bluuebunny/crossref_metadata_2025 huggingface dataset:
A Review of Adverse Cutaneous Drug Reactions Resulting from the Use of Interferon and Ribavirin
Authors: Mistry Nisha , Shapero Jonathan , Crawford Richard I
Published: March 2016

Drug-induced cutaneous eruptions are named among the most common side effects of many medications. Thus, cutaneous drug eruptions are a common cause of morbidity and mortality, especially in hospital settings. The present article reviews different presentations of drug-induced cutaneous eruptions, with a focus on eruptions reported secondary to the use of interferon and ribavirin. Presentations include injection site reactions, psoriasis, eczematous drug reactions, alopecia, sarcoidosis, lupus, fixed drug eruptions, pigmentary changes and lichenoid eruptions. Also reviewed are findings regarding life-threatening systemic drug reactions.
Esophageal Papillomatosis Complicated by Squamous Cell Carcinoma
Authors: Attila Tan , Fu Anna , Gopinath Nanda , Streutker Catherine J , Marcon Norman E
Published: March 2016

Esophageal papillomatosis is a very rare condition that is believed to have a benign clinical course. Recent reports underscore the potential development of a malignancy in association with squamous papillomatosis of the esophagus. A case of esophageal papillomatosis complicated by the development of esophageal invasive squamous cell carcinoma diagnosed after esophagectomy, despite multiple nondiagnostic endoscopic biopsies, is described. The patient also developed squamous cell carcinoma in the oral cavity and pyloric channel. The finding of extensive esophageal papillomatosis and unremitting dysphagia symptoms should prompt investigations into an underlying associated malignancy.
The Effect of Heartburn and Acid Reflux on the Severity of Nausea and Vomiting of Pregnancy
Authors: Gill Simerpal Kaur , Maltepe Caroline , Koren Gideon
Published: March 2016

BACKGROUND: Heartburn (HB) and acid reflux (RF) in the non-pregnant population can cause nausea and vomiting; therefore, it is plausible that in women with nausea and vomiting of pregnancy (NVP), HB/RF may increase the severity of symptoms.

OBJECTIVE: To determine whether HB/RF during pregnancy contribute to increased severity of NVP.

METHODS: A prospectively collected cohort of women who were experiencing NVP and HB, RF or both (n=194) was studied. The Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale and its Well-being scale was used to compare the severity of the study cohort’s symptoms. This cohort was compared with a group of women experiencing NVP but no HB/RF (n=188). Multiple linear regression was used to control for the effects of confounding factors.

RESULTS: Women with HB/RF reported higher PUQE scores (9.6±2.6) compared with controls (8.9±2.6) (P=0.02). Similarly, Well-being scores for women experiencing HB/RF were lower (4.3±2.1) compared with controls (4.9±2.0) (P=0.01). Multiple linear regression analysis demonstrated that increased PUQE scores (P=0.003) and decreased Well-being scores (P=0.005) were due to the presence of HB/RF as opposed to confounding factors such as pre-existing gastrointestinal conditions/symptoms, hyperemesis gravidarum in previous pregnancies and comorbidities.

CONCLUSION: The present cohort study is the first to demonstrate that HB/RF are associated with increased severity of NVP. Managing HB/RF may improve the severity of NVP.
Pyrosequencing Assay to Rapidly Detect Clarithromycin Resistance Mutations in CanadianHelicobacter pyloriIsolates
Authors: Slinger R , Yan L , Chan F , Forward K , Cooper-Lesins G , Best L , Haldane D , van Zanten S Veldhuyzen
Published: March 2016

BACKGROUND: Mutations at positions 2142 or 2143 in the two-copy 23S ribosomal RNA gene ofHelicobacter pyloriare highly predictive of in vitro clarithromycin resistance and failure of clarithromycin-containing treatment regimens.

OBJECTIVE: To design an assay to rapidly detect these mutations using rapid polymerase chain reaction and pyrosequencing, a novel method of ‘sequencing by synthesis’, and to test this assay with a collection of CanadianH pyloriisolates.

METHODS: Forty-twoH pyloriisolates (24 clarithromycin-resistant, 18 clarithromycin-susceptible) were studied. A target region in the 23S gene was rapidly amplified and sequenced by pyrosequencing.

RESULTS: Mutations at one of the two positions studied were present in 20 of the 24 (83%) clarithromycin-resistant isolates; 13 had double-copy A2143G mutations, four had double-copy A2142G mutations and three had single-copy A2143G mutations. There were no mutations in 17 of the 18 (94%) susceptible isolates. A single-copy A2142G mutation was detected in one susceptible isolate.

CONCLUSIONS: The pyrosequencing assay developed was able to detect and differentiate mutations at positions 2142 and 2143 in either one or both copies of theH pylori23S ribosdomal RNA gene. Further study is needed to determine whether this pyrosequencing assay can be used to determineH pylorisusceptibility to clarithromycin from clinical specimens such as stools or gastric biopsies.
Clinical Presentation, Diagnosis and Management of Cryptococcus gattii Cases: Lessons Learned from British Columbia
Authors: Galanis Eleni , Hoang Linda , Kibsey Pamela , Morshed Muhammad , Phillips Peter
Published: March 2016

The environmental fungus Cryptococcus gattii emerged on Vancouver Island, British Columbia (BC), in 1999. By the end of 2006, it led to 176 cases and eight deaths – one of the highest burdens of C gattii disease worldwide. The present paper describes three cases, and the BC experience in the diagnosis and management of this infection. All three cases presented with pulmonary findings, including cryptococcomas and infiltrates. One also presented with brain cryptococcomas. Cases were diagnosed by chest and brain imaging, and laboratory evidence including serum or cerebrospinal fluid cryptococcal antigen detection and culture of respiratory or cerebrospinal fluid specimens. Genotyping of fungal isolates confirmed infection with C gattii VGIIa. Pulmonary cases were treated with fluconazole. One patient with central nervous system disease was treated with amphotericin B followed by fluconazole. Although this infection remains rare, clinicians should be aware of it in patients with a compatible clinical presentation who are either living in or returning from a trip to BC.
Cultural Influences on the Assessment of Children’s Pain
Authors: Finley G Allen , Kristjánsdóttir Ólöf , Forgeron Paula A
Published: March 2016

Culture is commonly regarded as a factor in pain behaviour and experience, but the meaning of the term is often unclear. There is little evidence that pain perception is modified by cultural or ethnic factors, but pain expression by children and interpretation by caregivers may be affected by the culture of the patient or the caregiver. The present paper examines some of the research regarding cultural influences on children’s pain assessment, and addresses directions for future research. A focus on cultural influences should not distract clinicians from the need to be sensitive to individual beliefs and attitudes.
Perception of Asthma as a Factor in Career Choice among Young Adults with Asthma
Authors: Bhinder Sacha , Cicutto Lisa , Abdel-Qadir Husam M , Tarlo Susan M
Published: March 2016

BACKGROUND/AIM: Asthma is a common chronic condition that can be aggravated by workplace exposures. Young adults with asthma should know how their future occupation might affect their asthma, and potentially, their quality of life. The aim of the present study was to assess the awareness of young adults to occupational risks for asthma and high‐risk occupations, as well as their perception of the role of asthma in career choice.

METHODS: Young adults 16 to 22 years of age with reported physician‐diagnosed asthma were recruited to complete a questionnaire eliciting information regarding asthma control, career choice and awareness of occupational exposure risks.

RESULTS: A small majority of the study cohort (56.4%) could identify occupations that cause or exacerbate asthma, and 34.7% indicated that asthma was an important factor in their career plans. Family physicians were most responsible for asthma management (80.2%), but young adults were more likely to discuss asthma and career plans with their parents (43.6%) or friends (29.7%) than with their family physician (13.9%; P<0.001).

CONCLUSION: Young adults with asthma have suboptimal awareness of potential work‐related asthma risks. Family physicians most commonly provide asthma care to these young adults. However, few young adults are talking to their family physicians about career choices and asthma. This observation represents an area of asthma care that needs to be explored in young adults with asthma.
Risk Factors for Acquisition of Endemic Blastomycosis
Authors: Choptiany Maxym , Wiebe Lyle , Limerick Bill , Sarsfield Pete , Cheang Mary , Light Bruce , Hammond Greg , MacDonald Kerry , Trepman Elly , Pappas Peter , Embil John M
Published: March 2016

BACKGROUND: Blastomycosis is potentially fatal, but environmental risk factors for acquiring blastomycosis are not well established.

METHOD: Matched cross‐sectional questionnaire of 112 patients with history of blastomycosis and 118 control subjects in Manitoba and northwestern Ontario.

RESULTS: The most common tissues involved with blastomycosis were pulmonary, skin and soft tissues, and bone. A significantly greater proportion of patients with blastomycosis than control subjects were involved in outdoor occupations. A significantly greater percentage of patients with blastomycosis were immunosuppressed either from collagen vascular disease or immunosuppressive therapy, or had hypothyroidism. A significant association between canine and human blastomycosis was not observed.

CONCLUSIONS: Independent risk factors for development of blastomycosis included immunosuppression for any reason (including drugs or disease), collagen vascular disease, being an outdoor worker, and having a coworker with blastomycosis. Canine blastomycosis was not a risk factor for human disease in dog owners.
Profile of Serogroup Y Meningococcal Infections in Canada: Implications for Vaccine Selection
Authors: Le Saux Nicole , Bettinger Julie A , Wootton Susan , Halperin Scott A , Vaudry Wendy , Scheifele David W , Tsang Raymond
Published: March 2016

Canada is a leader in establishing routine infant immunization programs against meningococcal C disease. Currently, all provinces have routine programs to provide meningococcal C conjugate vaccines to infants and children. The result of the existing programs has been a decrease in serogroup C incidence. The second most common vaccine‐preventable serogroup in Canada is serogroup Y, the incidence of which has been stable. The availability of a quadrivalent conjugate vaccine against serogroups A, C, Y and W135 focuses attention on serogroup Y disease as it becomes relatively more prominent as a cause of vaccine‐preventable invasive meningococcal disease. This vaccine was licensed in November 2006 but is not routinely used except in Nunavut, New Brunswick and Prince Edward Island. To allow a better understanding of the ‘value added’ by a serogroup Y‐containing vaccine, it is necessary to have a contemporary profile of Y disease in Canada. In the present paper, recent surveillance data on invasive meningococcal disease across Canada are summarized.
Updating the Evidence Base for Suctioning Adult Patients: A Systematic Review
Authors: Overend Tom J , Anderson Cathy M , Brooks Dina , Cicutto Lisa , Keim Michael , McAuslan Debra , Nonoyama Mika
Published: March 2016

OBJECTIVES: To update a previous clinical practice guideline on suctioning in adult patients, published in the Canadian Respiratory Journal in 2001.

METHODS: A primary search of the MEDLINE (from 1998), CINAHL, EMBASE and The Cochrane Library (all from 1996) databases up to November 2007, was conducted. These dates reflect the search limits reached in the previous clinical practice guideline. A secondary search of the reference lists of retrieved articles was also performed. Two reviewers independently appraised each study before meeting to reach consensus. Study quality was evaluated using the Jadad and PEDro scales. When sufficient data were available, a meta‐analysis was conducted using a random effects model. Data are reported as ORs, weighted mean differences and 95% CIs. When no comparisons were possible, qualitative analyses of the data were completed.

RESULTS: Eighty‐one studies were critically appraised from a pool of 123. A total of 28 randomized controlled trials or randomized crossover studies were accepted for inclusion. Meta‐analysis was possible for open versus closed suctioning only. Recommendations from 2001 with respect to hyperoxygenation, hyperinflation, use of a ventilator circuit adaptor and subglottic suctioning were confirmed. New evidence was identified with respect to indications for suctioning, open suction versus closed suction systems, use of medications and infection control.

CONCLUSIONS: While new evidence continues to be varied in strength, and is still lacking in some areas of suctioning practice, the evidence base has improved since 2001. Members of the health care team should incorporate this evidence into their practice.
The Impact of Requiring Completion of an Online Infection Control Course on Health Professionals’ Intentions to Comply with Infection Control Guidelines: A Comparative Study
Authors: Yassi Annalee , Bryce Elizabeth A , Maultsaid Deirdre , Lauscher Helen Novak , Zhao Kun
Published: March 2016

BACKGROUND: Ensuring good infection control practice in health care facilities is a constant concern, yet evidence shows that the compliance of health care professionals with proper procedures is lacking, despite the existence of guidelines and training programs. An online infection control module was developed to provide ready access to training. Controversy exists about whether successfully completing such a course should be mandatory or strongly encouraged for all health care professionals. The objective of the present study was to compare the perception of safety culture and intention to comply with infection control guidelines in professionals who were required by their supervisors to take the course, and those who did so voluntarily.

METHODS: Survey responses on learning environment, safety climate and intention to comply with infection control guidelines in health care professionals who were required to take the course (supervisor‐required group [n=143]) and those who took the same course voluntarily (voluntary group [n=105]) were compared. Because randomization was thought to be too difficult to implement in the policy context in which the study was conducted, significant differences between the two groups were taken into account in the analysis.

RESULTS: Those required to take the course had a significantly better perception of the institutional safety climate (P<0.001), and had a higher reported intention to comply with infection control guidelines (P=0.040) than those who took the course voluntarily.

DISCUSSION: Requiring that staff complete a 30 min interactive online infection control module increased their intention to comply with infection control guidelines compared with those who voluntarily accessed this material based on promotional material. Consideration should be given to making the successful completion of an online infection control module a requirement for all health care professionals.
Rubella Immunity among Pregnant Women in a Canadian Provincial Screening Program
Authors: Kearns Mark J , Plitt Sabrina S , Lee Bonita E , Robinson Joan L
Published: March 2016

BACKGROUND: There are limited recent data on rubella immunity in women of childbearing age in Canada. In the present paper, the proportion of rubella seroreactivity and redundant testing (testing of women previously seropositive when tested by the same physician) in the Alberta prenatal rubella screening program were studied.

METHODS: In the present retrospective observational study, data on all specimens submitted for prenatal screening in Alberta between August 2002 and December 2005 were extracted from the Provincial Laboratory for Public Health database. The proportion of rubella screening and immunoglobulin G (IgG) seroreactivity were determined. Demographic variables were compared between rubella seroreactors and nonseroreactors. The proportion of redundant testing was determined.

RESULTS: Of 159,046 prenatal specimens, 88.3% (n=140,473) were screened for rubella immunity. In total, 8.8% of specimens tested negative for rubella IgG. Younger women (23.2% of women younger than 20 years of age versus 4.7% of women between 35 and 39 years of age; P<0.001) and women from northern Alberta (11.9% versus 8.1% [overall]; P<0.001) were significantly more likely to have seronegative specimens. Of the 20,044 women who had multiple rubella immunity screenings, 88.1% (n=17,651) had multiple positive test results. In total, 20.7% of the 42,274 specimens submitted from women with multiple screenings were deemed redundant.

DISCUSSION: Younger women were most likely to be seronegative for rubella. The public health significance of women entering their childbearing years with low or undetectable rubella IgG levels remains to be determined. A large number of women with documented rubella immunity were unnecessarily retested.
Improving the Assessment of Pediatric Chronic Pain: Harnessing the Potential of Electronic Diaries
Authors: Stinson Jennifer N
Published: March 2016

Current methods for evaluating chronic pain in children suffer from methodological problems. Real‐time data capture approaches using electronic diaries have been proposed as a new standard for pain measurement. However, there is limited information available regarding the development, feasibility and validity of these approaches in children. The present paper reviews problems with current measures; rationale for developing real‐time data capture approaches using electronic diaries; mechanics of developing electronic pain diaries; current evidence regarding their usability, feasibility and validity; and discusses future directions for research in this area.
Optimal Use of Raltegravir (Isentress®) in the Treatment of HIV‐Infected Adults – Canadian Consensus Guidelines
Authors: Rachlis Anita , Angel Jonathan B , Harris Marianne , Shafran Stephen D , Therrien Rachel , Tremblay Cécile , Wainberg Mark A
Published: March 2016

BACKGROUND AND OBJECTIVES: A meeting of a Canadian group with significant experience and knowledge in HIV management, consisting of five physicians, a pharmacist and an AIDS researcher, was convened. Their goal was to develop guidance for Canadian HIV‐treating physicians on the appropriate use of raltegravir (MK‐0518, Isentress®, Merck Frosst Canada Inc) in HIV‐infected adults.

METHODS: Evidence from the published literature and conference presentations, as well as expert opinions of the group members, was considered and evaluated to develop the recommendations. Feedback on the draft recommendations was obtained from this core group, as well as from five other physicians and scientists across Canada with expertise in HIV treatment and antiretroviral drug resistance, and experience in the use of raltegravir. The final recommendations represent the core group’s consensus agreement once all feedback was considered.

RESULTS/CONCLUSIONS: Recommendations were developed to guide physicians in the optimal use of raltegravir. The issues considered included raltegravir’s role in overall treatment strategy, efficacy, durability of effect, rate of viral load reduction, resistance, safety/toxicity, pharmacokinetics and drug interactions.
Pancreatic Cancer in Canada: Incidence and Mortality Trends from 1992 to 2005
Authors: Flook Robert , van Zanten Sander Veldhuyzen
Published: March 2016

BACKGROUND: Pancreatic cancer is the fourth-ranking cause of death among all major malignancies in Canada and has the lowest five-year survival rate.

AIM: To examine incidence and mortality trends of pancreatic cancer in Canada from 1992 to 2005, with particular emphasis on the role of cigarette smoking.

METHODS: Data from Health Canada and Statistics Canada were analyzed for age-adjusted incidence and mortality trends from 1992 to 2005. The future burden of pancreatic cancer in Canada was based on population projections.

RESULTS: The incidence rate of pancreatic cancer for women between 1992 and 2005 remained stable (8.49 and 8.48 cases per 100,000, respectively), and there was a decrease in the incidence for men from 11.1 per 100,000 in 1992 to 9.89 per 100,000 in 2005. This reduction may be the result of a decrease in smoking rates among Canadian men. The mortality rate of this cancer remains high. Approximately 99% of all pancreatic cancer cases occur in individuals older than 50 years of age. The total number of annual cases of pancreatic cancer in Canada is expected to more than double from 2636 cases in 2006 to 5619 in the year 2031.

CONCLUSION: The incidence of pancreatic cancer in Canada from 1992 to 2005 remained relatively stable, although the incidence decreased somewhat in men, perhaps as a result of a change in smoking behaviour. The total number of cases of pancreatic cancer is expected to more than double by 2031.
Viral Response to Specifically Targeted Antiviral Therapy for Hepatitis C and the Implications for Treatment Success
Authors: Cooper Curtis L
Published: March 2016

Currently, hepatitis C virus (HCV) antiviral therapy is characterized by long duration, a multitude of side effects, difficult administration and suboptimal success; clearly, alternatives are needed. Collectively, specifically targeted antiviral therapy for HCV (STAT-C) molecules achieve rapid viral suppression and very high rapid virological response rates, and improve sustained virological response rates. The attrition rate of agents within this class has been high due to various toxicities. Regardless, several STAT-C molecules are poised to become the standard of care for HCV treatment in the foreseeable future. Optimism must be tempered with concerns related to the rapid development of drug resistance with resulting HCV rebound. Strategies including induction dosing with interferon and ribavirin, use of combination high-potency STAT-C molecules and an intensive emphasis on adherence to HCV antiviral therapy will be critical to the success of this promising advance in HCV therapy.
Success in Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease
Authors: Scott Adrienne S , Baltzan Marcel A , Fox Joel , Wolkove Norman
Published: March 2016

BACKGROUND: Pulmonary rehabilitation (PR) is beneficial for some, but not all, patients with chronic lung disease.

OBJECTIVES: To determine the success rate of a comprehensive PR program for patients with chronic obstructive pulmonary disease (COPD) and to characterize the differences between responders and nonresponders.

METHODS: A chart review was performed on patients with a clinical diagnosis of COPD who were referred for PR. Success was defined according to clinically important changes in St George’s Respiratory Questionnaire scores and/or 6 min walk test distance.

RESULTS: The majority of subjects were men (58%) with a mean (± SD) age of 69±10 years (n=177). Sixty-two per cent of participants had a successful outcome with PR, with proportionally more responders noting subjective improvement than objective improvement on a 6 min walk test (73% versus 51%). Subjects with poor baseline St George’s Respiratory Questionnaire scores tended to improve the most (P=0.011 [ANOVA]). Successful participants had a greater forced expired volume in 1 s (1.1 L versus 0.9 L; P<0.05) and a lower BODE index (body mass index, airflow obstruction, dyspnea, and exercise capacity index) at baseline (9.6 versus 10.3; P<0.05). Success of PR was not correlated with age, sex, chronic hypoxemic respiratory failure or other chronic conditions. Successful participants were more likely to be compliant and to experience fewer adverse events (P≤0.001).

CONCLUSIONS: Our study reinforced the belief that the majority of participants with COPD benefit from PR. Few baseline characteristics were predictive of success. Subjectively measured improvement occurred more frequently than objectively measured improvement and was greatest in those with the poorest baseline values.
Validation of Coding Algorithms for the Identification of Patients with Primary Biliary Cirrhosis Using Administrative Data
Authors: Myers Robert P , Shaheen Abdel Aziz M , Fong Andrew , Wan Alex F , Swain Mark G , Hilsden Robert J , Sutherland Lloyd , Quan Hude
Published: March 2016

BACKGROUND: Large-scale epidemiological studies of primary biliary cirrhosis (PBC) have been hindered by difficulties in case ascertainment.

OBJECTIVE: To develop coding algorithms for identifying PBC patients using administrative data – a widely available data source.

METHODS: Population-based administrative databases were used to identify patients with a diagnosis code for PBC from 1994 to 2002. Coding algorithms for confirmed PBC (two or more of antimitochondrial antibody positivity, cholestatic liver biochemistry and/or compatible liver histology) were derived using chart abstraction data as the reference. Patients with a recorded PBC diagnosis but insufficient confirmatory data were classified as ‘suspected PBC’.

RESULTS: Of 189 potential PBC cases, 119 (60%) had confirmed PBC and 28 (14%) had suspected PBC. The optimal algorithm including two or more uses of a PBC code had a sensitivity of 94% (95% CI 71% to 100%) and positive predictive values of 73% (95% CI 61% to 75%) for confirmed PBC, and 89% (95% CI 82% to 94%) for confirmed or suspected PBC. Sensitivity analyses revealed greater accuracy among women, and with the use of multiple data sources and one or more years of data. Inclusion of diagnosis codes for conditions frequently misclassified as PBC did not improve algorithm performance.

CONCLUSIONS: Administrative databases can reliably identify patients with PBC and may facilitate epidemiological investigations of this condition.
Survey of Access to GastroEnterology in Canada: The SAGE Wait Times Program
Authors: Leddin Desmond , Bridges Ronald J , Morgan David G , Fallone Carlo , Render Craig , Plourde Victor , Gray Jim , Switzer Connie , McHattie Jim , Singh Harminder , Walli Eric , Murray Iain , Nestel Anthony , Sinclair Paul , Chen Ying , Irvine E Jan
Published: March 2016

BACKGROUND: Assessment of current wait times for specialist health services in Canada is a key method that can assist government and health care providers to plan wisely for future health needs. These data are not readily available. A method to capture wait time data at the time of consultation or procedure has been developed, which should be applicable to other specialist groups and also allows for assessment of wait time trends over intervals of years.

METHODS: In November 2008, gastroenterologists across Canada were asked to complete a questionnaire (online or by fax) that included personal demographics and data from one week on at least five consecutive new consultations and five consecutive procedure patients who had not previously undergone a procedure for the same indication. Wait times were collected for 18 primary indications and results were then compared with similar survey data collected in 2005.

RESULTS: The longest wait times observed were for screening colonoscopy (201 days) and surveillance of previous colon cancer or polyps (272 days). The shortest wait times were for cancer-likely based on imaging or physical examination (82 days), severe or rapidly progressing dysphagia or odynophagia (83 days), documented iron-deficiency anemia (90 days) and dyspepsia with alarm symptoms (99 days). Compared with 2005 data, total wait times in 2008 were lengthened overall (127 days versus 155 days; P<0.05) and for most of the seven individual indications that permitted data comparison.

CONCLUSION: Median wait times for gastroenterology services continue to exceed consensus conference recommended targets and have significantly worsened since 2005.
Identification and Epidemiology of Severe Respiratory Disease due to Novel Swine‐Origin Influenza A (H1N1) Virus Infection in Alberta
Authors: Zahariadis George , Joffe Ari R , Talbot James , deVilliers Albert , Campbell Patricia , Pabbaraju Kanti , Wong Sallene , Bastien Nathalie , Li Yan , Mitchell Robyn L , Pang Xiao-Li , Yanow Stephanie , Chui Linda , Predy Gerald , Willans David , Lee Bonita E , Preiksaitis Jutta K , Clement Bev , Jacobs Angela , Jaipaul Joy , Fonseca Kevin
Published: March 2016

BACKGROUND: In March 2009, global surveillance started detecting cases of influenza‐like illness in Mexico. By mid‐April 2009, two pediatric patients were identified in the United States who were confirmed to be infected by a novel influenza A (H1N1) strain. The present article describes the first identified severe respiratory infection and the first death associated with pandemic H1N1 (pH1N1) in Canada.

METHODS: Enhanced public health and laboratory surveillance for pH1N1 was implemented throughout Alberta on April 24, 2009. Respiratory specimens from all patients with a respiratory illness and travel history or those presenting with a severe respiratory infection requiring hospitalization underwent screening for respiratory viruses using molecular methods. For the first severe case identified and the first death due to pH1N1, histocompatibility leukocyte antigens were compared by molecular methods.

RESULTS: The first death (a 39‐year‐old woman) occurred on April 28, 2009, and on May 1, 2009, a 10‐year‐old child presented with severe respiratory distress due to pH1N1. Both patients had no travel or contact with anyone who had travelled to Mexico; the cases were not linked. Histocompatibility antigen comparison of both patients did not identify any notable similarity. pH1N1 strains identified in Alberta did not differ from the Mexican strain.

CONCLUSION: Rapid transmission of pH1N1 continued to occur in Alberta following the first death and the first severe respiratory infection in Canada, which were identified without any apparent connection to Mexico or the United States. Contact tracing follow‐up suggested that oseltamivir may have prevented ongoing transmission of pH1N1.
Canadian Digestive Health Foundation Public Impact Series: Gastroesophageal Reflux Disease in Canada: Incidence, Prevalence, and Direct and Indirect Economic Impact
Authors: Fedorak Richard N , van Zanten Sander Veldhuyzen , Bridges Ron
Published: March 2016

The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada. The current article presents the updated findings from the study concerning gastroesophageal reflux disease – a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications (Montreal definition).
Diagnostic Yield of Repeat Capsule Endoscopy and the Effect on Subsequent Patient Management
Authors: Svarta Sigrid , Segal Brandon , Law Joanna , Sandhar Ajit , Kwok Ricky , Jacques Andrew , Lakzadeh Pardis , Enns Robert
Published: March 2016

BACKGROUND: Capsule endoscopy (CE) has been shown to produce a high diagnostic yield in patients with obscure gastrointestinal bleeding (OGIB); however, in those with negative studies, management is controversial. Very few studies have reported on repeat CE in the same patient; data regarding this diagnostic strategy are limited.

OBJECTIVE: To determine the diagnostic yield of repeated CE studies and how this yield affects subsequent patient management.

METHODS: A retrospective chart review of all patients who underwent CE at St Paul’s Hospital (Vancouver, British Columbia) between December 2001 and June 2009 was conducted. Patients who underwent subsequent repeat CE were identified and divided into one of four subgroups. Findings were classified as positive or negative.

RESULTS: Eighty-two of 676 patients underwent more than one CE study. Group 1 (incomplete study) included 22 patients (27%) and yielded 10 positive findings (45%). Group 2 (screening) comprised four patients (5%) and yielded two positive findings (50%). Group 3 (ongoing symptoms despite previous negative study) totalled 26 patients (32%) and yielded 10 positive findings (38%). Group 4 (previous positive study with treatment/investigation) included 30 patients (37%) and yielded 23 positive findings (77%). Overall, the present study found positive findings in 55% (45 of 82) of repeated CE cases, which resulted in a change in management in 39% (n=32) of the patients.

CONCLUSION: Due to the high diagnostic yield and noninvasive nature of CE, repeat CE appears to be of benefit and should be considered for specific patients before other types of small bowel studies.
An Evidence‐Based Multidisciplinary Approach to the Management of Hepatocellular Carcinoma (HCC): The Alberta HCC Algorithm
Authors: Burak Kelly W , Kneteman Norman M
Published: March 2016

Hepatocellular carcinoma (HCC) is one of only a few malignancies with an increasing incidence in North America. Because the vast majority of HCCs occur in the setting of a cirrhotic liver, management of this malignancy is best performed in a multidisciplinary group that recognizes the importance of liver function, as well as patient and tumour characteristics. The Barcelona Clinic Liver Cancer (BCLC) staging system is preferred for HCC because it incorporates the tumour characteristics (ie, tumour‐node‐metastasis stage), the patient’s performance status and liver function according to the Child‐Turcotte‐Pugh classification, and then links the BCLC stage to recommended therapeutic interventions. However, the BCLC algorithm does not recognize the potential role of radiofrequency ablation for very early stage HCC, the expanding role of liver transplantation in the management of HCC, the role of transarterial chemoembolization in single large tumours, the potential role of transarterial radioembolization with 90Yttrium and the limited evidence for using sorafenib in Child‐Turcotte‐Pugh class B cirrhotic patients. The current review article presents an evidence‐based approach to the multidisciplinary management of HCC along with a new algorithm for the management of HCC that incorporates the BCLC staging system and the authors’ local selection criteria for resection, ablative techniques, liver transplantation, transarterial chemoembolization, transarterial radioembolization and sorafenib in Alberta.
Induced Sputum for the Diagnosis of Pulmonary Tuberculosis: Is It Useful in Clinical Practice?
Authors: Olsen S-R , Long R , Tyrrell GJ , Kunimoto D
Published: March 2016

BACKGROUND: Diagnosing pulmonary tuberculosis (PTB) is challenging in patients who are unable to spontaneously expectorate. Published evidence suggests that induced sputum (IS) is the least invasive and most cost-effective method of diagnosis, and should be used before fibre-optic bronchoscopy (FOB).

METHODS: The medical records of 337 adults treated for PTB in northern Alberta between 1997 and 2007 were reviewed to determine whether local practice patterns reflect the evidence. Microbiological data were collected from the Provincial Laboratory for Public Health. Demographic information was collected from the patients’ charts.

RESULTS: A total of 8.5% (26 of 307) of PTB patients had IS collected, whereas 35.8% (110 of 307) underwent FOB. Among FOB patients, 56.4% (62 of 110) had no sputum sent before the procedure and 29% (18 of 62) of these patients were smear positive. Only five patients referred for FOB had IS sent previously. There were no demographic factors predictive of IS use, whereas being an inpatient at a teaching facility or having a nodule or mass on chest x-ray was predictive of FOB referral. Because so few IS samples were available, not all patients had spontaneously expectorated sputum, IS and FOB tests performed; thus, the calculated yields were not comparable with one another.

CONCLUSIONS: Despite published evidence recommending IS collection before FOB referral in suspected PTB patients, clinicians in our health region appeared to prefer early FOB over IS by a large margin. This practice pattern is less cost effective and exposes patients and health care workers to greater risk. Further research is needed to identify the reasons for the underuse of sputum induction.
Outcome of Occupational Asthma after Removal from Exposure: A Follow‐Up Study
Authors: Lemiere Catherine , Chaboillez Simone , Welman Mélanie , Maghni Karim
Published: March 2016

BACKGROUND: Despite being removed from their workplace, the majority of workers with occupational asthma (OA) remain afflicted with asthma.

OBJECTIVES: To assess the time course of clinical, functional and inflammatory parameters in subjects with OA over a four‐year period, and whether the airway inflammation observed at the time of the diagnosis predicts the outcome of OA.

METHODS: The present study was a four‐year, prospective, longitudinal investigation of workers with OA. Spirometry, methacholine challenge and sputum induction were performed at two weeks, and followed up at six months, and one, two, three and four years after the performance of specific inhalation challenges.

RESULTS: A total of 24 subjects were enrolled. Overall, clinical and functional characteristics remained stable during the four‐year follow‐up period. Sputum eosinophil (Eos) counts decreased within two weeks after exposure. Two groups of subjects were identified according to low (less than 2%, Eos−) or high (2% or greater, Eos+) Eos counts after exposure to the offending agent. The Eos+ group decreased their dose of inhaled corticosteroids, had a trend toward an improvement of airway responsiveness as well as a stable forced expiratory volume in 1 s (FEV1), whereas the Eos− group showed a decrease in FEV1, without any improvement in their functional parameters. The Eos− group also had an increase in sputum neutrophils after exposure to the occupational agents as well as during the follow‐up period.

CONCLUSION: There was a rapid decrease in eosinophilic inflammation after removal from exposure. Subjects with a noneosinophilic asthmatic reaction during specific inhalation challenge seemed to have a poorer prognosis than subjects with eosinophilic airway inflammation.
Genetic Detection of Quinolone Resistance in Haemophilus parainfluenzae: Mutations in the Quinolone Resistance‐Determining Regions of gyrA and parC
Authors: Law Dennis KS , Shuel Michelle , Bekal Sadjia , Bryce Elizabeth , Tsang Raymond SW
Published: March 2016

The quinolone resistance‐determining regions of gyrA and parC of both quinolone‐sensitive and quinolone‐resistant Haemophilus parainfluenzae strains were amplified and sequenced. Similar to Haemophilus influenzae, resistance to quinolones in H parainfluenzae is associated with mutations in the quinolone resistance‐determining regions of both gyrA and parC. The present study discusses the importance of this finding.
Patient‐Controlled Oral Analgesia for Postoperative Pain Management Following Total Knee Replacement
Authors: Kastanias Patti , Gowans Sue , Tumber Paul S , Snaith Kianda , Robinson Sandra
Published: March 2016

PURPOSE: To investigate whether patient‐controlled oral analgesia (PCOA) used by individuals receiving a total knee replacement could reduce pain, increase patient satisfaction, reduce opioid use and/or reduce opioid side effects when compared with traditional nurse (RN)‐administered oral analgesia.

METHODS: Patients who underwent an elective total knee replacement at a quaternary care centre (Toronto Western Hospital, Toronto, Ontario) were randomly assigned to either PCOA or RN‐administered short‐acting oral opioids on postoperative day 2. Subjects in the RN group called the RN to receive their prescribed short‐acting opioid. Subjects in the PCOA group kept a single dose of their prescribed oral opioid at their bedside and took this dose when they felt they needed it, to a maximum of one dose every 2 h. Study outcomes, collected on postoperative day 2, included pain (measured by the Brief Pain Inventory – Short Form), patient satisfaction (measured by the Pain Outcome Questionnaire Satisfaction sub‐scale – component II), opioid use (oral morphine equivalents), opioid side effects (nausea, pruritis and/or constipation) and knee measures (maximum passive knee flexion and pain at maximum passive knee flexion, performed on the operative knee).

RESULTS: Study outcomes were analyzed twice. First, for a subset of 73 subjects who remained in their randomly assigned group (PCOA group, n=36; RN group, n=37), randomized analyses were performed. Second, for the larger sample of 88 subjects who were categorized by their actual method of receiving oral opioids (PCOA group, n=41; RN group, n=47), as‐treated analyses were performed. There were no differences in study outcomes between the PCOA and RN groups in either analysis.

CONCLUSION: PCOA was not superior to RN administration on study outcomes. However, PCOA did not increase opioid use or pain. PCOA remains an important element in the patient‐centred care facility.
Quantifying the Pain Experience in Hip and Knee Osteoarthritis
Authors: Gandhi Rajiv , Tsvetkov Dmitry , Dhottar Herman , Davey J Roderick , Mahomed Nizar N
Published: March 2016

PURPOSE: The present study investigated whether the conceptualization of hip and knee osteoarthritis pain implicit in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Medical Outcomes Study Short‐Form 36 (SF‐36) scales is complete, or whether the addition of another scale, such as the Short‐Form McGill Pain Questionnaire (MPQ‐SF), provides a more complete characterization. Furthermore, the impact that mental health symptoms and catastrophizing had on these scales was investigated.

METHODS: Before hip and knee arthroplasty, 200 patients completed surveys of demographic data, the WOMAC pain scale, the MPQ‐SF, the SF‐36 Bodily Pain scale, the Pain Catastrophizing Scale and the Hospital Anxiety and Depression Scale. Correlations between scales were calculated and linear regression modelling was used to determine the impact of mental health and catastrophizing on these three pain measures.

RESULTS: A strong correlation between the WOMAC and SF‐36 pain scales (r=−0.70) was found; however, both correlated only moderately with the MPQ‐SF (r=0.36 and r=−0.36, respectively). Linear regression modelling showed that the Pain Catastrophizing Scale significantly predicted a greater score on all three pain scales (P<0.05).

CONCLUSIONS: The addition of the MPQ‐SF appears to add to a more complete quantification of the pain experience in hip and knee osteoarthritis.
Invasive Group A Streptococcal Disease: Management and Chemoprophylaxis
Authors: Allen UD , Moore DL
Published: March 2016

Given the potentially devastating consequences of severe invasive group A streptococcal disease, attention has been directed toward the role of chemoprophylaxis and the optimization of management strategies. In response to this issue, Canadian guidelines were previously developed. However, the uptake of these recommendations is variable across Canada. The present document summarizes key components of the recommendations for use by Canadian physicians. The importance of penicillin in the treatment of group A streptococcal disease is reaffirmed, and the role of clindamycin is discussed. In addition, in situations in which chemoprophylaxis may be considered, the preferred agents are summarized.
Decolonization of Methicillin‐Resistant Staphylococcus aureus during Routine Hospital Care: Efficacy and Long‐Term Follow‐Up
Authors: Dow Gordon , Field Deanna , Mancuso Michelina , Allard Jacques
Published: March 2016

BACKGROUND/OBJECTIVE: Methicillin‐resistant Staphylococcus aureus (MRSA) colonization is associated with a significant risk of subsequent MRSA infection in the hospital setting. The use of decolonization as an infection control strategy remains highly controversial despite publications evaluating more than 40 different decolonization regimens over the past 60 years. The present study describes the benefits and potential drawbacks of such an approach in the patient population.

METHODS: A retrospective cohort study was performed to assess the efficacy and subsequent outcome for patients with newly identified MRSA colonization at the Horizon Health Network in Moncton, New Brunswick.

RESULTS: A total of 241 patients with MRSA colonization or infection during the study period (2000 to 2005 inclusive) were identified. Eighty‐nine MRSA‐positive patients were decolonized according to a standardized regimen (hospital protocol group), and 98 received an alternative decolonization regimen (other treatment group). No attempt at decolonization was made for 54 patients (no treatment group). The hospital protocol group demonstrated superior overall successful decolonization compared with the other treatment group (67 of 84 [80%] versus 48 of 89 [54%]; OR 3.3; 95% CI 1.6 to 7.1; P=0.0004) and the no treatment group (four of 43 [9%]; OR 36.9; 95% CI 11.2 to 161.7; P<0.000001). The mean observed duration of culture negativity for the subgroup who remained MRSA culture negative over the long term was 419±398 days (range one to 1817 days). Successful decolonization occurred in 115 patients and permitted subsequent release from contact isolation for 4530 patient‐days. The rate of clinical infection with MRSA was significantly lower in the hospital protocol group versus the other treatment group (16 of 89 [18%] versus 37 of 98 [38%]; OR 0.38; 95% CI 0.18 to 0.78; P=0.003).

CONCLUSION: The present study supports recent reports indicating that MRSA decolonization can be successful using a multifactorial approach (chlorhexidine soap, enhanced hygiene/housekeeping and combination oral/topical antimicrobial therapy) in hospitalized patients, both over the short and long term. Unlike previous studies, decolonization appeared to be effective in a relatively unselected population, including patients with lines and catheters. Inability to decolonize was most closely associated with failure to use a standardized decolonization protocol.
The Prevalence of Painful Incidents among Young Recreational Gymnasts
Authors: Coates Chrystal , McMurtry C Meghan , Lingley-Pottie Patricia , McGrath Patrick J
Published: March 2016

BACKGROUND: Although children experience pain during their daily life, research has generally focused on medical pain. Sport‐related pain has not been widely studied in children and research has not examined the occurrence of painful incidents in gymnastics. The prevalence of painful incidents among children in recreational gymnastics classes and accompanying coach responses were recorded.

METHODS: Sixty‐one children between five and 10 years of age were observed at a gymnastics club. A checklist was used to record painful incidents as well as coach and child responses.

RESULTS: The rate of painful incidents was 0.17 per child per hour observed. The floor apparatus was the most common site of incidents, while bumping into equipment was the most common incident. Based on observer ratings, most incidents were mild to moderate in severity and, on average, the child’s reaction to these mild to moderate incidents lasted for 8.5 s. Forty per cent of the children had a mild to moderate painful experience. Coaches reacted to more than 60% of the painful incidents, usually asking how the child was and what had happened. A significant difference was found between the mean severity ratings of painful incidents that were followed by coach response and incidents followed by no response.

CONCLUSION: Most children who attend recreational gymnastics classes will likely experience at least one mild to moderate painful experience for every 6 h of class. Coaches are more inclined to react to a painful incident than not. Moreover, a difference was found that suggests coaches responded to more painful incidents.