bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complementary and Alternative Medicine Use by Patients Chronically Infected with Hepatitis C Virus
Authors: White Colin P , Hirsch Gerilynn , Patel Sunil , Adams Fatin , Peltekian Kevork M 
Published: March 2016

Complementary and alternative medicine (CAM) is becoming increasingly popular in North America. The use of CAM is also popular in patients with chronic liver disease but is not well documented. The extent of use of CAM in chronic hepatitis C virus (HCV) infected patients was determined, and the demographic and clinical data between users and nonusers of CAM was compared.Seventy-six patients (30% female) with chronic HCV were interviewed. The mean age was 43±8 years. Current use of CAM for HCV was reported by 35 of 76 patients (46%). Eighteen of 76 patients within this group used herbal supplements (24%). The most commonly used herb wasSilybum marianum(milk thistle), reported by 10 of 76 patients (13.2%). Commonly reported benefits of CAM use included reduction in fatigue, boost in the immune system and improved gastrointestinal function. No adverse effects of CAM use were reported. In the present study, four of 18 patients (22%) with chronic liver disease taking herbal therapies were on herbs that increased bleeding time.The use of CAM in chronic HCV patients is significant. Patients should be asked specifically about their use of CAM. CAM use may have implications affecting conventional treatment and management of HCV.
Methicillin‐Resistant Staphylococcus aureus: A Public Health Issue with Economic Consequences
Authors: Goetghebeur Mireille , Landry Pierre-Alexandre , Han Donald , Vicente Colin 
Published: March 2016

BACKGROUND: Methicillin‐resistant Staphylococcus aureus (MRSA) has become endemic worldwide in hospitals, and community‐associated MRSA is spreading into the community at large.OBJECTIVES: To estimate the current cost of MRSA in Canada and to assess the magnitude of this public health issue.METHODS: An extensive review of the literature was conducted to gather epidemiology, health care resource utilization and cost data for MRSA in Canadian settings. The current MRSA burden was estimated using available cost data and the most recent epidemiology data.RESULTS: The rate of MRSA in Canadian hospitals increased from 0.46 to 5.90 per 1000 admissions between 1995 and 2004, while community‐associated MRSA continued to spread into the community. Patients harbouring MRSA required prolonged hospitalization (average 26 days of isolation per patient), special control measures, expensive treatments and extensive surveillance. Total cost per infected MRSA patient averaged $12,216, with hospitalization being the major cost driver (81%), followed by barrier precautions (13%), antimicrobial therapy (4%) and laboratory investigations (2%). The most recent epidemiological data, combined with available cost data, suggest that direct health care cost attributable to MRSA in Canada, including cost for management of MRSA‐infected and‐colonized patients and MRSA infrastructure, averaged $82 million in 2004 and could reach $129 million in 2010.CONCLUSION: MRSA is a costly public health issue that needs to be tackled if the growing burden of this disease in Canadian hospitals and in the community is to be limited.
Canadian Pediatric Gastroenterology Workforce: Current Status, Concerns and Future Projections
Authors: Morinville Véronique , Drouin Éric , Lévesque Dominique , Espinosa Victor M , Jacobson Kevan 
Published: March 2016

BACKGROUND: There is concern that the Canadian pediatric gastroenterology workforce is inadequate to meet health care demands of the pediatric population. The Canadian Association of Gastroenterology Pediatric Committee performed a survey to determine characteristics and future plans of the Canadian pediatric gastroenterology workforce and trainees.METHODS: Estimates of total and pediatric populations were obtained from the 2001 Census of Population, Statistics Canada (with estimates to July 1, 2005). Data on Canadian pediatric gastroenterologists, including clinical full-time equivalents, sex, work interests, opinions on workforce adequacy, retirement plans, fellowship training programs and future employment plans of fellows, were gathered through e-mail surveys and telephone correspondence in 2005 and 2006.RESULTS: Canada had an estimated population of 32,270,507 in 2005 (6,967,853 people aged zero to 17 years). The pediatric gastroenterology workforce was estimated at 9.2 specialists per million children. Women accounted for 50% of the workforce. Physician to pediatric population ratios varied, with Alberta demonstrating the highest and Saskatchewan the lowest ratios (1:69,404 versus 1:240,950, respectively). Between 1998 and 2005, Canadian pediatric gastroenterology fellowship programs trained 65 fellows (65% international trainees). Twenty-two fellows (34%) entered the Canadian workforce.CONCLUSIONS: The survey highlights the variable and overall low numbers of pediatric gastroenterologists across Canada, an increasingly female workforce, a greater percentage of part-time physicians and a small cohort of Canadian trainees. In conjunction with high projected retirement rates, greater demands on the work-force and desires to partake in nonclinical activities, there is concern for an increasing shortage of pediatric gastroenterologists in Canada in future years.
Survey of the Practice of Spinal Cord Stimulators and Intrathecal Analgesic Delivery Implants for Management of Pain in Canada
Authors: Peng Philip WH , Fedoroff Ingrid , Jacques Line , Kumar Krishna 
Published: March 2016

BACKGROUND: In 2006, the Canadian Neuromodulation Society was formed. The present survey characterizes the practice of spinal cord stimulator (SCS) and intrathecal analgesic delivery pump (IADP) implantation for pain management in different centres across Canada.METHOD: A structured questionnaire was designed to examine the funding source, infrastructure and patient screening process in different centres implanting SCSs and IADPs. Centres that performed more than 10 implants per year were surveyed. The survey was centre‐based, ie, each centre received one questionnaire regardless of the number of staff involved in neuromodulation practice.RESULTS: Fourteen centres were identified and 13 responded. Implantation of SCS and IADP was performed in 12 and 10 centres, respectively. In most centres, failed back surgery syndrome was the most frequent indication for SCS and IADP implantation. For SCS, all centres always performed a trial; the majority used percutaneous electrode (83%) before the SCS implantation. Routine psychological screening was performed in 25% of centres before any SCS trial procedure. For IADP, all centres performed a trial injection or infusion before implantation. Five centres (50%) performed psychological screening in almost all patients. Continuous infusion techniques were the most popular (50%) used for the trial.CONCLUSION: The present survey provides a ‘snapshot’ of the practice of SCS and IADP implantation in Canada. A review of SCS and IADP trials indicated that Canadian practices are mostly, but not always, consistent with those elsewhere.
Endoscopic pH Monitoring for Patients with Suspected or Refractory Gastroesophageal Reflux Disease
Authors: Turner Brian G , Saltzman John R , Hua Ling , Maurer Rie , Feldman Natan , Carr-Locke David L , Burakoff Robert , Liu Julia J 
Published: March 2016

BACKGROUND: Wireless pH studies can offer prolonged pH monitoring, which may potentially facilitate the diagnosis and management of patients with gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate the detection rate of abnormal esophageal acid exposure using prolonged pH monitoring in patients with suspected or refractory GERD symptoms.METHODS: Patients undergoing prolonged ambulatory pH studies for the evaluation of GERD-related symptoms were assessed. Patients with a known diagnosis of GERD were tested on medical therapy, while patients with suspected GERD were tested off therapy. The wireless pH capsules were placed during upper endoscopy 6 cm above the squamocolumnar junction.RESULTS: One hundred ninety-one patients underwent a total of 198 pH studies. Fifty ambulatory pH studies (25%) were excluded from the analysis: 27 patients (14%) had insufficient data capture (less than 18 h on at least one day of monitoring), 15 patients had premature capsule release (7%), seven were repeat studies (3.5%) and one had intolerable pain requiring capsule removal (0.5%). There were 115 patients undergoing pH studies who were off medication, and 33 patients were on therapy. For the two groups of patients, results were as follows: 32 (28%) and 22 (67%) patients with normal studies on both days; 58 (50%) and five (15%) patients with abnormal studies on both days; 18 (16%) and three (9%) patients with abnormal studies on day 1 only; and seven (6%) and three (9%) patients with abnormal studies on day 2 only, respectively.CONCLUSIONS: Prolonged 48 h pH monitoring can detect more abnormal esophageal acid exposure but is associated with a significant rate of incomplete studies.
Validation of the 30 Second Asthma Test™ as a Measure of Asthma Control
Authors: Ahmed Sara , Ernst Pierre , Tamblyn Robyn , Colman Neil 
Published: March 2016

BACKGROUND: The primary objective of asthma management is to help patients establish and maintain optimal disease control. Simple and efficient tools are needed to assess patient‐reported symptoms so that they can be used with or without airway function to evaluate asthma control.OBJECTIVE: The objective of the present study was to evaluate the validity of The 30 Second Asthma Test (GlaxoSmithKline Inc, Canada), based on the Canadian Asthma Guidelines, by estimating its relationship with criterion measures of control.RESULTS: The discriminative and diagnostic validity of The 30 Second Asthma Test™ was examined in a sample of 81 patients with a confirmed diagnosis of asthma. Based on a cut‐off score of two or greater on The 30 Second Asthma Test™, the overall agreement with specialist ratings was 65%, and 58% with per cent predicted forced expiratory volume in 1 s. The 30 Second Asthma Test™ scores distinguished between groups of patients who were classified based on the change in intensity of therapy.CONCLUSION: The results support the use of The 30 Second Asthma Test™ as a brief screening tool for asthma control.
Reproducibility of Wireless Capsule Endoscopy in the Investigation of Chronic Obscure Gastrointestinal Bleeding
Authors: Christodoulou Dimitrios , Haber Gregory , Beejay Umar , Tang Shou-jiang , Zanati Simon , Petroniene Rima , Cirocco Maria , Kortan Paul , Kandel Gabor , Tatsioni Athina , Tsianos Epameinondas , Marcon Norman 
Published: March 2016

BACKGROUND: Capsule endoscopy (CE) is a valuable tool in the diagnostic evaluation of obscure gastrointestinal bleeding, but limited information is available on the reproducibility of CE findings.OBJECTIVE: To compare two successive CE studies with push enteroscopy (PE) in patients presenting with chronic obscure gastrointestinal bleeding.METHODS: A prospective study was conducted. Ten patients (seven men and three women) with chronic obscure gastrointestinal bleeding and no contraindications for CE were eligible and completed the trial. For each patient, the first capsule was administered on day 1, the second capsule was administered on day 2 and PE was performed on day 3. Endoscopists were blinded to the capsule findings. Capsule findings were assessed independently by two investigators blinded to PE findings.RESULTS: A potential small intestinal bleeding source was found in 60% of the patients when all the studies were combined. A bleeding source was found in four patients in both CE studies. The second CE also identified a bleeding source in a fifth patient. Interobserver agreement by kappa analysis was 0.642 to 1.000 (P≤0.05) for the CE studies. PE identified a potential small bowel bleeding site in four patients, including one patient who had negative CE studies.CONCLUSIONS: This study confirmed the reproducibility of CE findings on successive studies. Some patients did not have a source of bleeding in the small intestine, and all studies found this.
Comparison of Canadian Versus American Emergency Department Visits for Acute Asthma
Authors: Rowe Brian H , Bota Gary W , Clark Sunday , Camargo Carlos A , on behalf of the Multicenter Airway Research Collaboration i  
Published: March 2016

BACKGROUND: Acute asthma is a common emergency department (ED) presentation in both Canada and the United States.OBJECTIVE: To compare ED asthma management and outcomes between Canada and the United States.MEHODS: A prospective cohort study of 69 American and eight Canadian EDs was conducted. Patients aged two to 54 years who presented with acute asthma underwent a structured ED interview and telephone follow‐up two weeks later.RESULTS: A total of 3031 patients were enrolled. Canadian patients were more likely to be white (89% versus 22%; P<0.001), have health insurance (100% versus 69%; P<0.001) and identify a primary care provider (89% versus 64%; P<0.001) than American patients. In addition, Canadian patients were more likely to be using inhaled corticosteroids (63% versus 44%; P<0.001) and had higher initial peak expiratory flow (61% versus 48%; P<0.001). In the ED, Canadians received fewer beta‐agonist (one versus two; P<0.001) and more anticholinergic (two versus one; P<0.001) treatments in the first hour; use of systemic corticosteroids was similar (60% versus 68%; P=0.13). Canadians were less likely to be hospitalized (11% versus 21%; P=0.02). Corticosteroids were prescribed similarly at discharge (60% versus 69%; P=0.13); however, Canadians were discharged more commonly on inhaled corticosteroids (63% versus 11%; P<0.001) and relapses were similar.CONCLUSIONS: Canadian patients with acute asthma have fewer barriers to primary care and are more likely to be on preventive medications, both before the ED visit and following discharge. Admissions rates are higher in the United States; however, relapse after discharge is similar between countries. These findings highlight the influences of preventive practices and heath care systems on ED visits for asthma.
Admission is not Always Necessary for Patients with Community‐Acquired Pneumonia in Risk Classes IV and V Diagnosed in the Emergency Room
Authors: Marrie TJ , Huang JQ 
Published: March 2016

OBJECTIVE: To determine the factors that allow patients with community‐acquired pneumonia who are at high risk of mortality (risk classes IV and V) to be treated at home.DESIGN: A prospective, observational study.SETTING: Six hospitals and one free‐standing emergency room in Edmonton, Alberta.PARTICIPANTS: The present study included 2354 patients in risk classes IV and V who had a diagnosis of pneumonia made by an emergency room physician or an internist.MEASUREMENTS: Symptoms, signs and laboratory findings, as well as outcome measures of length of stay and mortality.RESULTS: Of the total study group, 319 of the patients (13.5%) were treated on an ambulatory basis. Factors predictive of admission were definite or possible pneumonia on chest radiograph as read by a radiologist, functional impairment, altered mental status, substance abuse, psychiatric disorder, abnormal white blood cell count, abnormal lymphocyte count, oxygen saturation less than 90% and antibiotic administration in the week before admission. If chest pain was present, admission was less likely. Only two of the 319 patients required subsequent admission (both had positive blood cultures) and only two died.CONCLUSIONS: A substantial number of patients in risk classes IV and V can be safely treated at home. Factors that help clinicians to select this subset of patients are discussed.
Ventilation and Perfusion Lung Scintigraphy of Allergen‐Induced Airway Responses in Atopic Asthmatic Subjects
Authors: Parameswaran Krishnan , Knight Andrew C , Keaney Niall P , Williams E David , Taylor Ian K 
Published: March 2016

BACKGROUND: Both ventilation (V) and perfusion (Q) of the lungs are altered in asthma, but their relationships with allergen‐induced airway responses and gas exchange are not well described.METHODS: The effects of aerosolized allergen provocation of V/Q abnormalities in nonsmoking, male atopic asthmatics (six dual responders and two isolated early responders) were compared with measurements of airflow limitation (forced expiratory volume in 1 s [FEV1]), gas exchange (arterial oxygen saturation, arterial oxygen partial pressure and alveolar‐arterial oxygen gradient) and airway reactivity (provocative concentration of histamine causing a decrease of 20% in FEV1). V and Q lung scans at 30 min and 6 h following allergen challenge and changes in all variables were compared with prechallenge data. Digital image data were registered to baseline scans, and quantitative comparisons of changes made were supported by qualitative assessments of the images.RESULTS: All subjects showed evidence of impaired gas exchange, as reflected by lowered arterial oxygen tension and widened alveolar arterial oxygen gradients. Baseline V/Q scans were abnormal, and there were allergen‐induced changes in V and Q at 30 min, with scans at 6 h showing additional changes in Q, particularly in dual responders. Allergen‐induced gas trapping was evident at 30 min and was sustained at 6 h.CONCLUSIONS: Regional patterns of V and Q derived from lung scintigraphy showed a wider range of disturbances than were indicated by the magnitude of airflow limitation and arterial hypoxemia following allergen provocation, and they remained abnormal despite normalization of FEV1. Imaging of regional abnormalities of gas exchange may be relevant in the evaluation of patients with asthma.
The Effect of Biliary Sphincterotomy on Serum Cholesterol Levels in Postcholecystectomy Patients: A Pilot Study
Authors: Alazmi Waleed M , Fogel Evan L , Watkins James L , McHenry Lee , Sherman Stuart , Lehman Glen A 
Published: March 2016

BACKGROUND: Cholesterol, in the form of bile salts, is reabsorbed from the small intestine via the enterohepatic circulation. Biliary sphincterotomy increases the delivery of bile to the terminal ileum. If the absorptive capacity is exceeded, cholesterol excretion may increase, resulting in a decrease in serum cholesterol levels and improvement in serum lipid profiles.AIM: To determine the effect of biliary sphincterotomy on serum cholesterol levels in patients without biliary obstruction.PATIENTS AND METHODS: Postcholecystectomy patients with type III biliary sphincter of Oddi dysfunction (disabling pancreatobiliary-type pain with normal liver function tests and bile duct diameter) who underwent biliary sphincterotomy were identified retrospectively from the endoscopic retrograde cholangiopancreatography database. Baseline (pre-endoscopic retrograde cholangiopancreatography) laboratory investigations (including cholesterol) were obtained for all patients. The effect of sphincterotomy on total cholesterol levels was noted in all patients who returned for subsequent procedures (temporary pancreatic stent removal or evaluation of recurrent symptoms), and also in the subgroup of patients with baseline hypercholesterolemia (higher than 5.18 mmol/L).RESULTS: In the present pilot study, the performance of biliary sphincterotomy was associated with a reduction in total serum cholesterol levels in postcholecystectomy patients without biliary obstruction. This was statistically significant in patients with a baseline cholesterol level higher than 5.18 mmol/L. A possible effect on low-and high-density lipoprotein concentrations was not evaluated. The influence of dietary changes and exercise were not accounted for.CONCLUSION: A prospective, controlled study involving a larger series of patients is required to determine whether biliary sphincterotomy lowers cholesterol levels and improves lipid profiles.
Nursing Staff Knowledge and Beliefs about Pain in Elderly Nursing Home Residents with Dementia
Authors: Zwakhalen Sandra MG , Hamers Jan PH , Peijnenburg Rieneke HA , Berger Martijn PF 
Published: March 2016

BACKGROUND: Aging is known to be associated with a high prevalence (up to 80%) of persistent pain among residents of nursing homes. However, even with high pain prevalence rates, nursing home residents are at risk for undertreatment. Knowledge deficits and beliefs among nurses influence staff behaviour in pain assessment and management.OBJECTIVES: To develop a psychometrically sound questionnaire and to gather information about knowledge and beliefs of nursing staff regarding various aspects of pain in elderly patients with dementia. In addition, the differences among several categories of nurses (based on educational level and work experience) with respect to beliefs about pain were investigated.METHODS: Participants were 123 staff members of psychogeriatric wards in two nursing homes in the Netherlands (mean of 11.4 years of experience). Their results were compared with those of two groups of nurses, one consisting of 25 registered nurse PhD students in nursing science and the other consisting of 20 trainee pain nurse specialists.RESULTS: The main findings indicate that nursing home staff respondents showed knowledge deficits about several aspects of pain, even though they were satisfied about the way pain was assessed and treated at their wards. Specific knowledge deficits were found regarding pain treatment and medication in elderly nursing home residents. Staff educational level seemed to influence their beliefs and knowledge about pain in elderly nursing home patients.
Who Provides Gastrointestinal Endoscopy in Canada?
Authors: Hilsden Robert J , Tepper Joshua , Moayyedi Paul , Rabeneck Linda 
Published: March 2016

PURPOSE: To determine who provides gastrointestinal endoscopy in Canada and to understand provincial and regional differences in endoscopy providers.METHODS: Aggregate physician sociodemographic and activity data for 2002 were obtained from the Canadian Institute of Health Information’s National Physician Database. Physicians were classified as gastroenterologists, general surgeons and others.RESULTS: In 2002, 1444 physicians, including 735 surgeons, 551 gastroenterologists and 158 others, performed at least 100 colonoscopies or 100 gastroscopies. Gastroenterologists performed 53% of all colonoscopies and 59% of all gastroscopies. Gastroenterologists were the primary providers of colonoscopies in large urban areas, whereas surgeons were the primary providers in smaller urban and rural areas. An average of 317 colonoscopies were performed by surgeons, 516 by gastroenterologists and 203 by other physicians. The proportion of surgeon colonoscopists in each province ranged from 47% to 71%.CONCLUSIONS: Surgeons and gastroenterologists are the major providers of gastrointestinal endoscopy in Canada, but the distribution of these providers among provinces and urban and rural areas varies. Although surgeon endoscopists are more numerous, on average, they perform fewer procedures annually than internists.