bluuebunny/crossref_metadata_2025 huggingface dataset:
A Nine‐Year Audit of Open‐Access Upper Gastrointestinal Endoscopic Procedures: Results and Experience of a Single Centre
Authors: Keren Dean , Rainis Tova , Stermer Edy , Lavy Alexandra
Published: March 2016

BACKGROUND: The appropriateness and safety of open‐access endoscopy are very important issues as its use continues to increase.

OBJECTIVE: To present a review of a nine‐year experience with open‐access upper gastrointestinal endoscopy with respect to indications, diagnostic efficacy, safety and diseases diagnosed.

METHODS: A retrospective, observational case series of all patients who underwent open‐access endoscopy between January 2000 and December 2008 was conducted. Indications were classified as appropriate or not appropriate according to American Society of Gastrointestinal Endoscopy (ASGE) guidelines. Endoscopic diagnoses were based on widely accepted criteria. Major complication rates were assessed.

RESULTS: A total of 20,620 patients with a mean age of 58 years were assessed, of whom 11,589 (56.2%) were women and 9031 (43.8%) were men. Adherence to ASGE indications led to statistically significant, clinically relevant findings. The most common indications in patients older than age 45 years of age were dyspepsia (28.5%) and anemia (19.7%) in the ASGE‐appropriate group, and dyspepsia in patients younger than 45 years of age without therapy trial (6.6%) in the nonappropriate group. Of the examinations, 38.57% were normal. Hiatal hernia and nonerosive gastritis were the most common findings. Important diagnoses such as malignancies and duodenal ulcers would have been missed if endoscopies were performed only according to appropriateness. There were only two major complications and no mortalities.

CONCLUSIONS: Open‐access upper gastrointestinal endoscopy is a safe and effective system. More relevant findings were found when adhering to the ASGE guidelines. However, using these guidelines as the sole determining factor in whether to perform an endoscopy is not advisable because many clinically relevant diagnoses may be overlooked.
Heterogeneity of Rotavirus Testing and Admitting Practices for Gastroenteritis among 12 Tertiary Care Pediatric Hospitals: Implications for Surveillance
Authors: Bettinger Julie A. , Wills Kathryn , Le Saux Nicole , Scheifele David W , Halperin Scott A. , Vaudry Wendy , Members of the Canadian Immunization Monitoring Program, ACT
Published: March 2016

BACKGROUND: The Canadian Immunization Monitoring Program, ACTive (IMPACT) surveillance for rotavirus relies on monitoring hospital admissions. Because a diagnosis of rotavirus is not necessary for treatment purposes, and rotavirus is not a reportable disease, wide variation may exist in the admitting and testing practices for this disease. From 2005 to 2007, the number of rotavirus admissions differed significantly among IMPACT centres, and this variation could not be explained by population differences alone. Understanding this variation is important when interpreting surveillance data and estimating the cost‐effectiveness of rotavirus vaccination programs.

METHODS: Key informant interviews were conducted with pediatric infectious disease physicians and IMPACT nurse monitors involved with rotavirus surveillance to obtain in‐depth information about rotavirus testing and admitting practices at each of the 12 IMPACT centres.

RESULTS: A total of 18 of 24 interviews were completed, with at least one interview conducted with physicians and/or nurses at each centre. Four major differences were identified among the centres: case‐identification methods, admission definitions, admission criteria and testing criteria. The criteria for admitting and testing patients as well as which patients were defined as admissions had the greatest influence on case totals.

DISCUSSION: The present study found that differences in admitting and testing practices may contribute to significant differences in rotavirus admission totals. Given these differences, caution should be used when using local case estimates for cost‐effectiveness analyses and immunization program decisions. The present study illustrates that understanding the factors that influence the identification of a disease is important when interpreting and applying surveillance data.
Medical Management of Inflammatory Bowel Disease among Canadian Gastroenterologists
Authors: Jones J , Panaccione R , Russell ML , Hilsden R
Published: March 2016

BACKGROUND: Little is known about physician perceptions of and practices in using infliximab – a biological agent that was approved in Canada for the treatment of Crohn’s disease in 2001, and for ulcerative colitis in 2006.

OBJECTIVES: To describe Canadian gastroenterologists’ use and perceptions of infliximab in the treatment of refractory inflammatory bowel disease (IBD), and to identify factors that may influence a gastroenterologist’s decision to initiate infliximab therapy.

METHODS: A postal questionnaire was distributed to all practicing clinicians captured in the 2007 membership of the Canadian Association of Gastroenterology. Each physician was contacted up to a maximum of three times.

RESULTS: Of 466 questionnaires mailed out, responses were received from 336 (72%), with 292 respondents (63%) returning fully completed surveys. For 80% of respondents, IBD patients comprised less than 30% of their clinical practice. Most prescribed infliximab at an initial dose of 5 mg/kg (97%), prescribed loading doses at 0, 2 and 6 weeks (88%), premedicated with corticosteroids (74%), administered maintenance infusions at eight-week intervals (89%), co-administered immunosuppressive agents (81%) and continued infliximab ‘indefinitely’ as long as it was effective and well tolerated (76%). Most gastroenterologists (>70%) identified lack of drug insurance coverage and provincial funding criteria as important barriers to prescribing infliximab.

CONCLUSIONS: Most Canadian gastroenterologists exhibited similar practice patterns with respect to the use of infliximab for induction and maintenance therapy of IBD. Common barriers to the initiation of infliximab therapy were identified.
Yellow Nail Syndrome: Dystrophic Nails, Peripheral Lymphedema and Chronic Cough
Authors: Dornia Christian , Johst Ursula , Lange Tobias , Käb Sabine , Hamer Okka Wilkea
Published: March 2016

A case involving a 41-year-old man with yellow nail syndrome (YNS) is reported. YNS is a rare disorder characterized by yellow, dystrophic nails, peripheral lymphedema and bronchiectasis with recurrent lower respiratory tract infections. YNS is often misdiagnosed because the syndrome is not well known. An interdisciplinary approach is required to recognize and collate the components of the syndrome accurately. Correct diagnosis is of utmost clinical importance because YNS can occur secondary to malignancies and autoimmune disorders. Hence, the diagnosis of YNS must prompt further investigation.
A Simple, Innovative Way to Reduce Rhinitis Symptoms After Sedation during Endoscopy
Authors: Li Nai-Liang , Tseng Shiang-Chung , Hsu Che-Chang , Lai Wei-Ju , Su Hung-Chang , Cheng Tsun-I , Chen Wei-Chun , Peng Wen-Ling
Published: March 2016

BACKGROUND: Supplemental oxygen is routinely given via nasal cannula (NC) to patients undergoing moderate sedation for endoscopy. Some patients complain of profuse rhinorrhea and/or sneezing after the procedure, which results in additional medical costs and patient dissatisfaction.

OBJECTIVES: To determine the causal relationship between the route of oxygen delivery and troublesome nasal symptoms, and to seek possible solutions.

METHODS: Patients (n=836) were randomly assigned to one of the three following groups: the NC group (n=294), the trimmed NC (TNC) group (n=268) and the nasal mask (NM) group (n=274). All received alfentanil 12.5 μg/kg and midazolam 0.06 mg/kg, and adjunct propofol for sedation. Supplemental oxygen at a flow rate of 4 L/min was used in the NC and TNC groups, and 6 L/min in the NM group. The incidence of nasal symptoms and hypoxia were assessed.

RESULTS: The incidence of rhinitis symptoms was significantly higher in the NC group (7.1%) than in the TNC (0.4%) and NM (0%) groups (P<0.001). The incidence of hypoxia was lower in the NC group (3.1%) (P=0.040). All hypoxia events were transient (ie, less than 30 s in duration). On spirometry, the mean value of the lowest saturation of peripheral oxygen was found to be significantly lower in the NM group (96.8%) than in the NC group (97.7%) (P=0.004).

CONCLUSIONS: Trimming the NC or using NMs reduced the incidence of rhinitis symptoms; however, the incidence of hypoxia was higher. Further investigation regarding the efficiency of oxygen supplementation is warranted in the design of novel oxygen delivery devices.
Fecal Immunochemical Tests Compared with Guaiac Fecal Occult Blood Tests for Population-Based Colorectal Cancer Screening
Authors: Rabeneck Linda , Rumble R Bryan , Thompson Frank , Mills Michael , Oleschuk Curtis , Whibley Alexandra , Messersmith Hans , Lewis Nancy , The FIT Guidelines Expert Panel
Published: March 2016

Colorectal cancer (CRC) is the second most common cause of cancer deaths in Canadian men and women – accounting for almost 12% of all cancer deaths. In Ontario, it is estimated that 8100 persons were diagnosed with CRC in 2011, and 3250 died from the disease. CRC incidence and mortality rates in Ontario are among the highest in the world. Screening offers the best opportunity to reduce this burden of disease. The present report describes the findings and recommendations of Cancer Care Ontario’s Fecal Immunochemical Tests (FIT) Guidelines Expert Panel, which was convened in September 2010 by the Program in Evidence-Based Care. The purpose of the present guideline is to evaluate the existing evidence concerning FIT to inform the decision on how to replace the current guaiac fecal occult blood test with FIT in the Ontario ColonCancerCheck Program. Eleven articles were included in the present guideline, comprising two systematic reviews, five articles reporting on three randomized controlled trials and reports of four other studies. Additionally, one laboratory study was obtained that reported on several parameters of FIT tests that helped to inform the present recommendation. The performance of FIT is superior to the standard guaiac fecal occult blood test in terms of screening participation rates and the detection of CRC and advanced adenoma. Given greater specimen instability with the use of FIT, a pilot study should be undertaken to determine how to implement the FIT in Ontario.
Hyperpolarized 3He Functional Magnetic Resonance Imaging of Bronchoscopic Airway Bypass in Chronic Obstructive Pulmonary Disease
Authors: Mathew Lindsay , Kirby Miranda , Farquhar Donald , Licskai Christopher , Santyr Giles , Etemad-Rezai Roya , Parraga Grace , McCormack David G
Published: March 2016

A 73‐year‐old exsmoker with Global initiative for chronic Obstructive Lung Disease stage III chronic obstructive pulmonary disease underwent airway bypass (AB) as part of the Exhale Airway Stents for Emphysema (EASE) trial, and was the only EASE subject to undergo hyperpolarized 3He magnetic resonance imaging for evaluation of lung function pre‐ and post‐AB. 3He magnetic resonance imaging was acquired twice previously (32 and eight months pre‐AB) and twice post‐AB (six and 12 months post‐AB). Six months post‐AB, his increase in forced vital capacity was <12% predicted, and he was classified as an AB nonresponder. However, post‐AB, he also demonstrated improvements in quality of life scores, 6 min walk distance and improvements in 3He gas distribution in the regions of stent placement. Given the complex relationship between well‐established pulmonary function and quality of life measurements, the present case provides evidence of the value‐added information functional imaging may provide in chronic obstructive pulmonary disease interventional studies.
Endoscopic Ultrasound Fine-Needle Aspiration Characteristics of Primary Adenocarcinoma versus Other Malignant Neoplasms of The Pancreas
Authors: Gagovic Veronika , Spier Bret J , DeLee Ryan J , Barancin Courtney , Lindstrom Mary , Einstein Michael , Byrne Siobhan , Harter Josephine , Agni Rashmi , Pfau Patrick R , Frick Terrence J , Soni Anurag , Gopal Deepak V
Published: March 2016

BACKGROUND: Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) is often used to assist in the evaluation of pancreatic lesions and may help to diagnose benign versus malignant neoplasms. However, there is a paucity of literature regarding comparative EUS characteristics of various malignant pancreatic neoplasms (primary and metastatic).

OBJECTIVE: To compare and characterize primary pancreatic adenocarcinoma versus other malignant neoplasms, hereafter referred to as nonprimary pancreatic adenocarcinoma (NPPA), diagnosed by EUS-guided FNA.

METHODS: The present study was a retrospective analysis of a prospectively maintained database. The setting was a tertiary care, academic medical centre. Patients referred for suspected pancreatic neoplasms were evaluated. Based on EUS-FNA characteristics, primary pancreatic adenocarcinoma was differentiated from other malignant neoplasms. The subset of other neoplasms was defined as malignant lesions that were ‘NPPAs’ (ie, predominantly solid or solid/cystic based on EUS appearance and primary malignant lesions or metastatic lesions to the pancreas). Pancreatic masses that were benign cystic lesions (pseudocyst, simple cyst, serous cystadenoma) and focal inflammatory lesions (acute, chronic and autoimmune pancreatitis) were excluded.

RESULTS: A total of 230 patients were evaluated using EUS-FNA for suspected pancreatic mass lesions. Thirty-eight patients were excluded because they were diagnosed with inflammatory lesions or had purely benign cysts. One hundred ninety-two patients had confirmed malignant pancreatic neoplasms (ie, pancreatic adenocarcinoma [n=144], NPPA [n=48]). When comparing adenocarcinoma with NPPA lesions, there was no significant difference in mean age (P=0.0675), sex (P=0.3595) or average lesion size (P=0.3801). On average, four FNA passes were necessary to establish a cytological diagnosis in both lesion subtypes (P=0.396). Adenocarcinomas were more likely to be located in the pancreatic head (P=0.0198), whereas masses in the tail were more likely to be NPPAs (P=0.0006). Adenocarcinomas were also more likely to exhibit vascular invasion (OR 4.37; P=0.0011), malignant lymphadenopathy (P=0.0006), pancreatic duct dilation (OR 2.4; P=0.022) and common bile duct dilation (OR 2.87; P=0.039).

CONCLUSIONS: Adenocarcinoma was more likely to be present in the head of the pancreas, have lymph node and vascular involvement, as well as evidence of pancreatic duct and common bile duct obstruction. Of all malignant pancreatic lesions analyzed by EUS-FNA, 25% were NPPA, suggesting that FNA is crucial in establishing a diagnosis and may be helpful in preoperative planning.
The Nature and Influence of Pharmaceutical Industry Involvement in Asthma Trials
Authors: Bond Kenneth , Spooner Carol , Tjosvold Lisa , Lemière Catherine , Rowe Brian H
Published: March 2016

BACKGROUND: Pharmaceutical industry‐sponsored research has been shown to be biased toward reporting positive results. Frequent industry participation in trials assessing the efficacy of inhaled corticosteroid (ICS) and long‐acting beta2‐agonist (LABA) combination treatment makes assessing industry influence difficult and warrants an assessment of specific potential publication bias in this area.

OBJECTIVE: To describe the frequency of industry involvement in ICS/LABA trials and explore associations among significant outcomes, type of industry involvement and type of primary outcome.

METHODS: A systematic review of trials comparing ICS/LABA combination therapy with ICS monotherapy for asthma was conducted. Data concerning the type of industry sponsorship, primary outcome and statistical results were collected. Comparisons between type of sponsorship and significant results were analyzed using Pearson’s χ2 test and relative risk.

RESULTS: Of 91 included studies (median year of publication 2005 [interquartile range 1994 to 2008]), 86 (95%) reported pharmaceutical involvement. Author affiliation was reported in 49 of 86 (57%), and 19 of 86 (22%) were industry‐reported trials without full publications. The remainder were published journal articles. Studies with a first or senior author affiliated with industry were 1.5 times more likely to report statistically significant results for the primary outcome compared with studies with other types of industry involvement. Pulmonary measures were 1.5 times more likely to be statistically significant than were measures of asthma control.

CONCLUSIONS: The potential biases identified were consistent with other research focused on author role and industry involvement, and suggest that degree of bias may vary with type of affiliation.
A Breath of Fresh Air / Une boufée d’air frais: Abstracts from the 2012 Canadian Respiratory Conference
Authors: Wilcox Pearce
Published: March 2016

The present online supplement highlights the poster abstracts selected for presentation at the 5th Annual Canadian Respiratory Conference (CRC) held in Vancouver, British Columbia, in April 2012. The CRC is a partnership initiative of the Canadian Thoracic Society, Canadian Respiratory Health Professionals, The Lung Association and the Canadian COPD Alliance and has become the premiere national educational and scientific meeting for the respiratory community in Canada. I would like to acknowledge the leadership and expertise of the Scientific Committee, our conference speakers and abstract presenters, all of whom contributed to the delivery of an excellent program. The next Canadian Respiratory Conference will be held in Québec City, Quebec, April 11 to 13, 2012 (www.lung.ca/crc). We look forward to seeing you there!
Development and Pretesting of an Electronic Learning Module to Train Health Care Professionals on the Use of the Pediatric Respiratory Assessment Measure to Assess Acute Asthma Severity
Authors: Lehr Anab R , McKinney Martha L , Gouin Serge , Blais Jean-Guy , Pusic MV , Ducharme Francine M
Published: March 2016

BACKGROUND: Severity‐specific guidelines based on the Pediatric Respiratory Assessment Measure (PRAM), a validated clinical score, reduce pediatric asthma hospitalization rates.

OBJECTIVE: To develop, pretest the educational value of and revise an electronic learning module to train health care professionals on the use of the PRAM.

METHODS: The respiratory efforts of 32 children with acute asthma were videotaped and pulmonary auscultation was recorded. A pilot module, composed of a tutorial and 18 clinical cases, was developed in French and English. Health care professionals completed the module and provided feedback. The performance of participants, case quality and difficulty, and learning curve were assessed using the Rasch test; quantitative and qualitative feedback served to revise the module.

RESULTS: Seventy‐two participants (19 physicians, 22 nurses, four respiratory therapists and 27 health care trainees) with a balanced distribution across self‐declared expertise (26% beginner, 35% competent and 39% expert) were included. The accuracy of experts was superior to beginners (OR 1.79, 1.15 and 2.79, respectively). Overall performance significantly improved between the first and latter half of cases (P<0.001). Participants assessed the module to be clear (96%), relevant (98%), realistic (94%) and useful (99%) to learn the PRAM. The qualitative/quantitative analysis led to the deletion of three cases, modification of remaining cases to further enhance quality and reordering within three levels of difficulty.

DISCUSSION: Using rigorous educational methods, an electronic module was developed to teach health care professionals on use of the PRAM score. Using the back‐translation technique, both French and English versions were developed and validated simultaneously. The pilot module comprised a tutorial and three case‐scenario sections, and was tested on a target audience of physicians, nurses, respiratory therapists and medical trainees.

CONCLUSION: The final electronic learning module met the clarity and quality requirements of a good teaching tool, with a demonstrated learning effect and high appreciation by health care professionals. Available in French and English, it is offered to facilitate implementation of PRAM‐based acute pediatric asthma guidelines.
Optimal Oxygen Titration in Patients with Chronic Obstructive Pulmonary Disease: A Role for Automated Oxygen Delivery?
Authors: Lellouche François , Lipes Jed , L’Her Erwan
Published: March 2016

Oxygen therapy can be life‐saving for patients with chronic obstructive pulmonary disease (COPD) and is the backbone of any acute COPD treatment strategy. Although largely considered to be a benign drug, many publications have highlighted the need to accurately adjust oxygen delivery to avoid both hypoxemia and the problem of hyperoxia‐induced hypercapnia. Recent clinical data have shown that the deleterious effects of excess oxygen treatment can not only alter carbon dioxide levels (which has been known for more than 60 years) but can also lead to an increase in mortality. Nevertheless, despite the extensive literature, the risks associated with hyperoxia are often overlooked and published clinical recommendations are largely ignored. This failure in knowledge translation has become increasingly important not only because of the desire to reduce medical error, but in a society with limited health care resources, the economic burden of COPD is such that it cannot afford to make preventable medical mistakes. Recently, novel devices have been developed to automatically adjust oxygen flow rates to maintain stable oxygen saturations. These closed‐loop oxygen delivery systems have the potential to reduce medical error, improve morbidity and mortality, and reduce health care costs. Preliminary data in this field are promising and will require a significant amount of research in the coming years to determine the precise indications for these systems. The importance of appropriate oxygen dosing and the current literature regarding novel oxygen delivery systems are reviewed.
Tailored Therapy in Lung Cancer
Authors: Rakovich George , Tremblay Lise
Published: March 2016

Historically, all non‐small cell lung cancers were essentially grouped together and considered to be a single disease. However, it is now recognized that non‐small cell lung cancer actually comprises a genetically diverse group of tumours. This, in turn, affords a new opportunity for the development of effective treatments tailored to individual tumours and patients. Advances in molecular biology have made possible the development of drugs against specific molecular targets on cancer cells, most notably the tyrosine kinase inhibitors. The relevant literature and current practice guidelines are discussed. In addition, other related areas of active investigation, including tumour vaccines and pharmacogenetics, are briefly reviewed.
Magnetic Resonance Imaging of the Perineum in Pediatric Patients with Inflammatory Bowel Disease
Authors: Jamieson Douglas H , Shipman Peter , Jacobson Kevan
Published: March 2016

Magnetic resonance imaging (MRI) has profoundly changed and improved the investigation of abdominal and pelvic inflammatory bowel disease (IBD) in pediatrics. Using an imaging modality without ionizing radiation is of particular advantage because the pediatric IBD population is young and often requires repeat evaluation. MRI of the pelvis has become the imaging gold standard for detecting and monitoring perianal disease while bowel-directed imaging techniques (eg, enterography, enteroclysis and colonography) can accurately evaluate bowel inflammation in IBD. With recent technological innovations leading to faster and higher resolution, the role of MRI in IBD will likely continue to expand. The present article focuses on MRI of the perineum in pediatric IBD.
Introducing the Canadian Thoracic Society Framework for Guideline Dissemination and Implementation, with Concurrent Evaluation
Authors: Gupta Samir , Licskai Christopher , Van Dam Anne , Boulet Louis-Philippe
Published: March 2016

The Canadian Thoracic Society (CTS) is leveraging its strengths in guideline production to enable respiratory guideline implementation in Canada. The authors describe the new CTS Framework for Guideline Dissemination and Implementation, with Concurrent Evaluation, which has three spheres of action: guideline production, implementation infrastructure and knowledge translation (KT) methodological support. The Canadian Institutes of Health Research ‘Knowledge‐to‐Action’ process was adopted as the model of choice for conceptualizing KT interventions. Within the framework, new evidence for formatting guideline recommendations to enhance the intrinsic implementability of future guidelines were applied. Clinical assemblies will consider implementability early in the guideline production cycle when selecting clinical questions, and new practice guidelines will include a section dedicated to KT. The framework describes the development of a web‐based repository and communication forum to inventory existing KT resources and to facilitate collaboration and communication among implementation stakeholders through an online discussion board. A national forum for presentation and peer‐review of proposed KT projects is described. The framework outlines expert methodological support for KT planning, development and evaluation including a practical guide for implementers and a novel ‘Clinical Assembly – KT Action Team’, and in‐kind logistical support and assistance in securing peer‐reviewed funding.
Capnography Improves Detection of Apnea During Procedural Sedation for Percutaneous Transhepatic Cholangiodrainage
Authors: Schlag Christoph , Wörner Alexandra , Wagenpfeil Stefan , Kochs Eberhard F , Schmid Roland M , von Delius Stefan
Published: March 2016

BACKGROUND: Capnography provides noninvasive monitoring of ventilation and can enable early recognition of altered respiration patterns and apnea.

OBJECTIVE: To compare the detection of apnea and the prediction of oxygen desaturation and hypoxemia using capnography versus clinical surveillance during procedural sedation for percutaneous transhepatic cholangiodrainage (PTCD).

METHODS: Twenty consecutive patients scheduled for PTCD were included in the study. All patients were sedated during the procedure using midazolam and propofol. Aside from standard monitoring, additional capnographic monitoring was used and analyzed by an independent observer.

RESULTS: The mean (± SD) cumulative duration of apnea demonstrated by capnography was significantly longer than the mean cumulative duration of clinically detected apnea (207.5±348.8 s versus 8.2±17.9 s; P=0.015). The overall number of detected episodes of apnea was also significantly different (113 versus seven; P=0.012). There were 15 events of oxygen desaturation (decrease in oxygen saturation [SaO2] ≥5%), which were predicted in eight of 15 cases by capnography and in one of 15 cases by clinical observation. There were three events of hypoxemia (SaO2<90%) that were predicted in three of three cases by capnography and in one of three cases by clinical observation.

CONCLUSION: Capnographic monitoring was superior to clinical surveillance in the detection of apnea and in the prediction of oxygen desaturation during procedural sedation for PTCD.
Recent Advances in Thoracic X‐Ray Computed Tomography for Pulmonary Imaging
Authors: Precious Bruce J , Raju Rekha , Leipsic Jonathon
Published: March 2016

The present article reviews recent advances in pulmonary computed tomography (CT) imaging, focusing on the application of dual‐energy CT and the use of iterative reconstruction. Dual‐energy CT has proven to be useful in the characterization of pulmonary blood pool in the setting of pulmonary embolism, characterization of diffuse lung parenchymal diseases, evaluation of thoracic malignancies and in imaging of lung ventilation using inhaled xenon. The benefits of iterative reconstruction have been largely derived from reduction of image noise compared with filtered backprojection reconstructions which, in turn, enables the use of lower radiation dose CT acquisition protocols without sacrificing image quality. Potential clinical applications of iterative reconstruction include imaging for pulmonary nodules and high‐resolution pulmonary CT.
A Prospective Determination of the Incidence of Perceived Inappropriate Care in Critically Ill Patients
Authors: Singal Rohit K , Sibbald Robert , Morgan Brenda , Quinlan Mel , Parry Neil , Radford Michael , Martin Claudio M
Published: March 2016

BACKGROUND: Health care providers’ perceptions regarding appropriateness in end‐of‐life treatments have been widely studied. While nurses and physicians believe that rationing and other cost‐related practices sometimes occur in the intensive care unit (ICU), they allege that treatment is often excessive.

OBJECTIVE: To prospectively determine the incidence and causes of health care providers’ perceptions regarding appropriateness of end‐of‐life treatments.

METHODS: The present prospective study collected data from patients admitted to the medical‐surgical trauma ICU of a 30‐bed, Canadian teaching hospital over a three‐month period. Daily surveys were completed independently by bedside nurses, charge nurses and attending physician.

RESULTS: In total, 5224 of 6558 expected surveys (representing 294 patients) were analyzed, yielding a response rate of 79.7%. The incidence of perceived inappropriate care in the present study was 6.5% (19 of 294 patients), with ongoing treatment for >2 days after this determination occurring in 1% (three of 294 patients). However, at least one caregiver perceived inappropriate care at some point in 110 of 294 (37.5%) patients. In these cases, in which processes to address care were not already underway, respondents believed that important issues resulting in provision of inappropriate treatments included patient‐family issues and communication before or in the ICU. Caregivers did not know their patients’ wishes 22% (1129 of 5224) of the time.

CONCLUSIONS: Although ongoing inappropriate care appeared to be a rare occurrence, the issue was a concern to at least one caregiver in one‐third of cases. Public awareness for end‐of‐life issues, adequate communication, and up‐to‐date knowledge and practice in determining the wishes of critically ill patients are potential target areas to improve end‐of‐life care and reduce inappropriate care in the ICU. A daily, prospective survey of multidisciplinary caregivers, such as the survey used in the present study, is a viable and valuable means of determining the scope and causes of inappropriate care in the ICU.
Hepatocellular Carcinoma in a Large Canadian Urban Centre: Stage at Treatment and Its Potential Determinants
Authors: Khalili Korosh , Menezes Ravi , Yazdi Leyla Kochak , Jang Hyun-Jung , Kim Tae Kyoung , Sharma Suraj , Feld Jordan , Sherman Morris
Published: March 2016

OBJECTIVE: To determine whether there is a significant difference in tumour stage between patients initially found with hepatocellular carcinoma (HCC) at a tertiary hepatobiliary centre and patients referred with tumours detected elsewhere; and to determine variables associated with referral in a palliative stage.

METHODS: A retrospective review of 12,199 patients seen at a liver clinic over a 10.5-year period revealed 236 patients with HCC first detected internally (internal) and 163 who were referred with a known mass (referred). All patients were staged at the time of treatment using the Milan criteria for transplantation and Barcelona Clinic Liver Cancer (BCLC) staging system. Curative disease was defined as BCLC stages 0 and A. In the referred group, univariate and multivariate analyses were used to determine which of the following factors were significantly associated with presentation in a palliative stage: age, sex, ethnicity, cause of liver disease, presence of cirrhosis, location of residence and quintile of neighbourhood income.

RESULTS: In comparing the internal versus referred patients, significant differences were found in the proportion of patients fulfilling Milan criteria (72% versus 36%), those with curative disease (75% versus 49%) and those with very early stage tumour (BCLC stage 0, 23% versus 7%); all differences were statistically significant (P<0.001). In patients referred for treatment of HCC from an outside institution, none of the variables tested were associated with presentation in a palliative stage.

CONCLUSION: Patients with HCC referred to a liver treatment centre were more likely to be in palliative stages than those whose tumour was detected internally.
Lobectomy in Patients with Cystic Fibrosis
Authors: Sheikh Shahid I , McCoy Karen , Ryan-Wenger Nancy A , Patel Alpa , Kirkby Stephen
Published: March 2016

BACKGROUND: Some patients with cystic fibrosis (CF) develop severe but localized lung disease or recurrent hemoptysis/pneumothorax refractory to conventional medical therapies.

METHODS: The outcomes of lung resection in patients with CF and worsening localized lung disease or recurrent hemoptysis/pneumothorax refractory to conventional therapy (n=15) were evaluated by reviewing the medical records of all patients with CF followed at the CF Center at Nationwide Children’s Hospital (Columbus, Ohio, USA), who underwent lobectomy over a 15‐year period (1998 to 2012).

RESULTS: The median age of the 15 patients (93% Caucasian) was 20 years (range two to 41 years) and their mean forced expiratory volume in 1 s (FEV1) was 59.5% of predicted one year before surgery. Three patients died within two years after lobectomy; all three deaths occurred in patients with an FEV1 ≤40% of predicted before surgery. There were no significant changes in mean height, weight, body mass index, hospital admissions or antibiotic use over time. The mean FEV1 decreased over time. Compared with at surgery, decline in FEV1 in the year before surgery was −5.4% (P=0.024) and decline in the year after surgery was −1.3% (P=0.513); however, the difference in the rate of decline was not statistically significant.

CONCLUSION: In patients with CF and localized worsening bronchiectasis and/or recurrent hemoptysis/pneumothorax, lobectomy carried a significant risk of mortality, especially in patients with FEV1 ≤40% of predicted, and should only be considered when all other measures fail.
Mediastinal Staging for Lung Cancer
Authors: Gelberg Jacob , Grondin Sean , Tremblay Alain
Published: March 2016

Staging of the mediastinal and hilar lymph nodes plays a crucial role in identifying the best treatment option for patients with confirmed or suspected lung cancer and, in many cases, can simultaneously confirm a diagnosis of cancer. Noninvasive modalities, such as computed tomography (CT), positron emission tomography (PET) and PET‐CT, are an important first step in this assessment. Ultimately, invasive staging is frequently required to confirm or rule out the presence of metastatic disease within the lymph nodes. The present focused review describes and compares noninvasive and invasive modalities for mediastinal staging in lung cancer.
Excessive Daytime Sleepiness among Rural Residents in Saskatchewan
Authors: Gjevre John A , Pahwa Punam , Karunanayake Chandima P , Hagel Louise , Rennie Donna C , Lawson Josh , Dyck Roland , Dosman James A , the Saskatchewan Rural Health Study Team
Published: March 2016

BACKGROUND: Obstructive sleep apnea (OSA) is a common diagnosis in clinical practice. Excessive daytime sleepiness may be a warning for possible OSA.

OBJECTIVES: To assess the prevalence of excessive daytime sleepiness as measured by the Epworth Sleepiness Scale (ESS) in a rural community population; potential risk factors for OSA were also assessed.

METHODS: In 2010, a baseline respiratory health questionnaire within the Saskatchewan Rural Health Study was mailed to 11,982 households in Saskatchewan. A total of 7597 adults within the 4624 (42%) respondent households completed the ESS questionnaire. Participants were categorized according to normal or high (>10) ESS scores. Data obtained included respiratory symptoms, doctor‐diagnosed sleep apnea, snoring, hypertension, smoking and demographics. Body mass index was calculated. Multivariable logistic regression analysis examined associations between high ESS scores and possible risk factors. Generalized estimating equations accounted for the two‐tiered sampling procedure of the study design.

RESULTS: The mean age of respondents was 55.0 years and 49.2% were male. The prevalence of ESS>10 and ‘doctor diagnosed’ OSA were 15.9% and 6.0%, respectively. Approximately 23% of respondents reported loud snoring and 30% had a body mass index >30 kg/m2. Of those with ‘doctor‐diagnosed’ OSA, 37.7% reported ESS>10 (P<0.0001) and 47.7% reported loud snoring (P<0.0001). Risk of having an ESS>10 score increased with age, male sex, obesity, lower socioeconomic status, marriage, loud snoring and doctor‐diagnosed sinus trouble.

CONCLUSIONS: High levels of excessive daytime sleepiness in this particular rural population are common and men >55 years of age are at highest risk. Examination of reasons for residual sleepiness and snoring in persons with and without sleep apnea is warranted.
Reversible Pulmonary Arterial Hypertension Associated with Interferon‐Beta Treatment for Multiple Sclerosis
Authors: Gibbons E , Promislow S , Davies RA , Chandy G , Stewart DJ , Contreras-Dominguez V , Pugliese C , Dunne R , Mielniczuk LM
Published: March 2016

Interferon (IFN) therapy has an important role in the treatment of multiple sclerosis and chronic hepatitis C infection. A few case reports have described an association between IFN therapy and the development of irreversible pulmonary arterial hypertension (PAH), and it is currently listed as a possible drug‐induced cause of PAH in the most recent classification of pulmonary hypertension. A causal link between IFN use and PAH remains to be elucidated; many reports of PAH resulting from IFN occur in individuals with some other risk factor for PAH. The authors present a case involving a patient with multiple sclerosis with no known risk factors for PAH, who developed severe PAH after exposure to IFN therapy. The patient experienced significant clinical and hemodynamic improvement, with normalization of her pulmonary pressures after the initiation of combination therapy for PAH. At 28 months after diagnosis, she remains asymptomatic with no hemodynamic evidence of PAH and has been off all PAH therapy for 10 months.
Cutaneous Sarcoidosis in a Patient with Severe Asthma treated with Omalizumab
Authors: Yung Samuel , Han Duhyun , Lee Jason K
Published: March 2016

Omalizumab, a monoclonal anti‐immunoglobulin E antibody, has been used as an effective treatment for severe asthma associated with atopy over the past decade. Sarcoidosis is an idiopathic granulomatous disorder in which first‐line treatment is usually glucocorticoids. To the authors’ knowledge, the present report describes the first case of an association between omalizumab therapy and revelation of cutaneous sarcoidosis with the withdrawal of systemic glucocorticoids. A 56‐year‐old woman with severe allergic asthma dependent on oral prednisone initiated omalizumab treatment. As her symptoms of asthma improved over the course of a year, her prednisone was gradually tapered. After being off glucocorticoids, she developed skin nodules that had biopsy characteristics of sarcoidosis. The present case illustrates the need to monitor closely for potential unmasking of glucocorticoid‐responsive conditions when transitioning from systemic glucocorticoids to omalizumab therapy.
The Association between Obesity and Outcomes in Critically Ill Patients
Authors: Wardell Stephan , Wall Alastair , Bryce Rhonda , Gjevre John A , Laframboise Karen , Reid John K
Published: March 2016

BACKGROUND: Obesity rates are increasing worldwide, particularly in North America. The impact of obesity on the outcome of critically ill patients is unclear.

METHODS: A prospective observational cohort study of consecutive patients admitted to a tertiary critical care unit in Canada between January 10, 2008 and March 31, 2009 was conducted. Exclusion criteria were age <18 years, admission <24 h, planned cardiac surgery, pregnancy, significant ascites, unclosed surgical abdomen and brain death on admission. Height, weight and abdominal circumference were measured at the time of intensive care unit (ICU) admission. Coprimary end points were ICU mortality and a composite of ICU mortality, reintubation, ventilator‐associated pneumonia, line sepsis and ICU readmission. Subjects were stratified as obese or nonobese, using two separate metrics: body mass index (BMI) ≥30 kg/m2 and a novel measurement of 75th percentile for waist‐to‐height ratio (WHR).

RESULTS: Among 449 subjects with a BMI ≥18.5 kg/m2, both BMI and WHR were available for comparative analysis in 348 (77.5%). Neither measure of obesity was associated with the primary end points. BMI ≥30 kg/m2 was associated with a lower odds of six‐month mortality than the BMI <30 kg/m2 group (adjusted OR 0.59 [95% CI 0.36 to 0.97]; P=0.04) but longer intubation times (adjusted RR 1.56 [95% CI 1.17 to 2.07]; P=0.003) and longer ICU length of stay (adjusted RR 1.67 [95% CI 1.21 to 2.31]; P=0.002). Conversely, measurement of 75th percentile for WHR was associated only with decreased ICU readmission (OR 0.23 [95% CI 0.07 to 0.79]; P=0.02).

CONCLUSIONS: Obesity was not necessarily associated with worse outcomes in critically ill patients.
Using Omnidirectional Vision to Create a Model of the Environment: A Comparative Evaluation of Global-Appearance Descriptors
Authors: Payá L. , Reinoso O. , Berenguer Y. , Úbeda D.
Published: March 2016

Nowadays, the design of fully autonomous mobile robots is a key discipline. Building a robust model of the unknown environment is an important ability the robot must develop. Using this model, this robot must be able to estimate its current position and to navigate to the target points. The use of omnidirectional vision sensors is usual to solve these tasks. When using this source of information, the robot must extract relevant information from the scenes both to build the model and to estimate its position. The possible frameworks include the classical approach of extracting and describing local features or working with the global appearance of the scenes, which has emerged as a conceptually simple and robust solution. While feature-based techniques have been extensively studied in the literature, appearance-based ones require a full comparative evaluation to reveal the performance of the existing methods and to tune correctly their parameters. This work carries out a comparative evaluation of four global-appearance techniques in map building tasks, using omnidirectional visual information as the only source of data from the environment.
A Case of Bullous Skin Disease Presenting with Odynophagia: A Diagnostic Challenge
Authors: Kravvas G. , Veitch D. , Perrett C. M.
Published: March 2016

We report a case of Epidermolysis Bullosa Acquisita (EBA) that presented as a diagnostic challenge. A 60-year-old Qatari lady presented with odynophagia, oral ulceration, and weight loss. Multiple physicians investigated her for over 6 months with a multitude of tests and serial gastroscopies, all of which failed to reach a conclusive diagnosis. Only after referral to a dermatologist and full body examination was diagnosis finally achieved. After reviewing the literature, we provide a summary of EBA and highlight the importance of comprehensive clinical reviews in order to avoid unnecessary morbidity.
Diagnostic Difficulties in Pathological Laboratories in Developing Countries: A Case Report of Differentiated Squamous Cell Carcinoma in a Young Togolese Woman
Authors: Darré Tchin , Sonhaye Lantam , Tchaou Mazamaesso , Aboubakari Abdoul-Samadou , M’Bortche Bingo K. , Amégbor Kofi , Napo-Koura Gado
Published: March 2016

We report a case of poorly differentiated squamous cell carcinoma of the vulva induced by human papillomavirus in a 23-year-old woman, in whom we experienced diagnostic difficulties.
Pulmonary Aspergillosis in a Previously Healthy 13-Year-Old Boy
Authors: Rayment Jonathan H. , Narang Indra
Published: March 2016

Chronic granulomatous disease (CGD) is a rare, polygenic primary immunodeficiency. In this case report, we describe a previously healthy 13-year-old boy who presented with multifocal pulmonary aspergillosis and was subsequently diagnosed with an autosomal recessive form of chronic granulomatous disease. CGD has a variable natural history and age of presentation and should be considered when investigating a patient with recurrent or severe infections with catalase-positive organisms.
System Model Bias Processing Approach for Regional Coordinated States Information Involved Filtering
Authors: Zhou Zebo , Wu Yunlong
Published: March 2016

In the Kalman filtering applications, the conventional dynamic model which connects the states information of two consecutive epochs by state transition matrix is usually predefined and assumed to be invariant. Aiming to improve the adaptability and accuracy of dynamic model, we propose multiple historical states involved filtering algorithm. An autoregressive model is used as the dynamic model which is subsequently combined with observation model for deriving the optimal window-recursive filter formulae in the sense of minimum mean square error principle. The corresponding test statistics characteristics of system residuals are discussed in details. The test statistics of regional predicted residuals are then constructed in a time-window for model bias testing with two hypotheses, that is, the null and alternative hypotheses. Based on the innovations test statistics, we develop a model bias processing procedure including bias detection, location identification, and state correction. Finally, the minimum detectable bias and bias-to-noise ratio are both computed for evaluating the internal and external reliability of overall system, respectively.
Eclectic Ocular Comorbidities and Systemic Diseases with Eye Involvement: A Review
Authors: Pinazo-Durán María D. , Zanón-Moreno Vicente , García-Medina José J. , Arévalo J. Fernando , Gallego-Pinazo Roberto , Nucci Carlo
Published: March 2016

Coexistence of several ocular diseases is more frequent than suspected. In spite of the refractive errors, one or more of the following can be detected simultaneously: glaucoma, cataracts, uveitis, age-related macular degeneration, and dry eyes. In addition, as people age, ocular comorbidities are much more usually seen. Specific diseases are openly acknowledged to affect the eyes and vision, such as diabetes mellitus, hypertension blood pressure, arthritis, hyperthyroidism, neurodegenerative disorders, hematologic malignancies, and/or systemic infections. Recent advances in early diagnosis and therapy of the ophthalmic pathologies have reinforced patient options to prevent visual impairment and blindness. Because of this, it is essential not to overlook sight-threatening conditions such as the ocular comorbidities and/or the eye involvement in the context of systemic disorders. Moreover, the important role of the multidisciplinary cooperation to improve and sustain management of patients affected with eclectic ocular comorbidities and/or systemic disorders with eye repercussion is specifically addressed. This review intends to shed light on these topics to help in making opportune diagnosis and appropriately managing the affected patients.