bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain in Patients with Panic Disorder: Relation to Symptoms, Cognitive Characteristics and Treatment Outcome
Authors: Schmidt Norman B , Santiago Helen T , Trakowski John H , Kendren J Michael 
Published: March 2016

OBJECTIVE: Although there has been a link between certain types of pain, notably chest pain, and panic disorder, the relation between pain and panic disorder has not been systematically evaluated. In the present study, the relation between pain symptoms (headache, chest pain, stomach pain, joint pain) and the clinical presentation of patients with panic disorder was evaluated.HYPOTHESES: Pain was generally hypothesized to be related to increased symptoms of anxiety, panic‐relevant cognitive domains and treatment outcome. In terms of specific pain domains, headache and chest pain were expected to be more closely related to anxiety‐related symptoms.PARTICIPANTS AND METHODS: Patients (n=139) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition for panic disorder completed a set of standardized clinician‐rated and self‐reported measures. Moderator analyses were used in a subset of these patients completing a treatment outcome study.RESULTS: Approximately two‐thirds of the participants endorsed at least one current pain symptom. The hypotheses were partially supported, with pain being associated with higher levels of anxiety and depression symptoms, as well as panic frequency. Pain was also related to several cognitive features, including anxiety sensitivity and panic appraisals. Headache and chest pain were more highly associated with anxiety symptoms than was joint pain. Cognitive measures did not mediate the relation between anxiety and pain, and pain did not significantly moderate outcome in response to cognitive‐behavioural therapy.CONCLUSIONS: Co‐occurring pain symptoms appear to be more highly related to phenomenology than to treatment response in patients with panic disorder.
Oral Fluoroquinolones in the Treatment of Pneumonia, Bronchitis and Sinusitis
Authors: Mittmann Nicole , Jivraj Farah , Wong Angelina , Yoon Alice 
Published: March 2016

BACKGROUND: Despite a relatively large number of clinical studies comparing oral fluoroquinolones to one antibiotic class comparator, there is limited information on the relative efficacy of different fluoroquinolones.OBJECTIVE: To examine the efficacy and tolerability of oral fluoroquinolones in the treatment of mild to moderate community‐acquired pneumonia, acute exacerbations of chronic bronchitis and sinusitis.METHODS: A systematic review was undertaken with a MEDLINE search for antibiotics and indications. Included studies met the following criteria: original study; random allocation to treatment groups; treatment with one of the following oral antibiotics ‐ moxifloxacin, levofloxacin, ciprofloxacin, gatifloxacin; controlled by either placebo or an active comparator medication; double‐blind, single‐blind or open treatment; men and women (18 years of age and older); diagnosis of one of the three indications; and treatment duration of at least three days. Outcome measures included efficacy and safety. Comparative and single arm meta‐analyses were conducted. Statistical differences in antibiotic success rates were evaluated. Pooled point estimates and 95% CIs for the comparative statistics (z‐scores, P‐values) and the single‐arm analysis were examined to evaluate equivalence.RESULTS: The results of the comparative and single meta‐analyses revealed no major differences between the new fluoroquinolones. This is not surprising because the clinical studies were designed to show equivalence versus their comparators. Few comparative evaluations were conducted due to a paucity of studies. In relation to other competitors, small differences were seen.CONCLUSIONS: Results indicate that, in general, fluoroquinolones had similar efficacy, overall safety and dropout rates.
Multiple Sclerosis and Epstein-Barr Virus
Authors: Marrie Ruth Ann , Wolfson Christina 
Published: March 2016

OBJECTIVE: To evaluate the epidemiological evidence for an etiological role of Epstein-Barr virus in multiple sclerosis (MS).DATA SOURCES: MEDLINE and Cochrane Library searches of the medical literature identified 24 studies.DATA EXTRACTION: Studies were categorized as seroepidemiological, case-control or historical cohort, and were then classified within each group according to methodological rigour using criteria derived from published guidelines for the epidemiological study of MS.DATA SYNTHESIS: There was significant variability in the quality of evidence, and while two well-designed cohort studies found increased relative risks of MS in subjects with infectious mononucleosis, results from other studies were unconvincing.CONCLUSIONS: The evidence was insufficient to accept or reject the hypothesis that Epstein-Barr virus has an etiological role in MS. Further study, ideally using large samples of incident cases with blinded, trained interviewers using confirmatory sources for recalled data, is needed.
Diagnosing Asthma: The Fit between Survey and Administrative Database
Authors: Huzel Lisa , Roos Leslie L , Anthonisen Nick R , Manfreda Jure 
Published: March 2016

BACKGROUND:Standard methods for population studies of asthma include surveying population samples using questionnaires and examining people in laboratories. These procedures are extremely expensive. It would be helpful if, at least for some purposes, they could be replaced by cheaper techniques with adequate validity. OBJECTIVES: To determine agreement between survey and database in regard to the prevalence of asthma.METHODS: Responses to survey questions about asthma symptoms in the past 12 months were linked to physician claims in the Manitoba Population Health Repository.RESULTS: The overall agreement was moderate (κ=0.45 to 0.50) and increased if two years of physician claims were studied (κ=0.55 to 0.59); studying additional years had no further effect on agreement. Sex and smoking did not significantly affect the kappa scores.CONCLUSIONS: There were several plausible reasons for discrepancies. Symptoms recorded on the survey were intrinsically different from those recorded for physician visits. Physicians also used other respiratory codes instead of asthma, and survey participants did not see a physician every year for asthma. The estimates of prevalence derived from the survey and the administrative database included two overlapping groups of people. In each, the diagnosis of asthma seems justifiable, although the agreement between the two groups was only moderate to substantial. Both methods are useful, although they are useful for different purposes. Health care utilization estimates may be particularly useful for studying trends over time.
A Retrospective Analysis of Practice Patterns in the Treatment of Methicillin‐Resistant Staphylococcus aureus Skin and Soft Tissue Infections at Three Canadian Tertiary Care Centres
Authors: Conly John M , Stiver H Grant , Weiss Karl A , Becker Debbie L , Rosner Andrew J , Miller Elizabeth 
Published: March 2016

BACKGROUND: Methicillin‐resistant Staphylococcus aureus (MRSA) infections are increasingly being encountered and pose an increasing burden to the health care system in Canada.OBJECTIVE: To elucidate and characterize the factors influencing the current MRSA treatment patterns in patients with skin and soft tissue infections (SSTIs) before linezolid became available on the Canadian market.METHODS: A retrospective study collected demographic, treatment and resource use data on patients hospitalized at one of three geographically distinct tertiary care facilities, where MRSA SSTI treatment was initiated with intravenous (IV) vancomycin. Analysis of opportunities for IV‐to‐oral switch therapy was based on eligibility criteria.RESULTS: Of 89 patients identified over a 43‐month period, the mean (±SD) durations of anti‐infective treatment and hospitalization were 22.4±21 days and 28.9±20.8 days, respectively. An infected surgical wound was most common, representing 62.9% of infections. The mean duration of vancomycin treatment was 19.5 days and the mean number of 1 g doses received was 29.0±32.9. The majority of patients (55.1%) initiated vancomycin therapy a mean of 5.4±8.9 days after confirmation of MRSA. Of the 70% of patients meeting criteria for IV‐to‐oral switch therapy, only 10% received oral treatment. The most common reason cited for not switching was lack of an effective oral alternative. Analysis of switch therapy criteria found that IV treatment continued for a mean of 13 days despite the appropriateness of the oral route.CONCLUSIONS: Considerable variation exists in treatment patterns for MRSA infections. Improvements in the initiation of therapy and the use of IV‐to‐oral switch therapy may improve care and reduce the duration of hospitalization for MRSA SSTIs.
Older Adults with Alzheimer’s Disease, Comorbid Arthritis and Prescription of Psychotropic Medications
Authors: Balfour Judith E , O’Rourke Norm 
Published: March 2016

OBJECTIVES: It is assumed that analgesia is underutilized among those with Alzheimer disease and that these patients may be inappropriately prescribed neuroleptics and benzodiazepines. The current study examines this assertion.DESIGN: For this study, prescription levels of analgesics and psychotropic medications for Alzheimer disease patients with (n=245) and without (n=215) musculoskeletal conditions (ie, arthritis or rheumatism) are compared.SETTING: A national sample of community dwelling and institutionalized older adults was identified from the Canadian Study of Health and Aging* (CSHA).PARTICIPANTS: Persons from 36 cities and surrounding rural areas over 64 years of age were randomly identified for the CSHA from government health records in all but one province.MEASUREMENTS: Prescribed analgesic and psychotropic medications were examined, as well as dementia severity and dementia related behavioural disturbance.RESULTS: Less than half of Alzheimer patients with arthritis or rheumatism were treated for pain (ie, 109 of 245 patients); they were also more likely to be prescribed benzodiazepines compared with Alzheimer patients without musculoskeletal conditions (subsequent to initial consideration for analgesia, dementia severity and dementia‐related behaviours; äX2[ädf =1] =3.97, P=0.046).CONCLUSIONS: These findings are in accord with prior research attesting to the undertreatment of pain among older adults. These results can be generalized with greater confidence, given the random composition of the patient sample.
What Keeps Postpulmonary Resection Patients in Hospital?
Authors: Bardell T , Petsikas D 
Published: March 2016

BACKGROUND: Prolonged air leak (longer than three days) was hypothesized to be the primary cause of extended hospital stays following pulmonary resection. Its effect on length of stay (LOS) was compared with that of suboptimal pain control, nausea and vomiting, and other causes. Predictors of prolonged LOS and of prolonged air leaks were investigated.DESIGN: Retrospective review of 91 patients. Primary reasons for prolonged hospitalization were determined. Patient characteristics (demographic information, pulmonary function test results, body habitus measurements, smoking history), operative factors (procedure performed, duration of operation, complications) and postoperative factors (time of chest tube removal) were considered. Student′s t test and X2 analysis were used to compare continuous and ratio data, respectively, and linear regression analysis was used to define the equation relating two variables.RESULTS: The mean postoperative LOS was 6.4 days. Only prolonged air leak was predictive of increased LOS (9.4 days versus 5.4 days, P<0.001). Forced expiratory volume in 1 s less than 1.5 L/min, carbon monoxide diffusing capacity less than 80% predicted and the detection of a pneumothorax were all predictive of prolonged air leak. A strong correlation between the time of chest tube removal and LOS was found (r=0.937, P<0.001). Linear regression analysis showed postoperative LOS and duration of thoracostomy tube insertion to be related by the equation y = 0.88x + 2.49 days.CONCLUSIONS: These results suggest that increased LOS following pulmonary resection is due primarily to prolonged air leaks. Furthermore, patients who have their chest tubes removed sooner are discharged sooner.
Epidemiological and Economic Burden of Pneumococcal Disease in Canadian Children
Authors: Petit Geneviève , De Wals Philippe , Law Barbara , Tam Theresa , Erickson Lonny James , Guay Maryse , Framarin Alicia 
Published: March 2016

BACKGROUND: With the arrival of a new conjugate pneumococcal vaccine, it is important to estimate the burden of pneumococcal diseases in Canadian children. The epidemiological data and the economic cost of these diseases are crucial elements in evaluating the relevance of a vaccination program.METHODS: Using provincial databases, ad hoc surveys and published data, age‐specific incidence rates of pneumococcal infections were estimated in a cohort of 340,000 children between six months and nine years of age. The costs of these diseases to the health system and to families were also evaluated using data from Quebec and Manitoba.RESULTS: Cumulative risks were one in 5000 for pneumococcal meningitis, one in 500 for bacteremia and one in 20 for pneumonia, leading to 16 deaths in the cohort. About 262,000 otitis media episodes and 32,000 cases of myringotomy with ventilation tube insertion were attributable to Streptococcus pneumoniae. Societal costs were estimated at $125 million, of which 32% was borne by the health system and 68% was borne by families. Invasive infections represented only 2% of total costs, while 84% were generated by otitis media.CONCLUSION: Pneumococcal infections represent a significant burden for Canadian children and society that could be significantly reduced through immunization.
Re‐Evaluation of Acid‐Base Prediction Rules in Patients with Chronic Respiratory Acidosis
Authors: Martinu Tereza , Menzies Dick , Dial Sandra 
Published: March 2016

RATIONALE: The prediction rules for the evaluation of the acid‐base status in patients with chronic respiratory acidosis, derived primarily from an experimental canine model, suggest that complete compensation should not occur. This appears to contradict frequent observations of normal or near‐normal pH levels in patients with chronic hypercapnia.METHODS: Linear regression analysis was used to estimate the relationships between arterial pH, bicarbonate and partial pressure of carbon dioxide (PCO2) from 18 separate arterial blood gas measurements in 18 clinically stable outpatients with chronic hypercapnic respiratory failure from chronic obstructive lung disease, and without clinical conditions or medications likely to cause a primary metabolic alkalosis.RESULTS: The PCO2 ranged from 45 mmHg to 77 mmHg, and pH ranged from 7.37 to 7.44. In only three of the arterial blood gas measurements were the pH values lower than 7.38. From the regression equations derived from these measurements, the pH decreased by 0.014 for each 10 mmHg increase in the PCO2, and the bicarbonate level increased by 5.1 mmol/L. These values are quite different from a decrease in pH of 0.03 and an increase in bicarbonate of 3.5 mmol/L predicted using the rules derived from the canine model.CONCLUSIONS: In patients with chronic stable hypercapnia, acid‐base compensatory mechanisms appear to be more effective than would be predicted using the classic rules.
Treatment of Pediatric Chronic Pain with Tramadol Hydrochloride: Siblings with Ehlers‐Danlos Syndrome ‐ Hypermobility Type
Authors: Brown Stephen C , Stinson Jennifer 
Published: March 2016

OBJECTIVE: To evaluate the effectiveness of tramadol hydrochloride for the treatment of chronic pain refractory to previous treatment in two pediatric patients.METHODS: Tramadol hydrochloride was administered (50 mg/day to 150 mg/day) to two siblings with Ehlers‐Danlos syndrome ‐‐ Hypermobility type refractory to previous pharmacological treatments, and changes in pain intensity and physical activity were assessed.RESULTS: Pain intensity decreased and physical activity improved within days of starting therapy. Positive results have been maintained for 30 months.CONCUSIONS: Tramadol hydrochloride was a safe and effective treatment for relieving chronic pain in two pediatric patients suffering from the hypermobility type of Ehlers‐Danlos syndrome. No morbidity or side effects were noted during the 30‐month follow‐up.
The Canadian Optimal Therapy of COPD Trial: Design, Organization and Patient Recruitment
Authors: Aaron Shawn D , Vandemheen Katherine , Fergusson Dean , FitzGerald Mark , Maltais Francois , Bourbeau Jean , Goldstein Roger , McIvor Andrew , Balter Meyer , O′Donnell Denis 
Published: March 2016

BACKGROUND: There are no published studies that have assessed whether adding long‐acting beta 2‐agonist bronchodilators and/or inhaled steroids to chronic therapy with tiotropium would provide additional clinical benefit to patients with moderate to severe chronic obstructive pulmonary disease (COPD).METHODS: The Canadian Optimal Therapy of COPD Trial is a randomized, prospective, double‐blind, placebo‐controlled, multicentre trial funded by the Canadian Institutes of Health Research that has been designed to determine which combination of inhaled medications will most effectively prevent exacerbations and optimize disease‐specific quality of life in patients with COPD. The trial is the first to evolve from the Canadian Thoracic Society Clinical Trials Group. The study will randomize 432 patients with moderate to severe COPD to one of three parallel treatment arms for 52 weeks: tiotropium and fluticasone/salmeterol; tiotropium and salmeterol; or tiotropium and placebo inhaler. The participants will be allowed to use salbutamol as required throughout the trial period.OUTCOMES: The primary outcome measure is the proportion of patients in the three treatment groups who experienced a respiratory exacerbation within 52 weeks of randomization. Other outcomes that will be assessed over the 52‐week trial period will include: changes in disease‐specific quality of life and changes in dyspnea, health care use and changes in lung function. A pharmacoeconomic analysis will also be performed to evaluate the cost of these therapies.RESULTS: The study commenced recruitment in October 2003. It is currently operating at 22 centres across Canada and has randomized 137 patients during the first four months of recruitment. Recruitment is scheduled to continue until April 2005 or until 432 patients have been randomized.CONCLUSION: The present randomized, placebo‐controlled trial offers a unique opportunity to answer the question, what is the best combination of inhaled medications to use for COPD patients? It is hoped that optimal use of inhaled medications will improve patient health and quality of life, reduce patient respiratory exacerbations, and ultimately, reduce health care resource use.
The Effects of Transcranial Electrical Stimulation on Opiate‐Induced Analgesia in Rats
Authors: Kabalak Ayla A , Senel Oytun O , Gogus Nermin 
Published: March 2016

BACKGROUND AND OBJECTIVES: Recent experiments have shown that transcranial electrical stimulation significantly increases the potency and duration of the analgesic effects of opioids in humans and rats. In the present study, the influence of transcranial electrical stimulation (TCES) on the analgesic effect of remifentanil hydrochloride (HCl) in rats was determined.METHODS: Experiments were performed on 80 albino male Wistar rats. Rats were randomly assigned to four groups: remifentanil HCl, remifentanil HCl and TCES, TCES, and control (n=20/group). Remifentanil HCl was injected on the 55th minute. Analgesia was assessed using the wet tail‐flick latency test.RESULTS: In the remifentanil HCl group, analgesia (10.85±1.04 s) was reached at the fifth minute, and the analgesia was high for the first 10 min. In the remifentanil HCl and TCES group, the latency time peaked (16.60±1.19 s) at the fifth minute. This peak was 150% higher than that for the remifentanil HCl group, and 251% higher than the control or TCES groups. Analgesia in the remifentanil HCl and TCES group was sustained for 20 min at a statistically higher rate than the other treatment groups (P<0.001).CONCLUSIONS: TCES markedly increased the duration and analgesic potency of remifentanil HCl in rats. This effect appeared to be related to the release of enkephalins from brain structures, thus enhancing opioid analgesia.
Clinical Characteristics at Initial Presentation and Impact of Dual Therapy on the Outcome of Bacteremic Streptococcus pneumoniae Pneumonia in Adults
Authors: Weiss K , Low DE , Cortes L , Beaupre A , Gauthier R , Gregoire P , Legare M , Neoveu F , Thibert D , Tremblay C 
Published: March 2016

BACKGROUND: Approximately 10% of patients hospitalized with community‐acquired pneumonia (CAP) are bacteremic. Bacteremic Streptococcus pneumoniae pneumonia (BSPP) is the number one cause of mortality, representing up to 70% of all CAP deaths. In fact, all CAP guidelines have identified this issue as one of the most important issues when establishing their recommendations.OBJECTIVE: To assess the impact of dual antibiotic therapy in patients with BSPP.PATIENTS AND METHODS: All cases of BSPP in patients 18 years of age and older who were hospitalized from 1995 to 2000 were retrospectively analyzed. The standard initial therapeutic regimen used was cefuroxime with or without a macrolide from 1995 to 1997, and ceftriaxone and azithromycin or clarithromycin from 1998 to 2000. During the 1995 to 1997 period, only 16% of the patients initially received a macrolide, whereas all patients in the 1998 to 2000 period received a macrolide at admission.RESULTS: Ninety‐five patients (49 men, 46 women) with a mean age of 63 years (range 20 to 98 years) were included in the present study. The mean pneumonia severity index at admission was 113 for the monotherapy cohort and 114 for the dual therapy group. At admission, 30.5% of patients had a leukocyte count greater than 20´109/L, 11.5% had a systolic blood pressure less than 90 mmHg, 44.2% had a respiratory rate greater than 30 breaths/min and 33.6% had nausea/vomiting, necessitating some form of therapy or preventing the patient from eating. In addition, 16.8% had no fever at admission. Overall, 72.5% became afebrile within 48 h. Fifteen (15.8%) patients died (four within the first 72 h). The mortality rate was significantly higher in the monotherapy group (11 of 42 patients; 25.6%) than in the dual therapy cohort (four of 53 patients; 7.5%) (OR 0.23; 95% CI 0.07 to 0.74). Antibiotic resistance was not associated with increased mortality.CONCLUSION: The combination of ceftriaxone plus a macrolide significantly reduced the mortality rate compared with monotherapy (cefuroxime) in patients with CAP that have the highest mortality rate.