bluuebunny/crossref_metadata_2025_split huggingface dataset:
Group Interprofessional Chronic Pain Management in the Primary Care Setting: A Pilot Study of Feasibility and Effectiveness in a Family Health Team in Ontario
Authors: Angeles Ricardo N , Guenter Dale , McCarthy Lisa , Bauer Martha , Wolfson Miriam , Chacon Maria , Bullock Lana 
Published: March 2016

BACKGROUND: Approximately 18.9% of Canadians live with chronic pain. Primary care reform in Ontario presents unique opportunities to assess approaches to help these patients.OBJECTIVE: To assess the feasibility of an interprofessional primary care‐based program for patients living with chronic pain, and to examine the potential impact of such a program on quality of life and health resource utilization.METHODS: >An embedded mixed‐methods evaluation (randomized controlled trial with waiting list control and semistructured interviews) of an eight‐week series of small group sessions exploring multifactoral aspects of pain management was performed. Participants were randomly assigned to early intervention (EI) or delayed intervention (DI) groups. All participants received the intervention; the DI group served as a control group for comparison with the EI group. Outcomes included the Short Form‐36 Health Survey version 2 (SF‐36v2), medication use and health care utilization. Qualitative interviews were conducted to identify areas for program improvement.RESULTS: A total of 240 patients were recruited and 63 agreed to participate. The mean (± SD) age of the participants was 55±14.1 years and 62.3% were female. There was no significant difference in the mean change in SF‐36v2 summary scores between the EI and DI groups. However, the SF‐36v2 subscale score for bodily pain was significantly improved in the EI group compared with the DI group after six months of observation (mean difference = 13.1 points; P<0.05). There was also significant improvement in this score when both groups were pooled and aggregate preintervention and postintervention scores were compared. There was a significant decrease in the mean number of clinic visits in the six‐month period following the intervention compared with the six‐month period before the intervention (P=0.043).CONCLUSION: An interprofessional program in primary care for patients living with chronic pain may lead to improvements in quality of life and health resource utilization. The challenges to the feasibility of the program and its evaluation are recruitment and retention of patients, leading to the conclusion that the program, as it was conducted in the present study, is not appropriate for this setting.
Variations in the Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Authors: Sandhu Supna K , Chu Jackson , Yurkovich Marko , Harriman David , Taraboanta Catalin , FitzGerald J Mark 
Published: March 2016

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a significant cause of morbidity and mortality for patients with COPD. AECOPD are the leading cause of hospital admissions in Canada. Although multiple guidelines have been developed for the acute and chronic management of COPD, there are few quality assurance studies investigating adherence to these guidelines.METHODS: A retrospective chart review of all patients admitted to a tertiary care hospital in 2009 for an AECOPD was performed. Using a standardized data abstraction tool, adherence to current guidelines across different physician groups and patient outcomes were assessed. Particular focus was centred on differences in management across physician groups.RESULTS: Overall, 293 patients were evaluated. Of these, 82.6% were treated with one or more chronic COPD medication(s) in the community, with only 17.7% of patients treated with a long‐acting inhaled anticholinergic medication. For treatment of AECOPD, 58% of patients received corticosteroids and 84% received antibiotics. Compared with general medicine and the hospitalist service, the respiratory medicine service demonstrated significantly better adherence with current treatment guidelines; however, even this was less than optimal. In addition, there was poor follow‐up of patients cared for outside of the respiratory service.CONCLUSIONS: The present study identified significant care gaps in the treatment of patients admitted with AECOPD and on their discharge.
Rituximab for the Treatment of Patients with Autoimmune Hepatitis Who are Refractory or Intolerant to Standard Therapy
Authors: Burak Kelly W , Swain Mark G , Santodomino-Garzon Tania , Lee Samuel S , Urbanski Stefan J , Aspinall Alexander I , Coffin Carla S , Myers Robert P 
Published: March 2016

BACKGROUND: Although most patients with autoimmune hepatitis (AIH) respond to treatment with prednisone and/or azathioprine, some patients are intolerant or refractory to standard therapy. Rituximab is an anti-CD20 monoclonal antibody that depletes B cells and has demonstrated efficacy in other autoimmune conditions.AIMS: To evaluate the safety and efficacy of rituximab in patients with refractory AIH in an open-label, single-centre pilot study.METHODS: Six patients with definite, biopsy-proven AIH who failed prednisone and azathioprine treatment received two infusions of rituximab 1000 mg two weeks apart and were followed for 72 weeks.RESULTS: Rituximab was well tolerated with no serious adverse events. By week 24, mean (± SD) aspartate aminotransferase (AST) levels had significantly improved (90.0±23.3 U/L versus 31.3±4.2 U/L; P=0.03) and mean immunoglobulin G levels had fallen (16.4±2.0 g/L versus 11.5±1.1 g/L; P=0.056). The prednisone dose was weaned in three of four subjects, with one subject flaring after steroid withdrawal. Inflammation grade improved in all four subjects who underwent repeat liver biopsy at week 48. Regulatory T cell levels examined by FoxP3 immunohistochemistry paralleled inflammatory activity and did not increase on follow-up biopsies. There was no significant change in serum chemokine or cytokine levels from baseline to week 24 (n=5), although interferon-gamma-induced protein 10 levels improved in three of five subjects.CONCLUSIONS: Rituximab was safe, well tolerated and resulted in biochemical improvement in subjects with refractory AIH. These results support further investigation of rituximab as a treatment for AIH.
The Role of Hepatic Expression of STAT1, SOCS3 and PIAS1 in the Response of Chronic Hepatitis C Patients to Therapy
Authors: El-Saadany Sherif , Ziada Dina H , Bassat Hanan El , Farrag Wael , El-Serogy Hesham , Eid Manal , Abdallah Manal , Ghazy Medhat , Salem Hoda A 
Published: March 2016

BACKGROUND: The underlying mechanisms of hepatitis C virus (HCV) resistance to treatment are unknown. Signal transducers and activators of transcription (STAT) proteins play a critical role in antiviral defense.OBJECTIVE: To explore some of the mechanisms of HCV resistance to interferon, the expression of STAT1 and its negative regulators, protein inhibitor of activated STAT (PIAS1) and suppressor of cytokine signalling (SOCS3), in liver tissues of both inteferon responders and nonresponders in chronic HCV patients.METHODS: Sixty patients were divided into the following groups: group 1a comprised 38 treatment-responder chronic HCV patients; group 1b consisted of 22 treatment-nonresponder chronic HCV patients; and group 2 consisted of six control subjects. Liver biopsies were examined for histological scoring; STAT1, SOCS3 and PIAS1 expression was analyzed using Western blotting methods.RESULTS: STAT1 expression in the liver tissue of patients in group 1 was significantly increased compared with group 2 patients (P=0.001), while no significant difference in expression was observed between group 1a and group 1b patients (P=0.747). However, phosphorylated STAT1 protein was expressed at a significantly higher level in liver tissue of patients in group 1a compared with patients in group 1b (P=0.001). Western blot analysis of PIAS1 and SOCS3 protein expression in liver tissues from groups 1 and 2 revealed significantly increased expression in group 1 compared with group 2 (P=0.001). In addition, PIAS1 and SOCS3 protein expression was significantly higher in the liver tissues of patients in group 1b compared with patients in group 1a.CONCLUSION: Levels of STAT1 and/or the protein expression of its negative regulators, PIAS1 and SOCS3, may be a good predictor of response to therapy. These could be used as biomarkers that are easily detected by Western blotting or immunostaining during standard histopathological liver biopsy analysis.
The Impact of Serum Vancomycin Levels and Minimum Inhibitory Concentrations of Methicillin‐Resistant Staphylococcus aureus on Mortality in Patients with Nosocomial Pneumonia
Authors: Machado Denise Pires , Goldani Luciano Z , Paiva Rodrigo Minuto , Aquino Valério Rodrigues , de-Paris Fernanda , Lisboa Thiago , Jung Bruno , dos Santos Rodrigo Pires 
Published: March 2016

BACKGROUND: Vancomycin is the treatment of choice for methicillin‐resistant Staphylococcus aureus (MRSA) infections; however, treatment failure is not uncommon, even when the minimum inhibitory concentration (MIC) of the MRSA strain is within the susceptible range for vancomycin.OBJECTIVE: To describe the relationship between molecular markers such as the mecA and agrII genes, serum vancomycin levels and vancomycin MICs, and the 30‐day mortality rate of patients with nosocomial MRSA pneumonia in an intensive care unit (ICU).METHODS: The present study was a prospective cohort study including all patients with MRSA hospital‐acquired pneumonia or ventilator‐associated pneumonia who were admitted to the ICU of a tertiary care hospital between June 2009 and December 2011. The MIC for vancomycin was determined using the E‐test and broth microdilution methods. Variables analyzed included age, sex, comorbid conditions, serum vancomycin trough concentration, the Acute Physiology and Chronic Health Evaluation II (APACHE) score and the presence of the agrII gene. The primary outcome was mortality at 30 days.RESULTS: Thirty‐six (42.4%) patients died within 30 days of the index MRSA culture. A multiple regression analysis that included the variables of MIC (determined using the E‐test or broth microdilution methods), APACHE II score, serum vancomycin level and the presence of agrII revealed that only the APACHE II score was related to the 30‐day mortality rate (P=0.03). Seven patients (9.0%) with isolates exhibiting an MIC ≥1.5 μg/mL according to the E‐test method died, and nine patients (11.6%) survived (P=0.76). Of the patients for whom MICs were determined using the broth microdilution method, 11 (14.1%) patients with MICs of 1.0 μg/mL died, and 16 (20.5%) survived (P=0.92). The median APACHE II score of survivors was 22.5, and the median score of nonsurvivors was 25.0 (P=0.03). The presence of the agrII gene was not related to the 30‐day mortality rate.CONCLUSIONS: Patients with severe hospital‐acquired pneumonia presented with MRSA isolates with low to intermediate vancomycin MICs in the ICU setting. At the Hospital de Clínicas de Porto Alegre (Porto Alegre, Brazil), the 30‐day mortality rate was high, and was similar among patients with severe hospital‐acquired pneumonia infected with MRSA isolates that exhibited MICs of ≤1.5 μg/mL determined using the E‐test method and ≤1.0 μg/mL determined using the broth microdilution method in those who achieved optimal serum vancomycin levels. The APACHE II scores which provides an overall estimate of ICU mortality were independently associated with mortality in the present study, regardless of the MICs determined. Molecular markers, such as the agrII gene, were not associated with higher mortality in the present study.
Patient Satisfaction with the Endoscopy Experience and Willingness to Return in a Central Canadian Health Region
Authors: Loftus Russell , Nugent Zoann , Graff Lesley A , Schumacher Frederick , Bernstein Charles N , Singh Harminder 
Published: March 2016

OBJECTIVE: Patient experiences with endoscopy visits within a large central Canadian health region were evaluated to determine the relationship between the visit experience and the patients’ willingness to return for future endoscopy, and to identify the factors associated with patients’ willingness to return.METHODS: A self-report survey was distributed to 1200 consecutive individuals undergoing an upper and/or lower gastrointestinal endoscopy at any one of the six hospital-based endoscopy facilities in the region. The Spearman correlation coefficient was used to assess the association between the patients’ overall rating of the visits and willingness to return for repeat procedures under similar medical circumstances. Logistic regression analyses were performed to identify the factors associated with willingness to return for repeat endoscopy and overall satisfaction (rating) of the visit.RESULTS: A total of 529 (44%) individuals returned the questionnaire, with 45% rating the visit as excellent and 56% indicating they were extremely likely to return for repeat endoscopy. There was a low moderate correlation between overall rating of the visit and patients’ willingness to return for repeat endoscopy (r=0.30). The factors independently associated with patient willingness to return for repeat endoscopy included perceived technical skills of the endoscopists (OR 2.7 [95% CI 1.3 to 5.5]), absence of pain during the procedure (OR 2.2 [95% CI 1.3 to 3.6]) and history of previous endoscopy (OR 2.4 [95% CI 1.4 to 4.1]). In contrast, the independent factors associated with the overall rating of the visit included information provided pre- and postprocedure, wait time before and on the day of the visit, and the physical environment.CONCLUSIONS: To facilitate patient return for needed endoscopy, it is important to assess patients’ willingness to return because positive behavioural intent is not simply a function of satisfaction with the visit.
Use and Nonmedical Use of Prescription Opioid Analgesics in the General Population of Canada and Correlations with Dispensing Levels in 2009
Authors: Shield Kevin D , Jones Wayne , Rehm Jürgen , Fischer Benedikt 
Published: March 2016

BACKGROUND: In Canada, harm from nonmedical prescription opioid analgesic (POA) use (NMPOU) has increased in recent years; however, there are limitations to the current estimates of NMPOU. The 2009 Canadian Alcohol and Drug Use Monitoring Survey presents an opportunity to produce more accurate estimates of NMPOU.OBJECTIVES: To determine the prevalence of POA use, NMPOU and use of pain relievers to ‘get high’, and to assess correlations of these indicators with age, sex and provincial levels of dispensed POAs in Canada in 2009.METHODS: Data regarding POA use were obtained from the 2009 Canadian Alcohol and Drug Use Monitoring Survey (n=13,032). The amount of POAs dispensed in standardized daily doses was obtained from a representative sample of 2700 retail pharmacies across Canada. Associations among POA use, age, sex and the amount of POAs dispensed were evaluated using regression models. Differences in POA use across provinces were assessed using the Wald test.RESULTS: In Canada in 2009, the prevalence of POA use was 19.2% (95% CI 18.0% to 20.5%), NMPOU was 4.8% (95% CI 4.1% to 5.5%) and the use of pain relievers to get high was 0.4% (95% CI 0.1% to 0.8%). NMPOU was significantly associated with age. The use of pain relievers to get high varied significantly across provinces, while POA use and NMPOU did not show significant variations. The amount of POAs dispensed per province was not significantly correlated with any type of POA use.CONCLUSIONS: These findings confirm high POA use and NMPOU across Canada. Research is required to identify determinants of NMPOU.
Macrolide Use in the Treatment of Critically Ill Patients with Pneumonia: Incidence, Correlates, Timing and Outcomes
Authors: Sligl Wendy I , Hoang Holly , Eurich Dean T , Malhotra Atul , Marrie Thomas J , Majumdar Sumit R 
Published: March 2016

BACKGROUND: Macrolide antibiotics are commonly used to treat pneumonia despite increasing antimicrobial resistance. Evidence suggests that macrolides may also decrease mortality in severe sepsis via immunomodulatory properties.OBJECTIVE: To evaluate the incidence, correlates, timing and mortality associated with macrolide‐based treatment.METHODS: A population‐based cohort of critically ill adults with pneumonia at five intensive care units in Edmonton, Alberta, was prospectively followed over two years. Data collected included disease severity (Acute Physiology and Chronic Health Evaluation [APACHE] II score), pneumonia severity (Pneumonia Severity Index score), comorbidities, antibiotic treatments at presentation and time to effective antibiotic. The independent association between macrolide‐based treatment and 30‐day all‐cause mortality was examined using multivariable Cox regression. A secondary exploratory analysis examined time to effective antimicrobial therapy.RESULTS: The cohort included 328 patients with a mean Pneumonia Severity Index score of 116 and a mean APACHE II score of 17; 84% required invasive mechanical ventilation. Ninety‐one (28%) patients received macrolide‐based treatments, with no significant correlates of treatment except nursing home residence (15% versus 30% for nonresidents [P=0.02]). Overall mortality was 54 of 328 (16%) at 30 days: 14 of 91 (15%) among patients treated with macrolides versus 40 of 237 (17%) for nonmacrolides (adjusted HR 0.93 [95% CI 0.50 to 1.74]; P=0.8). Patients who received effective antibiotics within 4 h of presentation were less likely to die than those whose treatment was delayed (14% versus 17%; adjusted HR 0.50 [95% CI 0.27 to 0.94]; P=0.03).CONCLUSIONS: Macrolide‐based treatment was not associated with lower 30‐day mortality among critically ill patients with pneumonia, although receipt of effective antibiotic within 4 h was strongly predictive of survival. Based on these results, timely effective treatment may be more important than choice of antibiotics.
Antibiotic Resistance and Expression Of Resistance‐Nodulation‐Division Pump‐ and Outer Membrane Porin‐Encoding Genes in Acinetobacter Species Isolated from Canadian Hospitals
Authors: Fernando Dinesh , Zhanel George , Kumar Ayush 
Published: March 2016

BACKGROUND: Bacterial pathogens belonging to the genus Acinetobacter cause serious infections in immunocompromised individuals that are very difficult to treat due to their extremely high resistance to many antibiotics.OBJECTIVE: To investigate the role of resistance‐nodulation‐division (RND) pumps and porins in the antibiotic resistance of Acinetobacter species collected from Canadian hospitals.METHODS: Clinical isolates of Acinetobacter species collected from Canadian hospitals were analyzed for the expression of genes encoding RND pumps (adeB, adeG, adeJ, AciBau_2746 and AciBau_2436) and outer membrane porins (carO, 33 kDa porin and oprD) using quantitative reverse transcription (qRT) polymerase chain reaction. Species identification of the isolates was performed using a multiplex polymerase chain reaction method for gyrB.RESULTS: The expression of RND pump‐encoding genes was widespread in the clinical isolates of Acinetobacter species, with each of the isolates expressing at least one RND pump. adeG was found to be overexpressed in all of the isolates, while adeB was found to be overexpressed in only two isolates. Among the porin‐encoding genes, the expression of carO was considerably downregulated among the majority of isolates.CONCLUSION: The present study was the first to analyze the expression of RND pump‐ and porin‐encoding genes in the clinical isolates of Acinetobacter species from Canadian hospitals. The overexpression of genes encoding RND pumps and the downregulation of genes encoding porins was common in clinical isolates of Acinetobacter species from Canadian hospitals, with the AdeFGH pump being the most commonly expressed RND pump.
Prevalence of and Risk Factors for Self‐Reported Chronic Bronchitis in a Canadian Population: The Canadian Community Health Survey, 2007 To 2008
Authors: Karunanayake Chandima , Hagen Briana , Dosman James , Pahwa Punam 
Published: March 2016

BACKGROUND: Chronic bronchitis (CB) represents one of the respiratory disease phenotypes that affect the Canadian health care system significantly. Presently, almost 6.5% of total health care costs are related to respiratory diseases.OBJECTIVE: To determine the prevalence of self‐reported CB and associated risk factors in the Canadian general population.METHODS: Data regarding individuals ≥12 years of age from the Canadian Community Health Survey, 2007 to 2008, were analyzed. CB was determined through self‐reported health professional diagnosis. Information regarding covariates of importance, such as demographics, lifestyle variables and socioeconomic status, was obtained. A weighted logistic regression analysis was performed with appropriate technique for clustering effects.RESULTS: The prevalence of self‐reported CB was 2.5%. A greater prevalence of self‐reported CB associated with older age, female sex and white ethnic group was found. There were differences in the prevalence of self‐reported CB among regions of Canada for household income, educational attainment and smoking status.CONCLUSION: The results suggest an association between ethnicity and the prevalence of CB. The associations between self‐reported CB prevalence and household income, educational attainment and smoking status varied according to region of Canada.
Phenotyping of Chronic Obstructive Pulmonary Disease Using the Modified Bhalla Scoring System for High‐Resolution Computed Tomography
Authors: Tulek Baykal , Kivrak Ali Sami , Ozbek Seda , Kanat Fikret , Suerdem Mecit 
Published: March 2016

BACKGROUND: Identifying different phenotypes of chronic obstructive pulmonary disease (COPD) is important for both therapeutic options and clinical outcome of the disease.OBJECTIVE: To characterize the phenotypes of COPD according to high‐resolution computed tomography (HRCT) findings; and to correlate HRCT scores obtained using the modified Bhalla scoring system with clinical and physiological indicators of systemic inflammation.METHODS: The present study included 80 consecutive patients with stable COPD. HRCT scans were evaluated by two independent radiologists according to the modified Bhalla scoring system.RESULTS: Fifty‐four patients exhibited morphological changes on HRCT examination while 26 had no pathological findings. Patients with HRCT findings had lower spirometric measurements and higher levels of inflammation, and reported more exacerbations in the previous year compared with patients with no findings on HRCT. Patients with morphological changes were classified into one of three groups according to their HRCT phenotype(s): emphysema (E) only, E + bronchiectasis (B)/peribronchial thickening (PBT) or B/PBT only. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, C‐reactive protein (CRP) levels and the number of exacerbations among the groups were significantly different. Pairwise comparisons between the E only and E+B/PBT groups showed significantly lower FVC, FEV1 and FEV1/FVC values, and higher CRP levels and number of exacerbations compared with the B/PBT group. No significant differences were found between the E+B/PBT and the B/PBT groups. An inverse correlation was found between the total HRCT score and FVC, FEV1 and FEV1/FVC; the correlation was positive with CRP level, erythrocyte sedimentation rate and number of exacerbations.CONCLUSION: The present study exposed the intimate relationship between phenotype(s) characterized by HRCT and scoring for morphological abnormalities; and clinical and functional parameters and inflammatory markers. The inclusion of HRCT among routine examinations for COPD may provide significant benefits both in the management and prognosis of COPD patients.