bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Asthma Education on Asthma Severity, Quality of Life and Environmental Control
Authors: Côté Johanne , Cartier André , Robichaud Patricia , Boutin Hélène , Malo Jean-Luc , Rouleau Michel , Boulet Louis-Philippe 
Published: March 2016

BACKGROUND:Several studies have examined the influence of asthma education, focusing mainly on the use of health services.OBJECTIVES:To assess the influence of an asthma education program (AEP) on airway responsiveness, asthma symptoms, patient quality of life (QOL) and environmental control.DESIGN:A prospective, randomized, controlled study with parallel groups.SETTING:Three tertiary care hospitals in Quebec.POPULATION:One hundred and eighty-eight patients with moderate to severe asthma.INTERVENTION:After optimization of asthma treatment with inhaled corticosteroids, patients were randomly assigned to receive either an education program based on self-management (group E) or usual care (control group C).RESULTS:One year after an AEP, there was a significant decrease in the number of days per month without daytime asthma symptoms in group E only (P=0.03). Asthma daily symptom scores decreased significantly in group E in comparison with group C (P=0.006). QOL scores improved markedly in both groups after treatment optimization during the run-in period (P<0.01). After an AEP, the QOL score increased further in group E patients in comparison with group C patients (P=0.04). The concentration of methacholine that induces a 20% fall in forced expiratory volume in 1 s (PC20) improved significantly in both groups (group E 1.2±1.1 to 2.4±0.2, group C 1.5±1.2 to 2.4±1.3, P<0.01). After one year, 26 of 37 patients from group E sensitized to house dust mites (HDM) adopted the specific measures recommended to reduce their exposure to HDM, while none of the 21 subjects from group C did (P<0.001). Among the patients sensitized to cats or dogs, 15% of patients from group E and 23% of patients in group C no longer had a pet at home at the final visit (P>0.5).CONCLUSIONS:One year after the educational intervention, it was observed that the program had added value over and above that of optimization of medication and regular clinical follow-ups. The education program was highly effective in promoting HDM avoidance measures but minimally effective for removing domestic animals, suggesting that more efficient strategies need to be developed for the latter.
A Case‐Control Study of the Role of Cold Symptoms and other Historical Triggering Factors in Asthma Exacerbations
Authors: Tarlo Susan M , Broder Irvin , Corey Paul , Chan-Yeung Moira , Ferguson Alexander , Becker Allan , Warren Peter , Simons F Estelle R , Sherlock Christopher , Okada Marilyn , Manfreda Jure 
Published: March 2016

BACKGROUND: Asthma exacerbations can be provoked by many triggers such as allergens, respiratory irritants and viral infections. The relative importance of these has not been prospectively documented in a case‐control study.OBJECTIVE: To assess the relative importance of colds and other nonclimatic historical triggers of asthma exacerbations.METHODS: One hundred and nineteen adults and children with asthma in two Canadian cities participated in a one‐year study of the role of exacerbating factors in asthma. Among these, 36 pairs (21 adult, 15 children) completed the case‐control study. Patients were considered cases if they developed an acute asthma exacerbation and notified the centre within 24 h to allow the completion of a questionnaire and viral studies (cultures of nasopharyngeal swabs and serology). Control people with asthma were matched for sex, age and area of residence, had no exacerbation during the preceding four weeks and participated within 48 h of the case patients.RESULTS: Case patients versus control patients had a mean age of 22 years versus 20 years, 50% versus 55% were male, and 92% versus 86% had at least one positive aeroallergen skin test. Cases were more likely to have taken regular inhaled steroids (63% versus 33%, P<0.002). Cases were more likely to report the following within the previous week: fever (P<0.001), sore throat (P<0.001), increase in nasal symptoms (P<0.01), increased dust exposure (P<0.05), exposure to others with a cold (P<0.001) and, over the previous year, increased passive smoke exposure (P<0.05). Viral cultures and paired serology were negative.CONCLUSIONS: Symptomatic colds were the most common trigger of asthma exacerbations in the winter and spring, while a transient increase in dust exposure was also identified as a significant trigger. The association with chronic, passive smoke exposure and the use of inhaled costicosteroid medications likely reflected less stable pre‐study asthma in those with exacerbations.
Allergen Induced Increase in Nonallergic Airway Responsiveness: A Citation Classic Revisited
Authors: Cockcroft Donald W 
Published: March 2016

BACKGROUND:The present paper revisits the 1977 paper by DW Cockcroft, RE Ruffin, the late J Dolovich and FE Hargreave entitled "Allergen‐induced increase in nonallergic bronchial reactivity" (Clin Allergy 1977;7:503‐13) that became a citation classic. Although clinical types of asthma were recognized at the time, there was a poor understanding regarding the role of allergic reactions in causing increases in airway hyperresponsiveness. The objective was to study formally Dr Altounyan′s observation that patients with asthma showed increases in airway responsiveness at the times of natural allergen exposure during pollen season. Thirteen atopic patients with asthma were studied over two days, following inhalation of diluent (control) and following doubling amounts of an allergen solution at 10‐min intervals until forced expiration volume in 1 s fell by 20%. Methacholine and histamine challenges were performed before, at 8 h, at 32 h and seven days following the inhalations. A significant reduction (reduction of at least one doubling concentration) in the provocative concentration that causes a 20% fall in forced expiration volume in 1 s occurred in seven of 13 patients, and more often in subjects with a late bronchoconstrictor response to allergen challenge.IMPORTANCE: The study showed that large changes in airway responsiveness could occur in patients with asthma and suggested that allergens could cause, rather than trigger, asthma. The study also led to the concept of asthma inducers and inciters ‐‐ inducers causing airway inflammation and inciters provoking bronchospasm. The results led to a series of observations that have now implicated immunoglobulin E‐mediated airway inflammation as perhaps the most important cause of airway hyperresponsiveness in asthma.
Does Experience Influence Judgements of Pain Behaviour? Evidence from Relatives of Pain Patients and Therapists
Authors: Prkachin Kenneth M , Solomon Patty , Hwang Teresa , Mercer Susan R 
Published: March 2016

OBJECTIVE: Judgments about an individual′s pain can be profoundly important to sufferers. Relatively few studies have examined variables that may affect observers′ judgments of the pain of others. The present article reports two studies investigating the relationship between different kinds of exposure to pain problems and observers′ ratings of the pain intensity of patients.DESIGN: In the first study, 82 observers were classified into groups with positive and negative family histories of chronic pain. They viewed a videotape showing the facial expressions of shoulder pain patients undergoing physiotherapy assessments and rated the pain experienced by the subjects. In the second study, the data from observers having no experience with pain problems were compared with data collected from therapists having considerable experience with pain problems.RESULTS: Observers with a positive family history of chronic pain attributed greater pain to the patients than those with a negative family history of chronic pain. Professionals′ pain judgments were lower than those of control subjects.CONCLUSIONS: Together, the findings imply that one′s experiences with the different problems of pain patients may affect pain judgments. Alternative interpretations of the findings are considered.
A Critical Review of Oxazolidinones: An Alternative or Replacement for Glycopeptides and Streptogramins?
Authors: Zhanel George G , Schroeder Coleen , Vercaigne Lavern , Gin Alfred S , Embil John , Hoban Daryl J 
Published: March 2016

OBJECTIVE: To review the available data on the oxazolidinones linezolid and eperezolid.DATA SELECTION: Published reports were obtained by searching MEDLINE for articles published between 1992 and 2000, inclusive. References of published papers were also obtained and reviewed. Abstracts from scientific proceedings were reviewed.DATA EXTRACTION: Due to the limited data available regarding these agents, the criteria for study inclusion were not restrictive.DATA SYNTHESIS: The oxazolidinones (eg, linezolid) are a new antimicrobial class with a unique mechanism of action. They are active against resistant Gram‐positive cocci including methicillin‐susceptible and ‐resistant Staphylococcus aureus (MRSA), methicillin‐susceptible and ‐resistant Staphylococccus epidermidis, vancomycin‐resistant enterococci (VRE) and penicillin‐resistant Streptococcus pneumoniae (PRSP). Linezolid is active against anaerobes and displays modest activity against fastidious Gram‐negative pathogens such as Haemophilus influenzae, but is not active against Enterobacteriaceae. Linezolid is available both orally and parenterally, and has a bioavailability of 100%. Clinical trials comparing linezolid with standard therapy have demonstrated similar bacteriological and clinical cures rates to standard therapy in community‐ and hospital‐acquired pneumonia, uncomplicated and complicated skin and soft tissue infections, and infections caused by MRSA and VRE. Adverse effects have been minor and infrequent; however, platelets should be monitored in patients who have received more than two weeks of linezolid therapy. It is expected that these agents will have a bright future due to their excellent spectrum of activity against antibiotic‐resistant Gram‐positive organisms, such as MRSA, VRE and PRSP, and their excellent bioavailability.CONCLUSION: The oxazolidinones represent a new class of antimicrobials with a unique mechanism of action. They have excellent activity against susceptible and resistant Gram‐positive organisms such as MRSA, methicillin‐susceptible S epidermidis, VRE and PRSP, and a good adverse effect profile; they can be administered both intravenously and orally. Their potential use in Canada may be as an intravenous and oral alternative to glycopeptides and streptogramins.
How an Audit of Epidural Patients in a Community Hospital Setting Resulted in the Development of a Formal Acute Pain Management Service
Authors: Goldstein David H , VanDenKerkhof Elizabeth G , Sherlock Rebecca , Sherlock Judy , Harper Susan 
Published: March 2016

PURPOSE: To describe the results of an audit of patients who received epidural analgesics postoperatively and the subsequent development of a formal acute pain management service in a community hospital.METHODS: To understand how epidural analgesia was being used to treat postoperative pain at the Peterborough Regional Health Centre, Peterborough, Ontario, a retrospective chart review was performed. Audits were performed on 178 patients who had received epidural analgesia postoperatively from October 1994 to May 1995. Data pertaining to demographics, epidural analgesia, pain scores and side effects were collected.RESULTS: Sixty‐one per cent of patients received bupivacaine/ fentanyl infusions, and 39% received epidural morphine boluses. More than 60% of patients reported no pain postoperatively. Patients who received bupivacaine/fentanyl were more likely than those who received epidural morphine to also receive coanalgesia and transitional analgesia. Patients who received epidural morphine were more likely than those who received bupivacaine fentanyl to experience respiratory depression, hypotension and pruritus. Patients were followed by the anesthesiologist who provided the anesthetic. Anesthesiologists practised independently, and formal policies and procedures did not exist.CONCLUSIONS: As a result of the audit, an acute pain management service was developed. This included a team that did daily rounds and consisted of a nurse clinician and an anesthesiologist who was assigned to the service on a weekly basis. A committee was created, and formalized policies and procedures were established. Standardized order sheets, data sheets and a computerized database were developed. Reports for administrative and quality improvement purposes were generated monthly. Education programs were developed. Coanalgesia and transitional analgesia are now part of routine care, and epidural catheter placement close to the site of incision is encouraged. A postoperative nausea and vomiting algorithm, and a treatment regimen for pruritus have also been implemented.
Spirometry and Obstructive Lung Disease in Manitoba
Authors: Anthonisen NR , Dik N , Manfreda J , Roos LL 
Published: March 2016

BACKGROUND: Spirometry, the measurement of forced expiratory volume in 1 s and forced vital capacity, is recommended in the diagnosis and management of the obstructive lung diseases asthma and chronic obstructive pulmonary disease (COPD). The present report describes spirometry use in Manitoba and tests the hypothesis that regional spirometry use correlates with the prevalence of physician‐diagnosed obstructive lung diseases.METHODS: Spirometry is remunerated on a fee‐for‐service basis by Manitoba Health. Like other physician services, billing data include a diagnosis, patient identifiers, as well as the patient’s sex, date of birth and residential postal code. Physician billings for spirometry for 1991 to 1998 were analyzed, comparing data with billings for physician visits for obstructive diseases. Four age groups were examined, as were income quintiles in Winnipeg, Manitoba. In addition, the prevalence of physician‐diagnosed obstructive diseases were compared with spirometry rates in 49 service use areas of the province.RESULTS: Annually, about 3% of the Manitoba population underwent spirometry, and in aggregate, about 14% underwent spirometry during the eight years of the study. Rates in Winnipeg were higher than in the remainder of the province. Spirometry rates did not increase with time, and people who underwent spirometry had 1.4 to 1.7 tests/year. In children, higher income quintiles were tested more than lower income quintiles, while in adults, income quintiles were tested with equal frequency. People with obstructive lung disease accounted for about 75% of those tested, and in people with these diagnoses, the likelihood of testing increased approximately linearly with the number of physician visits for asthma or COPD. Children with asthma were tested less often than adults, and adults with asthma or both asthma and COPD were tested more often than those with COPD alone. In adults with asthma or asthma and COPD who had more than 10 physician visits for these diagnoses, testing rates were more than 70%, and multiple tests were common. In patients labelled with COPD only and with more than 20 physician visits, about one‐third did not undergo spirometry. In children aged five to 14 years and in adults 15 to 44 years old, regional spirometry rates correlated well with regional asthma rates. Regional spirometry rates also correlated significantly with regional rates of asthma and/or COPD in people older than 34 years old.INTERPRETATION: Spirometry use is considerably higher in patients with asthma than in patients with COPD, suggesting that guidelines are followed more closely in patients with asthma, and that many patients are labelled with COPD without appropriate documentation. Spirometry use is apparently indicative of physician interest in the problem of obstructive lung diseases.
Comparison of Intramuscular Betamethasone and Oral Pprednisone in the Prevention of Relapse of Acute Asthma
Authors: Chan John S , Cowie Robert L , Lazarenka Gerald C , Little Cinde , Scott Sandra , Ford Gordon T 
Published: March 2016

OBJECTIVE: To compare the relapse rate after a single intramuscular injection of a long acting corticosteroid, betamethasone, with oral prednisone in patients discharged from the emergency department (ED) for acute exacerbations of asthma.PATIENTS AND METHODS: Patients with acute exacerbations of asthma who were suitable for discharge from the ED were enrolled in a double-blind, randomized, placebo controlled pilot study. At discharge, patients were randomly assigned to receive either intramuscular betamethasone 12 mg and placebo capsules, or a placebo intramuscular injection and prednisone 50 mg daily for seven days. At days 7 and 21, patients were contacted by telephone to determine relapse. Relapse was defined as an unscheduled visit to a physician for treatment of continuing or worsening symptoms of asthma.RESULTS: One hundred and seventy-one patients were enrolled, of whom 87 were randomly assigned to the betamethasone group and 84 to the prednisone group. Baseline char- acteristics were matched evenly between the groups, with the exception of asthma duration (15.5 versus 21.2 years, respectively) and use of inhaled corticosteroids (46% versus 64.3% respectively) (P<0.05). Using intention-to-treat analysis, the relapse rates for betamethasone and prednisone at day 7 were 14.9% (13 of 87 patients) and 25% (21 of 84 patients), respectively (P=0.1), and at day 21, the rates were 36.8% (32 of 87 patients) and 31% (26 of 84 patients), respectively (P=0.4). There were no differences in symptom score, peak flows and adverse effects between the two groups at days 7 and 21.CONCLUSIONS: A single dose of intramuscular betamethasone 12 mg was safe and as efficacious as prednisone in preventing the relapse of acute asthma. There was a trend toward a reduced relapse rate at seven days. In select ED patients discharged for acute asthma, intramuscular betamethasone may be an effective alternative to prednisone.
Epidemiology of Hepatitis B in Canada
Authors: Zhang Jun , Zou Shimian , Giulivi Antonio 
Published: March 2016

OBJECTIVE: To provide a current and comprehensive review of the epidemiology of hepatitis B virus (HBV) in Canada.DATA SOURCES: Published and unpublished epidemiological studies and surveillance reports of the past decade, primarily from Canada were studied. Fifty reports addressing HBV surveillance, incidence and prevalence, transmission‐associated risk factors, co‐infections, and prevention strategies were reviewed.DATA SYNTHESIS: HBV infection is an important vaccine‐preventable infectious disease in Canada. The incidence rate of clinically recognized, acute HBV infection in 1998/1999 was estimated to be 2.3/100,000 people or approximately 700 cases a year. The prevalence of HBV carriers is estimated to be 0.5% to 1.0% of the population, but varies substantially according to population‐specific risk factors. Most acute HBV infections are associated with injection drug use or high risk heterosexual activities, but 20% to 30% of acute cases did not report any identified risk factors. Surveillance activities such as the National Notifiable Disease Reporting system provide information regarding trends and risk factors. The primary preventive strategy for HBV consists of universal immunization for preadolescents and/or infants. Other strategies, such as the universal prenatal screening and postnatal immunization, and the prevention of nosocomial acquistion, are also important. The recently described hepatitis B surface antigen (HBsAg) escape mutants may not be detected by current HBsAg test assays, and the existing HBV vaccines may not protect vaccinees from infections by such mutants.CONCLUSION: Ongoing surveillance and research are required to assess risk factors for HBV transmission, evaluate the effectiveness of immunization programs and monitor the impact of HBsAg escape mutants.
An Examination of Pain Perception and Cerebral Event‐Related Potentials following Carbon Dioxide Laser Stimulation in Patients with Alzheimer’s Disease and Age‐Matched Control Volunteers
Authors: Gibson Stephen J , Voukelatos Xenophon , Ames David , Flicker Leon , Helme Robert D 
Published: March 2016

BACKGROUND: Pain perception is known to depend on integrated cognitive processing. Alzheimer′s disease affects 5% to 10% of older adults, but the impact of this disease on pain sensitivity and report has yet to be fully investigated.AIM OF INVESTIGATION: The present study examined pain threshold, the reliability of pain report and the central nervous system processing of noxious input, as indexed by cerebral event‐related potentials (CERP).METHODS: Carbon dioxide laser detection and heat pain thresholds were determined on the hand dorsum of 15 healthy older adults (Mini‐Mental State Examination [MMSE] score 29.9±0.3) and 15 persons with cognitive impairment (MMSE score 12.7±6.1). Using an array of 15 silver/silver chloride scalp electrodes, the CERP and subjective rating of stimulus intensity were recorded after fixed intensity, 25 W laser stimuli.RESULTS: Compared with age‐matched controls, the detection threshold for just noticeable sensation was significantly increased in elderly adults suffering from Alzheimer′s disease. There was no difference in pain threshold intensity between persons with cognitive impairment and controls, although the former group was less reliable in reporting detection and pain threshold sensations. The subjective rating of a 25 W stimulus was virtually identical in both groups, and the amplitude of the major CERP component (P400) was similar; however, cognitively impaired adults exhibited a significant increase in the latency of the P400 response.CONCLUSION: The present findings indicate that pain perception in response to an acute heat pain stimulus is not diminished in older persons with cognitive impairment. Patients with Alzheimer′s disease may be slightly less reliable in threshold pain report, although the subjective rating of evoked pain and the level of poststimulus cortical activation following noxious stimulation were found to be similar to those of controls. A longer latency of the CERP may suggest slower cortical processing of nociceptive input by persons with Alzheimer′s disease.
Treatment of CMV Retinitis with Intravitreal Ganciclovir in the HAART Era
Authors: Campbell Robert J , Chow Benjamin , Victor Gary , Kravcik Steven , Hodge William G 
Published: March 2016

OBJECTIVE: To describe the course and outcome of cytomegalovirus (CMV) retinitis among AIDS patients treated with intravitreal ganciclovir and systemic highly active antiretroviral therapy (HAART). The secondary objective was to compare the course of CMV retinitis between patients receiving HAART and those not receiving this treatment.DESIGN: A retrospective cohort design consisting of 21 eyes from 16 patients with AIDS and CMV retinitis consecutively enrolled between January 1996 and August 1999. All patients received intravitreal ganciclovir therapy, and half of the patients began HAART as well. Duration of intravitreal therapy and ensuing disease quiescence, as well as CD4+ T cell counts at diagnosis and at cessation of ganciclovir, were calculated. Secondly, instantaneous hazards for outcomes such as CMV retinitis progression, ocular complications and mortality were compared.SETTING: Tertiary care centre in Ottawa, Ontario.RESULTS: Five of eight patients receiving HAART discontinued intravitreal ganciclovir after a mean treatment period of 428 days. During this period, their mean CD4+ count rose from 7.5 to 190/mL. Subsequently, none of these patients experienced retinitis progression during follow‐up periods lasting up to 820 days (mean of 617 days). Progression of CMV retinitis was 11.4 times more likely among those not receiving HAART (P=0.049).CONCLUSIONS: On initiating HAART, patients with CMV retinitis may enjoy significant recovery in CD4+ counts and sustained retinitis quiescence without specific anti‐CMV therapy. Intravitreal ganciclovir injections seem well suited to offer effective CMV control during temporary periods of decreased CD4+ counts while awaiting HAART‐mediated immune system reconstitution.