bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Attending a Healthcare Conference in Toronto During the Severe Acute Respiratory Syndrome Crisis: Survey of Delegates
Authors: Stinson Jennifer , McCartney Colin JL , Leung Andrea , Katz Joel 
Published: March 2016

OBJECTIVE: To describe the impact on delegates of attending the Canadian Pain Society′s annual meeting in Toronto during the severe acute respiratory syndrome (SARS) crisis in May 2003.METHODS: A prospective survey design was used. Surveys were sent to all delegates (n=432) who attended the conference, and 294 delegates responded (68% response rate). The survey was developed to determine the level of concern about travelling to Toronto; the adequacy of screening measures; the level of stress about attending; and the occupational consequences of attending.RESULTS: Fifty per cent of the participants were not concerned about travelling to Toronto, while the other 50% expressed some concern ranging from mild to serious. Concerns included being exposed to SARS and fear of transmitting it to others upon return. Reasons for attending the conference despite concern included a desire for continuing education, decrease in the number of reported SARS cases, and perceived minimal risk. Almost one‐half (n=140) felt the screening measures at the conference were adequate, while 4% felt they were inadequate and 9% somewhat adequate. Delegates (n=99) suggested that temperature‐taking (32.2%), improved screening vigilance (14.4%), SARS screening forms checked daily (9.1%), strictly controlled entry (8.1%) and adopting hospital screening procedures (7.1%) should have been instituted.CONCLUSION: Health care professionals planning conferences in this era of new respiratory diseases can benefit from understanding the responses of delegates who attended conferences during outbreaks. Clear communication about the potential risks and benefits, as well as instituting full screening precautions, will help to allay concerns.
Overdiagnosis of Asthma in the Community
Authors: Lindensmith Jorin , Morrison Debra , Deveau Carole , Hernandez Paul 
Published: March 2016

BACKGROUND: Overdiagnosis of asthma may be an emerging problem after years of attention to the rising prevalence and reported underdiagnosis of the disease.OBJECTIVES: A sample of adult asthmatics from the community was investigated to determine whether they met the current diagnostic criteria for asthma.METHODS: Ninety participants were studied from a self‐referred sample of physician‐labelled, adult asthmatics from the community. The setting was a tertiary care, university‐affiliated teaching hospital in Halifax, Nova Scotia. Three diagnostic criteria from the Canadian Thoracic Society Asthma Guidelines were used to demonstrate the presence of asthma: first, positive symptom history, and either, second, reversible airflow obstruction demonstrable on spirometry or documented peak expiratory flow rate diurnal variability, or, third, bronchial hyperreactivity to methacholine.RESULTS: At the time of the study, 41% of a sample of physician‐labelled asthmatics showed no evidence of reversible airflow obstruction and had a negative methacholine challenge. By backward logistical regression analysis, a higher mean number of medications used (P<0.01), a lower forced expiratory volume in 1 s (P<0.05) and using inhaled steroids (P<0.05) were predictive of meeting the diagnostic criteria for asthma. Sixty‐two per cent of subjects who did not meet the criteria for asthma were currently taking medications for ′asthma′. Only 52.2% of the subjects reported ever having undergone pulmonary function testing.CONCLUSIONS: Overdiagnosis of asthma is a potential problem, which may result in unnecessary or inappropriate medication use, increased health care costs and mislabelling of patients. The authors recommend greater use of objective diagnostic tests such as spirometry, peak flow diaries and bronchial provocation to establish a clinical diagnosis of asthma.
Translocation of Clostridium difficile Toxin B across Polarized Caco‐2 Cell Monolayers Is Enhanced by Toxin A
Authors: Du Tim , Alfa Michelle J 
Published: March 2016

Clostridium difficile is the etiological agent of antibiotic‐associated diarrhea; the most common form of nosocomial infectious diarrhea. The basis for the shock‐like systemic symptoms observed in severe cases of this infection are not known. It is hypothesized that the invasion of C difficile toxins A and/or B from the gut mucosa may contribute to these symptoms.A polarized tissue culture model employing Caco‐2 cells grown on transwell inserts was established to study the translocation of purified C difficile toxins A and B. C difficile toxins were 125I labelled and inoculated onto confluent polarized Caco‐2 cell monolayers to study translocation dynamics. Electrical resistance measurements were used to monitor monolayer confluence and tight junction integrity. Samples were taken from the apical and basal sides of the insert, as well as the insert itself, and tested using the human foreskin fibroblasts cell cytotoxicity assay to monitor partitioning of the radiolabelled toxins.Toxin A produced a 50% reduction in electrical resistance in 3 h whereas the same concentration of toxin B required at least 7 h to achieve the same effect. Both toxins A and B were able to translocate across confluent monolayers of Caco‐2 cells. The combination of toxin A and B together was synergistic with respect to promoting the translocation of toxin B. Although the addition of toxin A resulted in a 100% increase in the amount of toxin B able to translocate, no increases in toxin A translocation were observed. These findings suggest a model of pathogenesis in which C difficile toxin A facilitates the translocation of toxin B from the gut into submucosal areas where it may play a role in inflammatory damage.
The Costs and Consequences of Methicillin‐Resistant Staphylococcus aureus Infection Treatments in Canada
Authors: Rosner Andrew J , Becker Debbie L , Wong Angelina H , Miller Elizabeth , Conly John M 
Published: March 2016

BACKGROUND: A multinational randomized controlled trial has shown a trend toward early discharge of patients taking oral linezolid versus intravenous vancomycin (IV) in the treatment of methicillin‐resistant Staphylococcus aureus (MRSA) infections. Infection treatments resulting in shorter hospitalization durations are associated with cost savings from the hospital perspective.OBJECTIVE: To determine whether similar economic advantages are associated with oral linezolid, the costs and consequences of linezolid use following vancomycin IV versus the existing practice in the treatment of infections caused by MRSA were compared.METHODS: The charts of all patients admitted to one of three tertiary care teaching hospitals between January 1, 1997 and August 31, 2000 and treated with vancomycin IV for an active MRSA infection (skin and soft tissue only) were reviewed. Based on the vancomycin IV chart review data set and a simulated linezolid data set, the clinical consequences and the associated costs of MRSA treatment with vancomycin IV, and oral and IV forms of linezolid were quantified and compared within the framework of a cost‐consequence analysis.RESULTS: Patients treated with oral and IV forms of linezolid compared with the existing practice had a shorter length of stay and required fewer home IV care services, which resulted in a cost savings of $750 (2001 values) to the Canadian health care perspective.CONCLUSIONS: The estimated cost savings associated with linezolid use not only offset the higher acquisition cost of the anti‐infective, but may be substantial to health care systems across Canada, especially as the incidence of MRSA continues to rise.
Mycophenolic Acid Inhibits Replication of Type 2 Winnipeg, a Cerebrospinal Fluid‐Derived Reovirus Isolate
Authors: Hermann Laura L , Coombs Kevin M 
Published: March 2016

BACKGROUND: The role of reoviruses in human disease is uncertain. Most identified cases are sporadic and asymptomatic or produce minor upper respiratory or gastrointestinal symptoms. In November 1997, a reovirus was isolated from the cerebrospinal fluid of a severe combined immune deficient infant in Winnipeg, Manitoba. RNA characterization and sequencing studies demonstrated this reovirus isolate to be unique. Thus, the virus was named Type 2 Winnipeg (T2W).OBJECTIVES: Mycophenolic acid (MPA), a drug primarily used as an immunosuppressive agent, was assessed in the capacity to inhibit T2W viral growth.METHODS: The effects of MPA on viral growth were determined by plaque reduction assays. Cells were treated with different MPA concentrations, infected with T2W and incubated at 37°C for 0 h to 72 h. Virus titres were determined and compared with untreated controls.RESULTS: Production of infectious T2W progeny decreased more than 99% at 3 µg/mL MPA compared with untreated controls. Inhibition was not caused by cell toxicity because there was no difference in cell viability. The 50% cell toxic dose was 30 µg/mL MPA.CONCLUSIONS: MPA was able to inhibit viral growth of the novel reovirus T2W. Although MPA is usually used as an immunosuppressive agent, and despite the fact that T2W was isolated from an immunocompromised patient, these results suggest that MPA could have been used as a possible treatment at subimmunosuppressive doses. Animal studies to better define the antiviral and immunosuppressive activities of MPA (and its prodrug mycophenolate mofetil) appear warranted.
Pulmonary Rehabilitation Improves Functional Capacity in Patients 80 Years of Age or Older
Authors: Baltzan Marcel A , Kamel Hany , Alter Arlene , Rotaple Michael , Wolkove Norman 
Published: March 2016

OBJECTIVES: There is limited evidence that pulmonary rehabilitation improves exercise capacity in older patients with chronic respiratory disease. The objective of the present study was to determine whether patients 80 years of age or older gain similar benefits from pulmonary rehabilitation as do younger patients.DESIGN: Outcomes were compared in 230 consecutive inpatients with moderate to severe lung disease who participated in a comprehensive pulmonary rehabilitation program during a one‐year period. Outcomes included 6 min walk test distance (6MWT), the number of stairs completed in 2 min (2MST), Borg dyspnea scores after exertion and objective functional scores.RESULTS: There were no differences between older (80 to 91 years, n=43) and younger patients (n=187) with respect to sex, forced expiratory volume in 1 s (mean 0.77 L versus 0.72 L) or number of chronic medical diagnoses (2.4 versus 2.7). Older patients were less frequently survivors of mechanical ventilation (2.3% versus 16%). Baseline 6MWT (133 m versus 144 m; P=0.48) and 2MST (5.2 laps versus 6.5 laps; P=0.067) were similar but global function was lower (85 versus 89; P=0.040) in older patients than in younger patients, respectively. After pulmonary rehabilitation, all outcomes improved significantly regardless of age (all before‐after comparisons P<0.0001). Younger patients improved with a higher discharge 6MWT (231 m versus 185 m; P=0.004) and similar discharge 2MST (9.3 laps versus 7.9 laps; P=0.070) compared with older patients. Global function at discharge remained lower in older patients than younger patients (91 versus 94; P=0.002). The duration of rehabilitation and length of stay were similar between the two groups.CONCLUSION: A comprehensive inpatient pulmonary rehabilitation program is beneficial in selected patients 80 years of age or older.
User Perspectives on Issues that Influence the Quality of Daily life of Ventilator‐Assisted Individuals with Neuromuscular Disorders
Authors: Brooks Dina , King Audrey , Tonack Mark , Simson Helen , Gould Maria , Goldstein Roger 
Published: March 2016

OBJECTIVES: To identify user perspectives on the issues that impact the quality of the daily lives of ventilator‐assisted individuals living in the community.METHODS: Semistructured interviews were held with 26 Canadian ventilator‐assisted individuals (mean age 44±14 [SD] years, range 23 to 60 years; mean ventilator experience 18±13 years, range three to 53 years) whose disability from neuromuscular conditions necessitated assistance with activities of daily living. Participants described their daily life experiences and perceptions of the factors that limited or enhanced their quality. Interviews were tape‐recorded, transcribed and analyzed for emergent codes and themes.RESULTS: Ventilator users characterized important issues in terms of personal successes and limitations, as well as dependencies on others for daily living. Personal support services, income security, health care and transportation were important positive contributors to their quality of life. Dependency on others was clearly a negative contributor. The ventilator was regarded as a form of assistive technology, similar to a wheelchair. Ventilator users perceived that ventilation was associated with a stigma and negative assumptions about disability, particularly if suctioning was required.CONCLUSIONS: The majority of participants considered home mechanical ventilation to be a positive benefit for independent living, enhancing their overall health. They were clear as to the issues of importance to them, and formulated recommendations for health care providers and policy makers that could improve the quality of their daily lives. Many of the issues identified in the present report are faced by the growing community of ventilator users.
The Effect of Breathing and Skin Stimulation Techniques on Labour Pain Perception of Turkish Women
Authors: Yildirim Gulay , Sahin Nevin Hotun 
Published: March 2016

OBJECTIVE: To determine the effect of breathing techniques and
nurse‐administered massage on the pain perception of pregnant
woman during labour.SETTING AND PARTICIPANTS: The present study was conducted
among pregnant women (75% primiparous) admitted to the
SSK Bakirkoy Women and Children’s Hospital (Istanbul, Turkey)
between January 1, and September 1, 2000. The patients were in their
38th to 42nd week of pregnancy, not at high risk and expected to
have normal vaginal delivery. They were selected from volunteers by
nonrandom sampling.STUDY DESIGN: The present study involved 40 cases, with 20 in
the experimental group and 20 in the control group. Data were
obtained through the visual analogue scale, inspection form, observation
form and postnatal interview form. The study investigators provided
information about labour, breathing techniques and massage to
the pregnant women assigned to the experimental group at the beginning
of labour (latent phase). A study investigator also accompanied
them during labour. These women received nurse‐administered massage
and were encouraged to breathe and perform self‐administered
massage. They were also instructed to change their positions and to
relax.RESULTS AND CONCLUSION: Study results demonstrated that
nursing support and patient‐directed education concerning labour
and nonpharmacological pain control methods (eg, breathing and
cutaneous stimulation techniques) were effective in reducing the perception
of pain by pregnant women (when provided in the latent
labour phase before delivery), leading to a more satisfactory birth
experience.
HIV and Hepatitis C Virus Testing and Seropositivity Rates in Canadian Federal Penitentiaries: A Critical Opportunity for Care and Prevention
Authors: De Prithwish , Connor Nancy , Bouchard Françoise , Sutherland Donald 
Published: March 2016

BACKGROUND: Incarcerated persons experience high rates of HIV and hepatitis C virus (HCV) infection, but little is known about the burden of these bloodborne viruses among federal penitentiary inmates in Canada.OBJECTIVES: The present study investigates rates of testing and seropositivity for HIV and HCV among inmates in all 53 Canadian federal penitentiaries.METHODS: A cross‐sectional design using surveillance data on voluntary HIV and HCV antibody testing in 2002 were applied to estimate the rate of testing uptake and the rate of incident seropositive tests among new admissions to federal penitentiaries and resident inmates. Rates of testing and infection were further examined by sex and region. Seroprevalence of HIV and HCV was estimated from the number of cumulative positive tests to year‐end.RESULTS: Of 7670 new admissions during 2002, 30% were tested for HIV and HCV. Test seropositivity rates in this group were 0.7% for HIV and 10% for HCV. Of the 12,426 resident inmates, 28% were tested for HIV and 27% for HCV. Seropositivity rates in this group were 0.3% for HIV and 7% for HCV. Seroprevalence rates at year‐end for 2002 were 2.0% for HIV and 26% for HCV and were substantially higher among women offenders (HIV: 3.7% of women, 1.9% of men; HCV: 34% of women, 26% of men). Variations in testing uptake and test seropositivity were observed across regions.CONCLUSIONS: The present study underscores the value of continued monitoring and evaluation of trends in HIV and HCV infection, which remain prevalent in federal penitentiaries. Higher rates of testing are warranted for at‐risk inmates to improve early detection of infection and provide infected inmates with timely care and treatment. For those who remain free of infection, testing can provide the additional benefits of exposing inmates to health counselling and for the reinforcement of prevention messages. The period of incarceration is also a critical opportunity to link inmates with outside resources in preparation for release to the community.
French‐Canadian Version of the Chronic Respiratory and of the St George′s Respiratory Questionnaires: An Assessment of their Psychometric Properties in Patients with Chronic Obstructive Pulmonary Disease
Authors: Bourbeau Jean , Maltais Francois , Rouleau Michel , Guímont Chantal 
Published: March 2016

BACKGROUND: French versions of the Chronic Respiratory Questionnaire (CRQ) and the St George′s Respiratory Questionnaire (SGRQ) have largely been used in Canada, although the process by which they were translated remains unknown and the psychometric properties of these translated versions have not been assessed in a properly designed study.OBJECTIVE: To translate and evaluate the psychometric properties of the French‐Canadian versions of the CRQ and the SGRQ.METHODS: The questionnaires were translated according to standardized guidelines for cross‐cultural adaptation. Measurements were made at baseline and again after two weeks in 27 chronic obstructive pulomonary disease (COPD) patients known to have stable disease. Measurements were also taken pre‐ and post‐treatment in patients with acute exacerbation of COPD (33 patients) or in pulmonary rehabilitation (32 patients).RESULTS: The CRQ showed high test‐retest reliability (the majority above 0.70), although it was slightly lower for the dyspnea dimension (0.58 to 0.65). The SGRQ also showed high test‐retest reliability (above 0.80), although it was lower for the symptoms dimension (0.54 to 0.58). The internal consistency reliability coefficients ranged from 0.73 to 0.90 for the CRQ and above 0.80 for the SGRQ, except for the symptoms dimension. The Pearson′s correlation coefficients were low (less than 0.30) between most of the translated questionnaire dimension scores and forced expiratory volume in 1 s, 6 min walking test and dyspnea measures. The correlation was generally high (greater than 0.50) between the two questionnaires and the 36‐item short form health survey, and for those domains that measured the same construct. The changes in the total and subscale scores of the CRQ and the SGRQ (except for the symptoms domain) were all largely above the variability of the score in the stable disease group.CONCLUSION: The present study confirms that the French‐Canadian translated versions of the CRQ and the SGRQ perform well with respect to their psychometric properties. They are both suitable for their intended purpose, ie, to detect change in health status in patients with COPD when assessing if a treatment is beneficial. However, the symptoms domain of the SGRQ cannot be used to assess acute change with respect to a given therapy.
Different Profile of Interleukin‐10 Production in Circulating T Cells from Atopic Asthmatics Compared with Healthy Subjects
Authors: Matsumoto K , Narita S , Rerecich T , Snider DP , O′Byrne PM 
Published: March 2016

BACKGROUND: Interleukin (IL)‐10 is a pleiotropic cytokine released from various cells, including T cells. Although IL‐10 is suggested to inhibit allergic responses, its role in asthma remains uncertain. The purpose of the present study was to compare the profile of IL‐10 in circulating T cells from stable atopic asthmatics, atopic nonasthmatics and healthy controls.METHODS: Peripheral blood mononuclear cells were isolated, stained with anti‐CD3 and CD4/CD8 antibodies, and then processed for intracellular IL‐10 detection by flow cytometry.RESULTS: A kinetic study in healthy controls showed that stimulation with phorbol 12‐myristate 13‐acetate and ionomycin significantly increased the frequencies of IL‐10‐producing CD3+, CD4+ and CD8+ cells. Without stimulation, the frequencies of IL‐10‐producing CD3+, CD4+ and CD8+cells were significantly higher in asthmatics than in healthy controls, while a similar trend was observed in atopic nonasthmatics. Stimulation for 24 h significantly increased IL‐10‐producing CD3+, CD4+ and CD8+cells in healthy controls and atopic nonasthmatics, but not in asthmatics.CONCLUSIONS: The frequency of IL‐10‐producing T cells is increased in the circulation of stable atopic asthmatics compared with normal controls. The lack of enhancement in their frequency by phorbol 12‐myristate 13‐acetate and ionomycin in asthmatics suggests that the circulating T cells of asthmatic subjects are maximally stimulated with regards to IL‐10 production; alternatively, IL‐10 production by T cells from asthmatics may be regulated differently than T cells from other subjects.
Long‐Term Azithromycin Therapy in Cystic Fibrosis Patients: A Study on Drug Levels and Sputum Properties
Authors: Baumann Ulrich , King Malcolm , App Ernst M , Tai Shusheng , König Armin , Fischer Julia J , Zimmermann Torsten , Sextro Wolfgang , Hardt Horst von der 
Published: March 2016

BACKGROUND: Following reports on the treatment of diffuse panbronchiolitis (DPB), recent studies demonstrate that long term therapy with azithromycin (AZM) is effective in cystic fibrosis (CF) patients. However, the underlying mechanisms remain uncertain. Some macrolides, including AZM, display inhibition of virulence factors and other antipseudomonal effects at subinhibitory levels in vitro.OBJECTIVES: Drug doses used for CF and DPB therapy were investigated to determine whether they achieve corresponding sputum drug levels in CF patients in vivo.METHODS: In an open, prospective study, 14 CF patients with chronic Pseudomonas aeruginosa airway infection received 250 mg AZM either daily (′high dose′) or twice weekly (′low dose′) for 12 weeks. Viscoelasticity of sputum was assessed by magnetic microrheology.RESULTS: AZM accumulated in sputum by two orders of magnitude over a period of four weeks. In the following steady state, median AZM concentrations in sputum were 9.5 µg/mL (0.6 to 79.3 µg/mL, interquartiles 1.4 to 33.4 µg/mL) and 0.5 µg/mL (range less than 0.1 [below detection level] to 5.2 µg/mL, interquartiles 0.2 to 1.4 µg/mL) in the high and low dose groups, respectively. Viscoelasticity improved in all patients but one.CONCLUSIONS: The findings suggest that antipseudomonal activity has to be considered among the potential mechanisms of macrolide therapy. Further, viscoelasticity may be a valuable parameter in future clinical trials.