bluuebunny/crossref_metadata_2025_split huggingface dataset:
Susceptibility of Group A Beta‐Hemolytic Streptococci in the Lower St Lawrence Region, Quebec
Authors: DesRosiers Annie , Dolcé Patrick , Jutras Philippe , Jetté Louise P 
Published: March 2016

OBJECTIVE: To determine the susceptibility of group A beta‐hemolytic streptococci (GABHS) in the lower St Lawrence region, Quebec to different antibiotics, particularly macrolides, and to compare different antibiogram methods (disk diffusion, E‐test and microdilution) and incubation atmospheres (ambient air and 5% carbon dioxide).METHODS: A total of 384 strains of GABHS isolated from 377 patients (throat 335; other sites 49) from three hospitals in the lower St Lawrence region were analyzed for their susceptibility to erythromycin, clarithromycin, azithromycin, penicillin, clindamycin, cephalothin, rifampin and vancomycin by disk diffusion on Mueller‐Hinton (MH) agar supplemented with 5% defibrinated sheep blood (MHB) at 35ºC in 5% carbon dioxide. Strains that were found to be intermediately resistant or resistant to one of the antibiotics by disc diffusion, strains from sites other than throat, and a sample of 97 pharyngeal strains were evaluated by E‐test on MHB (35ºC, 5% carbon dioxide) for their susceptibility to the antibiotics erythromycin, clarithromycin, azithromycin, penicillin, clindamycin and ceftriaxone. In addition, minimum inhibitory concentrations (MICs) were determined for erythromycin and azithromycin by broth microdilution using MH broth supplemented with 2.5 % of lysed horse blood (35ºC, ambient air) on strains that were resistant or intermediately resistant to the macrolides (erythromycin, clarithromycin, azithromycin). An evaluation was also carried out on these strains to determine the influence of the incubating atmosphere (ambient air versus 5% carbon dioxide) on susceptibility results obtained by disk diffusion (erythromycin, clarithromycin and azithromycin) and E‐test (erythromycin and azithromycin) methods.RESULTS: Nine strains (2%) from nine patients (throat eight, pus one) were resistant to all macrolides as tested by three different techniques (disk diffusion, E‐test and microdilution). All strains were susceptible to all the other antibiotics tested. For the strains intermediately resistant or resistant to macrolides, incubation in a 5% carbon dioxide atmosphere was associated with a reduction in the diameter of inhibition determined by disk diffusion (P<0.001) with frequent minor variations in interpretation, and with an increase in the MIC by E‐test (P<0.001), which had no impact on interpretation.CONCLUSIONS: Resistance of GABHS to macrolides was not common (2%) in the lower St Lawrence Region. GABHS susceptibility to erythromycin seemed to predict the susceptibility to the other macrolides. Significant variation in antibiogram results (disk diffusion and E‐test) of GABHS susceptibility to macrolides was related to the incubation atmosphere and may have an impact on the interpretation of disk diffusion results.
Assessing Patients with Chronic Pain Using the Basic Personality Inventory as a Complement to the Multidimensional Pain Inventory
Authors: Burton Howard J , Kline Stephen A , Hargadon Robin , Cooper Barry S , Shick Roger D , Ong-Lam May C 
Published: March 2016

OBJECTIVE: To examine the utility of the Basic Personality Inventory (BPI) as a complementary tool to the Multidimensional Pain Inventory (MPI) for the evaluation of patients with chronic pain. It was hypothesized that patients labelled ′dysfunctional′ on the MPI would exhibit the highest levels of psychological distress as indicated by scores on BPI, followed in order by those labelled ′interpersonally distressed′, and those described as ′adaptive copers′. It was anticipated that this pattern would be independent of sex. In addition, validity of the BPI as a measure of psychological distress among patients with pain was examined using psychiatric diagnostic ratings as independent criteria.METHODS: Three hundred and twenty‐six patients with non‐malignant chronic pain seeking admission to a private pain clinic, an inpatient treatment program or a short term, multidisciplinary outpatient chronic pain program completed both the MPI and the BPI at a single sitting as part of a routine assessment procedure. The majority of patients underwent psychiatric assessment which specified Diagnostic and Statistical Manual of Mental Disorders‐III‐R (DSM‐III‐R) or DSM‐IV diagnosis. Psychiatric diagnosis was determined for a subsample of 110 patients in the present investigation by conducting a random chart review.RESULTS: The MPI patients classified as ′dysfunctional′ manifested significantly higher levels of BPI measured psychopathology than both ′interpersonally distressed′ and ′adaptive coper′ groups. ′Adaptive copers′ reported the lowest levels of psychological dysfunction while those labelled ′interpersonally distressed′ exhibited intermediate levels of dysfunction. Individuals with high levels of emotional distress as determined from the BPI were more likely to have an axis 1 disorder.CONCLUSIONS: The BPI is an accepted valid and reliable generic measure of emotional well‐being and may be used as a complementary index to the disease‐specific MPI in assessing chronic pain patients. A psychometric assessment battery consisting of the MPI and BPI can assist both clinicians and researchers in identifying problem areas that may impede treatment of patients with chronic pain and in assessing treatment outcomes.
Child Abuse and Dissociation in Patients with Complex Regional Pain Syndrome
Authors: Williams Michael , Read John , Large Robert 
Published: March 2016

>OBJECTIVE: In the absence of a proven medical explanation for the chronic pain syndrome Complex Regional Pain Syndrome type I (CRPS I), this study explored a hypothetical link between childhood physical and sexual abuse, and the subsequent development of CRPS I. The hypothesis predicts the existence of a subpopulation of CRPS I patients with a high frequency of dissociative experiences corresponding to a history of childhood trauma.DESIGN: To test this theory, CRPS I patients attending the Auckland Hospital Pain Clinic, Auckland, New Zealand were assessed by self‐report questionnaires for their frequency of dissociative experiences and for a history of childhood abuse. The data were compared with those of a low back pain control group and a healthy, pain‐free control group.RESULTS: CRPS I patients were not unusually dissociative and had not experienced significantly higher rates of childhood abuse than the general population. Two of the 18 CRPS I patients were highly dissociative; both reported childhood sexual abuse.CONCLUSIONS: A trauma‐dissociation pathway to CPRS I was not found. The desirability of screening for that subpopulation of CPRS I sufferers who may have been abused is discussed.
Pain Evoked by Electrical Stimulation of the Prepyloric Region of the Stomach: Cutaneous Sensibility Changes in the Referred Pain Area
Authors: Drewes Asbjørn M , Krarup Henrik B , Hansen Jesper B , Tage-Jensen Ulrik , Arendt-Nielsen Lars 
Published: March 2016

OBJECTIVE: To investigate the pain threshold and the referred pain areas to electrical stimulation of the prepyloric region of the stomach, and the cutaneous sensibility in the referred pain areas.DESIGN: Eight healthy males volunteered for the study. To identify the area of referred pain, all subjects participated in a study using the same model four months previously. During gastroscopy, repeated electrical burst stimuli were delivered in four adjacent prepyloric sites of the stomach, and the pain detection thresholds (PDTs) together with the area of pain referral were determined. Before, during and after continuous electrical painful stimuli delivered in the prepyloric region, the cutaneous sensitivities in the referred pain area and a control area on the chest were characterized using electrical, heat, touch and pinprick stimuli.RESULTS: The PDTs in the four prepyloric areas were not different and the location of the referred pain was reproducible. During the nociceptive visceral stimuli, hyperalgesia to heat stimulation was detected in the referred pain area compared with the control area, but the thresholds for electrical, touch and pinprick stimulations did not change.CONCLUSIONS: The reproducible pain thresholds in adjacent prepyloric sites make future analysis in patient groups possible because the precise site of stimulation can vary without changing the sensibility. The modality‐specific somatosensory changes in the referred pain areas further indicate that visceral pain can cause differentiated sensory changes. Modality‐specific sensibility changes are also seen in referred areas to muscle pain. Thus, the model may increase the information on viscerocutaneous convergence phenomena in humans.
Acute Respiratory Distress Syndrome: 30 Years Later?
Authors: Lesur Olivier , Berthiaume Yves , Blaise Gilbert , Damas Pierre , Deland Éric , Guimond Jean-Gilles , Michel René P 
Published: March 2016

Acute respiratory distress syndrome (ARDS) was first described about 30 years ago. Modern definitions and statements have recently been proposed to describe ARDS accurately, but none is perfect. Diffuse alveolar damage is the basic pathological pattern most commonly observed in ARDS, and the term includes permeability edema. The alveolar epithelium of the alveolar‐capillary barrier is clearly a key component requiring repair, given its multipotent functional activity. Lung inflammation and neutrophil accumulation are essential markers of disease in ARDS, and a wide variety of pro‐ and anti‐inflammatory cytokines have been described in the alveolar fluid and blood of patients. These molecules still have to prove their value as diagnostic or prognostic biomarkers of ARDS.Supportive therapy in ARDS improved in the past decade; mechanical ventilation with lung protective strategies and patient positioning are gaining interest, but the indications for corticosteroids for ARDS are still debated. Nitric oxide may have a place in the treatment of one‐third of patients. Novel approaches, such as surfactant replacement and liquid ventilation, may further improve supportive therapy. Innovative interventions may be on the horizon in treatments that help to resolve or modulate common pathways of ARDS, such as inflammation (eg, granulocyte‐colony stimulating factor) or epithelial repair (eg, keratinocyte growth factor).
Salmeterol and Fluticasone Propionate (50/250 μg) Administered via Combination Diskus Inhaler: As Effective as When Given via Separate Diskus Inhalers
Authors: Chapman Kenneth R , Ringdal Nils , Backer Vibeke , Palmqvist Mona , Saarelainen Seppo , Briggs Mark 
Published: March 2016

OBJECTIVE: To compare the efficacy and safety of a new combination Diskus inhaler containing both salmeterol 50 μg and fluticasone propionate 250 μg (Seretide) with the two drugs delivered via separate Diskus inhalers.DESIGN: A multicentre, double‐blind, double‐dummy study. Three hundred and seventy‐one symptomatic asthma patients (age range 13 to 75 years, mean 42 years) receiving inhaled corticosteroids were randomly assigned to two treatement groups: 28 weeks’ treatment with either salmeterol/fluticasone propionate (50/250 μg bid) via a single
Diskus inhaler (combination) and placebo bid via another Diskus inhaler, or salmeterol 50 μg bid via one Diskus inhaler and fluticasone propionate 250 μg bid via another (concurrent). Morning peak expiratory flow rate (PEFR) and symptoms were measured for the first 12 weeks and safety data were collected throughout the study.RESULTS: Over weeks 1 to 12, adjusted mean improvements in morning PEFR were 43 and 36 L/min for combination and concurrent therapies, respectively. The difference between the two treatment arms was 6 L/min (90% CI –13 to 0 L/min; P=0.114), which was within the predefined criteria for clinical equivalence. Adjusted mean improvements in forced expiratory volume in 1 s from baseline for week 28 were also similar between the two therapies. Thirty‐five per cent of patients receiving combination inhaler and 31% of those receiving concurrent therapy had a mean daytime symptom score of zero over weeks 1 to 12 compared with 1% and 2%, respectively, at baseline. There was no difference in the incidence of adverse events between the two treatment arms. Mean serum cortisol levels were similar, and no differences in frequency of abnormal results were noted between the two groups.CONCLUSIONS: This study shows that the combination of
salmeterol and fluticasone propionate in a single inhaler is as efficacious in achieving asthma control and as well tolerated over a 28‐week period as the two drugs administered individually.
Postherpetic Nneuralgia: Review of Treatment Modalities
Authors: Chan Philip SL , Clark Alexander J 
Published: March 2016

BACKGROUND: Varicella zoster virus (VZV) is the etiological agent for both varicella (chickenpox) and herpes zoster (HZ) (shingles). HZ results from the reactivation of VZV acquired during childhood. Postherpetic neuralgia (PHN) is the most common complication of HZ infection in immunocompetent patients. There is no universally accepted definition of PHN. While the mechanisms producing pain associated with PHN are not fully understood, peripheral and central processes are thought to be important.METHODS: The literature on the pathophysiology and the treatment of postherpetic neuralgia was reviewed for the past 30 years by using Index Medicus.CONCLUSIONS: Many modalities to treat PHN are available; none of them are very effective. The most commonly used modalities are tricyclic antidepressants, anticonvulsants, opioid analgesics, topical medications, physical modalities such as acupuncture and transcutaneous nerve stimulation, and nerve blocks. The tricyclic antidepressants have the most evidence supporting their role in treating PHN, although only half of the patients with PHN benefit. Recent studies support the use of opioid analgesics in PHN. There is a growing body of evidence in support of the use of gabapentin for PHN. Physical modalities and topical medications are probably most useful as adjuncts to centrally acting agents, not as a primary treatment modality. Injections (nerve blocks) are effective in relieving PHN anecdotally, although there are no controlled clinical trials showing efficacy.
Is Methicillin‐Resistant Staphylococcus aureus an Emerging Community Pathogen? A Review of the Literature
Authors: Gardam Michael A 
Published: March 2016

OBJECTIVES: To discuss the historical epidemiology of methicillin‐resistant Staphylococcus aureus (MRSA) and review the literature suggesting that MRSA has become a community pathogen.DATA SOURCES: A search of the MEDLINE database was performed, encompassing all English or French language citations from 1966 to 1999 and containing the subjects and/or text words: ′Staphylococcus aureus′, ′methicillin resistance′, ′endocarditis′, ′cellulites′, ′pneumonia′ and ′community‐acquired′. Articles published in other languages that provided English or French abstracts were included. All relevant references cited in articles obtained from the MEDLINE database and book chapters were also included.DATA EXTRACTION: All articles obtained from the above sources were examined and were included in the review if a laboratory or epidemiological study of community‐acquired MRSA was presented.DATA SYNTHESIS AND CONCLUSIONS: MRSA has emerged over the past 30 years to become a worldwide nosocomial pathogen and has recently been reported as a cause of community‐acquired infections. The changing epidemiology of MRSA is likely because of two mechanisms: the movement of nosocomial MRSA strains into the community and the de novo appearance of community strains resulting from the transfer of genetic material from methicillin‐resistant Gram‐positive organisms to sensitive S aureus strains. The emergence of MRSA as a community pathogen has occurred at a slower rate than it did for penicillin‐resistant S aureus (PRSA) in the 1950s and 1960s, possibly because the mechanism of methicillin resistance does not exhibit the same ease of transferability as that of penicillin resistance. Four case reports, seven case series, 10 case‐control studies and two cohort studies on community‐acquired MRSA were analyzed. Determining whether these reports involve new community‐acquired strains rather than previously acquired nosocomial strains can be problematic. It appears, however, that MRSA strains of both nosocomial and community origin are now endemic in certain communities in different parts of the world. Few surveillance studies of nonhospitalized patient populations have been performed to date; thus, the true prevalence of MRSA in the community at large is essentially unknown, although it appears to be low. At present, the empirical treatment of community‐acquired S aureus infections with a beta‐lactamase‐stable beta‐lactam antibiotic is appropriate for most populations. However, empirical vancomycin therapy for serious S aureus infections should be strongly considered for patients with significant risk factors for previously‐acquired nosocomial MRSA or for patients belonging to outpatient populations with a proven high prevalence of MRSA. Increasing vancomycin use will likely have a significant impact on the development of resistance in Gram‐positive organisms.
Common Mechanisms Underlying Opioid Tolerance and Dependence and Neuropathic Pain: Role of Metabotropic Glutamate Receptors
Authors: Fundytus Marian E 
Published: March 2016

It has been suggested that opioid tolerance and dependence share common mechanisms with neuropathic pain. This short review deals with the role of glutamate and glutamate receptors in opioid tolerance and dependence, and neuropathic pain. Particular attention is given to the role of metabotropic glutamate receptors (mGluRs). First, the different types of glutamate receptors, which include N‐methyl‐D‐aspartate, alpha‐amino‐3‐hydroxyl‐5‐methyl‐ isoxazole‐4‐propionic acid, kainate and mGluRs, are described. Following this, evidence suggesting that these receptors are involved in opioid tolerance and dependence are summarized. At the end of this section, a model that has been previously proposed to explain mechanisms by which mGluRs may be involved in opioid tolerance and dependence are described. Next is a discussion of the evidence suggesting that glutamate receptors are similarly involved in neuropathic pain, and also in opioid sensitivity associated with neuropathic pain. Again, a hypothetical model used to explain mechanisms by which mGluRs may be involved in neuropathic pain is briefly described. The relevance of the data is discussed in terms of some of the clinical implications of the material presented in the article.
Physician Asthma Management Practices in Canada
Authors: Jin Robert , Choi Bernard CK , Chan Benjamin TB , McRae Louise , Li Felix , Cicutto Lisa , Boulet Louis-Philippe , Mitchell Ian , Beveridge Robert , Leith Eric 
Published: March 2016

OBJECTIVES: To establish national baseline information on asthma management practices of physicians, to compare the reported practices with the Canadian Consensus recommendations and to identify results potentially useful for interventions that improve physician asthma management practices.DESIGN: National, stratified cross‐sectional survey.SETTINGS: The 10 provinces and two territories of Canada, from 1996 to 1997.PARTICIPANTS: Questionnaires were sent to 4489 physicians stratified by province/territory and specialty group (family/general practice, respirology, internal medicine, pediatrics and allergy/immunology); 2605 responses were received.OUTCOME MEASURES: Methods for the diagnosis, treatment, education and follow‐up of patients with asthma (′asthma management practices′).RESULTS: Significant variations existed among the five specialty groups in asthma management practices. A low use of objective measures of airflow limitation to assist with diagnosis was found among some respondents (mostly family physicians). Up to 40% of physicians regarded the daily fixed dosing (three or four times a day) of inhaled, short acting beta2‐agonist as ′first‐line therapy′ for moderate to severe asthma. A minority of physicians reported using written action plans for patients or referring them to other health professionals for asthma education. Insufficient time during appointments and a perceived lack of appropriate educational materials were frequently cited as reasons for not providing asthma education. The perceived knowledge of the Canadian Consensus recommendations varied among physicians but was lowest among nonspecialists.CONCLUSIONS: The survey showed variations in certain aspects of the management of asthma by physicians. The findings will help to target specific areas for future physician education programs and other behavioural change strategies.
Support for a Common Metric for Pediatric Pain Intensity Scales
Authors: von Baeyer Carl L , Hicks Carrie L 
Published: March 2016

Institutional adoption of routine measurement of pediatric pain has been impeded partly by the profusion of different metrics (eg, 0 to 5, 0 to 6, 0 to 10, 0 to 100) for reporting pain intensity on various instruments. The present paper discusses the importance of adopting a common metric, that is, a single numbering system on which estimates of pain intensity from various sources can be recorded. To explore both support and reservations concerning the adoption of a common metric, a survey questionnaire was sent in 1999 to an estimated 600 subscribers to the Pediatric Pain Internet Mailing List. Individuals working in pediatric institutions where children′s pain is routinely measured, or where adoption of such measures is planned, were requested to respond by e‐mail or mail. Responses (n=37) were from nurses (49%), physicians (24%), psychologists (7%) and others/unlisted (20%) on four continents. Adoption of a common metric was endorsed by 81% of respondents. Among the possible numbering systems, the 0 to 10 system was strongly favoured (70%) over other options. Respondents commented that adoption of a common metric would improve communication and consistency in measurement both within and among institutions. Some disadvantages, such as staff resistance to altering existing systems, were also suggested. The majority of respondents thought that it would be desirable to adopt a common metric. Among the possible numbering systems, the 0 to 10 system is by far the most favoured. Adopting a common 0 to 10 standard, and adapting existing tools to that metric, would be positive steps toward identifying and relieving children′s pain.