Multicenter evaluation of efficacy and safety of low-dose versus high-dose valganciclovir for prevention of cytomegalovirus disease in donor and recipient positive (D+/R+) renal transplant recipients.

Background: The cytomegalovirus (CMV) donor-positive/recipient-positive (D+/R+) population is the largest proportion of renal transplant recipients (RTR). Guidelines for prevention of CMV in the intermediate-risk D+/R+ population include prophylaxis with valganciclovir (VGCV) 900 mg/day for 3 months. This study is the first head-to-head analysis, to our knowledge, comparing the efficacy and safety CMV prophylaxis of VGCV 450 vs 900 mg/day for 3 months in D+/R+ RTR.

Evaluation of dosing and clinical outcomes in patients undergoing conversion of insulin glargine to insulin detemir.

Study Objectives: To evaluate the dose and frequency of insulin detemir for patients with diabetes mellitus undergoing conversion from insulin glargine to insulin detemir, and to assess glycemic control, weight gain, and risk of hypoglycemia after converting to insulin detemir.

Design: Retrospective medical record review.

Setting: Large academic medical center.

Effect of a pharmacist managed smoking cessation clinic on quit rates.

Objective: The purpose of this study was to quantify quit rates, determine factors predicting success, and analyze patients' perceptions at 3 months after participation in the pharmacist-managed Smoking Cessation Group Clinic.

Methods: This was a prospective, single group study that was conducted in patients that had participated in the Smoking Cessation Group Clinic at the University of Iowa Hospitals and Clinics. Clinic participants received structured group counseling covering various topics associated with cessation.

Evaluation of anticoagulation in patients with antiphospholipid syndrome.

Purpose: The quality of anticoagulation therapy in patients with antiphospholipid syndrome (APS) was evaluated.

Summary: The high risk of unnecessary anticoagulation and recent changes in the recommended International Normalized Ratio (INR) target range prompted a performance-improvement initiative to improve the care of patients with APS within the University of Iowa Hospitals and Clinics internal medicine and family medicine anticoagulation clinics. Twenty-three patients with an initial diagnosis of APS were evaluated through chart review to determine the anticoagulation indication, occurrence of thromboembolic events, and INR target range.

Use of hormone replacement therapy by postmenopausal women after publication of the Women's Health Initiative Trial.

Background: After publication of the Women's Health Initiative (WHI) trial in July 2002, many physicians discontinued hormone replacement therapy (HRT) in most of their postmenopausal patients. However, little is known about the women who remain on HRT.

Methods: We performed a retrospective chart analysis of 1000 postmenopausal women seen at an internal medicine practice to establish the prevalence of continued HRT use after publication of the WHI trial, determine the reasons for its use, and establish the prevalence of conditions adversely affected by HRT.

Prevalence of symptomatic peripheral arterial disease, modifiable risk factors, and appropriate use of drugs in the treatment of peripheral arterial disease in older persons seen in a university general medicine clinic.

Background: Persons with peripheral arterial disease (PAD) have a high incidence of cardiovascular morbidity and mortality.

Methods: We investigated the prevalence of symptomatic PAD, modifiable risk factors, and use of drugs in persons 60 years and older seen in a university general medicine clinic. Symptomatic PAD was documented if the person had a documented history of surgery for PAD, if the person had intermittent claudication or other lower extremity symptoms associated with absent or weak arterial pulses or an ankle-brachial index of <0.

Underutilization of calcium and vitamin D by older adults in a large general internal medicine practice.

The underutilization of calcium and vitamin D supplements in the prevention and treatment of osteoporosis is common among high-risk elders. Less is known about the prevalence and adequacy of calcium and vitamin D use by the general population of older adults. We performed a retrospective chart analysis of 617 women and 383 men over the age of 60 (mean age 73 +/- 9 years) seen at an internal medicine practice to establish the prevalence and evaluate the adequacy of calcium and vitamin D supplementation.