bluuebunny/crossref_metadata_2025_split huggingface dataset:
Practice and Documentation of Performance of Colonoscopy in a Central Canadian health Region
Authors: Singh Harminder , Kaita Lisa , Taylor Gerry , Nugent Zoann , Bernstein Charles 
Published: March 2016

OBJECTIVE: To evaluate the reporting and performance of colonoscopy in a large urban centre.METHODS: Colonoscopies performed between January and April 2008 in community hospitals and academic centres in the Winnipeg Regional Health Authority (Manitoba) were identified from hospital discharge databases and retrospective review of a random sample of identified charts. Information regarding reporting of colonoscopies (including bowel preparation, photodocumentation of cecum/ileum, size, site, characteristics and method of polyp removal), colonoscopy completion rates and follow-up recommendations was extracted. Colonoscopy completion rates were compared among different groups of physicians.RESULTS: A total of 797 colonoscopies were evaluated. Several deficiencies in reporting were identified. For example, bowel preparation quality was reported in only 20%, the agent used for bowel preparation was recorded in 50%, photodocumentation of colonoscopy completion in 6% and polyp appearance (ie, pedunculated or not) in 34%, and polyp size in 66%. Although the overall colonoscopy completion rate was 92%, there was a significant difference among physicians with varying medical specialty training and volume of procedures performed. Recommendations for follow-up procedures (barium enema, computed tomography colonography or repeat colonoscopy) were recorded for a minority of individuals with reported poor bowel preparation or incomplete colonoscopy.CONCLUSIONS: The present study found many deficiencies in reporting of colonoscopy in typical, city-wide clinical practices. Colonoscopy completion rates varied among different physician specialties. There is an urgent need to adopt standardized colonoscopy reporting systems in everyday practice and to provide feedback to physicians regarding deficiencies so they can be rectified.
Chronic Hepatitis C in Western Canada: A Survey of Practice Patterns among Gastroenterologists in Alberta and British Columbia
Authors: Pai Rohit , Ramji Alnoor , Lee Samuel S , Wong Winnie W , Yoshida Eric M 
Published: March 2016

OBJECTIVE: To survey gastroenterologists in British Columbia and Alberta with regard to awareness of chronic hepatitis C virus (HCV) management and practice patterns among physicians who treat and do not treat HCV-infected patients.METHODS: An anonymous two-page mail survey was distributed to actively practicing adult gastroenterologists in British Columbia and Alberta. Among physicians who treated HCV patients, respondents answered assessment of fibrosis pretreatment, measurement of rapid virological response, prescription of protease inhibitors (PIs), barriers to using these agents and referral patterns. For those who did not treat HCV, referral of patients for treatment and to whom was assessed.RESULTS: Seventy-seven of 166 individuals completed the survey (46% response rate). Most (49%) practiced in academic or large community (42%) settings. Chronic liver disease comprised <25% of individual practice in 71%. Forty-eight (62%) treated HCV and two-thirds prescribed a PI. Barriers to prescription included unfamiliarity (six of 16), lack of allied health (five of 16) and few suitable patients (seven of 16). Pretreatment liver biopsy was performed by 33% (16 of 48) and 69% (33 of 48) used noninvasive measures. Rapid virological response was measured in 83% (40 of 48). Referral patterns changed in 46% (22 of 48) of physicians who treated HCV. All respondents who did not treat HCV referred patients for consideration, with 90% (26 of 29) made to hepatologists.CONCLUSIONS: Chronic liver disease comprised <25% of practice in the majority of surveyed respondents. Among those who treated HCV, one-third have not prescribed a PI. Barriers to prescription and referral pattern changes are noted by those currently treating patients with HCV infection.
Colon Capsule Endoscopy: Detection of Colonic Polyps Compared with Conventional Colonoscopy and Visualization of Extracolonic Pathologies
Authors: Hagel Alexander F , Gäbele Erwin , Raithel Martin , Hagel Wolfgang H , Albrecht Heinz , de Rossi Thomas M , Singer Christine , Schneider Thomas , Neurath Markus F , Farnbacher Michael J 
Published: March 2016

BACKGROUND: Conventional colonoscopy (CC) is the gold standard for diagnostic examination of the colon. However, the overall acceptance of this procedure is low due to patient fears of complications or embarrassment. Colon capsule endoscopy (CCE) represents a minimally invasive, patient-friendly procedure that offers complete visualization of the entire intestine.OBJECTIVE: To assess the PillCam Colon 2 (Given Imaging Ltd, Israel) capsule with regard to feasibility, sensitivity and specificity for the detection of colonic pathologies and additional recorded extracolonic findings.METHODS: CCE was performed before CC in patients indicated for CC for known or suspected colonic disease. The results of both techniques were compared with regard to polyp detection. Additionally, bowel preparation and extracolonic pathologies were analyzed.RESULTS: Twenty-four patients (mean age 51.1 years) were included in the analysis. Visualization of the colon was complete in 23 CCs and 17 CCEs. No adverse events or major technical failures occurred. CC detected 47 polyps and CCE detected 43 polyps of any size (per-finding sensitivity 90.9%, specificity 67.6%). The accuracy of CCE in detecting polyp carriers was 81.5% (per-patient analysis). On average, the colon was adequately cleansed in 90.1% of patients. CCE identified esophageal, gastric and small bowel pathologies in seven (24%), nine (38%) and 14 (58%) patients, respectively.CONCLUSIONS: CCE proved to be technically feasible and safe. Acceptable sensitivity and moderate specificity levels in polyp detection were recorded. Bowel preparation was adequate in most patients. Because extracolonic pathologies were effectively visualized, new indications for the PillCam Colon 2 may be defined.
Variation in Outpatient Oral Antimicrobial Use Patterns among Canadian Provinces, 2000 to 2010
Authors: Glass-Kaastra Shiona K , Finley Rita , Hutchinson Jim , Patrick David M , Weiss Karl , Conly John 
Published: March 2016

BACKGROUND: The volume and patterns of antimicrobial drug use are key variables to consider when developing guidelines for prescribing, and programs to address stewardship and combat the increasing prevalence of antimicrobial resistant pathogens. Because drug programs are regulated at the provincial level, there is an expectation that antibiotic use may vary among provinces.OBJECTIVE: To assess these potential differences according to province and time.METHODS: Provincial antimicrobial prescribing data at the individual drug level were acquired from the Canadian Integrated Program for Antimicrobial Resistance Surveillance for 2000 to 2010. Data were used to calculate two yearly metrics: prescriptions per 1000 inhabitant‐days and the average defined daily doses per prescription. The proportion of liquid oral prescriptions of total prescriptions was also calculated as a proxy measure for the proportion of prescriptions given to children versus adults. To assess the significance of provincial antimicrobial use, linear mixed models were developed for each metric, accounting for repeated measurements over time.RESULTS: Significant differences among provinces were found, as well as significant changes in use over time. Newfoundland and Labrador was found to have significantly higher prescribing rates than all other provinces (P<0.001) in 2010, as well as the mean of all other provinces (P<0.001). In contrast, Quebec exhibited significantly lower prescribing than all other provinces (P<0.001 for all provinces except British Columbia, where P=0.024) and the mean of all other provinces (P<0.001).DISCUSSION/CONCLUSION: Reports of reductions in antimicrobial use at the Canadian level are promising, especially prescribing to children; however, care must be taken to avoid the pitfall of the ecological fallacy. Reductions are not consistent among the provinces or among the classes of antimicrobial drugs dispensed in Canada.
Deferred Consent in a Minimal‐Risk Study Involving Critically Ill Subarachnoid Hemorrhage Patients
Authors: Topolovec-Vranic Jane , Santos Marlene , Baker Andrew J , Smith Orla M , Burns Karen EA 
Published: March 2016

INTRODUCTION: Alterations from first‐party and surrogate decision‐maker consent can enhance the feasibility of research involving critically ill patients.OBJECTIVE: To describe the use of a deferred‐consent model to enable participation of critically ill patients in a minimal‐risk biomarker study.METHODS: A prospective observational study was conducted in which serum biomarker samples were collected three times daily over the first 14 days following aneurysmal subarachnoid hemorrhage. Sample collection was initiated on intensive care unit admission and consent was obtained when research personnel could approach the patient or the patient’s surrogate decision maker.RESULTS: Twenty‐seven patients were eligible for the study, of whom only five were capable of providing informed consent. Full consent was obtained for 21 (78%) patients through self‐ (n=4) and surrogate (n=17) consent. Partial consent or refusal (only permitting the collection of blood samples as a part of routine care or use of data) occurred in three patients. Among the 22 consents sought from surrogates, three (11%) refused participation. The refusals included the sickest patients in the cohort. Once consent was provided, no patient or surrogate withdrew consent before study completion.DISCUSSION: Use of a deferred consent model enabled participation of critically ill patients in a minimal‐risk biomarker study with no withdrawals.CONCLUSIONS: Further research and enhanced awareness of the potential utility of hybrid models, including deferred consent in addition to patient or surrogate consent, in the conduct of low‐risk and minimally interventional time‐sensitive studies of critically ill patients are required.
The Efficacy of a Multidisciplinary Group Program for Patients with Refractory Chronic Pain
Authors: Inoue Masayuki , Inoue Shinsuke , Ikemoto Tatsunori , Arai Young-Chang P , Nakata Masatoshi , Miyazaki Atsuko , Nishihara Makoto , Kawai Takashi , Hatakeyama Noboru , Yamaguchi Setsuko , Shimo Kazuhiro , Miyagawa Hirofumi , Hasegawa Tomomi , Sakurai Hiroki , Hasegawa Yoshinobu , Ohmichi Yusuke , Ushida Takahiro 
Published: March 2016

BACKGROUND: Chronic pain is a major problem because it can result in not only a reduction in activities of daily living and quality of life but also requires initiation of social assistance. Seeking only to eliminate pain itself would appear to be too narrow an objective, in addition to often being unachievable; therefore, a multifaceted, comprehensive approach with multiple objectives is needed.OBJECTIVE: To describe the effects of a program (the ‘Chronic Pain Class’) offering cognitive behavioural therapy to small groups of individuals with refractory chronic pain in Japan. Exercise was an important feature of the program.METHODS: A total of 46 patients who were experiencing treatment difficulties and decreased activity participated in the program. The programs were conducted in groups of five to seven patients who met weekly for nine weeks. Weekly sessions, which were approximately 2 h in duration, combined lectures with exercise. Several measures related to pain and physical function were administered at the beginning and the conclusion of the program.RESULTS: Nine patients dropped out during the program. A number of measures (eg, pain intensity, disability, catastrophizing thoughts) showed significant improvements after intervention (P<0.002 after Bonferroni correction). Furthermore, most measures of physical function showed substantial improvement, especially seated forward bends, zig‐zag walking, self‐care and 6 min walk test (P<0.001).CONCLUSION: The results of the present study provide evidence that a combination of cognitive behavioural therapy and exercise should be recommended to patients with refractory chronic pain.
Physician Global Assessments or Blood tests do not Predict Mucosal Disease Activity in Ulcerative Colitis
Authors: Brahmania Mayur , Bernstein Charles N 
Published: March 2016

BACKGROUND: Mucosal healing has been proposed as the therapeutic end point in the treatment of patients with ulcerative colitis (UC).OBJECTIVE: To investigate the relationship between physician global assessment (PGA) and laboratory blood tests (complete blood count, ferritin, C-reactive protein, albumin) and endoscopic findings in UC to determine whether they could be adequate surrogates for endoscopy.METHODS: A retrospective chart review of patients known to have UC from July 2008 to November 2012 was performed at the Health Sciences Centre, Winnipeg, Manitoba. Patients included individuals with UC who underwent colonoscopy within one month of clinic assessment. Blood tests were standard at the time of colonoscopy. Patients presenting through the emergency department, those with colonoscopies performed outside the authors’ institution, or whose colonoscopies and clinical assessments were undertaken more than one month apart were excluded. The PGA was used to determine disease activity in patients before colonoscopy. The Ulcerative Colitis Endoscopic Index of Severity, a validated scoring system to rate endoscopic disease severity in ulcerative colitis, was adapted.RESULTS: A total of 154 patients (mean [± SD] age 44±15.7 years) with UC were identified including 82 (53%) men. Mean hemoglobin level was 139 g/L, mean platelet level was 296×109/L, mean ferritin level was 102 μg/L, mean C-reactive protein level was 10 mg/L and mean albumin level was 40 g/L. Using endoscopy as the ‘gold standard’ for assessing UC activity (moderate-severe), abnormalities in laboratory parameters and PGA were both highly specific but not sensitive for identifying individuals with at least moderately active endoscopic disease. The PGA had higher positive and negative predictive values than the laboratory parameters.CONCLUSION: Neither blood tests nor PGA could replace endoscopy for assessing mucosal healing. When patients experienced active symptoms and abnormal serum markers, they were highly likely to have abnormal endoscopy. However, inactive symptoms or normal laboratory values did not preclude having active endoscopic disease.
Restauration Fonctionnelle du Rachis : Effet du Niveau Initial de Douleur sur Les Performances des Sujets Lombalgiques Chroniques
Authors: Caby Isabelle , Olivier N , Mendelek F , Kheir R Bou , Vanvelcenaher J , Pelayo P 
Published: March 2016

BACKGROUND: Chronic low back pain is a persistent lumbar pain of multifactorial origin. The initial pain level remains poorly used to analyze and compare responses in low back pain patients in a reconditioning program.OBJECTIVE: To assess and evaluate the responses of subjects with very painful chronic low back pain in a dynamic and intensive care program.METHODS: A total of 134 patients with chronic low back pain were included in a spine functional restoration program for five weeks. The subjects were classified into two groups by level of pain: a group experiencing severe pain (n=28) and a group experiencing mild to moderate pain (n=106). All subjects received identical support consisting primarily of physiotherapy, occupational therapy, cardiovascular and muscular reconditioning as well as psychological counselling. The physical parameters (flexibility, muscular strength) and psychological (quality of life) were measured before (T0) and after the program (T5sem).RESULTS: All physical and functional performances of the subjects with severe pain were lower and the impact of back pain on quality of life for these subjects was increased. All significant differences at T0 between the two groups were no longer present at T5sem.DISCUSSION: Muscular atrophy is more important in subjects with severe pain at T0. The intense pain would cause kinesiophobia and central inhibition in chronic low back pain. The analgesic effects of the spine functional restoration program allowed subjects to obtain similar physical, functional and psychological performances at the end of the five weeks of support.CONCLUSIONS: Patients with very painful chronic low back pain respond favourably to the dynamic and intensive program. The intensity of low back pain had no effect on responses to the program. The spine functional restoration program enables patients to better manage their pain, whatever its level.
Real‐Time Polymerase Chain Reaction for Microbiological Diagnosis of Parapneumonic Effusions in Canadian Children
Authors: Pernica Jeffrey M , Moldovan Ioana , Chan Francis , Slinger Robert 
Published: March 2016

BACKGROUND: Community‐acquired pneumonia (CAP) complicated by parapneumonic effusion/empyema is an infectious syndrome commonly encountered by physicians caring for children in Canada.OBJECTIVE: To investigate the incremental benefit of novel molecular testing for the microbiological diagnosis of pediatric CAP complicated by parapneumonic effusion/empyema in Canada.METHODS: A convenience sample of pleural fluid from 56 children who had been admitted to hospital in Ontario with CAP complicated by parapneumonic effusion between 2009 and 2011 was examined. Multiple uniplex real‐time polymerase chain reaction (PCR) testing was performed on these pleural fluids and compared with traditional culture‐based testing of blood and pleural fluid samples.RESULTS: Molecular methods detected a pathogen in 82% of cases, whereas traditional cultures of blood and pleural fluids detected a pathogen in only 25%. The majority of parapneumonic effusions were associated with pneumococcal infection; Streptococcus pneumoniae was detected in 62% of the samples using molecular methods but in only 14% of samples using culture‐based methods. Streptococcus pyogenes, detected in 16% of samples using PCR, was the second most common pathogen found. No patients were found to have empyema caused by Staphylococcus aureus.DISCUSSION: The results showed that multiple uniplex real‐time PCR performed substantially better than traditional culture methods for microbiological diagnosis of CAP complicated by effusion/ empyema. S pneumoniae and S pyogenes were found to be responsible for the majority of infections. The approach detected pathogens in a similar proportion of pleural fluid samples as previously reported nested PCR assays; furthermore, the real‐time closed‐well approach also minimized the risk of nonspecificity due to cross‐contamination relative to nested PCR.CONCLUSIONS: Real‐time PCR for the detection of bacterial DNA in pleural fluids has the potential to better define the microbiological cause of pediatric CAP. This approach could help clinicians provide targeted antimicrobial therapy.
Idiopathic Pulmonary Fibrosis: New Insights to Functional Characteristics at Diagnosis
Authors: Cortes-Telles Arturo , Forkert Lutz , O’Donnell Denis E , Morán-Mendoza Onofre 
Published: March 2016

BACKGROUND: The lung function of patients with idiopathic pulmonary fibrosis (IPF) has not been characterized in detail.OBJECTIVE: To characterize the heterogeneous physiological abnormalities that exist in patients with IPF during their initial clinical evaluation.METHODS: Lung function tests from 93 patients, performed within six months of the initial diagnosis of IPF, were obtained from a referral pulmonary function laboratory at a tertiary care hospital in Canada. A restrictive pattern was defined as total lung capacity (TLC) <95th percentile of predicted value. Patients with obstructive lung disease, lung cancer, emphysema and other restrictive lung diseases were excluded.RESULTS: On diagnosis, 73% of patients with IPF had a restrictive pattern, with a mean TLC of 72% of predicted. Mean forced vital capacity (FVC) was 71% and 44% of patients had an FVC <95th percentile. Mean diffusing capacity for carbon monoxide (DLco) was 60% and DLco/alveolar volume (VA) 92% of predicted. Increased severity of restriction – based on TLC – was associated with lower DLco (74% of predicted in mild restriction and 39% of predicted in severe restriction) and higher forced expiratory volume in 1 s (FEV1)/FVC ratio (82% of predicted in mild restriction and 90% of predicted in severe restriction) but not with age (76 years in mild restriction and 69 years in severe restriction). Regardless of severity of restriction, the average DLco/VA (≥86% of predicted) remained within normal limits.CONCLUSIONS: One in four patients with IPF had normal TLC and more than one‐half had a normal FVC during initial evaluation. As the severity of the restriction increased, FEV1/FVC increased, DLco decreased but DLco/VA remained normal.
Adult Attachment and Approaches to Activity Engagement in Chronic Pain
Authors: Andrews Nicole E , Meredith Pamela J , Strong Jenny , Donohue Genevieve F 
Published: March 2016

BACKGROUND: The way in which individuals with chronic pain habitually approach activity engagement has been shown to impact daily functioning, with both avoidance of one’s daily activities and overactivity (activity engagement that significantly exacerbates pain) associated with more pain, higher levels of physical disability and poorer psychological functioning.OBJECTIVE: To provide insight into the development of maladaptive habitual approaches to activity engagement in chronic pain by applying an attachment theory framework.METHODS: A sample of 164 adults with chronic pain completed selfreport measures of attachment, approach to activity and pain cognitions. Mediation analyses were undertaken to examine the direct association between attachment variables and maladaptive approaches to activity, and to test for the mediating role of pain cognitions (catastrophizing and thought suppression).RESULTS: Results demonstrated that higher levels of secure attachment were associated with lower levels of activity avoidance, which was fully mediated by lower levels of pain catastrophizing; higher levels of preoccupied or fearful attachment were directly associated with higher levels overactivity; higher levels of preoccupied attachment were associated with higher levels of activity avoidance, which was partially mediated by higher levels of pain catastrophizing; and higher levels of fearful attachment were indirectly associated with higher levels of activity avoidance through higher levels of catastrophizing.CONCLUSIONS: These results provide preliminary support for the suggestion that insecure attachment may be a source of vulnerability to the development of disabling activity patterns in chronic pain.