bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcutaneous Electrical Stimulation and Postoperative Total Knee Arthroplasty Pain
Authors: Mahomed Mohamed N , Maistrelli Gianni L , Mossanen Ayoob , Glazier Derek 
Published: March 2016

OBJECTIVE: To determine the efficacy of the Synaptic 2000 in reducing total knee replacement postoperative pain in a prospective randomized controlled trial.DESIGN: Patients were prospectively randomly assigned to two groups, one receiving seven days of transcutaneous electrical stimulation (TES) therapy in addition to standard postoperative care, and the other receiving standard postoperative care. Both groups received postoperative patient‐controlled analgesia and were switched to oral opiates.SETTING: Patients were treated at a university teaching hospital for elective primary unilateral total knee replacement.PATIENTS: All patients consented to enter the study. All had primary osteoarthritis. Fifteen patients were entered into each arm of the study, and all patients completed the study. The mean age of patients was 64 years for treatment and 71 years for controls.OUTCOME MEASURES: Outcome measures were analgesic consumption, return of knee range of motion and score on a visual analogue pain scale.RESULTS: No significant differences were noted in postoperative analgesic use, knee range of motion, length of stay or visual analogue pain scale score. Mean total analgesic use of morphine was 148 mg in the TES group and 108 mg in the control group. The TES group mean knee range of motion on postoperative day 7 was 75.3°; it was 73.6° in the control group. Group mean length of stay was 9.5 days in the TES group and 8.3 days in the control group.
Immunity to Diphtheria in a Sample of the Canadian Adult Population
Authors: Pelletier Louise , Duclos Philippe , Gill Peter , Deforest Adamedia 
Published: March 2016

OBJECTIVE: To assess immunity to diphtheria in a sample of Canadian adults.DESIGN: A seroprevalence study of a group of plasmapheresis donors was performed over a four‐month period in 1996. A convenience sample of 1619 sera was collected to obtain a good distribution by age groups and centres. The determination of diphtheria antitoxin concentrations was performed by neutralization of diphtheria toxin in cell culture.SUBJECTS: A total of 1619 plasmapheresis donors from Halifax, Quebec City, London, Calgary and Edmonton were studied.RESULTS: Of the 1619 sera, 20.3% tested showed susceptibility to diphtheria (antitoxin concentration less than 0.01 IU/mL). The proportion of susceptibles increased from 9.5% in subjects 30 to 39 years of age to 36.3% in those 60 years of age or more. The age group 20 to 29 years demonstrated a higher proportion of susceptibles (18.3%) than the next age group (30 to 39 years) in four of the five centres. Significant differences in antibody levels were also observed among the centres. There was no statistically significant difference between sexes.CONCLUSIONS: Overall, detectable antibody and presumably immunity to diphtheria in the present sample of Canadian adults is relatively good. However, reason(s) for the relatively high proportion of susceptibles in those aged 20 to 29 years of age in certain centres, as well as why Canada has not experienced any diphtheria outbreaks in the past 20 years given these susceptibility levels, should be investigated further.
Anti-inflammatory effects of salmeterol compared with beclomethasone in eosinophilic mild exacerbations of asthma: A randomized, placebo controlled trial
Authors: Turner Mark O , Johnston Patrick R , Pizzichini Emilio , Pizzichini Marcia MM , Hussack Pat A , Hargreave Frederick E 
Published: March 2016

BACKGROUND: Salmeterol is a potent long acting beta-agonist that is effective in relieving the symptoms and airflow limitation of asthma.OBJECTIVE: To determine whether the effect of salmeterol on clinical parameters in a mild eosinophilic exacerbation of asthma was similar to that of beclomethasone dipropionate (BDP) and, thus, is due to an anti-inflammatory property.PATIENTS AND METHODS: Thirty-four asthmatics with a persistent increase in symptoms for at least two weeks and an increase of sputum eosinophils of 4% or more were randomized in a double-blind fashion to one of three groups that received daily treatment with 100 µg salmeterol, 1 mg BDP or placebo in divided doses using identical pressurized inhalers. Patients were treated with study medications for three weeks, followed by one week of open label BDP (500 µg bid). Patients were seen at weekly intervals, and sputum and blood were obtained on each visit. The primary outcome measure was a change in sputum eosinophils, and secondary outcomes were changes in blood eosinophils, eosinophilic cationic protein (ECP) and clinical parameters. Three patients (one in each group) could not produce any sputum after randomization and were excluded from the analysis.RESULTS: Twelve patients received salmeterol, 10 received BDP and nine received placebo. Salmeterol treatment had no effect on sputum eosinophils geometric mean, (from 35.5 [24.9] to 26.9% [25.8]), blood eosinophils (from 7.6 [4.8] to 7.2% [3.9]) or ECP (from 33.1 [18.1] to 27.8 [16.3] mg/L) but improved morning peak expiratory flow (PEF) and diurnal variation of PEF, and decreased the use of rescue medication more than placebo (P<0.05 for all comparisons). In contrast, BDP improved both inflammatory indexes (sputum eosinophils from 22.5 [17.9] to 5.7% [6.8], blood eosinophils from 9.0 [5.5] to 2.1% 1.0, and serum ECP from 36.5 [22.0] to 16.1 [10.1] mg/L) as well as clinical parameters.CONCLUSIONS: These results show that salmeterol improves the symptoms and airway function of patients with asthma, but has no effect on eosinophilic airway infiltration. These findings support current asthma guidelines, which recommend the initial use of inhaled steroid to maximize clinical improvement. While salmeterol also produces clinical improvement, it does not suppress sputum eosinophilia. The analysis of induced or spontaneous sputum for inflammatory indexes may be a valuable clinical test to guide the use of inhaled steroid and/or a long acting beta-agonist.
Platelet Depletion and Severity of Streptococcal Endocarditis
Authors: Dall Lawrence , Miller Todd , Herndon Betty , Diez Ireneo , Dew Michelle 
Published: March 2016

OBJECTIVE: To evaluate the importance of thrombocytopenia in streptococcal endocarditis using an animal model.DESIGN: A model of human septic endocarditis was established in rats (polyethylene catheters across the aortic valve and administration of Streptococcus sanguis, 5×107 colony forming units [cfu] intravenous). Thrombocytopenia at four levels was produced by antiplatelet serum. Secondary methods of producing thrombocytopenia were also evaluated. At sacrifice (96 h after platelet depletion and 72 h after infection), vegetations were removed, weighed, diluted, plated and counted. Potential mechanisms of the dose‐response relationship between vegetation density and platelet count were evaluated.SETTING: Controlled research laboratory experiments.POPULATION STUDIED: Animal models of streptococcal endocarditis.MAIN RESULTS: The bacterial density of the aortic valve vegetations significantly increased as the platelet count decreased (P=0.0007). In severely thrombocytopenic animals (two‐dose antiplatelet serum), data suggest increased vegetation embolism. Platelet depletion, which was minimal with chemical methods, was produced most effectively by antithrombocyte serum. Platelet surfaces in endocarditis were found to express elevated CD62p proteins (72.7% endocarditis, 34.7% control). Platelet protein fractions were evaluated in vitro by both streptocidal (P=0.19) and phagocytosis‐stimulating assays. Platelet presence in mature aortic valve vegetations averaged only about 2%.CONCLUSIONS: In platelet depletion experiments using a rat model, a dose‐response relationship of peripheral circulating platelet depletion to aortic valve vegetation density was found. The mechanism relating thrombocytopenia to endocarditis severity remains unresolved.
The Nature and Prevalence of Pain in Dreams
Authors: Zadra Antonio L , Nielsen Tore A , Germain Anne , Lavigne Gilles , Donderi DC 
Published: March 2016

BACKGROUND: Little is known about the frequency and nature of pain in dreams. Several authors have suggested that pain may be beyond the representational capability of dreaming.OBJECTIVE: To obtain more detailed information on the nature and prevalence of pain in a larger sample of everyday dreams collected through home logs. To examine the context within which dreamed pain occurs and to assess participants′ retrospective recall of past experiences of pain in dreams.METHOD: One hundred and eighty‐five participants completed a battery of questionnaires and recorded their dreams for two consecutive weeks.RESULTS: Retrospective responses to the questionnaire indicate that close to 50% of individuals report having experienced pain in their dreams at least once. A total of 3045 dreams were reported in the home dream logs. Eighteen of these dreams contained unambiguous references to the subject experiencing pain.DISCUSSION: Pain sensations in dreams are reported as being realistic, localized to a specific area of the body, typically resulting from violent encounters with other characters and often accompanied by intense affect. A model is proposed to explain how sensory experiences such as pain can be produced in the dream state.CONCLUSION: Cognitive systems that contribute to the representation of pain imagery are sometimes functional during dreaming.
Serological Evidence of Increased Coccidioides immitis Infections in Western Canada in 1996
Authors: Prasad Errol , Diediw Patricia , Fernandes Donna , Hodge Lorreen , Ower Katherine , Rennie Robert 
Published: March 2016

OBJECTIVE: To investigate the epidemiology of Coccidioides immitis infection in persons returning to western Canada from C immitis endemic zones in southwestern United States.DESIGN: Review of C immitis serology requests from 1996.METHODS: Data were based on review of enzyme immunoassay and immunodiffusion results from 1993 to 1996 inclusive. Detailed information on clinical presentation, treatment and outcome of disease process was obtained through questionnaires and interviews with physicians who submitted Coccidioides serology requests in 1996.RESULTS: Positive serology for C immitis increased from 4.7% to 5.2% (between 1993 and 1995 inclusive) to 10.7% in 1996. Enzyme immunoassay for immunoglobulin G and/or immunoglobulin M or immunodiffusion was positive in 25 patients in 1996. The mean age of these patients was 62 years, and the predominant clinical presentation was pulmonary infiltrate with fever. All patients with positive serology were known to have travelled to central or southwestern Arizona or southern California.CONCLUSIONS: Travel to a defined coccidioidomycosis endemic zone presents a risk for the older traveller. Serology for C immitis supported the clinical, histological and microbiological diagnoses in patients who had travelled to this defined endemic zone.
Diarrhea Recurrence in Patients with Clostridium difficile‐Associated Diarrhea: Role of Concurrent Antibiotics
Authors: Alfa MJ , Harding GKM , Ronald AR , Light RB , MacFarlane N , Olson N , DeGagne P , Kasdorf K , Simor A , MacDonald KS , Louie L 
Published: March 2016

OBJECTIVE: To monitor prospectively patients with Clostridium difficile‐associated diarrhea (CAD) in a six hundred bed tertiary care hospital to determine which factors influenced the recurrence of the diarrhea.DESIGN: A prospective, nonrandomized study. After an initial diagnosis of CAD, patients were interviewed, and each week stool samples and environmental samples were monitored for the presence of toxigenic C difficile for as long as the patients remained in hospital. The relationship of concurrent antibiotics, prolonged fecal excretion of organism or toxin, and environmental contamination was assessed.PATIENTS: Over a two‐and‐a‐half year period, 75 consecutive patients with CAD were selected and those who gave their written informed consent were enrolled. A control group to evaluate environmental contamination consisted of 75 patients with diarrhea not associated with C difficile.RESULTS: Of the 75 CAD patients, 11 (14.7%) had a recurrence of their diarrhea. Diarrhea recurrence was associated with an increased rate of prolonged excretion of toxigenic organism and/or C difficile toxin(s) (nine of 11 [81.8%] compared with nine of 64 [14.1%]; P≤0.0001; relative risk 14.25; 95% CI 3.383 to 60.023). The risk of diarrhea recurrence was not related to a specific antibiotic but to concurrent therapy. Treatment within 30 days of initial CAD‐specific treatment with an antibiotic other than metronidazole or vancomycin occurred significantly more frequently in patients with recurrence of diarrhea compared with those who did not have a recurrence (eight of 11 [72.7%] compared with 22 of 64 [34.4%], P=0.022; relative risk 4; 95% CI 1.153 to 13.881). The environmental contamination rate for toxigenic C difficile in week one in the rooms of patients with diarrhea not caused by C difficile was low (two of 75 [2.6%]) compared with week one data for patients with CAD (14 of 75 [18.7%], P=0.002; relative risk 1.922; 95% CI 1.479 to 2.498). The most frequent site contaminated was the bedpan sprayer (eight of 14 [57.1%]). Pulsed field gel electrophoresis analysis of stool and environmental toxigenic isolates indicated that there was not a single endemic strain of C difficile.CONCLUSIONS: This study indicates that the recurrence of diarrhea may be related to concurrent ‘other’ antibiotics. Although data indicated that there was a correlation between diarrhea recurrence and prolonged fecal excretion of toxin, further studies are required to clarify the clinical significance.
No Increase in Frequency of Antifungal Resistance among Yeasts Isolated from Normally Sterile Sites in Patients at Foothills Hospital from 1993 to 1996
Authors: Gibb A Patrick , Thorson Cheryl , van den Elzen Harry 
Published: March 2016

OBJECTIVE: To determine the prevalence of resistance to antifungal drugs among yeasts isolated from sterile sites from patients in one hospital and the relationship of resistance to antifungal use, and to assess whether resistance was increasing.METHOD: Susceptibility testing performed by National Committee for Clinical Laboratory Standards (NCCLS) (Villanova, Pennsylvania) microdilution method and by E test. Antifungal use was determined by selected chart review and from pharmacy data.SPECIMENS AND SETTING: Tertiary care adult hospital with neonatal intensive care.POPULATION STUDIED: Distinct yeast isolates from sterile site specimens collected during the years 1993 to 1996.RESULTS: A total of 132 yeast isolates were studied, of which 78 (59%) were Candida albicans. The proportion of C albicans remained steady over the four‐year period, and there was no trend to increased resistance among C albicans. The number of isolates of all species with fluconazole microdilution minimum inhibitory concentration (MIC) greater than 8 mg/L in each of the four years were one of 32 in 1996, three of 26 in 1994, six of 33 in 1995, and one of 41 in 1996. A single isolate had an itraconazole microdilution MIC greater than 0.5 mg/L in each year. Prior use of antifungal therapy was rare in this patient population.CONCLUSIONS: The increase in resistance to antifungal drugs reported by some centres did not occur in this institution over the course of the study. This experience may reflect differences in infection control practices and in patterns of use of antifungal agents. The NCCLS method was found to be superior to the E test as a routine method for testing susceptibility of yeasts.
Host Defence to Pulmonary Mycosis
Authors: Mody Christopher H , Warren Peter W 
Published: March 2016

OBJECTIVE: To provide a basic understanding of the mechanisms of host defense to pathogenic fungi. This will help physicians understand why some patients are predisposed to fungal infections and update basic scientists on how microbial immunology applies to fungal disease.DATA SOURCES: English articles from 1966 to present were identified from a MEDLINE search.STUDY SELECTION: Articles were identified by a MEDLINE search of ‘exp lung/’ or ‘exp lung diseases/’ and ‘exp fungi/’. The titles and abstracts were screened to identify articles that contained salient information pertaining to host defense of respiratory mycoses.DATA EXTRACTION: Information was summarized from the articles pertaining to host defense of pulmonary mycosis that had been identified by the MEDLINE search.DATA SYNTHESIS: Fungi represent a unique and highly diverse group of pathogenic organisms that have become an increasingly prevalent cause of life‐threatening illness. A worldwide increase in persons with immunodeficiency has been a major contributing factor to the increase in fungal disease. As a result, clinicians are faced with an expanding array of fungal infections that pose diagnostic and therapeutic challenges. The respiratory tract is the route of acquisition for many important fungal infections; thus, understanding the host defense in the lung is an essential component of understanding host defense to fungal disease. With this understanding, fungi may be divided on the basis of the predilection of certain mycosis for specific immune defects.CONCLUSIONS: By separating fungi based on the host immune defects that predispose to disease, in conjunction with traditional divisions based on the geographic distribution of fungi, clinicians are able to focus their diagnostic efforts and to identify fungal pathogens better. In addition, an understanding of the normal host defense mechanisms that serve to control fungal infections is essential to the development of novel antifungal therapies.
The 1996 and 1997 National Survey of Physician Asthma Management Practices: Background and Study Methodology
Authors: Jin Robert L , Choi Bernard CK 
Published: March 2016

OBJECTIVES: To collect national baseline information on asthma management practices by physicians, and to compare these practices with the recommendations of the Canadian Asthma Consensus Conference (‘the guidelines’).DESIGN: Cross‐sectional survey of representative samples of physicians in Canada in late 1996 and early 1997.POPULATION STUDIED: Five specialty types of physicians who manage asthma patients: respirology, pediatrics, internal medicine, allergy and clinical immunology, and general practice and family medicine. Stratified sampling by province and specialty was used to select physicians for the study. Weighting was used in the analysis to generalize the results to the national level for the five specialty groups of physicians.METHOD: Mailed questionnaire, self‐administered by the respondent; three mailings of the questionnaires were used to increase the response rate.MAIN RESULTS: The frequency with which each of the five specialty types chose specific asthma management choices was determined, using weighted percentages representative of the specialty groups on a national basis. ANOVA determined the statistically significant differences among the five specialties in choosing particular asthma management actions. Then, logistic regression was used to calculate the odds ratios showing an association between the characteristics of the physician respondents and specific asthma management choices that they made in the survey.CONCLUSIONS: The data analysis demonstrated significant variations among physicians in asthma management practices, according to specialty type and other characteristics. The initial report was released in April 1998, and manuscripts for journal submissions are being prepared.
A Randomized Controlled Study of the Pain‐ and Tension‐Reducing Effects of 15 Min Workplace Massage Treatments Versus Seated Rest for Nurses in a Large Teaching Hospital
Authors: Katz Joel , Wowk Adarose , Culp Dianne , Wakeling Heather 
Published: March 2016

OBJECTIVES: To evaluate whether a series of eight 15 min, on‐site massage treatments would be effective in reducing pain and tension in nursing staff at a large teaching hospital.HYPOTHESES: On‐site massage treatment would result in reduced pain intensity and tension levels and increased relaxation compared with a control group receiving seated rest.DESIGN: Randomized, controlled trial of eight sessions of Swedish massage therapy versus eight sessions of seated rest.PARTICIPANTS: Thirty‐two hospital staff (29 registered nurses and three clerical staff) volunteers.SETTING: Participants were recruited from a tertiary care centre.OUTCOME MEASURES: Pulse rate (beats/min), pain measured using a 10 cm Visual Analogue Scale (VAS), tension (VAS), relaxation (yes/no) and the Profile of Mood States (POMS) were measured before and after each session.RESULTS: The groups did not differ significantly on baseline demographic variables or in attendance rates. Post‐treatment VAS pain, VAS tension, and total POMS scores showed the same pattern of results: one‐way ANCOVAs revealed a significant effect of the covariate (mean pretreatment score averaged across sessions attended) and a significant main effect for groups indicating that post‐treatment pain, tension and POMS scores were significantly lower in the massage group than in he seated rest group (all P<0.001). A greater proportion of the massage group reported a sense of relaxation, and had pain and tension relief that persisted for up to a day or longer post massage (P<0.0009).CONCLUSIONS: The provision of on‐site massage treatments for nursing staff at a large teaching hospital resulted in significant reductions in pain and tension levels and an increase in overall mood compared with a control group that received seated rest.
Similar Bronchodilation with Formoterol Delivered by Aerolizer or Turbuhaler
Authors: Lötvall J , Mellén A , Arvidsson P , Palmqvist M , Radielovic P , Kottakis J , Pfister P 
Published: March 2016

BACKGROUND: In many countries, two dry powder formulations of inhaled formoterol are available for clinical use; one uses a single‐dose device (Foradil, Aerolizer), and the other uses a multiple‐dose device (Oxis, Turbuhaler).OBJECTIVES: To study the bronchodilating effect of formoterol 12 μg when delivered via the Aerolizer and Turbuhaler devices over 12 h.STUDY DESIGN: Randomized, double‐blind, placebo controlled crossover study. Forced expiratory volume in one second (FEV1) was monitored during a 12 h period.PATIENTS: Nineteen nonsmoking asthma patients were included in the trial on the basis of reversibility of symptoms in response to inhaled salbutamol (either 200 or 400 μg given cumulatively; minimum reversibility 15%).RESULTS: There were no significant differences between the two dry powder devices regarding the change from baseline of FEV1 over 12 h, the area under the curve of FEV1 over 12 h or the maximum value of FEV1. The improvement in FEV1 with formoterol 12 μg versus placebo was highly significant for both devices.CONCLUSIONS: Formoterol is similarly effective when used as a dry powder when given by either Aerolizer or the Turbuhaler.