bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel Diagnostic and Therapeutic Techniques for Surveillance of Dysplasia in Patients with Inflammatory Bowel Disease
Authors: Iacucci M , Uraoka T , Gasia M Fort , Yahagi N
Published: March 2016

The risk for developing dysplasia and colorectal cancer in patients with longstanding inflammatory bowel disease (IBD) involving the colon is well documented. Random biopsies during white-light, standard-definition colonoscopy (33 to 50 biopsies) with or without dye spraying chromoendoscopy has been the recommended strategy in North America to detect dysplastic lesions in IBD. However, there are several limitations to this approach including poor physician adherence, poor sensitivity, increased procedure time and considerable cost. The new generation of high-definition endoscopes with electronic filter technology provide an opportunity to visualize colonic mucosal and vascular patterns in minute detail, and to identify subtle flat, multifocal, polypoid and pseudopolypoid neoplastic and non-neoplastic lesions. The application of these new technologies in IBD is slowly being adopted in clinical practice. In addition, the advent of confocal laser endomicroscopy provides an opportunity to explore real-time histology, thus redefining the understanding and characterization of the lesions in IBD. There is emerging evidence that serrated adenomas are also associated with longstanding IBD colitis and may be recognized as another important contributing factor to colorectal cancer development. The circumscribed neoplastic lesions can be treated using endoscopic therapeutic management such as mucosal resection or, especially, endoscopic submucosal dissection. This may replace panproctocolectomy in selected patients. The authors review the potential of these techniques to transform endoscopic diagnosis and therapeutic management of dysplasia in IBD.
Adult Attachment and Approaches to Activity Engagement in Chronic Pain
Authors: Andrews Nicole E , Meredith Pamela J , Strong Jenny , Donohue Genevieve F
Published: March 2016

BACKGROUND: The way in which individuals with chronic pain habitually approach activity engagement has been shown to impact daily functioning, with both avoidance of one’s daily activities and overactivity (activity engagement that significantly exacerbates pain) associated with more pain, higher levels of physical disability and poorer psychological functioning.

OBJECTIVE: To provide insight into the development of maladaptive habitual approaches to activity engagement in chronic pain by applying an attachment theory framework.

METHODS: A sample of 164 adults with chronic pain completed selfreport measures of attachment, approach to activity and pain cognitions. Mediation analyses were undertaken to examine the direct association between attachment variables and maladaptive approaches to activity, and to test for the mediating role of pain cognitions (catastrophizing and thought suppression).

RESULTS: Results demonstrated that higher levels of secure attachment were associated with lower levels of activity avoidance, which was fully mediated by lower levels of pain catastrophizing; higher levels of preoccupied or fearful attachment were directly associated with higher levels overactivity; higher levels of preoccupied attachment were associated with higher levels of activity avoidance, which was partially mediated by higher levels of pain catastrophizing; and higher levels of fearful attachment were indirectly associated with higher levels of activity avoidance through higher levels of catastrophizing.

CONCLUSIONS: These results provide preliminary support for the suggestion that insecure attachment may be a source of vulnerability to the development of disabling activity patterns in chronic pain.
Actinomyces graevenitzii Pulmonary Abscess Mimicking Tuberculosis in a Healthy Young Man
Authors: Gliga Smaranda , Devaux Mathilde , Woimant Marine Gosset , Mompoint Dominique , Perronne Christian , Davido Benjamin
Published: March 2016

Pulmonary actinomycosis is a rare disease that is often misdiag‐nosed as tuberculosis or lung cancer. Actinomyces graevenitzii is a relatively new recognized Actinomyces species isolated from various clinical samples. The authors report a case of pulmonary actinomycosis caused by A graevenitzii. A computed tomography examination revealed an excavated consolidation in the middle right lobe of a previously healthy young man who presented with a long history of moderate cough. Cultures of the bronchoalveolar lavage fluid confirmed the diagnosis of pulmonary abscess caused by A gravenitzii. At the three‐month follow‐up consultation and, after six weeks of high‐dose amoxicillin, the pulmonary lesion had completely disappeared.
The Role of Infant Pain Behaviour in Predicting Parent Pain Ratings
Authors: Riddell Rebecca Pillai , Flora David B , Stevens Sara , Greenberg Saul , Garfield Hartley
Published: March 2016

BACKGROUND: Research investigating how observers empathize or form estimations of an individual experiencing pain suggests that both characteristics of the observer (‘top down’) and characteristics of the individual in pain (‘bottom up’) are influential. However, experts have opined that infant behaviour should serve as a crucial determinant of infant pain judgment due to their inability to self‐report.

OBJECTIVE: To predict parents’ immunization pain ratings using archival data. It was hypothesized that infant behaviour (‘bottom up’) and parental emotional availability (‘top down’) would directly predict the most variance in parent pain ratings.

METHODS: Healthy infants were naturalistically observed during their two‐, four‐, six‐ and/or 12‐month immunization appointments. Cross‐sectional latent growth curve models in a structural equation model context were conducted at each age (n=469 to n=579) to examine direct and indirect predictors of parental ratings of their infant’s pain.

RESULTS: At each age, each model suggested that moderate amounts of variance in parent pain report were accounted for by models that included infant pain behaviours (R2=0.18 to 0.36). Moreover, notable differences were found for older versus younger infants with regard to parental emotional availability, infant sex, caregiver age and amount of variance explained by infant variables.

CONCLUSIONS: The results of the present study suggest that parent pain ratings are not predominantly predicted by infant behaviours, especially before four months of age. Current results suggest that recognizing infant pain behaviours during painful events may be an important area of parent education, especially for parents of very young infants. Further work is needed to determine other factors that predict parent judgments of infant pain.
Community‐Associated Methicillin‐Resistant Staphylococcus aureus Necrotizing Pneumonia without Evidence of Antecedent Viral Upper Respiratory Infection
Authors: Toro Cristina Moran , Janvier Jack , Zhang Kunyan , Fonseca Kevin , Gregson Dan , Church Deirdre , Laupland Kevin , Rabin Harvey , Elsayed Sameer , Conly John
Published: March 2016

BACKGROUND: USA300 community‐associated (CA) methicillin‐resistant Staphylococcus aureus (MRSA) strains causing necrotizing pneumonia have been reported in association with antecedent viral upper respiratory tract infections (URI).

METHODS: A case series of necrotizing pneumonia presenting as a primary or coprimary infection, secondary to CA‐MRSA without evidence of antecedent viral URI, is presented. Cases were identified through the infectious diseases consultation service records. Clinical and radiographic data were collected by chart review and electronic records. MRSA strains were isolated from sputum, bronchoalveolar lavage, pleural fluid or blood cultures and confirmed using standard laboratory procedures. MRSA strains were characterized by susceptibility testing, pulsed‐field gel electrophoresis, spa typing, agr typing and multilocus sequence typing. Testing for respiratory viruses was performed by appropriate serological testing of banked sera, or nucleic acid testing of nasopharyngeal or bronchoalveloar lavage specimens.

RESULTS: Ten patients who presented or copresented with CA necrotizing pneumonia secondary to CA‐MRSA from April 2004 to October 2011 were identified. The median length of stay was 22.5 days. Mortality was 20.0%. Classical risk factors for CA‐MRSA were identified in seven of 10 (70.0%) cases. Chest tube placement occurred in seven of 10 patients with empyema. None of the patients had historical evidence of antecedent URI. In eight of 10 patients, serological or nucleic acid testing testing revealed no evidence of acute viral coinfection. Eight strains were CMRSA‐10 (USA300). The remaining two strains were a USA300 genetically related strain and a USA1100 strain.

CONCLUSION: Pneumonia secondary to CA‐MRSA can occur in the absence of an antecedent URI. Infections due to CA‐MRSA are associated with significant morbidity and mortality. Clinicians need to have an awareness of this clinical entity, particularly in patients who are in risk groups that predispose to exposure to this bacterium.
Pain Assessment Using The Adolescent Pediatric Pain Tool: A Systematic Review
Authors: Fernandes Ananda Maria , De Campos Catarina , Batalha Luis , Perdigão Ana , Jacob Eufemia
Published: March 2016

BACKGROUND: The Adolescent Pediatric Pain Tool (APPT) is a multidimensional pain assessment tool designed to assess pain location (body outline diagram), intensity (word graphic rating scale) and quality (list of pain descriptors) in hospitalized children eight to 17 years of age.

OBJECTIVES: To identify the age range, health conditions, settings and purpose for which APPT has been used; the components of the APPT that have been used; and the reported clinical and research utility of the APPT.

METHODS: A systematic review of published studies using the APPT was performed. Studies were identified through electronic searches in CINAHL, Medline, PubMed, SciELO and PsycInfo.

RESULTS: Twenty‐three studies were analyzed. APPT has been used in patients between two and 68 years of age, with various acute and chronic conditions, in and out of hospital. All but six studies used the three components of the APPT. Most of the studies used the total number of sites marked, mean pain intensity and mean number of pain descriptors selected as main outcome measures; however, scoring methods varied. Studies report that the use of the APPT is relevant for clinical practice and for research.

CONCLUSION: Obtaining self‐report of pain using the APPT may help clinicians to tailor pain management interventions. It may also be used in studies to provide a deeper understanding of the pain experience and to examine the effectiveness of pain management interventions. However, outcome measures and methods of scoring the different components of the APPT need to be clearly identified.
Reference Values for Maximal Inspiratory Pressure: A Systematic Review
Authors: Pessoa Isabela MB Sclauser , Parreira Verônica Franco , Fregonezi Guilherme AF , Sheel A William , Chung Frank , Reid W Darlene
Published: March 2016

BACKGROUND: Maximal inspiratory pressure (MIP) is the most commonly used measure to evaluate inspiratory muscle strength. Normative values for MIP vary significantly among studies, which may reflect differences in participant demographics and technique of MIP measurement.

OBJECTIVE: To perform a systematic review with meta‐analyses to synthesize MIP values that represent healthy adults.

METHODS: A systematic literature search was conducted using Medline, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health (CINAHL) and Sport Discus databases. Two reviewers identified and selected articles, and abstracted data. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. A random‐effects model was used to calculate overall means and 95% CIs.

RESULTS: Of 22 included articles, MIP data were synthesized according to age group and sex from six reports (n=840) in the meta‐analyses. The mean QUADAS score was 3.5 of 7. The age range was between 18 and 83 years (426 men, 414 women). MIP began to decrease with age in the 40 to 60 years age range and continued to fall progressively with age. For the same age group, men tended to have higher MIPs than women. Sensitivity analysis of withdrawing studies from the meta‐analysis identified one study that contributed more to heterogeneity in some age groups.

DISCUSSION: MIP was higher in men and decreased with age, which was initially apparent in middle age. Several characteristics of participants and MIP technique influence values in healthy individuals.

CONCLUSIONS: The present meta‐analysis provides normative MIP values that are reflective of a large sample (n=840) and likely represents the broadest representation of participant characteristics compared with previous reports of normative data.
Tracheal Epstein‐Barr Virus‐Associated Smooth Muscle Tumour in an Hiv‐Positive Patient
Authors: Dominelli Giulio S , Jen Rachel , Park Kirily , Shaipanich Tawimas
Published: March 2016

Epstein‐Barr virus‐related smooth muscle tumours (EBV‐SMTs) are a rare but well recognized non‐AIDS‐defining malignancy that can also be found in several other immunosuppressed states. Pulmonary involvement of EBVSMTs is not uncommon, but it can present with multifocal lesions in any anatomical site. The present article describes an HIV‐positive woman with dyspnea who was found to have a large tracheal EBV‐SMT. The authors discuss their approach to diagnosis and management, and present unique follow‐up bronchoscopic imaging.
Diagnosis and Management of Asthma in Preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society Position Paper
Authors: Ducharme Francine M , Dell Sharon D , Radhakrishnan Dhenuka , Grad Roland M , Watson Wade TA , Yang Connie L , Zelman Mitchell
Published: March 2016

Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers.

In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.
Transperineal Ultrasonography in Perianal Crohn Disease: A Valuable Imaging Modality
Authors: Wright Emily K , Novak Kerri L , Lu Cathy , Panaccione Remo , Ghosh Subrata , Wilson Stephanie R
Published: March 2016

Aims of treatment for Crohn disease have moved beyond the resolution of clinical symptoms to objective end points including endoscopic and radiological normality. Regular re-evaluation of disease status to safely, readily and reliably detect the presence of inflammation and complications is paramount. Improvements in sonographic technology over recent years have facilitated a growing enthusiasm among radiologists and gastroenterologists in the use of ultrasound for the assessment of inflammatory bowel disease. Transabdominal intestinal ultrasound is accurate, affordable and safe for the assessment of lumi-nal inflammation and complications in Crohn disease, and can be performed with or without the use of intravenous contrast enhancement. Perianal fistulizing disease is a common, complex and often treatment-refractory complication of Crohn disease, which requires regular radiological monitoring. Endoanal ultrasound is invasive, uncomfortable and yields limited assessment of the perineal region. Although magnetic resonance imaging of the pelvis is established, timely access may be a problem. Transperineal ultrasound has been described in small studies, and is an accurate, painless and cost-effective method for documenting perianal fluid collections, fistulas and sinus tracts. In the present article, the authors review the literature regarding perineal ultrasound for the assessment of perianal Crohn disease and use case examples to illustrate its clinical utility.
Psychological Distress and Stressful Life Events in Pediatric Complex Regional Pain Syndrome
Authors: Wager Julia , Brehmer Hannah , Hirschfeld Gerrit , Zernikow Boris
Published: March 2016

BACKGROUND: There is little knowledge regarding the association between psychological factors and complex regional pain syndrome (CRPS) in children. Specifically, it is not known which factors precipitate CRPS and which result from the ongoing painful disease.

OBJECTIVES: To examine symptoms of depression and anxiety as well as the experience of stressful life events in children with CRPS compared with children with chronic primary headaches and functional abdominal pain.

METHODS: A retrospective chart study examined children with CRPS (n=37) who received intensive inpatient pain treatment between 2004 and 2010. They were compared with two control groups (chronic primary headaches and functional abdominal pain; each n=37), who also received intensive inpatient pain treatment. Control groups were matched with the CRPS group with regard to admission date, age and sex. Groups were compared on symptoms of depression and anxiety as well as stressful life events.

RESULTS: Children with CRPS reported lower anxiety and depression scores compared with children with abdominal pain. A higher number of stressful life events before and after the onset of the pain condition was observed for children with CRPS.

CONCLUSIONS: Children with CRPS are not particularly prone to symptoms of anxiety or depression. Importantly, children with CRPS experienced more stressful life events than children with chronic headaches or abdominal pain. Prospective long‐term studies are needed to further explore the potential role of stressful life events in the etiology of CRPS.
Serum Endocan as a Survival Predictor for Patients with Liver Cirrhosis
Authors: Toshikuni Nobuyuki , Ozaki Kazuaki , George Joseph , Tsutsumi Mikihiro
Published: March 2016

BACKGROUND: The relationship between endocan expression and outcome in patients with chronic liver disease is not fully understood.

OBJECTIVE: To examine whether serum endocan level is predictive of outcome in patients with liver cirrhosis.

METHODS: A total of 68 patients with liver cirrhosis were enrolled. Outcome predictors were analyzed using the Cox proportional hazards model. The overall survival rates were calculated using the Kaplan-Meier method, and differences were evaluated using the log-rank test.

RESULTS: During the median follow-up period (7.1 years), nine patients had hepatocellular carcinoma (HCC) and 10 patients died. Of the deceased patients, nine died due to hepatic decompensation or associated conditions. No significant factors were found to be predictive of the occurrence of HCC. In contrast, an elevated serum endocan level (≥2.0 ng/mL; HR 2.34 [95% CI 1.05 to 7.03]; P=0.037) and high Child-Pugh grade B/C (HR 2.65 [95% CI 1.30 to 6.89; P=0.006) were predictive of poor survival. Kaplan-Meier analysis revealed that the respective cumulative survival rates at five and 10 years were 97.1% and 87.4% in patients with serum endocan levels <2.0 ng/mL and 85.8% and 64.4% in patients with levels ≥2.0 ng/mL (P=0.009), respectively. Moreover, the cumulative survival rates were significantly different among the patient groups divided according to serum endocan level and Child-Pugh grade (P=0.002).

CONCLUSION: These findings suggest that serum endocan level may be a survival predictor for patients with liver cirrhosis.
Pain Management Strategies and Lessons from the Military: A Narrative Review
Authors: Vallerand April Hazard , Cosler Patricia , Henningfield Jack E. , Galassini Pam
Published: March 2016

BACKGROUND: Wounded soldiers often experience substantial pain, which must be addressed before returning to active duty or civilian life. The United States (US) military has instituted several guidelines and initiatives aimed at improving pain management by providing rapid access to medical care, and developing interdisciplinary multimodal pain management strategies based on outcomes observed both in combat and hospital settings.

OBJECTIVE: To provide a narrative review regarding US military pain management guidelines and initiatives, which may guide improvements in pain management, particularly chronic pain management and prevention, for the general population.

METHODS: A literature review of US military pain management guidelines and initiatives was conducted, with a particular focus on the potential of these guidelines to address shortcomings in chronic pain management in the general population.

DISCUSSION: The application of US military pain management guidelines has been shown to improve pain monitoring, education and relief. In addition, the US military has instituted the development of programs and guidelines to ensure proper use and discourage aberrant behaviours with regard to opioid use, because opioids are regarded as a critical part of acute and chronic pain management schemes. Inadequate pain management, particularly inadequate chronic pain management, remains a major problem for the general population in the US. Application of military strategies for pain management to the general US population may lead to more effective pain management and improved long‐term patient outcomes.
Clinical Practice Guidelines for the Medical Management of Nonhospitalized Ulcerative Colitis: The Patient Perspective
Authors: Steinhart A Hillary , Fernandes Aida
Published: March 2016

A series of clinical practice guidelines were recently developed by the Canadian Association of Gastroenterology (CAG) to provide clinicians with recommendations for the medical management of nonhospitalized ulcerative colitis (UC) patients. These guidelines were developed, reviewed and agreed on by expert clinicians and methodologists. Following the finalization of the guidelines, a group of patients with UC as well as several inflammatory bowel disease clinicians, were brought together for a half-day workshop to provide feedback from the patient perspective. At the workshop, the guideline development process was described and the guidelines were reviewed to ensure comprehension. Patients then had the opportunity to provide their insight to the relevance of the guideline development process and the content of the guidelines as it related to their personal experiences with UC. The patient group believed that, although the new guidelines will be a tremendous resource for the health care provider community, a more ‘lay-friendly’ version would better facilitate dialogue between patients and their health care practitioners. The importance of the patient/physician relationship is paramount when making decisions regarding treatment plans, in which patient preferences play a key role in determining the most appropriate therapy and dosing regimen, which, in turn, impact the likelihood of adherence to the treatment plan. It was also believed that quality of life issues were not fully addressed in the guidelines. Much could be learned from shared experiences and coping strategies that would empower patients to take charge of their health and become equal partners with their care providers.
Primary Pulmonary Synovial Sarcoma: A Case with Unique and Impressive Computed Tomography Findings
Authors: Kambo Jaspreet S , Richardson Bonnie , Ionescu Diana N , Tucker Tracy , Kraushaar Greg
Published: March 2016

Primary pulmonary synovial sarcoma (PPSS) is a rare malignancy. Its etiology, imaging features and optimal treatment are not well understood. Pulmonary pseudoaneurysms and lymphadenopathy are rare complications of synovial sarcomas. A 40‐year‐old woman with mild hemoptysis and thoracic back pain underwent a computed tomography scan that revealed multiple pulmonary lesions, paraesophageal lymphadenopathy and incidental bilateral pulmonary emboli. A diagnosis of PPSS was made through the identification of an SS18 translocation by fluorescence in situ hybridization. She was started on adriamycin, ifosfamide and mesna chemotherapy. Over the subsequent two months, she developed three pulmonary artery pseudoaneurysms, ultimately requiring endovascular coiling. Seven months after starting treatment, the patient was asymptomatic. The lesions and lymphadenopathy decreased in size. The present case highlights complications of a rare malignancy and demonstrates positive response to ifosfamide‐based chemotherapy in the setting of PPSS.
Pediatric Sand Aspiration Managed Using Bronchoscopy and Extracorporeal Membrane Oxygenation
Authors: Baqais Khaled , Mahoney Meagan , Tobler Kathleen , Hui Anita , Noseworthy Mary
Published: March 2016

Sand aspiration is a rare but potentially fatal occurrence to consider in near‐drownings, accidental burials or cave‐ins. Optimal management is not well defined.
Continuous Assessment of Labour Pain using Handgrip Force
Authors: Wickboldt Nadine , Savoldelli Georges , Rehberg-Klug Benno
Published: March 2016

BACKGROUND: Assessment of dynamic changes in painful experiences, such as labour, using conventional rating scales (eg, numerical rating scale [NRS]) has limitations. An alternative for continuous pain evaluation could be a signal generated by voluntary action of the parturient. Remifentanil administration for obstetric analgesia could be improved by these dynamic measures of labour pain. In the present study, handgrip force was measured by a dynamometer to signal labour pain.

OBJECTIVES: To evaluate: whether continuous monitoring of labour pain using handgrip force allows for determination of pain measurement during contractions; and the correlation between handgrip force and pain intensity on NRS.

METHODS: The present observational, single‐centre study included 43 parturients. After calibration of the dynamometer for individual hand muscle strength, pain was recorded during early and late labour using a dynamometer and an NRS. The primary end point was the correlation coefficient between NRS ratings and peak intensity recorded by the dynamometer.

RESULTS: All dynamometer‐registered readings were also registered by the external tocogram. All contractions recorded by external tocogram were also registered by the dynamometer. Handgrip force was moderately correlated with pain scores on the NRS. Mean handgrip force during contractions had the highest correlation coefficient (Pearson’s r=0.67) compared with peak handgrip force (r=0.56) and area under the curve of handgrip force (r=0.55).

CONCLUSIONS: Pain intensity and duration can be assessed continuously using handgrip force measured via a dynamometer. The feedback of intensity and duration of pain could optimize patient‐controlled remifentantil application for obstetric analgesia and other situations of highly variable pain intensity.
Comparison of Four Different Pain Relief Methods during Hysterosalpingography: A Randomized Controlled Study
Authors: Unlu Bekir Serdar , Yilmazer Mehmet , Koken Gulengul , Arioz Dagistan Tolga , Unlu Ebru , Baki Elif Dogan , Kurttay Cemile , Karacin Osman
Published: March 2016

BACKGROUND: Hysterosalpingography (HSG) is the most commonly used method for evaluating the anatomy and patency of the uterine cavity and fallopian tubes, and is an important tool in the evaluation of infertility. The most frequent side effect is the pain associated with the procedure.

OBJECTIVES: To evaluate four analgesic methods to determine the most useful method for reducing discomfort associated with HSG.

METHODS: In the present prospective study, 75 patients undergoing HSG for evaluation of infertility were randomly assigned to four groups: 550 mg of a nonsteroidal anti‐inflammatory drug (NSAID) (group 1); 550 mg NSAID + paracervical block (group 2); 550 mg NSAID + paracervical analgesic cream (group 3); or 550 mg NSAID + intrauterine analgesic instillation (group 4). A visual analogue scale was used to assess the pain perception at five predefined steps.

RESULTS: Instillation of the liquids used for HSG was found to be the most painful step of HSG, and this step was where the only significant difference among groups was observed. When comparing visual analogue scale scores, group 2 and group 3 reported significantly less pain than the other groups. Group 1 reported significantly higher mean ( ± SD) scores (7.2 ± 1.6) compared with groups 2 and 3 (4.7 ± 2.5 and 3.8 ± 2.4, respectively) (P<0.001). In addition, group 2 reported significantly less pain than group 4 (4.7 ± 2.5 versus 6.7 ± 1.8, respectively) (P<0.02).

CONCLUSIONS: For effective pain relief during HSG, in addition to 550 mg NSAID, local application of lidocaine cream to the posterior fornix of the cervix uteri and paracervical lidocaine injection into the cervix uteri appear to be the most effective methods.
Diagnostic Disparity of Previous and Revised American Thoracic Society Guidelines for Idiopathic Pulmonary Fibrosis
Authors: Fidler Lee , Shapera Shane , Mittoo Shikha , Marras Theodore K
Published: March 2016

BACKGROUND: A revised guideline for the diagnosis of idiopathic pulmonary fibrosis (IPF) was formulated by the American Thoracic Society (ATS) in 2011 to improve disease diagnosis and provide a simplified algorithm for clinicians. The impact of these revisions on patient classification, however, remain unclear.

OBJECTIVE: To examine the concordance between diagnostic guidelines to understand how revisions impact patient classification.

METHODS: A cohort of 54 patients with either suspected IPF or a working diagnosis of IPF was evaluated in a retrospective chart review, in which patient data were examined according to previous and revised ATS guidelines. Patient characteristics influencing the fulfillment of diagnostic criteria were compared using one‐way ANOVA and χ2 tests.

RESULTS: Revised and previous guideline criteria for IPF were met in 78% and 83% of patients, respectively. Revised guidelines modified a classification based on previous guidelines in 28% of cases. Fifteen percent of patients meeting previous ATS guidelines failed to meet revised criteria due to a lack of honeycombing on high‐resolution computed tomography and the absence of a surgical lung biopsy. Patients failing to meet previous and revised diagnostic criteria for IPF were younger.

CONCLUSION: The revised guidelines for the diagnosis of IPF classify a substantial proportion of patients differently than the previous guidelines.
Physician‐to‐Physician Telephone Consultations for Chronic Pain Patients: A Pragmatic Randomized Trial
Authors: Clark Alexander J , Taenzer Paul , Drummond Neil , Spanswick Christopher C , Montgomery Lori S , Findlay Ted , Pereira John X , Williamson Tyler , Palacios-Derflingher Luz , Braun Ted
Published: March 2016

BACKGROUND: The impact of telephone consultations between pain specialists and primary care physicians regarding the care of patients with chronic pain is unknown.

OBJECTIVES: To evaluate the impact of telephone consultations between pain specialists and primary care physicians regarding the care of patients with chronic pain.

METHODS: Patients referred to an interdisciplinary chronic pain service were randomly assigned to either receive usual care by the primary care physician, or to have their case discussed in a telephone consultation between a pain specialist and the referring primary care physician. Patients completed a numerical rating scale for pain, the Pain Disability Index and the Short Form‐36 on referral, as well as three and six months later. Primary care physicians completed a brief survey to assess their impressions of the telephone consultation.

RESULTS: Eighty patients were randomly assigned to either the usual care group or the standard telephone consultation group, and 67 completed the study protocol. Patients were comparable on baseline pain and demographic characteristics. No differences were found between the groups at six months after referral in regard to pain, disability or quality of life measures. Eighty percent of primary care physicians indicated that they learned new patient care strategies from the telephone consultation, and 97% reported that the consultation answered their questions and helped in the care of their patient.

DISCUSSION: Most primary care physicians reported that a telephone consultation with a pain specialist answered their questions, improved their patients’ care and resulted in new learning. Differences in patient status compared with a usual care control group were not detectable at six‐month follow‐up.

CONCLUSIONS: While telephone consultations are clearly an acceptable strategy for knowledge translation, additional strategies may be required to actually impact patient outcomes.
Gaps in the Hepatitis C Continuum of Care among Sex Workers in Vancouver, British Columbia: Implications for Voluntary Hepatitis C Virus Testing, Treatment and Care
Authors: Socías M Eugenia , Shannon Kate , Montaner Julio S , Guillemi Silvia , Dobrer Sabina , Nguyen Paul , Goldenberg Shira , Deering Kathleen
Published: March 2016

BACKGROUND: Hepatitis C virus (HCV) eradication leads to reduced morbidity, mortality and transmission. Despite the disproportionate burden of HCV among sex workers, data regarding the HCV care continuum in this population remain negligible.

METHODS: Using baseline data from an ongoing cohort of women sex workers in Vancouver (An Evaluation of Sex Workers’ Health Access, January 2010 to August 2013), the authors assessed HCV prevalence and engagement in the HCV care continuum within the past year. Multivariable logistic regression analyses were used to evaluate associations with recent (ie, in the past year) HCV testing.

RESULTS: Among 705 sex workers, 302 (42.8%) were HCV seropositive. Of these, 22.5% were previously unaware of their HCV status, 41.7% had accessed HCV-related care, 13.9% were offered treatment and only 1.0% received treatment. Among 552 HCV-seronegative sex workers, only one-half (52.9%) reported a recent HCV test. In multivariable analysis, women who self-identified as a sexual/gender minority (adjusted OR [aOR] 1.89 [95% CI 1.11 to 3.24]), resided in the inner city drug use epicentre (aOR 3.19 [95%CI 1.78 to 5.73]) and used injection (aOR 2.00 [95% CI 1.19 to 3.34]) or noninjection drugs (aOR 1.95 [95% CI 1.00 to 3.78]) had increased odds of undergoing a recent HCV test, while immigrant participants (aOR 0.24 [95% CI 0.12 to 0.48]) had decreased odds.

CONCLUSIONS: Despite a high burden of HCV among sex workers, large gaps in the HCV care continuum remain. Particularly concerning are the low access to HCV testing, with one-fifth of women living with HCV being previously unaware of their status, and the exceptionally low prevalence of HCV treatment. There is a critical need for further research to better understand and address barriers to engage in the HCV continuum for sex workers.
Characterization of Invasive Neisseria meningitidis from Atlantic Canada, 2009 To 2013: With Special Reference to the Nonpolysaccharide Vaccine Targets (Pora, Factor H Binding Protein, Neisseria Heparin‐Binding Antigen and Neisseria Adhesin A)
Authors: Tsang Raymond SW , Law Dennis KS , Gad Rita R , Mailman Tim , German Gregory , Needle Robert
Published: March 2016

BACKGROUND: Serogroup B Neisseria meningitidis (MenB) has always been a major cause of invasive meningococcal disease (IMD) in Canada. With the successful implementation of a meningitis C conjugate vaccine, the majority of IMD in Canada is now caused by MenB.

OBJECTIVE: To investigate IMD case isolates in Atlantic Canada from 2009 to 2013. Data were analyzed to determine the potential coverage of the newly licensed MenB vaccine.

METHODS: Serogroup, serotype and serosubtype antigens were determined from IMD case isolates. Clonal analysis was performed using multilocus sequence typing. The protein‐based vaccine antigen genes were sequenced and the predicted peptides were investigated.

RESULTS: The majority of the IMD isolates were MenB (82.5%, 33 of 40) and, in particular, sequence type (ST)‐154 B:4:P1.4 was responsible for 47.5% (19 of 40) of all IMD case isolates in Atlantic Canada. Isolates of this clone expressed the PorA antigen P1.4 and possessed the nhba genes encoding for Neisseria heparin‐binding antigen peptide 2, which together matched exactly with two of the four components of the new four‐component meningococcal B vaccine. Nineteen MenB isolates had two antigenic matches, another five MenB and one meningitis Y isolate had one antigenic match. This provided 75.8% (25 of 33) potential coverage for MenB, or a 62.5% (25 of 40) overall potential coverage for IMD.

CONCLUSION: From 2009 to 2013, IMD in Atlantic Canada was mainly caused by MenB and, in particular, the B:4:P1.4 ST‐154 clone, which accounted for 47.5% of all IMD case isolates. The new four‐component meningococcal B vaccine appeared to offer adequate coverage against MenB in Atlantic Canada.
How Can Surgeonfish Help Pediatric Surgeons? A Pilot Study Investigating the Antinociceptive Effect of Fish Aquariums in Adult Volunteers
Authors: Sanchez Matthieu , Delpont Marion , Bachy Manon , Kabbaj Reda , Annequin Daniel , Vialle Raphaël
Published: March 2016

BACKGROUND: Multiple distraction strategies have been proposed to reduce the incidence of anxiety and pain in children. Animal‐assisted therapy is acknowledged and used in children as an adjunctive treatment with cognitive, physical, psychosocial and spiritual benefits.

OBJECTIVE: To determine the effect of fish aquarium animal‐assisted therapy (FA‐AAT) on pain perception in a cohort of healthy volunteers.

METHODS: Sixty‐nine healthy subjects (mean age 27.3 years) were exposed to >20 different species of soft or hard corals and >25 fish in a 1000 L saltwater aquarium. Pain perception was assessed using an electrical stimulation device, the Pain Matcher (Cefar Medical AB, Sweden), after 5 min, 10 min, 20 min and 30 min of continuous aquarium viewing. The measurements were repeated 10 min after stopping aquarium viewing.

RESULTS: A statistically significant pain perception threshold augmentation was observed after a 5 min aquarium viewing. This threshold augmentation was also increased after 10 min, 20 min and 30 min of FA‐AAT. A remnant effect was noted up to 10 min after exposure. This short post‐viewing time period could be useful in clinical practice to perform certain painful procedures in children, such as those involving needles, under improved conditions immediately after aquarium exposure.

CONCLUSIONS: In the authors’ department, FA‐AAT is now used as a nonpharmacological antinociceptive technique in association with a protocol of inhalated oxygen/nitrous oxide mixtures for needle‐related procedures. Children and parents are invited to watch the aquarium during the 10 min to 20 min before venous punctures.
A Prospective Multicentre Study to Evaluate the Efficacy and Tolerability of Osmotic Release Oral System (Oros®) Hydromorphone in Opioid‐Naive Cancer Patients: Results of the Korean South West Oncology Group Study
Authors: Song Eun-Kee , Shim Hyunjeong , Han Hye-Suk , Sun DerSheng , Lee Soon-Il , Kang Myung Hee , Lee KyuTaek , Cho DoYeun , Cho In Sung , Park Suk Young , Kim Samyong , Yim Chang-Yeol
Published: March 2016

BACKGROUND: Osmotic release oral system (OROS®) hydromorphone is a potent, long‐acting opioid analgesic, effective and safe for controlling cancer pain in patients who have received other strong opioids. To date, few studies have examined the efficacy of hydromorphone for pain relief in opioid‐naive cancer patients.

OBJECTIVES: A prospective, open‐label, multicentre trial was conducted to determine the efficacy and tolerability of OROS hydromorphone as a single and front‐line opioid therapy for patients experiencing moderate to severe cancer pain.

METHODS: OROS hydromorphone was administered to patients who had not previously received strong, long‐acting opioids. The baseline evaluation (visit 1) was followed by two evaluations (visits 2 and 3) performed two and 14 weeks later, respectively. The starting dose of OROS hydromorphone was 4 mg/day and was increased every two days when pain control was insufficient. Immediate‐release hydromorphone was the only accepted alternative strong opioid for relief of breakthrough pain. The efficacy, safety and tolerability of OROS hydromorphone, including the effects on quality of life, and patients’ and investigators’ global impressions on pain relief were evaluated. The primary end point was pain intensity difference (PID) at visit 2 relative to visit 1 (expressed as %PID).

RESULTS: A total of 107 patients were enrolled in the present study. An improvement in pain intensity of >50% (≥50% PID) was observed in 51.0% of the full analysis set and 58.6% of the per‐protocol set. The mean pain score, measured using a numerical rating scale, was significantly reduced after two weeks of treatment, and most adverse events were manageable. Quality of life also improved, and >70% of patients and investigators were satisfied with the treatment.

CONCLUSIONS: OROS hydromorphone provided effective pain relief and improved quality of life in opioid‐naive cancer patients. As a single and front‐line treatment, OROS hydromorphone delivered rapid pain control.
Associations among Gender, Coping Patterns and Functioning for Individuals with Chronic Pain: A Systematic Review
Authors: El-Shormilisy Nina , Strong Jenny , Meredith Pamela J
Published: March 2016

BACKGROUND: Developing strategies for coping with chronic pain is an integral part of successfully living with this often debilitating health condition. While gender differences in pain coping strategies have long been investigated, the relationship between gender‐specific engagement in coping and associated functioning in individuals experiencing chronic pain is yet to be clearly understood.

OBJECTIVE: The present systematic review focused on studies that address these relationships to critically evaluate the available evidence.

METHODS: A systematic search was conducted using MEDLINE via Ovid, EMBASE, PsycINFO and CINAHL, with 7247 titles retrieved. To be included, studies had to be in English, focus on adult participants, consider chronic nonmalignant pain, use measures of coping and functioning (or disability), report on gender‐specific outcomes (for coping and functioning [or disability]), and investigate a relationship among gender, coping and functioning. One researcher screened abstracts and full‐text articles, and extracted and tabulated data, while two researchers independently assessed potential articles for eligibility and methodological quality.

RESULTS: Only seven studies met the inclusion criteria – six of high quality and one of moderate quality. The presented findings suggest that women in pain are more likely to use coping strategies considered to be maladaptive, resulting in poorer functioning, while men tend to engage in coping strategies considered to be adaptive, leading to better functional outcomes.

CONCLUSIONS: While there is some evidence supporting gender‐specific engagement in coping and associated functioning, future research is necessary to expand understanding of these interrelations.
Low Awareness but Positive Attitudes Toward Fecal Transplantation in Ontario Physicians
Authors: Dennis Madison , Salpeter Mary Jane , Hota Susy
Published: March 2016

BACKGROUND: Despite mounting evidence supporting fecal transplantation (FT) as a treatment for recurrent Clostridium difficile infection (CDI), adoption into clinical practice has been slow.

OBJECTIVE: To determine the health literacy and attitudes of academic physicians in Toronto and infectious disease physicians in Ontario toward FT as a treatment for recurrent CDI, and to determine whether these are significant barriers to adoption.

METHODS: Surveys were distributed to 253 general internists, infectious diseases specialists, gastroenterologists and family physicians.

RESULTS: The response rate was 15%. More than 60% of physicians described themselves as being ‘not at all’ or ‘somewhat’ familiar with FT. Of the 76% of physicians who had never referred a patient for FT, the most common reason (50%) was lack of awareness of where to access the treatment. The ‘ick factor’ accounted for only 13% of reasons for not referring. No respondent believed that the procedure was too risky to consider.

CONCLUSION: Despite general poor health literacy on FT, most physicians sampled share similar positive attitudes toward the treatment.
Fournier’S Gangrene Caused by Listeria Monocytogenes as the Primary Organism
Authors: Asahata Sayaka , Hirai Yuji , Ainoda Yusuke , Fujita Takahiro , Okada Yumiko , Kikuchi Ken
Published: March 2016

A 70‐year‐old man with a history of tongue cancer presented with Fournier’s gangrene caused by Listeria monocytogenes serotype 4b. Surgical debridement revealed undiagnosed rectal adenocarcinoma. The patient did not have an apparent dietary or travel history but reported daily consumption of sashimi (raw fish).

Old age and immunodeficiency due to rectal adenocarcinoma may have supported the direct invasion of L monocytogenes from the tumour. The present article describes the first reported case of Fournier’s gangrene caused by L monocytogenes. The authors suggest that raw ready‐to‐eat seafood consumption be recognized as a risk factor for listeriosis, especially in cases of skin and soft tissue infection.
Use of Morphine Sulphate by South African Paramedics for Prehospital Pain Management
Authors: Vincent-Lambert Craig , de Kock Joalda Marthiné
Published: March 2016

BACKGROUND: Evidence in the literature highlights the fact that acute pain in the prehospital setting remains poorly managed. Morphine remains the most commonly used analgesic agent in the South African prehospital emergency care setting. Although guidelines and protocols relating to the dosage and administration of morphine exist, little data are available describing its use by South African paramedics.

OBJECTIVES: To document and describe the way in which morphine is administered by a sample of South African paramedics for the management of acute pain in the prehospital setting.

METHODS: An Internet‐based survey was conducted. Sixty South African paramedics responded by completing the online questionnaire documenting and describing their use of morphine for management of acute pain.

RESULTS: Results revealed that participants appeared to be overly cautious of potential adverse effects associated with administration of morphine. Although the majority of participants calculated the dose of morphine to be administered correctly according to the patient’s weight, the majority do not appear to be administering this as a bolus; rather, they administer the calculated loading dose in a titrated manner over time. This method may result in a delay and or failure to adequately achieve therapeutic serum levels.

CONCLUSION: Failure to administer an appropriate bolus or ‘loading dose’ when administering morphine intravenously may result in ineffective and delayed pain management. The authors recommend more clearly defined protocols be developed to guide the use of morphine sulphate by paramedics in the local emergency medical services environment.