bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Parameters Predicting Survival Duration after Hepatectomy for Intrahepatic Cholangiocarcinoma
Authors: Jiang Bei-ge , Ge Rui-liang , Sun Liang-liang , Zong Ming , Wei Gong-tian , Zhang Yong-jie 
Published: March 2016

BACKGROUND: Currently, the most effective treatment for intrahepatic cholangiocarcinoma (ICC) is complete hepatic tumour excision.OBJECTIVE: To identify the clinical parameters associated with survival duration for ICC patients following hepatectomy, and to construct a mathematical model for predicting survival duration.METHODS: Demographic data and clinical variables for 102 patients diagnosed with ICC, who underwent exploratory laparotomy at a single centre from July 1998 to December 2000 and were followed for an average of 24 months, were collected in 2011. Patients were randomly assigned into training (n=76) and validation (n=26) groups. Univariate and multivariate analyses were performed to identify factors associated with posthepatectomy survival duration.RESULTS: Univariate analysis revealed that more than three lymph node metastases, a serum carbohydrate antigen 19-9 level >37 U/mL, stage IVa tumours, and intra- or perihepatic metastases were significantly associated with decreased survival duration. Curative resection was significantly associated with increased survival duration. A mathematical model incorporating parameters of age, sex, metastatic lymph node number, curative surgery, carbohydrate antigen 19-9 concentration, alpha-fetoprotein concentration, hepatitis B, TNM stage and tumour differentiation was constructed for predicting survival duration. For a survival duration of less than one year, the model exhibited 93.8% sensitivity, 92.3% total accuracy and a positive predictive value of 93.8%; for a survival duration of one to three years, the corresponding values were 80.0%, 69.2% and 57.1%, repsectively.CONCLUSIONS: The mathematical model presented in the current report should prove to be useful in the clinical setting for predicting the extent to which curative resection affects the survival of ICC patients, and for selecting optimal postoperative treatment strategies.
Hepatitis B Learning Needs Assessment of Family Medicine Trainees in Canada: Results of a Nationwide Survey
Authors: Sam Justina J , Heathcote E Jenny , Wong David KH , Wooster Douglas L , Shah Hemant 
Published: March 2016

BACKGROUND: An estimated 350 million people worldwide have chronic hepatitis B (CHB), which is a major cause of cirrhosis and hepatocellular carcinoma.OBJECTIVE: To assess the level of knowledge among family medicine trainees regarding the identification and management of CHB.METHODS: A questionnaire to assess knowledge regarding screening and management of patients with CHB and cirrhosis was developed. The questionnaire was pilot tested among primary care physicians, subsequently revised and distributed to family medicine trainees across Canada through an online survey program (QuestionPro).RESULTS: A total of 158 trainees completed the questionnaire. Of these, 54% to 56% routinely offered vaccination against hepatitis A or hepatitis B virus (HBV), and 42% regularly screened patients for HBV risk factors. The percentage who recognized the need to screen high-risk populations for CHB, ie, individuals from an HBV-endemic country, men who have sex with men, or intravenous drug users was 73%, 66% and 74%, respectively. While less than 50% of respondents used the appropriate HBV screening tests, 86% to 91% correctly interpreted various HBV serological patterns. Only 3% recognized cirrhosis in our case scenario. Almost 80% of respondents inappropriately preferred prescribing a narcotic or nonsteroidal anti-inflammatory drug over acetaminophen (4%) for pain control in a patient with cirrhosis. While less than 60% recognized HBeAg negative CHB as an indication for referral and treatment, 90% would have referred a patient in the immune-tolerant phase, even though treatment is not indicated.CONCLUSIONS: Knowledge gaps regarding CHB among family medicine trainees in the areas of primary prevention, disease recognition and management of cirrhosis were identified. Results suggest that opportunities to prevent potentially life-threatening complications are being missed.
Helicobacter pyloriInfection: Is Sequential Therapy Superior to Standard Triple Therapy? A Single-Centre Italian Study in Treatment-Naive and Non-Treatment-Naive Patients
Authors: Urgesi R , Pelecca G , Cianci R , Masini A , Zampaletta C , Riccioni ME , Faggiani R 
Published: March 2016

BACKGROUND: Clarithromycin resistance has decreased the eradication rates ofHelicobacter pylori.AIMS: To determine whether a 10-day course of sequential therapy (ST) is more effective at eradicatingH pyloriinfection than triple therapy (TT) in the first or second line, and to assess side effects and compliance with therapy.METHODS: One hundred sixty treatment-naive and 40 non-treatment-naive patients who were positive forH pyloriinfection by13C-urea breath test or endoscopy were enrolled. Eighty of 160 patients underwent TT, while 80 of 160 underwent ST with omeprazole (20 mg) plus amoxicillin (1 g) twice/day for five days, followed by omeprazole (20 mg) with tinidazole (500 mg) twice/day and clarithromycin (500 mg) twice/day for five consecutive days.H pylorieradication was evaluated by13C-urea breath test no sooner than four weeks after the end of treatment.RESULTS: Eradication was achieved in 59 of 80 treatment-naive patients treated with TT (74%), in 74 of 80 patients treated with ST (93%), and in 38 of 40 non-treatment-naive patients (95%). Eradication rates in treatment-naive patients with ST were statistically significantly higher than TT (92.5% versus 73.7%; P=0.0015; OR 4.39 [95% CI 1.66 to 11.58]). Mild adverse effects were reported for both regimens.CONCLUSIONS: ST appears to be a well-tolerated, promising therapy; however, randomized controlled trials with larger and more diverse sample populations are needed before it can be recommended as a first-line treatment.
Prediction and Prevention of Upper Gastrointestinal Bleeding after Cardiac Surgery: A Case Control Study
Authors: Bhat Mamatha , Larocque Martin , Amorim Marcos , Herba Karl , Martel Myriam , De Varennes Benoît , Barkun Alan 
Published: March 2016

BACKGROUND: Gastrointestinal (GI) complications of cardiovascular surgery, particularly bleeding, occur frequently.OBJECTIVE: To determine factors that predict upper GI bleeding (UGIB) after cardiac surgery to improve prognostication and, thus, outcomes.METHODS: The present case-control study reviewed institutional records spanning 2002 to 2005 for consecutive patients who developed in-hospital UGIB following cardiovascular surgery. Each case was matched to two to three controls for age, sex and date of hospital admission. Demographics, pharmacotherapy (including use of in-hospital acid suppression), endoscopic findings and outcomes were recorded. After adjustment for possible confounders, including Parsonnet score and demographic parameters, conditional logistic regression analysis identified independent significant predictors of the subsequent development of UGIB.RESULTS: The study population consisted of 131 cases (mean [± SD] age 68.8±10.2 years, 69.5% male, mean Parsonnet score 24.6±14.2) and 387 matched controls (mean age 68.8±10.8 years, 70.0% male, mean Parsonnet score 20.9±14.2). UGIB events occurred a mean of 10.3±7.7 days after cardiac surgery. Duration of mechanical ventilation (OR 3.01 [95% CI 1.44 to 6.28]), elevation of international normalized ratio (OR 1.91 [95% CI 1.31 to 2.78]) and occurrence ofClostridium difficilecolitis before bleeding (OR 3.15 [95% CI 1.19 to 8.36]) were independent risk factors. Use of histamine type 2 receptor antagonists (H2RAs) (OR 0.65 [95% CI 0.38 to 1.12]) or proton pump inhibitors (PPIs) (OR 0.60 [95% CI 0.27 to 1.32]) demonstrated trends toward protecting against UGIB after cardiac surgery.CONCLUSIONS: GI bleeding events occurred approximately 10 days after cardiac surgery in patients with a complicated postoperative course. Significant predictors of subsequent bleeding included increased duration of mechanical ventilation and elevation of international normalized ratio; routine acid suppression with PPIs should be considered in such patients.C difficilecolitis also significantly predicted UGIB, and H2RAs should be considered for acid suppression. Neither H2RAs nor PPIs were effective in preventing UGIB, although the small number of patients limits definitive conclusions regarding the role of acid suppression.
Wilson Disease: Canadian Perspectives on Presentation And Outcomes from an Adult Ambulatory Setting
Authors: Moores A , Fox SH , Lang AE , Hirschfield GM 
Published: March 2016

BACKGROUND: Wilson disease (WD) is a rare disorder of copper metabolism.OBJECTIVE: To describe the authors’ clinical experience with a cohort of 48 adult patients followed in an ambulatory setting.METHODS: A retrospective chart review of patients with a diagnosis of WD was performed.RESULTS: Fifty-nine charts were identified and 11 were excluded on further review. At diagnosis, 14 patients were asymptomatic, with 13 hepatic, 15 neurological and six mixed hepatic/neurological presentations. Ceruloplasmin levels were low (<0.20 g/L) in 94%, and 24 h urinary copper levels high (>0.60 μmol/L) in 95% of cases. D-penicillamine was the most common initial therapy (48%), with zinc the most common at review (65%). Overall, biopsy and ultrasound reports documented cirrhosis in 53%. Portal hypertension, defined as splenomegaly (>12.0 cm), reversed portal venous flow on ultrasound or varices/gastropathy on endoscopy was seen in 63%. At last review, 39% had elevated aspartate aminotransferase (>34 U/L) and/or alanine aminotransferase levels (>40 U/L). One death and one transplant occurred, while three patients had encephalopathy, two became jaundiced, two developed ascites and one experienced variceal bleed. Of 21 neurological presenting patients, 14 improved compared with baseline, with four making almost complete recovery. Eleven patients experienced documented episodes of neurological decline, including four with non-neurological presentation. Diagnostic magnetic resonance imaging showed basal ganglia (64%), brainstem (64%) abnormalities and atrophy (36%); follow-up showed basal ganglia lesions (50%) and atrophy (55%).CONCLUSION: WD is a diverse chronic disease with generally favourable outcomes for patients who respond to initial therapy, which can be managed predominantly in an ambulatory setting.
Pain Sensitivity Mediates The Relationship between Stress and Headache Intensity in Chronic Tension‐Type Headache
Authors: Cathcart Stuart , Bhullar Navjot , Immink Maarten , Della Vedova Chris , Hayball John 
Published: March 2016

BACKGROUND: A central model for chronic tension‐type headache (CTH) posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. The prediction from this model that pain sensitivity mediates the relationship between stress and headache activity has not yet been examined.OBJECTIVE: To determine whether pain sensitivity mediates the relationship between stress and prospective headache activity in CTH sufferers.METHOD: Self‐reported stress, pain sensitivity and prospective headache activity were measured in 53 CTH sufferers recruited from the general population. Pain sensitivity was modelled as a mediator between stress and headache activity, and tested using a nonparametric bootstrap analysis.RESULTS: Pain sensitivity significantly mediated the relationship between stress and headache intensity.CONCLUSIONS: The results of the present study support the central model for CTH, which posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. Implications for the mechanisms and treatment of CTH are discussed.
Active and Uncontrolled Asthma Among Children Exposed to Air Stack Emissions of Sulphur Dioxide from Petroleum Refineries in Montreal, Quebec: A Cross-Sectional Study
Authors: Deger Leylâ , Plante Céline , Jacques Louis , Goudreau Sophie , Perron Stéphane , Hicks John , Kosatsky Tom , Smargiassi Audrey 
Published: March 2016

BACKGROUND: Little attention has been devoted to the effects on children’s respiratory health of exposure to sulphur dioxide (SO2) in ambient air from local industrial emissions. Most studies on the effects of SO2have assessed its impact as part of the regional ambient air pollutant mix.OBJECTIVE: To examine the association between exposure to stack emissions of SO2from petroleum refineries located in Montreal’s (Quebec) east-end industrial complex and the prevalence of active asthma and poor asthma control among children living nearby.METHODS: The present cross-sectional study used data from a respiratory health survey of Montreal children six months to 12 years of age conducted in 2006. Of 7964 eligible households that completed the survey, 842 children between six months and 12 years of age lived in an area impacted by refinery emissions. Ambient SO2exposure levels were estimated using dispersion modelling. Log-binomial regression models were used to estimate crude and adjusted prevalence ratios (PRs) and 95% CIs for the association between yearly school and residential SO2exposure estimates and asthma outcomes. Adjustments were made for child’s age, sex, parental history of atopy and tobacco smoke exposure at home.RESULTS: The adjusted PR for the association between active asthma and SO2levels was 1.14 (95% CI 0.94 to 1.39) per interquartile range increase in modelled annual SO2. The effect on poor asthma control was greater (PR=1.39 per interquartile range increase in modelled SO2[95% CI 1.00 to 1.94]).CONCLUSIONS: Results of the present study suggest a relationship between exposure to refinery stack emissions of SO2and the prevalence of active and poor asthma control in children who live and attend school in proximity to refineries.
It’s a Man’s World: Does Orthotopic Liver Transplantation in the Elderly Male Confer an Additional Risk on Survival?
Authors: Slattery Eoin , Hegarty John E , McCormick P Aiden 
Published: March 2016

BACKGROUND: Orthotopic liver transplantation (OLT) in a well-selected population is a highly successful procedure, with one-year survival rates reported to be as high as 90%. Advanced age is considered to be a contraindication. Survival rates in patients >60 years of age appear to be comparable with those of younger patients. However, little objective data exist on the outcomes of patients >65 years of age undergoing OLT.OBJECTIVE: To review the outcomes of OLT in the Irish National Transplant Unit in patients >65 years of age and to compare outcomes with patients ≤65 years of age. Second, to identify any factors that may provide valuable prognostic information regarding outcomes.METHOD: Patients >65 years of age who underwent OLT since the inception of the National Liver Unit in 1993 were identified from a prospectively maintained database. Medical records were reviewed. Survival was compared with the overall cohort using the Kaplan-Meier technique. Independent variables between the two groups were assessed using logistic regression analysis.RESULTS: Between January 1993 and December 2009, 551 patients underwent 639 transplants in the Irish National Liver Transplant Unit. Forty-three transplants were performed in 40 patients >65 years of age. Unadjusted one- and three-year survival rates for the elderly cohort were 77.8% and 64.5%, respectively. This compared with 93% and 85%, respectively, in the unselected cohort. Using Kaplan-Meier analysis, a significant benefit in survival was observed in patients ≤65 years of age (P=0.017). Similarly, when adjusted for sex, a significant difference was noted between the groups. Male patients >65 years of age had poorer survival compared with their female counterparts >65 years of age and all patients ≤65 years of age (P=0.02). There was no significant difference between the groups with respect to preoperative variables such as bilirubin, creatinine and sodium levels, and Model for End-stage Liver Disease score. A significant difference was seen in male patients >65 years of age with more than one comorbidity, compared with female patients and male patients ≤65 years of age.CONCLUSION: Male sex was associated with poorer survival in patients >65 years of age undergoing OLT. Multiple comorbidities in elderly male patients should be considered a relative contraindication in patients being assessed for OLT.
Validity of Chronic Obstructive Pulmonary Disease Diagnoses in a Large Administrative Database
Authors: Lacasse Yves , Daigle Jean-Marc , Martin Sylvie , Maltais François 
Published: March 2016

BACKGROUND: Administrative databases are often used for research purposes, with minimal attention devoted to the validity of the included diagnoses.AIMS: To determine whether the principal diagnoses of chronic obstructive pulmonary disease (COPD) made in hospitalized patients and recorded in a large administrative database are valid.METHODS: The medical charts of 1221 patients hospitalized in 40 acute care centres in Quebec and discharged between April 1, 2003 and March 31, 2004, with a principal discharge diagnosis of COPD (International Classification of Diseases, Ninth Revisioncodes 491, 492 or 496) were reviewed. The diagnosis of COPD was independently adjudicated by two pulmonologists using clinical history (including smoking status) and spirometry. The primary outcome measure was the positive predictive value (PPV) of the database for the diagnosis of COPD (ie, the proportion of patients with an accurate diagnosis of COPD corroborated by clinical history and spirometry).RESULTS: The diagnosis of COPD was validated in 616 patients (PPV 50.4% [95% CI 47.7% to 53.3%]), with 372 patients (30.5%) classified as ‘indeterminate’. Older age and female sex were associated with a lower probability of an accurate diagnosis of COPD. Hospitalization in a teaching institution was associated with a twofold increase in the probability of a correct diagnosis.CONCLUSIONS: The results support the routine ascertainment of the validity of diagnoses before using administrative databases in clinical and health services research.
Etiology of Small Bowel Thickening on Computed Tomography
Authors: Finkelstone Lee , Wolf Ellen , Stein Marjorie W 
Published: March 2016

BACKGROUND: Abdominal pain is often evaluated using imaging, most often with computed tomography (CT). While CT is sensitive and specific for certain diagnoses, small bowel thickening is a nonspecific finding on CT with a broad differential diagnosis including infection, inflammation, ischemia and neoplasm.METHOD: A review of medical records of patients who underwent CT scans of the abdomen and pelvis over a one-year period and exhibited small bowel thickening were retrospectively evaluated to determine the final diagnosis.RESULTS: The etiologies of small bowel thickening on CT were as follows: infection (113 of 446 [25.34%]); reactive inflammation (69 of 446 [15.47%]); primary inflammation (62 of 446 [13.90%]); small bowel obstruction (38 of 446 [8.52%]); iatrogenic (33 of 446 [7.40%]); neoplastic (32 of 446 [7.17%]); ascites (30 of 446 [6.73%]); unknown (28 of 446 [6.28%]); ischemic (24 of 446 [5.38%]); and miscellaneous (17 of 446 [3.81%]).CONCLUSION: Infectious and inflammatory (primary or reactive) conditions were the most common cause of small bowel thickening in the present series; these data can be used to formulate a more specific differential diagnosis.
Comparability of Internet and Telephone Data in a Survey on the Respiratory Health of Children
Authors: Plante Céline , Jacques Louis , Chevalier Serge , Fournier Michel 
Published: March 2016

BACKGROUND:Mixing survey administration modes has generated concern about the comparability of responses between modes.OBJECTIVE:To explore the differences in respondent profiles, and responses between Internet and telephone questionnaires in a survey on respiratory diseases.METHODS:The data were generated from a mixed Internet and telephone survey of respiratory diseases among children in Montreal (Quebec), in 2006. Comparison of 12 selected questions was performed after standardization for respondent education and income. Stratification of analysis on education and income categories was also performed for the questions with significantly divergent responses.RESULTS:Six questions showed significant differences in responses between modes after standardization. The largest differences among the closed‐ended questions were observed for highly prevalent symptoms, dry cough during the night (difference of 9% for positive answer [P<0.01]) and symptoms of allergic rhinitis (difference of 7% for positive answer [P<0.01]). A large discrepancy was also found in the multiple choice question and with an open‐ended response (ie, free answer). For the three potentially sensitive questions, a desirability bias was probably present in one question on smoking habits (difference of 2.6 % for positive answer [P<0.05]).CONCLUSION:The differences observed between Internet and telephone responses to selected questions were not completely explained by socioeconomic disparities among the respondents. In a mixed‐mode survey (Internet and telephone), caution should be used when formulating sensitive, complex, open‐ended and long‐ended questions, and those related to highly prevalent and nonspecific symptoms.
Cost Effectiveness of Infant Vaccination for Rotavirus in Canada
Authors: Coyle Doug , Coyle Kathryn , Bettinger Julie A , Halperin Scott A , Vaudry Wendy , Scheifele David W , Le Saux Nicole 
Published: March 2016

INTRODUCTION: Rotavirus is the main cause of gastroenteritis in Canadian children younger than five years of age, resulting in significant morbidity and cost. The present study provides evidence on the cost effectiveness of two alternative rotavirus vaccinations (RotaTeq [Merck Frosst Canada Ltd, Canada] and Rotarix [GlaxoSmithKline, Canada]) available in Canada.METHODS: Analysis was conducted through a Markov model that followed a cohort of children from birth to five years of age. Analysis used pertinent data on the natural history of rotavirus and the effects of vaccination. Estimates of heath care costs for children requiring hospitalizations and emergency department visits were derived from the Canadian Immunization Monitoring Program, Active (IMPACT) surveillance, emergency department studies, as well as other Canadian studies. The model estimated the effect of vaccination on costs and quality‐adjusted life years (QALYs).RESULTS: The incremental cost per QALY gained from the health care system perspective was $122,000 for RotaTeq and $108,000 for Rotarix. From the societal perspective, both vaccination strategies were dominant – both cost saving and more effective. The cost‐effectiveness of vaccination is dependent on the mode of administration, the perspective adopted and the cost of the vaccine.CONCLUSIONS: From a societal perspective, a universal vaccination program against rotavirus will be both cost saving and more effective than no vaccination. Becasue the majority of rotavirus infections do not require emergency department visits or hospital admission, from a health care system perspective, a program would not be considered cost effective.