bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Dosing Guidelines for Use of Controlled‐Release Codeine in Chronic Noncancer Plan
Authors: Russell Alan , Watson C Peter , Clark Alexander J , Arkinstall William , Moulin Dwight , Hays Helen , Eisenhoffer John , Quigley Patricia , Harsanyi Zoltan , Darke Andrew
Published: March 2016

OBJECTIVE: The clinical utility of guidelines for conversion of patients from a combination analgesic preparation of acetaminophen 300 mg plus codeine 30 mg every 4 h to 6h as needed to scheduled controlled‐release (CR) codeine every 12 h was evaluated.

METHODS: Adult patients with chronic noncancer pain underwent a two‐week evaluation on acetaminophen plus codeine, followed by eight weeks of treatment with CR codeine. Patients taking four to six tablets of acetaminophen plus codeine per day were transferred to 50 mg CR codeine every 12 h; those on seven to nine tablets were transferred to 100 mg every 12 h; those on 10 to 12 tablets were transferred to 150 mg every 12 h; and those on greater than 12 tablets were transferred to 200 mg every 12 h. Subsequent dose adjustments were permitted. Acetaminophen (325 mg) was available for rescue. Pain intensity (five‐point categorical and 100 mm visual analog scale), pain related disability, adverse events and acceptability were assessed.

RESULTS: Of the 140 patients enrolled, 95 completed eight weeks of treatment with CR codeine. During month 1 and month 2, the mean CR codeine daily doses were 295.7±119.1 mg and 390.3±163.4 mg, respectively. Pain scores during both CR codeine month 1 and 2 were significantly lower than on acetaminophen plus codeine (53.6±20.9 mm and 49.7±23.7 mm versus 59.6±17.5 mm; P=0.0003, P=0.0001, respectively). CR codeine treatment was rated as moderately or highly acceptable by 82% of patients compared with 50% for acetaminophen plus codeine (P=0.001). Only seven patients (5.9%) discontinued CR codeine treatment because of adverse events.

CONCLUSION: The results confirm the safety, efficacy and patient acceptability of the initial conversion and maintenance dosing recommendations for CR codeine from a combination opioid/nonopioid analgesic.
Fluticasone Propionate, 100 µg bid, Using a Non‐CFC Propellant, HFA 134a, in Asthmatic Children
Authors: Lyttle Brian , Gillies John , Panov Maarja , Emeryk Andrzej , Wixon Claire
Published: March 2016

BACKGROUND: Secondary to phasing out chlorofluorocarbons (CFCs), the fluticasone propionate (FP) pressurized metered‐dose inhaler has been formulated in a nonozone‐depleting propellant, hydrofluoralkane (HFA) 134a.

OBJECTIVES: To demonstrate equivalent efficacy and safety of FP 200 µg daily propelled by HFA 134a to FP 200 µg daily propelled by CFCs 11 and 12 over a four‐week treatment period in pediatric asthmatic patients.

METHODS: The study was multinational, randomized, double blind and of parallel group design. Eligible patients aged 16 years and younger were steroid naive or receiving 500 µg/day or less of beclomethasone dipropionate, budesonide or flunisolide, or 250 µg/day or less of inhaled FP. The primary efficacy variable was mean morning peak expiratory flow with equivalence determined if the 90% CIs for the treatment differences between groups were within ±15 L/min.

RESULTS: Three hundred fifteen patients (mean age 9.3±2.8 years) were randomly assigned; 158 patients received FP HFA 134a and 157 patients received FP CFC. Over the four‐week treatment period, mean morning peak expiratory flow increased from baseline in both groups (14 L/min and 17 L/min, respectively), with a mean treatment difference of ‐2 L/min. Equivalence was demonstrated between the groups (90% CI ‐6 to +3 L/min; P=0.589). Both formulations were well tolerated with no serious drug‐related events.

CCONCLUSIONS: FP propelled by HFA 134a has equivalent efficacy and comparable safety to FP propelled by CFC propellants at a microgram equivalent dose in pediatric asthmatic patients.
Reasons for Testing Women for Genital Chlamydia trachomatis Infection in the Calgary Region
Authors: Church Deirdre L , Zentner Ali , Semeniuk Heather , Henderson Elizabeth , Read Ron
Published: March 2016

OBJECTIVE: To determine the clinical reason(s) for screening women with varying degrees of risk for genital Chlamydia trachomatis (CT) in the Calgary region.

DESIGN: Women aged 15 to 75 years were enrolled at various patient care locations. Pertinent risk factors for genital CT infection were recorded and a gynecological examination was performed. Two endocervical swabs and a first‐void urine sample were collected for CT detection using two different nucleic acid amplification test methods.

SETTING: Calgary is an urban region that provides healthcare services to a population of almost one million people. Microbiology services are provided by Calgary Laboratory Services through a centralized regional laboratory service.

MAIN RESULTS: 504 women with a mean age of 28.1 ± SD 8.22 years were enrolled. Two hundred ninety‐one women (57.8%) were at high risk for acquiring genital CT infection. Twenty‐eight (5.6%) tested positive for CT infection and almost all of these women (26 of 28, 93%) had risk factors for acquiring infection. Of the high‐risk women, 9.8% were CT positive versus only 1.3% of women at low risk (P=0.0001). Only two of 152 (1.3%) women older than 30 years had genital CT infections. Although most women were asymptomatic, those with laboratory‐confirmed CT infection were more likely to have genitourinary symptoms. Three hundred forty‐three of 476 (72%) women who did not have genital CT infection had no risk factors, and screening was done as part of a routine gynecological examination for other purposes (prenatal visit, Pap smear).

CONCLUSION: Women without risk factors are being screened routinely for genital CT infection as part of a routine gynecological examination done for other reasons. Elimination of the routine screening of low‐risk women older than 30 years of age would decrease the current regional utilization of CT tests by as much as one‐third.
The Descriptive Epidemiology of Primary Lung Cancer in an Alberta Cohort with a Mutivariate Analysis of Survival to Two Years
Authors: Demeter Sandor J , Chmielowiec Chester , Logus Wayne , Benkovska-Angelova Pauline , Jacobs Philip , Hailey David , McEwan Alexander
Published: March 2016

BACKGROUND: Lung cancer contributes significantly to cancer morbidity and mortality. Although case fatality rates have not changed significantly over the past few decades, there have been advances in the diagnosis, staging and management of lung cancer.

OBJECTIVE: To describe the epidemiology of primary lung cancer in an Alberta cohort with an analysis of factors contributing to survival to two years.

PATIENTS AND METHODS: Six hundred eleven Albertans diagnosed with primary lung cancer in 1998 were identified through the Alberta Cancer Registry. Through a chart review, demographic and clinical data were collected for a period of up to two years from the date of diagnosis.

RESULTS: The mean age at diagnosis was 66.5 years. The majority of cases (92%) were smokers. Adenocarcinoma, followed by squamous cell carcinoma, were the most frequent nonsmall cell lung cancer histologies. Adenocarcinoma was more frequent in women, and squamous cell carcinoma was more frequent in men. The overall two‐ year survival rates for nonsmall cell, small cell and other lung cancers were 24%, 10% and 13%, respectively. In multivariate analysis, stage, thoracic surgery and chemotherapy were significantly associated with survival to two years in nonsmall cell carcinoma; only stage and chemotherapy were significant in small cell carcinoma.

CONCLUSIONS: This study provides a Canadian epidemiological perspective, which generally concurs with the North American literature. Continued monitoring of the epidemiology of lung cancer is essential to evaluate the impact of advances in the diagnosis, staging and management of lung cancer. Further clinical and economic analysis, based on data collected on this cohort, is planned.
Recurrent Embolotherapy in Dieulafoy′s Disease of the Bronchus
Authors: Bhatia Praveen , Hendy MS , Li-Kam-Wa E , Bowyer PK
Published: March 2016

Dieulafoy′s disease is a vascular anomaly characterized by the presence of a dysplastic artery that is related to an epithelial ulcer. The French surgeon Georges Dieulafoy first described it in 1898. Most frequently, it is a gastrointestinal condition, but occurrence in the bronchus has been reported in a few cases. The case of a 52‐year‐old man with massive hemoptysis, for which he underwent successful embolotherapy 10 years previously, is described. Over the next 10 years, he had several hospital admissions due to hemoptysis, and he underwent successful embolotherapy on each occasion. This case report underlines the importance of bronchial arteriography as the investigation of choice for massive hemoptysis.
An Unusual Cause of an Incidental Lung Mass
Authors: Lawson Lindsay M , Tiwari Pari , Filipenko J Douglas
Published: March 2016

A 52-year-old woman was found to have a mass measuring 1 cm in diameter with radiographic features of a carcinoid tumour in the left lung during work-up for chest pain. Wedge excision of the lesion revealed a leiomyoma that had a similar histological appearance to uterine 'fibroids' removed eight years previously. This case is an example of benign metastasizing leiomyoma, an unusual lesion of uncertain etiopathogenesis.
Effects of Positive End‐Expiratory Pressure on Oscillated Volume during High‐Frequency Chest Compression in Children with Cystic Fibrosis
Authors: Dosman Cara F , Zuberbuhler Peter C , Tabk Joan I , Jones Richard L
Published: March 2016

OBJECTIVE: To investigate the effects of positive end‐expiratory pressure (PEEP) on end‐expiratory lung volume (EELV) and mean oscillated volume (Vosc) during high frequency chest compression (HFCC).

DESIGN: A clinic‐based prospective intervention study.

SETTING: Pulmonary function laboratory, University of Alberta, Edmonton, Alberta.

POPULATION: Nine children with cystic fibrosis with little or no obstructive airway disease who were selected from the outpatient Cystic Fibrosis and Pediatric Pulmonary Clinics at the University of Alberta Hospital, Edmonton, Alberta.

METHODS: Each child received HFCC alone (at 10 Hz with chest wall pressure of 8 cm H2O) and HFCC plus PEEP. A closed circuit spirometry system was used to measure HFCC‐ and PEEP‐induced changes in EELV, expressed as per cent baseline functional residual capacity (FRC) measured using helium dilution. An isothermic chamber permitted measurement of Vosc.

RESULTS: HFCC caused a significant 9% decrease in EELV. Adding 2.0±0.3 cm H2O of PEEP increased EELV back to at least the FRC level. With HFCC alone, Vosc was significantly lower during spontaneous expiration than during spontaneous inspiration, but adding PEEP to HFCC increased Vosc, especially during spontaneous expiration.

CONCLUSIONS: Adding PEEP during HFCC prevents the decrease in EELV and increases Vosc. Therefore, PEEP may improve HFCC‐induced mucus clearance in children with cystic fibrosis.
A Comparison of Bacteremic Pneumococcal Pneumonia with Nonbacteremic Community‐Acquired Pneumonia of Any Etiology — Results from a Canadian Multicenter Study
Authors: Marrie Thomas J , Low Donald E , de Carolis Emidio , the Canadian Community-Acquired Pneumonia Investigators
Published: March 2016

BACKGROUND: Bacteremic pneumococcal pneumonia has not been the subject of a multicentre Canadian Study.

OBJECTIVES: To compare bacteremic community‐acquired Streptococcus pneumoniae pneumonia with nonbacteremic community‐acquired pneumonia of any etiology.

METHODS: A prospective cohort study was conducted at 15 centres in eight Canadian provinces from January 1996 to January 1998.

RESULTS: Fifty‐six of the 450 patients (12.4%) had one or more blood cultures positive for S pneumoniae. Compared with the 394 blood culture‐negative patients, the bacteremic patients were younger (55.6 years versus 63.4 years; P=0.002). At presentation, bacteremic patients had a higher mean oral temperature (38.1±1.2°C versus 37.7±1.2°C; P=0.026), a higher pulse rate (108.4±22.1 beats/min versus 102.1±20.6 beats/min; P=0.033), a lower diastolic blood pressure reading (66.8±12.7 mmHg versus 73.8±15.8 mmHg; P=0.001) and a higher percentage of white blood cells that were band forms (22.1% versus 14.2%; P=0.0007). The time from onset of symptoms until admission to hospital was shorter among the bacteremic patients (4.6±3.7 days versus 7.0±13.9 days; P=0.005). Three capsular polysaccharide types accounted for 53.4% of the isolates: type 14, 29.2%; type 4, 12.1%; and type 22 F, 12.1%. Two of 44 isolates were resistant to penicillin.

CONCLUSIONS: While some differences in patient characteristics and presentation occur when patients with bacteremic pneumococcal pneumonia are compared with nonbacteremic patients with community‐acquired pneumonia, there is considerable overlap, and clinical presentation does not allow one to distinguish the bacteremic patients from the nonbacteremic patients.
Canada′s First Universal Varicella Immunization Program: Lessons from Prince Edward Island
Authors: Sweet Lamont , Gallant Peggy , Morris Marie , Halperin Scott A
Published: March 2016

A live attenuated varicella vaccine was licensed in Canada in December 1998. The first universal varicella immunization program in Canada was initiated in Prince Edward Island in 2000. Students in grades one to six without a history of varicella were offered the vaccine, administered by Public Health Nurses, in school clinics during February and March 2000. The acceptance rate ranged from 29.1% of all grade one students to 9.8% of all grade six students; overall, 18.8% of students received the vaccine. A universal program for children 12 months of age was introduced on April 1, 2000 and catch‐up clinics for those between 12 months of age and those in grade one were introduced in June 2000. Repeated media announcements and the cooperation of staff in schools and daycare facilities assisted in informing parents about the availability of the vaccine. Vaccine‐ associated adverse events have been uncommon and the vaccine has been well accepted.
Disability management: The Insurance Corporation of British Columbia experience
Authors: Harder Henry , Potts Leslie
Published: March 2016

Insurance Corporation of British Columbia (ICBC) is a Crown Corporation created by the Provincial Government in 1974 to provide compulsory auto insurance. It is a common‐law or tort system with ′add‐on′ no‐fault provisions (medical/rehabilitation and disability benefits). ICBC insures 2 million British Columbia (BC) residents and pays out over $2 billion (Cdn.) in claims annually. One billion of this is for injury claims. Currently, one percent of these claims are catastrophic losses (paraplegic, quadriplegic, traumatic brain injury) with the remainder being non‐catastrophic claims. Seventy percent of these non‐catastrophic claims are soft tissue (primarily whiplash) injuries.
Epidemiology, Antibiotic Susceptibility and Serotype Distribution of Streptococcus pneumoniae Associated with Invasive Pneumococcal Disease in British Columbia ‐ A Call to Strengthen Public Health Pneumococcal Immunization Programs
Authors: Bigham Mark , Patrick David M , Bryce Elizabeth , Champagne Sylvie , Shaw Carol , Wu Wrency , Ng Helen , Roscoe Diane , Roy Jacques , Isaac-Renton Judy
Published: March 2016

BACKGROUND: This study examined the epidemiology, antibiotic susceptibility and serotype distribution of Streptococcuspneumoniae associated with invasive pneumococcal disease (IPD) in British Columbia.

METHODS: Six hospitals and one private laboratory network participated in a prospective, sentinel laboratory based surveillance study of IPD, between October 1999 and October 2000. At each site, S pneumoniae isolates were collected and epidemiological data were gathered using a structured questionnaire, for all cases of IPD meeting the study case definition. Isolates were serotyped and tested for antimicrobial susceptibility. Bivariate associations were analyzed and multivariate logistic regression was used to identify independent risk factors associated with hospitalization or death.

RESULTS: One hundred three reports and isolates were collected. Seventy‐nine per cent of cases were community‐acquired, 64% required hospitalization and 5% died. Cases with one or more assessed risk factor for IPD and of female sex were independent variables associated with hospitalization or death. One‐third of isolates had reduced penicillin susceptibility and 96% of these represented serotypes contained in the 23‐valent pneumococcal polysaccharide vaccine (PPV‐23). Overall, 89% of serotypes identified are included in the PPV‐23 vaccine and 88% of isolates from children under five years of age are found in the 7‐valent pneumococcal conjugate vaccine (PCV‐7). Forty‐one per cent of cases qualified for publicly funded pneumococcal vaccine and 34% of eligible persons were vaccinated.

CONCLUSIONS: Overall, pneumococcal serotypes associated with IPD in this study closely matched serotypes included in PPV‐23 products currently licensed in Canada. Most serotypes associated with IPD in children under five years of age are included in a recently licenced PCV‐7. One third of isolates demonstrated reduced penicillin susceptibility, most involving serotypes included in PPV‐23. Effective delivery of current public health immunization programs using PPV‐23 and extending protection to infants and young children using the PCV‐7 will prevent many cases of IPD.
Legionnaires′ Disease ‐ Results of a Multicenter Canadian Study
Authors: Marrie Thomas J , de Carolis Emidio , Yu Victor L , Stout Janet , the Canadian Community-Acquired Pneumonia Investigators
Published: March 2016

BACKGROUND: There has never been a cross‐Canada surveillance project to determine the rate of Legionella species as a cause of community‐acquired pneumonia requiring hospitalization and to determine whether there are any regional differences in the rates of Legionnaires′ disease in Canada. Anecdotally, Legionnaires′ disease is thought to be uncommon in Western Canada.

METHODS: From January, 1996 through to October 31, 1997, a prospective study of the etiology of community acquired pneumonia requiring admission to 15 tertiary care hospitals in eight Canadian provinces was conducted. A urine sample from each patient was tested for Legionella pneumophila serogroup 1 antigen using a commercially available ELISA assay. A culture of sputum or other respiratory specimens for Legionellaceae was carried out at the discretion of the attending physician. Two hundred thirty‐four patients had acute and 6‐week convalescent serum samples tested for antibodies to L pneumophila serogroups 1 through 6 using an ELISA method.

RESULTS: 28 of the 850 patients (3.2%) had Legionnaires′ disease; 18 of 823 (2.1%) were positive for L pneumophila serogroup 1 by urinary antigen testing. The rate of Legionnaires′ disease, based on urinary antigen, at the Halifax site was higher than that at the other sites (seven of 163 patients versus 11 of 660 [P=0.04]). Of the 28 cases of Legionnaires′ disease identified using all methods, 11 of 277 patients (3.9%) were enrolled from Western provinces versus 17 of 573 patients (2.9%) from Eastern provinces (P=nonsignificant).

CONCLUSIONS: Legionnaires′ disease is just as common in Western as in Eastern Canada. L pneumophila serogroup 1 may be more common in Halifax than at the other sites studied.
Massive Pleural Effusion in an 18‐Year‐Old Girl with Ewing Sarcoma
Authors: Özge Cengiz , Çalikoglu Mukadder , Cinel Leyla , Apaydin F Demir , Özgür Eylem S
Published: March 2016

Ewing sarcoma is a bone tumour that commonly appears between ages five and 10 in the diaphysis of the long bones and predominantly presents with pain and swelling. The case of an 18‐year‐old girl who presented with back pain, cough, dyspnea, weakness and fever is described. Chest radiograph showed a homogenous density in the middle and inferior zones of the right hemithorax. Thoracic computed tomography revealed a diffuse pleural effusion and a 6.99 cmx4.45 cm solid mass composed of lobulated, small cystic lesions and calcifications in the right hemithorax. Biochemical analysis of pleural fluid showed hemorrhagic effusion and exudate. A pleural needle biopsy demonstrated solid uniform tumour cells with narrowed cytoplasm, round nuclei and uncertain nucleoli. All of the tumour cell cytoplasms stained with CD99. The pathological examination supported Ewing sarcoma. Three‐phase Tc‐99m methylene diphosphonate scintigraphy of the whole body showed pathological tracer uptake in a broad area of the eighth costal bone and in smaller areas of the ninth and 10th costal bones. This case is reported because Ewing sarcoma is a rare cause of pleural effusion in clinical practice among younger adults.
A Case of Spontaneous Methicillin‐Resistant Staphylococcus aureus Meningitis in a Health Care Worker
Authors: Dylewski Joe , Martel Guillaume
Published: March 2016

Meningitis caused by Staphylococcus aureus is an unusual illness that is often associated with bacteremia, contiguous infection and/or a post‐neurosurgical state. Until recently, most cases were caused by methicillin‐susceptible strains, but there are a few reports of methicillin‐resistant S aureus strains causing meningitis. A new case of meningitis caused by methicillin‐resistant S aureus in a neonatal intensive care nurse who did not have bacteremia or neurosurgery is reported. The patient made a full recovery after treatment with vancomycin and rifampin.
Does Technetium‐99m Diethylenetriaminepentaacetate Clearance Predict the Clinical Course of Idiopathic Pulmonary Fibrosis?
Authors: Mura Marco , Belmonte Gelorma , Fanti Stefano , Pacilli Angela Maria , Fasano Luca , Zompatori Maurizio , Schiavina Mario , Fabbri Mario
Published: March 2016

Clearance of inhaled technetium‐99m diethylenetriaminepentaacetate (99mTc‐DTPA) is a potential indicator of disease activity and progression in idiopathic pulmonary fibrosis (IPF). The objective of the present study was to evaluate the prognostic value of 99mTc‐DTPA scans in IPF. A total of 22 patients (18 males), aged 33 to 80 years with IPF were followed for six to 20 months (mean 13 months). At diagnosis, high resolution computed tomography (HRCT) scans showed a honeycomb pattern with bibasilar reticular opacities in all cases. At T0 (diagnosis) and T1 (follow‐up), each patient had pulmonary function tests (forced vital capacity, diffusing capacity of the lung for carbon monoxide and partial arterial O2 pressure), extension of fibrosis evaluated by HRCT visual score and 99mTc‐DTPA lung clearance. Results at T0 and T1 were compared, taking into account the whole population and patients with relatively fast and slow 99mTc‐DTPA wash‐out. 99mTc‐DTPA clearance did not show any significant correlation with functional tests or HRCT score. These findings indicate that clearance of inhaled 99mTc‐DTPA is not of value in following the progress of IPF.
Comparative Prevalence of Asthma in Different Groups of Athletes: A Survey
Authors: Langdeau Jean-Bruno , Turcotte Hélène , Thibault Guy , Boulet Louis-Philippe
Published: March 2016

BACKGROUND: The type of air predominantly inhaled during training seems to play an important role in the development of airway hyperresponsiveness in athletes; however, this factor has not been evaluated for asthma.

OBJECTIVE AND PATIENTS: To compare the prevalence of self‐reported and/or physician‐diagnosed asthma among four groups of athletes categorized according to the type of air predominantly inhaled during training: cold air (n=176), dry air (n=384), humid air (n=95), and mixed dry and humid air (n=43).

METHOD: Self‐administrated questionnaires were used.

RESULTS: One hundred seven (15.3%) of the 698 athletes reported having asthma; of these 107 athletes, 92 had physician‐diagnosed asthma. No significant differences were found for the prevalence of asthma: 15.9% (cold air), 15.4% (dry air), 12.6% (humid air) and 18.6% (mixed dry and humid air), respectively (P>0.05). Furthermore, no significant differences were observed among the groups for the prevalence of confirmed atopy, cold/flu or respiratory infections (all P>0.05), except for the prevalence of hay fever, which was significantly lower among athletes of the dry air group (P=0.04). Athletes having a first‐degree relative with asthma did not have a higher prevalence of asthma than those who did not (P>0.05).

CONCLUSION: The prevalence of asthma was not significantly different among the four groups of athletes and it was not associated with a family history of asthma.
Chronic Noncancer Pain and the Long Term Utility of Opioids
Authors: Watson CPN , Watt-Watson JH , Chipman ML
Published: March 2016

OBJECTIVE: To report on a long term experience in treating patients with chronic noncancer pain (CNCP).

METHODS: One hundred two patients with CNCP were seen every three months and followed for one year or more (median eight years, range one to 22). Demographic data, diagnostic categories and response to therapies were recorded. The utility and safety of opioid therapy, adverse events, impact on disability and issues related to previous psychiatric or chemical dependency history were documented.

RESULTS: Most patients reported a variety of neuropathic pain problems and most required chronic opioid therapy after the failure of other treatments. Although 44% reported being satisfied with pain relief despite adverse events, it is noteworthy that the remaining patients chose to continue therapy for the modest benefit of pain relief despite adverse events. Moreover, 54% were less disabled on opioid therapy.

CONCLUSIONS: This is a large sample of CNCP patients, most taking opioids over a long period of time. CNCP can be treated by opioids safely and with a modest effect, with improvement in functioning in some patients who are refractory to other measures. If care is taken, opioids may even be used effectively for patients with a history of chemical dependency.
Measurement of Antibiotic Consumption: A Practical Guide to the Use of the Anatomical Therapeutic Chemical Classification and Defined Daily Dose System Methodology in Canada
Authors: Hutchinson James M , Patrick David M , Marra Fawziah , Ng Helen , Bowie William R , Heule Laurie , Muscat Mark , Monnet Dominique L
Published: March 2016

Despite the global public health importance of resistance of microorganisms to the effects of antibiotics, and the direct relationship of consumption to resistance, little information is available concerning levels of consumption in Canadian hospitals and out‐patient settings. The present paper provides practical advice on the use of administrative pharmacy data to address this need. Focus is made on the use of the Anatomical Therapeutic Chemical classification and Defined Daily Dose system. Examples of consumption data from Canadian community and hospital settings, with comparisons to international data, are used to incite interest and to propose uses of this information. It is hoped that all persons responsible for policy decisions regarding licensing, reimbursement, prescribing guidelines, formulary controls or any other structure pertaining to antimicrobial use become conversant with the concepts of population antibiotic consumption and that this paper provides them with the impetus and direction to begin accurately measuring and comparing antibiotic use in their jurisdictions.
Surfactant — Where Are We in 2003?
Authors: Lewis JF
Published: March 2016

Surfactant research has progressed over the past several years to the extent that exogenous surfactant administration in patients with the acute respiratory distress syndrome (ARDS) is now being evaluated. Unfortunately, clinical responses have been variable, and we now need to take a look at how surfactant is altered in this disease so that more effective treatment strategies can be developed. This review briefly discusses the biophysical and host defense properties of surfactant, the impact of mechanical ventilation (MV) on the endogenous surfactant system and the most recent clinical data involving exogenous surfactant administration in patients with ARDS. Discussions regarding future directions of surfactant research both in ARDS and diseases other than acute lung injury are included.
Meeting Proceedings: Recommendations for Improved Acute Pain Services: Canadian Collaborative Acute Pain Initiative
Authors: Goldstein David H , Ellis Jacqueline , Brown Robert , Wilson Rosemary , Penning John , Chisom Kenneth , VanDenKerkhof Elizabeth , members of the Canadian Collaborative Acute Pain Initiative
Published: March 2016

The Canadian Collaborative Acute Pain Initiative, established in 2002, is a voluntary, multidisciplinary consortium of acute pain health professionals from across Canada whose goal is to improve acute pain management through discussion and consensus. The group met in January 2002 to define strategic areas related to the treatment of acute pain. The areas identified were: the definition of pain; the epidemiology of pain; the concept of an ′ideal′ acute pain management service; education; therapeutic options; symptom management; and research and safety. In November 2002, a second meeting was held to develop objectives and recommendations for the management of acute pain based on the defined areas. The outcome of these discussions is summarized in this paper.
Spirometric Findings among School‐Aged First Nations Children on a Reserve: A Pilot Study
Authors: Sin Don D , Sharpe Heather M , Cowie Robert L , Man SF Paul , on behalf of the Alberta Strategy to Help Manage Asthma (AST
Published: March 2016

BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) are increasing concerns for First Nations peoples in Canada. Although hospital utilization for asthma and COPD among First Nations peoples has been increasing, the prevalence of asthma or wheezing is comparable to national averages.

OBJECTIVES: A pilot study was conducted to determine the prevalence of impaired lung function in school‐aged First Nations children.

PATIENTS AND METHODS: A First Nations community in northern Alberta was selected to participate. Consent forms and a school health survey were completed by parents or guardians. Children with consent completed spirometry at school, and results were compared with predicted values.

RESULTS: A total of 36 children participated (response rate 70.6%). Of these, 19.4% of parents reported that their child had received a physician diagnosis of asthma at some point in their life; only 28.6% had a parental report of still having asthma. Parents smoked in 73.1% of the children′s homes. The mean (± SD) percentage of forced expiratory volume in 1 s (FEV1) over forced vital capacity (FVC) was 82.6%±6.9% (94.4%±0.08% of predicted). Evidence of airflow obstruction was found in 25% of the children. Parental report of the child ever having asthma was associated with impaired lung function (OR 3.20; P=0.033). Children in a home with reported mold exposure were less likely to have impaired lung function (OR 0.68; P=0.030).

CONCLUSIONS: Many children in this study already have established airflow obstruction and may be at increased risk for asthma or COPD. Exposure to mold appeared to be protective. Further research is needed to evaluate the lung health concerns of this population.
Canadian Standards Association Standard CAN/CSA/Z264.1‐02:2002: A New Voluntary Standard for Spacers and Holding Chambers Used with Pressurized Metered‐Dose Inhalers
Authors: Dolovich Myrna B , Mitchell Jolyon P
Published: March 2016

A new Canadian standard (CAN/CSA/Z264.1‐02:2002) has been published with the purpose of helping to ensure the safety, efficacy and functionality of spacers and/or holding chambers. They are prescribed for use by spontaneously breathing patients for the treatment of various respiratory diseases where medication is delivered to the lungs using pressurized‐metered dose inhalers. This consensus standard was developed with the support of pharmaceutical companies and manufacturers of spacers and holding chambers, and with the help of clinicians, retail pharmacists and representatives of patient advocate bodies associated with respiratory diseases and the dissemination of information related to the treatment and the delivery of inhaled medications. Advice was also sought from expert groups outside of Canada to ensure that the standard would be relevant internationally. Whereas monographs in the pharmaceutical compendia and guidance documents published by regulatory bodies provide information that is largely about the drug product and inhaler, this is the only standard whose focus is primarily on these add‐on devices. The purpose of the present review is to highlight the main features of the standard for clinicians by describing its scope, the tests that are intended to assure the robustness of the construction of these devices, the type of testing that is specified to establish in vitro efficacy, and the recommendations for the marking and labelling of the device and its associated packaging. Manufacturers who test their products to this Canadian Standards Association standard will be able to provide performance information about add‐on devices to the clinician, facilitating an informed decision when selecting devices for patients.
The Hazards of a Practicing Respirologist
Authors: Bowie Dennis
Published: March 2016

The advent of severe acute respiratory syndrome (SARS) in March 2003 reminded us that health care workers are at risk of being stricken with the very diseases that we are treating. Health care workers accounted for 65% of the SARS cases in Canada (1) and represented at least one‐quarter of the cases in Hong Kong (2). Because SARS presents as a severe pneumonia and is diagnosed by certain epidemiological characteristics, history and a positive chest x‐ray, respirologists are often the first‐line consultants to see patients with an unusual pneumonia. If we are lucky, there may be telling clues to the diagnosis such as a travel history or contact with other cases. However, in the absence of these clues, it behooves the medical profession to use universal precautions.
The Case of Dr George Gale V. the College of Physicians and Surgeons of Ontario: A Legal Analysis
Authors: Wilton Matthew
Published: March 2016

On March 15, 2002, anaesthetist and pain practitioner, Dr George Gale, had his license to practice medicine in Ontario revoked by a decision of the Discipline Committee of the College of Physicians and Surgeons of Ontario (CPSO) (1,2). To that point, Dr Gale had practiced medicine as an anaesthetist in Ontario without incident. The CPSO Discipline Committee hearing had taken place over 22 days in 2001 and 2002. The focus of the CPSO prosecution against Dr Gale was his pain practice conducted at a well‐known pain clinic in Toronto, Ontario. By an Ontario Divisional Court decision dated October 10, 2003, the CPSO Discipline Committee decision was set aside on appeal (3). Most importantly, the Ontario Divisional Court held that the penalty of revocation levied against Dr Gale was unfair and based on several serious errors made by the Discipline Committee. A closer examination of the decisions of both the Discipline Committee and the Ontario Divisional Court will hopefully illustrate both the medical standards of practice issues for pain practitioners, and some of the perils created by the self governing activities of the CPSO. To put the Gale decision in proper context, it will be necessary for us to briefly examine the function of the CPSO and its Discipline Committee.
After Guidelines, What?
Authors: Bowie Dennis M
Published: March 2016

In a recent survey, Canadian Thoracic Society (CTS) members indicated that they feel our association should be involved in the production of guidelines (1). There is evidence in the literature that suggests guidelines can have some effect in changing behaviour, although this is variable and modest at best. Certainly, the production of guidelines is not without costs, particularly in time spent by experts in reviewing the literature and producing them. For good reasons, delays frequently occur in their production, often leading to recommendations that may be outdated. People sometimes forget that one of the most important reasons for producing guidelines is to identify questions that require future research.
Serological Studies of West Nile Virus in a Liver Transplant Population
Authors: Nicolle LE , Gutkin A , Smart G , Dawood M , Drebot M , Van Caeseele P , Giulivi A , Minuk GY
Published: March 2016

BACKGROUND: Solid organ transplant populations are at increased risk for serious clinical manifestations of West Nile virus (WNV) infection.

OBJECTIVE: To monitor liver transplant recipients during the 2003 WNV season in Manitoba and to identify incidence, clinical presentation and serology.

METHODS: Serial blood specimens were obtained from adult patients followed at the liver transplant outpatient clinic between May 2003 and October 2003. Studies for WNV infection included immunoglobulin (Ig) G and IgM enzyme immunoassay (EIA), hemagglutination inhibition (HI), plaque reduction neutralization test and reverse transcriptase‐polymerase chain reaction.

RESULTS: None of the 79 patients had clinical presentations suggestive of WNV infection. On testing of the final serum specimen obtained, 14 patients (18%) had positive IgG anti‐WNV by EIA and six patients (7%) had indeterminate IgG anti‐WNV by EIA, although all were negative by IgM EIA. Four (20%) of the EIA‐positive samples were reactive by HI, but all of these were negative by WNV plaque reduction neutralization test; this is consistent with the presence of non‐West Nile flavivirus antibody in these sera. Blood specimens obtained throughout the season from EIA‐ and HI‐positive individuals were uniformly negative for WNV‐RNA by reverse transcriptase‐ polymerase chain reaction. Age, sex, hematology and biochemistry findings, hepatitis B or C virus status, immunosuppressive regimen (cyclosporin or tacrolimus) and pretransplant diagnosis of liver disease were similar for EIA‐positive and EIA‐negative patients. For the 10 patients with a positive IgG EIA maintained on cyclosporin, the cyclosporin level was 129.1±28.6 µg/L compared with 85.6±36.7 µg/L in 26 patients who were EIA‐negative (P=0.002).

CONCLUSIONS: False‐positive IgG EIA serology for WNV was common in this cohort of liver transplant recipients, and was associated with elevated serum cyclosporin levels.
Cartography of Emergency Department Visits for Asthma – Targeting High‐Morbidity Populations
Authors: Lajoie Pierre , Laberge Andrée , Lebel Germain , Boulet Louis-Philippe , Demers Marie , Mercier Pierre , Gagnon Marie-France
Published: March 2016

BACKGROUND: Asthma education should be offered with priority to populations with the highest asthma‐related morbidity. In the present study, the aim was to identify populations with high‐morbidity for asthma from the Quebec Health Insurance Board Registry, a large administrative database, to help the Quebec Asthma and Chronic Obstructive Pulmonary Disease Network target its interventions.

METHODS: All emergency department (ED) visits for asthma were analyzed over a one‐year period, considering individual and medical variables. Age‐ and sex‐adjusted rates, as well as standardized rate ratios related to the overall Quebec rate, among persons zero to four years of age and five to 44 years of age were determined for 15 regions and 163 areas served by Centres Locaux de Services Communautaires (CLSC). The areas with rates 50% to 300% higher (P<0.01) than the provincial rate were defined as high‐morbidity areas. Maps of all CLSC areas were generated for the above parameters.

RESULTS: There were 102,551 ED visits recorded for asthma, of which more than 40% were revisits. Twenty‐one CLSCs and 32 CLSCs were high‐morbidity areas for the zero to four years age group and five to 44 years age group, respectively. For the most part, the high‐morbidity areas were located in the south‐central region of Quebec. Only 47% of asthmatic patients seen in ED had also seen a physician in ambulatory care.

CONCLUSION: The data suggest that a significant portion of the population seeking care at the ED is undiagnosed and undertreated. A map of high‐morbidity areas that could help target interventions to improve asthma care and outcomes is proposed.
Symptom Resolution in Patients with Mycoplasma pneumoniae Pneumonia
Authors: Marrie Thomas J , Beecroft Michael , Herman-Gnjidic Zeljka , Poulin-Costello Melanie
Published: March 2016

BACKGROUND: Mycoplasma pneumoniae generally causes pneumonia of mild to moderate severity in adults. However, little is known about the time course of the resolution of symptoms in this illness.

OBJECTIVES: To determine the time course of the resolution of symptoms in M pneumoniae pneumonia.

METHODS: The severity of fatigue, cough, dyspnea, sputum and pleuritic chest pain were self‐scored and recorded daily for 14 days and on days 30 and 42. Each symptom was scored on a scale of 0 to 5. The sum of the five symptom scores had a range of 0 to 25 and was transformed into a value from zero to 100 by multiplying by four.

RESULTS: The mean composite symptom score for 76 patients was 59 (out of 100) at presentation, which declined to a score of 17 on day 14. Patients with a score of greater than 20 on day 14 had significantly higher scores throughout the course of the illness. Thirty‐four per cent of those who were employed did not take time off work.

CONCLUSIONS: Most patients with M pneumoniae pneumonia had resolution of their symptoms within two weeks; however, 12.6% were still symptomatic at 42 days.
Asthma and Allergic Rhinitis in Quebec Children
Authors: Lévesque Benoît , Rhainds Marc , Ernst Pierre , Grenier Anne-Marie , Kosatsky Tom , Audet Nathalie , Lajoie Pierre
Published: March 2016

BACKGROUND: The Health and Social Survey of Quebec Children and Youth, conducted on representative samples of children nine, 13 and 16 years of age, provided data on the prevalence and determinants of asthma and allergic rhinitis in Quebec.

OBJECTIVES: To determine the prevalence of asthma and allergic rhinitis among children in the province of Quebec and to identify the determinants of these pathologies.

METHODS: Three groups of more than 1100 children aged nine, 13 and 16 years were recruited. Respiratory symptoms were documented using the International Study of Asthma and Allergies in Childhood questionnaire. Questions enquiring about family income, smoking, degree of urbanization of the child′s school′s location and various variables related to indoor air were also included. The comparisons of proportions were done using the X2 test.

RESULTS: The prevalence rates for reported history of asthma varied from 14% to 15% depending on the age group. The prevalence of wheezing in the past year was 7% to 8%. Asthma was the primary cause of the limitation of activities due to a health problem in nine‐ and 13‐year‐old Quebecers, and the second most common cause in 16‐year‐old Quebecers. The prevalence of rhinitis, rhinoconjunctivitis and reported history of hay fever increased with age, reaching 28.0%, 15.9% and 21.1%, respectively, in the 16‐year‐old group. The prevalence of asthma and wheezing was associated with family history and allergies, and inversely related to family income.

CONCLUSIONS: The prevalence of childhood asthma is high in the province of Quebec. It is a major cause of the limitation of activities due to a health problem for young Quebecers. A family history of asthma and an atopic predisposition are important determinants in the development of asthma in Quebec.
A Survey of Cancer Pain Management Knowledge and Attitudes of British Columbian Physicians
Authors: Gallagher R , Hawley P , Yeomans W
Published: March 2016

INTRODUCTION: There are many potential barriers to adequate cancer pain management, including lack of physician education and prescription monitoring programs. The authors surveyed physicians about their specific knowledge of pain management and the effects of the regulation of opioids on their prescribing practices.

METHODS: A questionnaire was mailed out to British Columbia physicians who were likely to encounter cancer patients. The survey asked for physicians′ opinions about College of Physicians and Surgeons of British Columbia regulation and other issues related to their prescribing practices, and assessed basic knowledge of cancer pain management.

RESULTS: There was a 69% return rate with a total of 4618 evaluable responses. There was a significant difference among medical disciplines, years in practice, number of chronic pain patients seen and size of community of practice. The highest knowledge scores were achieved by oncologists and the lowest scores were from surgeons. Those who practiced in smaller communities had a higher average knowledge score. Those who felt their knowledge about cancer pain was inadequate scored lower than those who felt their knowledge was adequate. The questions most frequently answered incorrectly (or by ′don′t know′) were those about equianalgesic dosing (68%) and adequate breakthrough dosing (45%), revealing knowledge deficiencies that would significantly impair a physician′s ability to manage cancer pain.

CONCLUSIONS: The details of opioid prescribing are crucial areas to target education for cancer pain management. The surveyed physicians accepted the need for regulation of opioid prescribing with very few being fearful of scrutiny from the College of Physicians and Surgeons of British Columbia. However, the inconvenience of the triplicate prescription pad was more of a barrier to prescribing, it being of concern to 20% of respondents, particularly surgeons and medical specialists.
Membership Survey Results
Authors: Bowie Dennis M
Published: March 2016

In an effort to gather feedback from Canadian Thoracic Society (CTS) members, the Executive sent out a survey to the membership and received replies from approximately one‐third of the membership. This was an attempt to look at the role of the CTS and what the members wanted from the CTS.
A Randomized Trial to Evaluate the Sustained Efficacy of a Mucus Clearance Device in Ambulatory Patients with Chronic Obstructive Pulmonary Disease
Authors: Wolkove Norman , Baltzan Marc A , Kamel Hany , Rotaple Michael
Published: March 2016

OBJECTIVE: To determine whether a mucus clearance device (MCD) (Flutter; Axcan Scandipharm, USA) could consistently improve the bronchodilator response and exercise performance in patients with chronic obstructive pulmonary disease (COPD) when used in an ambulatory setting over a one‐week period.

SUBJECTS: Fifteen patients with severe COPD (mean age 71±10 years) were studied.

METHODS: A randomized crossover design compared an MCD with a sham MCD (SMCD), in which each were tested for one week. At the beginning and end of each study week, forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured before and after MCD or SMCD. A bronchodilator aerosol (ipratropium bromide and salbutamol sulphate) was then given, and FEV1 and FVC were remeasured 30 min, 60 min and 120 min later. A 6 min walk test (6MWT) was also performed.

RESULTS: FEV1 improved significantly (P<0.05) after bronchodilator administration with both the SMCD and MCD. The improvement was always greater with MCD use than with SMCD. At the baseline measure, 120 min postbronchodilator administration, the mean FEV1 improved by 24±24% with SMCD use and 60±28% with MCD use (P<0.05). After one week of use, the corresponding values at 120 min were 19±24% and 43±26% (P<0.05). Similar findings were obtained for FVC. 6MWT distances increased by 29±12 m (P<0.05) after one week of MCD use, whereas it decreased slightly (by 16±18 m) after SMCD. The decline in saturation with the 6MWT was smaller with MCD use than with SMCD use. After one week, the decline in saturation with MCD use was similar to baseline levels, although patients were walking farther. After one week, dyspnea was lower on walking with MCD use than with SMCD use.

CONCLUSION: Patients with COPD had an increased response to bronchodilator therapy after use of the MCD compared with SMCD use. The increase persisted after one week of use, and was associated with improved exercise performance as measured by the 6MWT.