bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diet, Lifestyle and Chronic Widespread Pain: Results from the 1958 British Birth Cohort Study
Authors: VanDenKerkhof Elizabeth G , Macdonald Helen M , Jones Gareth T , Power Chris , Macfarlane Gary J 
Published: March 2016

OBJECTIVES: To examine the relationship between diet and lifestyle, and chronic widespread pain (CWP). If persons with CWP have dietary and lifestyle habits consistent with an increased risk of cancer or cardiovascular disease, it may partially explain evidence in the literature suggesting an association between CWP and these diseases.METHODS: The 1958 British Birth Cohort Study comprises individuals born in England, Scotland and Wales in the United Kingdom during one week in March 1958. At 45 years of age, pain was recorded using a self‐completion questionnaire. CWP was classified using the American College of Rheumatology definition for fibromyalgia. Data were collected on diet and lifestyle at 33 and 42 years of age.RESULTS: A total of 8572 participants provided pain data at 45 years of age, of whom 12% reported CWP. Women with CWP, compared with those without, reported an unhealthy diet (ie, fruit/vegetable consumption less than once per week [OR 2.0; 95% CI 1.3 to 3.1], and fatty food [OR 1.7; 95% CI 1.1 to 2.7] and chips (french fries) [OR 1.5; 95% CI 1.0 to 2.4] at least once per day) that may have predisposed them to other chronic diseases such as cancer and cardiovascular disease. Women with CWP were also more likely to be unemployed (adjusted OR 1.4; 95% CI 1.1 to 1.8), to have had high physical exertion at work (adjusted OR 1.6; 95% CI 1.2 to 2.2) and elevated body mass index (overweight – adjusted OR 1.5, 95% CI 1.2 to 1.9; obese – adjusted OR 1.8, 95% CI 1.3 to 2.5). Similar relationships between lifestyle (but not diet) and the risk of CWP were identified in men.CONCLUSIONS: The findings for smoking, body mass index and (for women) diet offer support for the hypothesis that lifestyle factors may partially explain the association between CWP and cancer or cardiovascular disease. Prospective studies are necessary to confirm this relationship.
Opioid Medication Errors in Pediatric Practice: Four years’ Experience of Voluntary Safety Reporting
Authors: Mc Donnell Conor 
Published: March 2016

BACKGROUND: Opioids are the most common source of drug error that leads to harm in pediatric hospitals.OBJECTIVE: To undertake a comprehensive review of experience with voluntary safety reports describing pediatric opioid medication errors at The Hospital for Sick Children (Toronto, Ontario), and to characterize the specific opioids involved, severity and type of error described, hospital location and time of day that the error occurred.METHODS: All medication‐related safety reports submitted to an anonymous, voluntary electronic safety reporting database in a university‐affiliated pediatric hospital during the first four years of its use were examined. A database of opioid error reports was created for further analysis.RESULTS: A total of 5935 medication‐related safety reports were collected, 507 of which described opioids. Morphine was the most frequently reported opioid, administration was the most frequently reported stage of the medication process (192 errors) and surgical wards were the location from which opioid error was most frequently reported (128 reports). Twenty‐two reports described patient harm requiring urgent treatment and intervention. Errors with codeine or hydromorphone resulted in the most significant harm reported. A total of 162 reports described problems with inappropriate opioid disposal, missing opioids, or incorrect opioid counts and checks.CONCLUSIONS: Future opportunities for improvement in opioid safety should focus on morphine, opioid administration errors in general, the safe disposal of opioids in the hospital environment and the identification of pain as an adverse event.
Evaluation of the Do Bugs Need Drugs? Program in British Columbia: Can We Curb Antibiotic Prescribing?
Authors: McKay Rachel M. , Vrbova Linda , Fuertes Elaine , Chong Mei , David Samara , Dreher Kim , Purych Dale , Blondel-Hill Edith , Henry Bonnie , Marra Fawziah , Kendall Perry RW. , Patrick David M. 
Published: March 2016

OBJECTIVE: Antibiotic resistance is accelerated by the overuse of antibiotics. Do Bugs Need Drugs? is an educational program adapted in British Columbia to target both the public and health care professionals, with the aim of reducing unnecessary prescribing. The current article presents a descriptive evaluation of the impact of the program over the first four years.METHOD: Program implementation was measured by the amount of educational material distributed and the level of participation in educational sessions. The impact of the program was assessed by measuring changes in knowledge and prescribing habits of participating physicians, and by investigating provincial trends in antibiotic use.METHOD: Program implementation was measured by the amount of educational material distributed and the level of participation in educational sessions. The impact of the program was assessed by measuring changes in knowledge and prescribing habits of participating physicians, and by investigating provincial trends in antibiotic use.RESULTS: A total of 51,367 children, assisted‐living residents and health care professionals have participated in the program since its inception in the fall of 2005. Pre‐ and postcourse assessments of participating physicians indicated significant improvements in clinical knowledge and appropriate antibiotic treatment of upper respiratory tract infections. Overall rates of antibiotic use in the province have stabilized since 2006. The rates of consumption of fluoroquinolones and macrolides have levelled off since 2005. Utilization rates for acute bronchitis are at the same level as when the program was first implemented, but rates for other acute upper respiratory tract infections of interest have declined.CONCLUSIONS: The Do Bugs Need Drugs? program significantly improves physician antibiotic prescription decisions and is ecologically associated with desirable change in population antibiotic consumption patterns.
Factors Affecting the Prognosis of Small Hepatocellular Carcinoma in Taiwanese Patients Following Hepatic Resection
Authors: Ko Chih-Jan , Chien Su-Yu , Chou Chen-Te , Chen Li-Sheng , Chen Mei-Ling , Chen Yao-Li 
Published: March 2016

BACKGROUND: Small hepatocellular carcinoma (HCC) affects millions of individuals worldwide. Surveillance of high-risk patients increases the early detection of small HCC.OBJECTIVE: To identify prognostic factors affecting the overall survival (OS) and recurrence-free survival (RFS) of patients with small HCC.METHODS: The present prospective study enrolled 140 Taiwanese patients with stage I or stage II small HCC. Clinical parameters of interest included operation type, tumour size, tumour histology, Child-Pugh class, presence of hepatitis B surface antigen and liver cirrhosis, hepatitis C status, alpha-fetoprotein, total bilirubin and serum albumin levels, and administration of antiviral and salvage therapies.RESULTS: Tumour size correlated significantly with poorer OS in patients with stage I small HCC (P=0.014); however, patients with stage II small HCC experienced a significantly poorer RFS (P=0.033). OS rates did not differ significantly between patients with stage I and stage II small HCC. Tumour margins, tumour histology and cirrhosis did not significantly affect OS or RFS (P>0.05).DISCUSSION: Increasing tumour size has generally been associated with poorer prognoses in cases of HCC. The present study verified the relationship between small HCC tumour size and OS; however, a reduction in OS with increasing tumour size was demonstrated for patients with stage I – but not for stage II – small HCC.CONCLUSION: Patients with stage II small HCC may benefit from aggressive surveillance for tumour recurrence and appropriate salvage treatment. Further studies are needed for additional stratification of stage I patients to identify those at increased risk of death.
Opioid Analgesics Suppress Male Gonadal Function, but Opioid Use in Men and Women Does Not Correlate with Symptoms of Sexual Dysfunction
Authors: Wong Dana , Gray Dan , Simmonds Mark , Rashiq Saifee , Sobolev Igor , Morrish Donald W 
Published: March 2016

BACKGROUND: Opioid analgesia impairs gonadal function in men and women, but the correlation with symptoms and hormonal measurements of hypogonadism is not well established.OBJECTIVE: To determine the frequency of impaired gonadal function in men and women using opioids for chronic pain, and to determine the correlation of symptoms with hormonal measurements of gonadal function.METHODS: A prospective study of patients attending a multidisciplinary pain clinic was conducted. A total of 65 women (47 opioid users and 18 nonopioid analgesic controls) and 32 men (26 opioid users and six controls) were enrolled. Histories of sexual dysfunction and hormonal testing (men: total testosterone [TT], free testosterone [FT], prolactin and luteinizing hormone; women: FT, TT, prolactin, dehydroepiandrosterone sulphate, sex hormone‐binding globulin, progesterone, luteinizing hormone and follicle‐stimulating hormone, and estradiol) were obtained.RESULTS: In men, a low FT level was more common in opioid users (20/26; P=0.04). In men with abnormal hormone levels, there was no difference in the frequency of sexual dysfunction compared with men with normal hormone levels, and no difference in the frequency of opioid versus nonopioid use. In women, opioid users had lower FT levels (P=0.02). Low dehydroepiandrosterone sulphate was more frequent in women on opioids (P=0.03) in the menopausal group only (P=0.046). Premenopausal women taking opioids more frequently had a low TT level (P=0.03). The frequency of female sexual dysfunction was the same in opioid users (32/47) and controls (13/18; P=0.75), and also did not relate to any hormone abnormality.DISCUSSION: Men taking opioids had lower FT and higher prolactin levels, and women taking opioids had lower FT levels. Frequency of sexual dysfunction did not correlate with hormone levels in either men or women taking opioids.CONCLUSION: Opioids frequently cause low FT levels in men, but there is no relationship between abnormal hormone levels and symptoms of sexual dysfunction. Therefore, all men should be screened for low FT levels. Women on opioids had lower FT levels, but this did not correlate with sexual dysfunction symptoms. Therefore, measurements of FT or other hormones were not considered to be useful in women.
Physicians’ Attitudes and Practice Toward Treating Injection Drug Users Infected with Hepatitis C Virus: Results from a National Specialist Survey in Canada
Authors: Myles Angelique , Mugford Gerry J , Zhao Jing , Krahn Murray , Wang Peizhong Peter 
Published: March 2016

BACKGROUND: In Canada, more than 70% of new cases of hepatitis C virus (HCV) infection per year involve injection drug users (IDUs) and, currently, there is no consensus on how to offer them medical care.OBJECTIVE: To examine the characteristics of Canadian specialist physicians and their likelihood to provide treatment to HCV patients who are IDUs.METHODS: A nationwide, cross-sectional study was conducted in the specialty areas of hepatology, gastroenterology and infectious diseases to examine HCV services. The questionnaire requested information regarding basic demographics, referral pathways and opinions (yes/no), and examined how a physician’s treatment regimen is influenced by factors such as treatment eligibility, HCV care management and barriers to providing quality service.RESULTS: Despite the fact that the majority of prevalent and incident cases of HCV are associated with injection drug use, very few specialist physicians actually provide the necessary therapy to this population. Only 19 (19.79%) comprehensive service providers were likely to provide treatment to a current IDU who uses a needle exchange on a regular basis. The majority of comprehensive service providers (n=86 [89.58%]) were likely to provide treatment to a former IDU who was stable on substitution therapy. On bivariate analysis, factors associated with the likelihood to provide treatment to current IDUs included physicians’ type, ie, infectious disease specialists compared with noninfectious specialists (OR 3.27 [95% CI 1.11 to 9.63]), and the size of the community where they practice (OR 4.16 [95% CI 1.36 to 12.71] [population 500,000 or greater versus less than 500,000]). Results of the multivariate logistic regression analysis were largely consistent with the results observed in the bivariate analyses. After controlling for other confounding variables, only community size was significantly associated with providing treatment to current IDUs (OR 3.89 [95% CI 1.06 to 14.26] [population 500,000 or greater versus less than 500,000]).CONCLUSION: The present study highlighted the reluctance of specialists to provide treatment to current IDUs infected with HCV. Providing treatment services for HCV-infected substance abusers is challenging and there are many treatment barriers. However, effective delivery of treatment to this population will help to limit the spread of HCV. The present study clearly identified a need for improved HCV treatment accessibility for IDUs.
Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma: Predictors of Survival
Authors: Sawhney Summit , Montano-Loza Aldo J , Salat Peter , McCarthy Mairin , Kneteman Norman , Meza-Junco Judith , Owen Richard 
Published: March 2016

BACKGROUND: Transarterial chemoembolization (TACE) is the mainstay of management for patients with hepatocellular carcinoma who are not suitable for curative treatments.OBJECTIVE: To determine factors associated with mortality after the first TACE procedure.METHODS: From January 2004 to May 2008, 60 patients underwent TACE as treatment for hepatocellular carcinoma. Clinical and biochemical parameters before TACE, and response after TACE, were evaluated with conventional classifications (WHO, Response Evaluation Criteria in Solid Tumors [RECIST], and European Association for the Study of the Liver [EASL] criteria) and with one-, two- and three-dimensional assessment.RESULTS: Overall median survival after the first TACE procedure was 17.1±3.4 months. According to Cox regression analysis, having an alpha-fetoprotein level of greater than 200 ng/mL (HR 2.35 [P=0.02]) and a Model for End-stage Liver Disease (MELD) score of greater than 10 (HR 4.19 [P=0.001]) were associated with higher risk of mortality; whereas reduction in tumour size measured in one dimension (HR 0.96 [P=0.005]), two dimensions (HR 0.98 [P=0.004]) and three dimensions (HR 0.98 [P=0.001]) was associated with lower risk of mortality. Moreover, reduction in tumour size by 3% or more assessed in one, two or three dimensions was associated with lower risk of mortality (HR 0.48 [P=0.04]; HR 0.36 [P=0.01]; HR 0.31 [P=0.003], respectively). The three conventional classifications were not useful for predicting mortality (WHO: HR 1.07 [P=0.9]; RECIST: HR 0.94 [P=0.9]; EASL: HR 0.94 [P=0.9]).CONCLUSIONS: Having an alpha-fetoprotein level of greater than 200 ng/mL and a MELD score of greater than 10 before undergoing TACE was associated with a greater risk of mortality. Conventional classifications of response were not useful for predicting mortality. Reduction in tumour size after the first TACE procedure was associated with better survival, primarily if patients had more than a 3% reduction in tumour size assessed by three-dimensional measurement.
Cerebral Near‐Infrared Spectroscopy as a Measure of Nociceptive Evoked Activity in Critically III Infants
Authors: Ranger Manon , Johnston Celeste C , Limperopoulos Catherine , Rennick Janet E , du Plessis Adre J 
Published: March 2016

Due to the subtlety or absence of predictable, objective signs of pain in critically ill infants, health care professionals must often rely on observations of behavioural or nonspecific physiological signals. Although parameters such as heart rate or blood pressure could be regarded as relatively more objective or quantifiable measures than behavioural signals, they are often unstable and generally nonspecific. However, reducing inaccuracies in pain assessment and misinterpretation of pain intensity may be facilitated by new techniques that shed light on the cerebral responses to pain that could be measured directly. Near‐infrared spectroscopy is one such technique that has been used to detect subtle changes in the concentrations of oxygenated and deoxygenated hemoglobin in the brains of preterm and term infants in response to stressful and/or painful stimuli. Following a review of cortical pain responses, this article provides an overview of near‐infrared spectroscopy technology and its use in functional activation studies in critically ill infants, and its potential applications in clinical settings and pain research.Signs of pain may be subtle or absent in a critically ill infant. The complex nature of pain may further obscure its identification and measurement. Because the use of monitoring and neuroimaging techniques has become more common in pain research, an understanding of these specialized technologies is important. Near‐infrared spectroscopy (NIRS) is a noninvasive technique for monitoring tissue hemodynamics and oxygenation. There are indications that NIRS is capable of detecting the cerebral hemodynamic changes associated with sensory stimuli, including pain, in infants. These developments suggest that NIRS may play an important role in research focusing on pain perception in critically ill infants. The present review briefly describes the cortical responses to noxious stimuli, which parallel cerebral hemodynamic responses to various stimuli. This is followed by an overview of NIRS technology including a summary of the literature on functional studies that have used NIRS in infants. Current NIRS techniques have well‐recognized limitations that must be considered carefully during the measurement and interpretation of the signals. Nonetheless, until more advanced NIRS techniques emerge, the current devices have strengths that should be exploited.
Coagulability in Obstructive Sleep Apnea
Authors: Liak Christina , Fitzpatrick Michael 
Published: March 2016

BACKGROUND: Obstructive sleep apnea (OSA) is a common disorder that affects both quality of life and cardiovascular health. The causal link between OSA and cardiovascular morbidity/mortality remains elusive. One possible explanation is that repeated episodes of nocturnal hypoxia lead to a hypercoagulable state that predisposes patients to thrombotic events. There is evidence supporting a wide array of hematological changes that affect hemostasis (eg, increased hematocrit, blood viscosity, platelet activation, clotting factors and decreased fibrinolytic activity).OBJECTIVE: To provide a comprehensive review of the current evidence associating OSA with increased coagulability, and to highlight areas for future research.METHODS: Keyword searches in Ovid Medline were used to identify relevant articles; all references in the articles were searched for relevant titles. The Web of Science was used to identify articles citing the relevant articles found using the Ovid Medline search. All original peer‐reviewed articles, meta‐analyses and systematic reviews regarding the pertinent topics between 1990 and present were selected for review.RESULTS: Hematocrit, blood viscosity, certain clotting factors, tissue factor, platelet activity and whole blood coagulability are increased in patients with OSA, while fibrinolysis is impaired.CONCLUSION: There is considerable evidence that OSA is associated with a procoagulant state. Several factors are involved in the procoagulant state associated with OSA. There is a need for adequately powered clinical studies involving well‐matched control groups to address potential confounding variables, and to accurately delineate the individual factors involved in the procoagulant state associated with OSA and their response to treatment.
Liver Transplant Outcomes in a Canadian First Nations Population
Authors: Zhang M , Uhanova J , Minuk GY 
Published: March 2016

BACKGROUND: A higher incidence of autoimmune disorders may predispose First Nations (FN) individuals to higher rates and more severe episodes of rejection, graft loss and mortality following liver transplantation for advanced liver disease.METHODS: A retrospective review of patient outcomes in a single centre providing long-term follow-up care for FN and non-FN patients transplanted for advanced liver disease was conducted.RESULTS: A total of 20 FN and 129 non-FN charts were available for review. FN subjects were younger at transplantation (mean [± SD] age 32.4±4.1 years versus 46.3±1.4 years; P=0.00005), less often male (35% versus 58%; P=0.05), more commonly transplanted for autoimmune hepatitis (30% versus 4.7%; P=0.006), less often from urban residences (25% versus 74%; P=0.0001) and less compliant with medical care (20% versus 80%; P=0.007). After a mean follow-up period of 11.0±1.5 years and 8.4±0.5 years in FN and non-FN subjects, respectively, the incidence and severity of rejection, graft and patient survival were similar between cohorts.CONCLUSION: Although demographic profiles, nature of the underlying disease and compliance differed, the rates and severity of rejection, graft and patient survival were similar in FN and non-FN patients who underwent liver transplantation for advanced liver disease.
The Role of Torovirus in Nosocomial Viral Gastroenteritis at a Large Tertiary Pediatric Centre
Authors: Gubbay JB , Al-Rezqi A , Hawkes M , Williams L , Richardson SE , Matlow A 
Published: March 2016

OBJECTIVE: To describe the viral etiology and epidemiology of nosocomial viral gastroenteritis (NVG) at a tertiary care pediatric hospital and identify any changes over the past two decades.METHODS: Retrospective review of all patients with laboratory‐confirmed NVG at The Hospital for Sick Children (Toronto, Ontario), from January 1, 2004, to December 31, 2005.RESULTS: One hundred forty‐two episodes of NVG were found among 133 patients, occurring in 0.48 of 100 admissions. The median age was two years; 42% were <1 year of age and 41% were immunocompromised. The most commonly detected pathogen was torovirus (67% of episodes), followed by rotavirus (19%) and adenovirus (9%). Seventy‐five cases (53%) were epidemiologically linked in 32 separate clusters (median cluster size two, range two to four). The NVG rate fell from 0.63 of 100 to 0.22 of 100 admissions after March 2005 (P<0.001) when enhanced infection control precautions were instituted in response to an outbreak of vancomycin‐resistant Enterococcus.CONCLUSIONS: Torovirus remains the most commonly identified cause of NVG at The Hospital for Sick Children. Most NVG cases were epidemiologically linked, and a significant reduction in cases occurred after the institution of enhanced infection control practices following an outbreak of vancomycin‐resistant Enterococcus. Improved education and surveillance for NVG should lead to further reduction in this problem.