bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost Effectiveness Analysis of Azithromycin and Doxycycline for Chlamydia Trachomatis Infection in Women: A Canadian Perspective
Authors: Marra Fawziah , Marra Carlo A , Patrick David M 
Published: March 2016

OBJECTIVE: To assess the cost effectiveness of azithromycin versus doxycycline therapy for cervical Chlamydia trachomatis infections in Canada.DESIGN: A predictive decision analytic model using previously published clinical and economic evaluations, expert opinion and costs of medical care in Canada.POPULATION: A hypothetical cohort of 5000 women followed over 10 years.INTERVENTIONS: Two diagnostic strategies were compared, laboratory confirmed diagnosis (LCD) and presumptive diagnosis (PD) of C trachomatis infection. Under each strategy, two treatment alternatives were analyzed, a single 1 g dose of azithromycin and a seven‐day course of doxycycline as 100 mg twice daily.RESULTS: Despite a fourfold higher acquisition cost, under base case conditions, for both diagnostic strategies, the azithromycin treatment alternative was more cost effective than the doxycycline alternative. For the LCD model, the cost per cure for patients receiving azithromycin was $184.76 compared with $240.59 for patients receiving doxycycline, resulting in an incremental cost of $55.83. For the PD model, the cost per cure for patients treated with azithromycin was $51.48 compared with $51.82, resulting in an incremental cost of $0.34. For the hypothetical cohort of 5000 women, the use of azithromycin translates into a projected annual cost savings of $279,150 and $1,700 for the LCD and PD models, respectively. In one‐way sensitivity analyses for the LCD model, no clinically plausible changes in the base case estimates changed the results of the cost effectiveness outcome. In the PD model, clinically plausible changes in the probabilities of doxycycline cure, pelvic inflammatory disease, sequelae and chlamydia infection were found to alter the cost effectiveness outcome.CONCLUSIONS: Based on the results from our model, the azithromycin strategy should be employed for the treatment of laboratory confirmed cases. However, for presumptive cases, azithromycin should be used only if the probabilities of C trachomatis and pelvic inflammatory disease are more than 19%, doxycycline effectiveness is less than 78%, or the cost of azithromycin is less than $19.00.
Current Indications for the Use of Clindamycin: A Critical Review
Authors: Smieja Marek 
Published: March 2016

OBJECTIVES: To review the literature and develop evidence‐based guidelines for the use of the antibiotic clindamycin.DATA SOURCES: A search of the MEDLINE database for randomized clinical trials, cohort studies and review articles that examine the therapeutic use or potential adverse effects of clindamycin was undertaken for the years 1966 to 1996. In addition, relevant citations obtained from the references cited in the identified reviews, book chapters and antibiotic guidelines were included.DATA EXTRACTION: Selected articles examining the indications for or adverse effects from the prophylactic or therapeutic use of clindamycin were selected. A level of evidence was assigned to the indication according to published criteria.DATA SYNTHESIS AND CONCLUSIONS: Randomized clinical trials (level 1 evidence) support the use of clindamycin in a number of common conditions, including preoperative prophylaxis, intra‐abdominal infections, recurrent group A streptococcal pharyngitis, Chlamydia trachomatis cervicitis and anaerobic lung infections. Cohort studies (level 2 evidence) support the use of clindamycin for bone and soft tissue infections. Expert opinion (level 3 evidence) supports the use of clindamycin for invasive group A streptococcal infection and the treatment of diabetic foot infections. Clindamycin’s disadvantages are its high cost, the common occurrence of rash and the predisposition of patients taking clindamycin to Clostridium difficile‐associated colitis. Based on cohort studies, the risk of severe diarrhea in out‐patients is as low as one per 1000, but the risk of in‐patients acquiring C difficile colonization may be as high as 30%.
Imipenem and Meropenem: Comparison of In Vitro Activity, Pharmacokinetics, Clinical Trials and Adverse Effects
Authors: Zhanel George G , Simor Andrew E , Vercaigne Lavern , Mandell Lionell , the Canadian Carbapenem Discussion Group  
Published: March 2016

OBJECTIVE: To compare and contrast imipenem and meropenem in terms of in vitro activity, pharmacokinetics, clinical efficacy and adverse effects.DATA SELECTION: MEDLINE search from 1975 to 1997 and follow‐up of references.DATA EXTRACTION: Clinical trials comparing imipenem with meropenem, or either imipenem or meropenem with standard therapy in the treatment of serious infections were selected.DATA SYNTHESIS: Imipenem, the first carbapenem, was first marketed in 1987; meropenem was introduced to the market in 1996. In general, imipenem is more active against Gram‐positive cocci while meropenem is more active against Gram‐negative bacilli. The agents display similar pharmacokinetics. Clinical studies in patients with serious infections (intra‐abdominal infection, respiratory infection, septicemia, febrile neutropenia) report similar bacteriological and clinical cure rates with imipenem and meropenem. Meropenem is approved for the treatment of bacterial meningitis, whereas imipenem is not. Adverse effects are similar.CONCLUSIONS: Current literature supports the use of imipenem at a dose of 500 mg every 6 h and meropenem at 1 g every 8 h for the treatment of severe infections. For the treatment of serious infections, imipenem (500 mg every 6 h or 2 g/day [$98/day]) is more economical than meropenem (1 g every 8 h or 3 g/day [$142/day]) based on acquisition cost.
A Cross‐Canada Survey of Cytomegalovirus Prevention and Treatment Practices in Bone Marrow Transplant Recipients
Authors: Humar Atul , Lipton Jeff , Messner Hans , McGeer Allison , Mazzulli Tony 
Published: March 2016

OBJECTIVE: To gather information about cytomegalovirus (CMV) prevention and treatment practices in bone marrow transplantation (BMT) in Canada.DESIGN: A questionnaire was mailed to all centres across Canada performing BMT in January 1998. A second mailing was sent three months later.POPULATION STUDIED: Data on 15 centres performing allogeneic BMT (total patients 459) and 16 centres (total patients 703) performing autologous BMT were obtained.RESULTS: For allogeneic BMT, all donors and recipients had pretransplant CMV serology performed. Nine centres gave CMV‐negative blood to only donor‐negative/recipient‐negative patients, four centres to all patients and two centres to other subgroups. All allogeneic BMT centres had a strategy for CMV prevention. Three centres used universal ganciclovir prophylaxis, while 12 centres used some form of pre‐emptive ganciclovir therapy based on weekly antigenemia assays (four centres), weekly polymerase chain reaction (two centres), CMV blood cultures (one centre), CMV throat and urine cultures (one centre), CMV screening bronchoscopy (two centres), or a combination of antigenemia plus bronchoscopy (two centres). The dose and duration of pre‐emptive ganciclovir varied considerably from centre to centre. In addition, many centres used high dose acyclovir universally for a variable period of time post‐BMT. For the treatment of CMV pneumonia, 14 centres used ganciclovir plus immunoglobulin (IG) and one centre used ganciclovir alone. Ganciclovir treatment duration ranged from two to 11 weeks and the number of doses of IG from three to 18. Thirteen of 16 autologous BMT centres screened patients for CMV pretransplant. Ten centres used CMV negative blood for some or all of their patients. Only one centre performed routine CMV monitoring after autologous BMT.CONCLUSIONS: Practices for the prevention of CMV disease in BMT patients differ widely across centres, and further data may assist in developing a consensus regarding the optimal approach to CMV management.
Persistently HIV‐1 Seronegative Nairobi Sex Workers Are Susceptible to In Vitro Infection
Authors: Bienzle Dorothee , MacDonald Kelly S , Copeland Karen FT , Bwayo Job J , Plummer Francis A , Rosenthal Kenneth L 
Published: March 2016

OBJECTIVE: To evaluate whether resistance to HIV‐1 infection in a subset of highly exposed sex workers correlates with resistance at the cellular level.DESIGN: In vitro evaluation of susceptibility to infection by Kenyan HIV‐1 isolates and cellular production of potential mediators of resistance.SETTING: Samples were collected in a primary care clinic in Nairobi.PATIENTS: Thirteen individuals from a cohort of sex workers with a similar risk of acquiring HIV infection and six unexposed controls.INTERVENTIONS: Subjects were provided with appropriate primary care and counselling on the prevention of sexually transmitted diseases.RESULTS: No inherent cellular resistance to infection was identified. CD8+ cells from a subset of subjects strongly inhibited viral replication.CONCLUSIONS: Lack of infection in this cohort was not attributable to factors inherent to CD4+ cells. Resistance to HIV infection is likely to be multifactorial, and products of CD8+ cells and unique features of mucosal sites probably contribute to this state.
Tuberculosis among Aboriginal and Nonaboriginal Persons in British Columbia
Authors: Wang L , Noertjojo K , Elwood RK , FitzGerald J Mark 
Published: March 2016

OBJECTIVE: To compare cases of tuberculosis (TB) diagnosed among aboriginal persons with a random sample of nonaboriginal persons diagnosed with TB, and evaluate the trends in rates of disease between both groups during the same period.DESIGN: A case‐control study.SETTING: A provincial TB control program.PATIENTS AND METHODS: All patients with TB diagnosed among aboriginal persons in British Columbia between 1992 and 1996 were compared with control patients diagnosed during the same period. For each patient a control patient was identified.INTERVENTION: The demographic details, type of disease, bacteriology, risk factors for TB, therapy received as well as mode of administration were documented. The number of contacts identified for each patient as well as the number of patients completing chemoprophylaxis were identified. The rates of disease during the same period were also documented.RESULTS: During the study, 202 patients with TB were diagnosed among aboriginal persons and 201 controls were chosen. Apart from age at diagnosis (35.1±20 years versus 45.7±19.7), differences in the prevalence of lymphadenopathy (5.9% versus 16.4%, P=0.0008) and pleural disease (21.3% versus 16.4%, P=0.00008), there were no differences in presentation between aboriginal and nonaboriginal people. Aboriginal people were more likely to have a history of contact with a patient with TB (53% versus 17.9%, PÃ0.05), to have received directly observed therapy (55% versus 33.8%, P=0.00002) and to have contacts who were purified protein derivative (PPD) positive (4±9 versus 2±3, P=0.002). These contacts were more likely to start isoniazid (2±3 versus 1±1, P=0.002). Overall, there was a significant decline in rates of TB among aboriginal persons compared with the general population, but there was a small increase in rates among all subjects in the final year of the study.CONCLUSIONS: In the present study, significant variations in rates of TB among different population groups in British Columbia were found. During the study period, there was a greater decline in the rates of TB among aboriginal persons. A greater use of directly observed therapy and greater use of chemoprophylaxis occurred among aboriginal persons, which may have contributed to this decline, or alternatively, it simply reflects the natural evolution of the TB epidemic.
The Impact of Nationally Coordinated Pharmacy‐Based Asthma Education Intervention
Authors: Diamond Shelley Anne , Chapman Kenneth Ross 
Published: March 2016

OBJECTIVE: To assess the impact of a nationally coordinated pharmacy‐based educational intervention on self‐management behaviour and markers of asthma control in self‐referred patients with asthma.DESIGN: An asthma clinic day was set up by a national chain of community pharmacies whereby pharmacists used a structured questionnaire to assess asthma control and self‐care among self‐referred patients with doctor‐diagnosed asthma. In a one‐on‐one counselling session, each patient′s educational needs were identified and the appropriate education offered. A telephone follow‐up 30 days later assessed the impact of teaching.SETTING: Community pharmacies across Canada.OUTCOME MEASURES: The follow‐up questionnaire quantified the number of wheezing episodes or other symptoms per week, the number of night‐time awakenings per week, and the frequency of use of reliever and preventive medications.RESULTS: Of 4080 patients assessed, 22.2% used an inadequate inhaler technique, 16.4% used a short acting beta2‐agonist excessively and 21.0% were not using an inhaled corticosteroid daily despite a frequency of symptoms that would suggest that it was needed. Common educational interventions included a review of inhaler technique (41.9%), a recommendation for regular inhaled corticosteroids (31.5%) and a referral to the primary care physician (21.0%). Thirty days after the educational intervention, patients reported significant decreases in the frequency of daytime asthma symptoms, the frequency of nocturnal symptoms and the frequency with which short acting beta2‐agonists were used, while reporting significant increases in their use of preventive medication.CONCLUSIONS: A brief assessment and an educational intervention in the community pharmacy can produce significant short term improvements in patient‐reported symptom control and appropriate self‐management behaviour.
Influence of Bulla Volume on Postbullectomy Outcome
Authors: Baldi S , Palla A , Mussi A , Falaschi F , Carrozzi L , Giuntini C , Angeletti CA 
Published: March 2016

OBJECTIVE: To quantify the contribution of the resected volume and the presence of associated, functionally significant emphysema to the postoperative improvement of pulmonary function after resection of giant lung bullae.DESIGN: Patients undergoing elective surgery for giant bullae who had had complete pulmonary function and radiographic studies performed were reviewed retrospectively.SETTING: All 25 patients underwent surgery at the thoracic surgery unit of the University of Pisa, Pisa, Italy.METHODS: Pulmonary function was assessed before and 12 months after surgery. On the chest radiograph, the location of bullae, and the signs of compression and emphysema were evaluated. The radiographic total lung capacity (TLCx-ray) and the volume of bullae were measured according to the ellipse method. Postoperatively, functional and radiographic changes were analyzed. The percentage change in forced expiratory volume in 1 s (deltaFEV1%) after surgery was the main outcome measure. The influence of factors related to emphysema and bulla volume on the functional improvement postbullectomy was assessed by stepwise multiple regression.RESULTS: Before surgery, the TLCx-ray overestimated the TLC measured by nitrogen washout, with a mean difference between the two measurements of 1.095 L. A close relationship was found between the TLCx-ray and the plethysmographic TLC (n=6; r=0.95). After surgery, dyspnea lessened (P<0.05) and FEV1 increased (P<0.01). Statistically, the radiographic bulla volume was the single most important factor determining the deltaFEV1% (r=0.80, P<0.0001).CONCLUSIONS: These findings suggest that the preoperative size of bullae is the most important contributor to the improvement in ventilatory capacity after bullectomy, and that it is possible to predict the expected increase of postoperative FEV1 from preoperative bulla volume.
The Use of Guidelines for the Empiric Treatment of Hospital‐Acquired Pneumonia
Authors: Miletin Michael S , Chan Charles K 
Published: March 2016

BACKGROUND: Several practice guidelines for the empirical antimicrobial treatment of hospital‐acquired pneumonia (HAP) have been developed, but the acceptance and use of such guidelines are unknown.OBJECTIVE: To assess physicians′ use of empirical HAP guidelines published by the American Thoracic Society (ATS) and by The University Health Network, Toronto, Ontario.DESIGN: A retrospective assembly and chart review.SETTING: A university teaching hospital.PATIENTS: One hundred fifteen consecutive patients who had been diagnosed with pneumonia more than 48 h after admission to hospital over a 10‐month period.RESULTS: The charts of 115 patients were reviewed. Seventy‐five patients (65%) were treated empirically. Forty patients (35%) were treated based on microbiological data that were available before the initiation of antibiotics. Patients who received nonempirical treatment for HAP had a significantly greater acuity of illness than the empirically treated group. Thirty‐seven patients (49%) who received empirical therapy were treated according to either ATS or hospital guidelines for HAP. The use of guideline‐concordant antimicrobial therapy had no measurable effect on in‐hospital mortality (eight of 37 patients [21.6%] versus seven of 38 patients [18.4%], P=0.96) or median length of stay (19 days versus 21 days, P=0.30). Patients whose treatment did not follow guideline recommendations tended to receive appropriate antimicrobial coverage more often than did those patients whose treatment was guideline concordant (15 of 18 patients [83%] versus six of 11 patients [55%], P=0.49).CONCLUSIONS: Institutional and ATS guidelines for the empirical treatment of HAP are less widely used than would be predicted by chance at The University Health Network. The clinical utility of these guidelines remains to be proven.
Interactions between Host and Oral Commensal Microorganisms are Key Events in Health and Disease Status
Authors: Rouabhia Mahmoud 
Published: March 2016

The oral cavity has sometimes been described as a mirror that reflects a person′s health. Systemic diseases such as diabetes or vitamin deficiency may be seen as alterations in the oral mucosa. A variety of external factors cause changes in the oral mucosa, thus altering mucosal structure and function, and promoting oral pathologies (most frequently bacterial, fungal and viral infections). Little is known, however, about immune surveillance mechanisms that involve the oral mucosa.There is no direct contact between specific immune cells in the basal epithelium and microorganisms in the upper layers of the oral mucosa. The author′s hypothesis is that the protective immunity is conveyed through epithelial cells. The present brief review assesses the oral mucosa′s role as the main defence in the interactions between the host and the oral microbial community. A unique model was used to investigate these interactions as the cause of oral disease and to develop new treatments that exploit our knowledge of the host‐microorganism relationship.
Characterizing and Developing Strategies for the Treatment of Community‐Acquired Pneumonia at a Community Hospital
Authors: Fok Mark C , Kanji Zahra , Mainra Rajesh , Boldt Michael 
Published: March 2016

BACKGROUND: Patients admitted to Lions Gate Hospital, North Vancouver, British Columbia, with a primary diagnosis of community‐acquired pneumonia (CAP) have a mean length of stay (LOS) of 9.1 days compared with 7.9 days for peer group hospitals. This difference of 1.2 days results in an annual potential savings of 406 bed days and warranted an investigation into the management of CAP.OBJECTIVE: To characterize and provide recommendations for the management of CAP.METHODS: A retrospective chart review of patients admitted with a primary diagnosis of CAP between May 1, 2000 and August 31, 2000.RESULTS: Fifty‐one patients were included in the study, with a mean LOS of 9.9 days and a median LOS of five days. Based on pneumonia severity index scores calculated for each patient, eight patients (16%) were admitted inappropriately. Initial empirical antibiotic choices were consistent with the Canadian CAP guidelines in 27 patients (53%), with inconsistencies arising mainly because cephalosporin or azithromycin monotherapy regimens were prescribed. Step‐down from intravenous to oral antibiotics occurred in approximately 20 patients (39%). An additional 12 patients (24%) could have undergone step‐down, and step‐down was not applicable in 19 patients (37%). The potential annual cost avoidance from implementing admission criteria based on a pneumonia severity index score, applying step‐down criteria and promoting early discharge criteria was estimated to be $220,000.CONCLUSIONS: Considerable variability exists in the treatment of CAP. A CAP preprinted order sheet was developed to address the issues identified in the present study and provide consistency in the management of CAP at Lions Gate Hospital.
Outcome of Bacteremia and Fungemia in Pediatric Oncology Patients
Authors: Robinson Joan L , Rennie Robert P 
Published: March 2016

OBJECTIVE: To determine the outcome of paediatric oncology patients with positive blood cultures.>DESIGN: Retrospective chart review.SETTING: Tertiary care hospital.POPULATION STUDIED: Oncology patients up to 17 years of age with positive blood cultures from January 1, 1994 to March 31, 1999.MAIN RESULTS: There were 121 episodes of positive blood cultures in 76 patients. Seventeen episodes were excluded because blood cultures were contaminated. Of the organisms grown from the remaining episodes, 63% were Gram‐positive organisms, 23% were Gram‐negative organisms, 3% were fungal and 11% were mixed. There were 13 episodes with pure or mixed isolates of Staphylococcus aureus, of which nine occurred within 14 days of the placement of a new central venous tunnelled catheter. Central venous tunnelled catheters were retained in 76 of the 102 episodes when they were present. There were two relapses, and four children were admitted to the intensive care unit with septic shock, but all survived.CONCLUSIONS: The outcome was excellent with the current management of possible bacteremia in paediatric oncology patients, but the high incidence of S aureus bacteremia suggests that empirical antibiotics should be altered if sepsis is suspected within 14 days of the placement of a central venous catheter.