bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microbiologic Surveillance and Parenteral Antibiotic Use in a Critical Care Unit
Authors: Yamashita Sharon K , Louie Marie , Simor Andrew E , Rachlis Anita 
Published: March 2016

OBJECTIVE: To evaluate parenteral antibiotic utilization and bacterial resistance patterns in a critical care unit (CrCU).DESIGN: Descriptive, prospective audit of infection site, culture and antimicrobial susceptibility test results, parenteral antibiotic usage and duration, total antibiotic acquisition costs, and length of stay.SETTING: A 17‐bed medical‐surgical CrCU in a tertiary care teaching hospital in Metropolitan Toronto.PATIENTS: Two hundred and fifty‐eight patients admitted to the CrCU between May 1995 and April 1996 who received antimicrobial therapy.RESULTS: The most frequently prescribed antibiotics were cefazolin (47%, 1098 g), gentamicin (33%,141 g) and ceftriaxone (20%, 255 g). The most common indications for antimicrobial therapy included surgical prophylaxis (34%) and pneumonia (35%). The following organisms were isolated from patients treated with antibiotics: Staphylococcus aureus (26%), Pseudomonas aeruginosa (13%), enterococci (12%), Haemophilus influenzae (11%), Escherichia coli (11%), Enterobacter cloacae (8%) and other Gram‐negative bacilli (19%). Only 9% of Gram‐negative bacilli were resistant to aminoglycosides, 3% were resistant to ciprofloxacin and no extended‐spectrum beta‐lactamases or imipenem‐resistance were detected. No vancomycin‐resistant enterococci and only two methicillin‐resistant Staphylococcus aureus isolates were identified.CONCLUSIONS: Antibiotic use during the audit appeared appropriate for the specific clinical indications. Low levels of bacterial resistance were detected during the audit.
Accuracy of Children′s and Parents′ Memory for a Novel Painful Experience
Authors: Badali Melanie A , Pillai Rebecca R , Craig Kenneth D , Giesbrecht Kelly , Chambers Christine T 
Published: March 2016

BACKGROUND: Despite recent progress in understanding memory of pain in adults, the validity of the assumption that these findings extend to children has not been established. Because treatment often is evaluated on the basis of pain recall, it is crucial that the accuracy of pain memories in children be established.OBJECTIVES: To examine children′s ability to recall pain intensity and contextual details associated with a novel painful experience. Furthermore, children′s memories were compared with those of their parents.SUBJECTS AND METHODS: Twenty‐three parent‐child dyads were recruited from a sample participating in an earlier study investigating children′s responses to the cold pressor test and parents′ characterization of the children′s responses. Children (age five to 12 years) and parents independently had rated the child′s pain using a seven‐point Faces Pain Scale. Approximately one year later, they were asked to recall the experience and rate the pain again. Memory for contextual details associated with the event also was assessed through a series of open‐ended questions.RESULTS: A 2 (rater) × 2 (time period) repeated measures ANOVA examined the reliability of ratings and differences between parent and child ratings of pain, both recorded at the time of the cold pressor and recalled one year later. There were no significant differences in ratings over time or between parent and child.CONCLUSIONS: The findings indicate that children′s memories of a novel painful experience can be consistent over a long interval. Moreover, parents′ ratings also reflect good recall and can be in agreement with those of their children.
Electrical Nerve Stimulation Can Be Used as a Tool in fMRI Studies of Pain‐ and Tingling‐Evoked Activations
Authors: Davis Karen D , Kwan Chun L , Crawley Adrian P , Mikulis David J 
Published: March 2016

OBJECTIVES/HYPOTHESES: To determine whether transcutaneous electrical nerve stimulation (TENS) provides adequate, inexpensive and simple means to image innocuous and pain‐related activations in the thalamus and cortex.SUBJECTS AND METHODS: High resolution functional magnetic resonance imaging (fMRI) was used to obtain functional data sets on a 1.5T General Electric echospeed scanner (General Electric, Milwaukee) from six axial slices during interleaved periods of rest and TENS at either nonpainful tingling or painful intensities. The volume of brain imaged allowed inspection of stimulation‐related activations in the thalamus, insula and second somatosensory cortex (S2).RESULTS: Tingling TENS activations were identified primarily in the contralateral posterolateral thalamus. Painful TENS activations were found in the contralateral posterolateral thalamus, medial and/or anterior thalamus. The insula and S2 were activated in four of the subjects with tingling TENS and in all subjects with painful TENS. Tingling TENS activations were located in the posterior insula, whereas pain‐related activations were located in the anterior insula. Painful TENS activations found in S2 overlapped with tingling TENS activations.CONCLUSIONS: These findings demonstrate that TENS is a simple mode of stimulation that produces fairly consistent cortical activations, especially at painful levels, and thus may be useful in carefully designed and controlled clinical fMRI studies of pain and touch.
Outcome of Tuberculosis Treatment: A Comparison between Alberta and Nicaragua
Authors: Kassam Narmin , Fanning Anne , Cruz Jose Ramon , Tardencilla Alejandro 
Published: March 2016

OBJECTIVE: To measure the outcome of tuberculosis treatment in a low incidence, high income region, Alberta, and compare with an intermediate incidence, low income country with a model national tuberculosis program, Nicaragua.DESIGN: All 1992 sputum smear‐positive pulmonary cases from both regions were included. Treatment outcome was assigned retrospectively to Alberta cases according to the International Union Against Tuberculosis and Lung Diseases′ (IUATLD) criteria of cure, failure, transfer, absconder and death.SETTING: Alberta laboratories are required to report all Mycobacterium tuberculosis cultures to Alberta provincial tuberculosis services. Nicaragua cases are reported centrally to the Programa de control de tuberculosis in Managua using the IUATLD criteria.MAIN RESULTS: In Alberta, 222 tuberculosis cases were identified, of which 61 were smear positive. Nicaragua had 1552 smear positive cases of 2885 tuberculosis cases. Alberta′s outcomes were 82% cured, no failed treatment, 5% absconded, 2% transferred and 11% died; Nicaragua′s outcomes were 77% cured, 2% failed, 13% absconded, 5% transferred and 4% died. There was no significant difference in cure rates between Alberta and Nicaragua, P=0.33.CONCLUSIONS: Treatment outcomes can be measured effectively and reported in high income, low incidence settings. Alberta is achieving comparable cure rates with the Nicaraguan national tuberculosis program.
Is Video‐Assited Thoracoscopic Surgery Superior to Limited Axillary Thoracotomy in the Management of Spontaneous Pneumothorax?
Authors: Hyland Meaghen J , Ashrafi Ahmad S , Crépeau André , Mehran Reza J 
Published: March 2016

OBJECTIVE: To evaluate bullectomy and pleurectomy in the treatment of spontaneous pneumothorax (PNO) using video‐assisted thoracoscopic surgery (VATS), and to compare the outcome with that of the same procedure performed using limited axillary thoracotomy (LAT).DESIGN: A retrospective case series with patient follow‐up.SETTING: A Canadian tertiary care hospital.PATIENTS: The medical records of all patients with a spontaneous PNO treated by either VATS or LAT at the Ottawa Hospital ‐ General Campus, Ottawa, Ontario, between April 1993 and August 1999 were reviewed, and the patients were subsequently interviewed.MAIN OUTCOME MEASURES: Operative details (length of operation, operative complications); postoperative details (duration of chest tube, length of hospital stay, duration of analgesia, pain, time missed from work, complications, recurrence rate); and cost (hospital and operative, socioeconomic [time missed from work]).RESULTS: Fifty patients were identified who had had surgical treatment of a spontaneous PNO. Twenty‐eight patients were treated by LAT and 22 underwent VATS. The median length of follow‐up was 44.6 months (range four to 81.5 months). Three patients developed a recurrent PNO ‐ two patients after LAT and one patient after VATS. No difference was found between the two groups in the operating time or in the amount of pain experienced immediately after surgery. However, patients who underwent VATS had a shorter length of stay (P=0.002) and a shorter requirement for analgesics postoperatively (P=0.03). Overall, the total cost of VATS was no different than that for LAT; however, in terms of socioeconomic costs, patients in the VATS group missed significantly less time from work postoperatively (P=0.02).CONCLUSIONS: VATS offers a cost effective and better tolerated procedure for the management of spontaneous PNO than the time‐honoured open technique.
Initial Drug Regimen for Active Tuberculosis Cases in Montreal, 1995‐1998
Authors: Rivest Paul , Tannenbaum Terry N 
Published: March 2016

OBJECTIVES: To evaluate the proportion of tuberculosis (TB) cases initially treated with the recommended four‐drug regimen of isoniazid (INH), rifampin (RIF), pyrazinamide (PZA) and ethambutol (EMB) or streptomycin; and to identify factors associated with the choice of initial therapy.DESIGN: Descriptive analysis of surveillance data obtained by TB case notifications from physicians and microbiology laboratories.SETTING: The island of Montreal (with a population of 1,854,435 people).STUDY POPULATION: All TB cases reported between January 1, 1995 and December 31, 1998.OUTCOME MEASURE: The proportion of TB cases initially treated with a four‐drug regimen by sex, age, country of birth, site of disease and year of reporting.MAIN RESULTS: Seven hundred forty‐one cases were reported during the study period. Among the 687 analyzed cases, 406 (59.1%) received the recommended initial four‐drug regimen (INH‐RIF‐PZA‐EMB), 187 (27.2%) received an INH‐RIF‐PZA regimen, 61 (8.9%) received an INH‐RIF‐EMB regimen and 33 (4.8%) received an INH‐RIF regimen only. In a logistical regression model, a four‐drug regimen was significantly associated with respiratory disease (odds ratio [OR] 4.48; 95% CI 3.15 to 6.39), age younger than 65 years (OR 2.32; 95% CI 1.55 to 3.45), being foreign‐born (OR 1.62; 95% CI 1.06 to 2.48) and later year of reporting (OR 1.27; 95% CI 1.09 to 1.47).CONCLUSIONS: The proportion of TB cases initially treated with a four‐drug regimen has increased steadily since 1995, reaching 65% in 1998. However, given the rate of INH resistance in Montreal, efforts to promote the use of the initial four‐drug regimen must continue.
Patients′ Attitudes and Prior Treatments in Neuropathic Pain: A Pilot Study
Authors: Gilron Ian , Bailey Joan , Weaver Donald F , Houlden Robyn L 
Published: March 2016

BACKGROUND: Ongoing research continues to expand the knowledge of neuropathic pain. It is vital that established treatments and valuable discoveries ultimately improve patient care.OBJECTIVES: Attitudes and prior treatments of patients being screened for neuropathic pain trials were evaluated to provide further understanding of the barriers to the management of neuropathic pain.METHODS: A questionnaire was completed by patients with neuropathic pain who were either referred by local physicians or self referred in response to clinical trial advertisements from the authors′ facility.RESULTS: In total, 151 patients completed the questionnaire. Diagnoses included diabetic neuropathy (55.6%), postherpetic neuralgia (29.8%), idiopathic peripheral neuropathy (9.3%) and others (5.3%). The mean pain duration was 4.7 years, and the mean daily pain (on a score of 0 to 10) was 7.6. During questioning, 72.8% complained of inadequate pain control and 25.2% had never tried any antineuropathic analgesics (tricyclic antidepressants, opioids or anticonvulsants). New antineuropathic analgesics (eg, gabapentin) were being used by only 16.6%. Opioids, tricyclic antidepressants and anticonvulsants had never been tried by 41.1%, 59.6% and 72.2%, respectively. Fears of addiction and adverse effects were expressed by 31.8% and 48.3%, respectively.CONCLUSIONS: New, and even conventional, therapies are often not pursued, despite inadequate pain control. Several issues are discussed, including patient barriers to seeking pain management, patient and physician barriers to analgesic drug therapy, and appropriate use of and access to multidisciplinary pain centres. Failure to implement therapeutic advances in pain management not only hinders improvement in patient care, but also may render futile decades of research. Widespread professional, patient and public education, as well as continued interdisciplinary research on treatment barriers, is essential.
Economic Evaluation of the MEDENOX Trial: A Canadian Perspective
Authors: Lamy André , Wang Xiaoyin , Kent Rosanne , Smith Kelly M , Gafni Amiram 
Published: March 2016

OBJECTIVE: To perform an economic evaluation of the Prophylaxis in Medical Patients with Enoxaparin (MEDENOX) trial from a Canadian perspective.METHOD: Using a decision tree model, cost effectiveness analysis was carried out to compare the costs and consequences of thromboprophylaxis using enoxaparin 40 mg with placebo in tertiary and community settings. From a third party payer’s perspective, the model calculated the expected rate of symptomatic venous thromboembolism (VTE), and the total expected cost of prophylaxis and VTE management, including inpatient and outpatient treatment, professional fees and long term therapy. Data were derived directly from the MEDENOX trial. Costs are direct medical costs in year 2000 Canadian dollars.RESULTS: In a tertiary setting in which the estimated inpatient to outpatient deep vein thrombosis treatment ratio was 10%:90%, the total expected cost per patient was $64 in the enoxaparin group and $62 in the placebo group. The expected symptomatic VTE rates were 0.8% and 3.1% in the enoxaparin and placebo groups, respectively. The incremental cost effectiveness of enoxaparin 40 mg versus placebo was $87/VTE avoided. In a community hospital setting (with a 50%:50% inpatient to outpatient deep vein thrombosis treatment ratio), the total expected cost per patient was $68 in the enoxaparin group compared with $72 in the placebo group, indicating that prophylaxis with enoxaparin 40 mg was cost saving. The model was sensitive to the inpatient to outpatient ratio. However, within each setting, the results were not sensitive to changes in key variables.CONCLUSION: For patients hospitalized for acute respiratory failure, congestive heart failure or acute infectious disease and who are at moderate risk of developing VTE, thromboprophylaxis with enoxaparin 40 mg daily is a cost effective strategy in both tertiary and community settings.
Respiratory Symptoms and Asthma in Two Farming Populations: A Comparison of Hutterite and Non‐Hutterite Children
Authors: Rennie Donna C , Dosman James , Senthilselvan Ambikaipakan 
Published: March 2016

OBJECTIVE: To determine the prevalence of asthma and respiratory symptoms in a farming population of Hutterite and non‐Hutterite children.PARTICIPANTS AND SETTING: A population of 830 school‐age, farm‐dwelling children in rural Saskatchewan that included 83 children residing in Hutterite farming colonies.METHODS: A cross‐sectional survey questionnaire was sent to parents of children attending grades 1 to 5 in schools within a grain‐growing and mixed‐farming region of central Saskatchewan. The questionnaire was used to identify respiratory symptoms, environmental and host characteristics, and reported doctor‐diagnosed asthma.RESULTS: The prevalence of asthma in Hutterite children was 2.4% compared with 9.2% in non‐Hutterite children. While Hutterite children did not differ from their farming counterparts with regard to the frequency of reported respiratory allergies, they were less likely to be exposed to cigarette smoke and to participate in farm‐related activities. In the multivariate analysis, being Hutterite continued to be protective for asthma (odds ratio 0.21; 95% CI 0.05 to 0.89).CONCLUSION: The observed lower rate of asthma in Hutterite children than in non‐Hutterite children may be related to both genetic factors and differences in farming and household factors between the two groups.
A National Survey of Antimicrobial Prophylaxis in Adult Cardiac Surgery Across Canada
Authors: Paradiso-Hardy Fran L , Cornish Patti , Pharand Chantal , Fremes Stephen E 
Published: March 2016

OBJECTIVE: To characterize national and regional patterns of antimicrobial prophylaxis in adult cardiac surgery across Canada.DESIGN: Retrospective, cross‐sectional analysis.SETTING: Thirty‐three adult cardiac surgical centres across Canada.INTERVENTIONS: A one‐page questionnaire collecting information regarding institutional demographics and antimicrobial prophylaxis regimens for adult cardiac surgical procedures was mailed to all adult surgical centres across Canada. If a response was not received within one month, a second survey was mailed, followed by a telephone reminder within two weeks of the second mailing.MAIN RESULTS: The overall response rate was 100%. Prophylactic antimicrobials were used in all of the adult cardiac centres; single‐agent prophylaxis was used in 97% (32 of 33) of centres. Single‐dose antimicrobial prophylaxis was used in only 3% (one of 33) of centres. Preoperative and postoperative antimicrobial prophylaxis regimens varied both between provinces and within provinces across Canada. Cefazolin was the antimicrobial used in 88% (38 of 43) and 87% (33 of 38) of the reported preoperative and postoperative prophylaxis regimens, respectively. Antimicrobial prophylaxis was initiated in the operating room 72% (26 of 36) of the time, and intraoperative supplemental antimicrobial doses were administered for cardiac procedures that took longer than a median of 4 h (range 4 to 8 h). Overall, the median duration of antimicrobial prophylaxis treatment was 36 h (range 8 to 96 h).CONCLUSIONS: Despite the availability of various published guidelines, the present survey identified several areas for improvement with respect to antimicrobial prophylaxis in adult cardiac surgery across Canada.
Verotoxigenic Escherichia coli (Vtec): A Major Public Health Threat in Canada
Authors: Woodward David L , Clark Clifford G , Caldeira Richard A , Ahmed Rafiq , Rodgers Frank G 
Published: March 2016

BACKGROUND: Verotoxigenic Escherichia coli (VTEC) was first described in Canada during the 1980s as an emerging foodborne disease in association with morbidity and mortality in outbreaks of hemorrhagic colitis caused by E coli O157:H7.OBJECTIVE: To describe the surveillance activities and epidemiological laboratory markers of VTEC that are used at the National Laboratory for Enteric Pathogens (NLEP) to investigate sporadic cases and outbreaks of E coli O157:H7 and non‐O157 VTEC in Canada.METHODS: Passive surveillance was conducted by obtaining data on laboratory confirmed cases of VTEC from the Provincial Laboratories of Public Health across Canada. The laboratory epidemiological markers generated for isolates of VTEC included biotyping, serotyping, phage typing, toxin detection and characterization, and molecular typing using pulsed‐field gel electrophoresis.RESULTS: Major outbreaks of VTEC O157:H7 disease have been associated with ground beef, unpasteurized apple juice, salami and untreated water. In 1999 and 2000, a total of 46 outbreaks of E coli O157:H7 disease were investigated. Among those, one outbreak was associated with contact at a petting zoo and a second with the consumption of salami. An outbreak in 2000 in Ontario was associated with water and resulted in more than 1000 cases of human illness, with six deaths. The NLEP has also identified more than 100 non‐O157 VTEC serotypes from cattle and meat products. At least 23 VTEC serotypes found in humans were also identical to those found in cattle and meat products.CONCLUSIONS: The laboratory‐based information that is generated is used to define the incidence, sources of infection, risk factors, trends, distribution and transmission of VTEC to humans from food, water and animal sources. Prevention and control of outbreaks are high‐priority health concerns.
Additive Effect of Dornase Alfa and Nacystelyn on Transportability and Viscoelasticity of Cystic Fibrosis Sputum
Authors: Sun Feng , Tai Shusheng , Lim Thomas , Baumann Ulrich , King Malcolm 
Published: March 2016

OBJECTIVE: To investigate the effect of dornase alfa (DA), Nacystelyn (NAL) and their combination on mucociliary transportability and mucus viscoelasticity of cystic fibrosis (CF) sputum, and to assess whether the combination possesses an additive effect.DESIGN: Determination of transportability in frog palate and viscoelasticity in vitro.SETTING: Research laboratory at a medical centre. Patients: Sputa from 15 patients with CF, chronically infected with Pseudomonas aeruginosa, were studied.INTERVENTIONS: Sputum samples were incubated without any drug solution as a control, and with normal saline, DA, NAL and a mixture of DA and NAL in concentrations approximating those achieved in clinical practice.RESULTS: Normal saline (10% volume) by itself had a small effect on CF sputum transportability with a mean increase of 9%, and on viscoelasticity with a mean of decrease of 0.22 log units, respectively, compared with control (incubation without saline). DA (200 nM) further increased the transportability by a mean of 35% versus saline and decreased viscoelasticity by a mean of 0.30 log units. NAL (100 µM) increased the transportability by a mean of 32% and decreased viscoelasticity by a mean of 0.22 log units from the levels achieved with saline. The mixture of DA plus NAL at one‐half of the above concentration of each agent produced an additional increase in the transportability, by a mean of 18%, and a further decrease in viscoelasticity, by a mean of 0.25 log units, compared with DA or NAL as a single treatment.CONCLUSIONS: The combination of DA and NAL exhibits an additive effect for both the viscoelasticity and transportability of CF sputum samples. The two agents appear to act well together in breaking down the bonding due to extracellular DNA and mucins. Clinical studies should be undertaken to see whether the additive combination at lower concentration produces the anticipated benefits of improved airway clearance and fewer side effects.
A Short Version of the Pain Anxiety Symptoms Scale (PASS‐20): Preliminary Development and Validity
Authors: McCracken Lance M , Dhingra Lara 
Published: March 2016

BACKGROUND: Research has shown significant relations between fear and avoidance of pain and the suffering and disability of chronic pain. Effective measurement tools have formed the foundation for studying these relations.METHODS: The present article describes the initial development and validation of the PASS‐20, a short form version of the Pain Anxiety Symptoms Scale (PASS). Like the original inventory, the PASS‐20 measures fear and anxiety responses specific to pain. Items were selected for the short version based on item variance, item intercorrelation and reliability analyses.RESULTS: The PASS‐20 shows strong internal consistency, reliability, and good predictive and construct validity. Item reduction appears to result in minimal shrinkage of validity correlations.CONCLUSIONS: Overall, the results suggest that the short form retains adequate psychometric properties. Possible research and clinical implications for the PASS‐20 include more efficient screening during evaluations of patients with chronic pain, and use when the time or effort needed for the full version is prohibitive.