Identification and Evaluation of Risk Factors in Patients With Continuously Uncontrolled Hypertension

An aggressive strategy to manage hypertension in a large integrated healthcare organization achieved blood pressure control in 82% of hypertensive patients, as compared with 52% nationwide. It is unknown why the remaining 18% is uncontrolled. The objective of this study was to identify characteristics associated with patients whose blood pressure remains continuously uncontrolled. This nested case‐control study included 1583 continuously uncontrolled cases and 7901 matched controls. Univariate analysis revealed patients who visited their primary care provider frequently (odds ratio, 0.42; 95% confidence interval, 0.39–0.46) were adherent to antihypertensive medications (odds ratio, 0.12; 95% confidence interval, 0.10–0.14), and dispensed more medications (odds ratio, 0.86; 95% confidence interval, 0.85–0.87) were less likely to be continuously uncontrolled. Patient characteristics that were associated with continuously uncontrolled hypertension were the Patient Health Questionnaire‐9 score and higher body mass index. Since patients with controlled hypertension visited their provider more often, patients with continuously uncontrolled hypertension may benefit from more interaction with their healthcare system.     

Ketoconazole in the Prevention of Acute Respiratory Distress Syndrome

We conducted a critical review of the literature on ketoconazole in preventing acute respiratory distress syndrome (ARDS), a serious disorder associated with high mortality. Two double-blind, prospective, placebo-controlled, randomized trials compared ketoconazole with placebo for prophylaxis of ARDS. In one trial, compared with placebo, ketoconazole resulted in a reduced frequency of ARDS (6% vs 31%, p<0.01), lower plasma thromboxane B₂ levels (33 vs 75 pg/ml, p<0.05), and shorter intensive care unit stay (7 vs 15.5 days, p<0.05). In the second trial the drug reduced the frequency of ARDS (15% vs 64%, p=0.002), lowered thromboxane B₂ levels (83 vs 143 pg/ml), and reduced mortality (15% vs 39%, p=0.05) compared with placebo. Larger multicenter studies are warranted to validate the findings of these two trials.     

Association between encounter frequency and time to blood pressure control among patients with newly diagnosed hypertension: a retrospective cohort study

This retrospective cohort study of 95 957 patients from a large integrated healthcare organization was conducted to examine whether the frequency and intervals between outpatient encounters were associated with achieving blood pressure (BP) control. Patients were followed up until they were censored or achieved BP control up to 1 year. Additionally, this study examined the time to BP control. On average, follow‐up was significantly longer in patients with uncontrolled BP at 292.9 days compared with 232.2 days in those with BP control. The controlled BP group had significantly more encounters on average compared with the uncontrolled BP group (4.1 vs 3.1, standardized difference 0.33). As the number of days increased between encounters from the 1 to < 14 days, there was a consistently lower likelihood of achieving BP control. Encounter intervals of ≥180 days were associated with the lowest likelihood of achieving BP control. These findings suggest that there may be an optimal number of encounters to benefit patients with hypertension.     

Key Articles and Guidelines for the Prevention of Venous Thromboembolism

Venous thromboembolism (VTE) is an important medical problem that affects millions of patients each year. With appropriate prophylaxis, many of these thromboembolic events can be prevented. Although strong evidence supporting VTE prophylaxis spans several decades, several large American and global registries have documented very poor use of appropriate prophylaxis. Because of increasing regulatory requirements, hospitals nationwide are in the process of developing documentation of appropriate VTE prophylaxis programs for both surgical and medical patients. A wide range of clinicians must understand what constitutes appropriate VTE prophylaxis in various patient populations. With the existence of numerous pharmacologic agents, abundance of data from major clinical trials, and several nationally recognized clinical guidelines, compiling the needed reference material to make evidence-based decisions on appropriate VTE prophylaxis can be difficult for clinicians. Therefore, we provide a bibliography of key articles and guidelines related to the prevention of VTE in various patient groups. We hope this compilation will serve as a resource for pharmacists, physicians, nurses, residents, and students responsible for the care of patients who may be at risk for VTE.     

Nitric Oxide for ARDS—What Is the Evidence?

We critically reviewed English-language articles indexed on MEDLINE from 1966–1998 and those cited in indexed articles describing or investigating administration of nitric oxide (NO) in adult respiratory distress syndrome (ARDS). Studies evaluating NO exclusively in the pediatric population and in conditions other than ARDS (chronic obstructive pulmonary disease, asthma, cardiac surgery, pulmonary hypertension) were excluded, as were those published exclusively as abstracts. Of the 22 papers selected, 5 studies were dose-response trials, eight were comparative, and the rest were noncomparative. Dose-dependent decreases in pulmonary artery pressures and increases in arterial oxygenation were observed; however, the minimal effective dose varied. Several short-term noncomparative and small noncomparative prospective trials concluded that NO improves oxygenation and decreases pulmonary vasoconstriction without effects on systemic hemodynamics. However, evidence that NO improves outcomes in patients with ARDS is insufficient because mortality remained high, and the number of subjects in each study was low. Since improvements in oxygenation are not seen in all patients and outcomes or mortality might not be altered, NO should be reserved for selected patients in whom conventional therapy is not sufficient to maintain acceptable oxygenation levels.     

Guideline for the prevention of acute nausea and vomiting due to antineoplastic medication in pediatric cancer patients

This guideline provides an approach to the prevention of acute antineoplastic‐induced nausea and vomiting (AINV) in children. It was developed by an international, inter‐professional panel using AGREE and CAN‐IMPLEMENT methods. Evidence‐based interventions that provide optimal AINV control in children receiving antineoplastic agents of high, moderate, low, and minimal emetogenicity are recommended. Recommendations are also made regarding selection of antiemetic agents for children who are unable to receive corticosteroids for AINV control, the role of aprepitant and optimal doses of antiemetic agents. Gaps in the evidence used to support the recommendations were identified. The contribution of this guideline to AINV control in children requires prospective evaluation. Pediatr Blood Cancer 2013; 60: 1073–1082. © 2013 Wiley Periodicals, Inc.     

Children's Oncology Group's 2013 blueprint for research: Cancer control and supportive care

In cancer control research, the objective is to reduce overall morbidity and mortality by decreasing acute and delayed treatment‐related toxicities in all children with cancer. To date, the Children's Oncology Group (COG) has focused on infection, neurocognition, quality of life (QoL), and nutrition/antiemetics. COG is conducting randomized controlled trials (RCTs) to determine prophylaxis strategies that will reduce infections in high‐risk populations. Two RCTs are determining if modafinil or computerized cognitive training improve cognitive functioning in pediatric brain tumor patients. QoL is being assessed in acute leukemia patients. Improved supportive care outcomes will only occur when the most effective interventions are established. Pediatr Blood Cancer 2013; 60: 1027–1030. © 2012 Wiley Periodicals, Inc.