bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and Incidence of Antimicrobial‐Resistant Organisms among Hospitalized Inflammatory Bowel Disease Patients
Authors: Vaisman Alon , Pivovarov Kevin , McGeer Allison , Willey Barbara , Borgundvaag Bjug , Porter Vanessa , Gnanasuntharam Piraveina , Wei Yanliang , Nguyen Geoffrey C 
Published: March 2016

BACKGROUND: Patients with inflammatory bowel disease (IBD) experience frequent hospitalizations and use of immunosuppressive medications, which may predispose them to colonization with antimicrobial‐resistant organisms (ARO).OBJECTIVE: To determine the prevalence of ARO colonization on admission to hospital and the incidence of infection during hospitalization among hospitalized IBD patients.METHODS: A chart review comparing the prevalence of colonization and incidence of infection with methicillin‐resistant Staphylococcus aureus, vancomycin‐resistant enterococci and extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae (ESBL) in hospitalized IBD patients with those of non‐IBD controls was performed.RESULTS: On admission, there were no significant differences between IBD inpatients and controls in the prevalence of colonization of methicillin‐resistant S aureus (1.0% versus 1.2%; P=0.74), vancomycin‐resistant enterococci (0.2% versus 0%; P=1.0) or ESBL (4.1% versus 5.5%; P=0.33). Pooling data from historical clinic‐based cohorts, IBD patients were more likely than controls to have ESBL colonization (19% versus 6.6%; P<0.05). Antibiotic use on admission was associated with ESBL colonization among IBD inpatients (OR 4.2 [95% CI 1.4 to 12.6]). The incidence of ARO infections during hospitalization was not significantly different between IBD patients and controls. Among IBD patients who acquired ARO infections during hospitalizations, the mean time interval from admission to infection was shorter for those who were already colonized with ARO on admission.CONCLUSIONS: This particular population of hospitalized IBD patients was not shown to have a higher prevalence or incidence of ARO colonization or infection compared with non‐IBD inpatients.
Spirometry in Primary Care
Authors: Coates Allan L , Graham Brian L , McFadden Robin G , McParland Colm , Moosa Dilshad , Provencher Steeve , Road Jeremy 
Published: March 2016

Canadian Thoracic Society (CTS) clinical guidelines for asthma and chronic obstructive pulmonary disease (COPD) specify that spirometry should be used to diagnose these diseases. Given the burden of asthma and COPD, most people with these diseases will be diagnosed in the primary care setting. The present CTS position statement was developed to provide guidance on key factors affecting the quality of spirometry testing in the primary care setting. The present statement may also be used to inform and guide the accreditation process for spirometry in each province.Although many of the principles discussed are equally applicable to pulmonary function laboratories and interpretation of tests by respirologists, they are held to a higher standard and are outside the scope of the present statement.
Clinical Characteristics of Pediatric Patients Hospitalized with Methicillin‐Resistant Staphylococcus aureus in Canadian Hospitals from 2008 To 2010
Authors: Leifso Kirk Ryan , Gravel Denise , Mounchili Aboubaker , Kaldas Sherif , Le Saux Nicole 
Published: March 2016

Methicillin‐resistant Staphylococcus aureus (MRSA) infections were uncommon in children in Canada until the 1990s. Using a standardized case report form, treating physicians reported children hospitalized due to MRSA infections in Canadian hospitals through the Canadian Pediatric Surveillance Program in a 24‐month period (2008 to 2010). Of 155 cases reported, 70% were ≤4 years of age and approximately one‐third had an underlying medical condition. The most common clinical infections involved skin and soft tissue (69%), the lower respiratory tract (12%), and bone and joint (10%). Almost one‐third had had contact with the health care environment in the previous year and 18% had a known household member with MRSA. Initial therapy with a beta‐lactam alone occurred in 65%, while 22% included vancomycin. No child in this cohort died but 14% required admission to the intensive care unit. Of 143 reports of individual isolates, 93% were reported susceptible to trimethoprim‐sulfamethoxazole, 63% to clindamycin and 50% to mupirocin.The present study involved only children hospitalized with MRSA infections. It may not be representative of the children treated as outpatients nor children in selected areas of Canada where MRSA infections may be more endemic. Further targeted surveillance to identify risks and treatment practices in these populations may be important.
Determination of Susceptibility to Fosfomycin and Tigecycline of Enterobacteriaceae, Particularly Escherichia coli Isolates, Producing Extended‐Spectrum β‐Lactamases from Multiple Regional Canadian Hospitals
Authors: Beuk Carlee , Hill Christian , Whitehead Sue , Blondel-Hill Edith , Wagner Ken , Cheeptham Naowarat 
Published: March 2016

BACKGROUND: The worldwide spread of extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae, particularly Escherichia coli, has significantly limited therapeutic options, especially for urinary tract infections. Although limited in their indications, fosfomycin and tigecycline are potential agents to treat infections due to ESBL‐producing organisms. Although not routinely performed, susceptibility testing to both is necessary to ensure there is not an increase in resistance.METHODS: A total of 160 isolates of ESBL‐producing E coli were isolated from patients at multiple regional hospitals in the Interior Health Region of British Columbia from June 2009 to January 2012. Isolates were obtained from various body fluids and sites including urine (78.2%), wounds, blood, gall bladder drain and respiratory specimens. All isolates were tested using the E‐test method (Etest, bioMérieux, France) for tigecycline and Kirby Bauer disk diffusion method for fosfomycin using European Committee of Antimicrobial Susceptibility Testing breakpoints for tigecycline and Clinical and Laboratory Standards Institute zone sizes for fosfomycin.RESULTS: All 160 isolates were found to be susceptible to tigecycline, while five isolates (3.1%) were resistant to fosfomycin (four resistant, one intermediate).CONCLUSION: Although resistance to these antibiotics has previously been reported, the present study confirmed that isolates of ESBL‐producing E coli from the Interior Health Region of British Columbia remain highly susceptible to both tigecycline and fosfomycin.
Predictors of Recurrent Ingestion of Gastrointestinal Foreign Bodies
Authors: Grimes Ian C , Spier Bret J , Swize Lisa R , Lindstrom Mary J , Pfau Patrick R 
Published: March 2016

BACKGROUND: Gastrointestinal foreign bodies are commonly encountered; however, little knowledge exists as to the causes of foreign body ingestions and why they occur repeatedly in some patients.OBJECTIVE: To identify and define patients at high risk for recurrent foreign body ingestion.METHODS: A retrospective chart review of foreign body ingestion was conducted at a tertiary care medical centre over an 11-year period. Variables analyzed included age, sex, incarceration status,Diagnostic and Statistical Manual of Mental Disorders-IVdiagnosis, success of endoscopy, type of sedation used, method of extraction, complications, presence of gastrointestinal pathology, and incidence of recurrent food impaction or foreign body.RESULTS: A total of 159 patients with a foreign body ingestion were identified. One hundred fourteen (77%) experienced a single episode of ingestion and 45 (23%) experienced multiple ingestions. Of the patients with multiple ingestions, 27 (60%) had recurrent food impactions while 18 (40%) ingested foreign objects. In the recurrent ingestor group, a psychiatric disorder had been diagnosed in 16 patients (35.6%) and there were 13 incarcerated individuals (28.9%). The average number of recurrences was 2.6 per patient (117 total recurrences). Individuals with a psychiatric disorder experienced 3.9 recurrences per patient, while prisoners averaged 4.1 recurrences per patient. The combination of a psychiatric disorder and being incarcerated was associated with the highest recurrence rate (4.33 per patient). Multivariable logistic regression revealed that male sex (OR 2.9; P=0.022), being incarcerated (OR 3.0; P=0.024) and the presence of a psychiatric disorder (OR 2.5; P=0.03) were risk factors for recurrent ingestion.CONCLUSION: Risk factors for recurrent ingestion of foreign bodies were male sex, being incarcerated and the presence of a psychiatric disorder.
Hedgehog Signalling is Downregulated in Celiac Disease
Authors: Liang Rui , Hinds Rupert , Abud Helen E , Cheng Wei 
Published: March 2016

BACKGROUND: Celiac disease (CD) is a common autoimmune disorder of the small intestine that occurs in genetically predisposed individuals. Animal studies have suggested that the hedgehog (Hh) signalling pathway is involved in gut inflammation, injury and repair.OBJECTIVE: To examine the expression of components of the Hh signalling pathway in CD.METHODS: Children undergoing gastroscopy investigation for CD at Monash University (Victoria, Australia), and other children undergoing gastroscopy in whom small bowel pathology was not expected (ie, controls), were included in the present study. One histopathologist, who was blinded to the biopsy data, analyzed the biopsies and a diagnosis of CD was made according to standard Marsh criteria. From these samples, RNA was extracted and complementary DNA was synthesized using reverse transcription polymerase chain reaction. The levels of Hh ligand Sonic hh, Indian hh, protein patched homologue 1 (PTCH 1) and bone morphogenetic protein 4 (BMP4) messenger RNA were quantified by real-time polymerase chain reaction. Relative expression quantification was performed using the ΔΔCt method.RESULTS: Duodenal biopsies were collected from 37 children. There were 20 CD specimens and 17 normal controls. The relative expression of Sonic hh from CD patients was 58% lower than that of the controls; similarly, Indian hh expression was decreased in children with CD by 44%. Compared with controls, the expression of Hh receptor PTCH 1 decreased by 71% and the expression of the Hh target geneBMP4by 42%.CONCLUSIONS: The expression of the Hh signalling pathway genes was consistently downregulated in untreated CD children. These results suggest that the Hh signalling pathway plays a role in the mucosal lesions encountered in CD.
Pacing: A Concept Analysis of a Chronic Pain Intervention
Authors: Jamieson-Lega Kathryn , Berry Robyn , Brown Cary A 
Published: March 2016

BACKGROUND: The intervention of pacing is regularly recommended for chronic pain patients. However, pacing is poorly defined and appears to be interpreted in varying, potentially contradictory manners within the field of chronic pain. This conceptual lack of clarity has implications for effective service delivery and for researchers’ ability to conduct rigorous study. An examination of the background literature demonstrates that while pacing is often one part of a multidisciplinary pain management program, outcome research is hindered by a lack of a clear and shared definition of this currently ill‐defined construct.OBJECTIVES: To conduct a formal concept analysis of the term ‘pacing’.METHODS: A standardized concept analysis process (including literature scoping to identify all uses of the concept, analysis to determine defining attributes of the concept and identification of model, borderline and contrary cases) was used to determine what the concept of pacing does and does not represent within the current evidence base.RESULTS: A conceptual model including the core attributes of action, time, balance, learning and self‐management emerged. From these attributes, an evidence‐based definition for pacing was composed and distributed to stakeholders for review. After consideration of stakeholder feedback, the emergent definition of pacing was finalized as follows: “Pacing is an active self‐management strategy whereby individuals learn to balance time spent on activity and rest for the purpose of achieving increased function and participation in meaningful activities”.CONCLUSION: The findings of the present concept analysis will help to standardize the use and definition of the term pacing across disciplines for the purposes of both pain management and research.
Evaluation of MALDI‐TOF Mass Spectrometry and Sepsityper Kit™ for the Direct Identification of Organisms from Sterile Body Fluids in a Canadian Pediatric Hospital
Authors: Tadros Manal , Petrich Astrid 
Published: March 2016

Matrix‐assisted laser desorption/ionization time of flight mass spectrometry (MALDI‐TOF MS) can be used to identify bacteria directly from positive blood and sterile fluid cultures. The authors evaluated a commercially available kit – the Sepsityper Kit (Bruker Daltonik, Germany) – and MALDI‐TOF MS for the rapid identification of organisms from 80 flagged positive blood culture broths, of which 73 (91.2%) were blood culture specimens and seven (8.7%) were cerebrospinal fluid specimens, in comparison with conventional identification methods. Correct identification to the genus and species levels was obtained in 75 of 80 (93.8%) and 39 of 50 (78%) blood culture broths, respectively. Applying the blood culture analysis module, a newly developed software tool, improved the species identification of Gram‐negative organisms from 94.7% to 100% and of Gram‐positive organisms from 66.7% to 70%.MALDI‐TOF MS is a promising tool for the direct identification of organisms cultured from sterile sites.
CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core: Canadian Guidelines for Management and Treatment of HIV/Hepatitis C Coinfection in Adults
Authors: Hull Mark , Klein Marina , Shafran Stephen , Tseng Alice , Giguère Pierre , Côté Pierre , Poliquin Marc , Cooper Curtis , on behalf of The CIHR Canadian HIV Trials Network HIV/Hepati  
Published: March 2016

BACKGROUND: Hepatitis C virus (HCV) coinfection occurs in 20% to 30% of Canadians living with HIV, and is responsible for a heavy burden of morbidity and mortality. HIV‐HCV management is more complex due to the accelerated progression of liver disease, the timing and nature of antiretroviral and HCV therapy, mental health and addictions management, socioeconomic obstacles and drug‐drug interactions between new HCV direct‐acting antiviral therapies and antiretroviral regimens.OBJECTIVE: To develop national standards for the management of HCV‐HIV coinfected adults in the Canadian context.METHODS: A panel with specific clinical expertise in HIV‐HCV co‐infection was convened by The CIHR HIV Trials Network to review current literature, existing guidelines and protocols. Following broad solicitation for input, consensus recommendations were approved by the working group, and were characterized using a Class (benefit verses harm) and Level (strength of certainty) quality‐of‐evidence scale.RESULTS: All HIV‐HCV coinfected individuals should be assessed for HCV therapy. Individuals unable to initiate HCV therapy should initiate antiretroviral therapy to slow liver disease progression. Standard of care for genotype 1 is pegylated interferon and weight‐based ribavirin dosing plus an HCV protease inhibitor; traditional dual therapy for 24 weeks (for genotype 2/3 with virological clearance at week 4); or 48 weeks (for genotypes 2–6). Therapy deferral for individuals with mild liver disease may be considered. HIV should not be considered a barrier to liver transplantation in coinfected patients.DISCUSSION: Recommendations may not supersede individual clinical judgement.
Reduction of Central Line‐Associated Bloodstream Infection Rates in a Neonatal Intensive Care Unit after Implementation of a Multidisciplinary Evidence‐Based Quality Improvement Collaborative: A Four‐Year Surveillance
Authors: Ting Joseph Y , Goh Vicki SK , Osiovich Horacio 
Published: March 2016

BACKGROUND: The use of central venous catheters has permitted lifesaving treatment for critically ill neonates; however, the attributable mortality rate for central line‐associated bloodstream infections (CLABSIs) has been estimated to be between 4% and 20%. In 2006/2007, the authors’ neonatal intensive care unit (NICU) had a CLABSI rate that was nearly twofold higher than that reported by other Canadian NICUs.OBJECTIVE: To implement a quality improvement collaborative to reduce the incidence of neonatal CLABSI.METHODS: A retrospective observational study was performed to compare CLABSI in neonates admitted to the authors’ level III NICU between August 2007 and March 2011. The entire study period was divided into four time periods to evaluate secular trends. A comprehensive catheter‐related bloodstream infection prevention initiative was implemented in August 2007. The initiatives included staff education, standardization of skin preparation protocol, introduction of new antiseptic agents, implementation of central catheter insertion and maintenance checklists, reinforcement of the use of maximal sterile barrier precautions, and revision of the central catheter configuration and maintenance protocols.RESULTS: The median CLABSI rate of 7.9 per 1000 catheter days at the beginning of the study (period 1 [August 2007 to June 2008]) gradually decreased over the entire study period (P=0.034): period 2 (July 2008 to May 2009), 3.3 per 1000 catheter days; period 3 (June 2009 to April 2010), 2.6 per 1000 catheter days; and period 4 (May 2010 to March 2011), 2.2 per 1000 catheter days.CONCLUSION: A multidisciplinary evidence‐based quality improvement collaborative resulted in a significant reduction in the CLABSI rate. Continuous quality improvement measures are required to reduce catheter‐related bloodstream infections among low‐birth‐weight infants.
Motor Function Predicts Parent‐Reported Musculoskeletal Pain in Children with Cerebral Palsy
Authors: Barney Chantel C , Krach Linda E , Rivard Patrick F , Belew John L , Symons Frank J 
Published: March 2016

BACKGROUND: The relationship between pain and motor function is not well understood, especially for children and adolescents with communication and motor impairments associated with cerebral palsy (CP).OBJECTIVES: To determine whether a predictive relationship between motor function and musculoskeletal pain exists in children with CP.METHODS: Following informed consent, caregivers of 34 pediatric patients with CP (mean [± SD] age 9.37±4.49 years; 80.0% male) completed pain‐ and function‐related measures. Parents completed the Dalhousie Pain Interview and the Brief Pain Inventory based on a one‐week recall to determine whether pain had been experienced in the past week, its general description, possible cause, duration, frequency, intensity and interference with daily function. The Gross Motor Function Classification System (GMFCS) was used to classify the motor involvement of the child based on their functional ability and their need for assistive devices for mobility.RESULTS: GMFCS level significantly predicted parent‐reported musculoskeletal pain frequency (P<0.02), duration (P=0.05) and intensity (P<0.01). Duration of pain was significantly related to interference with activities of daily living (P<0.05).CONCLUSIONS: Children with CP with greater motor involvement, as indexed by GMFCS level, may be at risk for increased pain (intensity, frequency and duration) that interfers with activities of daily living. The clinical index of suspicion should be raised accordingly when evaluating children with developmental disability who cannot self‐report reliably.
Impact of Obesity on Perinatal Outcomes among Asthmatic Women
Authors: Thuot Meggie , Coursol Marc-André , Nguyen Sonia , Lacasse-Guay Vanessa , Beauchesne Marie-France , Fillion Anne , Forget Amélie , Kettani Fatima-Zohra , Blais Lucie 
Published: March 2016

BACKGROUND: Only one study has investigated the combined effect of maternal asthma and obesity on perinatal outcomes; however, it did not consider small‐for‐gestational age and large‐for‐gestational age infants.OBJECTIVES: To examine the impact of obesity on perinatal outcomes among asthmatic women.METHODS: A cohort of 1386 pregnancies from asthmatic women was reconstructed using three of Quebec’s administrative databases and a questionnaire. Women were categorized using their prepregnancy body mass index. Underweight, overweight and obese women were compared with normal weight women. The primary outcome was the birth of a small‐for‐gestational‐age infant, defined as a birth weight below the 10th percentile for gestational age and sex. Secondary outcomes were large‐for‐gestational‐age infants (birth weight >90th percentile for gestational age) and preterm birth (<37 weeks’ gestation). Logistic regression models were used to obtain the ORs of having small‐for‐gestational‐age infants, large‐for‐gestational‐age infants and preterm birth as a function of body mass index.RESULTS: The proportions of underweight, normal weight, overweight and obese women were 10.8%, 53.3%, 19.7% and 16.2%, respectively. Obese asthmatic women were not found to be significantly more at risk for giving birth to small‐for‐gestational‐age infants (OR 0.6 [95% CI 0.4 to 1.1]), large‐for‐gestational‐age infants (OR 1.2 [95% CI 0.7 to 2.2]) or having a preterm delivery (OR 0.7 [95% CI 0.4 to 1.3]) than normal‐weight asthmatic women.CONCLUSIONS: No significant negative interaction between maternal asthma and obesity on adverse perinatal outcomes was observed.
Evaluation of a Novel Method of Teaching Endobronchial Ultrasound: Physician‐ Versus Respiratory Therapist‐Proctored Simulation Training
Authors: Stather David Ryan , Chee Alex , MacEachern Paul , Dumoulin Elaine , Hergott Christopher A , Gelberg Jacob , Scott Sandra D , De Guzman Sylvia , Tremblay Alain 
Published: March 2016

BACKGROUND: Computer endobronchial ultrasound (EBUS) simulators have been demonstrated to improve trainee procedural skills before attempting to perform EBUS procedures on patients.OBJECTIVE: To compare EBUS performance following training with computer simulation proctored by EBUS‐trained respiratory therapists versus the same simulation training proctored by an interventional respirologist.METHODS: The present analysis was a prospective study of respiratory medicine trainees learning EBUS. Two cohorts of trainees were evaluated using a previously validated method using simulated cases with performance metrics measured by the simulator. Group 1 underwent EBUS training by performing 15 procedures on an EBUS simulator (n=4) proctored by an interventional respirologist. Group 2 received identical training proctored by a respiratory therapist with special training in EBUS (n=10).RESULTS: No significant differences between group 1 and group 2 were apparent for the primary outcome measures of total procedure time (15.15±1.34 min versus 14.78±2.88 min; P=0.816), the percentage of lymph nodes successfully identified (88.8±5.4 versus 80.91±8.9; P=0.092) or the percentage of successful biopsies (100.0±0.0 versus 98.75±3.95; P=0.549). The learning curves were similar between groups, and did not show an obvious plateau after 19 simulated procedures in either group.DISCUSSION: Acquisition of basic EBUS technical skills can be achieved using computer EBUS simulation proctored by specially trained respiratory therapists or by an interventional respirologist. There appeared to be no significant advantage to having an interventional respirologist proctor the computer EBUS simulation.