bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Eligibility for Treatment of Chronic Hepatitis C Infection with Shortened Duration of Therapy: Implications for Access to Care and Elimination Strategies in Canada
Authors: Borgia Sergio M , Rowaiye Adenike 
Published: March 2016

BACKGROUND: All oral, highly effective direct-acting antiviral combinations, such as sofosbuvir-ledipasvir, have recently been licensed in Canada but cost as much as $67,000 for a 12-week course of therapy, representing a major economic barrier to predominately single-payer health care systems such as that found in Ontario. In hepatitis C virus (HCV) genotype 1 noncirrhotic patients with a baseline viral load of <6×106IU/mL, treatment with sofosbuvir-ledipasvir can be shortened to eight weeks without compromising ≥95% efficacy. The number of HCV-infected patients in Ontario eligible for shortened therapy, and the associated cost savings, are unknown. The authors propose that treating every patient with shortened therapy, regardless of baseline viral load, would lead to significant public cost savings and collateral efficiencies, enabling increased HCV treatment capacity and cure.METHODS: The present study designed a three-part model to investigate the cost of cure per patient and cost savings per patient under three eligibility pathways: conservative, permissive and ideal. In the conservative model, every patient is treated for 12 weeks regardless of baseline viral load, whereas in the permissive model, patients with a baseline viral load <6×106IU/mL are treated for eight weeks. In the ideal model, every patient receives eight weeks of therapy regardless of baseline viral load. Relapsed patients are retreated for 12 weeks. Data obtained from the Ontario Public Health Laboratory were used to validate the model and generate the outcomes.RESULTS: In Ontario, 75.34% of HCV genotype 1 patients had a baseline viral load of <6×106IU/mL and were eligible for shortened therapy. The cost of cure per patient in the ideal model was $47,328.44, representing a 29% reduction in the cost of curative therapy and 3.5 weeks of shortened treatment duration compared with the conservative model. The ideal model generated a cost savings per patient of $3,855.17 (8% reduction in treatment cost) and 0.7 weeks of shorter therapy compared with the permissive model, and was the shortest and most efficient while maintaining a cure rate ≥95%.CONCLUSIONS: These results demonstrate that recommendations for a shortened treatment course of eight weeks using all-oral direct-acting antivirals in HCV genotype 1 noncirrhotic patients, regardless of baseline viral load, affords significant public cost savings and, on a population level, offers opportunities for expanded HCV treatment and cure.
Ulcerative Colitis-Associated Hospitalization Costs: A Population-Based Study
Authors: Coward Stephanie , Heitman Steven J , Clement Fiona , Hubbard James , Proulx Marie-Claude , Zimmer Scott , Panaccione Remo , Seow Cynthia , Leung Yvette , Datta Neel , Ghosh Subrata , Myers Robert P , Swain Mark , Kaplan Gilaad G 
Published: March 2016

BACKGROUND: Hospitalization costs for ulcerative colitis (UC) following the introduction of infliximab have not been evaluated.OBJECTIVE: To study predictors of costs for UC patients who were hospitalized for a flare or colectomy.METHODS: Population-based surveillance identified adults (≥18 years of age) admitted to hospital for UC flare or colectomy between 2001 and 2009 in the Calgary Health Zone (Alberta). Medical charts were reviewed and patients stratified into three admission types: responsive to inpatient medical therapy (n=307); emergent colectomy (n=227); and elective colectomy (n=208). The annual median cost with interquartile range (IQR) was calculated. Linear regression determined the effect of admission type on hospital charges after adjusting for age, sex, smoking, comorbidities, disease extent, medication use (eg, infliximab) and year. The adjusted cost increase was presented as the percent increase with 95% CIs. Joinpoint analysis assessed for an inflection point in hospital cost after the introduction of infliximab.RESULTS: Median hospitalization cost for UC flare, emergent colectomy and elective colectomy, respectively, were: $5,499 (IQR $3,374 to $8,904), $23,698 (IQR $17,981 to $32,385) and $14,316 (IQR $11,932 to $18,331). Adjusted hospitalization costs increased approximately 6.0% annually (95% CI 4.5% to 7.5%). Adjusted costs were higher for patients who underwent an elective colectomy (percent increase cost 179.8% [95% CI 151.6% to 211.1%]) or an emergent colectomy (percent increase cost 211.1% [95% CI 183.2% to 241.6%]) than medically responsive patients. Infliximab in hospital was an independent predictor of increased costs (percent increase cost 69.5% [95% CI 49.2% to 92.5%]). No inflection points were identified.CONCLUSION: Hospitalization costs for UC increased due to colectomy and infliximab.
Is Intra‐Articular Magnesium Effective for Postoperative Analgesia in Arthroscopic Shoulder Surgery?
Authors: Saritas Tuba Berra , Borazan Hale , Okesli Selmin , Yel Mustafa , Otelcioglu Seref 
Published: March 2016

BACKGROUND: Various medications are used intra‐articularly for postoperative pain reduction after arthroscopic shoulder surgery. Magnesium, a N‐methyl‐D‐aspartate receptor antagonist, may be effective for reduction of both postoperative pain scores and analgesic requirements.METHODS: A total of 67 patients undergoing arthroscopic shoulder surgery were divided randomly into two groups to receive intra‐articular injections of either 10 mL magnesium sulphate (100 mg/mL; group M, n=34) or 10 mL of normal saline (group C, n=33). The analgesic effect was estimated using a visual analogue scale 1 h, 2 h, 6 h, 8 h, 12 h, 18 h and 24 h after operation. Postoperative analgesia was maintained by intra‐articular morphine (0.01%, 10 mg) + bupivacaine (0.5%, 100 mL) patient‐controlled analgesia device as a 1 mL infusion with a 1 mL bolus dose and 15 min lock‐out time; for visual analogue scale scores >5, intramuscular diclofenac sodium 75 mg was administered as needed during the study period (maximum two times).RESULTS: Intra‐articular magnesium resulted in a significant reduction in pain scores in group M compared with group C 1 h, 2 h, 6 h, 8 h and 12 h after the end of surgery, respectively, at rest and with passive motion. Total diclofenac consumption and intra‐articular morphine + bupivacaine consumption were significantly lower in group M. Postoperative serum magnesium levels were significantly higher in group M, but were within the normal range.CONCLUSIONS: Magnesium causes a reduction in postoperative pain in comparison to saline when administered intra‐articularly after arthroscopic shoulder surgery, and has no serious side effects.
Partially Covered Self-Expandable Metal Stents versus Polyethylene Stents for Malignant Biliary Obstruction: A Cost-Effectiveness Analysis
Authors: Barkun Alan N , Adam Viviane , Martel Myriam , AlNaamani Khalid , Moses Peter L 
Published: March 2016

BACKGROUND/OBJECTIVE: Partially covered self-expandable metal stents (SEMS) and polyethylene stents (PES) are both commonly used in the palliation of malignant biliary obstruction. Although SEMS are significantly more expensive, they are more efficacious than PES. Accordingly, a cost-effectiveness analysis was performed.METHODS: A cost-effectiveness analysis compared the approach of initial placement of PES versus SEMS for the study population. Patients with malignant biliary obstruction underwent an endoscopic retrograde cholangiopancreatography to insert the initial stent. If the insertion failed, a percutaneous transhepatic cholangiogram was performed. If stent occlusion occurred, a PES was inserted at repeat endoscopic retrograde cholangiopancreatography, either in an outpatient setting or after admission to hospital if cholangitis was present. A third-party payer perspective was adopted. Effectiveness was expressed as the likelihood of no occlusion over the one-year adopted time horizon. Probabilities were based on a contemporary randomized clinical trial, and costs were issued from national references. Deterministic and probabilistic sensitivity analyses were performed.RESULTS: A PES-first strategy was both more expensive and less efficacious than an SEMS-first approach. The mean per-patient costs were US$6,701 for initial SEMS and US$20,671 for initial PES, which were associated with effectiveness probabilities of 65.6% and 13.9%, respectively. Sensitivity analyses confirmed the robustness of these results.CONCLUSION: At the time of initial endoscopic drainage for patients with malignant biliary obstruction undergoing palliative stenting, an initial SEMS insertion approach was both more effective and less costly than a PES-first strategy.
Use of Calcitonin in Recalcitrant Phantom Limb Pain Complicated by Heterotopic Ossification
Authors: Viana Ricardo , Payne Michael WC 
Published: March 2016

A common complication following amputation is phantom sensation, which may include experiencing pain in the phantom limb. This study details the management of phantom limb pain in a 72‐year‐old man, in whom comorbid heterotopic ossification was present. In addition, the authors provide a review of the literature regarding phantom limb pain management, and summarize the current understanding of heterotopic ossification and its possible link to peripheral nerve injury.BACKGROUND: Phantom limb pain (PLP) is a common complication after amputation, affecting up to 80% of the amputee population. However, only 5% to 10% of amputees have severe PLP impacting daily function. The present report details the management of severe, treatment‐resistant PLP in a 72‐year‐old man with a traumatic left transradial amputation and a comorbid complication of heterotopic ossification (HO).OBJECTIVE: To describe a case of PLP with HO and the possible role of calcitonin in the treatment of both conditions.METHODS: A systematic review of the literature regarding the management of PLP.RESULTS: Seventeen articles that directly addressed PLP were identified; 11 were randomized controlled trials. All involved small samples and follow‐up ranged from 6 h to one year, with the majority limited to six weeks.DISCUSSION: In the present case, medication management was limited by side effects, lack of response and the patient’s desire to avoid long‐term medication. Investigations revealed HO, which was suspected to envelop the median nerve in the proximal forearm. After several unsuccessful medication trials, the literature was reviewed in search of common variables between HO formation and persistent PLP. Ultimately, the biochemical effects associated with nerve injury were identified to be a possible factor in both HO and PLP development. Calcitonin’s proposed mechanisms of action may help to manage HO and PLP at multiple stages of disease development and maintenance. In the present case, a four‐week trial of intranasal calcitonin was successful, with pain control lasting at least 18 months.CONCLUSION: The present case report provided a review of the current literature in PLP pharmacological management and the current understanding of the etiology of PLP and HO, as well as how the two may coexist. It also provided an opportunity to discuss the proposed mechanisms of action of calcitonin in the management of PLP and HO.
Exogenous Endophthalmitis Caused by Enterococcus casseliflavus: A Case Report and Discussion Regarding Treatment of Intraocular Infection with Vancomycin‐Resistant Enterococci
Authors: Berenger Byron M , Kulkarni Shobhana , Hinz Brad J , MD Sarah E Forgie 
Published: March 2016

BACKGROUND: Endophthalmitis caused by enterococci is rare, and cases involving vancomycin‐resistant enterococci are even more so. Due to the poor bioavailability of many antibiotics in the vitreous chamber, special considerations are required when choosing antibiotics to treat these infections. The authors report the first case of exogenous endophthalmitis caused by Enterococcus casseliflavus via the unique mechanism of high‐velocity water stream trauma from a toy water gun.A previously healthy four‐year old boy presented with endophthalmitis of the left eye after injury from a water gun. Empirical treatment for endophthalmitis was started on presentation to the ophthalmologist. After the identification of the pathogen and a review of the literature, the antibiotic regimen was changed to include intravitreal ampicillin and amikacin with systemic linezolid.Endophthalmitis caused by E casseliflavus and other vancomycin‐resistant enterococci are challenging to treat. Rapid identification of vancomycin‐resistant enterococcal endophthalmitis is important to guide appropriate antibiotic therapy. Systemic linezolid achieves excellent intravitreal concentrations, and should be used in combination with intravitreal and topical antibiotics.
Risk Factors for Mortality in Patients with Alcoholic Hepatitis and Assessment of Prognostic Models: A Population-Based Study
Authors: Pang Jack XQ , Ross Erin , Borman Meredith A , Zimmer Scott , Kaplan Gilaad G , Heitman Steven J , Swain Mark G , Burak Kelly , Quan Hude , Myers Robert P 
Published: March 2016

BACKGROUND: Severe alcoholic hepatitis (AH) is associated with a substantial risk for short-term mortality.OBJECTIVES: To identify prognostic factors and validate well-known prognostic models in a Canadian population of patients hospitalized for AH.METHODS: In the present retrospective study, patients hospitalized for AH in Calgary, Alberta, between January 2008 and August 2012 were included. Stepwise logistic regression models identified independent risk factors for 90-day mortality, and the discrimination of prognostic models (Model for End-stage Liver Disease [MELD] and Maddrey discriminant function [DF]) were examined using areas under the ROC curves.RESULTS: A total of 122 patients with AH were hospitalized during the study period; the median age was 49 years (interquartile range [IQR] 42 to 55 years) and 60% were men. Median MELD score and Maddrey DF on admission were 21 (IQR 18 to 24) and 45 (IQR 26 to 62), respectively. Seventy-three percent of patients received corticosteroids and/or pentoxifylline, and the 90-day mortality was 17%. Independent predictors of mortality included older age, female sex, international normalized ratio, MELD score and Maddrey DF (all P<0.05). For discrimination of 90-day mortality, the areas under the ROC curves of the prognostic models (MELD 0.64; Maddrey DF 0.68) were similar (P>0.05). At optimal cut-offs of ≥22 for MELD score and ≥37 for Maddrey DF, both models excluded death with high certainty (negative predictive values 90% and 96%, respectively).CONCLUSIONS: In patients hospitalized for AH, well-known prognostic models can be used to predict 90-day mortality, particularly to identify patients with a low risk for death.
Yield of Screening Colonoscopy in Renal Transplant Candidates
Authors: AlAmeel Turki , Bseiso Bahaa , AlBugami Meteb M , AlMomen Sami , Roth Lee Stuart 
Published: March 2016

BACKGROUND: Cardiovascular disease is the most common cause of death among patients with end-stage renal disease undergoing maintenance dialysis. Renal transplantation offers a survival advantage to patients with end-stage renal disease; it is also associated with a three- to fivefold increase in the risk of developing a neoplasm.OBJECTIVE: To determine the yield of screening colonoscopy among patients with chronic kidney disease who were considered for renal transplantation.METHODS: Patients were included if they were ≥50 years of age, had chronic kidney disease and were being considered for renal transplantation. They underwent a screening colonoscopy that was performed as part of their pretransplant workup. Data from December 2008 to May 2014 were collected retrospectively for all eligible patients.RESULTS: During the study period, 433 patients were considered for renal transplantation. Of these, 170 underwent colonoscopies as part of their pretransplant workup. One was excluded because of previous history of colon cancer. Of the 169 procedures performed, ≥1 polyp(s) was diagnosed in 24%. The most common pathological diagnoses were hyperplastic polyp or normal colonic tissue. Fifteen (37%) patients had tubular adenomas and one patient had a sessile serrated adenoma. Advanced adenomas, defined as villous, tubulovillous or high-grade dysplasia, were found in four patients. Adenocarcinoma was diagnosed in one patient.CONCLUSION: In a population of asymptomatic potential kidney transplant recipients ≥50 years of age, the prevalence of colorectal adenomatous polyps was 24%. Colonoscopy appeared to be useful as a screening tool in potential transplant recipients.
Association among Fraction of Exhaled Nitrous Oxide, Bronchodilator Response and Inhaled Corticosteroid Type
Authors: Smith Ryan W , Downey Kim , Snow Nadia , Dell Sharon , Smith W Gary 
Published: March 2016

BACKGROUND: Fraction of exhaled nitrous oxide (FeNO) is a known marker of airway inflammation and a topic of recent investigation for asthma control in children.OBJECTIVE: To investigate the relationship among FeNO and bronchodilator response measured by spirometry and types of inhaled corticosteroids (ICS).METHODS: A one-year review of children tested with spirometry and FeNO in a regional pediatric asthma centre was conducted.RESULTS: A total of 183 children were included (mean [± SD] age 12.8±2.8 years). Fluticasone was used most commonly (n=66 [36.1%]), followed by ciclesonide (n=50 [27.3%]). Most children (n=73 [39.9%]) had moderate persistent asthma. Increased FeNO was associated with percent change in forced expiratory volume in 1 s (FEV1) after bronchodilator adjusted for allergic rhinitis, parental smoking and ICS type (B=0.08 [95% CI 0.04 to 0.12]; P<0.001). Similarly, FeNO was associated with percent change in forced expiratory flow at 25% to 75% of the pulmonary volume (FEF25–75) after bronchodilator adjusted for parental smoking and ICS type (B=0.13 [95% CI 0.01 to 0.24]; P=0.03). FeNO accounted for only 16% and 9% of the variability in FEV1and FEF25–75, respectively. Mean-adjusted FeNO was lowest in fluticasone users compared with no ICS (mean difference 18.6 parts per billion [ppb] [95% CI 1.0 to 36.2]) and there was no difference in adjusted FeNO level between ciclesonide and no ICS (5.9 ppb [95% CI −9.0 to 20.8]).CONCLUSION: FeNO levels correlated with bronchodilator response in a regional pediatric asthma centre. However, FeNO accounted for only 16% and 9% of the variability in FEV1and FEF25–75, respectively. Mean adjusted FeNO varied according to ICS type, suggesting a difference in relative efficacy between ICS beyond their dose equivalents.
Clinicians’ Guide to the Use of Fecal Calprotectin to Identify and Monitor Disease Activity in Inflammatory Bowel Disease
Authors: Bressler Brian , Panaccione Remo , Fedorak Richard N , Seidman Ernest G 
Published: March 2016

BACKGROUND: Objective monitoring of the severity of inflammation in patients with inflammatory bowel disease (IBD) is an essential part of disease management. However, repeat endoscopy to define extent and severity of inflammation is not practical. Fecal calprotectin (FC) is a biomarker that can be used as a surrogate test to distinguish inflammatory from noninflammatory gastrointestinal disease.METHODS: A targeted search of the literature regarding FC, focusing primarily on the past three years, was conducted to develop practical clinical guidance on the current utility of FC in the routine management of IBD patients.RESULTS: It is recommended that samples for FC testing be obtained from the first bowel excretion of the day. FC testing should be used as standard of care to accurately confirm inflammation and ‘real-time’ disease activity when a clinician suspects an IBD flare. Although FC is a reliable marker of inflammation, its role in routine monitoring in improving long-term outcomes has not yet been fully assessed. Based on available evidence, the authors suggest the following cut-off values and management strategies: when FC levels are <50 μg/g to 100 μg/g, quiescent disease is likely and therapy should be continued; when FC levels are >100 μg/g to 250 μg/g, inflammation is possible and further testing (eg, colonoscopy) is required to confirm inflammation; and when FC levels are >250 μg/g, active inflammation is likely and strategies to control inflammation should be initiated (eg, optimizing current therapies or switching to an alternative therapy).DISCUSSION: FC is a useful biomarker to accurately assess the degree of inflammation and should be incorporated into the management of patients with IBD.
Antimicrobial Susceptibility of Canadian Isolates of Helicobacter pylori in Northeastern Ontario
Authors: Eng Nelson F , Ybazeta Gustavo , Chapman Katrina , Fraleigh Nya L , Letto Rebecca , Altman Eleonora , Diaz-Mitoma Francisco 
Published: March 2016

BACKGROUND: Helicobacter pylori plays a significant role in gastritis and ulcers. It is a carcinogen as defined by the WHO, and infection can result in adenocarcinomas and mucosa‐associated lymphoid tissue lymphomas. In Canada, rates of antimicrobial resistance are relatively unknown, with very few studies conducted in the past 15 years.OBJECTIVE: To examine rates of resistance in Sudbury, Ontario, compare antimicrobial susceptibility methods and attempt to determine the molecular basis of antibiotic resistance.METHODS: Patients attending scheduled visits at Health Sciences North (Sudbury, Ontario) provided gastric biopsy samples on a volunteer basis. In total, 20 H pylori isolates were collected, and antimicrobial susceptibility testing (on amoxicillin, tetracycline, metronidazole, ciprofloxacin, levofloxacin and clarithromycin) was conducted using disk diffusion and E‐test methods. Subsequently, genomic DNA from these isolates was sequenced to detect mutations associated with antimicrobial resistance.RESULTS: Sixty‐five percent of the isolates were found to be resistant to at least one of the listed antibiotics according to E‐test. Three isolates were found to be resistant to ≥3 of the above‐mentioned antibiotics. Notably, 25% of the isolates were found to be resistant to both metronidazole and clarithromycin, two antibiotics that are normally prescribed as part of first‐line regimens in the treatment of H pylori infections in Canada and most of the world. Among the resistant strains, the sequences of 23S ribosomal RNA and gyrA, which are linked to clarithromycin and ciprofloxacin/levofloxacin resistance, respectively, revealed the presence of known point mutations associated with antimicrobial resistance.CONCLUSIONS: In general, resistance to metronidazole, ciprofloxacin/levofloxacin and clarithromycin has increased since the studies in the early 2000s. These results suggest that surveillance programs of H pylori antibiotic resistance may need to be revisited or improved to prevent antimicrobial therapy failure.