bluuebunny/crossref_metadata_2025_split huggingface dataset:
Playing Cards on Asthma Management: A New Interactive Method for Knowledge Transfer to Primary Care Physicians
Authors: Boulet Louis-Philippe , Borduas Francine , Bouchard Jacques , Blais Johanne , Hargreave Frederick E , Rouleau Michel 
Published: March 2016

OBJECTIVES: To describe an interactive playing card workshop in the communication of asthma guidelines recommendations, and to assess the initial evaluation of this educational tool by family physicians.DESIGN: Family physicians were invited to participate in the workshop by advertisements or personal contacts. Each physician completed a standardized questionnaire on his or her perception of the rules, content and properties of the card game.SETTING: A university‐based continuing medical education initiative.PARTICIPANTS: Primary care physicians.MAIN OUTCOME MEASURES: Physicians’ evaluation of the rules, content and usefulness of the program.RESULTS: The game allowed the communication of relevant asthma‐related content, as well as experimentation with a different learning format. It also stimulated interaction in a climate of friendly competition. Participating physicians considered the method to be an innovative tool that facilitated reflection, interaction and learning. It generated relevant discussions on how to apply guideline recommendations to current asthma care.CONCLUSIONS: This new, interactive, educational intervention, integrating play and scientific components, was well received by participants. This method may be of value to help integrate current guidelines into current practice, thus facilitating knowledge transfer to caregivers.
A Nosocomial Outbreak of Community‐Associated Methicillin‐Resistant Staphylococcus aureus among Healthy Newborns and Postpartum Mothers
Authors: Saunders Andrea , Panaro Linda , McGeer Allison , Rosenthal Alana , White Diane , Willey Barbara M , Gravel Denise , Bontovics Erika , Yaffe Barbara , Katz Kevin 
Published: March 2016

BACKGROUND: Community‐associated methicillin‐resistant Staphylococcus aureus (CA‐MRSA) has increasingly been isolated from individuals with no predisposing risk factors; however, such strains have rarely been linked to outbreaks in the hospital setting. The present study describes the investigation of an outbreak of CA‐MRSA that occurred in the maternal‐newborn unit of a large community teaching hospital in Toronto, Ontario.METHODS: Screening and clinical specimens collected from mothers and newborns delivered during the outbreak period, as well as from staff on the affected unit, were submitted for microbiological testing. Computerized delivery logs and nursing notes were reviewed, and a case control study was conducted.RESULTS: Analysis by pulsed‐field gel electrophoresis revealed 38 babies and seven mothers with MRSA colonization and/or infection by the same unique strain (Canadian MRSA‐10‐related) from September to December 2004. Isolates were characterized as having the staphylococcal chromosome cassette mec type IVa and were positive for the Panton‐Valentine leukocidin gene. No one health care worker was associated with all cases; however, mothers and newborns exposed to one particular nurse (Nurse A) were almost 23 times (odds ratio 22.7, 95% CI 3.3 to 195.9) more likely to acquire MRSA than those with no such contact. MRSA was successfully isolated from Nurse A and from an environmental swab of a telephone recently used by Nurse A; both isolates matched the pulsed‐field gel electrophoresis pattern of the outbreak strain.CONCLUSION: The first nosocomial outbreak of CA‐MRSA among healthy newborns and postpartum mothers in Canada is described. Effective control of sustained MRSA transmission within an institution may require prompt identification, treatment and monitoring of colonized and/or infected staff.
The Efficiency of Sputum Cell Counts in Cystic Fibrosis
Authors: Jayaram Lata , Labiris N Renee , Efthimiadis Ann , Vlachos-Mayer Helen , Hargreave Frederick E , Freitag Andreas P 
Published: March 2016

BACKGROUND: Technical factors relating to processing viscid sputum in cystic fibrosis (CF) and their influence on the reproducibility and validity of cell counts need to be evaluated. In addition, the methods need to be standardized so that they can be applied clinically and in research.OBJECTIVE: To examine the efficiency, reliability and validity of processing small volumes of spontaneously expectorated sputum from subjects with CF.METHODS: Sputum was collected from adults with CF (n=35) and compared with sputum from adults with infective bronchitis or bronchiectasis (IB/B) (n=16), or with asthma or chronic obstructive pulmonary disease (AS/COPD) (n=25). Selected sputum (100 mg to 200 mg) was processed with dithiothreitol (0.1%) and filtered. Total cell count (TCC) and viability were obtained in a counting chamber and cytospins were prepared and stained with Wright’s for a differential cell count. Sputum and filter remnant were processed for TCC, viability and differential cell count, and the efficiency was determined by comparing the mean loss in cell yield to the filter. Two different portions from the same sputum sample were processed for cell counts to determine reproducibility. Results were compared with those from IB/B and AS/COPD groups.RESULTS: Efficiency of cell dispersal was excellent and similar to that in AS/COPD and IB/B groups. Reproducibility of cell counts from two portions of a sputum sample was high (R≥0.80). CF sputum demonstrated a raised TCC and neutrophilia similar to IB/B but significantly higher than AS/COPD.CONCLUSION: The selection method of evaluating cell counts in viscid CF sputum is efficient, reproducible and valid.
The Utility of Ambulatory pH Monitoring in Patients Presenting with Chronic Cough and Asthma
Authors: AlHabib KF , Vedal S , Champion P , FitzGerald JM 
Published: March 2016

OBJECTIVE: To evaluate the prevalence of gastroesophageal reflux disease (GERD) in patients presenting with asthma and chronic cough.PATIENTS AND METHODS: The charts of 358 consecutive patients who were referred for ambulatory gastroesophageal pH monitoring to the Lung Centre in Vancouver, British Columbia, were reviewed, and the data of 108 (30%) patients with asthma and 134 (37%) patients with chronic cough were analyzed. The maintenance treatment for GERD was discontinued before patients underwent the pH monitoring study. One hundred eighteen (33%) patients were excluded.RESULTS: Reflux episodes identified reflux events as the percentage of time where the pH was less than four. For asthma patients, 70 (64.8%) had distal total reflux, 50 (46.3%) had distal upright reflux, 41 (38.3%) had distal supine reflux and 73 (67.6%) had other distal refluxes. Proximal total reflux in asthmatic patients was present in 56 (52%), proximal upright reflux in 55 (51%) and proximal supine reflux in 56 (52%) patients. For chronic cough patients, 70 (52.6%) had distal total reflux, 59 (44.4%) had distal upright reflux, 45 (34.4%) had distal supine reflux and 75 (56%) patients had other distal refluxes. In chronic cough patients, proximal total reflux was present in 70 (52%), proximal upright reflux in 80 (60%) and proximal supine reflux in 59 (44%). Presenting respiratory and/or reflux symptoms were absent in approximately 25% of patients with asthma and reflux, and in approximately 50% of patients with chronic cough and reflux. During pH monitoring, symptoms did not differ significantly between those with and without distal reflux in both study groups, except for more significant heartburn in patients with chronic cough and reflux (RR 2.0).CONCLUSIONS: The data of the present study support the observation that there is a high prevalence of GERD in patients with asthma or chronic cough. The use of different pH parameters for detecting acid reflux during 24 h ambulatory pH monitoring, such as proximal esophageal acid measurement, should be considered as part of the routine interpretation of such testing. A low threshold for diagnosing GERD in patients with asthma or chronic cough is essential, because respiratory and/or reflux symptoms can be absent or atypical in some of these patients.
The Sex Factor: Epidemiology and Management of Chronic Obstructive Pulmonary Disease in British Columbia
Authors: Camp Pat G , Chaudhry Munaza , Platt Howard , Roch Michael , Road Jeremy , Sin Donald , Levy Robert D 
Published: March 2016

BACKGROUND: The prevalence and mortality of chronic obstructive pulmonary disease (COPD) in women have been predicted to overtake that of men within the next decade. These predictions are based in part on data from surveys using self‐reports of a COPD diagnosis. Whether these predictions have been realized is unknown.METHODS: The prevalence and mortality of men and women in British Columbia were compared from fiscal years 1992/1993 to 2003/2004 using administrative health services data. Case definitions for COPD were developed using International Classification of Diseases ninth and 10th revision (ICD‐9/10) codes applied to medical and hospital data. Individuals 45 years and older, who had at least two physician visits or one hospitalization for specified COPD ICD‐9/10 codes within a 365‐day window, were considered to be cases. Cases were ascertained from 1992 to 2004.RESULTS: In 2003/2004, men had a greater prevalence (4.7% versus 4.0% in women) and a higher all‐cause mortality rate (5.4% versus 4.1% in women) than women. Both men and women with COPD had low COPD medication use (45%) and low referral for lung function testing (55%). Including the ICD‐9 code for ‘bronchitis, not specified as acute or chronic’ (ICD‐9 490) in the case definition resulted in a greater prevalence of COPD in women than in men overall, and in the 45 to 64 year age group.CONCLUSION: Prevalence and mortality measured with administrative health data do not show evidence of relative increase in the prevalence of COPD for women in British Columbia. However, further analysis of ICD‐9 490 may identify an early ‘at‐risk’ group, specifically in women.
Two for One: A Self‐Management Plan Coupled with a Prescription Sheet for Children with Asthma
Authors: Ducharme Francine M , Noya Francisco , McGillivray David , Resendes Sandy , Ducharme-Bénard Stéphanie , Zemek Roger , Bhogal Sanjit Kaur , Rouleau Rachel 
Published: March 2016

BACKGROUND: Despite strong recommendations in the asthma guidelines, the use of written self‐management plans remains low among asthmatic patients.OBJECTIVES: To develop a written self‐management plan, based on scientific evidence and expert opinions, in a format intended to facilitate its dispensing by health care professionals, and to test the perception of its relevance and clarity by asthmatic children, adolescents and adults.METHODS: Inspired by previously tested self‐management plans, surveys of asthma educators, expert opinions and the 2004 Canadian Asthma Guidelines, the authors simultaneously developed French and English versions of a written self‐management plan that coupled with a prescription. The self‐management plan was tested in parents and their asthmatic children (aged one to 17 years), and it was revised until 85% clarity and perceived relevance was achieved.RESULTS: Ninety‐seven children and their parents were interviewed. Twenty per cent had a self‐management plan. On the final revision, nearly all items were clear and perceived relevant by 85% or more of the interviewees. Two self‐management plans were designed for clinics and acute care settings, respectively. The plans are divided into three control zones identified by symptoms with optional peak flow values and symbolized by traffic light colours. They are designed in triplicate format with a prescription slip, a medical chart copy and a patient copy.CONCLUSION: The written self‐management plans, based on available scientific evidence and expert opinions, are clear and perceived to be relevant by children, adolescents and their parents. By incorporating the prescription and chart copies, they were designed to facilitate dispensing by physicians in both clinics and acute care settings.
Capacity Enhancement of Hepatitis C Virus Treatment through Integrated, Community-Based Care
Authors: Hill Warren D , Butt Gail , Alvarez Maria , Krajden Mel 
Published: March 2016

BACKGROUND: An estimated 250,000 Canadians are infected with the hepatitis C virus (HCV). The present study describes a cohort of individuals with HCV referred to community-based, integrated prevention and care projects developed in British Columbia. Treatment outcomes are reported for a subset of individuals undergoing antiviral therapy at four project sites.METHODS: Four demonstration projects based on a public health nurse and physician partnership were established in rural and small urban centres in British Columbia. Comprehensive medical assessments determined whether individuals received treatment, or counselling and education. Outcomes of the treatment group were compared with published randomized controlled trials. Client demographics were mapped using geographical information systems applications.RESULTS: A total of 1795 individuals were referred to the clinics for medical assessment between Septmber 2001 and December 2005. After assessment, 26% were eligible for therapy, while 74% received counselling and education. Wait times decreased annually, with one-half of all referrals assessed within 30 days. Combination antiviral therapy was initiated in 363 clients with interferon plus ribavirin (n=36) or pegylated interferon plus ribavirin (n=327). Treatment outcomes were available for 205 individuals. The overall rate of sustained virological response was 61% (126 of 205 individuals). The number of individuals assessed at each site represented, on average, 20% of the total cumulative reported HCV cases in the catchment areas.DISCUSSION: The study findings illustrate how a public health nurse and physician partnership can service a population with complex medical needs while simultaneously increasing local capacity. Treatment outcomes were comparable with published clinical trials.
Work‐Related Asthma in Montreal, Quebec: Population Attributable Risk in a Community‐Based Study
Authors: Demir Ahmet , Joseph Lawrence , Becklake Margaret R 
Published: March 2016

BACKGROUND: Occupational exposures are an important cause of adult‐onset asthma but the population attributable risk percentage (PAR%) has been less frequently studied.OBJECTIVES: To examine the distribution and determinants of adult asthma in six centres across Canada using data gathered in a community‐based study.METHODS: Data were gathered in a community survey of 2959 adults using the European Community Respiratory Health Survey Protocol. A subsample of 498 subjects completed detailed health and occupational questionnaires, methacholine challenge tests and allergy skin tests. Asthma was defined in three ways: current wheeze, asthma symptoms and/or medication, and airway hyperresponsiveness. Occupational exposures were classified as sensitizers or irritants. Associations between asthma and occupational exposures were examined using logistic regression analysis. Model selection was based on the findings for current wheeze, and the same model was applied to the other definitions of asthma.RESULTS: Fifty‐six per cent of subjects reported ever having had occupational exposure to sensitizers, and 9.8% to irritants. Current wheeze was associated with exposure to irritants (PAR% 4.54%), and airway hyperresponsiveness was associated with exposure to sensitizers (PAR% 30.7%). Neither a history of childhood asthma, atopy, nor confining the analysis to adult‐onset asthma affected these associations. Analysis of effect modification suggested two types of work‐related asthma: one due to exposure to occupational sensitizers, and the other due to exposure to irritants.CONCLUSIONS: Detailed assessment of past and current exposures is essential in the investigation of work‐related asthma. Childhood asthma reactivated or aggravated by work exposures is not easy to distinguish from asthma induced by work, a misclassification that could lead to an underestimation of work‐induced asthma. This should be taken into account in jurisdictions in which persons with work‐aggravated asthma are not eligible for workers’ compensation.
Pain Catastrophizing in Borderline Morbidly Obese and Morbidly Obese Individuals with Osteoarthritic Knee Pain
Authors: Somers Tamara J , Keefe Francis J , Carson James W , Pells Jennifer J , LaCaille Lara 
Published: March 2016

OBJECTIVE: There is limited information about how morbidly obese osteoarthritis (OA) patients cope with the pain they experience. Pain catastrophizing is an important predictor of pain and adjustment in persons with persistent pain. This may be particularly relevant in the morbidly obese (body mass index [BMI] of 40 kg/m2 or greater) OA population at risk for increased pain. The present study first examined whether borderline morbidly obese and morbidly obese OA patients report higher levels of pain catastrophizing than a sample of OA patients in the overweight and obese category (BMI between 25 kg/m2 and 34 kg/m2). Next, it examined how pain catastrophizing is related to important indexes of pain and adjustment in borderline morbidly obese and morbidly obese OA patients.METHODS: Participants included 43 individuals with knee OA who were borderline morbidly obese or morbidly obese (BMI of 38 kg/m2 or greater). Participants completed self‐report measures of pain catastrophizing, pain, psychological distress, quality of life, binge eating and eating self‐efficacy.RESULTS: The sample of borderline morbidly obese and morbidly obese OA patients reported significantly higher levels of pain catastrophizing (P=0.007) than a comparison sample of overweight and obese OA patients. Results suggested that patients who engaged in a high level of pain catastrophizing reported having much more intense and unpleasant pain, higher levels of binge eating, lower self‐efficacy for controlling their eating and lower weight‐related quality of life (P<0.05 for all).CONCLUSIONS: Pain catastrophizing is related to pain and adjustment in borderline morbidly obese and morbidly obese OA patients. Clinicians working with this population should consider assessing pain catastrophizing in the patients they treat.
Incidental Colorectal Computed Tomography Abnormalities: Would You Send every Patient for a Colonoscopy?
Authors: Stermer Edy , Lavy Alexandra , Rainis Tova , Goldstein Omer , Keren Dean , Zeina Abdel-Rauf 
Published: March 2016

BACKGROUND: The clinical significance of colorectal wall thickening (CRWT) in patients undergoing abdominal computed tomography (CT) has not yet been definitively established.OBJECTIVES: To compare alleged findings on abdominal CT with those of a follow-up colonoscopy.METHODS: Ninety-four consecutive patients found to have large-bowel abnormalities on abdominal CT were referred for colonoscopy. Of these patients, 48 were referred for a suspected colorectal tumour and 46 for CRWT. Colonoscopy was performed and findings were compared.RESULTS: Of the 48 suspected colorectal tumours, 34 were determined to be neoplastic lesions on colonoscopy. Of these, 26 were malignant and eight were benign. Colonoscopy revealed no abnormality in 30 of 46 patients with CRWT as a solitary finding, and revealed some abnormality in 16 patients (12 had diverticular disease, four had benign neoplastic lesions).CONCLUSIONS: CRWT as an incidental and solitary finding on CT should not be regarded as a pathology prompting a colonoscopy. Approximately two-thirds of the patients had a normal colonoscopy and the remaining patients had benign lesions (12 had diverticular disease and four had benign neoplastic lesions). However, many of these patients seem to warrant colonoscopy regardless of CT findings, particularly patients who have a family history of colorectal cancer, have positive fecal occult blood test results or who are older than 50 years of age.
Is Serum Hepcidin Causative in Hemochromatosis? Novel Analysis from a Liver Transplant with Hemochromatosis
Authors: Adams Paul C , McAlister Vivian , Chakrabarti Subrata , Levstik Mark , Marotta Paul 
Published: March 2016

BACKGROUND: Hepcidin is a circulating hepatic hormone that regulates iron balance. It has been speculated that hepcidin insufficiency or dysregulation may be the primary defect in genetic hemochromatosis.METHODS: A 62-year-old woman underwent elective liver transplantation for chronic hepatitis C cirrhosis. Genetic testing for hemochromatosis was subsequently performed on the donor and recipient. Liver iron concentration was measured in the donated liver at the time of transplantation, and at day 2 and day 652 post-transplant. Serum hepcidin was measured at day 935 in the recipient and in three other liver transplant recipients.RESULTS: The donor was discovered to have significant iron overload without fibrosis, with a liver iron concentration of 326 μmol/g (normal is 0 μmol/g to 35 μmol/g). Genetic testing confirmed that the 89-year-old female donor was a typical C282Y homozygote for hemochromatosis. The recipient did not carry either the C282Y or the H63D mutation of theHFEgene for hemochromatosis. Liver biopsy was performed on the recipient on day 2 and day 652 post-transplant; the liver iron concentrations were 333 μmol/g and 253 μmol/g, respectively. Serum hepcidin in the recipient was elevated at 111 ng/mL compared with that of the three other ambulatory liver transplant recipients (66 ng/mL, 76 ng/mL and 81 ng/mL).CONCLUSION: The liver transplant recipient described in the present report demonstrated a slight decrease in liver iron concentration over a 1.8-year follow-up period without specific therapy. Hepcidin insufficiency as a primary cause of genetic hemochromatosis seems unlikely based on the clinical profile of the present patient and the hepcidin measurements.
Tobacco Control and Nicotine Addiction in Canada: Current trends, Management and Challenges
Authors: McIvor Andrew 
Published: March 2016

Despite a significant decrease in tobacco use over the past four decades, cigarette smoking remains the leading preventable cause of death and disease in Canada. Nicotine addiction, unequal access to available support programs and gaps in continuity of health care are recognized as the main barriers to smoking cessation. To overcome these obstacles and to reach the Federal Tobacco Control Strategy goal of reducing smoking prevalence in Canada from 19% to 12% by 2011, several Canadian health care organizations developed extensive sets of recommendations. Improved access to affordable pharmacotherapies and behavioural counselling, better training of health care professionals and the addition of systemic cessation measures appear to be the key components in all of the proposed recommendations.The present article provides an overview of the current approaches to smoking cessation in Canada, describes the remaining challenges, and outlines recent recommendations that are geared toward not only tobacco control but also overall improvement in long‐term health outcomes.