bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial Differences in the Incidence of Colorectal Cancer
Authors: Virk Rukinder , Gill Sharlene , Yoshida Eric , Radley Simon , Salh Baljinder 
Published: March 2016

BACKGROUND: Colon cancer is one of the most common cancers and the second most common cause of cancer mortality in Western societies. Population screening has been introduced as a means to reducing its impact; however, there are little or no data on the incidence of this disorder in the different populations that comprise the Canadian population.OBJECTIVE: To retrospectively determine the incidence of colorectal cancer in selected racial populations of British Columbia.METHODS: The British Columbia Cancer Agency database was used to retrieve information on the incidence of cancers occurring during the years 1994 to 1998, with the British Columbia and national population censuses used to derive the age-specific and age-standardized incidence rates of colorectal cancers. Surnames were used to identify the origin of individuals from South Asian and Chinese backgrounds.RESULTS: For the Caucasian Canadian (C) population, the weighted age-standardized incidence rate ranged from 51.99 per 100,000 in 1995, to 57.68 per 100,000 in 1998. For Chinese Canadians (CC), the range was 39.2 per 100,000 in 1996, to 31.2 per 100,000 in 1998. For South Asian Canadians (SAC), the range was 7.40 per 100,000 in 1994, to 24.85 per 100,000 in 1998. The RR for the development of cancer were significantly different when comparing C versus CC (RR 1.9; 95% CI 1.58 to 2.31; P<0.001), C versus SAC (RR 7.1; 95% CI 4.20 to 12.0; P<0.0001) and CC versus SAC (RR 3.7; 95% CI 2.14 to 6.5; P<0.0001).CONCLUSIONS: Significant differences in the incidence of colorectal cancers have been defined for the first time in various racial subgroups in British Columbia. This finding may have important implications for both screening and understanding of the environmental factors influencing the biology of these lesions. Because SAC have among the highest incidence of atherosclerotic heart disease and diabetes, it suggests that unidentified genetic and/or environmental protective factors are capable of countering the traditionally recognized risk of high saturated fat intake for the development of colorectal cancer.
Physician Barriers to Population-Based, Fecal Occult Blood Test-Based Colorectal Cancer Screening Programs for Average-Risk Patients
Authors: McGregor S Elizabeth , Hilsden Robert J , Yang Huiming 
Published: March 2016

BACKGROUND: Colorectal cancer (CRC) screening is an efficacious but underused means to reduce the burden of CRC. Population-based CRC screening programs are currently being implemented in Canada and physicians are key partners in increasing screening uptake. The current study identified physician attitudes and barriers that need to be addressed by provincial programs.METHODS: A mailed survey of primary care physicians in Alberta.RESULTS: The survey response rate was 42.4% (806 of 1903). The majority of physicians suggested CRC screening as part of a routine periodic examination; however, the approach to test selection and the type of tests recommended varied by geographical region. The majority of physicians agreed (48%) or strongly agreed (36%) that a province-wide screening program is the best approach to reducing mortality from CRC. However, there were many serious concerns identified – the most common was endoscopic capacity for follow-up of patients with a positive fecal occult blood test (FOBT), which was cited by 55% to 69% of the physicians surveyed. The barriers to three commonly available tests (FOBT, flexible sigmoidoscopy and colonoscopy) varied according to health region, and the types of barriers identified varied according to the specific test.INTERPRETATION: Screening for CRC is gradually being accepted among primary care physicians in Alberta. A key finding of the present descriptive study was the regional variation in practices, perceived barriers and concerns about provincial population-based screening programs based on FOBT as the primary screening test. Provincial programs will need to address the issue of endoscopic capacity and perceived barriers to FOBT to gain primary care physician acceptance of FOBT-based CRC screening programs.
The Gastrointestinal Aspects of Halitosis
Authors: Kinberg Sivan , Stein Miki , Zion Nataly , Shaoul Ron 
Published: March 2016

BACKGROUND: Halitosis is a common human condition for which the exact pathophysiological mechanism is unclear. It has been attributed mainly to oral pathologies. Halitosis resulting from gastrointestinal disorders is considered to be extremely rare. However, halitosis has often been reported among the symptoms related to Helicobacter pylori infection and gastroesophageal reflux disease.OBJECTIVE: To retrospectively review the experience with children and young adults presenting with halitosis to a pediatric gastroenterology clinic.METHODS: A retrospective chart review of patients diagnosed with halitosis as a primary or secondary symptom was conducted. All endoscopies were performed by the same endoscopist.RESULTS: A total of 94 patients had halitosis, and of the 56 patients (59.6%) who were recently examined by a dental surgeon, pathology (eg, cavities) was found in only one (1.8%). Pathology was found in only six of 27 patients (28.7%) who were assessed by an otolaryngology surgeon. Gastrointestinal pathology was found to be very common, with halitosis present in 54 of the 94 (57.4%) patients. The pathology was noted regardless of dental or otolaryngological findings. Most pathologies, both macroscopically and microscopically, were noted in the stomach (60% non‐H pylori related), followed by the duodenum and the esophagus. Fifty‐two of 90 patients (57.8%) were offered a treatment based on their endoscopic findings. Of the 74 patients for whom halitosis improvement data were available, some improvement was noted in 24 patients (32.4%) and complete improvement was noted in 41 patients (55.4%).CONCLUSIONS: Gastrointestinal pathology was very common in patients with halitosis regardless of dental or otolaryngological findings, and most patients improved with treatment.
Practices in Peptic Ulcer Bleeding Controversies among University‐ Versus Nonuniversity‐Affiliated Gastroenterologists
Authors: Cheung Justin , Sawisky Grant , Enns Robert , Byrne Michael F , Zhu Qiaohao , Wong Clarence KW 
Published: March 2016

BACKGROUND: Practices relating to acute peptic ulcer bleeding (APUB) outside of guideline recommendations are unknown.OBJECTIVE: To evaluate the practices of university‐affiliated (UA) versus nonuniversity‐affiliated (non‐UA) gastroenterologists in controversial APUB issues.METHODS: Gastroenterologists in Canada were mailed an anonymous questionnaire (January 2008) regarding APUB management.RESULTS: Responses were received for 281 of the 530 questionnaires mailed (53%). There were no differences between the UA versus non‐UA gastroenterologists regarding acid suppression medication and route of administration pre‐ and postendoscopy (all P>0.05). There were no differences in endoscopic practices between groups regarding large versus small volume injection, endoclip versus combination injection plus coagulation, endoclip versus endoclip plus injection, and management of adherent clots (all P>0.05). There was variability within each group regarding optimal empirical acid suppression pre‐ and postendoscopy, volume of injection therapy and endoclip use. The non‐UA group had longer delays before restarting acetylsalicylic acid (P=0.08) and warfarin (P=0.02) post‐APUB.CONCLUSIONS: UA and non‐UA gastroenterologists have similar practices in acid suppression and endoscopic therapy for controversial APUB issues; however, non‐UA gastroenterologists appear more cautious in restarting acetylsalicylic acid and warfarin. Further studies are needed to address the optimal empirical acid suppression pre‐ and postendoscopy, injection therapy volume, endoclip use, and timing of restarting antiplatelet and anticoagulation therapy.
A Prospective Audit of Patient Experiences in Colonoscopy Using the Global Rating Scale: A Cohort of 1187 Patients
Authors: de Jonge Vincent , Sint Nicolaas Jerome , Lalor Eoin A , Wong Clarence K , Walters Brennan , Bala Anand , Kuipers Ernst J , van Leerdam Monique E , Veldhuyzen van Zanten Sander JO 
Published: March 2016

BACKGROUND: The Global Rating Scale (GRS) comprehensively evaluates the quality of an endoscopy department, providing a patient-centred framework for service improvement.OBJECTIVE: To assess patient experiences during colonoscopy and identify areas that need service improvement using the GRS.METHODS: Consecutive outpatients undergoing colonoscopy were asked to complete a pre- and postprocedure questionnaire. Questions were based on GRS items and a literature review. The preprocedure questionnaire addressed items such as patient characteristics and information provision. The postprocedure questionnaire contained questions regarding comfort, sedation, the attitude of endoscopy staff and aftercare.RESULTS: The preprocedure questionnaire was completed by 1187 patients, whereas the postprocedure part of the questionnaire was completed by 851 patients (71.9%). Fifty-four per cent of patients were first seen in the outpatient clinic. The indication for colonoscopy was explained to 85% of the patients. Sixty-five per cent of the patients stated that information about the risks of colonoscopy was provided. Sedation was used in 94% of the patients; however, 23% judged the colonoscopy to be more uncomfortable than expected. Ten per cent of patients rated the colonoscopy as (very) uncomfortable. Preliminary results of the colonoscopy were discussed with 87% of patients after the procedure. Twenty-one per cent of the patients left the hospital without knowing how to obtain their final results. Being comfortable while waiting for the procedure (OR 9.93) and a less uncomfortable procedure than expected (OR 2.99) were important determinants of the willingness to return for colonoscopy.CONCLUSIONS: The present study provided evidence supporting the GRS in identifyng service gaps in the quality of patient experiences for colonoscopy in a North American setting. Assessing experiences is useful in identifying areas that need improvement such as the provision of pre- and postprocedure information.
Canadian Hepatitis C Look‐Back Investigation to Detect Transmission from an Infected General Surgeon
Authors: Dawar Meenakshi , Stuart Tammy L , Sweet Lamont E , Neatby Anne M , Abbott Lewis P , Andonov Anton P , Wong Tom , Gervais Robert , Stirling Rob 
Published: March 2016

BACKGROUND: In February 2007, a general surgeon in Charlottetown, Prince Edward Island, tested positive for hepatitis C virus (HCV). The surgeon’s infection onset date could not be determined; however, episodic hepatic enzyme elevations were first detected in November 2004 and again in February 2007. HCV transmission during surgery, alhough rare, has been documented. A phased look‐back HCV screening program was conducted to detect HCV transmission from this surgeon to patients who underwent the highest‐risk procedures in the three years before his positive test.METHODS: Highest‐risk procedures were defined as exposure‐prone procedures (EPP) in which exposure to the surgeon’s blood was most likely. EPP patients from January 2004 to February 2007 were identified using hospital and administrative records. Linkages with the provincial notifiable disease for HCV was performed, and death records for deceased EPP patients were reviewed. Eligible patients were invited for screening.RESULTS: Of 6248 patients seen in phase 1, 272 (4.4%) were identified to be EPP. Of the 272 patients, 248 (91.1%) were invited for HCV testing and 24 (8.8%) were deceased. To date, 231 of 248 (93.1%) patients have presented for screening. Two patients (one alive, one deceased) were HCV positive before their EPP. Viral sequence of the surgeon’s isolate is unrelated to the first patient; the second individual has a resolved infection (polymerase chain reaction negative). No new transmission events were identified in the screened patients. The 95% CI of the transmission probability was estimated to be 0 to 0.016.INTERPRETATION: HCV transmission from the surgeon during a 38‐month look back was unlikely. In the absence of protocols for investigating HCV transmission from infected health care workers, screening was initially prioritized to the highest‐risk patients. The investigation has been satisfactorily terminated based on these results.
Posterior Interscalene Block: An Ultrasound‐Guided Case Series and Overview Of History, Anatomy and Techniques
Authors: McNaught Andrew , McHardy Paul , Awad Imad T 
Published: March 2016

BACKGROUND: The posterior interscalene block has been described as an alternative to the lateral interscalene block. However, this technique has not gained popularity because of the close proximity of the approach to vascular and central neural structures.OBJECTIVE: To describe the posterior interscalene block technique using ultrasound imaging, and to review the history of its evolution.METHODS: The use of ultrasound imaging to facilitate the insertion of interscalene catheters using the posterior approach in 11 patients undergoing total shoulder arthroplasty is described.RESULTS: All 11 patients had satisfactory analgesia in the first 24 h of the postoperative period. None of the patients complained of neck pain, as had been found in earlier techniques using the posterior approach.CONCLUSIONS: This modification of the posterior approach is a safe and effective method for the insertion of interscalene brachial plexus catheters. These catheters are also comfortable for patients and, in the present study, none of the catheters inadvertently fell out.
Rabeprazole Combined with Hydrotalcite is Effective for Patients with Bile Reflux Gastritis after Cholecystectomy
Authors: Chen Huimin , Li Xiaobo , Ge Zhizheng , Gao Yunjie , Chen Xiaoyu , Cui Yun 
Published: March 2016

BACKGROUND: Regardless of surgical technique, patients who have undergone cholecystectomy appear to be predisposed to the development of bile reflux gastritis.OBJECTIVE: To assess the efficacy of rabeprazole and hydrotalcite in patients with bile reflux gastritis after cholecystectomy.METHODS: Postcholecystectomy patients with bile reflux gastritis confirmed by endoscopy and 24 h gastric bilirubin monitoring were randomly assigned to one of four eight-week treatments: observation (group A), rabeprazole alone (group B), hydrotalcite alone (group C) and rabeprazole in combination with hydrotalcite (group D). Endoscopy and 24 h gastric bilirubin monitoring were repeated in all patients after treatment. Dyspeptic symptoms of abdominal pain, bloating, heartburn, bitter taste, endoscopic and histological finding, and biliary reflux were evaluated before and after treatment.RESULTS: After administering medication, patient symptoms in groups B, C and D were relieved – most significantly in group D (P<0.05). There were no significant differences in endoscopic hyperemia and histological inflammation among the groups (P>0.05). However, histological activity, the number of reflux episodes and the number of reflux episodes lasting longer than 5 min were significantly decreased only in group D (P<0.05). The total per cent of bilirubin absorption (value of 0.14 units or greater) time was decreased in groups B, C and D, and most significantly in group D (P<0.05).CONCLUSION: Rabeprazole combined with hydrotalcite is an effective therapeutic option in the treatment of patients with bile reflux gastritis after cholecystectomy.
Pneumococcal Peritonitis: Still with Us and Likely to Increase in Importance
Authors: Waisman Darcy C , Tyrrell Gregory J , Kellner James D , Garg Sipi , Marrie Thomas J 
Published: March 2016

BACKGROUND: Pneumococcal peritonitis is uncommon and poorly understood.METHODS: As part of a five‐year study (2000 to 2004) of invasive pneumococcal disease (IPD) in Alberta, all cases of peritonitis due to Streptococcus pneumoniae were reviewed and compared with all other cases of IPD.RESULTS: Twenty‐three of 1768 (1.3%) IPD patients were found to have peritonitis. Patients with peritonitis were more likely to have cirrhosis, hepatitis C, alcoholism and HIV/AIDS, than the remainder of the patients with IPD. The all‐cause mortality did not differ between the two groups. Peritonitis was classified as primary in nine (39%) patients, secondary in 12 (52%) patients, and genitourinary in females, specifically, in two (9%) patients. Pneumococcal serotypes causing peritonitis were under‐represented in current vaccines – 17% among peritonitis patients versus 53% for the remainder of IPD patients for the 7‐valent pneumococcal conjugate vaccine, and 56% versus 86% for the 23‐valent pneumococcal polysaccharide vaccine.CONCLUSIONS: Peritonitis represents a small subset of patients with IPD, but one that is likely to grow in importance given the increase in the number of patients with hepatitis C and HIV, and the reduced coverage of peritonitis serotypes in currently available vaccines.
Does the Methacholine Test Reproduce Symptoms?
Authors: Lévesque Marianne , Ghezzo Heberto , L’Archevêque Jocelyne , Malo Jean-Luc 
Published: March 2016

BACKGROUND: The interpretation of methacholine test results do not usually consider the symptoms for which the subject was referred and those that occur during the test.OBJECTIVE: To assess the association between methacholine test results and symptoms, and to examine variables that may affect this association.METHODS: A total of 400 prospectively chosen subjects who underwent methacholine testing for possible asthma were investigated. The subjects answered a short questionnaire regarding the symptoms for which they had been referred and those that were encountered during the methacholine test.RESULTS: The positive predictive value for the reproduction of symptoms during the test compared with symptoms for which subjects had been referred were 84% for dyspnea, 87% for cough, 81% for wheezing and 72% for chest tightness. The positive predictive value among the values obtained by measuring the provocative concentration of methacholine causing a 20% fall (PC20) in forced expiratory volume in 1 s on the one hand, and specific symptoms on the other, varied by up to approximately 50%; negative predictive values were higher. Forty-eight per cent of subjects with a PC20of 16 mg/mL or lower reported that the test had globally reproduced their symptoms. This association was significantly stronger in women, young subjects and those taking inhaled steroids.CONCLUSIONS: The methacholine test generally reproduced the symptoms for which the subjects were referred. The absence of a specific symptom (eg, dyspnea, cough, wheezing or chest tightness), either in daily life or at the time of methacholine testing, was more generally associated with a negative test than the reverse. The global impression that the test had reproduced what the patient had experienced in daily life was significantly associated with a positive test (ie, a PC20of 16 mg/mL or lower), with the association being stronger in young subjects and women.
Asthma and Allergic Disease Prevalence in a Diverse Sample of Toronto School Children: Results from the Toronto Child Health Evaluation Questionnaire (T‐CHEQ) Study
Authors: Dell Sharon D , Foty Richard G , Gilbert Nicolas L , Jerrett Michael , To Teresa , Walter Stephen D , Stieb David M 
Published: March 2016

BACKGROUND: Asthma is the most common chronic disease in children.OBJECTIVES: To describe the prevalence of asthma and allergic disease in a multiethnic, population‐based sample of Toronto (Ontario) school children attending grades 1 and 2.METHODS: In 2006, the Toronto Child Health Evaluation Questionnaire (T‐CHEQ) used the International Study of Asthma and Allergies in Childhood survey methodology to administer questionnaires to 23,379 Toronto school children attending grades 1 and 2. Modifications were made to the methodology to conform with current privacy legislation and capture the ethnic diversity of the population. Lifetime asthma, wheeze, hay fever and eczema prevalence were defined by parental report. Asthma was considered to be current if the child also reported wheeze or asthma medication use in the previous 12 months.RESULTS: A total of 5619 children from 283 randomly sampled public schools participated. Children were five to nine years of age, with a mean age of 6.7 years. The overall prevalence of lifetime asthma was 16.1%, while only 11.3% had current asthma. The reported prevalence of lifetime wheeze was 29.2%, while 14.2% reported wheeze in the past 12 months. Sociodemographic and major health determinant characteristics of the T‐CHEQ population were similar to 2001 census data, suggesting a diverse sample that was representative of the urban childhood population.CONCLUSIONS: Asthma continues to be a highly prevalent chronic disease in Canadian children. A large proportion of children with reported lifetime asthma, who were five to nine years of age, did not report current asthma symptomatology or medication use.
Analysis of Hospital Discharge Data to Characterize Obstructive Sleep Apnea and Its Management in Adult Patients Hospitalized in Canada: 2006 to 2007
Authors: Spurr Kathy F , Morrison Debra L , Graven Michael A , Webber Adam , Gilbert Robert W 
Published: March 2016

BACKGROUND: Diagnosed obstructive sleep apnea (OSA) affects 2% to 7% of middle-age persons worldwide and represents a substantial health care burden. The gold standard for treating OSA in adults is continuous positive airway pressure (CPAP) therapy. Compliance with this treatment is especially important in OSA patients experiencing concomitant acute and chronic disease or illness, and those undergoing procedures associated with sedation, analgesia and anesthesia.OBJECTIVE: To describe the clinical characteristics and management of hospitalized OSA patients in Canada.METHODS: Using the Canadian Institute for Health Information’s hospital Discharge Abstract Database (fiscal year 2006/2007), a retrospective cohort study of all acute care patients discharged with a diagnosis that included OSA was performed.RESULTS: An examination of the discharge data of 2,400,245 acute care hospital abstracts identified 8823 cases of OSA. The mean age of OSA patients was 45.7 years and 66.5% were men. The most common comorbidities in the adult OSA population were obesity, cardiovascular disease, type 2 diabetes mellitus and chronic obstructive pulmonary disease. In adult OSA patients, the reported surgical intervention rate using uvulopalatopharyngoplasty (9.6%) was much higher than interventional CPAP therapy (4.8%).CONCLUSIONS: Only a small percentage of hospitalized OSA patients were documented as having received CPAP therapy during their stay. Issues relating to the accuracy, specificity and completeness of the Canadian Institute for Health Information’s hospital Discharge Abstract Database specific to OSA and its management were identified. Practices pertaining to the reporting, coding and management of hospitalized adult OSA patients warrant further investigation and research.