bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Analysis of Selected Scales to Assess Prognosis in Acute Pancreatitis
Authors: Koziel Dorota , Gluszek Stanislaw , Matykiewicz Jaroslaw , Lewitowicz Piotr , Drozdzak Zuzanna
Published: March 2016

OBJECTIVE: To evaluate the utility of selected scales to prognosticate the severity and risk for death among patients with acute pancreatitis (AP) according to the revised Atlanta classification published in 2012.

METHODS: Prospective data regarding patients hospitalized due to AP were analyzed. The final analysis included a total of 1014 patients. The bedside index for severity in acute pancreatitis (BISAP), Panc 3 scores and Ranson scales were calculated using data from the first 24 h of admission.

RESULTS: Mild AP was diagnosed in 822 (81.1%) cases, moderate in 122 (12%) and severe in 70 (6.9%); 38 (3.7%) patients died. The main causes of AP were cholelithiasis (34%) and alcohol abuse (26.7%). Recurrence of AP was observed in 244 (24.1%) patients. In prognosticating the severity of AP, the most useful scale proved to be the Acute Physiology and Chronic Health Evaluation (APACHE) II (area under the curve [AUC] 0.724 [95% CI 0.655 to 0.793]), followed by BISAP (AUC 0.693 [95% CI 0.622 to 0.763]). In prognosticating a moderate versus mild course of AP, the CT severity index proved to be the most decisive (AUC 0.819 [95% CI 0.767 to 0.871]). Regarding prognosis for death, APACHE II had the highest predictive value (AUC 0.726 [95% CI 0.621 to 0.83]); however, a similar sensitivity was observed using the BISAP scale (AUC 0.707 [95% CI 0.618 to 0.797]).

CONCLUSIONS: Scoring systems used in prognosticating the course of the disease vary with regard to sensitivity and specificity. The CT severity index scoring system showed the highest precision in prognosticating moderately severe AP (as per the revised Atlanta criteria, 2012); however, in prognosticating a severe course of disease and mortality, APACHE II proved to have the greatest predictive value.
Peripheral neuromodulation for the treatment of refractory trigeminal neuralgia
Authors: Shaparin Naum , Gritsenko Karina , Garcia-Roves Diego Fernandez , Shah Ushma , Schultz Todd , DeLeon-Casasola Oscar
Published: March 2016

Trigeminal neuralgia is a type of orofacial pain that is diagnosed in 150,000 individuals each year, with an incidence of 12.6 per 100,000 person‐years and a prevalence of 155 cases per 1,000,000 in the United States. Trigeminal neuralgia pain is characterized by sudden, severe, brief, stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve, which can cause significant suffering for the affected patient population.

In many patients, a combination of medication and interventional treatments can be therapeutic, but is not always successful. Peripheral nerve stimulation has gained popularity as a simple and effective neuromodulation technique for the treatment of many pain conditions, including chronic headache disorders. Specifically in trigeminal neuralgia, neurostimulation of the supraorbital and infraorbital nerves may serve to provide relief of neuropathic pain by targeting the distal nerves that supply sensation to the areas of the face where the pain attacks occur, producing a field of paresthesia within the peripheral distribution of pain through the creation of an electric field in the vicinity of the leads.

The purpose of the present case report is to introduce a new, less‐invasive interventional technique, and to describe the authors’ first experience with supraorbital and infraorbital neurostimulation therapy for the treatment of trigeminal neuralgia in a patient who had failed previous conservative management.
Can social support work virtually? Evaluation of rheumatoid arthritis patients’ experiences with an interactive online tool
Authors: Kostova Zlatina , Caiata-Zufferey Maria , Schulz Peter J
Published: March 2016

BACKGROUND: There is strong empirical evidence that the support that chronic patients receive from their environment is fundamental for the way they cope with physical and psychological suffering. Nevertheless, in the case of rheumatoid arthritis (RA), providing the appropriate social support is still a challenge, and such support has often proven to be elusive and unreliable in helping patients to manage the disease.

OBJECTIVES: To explore whether and how social support for RA patients can be provided online, and to assess the conditions under which such support is effective. An online support tool was designed to provide patients with both tailored information and opportunities to interact online with health professionals and fellow sufferers. The general purpose was to identify where the support provided did – or did not – help patients, and to judge whether the determinants of success lay more within patients – their engagement and willingness to participate – or within the design of the website itself.

METHODS: The present study reports qualitative interviews with 19 users of the tool. A more specific purpose was to elaborate qualitatively on results from a quantitative survey of users, which indicated that any positive impact was confined to practical matters of pain management rather than extending to more fundamental psychological outcomes such as acceptance.

RESULTS AND CONCLUSIONS: Overall, online learning and interaction can do much to help patients with the everyday stresses of their disease; however, its potential for more durable positive impact depends on various individual characteristics such as personality traits, existing social networks, and the severity and longevity of the disease.
Tax-Deductible Provisions for Gluten-Free Diet in Canada Compared with Systems for Gluten-Free Diet Coverage Available in Various Countries
Authors: Pinto-Sanchez Maria Ines , Verdu Elena F , Gordillo Maria C , Bai Julio C , Birch Stephen , Moayyedi Paul , Bercik Premysl
Published: March 2016

Celiac disease affects 1% of the North American population, with an estimated 350,000 Canadians diagnosed with this condition. The disease is triggered by the ingestion of gluten, and a lifelong, strict gluten-free diet (GFD) is the only currently available treatment. Compliance with a strict GFD is essential not only for intestinal mucosal recovery and alleviation of symptoms, but also for the prevention of complications such as anemia, osteoporotic fractures and small bowel lymphoma. However, a GFD is difficult to follow, socially inconvenient and expensive. Different approaches, such as tax reduction, cash transfer, food provision, prescription and subsidy, have been used to reduce the additional costs of the GFD to patients with celiac disease. The current review showed that the systems in place exhibit particular advantages and disadvantages in relation to promoting uptake and compliance with GFD. The tax offset system used in Canada for GFD coverage takes the form of a reimbursement of a cost previously incurred. Hence, the program does not help celiac patients meet the incremental cost of the GFD – it simply provides some future refund of that cost. An ideal balanced approach would involve subsidizing gluten-free products through controlled vouchers or direct food provision to those who most need it, independently of ‘ability or willingness to pay’. Moreover, if the cost of such a program is inhibitive, the value of the benefits could be made taxable to ensure that any patient contribution, in terms of additional taxation, is directly related to ability to pay. The limited coverage of GFD in Canada is concerning. There is an unmet need for GFD among celiac patients in Canada. More efforts are required by the Canadian medical community and the Canadian Celiac Association to act as agents in identifying ways of improving resource allocation in celiac disease.
Toward Enteral Nutrition in the Treatment of Pediatric Crohn Disease in Canada: A Workshop to Identify Barriers and Enablers
Authors: Van Limbergen Johan , Haskett Jennifer , Griffiths Anne M , Critch Jeff , Huynh Hien , Ahmed Najma , deBruyn Jennifer C , Issenman Robert , El-Matary Wael , Walters Thomas D , Kluthe Cheryl , Roy Marie-Eve , Sheppard Elizabeth , Crandall Wallace V , Cohen Stan , Ruemmele Frank M , Levine Arie , Otley Anthony R
Published: March 2016

The treatment armamentarium in pediatric Crohn disease (CD) is very similar to adult-onset CD with the notable exception of the use of exclusive enteral nutrition (EEN [the administration of a liquid formula diet while excluding normal diet]), which is used more frequently by pediatric gastroenterologists to induce remission. In pediatric CD, EEN is now recommended by the pediatric committee of the European Crohn’s and Colitis Organisation and the European Society for Paediatric Gastroenterology Hepatology and Nutrition as a first-choice agent to induce remission, with remission rates in pediatric studies consistently >75%. To chart and address enablers and barriers of use of EEN in Canada, a workshop was held in September 2014 in Toronto (Ontario), inviting pediatric gastroenterologists, nurses and dietitians from most Canadian pediatric IBD centres as well as international faculty from the United States and Europe with particular research and clinical expertise in the dietary management of pediatric CD. Workshop participants ranked the exclusivity of enteral nutrition; the health care resources; and cost implications as the top three barriers to its use. Conversely, key enablers mentioned included: standardization and sharing of protocols for use of enteral nutrition; ensuring sufficient dietetic resources; and reducing the cost of EEN to the family (including advocacy for reimbursement by provincial ministries of health and private insurance companies). Herein, the authors report on the discussions during this workshop and list strategies to enhance the use of EEN as a treatment option in the treatment of pediatric CD in Canada.
Improvement in Obstructive Sleep Apnea Diagnosis and Management Wait Times: A Retrospective Analysis of a Home Management Pathway for Obstructive Sleep Apnea
Authors: Stewart Samuel Alan , Skomro Robert , Reid John , Penz Erika , Fenton Mark , Gjevre John , Cotton David
Published: March 2016

Obstructive sleep apnea is a common condition within the Canadian population. The current gold standard for diagnosis and management of patients is in-laboratory (in-lab) polysomnography; however, the limited availability of testing options for patients has led to long wait times and increased disease burden within the population. The Sleep Research Laboratory in Saskatoon (Saskatchewan) implemented a home management program to run in parallel with the in-lab system several years ago in an effort to increase their capacity and reduce wait times. The present study was a retrospective analysis of all patients referred to the program between 2009 and 2012. The home management system has improved wait times by diagnosing and managing up to one-half of the referred patient population, reducing the wait for in-lab treatment from a median of 152 days in 2009 to 92 days in 2012 (P<0.0001). Moving forward, home management can provide a viable alternative to in-lab testing for patients who meet strict entry criteria, reducing the in-lab workload and, ultimately, reducing wait times.
Post-Transplant Lymphoproliferative Disorder in Liver Transplant Recipients: Characteristics, Management and Outcome from a Single-Centre Experience with >1000 Liver Transplantations
Authors: Mumtaz Khalid , Faisal Nabiha , Marquez Max , Healey Alicia , Lilly Leslie B , Renner Eberhard L
Published: March 2016

BACKGROUND: The literature regarding post-transplant lymphoproliferative disorder (PTLD) in liver transplant recipients (LTRs) is limited.

OBJECTIVES: To study the incidence, predictors and outcomes of PTLD after liver transplantation in a single, large-volume centre.

METHODS: The charts of all LTRs (n=1372) in the authors’ centre between January 2000 and June 2012 were retrospectively reviewed and those who developed PTLD were identified. Demographic, clinical and treatment data were prospectively collected. Responses to treatment, including complete response, no response, relapse and survival, were recorded.

RESULTS: The incidence of PTLD in LTRs was 32 in 1372 (2.3%). Overall, median survival was 37 months (range 0.5 to 195 months), with one-, three- and five-year survival rates of 81%, 74% and 60%, respectively. Epstein-Barr virus (EBV)-negative patients had a better mean (± SD) survival (95±79 months) than EBV-positive patients (41±42 months) (P=0.02). For stage I/II PTLD, one-, three- and five-year actuarial survival was 87%, 87% and 75%, compared with 50%, 30% and 0% for stage III/IV PTLD, respectively (P=0.001). In patients with complete response, median survival was 58 months (range 10 to 195 months); and one-, three- and five-year actuarial survival was 100%, 94% and 76%, respectively, after diagnosis of PTLD. Changing immunosuppression (IS) from calcineurin inhibitor to sirolimus at the time of diagnosis may have improved survival (seven of seven survivors) compared with only decreasing or stopping IS (14 of 25 survivors) (P=0.07).

CONCLUSIONS: This series from a single large-volume centre showed excellent short and long-term survival after PTLD in adult LTRs who were EBV negative, had early disease and showed complete response. Consistent with the known in vitro antiproliferative effect of sirolimus, switching IS from calcineurin inhibitor to sirolimus may improve survival.
A Confirmed Case of Toxic Shock Syndrome Associated with the Use of a Menstrual Cup
Authors: Mitchell Michael A , Bisch Steve , Arntfield Shannon , Hosseini-Moghaddam Seyed M
Published: March 2016

Menstrual cups have been reported to be an acceptable substitute for tampons. These flexible cups have also been reported to provide a sustainable solution to menstrual management, with modest cost savings and no significant health risk.

The present article documents the first case of toxic shock syndrome associated with the use of a menstrual cup in a woman 37 years of age, using a menstrual cup for the first time. Toxic shock syndrome and the literature on menstrual cups is reviewed and a possible mechanism for the development of toxic shock syndrome in the patient is described.
Subacute bacterial endocarditis caused by Cardiobacterium hominis: A case report
Authors: Wong Davie , Carson Julie , Johnson Andrew
Published: March 2016

Cardiobacterium hominis, a member of the HACEK group of organisms, is an uncommon but important cause of subacute bacterial endocarditis. First‐line therapy is a third‐generation cephalosporin due to rare beta‐lactamase production. The authors report a case involving endovascular infection due to C hominis that initially tested resistant to third‐generation cephalosporins using an antibiotic gradient strip susceptibility method (nitrocephin negative), but later proved to be susceptible using broth microdilution reference methods (a ‘major’ error). There are limited studies to guide susceptibility testing and interpretive breakpoints for C hominis in the medical literature, and the present case illustrates some of the issues that may arise when performing susceptibility testing for fastidious organisms in the clinical microbiology laboratory.
Endoscopy in Canada: Proceedings of the National Roundtable
Authors: Switzer Noah , Dixon Elijah , Tinmouth Jill , Bradley Nori , Vassiliou Melina , Schwaitzberg Steve , Gomes Anthony , Ellsmere James , de Gara Chris
Published: March 2016

This 2014 roundtable discussion, hosted by the Canadian Association of General Surgeons, brought together general surgeons and gastroenterologists with expertise in endoscopy from across Canada to discuss the state of endoscopy in Canada. The focus of the roundtable was the evaluation of the competence of general surgeons at endoscopy, reviewing quality assurance parameters for high-quality endoscopy, measuring and assessing surgical resident preparedness for endoscopy practice, evaluating credentialing programs for the endosuite and predicting the future of endoscopic services in Canada. The roundtable noted several important observations. There exist inadequacies in both resident training and the assessment of competency in endoscopy. From these observations, several collaborative recommendations were then stated. These included the need for a formal and standardized system of both accreditation and training endoscopists.
Development of the Adolescent Cancer Suffering Scale
Authors: Khadra Christelle , Le May Sylvie , Tremblay Isabelle , Dupuis France , Cara Chantal , Mercier Geneviève , Vachon Marie France , Fiola Jacinthe Lachance
Published: March 2016

BACKGROUND: While mortality due to pediatric cancer has decreased, suffering has increased due to complex and lengthy treatments. Cancer in adolescence has repercussions on personal and physical development. Although suffering can impede recovery, there is no validated scale in French or English to measure suffering in adolescents with cancer.

OBJECTIVE: To develop an objective scale to measure suffering in adolescents with cancer.

METHODS: A methodological design for instrument development was used. Following a MEDLINE search, semistructured interviews were conducted with adolescents 12 to 19 years of age who had undergone four to six weeks of cancer treatment, and with a multidisciplinary cohort of health care professionals. Adolescents with advanced terminal cancer or cognitive impairment were excluded. Enrollment proceeded from the hematology‐oncology department/clinic in Montreal, Quebec, from December 2011 to March 2012. Content validity was assessed by five health care professionals and four adolescents with cancer.

RESULTS: Interviews with 19 adolescents and 16 health care professionals identified six realms of suffering: physical, psychological, spiritual, social, cognitive and global. Through iterative feedback, the Adolescent Cancer Suffering Scale (ACSS) was developed, comprising 41 questions on a four‐point Likert scale and one open‐ended question. Content validity was 0.98, and inter‐rater agreement among professionals was 88% for relevance and 86% for clarity. Adolescents considered the scale to be representative of their suffering.

CONCLUSIONS: The ACSS is the first questionnaire to measure suffering in adolescents with cancer. In future research, the questionnaire should be validated extensively and interventions developed. Once validated, the ACSS will contribute to promote a holistic approach to health with appropriate intervention or referral.
Prevalence and Management of Back Pain in Adolescent Idiopathic Scoliosis Patients: A Retrospective Study
Authors: Théroux Jean , Le May Sylvie , Fortin Carole , Labelle Hubert
Published: March 2016

BACKGROUND: Back pain (BP) has often been associated with adolescent idiopathic scoliosis (AIS), which is a three‐dimensional deviation of the vertebral column. In adolescents, chronic pain appears to be a predictor of health care utilization and has a negative impact on physical, psychological and family well‐being. In this population, BP tends to be persistent and may be a predictor of BP in adulthood.

OBJECTIVE: To document the prevalence and management of BP in AIS patients.

METHODS: A retrospective chart review of AIS patients who were referred to Sainte‐Justine University Teaching Hospital (Montreal, Quebec) from 2006 to 2011 was conducted.

RESULTS: A total of 310 randomly selected charts were reviewed. Nearly one‐half of the patients (47.3%) mentioned that they experienced BP, most commonly in the lumbar (19.7%) and thoracic regions (7.7%). The type of BP was documented in only 36% (n=112) of the charts. Pain intensity was specified in only 21% (n=65) of the charts. In approximately 80% (n=248) of the charts, no pain management treatment plan was documented.

CONCLUSIONS: The prevalence of BP was moderately high among the present sample of adolescents with AIS. An improved system for documenting BP assessment, type, treatment plan and treatment effectiveness would improve pain management for these patients.
Assessing Patient‐Centred Care for Chronic Pain: Validation of a New Research Paradigm
Authors: Paul-Savoie Emilie , Bourgault Patricia , Gosselin Emilie , Potvin Stéphane , Lafrenaye Sylvie
Published: March 2016

BACKGROUND: Chronic pain is a complex phenomenon resulting from biological, psychological and social factors, and the use of patient‐centred care (PCC) appears to be a promising avenue for its treatment. Various methods have been used for measuring PCC in nurses and physicians (caregivers); however, methodological problems have been raised following the observation of real clinical encounters or standardized patient simulations. The development of new strategies is required.

OBJECTIVE: To develop and validate an observation scale for the assessment of PCC in caregivers, using standardized videos of real patients with chronic pain.

METHODS: An expert panel developed five videos and the Sherbrooke Observation Scale of Patient‐Centered Care (SOS‐PCC), which were tested in a sample of 21 nurses and 21 physicians working with chronic pain patients. The content validity, internal consistency and inter‐rater reliability of the SOS‐PCC were assessed.

RESULTS: The expert panel was satisfied with the content validity of the SOS‐PCC. Results revealed good internal consistency (Cronbach’s alpha = 0.88) and inter‐rater reliability (intraclass coefficient = 0.93) for this scale.

CONCLUSIONS: To the authors’ knowledge, the SOS‐PCC is the first instrument available in French to assess PCC behaviour of caregivers using videos of real patients with chronic pain. The psychometric qualities of these instruments are good. Future studies will need to assess this instrument with other populations of caregivers.
Hepatitis C Virus Seroconversion among Hiv‐Positive Men Who Have Sex With Men With No History of Injection Drug Use: Results from a Clinical Hiv Cohort
Authors: Burchell Ann N , Gardner Sandra L , Mazzulli Tony , Manno Michael , Raboud Janet , Allen Vanessa G , Bayoumi Ahmed M , Kaul Rupert , McGee Frank , Millson Peggy , Remis Robert S , Wobeser Wendy , Cooper Curtis , Rourke Sean B
Published: March 2016

BACKGROUND: Internationally, there is a growing recognition that hepatitis C virus (HCV) may be sexually transmitted among HIV‐positive men who have sex with men (MSM).

OBJECTIVE: To report the first Canadian estimate of HCV seroincidence in 2000 to 2010 and its risk factors among HIV‐positive MSM with no known history of injection drug use.

METHODS: Data from the Ontario HIV Treatment Network Cohort Study, an ongoing cohort of individuals in HIV care in Ontario, were analyzed. Data were obtained from medical charts, interviews and record linkage with the provincial public health laboratories. The analysis was restricted to 1534 MSM who did not report injection drug use and had undergone ≥2 HCV antibody tests, of which the first was negative (median 6.1 person‐years [PY] of follow‐up; sum 9987 PY).

RESULTS: In 2000 to 2010, 51 HCV seroconversions were observed, an overall incidence of 5.1 per 1000 PY (95% CI 3.9 to 6.7). Annual incidence varied from 1.6 to 8.9 per 1000 PY, with no statistical evidence of a temporal trend. Risk for seroconversion was elevated among men who had ever had syphilis (adjusted HR 2.5 [95% CI 1.1 to 5.5) and men who had acute syphilis infection in the previous 18 months (adjusted HR 2.8 [95% CI 1.0 to 7.9]). Risk was lower for men who had initiated antiretroviral treatment (adjusted HR 0.49 [95% CI 0.25 to 0.95]). There were no statistically significant effects of age, ethnicity, region, CD4 cell count or HIV viral load.

CONCLUSIONS: These findings suggest that periodic HCV rescreening may be appropriate in Ontario among HIV‐positive MSM. Future research should seek evidence whether syphilis is simply a marker for high‐risk sexual behaviour or networks, or whether it potentiates sexual HCV transmission among individuals with HIV.
Edwardsiella tarda Bacteremia. A Rare but Fatal Water‐ and Foodborne Infection: Review of the Literature and Clinical Cases from a Single Centre
Authors: Hirai Yuji , Asahata-Tago Sayaka , Ainoda Yusuke , Fujita Takahiro , Kikuchi Ken
Published: March 2016

BACKGROUND: Edwardsiella tarda bacteremia (ETB) can be a fatal disease in humans.

OBJECTIVES: To determine the significant risk factors associated with death caused by ETB, and to examine the geographical, seasonal, environmental and dietary factors of the disease.

METHODS: A retrospective, observational, case control study was performed. The PubMed MEDLINE and Japanese Medical Abstract Society (www.jamas.or.jp) databases were searched for ETB case reports and meeting abstracts. In additon, retrospective chart reviews of patients with ETB at the Tokyo Women’s Medical University Hospital (Tokyo, Japan) were conducted to evaluate the risk factors associated with death using multivariate analyses.

RESULTS: The literature search yielded 46 publications, comprising 72 cases from the English (n=30), French (n=1), Spanish (n=1) and Japanese (n=14) literature. Five cases at the Tokyo Women’s Medical University Hospital were also included. Of the included 77 cases, the mean age was 61 years and 39% of patients were female; 77.2% of the cases occurred between June and November, and 45.5% were reported in Japan. Dietary factors (raw fish/meat exposure) were reported for 10.4% of patients and 12.9% reported environmental (ie, brackish water) exposure. The overall mortality rate was 44.6%; however, this rate increased to 61.1% for ETB patients with soft tissue infections. Liver cirrhosis was determined to be an independent risk factor associated with death (OR 12.0 [95% CI 2.46 to 58.6]; P=0.00213) using multivariate analyses.

DISCUSSION: To our knowledge, the present analysis was the first and largest multi‐language review of ETB. Clinical characteristics of ETB resemble those of Aeromonas, typhoid fever and Vibrio vulnificus infections, in addition to sharing similar risk factors.

CONCLUSION: ETB should be categorized as a severe food‐ and waterborne infection, which results in high mortality for patients with liver cirrhosis.
Characterization of Inflammatory Bowel Disease in Hospitalized Elderly Patients in a Large Central Canadian Health Region
Authors: Stepaniuk Peter , Bernstein Charles N , Nugent Zoann , Singh Harminder
Published: March 2016

OBJECTIVE: To determine differences in phenotype and treatment among hospitalized elderly and young patients with inflammatory bowel disease (IBD), and the utility ofInternational Classification of Diseases, 10th Revision(ICD)-10 codes in hospital discharge abstracts in diagnosing IBD in elderly patients.

METHODS: A large Canadian health region hospitalization discharge database was used to identify elderly (>65 years of age) and young (19 to 50 years of age) patients with IBD admitted between April 1, 2007 and March 31, 2012, and a random sample of elderly patients with other colonic conditions. Medical records were reviewed to confirm IBD diagnosis and extract clinical information. The characteristics of elderly versus young hospitalized IBD patients and accuracy of ICD-10 IBD discharge codes in the elderly were assessed.

RESULTS: One hundred forty-three elderly and 82 young patients with an IBD discharge diagnosis, and 135 elderly patients with other gastrointestinal discharge diagnoses were included. Elderly IBD patients were less likely to have ileocolonic Crohn disease (21.4% versus 50.9%; P=0.001), more likely to be prescribed 5-aminosalicylates (61% versus 43%; P=0.04), and less likely to be prescribed biologics (6% versus 21%; P=0.016) or immunomodulators (21% versus 42%; P=0.01). The sensitivity, specificity and positive predictive value of a single ICD code for CD were 98%, 96% and 94%, respectively, and for ulcerative colitis (UC) were 98%, 92% and 70%, respectively.

CONCLUSIONS: Treatment approaches in elderly patients were different than in younger IBD patients despite having disease sufficiently severe to require hospitalization. While less accurate in UC, a single ICD-10 IBD code was sufficient to identify elderly CD and UC hospitalized patients.
A Case Series of Third‐Trimester Raltegravir Initiation: Impact on Maternal HIV‐1 Viral Load and Obstetrical Outcomes
Authors: Boucoiran I , Tulloch K , Pick N , Kakkar F , van Schalkwyk J , Money D , Boucher M
Published: March 2016

OBJECTIVE: To describe the impact of initiating raltegravir (RAL)‐containing combination antiretroviral therapy (cART) regimens on HIV viral load (VL) in pregnant women who have high or suboptimal VL suppression late in pregnancy.

METHODS: HIV‐infected pregnant women who started RAL‐containing cART after 28 weeks’ gestation from 2007 to 2013 were identified in two university hospital centres.

RESULTS AND DISCUSSION: Eleven HIV‐infected women started RAL at a median gestational age of 35.7 weeks (range 31.1 to 38.0 weeks). Indications for RAL initiation were late presentation in pregnancy (n=4) and suboptimal VL suppression secondary to poor adherence or viral resistance (n=7). Mean VL at the time of RAL initiation was 73,959 copies/mL (range <40 to 523,975 copies/mL). Patients received RAL for a median of 20 days (range one to 71 days). The mean decline in VL from the time of RAL initiation to delivery was 1.93 log, excluding one patient who received only one RAL dose and one patient with undetectable VL at the time of RAL initiation. After eight days on RAL, 50% of the women achieved a VL <1000 copies/mL (the threshold for recommended Caesarean section to reduce the risk for perinatal transmission). There were no cases of perinatal HIV transmission.

CONCLUSION: The present study provides preliminary data to support the use of RAL‐containing cART to expedite HIV‐1 VL reduction in women who have a high VL or suboptimal VL suppression late in pregnancy, and to decrease the risk of HIV perinatal transmission while avoiding Caesarean section. Further assessment of RAL safety during pregnancy is warranted.
Pain in Canadian Veterans: Analysis of Data from the Survey on Transition to Civilian Life
Authors: VanDenKerkhof Elizabeth G , VanTil Linda , Thompson James M , Sweet Jill , Hopman Wilma M , Carley Meg E , Sudom Kerry
Published: March 2016

BACKGROUND: Little is known about the prevalence of chronic pain among Veterans outside the United States.

OBJECTIVE: To describe the prevalence of chronic pain and associated sociodemographic, health behaviour, employment/income, disability, and physical and mental health factors in Canadian Veterans.

METHODS: The 2010 Survey on Transition to Civilian Life included a nationally representative sample of 3154 Canadian Armed Forces Regular Force Veterans released from service between 1998 and 2007. Data from a telephone survey of Veterans were linked with Department of National Defence and Veterans Affairs Canada administrative databases. Pain was defined as constant/reoccurring pain (chronic pain) and as moderate/severe pain interference with activities.

RESULTS: Forty‐one percent of the population experienced constant chronic pain and 23% experienced intermittent chronic pain. Twenty‐five percent reported pain interference. Needing help with tasks of daily living, back problems, arthritis, gastrointestinal conditions and age ≥30 years were independently associated with chronic pain. Needing help with tasks of daily living, back problems, arthritis, mental health conditions, age ≥30 years, gastrointestinal conditions, low social support and noncommissioned member rank were associated with pain interference.

CONCLUSIONS: These findings provide evidence for agencies and those supporting the well‐being of Veterans, and inform longitudinal studies to better understand the determinants and life course effects of chronic pain in military Veterans.
Adenoma Detection Rates Decline with Increasing Procedural Hours in an Endoscopist’s Workload
Authors: Almadi Majid A , Sewitch Maida , Barkun Alan N , Martel Myriam , Joseph Lawrence
Published: March 2016

BACKGROUND: Operator fatigue may negatively influence adenoma detection (AD) during screening colonoscopy.

OBJECTIVE: To better characterize factors affecting AD, including the number of hours worked, and the number and type of procedures performed before an index screening colonoscopy.

METHODS: A retrospective cohort study was conducted involving individuals undergoing a screening colonoscopy at a major tertiary care hospital in Montreal, Quebec. Individuals were identified using an endoscopic reporting database; AD was identified by an electronic chart review. A hierarchical logistic regression analysis was performed to determine the association between patient- and endoscopist-related variables and AD.

RESULTS: A total of 430 consecutive colonoscopies performed by 10 gastroenterologists and two surgeons were included. Patient mean (± SD) age was 63.4±10.9 years, 56.3% were males, 27.7% had undergone a previous colonoscopy and the cecal intubation rate was 95.7%. The overall AD rate was 25.7%. Age was associated with AD (OR 1.06 [95% CI 1.03 to 1.08]), while female sex (OR 0.44 [95% CI 0.25 to 0.75]), an indication for average-risk screening (OR 0.47 [95% CI 0.27 to 0.80]) and an increase in the number of hours during which endoscopies were performed before the index colonoscopy (OR 0.87 [95% CI 0.76 to 0.99]) were associated with lower AD rates. On exploratory univariable analysis, a threshold of 3 h of endoscopy time performed before the index colonoscopy was associated with decreased AD.

CONCLUSION: The number of hours devoted to endoscopies before the index colonoscopy was inversely associated with AD rate, with decreased performance possibly as early as within 3 h. This metric should be confirmed in future studies and considered when optimizing scheduling practices.
Urinary Tract Infection Diagnosis and Response to Therapy in Long‐Term Care: A Prospective Observational Study
Authors: Daley Peter , Penney Carla , Wakeham Susan , Compton Glenda , McKim Aaron , O’Keefe Judy , Barrett Brendan , Nicolle Lindsay
Published: March 2016

BACKGROUND: The prevalence of asymptomatic bacteriuria among residents of long‐term care (LTC) facilities is high, and is a source of inappropriate antibiotic prescription.

OBJECTIVE: To establish symptoms and signs associated with a positive urine culture, and to determine whether antibiotic therapy is associated with functional improvement.

METHODS: A total of 101 LTC patients were prospectively observed after submission of urine for culture.

RESULTS: The culture positivity rate was consistent with the expected asymptomatic bacteriuria rate. Change in mental status and male sex were associated with culture positivity. Treatment decisions were not consistent with culture results. Treatment did not lead to improvement in activities of daily living scores at two days or seven days.

DISCUSSION: Significant growth cannot be well predicted based on clinical variables; thus, the decision to submit urine is somewhat arbitrary. Because urine culture testing and treatment does not lead to functional improvement, restricting access to the test may be reasonable.

CONCLUSION: Urine culture testing in LTC facilities does not lead to functional improvement.
Effects of Asm‐024, A Modulator of Acetylcholine Receptor Function, On Airway Responsiveness and Allergen‐Induced Responses in Patients with Mild Asthma
Authors: Boulet Louis-Philippe , Gauvreau Gail M , Cockcroft Donald W , Davis Beth , Vachon Luc , Cormier Yvon , O’Byrne Paul M
Published: March 2016

OBJECTIVES: To evaluate the safety, tolerability and clinical activity of ASM‐024, a new cholinergic compound with dual nicotinic and muscarinic activity, in mild allergic asthma.

METHODS: The present study involved 24 stable, mild allergic asthmatic subjects. In a cross‐over design, ASM‐024 (50 mg or 200 mg) or placebo were administered once daily by nebulization over three periods of nine consecutive days separated by a three‐week washout. The effect of each treatment on the forced expiratory volume in 1 s (FEV1), provocative concentration of methacholine causing a 20% decline in FEV1 (PC20), early and late asthmatic responses, and allergen‐induced inflammation were measured.

RESULTS: Seventeen subjects completed the study. During treatment with ASM‐024 at 50 mg or 200 mg, the PC20 value increased respectively from a mean (± SD) 2.56±3.86 mg/mL to 4.11 mg/mL (P=0.007), and from 3.12±4.37 mg/mL to 5.23 mg/mL (P=0.005) (no change with placebo). On day 7 (day preceding allergen challenge), postdosing FEV1 increased by 2.0% with 50 mg (P=0.005) and 1.9% with 200 mg (P=0.008) (placebo −1.1%). ASM‐24 had no inhibitory effect on early and late asthmatic responses, nor on sputum eosinophil or neutrophil levels. ASM‐024 induced no serious adverse events, but caused cough in 22% and 48% of the subjects with 50 mg and 200 mg, respectively, compared with 10% who were on placebo.

CONCLUSIONS: ASM‐024 did not inhibit allergen‐induced asthmatic response and related airway inflammation, but reduced methacholine airway responsiveness and slightly improved lung function. The mechanism by which ASM‐024 improves these outcomes requires further study.
Development and Validation of the French‐Canadian Chronic Pain Self‐Efficacy Scale
Authors: Lacasse Anaïs , Bourgault Patricia , Tousignant-Laflamme Yannick , Courtemanche-Harel Roxanne , Choinière Manon
Published: March 2016

BACKGROUND: Perceived self‐efficacy is a non‐negligible outcome when measuring the impact of self‐management interventions for chronic pain patients. However, no validated, chronic pain‐specific self‐efficacy scales exist for studies conducted with French‐speaking populations.

OBJECTIVES: To establish the validity of the use of the French‐Canadian Chronic Pain Self‐efficacy Scale (FC‐CPSES) among chronic pain patients.

METHODS: The Chronic Disease Self‐Efficacy Scale is a validated 33‐item self‐administered questionnaire that measures perceived self‐efficacy to perform self‐management behaviours, manage chronic disease in general and achieve outcomes (a six‐item version is also available). This scale was adapted to the context of chronic pain patients following cross‐cultural adaptation guidelines. The FC‐CPSES was administered to 109 fibromyalgia and 34 chronic low back pain patients (n=143) who participated in an evidence‐based self‐management intervention (the PASSAGE program) offered in 10 health care centres across the province of Quebec. Cronbach’s alpha coefficients (α) were calculated to determine the internal consistency of the 33‐ and six‐item versions of the FC‐CPSES. With regard to convergent construct validity, the association between the FC‐CPSES baseline scores and related clinical outcomes was examined. With regard to the scale’s sensitivity to change, pre‐ and postintervention FC‐CPSES scores were compared.

RESULTS: Internal consistency was high for both versions of the FC‐CPSES (α=0.86 to α=0.96). Higher self‐efficacy was significantly associated with higher mental health‐related quality of life and lower pain intensity and catastrophizing (P<0.05), supporting convergent validity of the scale. There was a statistically significant increase in FC‐CPSES scores between pre‐ and postintervention measures for both versions of the FC‐CPSES (P<0.003), which supports their sensitivity to clinical change during an intervention.

CONCLUSIONS: These data suggest that both versions of the FC‐CPSES are reliable and valid for the measurement of pain management self‐efficacy among chronic pain patients.
Lyme Disease: Knowledge and Practices of Family Practitioners in Southern Quebec
Authors: Ferrouillet Cécile , Milord François , Lambert Louise , Vibien Anne , Ravel André
Published: March 2016

BACKGROUND: Public health authorities in Quebec have responded to the progressive emergence of Lyme disease (LD) with surveillance activities and education for family physicians (FPs) who are key actors in both vigilance and case management.

OBJECTIVES: To describe FPs’ clinical experience with LD, their degree of knowledge, and their practices in two areas, one with known infected tick populations (Montérégie) and one without (regions nearby Montérégie).

METHODS: In the present descriptive cross‐sectional study, FPs were recruited during educational sessions. They were asked to complete a questionnaire assessing their clinical experience with Lyme disease, their knowledge of signs and symptoms of LD, and their familiarity with accepted guidelines for diagnosing and treating LD in two clinical scenarios (tick bite and erythema migrans).

RESULTS: A total of 201 FPs participated, mostly from Montérégie (n=151). Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices. A majority of participants agreed to more education on LD. As expected, FPs from Montérégie had a higher clinical experience with tick bites (57% versus 25%), better knowledge of LD endemic areas in Canada and erythema migrans characteristics, and better management of erythema migrans (72% versus 50%).

CONCLUSION: The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes. Such practices should be discouraged because they are unnecessary and overuse collective laboratory and medical resources. In addition, public health authorities must pursue their education efforts regarding FPs to optimize case management.
Prediction of Adaptive Self‐Regulatory Responses to Arthritis Pain Anxiety in Exercising Adults: Does Pain Acceptance Matter?
Authors: Cary Miranda A , Gyurcsik Nancy C , Brawley Lawrence R
Published: March 2016

BACKGROUND: Exercising for ≥150 min/week is a recommended strategy for self‐managing arthritis. However, exercise nonadherence is a problem. Arthritis pain anxiety may interfere with regular exercise. According to the fear‐avoidance model, individuals may confront their pain anxiety by using adaptive self‐regulatory responses (eg, changing exercise type or duration). Furthermore, the anxiety‐self‐regulatory responses relationship may vary as a function of individuals’ pain acceptance levels.

OBJECTIVES: To investigate pain acceptance as a moderator of the pain anxiety‐adaptive self‐regulatory responses relationship. The secondary objective was to examine whether groups of patients who differed in meeting exercise recommendations also differed in pain‐related and self‐regulatory responses.

METHODS: Adults (mean [± SD] age 49.75±13.88 years) with medically diagnosed arthritis completed online measures of arthritis pain‐related variables and self‐regulatory responses at baseline, and exercise participation two weeks later. Individuals meeting (n=87) and not meeting (n=49) exercise recommendations were identified.

RESULTS: Hierarchical multiple regression analysis revealed that pain acceptance moderated the anxiety‐adaptive self‐regulatory responses relationship. When pain anxiety was lower, greater pain acceptance was associated with less frequent use of adaptive responses. When anxiety was higher, adaptive responses were used regardless of pain acceptance level. MANOVA findings revealed that participants meeting the recommended exercise dose reported significantly lower pain and pain anxiety, and greater pain acceptance (P<0.05) than those not meeting the dose.

CONCLUSIONS: Greater pain acceptance may help individuals to focus their efforts to adapt to their pain anxiety only when it is higher, leaving self‐regulatory capacity to cope with additional challenges to exercise adherence (eg, busy schedule).
Improving Health Care Efficiency Through the Integration of a Physician Assistant into an Infectious Diseases Consult Service at a Large Urban Community Hospital
Authors: Decloe Melissa , McCready Janine , Downey James , Powis Jeff
Published: March 2016

BACKGROUND: Physician assistants (PAs) have recently been introduced into the Canadian health care system in some provinces; however, there are little data demonstrating their impact.

METHODS: A retrospective case‐control study was conducted between January 2010 and December 2013. Length of stay (LOS) and mortality were examined in the infectious diseases consult service (IDCS) compared with hospital‐wide controls. The two‐year period before the introduction of the PA to the IDCS of a large urban community hospital in Canada (2010 to 2011) was compared with the two‐year period following the introduction of the PA (2012 to 2013).

RESULTS: Following the introduction of a PA to the IDCS, there was a decrease in time to consultation from 21.4 h to 14.3 h (P<0.0001). LOS was significantly decreased among IDCS patients by 3.6 days more than that seen in matched hospital‐wide controls (P=0.0001). Mortality did not significantly change after PA introduction in either cases or controls.

DISCUSSION/CONCLUSION: PAs can improve health efficiencies in the Canadian health care setting, leading to reduction in LOS.
A Pilot Randomized Controlled Trial of Smoking Cessation in an Outpatient Respirology Clinic
Authors: Pakhale Smita , Baron Justine , Armstrong Michael A , Garde Avanti , Reid Robert D , Alvarez Gonzalo , Aitken Debbie , Mullen Kerri-Anne , Wells George , Pipe Andrew
Published: March 2016

OBJECTIVE: To assess the feasibility and potential effectiveness of a modified version of the Ottawa Model for Smoking Cessation in an outpatient respirology clinic.

METHODS: Adult tobacco smokers attending the respirology clinic and willing to choose a quit date within one month of enrollment were randomly assigned to receive standard care or the intervention. Standard care participants received smoking cessation advice, a brochure and a prescription for smoking cessation medication if requested. Intervention participants received a $110 voucher to purchase smoking cessation pharmacotherapy and were registered to an automated calling system. Answers to automated calls determined which participants required nurse telephone counselling. Feasibility indicators included recruitment and retention rates, and intervention adherence. The effectiveness indicator was self‐reported smoking status at 26 to 52 weeks.

RESULTS: Forty‐nine (54.4%) of 90 eligible smokers were randomly assigned to the intervention (n=23) or control (n=26) group. Self‐reported smoking status at 26 to 52 weeks was available for 32 (65.3%) participants. The quit rate for intervention participants was 18.2% compared with 7.7% for controls (OR2.36 [95% CI 0.39 to 14.15]).

CONCLUSION: It would be feasible to evaluate this intervention in a larger trial. Alternatives to face‐to‐face follow‐up at the clinic are recommended.