bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association between Endotoxin and Lung Function among Children and Adolescents Living in a Rural Area
Authors: Lawson Joshua A , Dosman James A , Rennie Donna C , Beach Jeremy , Newman Stephen C , Senthilselvan Ambikaipakan
Published: March 2016

Increased levels of endotoxin found in rural and agricultural areas are an environmental exposure believed to cause a paradoxical proinflammatory effect on respiratory health that can exacerbate asthma. Previous studies involving adults have demonstrated an association between high endotoxin levels and lower lung function. Apart from occupational settings, however, few studies have investigated the relationship between lung function and endotoxin exposure, such as environmental tobacco smoke, especially in children. This study examined the modifying effects of sex, pre‐existing asthma and other environmental exposures, including tobacco smoke, in children living in rural communities in Saskatchewan.

BACKGROUND/OBJECTIVES: Knowledge of the effects of domestic endotoxin on children’s lung function is limited. The association between domestic endotoxin and asthma or wheeze and lung function among school‐age children (six to 18 years of age) was examined. The interaction between endotoxin and other personal and environmental characteristics and lung function was also assessed.

METHODS: A case‐control study was conducted in and around the rural community of Humboldt, Saskatchewan, between 2005 and 2007. Parents of cases reported either doctor‐diagnosed asthma or wheeze in the previous year. Controls were randomly selected from those not reporting these conditions. Data were collected by questionnaire to ascertain symptoms and conditions, while spirometry was used to measure lung function including forced vital capacity and forced expiratory volume in 1 s. Dust collected from the child’s play area floor and the child’s mattress was used to quantify endotoxin, and saliva was collected to quantify cotinine levels and assess tobacco smoke exposure.

RESULTS: There were 102 cases and 207 controls included in the present study. Lower forced expiratory volume in 1 s was associated with higher mattress endotoxin load among female cases (beta=−0.25, SE=0.07 [P<0.01]). There was a trend toward lower forced vital capacity, which was associated with higher play area endotoxin load among cases with high tobacco smoke exposure (beta=−0.17, SE=0.09 [P<0.10]).

CONCLUSIONS: Findings indicated that high endotoxin levels present in common household areas of rural children with asthma or wheeze may also affect their lung function. These associations may be potentiated by tobacco smoke exposure and female sex.
Fear‐Avoidance Beliefs and Parental Responses to Pain in Adolescents with Chronic Pain
Authors: Wilson Anna C , Lewandowski Amy S , Palermo Tonya M
Published: March 2016

BACKGROUND: The fear‐avoidance model of chronic pain posits that fear of pain is associated with fear and avoidance of activity, which can lead to deconditioning and persistence of pain and disability. Despite being well supported in adults, little is known about the role of fear‐avoidance beliefs regarding physical activity in children. Research has shown that parental protectiveness contributes to activity limitations in children; however, no studies have examined relationships between protectiveness, and fear and avoidance.

OBJECTIVES: To conduct a cross‐sectional study to provide additional information regarding the reliability and validity of the Fear‐Avoidance Beliefs Questionnaire physical activity subscale among adolescents with chronic pain; examine fear‐avoidance beliefs and depressive symptoms as concurrent predictors of physical activity limitations; and test competing models using fear‐avoidance beliefs as mediators and moderators of the association between parental protectiveness and activity limitations.

METHODS: Adolescents (n=42) 11 to 17 years of age with chronic pain completed questionnaires assessing pain intensity, fear‐avoidance beliefs, depressive symptoms and physical activity limitations. Their parents completed questionnaires regarding protectiveness and adolescent activity limitations.

RESULTS: The Fear‐Avoidance Beliefs Questionnaire physical activity subscale was useful for assessing fear‐avoidance beliefs in the present population. In support of hypotheses, greater fear‐avoidance beliefs were associated with greater activity limitations, above pain intensity and depressive symptoms. Support was found for fear‐avoidance beliefs as mediators of the association between parental protectiveness and activity limitations. Tests of moderation were not significant.

CONCLUSIONS: Fear‐avoidance beliefs may be an important target for interventions focused on decreasing activity limitations in youth with chronic pain. Future research should investigate these associations longitudinally.
The Role of the Third Acid‐Fast Bacillus Smear in Tuberculosis Screening for Infection Control Purposes: A Controversial Topic Revisited
Authors: Wilmer A. , Bryce E. , Grant J.
Published: March 2016

INTRODUCTION: Recent studies have suggested that two negative acid‐fast bacillus (AFB) smears may be as effective as three when screening patients with suspected Mycobacterium tuberculosis for respiratory isolation purposes. However, current recommendations in Canada, the United States and Europe still support a three‐smear approach.

METHODS: The microbiology database of a tertiary care hospital was searched for sputum, tracheal aspirates and bronchoalveolar lavage samples from 2003 to 2007 that had been sent for mycobacterial testing. The first patient specimen to become AFB smear positive was noted. As well, the time required to collect the third specimen in hospitalized patients who remained smear negative was used to estimate the savings in isolation costs associated with a two‐smear approach.

RESULTS: There were 8347 respiratory specimens from 5168 patients in the five‐year period. Of these patients, 2.2% (116 of 5168) were AFB smear positive, of whom 55.2% (64 of 116) were culture positive for Mycobacterium tuberculosis. Overall 89% (57 of 64) of patients were identified as being AFB smear positive by the first smear, 7.8% (five of 64) were identified by the second smear and 3.2% (two of 64) were identified by further smears. Smear‐negative patients spent a combined 710 days in isolation awaiting collection of the third sample at a cost of approximately $142,000 over five years.

CONCLUSION: A two‐smear approach for discontinuation of respiratory isolation precautions is safe and has the potential to reduce hospital expenditures.
Normal Expiratory Flow Rate and Lung Volumes in Patients with Combined Emphysema and Interstitial Lung Disease: A Case Series and Literature Review
Authors: Heathcote Karen L , Cockcroft Donald W , Fladeland Derek A , Fenton Mark E
Published: March 2016

Pulmonary function tests in patients with idiopathic pulmonary fibrosis characteristically show a restrictive pattern including small lung volumes and increased expiratory flow rates resulting from a reduction in pulmonary compliance due to diffuse fibrosis. Conversely, an obstructive pattern with hyperinflation results in emphysema by loss of elastic recoil, expiratory collapse of the peripheral airways and air trapping. When the diseases coexist, pulmonary volumes are compensated, and a smaller than expected reduction or even normal lung volumes can be found. The present report describes 10 patients with progressive breathlessness, three of whom experienced severe limitation in their quality of life. All patients showed lung interstitial involvement and emphysema on computed tomography scan of the chest. The 10 patients showed normal spirometry and lung volumes with severe compromise of gas exchange. Normal lung volumes do not exclude diagnosis of idiopathic pulmonary fibrosis in patients with concomitant emphysema. The relatively preserved lung volumes may underestimate the severity of idiopathic pulmonary fibrosis and attenuate its effects on lung function parameters.
Whipple’s Disease‐Associated Pulmonary Hypertension with Positive Vasodilator Response Despite Severe Hemodynamic Derangements
Authors: Najm Salah , Hajjar Joud , Nelson Robert P , Moorthy Ramana S , Wolf Karen M , Lahm Tim
Published: March 2016

Pulmonary hypertension (PH) associated with Whipple’s disease (WD‐PH) is extremely rare, and the underlying pathophysiological processes are incompletely understood. Alterations in hemodynamics can be severe, with right ventricular (RV) dysfunction being common. A case involving a 23‐year‐old man with WD‐PH who exhibited a dramatic vasodilator response during right heart catheterization despite severely altered pulmonary hemodynamics and concomitant RV dysfunction is reported. While the patient’s symptoms responded poorly to treatment with nifedipine and sildenafil, significant improvement in dyspnea, RV dysfunction and pulmonary pressures were noted following antibiotic therapy. The present report highlights that despite severely elevated pulmonary artery pressures and RV dysfunction in WD‐PH patients, a highly significant vasodilator response and dramatic improvement with antibiotic therapy may be observed. Furthermore, the case highlights the phenomenon of PH in the setting of inflammation, suggesting that adequate control of the inflammatory response can be accompanied by a marked improvement in hemodynamics in certain types of PH.
The Model for End-Stage Liver Disease Accurately Predicts 90-Day Liver Transplant Wait-List Mortality in Atlantic Canada
Authors: Renfrew Paul Douglas , Quan Hude , Doig Christopher James , Dixon Elijah , Molinari Michele
Published: March 2016

OBJECTIVE: To determine the generalizability of the predictions for 90-day mortality generated by Model for End-stage Liver Disease (MELD) and the serum sodium augmented MELD (MELDNa) to Atlantic Canadian adults with end-stage liver disease awaiting liver transplantation (LT).

METHODS: The predictive accuracy of the MELD and the MELDNa was evaluated by measurement of the discrimination and calibration of the respective models’ estimates for the occurrence of 90-day mortality in a consecutive cohort of LT candidates accrued over a five-year period. Accuracy of discrimination was measured by the area under the ROC curves. Calibration accuracy was evaluated by comparing the observed and model-estimated incidences of 90-day wait-list failure for the total cohort and within quantiles of risk.

RESULTS: The area under the ROC curve for the MELD was 0.887 (95% CI 0.705 to 0.978) – consistent with very good accuracy of discrimination. The area under the ROC curve for the MELDNa was 0.848 (95% CI 0.681 to 0.965). The observed incidence of 90-day wait-list mortality in the validation cohort was 7.9%, which was not significantly different from the MELD estimate of 6.6% (95% CI 4.9% to 8.4%; P=0.177) or the MELDNa estimate of 5.8% (95% CI 3.5% to 8.0%; P=0.065). Global goodness-of-fit testing found no evidence of significant lack of fit for either model (Hosmer-Lemeshow χ2 [df=3] for MELD 2.941, P=0.401; for MELDNa 2.895, P=0.414).

CONCLUSION: Both the MELD and the MELDNa accurately predicted the occurrence of 90-day wait-list mortality in the study cohort and, therefore, are generalizable to Atlantic Canadians with end-stage liver disease awaiting LT.
Étude Descriptive du Processus D’ÉValuation et de Documentation de la Douleur Postopératoire dans un Hôpital Universitaire
Authors: Bergeron Dave A , Leduc Geneviève , Marchand Serge , Bourgault Patricia
Published: March 2016

Plusieurs études démontrent que les patients reçoivent souvent un traitement insatisfaisant de la douleur en contexte postopératoire. Le but de la présente étude descriptive était d’examiner et d’analyser diverses données ayant trait au soulagement de 40 patients après une intervention chirurgicale non urgente. Les patients ont rempli un journal de douleur afin d’évaluer le niveau d’intensité et de désagrément engendré par la douleur durant les trois premières journées postopératoires. Une analyse du dossier a permis de vérifier la documentation de l’évaluation de la douleur par le personnel infirmier. Les résultats indiquent que la douleur en contexte postopératoire est peu et inadéquatement évaluée et peu documentée par le personnel infirmier. Lorsque la douleur est évaluée selon une échelle numérique, les infirmières ont tendance à la sous‐évaluer en comparaison avec l’évaluation notée par les patients. Pour la première journée postopératoire, l’intensité moyenne de la douleur documentée par les infirmières est de 1,57 (±0,23) sur une échelle numérique de 0 à 10, alors que l’intensité moyenne documentée par les patients est de 3,82 (±0,41). Cette étude fait ainsi ressortir qu’il n’y a pas de corrélation significative entre l’intensité de la douleur documentée par l’infirmière et celle notée par le patient, ce qui peut expliquer en partie un soulagement non optimal.
Nonpharmacological Management of Procedural Pain in Infants and Young Children: An Abridged Cochrane Review
Authors: Riddell Rebecca Pillai , Racine Nicole , Turcotte Kara , Uman Lindsay S , Horton Rachel , Osmun Laila Din , Kohut Sara Ahola , Stuart Jessica Hillgrove , Stevens Bonnie , Lisi Diana
Published: March 2016

BACKGROUND: Acute pain and distress during medical procedures are commonplace for young children.

OBJECTIVE: To assess the efficacy of nonpharmacological interventions for acute procedural pain in children up to three years of age.

METHODS: Study inclusion criteria were: participants <3 years of age, involved in a randomized controlled or crossover trial, and use of a ‘no‐treatment’ control group (51 studies; n=3396). Additional studies meeting all criteria except for study design (eg, use of active control group) were qualitatively described (n=20).

RESULTS: For every intervention, data were analyzed separately according to age group (preterm‐born, term‐born neonate and older infant/young child) and type of pain response (pain reactivity, immediate pain‐related regulation). The largest standardized mean differences (SMD) for pain reactivity were as follows: sucking‐related interventions (preterm: −0.42 [95% CI −0.68 to −0.15]; neonate −1.45 [CI −2.34 to −0.57]), kangaroo care (preterm −1.12 [95% CI −2.04 to −0.21]), and swaddling/facilitated tucking (preterm −0.97 [95% CI −1.63 to −0.31]). For immediate pain‐related regulation, the largest SMDs were: sucking‐related interventions (preterm −0.38 [95% CI −0.59 to −0.17]; neonate −0.90 [CI −1.54 to −0.25]), kangaroo care 0.77 (95% CI −1.50 to −0.03]), swaddling/facilitated tucking (preterm −0.75 [95% CI −1.14 to −0.36]), and rocking/holding (neonate −0.75 [95% CI −1.20 to −0.30]). The presence of significant heterogeneity limited confidence in nonsignificant findings for certain other analyses.

CONCLUSIONS: Although a number of nonpharmacological treatments have sufficient evidence supporting their efficacy with preterm infants and healthy neonates, no treatments had sufficient evidence to support efficacy with healthy older infants/young children.
A Decade of Respiratory Syncytial Virus Epidemiology and Prophylaxis: Translating Evidence into Everyday Clinical Practice
Authors: Paes Bosco A , Mitchell Ian , Banerji Anna , Lanctôt Krista L , Langley Joanne M
Published: March 2016

Respiratory syncytial virus (RSV) is a common infection in infancy, with nearly all children affected by two years of age. Approximately 0.5% to 2.0% of all children are hospitalized with lower respiratory tract disease, of which 50% to 90% have bronchiolitis and 5% to 40% have pneumonia. Morbidity and mortality are highest in children with nosocomial infection and in those with underlying medical illnesses such as cardiac and chronic lung disease. Aboriginal children residing in remote northern regions are specifically considered to be at high risk for hospitalization due to RSV infection. Thorough hand washing and health education are the principal strategies in primary prevention. In the absence of a vaccine, palivizumab prophylaxis is currently the best intervention to reduce the burden of illness and RSV-related hospitalization in high-risk children. Health care professionals should provide palivizumab prophylaxis cost effectively in accordance with recommendations issued by pediatric societies and national advisory bodies.

The present article reviews the epidemiology of RSV infection and the short- and long-term impact of disease in high-risk infants and special populations. Prevention strategies and treatment are discussed based on the existing scientific evidence, and future challenges in the management of RSV infection are addressed.
Persistent Pain in a Community‐Based Sample of Children and Adolescents: Sex Differences in Psychological Constructs
Authors: Fuss Samantha , Pagé M Gabrielle , Katz Joel
Published: March 2016

BACKGROUND: Very few studies have investigated the psychological factors associated with the pain experiences of children and adolescents in community samples.

OBJECTIVES: To examine the lifetime prevalence of, and psychological variables associated with, persistent pain in a community sample of children and adolescents, and to explore differences according to sex, age and pain history.

METHODS: Participants completed the Childhood Anxiety Sensitivity Index (CASI), the Child Pain Anxiety Symptoms Scale (CPASS), the Multidimensional Anxiety Scale for Children‐10 (MASC‐10), the Pain Catastrophizing Scale for Children (PCS‐C) and a pain history questionnaire that assessed chronicity and pain frequency. After research ethics board approval, informed consent/assent was obtained from 1022 individuals recruited to participate in a study conducted at the Ontario Science Centre (Toronto, Ontario).

RESULTS: Of the 1006 participants (54% female, mean [± SD] age 11.6±2.7 years) who provided complete data, 27% reported having experienced pain that lasted for three months or longer. A 2×2×2 (pain history, age and sex) multivariate ANOVA was conducted, with the total scores on the CASI, the CPASS, the MASC‐10 and the PCS‐C as dependent variables. Girls with a history of persistent pain expressed higher levels of anxiety sensitivity (P<0.001) and pain catastrophizing (P<0.001) than both girls without a pain history and boys regardless of pain history. This same pattern of results was found for anxiety and pain anxiety in the older, but not the younger, age group.

CONCLUSIONS: Boys and girls appear to differ in terms of how age and pain history relate to the expression of pain‐related psychological variables. Given the prevalence of persistent pain found in the study, more research is needed regarding the developmental implications of persistent pain in childhood and adolescence.
Canadian Prediction Equations of Spirometric Lung Function for Caucasian Adults 20 to 90 Years of Age: Results from the Canadian Obstructive Lung Disease (COLD) Study and the Lung Health Canadian Environment (LHCE) Study
Authors: Tan WC , Bourbeau J , Hernandez P , Chapman K , Cowie R , FitzGerald MJ , Aaron S , Marciniuk DD , Maltais F , O’Donnell DE , Goldstein R , Sin D , Chan-Yeung M , Manfreda J , Anthonisen NR , Tate RB , Sears MR , Siersted HC , Becklake MR , Ernst P , Bowie DM , Sweet L , Van Til L
Published: March 2016

BACKGROUND: Currently, no reference or normative values for spirometry based on a randomly selected Canadian population exist.

OBJECTIVE: The aim of the present analysis was to construct spirometric reference values for Canadian adults 20 to 90 years of age by combining data collected from healthy lifelong nonsmokers in two population‐based studies.

METHOD: Both studies similarly used random population sampling, conducted using validated epidemiological protocols in the Canadian Obstructive Lung Disease study, and the Lung Health Canadian Environment study. Spirometric lung function data were available from 3042 subjects in the COLD study, which was completed in 2009, and from 2571 subjects in the LHCE study completed in 1995. A total of 844 subjects 40 to 90 years of age, and 812 subjects 20 to 44 years of age, were identified as healthy, asymptomatic, lifelong nonsmokers, and provided normative reference values for spirometry. Multiple regression models were constructed separately for Caucasian men and women for the following spirometric parameters: forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio, with covariates of height, sex and age. Comparison with published regression equations showed that the best agreement was obtained from data derived from random populations.

RESULTS: The best‐fitting regression models for healthy, never‐smoking, asymptomatic European‐Canadian men and women 20 to 90 years of age were constructed. When age‐ and height‐corrected FEV1, FVC and FEV1/FVC ratio were compared with other spirometry reference studies, mean values were similar, with the closest being derived from population‐based studies.

CONCLUSION: These spirometry reference equations, derived from randomly selected population‐based cohorts with stringently monitored lung function measurements, provide data currently lacking in Canada.
Postoperative Respiratory Depression Associated with Pregabalin: A Case Series and a Preoperative Decision Algorithm
Authors: Eipe Naveen , Penning John
Published: March 2016

Pregabalin is gaining popularity in the perioperative period for its usefulness in treating neuropathic pain and its apparent opioid‐sparing effect. The present report describes the perioperative course of three patients who received pregabalin and experienced significant respiratory depression in the postoperative period. All three patients consented to the report and publication of the present case series. The first patient was elderly with borderline renal dysfunction. She experienced respiratory arrest in the immediate postoperative period following a craniotomy for tumour excision. The second patient presented with severe respiratory depression 12 h after receiving a spinal anesthetic for joint replacement, and was later found to have clinically significant obstructive sleep apnea. The third patient, who was an otherwise healthy elderly individual on benzodiazepines for anxiety, experienced respiratory arrest in the postanesthesia care unit after an uneventful anesthesia for lumbar spine decompression. All of these patients were treated successfully with standard resuscitation measures. Although other causes of respiratory depression in these patients were considered, there appears to be an association between pregabalin and this complication. The present article briefly reviews the evidence regarding the perioperative use of pregabalin. Based on the authors’ experience and the available evidence, they believe that pregabalin may be useful in the management of acute pain in carefully selected patients undergoing certain surgeries. A clinical algorithm has been developed to guide the perioperative use of pregabalin. This algorithm may be helpful in increasing the safety of perioperative pregabalin use.
Should Albumin Be Used in All Patients with Spontaneous Bacterial Peritonitis?
Authors: Narula Neeraj , Tsoi Keith , Marshall John K
Published: March 2016

Patients with cirrhosis who develop spontaneous bacterial peritonitis (SBP) have been reported to experience a high incidence of renal impairment and mortality. Renal dysfunction is possibly related to altered systemic hemodynamics that leads to decreased effective arterial blood volume. Albumin, a plasma volume expander, has been investigated to determine whether it plays a role in patients with SBP. The current literature suggests that albumin can reduce renal impairment and mortality in high-risk SBP patients, defined as patients with a serum bilirubin level of greater than 68.4 μmol/L, a blood urea nitrogen level of greater than 10.7 mmol/L or a serum creatinine level greater than 88.4 μmol/L. The rationale for albumin and other volume expanders in SBP is discussed, accompanied by a review of the current literature.
Cytomegalovirus Colitis Following Azacitidine Therapy
Authors: Khan Rajal , Rudkin Pam , Grewal Kuljit , Leonard Jennifer , Hamodat Mowafak , Hutchinson Jim , Daley Peter
Published: March 2016

The present report describes the first recognized case of cytomegalovirus (CMV) colitis following azacitidine therapy. A 66‐year‐old woman with myelodysplastic syndrome developed CMV colitis, which responded to treatment with ganciclovir. Currently, patients receiving azacitidine do not undergo CMV testing, or receive prophylaxis or CMV‐free blood products; however, this policy needs to be revised.
An Examination of the Observed Placebo Effect Associated with the Treatment of Low Back Pain – A Systematic Review
Authors: Puhl Aaron A , Reinhart Christine J , Rok Elisabeth R , Injeyan H Stephen
Published: March 2016

OBJECTIVE: To determine whether the nonspecific effects that occur following the use of sham interventions to treat nonspecific low back pain (LBP) are large enough to be considered clinically meaningful.

DESIGN: Electronic databases were searched systematically for randomized placebo‐controlled trials of interventions for LBP that used sham ultrasound, sham laser or sham drug therapy as the placebo control. Study selection was accomplished via independent evaluation of scientific admissibility by three reviewers and final decisions of inclusion were based on consensus.

RESULTS: None of the studies using sham ultrasound as the placebo control in the treatment of LBP were acceptable for inclusion. Twelve studies were included in the present evaluation of the placebo effect – eight trials that met the strict inclusion criteria for best evidence (three using sham laser placebo and five using sham medication placebo) and four sham medication studies that ‘just missed’ the inclusion criteria for best evidence. Although the evidence from studies using sham laser was inconclusive, the present review did find a clinically meaningful change in LBP scores following the use of sham oral medications.

CONCLUSIONS: The present best‐evidence review found a clinically meaningful change in pain scores following the use of sham oral medications for the treatment of nonspecific LBP. This finding suggests that further clinical research is warranted to identify which patient subgroups could benefit most from such treatment and to distinguish the true contribution of the placebo effect from other nonspecific effects.
Detection of Scabies: A Systematic Review of Diagnostic Methods
Authors: Leung Victor , Miller Mark
Published: March 2016

This study systematically reviewed the accuracy and precision of history, physical examination and tests for diagnosing scabies. Using a structured search strategy, Medline and Embase databases were searched for English and French language articles that included a diagnosis of scabies. Studies comparing history, physical examination and/or any diagnostic tests with the reference standard of microscopic visualization of mites, eggs or fecal elements obtained from skin scrapings or biopsies were included for analysis. History and examination of pruritic dermatoses failed to accurately diagnose scabies infection. The accuracy of dermatoscopy, performed by a trained practitioner, was determined; however, the accuracy of other diagnostic tests could not be calculated from the data in the literature. In the face of such diagnostic inaccuracy, research to identify or develop accurate diagnostic tests for scabies infection is needed and justifiable.

BACKGROUND: Accurate diagnosis of scabies infection is important for patient treatment and for public health control of scabies epidemics.

OBJECTIVE: To systematically review the accuracy and precision of history, physical examination and tests for diagnosing scabies.

METHODS: Using a structured search strategy, Medline and Embase databases were searched for English and French language articles that included a diagnosis of scabies. Studies comparing history, physical examination and/or any diagnostic tests with the reference standard of microscopic visualization of mites, eggs or fecal elements obtained from skin scrapings or biopsies were included for analysis. Data were extracted using standard criteria.

RESULTS: History and examination of pruritic dermatoses failed to accurately diagnose scabies infection. Dermatoscopy by a trained practitioner has a positive likelihood ratio of 6.5 (95% CI 4.1 to 10.3) and a negative likelihood ratio of 0.1 (95% CI 0.06 to 0.2) for diagnosing scabies. The accuracy of other diagnostic tests could not be calculated from the data in the literature.

CONCLUSIONS: In the face of such diagnostic inaccuracy, clinical judgment is still practical in diagnosing scabies. Two tests are used – the burrow ink test and handheld dermatoscopy. The burrow ink test is a simple, rapid, noninvasive test that can be used to screen a large number of patients. Handheld dermatoscopy is an accurate test, but requires special equipment and trained practitioners. Given the morbidity and costs of scabies infection, and that studies to date lack adequate internal and external validity, research to identify or develop accurate diagnostic tests for scabies infection is needed and justifiable.
Outcomes of Chronic Hepatitis C Therapy in Patients Treated in Community Versus Academic Centres in Canada: Final Results of APPROACH (A Prospective Study of Peginterferon alfa-2a and Ribavirin at Academic and Community Centres in Canada)
Authors: Myers Robert P , Cooper Curtis , Sherman Morris , Lalonde Richard , Witt-Sullivan Helga , Elkashab Magdy , Harris Paul , Balshaw Rob , Usaty Christopher , Marotta Paul J
Published: March 2016

BACKGROUND: In patients chronically infected with the hepatitis C virus (HCV), it is not established whether viral outcomes or health-related quality of life (HRQoL) differ between individuals treated at academic or community centres.

METHODS: In the present observational study, adults with chronic HCV were treated with peginterferon alfa-2a 180 μg/week plus ribavirin at 45 Canadian centres (16 academic, 29 community). The primary efficacy end point was sustained virological response (SVR). Other outcome measures included HRQoL (assessed using the 36-item Short-Form Health Survey), heath resource use, and workplace productivity and absences within a 60-day interval.

RESULTS: In treatment-naive patients infected with HCV genotype 1, significantly higher SVR rates were achieved in those treated at academic (n=54) compared with community (n=125) centres (52% versus 32% [P=0.01]), although rates of dosage reduction and treatment discontinuation were similar across settings. SVR rates among patients infected with genotype 2/3 were similar between academic (n=59) and community (n=100) centres (64% versus 67% [P=0.73]). Following antiviral therapy, patients with genotype 1 who achieved an SVR (n=67) had significantly higher mean scores on the physical (P=0.005) and mental components of the 36-item Short-Form Health Survey (P=0.043) compared with those without an SVR (n=111). In contrast, HRQoL scores were similar in HCV genotype 2/3 patients with and without an SVR. There were no differences in workplace productivity or absences between patients with and without an SVR. The most frequently used health care resources by all patients were visits and phone calls to hepatitis nurses, and general practice or walk-in clinics.

CONCLUSION: Patients infected with HCV genotype 1 achieved higher SVR rates when treated at academic rather than community centres in Canada. The reasons for this difference require additional investigation.
Diet, Lifestyle and Chronic Widespread Pain: Results from the 1958 British Birth Cohort Study
Authors: VanDenKerkhof Elizabeth G , Macdonald Helen M , Jones Gareth T , Power Chris , Macfarlane Gary J
Published: March 2016

OBJECTIVES: To examine the relationship between diet and lifestyle, and chronic widespread pain (CWP). If persons with CWP have dietary and lifestyle habits consistent with an increased risk of cancer or cardiovascular disease, it may partially explain evidence in the literature suggesting an association between CWP and these diseases.

METHODS: The 1958 British Birth Cohort Study comprises individuals born in England, Scotland and Wales in the United Kingdom during one week in March 1958. At 45 years of age, pain was recorded using a self‐completion questionnaire. CWP was classified using the American College of Rheumatology definition for fibromyalgia. Data were collected on diet and lifestyle at 33 and 42 years of age.

RESULTS: A total of 8572 participants provided pain data at 45 years of age, of whom 12% reported CWP. Women with CWP, compared with those without, reported an unhealthy diet (ie, fruit/vegetable consumption less than once per week [OR 2.0; 95% CI 1.3 to 3.1], and fatty food [OR 1.7; 95% CI 1.1 to 2.7] and chips (french fries) [OR 1.5; 95% CI 1.0 to 2.4] at least once per day) that may have predisposed them to other chronic diseases such as cancer and cardiovascular disease. Women with CWP were also more likely to be unemployed (adjusted OR 1.4; 95% CI 1.1 to 1.8), to have had high physical exertion at work (adjusted OR 1.6; 95% CI 1.2 to 2.2) and elevated body mass index (overweight – adjusted OR 1.5, 95% CI 1.2 to 1.9; obese – adjusted OR 1.8, 95% CI 1.3 to 2.5). Similar relationships between lifestyle (but not diet) and the risk of CWP were identified in men.

CONCLUSIONS: The findings for smoking, body mass index and (for women) diet offer support for the hypothesis that lifestyle factors may partially explain the association between CWP and cancer or cardiovascular disease. Prospective studies are necessary to confirm this relationship.
Opioid Medication Errors in Pediatric Practice: Four years’ Experience of Voluntary Safety Reporting
Authors: Mc Donnell Conor
Published: March 2016

BACKGROUND: Opioids are the most common source of drug error that leads to harm in pediatric hospitals.

OBJECTIVE: To undertake a comprehensive review of experience with voluntary safety reports describing pediatric opioid medication errors at The Hospital for Sick Children (Toronto, Ontario), and to characterize the specific opioids involved, severity and type of error described, hospital location and time of day that the error occurred.

METHODS: All medication‐related safety reports submitted to an anonymous, voluntary electronic safety reporting database in a university‐affiliated pediatric hospital during the first four years of its use were examined. A database of opioid error reports was created for further analysis.

RESULTS: A total of 5935 medication‐related safety reports were collected, 507 of which described opioids. Morphine was the most frequently reported opioid, administration was the most frequently reported stage of the medication process (192 errors) and surgical wards were the location from which opioid error was most frequently reported (128 reports). Twenty‐two reports described patient harm requiring urgent treatment and intervention. Errors with codeine or hydromorphone resulted in the most significant harm reported. A total of 162 reports described problems with inappropriate opioid disposal, missing opioids, or incorrect opioid counts and checks.

CONCLUSIONS: Future opportunities for improvement in opioid safety should focus on morphine, opioid administration errors in general, the safe disposal of opioids in the hospital environment and the identification of pain as an adverse event.
Evaluation of the Do Bugs Need Drugs? Program in British Columbia: Can We Curb Antibiotic Prescribing?
Authors: McKay Rachel M. , Vrbova Linda , Fuertes Elaine , Chong Mei , David Samara , Dreher Kim , Purych Dale , Blondel-Hill Edith , Henry Bonnie , Marra Fawziah , Kendall Perry RW. , Patrick David M.
Published: March 2016

OBJECTIVE: Antibiotic resistance is accelerated by the overuse of antibiotics. Do Bugs Need Drugs? is an educational program adapted in British Columbia to target both the public and health care professionals, with the aim of reducing unnecessary prescribing. The current article presents a descriptive evaluation of the impact of the program over the first four years.

METHOD: Program implementation was measured by the amount of educational material distributed and the level of participation in educational sessions. The impact of the program was assessed by measuring changes in knowledge and prescribing habits of participating physicians, and by investigating provincial trends in antibiotic use.

METHOD: Program implementation was measured by the amount of educational material distributed and the level of participation in educational sessions. The impact of the program was assessed by measuring changes in knowledge and prescribing habits of participating physicians, and by investigating provincial trends in antibiotic use.

RESULTS: A total of 51,367 children, assisted‐living residents and health care professionals have participated in the program since its inception in the fall of 2005. Pre‐ and postcourse assessments of participating physicians indicated significant improvements in clinical knowledge and appropriate antibiotic treatment of upper respiratory tract infections. Overall rates of antibiotic use in the province have stabilized since 2006. The rates of consumption of fluoroquinolones and macrolides have levelled off since 2005. Utilization rates for acute bronchitis are at the same level as when the program was first implemented, but rates for other acute upper respiratory tract infections of interest have declined.

CONCLUSIONS: The Do Bugs Need Drugs? program significantly improves physician antibiotic prescription decisions and is ecologically associated with desirable change in population antibiotic consumption patterns.
Factors Affecting the Prognosis of Small Hepatocellular Carcinoma in Taiwanese Patients Following Hepatic Resection
Authors: Ko Chih-Jan , Chien Su-Yu , Chou Chen-Te , Chen Li-Sheng , Chen Mei-Ling , Chen Yao-Li
Published: March 2016

BACKGROUND: Small hepatocellular carcinoma (HCC) affects millions of individuals worldwide. Surveillance of high-risk patients increases the early detection of small HCC.

OBJECTIVE: To identify prognostic factors affecting the overall survival (OS) and recurrence-free survival (RFS) of patients with small HCC.

METHODS: The present prospective study enrolled 140 Taiwanese patients with stage I or stage II small HCC. Clinical parameters of interest included operation type, tumour size, tumour histology, Child-Pugh class, presence of hepatitis B surface antigen and liver cirrhosis, hepatitis C status, alpha-fetoprotein, total bilirubin and serum albumin levels, and administration of antiviral and salvage therapies.

RESULTS: Tumour size correlated significantly with poorer OS in patients with stage I small HCC (P=0.014); however, patients with stage II small HCC experienced a significantly poorer RFS (P=0.033). OS rates did not differ significantly between patients with stage I and stage II small HCC. Tumour margins, tumour histology and cirrhosis did not significantly affect OS or RFS (P>0.05).

DISCUSSION: Increasing tumour size has generally been associated with poorer prognoses in cases of HCC. The present study verified the relationship between small HCC tumour size and OS; however, a reduction in OS with increasing tumour size was demonstrated for patients with stage I – but not for stage II – small HCC.

CONCLUSION: Patients with stage II small HCC may benefit from aggressive surveillance for tumour recurrence and appropriate salvage treatment. Further studies are needed for additional stratification of stage I patients to identify those at increased risk of death.
Diverticular Disease: Epidemiology and Management
Authors: Weizman Adam V , Nguyen Geoffrey C
Published: March 2016

Diverticular disease of the colon is among the most prevalent conditions in western society and is among the leading reasons for outpatient visits and causes of hospitalization. While previously considered to be a disease primarily affecting the elderly, there is increasing incidence among individuals younger than 40 years of age. Diverticular disease most frequently presents as uncomplicated diverticulitis, and the cornerstone of management is antibiotic therapy and bowel rest. Segmental colitis associated with diverticula shares common histopathological features with inflammatory bowel disease and may benefit from treatment with 5-aminosalicylates. Surgical management may be required for patients with recurrent diverticulitis or one of its complications including peridiverticular abscess, perforation, fistulizing disease, and strictures and/or obstruction.
Opioid Analgesics Suppress Male Gonadal Function, but Opioid Use in Men and Women Does Not Correlate with Symptoms of Sexual Dysfunction
Authors: Wong Dana , Gray Dan , Simmonds Mark , Rashiq Saifee , Sobolev Igor , Morrish Donald W
Published: March 2016

BACKGROUND: Opioid analgesia impairs gonadal function in men and women, but the correlation with symptoms and hormonal measurements of hypogonadism is not well established.

OBJECTIVE: To determine the frequency of impaired gonadal function in men and women using opioids for chronic pain, and to determine the correlation of symptoms with hormonal measurements of gonadal function.

METHODS: A prospective study of patients attending a multidisciplinary pain clinic was conducted. A total of 65 women (47 opioid users and 18 nonopioid analgesic controls) and 32 men (26 opioid users and six controls) were enrolled. Histories of sexual dysfunction and hormonal testing (men: total testosterone [TT], free testosterone [FT], prolactin and luteinizing hormone; women: FT, TT, prolactin, dehydroepiandrosterone sulphate, sex hormone‐binding globulin, progesterone, luteinizing hormone and follicle‐stimulating hormone, and estradiol) were obtained.

RESULTS: In men, a low FT level was more common in opioid users (20/26; P=0.04). In men with abnormal hormone levels, there was no difference in the frequency of sexual dysfunction compared with men with normal hormone levels, and no difference in the frequency of opioid versus nonopioid use. In women, opioid users had lower FT levels (P=0.02). Low dehydroepiandrosterone sulphate was more frequent in women on opioids (P=0.03) in the menopausal group only (P=0.046). Premenopausal women taking opioids more frequently had a low TT level (P=0.03). The frequency of female sexual dysfunction was the same in opioid users (32/47) and controls (13/18; P=0.75), and also did not relate to any hormone abnormality.

DISCUSSION: Men taking opioids had lower FT and higher prolactin levels, and women taking opioids had lower FT levels. Frequency of sexual dysfunction did not correlate with hormone levels in either men or women taking opioids.

CONCLUSION: Opioids frequently cause low FT levels in men, but there is no relationship between abnormal hormone levels and symptoms of sexual dysfunction. Therefore, all men should be screened for low FT levels. Women on opioids had lower FT levels, but this did not correlate with sexual dysfunction symptoms. Therefore, measurements of FT or other hormones were not considered to be useful in women.
Physicians’ Attitudes and Practice Toward Treating Injection Drug Users Infected with Hepatitis C Virus: Results from a National Specialist Survey in Canada
Authors: Myles Angelique , Mugford Gerry J , Zhao Jing , Krahn Murray , Wang Peizhong Peter
Published: March 2016

BACKGROUND: In Canada, more than 70% of new cases of hepatitis C virus (HCV) infection per year involve injection drug users (IDUs) and, currently, there is no consensus on how to offer them medical care.

OBJECTIVE: To examine the characteristics of Canadian specialist physicians and their likelihood to provide treatment to HCV patients who are IDUs.

METHODS: A nationwide, cross-sectional study was conducted in the specialty areas of hepatology, gastroenterology and infectious diseases to examine HCV services. The questionnaire requested information regarding basic demographics, referral pathways and opinions (yes/no), and examined how a physician’s treatment regimen is influenced by factors such as treatment eligibility, HCV care management and barriers to providing quality service.

RESULTS: Despite the fact that the majority of prevalent and incident cases of HCV are associated with injection drug use, very few specialist physicians actually provide the necessary therapy to this population. Only 19 (19.79%) comprehensive service providers were likely to provide treatment to a current IDU who uses a needle exchange on a regular basis. The majority of comprehensive service providers (n=86 [89.58%]) were likely to provide treatment to a former IDU who was stable on substitution therapy. On bivariate analysis, factors associated with the likelihood to provide treatment to current IDUs included physicians’ type, ie, infectious disease specialists compared with noninfectious specialists (OR 3.27 [95% CI 1.11 to 9.63]), and the size of the community where they practice (OR 4.16 [95% CI 1.36 to 12.71] [population 500,000 or greater versus less than 500,000]). Results of the multivariate logistic regression analysis were largely consistent with the results observed in the bivariate analyses. After controlling for other confounding variables, only community size was significantly associated with providing treatment to current IDUs (OR 3.89 [95% CI 1.06 to 14.26] [population 500,000 or greater versus less than 500,000]).

CONCLUSION: The present study highlighted the reluctance of specialists to provide treatment to current IDUs infected with HCV. Providing treatment services for HCV-infected substance abusers is challenging and there are many treatment barriers. However, effective delivery of treatment to this population will help to limit the spread of HCV. The present study clearly identified a need for improved HCV treatment accessibility for IDUs.
Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma: Predictors of Survival
Authors: Sawhney Summit , Montano-Loza Aldo J , Salat Peter , McCarthy Mairin , Kneteman Norman , Meza-Junco Judith , Owen Richard
Published: March 2016

BACKGROUND: Transarterial chemoembolization (TACE) is the mainstay of management for patients with hepatocellular carcinoma who are not suitable for curative treatments.

OBJECTIVE: To determine factors associated with mortality after the first TACE procedure.

METHODS: From January 2004 to May 2008, 60 patients underwent TACE as treatment for hepatocellular carcinoma. Clinical and biochemical parameters before TACE, and response after TACE, were evaluated with conventional classifications (WHO, Response Evaluation Criteria in Solid Tumors [RECIST], and European Association for the Study of the Liver [EASL] criteria) and with one-, two- and three-dimensional assessment.

RESULTS: Overall median survival after the first TACE procedure was 17.1±3.4 months. According to Cox regression analysis, having an alpha-fetoprotein level of greater than 200 ng/mL (HR 2.35 [P=0.02]) and a Model for End-stage Liver Disease (MELD) score of greater than 10 (HR 4.19 [P=0.001]) were associated with higher risk of mortality; whereas reduction in tumour size measured in one dimension (HR 0.96 [P=0.005]), two dimensions (HR 0.98 [P=0.004]) and three dimensions (HR 0.98 [P=0.001]) was associated with lower risk of mortality. Moreover, reduction in tumour size by 3% or more assessed in one, two or three dimensions was associated with lower risk of mortality (HR 0.48 [P=0.04]; HR 0.36 [P=0.01]; HR 0.31 [P=0.003], respectively). The three conventional classifications were not useful for predicting mortality (WHO: HR 1.07 [P=0.9]; RECIST: HR 0.94 [P=0.9]; EASL: HR 0.94 [P=0.9]).

CONCLUSIONS: Having an alpha-fetoprotein level of greater than 200 ng/mL and a MELD score of greater than 10 before undergoing TACE was associated with a greater risk of mortality. Conventional classifications of response were not useful for predicting mortality. Reduction in tumour size after the first TACE procedure was associated with better survival, primarily if patients had more than a 3% reduction in tumour size assessed by three-dimensional measurement.