bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chlamydia Infection in Street Youth: Need for More Aggressive Screening Programs
Authors: Tam R , MacDonald N , Feder S , Giglia L , Peeling R , Gully P , Toye B , Doherty J 
Published: March 2016

OBJECTIVES: To determine, first, the sexual practices among street youth in the Ottawa‐Carleton, Ontario region; second, the percentage of street youth who report previous sexually transmitted disease (STD) screening; and third, the rate of previous infection with Chlamydia trachomatis in this population.METHODS: This prospective street youth pilot study was cross‐sectional in design. Street youth aged 15 to 20 years were recruited through a drop‐in centre or shelter in Ottawa, Ontario between August and October 1993. Information on demographics, substance use, current sexual practices and STD screening and infection history were obtained through a structured face to face interview and a 75‐item questionnaire. Past C trachomatis infection was determined by microimmunofluorescence assay with purified antigens of C trachomatis (serovars A to K), Chlamydia psittaci (avian strain 6BC) and Chlamydia pneumoniae (TW‐183 strain).RESULTS: Ninety‐eight per cent of the youth approached participated. Of the 100 street youth (61 males, mean age 17.8 years; 39 females, mean age 17.1 years), 94% were sexually active, with 21% of males and 26% of females having had four or more different sexual partners in the previous year. Only 27% of males and 8% of females reported consistent condom use with all partners all of the time. Thirty per cent of males and 50% of females reported previous STD testing. Of the 100 street youth, 22 (16 males and six females) had had previous C trachomatis infection by serotesting, but only three of 16 (19%) of these males and three of six (50%) of these females reported previous STD testing. None of the 22 recalled previous diagnosis or treatment for any STD.CONCLUSIONS: These street youth reported a high prevalence of risky sexual behaviour, and this supports the national STD guidelines for targeted screening in this population. The current screening guidelines for C trachomatis in this population do not reach the majority of street youth.
An Assessment of the Utilization of Diagnostic Parasitology Laboratory Services in Ontario
Authors: Richardson Harold , Fleming Christine , Palmer Josephine , Chen Erluo , Lannigan Robert , The Microbiology Committee  
Published: March 2016

OBJECTIVE: Diagnostic parasitology services in Ontario were assessed to determine whether the reduction in the number of provider laboratories from 209 to 70 over the period 1977 to 1994 has affected the availability and quality of service.DESIGN: A questionnaire on parasitology practice was distributed to all laboratories. Responses were validated against data from the requisitions, work cards and reports submitted by licensed parasitology laboratories in a pattern‐of‐practice survey.SETTING AND PARTICIPANTS: Laboratories in Ontario are licensed by the provincial Ministry of Health and subjected to mandatory proficiency testing. Laboratories not licensed in parasitology may receive specimens for referral to another facility for processing.MAIN OUTCOME MEASURES: Assessment included receipt of fecal specimens for parasitology, on‐site testing, the limitation of testing, work referred elsewhere for primary investigation or confirmation, laboratory to which work was referred, and the turnaround time for both on‐site and referred work.RESULTS: Ninety‐eight per cent of 338 laboratories returned the questionnaire. Three hundred and six received specimens for parasitology. Sixty‐four performed the testing. Of the remainder, 235 referred to 40 laboratories. Approximately 31,000 specimens were processed monthly, with 78% examined within private laboratories and 62% having a turnaround time of at least three days. The yield of positive findings was 3% or more of patients.CONCLUSIONS: The presence of fecal parasites has been reliably determined and the genus, species and stage of the organism correctly identified. Utilization must be improved through understanding of the factors increasing the pretest likelihood of a positive finding.
The Role of Ganciclovir for the Management of Cytomegalovirus Retinitis in HIV Patients: Pharmacological Review and Update on New Developments
Authors: Tseng Alice , Foisy Michelle 
Published: March 2016

OBJECTIVE: To review the pharmacology and pharmacokinetics of intravenous, oral and intraocular ganciclovir, and to discuss the role of these various formulations in the management of cytomegalovirus (CMV) retinitis in AIDS patients.DATA SOURCES: A MEDLINE search (1987 through November 1995) of English‐language literature using the main medical subject headings ‘ganciclovir’ and ‘cytomegalovirus’, and the subheading ‘acquired immunodeficiency syndrome’. Relevant articles were also selected from references of identified articles. Abstracts from recent medical conferences of infectious diseases, pharmacology and human immunodeficiency virus were screened for additional data.STUDY SELECTION AND DATA EXTRACTION: All articles and abstracts discussing the use of ganciclovir for the management or prophylaxis of CMV retinitis in AIDS patients were considered for inclusion. Pertinent information, as judged by the authors, was selected and synthesized for discussion.DATA SYNTHESIS: Ganciclovir has demonstrated virustatic activity against CMV, and is often administered 5 mg/kg intravenously every 12 h as first‐line therapy for CMV retinitis. Intravenous maintenance therapy at 5 mg/kg daily is usually effective at delaying retinitis progression for approximately 60 to 70 days. Neutropenia and thrombocytopenia are observed frequently, often necessitating interruption or discontinuation of therapy. Local drug administration may delay disease progression even further, and may be considered for patients who are intolerant to or failing intravenous therapy. However, systemic ganciclovir should be encouraged to reduce the risk of developing contralateral eye or end‐organ CMV disease. Oral ganciclovir at 1 g tid is almost as effective as intravenous ganciclovir 5 mg/kg/day in delaying retinitis progression and is associated with fewer line‐related complications. Absorption, drug interactions, cost and compliance should also be considered.CONCLUSIONS: Until recently, ganciclovir was available only for intravenous use. Recent developments allow for intraocular and oral administration of this agent. A clear understanding of the advantages and disadvantages of these new formulations is required in order to select the most appropriate product for managing CMV retinitis in AIDS patients.
Bedside Pulse Oximeters with a Clinical Algorithm Make Economic Sense in the Intensive Care Unit
Authors: Leasa David J , Walker Jacqueline M 
Published: March 2016

OBJECTIVE: To determine the effect on arterial blood gas (ABG) and hospital resource use by introducing a strategy of using bedside oximeters with a clinical algorithm, based on the argument that bedside pulse oximeters make economic sense in the intensive care unit (ICU) if safe patient oxygenation can be ensured at a lower cost than that of existing monitoring options.DESIGN: A before and after design was used to examine the consequences of a pulse oximeter at each bedside in the ICU along with a pulse oximeter clinical algorithm (POCA) describing use for titrating oxygen therapy and for performing ABG analysis.SETTING: A 19‐bed multidisciplinary ICU with a six‐bed extended ICU (EICU) available to function as a ′step‐down′ facility.PATIENTS: All patients admitted to the ICU/EICU over two 12‐month periods were included.RESULTS: The strategy yielded a 31% reduction in the mean number of ABGs per patient after POCA (20.0±26.1 versus 13.8±16.7, mean ± SD; P<0.001) as well as a potential annual cost savings of $32,831.CONCLUSIONS: Bedside oximeters within the ICU, when used with explicit guidelines, reduce ABG use and result in hospital cost savings.
Incidence and Susceptibility of Aerobic Gram‐Negative Bacilli from 20 Canadian Intensive Care Units: 1989–1993
Authors: Bryce Elizabeth A , Colby W David , Haket Jacques , Poisson Michel W , Smith John A 
Published: March 2016

OBJECTIVE: To assess the prevalence of antibiotic resistance in Canadian intensive care units.DESIGN: The antimicrobial profiles of 1939 Gram‐negative bacilli isolated in 20 Canadian intensive care units were analyzed using a custom designed MicroScan panel.SETTING: The majority of the hospitals were tertiary care institutions, but some community hospitals were included.PATIENTS: Adult intensive care unit patients were the sources of isolates.MAIN RESULTS: Pseudomonas aeruginosa was the most frequently isolated microorganism overall, with Escherichia coli the most common initial isolate. Comparison of initial and repeat isolates showed that P aeruginosa readily acquired resistance to all antibiotic classes except the aminoglycosides. Enterobacter aerogenes developed resistance to ciprofloxacin and Enterobacter cloacae demonstrated resistance to all beta‐lactam antibiotics except for imipenem on repeat isolation. Other Enterobacteriaceae remained susceptible. Historical comparison with data derived four years previously from 15 of the centres showed increased resistance of P aeruginosa and Acinetobacter species to ciprofloxacin while other susceptibility patterns remained stable.CONCLUSIONS: The prevalence of Gram‐negative resistance in Canadian hospitals is less than that reported in surveys done in some other countries, and was relatively stable over four years.
Decision Analysis Modelling of Costs and Outcomes following Cefepime Monotherapy in Canada
Authors: Halpern Michael T , Brown Ruth E , Drolet Martine , Sorensen Sonja V , Mandell Lionel A 
Published: March 2016

OBJECTIVE: To evaluate the comparative cost of treatment and intermediate outcomes (percentage resistant organisms, days in hospital, etc) among cefepime and alternative parenteral antibiotics used for empiric monotherapy.DESIGN: Decision analysis model, based on published literature, clinical trial results and information from infectious disease clinicians.SETTING: A Canadian tertiary care hospital.INTERVENTION: Comparison of cefepime, ceftazidime, ceftriaxone, cefotaxime and ciprofloxacin in the treatment of lower respiratory tract infections, urinary tract infections, skin/soft tissue infections, septicemia and febrile neutropenia.MAIN RESULTS: Cefepime treatment results in the lowest average cost per patient when used as initial empiric therapy for lower respiratory tract infections and for skin/soft tissue infections. Cefepime therapy is among the lowest cost treatments for the other infectious disease conditions and has the lowest cost for a weighted ‘average’ condition. Sensitivity analysis indicates that model results are most sensitive to duration of hospitalization.CONCLUSIONS: Initial empiric monotherapy with cefepime for serious infectious disease conditions may result in cost savings compared with alternative parenteral agents.
Double‐Blind Prospective Randomized Study Comparing Topical Mupirocin and Placebo for the Prevention of Infection Associated with Central Venous Catheters
Authors: Conly John M , Rennie Robert , Tan Leonard , Bagg Colin , Stein Karen , Peters Barb 
Published: March 2016

OBJECTIVE: To compare the incidence of exit site colonization, local catheter‐related infection and catheter‐related bacteremia in patients randomized to receive either topical 2% mupirocin or placebo at the catheter exit site.PATIENTS AND METHODS: Patients requiring central venous catheters for more than three days were randomized to receive in a double‐blind fashion either topical mupirocin or an identical placebo at the exit site three times weekly at the time of dressing change. Insertion, site care and removal of catheters were standardized. Serial semiquantitataive cultures of the skin at the catheter insertion site were performed using a sterile 25 cm2 template. The distal and proximal catheter segments were cultured using a standardized semiquantitative technique, and any suspect catheter‐related bacteremia was investigated with two sets of peripheral blood cultures, a 10 mL sample of infusate and clinical assessment. Both univariate and multivariate analyses were conducted on individual risk factors to determine factors that might influence the outcomes of local or systemic catheter‐related infection.RESULTS: Local catheter‐related infection (defined as more than 15 colony forming units [cfu] on culture of the proximal or distal catheter segment) occurred in six of 57 (10.5%) in the mupirocin group versus 18 of 69 (26%) in the placebo group (P<0.05) for the distal catheter segments and in one of 40 (2.5%) versus 13 of 47 (27.6%) for the proximal segments in the mupirocin and placebo groups (P<0.006), respectively. Catheter‐related bacteremia occurred in one of 57 (1.8%) of the mupirocin group but in five of 69 (7.2%) of the placebo group (P=0.15). Stepwise logistic regression revealed that cutaneous colonization at the insertion site of at least 103 cfu/mL/25 cm2 (OR 2.6; CI 1.0 to 6.9) and the use of placebo (OR 3.3; CI 1.2 to 9.0) were significant factors predicting local catheter‐related infection; whereas mupirocin was associated with reciprocal protective effect (OR 0.3; 95% CI 0.1 to 0.8).CONCLUSIONS: These findings suggest that patients receiving topical mupirocin at the exit site for long term central venous catheters have significantly less local catheter‐related infection, and there is a trend towards less catheter‐related bacteremia.
Detection of Peripheral Ventilation Inhomogeneity in Smokers
Authors: Cotton DJ , Mink JT , Graham BL 
Published: March 2016

BACKGROUND: In smokers, ‘small airways’ narrowing alters the conventional, vital capacity single breath washout (SBWVC). Although, in some studies, the test predicts smokers at risk of developing chronic airflow limitation, its wide variability partly explains its poor positive predictive value. An alternative explanation for the test’s poor predictive value is that it may not accurately reflect small airway narrowing in the lung periphery.OBJECTIVE: To determine whether smoke‐induced increases in ventilation inhomogeneity differ between SBWVC manoeuvres, which augment topographical (apex‐to‐base) ventilation inhomogeneity, and submaximal manoeuvres (SBWSM), which enhance peripheral ventilation inhomogeneity.STUDY GROUP AND DESIGN: Cross‐sectional study of 21 current smokers and 21 nonsmokers with similar age and forced expiratory volumes in 1 s (FEV1).METHODS: Smokers and nonsmokers performed SBW with either slow vital capacity inhalation and exhalation of test gas without breath holding (SBWVC); or slow inhalation of test gas from functional residual capacity to one‐half inspiratory capacity and, after 0 s or 10 s of breath holding, slow exhalation to residual volume (SBWSM). For all SBW the normalized phase III helium slope (Sn), closing capacity (CC) as a percentage of total lung capacity (TLC) and mixing efficiency (Emix) were measured.RESULTS: For SBWVC, smoking had no effect on Sn or Emix. However, CC/TLC was increased in smokers (P<0.05), but did not correlate with pack years or age. For SBWSM, smoking had no effect on Emix or CC/TLC, but resulted in a steeper Sn (P <0.05), which decreased more with breath holding (P<0.01) and correlated with pack years (P<0.05) at 0 s but not 10 s of breath holding.CONCLUSIONS: In smokers with normal FEV1, SBWSM manoeuvres reveal increases in breath hold time‐dependent ventilation inhomogeneity in the lung periphery, not detected by conventional SBWVC.
Chronic Lung Disease in Canadian Aboriginal Children Is Not Caused by Abnormal Cilia
Authors: Rubin Bruce K , Kumar Vijay 
Published: March 2016

BACKGROUND: It has been suggested that abnormalities of the airway cilia are responsible for some of the increased prevalence of bronchiectasis among the Polynesian population of New Zealand.OBJECTIVE: To determine whether abnormalities of the ciliary axoneme were present in Cree children with recurrent pneumonia.DESIGN: Retrospective identification of Cree children under 18 years of age with three or more documented episodes of pneumonia, at least one of which was severe enough to require hospitalization. Physical examination and nasal brushing for ciliary ultrastructure were performed on those who consented to participate in the study.SETTING: Out‐patient department of Moose Factory General Hospital, the referral hospital for the James Bay Region of Northern Ontario.PATIENTS: Ten children (seven males; three females) met the diagnostic criteria and lived in Moose Factory or Moosonee. Six patients (five boys, one girl, mean age 7 years 2 months) consented to examination and nasal brushing.RESULTS: Although the percentage of abnormal cilia (21%) was three to seven times greater than that reported for the control population, the abnormalities seen were characteristic of acquired axonemal defects rather than primary ciliary dyskinesia.CONCLUSIONS: In this population, recurrent pneumonia did not appear to be associated with congenital defects of the ciliary axoneme (primary ciliary dyskinesia). This is consistent with a review of published transmission electron microscopy studies of nasal cilia from the Maori of New Zealand.
A Systematic Overview of the Measurement Properties of the Chronic Respiratory Questionnaire
Authors: Lacasse Yves , Wong Eric , Guyatt Gordon 
Published: March 2016

BACKGROUND: Assessment of health‐related quality of life (HRQL) of patients with chronic lung disease has become an important aspect of many clinical investigations. The authors examined the measurement properties of a disease‐specific HRQL questionnaire, the Chronic Respiratory Questionnaire (CRQ), when used by independent investigators in clinical trials and observational studies.METHODS: All published papers citing the original 1987 CRQ publication were identified using the Science Citation Index, and abstracts presented at international conferences were found by hand search. Clinical trials and observational studies were included if they reported data bearing on the CRQ’s measurement properties.RESULTS: Of 90 papers and 20 abstracts, 32 met the inclusion criterion. CRQ domains of fatigue, mastery and emotional function have high reliability, and face, content and construct validity in differentiating among patients with better and worse HRQL. Because of its self‐generated items, the dyspnea domain works less well in discriminating among patients with lesser and greater dyspnea. When CRQ has been used to evaluate treatment, all four domains have performed well in detecting small treatment effects. The minimal important difference in CRQ score (0.5 per item) provides guidance for both planning studies and interpreting results. To maximize CRQ interpretability, investigators should present results as the mean score per item within each domain on a seven‐point scale.CONCLUSION: The CRQ has proved valid and responsive to change. Its standardization and continued wide use will enhance the understanding of the impact of treatments on patients’ HRQL.
Changes in the Cardiopulmonary Response to Exercise after Cardiac Transplantation in Patients Enrolled in an Early Rehabilitation Program
Authors: Bussières Lizanne M , Pflugfelder Peter W , Taylor Albert W , Ahmad Dildar , Weernink Corinne , Kostuk William J 
Published: March 2016

OBJECTIVE: To evaluate the changes in the cardiopulmonary response to exercise in the first year after cardiac transplantation in patients enrolled in a rehabilitation program in the first three months post‐transplantation.METHODS: A graded cycle exercise test with mixed expired gas analysis was performed on patients with end‐stage cardiac failure before and serially after cardiac transplantation at one, three and 12 months.RESULTS: Before cardiac transplantation, seven patients were fit enough to be tested. They had a low peak oxygen uptake (VO2 max) and a blunted heart rate and blood pressure response to exercise. They also displayed a restrictive pattern of ventilation during exercise. At three months following transplantation, patients (n=19) had a significantly higher VO2 max (19.9±5.3 versus 9.8±1.4 mL/kg/min, P<0.05), higher peak systolic blood pressure (177±22 versus 94±18 mmHg, P<0.05), greater peak minute ventilation (70±23 versus 34±5 L/min, P<0.05) and lower slope of minute ventilation to carbon dioxide output (35.4±6.2 versus 45.1±6.7, P<0.05) than before transplantation. The VO2 max measured at 12 months post‐transplant was similar to the three month value and was on average equal to 59% of the predicted value.CONCLUSIONS: These results indicate that there is a rapid and marked improvement in exercise capacity in patients following cardiac transplantation. These changes are associated with significant respiratory and cardiovascular adaptations. However, despite the marked improvement in exercise capacity, the VO2 max of cardiac transplant recipients enrolled in an early rehabilitation program did not return to normal at 12 months after surgery.
Role of Computed Tomography and Mediastinoscopy in the Staging of Lung Cancer: A Canadian Opinion Poll
Authors: Jones Graham L , Miller John D 
Published: March 2016

OBJECTIVES: To address the Canadian Lung Oncology group’s recently published results and recommendations suggesting that mediastinoscopy is unnecessary in the staging nonsmall cell lung cancer when computed tomography shows no enlarged mediastinal lymph nodes (larger than 1 cm in short axis); to evaluate the practice of thoracic surgeons across Canada in staging presumably operable lung cancer; and to assess the effect of the Canadian Lung Oncology Group’s recommendations on current thoracic surgical practice in Canada.DESIGN: A survey of Canadian thoracic surgeons (n=38) regarding the roles of computed tomography and mediastinoscopy in evaluating mediastinal disease in patients with operable lung cancer.RESULTS: There was an 89% response rate. Ninety‐one per cent of surgeons used computed tomography routinely, but only 10% of surgeons thought it to be more accurate than mediastinoscopy. Sixty‐eight per cent would rely on a negative scan (nodes smaller than 1 cm in shortest diameter) to rule out mediastinal disease.CONCLUSIONS: There are numerous circumstances where negative computed tomography does not adequately assess nodal status. A guideline for the use of computed tomography and mediastinoscopy in evaluating and staging lung cancer is presented. Mediastinoscopy should be considered in the staging of patients with negative computed tomography if the patient is at high risk of mediastinal disease, where negative computed tomography is typically unreliable and when the risk associated with an unnecessary thoracotomy is high.