bluuebunny/crossref_metadata_2025 huggingface dataset:
Should My Patient with Inflammatory Bowel Disease on Immunosuppressive Therapy be Vaccinated against Influenza Virus?
Authors: Narula Neeraj , Yamamura Deborah LR , Marshall John K
Published: March 2016

Crohn’s disease and ulcerative colitis are variants of inflammatory bowel disease (IBD) for which immunosuppressive therapy is often required. Immunosuppressed patients are at increased risk for infections, including vaccine‐preventable diseases such as influenza. Although several guidelines recommend routine influenza immunization for such patients, recent literature suggests that this patient population may be inadequately immunized. Current research suggests that inactivated influenza vaccines are effective, well tolerated and can be administered safely in most IBD patients. Studies in other immunosuppressed populations have also demonstrated the safety of inactivated vaccines. The present article reviews the literature regarding the safety and efficacy of influenza vaccination in IBD patients receiving immunosuppressive therapy.
Early Use of Magnetic Endoscopic Imaging by Novice Colonoscopists: Improved Performance without Increase in Workload
Authors: Coderre Sylvain , Anderson John , Rikers Remy , Dunckley Paul , Holbrook Karen , McLaughlin Kevin
Published: March 2016

BACKGROUND: Magnetic endoscopic imaging represents a recent advance in colonoscopy training. This technique provides adjunct information to the endoscopist, specifically with regard to colonoscope loop formation.

OBJECTIVE: To examine the effect of a magnetic endoscopic imager on novice performance and workload in colonoscopy.

METHODS: Twenty complete novices received an introductory teaching session followed by the completion of two procedures on a colonoscopy model. One-half of the participants performed their first procedure with the imager, and the second procedure without, while the other one-half were trained with the inverse sequence. Two main outcome measures were recorded: distance achieved and total workload as measured by the National Aeronautics and Space Administration task load index tool.

RESULTS: A significant improvement was noted between the first and second colonoscopies, with the best performance recorded for participants who performed their first procedure with the imager, and their second without. The imager did not significantly change the total workload.

DISCUSSION: The study participants paid attention to the magnetic endoscopic imager; however, this did not translate into a measurable increase in novice workload. A delayed learning benefit was conferred to the group exposed to the imager on their first colonoscopy, suggesting that, even at an early training stage, the additional imager information entered working memory and was processed in a useful fashion. The introductory teaching strategy used in the present study was successful as judged by the overall distance achieved and performance improvement seen in all study participants.
Canadian Digestive Health Foundation Public Impact Series. Inflammatory Bowel Disease in Canada: Incidence, Prevalence, and Direct and Indirect Economic Impact
Authors: Fedorak Richard N , Wong Karen , Bridges Ron
Published: March 2016

The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada in 2009. The current article presents the updated findings from the study concerning inflammatory bowel diseases – specifically, Crohn’s disease and ulcerative colitis.
Awareness of Risk Factors among Persons at Risk for Lung Cancer, Chronic Obstructive Pulmonary Disease and Sleep Apnea: A Canadian Population-Based Study
Authors: Walker Shannon L , Saltman David L , Colucci Rosemary , Martin Lesli
Published: March 2016

OBJECTIVE: To assess awareness among persons at risk for lung cancer, chronic obstructive pulmonary disease (COPD) and sleep apnea regarding symptoms and risk factors of the disease, and their attitudes regarding the disease and toward those who are affected.

METHODS: A quantitative hybrid telephone and Internet survey of a representative population of Canadian adults at risk for at least one of the three diseases was conducted. To measure the awareness and attitudes of First Nations, Inuit and Métis people to these diseases, a proportionate number were also surveyed.

RESULTS: A total of 3626 individuals were contacted. Of these, 3036 (84%) were eligible to participate. Of those at risk for lung cancer and COPD, 65% and 69%, respectively, were due to tobacco smoke exposure. Among those at risk, 72% believed that they were informed about lung cancer compared with 36% for COPD and 56% for sleep apnea. Most respondents were knowledgeable about the common symptoms of lung cancer, COPD and sleep apnea, but were less aware of the impact lifestyle choices could have on the development of these disorders and the availability of treatment. Most of the participants (77%) believed that smoking was an addiction rather than a habit (19%). There were no significant differences in the awareness of risk factors, symptoms and attitudes toward all three lung diseases between First Nations, Inuit and Métis people and the general population.

CONCLUSIONS: Canadians are reasonably aware of risk factors and symptoms for lung cancer and sleep apnea. However, there is poor awareness of COPD as a disease entity. There is a lack of appreciation for the impact lifestyle choices and changes can have on lung diseases.
Will Universal Access to Antiretroviral Therapy Ever be Possible? The Health Care Worker Challenge
Authors: Maddison André R , Schlech Walter F
Published: March 2016

The United Nations millennium development goal of providing universal access to antiretroviral therapy (ART) for patients living with HIV/AIDS by 2010 is unachievable. Currently, four million people are receiving ART, of an estimated 13.7 million who need it. A major challenge to achieving this goal is the shortage of health care workers in low‐income and low‐resource areas of the world. Sub‐Saharan African countries have 68% of the world’s burden of illness from AIDS, yet have only 3% of health care workers worldwide. The shortage of health care providers is primarily caused by a national and international ‘brain drain,’ poor distribution of health care workers within countries, and health care worker burnout.

Even though the millennium development goal to provide universal access to ART will not be met by 2010, it is imperative to continue to build on the momentum created by these humanitarian goals. The present literature review was written with the purpose of attracting research and policy attention toward evidence from small‐scale projects in sub‐Saharan Africa, which have been successful at increasing access to ART. Specifically, a primary‐care model of ART delivery, which focuses on decentralization of services, task shifting and community involvement will be discussed. To improve the health care worker shortage in sub‐Saharan Africa, the conventional model of health care delivery must be replaced with an innovative model that utilizes doctors, nurses and community members more effectively.
A Research Synthesis of Therapeutic Interventions for Whiplash‐Associated Disorder (WAD): Part 4 – Noninvasive Interventions for Chronic WAD
Authors: Teasell Robert W , McClure J Andrew , Walton David , Pretty Jason , Salter Katherine , Meyer Matthew , Sequeira Keith , Death Barry
Published: March 2016

Whiplash‐associated disorder (WAD) represents a significant public health problem, resulting in substantial social and economic costs throughout the industrialized world. While many treatments have been advocated for patients with WAD, scientific evidence supporting their effectiveness is often lacking. A systematic review was conducted to evaluate the strength of evidence for various WAD therapies. Multiple databases (including Web of Science, EMBASE and PubMed) were searched to identify all studies published from January 1980 through March 2009 that evaluated the effectiveness of any clearly defined treatment for acute (less than two weeks), subacute (two to 12 weeks) or chronic (longer than 12 weeks) WAD. The present article, the fourth in a five‐part series, evaluates the evidence for noninvasive interventions initiated during the chronic phase of WAD. Twenty‐two studies that met the inclusion criteria were identified, 12 of which were randomized controlled trials with ‘good’ overall methodological quality (median Physiotherapy Evidence Database score of 6). For the treatment of chronic WAD, there is evidence to suggest that exercise programs are effective in relieving whiplash‐related pain, at least over the short term. While the majority of a subset of nine studies supported the effectiveness of interdisciplinary interventions, the two randomized controlled trials provided conflicting results. Finally, there was limited evidence, consisting of one supportive case series each, that both manual joint manipulation and myofeedback training may provide some benefit. Based on the available research, exercise programs were the most effective noninvasive treatment for patients with chronic WAD, although many questions remain regarding the relative effectiveness of various exercise regimens.
Racial Differences in the Incidence of Colorectal Cancer
Authors: Virk Rukinder , Gill Sharlene , Yoshida Eric , Radley Simon , Salh Baljinder
Published: March 2016

BACKGROUND: Colon cancer is one of the most common cancers and the second most common cause of cancer mortality in Western societies. Population screening has been introduced as a means to reducing its impact; however, there are little or no data on the incidence of this disorder in the different populations that comprise the Canadian population.

OBJECTIVE: To retrospectively determine the incidence of colorectal cancer in selected racial populations of British Columbia.

METHODS: The British Columbia Cancer Agency database was used to retrieve information on the incidence of cancers occurring during the years 1994 to 1998, with the British Columbia and national population censuses used to derive the age-specific and age-standardized incidence rates of colorectal cancers. Surnames were used to identify the origin of individuals from South Asian and Chinese backgrounds.

RESULTS: For the Caucasian Canadian (C) population, the weighted age-standardized incidence rate ranged from 51.99 per 100,000 in 1995, to 57.68 per 100,000 in 1998. For Chinese Canadians (CC), the range was 39.2 per 100,000 in 1996, to 31.2 per 100,000 in 1998. For South Asian Canadians (SAC), the range was 7.40 per 100,000 in 1994, to 24.85 per 100,000 in 1998. The RR for the development of cancer were significantly different when comparing C versus CC (RR 1.9; 95% CI 1.58 to 2.31; P<0.001), C versus SAC (RR 7.1; 95% CI 4.20 to 12.0; P<0.0001) and CC versus SAC (RR 3.7; 95% CI 2.14 to 6.5; P<0.0001).

CONCLUSIONS: Significant differences in the incidence of colorectal cancers have been defined for the first time in various racial subgroups in British Columbia. This finding may have important implications for both screening and understanding of the environmental factors influencing the biology of these lesions. Because SAC have among the highest incidence of atherosclerotic heart disease and diabetes, it suggests that unidentified genetic and/or environmental protective factors are capable of countering the traditionally recognized risk of high saturated fat intake for the development of colorectal cancer.
Physician Barriers to Population-Based, Fecal Occult Blood Test-Based Colorectal Cancer Screening Programs for Average-Risk Patients
Authors: McGregor S Elizabeth , Hilsden Robert J , Yang Huiming
Published: March 2016

BACKGROUND: Colorectal cancer (CRC) screening is an efficacious but underused means to reduce the burden of CRC. Population-based CRC screening programs are currently being implemented in Canada and physicians are key partners in increasing screening uptake. The current study identified physician attitudes and barriers that need to be addressed by provincial programs.

METHODS: A mailed survey of primary care physicians in Alberta.

RESULTS: The survey response rate was 42.4% (806 of 1903). The majority of physicians suggested CRC screening as part of a routine periodic examination; however, the approach to test selection and the type of tests recommended varied by geographical region. The majority of physicians agreed (48%) or strongly agreed (36%) that a province-wide screening program is the best approach to reducing mortality from CRC. However, there were many serious concerns identified – the most common was endoscopic capacity for follow-up of patients with a positive fecal occult blood test (FOBT), which was cited by 55% to 69% of the physicians surveyed. The barriers to three commonly available tests (FOBT, flexible sigmoidoscopy and colonoscopy) varied according to health region, and the types of barriers identified varied according to the specific test.

INTERPRETATION: Screening for CRC is gradually being accepted among primary care physicians in Alberta. A key finding of the present descriptive study was the regional variation in practices, perceived barriers and concerns about provincial population-based screening programs based on FOBT as the primary screening test. Provincial programs will need to address the issue of endoscopic capacity and perceived barriers to FOBT to gain primary care physician acceptance of FOBT-based CRC screening programs.
Methicillin‐Resistant Staphylococcus aureus Endocarditis and de Novo Development of Daptomycin Resistance during Therapy
Authors: Twele L , Moyen E , Zhang K , Dalton B , Church D , Conly J
Published: March 2016

Daptomycin resistance in Staphylococcus aureus has been previously reported, but the development of resistance while on therapy with subsequent clinical failure for endocarditis has been infrequently reported. A case of persistent methicillin‐resistant S aureus (MRSA) bacteremia in the setting of right‐sided endocarditis in a 38‐year‐old man with a history of intravenous drug use is presented. He developed de novo resistance to daptomycin during therapy after several courses of antibiotics, with subsequent clinical failure. Isolates were identified by molecular characterization to be community‐acquired MRSA 10 (USA300). To the authors’ knowledge, the present case was the first in Canada to involve the de novo development of daptomycin resistance with clinical failure due to MRSA during therapy for endocarditis. Clinicians and microbiologists must be aware of this phenomenon given the implications for treatment and transmission of the strain. It also raises questions regarding the use of daptomycin in settings of heavily pretreated patients with persistent MRSA bacteremia.
The Gastrointestinal Aspects of Halitosis
Authors: Kinberg Sivan , Stein Miki , Zion Nataly , Shaoul Ron
Published: March 2016

BACKGROUND: Halitosis is a common human condition for which the exact pathophysiological mechanism is unclear. It has been attributed mainly to oral pathologies. Halitosis resulting from gastrointestinal disorders is considered to be extremely rare. However, halitosis has often been reported among the symptoms related to Helicobacter pylori infection and gastroesophageal reflux disease.

OBJECTIVE: To retrospectively review the experience with children and young adults presenting with halitosis to a pediatric gastroenterology clinic.

METHODS: A retrospective chart review of patients diagnosed with halitosis as a primary or secondary symptom was conducted. All endoscopies were performed by the same endoscopist.

RESULTS: A total of 94 patients had halitosis, and of the 56 patients (59.6%) who were recently examined by a dental surgeon, pathology (eg, cavities) was found in only one (1.8%). Pathology was found in only six of 27 patients (28.7%) who were assessed by an otolaryngology surgeon. Gastrointestinal pathology was found to be very common, with halitosis present in 54 of the 94 (57.4%) patients. The pathology was noted regardless of dental or otolaryngological findings. Most pathologies, both macroscopically and microscopically, were noted in the stomach (60% non‐H pylori related), followed by the duodenum and the esophagus. Fifty‐two of 90 patients (57.8%) were offered a treatment based on their endoscopic findings. Of the 74 patients for whom halitosis improvement data were available, some improvement was noted in 24 patients (32.4%) and complete improvement was noted in 41 patients (55.4%).

CONCLUSIONS: Gastrointestinal pathology was very common in patients with halitosis regardless of dental or otolaryngological findings, and most patients improved with treatment.
Canadian Association of Gastroenterology Position Statement on Screening Individuals at Average Risk for Developing Colorectal Cancer: 2010
Authors: Leddin Desmond J , Enns Robert , Hilsden Robert , Plourde Victor , Rabeneck Linda , Sadowski Daniel C , Singh Harminder
Published: March 2016

The Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation published guidelines on colon cancer screening in 2004. Subsequent to the publication of these guidelines, many advances have occurred, thereby necessitating a review of the existing guidelines in the context of new technologies and clinical knowledge. The assembled guideline panel recognized three recent American sets of guidelines and identified seven issues that required comment from a Canadian perspective. These issues included, among others, the role of program-based screening, flexible sigmoidoscopy, computed tomography colonography, barium enema and quality improvement. The panel also provided context for the selection of the fecal immunochemical test as the fecal occult blood test of choice, and the relative role of colonoscopy as a primary screening tool. Recommendations were also provided for an upper age limit for colon cancer screening, whether upper endoscopy should be performed following a negative colonoscopy for a positive fecal occult blood test and when colon cancer screening should resume following negative colonoscopy.
Practices in Peptic Ulcer Bleeding Controversies among University‐ Versus Nonuniversity‐Affiliated Gastroenterologists
Authors: Cheung Justin , Sawisky Grant , Enns Robert , Byrne Michael F , Zhu Qiaohao , Wong Clarence KW
Published: March 2016

BACKGROUND: Practices relating to acute peptic ulcer bleeding (APUB) outside of guideline recommendations are unknown.

OBJECTIVE: To evaluate the practices of university‐affiliated (UA) versus nonuniversity‐affiliated (non‐UA) gastroenterologists in controversial APUB issues.

METHODS: Gastroenterologists in Canada were mailed an anonymous questionnaire (January 2008) regarding APUB management.

RESULTS: Responses were received for 281 of the 530 questionnaires mailed (53%). There were no differences between the UA versus non‐UA gastroenterologists regarding acid suppression medication and route of administration pre‐ and postendoscopy (all P>0.05). There were no differences in endoscopic practices between groups regarding large versus small volume injection, endoclip versus combination injection plus coagulation, endoclip versus endoclip plus injection, and management of adherent clots (all P>0.05). There was variability within each group regarding optimal empirical acid suppression pre‐ and postendoscopy, volume of injection therapy and endoclip use. The non‐UA group had longer delays before restarting acetylsalicylic acid (P=0.08) and warfarin (P=0.02) post‐APUB.

CONCLUSIONS: UA and non‐UA gastroenterologists have similar practices in acid suppression and endoscopic therapy for controversial APUB issues; however, non‐UA gastroenterologists appear more cautious in restarting acetylsalicylic acid and warfarin. Further studies are needed to address the optimal empirical acid suppression pre‐ and postendoscopy, injection therapy volume, endoclip use, and timing of restarting antiplatelet and anticoagulation therapy.
A Prospective Audit of Patient Experiences in Colonoscopy Using the Global Rating Scale: A Cohort of 1187 Patients
Authors: de Jonge Vincent , Sint Nicolaas Jerome , Lalor Eoin A , Wong Clarence K , Walters Brennan , Bala Anand , Kuipers Ernst J , van Leerdam Monique E , Veldhuyzen van Zanten Sander JO
Published: March 2016

BACKGROUND: The Global Rating Scale (GRS) comprehensively evaluates the quality of an endoscopy department, providing a patient-centred framework for service improvement.

OBJECTIVE: To assess patient experiences during colonoscopy and identify areas that need service improvement using the GRS.

METHODS: Consecutive outpatients undergoing colonoscopy were asked to complete a pre- and postprocedure questionnaire. Questions were based on GRS items and a literature review. The preprocedure questionnaire addressed items such as patient characteristics and information provision. The postprocedure questionnaire contained questions regarding comfort, sedation, the attitude of endoscopy staff and aftercare.

RESULTS: The preprocedure questionnaire was completed by 1187 patients, whereas the postprocedure part of the questionnaire was completed by 851 patients (71.9%). Fifty-four per cent of patients were first seen in the outpatient clinic. The indication for colonoscopy was explained to 85% of the patients. Sixty-five per cent of the patients stated that information about the risks of colonoscopy was provided. Sedation was used in 94% of the patients; however, 23% judged the colonoscopy to be more uncomfortable than expected. Ten per cent of patients rated the colonoscopy as (very) uncomfortable. Preliminary results of the colonoscopy were discussed with 87% of patients after the procedure. Twenty-one per cent of the patients left the hospital without knowing how to obtain their final results. Being comfortable while waiting for the procedure (OR 9.93) and a less uncomfortable procedure than expected (OR 2.99) were important determinants of the willingness to return for colonoscopy.

CONCLUSIONS: The present study provided evidence supporting the GRS in identifyng service gaps in the quality of patient experiences for colonoscopy in a North American setting. Assessing experiences is useful in identifying areas that need improvement such as the provision of pre- and postprocedure information.
Autisme et Douleur – Analyse Bibliographique
Authors: Dubois Amandine , Rattaz Cécile , Pry René , Baghdadli Amaria
Published: March 2016

The purpose of the present article was to assess the available literature concerning pain and autism. First, authors summarized the published articles on pain reactivity in people with autism. Second, the hypotheses envisaged to explain the presence of expressive particularities in people with autism spectrum disorders were reviewed; these included endogenous opioid excess theory, sensorial abnormalities and sociocommunicative deficit. Finally, the present review dealt with the tools available to assess and manage pain in people with autism. In conclusion, the authors revealed the need for more research to obtain more consensual data and provided some recommendations in this domain that were underexploited by the scientific community. From a clinical point of view, more knowledge about pain in people with autism should enable the development of specific assessment tools and, consequently, better pain management in daily care.
Canadian Hepatitis C Look‐Back Investigation to Detect Transmission from an Infected General Surgeon
Authors: Dawar Meenakshi , Stuart Tammy L , Sweet Lamont E , Neatby Anne M , Abbott Lewis P , Andonov Anton P , Wong Tom , Gervais Robert , Stirling Rob
Published: March 2016

BACKGROUND: In February 2007, a general surgeon in Charlottetown, Prince Edward Island, tested positive for hepatitis C virus (HCV). The surgeon’s infection onset date could not be determined; however, episodic hepatic enzyme elevations were first detected in November 2004 and again in February 2007. HCV transmission during surgery, alhough rare, has been documented. A phased look‐back HCV screening program was conducted to detect HCV transmission from this surgeon to patients who underwent the highest‐risk procedures in the three years before his positive test.

METHODS: Highest‐risk procedures were defined as exposure‐prone procedures (EPP) in which exposure to the surgeon’s blood was most likely. EPP patients from January 2004 to February 2007 were identified using hospital and administrative records. Linkages with the provincial notifiable disease for HCV was performed, and death records for deceased EPP patients were reviewed. Eligible patients were invited for screening.

RESULTS: Of 6248 patients seen in phase 1, 272 (4.4%) were identified to be EPP. Of the 272 patients, 248 (91.1%) were invited for HCV testing and 24 (8.8%) were deceased. To date, 231 of 248 (93.1%) patients have presented for screening. Two patients (one alive, one deceased) were HCV positive before their EPP. Viral sequence of the surgeon’s isolate is unrelated to the first patient; the second individual has a resolved infection (polymerase chain reaction negative). No new transmission events were identified in the screened patients. The 95% CI of the transmission probability was estimated to be 0 to 0.016.

INTERPRETATION: HCV transmission from the surgeon during a 38‐month look back was unlikely. In the absence of protocols for investigating HCV transmission from infected health care workers, screening was initially prioritized to the highest‐risk patients. The investigation has been satisfactorily terminated based on these results.
Posterior Interscalene Block: An Ultrasound‐Guided Case Series and Overview Of History, Anatomy and Techniques
Authors: McNaught Andrew , McHardy Paul , Awad Imad T
Published: March 2016

BACKGROUND: The posterior interscalene block has been described as an alternative to the lateral interscalene block. However, this technique has not gained popularity because of the close proximity of the approach to vascular and central neural structures.

OBJECTIVE: To describe the posterior interscalene block technique using ultrasound imaging, and to review the history of its evolution.

METHODS: The use of ultrasound imaging to facilitate the insertion of interscalene catheters using the posterior approach in 11 patients undergoing total shoulder arthroplasty is described.

RESULTS: All 11 patients had satisfactory analgesia in the first 24 h of the postoperative period. None of the patients complained of neck pain, as had been found in earlier techniques using the posterior approach.

CONCLUSIONS: This modification of the posterior approach is a safe and effective method for the insertion of interscalene brachial plexus catheters. These catheters are also comfortable for patients and, in the present study, none of the catheters inadvertently fell out.
Rabeprazole Combined with Hydrotalcite is Effective for Patients with Bile Reflux Gastritis after Cholecystectomy
Authors: Chen Huimin , Li Xiaobo , Ge Zhizheng , Gao Yunjie , Chen Xiaoyu , Cui Yun
Published: March 2016

BACKGROUND: Regardless of surgical technique, patients who have undergone cholecystectomy appear to be predisposed to the development of bile reflux gastritis.

OBJECTIVE: To assess the efficacy of rabeprazole and hydrotalcite in patients with bile reflux gastritis after cholecystectomy.

METHODS: Postcholecystectomy patients with bile reflux gastritis confirmed by endoscopy and 24 h gastric bilirubin monitoring were randomly assigned to one of four eight-week treatments: observation (group A), rabeprazole alone (group B), hydrotalcite alone (group C) and rabeprazole in combination with hydrotalcite (group D). Endoscopy and 24 h gastric bilirubin monitoring were repeated in all patients after treatment. Dyspeptic symptoms of abdominal pain, bloating, heartburn, bitter taste, endoscopic and histological finding, and biliary reflux were evaluated before and after treatment.

RESULTS: After administering medication, patient symptoms in groups B, C and D were relieved – most significantly in group D (P<0.05). There were no significant differences in endoscopic hyperemia and histological inflammation among the groups (P>0.05). However, histological activity, the number of reflux episodes and the number of reflux episodes lasting longer than 5 min were significantly decreased only in group D (P<0.05). The total per cent of bilirubin absorption (value of 0.14 units or greater) time was decreased in groups B, C and D, and most significantly in group D (P<0.05).

CONCLUSION: Rabeprazole combined with hydrotalcite is an effective therapeutic option in the treatment of patients with bile reflux gastritis after cholecystectomy.
Pneumococcal Peritonitis: Still with Us and Likely to Increase in Importance
Authors: Waisman Darcy C , Tyrrell Gregory J , Kellner James D , Garg Sipi , Marrie Thomas J
Published: March 2016

BACKGROUND: Pneumococcal peritonitis is uncommon and poorly understood.

METHODS: As part of a five‐year study (2000 to 2004) of invasive pneumococcal disease (IPD) in Alberta, all cases of peritonitis due to Streptococcus pneumoniae were reviewed and compared with all other cases of IPD.

RESULTS: Twenty‐three of 1768 (1.3%) IPD patients were found to have peritonitis. Patients with peritonitis were more likely to have cirrhosis, hepatitis C, alcoholism and HIV/AIDS, than the remainder of the patients with IPD. The all‐cause mortality did not differ between the two groups. Peritonitis was classified as primary in nine (39%) patients, secondary in 12 (52%) patients, and genitourinary in females, specifically, in two (9%) patients. Pneumococcal serotypes causing peritonitis were under‐represented in current vaccines – 17% among peritonitis patients versus 53% for the remainder of IPD patients for the 7‐valent pneumococcal conjugate vaccine, and 56% versus 86% for the 23‐valent pneumococcal polysaccharide vaccine.

CONCLUSIONS: Peritonitis represents a small subset of patients with IPD, but one that is likely to grow in importance given the increase in the number of patients with hepatitis C and HIV, and the reduced coverage of peritonitis serotypes in currently available vaccines.
Does the Methacholine Test Reproduce Symptoms?
Authors: Lévesque Marianne , Ghezzo Heberto , L’Archevêque Jocelyne , Malo Jean-Luc
Published: March 2016

BACKGROUND: The interpretation of methacholine test results do not usually consider the symptoms for which the subject was referred and those that occur during the test.

OBJECTIVE: To assess the association between methacholine test results and symptoms, and to examine variables that may affect this association.

METHODS: A total of 400 prospectively chosen subjects who underwent methacholine testing for possible asthma were investigated. The subjects answered a short questionnaire regarding the symptoms for which they had been referred and those that were encountered during the methacholine test.

RESULTS: The positive predictive value for the reproduction of symptoms during the test compared with symptoms for which subjects had been referred were 84% for dyspnea, 87% for cough, 81% for wheezing and 72% for chest tightness. The positive predictive value among the values obtained by measuring the provocative concentration of methacholine causing a 20% fall (PC20) in forced expiratory volume in 1 s on the one hand, and specific symptoms on the other, varied by up to approximately 50%; negative predictive values were higher. Forty-eight per cent of subjects with a PC20of 16 mg/mL or lower reported that the test had globally reproduced their symptoms. This association was significantly stronger in women, young subjects and those taking inhaled steroids.

CONCLUSIONS: The methacholine test generally reproduced the symptoms for which the subjects were referred. The absence of a specific symptom (eg, dyspnea, cough, wheezing or chest tightness), either in daily life or at the time of methacholine testing, was more generally associated with a negative test than the reverse. The global impression that the test had reproduced what the patient had experienced in daily life was significantly associated with a positive test (ie, a PC20of 16 mg/mL or lower), with the association being stronger in young subjects and women.
Asthma and Allergic Disease Prevalence in a Diverse Sample of Toronto School Children: Results from the Toronto Child Health Evaluation Questionnaire (T‐CHEQ) Study
Authors: Dell Sharon D , Foty Richard G , Gilbert Nicolas L , Jerrett Michael , To Teresa , Walter Stephen D , Stieb David M
Published: March 2016

BACKGROUND: Asthma is the most common chronic disease in children.

OBJECTIVES: To describe the prevalence of asthma and allergic disease in a multiethnic, population‐based sample of Toronto (Ontario) school children attending grades 1 and 2.

METHODS: In 2006, the Toronto Child Health Evaluation Questionnaire (T‐CHEQ) used the International Study of Asthma and Allergies in Childhood survey methodology to administer questionnaires to 23,379 Toronto school children attending grades 1 and 2. Modifications were made to the methodology to conform with current privacy legislation and capture the ethnic diversity of the population. Lifetime asthma, wheeze, hay fever and eczema prevalence were defined by parental report. Asthma was considered to be current if the child also reported wheeze or asthma medication use in the previous 12 months.

RESULTS: A total of 5619 children from 283 randomly sampled public schools participated. Children were five to nine years of age, with a mean age of 6.7 years. The overall prevalence of lifetime asthma was 16.1%, while only 11.3% had current asthma. The reported prevalence of lifetime wheeze was 29.2%, while 14.2% reported wheeze in the past 12 months. Sociodemographic and major health determinant characteristics of the T‐CHEQ population were similar to 2001 census data, suggesting a diverse sample that was representative of the urban childhood population.

CONCLUSIONS: Asthma continues to be a highly prevalent chronic disease in Canadian children. A large proportion of children with reported lifetime asthma, who were five to nine years of age, did not report current asthma symptomatology or medication use.
A Research Synthesis of Therapeutic Interventions for Whiplash‐Associated Disorder (WAD): Part 5 – Surgical and Injection‐Based Interventions for Chronic WAD
Authors: Teasell Robert W , McClure J Andrew , Walton David , Pretty Jason , Salter Katherine , Meyer Matthew , Sequeira Keith , Death Barry
Published: March 2016

Whiplash‐associated disorder (WAD) represents a significant public health problem, resulting in substantial social and economic costs throughout the industrialized world. While many treatments have been advocated for patients with WAD, scientific support regarding their effectiveness is often lacking. A systematic review was conducted to evaluate the strength of evidence associated with various WAD therapies. Multiple databases (including Web of Science, EMBASE and PubMed) were searched to identify all studies published from January 1980 through March 2009 that evaluated the effectiveness of any well‐defined treatment for acute (less than two weeks), subacute (two to 12 weeks) or chronic (more than 12 weeks) WAD. The present article, the fifth in a five‐part series, evaluates the evidence for surgical and injection‐based interventions initiated during the chronic phase of WAD. Twenty‐five studies were identified that met the inclusion criteria, six of which were randomized controlled trials with ‘good’ overall methodological quality (median Physiotherapy Evidence Database score of 7.5). For the treatment of chronic WAD, there was moderate evidence supporting radiofrequency neurotomy as an effective treatment for whiplash‐related pain, although relief is not permanent. Sterile water injections have been demonstrated to be superior to saline injections; however, it is not clear whether this treatment is actually beneficial. There was evidence supporting a wide range of other interventions (eg, carpal tunnel decompression) with each of these evaluated by a single nonrandomized controlled trial. There is contradictory evidence regarding the effectiveness of botulinum toxin injections, and cervical discectomy and fusion. The evidence is not yet strong enough to establish the effectiveness of any of these treatments; of all the invasive interventions for chronic WAD, radiofrequency neurotomy appears to be supported by the strongest evidence. Further research is required to determine the efficacy and the role of invasive interventions in the treatment of chronic WAD.
Analysis of Hospital Discharge Data to Characterize Obstructive Sleep Apnea and Its Management in Adult Patients Hospitalized in Canada: 2006 to 2007
Authors: Spurr Kathy F , Morrison Debra L , Graven Michael A , Webber Adam , Gilbert Robert W
Published: March 2016

BACKGROUND: Diagnosed obstructive sleep apnea (OSA) affects 2% to 7% of middle-age persons worldwide and represents a substantial health care burden. The gold standard for treating OSA in adults is continuous positive airway pressure (CPAP) therapy. Compliance with this treatment is especially important in OSA patients experiencing concomitant acute and chronic disease or illness, and those undergoing procedures associated with sedation, analgesia and anesthesia.

OBJECTIVE: To describe the clinical characteristics and management of hospitalized OSA patients in Canada.

METHODS: Using the Canadian Institute for Health Information’s hospital Discharge Abstract Database (fiscal year 2006/2007), a retrospective cohort study of all acute care patients discharged with a diagnosis that included OSA was performed.

RESULTS: An examination of the discharge data of 2,400,245 acute care hospital abstracts identified 8823 cases of OSA. The mean age of OSA patients was 45.7 years and 66.5% were men. The most common comorbidities in the adult OSA population were obesity, cardiovascular disease, type 2 diabetes mellitus and chronic obstructive pulmonary disease. In adult OSA patients, the reported surgical intervention rate using uvulopalatopharyngoplasty (9.6%) was much higher than interventional CPAP therapy (4.8%).

CONCLUSIONS: Only a small percentage of hospitalized OSA patients were documented as having received CPAP therapy during their stay. Issues relating to the accuracy, specificity and completeness of the Canadian Institute for Health Information’s hospital Discharge Abstract Database specific to OSA and its management were identified. Practices pertaining to the reporting, coding and management of hospitalized adult OSA patients warrant further investigation and research.
Outcomes Following Chronic Obstructive Pulmonary Disease Presentations to Emergency Departments in Alberta: A Population-Based Study
Authors: Rowe Brian H , Voaklander Donald C , Marrie Thomas J , Senthilselvan Ambikaipakan , Klassen Terry P , Rosychuk Rhonda J
Published: March 2016

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a complex, multisystem disorder that often results in exacerbations requiring emergency department (ED) management. Following an exacerbation and discharge from the ED, reassessment and management adjustment with a health care provider are recommended to re-establish control of the disease.

OBJECTIVES: To describe outcomes of all COPD presentations to EDs made by adults in Alberta including the time spent in the ED and the physician visits following the ED visit.

METHODS: Provincial administrative databases were used to obtain all ED encounters for COPD during six fiscal years (1999 to 2005). The information extracted included demographics, ED visit timing, and acute and subacute outcomes (physician visits up to 365 days after discharge for all 7302 discharged individuals during a one-year period). Data analysis included descriptive summaries and survival curves.

RESULTS: There were 85,330 ED visits for acute COPD, of which 67% were discharged from the ED. Median ED length of stay was longer in large urban areas (Calgary: 5 h 9 min; Edmonton: 4 h 58 min) than in other regions of Alberta (1 h 17 min). Admissions resulted from 32% of visits and varied among regions; however, few were admitted to the intensive care unit (1%) or died (0.1%). Following discharge, the median time to first follow-up with a physician was 13 days; however, only 40% of patients had follow-up visits in the first seven days. Repeat ED visits within seven days occurred in 5.7% of discharged patients, while 25.6% of discharged patients had repeat ED visits within 365 days of discharge.

CONCLUSIONS: More than 30% of COPD ED visits resulted in admission; regional variation was significant. Moreover, discharged patients experienced delayed follow-up and often required repeat ED visits. Interventions to improve reassessment and reduce COPD-related repeat ED visits should be explored.
Management of Hepatitis B: A Longitudinal National Survey – Impact of the Canadian Hepatitis B Consensus Guidelines
Authors: Marotta Paul , Lucas Kurt
Published: March 2016

BACKGROUND: The Canadian Association for the Study of the Liver, and The Association of Medical Microbiology and Infectious Diseases Canada, jointly developed the Canadian Chronic Hepatitis B (HBV) Consensus Guidelines to assist practitioners involved in the management of this complex disease. These guidelines were published in The Canadian Journal of Gastroenterology in June 2007 and distributed to all Canadian gastroenterologists and hepatologists.

OBJECTIVE: To assess the degree to which Canadian specialist physicians were able to incorporate the recommendations from the Canadian HBV Consensus Guidelines into their daily practice.

METHODS: A 30 min telephone survey probing the management strategies of 80 key HBV specialists was completed on three occasions, eight months apart, to longitudinally assess the impact of the Canadian HBV Consensus Guidelines on the management of HBV. The questionnaire detailed HBV practice patterns, the impact of the Canadian HBV Consensus Guidelines on clinical practice and HBV management.

RESULTS: The majority of specialists incorporated many of the published recommendations outlined in the Canadian HBV Consensus Guidelines into their daily practice for patients with HBV. However, because public drug coverage is a major hurdle in the management of HBV, patients are provided markedly different HBV treatments depending on whether they have public or private drug insurance coverage.

CONCLUSIONS: The management of HBV is growing in complexity and continues to evolve rapidly. The Canadian HBV Consensus Guidelines have served as a valuable tool for many physicians in the management of HBV. However, effective treatment algorithms continue to be rendered irrelevant by restrictive drug coverage issues. Coverage for effective therapies and, therefore, management of HBV, differs widely across Canada depending on therapy reimbursement criteria rather than patient characteristics.
The Relationship among Antibiotic Consumption, Socioeconomic Factors and Climatic Conditions
Authors: Marra Fawziah , Mak Sunny , Chong Mei , Patrick David M
Published: March 2016

BACKGROUND: Antibiotic consumption in human populations is one of the factors responsible for the emergence of resistant organisms. It is important to track population‐based data on an ongoing basis, and to explore the determinants of regional variation in antibiotic consumption.

METHODS: Population‐level data were obtained on all outpatient oral antibiotic prescriptions dispensed within British Columbia (BC) between 1996 and 2007. Prescriptions were expressed as the defined daily dose per 1000 inhabitants. Geographical information systems mapping was used to display the spatial variations of antibiotic consumption in BC. The relationships among antibiotic consumption, socioeconomic factors and climatic conditions were explored using Pearson’s correlation and regression modelling.

RESULTS: Overall antibiotic consumption was highest in the northern regions of BC. Higher rates of consumption were associated with a greater proportion of the Aboriginal population, lower levels of education and individuals younger than 15 years of age. An inverse correlation was found between some classes of antibiotics and the following factors: individuals older than 65 years of age, mortality rate, doctor‐to‐population ratio, household size and higher July temperatures. The adjusted regression analyses indicated that higher antibiotic consumption was associated with a higher proportion of Aboriginals and household income.

CONCLUSION: Different rates of antibiotic consumption exist within BC. The use of antibiotics is correlated with several socioeconomic factors and climatic conditions. It may be useful to consider these factors when designing policies to address antibiotic consumption in the community.
The Changing Frequency of Celiac Disease Diagnosed at the Stollery Children’s Hospital
Authors: Rajani Seema , Huynh Hien Q , Turner Justine
Published: March 2016

BACKGROUND: Celiac disease (CD) is recognized as one of the most common and important autoimmune gastrointestinal disorders affecting children. There is evidence that a diagnosis of CD during childhood improves health outcomes. The increasing prevalence of CD is due to increased awareness of the wide range of extraintestinal symptoms associated with CD.

OBJECTIVE: To determine whether there has been a temporal increase in the diagnosis of CD associated with an increased diagnosis of children without typical gastrointestinal symptoms at the Stollery Children’s Hospital (Edmonton, Alberta).

METHODS: Patients with biopsy‐proven CD diagnosed at the Stollery Children’s Hospital from 1998 to 2007, were identified by retrospective chart review. Baseline and follow‐up data, including demographics, symptoms, risk factors, anthropometrics and laboratory investigations, were collected.

RESULTS: An increase in the frequency of diagnosis of CD was noted during the study period, particularly from January 2003 onward. Before January 2003, nine children were diagnosed with CD – all with typical symptoms. Between January 2003 and January 2007, inclusive, 149 children were diagnosed with CD, of whom 46% had absent or atypical symptoms. At follow‐up, 96% of patients reported improved symptoms, including 53% of individuals who reported being asymptomatic before diagnosis.

CONCLUSIONS: In the last four years of the period studied, the number of children diagnosed with CD at Stollery Children’s Hospital increased 11‐fold. Screening children at risk for CD, and those with atypical presentations, contributed to the increased number of diagnoses. Identification of CD and establishment of lifelong, dietary gluten avoidance during childhood has important health benefits and should be encouraged.