting, abdominal pain and jaundice. LFTs now revealed a total bilirubin 6.5 mg/dL, AST 1747 IU/L and ALT 1589 IU/L. After 6 days at the outside hospital, she was transferred in acute liver failure with coagulopathy and stage II encephalopathy. Liver transplant evaluation was promptly initiated and she was listed as status 1. PTU was the only medication she had taken and all serologic, autoimmune, and metabolic studies were negative. She demonstrated rapid clinical deterioration while awaiting transplant, requiring intubation and CNS pressure monitoring. On our hospital day 7, she underwent orthotopic liver transplant, but succumbed to tonsillar herniation immediately after surgery. Pathology from her explanted liver revealed marked necrosis and fibrosis, consistent with drug-induced liver injury (DILI) (Fig. 1). ALF from non-acetaminophen DILI often has a poor prognosis with a mortality rate as high as 75%. PTU-associated hepatotoxicity has been a well-recognized phenomenon in the clinical literature for >50 years. However, as deaths related to PTU DILI are rare, routine monitoring of LFTs was considered unnecessary in national thyroid society guidelines, although monitoring WBC levels was advised (JAMA 1995;273:808)FigureConclusion: Given the wide spectrum of PTU related DILI, ranging from asymptomatic elevations in ALT to fatal ALF, we agree with the advice to obtain baseline and surveillance LFTs to prevent irreversible liver damage, as is being recommended by several non-U.S. groups (Am J Gastro 2001;96:165), and call for a reappraisal of LFT monitoring guidelines in the U.S.

Preference for Reference

This exploratory study investigated the help-seeking preferences of library users at two large urban universities in Toronto. Reference desk and virtual reference users were compared in terms of their perceptions of the options now available for obtaining reference help. The premise for the study was based on the assumption that a reasonable exposure to newer reference services, such as chat and e-mail, had occurred, therefore allowing for an examination of emerging preferences for different types of services. Surveys were distributed to both reference desk and virtual reference users asking seven core questions exploring use and preference for reference services as well as habits and preferences for study location (in library, off campus, etc.). The results suggest that the reference desk continues to be the most popular method of getting help in the library, but virtual reference satisfies a niche for users who prefer to work outside the library. Those who use virtual reference tend to perceive their options for getting help differently from other users. Virtual reference users do not perceive virtual reference as a novelty or as a marginal service, but see it as a significant service option. In addition, the results show that virtual reference services may have a special appeal to graduate students since graduate students seem more likely to conduct their research outside the library. The study concludes with recommendations for planning and for future research.

Pharmacogenomic Biomarker Information in Drug Labels Approved by the United States Food and Drug Administration: Prevalence of Related Drug Use

To review the labels of United States Food and Drug Administration (FDA)-approved drugs to identify those that contain pharmacogenomic biomarker information, and to collect prevalence information on the use of those drugs for which pharmacogenomic information is included in the drug labeling. Retrospective analysis. The Physicians' Desk Reference Web site, Drugs@FDA Web site, and manufacturers' Web sites were used to identify drug labels containing pharmacogenomic information, and the prescription claims database of a large pharmacy benefits manager (insuring > 55 million individuals in the United States) was used to obtain drug utilization data. Pharmacogenomic biomarkers were defined, FDA-approved drug labels containing this information were identified, and utilization of these drugs was determined. Of 1200 drug labels reviewed for the years 1945-2005, 121 drug labels contained pharmacogenomic information based on a key word search and follow-up screening. Of those, 69 labels referred to human genomic biomarkers, and 52 referred to microbial genomic biomarkers. Of the labels referring to human biomarkers, 43 (62%) pertained to polymorphisms in cytochrome P450 (CYP) enzyme metabolism, with CYP2D6 being most common. Of 36.1 million patients whose prescriptions were processed by a large pharmacy benefits manager in 2006, about 8.8 million (24.3%) received one or more drugs with human genomic biomarker information in the drug label. Nearly one fourth of all outpatients received one or more drugs that have pharmacogenomic information in the label for that drug. The incorporation and appropriate use of pharmacogenomic information in drug labels should be tested for its ability to improve drug use and safety in the United States.

Book Review of Hazardous Chemicals Desk Reference, 6th ed.

ADVERTISEMENT RETURN TO ISSUEPREVBook ReviewNEXTBook Review of Hazardous Chemicals Desk Reference, 6th ed.Cite this: J. Am. Chem. Soc. 2008, 130, 37, 12549Publication Date (Web):July 30, 2008Publication History Published online30 July 2008Published inissue 17 September 2008https://doi.org/10.1021/ja805584mCopyright © 2008 American Chemical SocietyRIGHTS & PERMISSIONSArticle Views122Altmetric-Citations-LEARN ABOUT THESE METRICSArticle Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated. Share Add toView InAdd Full Text with ReferenceAdd Description ExportRISCitationCitation and abstractCitation and referencesMore Options Share onFacebookTwitterWechatLinked InReddit Read OnlinePDF (71 KB) Get e-AlertsSUBJECTS:Materials,Physical and chemical properties Get e-Alerts