bluuebunny/crossref_metadata_2025_split huggingface dataset:
Toward Optimal End‐of‐Life Care for Patients with Advanced Chronic Obstructive Pulmonary Disease: Insights from a Multicentre Study
Authors: Rocker Graeme M , Dodek Peter M , Heyland Daren K , for the Canadian Researchers at the End of Life Network  
Published: March 2016

BACKGROUND: Understanding patients’ needs and perspectives is fundamental to improving end‐of‐life (EOL) care. However, little is known of what quality care means to patients who have advanced lung disease.OBJECTIVES: To describe ratings of importance and satisfaction with elements of EOL care, informational needs, decision‐making preferences, obstacles to a preferred location of death, clinical outcomes, and health care use before and during an index hospital admission for patients who have advanced chronic obstructive pulmonary disease (COPD).METHODS: A questionnaire with regard to quality EOL care was administered to patients older than 55 years of age who had advanced medical disease in five Canadian teaching hospitals.RESULTS: For 118 hospitalized patients who had advanced COPD, the following items were rated as extremely important for EOL care: not being kept alive on life support when there is little hope for meaningful recovery (54.9% of respondents), symptom relief (46.6%), provision of care and health services after discharge (40.0%), trust and confidence in physicians (39.7%), and not being a burden on caregivers (39.6%). Compared with patients who had metastatic cancer, patients with COPD had lower (P<0.05) satisfaction with care, interest in information about prognosis, cardiopulmonary resuscitation or mechanical ventilation, and referral rates to palliative care, whereas use of acute care services was higher (P<0.05) for patients who had advanced COPD.CONCLUSION: Canadian patients who have advanced COPD identify several priorities for improving care. Avoidance of prolonged or unwanted life support requires more effective communication, decision making and goal setting. Patients also deserve better symptom control and postdischarge strategies to minimize perceived burdens on caregivers, emergency room visits and hospital admissions.
The Management of Acute Uncomplicated Cystitis in Adult Women by Family Physicians in Canada
Authors: McIsaac Warren J , Prakash Preeti , Ross Susan 
Published: March 2016

INTRODUCTION: There are few Canadian studies that have assessed prescribing patterns and antibiotic preferences of physicians for acute uncomplicated cystitis. A cross‐Canada study of adult women with symptoms of acute cystitis seen by primary care physicians was conducted to determine current management practices and first‐line antibiotic choices.METHODS: A random sample of 2000 members of The College of Family Physicians of Canada were contacted in April 2002, and were asked to assess two women presenting with new urinary tract symptoms. Physicians completed a standardized checklist of symptoms and signs, indicated their diagnosis and antibiotics prescribed. A urine sample for culture was obtained.RESULTS: Of the 418 responding physicians, 246 (58.6%) completed the study and assessed 446 women between April 2002 and March 2003. Most women (412 of 420, for whom clinical information about antibiotic prescriptions was available) reported either frequency, urgency or painful urination. Physicians would have usually ordered a urine culture for 77.0% of the women (95% CI 72.7 to 80.8) and prescribed an antibiotic for 86.9% of the women (95% CI 83.3 to 90.0). The urine culture was negative for 32.8% of these prescriptions. The most commonly prescribed antibiotic was trimethoprim/sulfamethoxazole (40.8%; 95% CI 35.7 to 46.1), followed by fluoroquinolones (27.4%; 95% CI 22.9 to 32.3) and nitrofurantoin (26.6%; 95% CI 22.1 to 31.4).CONCLUSION: Empirical antibiotic prescribing is standard practice in the community, but is associated with high levels of unnecessary antibiotic use. While trimethoprim/sulfamethoxazole is the first‐line empirical antibiotic choice, fluoroquinolone antibiotics have become the second most commonly prescribed empirical antibiotic for acute cystitis. The effect of current prescribing patterns on community levels of quinolone‐resistant Escherichia coli may need to be monitored.
Liver Transplantation for Hepatic Epithelioid Hemangioendothelioma: The Canadian Multicentre Experience
Authors: Nudo Carmine G , Yoshida Eric M , Bain Vincent G , Marleau Denis , Wong Phil , Marotta Paul J , Renner Eberhard , Watt Kymberly D , Deschênes Marc 
Published: March 2016

INTRODUCTION: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare entity. At the present time, there is no standardized effective therapy. Liver transplantation (LT) has emerged as a treatment for this rare tumour.OBJECTIVE: To evaluate the outcome of liver transplantation for HEHE at eight centres across Canada.METHODS: The charts of patients who were transplanted for HEHE at eight centres across Canada were reviewed.RESULTS: A total of 11 individuals (eight women and three men) received a LT for HEHE. All LTs were performed between 1991 and 2005. The mean (± SD) age at LT was 38.7±13 years. One patient had one large liver lesion (17 cm × 14 cm × 13 cm), one had three lesions, one had four lesions and eight had extensive (five or more) liver lesions. One patient had spleen involvement and two had involved lymph nodes at the time of transplantation. The mean duration of follow-up was 78±63 months (median 81 months). Four patients (36.4%) developed recurrence of HEHE with a mean time to recurrence of 25±25 months (median 15.6 months) following LT. The calculated survival rate following LT for HEHE was 82% at five years.CONCLUSIONS: The results of LT for HEHE are encouraging, with a recurrence rate of 36.4% and a five-year survival rate of 82%. Further studies are needed to help identify patients who would benefit most from LT for this rare tumour.
A Review of Influenza Vaccine Immunogenicity and Efficacy in HIV‐Infected Adults
Authors: Cooper Curtis , Hutton Brian , Fergusson Dean , Mills Edward , Klein Marina B , Boivin Guy , Halperin Scott 
Published: March 2016

BACKGROUND: HIV‐seropositive adults are at an increased risk for influenza infection. They also develop more severe influenza disease and are hyporesponsive to current influenza vaccinations.METHODS: The authors examined findings from a systematic review of influenza vaccination in HIV‐seropositive adults, and evaluated other relevant studies. A narrative overview of findings formulated to summarize the implications of currently available literature is presented. The primary goal of the present review is to assess the limitations of current evidence and to provide a framework for additional research.RESULTS: There is a paucity of knowledge regarding the relative value of prophylactic influenza vaccination in HIV‐positive adults compared with immunocompetent populations. There are shortcomings related to study methodology and temporal changes in the characteristics of patient baseline immune status, which limit the utility of this information to shape public health policy.CONCLUSIONS: There is a pressing need to pursue methodologically rigorous studies that will increase knowledge related to improving the effectiveness of preventive influenza measures in this patient population.
Measuring the Impact of Rotavirus Acute Gastroenteritis Episodes (MIRAGE): A prospective Community‐Based Study
Authors: Sénécal Martin , Brisson Marc , Lebel Marc H , Yaremko John , Wong Richard , Gallant Lee Ann , Garfield Hartley A , Ableman Darryl J , Ward Richard L , Sampalis John S , Mansi James A , for the MIRAGE study group  
Published: March 2016

BACKGROUND: Current assessments of the burden of rotavirus (RV)‐related gastroenteritis are needed to evaluate the potential benefits of RV immunization interventions. The objective of the present study was to characterize the burden of RV gastroenteritis among children presenting in outpatient settings with gastroenteritis.METHODS: Between January and June 2005, 395 children younger than three years of age presenting with gastroenteritis symptoms (at least three watery or looser‐than‐normal stools, or forceful vomiting within the previous 24 h period) were recruited from 59 Canadian clinics and followed for two weeks. Stool specimens were tested for the RV antigen. Gastroenteritis‐related symptoms, health care utilization, parental work loss and other cases of gastroenteritis in the household were assessed by questionnaires and daily symptom cards that were completed by caregivers.RESULTS: Of 336 conclusive test results, 55.4% were RV positive (RV+). In addition to diarrhea, 67.2% and 89.3% of RV+ children experienced fever or vomiting, respectively. Compared with RV‐negative (RV–) children, RV+ children were more likely to experience the three symptoms concurrently (57.0% versus 26.7%; P<0.001), to be hospitalized (12.9% versus 3.9%; P=0.008) and to induce parental work loss (53.8% versus 37.3%; P=0.003). The median duration of gastroenteritis was eight days for RV+ children (nine days for RV– children). Additional cases of gastroenteritis were present in 46.8% of households in the RV+ group (51.3% of households in the RV– group).CONCLUSIONS: RV gastroenteritis cases were more severe than other gastroenteritis cases, were hospitalized more often and were associated with considerably more work loss.
Adjuvant Chemotherapy in Resected Lung Cancer: Two‐Year Experience in a University Hospital
Authors: Bouchard Nicole , Laberge Francis , Raby Bruno , Martin Sylvie , Lacasse Yves 
Published: March 2016

BACKGROUND: Randomized trials have confirmed the benefits of adjuvant chemotherapy in improving survival in resected early‐stage non‐small‐cell lung cancer (NSCLC). The extent to which these results have translated into clinical practice is unknown.OBJECTIVE: To examine the referral pattern of patients with resected lung cancer to adjuvant chemotherapy, and to compare compliance and toxicities with current literature.METHODS: A retrospective analysis of all patients who underwent a surgical resection for lung cancer at Laval Hospital (Quebec City, Quebec) from March 2004 to January 2006 was conducted.RESULTS: A total of 258 patients underwent surgery. Seven patients were excluded because of early postoperative death, and two patients were excluded because of incomplete data. Data from 249 patients were analyzed (94% NSCLC). Fifty per cent were referred to medical oncology for consideration of adjuvant chemotherapy, including 37 of 61 patients with stage II NSCLC. One hundred patients received chemotherapy. No significant difference in age, sex, comorbidities and surgical procedures was observed between those who received chemotherapy and those who did not. Chemotherapy was initiated 47 days (median) after the surgery and consisted mainly of cisplatin‐vinorelbine (38%), cisplatin‐etoposide (22%) and carboplatin‐paclitaxel (20%). Sixty‐six per cent of the patients completed all four cycles. Grade 3 or 4 toxicities consisted mainly of fatigue (23%) and cytopenia (40%). No death was registered; 15% had to be hospitalized because of adverse effects.CONCLUSION: Although adjuvant chemotherapy is gaining acceptance in clinical practice, more patients should be referred to medical oncology following surgical resection. Compliance and toxicity are similar to or better than those described in published randomized trials.
Review of Systematic Reviews on Acute Procedural Pain in Children in the Hospital Setting
Authors: Stinson Jennifer , Yamada Janet , Dickson Alison , Lamba Jasmine , Stevens Bonnie 
Published: March 2016

BACKGROUND: Acute pain is a common experience for hospitalized children. Despite mounting research on treatments for acute procedure‐related pain, it remains inadequately treated.OBJECTIVE: To critically appraise all systematic reviews on the effectiveness of acute procedure‐related pain management in hospitalized children.METHODS: Published systematic reviews and meta‐analyses on pharmacological and nonpharmacological management of acute procedure‐related pain in hospitalized children aged one to 18 years were evaluated. Electronic searches were conducted in the Cochrane Database of Systematic Reviews, Medline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature and PsycINFO. Two reviewers independently selected articles for review and assessed their quality using a validated seven‐point quality assessment measure. Any disagreements were resolved by a third reviewer.RESULTS: Of 1469 published articles on interventions for acute pain in hospitalized children, eight systematic reviews met the inclusion criteria and were included in the analysis. However, only five of these reviews were of high quality. Critical appraisal of pharmacological pain interventions indicated that amethocaine was superior to EMLA (AstraZeneca Canada Inc) for reducing needle pain. Distraction and hypnosis were nonpharmacological interventions effective for management of acute procedure‐related pain in hospitalized children.CONCLUSIONS: There is growing evidence of rigorous evaluations of both pharmacological and nonpharmacological strategies for acute procedure‐related pain in children; however, the evidence underlying some commonly used strategies is limited. The present review will enable the creation of a future research plan to facilitate clinical decision making and to develop clinical policy for managing acute procedure‐related pain in children.
Increase of Urinary 5-Hydroxyindoleacetic Acid Excretion but Not Serum Chromogranin a Following Over-The-Counter 5-Hydroxytryptophan Intake
Authors: Joy Tisha , Walsh Grace , Tokmakejian Sonya , Van Uum Stan HM 
Published: March 2016

BACKGROUND: 5-hydroxyindoleacetic acid (5-HIAA) excretion is commonly measured for biochemical detection of carcinoid tumours. A 77-year-old woman was referred for elevated 24 h urine 5-HIAA excretion (510 μmol/day; normal is less than 45 μmol/day) and serum chromogranin A (CgA) (72.1 U/L; normal is less than 18 U/L), both subsequently normalized after discontinuation of 5-hydroxytryptophan (5-HTP). 5-HTP, a precursor of serotonin, is not commonly listed as a substance that increases 5-HIAA levels in urine. The effect of 5-HTP on CgA has not been previously described.OBJECTIVES: To determine whether, and to what extent, oral 5-HTP increases urine 5-HIAA excretion and serum CgA levels in healthy volunteers.PATIENTS AND METHODS: A randomized, prospective, double-blind, placebo-controlled crossover study, with a four-day washout period, was performed in a general community setting. Eight healthy subjects aged 22 to 58 years were recruited by advertising. Bedtime ingestion of 5-HTP 100 mg/day was compared with placebo ingestion for 10 days. Twenty-four hour urine excretion of 5-HIAA and serum CgA were the main outcome measures.RESULTS: Median (range) urinary 5-HIAA excretion was 204 μmol/day (22 μmol/day to 459 μmol/day) during 5-HTP intake, compared with 18 μmol/day (12 μmol/day to 36 μmol/day) during placebo intake (P=0.017). 5-HTP did not affect clinical symptoms or serum CgA levels.CONCLUSIONS: Oral 5-HTP increases urinary 5-HIAA excretion with considerable interindividual variation. In a small number of subjects, oral 5-HTP did not affect serum CgA levels. Therefore, increased 5-HIAA levels with normal CgA levels may suggest 5-HTP ingestion. The use of over-the-counter 5-HTP should be excluded as the cause of increased urinary 5-HIAA levels before initiating diagnostic tests to search for a carcinoid tumour. 5-HTP should be added to popular references as a substance that may cause increased 5-HIAA excretion.
The Prevalence and Predictors of Tuberculin Positivity in Subjects Screened for Reasons other than Contact Investigation
Authors: Hernández-Garduño Eduardo , Elwood R Kevin 
Published: March 2016

BACKGROUND: No previous studies have estimated the rates of tuberculin positivity (TP) in noncontact populations within the same community, which is important for prioritizing and implementing preventive measures.OBJECTIVES: To estimate the prevalence and predictors of TP in noncontact populations.METHODS: A retrospective analysis of tuberculin results of non‐contact populations screened in British Columbia from 1990 to 2002 was conducted.RESULTS: The period prevalence of TP in 59,791 screened subjects was 12.7% (95% CI 12.4% to 13.0%), 30.4% (95% CI 28.2% to 32.7%) and 60.9% (95% CI 60.3% to 61.6%) for Canadian‐born non‐Aboriginals (CBNAs), Canadian‐born Aboriginals (CBAs) and foreign born (FB), respectively. After controlling for age and sex, independent predictors of TP included Bacille Calmette‐Guérin (BCG) vaccination (OR 19.6, 95% CI 17.9 to 21.5), country of birth (CBA: OR 2.87, 95% CI 2.44 to 3.37; FB: OR 3.67, 95% CI 3.34 to 4.03) and the following populations: correctional centre residents (OR 4.14, 95% CI 1.87 to 9.15), residents of long‐term care and community care facilities (OR 1.79, 95% CI 1.44 to 2.23), immigrants (OR 1.75, 95 % CI 1.50 to 2.04), health centre employees (OR 1.71, 95 % CI 1.56 to 1.88), volunteers (OR 1.38, 95% CI 1.14 to 1.68), self‐referred healthy subjects (OR 1.30, 95% CI 1.15 to 1.48) and students (OR 1.27, 95% CI 1.19 to 1.35). CBAs, FB and male subjects were less likely to react to tuberculin than CBNAs and female subjects among those vaccinated with Bacille Calmette‐Guérin (P<0.05).CONCLUSIONS: Rates of TP correlate with disease rates by sex and origin. The continuation of tuberculin screening programs is warranted in noncontact populations with high TP rates, where unknown exposure to active cases is more likely to occur. Further research is needed to determine the reasons why a higher response to tuberculin occurs in BCG‐vaccinated women and CBNAs.
The CASE Survey: Patient and Physician Perceptions Regarding Asthma Medication Use and Associated Oropharyngeal Symptoms
Authors: FitzGerald J Mark , Chan Charles KN , Holroyde Martin C , Boulet Louis-Philippe 
Published: March 2016

BACKGROUND: Oropharyngeal (OP) symptoms are common in asthma patients using inhaled corticosteroids (ICSs) alone and in combination with a long‐acting beta2‐agonist (LABA). Patterns of medication use, level of asthma control and association with OP symptoms are not often reported in a nonstudy setting.OBJECTIVES: To determine the prevalence of OP symptoms among adult asthma patients using ICSs alone and an ICS plus a LABA; to investigate the relationships between medication use, asthma control and OP symptoms; and to assess family physicians’ (FPs’) perceptions of the prevalence and management of OP symptoms.METHODS: A random telephone survey of 1003 asthma patients and 250 FPs treating asthma patients was conducted from February to March 2005 across Canada.RESULTS: Twenty‐four per cent of patients experienced OP symptoms; 67% of them spoke to their FPs about the OP symptoms. Thirty‐one per cent of patients who experienced OP symptoms stopped or reduced their dose of medication. OP symptoms were reported by 25% of patients using ICSs and 22% using an ICS plus a LABA. The incidence of OP symptoms was not affected by the choice of inhalation device (metered‐dose inhaler versus dry powder inhaler) or the use of a spacer. Fifty‐eight per cent of patients had uncontrolled asthma; patients achieving a lower level of general education were more likely to have poor control. Patients with uncontrolled asthma were more likely than those with controlled asthma to report OP symptoms (28% versus 18%, respectively; P<0.05). Eighty‐nine per cent of FPs had patients who had reported OP symptoms to them. FPs estimated that 15% of their patients experienced OP symptoms and that compliance to treatment worsened in approximately 20% of them.CONCLUSIONS: The prevalence of OP symptoms in asthma patients using ICSs and an ICS plus a LABA is significant. OP symptoms were found to be associated with a reduced patient education level, with a likelihood of reducing or stopping medication, and with a less well‐controlled asthma patient. While FPs recognized that a significant proportion of their asthma patients experience OP symptoms and that OP symptoms may affect compliance, they underestimated the prevalence of this problem.
Esophageal Leiomyomatosis – An Unusual Cause of Pseudoachalasia
Authors: Ray Sukanta , Saluja Sundeep Singh , Gupta Ruchika , Chattopadhyay Tushar Kanti 
Published: March 2016

Esophageal leiomyomatosis is a rare hamartomatous disorder with varied presentation. In the literature, it is described mostly in children, and is associated with Alport’s syndrome. A case of leiomyomatosis that presented as achalasia not associated with Alport’s syndrome is described in a 35-year-old woman with a 16-year history of dysphagia. Barium swallow showed a smooth narrowing at the lower end of the esophagus with a longer than usual stricture length. Endoscopy showed a dilated esophagus with a submucosal nodule in the region of the cardia. A computed tomography scan revealed circumferential thickening of the esophagus involving the gastroesophageal junction, with fat planes maintained with the adjacent structure. Endoscopic ultrasound demonstrated a lesion arising from the muscularis propria. The manometry findings were suggestive of achalasia. She underwent transhiatal esophagectomy with gastric pull-up.Leiomyomatosis should be considered as a cause of psuedoachalasia in patients with symptoms suggestive of achalasia and atypical barium findings. Attempts should be made to confirm the diagnosis preoperatively using computed tomography and/or endoscopic ultrasound. Esophagectomy is the treatment of choice.
Understanding Caregiver Judgments of Infant Pain: Contrasts of Parents, Nurses and Pediatricians
Authors: Pillai Riddell Rebecca R , Horton Rachel E , Hillgrove Jessica , Craig Kenneth D 
Published: March 2016

BACKGROUND: Research suggests that caregivers’ beliefs pertaining to infant pain and which infant pain cues are perceived to be important play an integral role in pediatric pain assessment and management.OBJECTIVES: Following a recent quasi‐experimental study reporting on caregiver background and age differences in actual infant pain judgments, the present study clarified these findings by analyzing caregivers’ pain beliefs and the cues they use to make pain assessments, and by examining how the wording of belief questions influenced caregivers’ responses.METHODS: After making pain judgments based on video footage of infants between two and 18 months of age receiving immunizations, parents, nurses and pediatricians were required to respond to questionnaires regarding pain beliefs and importance of cues.RESULTS: Parents generally differed from pediatricians. Parents tended to have less optimal beliefs regarding medicating the youngest infants, were more influenced by question wording, and reported using many more cues when judging older infants than other caregiver groups. In terms of beliefs, influence of question wording and cue use, nurses tended to fall in between both groups; they displayed similarities to both parents and pediatricians.CONCLUSIONS: Paralleling the original findings on pain judgments, these findings suggest that parents differ from pediatricians in their pain beliefs and the cues they use to make pain judgments. Moreover, some similarities were found between parents and nurses, and between nurses and pediatricians. Finally, caution must be taken when interpreting research pertaining to beliefs about infant pain because question wording appears to influence interpretation.