bluuebunny/crossref_metadata_2025_split huggingface dataset:
Economic Impact of Using an Immunostimulating Agent to Prevent Severe Acute Exacerbations in Patients with Chronic Obstructive Pulmonary Disease
Authors: Collet Jean-Paul , Ducruet Thierry , Haider Seema , Shapiro Stan , Robinson Ann , Renzi Paolo M , Contandriopoulos André-Pierre , Ernst Pierre 
Published: March 2016

RATIONALE: OM‐85 BV, an immunostimulant made from bacterial extracts, has been shown to reduce the risk of hospitalization for acute exacerbation in patients with chronic obstructive pulmonary disease, as well as to reduce the length of stay for all hospitalizations.METHODS: In conjunction with a placebo controlled, randomized clinical trial, a cost effectiveness analysis was carried out to assess the economic impact of using OM‐85 BV. In the analysis, effectiveness was defined as the difference in the number of severe acute exacerbations, assessed by the number of hospitalizations for a respiratory problem, between the placebo and OM‐85 BV‐treated groups.RESULTS: The median cost to prevent one day of hospitalization for a respiratory condition was CDN$45, with a 95% CI of CDN$18 to CDN$210. Bootstrap of the study population and sensitivity analyses showed that the results were robust and not likely due to random fluctuation; 98.8% of the cost effectiveness and 96.8% of the cost‐benefit ratios favoured the use of OM‐85 BV. Indirect costs, defined as a need for help, were reduced by 36% in the group treated with OM‐85 BV: 779 h of help compared with 1212 h in the placebo group. This trend, while not significant, is consistent with other results and suggests a decrease in the severity of exacerbations in the OM‐85 BV‐treated group.CONCLUSION: Given the high prevalence of chronic obstructive pulmonary disease worldwide and the high cost of acute exacerbations, immunostimulants may become a key element in the improved control of this condition.
Bullae, Bronchiectasis and Nutritional Emphysema in Severe Anorexia Nervosa
Authors: Cook Victoria J , Coxson Harvey O , Mason Andrew G , Bai Tony R 
Published: March 2016

STUDY OBJECTIVES: Pulmonary complications of anorexia nervosa are rarely documented. The case of a patient with anorexia nervosa and pulmonary disease is presented, a new quantitative computed tomography (CT) method for the detection of emphysema is employed, the literature is reviewed and the concept of ′nutritional′ emphysema is discussed.RESULTS: The case of a 34‐year‐old, nonsmoking woman with long‐standing severe anorexia nervosa who was evaluated for cough and progressive shortness of breath is reported. Pulmonary function testing showed a predominant restrictive pattern with a marked reduction in carbon monoxide transfer and respiratory muscle strength, and an elevated residual volume. Imaging revealed bullae and bronchiectasis, and quantitative analysis of the CT scan was consistent with mild, generalized emphysema. Bronchial washings grew Pseudomonas aeruginosa. Known causes for bronchiectasis were excluded. A literature review disclosed few reported noninfectious pulmonary complications of anorexia nervosa.CONCLUSIONS: To the authors’ knowledge, this is the first report of bullae and bronchiectasis in a patient with anorexia nervosa, and the CT analysis was consistent with mild emphysema. Malnutrition has been associated with emphysematous changes in animals and may be the primary insult in the development of emphysema, bullae and bronchiectasis in the present patient.
Mumps Caused by an Inadequately Attenuated Measles, Mumps and Rubella Vaccine
Authors: Bakker WJ , Mathias RG 
Published: March 2016

PROBLEM: Reports of mumps following measles, mumps and rubella (MMR) immunization.OBJECTIVE: To determine whether mumps was caused by immunization or whether there was a concurrent epidemic of a wild strain of mumps.DESIGN AND PARTICIPANTS: Analysis of surveillance data and a cohort study of three schools that participated in the campaign.OUTCOME MEASURES: Cases of clinical mumps and orchitis, and immunization history and records were reviewed. The MMR vaccine was produced by the Serum Institute of India and contained the Leningrad‐Zagreb strain of mumps virus. Four lots were used in the specific immunization campaign.RESULTS: Sentinel health facility surveillance showed an increase in mumps after two school immunization campaigns in western Suriname and a mass immunization campaign in the same region. There was also an increase in a geographically separate region following a mass campaign with the same vaccine. Three hundred fifteen children from three schools that were targeted in the immunization campaign were interviewed. The attack rate for mumps in those immunized was 15.1%; in those not immunized, the attack rate was 4.7%. In the affected males, the attack rate for orchitis was five of 19 (21%). Assuming 90% protection by the MMR vaccine, the incidence ratio (observed to expected) was 32.CONCLUSIONS: The mumps outbreak was caused by an inadequately attenuated MMR vaccine. Because this vaccine had not been used in these populations before in Suriname, it was not possible to determine wether the outbreak was due the virulence of the Leningrad‐Zagreb mumps strain or due to production problems with one or more specific lots of vaccine. The vaccine was withdrawn from further use.
Nicotine Replacement Combined with a Novel Compound (ProBAN) for Smoking Cessation: A Pilot Study
Authors: Leigh Richard , Viner Norman M , Cox Gerard , Balon Jeffrey W , Wilson Douglas MC , O’Shaughnessy Denise , Walker Corinne , Brosky Gerry , Sears Malcolm R 
Published: March 2016

BACKGROUND: Smoking cessation rates with available pharmacological therapies remain suboptimal. Anecdotal observations with a combination of sublingual pralidoxime and ipratropium (ProBAN) suggested that these agents in combination with nicotine gum improved quit rates.OBJECTIVE: To determine whether ProBAN together with nicotine replacement improves quit rates compared with nicotine replacement alone.DESIGN: A 12‐week, prospective, double‐blind, randomized, placebo controlled pilot study. SETTING: University‐affiliated outpatient clinic.POPULATION STUDIED: Healthy adult smokers were recruited via advertisements. Of 107 subjects seen at the screening visit, 27 were excluded because of comorbid illness or concomitant medication use.INTERVENTIONS: Of 80 eligible subjects, 40 were randomly assigned to receive treatment with ProBAN sub‐ lingual tablets and nicotine gum (treatment group), and 40 to receive placebo tablets and nicotine gum (control group) for 12 weeks. The primary outcome was complete continuous abstinence of smoking from one through 12 weeks after the quit date.MAIN RESULTS: There were no adverse effects in the treatment group. At one week after the quit date, 35% of ProBAN‐treated subjects had quit compared with 18% of control subjects (odds ratio [OR] 2.5, 95% CI 0.9 to 7.2). Corresponding quit rates at four weeks were 28% and 15% (OR 2.1, 95% CI 0.7 to 6.5), at eight weeks were 25% and 13% (OR 2.3, 95% CI 0.7 to 7.6), and at 12 weeks were 23% and 13% (OR 2.0, 95% CI 0.6 to 6.7), respectively.CONCLUSIONS: This pilot study indicated that ProBAN combined with nicotine replacement doubled the continuous sustained quit rate compared with nicotine replacement alone, with no adverse effects. Although not statistically significant due to the size of the study, this result suggests that it may be an effective therapy for smoking cessation, and larger studies are warranted.
Opinions of Quebec Parents and Vaccinators on the Usefulness of Chickenpox Vaccine
Authors: Boulianne Nicole , Duval Bernard , Serres Gaston De , Deceuninck Geneviève , Dionne Marc , Carsley John , Valiquette Louise , Massé Richard 
Published: March 2016

BACKGROUND: A chickenpox vaccine was recently licensed in Canada. Because this vaccine has caused some controversy within the health care profession, studies among Quebec parents and vaccine providers were carried out, surveying their opinions concerning chickenpox vaccination.METHODS: Three studies among parents of preadolescents, parents of two‐year‐old children completely or incompletely vaccinated and vaccinators were completed. The studies asked for opinions concerning the usefulness of vaccinating children against chickenpox.RESULTS: The majority of parents of preadolescents (56%), and parents of two‐year‐old children completely (64%) and incompletely vaccinated (60%) favoured chickenpox vaccination. Among vaccinators, 53% of paediatricians, 37% of general practitioners and 33% of nurses considered universal vaccination of young children to be useful. A greater proportion of health care professionals were in favour of a policy of vaccinating groups at risk, such as susceptible adolescents (86%, 75% and 58%, respectively). There was a positive association between the perceived severity of chickenpox and the potential usefulness of the vaccine.CONCLUSION: Quebec parents are more favourably disposed to chickenpox vaccine than vaccine providers. In contrast, strategies targeting susceptible groups would be generally well received by health care professionals. A considerable amount of work will be needed to convince vaccinators of the benefits of a universal childhood vaccination against chickenpox.
Asthma in Adolescents: A Randomized, Controlled Trial of an Asthma Program for Adolescents and Young Adults with Severe Asthma
Authors: Cowie Robert L , Underwood Margot F , Little Cinde B , Mitchell Ian , Spier Sheldon , Ford Gordon T 
Published: March 2016

BACKGROUND: Asthma is common and is often poorly controlled in adolescent subjects.OBJECTIVE: To determine the impact of an age‐specific asthma program on asthma control, particularly on exacerbations of asthma requiring emergency department treatment, and on the quality of life of adolescents with asthma.METHODS: The present randomized, controlled trial included patients who were 15 to 20 years of age and had visited emergency departments for management of their asthma. The interventional group attended an age‐specific asthma program that included assessment, education and management by a team of asthma educators, respiratory therapists and respiratory physicians. In the control group, spirometry was performed, and the patients continued to receive usual care from their regular physicians. The outcomes were assessed by a questionnaire six months after entry into the study.RESULTS: Ninety‐three subjects entered the study and were randomly assigned to the intervention or control group. Of these, only 62 patients were available for review after six months. Subjects in both the control and the intervention groups showed a marked improvement in their level of asthma control, reflected primarily by a 73% reduction in the rate of emergency department attendance for asthma. Other indexes of disease control, including disease‐specific quality of life, as assessed by questionnaires, were improved. There was, however, no discernible difference between the subjects in the two groups, with the exception of an improvement in favour of the intervention group in the symptom (actual difference 0.7, P=0.048) and emotional (actual difference 0.8, P=0.028) domains of the asthma quality of life questionnaire. The overall quality of life score favoured the intervention group by a clinically relevant difference of 0.6, but this difference did not reach statistical significance (P=0.06).CONCLUSIONS: Although all subjects demonstrated a significant improvement in asthma control and quality of life, the improvement attributable to this intervention was limited to two domains in disease‐specific quality of life.
The Effects of Catastrophic Thinking about Pain on Attentional Interference by Pain: No Mediation of Negative Affectivity in Healthy Volunteers and in Patients with Low Back Pain
Authors: Crombez G , Eccleston C , den Broeck A Van , Houdenhove B Van , Goubert L 
Published: March 2016

BACKGROUND: Previous studies have shown that catastrophic thinking about pain enhances attentional interference in healthy volunteers.OBJECTIVE: To investigate whether the attentional effects of pain catastrophizing can be accounted for by the more general predisposition of negative affectivity.METHODS: Sixty‐seven pain‐free students participated in the first experiment, and 33 patients with chronic low back pain participated in the second experiment. In both experiments, participants performed an auditory reaction time task while being exposed to a series of threatening electrocutaneous stimuli. Retardation in reaction times to auditory probes during pain was taken as an index of the attentional interruption by pain. Participants also completed self‐report instruments of negative affectivity and pain catastrophizing.RESULTS: In both experiments, pain catastrophizing enhanced attentional interference by pain. This effect was most pronounced immediately after the onset of the electrocutaneous stimulus. The effect remained after controlling for the effects of negative affectivity.CONCLUSIONS: Catastrophic thinking about pain enhances attentional interruption by pain in normal samples, as well as in clinical samples of patients with chronic back pain. This effect is specific to pain catastrophizing and cannot be explained by the more general disposition of negative affectivity.
Disrupted Sleep Patterns and Daily Functioning in Patients with Chronic Pain
Authors: McCracken Lance M , Iverson Grant L 
Published: March 2016

OBJECTIVE: To investigate the role of disturbed sleep in the daily functioning of persons with chronic pain.SUBJECTS AND METHODS: Participants comprised 287 patients seeking treatment for chronic pain at a university pain clinic. All patients completed the measures employed in the present study as part of a comprehensive initial evaluation.RESULTS: Descriptive analyses showed that 88.9% of patients reported as least one problem with disturbed sleep. Correlation analyses showed that greater sleep disturbance was associated with greater pain, disability, depression and physical symptoms, and less daily uptime. Hierarchical regression analyses showed that sleep disturbance predicted disability, daily uptime and physical symptoms independent of pain or depression.CONCLUSIONS: Sleep disruption is usually considered to be a consequence of the pain experience. However, the results of the present study reinforce the view that sleep disturbance may have a bidirectional relation with other features of chronic pain. Future studies should confirm that repairing disrupted sleep leads to an improvement in patients′ daily activity and a reduction in their suffering.
Chronic Traumatic and Congenital Diaphragmatic Hernias: Presentation and Surgical Management
Authors: Sattler Scott , Canty Timothy G , Mulligan Michael S , Wood Douglas E , Scully J Michael , Vallieres Eric , Pohlman Timothy , Karmy-Jones Riyad 
Published: March 2016

BACKGROUND: The diagnosis of chronic diaphragmatic hernias, whether due to congenital defects or trauma, may be difficult to make and may rely on clinical suspicion in the setting of persistent nondiagnostic radiographic findings. Repair is indicated to avoid catastrophic cardiopulmonary compromise and/or incarceration of abdominal organs.STUDY OBJECTIVES: To review the varied presentations and treatment of chronic diaphragmatic hernia.DESIGN: Retrospective review.SETTING: University of Washington and Harborview Medical Center, Seattle, Washington.PATIENTS: Between 1997 and 2001, nine patients presented with chronic diaphragmatic hernia (two congenital cases, seven post‐traumatic cases). Four cases involved the right diaphragm. The following clinical features were noted: asymptomatic, chest radiograph showing bowel herniation (n=1); chest wall mass (n=1); asymptomatic with the chest radiograph showing marked elevation of hemidiaphragm (n=1); dyspnea with the chest radiograph showing marked elevation of hemidiaphragm (n=1); diarrhea and heartburn (n=1); generalized gastrointestinal upset (n=1); recurrent pneumonia (n=2); recurring effusions (n=4); and dyspnea on exertion (n=5).INTERVENTIONS: Diagnosis was confirmed by chest radiograph in two patients, chest computed tomography scan in one patient, barium studies in three patients and thoracoscopy in three patients. All hernias were repaired via thoracotomy, and two hernias were repaired with artificial patch.CONCLUSIONS: Patients with chronic diaphragmatic hernias present with a variety of symptoms and radiographic findings. When radiology or symptoms suggest bowel involvement, barium studies are appropriate. In other cases, chest computed tomography scans and/or thoracoscopy are useful. Repair is accomplished through the ipsilateral chest, with primary repair of the diaphragm preferred over patch repair.
Review of the Use of Cephalosporins in Children with Anaphylactic Reactions from Penicillins
Authors: Hameed Tahir K , Robinson Joan L 
Published: March 2016

OBJECTIVE: It is a widely accepted practice that children with anaphylaxis from penicillins should avoid cephalosporins. The purpose of the present study was to determine whether there is evidence in the literature to support this practice.DATA SOURCES: MEDLINE, EMBASE, Toxline, Inter‐national Pharmaceutical Abstracts and PubMed were used to search the literature published from 1966 to 2001. The Canadian Medical Protective Association, Health Canada and the Boston Collaborative Drug Surveillance Program were also contacted to determine whether there were any unpublished cases of cross‐reactivity between penicillins and cephalosporins.DATA EXTRACTION: Cases describing the use of cepha‐losporins in adults and children with positive penicillin skin tests or anaphylaxis from penicillin were evaluated. Case reports of anaphylaxis from cephalosporins in paediatric patients were identified.DATA SYNTHESIS: There have been five reported cases of serious reactions from cephalosporins in patients with a history of anaphylaxis from penicillins. All cases occurred in adults; three developed anaphylaxis from the older, first‐generation cephalosporins, cephalothin and cephaloridine; one developed anaphylaxis from cefamandole; and one developed anaphylaxis from cefaclor. There have been 12 other published reports of anaphylaxis from cephalosporins in adults with a history of penicillin allergy or a positive penicillin skin test, but with no history of anaphylaxis from penicillin. In seven studies, in which a total of 158 patients with positive penicillin skin tests were administered cephalosporins, seven had apparent immunoglobulin E‐mediated reactions when they were given a cephalosporin. When the class of cephalosporin was able to be determined, none of the reports of reactions from cephalosporins in patients with allergies to penicillin involved third‐generation cephalosporins. There have been 13 case reports of anaphylaxis from cephalosporins in paediatric patients.CONCLUSIONS: There are no published case reports of anaphylaxis from cephalosporins in children with anaphylaxis from penicillin, and there are only a small number of such reports in adults. Anaphylaxis from cephalosporins appears to be incredibly rare in children. There is minimal evidence in the literature to support the avoidance of cephalosporins in children with anaphylaxis from penicillins.
Canadian Respirologists’ Experience with Lymphangioleiomyomatosis
Authors: Pollock-BarZiv Stacey M , Cohen Marsha M , Maclean Heather , Downey Gregory P 
Published: March 2016

BACKGROUND: Lymphangioleiomyomatosis (LAM) is a rare pulmonary disease occurring primarily in women. A literature review of LAM in Canada found sporadic mention of LAM in case reports or within lung transplant studies. The LAM Foundation, a patient support and research funding organization, lists 23 Canadian patients in its database. The present study was designed to assess the scope of LAM across Canada and to identify potential patients for further evaluation. OBJECTIVES: To ascertain Canadian respirologists’ experience with patients with LAM (current and historical), lung transplantation (single or bilateral) and deaths due to LAM, and awareness of the LAM Foundation.METHODS: Four hundred twelve brief surveys were sent anonymously to members of the Canadian Lung Association (inserted in their newsletters) to ascertain the experience of Canadian respirologists with LAM.RESULTS: One hundred twelve surveys were returned (27%). Fifty‐one respondents had ′ever′ been involved in the care of at least one patient with LAM; eight had cared for three or more patients. At the time of the study, 26 respondents were following a total of 46 patients with LAM; 22 of the 51 respirologists (43%) who had ever cared for a patient with LAM reported the death of a patient. Thirty‐three patients had been put on wait lists for transplantation; six died while on the wait list. Nineteen patients underwent lung transplantation ‐ six single‐lung recipients and 13 bilateral lung recipients. Of the 51 respirologists who had ever cared for a patient with LAM, only 30 (61%) were aware of the LAM Foundation’s services. Of the 112 respondents, only 47 (43%) were aware of the LAM Foundation.CONCLUSIONS: This study identified a moderate level of awareness of a significant existing patient support and research service (the LAM Foundation). There were many patients with LAM who were unknown to the LAM Foundation and could benefit from its resources. Results suggest that there may be more patients with LAM in Canada than are reported in the existing literature.