bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oxygen Desaturation During a 6 Min Walk Test is a Sign of Nocturnal Hypoxemia
Authors: Scott Adrienne S , Baltzan Marcel A , Chan Ryan , Wolkove Norman 
Published: March 2016

BACKGROUND/OBJECTIVES: Patients with chronic obstructive pulmonary disease (COPD) may experience sleep disordered breathing with nocturnal desaturation. An exploratory study was performed to determine whether any commonly measured clinical parameters were useful in predicting nocturnal desaturation in patients with COPD. A validation study was subsequently performed to confirm the utility of the parameter identified in the exploratory study as most useful in this regard.METHODS: A total of 103 (exploratory cohort) and 200 (validation cohort) consecutive patients with COPD admitted for pulmonary rehabilitation were evaluated. Standard outcome measures including nocturnal oximetry and the 6 min walk test (6MWT) on room air with continuous pulse oximetry were assessed. Patients with sleep apnea or those undergoing long‐term oxygen therapy were excluded.RESULTS: In the exploratory study, the mean (± SD) patient age was 70±9.9 years, with forced expiratory volume in 1 s of 0.76±0.34 L, which was 36±16% of predicted. Body mass index, arterial oxygen tension, oxygen saturation by pulse oximetry at rest and during the 6MWT all demonstrated significant correlations with percentage of time spent with a saturation <90%. When the lowest pulse oximetry during the 6MWT was ≤88%, 10 of 21 patients demonstrated a saturation <90% for at least 30% of sleep time. This measure yielded a positive likelihood ratio of 3.77 (95% CI 1.87 to 7.62) compared with those who did not reach this threshold value. The validation study confirmed similar detection characteristics.CONCLUSIONS: Results from the present study suggest that monitoring oxygen saturation changes during a 6MWT is useful in helping to identify COPD patients who may experience significant nocturnal desaturation.
The Increasing Prevalence of Clindamycin Resistance in Staphylococcus aureus Isolates in Children with Head and Neck Abscesses
Authors: Alexander Ashlin J. , Richardson Susan E. , Sharma Alok , Campisi Paolo 
Published: March 2016

OBJECTIVE: To retrospectively review trends in clindamycin resistance among Staphylococcus aureus head and neck abscesses between January 2000 and June 2008.METHODS: Between January 2000 and June 2008, inpatient and out‐patient S aureus isolates were reviewed for antibiotic susceptibility. In particular, cultures from 153 abscesses in the head and neck region were assessed for clindamycin and methicillin resistance patterns.RESULTS: Annual clindamycin resistance rates for all S aureus isolates, and specifically for S aureus head and neck abscesses, revealed concerning levels of clindamycin and methicillin resistance. After 2002, the mean clindamycin resistance rate in head and neck abscesses was approximately 27%. The number of new cases of methicillin‐resistant S aureus per year increased from four cases in 2000 to 44 cases in 2007.CONCLUSION: Antibiotic resistance should be considered following failed empirical therapy of head and neck abscesses with clindamycin.
The Postoperative Pain Assessment Skills Pilot Trial
Authors: McGillion Michael , Dubrowski Adam , Stremler Robyn , Watt-Watson Judy , Campbell Fiona , McCartney Colin , Victor J Charles , Wiseman Jeffrey , Snell Linda , Costello Judy , Robb Anja , Nelson Sioban , Stinson Jennifer , Hunter Judith , Dao Thuan , Promislow Sara , McNaughton Nancy , White Scott , Shobbrook Cindy , Jeffs Lianne , Mauch Kianda , Leegaard Marit , Beattie W Scott , Schreiber Martin , Silver Ivan 
Published: March 2016

BACKGROUND/OBJECTIVES: Pain‐related misbeliefs among health care professionals (HCPs) are common and contribute to ineffective postoperative pain assessment. While standardized patients (SPs) have been effectively used to improve HCPs’ assessment skills, not all centres have SP programs. The present equivalence randomized controlled pilot trial examined the efficacy of an alternative simulation method – deteriorating patient‐based simulation (DPS) – versus SPs for improving HCPs’ pain knowledge and assessment skills.METHODS: Seventy‐two HCPs were randomly assigned to a 3 h SP or DPS simulation intervention. Measures were recorded at baseline, immediate postintervention and two months postintervention. The primary outcome was HCPs’ pain assessment performance as measured by the postoperative Pain Assessment Skills Tool (PAST). Secondary outcomes included HCPs knowledge of pain‐related misbeliefs, and perceived satisfaction and quality of the simulation. These outcomes were measured by the Pain Beliefs Scale (PBS), the Satisfaction with Simulated Learning Scale (SSLS) and the Simulation Design Scale (SDS), respectively. Student’s t tests were used to test for overall group differences in postintervention PAST, SSLS and SDS scores. One‐way analysis of covariance tested for overall group differences in PBS scores.RESULTS: DPS and SP groups did not differ on post‐test PAST, SSLS or SDS scores. Knowledge of pain‐related misbeliefs was also similar between groups.CONCLUSIONS: These pilot data suggest that DPS is an effective simulation alternative for HCPs’ education on postoperative pain assessment, with improvements in performance and knowledge comparable with SP‐based simulation. An equivalence trial to examine the effectiveness of deteriorating patient‐based simulation versus standardized patients is warranted.
Conventional Versus Rosemont Endoscopic Ultrasound Criteria for Chronic Pancreatitis: Comparing Interobserver Reliability and Intertest Agreement
Authors: Kalmin Bruce , Hoffman Brenda , Hawes Robert , Romagnuolo Joseph 
Published: March 2016

BACKGROUND: The Rosemont criteria (RC) were recently proposed by expert consensus to standardize endoscopic ultrasound (EUS) features and thresholds for diagnosing chronic pancreatitis (CP); however, they are cumbersome and are not validated.OBJECTIVE: To determine interobserver agreement between RC and conventional criteria (CC), and to assess intertest agreement in the diagnosis of CP.METHODS: Thirty-six consecutive patients who underwent EUS for abdominal pain or pancreatitis were retrospectively reviewed. Anonymized images were independently chosen as best representations of the pancreatic body and reviewed by three experts who recorded the presence of CC and RC features. Agreement (proportion and kappa statistic) between CC and RC was calculated. Interobserver agreement within the CC and RC was assessed. Secondary comparisons with endoscopic retrograde cholangiopancreatography were made where available.RESULTS: Using CC, 60 readings (83.3%) were negative for CP, while 12 readings (16.7%) were positive. Using RC, 59 readings (81.9%) were negative for CP, while 13 (18.1%) were positive. The weighted kappa for interobserver agreement for CC (four categories: normal/low probability, indeterminate, high probability or calcific) was 0.50, with 80.0% overall agreement, versus 0.27 and 68.1% for the four RC categories (normal, indeterminate, suggestive of and consistent with). Agreement on a positive diagnosis with CC was 86.1% (P=0.38 [McNemar’s exact test]), with a kappa of 0.47; for RC, agreement was lower at 80.6% (P=0.016 [McNemar’s exact test]), with a kappa of 0.38. For patients who underwent endoscopic retrograde cholangiopancreatography (n=12), false-negative and false-positive rates between CC and RC did not appear to be different.CONCLUSIONS: The RC do not appear to achieve the goals of improving accuracy and interobserver agreement for diagnosing CP.
Therapeutic Drug Monitoring in the Treatment of Active Tuberculosis
Authors: Babalik Aylin , Mannix Sharyn , Francis Denis , Menzies Dick 
Published: March 2016

Therapeutic drug monitoring ensures optimal dosing while aiming to reduce toxicity. However, due to the high costs and complexity of testing, therapeutic drug monitoring is not routinely used in the treatment of individuals with active tuberculosis, despite the efficacy demonstrated in several randomized trials. This study reviewed data spanning five years regarding the frequency of finding low drug levels in patients with tuberculosis, the dosing adjustments that were required to achieve adequate levels and the factors associated with low drug levels.BACKGROUND: Therapeutic drug monitoring (TDM) is used to optimize dosing that maximizes therapeutic benefit while minimizing toxicity. In the treatment of active tuberculosis (TB), TDM is not routine, yet low levels of anti-TB drugs can be associated with poorer treatment outcomes.METHODS: In a retrospective case control study, patients with active TB in whom TDM was performed were considered cases and compared with controls who did not undergo TDM, and matched according to year of diagnosis and the results of direct smear microscopy. Medical records were reviewed to abstract demographic, clinical, radiographic and microbiological data including time until smear and culture conversion.RESULTS: In total, 20 patients were identified in whom TDM was performed, of whom 17 (87%) had at least one low drug concentration. Overall, 27 of 45 (60%) initial drug concentrations were low and resulted in an increased drug dosage. Low drug levels were found in 13 of 15 (87%) isoniazid, four of five (80%) rifabutin and eight of 12 (67%) rifampin measurements, but in only two of 13 (15%) pyrazinamide measurements. Within cases only, the 17 patients with low serum drug levels were significantly more likely to have comorbid illnesses, be smear positive, have lower serum albumin levels and had nonsignificantly longer time to culture conversion, compared with the three cases in whom all drug levels were within therapeutic ranges.CONCLUSIONS: TB drug levels were frequently below clinically acceptable levels in patients with active TB, particularly in those with HIV infection or other comorbidities. TDM is potentially useful for the treatment of active TB, but is currently underused.
Quality of Internet‐Based Information on Gastrointestinal Diseases
Authors: Tangri Vikram , Chande Nilesh 
Published: March 2016

BACKGROUND: The Internet is becoming an increasingly common source of health information for patients.OBJECTIVE: To examine the quality of gastrointestinal disease‐ and symptom‐related Internet sites that might be searched by patients.METHODS: A total of 120 websites were evaluated from July to November 2009 using the DISCERN instrument to determine the quality of content of health and treatment information.RESULTS: There was substantial variability in the quality of Internet resources regarding gastrointestinal diseases and their symptoms. Information‐based and institutional websites were rated highest. Resources related to celiac disease, colon cancer and abdominal pain scored the highest.CONCLUSIONS: Overall, the quality of web‐based resources was variable. Because patient education is important in the management of gastroenterological diseases, the increasing use of the Internet poses new opportunities and challenges for physicians.
Endoscopic Band Ligation Versus Pharmacological Therapy for Variceal Bleeding in Cirrhosis: A Meta-Analysis
Authors: Li Lan , Yu Chaohui , Li Youming 
Published: March 2016

OBJECTIVE: To conduct a meta-analysis of published, full-length, randomized controlled trials evaluating the efficacy of endoscopic band ligation (EBL) versus pharmacological therapy for the primary and secondary prophylaxis of variceal hemorrhage in patients with cirrhosis.METHODS: Literature searches were conducted using the PubMed, EMBASE and Cochrane Library databases. Eighteen randomized clinical trials that fulfilled the inclusion criteria were further pooled into a meta-analysis.RESULTS: Among 1023 patients in 12 trials comparing EBL with beta-blockers for primary prevention, there was no significant difference in gastrointestinal bleeding (RR 0.79 [95% CI 0.61 to 1.02]), all-cause deaths (RR 1.06 [95% CI 0.86 to 1.30]) or bleeding-related deaths (RR 0.66 [95% CI 0.38 to 1.16]). There was a reduced trend toward significance in variceal bleeding with EBL compared with beta-blockers (RR 0.72 [95% CI 0.54 to 0.96]). However, variceal bleeding was not significantly different between the two groups in high-quality trials (RR 0.84 [95% CI 0.60 to 1.17]). Among 687 patients from six trials comparing EBL with beta-blockers plus isosorbide mononitrate for secondary prevention, there was no effect on either gastrointestinal bleeding (RR 0.95 [95% CI 0.65 to 1.40]) or variceal bleeding (RR 0.89 [95% CI 0.53 to 1.49]). The risk for all-cause deaths in the EBL group was significantly higher than in the medical group (RR 1.25 [95% CI 1.01 to 1.55]); however, the rate of bleeding-related deaths was unaffected (RR 1.16 [95% CI 0.68 to 1.97]).CONCLUSIONS: Both EBL and beta-blockers may be considered first-line treatments to prevent first variceal bleeding, whereas beta-blockers plus isosorbide mononitrate may be the best choice for the prevention of rebleeding.
The Metabolic Syndrome Is Associated with Complicated Gallstone Disease
Authors: Ata Naim , Kucukazman Metin , Yavuz Bunyamin , Bulus Hakan , Dal Kursat , Ertugrul Derun Taner , Yalcin Ahmet Arif , Polat Mehmet , Varol Numan , Akin Kadir Okhan , Karabag Aral , Nazligul Yasar 
Published: March 2016

BACKGROUND: Gallstone disease (GD) is a common condition worldwide. Several studies demonstrated that the presence of gallstones is strongly associated with cardiovascular disease. The metabolic syndrome is a highly prevalent cardiovascular condition.OBJECTIVE: To examine the relationship between complicated GD (CGD) and the metabolic syndrome or its components.METHODS: Two hundred seventeen patients with gallstones were examined. All patients underwent biliary ultrasonography after a complete medical history and laboratory examination. Data collection for the diagnosis of metabolic syndrome included measurements of waist circumference, blood pressure and lipids, and biochemical tests.RESULTS: Of the 217 patients examined, 115 patients (53%) had CGD and 102 patients (47%) had uncomplicated GD (UCGD). There was a significant difference between the number of patients with large gallstones in the CGD and UCGD groups (n=14 [12%] versus n=2 [2%], respectively; P=0.004). Metabolic syndrome, diabetes mellitus and large waist circumference were more prevalent in the CGD group than in the UCGD group. Homeostatic model assessment of insulin resistance scores were higher in the CGD group than in UCGD group (2.51 [95% CI 0.57 to 23.90] versus 2.20 [95% CI 0.09 to 8.87], respectively; P=0.032). Logistic regression analysis revealed that the presence of metabolic syndrome (OR 1.434; 95% CI 1.222 to 1.846, P=0.014), diabetes mellitus (OR 1.493; 95% CI 1.255 to 1.953; P=0.035) and large gallstones (OR 1.153; 95% CI 1.033 to 1.714; P=0.017) were independent predictors of CGD.CONCLUSION: Results of the present study demonstrated that metabolic syndrome, diabetes and gallstone size were associated with CGD. Further prospective studies are needed to understand the clinical importance of this association.
Treatment of Neuropathic Pain with 5% Lidocaine‐Medicated Plaster: Five Years of Clinical Experience
Authors: Delorme Claire , Navez Marie L , Legout Valérie , Deleens Rodrigue , Moyse Dominique 
Published: March 2016

BACKGROUND: Neuropathic pain is often severe and adversely affects patients’ quality of life.OBJECTIVE: To perform a retrospective, observational study investigating the efficacy and safety of treating refractory chronic neuropathic pain with 5% lidocaine‐medicated plaster, in patients attending pain centres.METHODS: Medical records from 467 patients treated with 5% lidocaine‐medicated plaster were evaluated for efficacy (maximum and minimum pain intensities and coanalgesic consumption) and adverse events. Data from an initial assessment and at least one follow‐up visit had to be available, and separate analyses were conducted for the general population and the subpopulation older than 70 years of age.RESULTS: Of the patients enrolled, 25.0% were older than 70 years of age. While 20.6% had postherpetic neuralgia, 76.3% had other types of peripheral pain. Approximately 78.1% of cases of peripheral neuropathic pain followed surgery, and 23% were post‐traumatic pain. The time from onset to referral was more than one year in two‐thirds of cases. All patients experienced pain of at least moderate severity (mean [± SD] 11‐point numerical rating scale score 5.2±2.4 to 8.2±1.6). Treatment with 5% lidocaine‐medicated plaster reduced pain intensity by more than 50% in 45.5% of patients, and by at least 30% in 82.2%. Of note, the consumption of analgesics and coanalgesics was significantly reduced. Results were similar in both the general population and the subpopulation older than 70 years of age, at high risk and often receiving multiple medications.CONCLUSIONS: Treatment of refractory neuropathic pain with 5% lidocaine‐medicated plaster clearly demonstrated efficacy and an excellent safety profile in patients with refractory neuropathic pain.
Reactions to a Targeted Intervention to Increase Fecal Occult Blood Testing among Average-Risk Adults Waiting for Screening Colonoscopy
Authors: McGregor S Elizabeth , Ritvo Paul , Tinmouth Jill , Kornblum Ashley , Myers Ronald , Hilsden Robert J , Paszat Lawrence F , Rabeneck Linda 
Published: March 2016

BACKGROUND: Increasing demand combined with limited capacity has resulted in long wait times for average-risk adults referred for screening colonoscopy for colorectal cancer. Management of patients on these growing wait lists is an emerging clinical issue.OBJECTIVE: To inform the content and design of a mailed targeted invitation for patients to undergo annual fecal occult blood testing (FOBT) while awaiting colonoscopy.METHODS: Focus groups (FGs) with average-risk patients on a wait list for screening colonoscopy at a high-throughput academic outpatient colonoscopy facility were conducted. During each FG session, feedback regarding a range of materials under consideration for the planned intervention was elicited using a semistructured facilitator guide. The FG sessions were recorded and transcribed verbatim, and analyzed using the constant comparative method to identify key themes.RESULTS: Findings from the three FGs (n=28) suggested that average-risk patients on a wait list for screening colonoscopy would be receptive to a targeted intervention recommending they undergo FOBT while waiting. Participants indicated that the invitation to undergo FOBT was an important acknowledgement that they were on an actively managed list, and that a mechanism to ensure that they were correctly triaged while waiting was in place. Several specific suggestions to improve the design of the targeted intervention were obtained.CONCLUSIONS: Results of the present study provide useful information for developing effective strategies to manage average-risk individuals facing long wait times for screening colonoscopy.
Heterogeneity of Bronchitis in Airway Diseases in Tertiary Care Clinical Practice
Authors: D’silva Liesel , Hassan Nesreen , Wang Hong-Yu , Kjarsgaard Melanie , Efthimiadis Ann , Hargreave Frederick E , Nair Parameswaran 
Published: March 2016

BACKGROUND: Sputum cell counts have identified inflammatory subtypes of bronchitis in relatively small numbers of subjects with asthma, chronic obstructive pulmonary disease (COPD) and chronic cough in research studies. The prevalence of different subtypes of bronchitis in routine clinical practice, however, has not been reported.OBJECTIVE: To examine the heterogeneity of bronchitis and its relationship to the severity of airflow obstruction.METHODS: A retrospective cross‐sectional survey based on a computerized database of spontaneous or induced sputum cell counts examined in a large university tertiary respiratory outpatient clinic.RESULTS: The database contained 4232 consecutive sputum records from 2443 patients with chronic cough (39%), asthma (37%), asthma with COPD (9%), COPD (13%) and bronchiectasis (3%). Total and differential cell counts were obtained from 86% of successful sputum samples. Induced sputum provided more viable samples than spontaneous expectorate. Approximately one‐third of patients with asthma and one‐fifth of patients with COPD experience eosinophilic bronchitis. Asthmatic patients with moderate to severe airflow obstruction had a greater number of sputum eosinophils. There was a significantly higher number of total cell counts and percentage of neutrophils in the sputum of COPD patients with moderate and severe airflow obstruction than in those with mild airflow obstruction.CONCLUSION: There is heterogeneity in the cellularity of sputum in various airway diseases. Patients with clinically stable airway diseases may have high sputum cell counts. During exacerbations, more patients may experience neutrophilic bronchitis. Severity of airflow obstruction is associated with eosinophilic bronchitis in patients with asthma, and neutrophilic bronchitis in patients with nonasthmatic COPD.
A Randomized Controlled Trial of Four Precolonoscopy Bowel Cleansing Regimens
Authors: Kao Dina , Lalor Eoin , Sandha Gurpal , Fedorak Richard N , van der Knoop Bloeme , Doornweerd Stieneke , van Kooten Harmke , Schreuders Eline , Midodzi William , van Zanten Sander Veldhuyzen 
Published: March 2016

BACKGROUND: The ideal bowel cleansing regimen for colonoscopy has yet to be determined.OBJECTIVE: To compare the cleansing efficacy, and patient tolerability and safety of four bowel preparation regimens.METHODS: A total of 834 patients undergoing outpatient colonoscopy were randomly assigned to one of four regimens: 4 L polyethylene glycol (PEG); 2 L PEG + 20 mg bisacodyl; 90 mL of sodium phosphate (NaP); or two sachets of a commercially available bowel cleansing solution (PSMC) + 300 mL of magnesium citrate (M). The primary outcome measure was cleansing efficacy, which was scored by blinded endoscopists using the Ottawa Bowel Preparation Scale. Secondary outcome measures were bowel preparation quality according to time of colonoscopy, and patient tolerability and safety.RESULTS: The mean total cleansing score was significantly worse in the NaP group compared with the other three groups (P<0.0001). The mean cleansing scores were worse in patients who underwent morning versus afternoon colonoscopy, a finding that was consistent in all four groups. PSMC + M was the best tolerated regimen. No clinically significant mean changes in creatinine or electrolyte levels were identified, although a significantly higher proportion of patients in the NaP group developed hypokelemia (P<0.0001).CONCLUSIONS: 2 L PEG + 20 mg bisacodyl, or PSMC + M was as efficacious as 4 L PEG and superior to NaP for bowel cleansing. A short interval between the completion of bowel preparation and the start of colonoscopy (ie, ‘runway time’), irrespective of bowel preparation regimen, appeared to be a more important predictor of bowel cleanliness than the cathartic agents used.