bluuebunny/crossref_metadata_2025_split huggingface dataset:
Empyema: An Increasing Concern in Canada
Authors: Finley Christian , Clifton Joanne , FitzGerald J Mark , Yee John 
Published: March 2016

BACKGROUND: Empyema is a suppurative infection of the pleural space. Without prompt treatment, it can result in significant hospital stays, more invasive treatments as it progresses, and substantial morbidity and mortality.OBJECTIVES: The primary objective of the present study was to evaluate whether there has been an increasing incidence of empyema in Canada. A secondary objective was to investigate whether this increase disproportionately affects any age group.METHODS: The Discharge Abstract Database of the Canadian Institute for Health Information was used to evaluate national empyema data.RESULTS: There were 11,294 patients identified with empyema over the nine‐year period of the present study, of whom 31% were women. The mean (± SD) length of stay was stable throughout the study at 21.82±33.88 days, and 63.4% were discharged home. The incidence rate ratio (IRR) was defined as the ratio of the incidence rate of medical empyema in 2003 divided by the incidence rate in 1995. Medical empyema increased significantly (IRR 1.30, 95% CI 1.20 to 1.41; P<0.001), as did empyema of unknown cause (IRR 1.29, 95% CI 1.08 to 1.54; P=0.005), while surgical empyema did not appear to increase (IRR 1.17, 95% CI 0.97 to 1.43; P=0.114). A Poisson regression showed an increase in the indirect age‐standardized IRR during the study period (IRR 1.025, 95% CI 1.018 to 1.032; P<0.001). The IRR for patients younger than 19 years of age from 1995 to 2003 was 2.20 (95% CI 1.56 to 3.10), while the IRR in patients older than 19 years was 1.23 (95% CI 1.14 to 1.34).CONCLUSIONS: The present study demonstrates the increasing rate of empyema in Canada and shows a change in pattern of disease. The disproportionate rate change in the pediatric population suggests a high‐risk group that needs to be addressed. In the adult population, while cause is unknown, it is necessary to continually educate front‐line physicians to confront both the increased burden of this disease, caused by an aging population, and the underlying increasing rate of empyema in Canada.
Chronic Pain Assessment: A Seven‐Factor Model
Authors: Davidson Megan A , Tripp Dean A , Fabrigar Leandre R , Davidson Paul R 
Published: March 2016

BACKGROUND: There are many measures assessing related dimensions of the chronic pain experience (eg, pain severity, pain coping, depression, activity level), but the relationships among them have not been systematically established.OBJECTIVE: The present study set out to determine the core dimensions requiring assessment in individuals with chronic pain.METHODS: Individuals with chronic pain (n=126) completed the Beck Anxiety Inventory, Beck Depression Inventory, Beck Hopelessness Scale, Chronic Pain Coping Index, Multidimensional Pain Inventory, Pain Catastrophizing Scale, McGill Pain Questionnaire – Short Form, Pain Disability Index and the Tampa Scale of Kinesiophobia.RESULTS: Before an exploratory factor analysis (EFA) of the nine chronic pain measures, EFAs were conducted on each of the individual measures, and the derived factors (subscales) from each measure were submitted together for a single EFA. A seven‐factor model best fit the data, representing the core factors of pain and disability, pain description, affective distress, support, positive coping strategies, negative coping strategies and activity.CONCLUSIONS: Seven meaningful dimensions of the pain experience were reliably and systematically extracted. Implications and future directions for this work are discussed.
Clinical Manifestations and Treatment of Adult‐Onset Asthma and Periocular Xanthogranuloma
Authors: Cavallazzi Rodrigo , Hirani Amyn , Vasu Tajender S , Sergott Robert C , Bilyk Jurij R , Eagle Ralph C , Weibel Sandra 
Published: March 2016

BACKGROUND: Adult‐onset asthma and periocular xanthogranuloma is an uncommon and recently described disease. Little is known about the condition because only a few case reports and series are available.OBJECTIVE/METHODS: To describe the clinical manifestations, lung physiology, and response to systemic treatment of three patients with adult‐onset asthma and periocular xanthogranuloma, followed by a review of the literature.RESULTS: Three men, with an age at diagnosis ranging from 48 to 51 years, presented with right periorbital swelling, asthma and chronic rhinosinusitis. The patients’ lung physiology was consistent with airway obstruction. Diagnosis was established by periorbital biopsy. All patients received oral corticosteroids for their periorbital swelling, without significant clinical response. Two patients received oral methotrexate, with nearly complete resolution of periorbital swelling. A third patient received oral azathioprine, without clinical response. The three patients had improvement of their asthma with inhaled steroids/long‐acting bronchodilator, and immunosuppressive medication.CONCLUSION: A triad consisting of periorbital swelling, asthma and chronic rhinosinusitis should raise the suspicion of adult‐onset asthma and periocular xanthogranuloma. Oral methotrexate should be considered as an alternative to corticosteroids in the treatment of this disorder.
Effects of Virtual Reality Immersion and Audiovisual Distraction Techniques for Patients with Pruritus
Authors: Leibovici Vera , Magora Florella , Cohen Sarale , Ingber Arieh 
Published: March 2016

BACKGROUND: Virtual reality immersion (VRI), an advanced computer‐generated technique, decreased subjective reports of pain in experimental and procedural medical therapies. Furthermore, VRI significantly reduced pain‐related brain activity as measured by functional magnetic resonance imaging. Resemblance between anatomical and neuroendocrine pathways of pain and pruritus may prove VRI to be a suitable adjunct for basic and clinical studies of the complex aspects of pruritus.OBJECTIVES: To compare effects of VRI with audiovisual distraction (AVD) techniques for attenuation of pruritus in patients with atopic dermatitis and psoriasis vulgaris.METHODS: Twenty‐four patients suffering from chronic pruritus – 16 due to atopic dermatitis and eight due to psoriasis vulgaris – were randomly assigned to play an interactive computer game using a special visor or a computer screen. Pruritus intensity was self‐rated before, during and 10 min after exposure using a visual analogue scale ranging from 0 to 10. The interviewer rated observed scratching on a three‐point scale during each distraction program.RESULTS: Student’s t tests were significant for reduction of pruritus intensity before and during VRI and AVD (P=0.0002 and P=0.01, respectively) and were significant only between ratings before and after VRI (P=0.017). Scratching was mostly absent or mild during both programs.CONCLUSIONS: VRI and AVD techniques demonstrated the ability to diminish itching sensations temporarily. Further studies on the immediate and late effects of interactive computer distraction techniques to interrupt itching episodes will open potential paths for future pruritus research.
Risk Factors and Outcomes Associated with Chronic Obstructive Pulmonary Disease Exacerbations Requiring Hospitalization
Authors: Bahadori Katayoun , FitzGerald J Mark , Levy Robert D , Fera Tharwat , Swiston John 
Published: March 2016

BACKGROUND: Acute respiratory exacerbations are the most frequent cause of medical visits, hospitalization and death for chronic obstructive pulmonary disease (COPD) patients and, thus, exert a significant social and economic burden on society.OBJECTIVE: To identify the risk factors associated with hospital readmission(s) for acute exacerbation(s) of COPD (AECOPD).METHODS: A review of admission records from three large urban hospitals in Vancouver, British Columbia, identified 310 consecutive patients admitted for an AECOPD between April 1, 2001, and December 31, 2002. Logistic regression analysis was performed to identify risk factors for readmissions following an AECOPD.RESULTS: During the study period, 38% of subjects were readmitted at least once. The mean (± SD) duration from the index admission to the first readmission was 5±4.08 months. Comparative analysis among the three hospitals identified a significant difference in readmission rates (54%, 36% and 18%, respectively). Logistic regression analysis revealed that preadmission home oxygen use (OR 2.55; 95%CI 1.45 to 4.42; P=0.001), history of a lung infection within the previous year (OR 1.73; 95% CI 1.01 to 2.97; P=0.048), other chronic respiratory disease (OR 1.78; 95% CI 1.06 to 2.99; P=0.03) and shorter length of hospital stay (OR 0.97; 95% CI 0.945 to 0.995; P=0.021) were independently associated with frequent readmissions for an AECOPD.CONCLUSIONS: Hospital readmission rates for AECOPD were high. Only four clinical factors were found to be independently associated with COPD readmission. There was significant variability in the readmission rate among hospitals. This variability may be a result of differences in the patient populations that each hospital serves or may reflect variability in health care delivery at different institutions.
Does Onsite Cytotechnology Evaluation Improve the Accuracy of Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy?
Authors: Alsohaibani Fahad , Girgis Safwat , Sandha Gurpal Singh 
Published: March 2016

BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the preferred modality for the cytological diagnosis of various cancers. Onsite cytopathology interpretation is not available in most centres.OBJECTIVE: To assess whether the the adequacy of tissue sampling assessed by an onsite cytotechnologist improves the diagnostic accuracy of EUS-FNA.METHODS: The present study is a retrospective review of all patients undergoing solid mass EUS-FNA between September 2005 and August 2007. Patients in group I (September 2005 to August 2006) had cytology slides prepared by an endoscopy nurse. Patients in group II (September 2006 to August 2007) had cytology slides prepared, stained and assessed for adequacy of tissue sampling by a cytotechnologist in the endoscopy suite. The final cytopathological diagnosis (definitely positive, definitely negative or inconclusive) was compared between the two groups.RESULTS: A total of 49 EUS-FNA procedures were performed in 47 patients in group I and 60 EUS-FNA procedures in 55 patients in group II. Pancreatic masses were the most common target site in both groups. The total number of needle passes was 105 in group I (mean 2.14 passes per patient; range one to five needle passes) and 158 in group II (mean 2.63 passes per patient; range one to four needle passes). The difference in the number of needle passes was not statistically significant between groups. The final diagnosis was definite in 53% in group I compared with 77% in group II (P=0.01). The percentage of inconclusive diagnoses was 47% in group I and 23% in group II (P=0.001).CONCLUSION: Onsite cytotechnologist interpretation of adequacy of tissue sampling significantly improves the diagnostic yield of EUS-FNA. This appears to be independent of the total number of needle passes undertaken for tissue sampling.
Assessment and Management of Patients with Chronic Cough by Certified Respiratory Educators: A Randomized Controlled Trial
Authors: Field Stephen K , Conley Diane P , Thawer Amin M , Leigh Richard , Cowie Robert L 
Published: March 2016

BACKGROUND: The value of other health care professionals is increasingly being recognized to compensate for the shortage of physicians in Canada. Chronic cough is one of the most common reasons for consultation with a respirologist. In the present study, a prospective, randomized, controlled study was undertaken to determine whether Certified Respiratory Educators (CREs) could manage screened patients with chronic cough as effectively as respirologists.METHODS: An eight‐week, prospective, parallel‐design, randomized, controlled trial of the management of chronic cough patients was conducted. Patients were screened to exclude those with potentially life‐threatening conditions. The primary outcome was the number of patients whose cough resolved or subjectively improved.RESULTS: A total of 198 patients were randomly assigned, and eight‐week data were available on 151 patients. Mean age of the patients was 49.8±13.4 years, 70.2% were female and median cough duration was 16 months. The screening process was effective and referral wait times decreased from a median of two months to less than four weeks (P<0.0001). The educators averaged 4.9 contacts per patient compared with 2.7 by the physicians over the eight‐week study period (P<0.0001). Most patients had had multiple therapeutic trials before referral. Cough resolved or improved in two‐thirds of the patients at eight weeks; however, more patients showed improvement in the educator arm than in the physician arm, P<0.02. Cough‐specific quality of life improved similarly in the two study arms at eight weeks (physician arm: 61.5±14.1 to 52.6±14.4, P<0.0001; CRE arm: 58.1±14.9 to 50.0±15.8, P=0.0003).CONCLUSIONS: CREs can safely and effectively assess, as well as appropriately treat, screened patients with chronic cough with a resultant reduction in wait times.
The Diagnostic Value of Double-Balloon Enteroscopy in Children with Small Bowel Disease: Report of 31 Cases
Authors: Liu Wei , Xu Chundi , Zhong Jie 
Published: March 2016

BACKGROUND AND OBJECTIVE: Before the introduction of double-balloon enteroscopy (DBE), it was impossible to visualize the entire small bowel. Its diagnostic yield has been assessed in adults, but not yet in children. The present retrospective study evaluated the diagnostic usefulness and safety of DBE in children with suspected small bowel disease.METHODS: Between June 2003 and June 2007, 31 patients (19 boys and 12 girls, age range three to 14 years) with suspected small bowel disease underwent DBE after receiving negative evaluations using other diagnostic modalities.RESULTS: There were no severe complications. In two patients, the entire small bowel was viewed using oral and anal approaches, and for the remaining 29 patients, only one approach was used. The sites of disease in were identified in 25 of 31 cases (80.65%). The bleeding source was found in 21 of 27 patients with obscure gastrointestinal bleeding (diagnostic rate of 77.78%). Different diseases were identified in four children with chronic diarrhea.CONCLUSION: DBE is a safe and effective method to diagnose patients with suspected small bowel disorders.
Workshops to Disseminate the Canadian Thoracic Society Guidelines for Chronic Obstructive Pulmonary Disease to Health Care Professionals in Ontario: Impact on Knowledge, Perceived Health Care Practices and Participant Satisfaction
Authors: Moosa Dilshad , Blouin Maria , Hill Kylie , Goldstein Roger 
Published: March 2016

BACKGROUND: The Canadian Thoracic Society (CTS) has developed a clinical practice guideline (CPG) regarding the management of patients with chronic obstructive pulmonary disease (COPD). Implementation of this CPG in the primary care setting requires an effective dissemination strategy.OBJECTIVES: To examine the change in knowledge, participant satisfaction and perceived changes in clinical practice among health care professionals working in the primary care setting following attendance at a workshop to disseminate the CTS CPG for COPD.METHODS: A 2.5 h workshop was conducted in three community health sites within Ontario. Each workshop comprised a didactic presentation and interactive case study discussions. Before, and one month following the workshop, a structured knowledge assessment questionnaire was administered. A structured satisfaction questionnaire and evaluative form that examined the impact of the workshop on the clinical management of COPD patients were administered immediately and three months following completion of the workshop, respectively.RESULTS: Sixty‐nine participants attended the workshop. The mean score for the structured knowledge assessment questionnaire increased from 8.5±2.7 to 10.6±2.0 following the workshop (P=0.008). Eighty‐nine per cent and 96% of participants indicated that they would recommend the workshop to a colleague and had greater confidence in their management of COPD patients, respectively. Following attendance of the workshop, 73%, 69% and 46% described increased patient education, patient monitoring and the use of objective testing in clinical practice, respectively.CONCLUSIONS: Workshop attendance was associated with high levels of satisfaction and important self‐reported changes in clinical practice, which may reflect improved knowledge of the CTS CPG for COPD.
Liver Biopsies for Chronic Hepatitis C: Should Nonultrasound-Guided Biopsies Be Abandoned?
Authors: Flemming Jennifer A , Hurlbut David J , Mussari Ben , Hookey Lawrence C 
Published: March 2016

BACKGROUND/OBJECTIVE: Liver biopsy has been the gold standard for grading and staging chronic hepatitis C virus (HCV)-mediated liver injury. Traditionally, this has been performed by trained practitioners using a nonimage-guided percutaneous technique at the bedside. Recent literature suggests an expanding role for radiologists in obtaining biopsies using an ultrasound (US)-guided technique. The present study was undertaken study to determine if the two techniques produced liver biopsy specimens of similar quality and hypothesized that at our institution, non-US-guided percutaneous liver biopsies for HCV would be of higher quality than US-guided specimens.METHODS: Liver biopsies from 100 patients with chronic HCV infection (50 consecutive US-guided and 50 consecutive non-US-guided), were retrospectively identified using a hospital histopathology database. All original biopsy slides were coded and prospectively reanalyzed by a single hepatopathologist who was blinded to the technique used in obtaining the biopsy. Additionally, all liver biopsies for chronic HCV infection completed at the centre from 1998 to 2007 were identified and the technique used was recorded. Biopsy quality was determined primarily by the number of complete portal tracts (CPTs) identifiable in the slides. The total length of specimen and the degree of fragmentation were secondary outcome measures.RESULTS: There was a slight difference observed between the US-guided and non-US-guided groups in mean age (46.3 years versus 42.5 years, repectively; P=0.018) but no differences in sex, presence of cirrhosis, bilirubin, creatinine, international normalized ratio, and grade or stage of disease. Biopsies obtained using the US-guided technique produced higher quality specimens than the non-US-guided technique based on our primary outcome of number of CPTs in the biopsy (11.8 versus 7.4; P<0.001). US-guided specimens also were longer (24.4 mm versus 19.7 mm; P=0.001), had less fragmentation (P=0.016), and a higher overall histopathological quality assessment (P=0.026) than the non-US-guided biopsies. However, there was no significant difference between the two groups in the ability to grade and stage the disease (96% US-guided versus 90% in non-US-guided (P=0.20). Over a 10-year period, 763 biopsies for chronic HCV infection were identified with an obvious trend toward the increased use of US-guided technique observed at 2% in 1998 to 85% in 2007.CONCLUSIONS: US-guided liver biopsies for chronic HCV are the most common method of obtaining specimens at the Kingston General Hospital, Kingston, Ontario, and are of higher quality than non-US-guided specimens. However, there is no significant difference in the two techniques in the ability to grade and stage chronic HCV.
Douleurs et conflits : Approche comparative et implications pour la qualité des soins en fin de vie
Authors: Mpinga Emmanuel Kabengele , Verloo Henk , Rapin Charles-Henri , Chastonay Philippe 
Published: March 2016

Are conflicts to an organization what pain is to an organism?OBJECTIVES: To explore the similarities and the differences between pain and conflicts in palliative care settings, and to better understand the potential importance of conflicts in end of life quality of care.METHODS: Comparative and reflective methods focusing on how conflicts and pain are taken care of in health structures.RESULTS: Pain and conflicts present numerous similarities such as identity, typology, prevalence, warning function, economic and social costs, denial, occultation and hurdles to appropriate management. Differences also exist regarding pain – there are prevention programs on local and international levels; there are specific research and training programs; and there is also some social visibility. This does not yet exist on a larger scale regarding conflicts.CONCLUSION: Decision makers at clinical and public health levels should probably push to label conflicts as indicators of quality of care and develop appropriate health policy programs.
A Multicentre, Observational Study of Sodium Picosulfate and Magnesium Citrate as a Precolonoscopy Bowel Preparation
Authors: Love Jonathan , Bernard Edmond-Jean , Cockeram Alan , Cohen Lawrence , Fishman Martin , Gray James , Morgan David 
Published: March 2016

BACKGROUND: Sodium picosulfate with magnesium citrate (PSMC) has been available as a precolonoscopy bowel preparation in Canada since 2005. A high patient acceptability and preference appears to have contributed to its wide adoption across the country. Despite its frequent use, there are relatively few published studies of this product, especially reports regarding its use in routine clinical practice. Moreover, to date, there have been no Canadian studies of any kind.OBJECTIVE: To conduct a preliminary evaluation of PSMC by prospectively collecting data describing its effectiveness.METHODS: In the present multicentre, observational study, sequential patients used PSMC according to each institution’s standard colonoscopy protocol. Differences in bowel cleansing protocols included dose timing, fluid intake, dietary restrictions and administration of bisacodyl. During colonoscopy, preparation quality was rated separately for the right and left sides of the colon.RESULTS: Of the 613 patients entered, 606 were evaluable for efficacy. For the right and left colon, respectively, 93.0% and 96.2% of preparations were rated either ‘excellent’ or ‘adequate’. In the 334 patients who received adjunctive bisacodyl and the 272 patients who did not, the results were similar: for the right and left colon, 92.3% and 97.1% of those who did not, and 93.4% and 95.7% of those who did receive bisacodyl, respectively, were rated either ‘excellent’ or ‘adequate’.CONCLUSIONS: Despite the differences in bowel cleansing protocols used at each hospital (including an additional laxative), PSMC consistently yielded a high percentage of positive ratings for efficacy.