bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic yield of Capsule Endoscopy in the Setting of Iron Deficiency Anemia without Evidence of Gastrointestinal Bleeding
Authors: Tong Jessica , Svarta Sigrid , Ou George , Kwok Ricky , Law Joanna , Enns Robert 
Published: March 2016

BACKGROUND: The diagnostic yield of capsule endoscopy (CE) in the setting of iron deficiency anemia (IDA) without evidence of occult/overt bleeding has been questioned. Often, these patients have nongastrointestinal causes of iron deficiency but undergo CE to exclude a potential small bowel source.OBJECTIVE: To assess the diagnostic yield of CE, the characteristics predicting positive results, the presumed etiology of IDA in negative/normal CE and patient management after CE.METHODS: A retrospective review of 934 patients who underwent CE between December 2001 and February 2010 was conducted. All patients had undergone previous negative endoscopic examinations before CE. Patients with IDA but no evidence of overt/occult bleeding were separated into three categories based on CE findings: group A – positive; group B – negative/normal; and group C – incomplete/indeterminate.RESULTS: A total of 101 capsules in 97 patients were evaluated. Group A had 25 subjects with positive findings on CE, 18 of whom were managed supportively. Group B consisted of 69 subjects with negative/normal CE, 60 of whom were treated supportively. Group C consisted of three subjects with incomplete CE results.CONCLUSION: In patients with IDA without evidence of gastrointestinal bleeding, CE had a low diagnostic yield (25.7%), which increased to 45.5% after adjusting for low dietary iron intake and menorrhagia. However, CE did not alter management in most patients regardless of findings, and many of the lesions requiring intervention were within reach of standard endoscopes. No predictor of positive results was found. In this patient population, careful history taking and thorough endoscopy could improve CE utilization, although its value is still relatively limited.
Coagulase‐Negative Staphylococcus, Catheter‐Related, Bloodstream Infections and their Association with Acute Phase Markers of Inflammation in the Intensive Care Unit: An Observational Study
Authors: Rewa Oleksa , Muscedere John , Reynolds Steve , Jiang Xuran , Heyland Daren K 
Published: March 2016

OBJECTIVE: To examine the relationship between the isolation of coagulase‐negative Staphylococcus in blood cultures and acute phase markers of inflammation.METHODS: The present study was a prospective observational analysis conducted at three medical/surgical intensive care units (ICUs) involving adult patients with an expected ICU stay of more than 24 h duration.RESULTS: Of the 598 patients enrolled, 573 developed suspected bloodstream infection and 434 (72.6%) had blood cultures sent 24 h after ICU admission; 142 were excluded due to positive cultures from other sites. Of the remaining 292 patients, 31 (10.7%) grew coagulase‐negative Staphylococcus, 59 (20.2%) grew known pathogenic organisms and 202 (69.2%) did not grow any organisms in their blood cultures. Twenty‐five patients without suspicion of infection served as the control group. Interleukin (IL)‐6, procalcitonin (PCT) and C‐reactive protein (CRP) levels were highest among the known pathogen group (IL‐6 271.8 U/L, PCT 4.6 U/L and CRP 164 mg/L), were similar between the coagulase‐negative Staphylococcus and negative culture groups (IL‐6 67.0 U/L versus 61.4 U/L [P=1.00]; PCT 1.0 U/L versus 0.9 U/L [P=0.80]; and CRP 110 mg/L versus 103 mg/L [P=0.75]), and were lowest in the control group (IL‐6 31.0 U/L, PCT 0.2 U/L and CRP 41.0 mg/L). In the coagulase‐negative Staphylococcus group, patients who died by day 28 had increased inflammatory bio‐marker levels compared with survivors, although the differences were not statistically significant.CONCLUSIONS: Coagulase‐negative Staphylococcus isolated from blood cultures were associated with lower levels of inflammation compared with bloodstream infections due to known pathogens and were comparable with levels in patients with negative cultures.
Development and Validation of an Administrative Case Definition for Inflammatory Bowel Diseases
Authors: Rezaie Ali , Quan Hude , Fedorak Richard N , Panaccione Remo , Hilsden Robert J 
Published: March 2016

BACKGROUND: A population-based database of inflammatory bowel disease (IBD) patients is invaluable to explore and monitor the epidemiology and outcome of the disease. In this context, an accurate and validated population-based case definition for IBD becomes critical for researchers and health care providers.METHODS: IBD and non-IBD individuals were identified through an endoscopy database in a western Canadian health region (Calgary Health Region, Calgary, Alberta). Subsequently, using a novel algorithm, a series of case definitions were developed to capture IBD cases in the administrative databases. In the second stage of the study, the criteria were validated in the Capital Health Region (Edmonton, Alberta).RESULTS: A total of 150 IBD case definitions were developed using 1399 IBD patients and 15,439 controls in the development phase. In the validation phase, 318,382 endoscopic procedures were searched and 5201 IBD patients were identified. After consideration of sensitivity, specificity and temporal stability of each validated case definition, a diagnosis of IBD was assigned to individuals who experienced at least two hospitalizations or had four physician claims, or two medical contacts in the Ambulatory Care Classification System database with an IBD diagnostic code within a two-year period (specificity 99.8%; sensitivity 83.4%; positive predictive value 97.4%; negative predictive value 98.5%). An alternative case definition was developed for regions without access to the Ambulatory Care Classification System database. A novel scoring system was developed that detected Crohn disease and ulcerative colitis patients with a specificity of >99% and a sensitivity of 99.1% and 86.3%, respectively.CONCLUSION: Through a robust methodology, a reproducible set of criteria to capture IBD patients through administrative databases was developed. The methodology may be used to develop similar administrative definitions for chronic diseases.
Current Considerations in Direct Percutaneous Endoscopic Jejunostomy
Authors: Zhu Yanfei , Shi Liping , Tang Hao , Tao Guoqing 
Published: March 2016

For patients who are unable to meet their nutritional needs orally, enteral feeding via a percutaneous approach has become the mainstay of therapy. However, traditional enteral feeding methods, such as percutaneous endoscopic gastrostomy, may not be viable options for patients with severe gastroparesis or gastric outlet obstruction. Direct percutaneous endoscopic jejunostomy (DPEJ) is an enteral access method that was first described more than 20 years ago and has gained popularity among gastroenterologists. This review discusses the indications for and contraindications to DPEJ, the procedure, the application of DPEJ in specific subsets of patients with gastrointestinal disorders, and presents a brief tabular summary of complications and success rates of DPEJ in case series published since 2000.BACKGROUND: Direct percutaneous endoscopic jejunostomy (DPEJ) is a well-known approach to deliver postpyloric enteral nutritional support to individuals who cannot tolerate gastric feeding. However, it is technically difficult, and some case series have reported significant procedural failure rates. The present article describes current indications, successes and complications of DPEJ placementMETHODS: A MEDLINE database search was performed to identify relevant articles using the key words “direct percutaneous endoscopic jejunostomy”, “percutaneous endoscopic gastrostomy”, and “percutaneous endoscopic gastrostomy with a jejunal extension tube”. Additional articles were identified by a manual search of the references cited in the key articles obtained in the primary search.RESULTS: DPEJ is gradually becoming more common in the treatment of patients who cannot tolerate gastric feeding. Differences in patient selection and technique modifications may contribute to the various success rates reported. Failure is most often due to inadequate transillumination or gastroduodenal obstruction. Currently, there are limited data to evaluate the safety and effectiveness of DPEJ.CONCLUSION: The clinical use of DPEJ is increasing. With appropriate care and expertise, DPEJ may prove to be reliable and safe.
Incomplete Colonoscopy: Maximizing Completion Rates of Gastroenterologists
Authors: Brahmania Mayur , Park Jei , Svarta Sigrid , Tong Jessica , Kwok Ricky , Enns Robert 
Published: March 2016

BACKGROUND Cecal intubation is one of the goals of a quality colonoscopy; however, many factors increasing the risk of incomplete colonoscopy have been implicated. The implications of missed pathology and the demand on health care resources for return colonoscopies pose a conundrum to many physicians. The optimal course of action after incomplete colonoscopy is unclear.OBJECTIVES: To assess endoscopic completion rates of previously incomplete colonoscopies, the methods used to complete them and the factors that led to the previous incomplete procedure.METHODS: All patients who previously underwent incomplete colonoscopy (2005 to 2010) and were referred to St Paul’s Hospital (Vancouver, British Columbia) were evaluated. Colonoscopies were re-attempted by a single endoscopist. Patient charts were reviewed retrospectively.RESULTS: A total of 90 patients (29 males) with a mean (± SD) age of 58±13.2 years were included in the analysis. Thirty patients (33%) had their initial colonoscopy performed by a gastroenterologist. Indications for initial colonoscopy included surveillance or screening (23%), abdominal pain (15%), gastrointestinal bleeding (29%), change in bowel habits or constitutional symptoms (18%), anemia (7%) and chronic diarrhea (8%). Reasons for incomplete colonoscopy included poor preparation (11%), pain or inadequate sedation (16%), tortuous colon (30%), diverticular disease (6%), obstructing mass (6%) and stricturing disease (10%). Reasons for incomplete procedures in the remaining 21% of patients were not reported by the referring physician. Eighty-seven (97%) colonoscopies were subsequently completed in a single attempt at the institution. Seventy-six (84%) colonoscopies were performed using routine manoeuvres, patient positioning and a variable-stiffness colonoscope (either standard or pediatric). A standard 160 or 180 series Olympus gastroscope (Olympus, Japan) was used in five patients (6%) to navigate through sigmoid diverticular disease; a pediatric colonoscope was used in six patients (7%) for similar reasons. Repeat colonoscopy on the remaining three patients (3%) failed: all three required surgery for strictures (two had obstructing malignant masses and one had a severe benign obstructing sigmoid diverticular stricture).CONCLUSION: Most patients with previous incomplete colonoscopy can undergo a successful repeat colonoscopy at a tertiary care centre with instruments that are readily available to most gastroenterologists. Other modalities for evaluation of the colon should be deferred until a second attempt is made at an expert centre.
Patient Characteristics and Outcomes of a Provincial Prolonged‐Ventilation Weaning Centre: A Retrospective Cohort Study
Authors: Rose Louise , Fraser Ian M 
Published: March 2016

BACKGROUND: Growing numbers of critically ill patients require prolonged mechanical ventilation and experience difficulty with weaning. Specialized centres may facilitate weaning through focused interprofessional expertise with an emphasis on rehabilitation.OBJECTIVE: To characterize the population of a specialized prolonged‐ventilation weaning centre (PWC) in Ontario, and to report weaning, mobility, discharge and survival outcomes.METHODS: Data from consecutively admitted patients were retrospectively extracted from electronic and paper medical records by research staff and verified by the primary investigator.RESULTS: From January 2004 to March 2011, 144 patients were admitted: 115 (80%) required ventilator weaning, and 29 (20%) required tracheostomy weaning or noninvasive ventilation. Intensive care unit length of stay before admission was a median 51 days (interquartile range [IQR] 35 to 86 days). Of the patients admitted for ventilator weaning, 76 of 115 (66% [95% CI 55% to 75%]) achieved a 24 h tracheostomy mask trial in a median of 15 days (IQR eight to 25 days). Weaning success, defined as no further ventilation for seven consecutive days, was achieved by 61 patients (53% [95% CI 44% to 62%]) in a median duration of 62 days (IQR 46 to 95 days) of ventilation, and 14 days (IQR nine to 29 days) after PWC admission. Seventeen patients died during admission. Of the 91 patients discharged from the PWC for one year, 43 (47.3% [95% CI 37.3% to 57.4%]) survived; of the 78 discharged for two years, 27 (34.6% [95% CI 25.0% to 45.7%]) were alive; of the 53 discharged for three years, 19 (35.9% [95% CI 24.3% to 49.3%]) were alive; and seven of 22 (31.8% [95% CI 16.4% to 52.7%]) survived to five years.CONCLUSIONS: Weaning success was moderate despite a prolonged intensive care unit stay before admission, but was comparable with studies reporting weaning outcomes from centres in other countries. Few patients survived to five years.
Clinical Presentation of Patients with Aseptic Meningitis, Factors Influencing Treatment and Hospitalization, and Consequences of Enterovirus Cerebrospinal Fluid Polymerase Chain Reaction Testing
Authors: Patriquin Glenn , Hatchette Jill , Forward Kevin 
Published: March 2016

INTRODUCTION: Clinical and laboratory features of enteroviral meningitis may overlap with those of bacterial meningitis. In the present retrospective review, we compared features of enteroviral (EV)‐positive and ‐negative patients to determine those that were most influential in admission, discharge and in anti‐infective administration.METHODS: Data were analyzed from the records of 117 pediatric and adult patients who underwent cerebrospinal fluid (CSF) EV testing over a three‐year period.RESULTS: The oldest EV‐positive patient was 34 years of age and the occurrence of the disease was highly seasonal. EV‐positive patients were more likely to report fever, rash, photophobia, short onset and exposure to an ill contact. A positive polymerase chain reaction (PCR) result was associated with relatively short hospitalization. Seizure and neurological symptoms were more strongly associated with a negative PCR test result. CSF characteristics did not discriminate well between patients with positive and negative PCR tests. Patients with imperfect Glasgow Coma Scores or with neurological symptoms were more likely to be admitted to hospital than those without. Fever and recent onset predicted determinants of anti‐infective use.CONCLUSION: The present retrospective study confirms previous reports regarding seasonality and the young age of positive patients. Factors that indicate nonenteroviral etiology were appropriately also those that influenced hospitalization. Patients with EV meningitis were likely to be treated with empirical anti‐infectives, and a substantial proportion continued to take antibiotics for more than 24 h after receiving the positive EV PCR test result.
Optimizing Hepatitis C Therapy in HIV/hepatitis C Virus (HCV) Coinfected Patients: Analysis of HCV Viral Kinetics on Treatment
Authors: James Paul Damien , Wong David KH 
Published: March 2016

INTRODUCTION: Hepatitis C virus (HCV) infection is potentially curable, but the sustained virological response (SVR) has been shown to be lower in patients coinfected HIV. A single‐centre experience treating individuals with HCV and HIV coinfection is reported.METHODS: Twenty‐one patients who received standard doses of pegylated interferon with weight‐based dosing of ribavirin (mean 14.3 mg/kg) were retrospectively reviewed. Qualitative HCV polymerase chain reaction (PCR) was performed prospectively every four weeks if the patient remained HCV PCR positive. All patients with HCV genotype 1 were treated for 48 weeks. Patients with genotype 2 or 3 were treated for 24 weeks and 32 weeks to 36 weeks if their HCV RNA level was undetectable after four weeks (RVR4) or eight weeks (RVR8) of therapy, respectively. If RVR8 was not achieved, the treatment was continued for 48 weeks.RESULTS: There were no dropouts or dose reductions within the first 12 weeks of treatment. SVR status was available for 20 patients and adequate serum for viral kinetics analyses was available for 17 patients. Eighty per cent of the patients achieved SVR (50% genotype 1; 100% genotypes 2 and 3). The week 8 viral load remained elevated for all genotype 1 nonresponders.DISCUSSION: High effectiveness rates were seen, particularly in patients with HCV genotype 2 and 3 who were treated for shorter durations. HCV viral loads after eight weeks of therapy helped distinguish patients with HCV genotype 1 who would respond to therapy.
Anxiety and Functional Disability in a Large Sample of Children and Adolescents with Chronic Pain
Authors: Simons Laura E , Sieberg Christine B , Claar Robyn Lewis 
Published: March 2016

BACKGROUND: Anxiety is the most common psychiatric condition in children and adolescents, and is linked to significant disruptions across domains of function. Due to the avoidant nature of anxiety and pain‐related disability, studying anxiety symptoms in children with chronic and recurrent pain conditions is important.OBJECTIVES: To examine anxiety symptoms in a large cohort of children and adolescents evaluated for complex chronic and recurrent pain conditions.METHODS: Through retrospective chart review, data on anxiety, pain and functional disability were collected from 655 children evaluated at a multidisciplinary pain clinic over a three‐year period.RESULTS: Approximately 11% of children and adolescents reported clinically elevated anxiety symptoms, with elevated levels across dimensions of anxiety ranging from 14% (social anxiety, worry) to 27% (physiological). In addition, a notable 31% of the sample potentially minimized their anxiety by responding in a socially desirable manner. Anxiety was linearly associated with greater pain‐related functional disability, but was not directly correlated with pain. Moderation analyses revealed that at low levels of worry, higher levels of pain were associated with greater functional disability, whereas at high levels of worry, pain no longer predicted the level of functional disability.CONCLUSIONS: These findings document the prevalence of anxiety in children and adolescents with chronic pain, and also extend recent studies examining the complex relationships among pain, anxiety and pain‐related disability.
Does Pain Necessarily Have an Affective Component? Negative Evidence from Blink Reflex Experiments
Authors: Horn Claudia , Blischke Yvonne , Kunz Miriam , Lautenbacher Stefan 
Published: March 2016

The experience of pain can be described using two dimensions – sensory and affective‐motivational – of which the affective‐motivational component is strongly modulated by context and the cognitive appraisal of pain. In pain research, the sensory component is commonly represented by ratings of pain intensity, while the affective component is represented by ratings of pain unpleasantness. However, there is evidence to suggest that test subjects tend to judge pain intensity different from unpleasantness whenever separate scales for both dimensions are presented concurrently. This study used a startle reflex as an objective measure of affective response to stimuli of varying intensities to determine whether the affective component can be abolished when predictable stimulation paradigms are applied.BACKGROUND: Experimental pain research has shown that the affective component of pain is influenced strongly by situational characteristics; affective pain processing appears to be particularly pronounced in situations that provoke a feeling of uncertainty and uncontrollability.OBJECTIVES: To determine whether the affective component of pain can be completely abolished if a ‘safe’, particularly predictable stimulation paradigm is applied.METHOD: Forty healthy volunteers recruited at the University of Bamberg (Bamberg, Germany) were assessed in two experiments. Tonic contact heat stimuli staged in three intensities (warmth, heat and pain) relative to the individual pain threshold was applied; these were predictable with regard to intensity and course, and the subjects had easy access to control. The startle reflex was assessed as an objective measure of affective response. In addition, the subjects provided unpleasantness ratings. To compare these results to a gold standard for affective response, affective pictures taken from the International Affective Picture System were presented during temperature stimulation in the second experiment.RESULTS: Both experiments showed no potentiation of the startle reflex under painful heat stimulation compared with the two nonpainful stimulus intensities (heat and warmth), although the painful stimulation was clearly rated as more unpleasant.CONCLUSIONS: Results suggest that it is possible to develop a ‘safe’ noxious stimulus, which is rated as clearly unpleasant, but lacks physiological indication of negative affect. This divergence might be explained by subjective ratings being influenced by the instructions. The possibility of reducing the pain affect by suggesting ‘safety’ may be of therapeutic interest.
The Coincidence of Necrotizing Enterocolitis and Rotavirus Infections and Potential Associations with Cytokines
Authors: Sızmaz Efsun , Satar Mehmet , Özlü Ferda , Yaman Akgün , Yıldızdaş Hacer Yapıcıoğlu , Özcan Kenan 
Published: March 2016

BACKGROUND: Necrotizing enterocolitis (NEC) is the most common gastrointestinal disease in neonatal intensive care units. Although the pathogenesis of NEC remains unclear, evidence suggests that infections, especially bacterial infections, may play an important role. Viral infections may also result in NEC. Several outbreaks of NEC associated with rotaviruses have been described previously.OBJECTIVE: To investigate the association between rotavirus (RV) and serum interleukin (IL)‐6 and IL‐8 levels in infants with NEC.METHODS: RV infections were prospectively studied using antigen detection in the stools of 31 infants with NEC. Additionally, serum levels of IL‐6, IL‐8 and tumour necrosis factor‐alpha were tested using micro‐ELISA at 0 h and 48 h after diagnosis of NEC.RESULTS: Fecal specimens from 13 infants were positive, while fecal specimens from 18 infants were negative for RV according to antigen detection (RV+ and RV− groups, respectively). The mortality rate and the severity of NEC were not significantly different between the RV+ and RV− groups. IL‐6 levels at 0 h and 48 h after diagnosis of NEC in RV+ infants were lower compared with RV− infants, while IL‐8 levels were greater at 0 h and 48 h after diagnosis of NEC in RV+ infants compared with RV− infants.CONCLUSION: A high prevalence of RV infection in neonates with NEC was found. Decreased IL‐6 levels and increased IL‐8 and tumour necrosis factor‐alpha levels in RV+ neonates with NEC suggests a role for RV in NEC.