bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reasons for Coming to Hospital after Treatment for Community‐Acquired Pneumonia on an Ambulatory Basis
Authors: Shariatzadeh Mohammedreza , Marrie Thomas J 
Published: March 2016

BACKGROUND: Most patients with community‐acquired pneumonia (CAP) are treated on an ambulatory basis. OBJECTIVE: To evaluate the reasons for presentation to hospital after treatment for CAP on an ambulatory basis.METHODS: The study, conducted in five hospitals in the Capital Health Region (Edmonton, Alberta), enrolled adult patients aged 17 years or older who presented with a history of having been diagnosed and treated for pneumonia within the previous month. A current diagnosis of pneumonia was based on two or more symptoms or signs of CAP, plus radiographic evidence of pneumonia.RESULTS: Seventy‐five (77.3%) of the 97 patients who met the inclusion criteria had CAP, and 22 (22.7%) patients presented with a noninfectious illness. Of the patients with CAP, 25 (33.3%) met the study criteria for worsening of a comorbid illness, 23 (30.7%) had clinical failure, 16 (21.3%) had microbiological failure, six (8.0%) were noncompliant, four (5.3%) had failure of expectations and one (1.3%) had adverse effects of antimicrobial therapy.CONCLUSIONS: Underlying diseases, exacerbations of comorbidities and complications of CAP, as well as confounders such as unusual infections and noninfectious conditions that mimic CAP, are all reasons for presenting to hospital after treatment for CAP in an ambulatory setting.
Implementing Practice Guidelines: A Workshop on Guidelines Dissemination and Implementation with a Focus on Asthma and COPD
Authors: Boulet Louis-Philippe , Becker Allan , Bowie Dennis , Hernandez Paul , McIvor Andrew , Rouleau Michel , Bourbeau Jean , Graham Ian D , Logan Jo , Légaré France , Ward Thomas F , Cowie Robert L , Drouin Denis , Harris Stewart B , Tamblyn Robyn , Ernst Pierre , Tan Wan C , Partridge Martyn R , Godard Philippe , Herrerias Carla T , Wilson John W , Stirling Liz , Rozitis Emily-Brynn , Garvey Nancy , Lougheed Diane , Labrecque Manon , Rea Renata , Holroyde Martin C , Fagnan Danielle , Dorval Eileen , Pogany Lisa , Kaplan Alan , Cicutto Lisa , Allen Mary L , Moraca Serge , FitzGerald J Mark , Borduas Francine 
Published: March 2016

The present supplement summarizes the proceedings of the symposium “Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD”, which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue), the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD) guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients’ associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals.This important event provided a unique opportunity for all participants to discuss key issues in improving the care of patients with asthma and COPD. These two diseases are responsible for an enormous human and socioeconomic burden around the world. Many reports have indicated that current evidence‐based guidelines are underused by physicians and others, and that there are many barriers to an effective translation of recommendations into day‐to‐day care. There is therefore a need to develop more effective ways to communicate key information to both caregivers and patients, and to promote appropriate health behaviours. This symposium contributed to the initiation of what could become the “Canadian Asthma and COPD Campaign”, aimed at improving care and, hence, the quality of life of those suffering from these diseases.It is hoped that this event will be followed by other meetings that focus on how to improve the transfer of key recommendations from evidence‐based guidelines into current care, and how to stimulate research to accomplish this.
An Assessment of Linezolid Utilization in Selected Canadian Provinces
Authors: Walker Sandra , Dresser Linda , Becker Debbie , Scalera Alissa 
Published: March 2016

BACKGROUND: Linezolid is approved for the treatment of designated infections caused by methicillin‐resistant and ‐susceptible Staphylococcus aureus and vancomycin‐resistant Enterococcus faecium.OBJECTIVE: To characterize linezolid utilization since its launch in Canada in 2001.METHODS: Demographics, antimicrobial regimens, and clinical and resource utilization data for linezolid‐treated patients were collected retrospectively by hospital pharmacists at nine tertiary care hospitals in four provinces. Statistics describing linezolid utilization were calculated and the appropriateness of use was assessed according to a treatment algorithm based on recommendations of the Infectious Diseases Pharmacy Specialty Network in 2001.RESULTS: Ninety‐nine linezolid courses were prescribed for 103 infections in 95 patients (mean age 57.8 years, 52.6% male) with an average length of hospital stay of 40.6 days. Fifty‐three per cent of patients had an allergy to at least one antibiotic other than linezolid. The major use of linezolid was for treatment of skin and soft tissue infections (32.0%), followed by bacteremia (15.5%). The most prevalent pathogen was methicillin‐resistant S aureus, identified in 44.7% of infections. Linezolid was primarily prescribed as the oral form following other intravenous anti‐infectives (55.6% of courses) for an average duration of 14.4 days. The rate of appropriate utilization was 53% (range 25% to 75% by site). In 93.5% of courses deemed inappropriate, recommended first‐line therapies were not attempted before linezolid.CONCLUSIONS: Linezolid was prescribed appropriately in approximately one‐half of cases reviewed. The rate of appropriate utilization is similar to those rates reported in other Canadian antibiotic reviews.
Pain Prevalence in Nine‐ to 13‐Year‐Old School Children
Authors: van Dijk Adam , McGrath Patricia A , Pickett William , VanDenKerkhof Elizabeth G 
Published: March 2016

BACKGROUND: Despite significant progress in the epidemiology of chronic pain in adults, major gaps remain in our understanding of the epidemiology of chronic pain in children. In particular, the incidence, prevalence and sensory characteristics of many types of pain in Canadian children are unknown.OBJECTIVES: A study to obtain the lifetime and point prevalence of common acute pains, recurrent pain syndromes and chronic pains was conducted in a cohort of 495 school children, nine to 13 years of age, in eastern Ontario.METHODS: Children reported their pain experiences and described the intensity, affect and duration of the pains experienced over the previous month by completing the Pain Experience Interview –Short Form.RESULTS: The majority of children (96%) experienced some acute pain over the previous month, with headache (78%) being most frequently reported. Lifetime prevalence for certain acute pains differed significantly by sex (P<0.05). Fifty‐seven per cent of children reported experiencing at least one recurrent pain, while 6% were identified as having had or currently having chronic pain.DISCUSSION: The prevalence of acute pain in this Canadian cohort is consistent with international estimates of acute pain experiences (ie, headache) and recurrent pain problems (ie, recurring headache, abdominal pain and growing pains). However, 6% of children reported chronic pain. The self‐completed Pain Experience Interview – Short Form provides a feasible administration technique for obtaining population estimates of childhood pain, and for conducting longitudinal studies to identify risk and prognostic factors for chronic pain.
Risk of Ruling out Severe Acute Respiratory Syndrome by Ruling in another Diagnosis: Variable Incidence of Atypical Bacteria Coinfection Based on Diagnostic Assays
Authors: Zahariadis George , Gooley Ted A , Ryall Phyllis , Hutchinson Christine , Latchford Mary I , Fearon Margaret A , Jamieson Frances B , Richardson Susan , Kuschak Theodore , Mederski Barbara 
Published: March 2016

BACKGROUND: Severe acute respiratory syndrome (SARS) caused the first epidemic of the 21st century and continues to threaten the global community.OBJECTIVE: To assess the incidence of coinfection in patients confirmed to have SARS‐associated coronavirus (SARS‐CoV) infection, and thus, to determine the risk of ruling out SARS by ruling in another diagnosis. METHODS: The present report is a retrospective study evaluating the incidence and impact of laboratory‐confirmed SARS‐CoV and other pulmonary pathogens in 117 patients. These patients were evaluated in a Toronto, Ontario, community hospital identified as the epicentre for the second SARS outbreak.RESULTS: Coinfection with other pulmonary pathogens occured in patients with SARS. Seventy‐three per cent of the patient population evaluated had laboratory‐confirmed SARS‐CoV infection. Serology showing acute or recent Chlamydophila pneumoniae or Mycoplasma pneumoniae infection revealed an incidence of 30% and 9%, respectively, in those with SARS. These rates are similar to previously published studies on coinfection in pneumonia. All nucleic acid diagnostic assays were negative for C pneumoniae and M pneumoniae in respiratory samples from patients with SARS having serological evidence for these atypical pathogens.CONCLUSIONS: Diagnostic assays for well‐recognized pulmonary pathogens have limitations, and ruling out SARS‐CoV by ruling in another pulmonary pathogen carries significant risk. Despite positive serology for atypical pathogens, in a setting where clinical suspicion for SARS is high, specific tests for SARS should be performed to confirm or exclude a diagnosis.
Photodynamic Therapy in Barrett’s Esophagus: Results of Treatment of 17 Patients
Authors: Weiss Alan A , Wiesinger Holly AR , Owen David 
Published: March 2016

BACKGROUND: Barrett’s esophagus (BE) with dysplasia may progress to esophageal adenocarcinoma. Photodynamic therapy is a promising treatment for BE.OBJECTIVE: To determine if photodynamic therapy is an acceptable alternative to esophagectomy in BE patients with high-grade dysplasia or early adenocarcinoma.METHODS: Seventeen patients were treated with photodynamic therapy for BE and high-grade dysplasia or early esophageal adenocarcinoma. Patients with residual Barrett’s epithelium were treated with supplemental argon plasma coagulation or potassium titanyl phosphate laser. Patients underwent follow-up endoscopy three, six, nine and 12 months post-treatment, then every six to 12 months. Mean follow-up was 21 months.RESULTS: High-grade dysplasia or early adenocarcinoma was completely eliminated in nine of 15 (60%) patients. High-grade dysplasia was downgraded in one patient, persisted in one patient and progressed in four patients. Two patients with early esophageal adenocarcinoma were nonresponders. Complications included stricture, sunburn, urticaria, small pleural effusions, esophageal spasm and transient atrial fibrillation.CONCLUSIONS: Photodynamic therapy with supplemental ablation is a good, noninvasive therapy for elimination of high-grade dysplasia and early adenocarcinoma in BE. Failure to eliminate dysplastic epithelium occurred in 40% of the patients, thereby necessitating careful follow-up.
Mode of Transmission, Rather than the Hepatitis C Virus, as a Major Determinant of Poor Interpersonal Relationships in Patients with Chronic Hepatitis C
Authors: La Thuy Phuong , Deschênes Marc 
Published: March 2016

BACKGROUND: Recent studies have demonstrated that patients with the hepatitis C virus (HCV) have significant neurocognitive impairment.OBJECTIVE: To assess whether chronic HCV infection impacts on patient marital status, living arrangement and employment.METHODS: The charts of patients with chronic hepatitis C and hepatitis B were reviewed.RESULTS: The mean (± SD) age of the 129 patients with the hepatitis B virus (HBV) was 46±15 years and that of the 428 patients with HCV was 48±15 years. Sixty-seven per cent of HBV patients were men, compared with 68% of HCV patients. Eighty per cent of HCV patients were Caucasian, compared with 44% of patients with HBV. The main modes of transmission were intravenous drug use (37%) and transfusion of blood products (37%) for HCV, compared with country of origin (76%) for HBV. There were no differences in marital status rates between HBV- and HCV-infected patients (HBV – married (73%), single (21%) and divorced (6%); and HCV – married (66%), single (23%) and divorced (10%); P=0.20). HCV patients lived alone more often than HBV patients (HBV – 13%, HCV – 22%; P=0.03). There was no difference in overall employment rate between HCV and HBV patients (81% versus 87%; P=0.15). Though there may not have been overall differences between HCV and HBV marital status and employment status, there were differences in the HCV subgroups. These subgroup differences were discovered in the multivariate analysis; mode of transmission was identified as the only predictor of the patients’ marital status and employment status.CONCLUSIONS: The most important determinant of interpersonal relationships was the mode of transmission of the viral hepatitis rather than the type of viral infection: past intravenous drug users had lower level relationships.
Increased Risk of Colorectal Cancer in Ulcerative Colitis Patients Diagnosed after 40 Years of Age
Authors: Karvellas Constantine J , Fedorak Richard N , Hanson John , Wong Clarence KW 
Published: March 2016

BACKGROUND: The association between ulcerative colitis (UC) and colorectal cancer (CRC) is well established. Retrospective data show a 5.4% CRC incidence rate among patients with pancolitis and suggest that cancer surveillance should be provided to patients following eight to 10 years of extensive UC.AIM: To identify premalignant risk factors for UC patients and to determine whether current recommendations for cancer surveillance need reviewing.PATIENTS AND METHODS: A retrospective audit was conducted of adult patients with UC who were diagnosed with CRC between 1991 and 2002 in five hospitals in Edmonton, Alberta.RESULTS: Thirty-one cases of CRC (68% male) were identified. In this group, the mean ages at diagnosis were 44.4 years for UC patients and 60.1 years for CRC patients. For patients in whom the initial data of diagnosis of UC could be determined (n=29), the median duration of UC at the time of CRC diagnosis was 16 years. Patients diagnosed with UC after 40 years of age (n=15, mean age 64 years) progressed more rapidly to CRC than patients diagnosed before 40 years of age (n=14, mean age 23 years). The median durations of UC before development of CRC were 22 years and 10 years, respectively, for patients with a diagnosis of UC before and after 40 years of age (OR 11.5, 95% CI 2.41 to 20.16; P=0.00029). Only four patients (13%) were enrolled in an appropriate cancer-screening program. Nine of these UC patients (29%) who were older than 40 years of age developed CRC before the 10-year point.CONCLUSIONS: In the present study, patients diagnosed with UC after 40 years of age developed CRC more rapidly than those diagnosed before 40 years of age. This finding suggests that patients who are diagnosed with UC after 40 years of age should undergo CRC surveillance earlier than current recommendations.
Health Care‐Associated Staphylococcus aureus Pneumonia
Authors: Webster Duncan , Chui Linda , Tyrrell Gregory J , Marrie Thomas J 
Published: March 2016

INTRODUCTION: While Staphylococcus aureus is an uncommon but serious cause of traditional community‐acquired pneumonia (CAP), it is a predominant cause of nosocomial pneumonia in addition to the unique clinical entity of health care‐associated pneumonia (HCAP). A cohort of bacteremic S aureus pneumonia cases was reviewed to determine the role of HCAP among the cohort, and to assess for differences between CAP and HCAP.PATIENTS AND METHODS: Bacteremic S aureus pneumonia cases were identified from a prospective study of all patients diagnosed with CAP who presented to hospitals in Edmonton, Alberta, between November 2000 and November 2002. These cases were subsequently reviewed retrospectively. Demographic, clinical and microbiological data were obtained, and patients were classified as having CAP or HCAP. Relatedness of isolates was determined by pulsed‐field gel electrophoresis analysis in conjunction with epidemiological information.RESULTS: There were 28 cases of bacteremic S aureus pneumonia identified. Fifty‐seven per cent were reclassified as having HCAP, and 43% remained classified as having CAP. The CAP cohort was significantly younger than the HCAP cohort (mean age 49.0±23.7 years versus 67.8±18.6 years; P=0.035) with higher rates of intravenous drug use (50% versus 0%; P=0.002). Long‐term care facility residence (44%) was common in the HCAP cohort. The HCAP cohort presented with more severe illness, having a higher mean pneumonia severity index score (143.1±41.1 versus 98.2±54.6; P=0.028), and despite fewer embolic complications, there was a trend toward a significantly higher mortality rate (31% versus 0%; P=0.052). Two community‐acquired isolates cultured in the setting of intravenous drug use were methicillin‐resistant, and no isolates were positive for Panton‐Valentine leukocidin. There was evidence of relatedness involving 44% of the HCAP isolates by pulsed‐field gel electrophoresis analysis.CONCLUSION: HCAP accounts for a significant number of cases that, when using traditional definitions, would be classified as CAP. Severity of illness and mortality was excessive within the HCAP group. There was evidence of relatedness and spread of common strains in the HCAP cohort. The present study supports recommendations for treatment guidelines directed toward the entity of HCAP and the empirical coverage of S aureus among certain high‐risk groups.
Asthma is not Enough: Continuation of Smoking Among Parents with an Asthmatic Child
Authors: Liem Joel J , Kozyrskyj Anita L , Benoit Cecilia M , Becker Allan B 
Published: March 2016

BACKGROUND: Ideally, on diagnosis of asthma in a child, parents are counselled to decrease environmental tobacco smoke exposure to their children.OBJECTIVE: To determine whether a diagnosis of asthma in children altered parental smoking behaviour toward a reduction in environmental tobacco smoke exposure.METHODS: In 2002/2003, a survey was sent to 12,556 households with children born in 1995 in Manitoba. Parents were asked whether their seven‐year‐old child had asthma, and whether smokers were present in the home in 1995 and/or currently. The likelihood (OR) of a change in parental smoking behaviour was determined according to the presence of asthma in their child, a family history of asthma, the location of residence (rural or urban) and their socioeconomic status.RESULTS: A total of 3580 surveys (28.5%) were returned. The overall prevalence of parental smoking in 1995 and 2002/2003 was 32.2% and 23.4%, respectively (31.9%/23.2% and 32.3%/23.6% in rural and urban environments, respectively). In 2002/2003, the prevalence of parental smoking in homes with asthmatic children was 29.8%. Parents were not more likely to quit smoking (OR=1.01, 95% CI 0.66 to 1.54) or smoke outside (OR=1.02, 95% CI 0.56 to 1.83) if their child developed asthma. Parental smoking behaviour (quit smoking or smoked outside) did not change if there was a positive family history of asthma (OR=1.04, 95% CI 0.78 to 1.37), if they lived in a rural or urban location (OR=0.94, 95% CI 0.71 to 1.23), or if they were from a low‐ or high‐income household (OR=1.12, 95% CI 0.85 to 1.47).CONCLUSIONS: The likelihood of altering parental smoking behaviour occurred independently of a diagnosis of asthma in their child, a family history of asthma, the location of residence and their socioeconomic status.
Low Risk of Irritable Bowel Syndrome afterClostridium difficileInfection
Authors: Piche Thierry , Vanbiervliet Geoffroy , Pipau Fernand Girard , Dainese Raffaella , Hébuterne Xavier , Rampal Patrick , Collins Stephen M 
Published: March 2016

OBJECTIVE: The incidence of postinfectious irritable bowel syndrome (IBS) ranges between 4% and 32% of individuals after bacterial or parasitic infection. This study analyzed IBS symptoms in hospitalized patients three months after a symptomaticClostridium difficileinfection.PATIENTS AND METHODS: All patients with a proven, symptomaticC difficileinfection identified in the department of bacteriology over a four-month period were considered for enrolment. Patients were excluded in cases of pre-existing IBS or other organic gastrointestinal diseases. Patients completed both modified Talley and Rome II questionnaires within five days of clinical improvement with metronidazole and at three months postinfection, when stools were cultured andC difficiletoxins were examined to exclude ongoing infection.RESULTS: Twenty-three patients were evaluated three months after infection withC difficile. Just after infection, 15 patients were symptom free, whereas eight patients exhibited symptoms suggestive of IBS. Three months after infection, 22 patients remained symptom free, whereas one patient presented with symptoms indicative of IBS. That female patient had a prolonged infection without vomiting.CONCLUSIONS: We have shown that while transient functional bowel disorder occurred in 34.7% of patients (eight of 23 patients) recently infected withC difficile, only 4.3% of patients (one of 23 patients) had symptoms indicative of IBS after three months (ie, postinfectious IBS). Because an age-related reduction in immune responsiveness has been documented, it can be speculated that the low incidence of postinfectious IBS may be explained by the older age of the study population. Therefore, it cannot be excluded that the findings may be different in younger patients.