bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methicillin‐Resistant Staphylococcus aureus in a Canadian Intensive Care Unit: Delays in Initiating Effective Therapy Due to the Low Prevalence of Infection
Authors: Sligl Wendy , Taylor Geoffrey , Gibney RT Noel , Rennie Robert , Chui Linda 
Published: March 2016

INTRODUCTION: Methicillin‐resistant Staphylococcus aureus (MRSA) infection in intensive care units (ICUs) has increased dramatically in prevalence in recent years, and is associated with increased morbidity, mortality and cost of care. The aim of the present study was to describe the epidemiology and outcomes of MRSA infection in the general systems ICU at the University of Alberta Hospital in Edmonton, Alberta.METHODS: A retrospective cohort analysis of patients infected with MRSA in a general systems ICU was conducted from January 1, 1997, to August 15, 2005.RESULTS: Forty‐six cases of MRSA were identified, of which 36 (78.3%) were infected. The most common admitting diagnoses included respiratory failure (41.7%) and sepsis or septic shock (36.1%). Infection was hospital acquired in 58.3% of cases (10 cases ICU acquired), with a median time to infection of 11 days. The most common sites of infection were the respiratory tract, skin and blood. Median lengths of stay were 13 days in the unit and 27 days in‐hospital. Crude mortality was 55.6%. Time to appropriate antimicrobial treatment was delayed in 80.5% of patients. Four prototypical Canadian MRSA (CMRSA) strains were identified by pulsed‐field gel electrophoresis. Hospital‐acquired strains were predominantly CMRSA‐2 (59%), indicating that this clone circulates at the University of Alberta Hospital.CONCLUSIONS: MRSA infection remains uncommon at the University of Alberta Hospital, resulting in delays in instituting appropriate antimicrobial therapy. To date, only a few community‐acquired strains have been noted. ICU acquisition of MRSA remains rare, with only 10 cases over the past nine years. The majority of hospital‐acquired strains were CMRSA‐2.
Data Equivalency of an Interactive Voice Response System for Home Assessment of Back Pain and Function
Authors: Shaw William S , Verma Santosh K 
Published: March 2016

BACKGROUND: Interactive voice response (IVR) systems that collect survey data using automated, push‐button telephone responses may be useful to monitor patients’ pain and function at home; however, its equivalency to other data collection methods has not been studied.OBJECTIVES: To study the data equivalency of IVR measurement of pain and function to live telephone interviewing.METHODS: In a prospective cohort study, 547 working adults (66% male) with acute back pain were recruited at an initial outpatient visit and completed telephone assessments one month later to track outcomes of pain, function, treatment helpfulness and return to work. An IVR system was introduced partway through the study (after the first 227 participants) to reduce the staff time necessary to contact participants by telephone during nonworking hours.RESULTS: Of 368 participants who were subsequently recruited and offered the IVR option, 131 (36%) used IVR, 189 (51%) were contacted by a telephone interviewer after no IVR attempt was made within five days, and 48 (13%) were lost to follow‐up. Those with lower income were more likely to use IVR. Analysis of outcome measures showed that IVR respondents reported comparatively lower levels of function and less effective treatment, but not after controlling for differences due to the delay in reaching non‐IVR users by telephone (mean: 35.4 versus 29.2 days).CONCLUSIONS: The results provided no evidence of information or selection bias associated with IVR use; however, IVR must be supplemented with other data collection options to maintain high response rates.
Preoperative Alpha-Fetoprotein Slope is Predictive of Hepatocellular Carcinoma Recurrence after Liver Transplantation
Authors: Han Kathy , Tzimas George N , Barkun Jeffrey S , Metrakos Peter , Tchervenkov Jean I , Hilzenrat Nir , Wong Phil , Deschênes M 
Published: March 2016

BACKGROUND: Liver transplantation (LT) offers a possible cure for patients with hepatocellular carcinoma (HCC) and cirrhosis. However, tumour progression while on the waiting list and tumour recurrence after LT are common. The prognostic significance of various pre- and postoperative variables were investigated in regard to tumour recurrence, with an emphasis on the slope of preoperative serum alpha-fetoprotein (AFP) levels.PATIENTS AND METHODS: Data from 48 patients who had HCC diagnosed preoperatively and underwent LT at the McGill University Health Centre (Montreal, Quebec) were reviewed retrospectively, and possible risk factors for tumour recurrence were examined.RESULTS: Univariate analysis revealed a positive correlation between the preoperative AFP slope and vascular invasion (P = 0.045), total tumour diameter at explant (P = 0.040), Cancer of the Liver Italian Program score (P = 0.017) and recurrence-free survival (P = 0.028). Of the preoperative variables examined, only the preoperative AFP slope was identified as an independent predictor of tumour recurrence by multivariate analysis. Receiver operating characteristic analysis showed that the best discriminant cut-off value, calculated as the value of the maximized likelihood ratio, was preoperative AFP slope greater than 50 µg/L per month. At this cut-off, sensitivity was 36%, and specificity was 97%. Patients with a preoperative AFP slope greater than 50 µg/L per month had a much worse one-year recurrence-free survival rate than those with a preoperative AFP slope 50 µg/L per month or less (40% versus 90%, P < 0.001).CONCLUSIONS: These results suggest that the preoperative AFP slope is an important predictor of HCC recurrence after LT and should be examined in future studies of patients receiving LT for HCC.
Improvement of Lumbar Bone Mass after Infliximab Therapy in Crohn’s Disease Patients
Authors: Mauro Marina , Radovic Vladimir , Armstrong David 
Published: March 2016

BACKGROUND: Patients with Crohn’s disease (CD) have a high risk of developing osteoporosis, but the mechanisms underlying bone mass loss are unclear. Elevated proinflammatory cytokines, such as tumour necrosis factor-alpha (TNFα), have been implicated in the pathogenesis of bone resorption.AIM: To assess whether suppression of TNFα with infliximab treatment has a beneficial effect on lumbar bone mass.METHODS: Adult CD patients who had received infliximab treatment, and who underwent lumbar densitometric evaluation before and during treatment, were selected. Adult CD patients who had never received infliximab treatment were selected as controls. Information regarding age, sex, weight, duration of CD, use of glucocorticoids and bisphosphonates, and signs of disease activity between both densitometric measurements were collected.RESULTS: Data from 45 patients were analyzed. The control group (n=30, mean [± SD] 26.7±9 years of age) had a significantly higher increase in body weight between both evaluations (6.26%±8%) than the infliximab group (n=15, 30.6±13 years), which had an increase of 0.3%±7.4%. There was a strong correlation between the final weight and lumbar bone mineral content (BMC) in both groups. The infliximab group had a significant increase in lumbar bone area (4.15%±6.6%), BMC (12.8%±13.6%) and bone mineral density (8.13%±7.7%) between both evaluations (interval 22.6±11 months) compared with the control group. The increase in BMC in patients who had received infliximab treatment was significant when compared with control patients who had received glucocorticoids (n=8) or had evidence of disease activity (n=13).CONCLUSION: Infliximab therapy improved lumbar bone mass independent of nutritional status. This finding suggests that TNFα plays a role in bone loss in CD.
An Assessment of Endoscopic and Concomitant Management of Acute Variceal Bleeding at a Tertiary Care Centre
Authors: Singh H , Targownik LE , Ward G , Minuk GY , Bernstein CN 
Published: March 2016

BACKGROUND: Several therapies have been demonstrated to be beneficial in the management of acute variceal bleeding (AVB). The aim of the present study was to characterize the use of these therapies at a Canadian tertiary care centre.PATIENTS AND METHODS: A comprehensive chart review was performed to assess the management of all adult cirrhotic patients with AVB who were admitted to a university-affiliated, tertiary care centre between April 2001 and March 2004.RESULTS: A total of 81 AVB patients were identified with a mean age of 53.7±13.2 years and a median model for end-stage liver disease score of 14. Endoscopy was performed within 8.2±7.6 h of admission. Variceal banding was performed for 87% of patients with esophageal varices, which were the most common source of bleeding (80%). Octreotide was used in 82% of patients for a mean duration of 74.3±35.4 h; prophylactic antibiotics were used in 25% of patients and beta-blockers were used in 24% of patients without any contraindications. Follow-up endoscopy was arranged for 46 of 71 (65%) survivors. Prophylactic antibiotic use was associated with the presence of ascites, while beta-blockers were used more often in the last year of the study.CONCLUSIONS: There is a disconnection between the use of evidence-based recommendations and routine clinical practices in the management of AVB. Deficiencies identified include the lack of use of prophylactic antibiotics and beta-blockers, variable use of octreotide and inadequate follow-up recommendations. There is a need to identify measures to improve the process of care for patients with AVB which would ensure optimal management of these patients.
Association ofApolipoprotein A1-C3Gene Cluster Polymorphisms with Gallstone Disease
Authors: Dixit Manjusha , Choudhuri Gourdas , Saxena Rajan , Mittal Balraj 
Published: March 2016

INTRODUCTION: Genetic polymorphisms in apolipoprotein genes may be associated with alteration in lipid profile and susceptibility to gallstone disease.AIM: To determine the association betweenapolipoprotein A1(APOA1) (−75 guanine [G] to adenine [A] and +83/84 M2+/−,MspI) andapolipoprotein C3(APOC3) (SstI) polymorphisms with gallstone disease.METHODS:MspIpolymorphisms of theAPOA1gene andSstIpolymorphisms ofAPOC3were analyzed in DNA samples of 214 gallstone patients and 322 age- and sex-matched healthy controls. All statistical analyses were performed using SPSS version 11.5 (SPSS, USA) and Arlequin version 2.0 (Arlequin, Switzerland).RESULTS: TheAPOA1−75 G/A polymorphism was significantly associated with gallstone disease. Patients with the GG genotype (P=0.015) and G allele carriers (P=0.004) had a significantly higher risk of gallstone disease (1.087-fold and 1.561-fold, respectively), whereas patients with AA genotypes (P=0.011) and A allele carriers (P=0.004) were protected (OR 0.230 and 0.641, respectively) against gallstone disease.APOA1+83 M2+/−andAPOC3 SstIpolymorphisms were not associated with gallstone disease. Case-control analysis of haplotypes showed a significant association in males only. G-M2+-S1 conferred risk for gallstone disease (P=0.036; OR 1.593, 95% CI 1.029 to 2.464), while A-M2+-S1 was protective (P=0.002; OR 0.370, 95% CI 0.197 to 0.695) against gallstone disease. InAPOA1−75-APOA1+83bilocus haplotypes, G-M2+was associated (P=0.0001) with very high risk (OR 3.173, 95% CI 1.774 to 5.674) for gallstone disease in males only.APOA1−75-APOC3SstIhaplotypes also showed significant association whileAPOA1+83-APOC3SstIhaplotypes showed no association with gallstone disease.CONCLUSIONS: TheAPOA1−75 G/A polymorphism is associated with gallstone disease and shows sex-specific differences. On the other hand,APOA1M2+/−andAPOC3 SstIpolymorphisms may not be associated with gallstone disease. Haplotype analysis is a better predictor of risk for gallstone disease.
Gallbladder Carcinoma Associated with Anomalous Pancreaticobiliary Duct Junction
Authors: Kang Chang Moo , Kim Kyung Sik , Choi Jin Sub , Lee Woo Jung , Kim Byong Ro 
Published: March 2016

BACKGROUND: Anomalous pancreaticobiliary ductal junction (APBDJ) is believed to be one of the risk factors for gallbladder carcinoma. The present study aims to delineate the gallbladder carcinoma characteristics associated with APBDJ.PATIENTS AND METHODS: Patients with gallbladder carcinoma associated with APBDJ between August 1992 and February 2005 were retrospectively reviewed. Two types of APBDJ classifications were considered: right-angle type (C-P) and acute-angle type (P-C).RESULTS: Ten of 218 patients (4.6%) with gallbladder carcinomas were associated with APBDJ. All patients were female with a mean age of 55.4 years (range 41 to 72 years). Gallstones were absent in nine patients. Seven patients (70%) had the P-C type and three patients (30%) had the C-P type. Survival differences between the P-C type and the C-P type of gallbladder carcinomas were noted (P = 0.0269). Patients with incidentally detected gallbladder carcinoma had superior survival (P = 0.0316).CONCLUSION: Gallbladder carcinomas associated with APBDJ were significantly related to relatively young female patients without gallbladder stones. Survival outcomes in these patients were not different from those of gallbladder carcinoma without APBDJ. In particular, the P-C type of APBDJ seemed to be more associated with relatively advanced gallbladder carcinomas, and patients with incidentally detected gallbladder carcinomas with APBDJ had superior survival.
Demographic and Psychosocial Predictors of Acute Perioperative Pain for Total Knee Arthroplasty
Authors: Roth Maya L , Tripp Dean A , Harrison Mark H , Sullivan Michael , Carson Patricia 
Published: March 2016

BACKGROUND: As the North American population ages, the prevalence of knee osteoarthritis and the surgical interventions (ie, total knee arthroplasty [TKA]) aimed at correcting pain and disability will also rise proportionally. Therefore, efforts to better understand the factors associated with surgical outcomes are warranted. To date, no studies have examined the impact of psychosocial factors on acute postoperative TKA pain.OBJECTIVES: The primary objective was to examine the associations among catastrophizing, negative mood, demographics and acute postoperative pain following TKA. Ancillary analyses examined the association of preoperative psychological variables with postoperative pain.METHODS: Patients completed questionnaire packages 2 h before their surgery and on three consecutive postoperative days while in the hospital. The questionnaire packages included the Short Form –McGill Pain Questionnaire, the Pain Catastrophizing Scale and the Shortened Version of Profile of Mood States. The Mini‐Mental State Examination was also administered. Demographic data were extracted from patients’ medical charts.RESULTS: Associations among catastrophizing, negative mood and pain were established. Regressions showed that younger age predicted greater preoperative and postoperative day 1 pain; catastrophizing predicted preoperative and postoperative day 2 pain; and negative mood predicted postoperative day 3 pain. Catastrophizing and negative mood were highly correlated at several assessment points. Preoperative variables did not predict postoperative pain.CONCLUSION: These results have postoperative pain management implications. Heightened attention to psychosocial variables, such as postoperative catastrophizing and negative mood, may be useful in identifying patients at risk for greater postoperative pain.
Upper Gastrointestinal Bleeding Secondary to an Aberrant Right Subclavian Artery-Esophageal Fistula: A Case Report and Review of the Literature
Authors: Millar Adam , Rostom Alaa , Rasuli Pasteur , Saloojee Nav 
Published: March 2016

An aberrant right subclavian artery (ARSA) is a common aortic arch abnormality. A case of a 57-year-old man presenting with melena and hypotension secondary to an ARSA-esophageal fistula is reported. The current report is unique because it is the first reported case of ARSA-esophageal fistula associated with prior esophagectomy and gastric pull-up. A MedLine search was performed for ARSA-esophageal fistula cases, which were then compared with the present case. Because this patient had no vascular conduits, nasogastric or endotracheal tubes, the fistula likely occurred secondary to the previous surgery. This case is unusual because the patient survived the original hemorrhage associated with the ARSA-esophageal fistula.An ARSA-esophageal fistula is a rare, but potentially fatal cause of upper gastrointestinal bleeding. A high index of suspicion is needed to make the diagnosis. This condition should be considered in patients with risk factors combined with hemodynamically significant gastrointestinal bleeding.
Ethnocultural and Sex Characteristics of Patients Attending a Tertiary Care Pain Clinic in Toronto, Ontario
Authors: Mailis-Gagnon Angela , Yegneswaran Balaji , Nicholson Keith , Lakha SF , Papagapiou Marios , Steiman Amanda J , Ng Danny , Cohodarevic Tea , Umana Margarita , Zurowski Mateusz 
Published: March 2016

BACKGROUND: Ethnocultural factors and sex may greatly affect pain perception and expression. Emerging literature is also documenting racial and ethnic differences in pain access and care.OBJECTIVE: To define the sex and ethnocultural characteristics of patients attending a tertiary care, university‐affiliated pain clinic in Toronto, Ontario.METHODS: Data were collected on 1242 consecutive, new patients seen over a three‐year period at the Comprehensive Pain Program (CPP) in downtown Toronto. Data were compared with the Canada 2001 Census.RESULTS: English‐speaking, Canadian‐born patients constituted 58.6% of the CPP population, similar to the 2001 Canadian Census data for the Greater Toronto Area. Certain visible minority groups (Indo‐Pakistani and Chinese) were significantly under‐represented, while European groups were over‐represented. While women outnumbered men, they presented with lower levels of physical pathology in general, particularly in certain ethnic groups. Patients from Europe (representing primarily immigrants who arrived in Canada before 1960), were older, by 10 years to 15 years, than the average CPP population, and had a much higher incidence of physical or medical disorders.CONCLUSIONS: The implications of the study and the importance of sex and ethnicity in terms of presentation to Canadian pain clinics are discussed. Future well‐designed studies are needed to shed light on the role of both patients’ and physicians’ ethnicity and sex in pain perception and expression, decision‐making regarding pain treatments and acceptance of pain treatments.
Nocturnal Oxygen Therapy in Patients with Chronic Obstructive Pulmonary Disease: A Survey of Canadian Respirologists
Authors: Lacasse Yves , Sériès Frédéric , Martin Sylvie , Maltais François 
Published: March 2016

BACKGROUND: Current evidence does not clearly support the provision of nocturnal oxygen therapy in patients with chronic obstructive pulmonary disease (COPD) who desaturate during sleep but who would not otherwise qualify for long‐term oxygen therapy (LTOT).OBJECTIVES: To characterize the perception and clinical practice of Canadian respirologists regarding the indications and prescription of nocturnal oxygen therapy in COPD, and to determine what Canadian respirologists consider an important treatment effect of nocturnal oxygen therapy in a randomized, placebo‐controlled trial.METHODS: A mail survey of all the respirologists registered in the 2006 Canadian Medical Directory was conducted.RESULTS: A total of 543 physicians were surveyed. The response rate was 60%, and 99% of the respondents indicated that the problem of nocturnal oxygen desaturation is clinically relevant. Eighty‐two per cent interpret oximetry tracings themselves, and 87% have access to a sleep laboratory. Forty‐two per cent believe that all COPD patients with significant nocturnal desaturation should have a polysomnography to rule out sleep apnea, and 41% would prescribe nocturnal oxygen therapy to active smokers. Assuming a risk of death or progression to LTOT of 40% over a three‐year period, the respirologists indicated that to declare nocturnal oxygen therapy effective in reducing the rate of major clinical events in a clinical trial, the minimal absolute risk difference of death or progression to LTOT between oxygen and room air breathing should be 14%.CONCLUSIONS: Canadian respirologists are interested in the issue of nocturnal oxygen desaturation in COPD. There is variation in clinical practices among Canadian respirologists in several aspects of the management of this problem.
The effect of different strains ofHelicobacter pylorion platelet aggregation
Authors: Corcoran Paul A , Atherton John C , Kerrigan Steve W , Wadstrom Torkel , Murray Frank E , Peek Richard M , Fitzgerald Desmond J , Cox Dermot M , Byrne Michael F 
Published: March 2016

BACKGROUND AND AIMS:Helicobacter pyloriis the major causative agent in peptic ulcer disease and is strongly implicated in the development of gastric cancer. It has also been linked, less strongly, to cardiovascular disease. The mechanisms by which certain strains ofH pyloriinduce platelet aggregation through interactions with platelet glycoprotein Ib have been previously described.METHODS: In the present study, 21 different strains ofH pylori, varying in their vacuolating toxin gene, cytotoxic-associated gene A status and other pathogenicity factors, were tested for their ability to induce platelet aggregation.RESULTS: Ten of the 21 strains induced platelet aggregation, a response that appeared to be independent of their vacuolating toxin gene and cytotoxic-associated gene A status.CONCLUSIONS: Platelet aggregation has been suggested to be one of the possible mechanisms involved in the effects on the cardiovascular system induced byH pylori. Our results suggest that any putative roleH pyloriplays in cardiovascular disease may be strain dependent. Further work to identify theH pylorifactors involved in induction of platelet aggregation may allow for identification of ‘higher risk’ strains for cardiovascular disease.
Determinants of Antiviral Treatment Initiation in a Hepatitis C-infected Population Benefiting from Universal Health Care Coverage
Authors: Moirand Romain , Bilodeau Marc , Brissette Suzanne , Bruneau Julie 
Published: March 2016

BACKGROUND AND AIMS: In view of increasing therapeutic efficacy, the delivery of hepatitis C virus (HCV) antiviral treatment is expected to increase. Yet practical experience reveals a low rate of treatment, particularly among intravenous drug users. The aim of the present study was to examine the prevalence of HCV treatment and identify factors associated with HCV treatment in a population of patients evaluated in an academic hepatology outpatient clinic between 2001 and 2002.PATIENTS AND METHODS: The charts of HCV-infected patients who attended the outpatient clinic of the liver division between January 2001 and December 2002 were retrospectively reviewed. Regression analyses were conducted to compare patients according to HCV treatment initiation.RESULTS: Of 378 eligible patients (past intravenous drug users 61%), 143 (38%) initiated antiviral treatment. Enrolment in a methadone maintenance program and a strong willingness to get treatment were independently associated with treatment initiation, while current intravenous drug use, alcoholic liver damage on biopsy, precarious housing arrangements and personality disorders were negatively associated with treatment initiation. Among patients who were offered treatment, 40% refused (they did not differ from the treated group for past or current substance abuse).CONCLUSIONS: Only 38% of eligible patients initiated treatment; treatment refusal was very common. The results of the present study showed that a significant barrier to therapy involved patient perceptions.