bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence of Addiction Risk on Nursing Students’ Expectations of Patients’ Pain Reports: A Clinical Vignette Approach
Authors: Miceli Paula C , Katz Joel
Published: March 2016

OBJECTIVE: To examine the influence of addiction risk (substance abuse history [SAH]) and pain relief (PR) on nursing and non‐nursing students’ perceptions of pain in a postoperative vignette patient.

METHODS: Using a 2×2 design, the independent variables SAH (present/+, absent/–) and PR (adequate, little) were varied systematically to produce four vignettes. Participants were randomly assigned to receive one of the four vignettes that described a 45‐year‐old man after a total hip replacement. Participants rated the vignette patient’s experienced and reported pain intensity (PI) on a 0 mm to 100 mm visual analogue scale and addiction risk on a 0 mm to 100 mm visual analogue scale. A pain congruence (PC) score was calculated (PC = reported PI – experienced PI), and was interpreted as congruent (±2 mm) or incongruent (+2 mm to +100 mm for expected pain over‐reporting; −2 mm to −100 mm for expected pain under‐reporting).

RESULTS: Responses from undergraduate nursing (n=89) and non‐nursing (n=88) students were analyzed. The estimated addiction risk was significantly lower in nursing (14% to 45%) versus non‐nursing students (50%). Nursing students’ mean PC scores were not significantly altered by SAH alone. Expectations of pain over‐reporting were observed under conditions of SAH+/adequate PR, but not SAH+/little PR. In non‐nursing students, SAH and PR were significant and independent factors influencing mean PC scores in the direction of pain over‐reporting.

CONCLUSION: Under most conditions, nursing students expected pain under‐reporting by the postoperative vignette patient. However, nursing students did expect pain to be over‐reported when addiction risk was high and PR was adequate. These data suggest that nursing students’ expectations regarding pain over‐ and under‐reporting were sensitive to perceptions of addiction risk, but involved additional factors (eg, level of PR).
Respiratory Watch: Development of a Provincial System for Respiratory Syncytial Virus Surveillance in Nova Scotia, 2005–2008
Authors: Al-Assam Assaad , Langley Joanne M , Sarwal Shelly
Published: March 2016

OBJECTIVE: Respiratory syncytial virus (RSV) is the most common cause of severe lower respiratory tract infection in young children and is increasingly recognized as a cause of influenza‐like illness in those older than 65 years of age. A surveillance system to provide timely local information about RSV activity in Nova Scotia (NS) is described.

METHODS: A case report form was developed for weekly reporting of all laboratory isolates of RSV at diagnostic laboratories around the province. Laboratories were asked to send the forms by fax each Friday to the Nova Scotia Department of Health Promotion and Protection. Data were entered in Excel (Microsoft, USA) and aggregate results summarized by age, sex, health district and date of laboratory confirmation for 2005 to 2008.

RESULTS: During three winter seasons (2005–2006, 2006–2007 and 2007–2008), there were 207, 350 and 186 isolates of RSV reported in NS, respectively. The average incidences of RSV in NS varied greatly by age, with the highest rates in infants younger than 24 months of age, and approaching 4000 cases per 100,000 population in infants up to five months of age. The duration of the RSV outbreak was approximately five to six months each year, but the month of onset varied.

CONCLUSIONS: A RSV surveillance system was successfully established in NS that provides weekly data to the public health system, clinicians and infection control practitioners. The time of onset and severity of the RSV season varied over time. These data can be used to plan anti‐RSV passive prophylaxis programs and infection control education, and distinguish RSV outbreaks from other viruses in acute care and long‐term care settings.
Filing for Workers’ Compensation among Ontario Cases of Mesothelioma
Authors: Payne Jennifer Isabelle , Pichora Erin
Published: March 2016

BACKGROUND/OBJECTIVE: For many types of cancer, disease attribution to occupational exposures is difficult. Mesothelioma, however, is a ‘sentinel’ occupational cancer associated with asbestos exposure. The present study linked workers’ compensation claims data with cancer registry data to explore the completeness of reporting of mesothelioma to the Ontario Workplace Safety and Insurance Board (WSIB) according to characteristics of cases diagnosed among Ontario residents.

METHODS: Two data sources were linked at the person level: the WSIB Occupational Disease Information and Surveillance System and the Ontario Cancer Registry. Filing rates were calculated as the proportion of Ontario Cancer Registry mesothelioma cases (International Classification of Diseases – Oncology code 905) that linked to a WSIB‐filed cancer claim. Filing rates were calculated for the period 1980 to 2002, and trends were calculated by year, age and county of residence at diagnosis.

RESULTS: The filing rate for compensation has increased little over the past 20 years, reaching a high of 43% in 2000. Overall, filing rates were highest among pleural mesothelioma cases among men (range 27% to 57%). Filing rates were highest among individuals 50 to 59 years of age and declined substantially throughout the retirement years. There was substantial variation in filing rates by area of residence, with the highest rate being in Lambton County, Ontario.

CONCLUSION: The filing rate for compensation in Ontario was much lower than the estimated proportion of cases eligible for compensation. The increased filing rate in Lambton County was likely related to this community’s awareness of the association between asbestos and mesothelioma. Physicians can play an important role in educating patients of their potential entitlement to compensation benefits.
Dynamic Kine Magnetic Resonance Imaging in Whiplash Patients and in Age‐ and Sex‐Matched Controls
Authors: Lindgren Karl-August , Kettunen Jyrki A , Paatelma Markku , Mikkonen Raija HM
Published: March 2016

The multitude of symptoms following a whiplash injury has given rise to much discussion because of the lack of objective radiological findings. The ligaments that stabilize the upper cervical spine can be injured. Dynamic kine magnetic resonance imaging (dMRI) may reveal the pathological motion patterns caused by injury to these ligaments. To compare the findings and motion patterns in the upper cervical spine, 25 whiplash trauma patients with longstanding pain, limb symptoms and loss of balance indicating a problem at the level of C0–C2, as well as matched healthy controls were imaged using dMRI. Imaging was performed with an Intera 1.5 T (Philips Healthcare, USA) magnet. A physiotherapist performed the bending and rotation of the upper cervical spine for the subjects to ensure that the movements were limited to the C0–C2 level. An oblique coronal T2‐ and proton density‐weighted sequence and a balanced fast field echo axial sequence were used. The movements between C0–C2 and the signal from the alar ligaments were analyzed. Contact of the transverse ligament and the medulla in rotation was seen in two patients. The signal from the alar ligaments was abnormal in 92% of the patients and in 24% of the control subjects (P<0.0001). Abnormal movements at the level of C1–C2 were more common in patients than in controls (56% versus 20%, P=0.028). Whiplash patients with longstanding symptoms had both more abnormal signals from the alar ligaments and more abnormal movements on dMRI at the C0–C2 level than controls.
Predicting the Need for Supplemental Oxygen During Airline Flight in Patients with Chronic Pulmonary Disease: A Comparison of Predictive Equations and Altitude Simulation
Authors: Bradi Ana C , Faughnan Marie E , Stanbrook Matthew B , Deschenes-Leek Eva , Chapman Kenneth R
Published: March 2016

BACKGROUND: Patients with chronic pulmonary diseases are at increased risk of hypoxemia when travelling by air. Screening guidelines, predictive equations based on ground level measurements and altitude simulation laboratory procedures have been recommended for determining risk but have not been rigorously evaluated and compared.

OBJECTIVES: To determine the adequacy of screening recommendations that identify patients at risk of hypoxemia at altitude, to evaluate the specificity and sensitivity of published predictive equations, and to analyze other possible predictors of the need for in‐flight oxygen.

METHODS: The charts of 27 consecutive eligible patients referred for hypoxia altitude simulation testing before flight were reviewed. Patients breathed a fraction of inspired oxygen of 0.15 for 20 min. This patient population was compared with the screening recommendations made by six official bodies and compared the partial pressure of arterial oxygen (PaO2) obtained during altitude simulation with the PaO2 predicted by 16 published predictive equations.

RESULTS: Of the 27 subjects, 25% to 33% who were predicted to maintain adequate oxygenation in flight by the British Thoracic Society, Aerospace Medical Association or American Thoracic Society guidelines became hypoxemic during altitude simulation. The 16 predictive equations were markedly inaccurate in predicting the PaO2 measured during altitude simulation; only one had a positive predictive value of greater than 30%. Regression analysis identified PaO2 at ground level (r=0.50; P=0.009), diffusion capacity (r=0.56; P=0.05) and per cent forced expiratory volume in 1 s (r=0.57; P=0.009) as having predictive value for hypoxia at altitude.

CONCLUSIONS: Current screening recommendations for determining which patients require formal assessment of oxygen during flight are inadequate. Predictive equations based on sea level variables provide poor estimates of PaO2 measured during altitude simulation.
Herpes Zoster and Postherpetic Neuralgia: Past, Present and Future
Authors: Bennett Gary J , Watson C Peter N
Published: March 2016

OBJECTIVES: The history behind the current understanding of the varicella‐zoster virus and its relationship to the pain conditions caused by shingles and postherpetic neuralgia are reviewed. The framework for the current conceptualization is Hope‐Simpson’s latency hypothesis. Data from recent work in virology, neuroanatomy and epidemiology are reviewed, as is work using varicella‐zoster virus‐infected animals. The recent data largely confirm Hope‐Simpson’s hypothesis and extend it significantly.
Anaerobic Brain Abscess following Chronic Suppurative Otitis Media in a Child from Uganda
Authors: Cox KA , Al-Rawahi G , Kollmann TR
Published: March 2016

Brain abscess, while rare, confers high mortality, especially in the developing world. The case of a Ugandan child with a polymicrobial brain abscess including infection with Tissierella praeacuta/Clostridium hastiforme requiring repeated drainage and eventual surgical excision is reported. The case demonstrates the importance of considering anaerobic organisms in the treatment of children with brain abscess from the developing world.
Antimicrobial Susceptibility of Invasive and Lower Respiratory Tract Isolates of Streptococcus pneumoniae, 1998 to 2007
Authors: Vanderkooi Otto G , McConnell Athena , Church Deirdre L , Kellner James D
Published: March 2016

Previous surveys of antimicrobial resistance in Streptococcus pneumoniae have found differences depending on source of isolate (eg, higher resistance in lower respiratory tract [LRT] versus invasive isolate) and age (higher resistance in children versus adults). Susceptibility profiles in the Calgary Health Region (approximately 1.25 million population) over a 10‐year period were studied. Prospective laboratory‐based population surveillance for S pneumoniae disease has been conducted since 1998. Patient demographics and susceptibility testing were analyzed. In total, 2382 patient isolates were available for analysis from 1998 to 2007. Of these, 1170 isolates were invasive while 496 were LRT. Patient age distribution was: younger than five years, 14%; five to 17 years, 6%; 18 to 64 years, 56%; and 65 years or older, 24%. Mean patient age was 44.8 years and 60.0% were male. The overall incidence of nonsusceptibility was: penicillin, 8.2%; amoxicillin, 0.3%; cefuroxime, 6.2%; ceftriaxone, 1.7%; erythromycin, 8.8%; trimethoprim‐sulfamethoxazole (TMP‐SMX), 25.6%; clindamycin, 2.3%; and levofloxacin, 0.2%. Overall resistance rates were stable, except for increasing erythromycin resistance from 5.4% (1998) to a high of 14.2% (2004) (P=0.007). Isolates that were nonsusceptible to penicillin or TMP‐SMX were more likely to be multidrug resistant (P<0.001) compared with penicillin‐ or TMP‐SMX‐susceptible isolates. Compared with invasive isolates, LRT isolates showed more resistance to penicillin, TMP‐SMX, cefuroxime and erythromycin, and were more likely to be multidrug resistant. Isolates from children younger than five years of age are more likely to be multidrug resistant and resistant to erythromycin and cefotaxime. Ongoing surveillance of S pneumoniae isolates is important because resistance rates vary by source and patient age among health care regions.
A Near‐Fatal Infection with Oseltamivir‐Resistant Seasonal Influenza A in a Previously Healthy Child: Case Report
Authors: Papenburg Jesse , Karatzios Christos , Li Yan , Bastien Nathalie , Semret Makeda , Moore Dorothy
Published: March 2016

A case of near‐fatal oseltamivir‐resistant seasonal influenza A infection in a previously healthy four‐year‐old boy is reported. This case highlights three important points for physicians: oseltamivir‐resistant influenza A (H1N1) has recently emerged in North America; contrary to previously held beliefs, such strains are capable of causing severe disease in healthy children; and given this change in epidemiology, clinicians caring for children with severe seasonal influenza A infection should consider empiric dual therapy with oseltamivir and amantadine.
Montelukast as an Alternative to Low‐Dose Inhaled Corticosteroids in the Management of Mild Asthma (The SIMPLE Trial): An Open‐Label Effectiveness Trial
Authors: McIvor R Andrew , Kaplan Alan , Koch Caroline , Sampalis John S
Published: March 2016

OBJECTIVE: To evaluate the effectiveness of montelukast as monotherapy for patients with mild asthma who remain uncontrolled or unsatisfied while on inhaled corticosteroid (ICS) monotherapy.

DESIGN: A multicentre, open‐label study. Patients (six years of age or older) had ICS therapy discontinued and were treated with orally administered montelukast once daily for six weeks.

MAIN OUTCOME MEASURES: The primary outcome measure was the rate at which asthma symptom control was achieved or maintained after six weeks of treatment. The secondary outcome measures were to compare compliance and physician satisfaction, and to further assess the safety and tolerability of montelukast.

RESULTS: Of the 534 patients enrolled, 481 (90.1%) completed the study. Mean (± SD) age was 27.8±19.0 years. The number of patients with uncontrolled symptoms decreased from 455 (85.2%) at baseline to 143 (26.8%) at week 6 (P<0.001), and mean Asthma Control Questionnaire score decreased from 1.4±0.8 to 0.6±0.6 (P<0.001), representing a clinically significant improvement. Of the 79 patients with controlled asthma symptoms at baseline, 73.4% maintained asthma control at week 6. Compliance to asthma therapy increased from 41% at baseline for ICS to 88% at week 6 for montelukast (P<0.001). Physician satisfaction with treatment increased from 43% to 85% (P<0.001) and patient satisfaction increased from 45% at baseline to 94% at week 6. No serious adverse events were reported over the course of the study.

CONCLUSION: Montelukast is an effective and well‐tolerated alternative to ICS treatment in patients with mild asthma who are uncontrolled or unsatisfied with low‐dose ICS therapy.
Retreatment with Pegylated Interferon Alpha-2a and Ribavirin in Patients with Chronic Hepatitis C Who Have Relapsed or Not Responded to a First Course of Pegylated Interferon-Based Therapy
Authors: Yoshida Eric M , Sherman Morris , Bain Vincent G , Cooper Curtis L , Deschênes Marc , Marotta Paul J , Lee Samuel S , Krajden Mel , Witt-Sullivan Helga , Bailey Robert J , Usaty Christopher , Peltekian Kevork , the Canadian Pegasys Study Group
Published: March 2016

BACKGROUND: Pegylated interferon (pegIFN) and ribavirin combination therapy remains the first-line treatment for chronic hepatitis C virus (HCV) infection. In contrast to the wealth of studies in treatment-naive patients, the effectiveness of retreatment in patients who have previously failed pegIFN-based therapy is largely unreported.

AIM: To assess the effectiveness of the retreatment of patients who have previously failed an initial course of pegIFN-based therapy with pegIFNα-2a and ribavirin.

METHODS: A post-hoc analysis of a multicentre open-label study was performed. Patients received pegIFNα-2a and ribavirin at a dose of 800 mg/day and later 1000 mg/day to 1200 mg/day for 24 to 48 weeks at the discretion of the investigator. Outcomes at week 12 (early virological response [EVR]) and week 24 (sustained virological response [SVR]) were analyzed.

RESULTS: Eighty-seven patients who had relapsed after previous pegIFN-based therapy (n=28; 78% genotype 1) or were nonresponders (n=59; 71% genotype 1) were analyzed. Of the relapsers, 86% achieved an EVR and 68% achieved an SVR. In relapsers to pegIFN monotherapy (n=15) or pegIFN plus ribavirin (n=13), 60% and 77% achieved an SVR, respectively. Fibrosis and genotype did not affect the likelihood of SVR in relapsers although this may be the result of the relatively small number of patients. In previous nonresponders, an EVR was achieved in 53% but an SVR occurred in only 17%. In nonresponders to pegIFN monotherapy (n=9) and pegIFN plus ribavirin (n=50), 33% and 14% achieved an SVR, respectively. Genotype did not affect SVR in nonresponders. Only 10% with a METAVIR score of F3 or F4 on liver biopsy achieved an SVR.

CONCLUSIONS: Relapse after previous pegIFN-based therapy is associated with a strong probability of treatment success whereas retreatment of those with previous nonresponse does not.
Routine Immunization of Adults in Canada: Review of the Epidemiology of Vaccine‐Preventable Diseases and Current Recommendations for Primary Prevention
Authors: Parkins Michael D , McNeil Shelly A , Laupland Kevin B
Published: March 2016

Vaccination is one of the greatest achievements in public health of the 20th century. However, the success of vaccine uptake and adherence to immunization guidelines seen in pediatric populations has not been observed among adult Canadians. As a result of the disparity in susceptibility to vaccine‐preventable disease, there has been an increasing shift of vaccine‐preventable childhood diseases into adult populations. Accordingly, morbidity and mortality due to vaccine‐preventable illnesses now occur disproportionately in adults. All Canadians, irrespective of age, should have immunity to measles, mumps, rubella, tetanus, diphtheria, pertussis and varicella. All adult Canadians with significant medical comorbidities or those older than 65 years of age should receive the pneumococcal polysaccharide vaccine and yearly trivalent inactivate influenza vaccines. The present review summarizes the burden of illness of these vaccine‐preventable diseases in the Canadian adult population and reviews the current immunization recommendations. Vaccination of all Canadians to these common agents remains a vital tool to decrease individual morbidity and mortality and reduce the overall burden of preventable disease in Canada.
Predictors of Medication Adherence in Pediatric Inflammatory Bowel Disease Patients at the Stollery Children’s Hospital
Authors: Kitney L , Turner JM , Spady D , Malik B , El-Matary W , Persad R , Huynh HQ
Published: March 2016

BACKGROUND: Patients with inflammatory bowel disease (IBD) often do not take their medications as prescribed.

OBJECTIVE: To examine self-reported adherence rates in IBD patients at the Stollery Children’s Hospital (Edmonton, Alberta) and to determine predictors of medication adherence.

METHODS: A survey was mailed to 212 pediatric IBD patients of the Stollery Children’s Hospital. A chart review was completed for those who returned the survey.

RESULTS: A total of 119 patients completed the survey. The nonresponders were significantly older than responders (14.5 years versus 13.2 years; P=0.032). The overall adherence rate was 80%. Nonadherence was associated with older age (14.6 years versus 13.0 years; P=0.04), longer disease duration (5.0 years versus 3.1 years; P=0.004) and reported use of herbal medications (40.0% versus 13.6%; P=0.029). The most common reasons reported for missing medications were forgetfulness, feeling better and too many medications. In addition, patients reported being more likely to take anti-inflammatory medications and less likely to take herbal medicines.

CONCLUSION: Identified predictors of nonadherence such as age, disease duration and use of herbal treatments may enable the development of specific strategies to improve adherence in adolescents with IBD.
A Case of Disseminated Infection Caused by Streptococcus equi Subspecies zooepidemicus
Authors: Poulin Marie-France , Boivin Guy
Published: March 2016

Human infections with Streptococcus equi subspecies zooepidemicus, a group C streptococcus, are very rare and are generally associated with contact with horses, and consumption of unpasteurized milk products, goat cheese or pork. In most cases S zooepidemicus leads to fulminant infections. The case of a middle‐aged woman who had sporadic contact with horses is described in the present report. She developed a bacteremia with severe and extensive complications that included meningitis, mitral endocarditis and blindness due to bilateral endophthalmitis. To the authors’ knowledge, this is the first reported case of an endophthalmitis due to S zooepidemicus. Because of a penicillin allergy, the patient was treated with ceftriaxone and rifampin over six weeks and survived. The present case report highlights the severe complications associated with S zooepidemicus infection.
2009 Canadian Association of Gastroenterology Educational Needs Assessment Report
Authors: Rostom Alaa , Daniels Sandra
Published: March 2016

The annual survey of Canadian Association of Gastroenterology (CAG) members’ educational needs was conducted via an online survey during April 2009. A total of 261 individuals completed the survey. Similar to previous years, inflammatory bowel disease (IBD) topics – particularly Crohn’s disease and ulcerative colitis (UC) therapeutics, and difficult IBD cases – were most in demand for future educational events. Other highly rated areas were endoscopic techniques and therapeutics, celiac disease, approach to gastrointestinal (GI) infections and live endoscopy. The two most popular educational formats were ‘Lectures/presentations streamed to computer/podcasts’ and ‘A CAG educational portal to on-line presentations, self-assessments and maintenance of certification (MainCert) point tracking’.
Prevalence and Incidence of Hepatitis C Virus in Hemodialysis Patients in British Columbia: Follow‐up after a Possible Breach in Hemodialysis Machines
Authors: Tu Andrew W , Buxton Jane A , Whitlock Mandy , Djurdjev Ognjenka , Chong Mei , Krajden Mel , Beaulieu Monica , Levin Adeera
Published: March 2016

BACKGROUND: A possible breach of the transducer protector in specific dialysis machines was reported in June 2004 in British Columbia (BC), which led to testing of hemodialysis patients for hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV. This testing provided an opportunity to examine HCV incidence, prevalence and coinfection with HBV and HIV, and to compare anti‐HCV and HCV polymerase chain reaction (PCR).

METHODS: The results of hemodialysis patients who were dialyzed on the implicated machines (65% of BC dialysis patients), and tested for HCV, HBV and HIV, between June 1, 2004, and December 31, 2004, were reviewed and compared with available previous results.

RESULTS: Of 1286 hemodialysis patients with anti‐HCV and/or HCV‐PCR testing, 69 (5.4%) tested positive. Two HCV genotype 4 seroconversions were identified. HCV incidence rate on dialysis was 78.8 cases per 100,000 person‐years. Younger age, history of renal transplant and past HBV infection were associated with HCV infection. No occult infection was identified using HCV‐PCR.

INTERPRETATION: Hemodialysis patients had three times the HCV prevalence rate of the general BC population, and more than 20 times the incident rate of the general Canadian population. One of the two seroconversions occurred before the testing campaign; the patient was likely infected during hemodialysis in South Asia. The other was plausibly a late seroconversion following renal transplant in South Asia. Nosocomial transmission cannot be ruled out because both patients were dialyzed in the same centre. Baseline and annual anti‐HCV testing is recommended. HCV‐PCR should be considered at baseline for persons with HCV risk factors, and for returning travellers who received dialysis in HCV‐endemic countries to identify HCV infection occurring outside the hemodialysis unit.
Canadian Consensus Guidelines for the Optimal Use of Etravirine in the Treatment of HIV‐Infected Adults
Authors: Harris Marianne , Angel Jonathan B , Baril Jean-Guy , Rachlis Anita , Trottier Benoit
Published: March 2016

BACKGROUND AND OBJECTIVES: A group of five Canadian physicians with significant experience in HIV management was convened. Their goal was to develop guidance specifically for Canadian HIV‐treating physicians on the appropriate use of etravirine (TMC125, Intelence, Tibotec BVBA, Belgium) in adult HIV‐infected patients.

METHODS: Evidence from the published literature, conference presentations and expert opinions of the group members were used to develop the recommendations. Feedback on the draft recommendations was obtained from this core group, and from seven other physicians across Canada with clinical HIV treatment expertise and experience in the use of etravirine, as well as two Canadian scientists with HIV expertise. The final recommendations represent the core group’s consensus agreement, taking all feedback into consideration.

RESULTS AND CONCLUSIONS: The recommendations were developed to guide physicians in the optimal use of etravirine. The issues considered included HIV disease status, antiretroviral treatment history, drug resistance profiles, predictors of response to etravirine, background antiretroviral regimen and drug‐drug interactions.
Lack of Effect of Lactose Digestion Status on Baseline Fecal Microflora
Authors: Szilagyi Andrew , Shrier Ian , Chong George , Je Jung Sung , Park Sunghoon , Heilpern Debra , Lalonde Catherine , Cote Louis-Francois , Lee Byong
Published: March 2016

BACKGROUND: The genetics of intestinal lactase divide the world’s population into two phenotypes: the ability (a dominant trait) or inability (a recessive trait) to digest lactose. A prebiotic effect of lactose may impact the colonic flora of these phenotypes differently.

OBJECTIVE: To detect and evaluate the effects of lactose on subjects divided according to their ability to digest lactose.

METHODS: A total of 57 healthy maldigesters (n=30) and digesters (n=27) completed diet questionnaires, genetic and breath hydrogen testing, and quantitative stool analysis for species of bacteria. Log10transformation of bacterial counts was compared with lactose intake in both groups using multiple regression analysis.

RESULTS: There was a significant relationship between genetic and breath hydrogen tests. Daily lactose intake was marginally lower in lactose maldigesters (median [interquartile range] 12.2 g [31 g] versus 15 g [29.6 g], respectively). There was no relationship between lactose intake and breath hydrogen tests in either group. There were no differences in bacterial counts between the two groups, nor was there a relationship between bacterial counts and lactose intake in either group.

CONCLUSION: The differential bacterial effects of lactose were not quantitatively detected in stool samples taken in the present study.
Positive Urine Cultures: A Major Cause of Inappropriate Antimicrobial Use in Hospitals?
Authors: Silver Samuel A , Baillie Laura , Simor Andrew E
Published: March 2016

INTRODUCTION: Urine specimens are among the most common samples submitted for culture to microbiology laboratories. The objectives of the present study were to describe the indications for obtaining urine cultures in a cohort of hospitalized patients, and to determine the appropriateness of antimicrobial therapy in response to urine culture results.

METHODS: The study was performed at a teaching hospital with an adjoining long‐term care facility from June 1 to July 31, 2006. The medical records of nonpregnant adult patients with and without bacteriuria were reviewed. A symptomatic urinary tract infection was defined as the presence of bacteriuria in a patient with fever or urinary symptoms; asymptomatic bacteriuria was defined as bacteriuria without urinary symptoms and no infection evident at another site.

RESULTS: Medical records of 335 eligible patients (64% male; mean age 68 years) were reviewed, including all 137 with bacteriuria, and 198 with negative urine cultures. In total, 51% of the urine specimens were obtained from an indwelling urinary catheter, and 28% were voided urine samples. Confusion (57%) and fever (36%) were the most common indications noted for obtaining the urine cultures. Only 34 patients (25% of those with positive urine cultures) met the criteria for a symptomatic urinary tract infection; 67 (49%) had asymptomatic bacteriuria and 36 (26%) had infection at a nonurinary site. Of those with asymptomatic bacteriuria, 64% received antimicrobial therapy for a total of 347 days. Confused patients with asymptomatic bacteriuria were more likely to be treated than were bacteriuric patients without altered mental status (OR 1.8, 95% CI 1.2 to 4.1; P=0.03).

CONCLUSIONS: Urine cultures are frequently obtained from hospitalizedpatients,evenintheabsenceofurinarysymptoms.Asymptomatic bacteriuria is often treated in these patients, and accounts for a substantial burden of inappropriate antimicrobial use in hospitals. Effective strategies to improve urine culture ordering and antimicrobial utilization in hospitals need to be implemented.
Do Patients Undergo Prostate Examination while Having a Colonoscopy?
Authors: Hammett Tess , Hookey Lawrence C , Kawakami Jun
Published: March 2016

OBJECTIVES: To determine the rate at which physicians report performing a digital rectal examination and comment on the prostate gland before performing colonoscopy in men 50 to 70 years of age.

METHODS: A retrospective chart review of all men 50 to 70 years of age who had a colonoscopy in Kingston, Ontario, in 2005 was completed. It was noted whether each physician described performing a digital rectal examination before the colonoscopy, and if so, whether he or she commented on the prostate.

RESULTS: In 2005, 846 eligible colonoscopies were performed by 17 physicians in Kingston, Ontario. In 29.2% of cases, the physician made no comment about having performed a digital rectal examination; in 55.8% of cases, the physician commented on having completed a digital rectal examination but said nothing about the prostate; and in 15.0% of cases, the physician made a comment regarding the prostate. No physician consistently commented on the prostate for all patients, and in no circumstances was direct referral to another physician or follow-up suggested.

DISCUSSION: A colonoscopy presents an ideal opportunity for physicians to use a digital rectal examination to assess for prostate cancer. Physicians performing colonoscopies in men 50 to 70 years of age should pay special attention to the prostate while performing a digital rectal examination before colonoscopy. This novel concept may help maximize resources for cancer screening and could potentially increase the detection rate of clinically palpable prostate cancer.
Use of Lidocaine Patches for Neuropathic Pain in a Comprehensive Cancer Centre
Authors: Fleming Julia Ann , O’Connor Bradley David
Published: March 2016

BACKGROUND: There are few reports of the use of the lidocaine 5% patch (L5%P) for neuropathic pain (NP) in the cancer patient. Within a comprehensive cancer centre, L5%P has been prescribed by the Pain and Palliative Care Service (Peter McCallum Cancer Centre, East Melbourne, Victoria, Australia) for selected patients with NP since 2001.

OBJECTIVE: To retrospectively audit the use of L5%P within a comprehensive cancer centre.

METHODS: All L5%P prescriptions up to January 2009 were listed and patient medical records were searched to determine neuropathic pain syndromes treated, the presence of allodynia, previous analgesic medications, treatment duration and outcome.

RESULTS: L5%P was prescribed for 97 patients, most frequently for persistent postsurgical NP (n=26), postherpetic neuralgia (n=24) and cancer‐related NP (n=18). Six patients had no history of cancer and two patients never applied L5%P. Reviewers classed L5%P analgesic efficacy as ‘potent’ in 38% of patients with postherpetic neuralgia, 35% of patients with postsurgical pain, 27% of patients with NP after other treatments for cancer and 12% of patients with NP attributed to cancer alone. Allodynia featured in at least 60% of patients. Where allodynia was present, the efficacy of L5%P was assessed as ‘potent’ in 38% and ‘partial’ in 24%, but ‘ineffective’ in 26%, and ‘causing worse pain’ in 3.4% of patients. Treatment duration extended longer than one month in 52 patients, longer than two months in 29 patients and longer than one year in 13 patients. Therapy was ceased due to skin irritation in seven patients. The outcomes in relation to other reports are discussed.

CONCLUSION: The present data support trials of L5%P for cancer patients with NP syndromes associated with allodynia.
A Single‐Centre 10‐Year Experience with Candida Bloodstream Infections
Authors: Labbé Annie-Claude , Pépin Jacques , Patiño Carlos , Castonguay Stéphanie , Restieri Christiane , Laverdiere Michel
Published: March 2016

OBJECTIVE: To describe the clinical and microbiological features associated with Candida bloodstream infections observed at Hôpital Maisonneuve‐Rosemont (Montreal, Quebec) between August 1996 and July 2006.

METHODS: Episodes were retrieved from the microbiology laboratory. Different patient episodes and different isolate episodes in the same patient were selected. Antifungal susceptibility was determined by the Clinical and Laboratory Standards Institute’s (USA) M27A2 method.

RESULTS: A total of 190 different episodes of candidemia in 185 patients were identified. Eleven (6%) episodes occurred in outpatients. Candida albicans was identified in the majority of episodes (57%). Its frequency remained stable over the years. The proportion of Candida krusei candidemia episodes increased between 2003 and 2006, but this was not statistically significant. A central venous indwelling catheter or a peripherally inserted central catheter line was present in the majority of patients (167 [88%]). Of the indwelling catheters removed at the time of diagnosis, 39% were positive for Candida species on culture. Overall, voriconazole was the most active agent (the minimum inhibitory concentration required to inhibit the growth of 90% of organisms was 0.5 mg/L). Resistance to fluconazole was observed in 26 (14%) isolates (C albicans, 4%; versus non‐albicans Candida species, 27%; P<0.001). Being on the hematology‐oncology unit at the time of diagnosis (adjusted OR 7.8; 95% CI 2.3 to 27.1; P=0.001) and having received fluconazole or itraconazole within the past three months (adjusted OR 8.3; 95% CI 2.8 to 24.4; P<0.001) were significantly associated with resistance to fluconazole in multivariate analysis.

CONCLUSIONS: At Hôpital Maisonneuve‐Rosemont, the frequency and species distribution of blood isolates of Candida remained stable over the past decade. In vitro resistance of C albicans to fluconazole and itraconazole remained minimal; resistance of non‐albicans Candida species to fluconazole did not increase significantly. The new antifungal agents all had high in vitro activity against the bloodstream Candida isolates.
Adrenaline Injection Plus Argon Plasma Coagulation versus Adrenaline Injection Plus Hemoclips for Treating High-Risk Bleeding Peptic Ulcers: A Prospective, Randomized Trial
Authors: Taghavi Seyed Alireza , Soleimani Seyed Mohammad , Hosseini-Asl Seyed Mohammad Kazem , Eshraghian Ahad , Eghbali Hajar , Dehghani Seyed Mohsen , Ahmadpour Bita , Saberifiroozi Mehdi
Published: March 2016

BACKGROUND/OBJECTIVE: Several combination endoscopic therapies are currently in use. The present study aimed to compare argon plasma coagulation (APC) + adrenaline injection (AI) with hemoclips + AI for the treatment of high-risk bleeding peptic ulcers.

METHODS: In a prospective randomized trial, 172 patients with major stigmata of peptic ulcer bleeding were randomly assigned to receive APC + AI (n=89) or hemoclips + AI (n=83). In the event of rebleeding, the initial modality was used again. Patients in whom treatment or retreatment was unsuccessful underwent emergency surgery. The primary end point of rebleeding rate and secondary end points of initial and definitive hemostasis need for surgery and mortality were compared between the two groups.

RESULTS: The two groups were similar in all background variables. Definitive hemostasis was achieved in 85 of 89 (95.5%) of the APC + AI and 82 of 83 (98.8%) of the hemoclips + AI group (P=0.206). The mean volume of adrenaline injected in the two groups was equal (20.7 mL; P=0.996). There was no significant difference in terms of initial hemostasis (96.6% versus 98.8%; P=0.337), rate of rebleeding (11.2% versus 4.8%; P=0.124), need for surgery (4.5% versus 1.2%; P=0.266) and mortality (2.2% versus 1.2%; P=0.526). When compared for the combined end point of mortality plus rebleeding and the need for surgery, there was an advantage for the hemoclip group (6% versus 15.7%, P=0.042).

CONCLUSION: Hemoclips + AI has no superiority over APC + AI in treating patients with high-risk bleeding peptic ulcers. Hemoclips + AI may be superior when a combination of all negative outcomes is considered.
Computed Tomographic Scan Evaluation of Pulmonary Blastomycosis
Authors: Ronald Suzanne , Strzelczyk Jacek , Moore Sean , Trepman Elly , Cheang Mary , Limerick Bill , Wiebe Lyle , Sarsfield Pete , MacDonald Kerry , Meyers Michael , Embil John M
Published: March 2016

BACKGROUND: Blastomycosis is an uncommon granulomatous pulmonary and extrapulmonary infectious disease caused by the thermally dimorphic fungus Blastomyces dermatitidis. Diagnosis may be delayed or difficult because of varied presentation. The characteristics of blastomycosis on computed tomographic (CT) scan of the chest are not well characterized.

METHODS: The images from 34 chest CT scans from patients with confirmed pulmonary blastomycosis were retrospectively reviewed.

RESULTS: The most common CT findings were air bronchograms in 22 patients (65%), consolidation in 21 patients (62%), nodules (smaller than 3 cm) in 21 patients (62%) and lymph node enlargement (mediastinal and hilar nodes combined) in 12 patients (35%). Only four patients (12%) had a miliary pattern.

CONCLUSIONS: A specific abnormality characteristic of pulmonary blastomycosis was not identified on CT scanning. The diagnosis can only be made in the context of a high index of clinical suspicion with histological or culture confirmation.
Gastrostomy Tube Placement by Radiological versus Endoscopic Methods in an Acute Care Setting: A Retrospective Review of Frequency, Indications, Complications and Outcomes
Authors: Galaski Amy , Peng Wei Wei , Ellis Michelle , Darling Pauline , Common Andrew , Tucker Emma
Published: March 2016

OBJECTIVES: To describe the current practice of placing gastrostomy tubes (endoscopic and radiological), patient characteristics, indications for enteral support, complications and outcomes over a 13-month period, and explore factors that influenced complications and outcomes. Second, to provide Canadian data regarding feeding tube placement because no current literature reflecting these practices for Canadian hospitals is available.

METHODS: Retrospective chart reviews were conducted. Patients who had initial percutaneous endoscopic gastrostomy (PEG) or percutaneous radiological gastrostomy (PRG) tubes inserted for nutritional purposes were included in the study.

RESULTS: A total of 136 charts which included 30 PEG and 44 PRG procedures were reviewed. The PRG group was older than the PEG group (mean [± SD] age 68±19 years versus 55±21 years, respectively; P=0.008). Patients in PEG group had longer lengths of hospital stay and more intensive care unit admissions than the PRG group (P=0.029). The main reason for tube insertion was dysphagia/aspiration (PEG [60%] and PRG [77%]). Minor complications were comparable between the two groups (P=0.678). There were three cases of major complications overall. More subjects in the PRG group died (18%) while in hospital than in the PEG group (3%) (P=0.055). No procedure-related deaths occured in either group.

CONCLUSIONS: Both methods of tube insertion provided a safe route for nutrition delivery despite a significant cost differential with PEGs costing 44% more than PRGs. Characteristics such as age, presence of ascites and severity of disease influenced the method of insertion despite the lack of current guidelines. Overall, the present study provides new descriptive data in a Canadian context.
Occult Dysplasia in a Localized Giant Pseudopolyp in Crohn’s Colitis: A Case Report
Authors: Wyse Jonathan , Lamoureux Esther , Gordon Philip H , Bitton Alain
Published: March 2016

Localized giant pseudopolyposis of the colon (pseudopolyp larger than 1.5 cm in size) is a rare complication of inflammatory bowel disease. There is one report of an occult carcinoma within such a lesion, and no reports of sole dysplasia. A case of a 42-year-old man with longstanding Crohn’s colitis who underwent a colonoscopy revealing a large, multilobulated mass at the splenic flexure that was not amenable to endoscopic removal, is described. Multiple biopsies showed no dysplasia and histology was consistent with an inflammatory pseudopolyp. Computed tomographic colonography demonstrated a mass resembling a large villous tumour. A decision for surgery was made. The surgical specimen was a complex anastomosing inflammatory pseudopolyp 5 cm × 4 cm × 3 cm in size, with a focus of low-grade dysplasia in an area free of inflammation.

The present case is the first reported occult dysplasia in a giant pseudopolyp. Occult dysplasia without superficial dysplasia may exist in these lesions and further studies are needed to examine risk factors that make a giant pseudopolyp more likely to harbour dysplasia and/or carcinoma.
Predictors of Malignancy and Recommended Follow-Up for Patients with Negative Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Suspected Pancreatic Lesions
Authors: Spier Bret J , Johnson Eric A , Gopal Deepak V , Frick Terrence , Einstein Michael M , Byrne Siobhan , Koscik Rebecca L , Liou Jinn-Ing , Broxmeyer Terri , Selvaggi Suzanne M , Pfau Patrick R
Published: March 2016

BACKGROUND: Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) can characterize and diagnose pancreatic lesions as malignant, but cannot definitively rule out the presence of malignancy. Outcome data regarding the length of follow-up in patients with negative or nondiagnostic EUS-FNA of pancreatic lesions are not well-established.

OBJECTIVE: To determine the long-term outcome and provide follow-up guidance for patients with negative EUS-FNA diagnosis of suspected pancreatic lesions based on imaging predictors.

METHODS: A retrospective review of patients undergoing EUS-FNA for suspected pancreatic lesions, but with negative or nondiagnostic FNA results was conducted at a tertiary care referral medical centre. Patient demographics, EUS imaging characteristics and follow-up data were examined.

RESULTS: Seventeen of 55 patients (30.9%) with negative/nondiagnostic FNA were subsequently diagnosed with pancreatic malignancy. The risk of cancer was significantly higher for patients who had associated lymph nodes on EUS (P<0.001) and vascular involvement on EUS (P=0.001). The mean time to diagnosis in the group with false-negative EUS-FNA diagnosis was 66 days. The true-negative EUS-FNA patients were followed for a mean of 403 days after negative EUS-FNA results without the development of malignancy.

CONCLUSION: For patients undergoing EUS-FNA for a suspected pancreatic lesion, a negative or nondiagnostic FNA does not provide conclusive evidence for the absence of cancer. Patients for whom vascular invasion and lymphadenopathy are detected on EUS are more likely to have a true malignant lesion and should be followed closely. When a patient has been monitored for six months or more with no cancer being diagnosed, there appears to be much less chance that a pancreatic malignancy is present.
Huge Pulmonary Artery Aneurysm
Authors: Hammad Aiman M , Al-Qahtani Sultan M , Al-Zahrani Mohammed A
Published: March 2016

Pulmonary artery aneurysms (PAAs) are uncommon entities. PAAs are caused mostly by trauma (often iatrogenic), infections and Behcet’s disease (BD). Less common causes are pulmonary hypertension, congenital heart disease and neoplasm. BD is a multisystem disorder presenting with recurrent oral and genital ulcerations, as well as ocular involvement, and PAA is one of its rare complications. A case of huge PAA, in which the usual criteria for the clinical diagnosis of BD were present, is described. Transcatheter embolization resulted in clinical improvement.
Factors Associated with Chronic Noncancer Pain in the Canadian Population
Authors: Rashiq Saifudin , Dick Bruce D
Published: March 2016

Chronic noncancer pain (CNCP) is a prevalent health problem with pervasive negative effects on the individual’s quality of life. Previous epidemiological studies of CNCP have suggested a number of individual biological, psychological and societal correlates of CNCP, but it has rarely been possible to simultaneously compare the relative strengths of many such correlates in a Canadian population sample. With data provided by the 1996/1997 Canadian National Population Health Survey, ordinal logistic regression was used to examine the extent to which a number of population variables are associated with CNCP in a large (n=69,365) dataset. The analysis revealed cross‐sectional correlations of varying strengths between CNCP and 27 factors. Increasing age, low income, low educational achievement, daily cigarette smoking, physical inactivity and abstention from alcohol were among the factors found to increase CNCP risk. The considerable impact of distress and depression on CNCP are also highlighted. A number of comorbid medical illnesses increased CNCP risk, including some (such as chronic obstructive pulmonary disease, epilepsy and thyroid disease) that have not hitherto been associated with pain. White race and the affirmation of an important role for spirituality or faith reduced CNCP risk. In contrast to some previous studies, female sex did not emerge as an independent CNCP risk. The present exploratory analysis describes associations between CNCP and a number of characteristics from several domains, thus suggesting many areas for further research.