bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of the Role of the Cytomegalovirus as a Respiratory Pathogen in HIV‐Infected Patients
Authors: de la Hoz Rafael E , Hayashi Shizu , Cook Darrel , Sherlock Christopher , Hogg James C 
Published: March 2016

OBJECTIVE: To investigate the occurrence of cytomegalovirus (CMV) pneumonitis in the setting of human immunodeficiency virus (HIV) infection and whether the presence of CMV as copathogen is associated with increased clinical severity or short term mortality in patients with Pneumocystis carinii pneumonia.DESIGN: Retrospective cohort study.SETTING: Tertiary care university hospital.PATIENTS: One‐hundred and fourteen HIV‐infected homosexual men with pneumonia, followed for a minimum of four weeks.MEASUREMENTS: Clinical indicators of severity of pneumonia, microbiology of bronchoalveolar fluid and relative risk of short term mortality.RESULTS: Only two cases of CMV pneumonitis were found, one together with P carinii. However, 45 of the 86 patients with P carinii pneumonia were co‐infected with CMV. No difference in clinical severity was detected between patients co‐infected with P carinii and CMV and those with P carinii alone. The relative risk of short term mortality was 3.64 (95% CI 0.82 to 16.18), in patients with co‐infection compared with those with P carinii alone. The risk reached statistical significance for patients with earlier stages of HIV infection.CONCLUSIONS: CMV pneumonitis occurs rarely in HIV‐infected patients, while CMV co‐infection occurs in at least 50% of the cases of P carinii pneumonia. Although no difference in clinical severity was detected, this study suggests that short term mortality from P carinii pneumonia may be increased by CMV co‐infection, particularly in patients with earlier stages of the disease.
Survey of Physicians Concerning the Use of Chest Radiography in the Diagnosis of Pneumonia in Out‐Patients
Authors: Marrie Thomas J 
Published: March 2016

OBJECTIVE: To determine how physicians use chest radiography in the diagnosis of pneumonia in ambulatory patients.STUDY POPULATION: A convenience sample of 176 Nova Scotia family physicians and internists selected to represent all geographic areas of the province proportional to population.STUDY INSTRUMENT: A 35‐item questionnaire covering demographics, experience with out‐patients with pneumonia, use of chest radiographs to make this diagnosis and factors that were considered important in the decision to perform initial and follow‐up chest radiographs. Two skill‐testing questions were also included.RESULTS: One hundred and fourteen of 176 (64.7%) responded; 88% had treated out‐patients with pneumonia in the previous three months. Fifty‐seven per cent of physicians requested chest radiographs on 90% to 100% of out‐patients in whom they had made a clinical diagnosis of pneumonia. These physicians were more likely to be internists and to have graduated before 1970. Factors that ranked most important in the decision to request the initial chest radiograph were clinical appearance, respiratory distress and physical findings, while age and smoking history contributed most to the decision to perform a follow‐up chest radiograph.CONCLUSIONS: There is considerable variability among physicians in requesting chest radiographs on out‐patients with a clinical diagnosis of pneumonia. Physician and patient factors contribute to this variability.
Laboratory Diagnosis for Giardia Lamblia Infection: A Comparison of Microscopy, Coprodiagnosis and Serology
Authors: Behr Marcel A , Kokoskin Evelyne , Gyorkos Theresa W , Cédilotte Lyne , Faubert Gaetan M , MacLean J Dick 
Published: March 2016

OBJECTIVE: To evaluate newer techniques such as coproantigen detection and serology in the diagnosis of symptomatic Giardia lamblia infection.DESIGN: Blinded comparison of copro‐antigen detection (by ELISA), serology (immunoglobulin IgG and IgM anti‐G lamblia by ELISA, and IgG, IgM and IgA by immunoblot) and microscopy in clinical samples. Microscopic findings for three preserved stools were considered the gold standard.SETTING: Travel medicine clinic.POPULATION STUDIED: Adults, post‐travel, with gastrointestinal symptomatology.MAIN RESULTS: For 152 previously collected stools, copro‐antigen detection had a sensitivity of 73 of 74 (98.6%) and a specificity of 78 of 78 (100%). In clinical samples of 62 patients, eight of the 62 patients (13%) were diagnosed with G lamblia infection on microscopy. Copro‐antigen diagnosis was accurate in symptomatic patients, with sensitivity of seven of eight (87.5%) and specificity of 52 of 54 (96.8%). Serology was less accurate. IgG response to G lamblia had sensitivity of four of seven and specificity of 24 of 50 (48%), and IgM response had sensitivity of three of six and specificity 27 of 48 (56%). Western blot had a sensitivity of five of seven and a specificity of 38 of 49 (78%).CONCLUSIONS: Copro‐antigen diagnosis of G lamblia is highly accurate in patients with chronic gastrointestinal complaints, while serology is less accurate and appears to be less useful diagnostically.
Measuring Health‐Related Quality of Life: General Issues
Authors: Guyatt Gordon H 
Published: March 2016

Clinicians and policy makers recognize the importance of measuring health‐related quality of life (HRQL) to make informed patient management and policy decisions. Self‐ or interviewer‐administered questionnaires can be used to measure cross‐sectional differences in quality of life among patients at a point in time (discriminative instruments) or longitudinal changes in HRQL within patients over time (evaluative instruments). Both discriminative and evaluative instruments must be valid (ie, measure what they are supposed to measure) and have a high ratio of signal to noise (reliability and responsiveness for the two instruments, respectively). Reliable discriminative instruments are able to differentiate reproducibly among persons. Responsive evaluative measures are able to detect important changes in HRQL over time, even if those changes are small. HRQL should also be interpretable B that is, clinicians and policy makers must be able to identify differences in scores that correspond to trivial, small, moderate and large differences.There are two basic approaches to quality of life measurement: generic instruments that attempt to provide a summary of HRQL and specific instruments that focus on problems associated with individual disease states, patient groups or areas of function. Generic instruments include health profiles and instruments that generate health utilities. The approaches are not mutually exclusive. Each approach has its strengths and weaknesses and may be suitable under different circumstances. Investigations of HRQL have led to the development of instruments suitable for detecting minimally important effects in clinical trials, for measuring the health of populations and for providing information for policy decisions.
Randomized Double‐Blind Trial of the Effects of Humidified Compared with Nonhumidified Low Flow Oxygen Therapy on the Symptoms of Patients
Authors: Andres Darcy , Thurston Norma , Brant Rollin , Flemons Ward , Fofonoff Doreen , Ruttimann Ardis , Sveinson Sandra , Neil Carol 
Published: March 2016

OBJECTIVE: To determine the effects of humidified versus nonhumidified low flow oxygen therapy on the subjective symptoms of patients.METHODS: Randomized double‐blind clinical trial conducted in a tertiary care university teaching hospital. The sample included medical and surgical in‐patients receiving oxygen therapy who met criteria including medical stability, no overt cognitive impairment, English comprehension, voluntary participation and attending physician agreement. Humidified subjects numbered 96 and nonhumidified subjects were 95. The intervention was humidified or nonhumidified oxygen administration using two flowmeters covered by an opaque bag. Patients receiving oxygen therapy longer than three days (first period) were crossed to the alternate treatment (second period) and followed for three more days.RESULTS: Mean symptom scores for nasal dryness were low (mild) for both groups; however, humidification group scores were significantly lower (P=0.018) in the first period than the nonhumidification scores. A corresponding increase in the incidence of nosebleeds was not statistically significant between groups nor were there statistically significant differences between groups for other symptoms/problems. The prevailing trend was decreased incidence of dry mouth, dry throat, headache and chest discomfort during the study.CONCLUSIONS: Although this sample was large enough to expose statistically significant group differences in nasal dryness, the difference was not judged to be clinically significant. The predominant trend was a decrease in symptom scores over time with either treatment. In this group of patients, humidified oxygen does not appear to alleviate subjective symptoms.
Evaluation of Open Lung Biopsy in Critically Ill, Ventilator Dependent Intensive Care Unit Patients
Authors: Hughes Richard , McGuire Glenn 
Published: March 2016

OBJECTIVE: Evaluation of the benefits and risks of performing open lung biopsy (OLB) in critically ill, ventilator dependent intensive care unit patients.DESIGN: Retrospective chart review from 1990 to 1995.SETTING: A tertiary care teaching hospital intensive care unit.INTERVENTION: OLB in patients requiring mechanical ventilation for respiratory failure.MEASUREMENTS: Data collected included preoperative investigations, lung injury score, diagnosis, treatment and eventual outcome.RESULTS: Twenty‐seven patients (14 male, 13 female) were mechanically ventilated before OLB for a median duration of seven days. A change in clinical management occurred in 85% of the patients as a result of new information obtained from the OLB. There was no statistical difference in overall outcome whether OLB was performed early or later in the course of respiratory failure once the patient was mechanically ventilated. The incidence of perioperative complications was 37%. Ten patients eventually left hospital.CONCLUSIONS: In a small percentage of intensive care patients refractory to the usual medical treatment modalities, open lung biopsy intervention is required to attempt to obtain a specific diagnosis.
Varicella Zoster Virus Infections in Canadian Children in the Prevaccine Era: A Hospital‐Based Study
Authors: Kuhn Susan , Davies H Dele , Jadavji Taj 
Published: March 2016

OBJECTIVE: To describe the clinical course of children admitted for varicella zoster virus (VZV) infections to a pediatric hospital before the release of VZV vaccine in Canada.DESIGN: Retrospective case series.SETTING: Tertiary pediatric hospital. Population studied was children aged 18 years or younger admitted to hospital between 1983 and 1992 who were discharged with a diagnosis of varicella or zoster. Of the 201 children who were identified, 36 were excluded, leaving 165 for analysis.RESULTS: There was a male:female ratio of 1.5:1 and a median age of 5.3 years (range two weeks to 18 years). The group included those who were previously healthy (70, 42.4%), immunocompromised (60, 36.4%), and those with nonimmunocompromising conditions (35, 21.2%). Comparison of immunocompetent and immunocompromised children revealed that complication of VZV infection was a more common reason for admission among the former (86 of 105, 81.9%, P<0.001), whereas treatment with acyclovir to limit dissemination was the most common reason in the latter (53 of 60, 88.3%, P<0.001). Skin and soft tissue infections were the most common complications in immunocompetent children (36 of 98) and those younger than five years (26 of 53), whereas pulmonary complications predominated among immunocompromised patients (eight of 98) and neurological complications in five‐ to 10‐year‐olds (16 of 36). Only one death (0.6%) occurred in an immunocompetent patient. Group A beta‐hemolytic streptococci and Staphylococcus aureus caused equal numbers of secondary infections (92% of all isolates).CONCLUSIONS: Complications of VZV infections and secondary prophylactic antiviral treatment of immunocompromised children explain the majority of hospitalizations in this institution, and can be monitored after VZV vaccine introduction. Complications vary significantly with underlying healthy status and age.
Cat Scratch Disease: The Story Continues
Authors: Opavsky Mary Anne 
Published: March 2016

OBJECTIVE: To present a perspective on the current state of knowledge of cat scratch disease (CSD), including the evidence for Bartonella henselae as the etiological agent, epidemiological and clinical characteristics of the disease, available diagnostic tests and current therapeutic options.DATA SOURCES: MEDLINE search of the literature published from 1966 to 1995 using ‘cat scratch disease’, ‘Bartonella henselae’, ‘Rochalimaea henselae’ as key words and bibliographies of selected papers.DATA EXTRACTION: Selected studies reporting data on etiology, epidemiology, clinical characteristics, diagnosis and therapy of CSD were evaluated.DATA SYNTHESIS AND CONCLUSIONS: Evidence accumulated to date supports B henselae as the etiological agent of CSD. The most significant risk factors for CSD are being licked on the face, scratched or bitten by a kitten and owning a kitten with fleas. Available serological tests can confirm classic CSD and identify B henselae as the cause of more atypical presentations, such as fever of unknown origin, granulomatous hepatitis, encephalitis and osteomyelitis. Symptomatic management is appropriate for isolated lymphadenopathy caused by CSD in healthy individuals; however, antibiotic therapy may be indicated for patients with more severe manifestations of the disease and immunocompromised hosts. Further study of CSD, in particular the epidemiology and therapy, is warranted. A better understanding of the pathogenesis of B henselae infection will have important implications in both immunocompetent and immunocompromised individuals.
Transmissibility and Infection Control Implications of Burkolderia cepacia in Cystic Fibrosis
Authors: Fung Scott K , Dick H , Devlin H , Tullis E 
Published: March 2016

OBJECTIVE: To describe the microbiology and potential virulence factors of Burkholderia cepacia; to discuss the studies that have investigated its mode of transmission among cystic fibrosis patients; and to identify the major risk factors associated with acquisition of this pathogen inside and outside of the hospital environment.DATA SOURCES: MEDLINE search of the literature published between 1986 and 1997 using the key words/subject words Pseudomonas cepacia, Burkholderia cepacia, cystic fibrosis, infection control and transmissibility, and the bibliography of selected papers.DATA EXTRACTION: Selected studies examining epidemiology, microbiology, virulence factors and mode of transmission of B cepacia in cystic fibrosis.DATA SYNTHESIS AND CONCLUSIONS: B cepacia is a multidrug‐resistant Gram‐negative bacillus that has recently been recognized as a major respiratory pathogen in patients with cystic fibrosis. Colonization by this organism can lead to rapid pulmonary deterioration and premature death. Recent studies based on genomic subtyping techniques have suggested that it can be transmitted from person to person. Close social contact and hospitalization have been identified as risk factors for cross‐infection. With the implementation of strict infection control policies such as segregation according to colonization status, the rate of new colonization has substantially decreased in most cystic fibrosis treatment centres.
Invasive Fungal Infections in Canada from 1992 to 1994
Authors: Nicolle LE , Rotstein C , Bourgault AM , St-Germain G , Garber G , the Canadian Infectious Diseases Society Invasive Fungal Reg  
Published: March 2016

PURPOSE: To describe the frequency, characteristics and impact of invasive fungal infection in Canada.METHODS: Nominal case reporting with standardized data collection from selected sites across Canada. Cases were found primarily through laboratory review with supplementation by record review and clinical surveillance at some sites.RESULTS: The frequency of invasive fungal infection varied from 3.54 to 6.64/100,000 population per year. Candida species were responsible for 66% of all reports; 80% of candidal infections were bloodstream isolates. Crytococcus neoformans, Aspergillus species and Histoplasma capsulatum each accounted for 5% to 10% of cases, and all other organisms less than 5% each. Human immunodeficiency virus infection was an important comorbidity for cryptococcus and histoplasma infections, and was associated with increased mortality for only histoplasma infections. Geographical variation of histoplasma, blastomyces and coccidioidomyces infection was confirmed. Case fatality was high for all invasive fungal infections, except coccidioidomycosis, blastomycosis and sporotrichosis.CONCLUSIONS: Candida species infections are the major pathogens in invasive fungal infections in Canada; all other species occur relatively infrequently. The potential for therapeutic intervention to limit mortality requires further assessment.
Classification of Chronic Pain at a Multidisciplinary Pain Rehabilitation Clinic
Authors: Lidbeck Jan , Hautkamp Gertie IM , Ceder Ritva A , Näslund Urban LO 
Published: March 2016

OBJECTIVE: To make a detailed diagnostic analysis of patients with chronic pain syndromes, including classification according to the International Association for the Study of Pain (IASP).DESIGN: Descriptive study of consecutive referrals during a two‐year period.SETTING: A multidisciplinary out‐patient pain clinic focused on occupational rehabilitation.SUBJECTS: A total of 309 chronic pain patients.METHODS: After a standardized multimodal physical and psychological examination, the chronic pain syndrome of each patient was assigned one or more clinical diagnoses; assigned to an etiological pain category (nociceptive pain, non‐nociceptive including idiopathic pain, and psychological pain); and coded diagnostically according to IASP taxonomy.RESULTS: In all, 397 clinical diagnoses were made (ie, a mean of 1.3 diagnoses per patient). A large majority (87%) received a diagnosis of myalgia. Myofascial pain (trigger point syndrome) was diagnosed in two‐thirds of the patients and was the most frequent clinical pain syndrome. A total of 51.8% of the pain syndromes were categorized as nociceptive, 43.0% as idiopathic and less than 1% as pain of psychological origin. Classification using the IASP system yielded a very high proportion of nociceptive, musculoskeletal pain syndromes of high intensity, with widespread pain and/or pain located in the neck/shoulder/arm region, and of dysfunctional etiology.CONCLUSIONS: Musculoskeletal pain was very common in this series, and myofascial pain syndromes were the most frequent specific pain disorders. However, myofascial pain had generally gone unrecognized by the referring physician. In contrast to findings of other studies, the incidence of low back pain and of primary psychological pain was low. Comparison of the results with those of Swedish epidemiological surveys showed the frequencies of the diagnoses in this series to be representative of chronic pain syndromes in the Swedish general population.
Comparison of Budesonide Turbuhaler with Budesonide Aqua in the Treatment of Seasonal Allergic Rhinitis
Authors: Yang William H , Dolovich Jerry , Drouin Michel A , Keith Paul , Haddon Jennifer , Jennings Barbara , the Rhinocort Study Group  
Published: March 2016

OBJECTIVE: To compare the effect of budesonide Turbuhaler 400 µg/day with budesonide aqua 256 µg/day in the treatment of seasonal allergic rhinitis (SAR). Secondarily to ascertain patients′ preferences for the two nasal devices and to assess quality of life.DESIGN: Randomized, multicentre, double‐blind, double‐ dummy, parallel groups study.SETTING: Private practices and hospital clinics in Ontario, Quebec and Manitoba.POPULATION: Two hundred and eighty‐four out‐patients with SAR, who were symptomatic during the ragweed season, volunteered for enrolment (243 randomized).RESULTS: Mean daily nasal symptom scores were significantly reduced with treatment. There were no statistically significant changes from baseline for eye symptoms. Most patients (more than 80%) achieved substantial control of their symptoms with budesonide. The most common nasal and non‐nasal adverse events for both groups were epistaxis and headache. Turbuhaler was easier to use and more convenient to carry, had less of an unpleasant taste, and caused less nasal irritation than the aqua spray. More than twice as many patients preferred Turbuhaler to the aqua spray (69% versus 31%). Improvement in quality of life from baseline to clinic visits was statistically significant in both groups.CONCLUSION: Once daily use of 256 mg of budesonide aqua and 400 mg of budesonide Turbuhaler are equally safe and efficacious in the treatment of SAR. Patients preferred the budesonide powder formulation delivered via Turbuhaler two to one over the aqua formulation.
Implementation and Evaluation of a Preprinted Perioperative Antimicrobial Prophylaxis Order Form in a Teaching Hospital
Authors: Au Paul , Salama Suzette , Rotstein Coleman 
Published: March 2016

OBJECTIVE: To determine the effect of a preprinted perioperative antimicrobial prophylaxis order form on the appropriateness, standardization and cost of surgical prophylaxis.DESIGN: A pre‐ and postintervention prospective study with evaluation of drug acquisition costs in selected surgical procedures.SETTING: A 420‐bed teaching hospital in the Hamilton‐Wentworth region.PATIENTS: A three‐month survey of 901 consecutive patients followed by a two‐month trial period of 725 consecutive patients undergoing general surgery, orthopedic and urological procedures.INTERVENTION: A perioperative antimicrobial prophylaxis order form was developed based on guidelines from the literature and input from physician and nursing staff. The form was introduced through educational inservices and put into operation.MEASUREMENT: The measurement of antimicrobial perioperative prophylaxis appropriateness and drug acquisition costs were assessed pre‐ and postintroduction of the order form. Subsequently, prescriber compliance and satisfaction with the program were also evaluated.RESULTS: Appropriateness of perioperative antimicrobial surgical prophylaxis was increased from 36% in the baseline period to 79% in the trial period (P<0.0001). A reduction of $440.71 ($23.20/procedure) in drug acquisition costs was observed for 19 matched hip and knee prosthetic surgical procedures between the baseline and trial periods. In addition, compliance with the perioperative order form rose steadily during the trial period. Physician prescribers reported that the form was used, and was appropriate and user‐friendly but that it did not influence their prescribing habits. Nurses responded that the form was helpful and improved the timing of prophylaxis.CONCLUSIONS: The perioperative antimicrobial prophylaxis order form standardized antimicrobial administration time and resulted in an increase in appropriateness. A reduction in antimicrobial costs for surgical procedures was realized. This quality improvement project has enhanced the quality of patient care.