bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pandemic Influenza is a Strong Motivator for Participation in Vaccine Clinical Trials among HIV‐Positive Canadian Adults
Authors: Kiberd MB , Cooper C , Slaunwhite JM , Halperin B , Haase D , McNeil SA 
Published: March 2016

BACKGROUND: HIV‐positive patients represent an immunosuppressed population at risk for severe influenza. In the event of a pandemic, such as 2009 H1N1, rapid implementation of vaccine clinical trials in target populations will be critical. In the present paper, knowledge and attitudes of HIV‐positive adults regarding seasonal/pandemic influenza vaccination were evaluated, and facilitators and barriers to participation in vaccine clinical trials were explored.METHODS: A validated, 70‐item, self‐administered questionnaire was distributed to all HIV patients presenting for routine follow‐up at eight Canadian Institutes of Health Research Canadian HIV Trials Network (CTN) sites from October 2008 to February 2009, as well as all participants in CTN trial 237. This study has representation from all Canadian provinces.RESULTS: In total, 610 HIV‐positive adults responded (298 CTN 237 participants; 312 non‐CTN 237 participants). Most reported receiving influenza vaccine last season (83% of CTN 237 participants versus 83% non‐CTN 237 participants; P not significant) and most would receive a pandemic influenza vaccine if offered (76% versus 73%; P not significant). A majority believed that it was important to include HIV patients in vaccine clinical trials (65% versus 53%; P<0.001) and would agree to participate in trials of a pandemic vaccine if invited (86% versus 51%; P≤0.0001). Predictors of willingness to participate in a pandemic vaccine trial were ‘desire to be protected from pandemic flu’, OR 4.5 (95% CI 2 to 8) and ‘desire to help others’, OR 2.3 (95% CI 1.3 to 4.5). ‘Fear of needles’, OR 0.49 (95% CI 0.1 to 1.5) and ‘need for extra blood tests’, OR 0.49 (95% CI 0.2 to 1.4) were key barriers to participation.CONCLUSION: Most HIV‐positive Canadian adults surveyed receive influenza vaccination. Protection from pandemic influenza is considered important and is a motivator for receiving influenza vaccine and future trial participation. Modifiable barriers to these objectives identified in the present study should be the focus of efforts to increase influenza immunization in this population.
Incidence of Duodenal Ulcers and Gastric Ulcers in a Western Population: Back to Where It Started
Authors: Groenen Marcel JM , Kuipers Ernst J , Hansen Bettina E , Ouwendijk Rob J Th 
Published: March 2016

BACKGROUND/OBJECTIVES: As recently as 40 years ago, a decline in the incidence of peptic ulcers was observed. The discovery of Helicobacter pylori had a further major impact on the incidence of ulcer disease. Our aim was to evaluate the trends in the incidence and bleeding complications of ulcer disease in the Netherlands.METHODS: From a computerized endoscopy database of a district hospital, the data of all patients who underwent upper gastrointestinal endoscopy from 1996 to 2005 were analyzed. The incidence of duodenal and gastric ulcers, with and without complications, were compared over time.RESULTS: Overall, 20,006 upper gastrointestinal endoscopies were performed. Duodenal ulcers were diagnosed in 696 (3.5%) cases, with signs of bleeding in 158 (22.7%). Forty-five (6.5%) of these ulcers were classified as Forrest I and 113 (16.2%) as Forrest II. Gastric ulcers were diagnosed in 487 cases (2.4%), with signs of bleeding in 60 (12.3%). A Forrest 1 designation was diagnosed in 19 patients (3.9%) and Forrest 2 in 41 patients (8.4%). The incidence of gastric ulcers was stable over time, while the incidence of duodenal ulcers declined.CONCLUSIONS: The incidence of duodenal ulcer disease in the Dutch population is steadily decreasing over time. Test and treatment regimens for H pylori have possibly contributed to this decline. With a further decline in the prevalence of H pylori, the incidence of gastric ulcers is likely to exceed the incidence of duodenal ulcers in the very near future, revisiting a similar situation that was present at the beginning of the previous century.
Canadian Association of Gastroenterology Clinical Practice Guidelines: The Use of Tumour Necrosis Factor-Alpha Antagonist Therapy in Crohn’s Disease
Authors: Sadowski Daniel C , Bernstein Charles N , Bitton Alain , Croitoru Ken , Fedorak Richard N , Griffiths Anne , the CAG Crohn’s Consensus Group  
Published: March 2016

BACKGROUND: Guidelines regarding the use of infliximab in Crohn’s disease were previously published by the Canadian Association of Gastroenterology in 2004. However, recent clinical findings and drug developments warrant a review and update of these guidelines.OBJECTIVE: To review and update Canadian guidelines regarding the use of tumour necrosis factor-alpha antibody therapy in both luminal and fistulizing Crohn’s disease.METHODS: A consensus group of 25 voting participants developed a series of recommendation statements that addressed pertinent clinical questions and gaps in existing knowledge. An iterative voting and feedback process was used in advance of the consensus meeting in conjunction with a systematic literature review to refine the voting statements. These statements were brought to a formal consensus meeting held in Montreal, Quebec (March 2008), wherein each statement underwent discussion, reformulation, voting and subsequent revision until group consensus was obtained (at least 80% agreement).OUTCOME: The 47 voting statements addressed three themes: induction therapy, maintenance therapy and safety issues. As a result of the iterative process, 23 statements achieved consensus and were submitted for publication.CONCLUSION: In the past five years, tumour necrosis factor-alpha antagonist therapy has become a cornerstone in the management of moderate-to-severe Crohn’s disease refractory to conventional treatment algorithms. The evidentiary base supporting the use of these drugs in Crohn’s disease is substantial and strengthened by results from long-term clinical and molecular studies. However, significant gaps in knowledge exist, particularly with regard to treatment failure. Confidence in the safety of these drugs is increasing, provided that therapy is administered in a clinical setting in which potential complications can be readily recognized and treated.
Prevalence and Correlates of Pain in the Canadian National Palliative Care Survey
Authors: Wilson Keith G , Chochinov Harvey Max , Allard Pierre , Chary Srini , Gagnon Pierre R , Macmillan Karen , De Luca Marina , O’Shea Fiona , Kuhl David , Fainsinger Robin L 
Published: March 2016

BACKGROUND: Pain is a common problem for people with cancer who are nearing the ends of their lives.OBJECTIVE: In the present multicentre Canadian study of palliative cancer care, the prevalence of pain, its perceived severity and its correlates across a range of physical, social, psychological, and existential symptoms and concerns were examined.METHODS: Semistructured interviews were conducted with 381 patients. In addition to inquiring about pain, the interview also assessed 21 other symptoms and concerns, and collected information about demographic characteristics, functional status and medication use.RESULTS: Pain of any intensity was reported by 268 (70.3%) participants, although for 139 (36.5%), the severity was rated as minimal or mild. For 129 (33.9%) individuals, pain was reported as moderate to extreme, and considered by the respondents to be an important ongoing problem. Patients who reported moderate to extreme pain were younger than other participants, but had lower functional status and a shorter median survival duration. They were more likely than other participants to be treated with opioid medications (P<0.001) and, less reliably, with benzodiazepines (P=0.079). Compared with participants with no, minimal or mild pain, those with moderate to extreme pain had a higher prevalence of distressing problems on 11 of 21 other symptoms and concerns. The strongest correlations were with general malaise (rho = 0.44), suffering (rho = 0.40), nausea (rho = 0.34), weakness (rho = 0.31), drowsiness (rho = 0.29) and anxiety (rho = 0.29).CONCLUSIONS: Pain continues to be a difficult problem for many patients who are receiving palliative cancer care, particularly younger individuals who are nearing death.
A Double‐Blind, Randomized, Controlled Trial of Topical Polysporin Triple Compound Versus Topical Mupirocin for the Eradication of Colonization with Methicillin‐Resistant Staphylococcus aureus in a Complex Continuing Care Population
Authors: O’Grady S , Hirji Z , Pejcic-Karapetrovic B , Fung S , Dedier H , Takata-Shewchuk J , Zhang K , Conly J 
Published: March 2016

BACKGROUND: Intranasal mupirocin or Polysporin Triple (PT) ointment (polymyxin B, bacitracin, gramicidin), in combination with chlorhexidine body washes, have been used for eradicating methicillin‐resistant Staphylococcus aureus (MRSA), but no comparative studies have been done.METHODS: A double‐blind, randomized, controlled clinical trial to compare the efficacy of mupirocin versus PT ointment in combination with chlorhexidine body washes in eradicating MRSA carriage was conducted. Asymptomatic MRSA carriers, medically stable and at least 18 years of age who were patients on medical wards, received twice daily application of either mupirocin or PT ointment to the anterior nares plus once daily 2% chlorhexidine body washes for seven days. Follow‐up swabs from multiple sites using broth enrichment were conducted at 48 h, and one, two, four, eight and 12 weeks.RESULTS: Of 103 patients eligible for analysis (54 mupirocin; 49 PT), no significant differences between the two groups with respect to baseline demographics, risk factors for MRSA or MRSA colonization sites were noted. At 48 h, 35 of 54 (65%) patients in the mupirocin group versus 15 of 49 (31%) in the PT group (P=0.001) were found to be MRSA negative at all sites. Significant differences were observed at one and two weeks but were not maintained at other intervals. In those with complete microbiological follow‐up, MRSA eradication at all sites occurred in 12 of 39 (30.8%) mupirocin‐ and one of 36 (2.8%) PT‐treated patients (P=0.001).CONCLUSION: Both agents demonstrated poor efficacy and PT was significantly less efficacious than mupirocin at 12 weeks in eradicating MRSA from all sites.
A Survey of Prelicensure Pain Curricula in Health Science Faculties in Canadian Universities
Authors: Watt-Watson Judy , McGillion M , Hunter J , Choiniere M , Clark AJ , Dewar A , Johnston C , Lynch M , Morley-Forster P , Moulin D , Thie N , von Baeyer CL , Webber K 
Published: March 2016

OBJECTIVE: The present exploratory, descriptive study aimed to determine the designated time for mandatory pain content in curricula of major Canadian universities for students in health science and veterinary programs before being licensed.METHOD: Major Canadian university sites (n=10) were chosen where health science faculties included at least medicine (n=10) and nursing (n=10); many also included dentistry (n=8), pharmacy (n=7), physical therapy (n=8) and/or occupational therapy (n=6). These disciplines provide the largest number of students entering the workforce but are not the only ones contributing to the health professional team. Veterinary programs (n=4) were also surveyed as a comparison. The Pain Education Survey, developed from previous research and piloted, was used to determine total mandatory pain hours.RESULTS: The majority of health science programs (67.5%) were unable to specify designated hours for pain. Only 32.5% respondents could identify specific hours allotted for pain course content and/or additional clinical conferences. The average total time per discipline across all years varied from 13 h to 41 h (range 0 h to 109 h). All veterinary respondents identified mandatory designated pain content time (mean 87 h, range 27 h to 200 h). The proportion allotted to the eight content categories varied, but time was least for pain misbeliefs, assessment and monitoring/follow‐up planning.CONCLUSIONS: Only one‐third of the present sample could identify time designated for teaching mandatory pain content. Two‐thirds reported ‘integrated’ content that was not quantifiable or able to be determined, which may suggest it is not a priority at that site. Many expressed a need for pain‐related curriculum resources.
The Influence of Addiction Risk on Nursing Students’ Expectations of Patients’ Pain Reports: A Clinical Vignette Approach
Authors: Miceli Paula C , Katz Joel 
Published: March 2016

OBJECTIVE: To examine the influence of addiction risk (substance abuse history [SAH]) and pain relief (PR) on nursing and non‐nursing students’ perceptions of pain in a postoperative vignette patient.METHODS: Using a 2×2 design, the independent variables SAH (present/+, absent/–) and PR (adequate, little) were varied systematically to produce four vignettes. Participants were randomly assigned to receive one of the four vignettes that described a 45‐year‐old man after a total hip replacement. Participants rated the vignette patient’s experienced and reported pain intensity (PI) on a 0 mm to 100 mm visual analogue scale and addiction risk on a 0 mm to 100 mm visual analogue scale. A pain congruence (PC) score was calculated (PC = reported PI – experienced PI), and was interpreted as congruent (±2 mm) or incongruent (+2 mm to +100 mm for expected pain over‐reporting; −2 mm to −100 mm for expected pain under‐reporting).RESULTS: Responses from undergraduate nursing (n=89) and non‐nursing (n=88) students were analyzed. The estimated addiction risk was significantly lower in nursing (14% to 45%) versus non‐nursing students (50%). Nursing students’ mean PC scores were not significantly altered by SAH alone. Expectations of pain over‐reporting were observed under conditions of SAH+/adequate PR, but not SAH+/little PR. In non‐nursing students, SAH and PR were significant and independent factors influencing mean PC scores in the direction of pain over‐reporting.CONCLUSION: Under most conditions, nursing students expected pain under‐reporting by the postoperative vignette patient. However, nursing students did expect pain to be over‐reported when addiction risk was high and PR was adequate. These data suggest that nursing students’ expectations regarding pain over‐ and under‐reporting were sensitive to perceptions of addiction risk, but involved additional factors (eg, level of PR).
Respiratory Watch: Development of a Provincial System for Respiratory Syncytial Virus Surveillance in Nova Scotia, 2005–2008
Authors: Al-Assam Assaad , Langley Joanne M , Sarwal Shelly 
Published: March 2016

OBJECTIVE: Respiratory syncytial virus (RSV) is the most common cause of severe lower respiratory tract infection in young children and is increasingly recognized as a cause of influenza‐like illness in those older than 65 years of age. A surveillance system to provide timely local information about RSV activity in Nova Scotia (NS) is described.METHODS: A case report form was developed for weekly reporting of all laboratory isolates of RSV at diagnostic laboratories around the province. Laboratories were asked to send the forms by fax each Friday to the Nova Scotia Department of Health Promotion and Protection. Data were entered in Excel (Microsoft, USA) and aggregate results summarized by age, sex, health district and date of laboratory confirmation for 2005 to 2008.RESULTS: During three winter seasons (2005–2006, 2006–2007 and 2007–2008), there were 207, 350 and 186 isolates of RSV reported in NS, respectively. The average incidences of RSV in NS varied greatly by age, with the highest rates in infants younger than 24 months of age, and approaching 4000 cases per 100,000 population in infants up to five months of age. The duration of the RSV outbreak was approximately five to six months each year, but the month of onset varied.CONCLUSIONS: A RSV surveillance system was successfully established in NS that provides weekly data to the public health system, clinicians and infection control practitioners. The time of onset and severity of the RSV season varied over time. These data can be used to plan anti‐RSV passive prophylaxis programs and infection control education, and distinguish RSV outbreaks from other viruses in acute care and long‐term care settings.
Filing for Workers’ Compensation among Ontario Cases of Mesothelioma
Authors: Payne Jennifer Isabelle , Pichora Erin 
Published: March 2016

BACKGROUND/OBJECTIVE: For many types of cancer, disease attribution to occupational exposures is difficult. Mesothelioma, however, is a ‘sentinel’ occupational cancer associated with asbestos exposure. The present study linked workers’ compensation claims data with cancer registry data to explore the completeness of reporting of mesothelioma to the Ontario Workplace Safety and Insurance Board (WSIB) according to characteristics of cases diagnosed among Ontario residents.METHODS: Two data sources were linked at the person level: the WSIB Occupational Disease Information and Surveillance System and the Ontario Cancer Registry. Filing rates were calculated as the proportion of Ontario Cancer Registry mesothelioma cases (International Classification of Diseases – Oncology code 905) that linked to a WSIB‐filed cancer claim. Filing rates were calculated for the period 1980 to 2002, and trends were calculated by year, age and county of residence at diagnosis.RESULTS: The filing rate for compensation has increased little over the past 20 years, reaching a high of 43% in 2000. Overall, filing rates were highest among pleural mesothelioma cases among men (range 27% to 57%). Filing rates were highest among individuals 50 to 59 years of age and declined substantially throughout the retirement years. There was substantial variation in filing rates by area of residence, with the highest rate being in Lambton County, Ontario.CONCLUSION: The filing rate for compensation in Ontario was much lower than the estimated proportion of cases eligible for compensation. The increased filing rate in Lambton County was likely related to this community’s awareness of the association between asbestos and mesothelioma. Physicians can play an important role in educating patients of their potential entitlement to compensation benefits.
Predicting the Need for Supplemental Oxygen During Airline Flight in Patients with Chronic Pulmonary Disease: A Comparison of Predictive Equations and Altitude Simulation
Authors: Bradi Ana C , Faughnan Marie E , Stanbrook Matthew B , Deschenes-Leek Eva , Chapman Kenneth R 
Published: March 2016

BACKGROUND: Patients with chronic pulmonary diseases are at increased risk of hypoxemia when travelling by air. Screening guidelines, predictive equations based on ground level measurements and altitude simulation laboratory procedures have been recommended for determining risk but have not been rigorously evaluated and compared.OBJECTIVES: To determine the adequacy of screening recommendations that identify patients at risk of hypoxemia at altitude, to evaluate the specificity and sensitivity of published predictive equations, and to analyze other possible predictors of the need for in‐flight oxygen.METHODS: The charts of 27 consecutive eligible patients referred for hypoxia altitude simulation testing before flight were reviewed. Patients breathed a fraction of inspired oxygen of 0.15 for 20 min. This patient population was compared with the screening recommendations made by six official bodies and compared the partial pressure of arterial oxygen (PaO2) obtained during altitude simulation with the PaO2 predicted by 16 published predictive equations.RESULTS: Of the 27 subjects, 25% to 33% who were predicted to maintain adequate oxygenation in flight by the British Thoracic Society, Aerospace Medical Association or American Thoracic Society guidelines became hypoxemic during altitude simulation. The 16 predictive equations were markedly inaccurate in predicting the PaO2 measured during altitude simulation; only one had a positive predictive value of greater than 30%. Regression analysis identified PaO2 at ground level (r=0.50; P=0.009), diffusion capacity (r=0.56; P=0.05) and per cent forced expiratory volume in 1 s (r=0.57; P=0.009) as having predictive value for hypoxia at altitude.CONCLUSIONS: Current screening recommendations for determining which patients require formal assessment of oxygen during flight are inadequate. Predictive equations based on sea level variables provide poor estimates of PaO2 measured during altitude simulation.
Montelukast as an Alternative to Low‐Dose Inhaled Corticosteroids in the Management of Mild Asthma (The SIMPLE Trial): An Open‐Label Effectiveness Trial
Authors: McIvor R Andrew , Kaplan Alan , Koch Caroline , Sampalis John S 
Published: March 2016

OBJECTIVE: To evaluate the effectiveness of montelukast as monotherapy for patients with mild asthma who remain uncontrolled or unsatisfied while on inhaled corticosteroid (ICS) monotherapy.DESIGN: A multicentre, open‐label study. Patients (six years of age or older) had ICS therapy discontinued and were treated with orally administered montelukast once daily for six weeks.MAIN OUTCOME MEASURES: The primary outcome measure was the rate at which asthma symptom control was achieved or maintained after six weeks of treatment. The secondary outcome measures were to compare compliance and physician satisfaction, and to further assess the safety and tolerability of montelukast.RESULTS: Of the 534 patients enrolled, 481 (90.1%) completed the study. Mean (± SD) age was 27.8±19.0 years. The number of patients with uncontrolled symptoms decreased from 455 (85.2%) at baseline to 143 (26.8%) at week 6 (P<0.001), and mean Asthma Control Questionnaire score decreased from 1.4±0.8 to 0.6±0.6 (P<0.001), representing a clinically significant improvement. Of the 79 patients with controlled asthma symptoms at baseline, 73.4% maintained asthma control at week 6. Compliance to asthma therapy increased from 41% at baseline for ICS to 88% at week 6 for montelukast (P<0.001). Physician satisfaction with treatment increased from 43% to 85% (P<0.001) and patient satisfaction increased from 45% at baseline to 94% at week 6. No serious adverse events were reported over the course of the study.CONCLUSION: Montelukast is an effective and well‐tolerated alternative to ICS treatment in patients with mild asthma who are uncontrolled or unsatisfied with low‐dose ICS therapy.