bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV and Hepatitis C Virus Testing and Seropositivity Rates in Canadian Federal Penitentiaries: A Critical Opportunity for Care and Prevention
Authors: De Prithwish , Connor Nancy , Bouchard Françoise , Sutherland Donald
Published: March 2016

BACKGROUND: Incarcerated persons experience high rates of HIV and hepatitis C virus (HCV) infection, but little is known about the burden of these bloodborne viruses among federal penitentiary inmates in Canada.

OBJECTIVES: The present study investigates rates of testing and seropositivity for HIV and HCV among inmates in all 53 Canadian federal penitentiaries.

METHODS: A cross‐sectional design using surveillance data on voluntary HIV and HCV antibody testing in 2002 were applied to estimate the rate of testing uptake and the rate of incident seropositive tests among new admissions to federal penitentiaries and resident inmates. Rates of testing and infection were further examined by sex and region. Seroprevalence of HIV and HCV was estimated from the number of cumulative positive tests to year‐end.

RESULTS: Of 7670 new admissions during 2002, 30% were tested for HIV and HCV. Test seropositivity rates in this group were 0.7% for HIV and 10% for HCV. Of the 12,426 resident inmates, 28% were tested for HIV and 27% for HCV. Seropositivity rates in this group were 0.3% for HIV and 7% for HCV. Seroprevalence rates at year‐end for 2002 were 2.0% for HIV and 26% for HCV and were substantially higher among women offenders (HIV: 3.7% of women, 1.9% of men; HCV: 34% of women, 26% of men). Variations in testing uptake and test seropositivity were observed across regions.

CONCLUSIONS: The present study underscores the value of continued monitoring and evaluation of trends in HIV and HCV infection, which remain prevalent in federal penitentiaries. Higher rates of testing are warranted for at‐risk inmates to improve early detection of infection and provide infected inmates with timely care and treatment. For those who remain free of infection, testing can provide the additional benefits of exposing inmates to health counselling and for the reinforcement of prevention messages. The period of incarceration is also a critical opportunity to link inmates with outside resources in preparation for release to the community.
French‐Canadian Version of the Chronic Respiratory and of the St George′s Respiratory Questionnaires: An Assessment of their Psychometric Properties in Patients with Chronic Obstructive Pulmonary Disease
Authors: Bourbeau Jean , Maltais Francois , Rouleau Michel , Guímont Chantal
Published: March 2016

BACKGROUND: French versions of the Chronic Respiratory Questionnaire (CRQ) and the St George′s Respiratory Questionnaire (SGRQ) have largely been used in Canada, although the process by which they were translated remains unknown and the psychometric properties of these translated versions have not been assessed in a properly designed study.

OBJECTIVE: To translate and evaluate the psychometric properties of the French‐Canadian versions of the CRQ and the SGRQ.

METHODS: The questionnaires were translated according to standardized guidelines for cross‐cultural adaptation. Measurements were made at baseline and again after two weeks in 27 chronic obstructive pulomonary disease (COPD) patients known to have stable disease. Measurements were also taken pre‐ and post‐treatment in patients with acute exacerbation of COPD (33 patients) or in pulmonary rehabilitation (32 patients).

RESULTS: The CRQ showed high test‐retest reliability (the majority above 0.70), although it was slightly lower for the dyspnea dimension (0.58 to 0.65). The SGRQ also showed high test‐retest reliability (above 0.80), although it was lower for the symptoms dimension (0.54 to 0.58). The internal consistency reliability coefficients ranged from 0.73 to 0.90 for the CRQ and above 0.80 for the SGRQ, except for the symptoms dimension. The Pearson′s correlation coefficients were low (less than 0.30) between most of the translated questionnaire dimension scores and forced expiratory volume in 1 s, 6 min walking test and dyspnea measures. The correlation was generally high (greater than 0.50) between the two questionnaires and the 36‐item short form health survey, and for those domains that measured the same construct. The changes in the total and subscale scores of the CRQ and the SGRQ (except for the symptoms domain) were all largely above the variability of the score in the stable disease group.

CONCLUSION: The present study confirms that the French‐Canadian translated versions of the CRQ and the SGRQ perform well with respect to their psychometric properties. They are both suitable for their intended purpose, ie, to detect change in health status in patients with COPD when assessing if a treatment is beneficial. However, the symptoms domain of the SGRQ cannot be used to assess acute change with respect to a given therapy.
Different Profile of Interleukin‐10 Production in Circulating T Cells from Atopic Asthmatics Compared with Healthy Subjects
Authors: Matsumoto K , Narita S , Rerecich T , Snider DP , O′Byrne PM
Published: March 2016

BACKGROUND: Interleukin (IL)‐10 is a pleiotropic cytokine released from various cells, including T cells. Although IL‐10 is suggested to inhibit allergic responses, its role in asthma remains uncertain. The purpose of the present study was to compare the profile of IL‐10 in circulating T cells from stable atopic asthmatics, atopic nonasthmatics and healthy controls.

METHODS: Peripheral blood mononuclear cells were isolated, stained with anti‐CD3 and CD4/CD8 antibodies, and then processed for intracellular IL‐10 detection by flow cytometry.

RESULTS: A kinetic study in healthy controls showed that stimulation with phorbol 12‐myristate 13‐acetate and ionomycin significantly increased the frequencies of IL‐10‐producing CD3+, CD4+ and CD8+ cells. Without stimulation, the frequencies of IL‐10‐producing CD3+, CD4+ and CD8+cells were significantly higher in asthmatics than in healthy controls, while a similar trend was observed in atopic nonasthmatics. Stimulation for 24 h significantly increased IL‐10‐producing CD3+, CD4+ and CD8+cells in healthy controls and atopic nonasthmatics, but not in asthmatics.

CONCLUSIONS: The frequency of IL‐10‐producing T cells is increased in the circulation of stable atopic asthmatics compared with normal controls. The lack of enhancement in their frequency by phorbol 12‐myristate 13‐acetate and ionomycin in asthmatics suggests that the circulating T cells of asthmatic subjects are maximally stimulated with regards to IL‐10 production; alternatively, IL‐10 production by T cells from asthmatics may be regulated differently than T cells from other subjects.
Long‐Term Azithromycin Therapy in Cystic Fibrosis Patients: A Study on Drug Levels and Sputum Properties
Authors: Baumann Ulrich , King Malcolm , App Ernst M , Tai Shusheng , König Armin , Fischer Julia J , Zimmermann Torsten , Sextro Wolfgang , Hardt Horst von der
Published: March 2016

BACKGROUND: Following reports on the treatment of diffuse panbronchiolitis (DPB), recent studies demonstrate that long term therapy with azithromycin (AZM) is effective in cystic fibrosis (CF) patients. However, the underlying mechanisms remain uncertain. Some macrolides, including AZM, display inhibition of virulence factors and other antipseudomonal effects at subinhibitory levels in vitro.

OBJECTIVES: Drug doses used for CF and DPB therapy were investigated to determine whether they achieve corresponding sputum drug levels in CF patients in vivo.

METHODS: In an open, prospective study, 14 CF patients with chronic Pseudomonas aeruginosa airway infection received 250 mg AZM either daily (′high dose′) or twice weekly (′low dose′) for 12 weeks. Viscoelasticity of sputum was assessed by magnetic microrheology.

RESULTS: AZM accumulated in sputum by two orders of magnitude over a period of four weeks. In the following steady state, median AZM concentrations in sputum were 9.5 µg/mL (0.6 to 79.3 µg/mL, interquartiles 1.4 to 33.4 µg/mL) and 0.5 µg/mL (range less than 0.1 [below detection level] to 5.2 µg/mL, interquartiles 0.2 to 1.4 µg/mL) in the high and low dose groups, respectively. Viscoelasticity improved in all patients but one.

CONCLUSIONS: The findings suggest that antipseudomonal activity has to be considered among the potential mechanisms of macrolide therapy. Further, viscoelasticity may be a valuable parameter in future clinical trials.
Clinical Outcome with Oral Linezolid and Rifampin Following Recurrent Methicillin‐Resistant Staphylococcus aureus Bacteremia Despite Prolonged Vancomycin Treatment
Authors: Schwalm Jon-David , El-Helou Philippe , Lee Christine H
Published: March 2016

Drug‐resistant Gram‐positive bacteria, especially Staphylococcus aureus, are emerging as the predominant organisms involved in both nosocomial and community‐acquired infections. Since the 1980s, vancomycin has been the first‐line antibiotic used to treat methicillin‐resistant S aureus. However, allergy and intolerance to vancomycin, the increasing number of vancomycin clinical failures and the existence of vancomycin intermediate‐susceptible isolates of S aureus suggest that new antibiotics are needed. This paper reports the only known case of a successful clinical outcome with long term oral linezolid and rifampin therapy in the management of recurrent and persistent methicillin‐resistant S aureus bacteremia with metastatic infections despite prolonged vancomycin use. More than two years since the initiation of linezolid and rifampin, the study patient has been clinically well with no evidence of adverse drug reactions including cytopenia and hepatic toxicities. Physicians must be aware of the novel developments in antibiotic therapy to treat drug‐resistant bacterial infections.
Safety and Efficacy of HFA‐134a Beclomethasone Dipropionate Extra‐Fine Aerosol over Six Months
Authors: Boulet Louis-Philippe , Cartier André , Ernst Pierre , Larivée Pierre , Laviolette Michel
Published: March 2016

OBJECTIVE: To compare the systemic safety and efficacy of hydrofluoroalkane beclomethasone dipropionate (HFA‐BDP) extra‐fine aerosol 800 µg/day with chlorofluorocarbon (CFC)‐BDP 1500 µg/day.

DESIGN: Six‐month, randomized, parallel‐group, double‐blind, double‐dummy study.

PATIENTS: Patients (n=141) with moderate to severe asthma adequately controlled by CFC‐BDP 1000 µg/day to 2000 µg/day.

INTERVENTIONS: Patients received CFC‐BDP 1500 µg/day during a two‐week run‐in period and were then randomized to either HFA‐BDP (n=70) or CFC‐BDP (n=71).

RESULTS: Similar proportions of HFA‐BDP and CFC‐BDP patients had a 24 h urinary free cortisol values below the reference range at month 6 (15% versus 25%, P=0.35). Measures of adrenocorticotrophic hormone stimulation and morning plasma cortisol levels were also similar in each group. The frequency of skin bruising and oral candidiasis was low for both treatments. No change in intraocular pressure was reported for either treatment. Pulmonary function was similar in both groups; however, the onset of the first asthma exacerbation or increased asthma symptoms tended to be earlier for CFC‐BDP than for HFA‐BDP (P=0.076); 27% of CFC‐BDP patients reported increased asthma symptoms, compared with 14% of HFA‐BDP patients (P=0.095).

CONCLUSIONS: HFA‐BDP 800 µg/day has a systemic adverse event profile comparable to that of CFC‐BDP 1500 µg/day, and further control of asthma symptoms may be achieved after a switch from CFC‐BDP 1500 µg/day to HFA‐BDP 800 µg/day.
Outcomes of Asthma Education: Results of a Multisite Evaluation
Authors: Hopman Wilma M , Garvey Nancy , Olajos-Clow Jennifer , White-Markham Andrea , Lougheed M Diane
Published: March 2016

BACKGROUND: This observational study compared the effectiveness of a standardized adult asthma education program administered in a variety of sites and practice settings on health care utilization, absenteeism, amount of leisure time missed and quality of life (using the Medical Outcomes Study 36‐Item Short Form 1.0 [SF‐36]).

METHODS: Seven asthma centres participated in an uncontrolled, multicentre, prospective, observational study using a pre‐post design. Variables included hospital‐ and community‐based centres, an academic hospital setting and the presence or absence of physician attendance. Trained asthma educators administered a guided self‐ management education program, and standardized questionnaires were used for patient assessment at baseline and six months after education.

RESULTS: Of the 517 patients enrolled at baseline, 396 were eligible for the six‐month follow‐up. Follow‐up data were available for 252 patients. SF‐36 data were collected for 241 patients at six sites, with follow‐up data available for 103 of 155 eligible patients. Asthma education was associated with substantial improvements in scheduled and unscheduled physician visits, unscheduled specialist visits, emergency department visits, hospital admissions, hospitalized days, missed work or school days and missed days of leisure time. There were also statistically significant improvements in all but one SF‐36 domain. These improvements were comparable across all geographical sites and physical settings.

CONCLUSIONS: Standardized asthma education appears to be effective when administered in a variety of practice settings, and may be associated with significant improvements in patient outcomes. The significant decline in health care utilization implies that substantial health care savings may occur as a result of the implementation of standardized asthma education programs.
The Diagnosis of Asthma
Authors: Anthonisen Nick R
Published: March 2016

In this issue of the Canadian Respiratory Journal, LindenSmith et al (pages 111 to 116) present data that strongly suggest that patients who do not have asthma frequently acquire this diagnosis. They recruited 90 adults who thought that they had asthma and, in fact, had symptoms of asthma, and found that over 40% of them did not have objective evidence of the disease; of these, 43% were taking inhaled corticosteroids. Objective evidence was defined as demonstrable reversible airways obstruction, meaning spirometric response to inhaled bronchodilators, diurnal peak flow variability and/or methacholine responsiveness. Of these, methacholine response was by far the most important; in fact, a confirmed diagnosis amounted to symptoms plus methacholine sensitivity. The authors discussed possible reasons for lack of methacholine responsiveness in people who really have asthma, but were unconvinced that these were important confounders in their study and cited other studies that have also found that asthma is overdiagnosed.
Innovation and Challenges in Funding Rapid Research Responses to Emerging Infectious Diseases: Lessons Learned from the Outbreak of Severe Acute Respiratory Syndrome
Authors: Singh Bhagirath
Published: March 2016

Although the local public health response to the severe acute respiratory syndrome outbreak in Canada was critical to the diagnosis, management and treatment of patients, such a rapid research response required a national effort to engage the research and stakeholder communities. The Canadian research effort, coordinated through the Institute of Infection and Immunity of the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research, has provided insight into the mechanisms required to ensure the rapid development of strategical initiatives in response to emerging infectious diseases. It has also provided a rational basis to set up a national network to be engaged if needed in the future.
Inhaled Corticosteroid Therapy Does Not Control Asthma
Authors: Cowie Robert L , Underwood Margot F , Field Stephen K
Published: March 2016

BACKGROUND: Randomized clinical trials demonstrate efficacy and show that inhaled corticosteroid therapy can control asthma, but details concerning their effectiveness in achieving this goal in the community are lacking.

OBJECTIVES: To determine whether inhaled corticosteroid therapy is effective in controlling asthma and to examine the rates of asthma control in relation to inhaled corticosteroid use outside the realm of randomized controlled trials.

METHODS: Different populations were examined cross‐sectionally to determine whether self‐reported use of inhaled corticosteroids was associated with control of asthma. Subjects with asthma in the community and those attending a university‐based asthma program were studied. The definition of asthma control was based on the recommendations of the Canadian Consensus Report. The elements of asthma control were examined in the context of the subject′s stated use and dose of the inhaled corticosteroid.

RESULTS: Asthma was controlled in 20% (95% CI 18.7% to 21.3%) of the 3427 subjects included in the present study. Only 15% (95% CI 13.5% to 16.5%) of the 2437 subjects using inhaled corticosteroids exhibited asthma control compared with 33% (95% CI 31.1% to 35.9%) of the 990 subjects not using inhaled corticosteroids (P<0.000001).

CONCLUSIONS: Although it is known that inhaled corticosteroid therapy can result in asthma control in most individuals with asthma, the present study has shown that this result may not be attained outside the realm of randomized clinical trials. Inhaled corticosteroid use for asthma in a ′real world′ setting appears to reflect disease severity.
Helical Computed Tomography has a Role in the Screening of Lung Cancer ‐‐ The Pro Argument
Authors: Patel Milan
Published: March 2016

In 2003, approximately 21,000 new cases of lung cancer were diagnosed across Canada. Nearly 19,000 Canadians died of this devastating disease that year (1). Worldwide, there are over one million cases identified annually (2). In the Western world, more patients die of lung cancer than from breast, prostate and colon cancer combined. Despite these figures, lung cancer has remained low on the health care agenda. In the past three decades, there has been little improvement in observed lung cancer survival rates, with overall five‐year survival rates approaching 15% (3).
Bacillary Angiomatosis in an HIV‐positive Man with Multiple Risk Factors: A Clinical and Epidemiological Puzzle
Authors: Mateen Farrah J , Newstead Jill C , McClean Karen L
Published: March 2016

A 36‐year‐old man with advanced AIDS presented with skin lesions, fever and weight loss. Physical examination revealed skin lesions suggestive of bacillary angiomatosis. Diagnostic imaging identified bone lesions, soft tissue masses and a single hepatic lesion. His clinical presentation was most consistent with Bartonella quintana; however, his risk for infection with B quintana was limited to a remote, brief period of homelessness. In contrast, his frequent contact with cats presented substantial potential exposure to Bartonella henselae. Diagnosing a Bartonella infection presents challenges. The detection of bacteremia is hindered by slow growth in BACTEC media (BD Diagnostic Systems, Canada). In the present case, recovery of the organism required blind subcultures after at least eight days of incubation. Speciation by 16s ribosomal RNA analysis confirmed B quintana as the pathogen. Because the patient presented with skin lesions, the diagnosis was straightforward; however, skin lesions are nondiagnostic in some cases. Microbiological confirmation of the diagnosis rests on sufficient clinical suspicion to apply labour‐intensive laboratory protocols.
Lyme Disease: Is It or Is It Not?
Authors: Johnston BL , Conly JM
Published: March 2016

This past summer, Lyme disease was the topic of a Focus section in the Globe and Mail (1). In this section, the reporter described her experience of having physicians unable and then unwilling to diagnose her symptoms of "skin on fire, dizziness and chest pains, twitching muscles, and trouble keeping balance" as Lyme disease following a tick bite three years previously on Prince Edward Island. She reported finding support for her diagnosis after obtaining a positive test from a California laboratory and after seeing approximately 20 physicians. In her article, she speaks to the controversy surrounding the diagnosis and treatment of Lyme disease, and the tension it creates between those who believe they have it and the physicians they see.
Effects of Inhaled Fenoterol and Positive End‐Expiratory Pressure on the Respiratory Mechanics of Patients with Chronic Obstructive Pulmonary Disease
Authors: Guerin Claude , Durand Pierre-Guy , Pereira Cécile , Richard Jean-Christophe , Poupelin Jean-Charles , Lemasson Stéphane , Badet Michel , Philit François , Vecellio Laurent , Chantrel Gilles
Published: March 2016

BACKGROUND: During acute ventilatory failure in patients with chronic obstructive pulmonary disease (COPD), applying external positive end‐expiratory pressure (PEEPe) will reopen small airways and, thus, may enhance peripheral deposition as well as the physiological effects of inhaled beta‐2 agonists.

OBJECTIVE: To investigate the efficacy of inhaled fenoterol applied by zero end‐expiratory pressure (ZEEPe) or PEEPe.

METHODS: Ten patients with COPD who were intubated and mechanically ventilated received fenoterol (10 mg/4 mL) via the ventilator using a jet nebulizer for 30 min on ZEEPe and PEEPe set at 80% of the total PEEP in a random order. The total resistance of the respiratory system (rapid airway occlusion technique), change in end‐expiratory lung volume and expiratory flow limitation were assessed before and 5 min, 15 min, 30 min, 60 min and 240 min after fenoterol inhalation.

RESULTS: Before inhalation and 60 min after inhalation, the total PEEP, the change in end‐expiratory lung volume and the total resistance of the respiratory system were 8±3 cmH2O and 6±3 cmH2O, 0.61±0.34 L and 0.43±0.32 L, and 26±7 cmH2O/L/s and 23±6 cmH2O/L/s, respectively, with ZEEPe, and 9±3 cmH2O and 8±3 cmH2O (P<0.05 versus ZEEPe), 0.62±0.34 L and 0.62±0.37 L (P<0.05 versus ZEEPe), and 26±9 H2O/L/s and 25±9 H2O/L/s, respectively, with PEEPe. Three patients became not flow‐limited under the combination of PEEPe and fenoterol.

CONCLUSIONS: In patients with COPD, fenoterol combined with PEEPe has opposing effects on respiratory mechanics. First, it does not significantly reduce lung hyperinflation or inspiratory resistances. Second, it allows expiratory flow limitation reversal in some patients. These findings result from the net effect on end‐expiratory lung volume of each intervention. This implies that if fenoterol is used in combination with PEEPe, the level of PEEPe should be reassessed during the time course of the drug to prevent any further lung hyperinflation.
The laboratory diagnosis of Chlamydia trachomatis infections
Authors: Chernesky Max A
Published: March 2016

Lower genital tract infections with Chlamydia trachomatis are predominantly asymptomatic in men and women. Diagnostic technology has provided several approaches to the diagnosis of C trachomatis. Outside of cells, Chlamydia can die or degrade without optimal storage and transportation. Because some of the other assays perform better on certain specimen types, it is important for laboratories to recognize these differences and provide advice to physicians and nurses collecting patient specimens, with the objective of diagnosing lower genital tract infections to prevent transmission and upper tract damage. Most invasive specimens, such as cervical or urethral swabs, may be collected for culture, antigen or nucleic acid detection. Noninvasive samples such as first‐void urine and vaginal swabs can be easily collected by the patient; these samples must be tested by more sensitive nucleic acid amplification tests. These newer investigative strategies should enable implementation of screening programs to identify and treat partners. Serology has not been particularly useful for the diagnosis of acute C trachomatis infections in adults. Presently, it appears that antibiotic‐resistant C trachomatis is not a clinical problem. Laboratories providing C trachomatis diagnosis require participation in continuous quality improvement programs.
The Laboratory Diagnosis of Trichomonas vaginalis
Authors: Garber Gary E
Published: March 2016

Trichomonas vaginalis, a parasitic protozoa that causes the sexually transmitted infection trichomoniasis, is the sexually transmitted infection with the largest annual incidence, exceeding 170 million cases per year. The disease can be difficult to diagnose due to its heterogeneous presentation and problems with diagnostic testing. All diagnostic tests are fraught with imperfections, but the old, reliable wet mount examination (in trained hands), and the newer InPouch method may be advantageous due to simplicity in technology and cost. The present article reviews the pros and cons of culture, antibody and nucleic acid‐based technologies that may point to future diagnostic advances.
Patterns and Determinants of Compliance with Inhaled Steroids in Adults with Asthma
Authors: Lacasse Yves , Archibald Hélène , Ernst Pierre , Boulet Louis-Philippe
Published: March 2016

BACKGROUND: Patient compliance with inhaled corticosteroids (ICS) in asthma is considered to be suboptimal.

OBJECTIVES: To describe the patterns of compliance with ICS and identify factors determining the compliance to ICS in adults with asthma.

METHODS: Based on a review of the literature and interviews with asthmatic patients who require the regular use of ICS, potential determinants of compliance to ICS were identified. Questionnaires related to these determinants were then administered to a cohort of patients from three subspecialty clinics, including two from university‐affiliated centres. Patients with mild‐to‐moderate asthma who were 15 years of age and older and required (from the physician′s point of view) ICS as maintenance medication because of persistent asthma were included in the study. Patients were followed for a period of 12 weeks. Compliance was measured using electronic devices.

RESULTS: Data from 124 patients (51 men; mean age 47±15 years; mean prescribed daily dose of ICS [fluticasone propionate] 643±385 µg) were analyzed. On average, the patients took 72±24% of their prescription. Four patterns of compliance were observed and are described: 1A ‐‐ regular compliance (n=29); 1B ‐‐ irregular compliance (n=37); 2A ‐‐ regular noncompliance (n=24); and 2B ‐‐ irregular noncompliance (n=34). Among the potential predictors of noncompliance, age was the only significant predictor (compliance increased with increasing age). There was no difference in asthma control between compliant and noncompliant patients.

CONCLUSION: Compliance to ICS in patients with asthma is often suboptimal and difficult to predict. The observations suggest that some asthmatics may be overtreated with ICS.
Does Sex Influence the Impact That Smoking, Treatment Interruption and Impaired Pulmonary Function Have on Outcomes in Limited Stage Small Cell Lung Cancer Treatment?
Authors: Videtic Gregory MM , Truong Pauline T , Ash Robert B , W Yu Edward , Kocha Walter I , Vincent Mark D , Tomiak Anna T , Dar A Rashid , Whiston Frances , Stitt Larry W
Published: March 2016

PURPOSE: To look for survival differences between men and women with limited stage small cell lung cancer (LS‐SCLC) by examining stratified variables that impair treatment efficacy.

METHODS: A retrospective review of 215 LS‐SCLC patients treated from 1989 to 1999 with concurrent chemotherapy‐radiotherapy modelled on the ′early‐start′ thoracic radiotherapy arm of a National Cancer Institute of Canada randomized trial.

RESULTS: Of 215 LS‐SCLC patients, 126 (58.6%) were men and 89 (41.4%) were women. Smoking status during treatment for 186 patients (86.5%) was: 107 (58%) nonsmoking (NS) (76 [71%] male [M]; 31 [29%] female [F]) and 79 (42%) smoking (S) (36 M [46%]; 43 F [54%]) (continuing‐to‐smoke F versus M, P=0.001). Fifty‐six patients (26%) had radiotherapy interruptions (RTI) during chemotherapy‐radiotherapy because of toxicity. Radiotherapy breaks were not associated with sex (P=0.95). Survival by sex and smoking status at two years was: F + NS = 38.7%; F + S = 21.6%; M + NS = 22.9%; and M + S = 9.1% (P=0.0046). Survival by sex and RTI status at two years was: F + no RTI = 32.4%; F + RTI = 23.6%; M + no RTI = 23.0%; and M + RTI = 3.8% (P=0.0025). Diffusion capacity for carbon monoxide (DLCO) was recorded for 86 patients (40%) and median survival by sex and DLCO was F = 16.7 months and M = 12.1 months for a DLCO less than 60%; and for a DLCO 60% or more, F = 15.1 months and M = 15.3 months. First relapses were recorded in 132 cases (61%), with chest failure in men (45%) greater than for women (35%) and cranial failure rates similar between sexes (48%). Upon multivariable analysis, continued smoking was the strongest negative factor affecting survival.

CONCLUSIONS: In LS‐SCLC, women overall do better than men, with or without a negative variable. The largest quantifiable improvement in survival for women came from smoking cessation, and for men from avoidance of breaks during treatment.
The Prevalence of Hepatitis A in Children in British Columbia
Authors: Ochnio Jan J , Scheifele David W , Fyfe Murray , Bigham Mark , Bowering David , Martiquet Paul , Ho Margaret , Talling Douglas N
Published: March 2016

BACKGROUND: The risk of hepatitis A virus (HAV) infection during childhood is difficult to estimate without population serosurveys because HAV‐related symptoms are often mild at this age. Few serosurveys have been conducted in Canada. The present study surveyed teenagers in two nonurban regions of British Columbia where the historical rate of reported HAV either exceeded (region A) or was less than (region B) the historical provincial rate.METHODS: A point prevalence survey of salivary HAV‐specific immunoglobulin G was conducted in high schools among grade 9 students in regions A and B. A questionnaire was used to gather sociodemographic data. The survey was extended to grade 1 and grade 5 students in community 1 of region B. Associations between risk factors and prior infection were evaluated by logistic regression.

RESULTS: Eight hundred eleven grade 9 students were tested. Antibody to HAV was detected in 4.7% of students in region A (95% CI 2.9% to 7.2%) and 9.6% of students in region B (95% CI 6.9% to 12.9%). The region B figure reflected HAV antibody prevalence rates of 19.5% in community 1 and 2.5% in the remainder of the region. Younger students in community 1 had low HAV antibody to HAV prevalence rates (3.9% for grade 1 and 3.1% for grade 5), and positive tests in this community were associated with a particular school, foreign travel and brief residence. The risk factors for HAV infection in grade 9 students were not determined.

CONCLUSIONS: Children in nonurban areas of British Columbia are generally at low risk of HAV infection during the first decade of life regardless of the reported population rates, thereby permitting the consideration of school‐based HAV immunization programs.
Francisella philomiragia Adenitis and Pulmonary Nodules in a Child with Chronic Granulomatous Disease
Authors: Mailman Timothy , Schmidt Matthias H
Published: March 2016

Francisella philomiragia is a rare and opportunistic pathogen capable of producing invasive infection in patients with compromised neutrophil function and in patients that have survived a near‐drowning. A case of F philomiragia adenitis and lung nodules, refractory to cephalosporin therapy, is reported in a 10‐year‐old boy with chronic granulomatous disease following a facial abrasion from a saltwater crab. To the authors′ knowledge, this is the first Canadian clinical isolate to be reported. Genus and species identification was confirmed via 16S ribosomal RNA sequence analysis. A literature review revealed three groups at risk of F philomiragia infection: young patients with chronic granulomatous disease; adults with hematogenous malignancy; and near‐drowning patients. Pneumonia, fever without an apparent source and sepsis are the main clinical presentations. Invasive procedures may be required to isolate this organism and ensure appropriate antimicrobial therapy. Limited awareness of F philomiragia has led to delayed identification, patient death and misidentification as Francisella tularensis ‐ a biosafety level three pathogen and potential bioterrorism agent.
Treatment of Whiplash‐Associated Disorders ‐ Part I: Non‐Invasive Interventions
Authors: Conlin Anne , Teasell Robert , Bhogal Sanjit , Sequeira Keith
Published: March 2016

BACKGROUND: A whiplash‐associated disorder (WAD) is an injury due to an acceleration‐deceleration mechanism at the neck. WAD represents a very common and costly condition, both economically and socially. In 1995, the Quebec Task Force published a report that contained evidence‐based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus‐based recommendations.

OBJECTIVE: The objective of the present article ‐ the first installment of a two‐part series on interventions for WAD ‐ is to provide a systematic review of the literature published between January 1993 and July 2003 on noninvasive interventions for WAD using meta‐analytical techniques.

METHODS OF THE REVIEW: Three medical literature databases were searched for identification of all studies on the treatment of WAD. Randomized controlled trials (RCTs) and epidemiological studies were categorized by treatment modality and analyzed by outcome measure. The methodological quality of the RCTs was assessed. When possible, pooled analyses of the RCTs were completed for meta‐analyses of the data. The results of all the studies were compiled and systematically reviewed.

RESULTS: Studies were categorized as exercise alone, multimodal intervention with exercise, mobilization, strength training, pulsed magnetic field treatment and chiropractic manipulation. A total of eight RCTs and 10 non‐RCTs were evaluated. The mean score of methodological quality of the RCTs was five out of 10. Pooled analyses were completed across all treatment modalities and outcome measures. The outcomes of each study were summarized in tables.

CONCLUSIONS: There exists consistent evidence (published in two RCTs) in support of mobilization as an effective noninvasive intervention for acute WAD. Two RCTs also reported consistent evidence that exercise alone does not improve range of motion in patients with acute WAD. One RCT reported improvements in pain and range of motion in patients with WAD of undefined duration who underwent pulsed electromagnetic field treatment. Conflicting evidence in two RCTs exists regarding the effectiveness of multimodal intervention with exercise. Limited evidence, in the form of three non‐RCTs, exists in support of chiropractic manipulation. Future research should be directed toward clarifying the role of exercise and manipulation in the treatment of WAD, and supporting or refuting the benefit of pulsed electromagnetic field treatment. Mobilization is recommended for the treatment of pain and compromised cervical range of motion in the acute WAD patient.
Treatment of Whiplash‐Associated Disorders ‐ Part II: Medical and Surgical Interventions
Authors: Conlin Anne , Bhogal Sanjit , Sequeira Keith , Teasell Robert
Published: March 2016

BACKGROUND: Whiplash‐associated disorder (WAD) is a term used to describe injury due to an acceleration‐deceleration mechanism at the neck. In 1995, the Quebec Task Force published a report that contained evidence‐based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus‐based recommendations.

OBJECTIVE: The objective of the present article ‐ the second installment of a two part review on WAD ‐ is to provide a systematic review of the literature published between January 1993 and July 2003 on medical and surgical interventions for WAD using meta‐analytical techniques.

METHODS OF THE REVIEW: Three medical literature databases were searched for identification of all clinical trials on the treatment of WAD. Randomized controlled trials (RCTs) and epidemiological studies were categorized by treatment modality and analyzed by outcome measures. The methodological quality of the RCTs was assessed. When possible, pooled analyses of the RCTs were completed for meta‐analyses of the data. The results of all the studies were compiled and systematically reviewed.

RESULTS: The studies were categorized as medical or surgical interventions. A total of five RCTs and six non‐RCTs were evaluated. The mean methodological quality of the RCTs was 7.3 among studies on medical interventions and 7.5 for studies on surgical intervention. Pooled analyses were completed across all treatment modalities and outcome measures. The outcomes of each study were summarized in tables.

CONCLUSIONS: While several quality RCTs and epidemiological studies have been published since 1993 on medical and surgical interventions, the cumulative evidence is lacking. Moderate evidence exists in support of radiofrequency neurotomy. Evidence for steroid injections, botulinum treatments, carpal tunnel decompression and cervical discectomy is conflicting or unclear. Future research is required to clarify the utility of radiofrequency neurotomy and pulsed electromagnetic field treatment for WAD.
What do central venous catheter‐associated bloodstream infections have to do with bundles?
Authors: Johnston BL , Conly JM
Published: March 2016

Interest in the patient safety agenda continues to grow in North America. In the United States (US), the Institute for Healthcare Improvement (IHI) has begun a campaign to make health care safer and more effective by encouraging hospitals to implement interventions they believe can avoid 100,000 deaths between January 2005 and July 2006 (1). The IHI, a not‐for‐profit organization founded in 1991, promotes the improvement of health by advancing the quality and value of health care (2). Three of the six areas for action chosen by the IHI for their ′100,000 Lives Campaign′ relate to prevention of nosocomial infections: central line infections, surgical site infections and ventilator‐associated pneumonia. In Canada, a grassroots patient safety campaign modelled after the IHI′s ′100,000 Lives Campaign′ has formed (3). This ′Safer Healthcare Now!′ campaign focuses on the same six strategies chosen for the ′100,000 Lives Campaign′. Across the country, hospitals are being invited to join the ′Safer Healthcare Now!′ campaign.
The Prevalence and Incidence of Sexually Transmitted Infections in a Prospective Cohort of Injection Drug Users in Vancouver, British Columbia
Authors: Kuyper Laura M , Collins Courtney LC , Kerr Thomas , Hogg Robert S , Li Kathy , Tyndall Mark W , Montaner Julio SG , Wood Evan
Published: March 2016

BACKGROUND: While several studies have reported on sexual risk behaviours and the prevalence of sexually transmitted infections (STIs) among injection drug users (IDUs), there are fewer prospective studies that have been able to examine populations of IDUs with no history of STIs. Therefore, the authors examined prevalence, correlates and factors associated with time to first STI infection in a prospective cohort of IDUs in Vancouver, British Columbia.

METHODS: The authors examined the prevalence and correlates of STIs among IDUs at the time of recruitment into a prospective cohort study. The authors also evaluated the cumulative rate of time to first STI among IDUs with no history of STIs at baseline using the Kaplan‐Meier method, and modelled factors independently associated with first STI using Cox regression.

RESULTS: Between May 1996 and November 2003, 1560 individuals were recruited into the cohort; of these individuals, 745 reported a history of STI at baseline. Among the 815 who did not report an STI at baseline, 671 (82%) had at least one follow‐up visit and were eligible for the analysis of time to first STI. After 36 months of follow‐up, the cumulative rate of first STI was 8.2% for men and 15.9% for women (log‐rank P<0.001), whereas the cumulative rate of first STI was 8.0% for IDUs who did not report sex trade involvement versus 19.8% for IDUs who reported sex trade involvement (log‐rank P<0.001). In multivariate analyses, the risk of first STI remained independently associated with unprotected sex with regular partners (relative hazard=2.04, 95% CI 1.29 to 3.23; P=0.001) and unprotected sex with sex trade clients (relative hazard=2.36, 95% CI 1.46 to 3.82; P=0.005).

CONCLUSIONS: In the present study, the authors found that STIs were associated with both regular sex partnerships and sex trade involvement. These findings are of particular concern because both unprotected sex with regular partners and sex trade involvement is common among IDUs. Interventions to encourage condom use among IDUs, particularly those with regular sex partners and those involved in the sex trade, should be further developed.
Determinants of Hospital Length of Stay among Patients with Pneumonia Admitted to a Large Canadian Hospital from 1991 to 2001
Authors: McGregor Margaret J , FitzGerald J Mark , Reid Robert J , Levy Adrian R , Schulzer Michael , Jung David , Groshaus Horacio E , Cox Michelle B
Published: March 2016

BACKGROUND: Pneumonia is a common reason for hospital admission, and the cost of treatment is primarily determined by length of stay (LOS).

OBJECTIVES: To explore the changes to and determinants of hospital LOS for patients admitted for the treatment of community‐acquired pneumonia over a decade of acute hospital downsizing.

METHODS: Data were extracted from the database of Vancouver General Hospital, Vancouver, British Columbia, on patients admitted with community‐acquired pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 481.xx, 482.xx, 483.xx, 485.xx and 486.xx) from January 1, 1991 to March 31, 2001. The effects of sociodemographic factors, the specialty of the admitting physician (family practice versus specialist), admission from and/or discharge to a long‐term care facility (nursing home) and year of admission, adjusted for comorbidity, illness severity measures and other potential confounders were examined. Longitudinal changes in these factors over the 10‐year period were also investigated.

RESULTS: The study population (n=2495) had a median age of 73 years, 53% were male and the median LOS was six days. Adjusted LOS was longer for women (10% increase, 95% CI 3 to 16), increasing age group (7% increase, 95% CI 4 to 10), admission under a family physician versus specialist (42% increase, 95% CI 32 to 52) and admission from home with subsequent discharge to a long‐term care facility (75% increase, 95% CI 47 to 108). Adjusted hospital LOS decreased by an estimated 2% (95% CI 1 to 3) per annum. The mean age at admission and the proportion admitted from long‐term care facilities both increased significantly over the decade (P<0.05).

CONCLUSIONS: Results suggest that the management of hospitalized patients with pneumonia changed substantially between 1991 and 2001. The interface of long‐term care facilities with acute care would be an important future area to explore potential efficiencies in caring for patients with pneumonia.
The Laboratory Diagnosis of Sexually Transmitted Infections in Cases of Sexual Assault and Abuse
Authors: Chernesky Max A , Hewitt Colin
Published: March 2016

Laboratory staff dealing with samples from victims must be aware that such patients have been psychologically traumatized and deserve special care. The help of a sexual assault care team should be sought if available, and appropriate specimens should be collected two to 10 days after an incident, preferably in a single visit. Specimens should be clearly labelled, and the laboratory should be informed. In the laboratory, all procedures need to be clearly documented. There are special requirements for the collection of forensic specimens and associated records, which may later be required for legal proceedings. The laboratory must know what the current legal status is for any test being used in that community. The present article serves as a guideline to more detailed practice standards for the investigation of individual sexually transmitted infections in assault and abuse situations.
The Role of The Cytomegalovirus Antigenemia Assay in the Detection and Prevention of Cytomegalovirus Syndrome and Disease in Solid Organ Transplant Recipients: A Review of the British Columbia Experience
Authors: Greanya Erica D , Partovi Nilufar , Yoshida Eric M , Shapiro R Jean , Levy Robert D , Sherlock Chris H , Stephens Gwen M
Published: March 2016

BACKGROUND: The pp65 cytomegalovirus (CMV) antigenemia assay has been used as a means of guiding the pre‐emptive therapy of CMV disease in solid organ transplant (SOT) recipients. Recently, concerns have been raised regarding the utility of the test to accurately and precisely detect viral activity early enough to reduce the morbidity and mortality associated with CMV.

OBJECTIVE: To determine the performance characteristics of the method of antigenemia testing of SOT recipients used at Vancouver General Hospital, Vancouver, British Columbia.

METHODS: All SOT recipients between January 1, 1999, and June 30, 2000, were retrospectively reviewed for six months following transplantation. Physical examination results, laboratory parameters, antigenemia results and treatment information were reviewed.

RESULTS: A total of 134 kidney, liver, lung and kidney‐pancreas transplant recipients were included in the analysis. The overall performance characteristics of the antigenemia assay in predicting CMV disease included a sensitivity of 64%, a specificity of 81%, a positive predictive value of 76% and a negative predictive value of 71%. A mean of 18 days passed between the onset of signs and symptoms of CMV disease/syndrome and the first recorded positive antigenemia result, and only 26% of patients had a positive test result before the onset of symptoms. It was found that an antigenemia test breakpoint of at least one positive cell for defining a positive test provided the most sensitive and specific prediction, with increased odds of developing CMV disease.

CONCLUSIONS: Based on performance characteristics, the Vancouver General Hospital′s current method of antigenemia testing to guide pre‐emptive ganciclovir therapy in SOT patients is not optimal for the early detection of disease. Further study is needed on new molecular testing methods to determine if our ability to predict CMV disease can be improved.
Necrotizing Fasciitis Resulting from Human Bites: A Report of Two Cases of Disease Caused by Group A Streptococci
Authors: Sikora Christopher A , Spielman Jack , MacDonald Kerry , Tyrrell Gregory J , Embil John M
Published: March 2016

Necrotizing fasciitis is a serious and potentially life‐threatening condition. Although bite wounds are common, they are not frequently reported as a cause of necrotizing fasciitis. In the present article, two cases of bite‐associated necrotizing fasciitis caused by group A streptococcus are reported. Previously published cases are also reviewed.