bluuebunny/crossref_metadata_2025 huggingface dataset:
Publicly Funded, Pegylated Interferon-Alpha Treatment in British Columbia: Disparities in Treatment Patterns for People with Hepatitis C
Authors: Hsu Priscilla C , Buxton Jane A , Tu Andrew W , Hill Warren D , Yu Amanda , Krajden Mel
Published: March 2016

BACKGROUND: An estimated 60,000 British Columbians are chronically infected with the hepatitis C virus (HCV); 10% to 20% will develop cirrhosis after 20 years and 5% to 10% of these will develop hepatocellular carcinoma. Although treatment may prevent cirrhosis and liver cancer, and improve quality of life, availability is limited.

METHODS: Individuals with HCV genotypes 1, 4, 5 and 6 who underwent baseline HCV-RNA tests between January 1, 2003 and December 31, 2005, and were eligible for publicly funded treatment through PharmaCare were linked to British Columbia’s reportable disease database. Patterns in treatment were examined, including age at treatment, sex, location, time to treatment from HCV diagnosis and seasonality of treatment.

RESULTS: When corrected for HCV prevalence, men were more likely to receive treatment than women (RR 1.16, 95% CI 1.02 to 1.31). Patients aged 35 to 54 years and 55 years or older were 3.45 times (95% CI 2.80 to 4.26 times) and 4.49 times (95% CI 3.55 to 5.69 times), respectively, more likely to initiate treatment than 15- to 34-year-olds. Differences were noted between health authorities. Patients in rural health service delivery areas (HSDAs) were 1.25 times (95% CI 1.10 to 1.42 times) more likely to receive treatment than those in urban HSDAs. Patients had an average lapse of four years between HCV diagnosis and receiving treatment. The highest proportion of patients initiated therapy between January and March (36.5%), with the lowest between October and December (less than 14%).

CONCLUSIONS: This data linkage enabled us to identify populations less likely to receive publicly funded treatment. Rural HSDAs have higher rates of therapy initiation; this pattern merits further research but may be a result of integrated prevention and care projects in rural areas. Policy changes to the current PharmaCare funding co-payment schedules could reduce seasonal variability of treatment initiations throughout the year.
Hyperferritinemia in the Chinese and Asian Community: A Retrospective Review of the University of British Columbia Experience
Authors: Yenson Paul R , Yoshida Eric M , Li Charles H , Chung Henry V , Tsang Peter WK
Published: March 2016

BACKGROUND AND METHODS: Elevated serum ferritin is a common clinical finding. The etiology of hyperferritinemia in the Asia-Pacific population is less clear due to a low prevalence of knownHFEmutations such asC282YandH63D, as well as an increased prevalence of viral hepatitis and hereditary anemia. A retrospective case review of 80 patients of Asian ethnicity referred to three subspecialists in tertiary care teaching hospitals between January 1997 and March 2005 for assessment of hyperferritinemia was performed.

RESULTS: Only four patients (5%) had iron overload on liver biopsy or quantitative phlebotomy. Forty-nine patients (61%) had secondary causes for their hyperferritinemia, of which 26 had liver disease; 16 of those patients also had viral hepatitis. Thirteen patients fulfilled criteria for the insulin resistance syndrome. Other causes included hematological disorders (n=10), malignancy (n=2) and inflammatory arthritis (n=2). Twenty-seven cases (34%) of unexplained hyperferritinemia were found. Of a total of 22 patients who underwent liver biopsy, significant iron deposition was found in one patient. Fifteen patients underwentC282YandH63Dgenotyping, with two cases ofH63Dheterozygosity. Fourteen patients had first-degree relatives with hyperferritinemia. Three families were identified with more than two members affected, which is suggestive of a possible hereditary hyperferritinemia syndrome.

CONCLUSION: Secondary causes of elevated ferritin in the Asian population, particularly liver disease, are common, but primary iron overload syndromes appear to be rare. In a significant proportion of patients, the etiology remains unexplained. The genetic basis for hyperferritinemia in Asians is poorly defined and requires further study.
Chronic Pain and Fatigue: Associations with Religion and Spirituality
Authors: Baetz Marilyn , Bowen Rudy
Published: March 2016

BACKGROUND: Conditions with chronic, non‐life‐threatening pain and fatigue remain a challenge to treat, and are associated with high health care use. Understanding psychological and psychosocial contributing and coping factors, and working with patients to modify them, is one goal of management. An individual’s spirituality and/or religion may be one such factor that can influence the experience of chronic pain or fatigue.

METHODS: The Canadian Community Health Survey (2002) obtained data from 37,000 individuals 15 years of age or older. From these data, four conditions with chronic pain and fatigue were analyzed together – fibromyalgia, back pain, migraine headaches and chronic fatigue syndrome. Additional data from the survey were used to determine how religion and spirituality affect psychological well‐being, as well as the use of various coping methods.

RESULTS: Religious persons were less likely to have chronic pain and fatigue, while those who were spiritual but not affiliated with regular worship attendance were more likely to have those conditions. Individuals with chronic pain and fatigue were more likely to use prayer and seek spiritual support as a coping method than the general population. Furthermore, chronic pain and fatigue sufferers who were both religious and spiritual were more likely to have better psychological well‐being and use positive coping strategies.

INTERPRETATION: Consideration of an individual’s spirituality and/or religion, and how it may be used in coping may be an additional component to the overall management of chronic pain and fatigue.
Propofol Use for Sedation during Endoscopy in Adults: A Canadian Association of Gastroenterology Position Statement
Authors: Byrne Michael F , Chiba Naoki , Singh Harminder , Sadowski Daniel C ,   for the Clinical Affairs Committee of the Canadian Association of Gastroenterology
Published: March 2016

Over the past decade, multiple clinical reports have demonstrated that the use of propofol sedation for gastrointestinal endoscopy by gastroenterologists and trained endoscopy nurses is safe and effective in appropriately selected patients. Proposed benefits of propofol sedation include rapid onset of action, improved patient comfort and rapid clearance, as well as prompt recovery and discharge from the endoscopy unit. As a result of medical evidence, a number of international professional societies have endorsed the use of propofol in gastrointestinal endoscopy. In Canada, no formal guidelines currently exist. In the present article, the Clinical Affairs Committee of the Canadian Association of Gastroenterology presents a position statement, incorporating updated information on the use of propofol sedation for endoscopy in adult patients.
Dyspareunia in Postmenopausal Women: A Critical Review
Authors: Kao Alina , Binik Yitzchak M , Kapuscinski Anita , Khalifé Samir
Published: March 2016

BACKGROUND: Dyspareunia, or pain during sexual intercourse, is among the problems most frequently reported by postmenopausal women. Past literature has almost unanimously attributed dyspareunic pain occurring during or after the menopausal transition to declining estrogen levels and vaginal atrophy.

OBJECTIVES: To critically review the literature on the prevalence, risk factors, etiology, clinical presentation and treatment of post‐menopausal dyspareunia. The present review also examines the traditional and widely held conceptualization of postmenopausal dyspareunia as a direct symptom of hormonal decline.

METHODS: Searches of medical and psychological databases were performed for relevant articles and empirical studies. The methodological quality and outcomes of the studies were systematically reviewed.

RESULTS: Available empirical evidence suggests that dyspareunia is common in postmenopausal women, and that it is not highly correlated with menopausal status, estrogen levels or vaginal atrophy. Decreasing levels of endogenous estrogen contribute to the development of dyspareunia in postmenopausal women suffering from vaginal atrophy. Hormonal supplementation is beneficial in alleviating their pain. However, a substantial proportion of treated women do not report relief.

CONCLUSIONS: Postmenopausal dyspareunia occurring concurrently with vaginal atrophy is strongly associated with a lack of estrogen in the genital tract. However, a significant percentage of postmenopausal women experience dyspareunic pain that is not caused by hypoestrogenism. It is likely that other types of dyspareunia that occur premenopausally are also occurring in postmenopausal women. Research is needed to adequately address this issue. A change in perspective toward a multiaxial pain‐focused approach is proposed for future research concerning dyspareunia in postmenopausal women.
Chemoradiation‐Induced Superior Vena Cava Syndrome: A Case Report
Authors: Castonguay Mathieu , Rodrigues George , Vincent Mark , Malthaner Richard A , Guo Lin-Ruo
Published: March 2016

A case of a 54‐year‐old man who developed superior vena cava syndrome secondary to vascular fibrosis, 30 months after radical chemoradiation for stage III non‐small cell lung cancer, is presented. The literature regarding the etiology, diagnosis and treatment of this rare entity is discussed.
Delayed Tuberculosis Treatment in Urban and Suburban Ontario
Authors: Gershon Andrea S , Wobeser Wendy , Tu Jack V
Published: March 2016

BACKGROUND: Delay in the treatment of patients with tuberculosis (TB) increases the risk of poor clinical outcomes – including death and transmission of disease – and may be reducible.

OBJECTIVE: To estimate delays in TB treatment in a Canadian, multicultural population and to examine factors associated with longer time to treatment.

METHODS: Adult cases of active TB from January 1998 to December 2001 from the Ontario Reportable Disease Information System were included. Time to treatment was defined as the number of days between symptom onset and treatment.

RESULTS: Data from 1753 TB patients (76% of eligible patients) were analyzed. Median time to treatment was 62 days (interquartile range 31 to 114 days). Time periods longer than the median time to treatment were independently associated with middle‐aged patients (OR 1.54, 95% CI 1.21 to 1.98), foreign‐born patients who had lived in Canada for more than 10 years (OR 1.47, 95% CI 1.02 to 2.12), patients with nonpulmonary disease (OR 1.57, 95% CI 1.28 to 1.92) and patients managed within certain health districts.

CONCLUSION: A time to TB treatment of two months or more is common in Ontario, and associated with several factors. Future studies are needed to build on these findings to decrease delay and improve individual and public health outcomes.
Burkholderia pseudomallei Infection in a Cystic Fibrosis Patient from the Caribbean: A Case Report
Authors: Corral Dimas Mateos , Coates Allan L , Yau Yvonne CW , Tellier Raymond , Glass Mindy , Jones Steven M , Waters Valerie J
Published: March 2016

Burkholderia pseudomallei is a pathogen identified with increasing frequency in the respiratory tracts of cystic fibrosis (CF) patients from endemic areas such as Southeast Asia and northern Australia. The following report describes the first known reported case in a CF patient from the Caribbean attending a North American CF clinic.
Prevalence of Asthma and Risk Factors for Asthma‐Like Symptoms in Aboriginal and Non‐Aboriginal Children in the Northern Territories of Canada
Authors: Gao Zhiwei , Rowe Brian H , Majaesic Carina , O’Hara Cindy , Senthilselvan A
Published: March 2016

BACKGROUND: Few studies have investigated the prevalence and risk factors of asthma in Canadian Aboriginal children.

OBJECTIVE: To determine the prevalence of asthma and asthma‐like symptoms, as well as the risk factors for asthma‐like symptoms, in Aboriginal and non‐Aboriginal children living in the northern territories of Canada.

METHODS: Data on 2404 children, aged between 0 and 11 years, who participated in the North component of the National Longitudinal Survey of Children and Youth were used in the present study. A child was considered to have an asthma‐like symptom if there was a report of ever having had asthma, asthma attacks or wheeze in the past 12 months.

RESULTS: After excluding 59 children with missing information about race, 1399 children (59.7%) were of Aboriginal ancestry. The prevalence of asthma was significantly lower (P<0.05) in Aboriginal children (5.7%) than non‐Aboriginal children (10.0%), while the prevalence of wheeze was similar between Aboriginal (15.0%) and non‐Aboriginal (14.5%) children. In Aboriginal children, infants and toddlers had a significantly greater prevalence of asthma‐like symptoms (30.0%) than preschool‐aged children (21.5%) and school‐aged children (11.5%). Childhood allergy and a mother’s daily smoking habit were significant risk factors for asthma‐like symptoms in both Aboriginal and non‐Aboriginal children. In addition, infants and toddlers were at increased risk of asthma‐like symptoms in Aboriginal children. In analyses restricted to specific outcomes, a mother’s daily smoking habit was a significant risk factor for current wheeze in Aboriginal children and for ever having had asthma in non‐Aboriginal children.

CONCLUSIONS: Asthma prevalence appears to be lower in Aboriginal children than in non‐Aboriginal children. The association between daily maternal smoking and asthma‐like symptoms, which has been mainly reported for children living in urban areas, was observed in Aboriginal and non‐Aboriginal children living in northern and remote communities in Canada.
Infiltrative Lung Diseases: Complications of Novel Antineoplastic Agents in Patients with Hematological Malignancies
Authors: Vahid Bobbak , Marik Paul E
Published: March 2016

Infiltrative lung disease is a well‐known complication of antineoplastic agents in patients with hematological malignancies. Novel agents are constantly being added to available treatments. The present review discusses different pulmonary syndromes, pathogenesis and management of these novel agents.
Toward Optimal End‐of‐Life Care for Patients with Advanced Chronic Obstructive Pulmonary Disease: Insights from a Multicentre Study
Authors: Rocker Graeme M , Dodek Peter M , Heyland Daren K , for the Canadian Researchers at the End of Life Network
Published: March 2016

BACKGROUND: Understanding patients’ needs and perspectives is fundamental to improving end‐of‐life (EOL) care. However, little is known of what quality care means to patients who have advanced lung disease.

OBJECTIVES: To describe ratings of importance and satisfaction with elements of EOL care, informational needs, decision‐making preferences, obstacles to a preferred location of death, clinical outcomes, and health care use before and during an index hospital admission for patients who have advanced chronic obstructive pulmonary disease (COPD).

METHODS: A questionnaire with regard to quality EOL care was administered to patients older than 55 years of age who had advanced medical disease in five Canadian teaching hospitals.

RESULTS: For 118 hospitalized patients who had advanced COPD, the following items were rated as extremely important for EOL care: not being kept alive on life support when there is little hope for meaningful recovery (54.9% of respondents), symptom relief (46.6%), provision of care and health services after discharge (40.0%), trust and confidence in physicians (39.7%), and not being a burden on caregivers (39.6%). Compared with patients who had metastatic cancer, patients with COPD had lower (P<0.05) satisfaction with care, interest in information about prognosis, cardiopulmonary resuscitation or mechanical ventilation, and referral rates to palliative care, whereas use of acute care services was higher (P<0.05) for patients who had advanced COPD.

CONCLUSION: Canadian patients who have advanced COPD identify several priorities for improving care. Avoidance of prolonged or unwanted life support requires more effective communication, decision making and goal setting. Patients also deserve better symptom control and postdischarge strategies to minimize perceived burdens on caregivers, emergency room visits and hospital admissions.
The Management of Acute Uncomplicated Cystitis in Adult Women by Family Physicians in Canada
Authors: McIsaac Warren J , Prakash Preeti , Ross Susan
Published: March 2016

INTRODUCTION: There are few Canadian studies that have assessed prescribing patterns and antibiotic preferences of physicians for acute uncomplicated cystitis. A cross‐Canada study of adult women with symptoms of acute cystitis seen by primary care physicians was conducted to determine current management practices and first‐line antibiotic choices.

METHODS: A random sample of 2000 members of The College of Family Physicians of Canada were contacted in April 2002, and were asked to assess two women presenting with new urinary tract symptoms. Physicians completed a standardized checklist of symptoms and signs, indicated their diagnosis and antibiotics prescribed. A urine sample for culture was obtained.

RESULTS: Of the 418 responding physicians, 246 (58.6%) completed the study and assessed 446 women between April 2002 and March 2003. Most women (412 of 420, for whom clinical information about antibiotic prescriptions was available) reported either frequency, urgency or painful urination. Physicians would have usually ordered a urine culture for 77.0% of the women (95% CI 72.7 to 80.8) and prescribed an antibiotic for 86.9% of the women (95% CI 83.3 to 90.0). The urine culture was negative for 32.8% of these prescriptions. The most commonly prescribed antibiotic was trimethoprim/sulfamethoxazole (40.8%; 95% CI 35.7 to 46.1), followed by fluoroquinolones (27.4%; 95% CI 22.9 to 32.3) and nitrofurantoin (26.6%; 95% CI 22.1 to 31.4).

CONCLUSION: Empirical antibiotic prescribing is standard practice in the community, but is associated with high levels of unnecessary antibiotic use. While trimethoprim/sulfamethoxazole is the first‐line empirical antibiotic choice, fluoroquinolone antibiotics have become the second most commonly prescribed empirical antibiotic for acute cystitis. The effect of current prescribing patterns on community levels of quinolone‐resistant Escherichia coli may need to be monitored.
Liver Transplantation for Hepatic Epithelioid Hemangioendothelioma: The Canadian Multicentre Experience
Authors: Nudo Carmine G , Yoshida Eric M , Bain Vincent G , Marleau Denis , Wong Phil , Marotta Paul J , Renner Eberhard , Watt Kymberly D , Deschênes Marc
Published: March 2016

INTRODUCTION: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare entity. At the present time, there is no standardized effective therapy. Liver transplantation (LT) has emerged as a treatment for this rare tumour.

OBJECTIVE: To evaluate the outcome of liver transplantation for HEHE at eight centres across Canada.

METHODS: The charts of patients who were transplanted for HEHE at eight centres across Canada were reviewed.

RESULTS: A total of 11 individuals (eight women and three men) received a LT for HEHE. All LTs were performed between 1991 and 2005. The mean (± SD) age at LT was 38.7±13 years. One patient had one large liver lesion (17 cm × 14 cm × 13 cm), one had three lesions, one had four lesions and eight had extensive (five or more) liver lesions. One patient had spleen involvement and two had involved lymph nodes at the time of transplantation. The mean duration of follow-up was 78±63 months (median 81 months). Four patients (36.4%) developed recurrence of HEHE with a mean time to recurrence of 25±25 months (median 15.6 months) following LT. The calculated survival rate following LT for HEHE was 82% at five years.

CONCLUSIONS: The results of LT for HEHE are encouraging, with a recurrence rate of 36.4% and a five-year survival rate of 82%. Further studies are needed to help identify patients who would benefit most from LT for this rare tumour.
A Review of Influenza Vaccine Immunogenicity and Efficacy in HIV‐Infected Adults
Authors: Cooper Curtis , Hutton Brian , Fergusson Dean , Mills Edward , Klein Marina B , Boivin Guy , Halperin Scott
Published: March 2016

BACKGROUND: HIV‐seropositive adults are at an increased risk for influenza infection. They also develop more severe influenza disease and are hyporesponsive to current influenza vaccinations.

METHODS: The authors examined findings from a systematic review of influenza vaccination in HIV‐seropositive adults, and evaluated other relevant studies. A narrative overview of findings formulated to summarize the implications of currently available literature is presented. The primary goal of the present review is to assess the limitations of current evidence and to provide a framework for additional research.

RESULTS: There is a paucity of knowledge regarding the relative value of prophylactic influenza vaccination in HIV‐positive adults compared with immunocompetent populations. There are shortcomings related to study methodology and temporal changes in the characteristics of patient baseline immune status, which limit the utility of this information to shape public health policy.

CONCLUSIONS: There is a pressing need to pursue methodologically rigorous studies that will increase knowledge related to improving the effectiveness of preventive influenza measures in this patient population.
Measuring the Impact of Rotavirus Acute Gastroenteritis Episodes (MIRAGE): A prospective Community‐Based Study
Authors: Sénécal Martin , Brisson Marc , Lebel Marc H , Yaremko John , Wong Richard , Gallant Lee Ann , Garfield Hartley A , Ableman Darryl J , Ward Richard L , Sampalis John S , Mansi James A , for the MIRAGE study group
Published: March 2016

BACKGROUND: Current assessments of the burden of rotavirus (RV)‐related gastroenteritis are needed to evaluate the potential benefits of RV immunization interventions. The objective of the present study was to characterize the burden of RV gastroenteritis among children presenting in outpatient settings with gastroenteritis.

METHODS: Between January and June 2005, 395 children younger than three years of age presenting with gastroenteritis symptoms (at least three watery or looser‐than‐normal stools, or forceful vomiting within the previous 24 h period) were recruited from 59 Canadian clinics and followed for two weeks. Stool specimens were tested for the RV antigen. Gastroenteritis‐related symptoms, health care utilization, parental work loss and other cases of gastroenteritis in the household were assessed by questionnaires and daily symptom cards that were completed by caregivers.

RESULTS: Of 336 conclusive test results, 55.4% were RV positive (RV+). In addition to diarrhea, 67.2% and 89.3% of RV+ children experienced fever or vomiting, respectively. Compared with RV‐negative (RV–) children, RV+ children were more likely to experience the three symptoms concurrently (57.0% versus 26.7%; P<0.001), to be hospitalized (12.9% versus 3.9%; P=0.008) and to induce parental work loss (53.8% versus 37.3%; P=0.003). The median duration of gastroenteritis was eight days for RV+ children (nine days for RV– children). Additional cases of gastroenteritis were present in 46.8% of households in the RV+ group (51.3% of households in the RV– group).

CONCLUSIONS: RV gastroenteritis cases were more severe than other gastroenteritis cases, were hospitalized more often and were associated with considerably more work loss.
Removal of an Impaled Knife under Thoracoscopic Guidance
Authors: Isenburg Seth , Jackson Nicole , Karmy-Jones Riyad
Published: March 2016

Thoracoscopy is being increasingly utilized in stable patients to manage both blunt and penetrating injuries. The case of a patient who presented with a knife impaled in the chest is reported. The knife was able to be removed under thoracoscopic guidance, avoiding thoracotomy.
Celiac Crisis in an Adult on Immunosuppressive Therapy
Authors: Shammeri Owayed Al , Duerksen Donald R
Published: March 2016

‘Celiac crisis’ is a rare presentation of celiac disease with manifestations that include severe diarrhea, and severe metabolic and electrolyte abnormalities. It is most frequently seen in children younger than two years of age and has been rarely described in adults. A case of a 50-year-old woman who presented with diarrhea, severe dehydration, hypokalemia and metabolic acidosis is described. Based on positive serology and small bowel biopsy, she was diagnosed with celiac disease. She also had histological evidence of lymphocytic colitis. Microscopic colitis has not previously been described in association with celiac crisis, but it may have contributed to the presentation of celiac crisis in the current case. The patient was on corticosteroids and azathioprine for autoimmune hepatitis at the time of her presentation. The current case demonstrates that modest immunosuppression does not prevent a celiac crisis, although previous reports have shown that patients may respond rapidly to high-dose corticosteroids.
Adjuvant Chemotherapy in Resected Lung Cancer: Two‐Year Experience in a University Hospital
Authors: Bouchard Nicole , Laberge Francis , Raby Bruno , Martin Sylvie , Lacasse Yves
Published: March 2016

BACKGROUND: Randomized trials have confirmed the benefits of adjuvant chemotherapy in improving survival in resected early‐stage non‐small‐cell lung cancer (NSCLC). The extent to which these results have translated into clinical practice is unknown.

OBJECTIVE: To examine the referral pattern of patients with resected lung cancer to adjuvant chemotherapy, and to compare compliance and toxicities with current literature.

METHODS: A retrospective analysis of all patients who underwent a surgical resection for lung cancer at Laval Hospital (Quebec City, Quebec) from March 2004 to January 2006 was conducted.

RESULTS: A total of 258 patients underwent surgery. Seven patients were excluded because of early postoperative death, and two patients were excluded because of incomplete data. Data from 249 patients were analyzed (94% NSCLC). Fifty per cent were referred to medical oncology for consideration of adjuvant chemotherapy, including 37 of 61 patients with stage II NSCLC. One hundred patients received chemotherapy. No significant difference in age, sex, comorbidities and surgical procedures was observed between those who received chemotherapy and those who did not. Chemotherapy was initiated 47 days (median) after the surgery and consisted mainly of cisplatin‐vinorelbine (38%), cisplatin‐etoposide (22%) and carboplatin‐paclitaxel (20%). Sixty‐six per cent of the patients completed all four cycles. Grade 3 or 4 toxicities consisted mainly of fatigue (23%) and cytopenia (40%). No death was registered; 15% had to be hospitalized because of adverse effects.

CONCLUSION: Although adjuvant chemotherapy is gaining acceptance in clinical practice, more patients should be referred to medical oncology following surgical resection. Compliance and toxicity are similar to or better than those described in published randomized trials.
Review of Systematic Reviews on Acute Procedural Pain in Children in the Hospital Setting
Authors: Stinson Jennifer , Yamada Janet , Dickson Alison , Lamba Jasmine , Stevens Bonnie
Published: March 2016

BACKGROUND: Acute pain is a common experience for hospitalized children. Despite mounting research on treatments for acute procedure‐related pain, it remains inadequately treated.

OBJECTIVE: To critically appraise all systematic reviews on the effectiveness of acute procedure‐related pain management in hospitalized children.

METHODS: Published systematic reviews and meta‐analyses on pharmacological and nonpharmacological management of acute procedure‐related pain in hospitalized children aged one to 18 years were evaluated. Electronic searches were conducted in the Cochrane Database of Systematic Reviews, Medline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature and PsycINFO. Two reviewers independently selected articles for review and assessed their quality using a validated seven‐point quality assessment measure. Any disagreements were resolved by a third reviewer.

RESULTS: Of 1469 published articles on interventions for acute pain in hospitalized children, eight systematic reviews met the inclusion criteria and were included in the analysis. However, only five of these reviews were of high quality. Critical appraisal of pharmacological pain interventions indicated that amethocaine was superior to EMLA (AstraZeneca Canada Inc) for reducing needle pain. Distraction and hypnosis were nonpharmacological interventions effective for management of acute procedure‐related pain in hospitalized children.

CONCLUSIONS: There is growing evidence of rigorous evaluations of both pharmacological and nonpharmacological strategies for acute procedure‐related pain in children; however, the evidence underlying some commonly used strategies is limited. The present review will enable the creation of a future research plan to facilitate clinical decision making and to develop clinical policy for managing acute procedure‐related pain in children.
Increase of Urinary 5-Hydroxyindoleacetic Acid Excretion but Not Serum Chromogranin a Following Over-The-Counter 5-Hydroxytryptophan Intake
Authors: Joy Tisha , Walsh Grace , Tokmakejian Sonya , Van Uum Stan HM
Published: March 2016

BACKGROUND: 5-hydroxyindoleacetic acid (5-HIAA) excretion is commonly measured for biochemical detection of carcinoid tumours. A 77-year-old woman was referred for elevated 24 h urine 5-HIAA excretion (510 μmol/day; normal is less than 45 μmol/day) and serum chromogranin A (CgA) (72.1 U/L; normal is less than 18 U/L), both subsequently normalized after discontinuation of 5-hydroxytryptophan (5-HTP). 5-HTP, a precursor of serotonin, is not commonly listed as a substance that increases 5-HIAA levels in urine. The effect of 5-HTP on CgA has not been previously described.

OBJECTIVES: To determine whether, and to what extent, oral 5-HTP increases urine 5-HIAA excretion and serum CgA levels in healthy volunteers.

PATIENTS AND METHODS: A randomized, prospective, double-blind, placebo-controlled crossover study, with a four-day washout period, was performed in a general community setting. Eight healthy subjects aged 22 to 58 years were recruited by advertising. Bedtime ingestion of 5-HTP 100 mg/day was compared with placebo ingestion for 10 days. Twenty-four hour urine excretion of 5-HIAA and serum CgA were the main outcome measures.

RESULTS: Median (range) urinary 5-HIAA excretion was 204 μmol/day (22 μmol/day to 459 μmol/day) during 5-HTP intake, compared with 18 μmol/day (12 μmol/day to 36 μmol/day) during placebo intake (P=0.017). 5-HTP did not affect clinical symptoms or serum CgA levels.

CONCLUSIONS: Oral 5-HTP increases urinary 5-HIAA excretion with considerable interindividual variation. In a small number of subjects, oral 5-HTP did not affect serum CgA levels. Therefore, increased 5-HIAA levels with normal CgA levels may suggest 5-HTP ingestion. The use of over-the-counter 5-HTP should be excluded as the cause of increased urinary 5-HIAA levels before initiating diagnostic tests to search for a carcinoid tumour. 5-HTP should be added to popular references as a substance that may cause increased 5-HIAA excretion.
Rare Lung Diseases II: Pulmonary Alveolar Proteinosis
Authors: Juvet Stephen C , Hwang David , Waddell Thomas K , Downey Gregory P
Published: March 2016

The present article is the second in a series on rare lung diseases. It focuses on pulmonary alveolar proteinosis (PAP), a disorder in which lipoproteinaceous material accumulates in the alveolar space. PAP was first described in 1958, and for many years the nature of the material accumulating in the lungs was unknown. Major insights into PAP have been made in the past decade, and these have led to the notion that PAP is an autoimmume disorder in which autoantibodies interfere with signalling through the granulocyte‐macrophage colony‐stimulating factor receptor, leading to macrophage and neutrophil dysfunction. This has spurred new therapeutic approaches to this disorder. The discussion of PAP will begin with a case report, then will highlight the classification of PAP and review recent insights into the pathogenesis of PAP. The approach to therapy and the prognosis of PAP will also be discussed.
The Prevalence and Predictors of Tuberculin Positivity in Subjects Screened for Reasons other than Contact Investigation
Authors: Hernández-Garduño Eduardo , Elwood R Kevin
Published: March 2016

BACKGROUND: No previous studies have estimated the rates of tuberculin positivity (TP) in noncontact populations within the same community, which is important for prioritizing and implementing preventive measures.

OBJECTIVES: To estimate the prevalence and predictors of TP in noncontact populations.

METHODS: A retrospective analysis of tuberculin results of non‐contact populations screened in British Columbia from 1990 to 2002 was conducted.

RESULTS: The period prevalence of TP in 59,791 screened subjects was 12.7% (95% CI 12.4% to 13.0%), 30.4% (95% CI 28.2% to 32.7%) and 60.9% (95% CI 60.3% to 61.6%) for Canadian‐born non‐Aboriginals (CBNAs), Canadian‐born Aboriginals (CBAs) and foreign born (FB), respectively. After controlling for age and sex, independent predictors of TP included Bacille Calmette‐Guérin (BCG) vaccination (OR 19.6, 95% CI 17.9 to 21.5), country of birth (CBA: OR 2.87, 95% CI 2.44 to 3.37; FB: OR 3.67, 95% CI 3.34 to 4.03) and the following populations: correctional centre residents (OR 4.14, 95% CI 1.87 to 9.15), residents of long‐term care and community care facilities (OR 1.79, 95% CI 1.44 to 2.23), immigrants (OR 1.75, 95 % CI 1.50 to 2.04), health centre employees (OR 1.71, 95 % CI 1.56 to 1.88), volunteers (OR 1.38, 95% CI 1.14 to 1.68), self‐referred healthy subjects (OR 1.30, 95% CI 1.15 to 1.48) and students (OR 1.27, 95% CI 1.19 to 1.35). CBAs, FB and male subjects were less likely to react to tuberculin than CBNAs and female subjects among those vaccinated with Bacille Calmette‐Guérin (P<0.05).

CONCLUSIONS: Rates of TP correlate with disease rates by sex and origin. The continuation of tuberculin screening programs is warranted in noncontact populations with high TP rates, where unknown exposure to active cases is more likely to occur. Further research is needed to determine the reasons why a higher response to tuberculin occurs in BCG‐vaccinated women and CBNAs.
Colonoscopic Preoperative Localization Using Submucosal Injection of Radiolabelled Colloid
Authors: Cho Carolyn , Jain Sanjiv , Pilbeam Mark , Tait Noel , Thomson Andrew
Published: March 2016

Malignant colonic polyps can be removed endoscopically but surgical resection is sometimes required. However, the polypectomy site can be difficult to locate. Current methods use various tattooing agents, with varying degrees of success. A new technique using pre-operative injection of technetium-99m-labelled antimony colloid, with intraoperative localization using a handheld gamma probe, is described. Although unsuccessful in terms of localizing a previously partially resected polyp, the technique itself proved safe and simple, and has some advantages over other endoscopic approaches.
The CASE Survey: Patient and Physician Perceptions Regarding Asthma Medication Use and Associated Oropharyngeal Symptoms
Authors: FitzGerald J Mark , Chan Charles KN , Holroyde Martin C , Boulet Louis-Philippe
Published: March 2016

BACKGROUND: Oropharyngeal (OP) symptoms are common in asthma patients using inhaled corticosteroids (ICSs) alone and in combination with a long‐acting beta2‐agonist (LABA). Patterns of medication use, level of asthma control and association with OP symptoms are not often reported in a nonstudy setting.

OBJECTIVES: To determine the prevalence of OP symptoms among adult asthma patients using ICSs alone and an ICS plus a LABA; to investigate the relationships between medication use, asthma control and OP symptoms; and to assess family physicians’ (FPs’) perceptions of the prevalence and management of OP symptoms.

METHODS: A random telephone survey of 1003 asthma patients and 250 FPs treating asthma patients was conducted from February to March 2005 across Canada.

RESULTS: Twenty‐four per cent of patients experienced OP symptoms; 67% of them spoke to their FPs about the OP symptoms. Thirty‐one per cent of patients who experienced OP symptoms stopped or reduced their dose of medication. OP symptoms were reported by 25% of patients using ICSs and 22% using an ICS plus a LABA. The incidence of OP symptoms was not affected by the choice of inhalation device (metered‐dose inhaler versus dry powder inhaler) or the use of a spacer. Fifty‐eight per cent of patients had uncontrolled asthma; patients achieving a lower level of general education were more likely to have poor control. Patients with uncontrolled asthma were more likely than those with controlled asthma to report OP symptoms (28% versus 18%, respectively; P<0.05). Eighty‐nine per cent of FPs had patients who had reported OP symptoms to them. FPs estimated that 15% of their patients experienced OP symptoms and that compliance to treatment worsened in approximately 20% of them.

CONCLUSIONS: The prevalence of OP symptoms in asthma patients using ICSs and an ICS plus a LABA is significant. OP symptoms were found to be associated with a reduced patient education level, with a likelihood of reducing or stopping medication, and with a less well‐controlled asthma patient. While FPs recognized that a significant proportion of their asthma patients experience OP symptoms and that OP symptoms may affect compliance, they underestimated the prevalence of this problem.
Esophageal Leiomyomatosis – An Unusual Cause of Pseudoachalasia
Authors: Ray Sukanta , Saluja Sundeep Singh , Gupta Ruchika , Chattopadhyay Tushar Kanti
Published: March 2016

Esophageal leiomyomatosis is a rare hamartomatous disorder with varied presentation. In the literature, it is described mostly in children, and is associated with Alport’s syndrome. A case of leiomyomatosis that presented as achalasia not associated with Alport’s syndrome is described in a 35-year-old woman with a 16-year history of dysphagia. Barium swallow showed a smooth narrowing at the lower end of the esophagus with a longer than usual stricture length. Endoscopy showed a dilated esophagus with a submucosal nodule in the region of the cardia. A computed tomography scan revealed circumferential thickening of the esophagus involving the gastroesophageal junction, with fat planes maintained with the adjacent structure. Endoscopic ultrasound demonstrated a lesion arising from the muscularis propria. The manometry findings were suggestive of achalasia. She underwent transhiatal esophagectomy with gastric pull-up.

Leiomyomatosis should be considered as a cause of psuedoachalasia in patients with symptoms suggestive of achalasia and atypical barium findings. Attempts should be made to confirm the diagnosis preoperatively using computed tomography and/or endoscopic ultrasound. Esophagectomy is the treatment of choice.
Understanding Caregiver Judgments of Infant Pain: Contrasts of Parents, Nurses and Pediatricians
Authors: Pillai Riddell Rebecca R , Horton Rachel E , Hillgrove Jessica , Craig Kenneth D
Published: March 2016

BACKGROUND: Research suggests that caregivers’ beliefs pertaining to infant pain and which infant pain cues are perceived to be important play an integral role in pediatric pain assessment and management.

OBJECTIVES: Following a recent quasi‐experimental study reporting on caregiver background and age differences in actual infant pain judgments, the present study clarified these findings by analyzing caregivers’ pain beliefs and the cues they use to make pain assessments, and by examining how the wording of belief questions influenced caregivers’ responses.

METHODS: After making pain judgments based on video footage of infants between two and 18 months of age receiving immunizations, parents, nurses and pediatricians were required to respond to questionnaires regarding pain beliefs and importance of cues.

RESULTS: Parents generally differed from pediatricians. Parents tended to have less optimal beliefs regarding medicating the youngest infants, were more influenced by question wording, and reported using many more cues when judging older infants than other caregiver groups. In terms of beliefs, influence of question wording and cue use, nurses tended to fall in between both groups; they displayed similarities to both parents and pediatricians.

CONCLUSIONS: Paralleling the original findings on pain judgments, these findings suggest that parents differ from pediatricians in their pain beliefs and the cues they use to make pain judgments. Moreover, some similarities were found between parents and nurses, and between nurses and pediatricians. Finally, caution must be taken when interpreting research pertaining to beliefs about infant pain because question wording appears to influence interpretation.
Sex Disparities in Effects of Cystic Fibrosis‐Related Diabetes on Clinical Outcomes: A Matched Study
Authors: Miller Robert J , Tildesley Hugh D , Wilcox Pearce G , Zhang Hongbin , Kreisman Stuart H
Published: March 2016

BACKGROUND: Cystic fibrosis‐related diabetes (CFRD) is an increasingly prevalent comorbidity factor for patients with cystic fibrosis (CF). CFRD has been associated with an accelerated decline in clinical parameters and an increased mortality rate.

OBJECTIVES: To investigate the clinical impact of CFRD on pulmonary function and clinical status using a matched study design to further explore potential causality.

METHODS: Charts from the adult CF clinic at St Paul’s Hospital (Vancouver, British Columbia) were retrospectively reviewed. Forty CFRD patients with and without fasting hyperglycemia were matched to CF patients with nondiabetic glucose tolerance based on sex, age and forced expiratory volume in 1 s (FEV1).

RESULTS: Sixteen of 40 CFRD patients (40%) died compared with nine of 40 patient controls (23%) (P=0.13). CFRD patients were more likely to experience declines in FEV1 (P<0.01), especially women (P<0.01). Patients with CFRD were not more likely to be hospitalized (P=0.39). Body mass index did not differ between groups.

CONCLUSIONS: Patients with CFRD had higher rates of FEV1 deterioration than nondiabetic patients with CF, and showed a trend toward increased mortality. The present study suggests that CFRD has a significant clinical impact and should be carefully considered when evaluating the status of CF patients.
Role of Health Care Professionals in Multidisciplinary Pain Treatment Facilities in Canada
Authors: Peng Philip , Stinson Jennifer N , Choiniere Manon , Dion Dominique , Intrater Howard , LeFort Sandra , Lynch Mary , Ong May , Rashiq Saifee , Tkachuk Gregg , Veillette Yves , the STOPPAIN Investigators Group
Published: March 2016

PURPOSE: To examine the role of health care professionals in multidisciplinary pain treatment facilities (MPTF) for the treatment of chronic pain across Canada.

METHODS: MPTF were defined as clinics that advertised specialized multidisciplinary services for the diagnosis and management of chronic pain, and had staff from a minimum of three different health care disciplines (including at least one medical specialty) available and integrated within the facility. Administrative leaders at eligible MPTF were asked to complete a detailed questionnaire on their infrastructure as well as clinical, research, teaching and administrative activities.

RESULTS: A total of 102 MPTF returned the questionnaires. General practitioners, anesthesiologists and physiatrists were the most common types of physicians integrated in the MPTF (56%, 51% and 32%, respectively). Physiotherapists, psychologists and nurses were the most common nonphysician professionals working within these MPTF (75%, 68% and 57%, respectively), but 33% to 56% of them were part‐time staff. Only 77% of the MPTF held regular interdisciplinary meetings to discuss patient management, and 32% were staffed with either a psychologist or psychiatrist. The three most frequent services provided by physiotherapists were patient assessment, individual physiotherapy or exercise, and transcutaneous electrical nerve stimulation. The three most common services provided by psychologists were individual counselling, cognitive behavioural therapy and psychodynamic therapy. The major roles of nurses were patient assessment, assisting in interventional procedures and patient education.

CONCLUSION: Different health care professionals play a variety of important roles in MPTF in Canada. However, few of them are involved on a full‐time basis and the extent to which pain is assessed and treated in a truly multidisciplinary manner is questionable.
Prospective Relation between Catastrophizing and Residual Pain following Knee Arthroplasty: Two‐Year Follow‐Up
Authors: Forsythe Michael E , Dunbar Michael J , Hennigar Allan W , Sullivan Michael JL , Gross Michael
Published: March 2016

BACKGROUND: Pain is the primary indication for both primary and revision total knee arthroplasty (TKA); however, most arthroplasty outcome measures do not take pain into account.

OBJECTIVE: To document the prospective pain experience following TKA, with subjective pain‐specific questionnaires to determine if comorbidities, preoperative pain or preoperative pain catastrophizing scores are predictive of long‐term pain outcomes.

METHODS: Fifty‐five patients with a primary diagnosis of osteoarthritis of the knee, who were scheduled to undergo TKA, were asked to fill out the McGill Pain Questionnaire (MPQ) and the Pain Catastrophizing Scale (PCS) preoperatively and at three, 12 and 24 months follow‐up. Comorbidities were extracted from the Queen Elizabeth II Health Sciences Centre health information system.

RESULTS: The overall response rate (return of completed questionnaires) was 84%. There was a significant decrease in the MPQ scores (P<0.05) postoperatively. PCS scores did not change over time. Receiver operating characteristic curves revealed the number of comorbidities per patient predicted the presence of pain postoperatively, as documented by the numerical rating subscale of the MPQ at 24 months (P<0.05). Receiver operating characteristic curves for pre‐operative PCS and rumination subscale scores predicted the presence of pain, as measured by the Pain Rating Index subscale of the MPQ at 24 months (P<0.05). Preoperative PCS scores and comorbidities were significantly higher in the persistent pain group (P<0.05).

CONCLUSIONS: The number of comorbidities predicted the presence of pain at 24 months follow‐up and, for the first time, preoperative PCS scores were shown to predict chronic postoperative pain. This may enable the identification of knee arthroplasty patients at risk for persistent postoperative pain, thus allowing for efficient administration of preoperative interventions to improve arthroplasty outcomes.