bluuebunny/crossref_metadata_2025 huggingface dataset:
A Triage Approach to Managing a Two Year Wait‐List in a Chronic Pain Program
Authors: Clark Alexander J , Beauprie Ian , Clark Lynne B , Lynch Mary E
Published: March 2016

OBJECTIVE: Individuals with chronic pain referred to specialist chronic pain management programs frequently wait months to years for assessment and care. In the authors′ pain management program, approximately 600 patients are on the waiting list. An innovative recommendation program to encourage and educate referring physicians to continue active care of pain during this waiting period was developed.

METHODS: All referrals to the Queen Elizabeth II Health Sciences Centre′s Pain Management Unit for a one‐year period were reviewed and triaged as either ′regular waiting list′ or ′fast track′. Patients in the fast track group were seen within four months and required limited interventions or were urgent in nature. The regular waiting list group waited up to 27 months for assessment and development of a treatment plan. Treatment recommendations were faxed to the referring physician. A follow‐up questionnaire was sent to each physician to assess whether these treatment recommendations were useful.

RESULTS: Recommendations were faxed for 297 patients. One hundred forty‐nine physicians returned the follow‐up questionnaire. Ninety‐five physicians used the recommendations and 68 patients followed the recommendations. Seventy‐nine physicians felt that the recommendations were helpful to them in their care of the patient. For 39 patients, the recommendations were helpful. The most frequently used recommendations were those on medications (eg, tricylic antidepressants, anticonvulsants, nonsteroidal anti‐inflammatory drugs and controlled‐release opioids). Other modalities included participation in an interdisciplinary group program and physiotherapy.

CONCLUSIONS: A triage review process with recommendations faxed to referring physicians was developed and put into action for one year. The recommendations were used by 32% of the physicians (64% of responding physicians). Fifty‐three per cent of responding physicians felt that the recommendations were helpful in the care of their patient. This process led to a benefit in care, as perceived by the physician, in 26% of patients (of physicians who returned the questionnaire [13% of all patients]) on the waiting list for a tertiary care pain management unit.
Deep Inspiration Avoidance and Airway Response to Methacholine: Influence of Body Mass Index
Authors: Boulet Louis-Philippe , Turcotte Hélène , Boulet Geneviève , Simard Barbara , Robichaud Patricia
Published: March 2016

OBJECTIVE: To evaluate the effects of deep inspiration avoidance response to methacholine inhalation in 23 nonobese (body mass index between 18 kg/m2 and 30 kg/m2) and 27 obese (body mass index 30 kg/m2 or greater), nonatopic, nonasthmatic normal subjects.

METHODS: Each subject had four methacholine challenges. In tests A and B, the first postmethacholine forced expiratory volume in 1 s (FEV1) was measured at 30 s and 3 min postinhalation, respectively; tests C and D were single‐dose tests (using the final dose of test B), with the first postmethacholine FEV1 being obtained at 3 min, without (test C) or with (test D) 20 min of deep inspiration avoidance before inhalation.

RESULTS: The mean provocative concentrations inducing a 20% fall in FEV1 on tests A and B were 80.6 mg/mL and 28.5 mg/mL (P<0.0001) in nonobese subjects, respectively, and 56.3 mg/mL and 21.5 mg/mL (P<0.0001) in obese subjects, respectively. No significant differences were observed in test A or B between control and obese subjects. Mean falls in FEV1 for tests C and D were 20.3% and 40.0% (P=0.0003) in nonobese subjects, respectively, and 18.5% and 23.6% (P>0.05) in obese subjects, respectively.

CONCLUSIONS: As previously observed in patients with asthma, the present study found that nonasthmatic obese subjects had no increase in the fall in FEV1 after deep inspiration avoidance before methacholine, whereas nonobese subjects did, suggesting that obesity alters airway function. No significant changes were found between groups for symptom perception.
High‐Frequency Chest Compression: A Summary of the Literature
Authors: Dosman Cara F , Jones Richard L
Published: March 2016

The purpose of the present literature summary is to describe high‐frequency chest compression (HFCC), summarize its history and outline study results on its effect on mucolysis, mucus transport, pulmonary function and quality of life. HFCC is a mechanical method of self‐administered chest physiotherapy, which induces rapid air movement in and out of the lungs. This mean oscillated volume is an effective method of mucolysis and mucus clearance. HFCC can increase independence. Some studies have shown that HFCC leads to more mucus clearance and better lung function compared with conventional chest physiotherapy. However, HFCC also decreases end‐expiratory lung volume, which can lead to increased airway resistance and a decreased oscillated volume. Adding positive end‐expiratory pressure to HFCC has been shown to prevent this decrease in end‐expiratory lung volume and to increase the oscillated volume. It is possible that the HFCC‐induced decrease in end‐expiratory lung volume may result in more mucus clearance in airways that remain open by reducing airway size. Adjunctive methods, such as positive end‐expiratory pressure, may not always be needed to make HFCC more effective.
Illicit Drugs, Infectious Disease and Public Health: A Historical Perspective
Authors: Berridge Virginia , Bourne Shawna
Published: March 2016

The present report outlines a presentation by Professor Virginia Berridge at the Second Stanier Lecture held in Halifax, Nova Scotia, on November 5, 2002. The relationship among public health concepts, illicit drug use prevention and policy, and infection control strategies in England and other locations is paralleled over the course of two centuries. This historical journey analyzes changes in public health and demonstrates how history and public health have intersected at various times to result in the public health approaches used today.
Community‐Acquired Methicillin‐Resistane Staphylococcus aureus: Getting over It
Authors: Nicolle LE
Published: March 2016

There are three sure things in life: death, taxes and antimicrobial resistance appearing on the heels of the introduction and widespread use of an antimicrobial agent. Staphylococcus aureus has always been a poster child for the emergence of antimicrobial resistance (1). Penicillin‐resistant strains of S aureus surfaced immediately following the introduction of penicillin in the late 1940s; within a few years, most hospital strains were penicillin resistant. There was also the rapid emergence of methicillin‐resistant S aureus (MRSA) following the introduction of methicillin in the 1960s. While the replacement of nosocomial methicillin‐susceptible S aureus by MRSA has proceeded at different rates in different regions, the overall global progression has been relentless. MRSA became common in Canadian health care facilities later than in the United States; however, since the early 1990s, nosocomial MRSA in Canada has steadily and irrevocably increased (2).
A Canadian, Multicentre, Randomized Clinical Trial of Home‐Based Pulmonary Rehabilitation in Copd: Rationale and Methods
Authors: Maltais François , Bourbeau Jean , Lacasse Yves , Shapiro Stan , Perrault Hélène , Penrod John R , Baltzan Marc , Rouleau Michel , Julien Marcel , Paradis Bruno , Audet Richard , Hernandez Paul , Levy Robert D , Camp Pat , Lecours Richard , Picard Danielle , Bernard Sarah
Published: March 2016

BACKGROUND: Pulmonary rehabilitation remains largely underused. Self‐monitored, home‐based rehabilitation is a promising approach to improving the availability of pulmonary rehabilitation.

OBJECTIVE: To report the rationale and methods of a trial comparing the effectiveness of self‐monitored, home‐based rehabilitation with hospital‐based, outpatient rehabilitation in patients with chronic obstructive pulmonary disease (COPD).

STUDY DESIGN: A parallel‐group, randomized, noninferiority, multicentre trial will be performed with 240 patients with moderate to severe COPD.

INTERVENTION: Patients will be randomly assigned to conventional, supervised, hospital‐based outpatient rehabilitation or self‐monitored, home‐based rehabilitation. Both interventions will include a standardized, comprehensive self‐management program, in addition to the hospital‐based outpatient or home‐based exercise program. After the three‐month intervention, patients in both groups will be encouraged to continue exercising at home. Patients will be assessed monthy with telephone interviews and in person at enrollment, three months and 12 months.

OUTCOMES: The dyspnea domain of the Chronic Respiratory Questionnaire (CRQ) at 12 months is the primary outcome variable. Secondary outcome variables include total and domain‐specific CRQ scores; exercise tolerance and activity of daily living; health service use over the one‐year study period; and direct and indirect costs of COPD treatment.

ANALYSIS: An intent‐to‐treat approach will be used as the primary analysis. The primary analysis will focus on the change in the CRQ dyspnea score using a two‐sided t distribution based on 95% CIs. The same approach will be used for secondary continuous outcome variables.

CONCLUSION: The present trial will address two unresolved issues in pulmonary rehabilitation for patients with COPD: the short‐term and long‐term effectiveness of home‐based pulmonary rehabilitation strategies. The authors will also determine if home‐based pulmonary rehabilitation can reduce health service use (eg, hospitalizations and emergency visits) and if it can be done at a lower cost than the traditional hospital‐based outpatient pulmonary rehabilitation.
Cost Effectiveness of Positron Emission Tomography for the Management of Potentially Operable Non‐Small Cell Lung Cancer in Quebec
Authors: Nguyen Van Hung , Péloquin Serge , Lacasse Yves
Published: March 2016

BACKGROUND: The potential benefits of positron emission tomography (PET) scanning stem from the fact that it can reduce the number of diagnostic examinations; particularly, the number of unnecessary thoracic surgeries.

OBJECTIVE: To evaluate the economic impact and cost‐effectiveness of PET scanning in the management of potentially operable non‐small cell lung cancer in Quebec.

METHODS: A decision tree was developed. Two strategies were compared: chest computed tomography (CT) alone or CT and whole‐body PET. The various paths of each strategy were dependent on the numerous variables that were determined from a literature review. The costs and life expectancy were determined for each strategy under consideration. Life expectancy was calculated using the declining exponential approximation of life expectancy. Costs were obtained from the Quebec diagnosis‐related group database and Quebec physician fee schedules.

RESULTS: The mean cost of the CT strategy was $8,455 per patient compared with $9,723 for the PET strategy, for a cost differential of $1,268. The PET strategy extended life expectancy by slightly more than three months (0.27 years) compared with the survival of the CT strategy. The incremental cost‐effectiveness ratio was $4,689. Considering the number of new cases and the prevalence of mediastinal metastases, the budget impact would be $8,613,693.

CONCLUSION: The use of PET to detect local and distant metastases in non‐small cell lung cancer is an intervention that would require an acceptable investment for each life‐year gained.
The Face of Pain ‐ A Pilot Study to Validate the Measurement of Facial Pain Expression with an Improved EMG Method
Authors: Wolf Karsten , Raedler Thomas , Henke Kai , Kiefer Falk , Mass Reinhard , Quante Markus , Wiedemann Klaus
Published: March 2016

OBJECTIVE: The purpose of this pilot study was to establish the validity of an improved facial electromyogram (EMG) method for the measurement of facial pain expression.

BACKGROUND: Darwin defined pain in connection with fear as a simultaneous occurrence of eye staring, brow contraction and teeth chattering. Prkachin was the first to use the video‐based Facial Action Coding System to measure facial expressions while using four different types of pain triggers, identifying a group of facial muscles around the eyes.

METHOD: The activity of nine facial muscles in 10 healthy male subjects was analyzed. Pain was induced through a laser system with a randomized sequence of different intensities. Muscle activity was measured with a new, highly sensitive and selective facial EMG.

RESULTS: The results indicate two groups of muscles as key for pain expression. These results are in concordance with Darwin′s definition. As in Prkachin′s findings, one muscle group is assembled around the orbicularis oculi muscle, initiating eye staring. The second group consists of the mentalis and depressor anguli oris muscles, which trigger mouth movements.

CONCLUSIONS: The results demonstrate the validity of the facial EMG method for measuring facial pain expression. Further studies with psychometric measurements, a larger sample size and a female test group should be conducted.
Pain Reports by Older Adults in Long‐Term Care: A Pilot Study of Changes Over Time
Authors: Gibson Margaret C , Woodbury M Gail , Hay Kim , Bol Nancy
Published: March 2016

PURPOSE: To document self‐reported pain descriptions throughout residency in a long‐term care facility for a convenience sample of older adults (Canadian war veterans).

DESIGN AND METHODS: The present study was a longitudinal, fixed‐cohort study with anticipated attrition. Participants (n=33) were assessed every three months from admission until attrition or end of study (three years). The assessments included standardized measures of psychosocial functioning and a comprehensive pain questionnaire for residents who reported a pain problem.

RESULTS: On average, respondents completed five assessments before attrition and reported pain in 69% of assessments. The likelihood of pain report decreased as the number of assessments increased. Cross‐sectional analysis indicated that, at admission, pain duration was greater and nonverbal pain expression less prominent than later in residency. Longitudinal analysis indicated greater than 50% within‐subject variability across three consecutive pain reports for nonpharmacological pain relief, pain expression and functional impact of pain.

CONCLUSION: The present study highlights the need for patient‐centred, longitudinal investigations of both the natural progression of pain and environmental factors that mediate pain management in the interests of improving pain control for this population.
Epidemiology of Community‐Acquired Pneumonia in Edmonton, Alberta: An Emergency Department‐Based Study
Authors: Marrie Thomas J , Huang Jane Q
Published: March 2016

Patients aged 17 years and older who presented to seven emergency departments in Edmonton, Alberta over a two‐year period with community‐acquired pneumonia (n=8144) were studied. The admission rates were 271/100,00 and 296/100,000 persons for year 1 and year 2 of the study, respectively. The admission rate increased with increasing age, peaking at 4639/100,000/year for those 90 years of age and older. In contrast, the percentage of patients who were admitted to an intensive care unit was highest for those in the younger age groups between 17 and 59 years of age. From 59 years of age and older, there was a progressive decline in the percentage of patients admitted to an intensive care unit, with approximately 1% of those in the 90 years and older age group admitted. A pronounced seasonal effect on the number of patients presenting to emergency department was also noted. During the winter months, there was up to a 50% increase in the number of cases compared with the summer months.
Invasive Aspergillosis in Patients with Chronic Obstructive Pulmonary Diseases
Authors: Muquim Aziz , Menzies Dick , Dial Sandra
Published: March 2016

OBJECTIVES: To determine the outcomes, and clinical and therapeutic factors associated with the development of invasive pulmonary aspergillosis (IPA) in patients with obstructive pulmonary diseases.

DESIGN: A case control study examining patients who developed IPA while hospitalized, and controls who were matched by year of hospitalization and type of obstructive lung disease.

SETTING: A tertiary care university‐affiliated respiratory hospital.

PATIENTS: Twelve patients were identified who had developed nosocomial IPA. Each case was compared with four control patients: two with and two without Aspergillus colonization.

RESULTS: Patients and control patients had similar demographic characteristics, comorbid illnesses and severity of underlying pulmonary disease. All cases required admission to the intensive care unit and eight patients (67%) died, whereas only 17% of control patients required admission to the intensive care unit and 7% died. The patients with IPA received significantly higher daily doses of corticosteroids (median 106 mg of prednisone or equivalent for 18 days) and more broad‐spectrum antibiotics (median three antibiotics for 13 days) in hospital before the development of aspergillosis compared with the control patients (median 44 mg for 14 days, and 1.5 antibiotics for nine days, respectively). Among the control patients, those with Aspergillus colonization were more likely to have received corticosteroid therapy and broad‐spectrum antibiotics during and in the month preceding the index hospitalization, although the hospital course was not different.

CONCLUSIONS: IPA, although rare in patients with chronic obstructive lung diseases, was associated with high doses of corticosteroids and multiple broad‐spectrum antibiotics. More judicious use of antibiotics and avoidance of prolonged high‐dose corticosteroids may help prevent occurrences of IPA with its attendant serious morbidity and high mortality.
Natural Disasters, Corpses and the Risk of Infectious Diseases
Authors: Conly JM , Johnston BL
Published: March 2016

The recent occurrence of the category 4 Hurricane Katrina devastated the United States? Gulf Coast. The hurricane caused widespread destruction and flooding, and left hundreds of thousands of people homeless. The mounting death toll was reported at almost 300 deaths as of September 8, 2005 (1,2). The unfolding events and high death toll have left an unusual situation in which there are many decomposing corpses either lying on the streets or floating in the flood waters. The presence of these corpses in open settings, such as in public places and in the water that has inundated much of the city of New Orleans, naturally raises concerns about the occurrence of infectious disease epidemics (3). In the aftermath of large natural disasters, instinctive uncertainties arise among workers and the general population with respect to the appropriate handling and disposal of dead bodies and human remains. Given the recent occurrence of Hurricane Katrina as a large natural disaster and the unprecedented setting of the numerous corpses requiring disposal, it was considered timely to review the infectious disease risks associated with the handling of dead bodies.
Outbreaks of Infection Caused by Community‐Acquired Methicillin‐Resistant Staphylococcus aureus in a Canadian Correctional Facility
Authors: Main Cheryl L , Jayaratne Padman , Haley Allan , Rutherford Candy , Smaill Fiona , Fisman David N
Published: March 2016

BACKGROUND: Methicillin‐resistant Staphylococcus aureus (MRSA) has been identified in prison settings in the United States. The present study investigated two clusters of skin and soft tissue infection caused by community‐acquired (CA) MRSA in a correctional facility in southern Ontario.

METHODS: Outbreak investigations were conducted by the responsible public health authority. Strain relatedness was assessed through comparison of pulsed‐field gel electrophoresis and antibiograms.

RESULTS: Two distinct outbreaks of CAMRSA‐associated disease occurred in 2002 and 2004. Most patients presented with abscesses in the lower extremities. All isolates had identical DNA banding patterns on pulsed‐field gel electrophoresis. One‐half of the affected inmates resided in a cellblock with one other affected inmate. No other risk factors were identified.

CONCLUSIONS: One of the first outbreaks of CAMRSA infections in a correctional facility in Canada is documented. Taken in conjunction with outbreaks elsewhere, this suggests that residence in correctional facilities may be a risk factor for CAMRSA infection.
Cardiobacterium hominis Endocarditis: A Case Report and Review of the Literature
Authors: Walkty Andrew
Published: March 2016

The present case report describes the clinical course of a patient who presented with Cardiobacterium hominis endocarditis. A review of the literature follows the case presentation. C hominis, a fastidious Gram‐negative bacillus, is a member of the HACEK group of microorganisms (Haemophilus species, Actinobacillus actinomycetemcomitans, C hominis, Eikenella corrodens and Kingella kingae). Endocarditis caused by C hominis is uncommon and generally follows a subacute course. Patients may present with constitutional symptoms, symptoms related to valvular destruction or symptoms secondary to embolic events. Diagnosis requires identification of the pathogen from blood or vegetation by either culture or molecular techniques. Blood cultures may require prolonged incubation, highlighting the importance of incubating blood cultures for at least two to three weeks in patients with suspected endocarditis. In the past, C hominis was generally sensitive to penicillin. However, reports of beta‐lactamase‐producing C hominis have appeared in the literature over the past decade. The current recommendation for first‐line treatment is a third‐generation cephalosporin (ceftriaxone) for four weeks (six weeks if a prosthetic valve is in place).
Canadian Laboratory Standards for Sexually Transmitted Infections: Best Practice Guidelines
Authors: Chernesky Max A , Patrick David
Published: March 2016

Sexually transmitted infections (STI) continue to spread, and show no international boundaries. Diseases such as gonorrhea and syphilis, which we thought were under control in Canadian populations, have increased in incidence. Sexually transmitted or associated syndromes such as cervicitis, enteric infections, epididymitis, genital ulcers, sexually related hepatitis, ophthalmia neonatorum, pelvic inflammatory disease, prostatitis and vulvovaginitis present a challenge for the physician to identify the microbial cause, treat the patient and manage contacts. During the past 10 years, new technologies developed for the diagnosis of STIs have provided a clearer understanding of the real accuracy of traditional tests for the diagnosis of infections caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, herpes simplex viruses, hepatitis B virus, human papillomaviruses, HIV, Haemophilus ducreyi, Trichomonas vaginalis and mycoplasmas. This has presented a major challenge to the diagnostic laboratory, namely, selecting the most sensitive and specific test matched with the most appropriate specimens to provide meaningful and timely results to facilitate optimal patient care.
Aspergillus‐Related Lung Disease
Authors: Al-Alawi Alia , Ryan C Frank , Flint Julia D , Müller Nestor L
Published: March 2016

Aspergillus is a ubiquitous dimorphic fungus that causes a variety of human diseases ranging in severity from trivial to life‐threatening, depending on the host response. An intact host defence is important to prevent disease, but individuals with pre‐existing structural lung disease, atopy, occupational exposure or impaired immunity are susceptible. Three distinctive patterns of aspergillus‐related lung disease are recognized: saprophytic infestation of airways, cavities and necrotic tissue; allergic disease including extrinsic allergic alveolitis, asthma, allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis and chronic eosinophilic pneumonia; and airway and tissue invasive disease ‐‐ pseudomembranous tracheobronchitis, acute bronchopneumonia, angioinvasive aspergillosis, chronic necrotizing aspergillosis and invasive pleural disease. A broad knowledge of these clinical presentations and a high index of suspicion are required to ensure timely diagnosis and treatment of the potentially lethal manifestations of aspergillus‐related pulmonary disease. In the present report, the clinical, radiographic and pathological aspects of the various aspergillus‐related lung diseases are briefly reviewed.
The Laboratory Diagnosis of Haemophilus ducreyi
Authors: Alfa Michelle
Published: March 2016

Chancroid is a sexually transmitted infection caused by Haemophilus ducreyi. This fastidious, Gram‐negative coccobacilli dies rapidly outside the human host, making diagnostic testing using culture methods difficult. This genital ulcer infection is not common in Canada and, therefore, can often be misdiagnosed. The objective of the present paper is to provide practical approaches for the diagnosis of chancroid in Canadian patients where the prevalence of this infection is low. Issues related to sample collection, sample transport and available diagnostic tests are reviewed, and several alternative approaches are outlined. Although antigen detection, serology and genetic amplification methods have all been reported for H ducreyi, none are commercially available. Culture is still the primary method available to most laboratories. However, the special media necessary for direct bedside inoculation is often not available; therefore, communication with the diagnostic laboratory and rapid specimen transport are essential when chancroid is suspected
Neural Mechanisms of Temporomandibular Joint and Masticatory Muscle Pain: A Possible Role for Peripheral Glutamate Receptor Mechanisms
Authors: Lam David K , Sessle Barry J , Cairns Brian E , Hu James W
Published: March 2016

The purpose of the present review is to correlate recent knowledge of the role of peripheral ionotropic glutamate receptors in the temporomandibular joint and muscle pain from animal and human experimental pain models with findings in patients. Chronic pain is common, and many people suffer from chronic pain conditions involving deep craniofacial tissues such as temporomandibular disorders or fibromyalgia. Animal and human studies have indicated that the activation of peripheral ionotropic glutamate receptors in deep craniofacial tissues may contribute to muscle and temporomandibular joint pain and that sex differences in the activation of glutamate receptors may be involved in the female predominance in temporomandibular disorders and fibromyalgia. A peripheral mechanism involving autocrine and/or paracrine regulation of nociceptive neuronal excitability via injury or inflammation‐induced release of glutamate into peripheral tissues that may contribute to the development of craniofacial pain is proposed.
An Evaluation of the Management of Asymptomatic Catheter‐Associated Bacteriuria and Candiduria at The Ottawa Hospital
Authors: Dalen Dawn M , Zvonar Rosemary K , Jessamine Peter G
Published: March 2016

BACKGROUND: Asymptomatic catheter‐associated urinary tract infections (CAUTIs) are common in hospitalized patients. They are associated with a low incidence of sequelae and morbidity, and in most patients resolve spontaneously on removal of the catheter. As a result, it is not recommended that asymptomatic catheter‐associated bacteriuria or candiduria be treated with antimicrobial agents while the catheter remains in place because it may lead to the evolution of resistant flora.

OBJECTIVE: To assess the current management of patients with CAUTIs with respect to antimicrobial therapy at The Ottawa Hospital and the University of Ottawa Heart Institute, Ottawa, Ontario.

METHODS: A prospective observational study over a period of 26 consecutive days was conducted at The Ottawa Hospital (General and Civic campuses) and the University of Ottawa Heart Institute. Inpatients with an indwelling catheter, a positive urine culture and the absence of UTI signs or symptoms were assessed. Patients were followed for five days to determine whether antimicrobials were prescribed.

RESULTS: From March 3 to March 28, 2003, 29 of 119 patients screened met inclusion criteria. Of these 29 patients, 15 (52%) were prescribed antimicrobials and were therefore considered to be inappropriately managed. Differences were observed between the appropriate and inappropriate management groups in terms of duration of stay to positive urine culture and whether yeast or bacteria were isolated from the culture.

CONCLUSION: Antimicrobial agents were prescribed in over one‐half of CAUTI cases, contrary to recommendations from the literature. Education is required to bring this strongly supported recommendation into clinical practice.
Fear of Pain and Fear of Falling among Younger and Older Adults with Musculoskeletal Pain Conditions
Authors: Martin Ronald R , Hadjistavropoulos Thomas , McCreary Donald R
Published: March 2016

BACKGROUND: The fear‐avoidance model of pain accounts for the debilitating consequences of strong fear as a component of reactions to painful conditions (eg, movements become anxiety‐provoking because they cause pain). The model, which is supported in the literature, posits that fear of pain interferes with recovery because it leads to avoidance of beneficial activity. Despite the high prevalence of pain among the elderly, investigations of fear of pain in this population are scarce. A related construct, fear of falling, has been studied among elderly (but not younger) adults as an age‐specific concern.

OBJECTIVES: To examine the relationship between fear of pain and fear of falling. Specifically, it is hypothesized that fear of pain and fear of falling are distinct constructs. Moreover, the authors investigated whether fear of falling becomes more relevant with increasing age in a sample of seniors and younger adults with musculoskeletal conditions.

METHODS: A convenience sample of younger and older adult physiotherapy outpatients (n=226) receiving treatment for musculoskeletal conditions were recruited for the study. Fear of pain and fear of falling were assessed using self‐report measures.

RESULTS: There were no age differences with respect to fear of pain and fear of falling. Regression analyses showed that fear of pain measures contribute substantial unique variance to the prediction of each other; however, they only make minor unique contributions to the prediction of fear of falling. Similar results were obtained through confirmatory analyses using structural modelling techniques.

CONCLUSIONS: The analyses supported the distinctiveness of fear of pain and fear of falling. Moreover, among physiotherapy outpatients with musculoskeletal pain conditions, fear of falling and fear of pain are distinct constructs that appear to represent the concerns of both seniors and younger pain patients.
Regional Variations in Risk Factors for Asthma in School Children
Authors: Lawson Joshua A , Rennie Donna C , Senthilselvan Ambikaipakan , Cockcroft Donald W , McDuffie Helen H
Published: March 2016

BACKGROUND: The authors have previously reported an increased prevalence of asthma in Estevan, Saskatchewan (21.4%) compared with Swift Current, Saskatchewan (16.2%).

OBJECTIVE: To determine the association between asthma and personal and indoor environmental risk factors in these communities.

METHODS: A population‐based cross‐sectional study was conducted in January 2000. A questionnaire was distributed to school children in grades 1 to 6 for completion by a parent. Multivariate logistic regression was used to examine associations between various risk factors and physician‐diagnosed asthma.

RESULTS: Asthma was associated with respiratory allergy (adjusted OR [adjOR]=8.85, 95% CI 6.79 to 11.54), early respiratory illness (adjOR=2.81, 95% CI 1.96 to 4.03) and family history of asthma (adjOR=2.37, 95% CI 1.67 to 3.36). Several environmental factors varied with asthma by town. In Estevan, asthma was associated with home mould or dampness (adjOR=1.82, 95% CI 1.23 to 2.69) and was inversely associated with air conditioning (adjOR=0.56, 95% CI 0.37 to 0.85). The risk of asthma was increased if the child had previous exposure to environmental tobacco smoke from the mother in both communities (Swift Current: OR=1.87, 95% CI 1.06 to 3.30; Estevan: OR=2.00, 95% CI 1.17 to 3.43), and there was an inverse association with current exposure to environmental tobacco smoke from the mother in Estevan (OR=0.64, 95% CI 0.40 to 1.00). When multivariate analyses were stratified by sex, the relationship between home mould or dampness and asthma was most prominent in girls in Estevan.

CONCLUSIONS: Despite a similar regional location, different risk factors for asthma were identified in each community. Local environmental factors are important to consider when interpreting findings and planning asthma care.
Treatment Outcomes in a Centralized Specialty Clinic for Hepatitis C Virus Are Comparable with Those from Clinical Trials
Authors: DE Kaita Kelly , Wong Stephen , Renner Eberhard , Minuk Gerald Y
Published: March 2016

BACKGROUND: Outcomes from industry-sponsored registration trials are often considered to be more favourable than those achieved in clinical practice because patients involved in the former are highly selected and supported, but it is not known if this impression is valid.

OBJECTIVE: To determine the outcome of hepatitis C virus (HCV)-infected patients who received therapies for chronic HCV in a single urban centre and compare the results with those derived from contemporary, industry-sponsored trials.

DESIGN: Retrospective chart review of HCV-infected patients referred to the Viral Hepatitis Investigative Unit in Winnipeg, Manitoba, between 1998 and 2003.

METHODS: The Viral Hepatitis Investigative Unit database was used to identify all referred patients with positive anti-HCV antibodies. Charts were reviewed for the following data: patient demographics; viral genotype; indications and contraindications to treatment; treatment type; and outcome of antiviral therapy.

RESULTS: For 1800 anti-HCV positive patients identified, 1078 charts were available for review. Of these patients, the mean age was 47 years (range 11 years to 90 years) and 53% were men. Genotype 1 was the most common (65%). A total of 331 patients (31%) had received antiviral therapy. The sustained viral responses were similar to those described in industry-sponsored registration trials. Specifically, the sustained viral responses for interferon-alpha monotherapy (n=81) was 22.2%, interferon-alpha plus ribavirin (n=180) 44.4%, pegylated interferon monotherapy (n=38) 44.7% and pegylated interferon plus ribavirin (n=24) 54.2%.

CONCLUSION: HCV treatment outcomes from a single urban centre were similar to those described in industry-sponsored registration trials despite the high selection and support provided to patients enrolled in the latter studies.
Factors Associated with Poor Asthma Control in Children Aged Five to 13 years
Authors: Mcghan SL , MacDonald C , James DE , Naidu P , Wong E , Sharpe H , Hessel PA , Befus AD
Published: March 2016

BACKGROUND: Most children with asthma should be able to achieve acceptable control. However, are there differences between those with acceptable and poor control, and if so, how can health care approaches be modified accordingly?

OBJECTIVE: To examine the characteristics of elementary school children aged five to 13 years with acceptable and poor levels of asthma control.

METHODS: The present cross‐sectional study of children with asthma used five indicators of control, as outlined by the Canadian Asthma Consensus Report, to categorize acceptable and poor asthma control.

RESULTS: Of 153 children, 115 (75%) were rated as having poorly controlled asthma. Of those with poor control, 65 (64%) children were currently using inhaled corticosteroids, and 65% of those reported using inhaled corticosteroids daily versus as needed. Fifty‐one per cent of the children with poorly controlled asthma had exposure to tobacco smoke, whereas 79% of the children with asthma under acceptable control were from households with no smokers (P=0.002). The poor control group also had significantly worse parental perceptions of the psychosocial impact of asthma on their child. No significant difference was found in the percentage of those who had written action plans in the poor control group (28%) compared with the acceptable control group (26%), and similar percentages in each group stated that they used the plans.

CONCLUSIONS: Despite the high use of inhaled corticosteroids, the majority of children had poorly controlled asthma. The poor control group had more exposure to tobacco smoke and a worse psychosocial impact due to asthma. Few children had past asthma education and action plans, suggesting that there is a need to improve access to and tools for education.
Helicobacter pyloriEradication with Either Seven-Day or 10-Day Triple Therapies, and with a 10-Day Sequential Regimen
Authors: Scaccianoce Giuseppe , Hassan Cesare , Panarese Alba , Piglionica Donato , Morini Sergio , Zullo Angelo
Published: March 2016

BACKGROUND:Helicobacter pylorieradication rates achieved by standard seven-day triple therapies are decreasing in several countries, while a novel 10-day sequential regimen has achieved a very high success rate. A longer 10-day triple therapy, similar to the sequential regimen, was tested to see whether it could achieve a better infection cure rate.

METHODS: Patients with nonulcer dyspepsia andH pyloriinfection were randomly assigned to one of the following three therapies: esomeprazole 20 mg, clarithromycin 500 mg and amoxycillin 1 g for seven days or 10 days, or a 10-day sequential regimen including esomeprazole 20 mg plus amoxycillin 1 g for five days and esomeprazole 20 mg, clarithromycin 500 mg and tinidazole 500 mg for the remaining five days. All drugs were given twice daily.H pylorieradication was checked four to six weeks after treatment by using a13C-urea breath test.

RESULTS: Overall, 213 patients were enrolled.H pylorieradication was achieved in 75.7% and 77.9%, in 81.7% and 84.1%, and in 94.4% and 97.1% of patients following seven-day or 10-day triple therapy and the 10-day sequential regimen, at intention-to-treat and per protocol analyses, respectively. The eradication rate following the sequential regimen was higher than either seven-day (P=0.002) or 10-day triple therapy (P=0.02), while no significant difference emerged between the latter two regimens (P=0.6).

CONCLUSIONS: The 10-day sequential regimen was significantly more effective than both triple regimens, while 10-day triple therapy failed to significantly increase theH pylorieradication rate achieved by the standard seven-day regimen.
The Role of Omalizumab in the Treatment of Severe Allergic Asthma
Authors: Chapman Kenneth R , Cartier Andre , Hébert Jacques , McIvor R Andrew , Schellenberg R Robert
Published: March 2016

BACKGROUND: A novel anti‐immunoglobulin E (anti‐IgE) therapy for asthma, omalizumab, has been approved for use in Canada.

OBJECTIVE: To review the basic and clinical data for omalizumab, and to examine its possible role for asthma management in Canada.

METHODS: A literature search from 1960 to 2006 was conducted in MEDLINE to identify studies of omalizumab. In addition, abstracts from recent respiratory and allergy scientific meetings were sought, and any unpublished data were requested from the manufacturer. A consensus panel of respiratory and allergy specialists reviewed and summarized the data, and derived a set of recommendations for omalizumab use.

RESULTS: Omalizumab is a humanized monoclonal antibody designed to bind to the C epsilon 3 domain of the IgE molecule, forming soluble immune complexes that are cleared by the reticuloendothelial system. Subcutaneous injections, given at two‐ or fourweek intervals at the recommended dose, result in a rapid decrease in free circulating IgE levels. In two phase III clinical trials of 1405 adult and adolescent patients with moderate to severe asthma maintained on moderate doses of inhaled corticosteroids (ICS), omalizumab reduced exacerbation rates compared with placebo, and was associated with improved symptoms and a greater corticosteroid‐sparing effect. In a trial of 419 patients with severe disease that was uncontrolled despite the use of high‐dose ICS and concurrent long‐acting beta2‐agonists, severe exacerbations were 50% less frequent in omalizumab‐treated patients than in control subjects. Retrospective analyses have identified the characteristics of patients most likely to respond to omalizumab treatment.

RECOMMENDATIONS: Omalizumab may be considered as a potential adjunctive therapy in atopic patients with severe asthma uncontrolled by conventional therapy with optimal doses of ICS and appropriate adjunctive therapy (eg, long‐acting beta2‐agonists). Typically, patients are identified by the need for frequent short course or continuous oral corticosteroids. Therapy should be initiated only after review by a specialist to confirm the diagnosis and that conventional therapy is optimal.
Chronic Neck Pain and Whiplash: A Case‐Control Study of the Relationship between Acute Whiplash Injuries and Chronic Neck Pain
Authors: Freeman Michael D , Croft Arthur C , Rossignol Annette M , Centeno Christopher J , Elkins Whitney L
Published: March 2016

The authors undertook a case‐control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain.

Four hundred nineteen patients and 246 controls were randomly enrolled. Patients were defined as individuals with chronic neck pain, and controls as those with chronic back pain. The two groups were surveyed for cause of chronic pain as well as demographic information. The two groups were compared using an exposure‐odds ratio. Forty‐five per cent of the patients attributed their pain to a motor vehicle accident. An OR of 4.0 and 2.1 was calculated for men and women, respectively.

Based on the results of the present study, it reasonable to infer that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident.
Elderly Patients Are at Greater Risk of Cytopenia During Antiviral Therapy for Hepatitis C
Authors: Nudo CG , Wong P , Hilzenrat N , Deschênes M
Published: March 2016

The results of antiviral therapy for hepatitis C virus (HCV) have improved recently with the use of pegylated interferon (PEG-IFN)/ribavirin (RBV) combination therapy. At this point, most patients with chronic HCV remain untreated. Thus, it is anticipated that therapy will be more appealing and prescribed more broadly than in the past, including in patients considered marginal.

AIM: To examine the effects of PEG-IFN-based antiviral therapy in elderly patients with chronic HCV.

METHODS: The charts of patients treated with chronic HCV were reviewed. Patients were defined as elderly if they were 60 years of age or older. The control group consisted of patients younger than 60 years of age who were matched to the treated elderly patients based on sex, treating physician, prescribed treatment and intended prescribed treatment duration. The data recorded included end of treatment response, sustained virological response (SVR), adverse events, dose modification and withdrawal of therapy.

RESULTS: Thirty of 147 (20.4%) elderly patients attending a hepatitis C clinic were treated. The average age of the elderly patients was 65±4 years. Forty-three per cent were men and 57% were women. Ten per cent received IFN monotherapy, 70% received a combination of IFN/RBV therapy and 20% received a combination of PEG-IFN/RBV therapy. The overall response rates in the elderly patients compared with the younger patients was 46.7% versus 65.8% (P=0.11) for end of treatment response and 33.3% versus 51.2% (P=0.13) for SVR. The rate of dose modification was 50% in the elderly patients compared with 29% in the control group (P=0.08). Therapy was discontinued in 53% of the elderly compared with 34% of younger patients (P=0.17). The younger patients reported more side effects than elderly patients; although, there were more laboratory abnormalities (anemia, thrombocytopenia and neutropenia) in the elderly patients during therapy than in the younger group (0.93 per patient versus 0.49 per patient, P=0.01).

CONCLUSION: Elderly patients with chronic HCV can be treated successfully. However, they are more at risk to develop cytopenias while on treatment. In such patients, the close monitoring of blood counts is necessary. Larger studies are needed to confirm these findings and to determine whether SVR differs in this population.
The Diversity of Liver Diseases among Outpatient Referrals for Elevated Serum Ferritin
Authors: Wong Karen , Adams Paul C
Published: March 2016

BACKGROUND: The aim of the present study was to examine the diversity of liver diseases in outpatients referred because of elevated serum ferritin.

METHODS: A retrospective review was performed of outpatient referrals for serum ferritin elevations made to a tertiary care centre liver clinic between 1999 and 2005. Information regarding serum ferritin, transferrin saturation, liver biopsy, liver iron concentration and final diagnosis was extracted. Patients were stratified into two groups based on ferritin concentration: ferritin concentration 300 μg/L to 1000 μg/L, and ferritin concentration greater than 1000 μg/L.

RESULTS: A total of 482 charts were reviewed, of which 119 (25%) had ferritin concentrations greater than 1000 μg/L.HFE-linked hemochromatosis, nonalcoholic steatohepatitis and alcohol-related liver disease were the top three diagnoses.HFE-linked hemochromatosis accounted for 28% to 42% of the diagnoses in all subgroups. The percentage of patients diagnosed withHFE-linked hemochromatosis was similar in the ferritin 300 μg/L to 1000 μg/L and the ferritin greater than 1000 μg/L groups (P=0.067). Among patients with ferritin greater than 1000 μg/L, 63% underwent a liver biopsy. Of those with an elevated liver iron concentration (greater than 35 μmol/g dry weight), 71% had a transferrin saturation greater than 50% (88% of C282Y homozygotes and 43% of non-C282Y homozygotes). In non-C282Y homozygotes with an elevated serum ferritin concentration greater than 1000 μg/L, 64% did not have iron overload on liver biopsy.

CONCLUSION:HFE-linked hemochromatosis accounted for less than one-half of the diagnoses in an outpatient population referred for elevated ferritin, suggesting a need to search further for an alternate cause.