bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antituberculous Drug Resistance in Western Canada (1993 to 1994)
Authors: Long Richard , Fanning Anne , Cowie Robert , Hoeppner Vernon , Fitzgerald Mark , The Western Canada Tuberculosis Group  
Published: March 2016

OBJECTIVES: To estimate the magnitude of antituberculous drug resistance and identify prospectively the risk factors for its development in tuberculosis (TB) patients in western Canada over a one‐year period.DESIGN: Comparison of drug‐resistant and nondrug‐resistant cases of TB.SETTING: Western Canada.PATIENTS: All people with TB reported to the TB registries of Manitoba, British Columbia, Alberta and Saskatchewan between February 1, 1993 and January 31, 1994.MAIN OUTCOME MEASURES: Drug susceptibility testing was performed in all cases of culture‐positive tuberculosis. Patients at risk for human immunodeficiency virus (HIV) infection were serotested.RESULTS: Of 534 culture positive cases of TB, 37 (6.9%) were drug resistant. Odds ratios suggested that the risk of drug resistance was significantly higher among those with reactivation than among those with new disease, and among those born outside of Canada than among those born in Canada. Ninety per cent of the foreign‐born patients with drug‐resistant disease were from Asia. Of the 35 patients with drug resistance whose type of resistance was known, 76% had initial and 24% had acquired drug resistance. The initial resistance rate in Asian‐born patients was 14%. Most of the 37 drug‐resistant cases were resistant to isoniazid (68%), streptomycin (49%) or both (22%). Twelve (32%) of the 37 cases were resistant to two or more first‐line drugs. Of 14 patients who were HIV seropositive only one, a foreign‐born patient, was drug resistant.CONCLUSION: Antituberculous drug resistance is low among Canadian‐born patients in western Canada, but not uncommon among those born outside Canada. Initial therapy of foreign‐born patients should include four first‐line drugs.
Genetic Characterization of the Hemagglutinin Gene of Influenza B Virus which Predominated in the 1985/86 Canadian Influenza Season
Authors: Zou Shimian , Prud’homme Isabelle , Weber John M 
Published: March 2016

OBJECTIVE: To characterize the hemagglutinin (HA) gene of B/Canada/3/85, a prototype strain of influenza B virus variants that emerged in the 1984/85 influenza season and predominated in the 1985/86 season in Canada.DESIGN: Sequencing and comparison of the HA genes of B/Canada/3/85 and the vaccine strains for the 1985/86 season, B/USSR/100/83, and for the 1986/87 season, B/Ann Arbor/1/86.RESULTS: B/Canada/3/85 was similar to B/Ann Arbor/1/86 and significantly different from B/USSR/100/83. Phylogenetic analysis of the HA1‐coding sequences indicated that B/Canada/3/85 and several other 1985 strains isolated in distant parts of the world were very closely related and were early variants representing the emergence of a new lineage, the B/Victoria/2/87 lineage. B/Canada/3/85 differed from B/USSR/100/83 in nucleotide sequence by 3.44% and in amino acid sequence by 3.33%. There was also an insertion of two amino acids in the HA1 region of B/Canada/3/85.CONCLUSIONS: B/Canada/3/85 was one of the herald strains for the 1985/1986 influenza B epidemic. The amino acid mutations and the two‐codon insertion together may account for the observed antigenic changes in the HA of the influenza B variants.
Chronic Use of Opioids for Nonmalignant pain: A Prospective Study
Authors: Fuchs Perry N , Gamsa Ann 
Published: March 2016

OBJECTIVE: To assess the effects of long term opioid therapy on pain, mood, and social and leisure activities in patients with chronic nonmalignant pain.METHODS: Fourteen patients (eight males and six females) were treated with opioid medications for chronic nonmalignant pain not improved by previous treatments. Baseline measures of pain intensity were obtained before introducing opioids. Patients were monitored throughout the study, with outcome measured four to 32 months after opioids were started. The final measures examined drug dose, side effects, pain level, pain relief, emotional status, and involvement in social and leisure activities.RESULTS: A total of 64.3% of patients reported good to excellent pain relief with opioid medication, and 64.3% reported reduced pain intensity, the decrease ranging from 25% to 100% (from baseline measures) on a scale rated from 0 to 10. As well, 64.3% scored their emotional state as 5 or better on the 0 to 10 scale (0 indicating greatest distress), and 64.3% reported at least moderate (at least 5 on the 0 to 10 scale) involvement in leisure and social activities. There was a significant negative correlation between pain intensity and amount of leisure and social activity; 88.9% of patients who reported moderate to full involvement in leisure and social activities also noted decreased pain on the 0 to 10 scale. Other than one patient who developed tolerance, there were no notable problems with dose escalation or with any other form of substance abuse.CONCLUSIONS: Some patients with chronic nonmalignant pain benefit from long term opioid therapy without developing unmanageable side effects, tolerance or substance abuse problems. These results, together with previous findings, show that opioids can be a safe and useful long term treatment for chronic nonmalignant pain.
Emotional Components of Pain
Authors: Hale Carla J , Hadjistavropoulos Thomas 
Published: March 2016

BACKGROUND: Current definitions of pain suggest that emotion is an essential component of pain, however, the presumed relationship between emotion and pain, and the specific emotions that are involved in pain experiences have yet to be clarified.OBJECTIVE: To address these issues in order to assist in making current conceptualizations of pain more explicit.DESIGN: Thirty adult patients undergoing routine blood tests were videotaped. Spontaneous facial reactions were examined for distinct expressions of emotion and pain occurring at baseline, swabbing and venepuncture intervals. Expressions were assessed objectively with the Facial Action Coding System (FACS) and rated subjectively by 48 untrained judges. Patients also provided baseline and postneedle self‐reports of experienced pain.RESULTS: Comparison of venepuncture, swabbing and baseline segments revealed that objective measures of pain‐related facial activity, subjective ratings of pain expression and self‐reported ratings of pain increased significantly from baseline to venepuncture and that measures of disgust, anger, fear and happiness also varied significantly across segments. Regression analyses indicated that measures of pain could be predicted from measures of specific emotions.CONCLUSIONS: Emotion is an essential component of the acute phasic pain experienced during venepuncture. Although the occurrence of specific emotions varied as a function of pain, objective behavioural indexes and subjective behavioural ratings of pain were predicted by different emotional components than patients′ self‐reports.
Efficacy of 12 Hourly Controlled‐Release Condeine Compared with as Required Dosing of Acetaminophen Plus Codeine in Patients with Chronic Low Back Pain
Authors: Hale Martin E , Speight Kevin L , Harsanyi Zoltan , Iwan Tad , Slagle N Susan , Lacouture Peter G , Darke Andrew C 
Published: March 2016

OBJECTIVE: To compare pain relief and stability of pain control in patients with chronic low back pain treated with scheduled 12 hourly doses of controlled‐release codeine or as required doses of a fixed combination of acetaminophen and codeine.PATIENTS AND METHODS: Patients were assigned to five days of treatment with controlled‐release codeine (Codeine Contin; Purdue Frederick) 100 mg q12h or placebo q12h in a randomized, double‐blind, parallel group study. Acetaminophen 325 mg q4h prn was available as rescue to the codeine group and acetaminophen 325 mg plus codeine 30 mg q4h prn was available to the placebo group. Pain intensity was assessed pretreatment and four times daily using a four‐point categorical scale. Acceptability of therapy was assessed twice daily on a five‐point scale.RESULTS: Of 104 patients enrolled, 82 were able to be evaluated for safety and efficacy. Sum of pain intensity differences scores were significantly lower on controlled‐release codeine than on as required acetaminophen plus codeine at all assessments. The number of changes in pain intensity throughout the day was higher with acetaminophen plus codeine than with codeine alone (8.6±0.7 versus 6.1±0.6, respectively, P=0.011). Mean total daily codeine dose was 200 mg in the codeine group and 71.1±6.6 mg in the acetaminophen plus codeine group (P=0.0001). Mean total daily prn acetaminophen consumption was 542.2±86.5 mg in the codeine group and 770.8±71.5 mg in the fixed combination group (P=0.0452).CONCLUSION: Twelve hourly dosing of controlled‐release codeine provides greater and more stable pain relief in patients with chronic low back pain than as required dosing of an acetaminophen plus codeine combination.
Study of the Comparative Activity of Piperacillin/Tazobactam with Currently Available Antibiotics against 8206 Aerobic Isolates
Authors: Forward Kevin R , Low Donald E , Laverdiere Michel , Rennie Robert , Simor Andrew E , Franks Patricia A , Members of the Canadian Piperacillin/Tazobactam Study Group  
Published: March 2016

OBJECTIVES: To compare the activity of piperacillin‐tazobactam with piperacillin and other parenterally administered antibiotics against aerobic Gram‐negative bacilli and Gram‐positive cocci isolated from across Canada, and to determine the prevalence of resistance mediated by extended‐spectrum cephalosporinases.METHODS: Sixty‐one laboratories participated. Disk diffusion testing was performed in accordance with methods outlined by the National Committee for Clinical Laboratory Standards. Susceptibilities were performed on 8206 strains. Escherichia coli and Klebsiella pneumoniae with reduced susceptibilities to third‐generation cephalosporins were screened for extended‐spectrum beta‐lactamases (ESBLs).RESULTS: Piperacillin‐tazobactam was active against 92% of the strains, piperacillin against 81% and ticarcillin‐clavulanic acid against 88%. Few differences were observed in the relative susceptibility of strains from teaching or community hospitals, from different anatomic sites or from different regions of the country. Aerobic Gram‐negative bacilli tested tended to be more susceptible to all the agents than was recently reported in a similar American study. Only 43% of Enterococcus faecium were susceptible to ampicillin and 42% to piperacillin piperacillin with and without tazobactam. Only two enterococcal strains were resistant to vancomycin, and 19 had intermediate zone sizes. Of the 10 strains of E coli and eight strains of K pneumoniae with reduced susceptibility to extended spectrum cephalosporins, only one demonstrated typical ESBL activity.CONCLUSIONS: Canadian aerobic Gram‐positive cocci and Gram‐negative bacilli remain highly susceptible to many currently available antibiotics. The findings confirm a broad spectrum of activity of piperacillin‐tazobactam and indicate that the pattern of susceptibility is quite uniform from different body sites, in both teaching and community hospitals, and across the country.
Birthweight and Preterm Birth in Relation to Indicators of Childhood Asthma
Authors: Demissie Kitaw , Ernst Pierre , Joseph Lawrence , Becklake Margaret R 
Published: March 2016

BACKGROUND: Early life events may have long term consequences on respiratory health including the risk of developing asthma.OBJECTIVE: To examine the independent roles of birthweight and preterm birth on childhood asthma after accounting for socioeconomic status.METHODS: A total of 989 elementary school children performed spirometry before and after a free‐running exercise challenge. A subsample of 327 children underwent methacholine bronchoprovocation and allergy skin prick tests to common inhaled aeroallergens. Information on birthweight and preterm birth was obtained by parental interview. Socioeconomic status was established using parental occupation.RESULTS: After adjusting for the effects of important confounding variables, birthweight was positively associated with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1); FVC increased 4.5% per kg (95% CI 1.7 to 7.4) and FEV1 4.4% per kg (95% CI 1.8 to 7.2). Birthweight was not related to exercise‐induced bronchospasm or an asthma diagnosis, but airway responsiveness to methacholine increased as birthweight decreased (P=0.01). Preterm birth independent of birthweight was associated with a lower FEV1/FVC (‐1.7%; 95% CI ‐2.8 to ‐0.5).CONCLUSIONS: Birthweight appears to be related to lung size and methacholine responsiveness while preterm birth appears to diminish airway size.
Prospective, Randomized Comparison of Intravenous and Oral Ciprofloxacin with Intravenous Ceftazidime in the Treatment of Nosocomial Pneumonia
Authors: Saginur Raphael , Garber Gary , Darling Gail , Shafran Stephen , Cameron William , Jones Gwynne , Auclair Francois , the Canadian Infectious Disease Society Multicenter Nosocomi  
Published: March 2016

OBJECTIVE: To compare the efficacy of intravenous and oral ciprofloxacin and intravenous ceftazidime in the treatment of nosocomial pneumonia.DESIGN: Randomized, nonblinded, multicentre comparative trial.SETTING: Seven Canadian university hospitals.POPULATION: Adult patients with moderate to severe pneumonia developing 72 h or longer after hospitalization.METHODS: After informed consent was obtained, patients were randomized to receive intravenous ciprofloxacin 300 mg every 12 h or ceftazidime 2 g every 8 h. After three days, patients in the ciprofloxacin arm could be switched to oral ciprofloxacin, 750 mg every 12 h. Concomitant clindamycin was allowed for three days in patients with syndromes consistent with Gram‐positive or anaerobic infection. Erythromycin could be used if cultures revealed no pathogen.RESULTS: A total of 149 patients were enrolled, of whom 124 were eligible for efficacy analysis. Of 119 pathogens identified in 87 patients, 84 were Gram‐negative, and 35 Gram‐positive. The mean duration of ciprofloxacin therapy was 12.1 days, of which 9.2 days were given intravenously. Ceftazidime was given for a mean of 9.8 days. There was eradication or reduction of pathogens in 75.7% of ciprofloxacin patients and 70.6% of the ceftazidime group. Clinical resolution or improvement occurred in 87.1% of ciprofloxacin recipients and 87.3% of the ceftazidime group. Eight ciprofloxacin and six ceftazidime patients died. Overall outcomes were considered to be successful in 85.2% of ciprofloxacin patients and 87.1% of ceftazidime recipients. Adverse events were mild.CONCLUSIONS: There were similar efficacy and safety of intravenous and oral ciprofloxacin and intravenous ceftazidime in the treatment of patients with hospital‐acquired pneumonia. Physicians were reluctant to use oral therapy in patients.
Out‐Patient Cognitive‐Behavioural Treatment of Fibromyalgia: Impact on Pain Response and Health Status
Authors: Nielson Warren R , Harth Manfred , Bell David A 
Published: March 2016

OBJECTIVE: To evaluate a cognitive‐behavioural out‐patient program for patients with fibromyalgia syndrome.PATIENTS AND METHODS: A quasi‐experimental design was used to evaluate 101 patients who participated in a four‐week program that included psychological, family educational, occupational therapy and physiotherapy interventions. After discharge, patients were seen four times over one year for day‐long review sessions. Five pain response scales from the Multidimensional Pain Inventory (MPI) and the Fibromyalgia Impact Questionnaire (FIQ) were used to assess treatment effects. Data were analyzed using multivariate ANOVAs followed by multiple comparisons using Tukey′s honestly significant difference test.RESULTS: The overall multivariate effect for the MPI was significant (P<0.0001). Subsequent multiple comparisons indicated consistent improvement in pain severity, life interference, life control, emotional distress and activity level scores at discharge, but no change during a no‐treatment waiting list control interval. These effects were maintained at a 12‐month follow‐up with the exception of activity level. The multivariate effect across the FIQ scales was significant (P<0.01). Multiple comparisons indicated that all variables except physical impairment improved at discharge. Impairment (P<0.05), anxiety and well‐being (P<0.01) improved at follow‐up compared with scores at admission.CONCLUSIONS: Pain response and health status improve following intensive cognitive‐behavioural treatment. These effects persist at one year but are generally weaker than at discharge. The largest effects were on indexes that reflect emotional status and general well‐being. Implications of these findings for fibromyalgia treatment programs are discussed.
Correlations between Ratings of Pain, Disability and Impairment in Chronic Whiplash‐Associated Disorder
Authors: Vernon Howard 
Published: March 2016

OBJECTIVE: To investigate the level of correlation among pain, disability and physical impairment scores in chronic whiplash‐associated disorder patients.SUBJECTS: Adults with chronic whiplash‐associated disorder referred for secondary independent assessment.METHODS: Forty‐four subjects (16 males, 28 females) were included in the sample. Self‐rated pain was measured on a five‐point verbal rating scale. Self‐rated disability was measured using the Neck Disability Index (NDI) and the Disability Rating Index (DRI). Physical impairment was measured as active cervical ranges of motion obtained with a cap goniometer. Descriptive statistics were reported and Pearson product moment correlations were obtained with the P value at 0.01.RESULTS: Mean ± SD age of the subjects was 36.4±8.7 years. Mean duration of complaint was 15.2±12.3 months. Mean pain score out of 5 was 2.5±1.2. Mean NDI and DRI scores were 23.2±9.3 out of 50 and 21.6±9.1 out of 48, respectively. These scores correlated very highly (r=0.89, P=0.0001). The average reduction of ranges of motion compared with published norms was approximately 25%. The correlations among ranges of motion, NDI, DRI and pain scores ranged from ‐0.32 to ‐0.66 (P<0.05 to P=0.0001). Age and duration of complaint correlated poorly with ranges of motion.CONCLUSIONS: The self‐ratings of pain and disability obtained from these chronic whiplash‐associated disorder sufferers appear to be consistent with, and correlate reasonably well with, levels of physical impairment. Physical impairment ratings do not appear to correlate well with duration, which suggests that factors related to pain and physical impairment may play an important role in the development of chronicity in whiplash‐associated disorder.
The Patient Level Cost of Asthma in Adults in South Central Ontario
Authors: Ungar Wendy J , Coyte Peter C , Chapman Kenneth R , MacKeigan Linda , the Pharmacy Medication Monitoring Program Advisory Board  
Published: March 2016

OBJECTIVE: To assess the annual cost of asthma per adult patient from the perspectives of society, the Ontario Ministry of Health and the patient.DESIGN: Prospective cost of illness evaluation.SETTING: Ambulatory out‐patients residing in southern central Ontario.POPULATION STUDIED: Nine hundred and forty patients with asthma over 15 years of age studied between May 1995 and April 1996.OUTCOME MEASURES: Direct costs, such as respiratory‐related visits to general/family practitioners, respiratory specialists, emergency rooms, hospital admissions, laboratory tests, prescription medications, dispensing fees, devices and out‐of‐pocket expenses, were calculated. Indirect costs, such as absences from work or usual activities, and travel and waiting time, were studied.MAIN RESULTS: Unadjusted annual costs were $2,550 per patient. Hospitalizations and medications each accounted for 22% of the total cost and indirect costs 50% of the total costs. More severe disease, older age, smoking, drug plan availability and retirement were significant predictors of costs. Annual costs per patient varied from $1,255 (95% CI $1,061 to $1,485) in young nonsmokers with no drug plan and mild disease to $5,032 (95% CI $4,347 to $5,825) in older smokers with drug plans and severe disease. Clinically important reductions in the quality of life occurred with increasing severity.CONCLUSIONS: Interventions aimed at reducing productivity losses, admissions to hospital and medication costs may result in savings to society, the provincial government and the patient. The quality of policy and allocation decisions may be enhanced by cost of illness estimates that are comprehensive, precise and incorporate multiple perspectives.
Current Practices of Adjunctive Therapy for Pertussis at Six Canadian Tertiary Care Pediatric Hospitals
Authors: Naugler Christopher T , Halperin Scott A 
Published: March 2016

OBJECTIVE: To document initial investigations and treatment used in the management of children hospitalized with pertussis.DESIGN: Retrospective chart review encompassing admissions from January 1, 1991 to June 1, 1995.SETTING: Six Canadian pediatric hospitals representing about 39% of the pediatric tertiary care beds in Canada.PATIENTS: Four hundred and forty children who met the inclusion criterion of a primary admitting diagnosis of pertussis and who did not meet the exclusion criterion of nosocomially acquired pertussis or a prior admission for pertussis during the study period.MAIN RESULTS: Most patients had cultures positive for Bordetella pertussis, although the proportion of positive tests varied widely among hospitals. Erythromycin was the most commonly used medication; however, only 47% of children received the recommended dosage. Salbutamol and corticosteroids were used most often in patients with reactive airways disease. Younger children and those with reactive airways disease had longer lengths of stay in hospital.CONCLUSIONS: Pertussis treatment varied widely among the six hospitals studied, and was often not consistent with current Canadian recommendations. The results will allow practitioners to place their practices in a national perspective and provide a baseline for further studies.