bluuebunny/crossref_metadata_2025_split huggingface dataset:
Admissions to Canadian Hospitals for Acute Asthma: A Prospective, Multicentre Study
Authors: Rowe Brian H , Villa-Roel Cristina , Abu-Laban Riyad B , Stenstrom Rob , Mackey Duncan , Stiell Ian G , Campbell Sam , Young Bryan 
Published: March 2016

BACKGROUND:Asthma exacerbations constitute one of the most common causes of emergency department (ED) attendance in most developed countries. While severe asthma often requires hospitalization, variability in admission practices has been observed.OBJECTIVE:To describe the factors associated with admission to Canadian hospitals for acute asthma after ED treatment.METHODS:Subjects 18 to 55 years of age treated for acute asthma in 20 Canadian EDs prospectively underwent a structured ED interview (n=695) and telephone interview two weeks later.RESULTS:The median age of the patients was 30 years, and the majority were women (62.8%). The admission rate was 13.1% (95% CI 10.7% to 15.8%). Admitted patients were older, more often receiving oral or inhaled corticosteroids at presentation, and more frequently receiving systemic corticosteroids and magnesium sulphate in the ED. Similar proportions received beta‐2 agonists and/or ipratropium bromide within 1 h of arrival. On multivariable analyses, factors associated with admission included age, previous admission in the past two years, more than eight beta‐2 agonist puffs in the past 24 h, a Canadian Triage and Acuity Score of 1 to 2, a respiratory rate of greater than 22 breaths/min and an oxygen saturation of less than 95%.CONCLUSION:The admission rate for acute asthma from these Canadian EDs was lower than reported in other North American studies. The present study provides insight into practical factors associated with admission for acute asthma and highlights the importance of history and asthma severity markers on ED decision making. Further efforts to standardize ED management and expedite admission decision‐making appear warranted.
Risk Factors and Outcomes for the Development of Malignancy in Lung and Heart‐Lung Transplant Recipients
Authors: Metcalfe Michael J , Kutsogiannis Demetrios J , Jackson Kathy , Oreopoulous Antigone , Mullen John , Modry Denis , Weinkauf Justin , Lien Dale C , Stewart Ken C 
Published: March 2016

BACKGROUND: Many factors may limit survival from lung and heart‐lung transplantation, including malignancy.OBJECTIVE: To investigate factors associated with the development of malignancy following transplantation and its effect on survival by retrospectively reviewing a population of lung transplant recipients.METHODS: Data from 342 consecutive lung transplant patients were collected. Results were analyzed by fitting variables into a multivariate logistic regression model predicting the development of post‐transplant malignancies. Covariates were selected based on crude associations that reached a level of significance at P≤0.10. Length of survival was analyzed using the Kaplan‐Meier method.RESULTS: Fifty‐eight subjects developed post‐transplant malignancies, which were the cause of death of 14 patients. Twenty‐one patients had a pretransplant malignancy, of whom six developed a malignancy post‐transplant – of these, two were fatal recurrences. No risk factors were significantly associated with all forms of post‐transplant malignancy. When adjusted for age at transplantation and donor smoking history, Epstein‐Barr virus seropositivity at the time of transplant was significantly associated with a reduced risk of a post‐transplant lymphoproliferative disorder (OR 0.17; 95% CI 0.05 to 0.59). The median survival time in individuals without a post‐transplant malignancy was significantly shorter than in those with a post‐transplant malignancy (P=0.018 Wilcoxon [Breslow]). This may be secondary to the length of time required to develop malignancy and the fact that not all malignancies that developed were fatal. The median time to develop malignancy was greater than two years. In addition, the 14 patients who died as a result of their malignancy had a significantly shorter survival time than the 44 who died because of nonmalignant causes (P<0.001).CONCLUSIONS: Malignancy was not associated with an overall decrease in survival time when compared with those who did not develop a malignancy. Risk factors specific for the development of malignancies remain difficult to specify.
Prophylactic Positive End‐Expiratory Pressure and Postintubation Hemodynamics: An Interventional, Randomized Study
Authors: Lesur Olivier , Remillard Marie-Anaïs , St-Pierre Catherine , Falardeau Simon 
Published: March 2016

OBJECTIVE: To investigate the hemodynamic and outcome effects of implementing prophylactic positive end‐expiratory pressure (PEEP) versus zero end‐expiratory pressure (ZEEP) in patients during the postintubation period in the emergency setting.METHODS: The present study was a prospective, single‐centre, interventional, single‐blinded randomized trial performed in a 16‐bed medical intensive care unit. The study cohort consisted of consecutive patients who urgently required intubation. During the postintubation period, patients received either 5 cmH2O PEEP or ZEEP. The primary aim was to assess the variation in mean arterial pressure (MAP) from baseline up to 90 min postintubation. The secondary aim was to determine the mean duration of intubation, level of MAP support after intubation and 28‐day mortality.RESULTS: Seventy‐five consecutive patients with similar mean (± SD) baseline characteristics and preintubation MAP (76±18 mmHg in the ZEEP group and 78.5±23 mmHg in the PEEP group, P=Not significant [NS]) were studied. The final analysis was performed in 33 patients in the ZEEP group and 30 patients in the PEEP group. Regarding outcome measures following intubation, delta MAP (ie, the difference between the lowest MAP values from baseline) was not differentially affected in either group (P=NS); the mean durations of intubation were similar (ZEEP 9.2±8.5 days versus PEEP 9.2±8.8 days, P=NS); 28‐day mortality was not discriminative (ZEEP 14 of 33, PEEP nine of 30; P=NS); and levels of MAP support after intubation were comparable between the two groups.CONCLUSION: In the present trial, there was no evidence that implementing a prophylactic PEEP of 5 cmH2O adversely affects short‐term hemodynamics or outcome in medical intensive care patients during the postintubation period.
Endoscopic Management of Gastric Variceal Bleeding with Cyanoacrylate Glue Injection: Safety and Efficacy in a Canadian Population
Authors: Al-Ali Jaber , Pawlowska Monika , Coss Alan , Svarta Sigrid , Byrne Michael , Enns Robert 
Published: March 2016

BACKGROUND: Gastric variceal bleeding (GVB) is a major cause of morbidity and mortality among patients with portal hypertension. Endoscopic band ligation and standard sclerotherapy have been used but have significant limitations. Decompression through transjugular intrahepatic portosystemic shunt insertion has been shown to be effective. Gastric variceal injection therapy with a commercially available cyanoacrylate glue is less invasive than transjugular intrahepatic portosystemic shunt insertion and has recently been shown to be effective for acute hemostasis.OBJECTIVE: To assess the immediate and long-term outcomes of cyanoacrylate glue injection therapy for GVB.METHODS: A retrospective chart review was conducted to identify patients treated with cyanoacrylate injection for GVB at two tertiary care hospitals over a period of six years. The outcomes assessed included complications, acute hemostasis, rebleeding rate and all-cause mortality.RESULTS: Thirty-seven patients (60% men) underwent cyanoacrylate glue injections for GVB. The median follow-up period was 14 months and included 29 patients (eight were lost to follow-up). Initial hemostasis was achieved in 35 patients (95%). No significant complications from cyanoacrylate injection were observed. Early rebleeding was rare (8%) and late rebleeding occurred in only 28% of patients. The all-cause mortality rate was 28.6% during the median follow-up period.CONCLUSION: The data suggest that cyanoacrylate injection therapy is safe and effective for the prevention of short- and long-term bleeding from gastric varices. Furthermore, although these patients had significant comorbid disease, survival in the follow-up time period was greater than 70%.
Opportunity Costs of Gastrointestinal Endoscopic Training in Canada
Authors: Depew WT , Hookey LC , Vanner SJ , Louw JA , Lowe CE , Ropeleski MJ , Beyak MJ , Lazarescu A , Paterson WG 
Published: March 2016

BACKGROUND: No data exist to define the opportunity costs related to instruction in endoscopic procedures in Royal College of Physicians and Surgeons of Canada-accredited teaching centres. Academic and institutional administrators expect staff to achieve acceptable performance standards. There is a need to measure some of the effects of training activity in the establishment of such standards.OBJECTIVE: To measure the effect of resident training in colonoscopy on real procedure times and, as a secondary goal, to estimate procedural losses related to the process of training.METHODS: Real procedure times for ambulatory colonoscopy in a single academic, hospital-based endoscopy unit were documented. Times for certified endoscopy instructors functioning solo were compared with times for procedures involving trainees at several levels of colonoscopic experience. Procedural reductions associated with resident training were estimated based on the parameters derived from the results. The analysis was executed retrospectively using prospectively collected data.RESULTS: Resident training prolonged procedure times for ambulatory colonoscopy by 50%. The trainee effect was consistent, although variable in degree, among a variety of endoscopy instructors. Such increased procedure times have the potential to reduce case throughput and endoscopist remuneration.CONCLUSIONS: Resident training in colonoscopy in a Canadian certified training program has significant negative effects on case throughput and endoscopist billings. These factors should be considered in any assessment of performance in similar training environments.
Comparing Patient and Endoscopist Perceptions of the Colonoscopy Indication
Authors: Sewitch Maida J , Stein Dara , Joseph Lawrence , Bitton Alain , Hilsden Robert J , Rabeneck Linda , Paszat Lawrence , Tinmouth Jill , Cooper Mary Anne 
Published: March 2016

BACKGROUND: Determining whether a colonoscopy is performed for screening or nonscreening purposes can facilitate clinical practice and research. However, there is no simple method to determine the colonoscopy indication using patient medical files or health administrative databases.OBJECTIVE: To determine patient‐endoscopist agreement on the colonoscopy indication.METHODS: A cross‐sectional study was conducted among staff endoscopists and their patients at seven university‐affiliated hospitals in Montreal, Quebec. The study participants were 50 to 75 years of age, they were able to understand English or French, and were about to undergo colonoscopy. Self‐ (endoscopist) and interviewer‐administered (patient) questionnaires ascertained information that permitted classification of the colonoscopy indication. Patient colonoscopy indication was defined as the following: perceived screening (routine screening, family history, age); perceived nonscreening (follow‐up); medical history that implied nonscreening; and a combination of the three preceding indications. Agreement between patient and endoscopist indications was measured using concordance and Kappa statistic.RESULTS: In total, 702 patients and 38 endoscopists participated. The three most common reasons for undergoing colonoscopy were routine screening/regular check‐up (33.8%), follow‐up to a previous problem (30.2%) and other problem (24.6%). Concordance (range 0.79 to 0.85) and Kappa (range 0.58 to 0.70) were highest for perceived nonscreening colonoscopy. Recent large bowel symptoms accounted for 120 occurrences of disagreement in which the patient perceived a nonscreening colonoscopy while the endoscopist perceived a screening colonoscopy.CONCLUSIONS: Patient self‐report may be an acceptable means for rapidly assessing whether a colonoscopy is performed for screening or nonscreening purposes. Delivery of patient‐centred care may help patients and endoscopists reach a shared understanding of the reason for colonoscopy.
The Role of Garlic in Hepatopulmonary Syndrome: A Randomized Controlled Trial
Authors: De Binay K , Dutta Deep , Pal Subrata K , Gangopadhyay Subhabrata , Das Baksi Sumanta , Pani Adyapad 
Published: March 2016

BACKGROUND: Increased nitric oxide production in cirrhosis has been commonly implicated in the genesis of hepatopulmonary syndrome (HPS). Initial studies suggested that garlic, a constituent of the daily diet, may have a role in the treatment of HPS by altering nitric oxide production.OBJECTIVE: To evaluate the effects of oral garlic supplementation on arterial blood gas parameters, and overall morbidity and mortality in patients with HPS.METHODS: Twenty-one and 20 HPS patients were randomly assigned to receive either oral garlic supplementation or placebo, respectively, and were evaluated monthly over a period of nine to 18 months.RESULTS: After nine months, garlic supplementation was associated with a 24.66% increase in baseline arterial oxygen levels (83.05 mmHg versus 66.62 mmHg; P<0.001), compared with only a 7.37% increase (68.75 mmHg versus 64.05 mmHg; P=0.02) among subjects in the placebo group. There was also a 28.35% decrease in alveolar-arterial oxygen gradient (21.35 mmHg versus 29.77 mmHg; P<0.001) among patients with HPS who received garlic, in contrast with only a 10.73% decrease (29.11 mmHg versus 32.61 mmHg; P=0.12) among those in the placebo group. After nine months, the arterial oxygen level was significantly higher (83.05 mmHg versus 68.75 mmHg; P<0.001) and the alveolar-arterial oxygen gradient was significantly lower (21.35 mmHg versus 29.11 mmHg; P<0.001) among patients receiving garlic compared with those receiving placebo. Reversal of HPS was observed in 14 of 21 patients (66.67%) on garlic supplementation (intent-to-treat analysis) and in one of 20 patients (5%) on placebo. Two of 21 patients undergoing garlic supplementation died during follow-up in contrast to seven of 20 patients who were on placebo.CONCLUSIONS: Garlic supplementation may be beneficial in patients with HPS for the reversal of intrapulmonary shunts as well as reducing hypoxemia and mortality.
Fibromyalgia and the Therapeutic Relationship: Where Uncertainty Meets Attitude
Authors: Hayes Sean M , Myhal Genevieve C , Thornton John F , Camerlain Monique , Jamison Cynthia , Cytryn Kayla N , Murray Suzanne 
Published: March 2016

BACKGROUND: Fibromyalgia remains underdiagnosed and suboptimally treated even though it affects an estimated 3.3% of Canadians. The present study examines knowledge and attitudinal challenges affecting optimal care.METHODS: A mixed‐methods approach was employed. Discussion groups, semistructured interviews and a quantitative online survey (five‐point scale) were conducted (June 2007 to January 2008). Participants included 189 general practitioners (GPs) and 139 specialists (anesthesiologists, neurologists, physiatrists, psychiatrists and rheumatologists) distributed across Canada. Participants included 18 patients to enrich the scope of the findings.RESULTS: GPs reported insufficient knowledge and skill in diagnosing fibromyalgia, with not all believing it to be a diagnosable condition (mean 3.74/5). Twenty‐three per cent of GPs and 12% of specialists characterized fibromyalgia patients as malingerers. They further reported a lack of knowledge and skill in treating fibromyalgia (mean 2.73/5), including the pain, sleep disorders and mood disorders related to the condition (mean 3.32/5). Specialists shared these challenges, although to a lesser degree – “We are not trained to treat distress and suffering” (Specialist). Attitudinal issues centred around frustration (mean 3.91/5) and negative profiling of fibromyalgia patients (mean 3.06/5 and 1.99/5).CONCLUSIONS: Findings revealed the presence of GP attitudinal and confidence challenges in caring for fibromyalgia patients. As care of fibromyalgia patients moves to general practices, these fundamental competencies must be addressed to assure that all patients receive the quality of care necessary to manage their disease and to empower physicians to be more professionally effective. As stated by one patient, “Why are we being penalized for having this disability?”
Early Use of Magnetic Endoscopic Imaging by Novice Colonoscopists: Improved Performance without Increase in Workload
Authors: Coderre Sylvain , Anderson John , Rikers Remy , Dunckley Paul , Holbrook Karen , McLaughlin Kevin 
Published: March 2016

BACKGROUND: Magnetic endoscopic imaging represents a recent advance in colonoscopy training. This technique provides adjunct information to the endoscopist, specifically with regard to colonoscope loop formation.OBJECTIVE: To examine the effect of a magnetic endoscopic imager on novice performance and workload in colonoscopy.METHODS: Twenty complete novices received an introductory teaching session followed by the completion of two procedures on a colonoscopy model. One-half of the participants performed their first procedure with the imager, and the second procedure without, while the other one-half were trained with the inverse sequence. Two main outcome measures were recorded: distance achieved and total workload as measured by the National Aeronautics and Space Administration task load index tool.RESULTS: A significant improvement was noted between the first and second colonoscopies, with the best performance recorded for participants who performed their first procedure with the imager, and their second without. The imager did not significantly change the total workload.DISCUSSION: The study participants paid attention to the magnetic endoscopic imager; however, this did not translate into a measurable increase in novice workload. A delayed learning benefit was conferred to the group exposed to the imager on their first colonoscopy, suggesting that, even at an early training stage, the additional imager information entered working memory and was processed in a useful fashion. The introductory teaching strategy used in the present study was successful as judged by the overall distance achieved and performance improvement seen in all study participants.
Awareness of Risk Factors among Persons at Risk for Lung Cancer, Chronic Obstructive Pulmonary Disease and Sleep Apnea: A Canadian Population-Based Study
Authors: Walker Shannon L , Saltman David L , Colucci Rosemary , Martin Lesli 
Published: March 2016

OBJECTIVE: To assess awareness among persons at risk for lung cancer, chronic obstructive pulmonary disease (COPD) and sleep apnea regarding symptoms and risk factors of the disease, and their attitudes regarding the disease and toward those who are affected.METHODS: A quantitative hybrid telephone and Internet survey of a representative population of Canadian adults at risk for at least one of the three diseases was conducted. To measure the awareness and attitudes of First Nations, Inuit and Métis people to these diseases, a proportionate number were also surveyed.RESULTS: A total of 3626 individuals were contacted. Of these, 3036 (84%) were eligible to participate. Of those at risk for lung cancer and COPD, 65% and 69%, respectively, were due to tobacco smoke exposure. Among those at risk, 72% believed that they were informed about lung cancer compared with 36% for COPD and 56% for sleep apnea. Most respondents were knowledgeable about the common symptoms of lung cancer, COPD and sleep apnea, but were less aware of the impact lifestyle choices could have on the development of these disorders and the availability of treatment. Most of the participants (77%) believed that smoking was an addiction rather than a habit (19%). There were no significant differences in the awareness of risk factors, symptoms and attitudes toward all three lung diseases between First Nations, Inuit and Métis people and the general population.CONCLUSIONS: Canadians are reasonably aware of risk factors and symptoms for lung cancer and sleep apnea. However, there is poor awareness of COPD as a disease entity. There is a lack of appreciation for the impact lifestyle choices and changes can have on lung diseases.
Will Universal Access to Antiretroviral Therapy Ever be Possible? The Health Care Worker Challenge
Authors: Maddison André R , Schlech Walter F 
Published: March 2016

The United Nations millennium development goal of providing universal access to antiretroviral therapy (ART) for patients living with HIV/AIDS by 2010 is unachievable. Currently, four million people are receiving ART, of an estimated 13.7 million who need it. A major challenge to achieving this goal is the shortage of health care workers in low‐income and low‐resource areas of the world. Sub‐Saharan African countries have 68% of the world’s burden of illness from AIDS, yet have only 3% of health care workers worldwide. The shortage of health care providers is primarily caused by a national and international ‘brain drain,’ poor distribution of health care workers within countries, and health care worker burnout.Even though the millennium development goal to provide universal access to ART will not be met by 2010, it is imperative to continue to build on the momentum created by these humanitarian goals. The present literature review was written with the purpose of attracting research and policy attention toward evidence from small‐scale projects in sub‐Saharan Africa, which have been successful at increasing access to ART. Specifically, a primary‐care model of ART delivery, which focuses on decentralization of services, task shifting and community involvement will be discussed. To improve the health care worker shortage in sub‐Saharan Africa, the conventional model of health care delivery must be replaced with an innovative model that utilizes doctors, nurses and community members more effectively.