bluuebunny/crossref_metadata_2025_split huggingface dataset:
The BC Community Pharmacy Asthma Study: A Study of Clinical, Economic and Holistic Outcomes Influenced by an Asthma Care Protocol Provided by Specially Trained Community Pharmacists in British Columbia
Authors: Mclean William , Gillis Jane , Waller Ron 
Published: March 2016

OBJECTIVES: Despite advances in recent years, asthma morbidity and mortality have been noted to be on the increase in the past decade. The present study examined the failures and recommendations of past studies and introduced a new milieu for asthma care ‐ the community pharmacy. The study incorporated a care protocol with the important ingredients of asthma education on medications, triggers, self‐monitoring and an asthma plan, with pharmacists taking responsibility for outcomes, assessment of a patient′s readiness to change and tailoring education to that readiness, compliance monitoring and physician consultation to achieve asthma prescribing guidelines.METHODS: Thirty‐three pharmacists in British Columbia, specially trained and certified in asthma care, agreed to participate in a study in which experienced pharmacists would have asthma patients allocated to enhanced (pharmaceutical) care (EC) or usual care (UC). Pharmacists less experienced were clustered by geography and had their pharmacies randomized to two levels of care; each pharmacy then had patients randomized to EC versus control, UC versus control or EC versus UC depending on their pharmacy randomization. Six hundred thirty‐one patients provided consent, of which 225 in EC or UC were analyzed for all outcomes. Patients were followed for one year.RESULTS: Compared with patients in the UC group, the results of those in the EC group were as follows: symptom scores decreased by 50%; peak flow readings increased by 11%; days off work or school were reduced by approximately 0.6 days/month; use of inhaled beta‐agonists was reduced by 50%; overall quality of life improved by 19%, and the specific domains of activity limitations, symptoms and emotional function also improved; initial knowledge scores doubled; emergency room visits decreased by 75%; and medical visits decreased by 75%. A patient satisfaction survey revealed that the population was extremely pleased with their pharmacy services. Cost analysis reinforces the EC model, which is more cost effective than UC in terms of most direct and indirect costs in asthma patients.CONCLUSION: Specially trained community pharmacists in Canada, using a pharmaceutical care‐based protocol, can produce impressive improvements in clinical, economic and humanistic outcome measures in asthma patients. The health care system needs to produce incentives for such care.
Three Generations of Experience and Thought in Microbiology and Infection
Authors: Goldner Morris 
Published: March 2016

Views and comments were sought from Brian Lacey, who was professionally active from the 1930s to the 1970s, Alain Dublanchet, active from the 1960s to the 2000s, and Mark Pallen, active from the 1990s to 2000 and beyond. Professor Lacey was professor of microbiology at the Westminster Medical School, University of London, United Kingdom, for many years and is now retired. Docteur Dublanchet is the long time head of the laboratory of microbiology and virology at the Centre Hospitalier Intercommunal de Villeneuve‐Saint‐Georges in the greater Paris area. Professor Pallen is currently professor of bacterial genetics at the Medical School, University of Birmingham (United Kingdom); he is a keen enthusiast of genomic studies in the interest of molecular pathogenesis research. All three are medically qualified. Four questions were posed to each:What was the situation like in the infectious disease field when you first started your career?What do you feel have been the most important accomplishments with regard to problems of infectious disease during your period of activity?What do you foresee as the vital matters that still need to be addressed for countering infectious disease?Can infectious disease ever, practically, be eradicated and, if so, how would this be accomplished?
Parental Judgments of Infant Pain: Importance of Perceived Cognitive Abilities, Behavioural Cues and Contextual Cues
Authors: Pillai Riddell Rebecca R , Badali Melanie A , Craig Kenneth D 
Published: March 2016

BACKGROUND: Despite blatant indications, such as behavioural and contextual cues, infant pain is often undermanaged by adult caretakers. The belief that infants are limited in their abilities to comprehend the meaning of an experience or recall that experience has been used to minimize or deny the need for intervention in this vulnerable population.OBJECTIVES: This investigation explored parental beliefs regarding the impact of infant cognitive capabilities, behavioural cues and contextual cues to their pain judgments. Particular interest was focused on their beliefs regarding the general cognitive capabilities of infants of different ages.METHODS: Forty‐nine parents viewed videotapes of healthy infants, aged two, four, six, 12 and 18 months, receiving routine immunization injections and provided judgements of the severity of pain on a 100 mm Visual Analogue Scale. Upon completion of their pain judgements for each of the five age groups (two infants per age group; 10 infants total), parents completed questionnaires regarding their beliefs about the capabilities of infants in that age group and then reported the importance of the various cues utilized to formulate their pain judgements.RESULTS: Parents attributed substantial pain to infants in all age groups, almost twice the amount they hypothesized an adult undergoing a similar injection would experience. The cues rated as most important for judgements were similar for infants of varying ages. Overall, facial expressions, sounds and body movements were consistently reported to be most important. Parents acknowledged the development of memory and understanding of pain throughout infancy. However, these beliefs were not deemed by parents as important to their pain ratings, nor were their importance ratings directly related to the pain ratings.CONCLUSION: Parents judged that infants undergoing a routine immunization were experiencing clinically significant levels of pain. However, despite generally acknowledging a developing trajectory for memory and understanding across the five age groups, parents did not indicate that a child′s ability to remember and understand pain were essential features of their pain judgements. The results indicated that memory and understanding did not influence parental judgements of infant pain demonstrating the validity of the parents′ self‐assessments.
An Economic Evaluation of Voriconazole versus Amphotericin B for the Treatment of Invasive Aspergillosis in Canada
Authors: Rotstein Coleman , Laverdière Michel , Marciniak Anne , Ali Farzad 
Published: March 2016

BACKGROUND: Invasive aspergillosis (IA) is a serious fungal infection that affects immunocompromised patients. The Global Comparative Aspergillosis study demonstrated that voriconazole, a new broad‐spectrum triazole, had better responses and improved survival compared with conventional amphotericin B deoxycholate (CAB) and other licensed antifungal therapy (OLAT) for the treatment of definite or probable aspergillosis.OBJECTIVES: To compare costs and outcomes of voriconazole and CAB for the treatment of definite or probable aspergillosis in Canada.METHODS: A cost‐consequence decision tree model was designed to reflect the treatment pathways used in clinical practice when using voriconazole or CAB as primary therapy for IA. Therapy included initial treatment with either voriconazole or CAB and then switched to an OLAT in the event of an inadequate response, severe toxicity or intolerance. The principal data source used was the Global Comparative Aspergillosis study.RESULTS: The total cost of voriconazole when compared with CAB as initial therapy for IA was $38,319 versus $42,495 per patient, respectively, representing a 9.8% cost reduction for each patient treated with voriconazole. The higher mean cost in the CAB arm was primarily due to the high proportion of patients (73.7%) who were switched to an OLAT due to severe side effects or an inadequate response. Treating with voriconazole was a dominant strategy. The number of patients that had to be treated with voriconazole instead of CAB to save one additional life was eight.CONCLUSIONS: Voriconazole as primary treatment for IA increased the chances of successful treatment, improved survival and may represent a potential cost saving strategy in Canada.
Perspectives on Emerging Zoonotic Disease Research and Capacity Building in Canada
Authors: Stephen Craig , Artsob Harvey , Bowie William R , Drebot Michael , Fraser Erin , Leighton Ted , Morshed Muhammad , Ong Corinne , Patrick David 
Published: March 2016

Zoonoses are fundamental determinants of community health. Preventing, identifying and managing these infections must be a central public health focus. Most current zoonoses research focuses on the interface of the pathogen and the clinically ill person, emphasizing microbial detection, mechanisms of pathogenicity and clinical intervention strategies, rather than examining the causes of emergence, persistence and spread of new zoonoses. There are gaps in the understanding of the animal determinants of emergence and the capacity to train highly qualified individuals; these are major obstacles to preventing new disease threats. The ability to predict the emergence of zoonoses and their resulting public health and societal impacts are hindered when insufficient effort is devoted to understanding zoonotic disease epidemiology, and when zoonoses are not examined in a manner that yields fundamental insight into their origin and spread.Emerging infectious disease research should rest on four pillars: enhanced communications across disciplinary and agency boundaries; the assessment and development of surveillance and disease detection tools; the examination of linkages between animal health determinants of human health outcomes; and finally, cross‐disciplinary training and research. A national strategy to predict, prevent and manage emerging diseases must have a prominent and explicit role for veterinary and biological researchers. An integrated health approach would provide decision makers with a firmer foundation from which to build evidence‐based disease prevention and control plans that involve complex human/animal/environmental systems, and would serve as the foundation to train and support the new cadre of individuals ultimately needed to maintain and apply research capacity in this area.
Inhaled Corticosteroids in COPD: Determinants of Use and Trends in Patient Persistance with Treatment
Authors: Blais Lucie , Bourbeau Jean , Dheehy Odile , LeLorier Jacques 
Published: March 2016

METHODS: The determinants of a new treatment with inhaled corticosteroids and secular trends in patient persistence with treatment among chronic obstructive pulmonary disease (COPD) patients were investigated. A cohort of 3768 physician‐diagnosed, elderly COPD patients was selected between 1990 and 1996 from the health care administrative database of the Régie de l′assurance maladie du Québec. A nested case‐control design was used to identify patient and physician characteristics that were associated with a new treatment with inhaled corticosteroids. Treatment persistence with inhaled corticosteroids was also estimated using Kaplan‐Meier analysis. In addition to that, changes in treatment persistence over time, from 1990 to 1995, were investigated by estimating the yearly proportion of patients persisting for less than one year.RESULTS: Within the cohort, the yearly percentage of patients filling at least one prescription for inhaled corticosteroids was 42.2% in 1990 and increased to 53.1% in 1995 (P=0.001). Using a conditional logistic regression model, it was found that the patients most likely to initiate a treatment with inhaled corticosteroids were those who had severe COPD (rate ratio [RR] 1.7; 95% CI 1.4 to 2.0), those who were hospitalized for COPD (RR 10.0; 95% CI 5.6 to 17.9), those who consulted a respirologist in the previous month (RR 2.3; 95% CI 1.6 to 3.3) or those who visited more than three different physicians in the previous three months (RR 1.6; 95% Cl 1.3 to 1.9). The proportion of patients persisting with inhaled corticosteroids for less than one year rose by 19.4%, from 47.6% in 1990 to 67.0% in 1995 (P=0.011; test for trend).CONCLUSIONS: The use of inhaled corticosteroids increased while patient persistence decreased between 1990 and 1995. Disease severity, as well as recent consultation to a respirologist and multiple visits to a physician, were associated with a strong likelihood of being prescribed inhaled corticosteroids. The cost of this practice is far from negligible, while their clinical impact is still uncertain.
Exploring Physicians′ Comfort Level with Opioids for Chronic Noncancer Pain
Authors: Scanlon Martin N , Chugh Urmil 
Published: March 2016

OBJECTIVE: To explore the attitudes of family physicians (FPs) toward the use of opioids in the management of chronic noncancer pain (CNCP) in the Calgary Health Region (CHR), Calgary, Alberta.METHODS: From January to February 2003, random samples of 147 FPs (32 were used to pretest the instrument and were therefore excluded from the findings) and 142 specialists practicing in the CHR were invited to participate in a 20 min survey to explore aspects of CNCP management in the CHR. Physicians′ comfort in prescribing opioids and nonsteroidal anti‐inflammatory drugs for CNCP was measured on a four‐point ordinal scale. The specialists′ subgroup served as a quasi‐control group. In addition, a short version of the survey was provided for those physicians who declined to fully partake in the study. This allowed the researchers to compare important characteristics between respondents and nonrespondents.RESULTS: A total of 125 physicians (63 FPs and 62 specialists) participated in the study. The overall response rate was 48.6% and response rates for FPs and specialists were 54.8% and 43.7%, respectively. Response rates for the long version of the survey were 42.6% for FPs (n=49), 31.6% for other specialists (n=45) and 36.6% for both combined. The majority of FPs and specialists (98% and 71.1%, respectively) reported that ′they can handle′ nonsteroidal anti‐inflammatory drugs, Tylenol No 3 with Codeine (Janssen‐Ortho/McNeil Consumer Healthcare, Canada) (95.9% and 64.4%, respectively), morphine/MS Contin (Purdue Pharma, Canada) (61.2% and 24.4%, respectively) and Percocet (Bristol‐Myers Squibb, Canada)/OxyContin (Purdue Pharma, Canada) (61.2% and 33.3%, respectively). Fewer FPs and specialists report that ′they can handle′ Dilaudid (Abbott Laboratories, Canada)/Hydromorph Contin (Purdue Pharma, Canada) (36.7% and 13.3%, respectively), fentanyl patch (30.6% and 11.1%, respectively) and methadone (0% and 6.7%, respectively). Male FPs reported a greater degree of comfort than female FPs regarding morphine/MS Contin, Percocet/OxyContin and Dilaudid/Hydromorph Contin (Mann‐Whitney U tested at a£0.05). No sex differences were detected among specialists. No relationship was detected between comfort and years of practice or number of chronic pain patients in practice. Among specialists, a weak positive relationship was detected between the degree of comfort with methadone (Spearman′s rank correlation coefficient=0.35, a=0.03) and the significance of pain management in the practice. Except for methodone, the FPs reported a higher confidence with the drugs in question compared with specialists (a£0.05).CONCLUSIONS: FPs in the CHR need to increase their comfort level toward opioids in general to adequately manage CNCP. Their lack of comfort may reflect a lack of education or fear of regulatory scrutiny.
The Computer‐Assisted Cognitive/Imagery System for Use in the Management of Pain
Authors: Borckardt Jeffrey J , Younger Jarred , Winkel Justin , Nash Michael R , Shaw Darlene 
Published: March 2016

BACKGROUND: There is growing interest in computer‐delivered psychological interventions for a number of clinical conditions, including pain.OBJECTIVES: This study tests the effectiveness of a new computer‐delivered pain‐management program using a laboratory pain paradigm.METHODS: One hundred twenty undergraduate students were randomly assigned to either the computerized pain‐management group or the distraction control group. Subjects underwent a cold‐pressor task and were asked to continuously rate their subjective pain experience.RESULTS: Women receiving the computerized pain management intervention were able to tolerate the cold‐pressor task longer than those in the control group. No effect was found for men. Subjective pain ratings were consistently lower during the cold‐pressor task for subjects in the computerized pain‐management group regardless of sex. Subjects receiving the computerized intervention reported feeling more comfortable and relaxed than control subjects during the cold‐pressor task.CONCLUSIONS: Findings indicate that further investigations of the program used in this study are warranted to determine its potential clinical utility and that of similar computerized interventions for pain.
Canadian Consensus Guidelines for the Management of Cytomegalovirus Disease in HIV/AIDS
Authors: Lalonde Richard G , Bovivin Guy , Deschênes Jean , Hodge William G , Hopkins J Jill , Klein Alex H , Lindley Janette I , Phillips Peter , Shafran Stephen D , Walmsley Sharon 
Published: March 2016

BACKGROUND: The management of HIV‐infected patients with cytomegalovirus (CMV) disease has changed significantly with the availability of highly active antiretroviral therapy (HAART).OBJECTIVES: These updated guidelines are intended to provide practical help to physicians managing HIV‐positive patients with or at risk for CMV disease.METHODS: The 10 members of the Canadian CMV Disease in HIV/AIDS Consensus Group were infectious disease specialists, a primary care physician and ophthalmologists with expertise in HIV and CMV infection. Financial support by Hoffmann‐La Roche Canada Ltd was unrestricted, and was limited to travel expenses and honoraria. The consensus group met in June and October 2002. Key areas to be considered were identified, and group members selected, reviewed and presented relevant recent literature for their assigned section for the group′s consideration. Evidence was assessed based on established criteria, which were expert opinions of the members. Draft documents were circulated to the entire group and modified until consensus was reached. The final guidelines represent the group′s consensus agreement. The guidelines were approved by the Canadian Infectious Disease Society.RESULTS AND CONCLUSIONS: The guidelines address symptom monitoring, screening for early detection and prevention, and treatment using oral, intravenous and intraocular anti‐CMV therapies in conjunction with HAART.
Outcome of Patients Admitted to Intensive Care Unit for Acute Exacerbation of Idiopathic Pulmonary Fibrosis
Authors: Al-hameed Fahad M , Sharma Sat 
Published: March 2016

RATIONALE: The aim of this study was to evaluate the outcome of intensive care unit (ICU) admission in patients with idiopathic pulmonary fibrosis (IPF) who develop acute respiratory failure of unknown etiology.METHODS: A retrospective study at University of Manitoba hospitals reviewed all patients admitted to the ICU from November 1988 to December 2000 with IPF requiring mechanical ventilation for unknown causes of acute respiratory failure. Survival at hospital discharge was assessed as the primary end point and ICU length of stay as a secondary end point. In the absence of open lung biopsy, major and minor clinical criteria (as per American Thoracic Society statements) were used for the diagnosis of IPF. Infections were ruled out by extensive surveillance cultures and/or bronchoscopy with bronchoalveolar lavage.RESULTS: Eighty‐eight charts were reviewed and 25 patients met the inclusion criteria. The mean (± SD) age was 69±11 years (range 42 to 96 years) and 23 patients were male. With the exception of one survivor who was discharged home, 21 patients died while receiving mechanical ventilation, and three patients died in hospital shortly after ICU discharge (one day, 22 days and 67 days). Intubation and mechanical ventilation were administered to 21 patients, with a mean duration of 11±6 days (range two to 27 days); the other four patients were treated with noninvasive ventilation. The average duration of symptoms before ICU admission was 22±26 days. All patients were treated with systemic corticosteroids, while eight patients received additional chemotherapy.CONCLUSIONS: In the absence of a reversible cause, patients with IPF who develop acute exacerbation of IPF may not benefit from ICU admission and mechanical ventilation. However, it is imperative that a diagnostic workup be performed to rule out an infectious or other reversible cause of respiratory failure before admission to the ICU is denied.
A Population‐Based Evaluation of a Regional Asthma Education Centre
Authors: Cowan Simone , Ernst Pierre , Cartier André , Boulet Louis-Philippe 
Published: March 2016

BACKGROUND: A population‐based, ecological evaluation was conducted to determine the impact of a regional asthma education centre on reducing asthma‐related morbidity and improving the quality of prescribing.METHODS: The number of emergency department (ED) visits for respiratory‐related illness and the prescribing of antiasthmatic medications were monitored during consecutive 18‐month pre‐ and postintervention periods in two communities with similar health care resources. Using defined daily doses, the quality of prescribing was assessed by calculating the ratio of inhaled corticosteroids to inhaled, short‐acting beta2‐agonists.RESULTS: The reduction in the rate of respiratory‐related ED visits in subjects five to 45 years of age was 410 per 10,000 people and 450 per 10,000 people for the intervention and nonintervention communities, respectively. A significant reduction in the rate of ED visits of 698 per 10,000 people was found for patients aged 35 to 45 years in the intervention community (P<0.05). The reduction achieved statistical significance in the nonintervention community in younger patients: 557 per 10,000 people and 567 per 10,000 people for patients aged five to 14 years and 15 to 24 years, respectively (P<0.05). The ratio of inhaled corticosteroids to inhaled beta2‐ agonists increased from 0.47 to 0.78 in the intervention community ‐‐ a 66% change. However, over the course of the preintervention period, the prescribing ratio was already increasing in this community. The corresponding ratios were 0.47 and 0.53 in the nonintervention community ‐‐ an increase of 13%.CONCLUSIONS: A conclusive association between the establishment of an asthma education centre and changes in health care use or the quality of prescribing could not be demonstrated.