bluuebunny/crossref_metadata_2025_split huggingface dataset:
Updating the Evidence Base for Suctioning Adult Patients: A Systematic Review
Authors: Overend Tom J , Anderson Cathy M , Brooks Dina , Cicutto Lisa , Keim Michael , McAuslan Debra , Nonoyama Mika 
Published: March 2016

OBJECTIVES: To update a previous clinical practice guideline on suctioning in adult patients, published in the Canadian Respiratory Journal in 2001.METHODS: A primary search of the MEDLINE (from 1998), CINAHL, EMBASE and The Cochrane Library (all from 1996) databases up to November 2007, was conducted. These dates reflect the search limits reached in the previous clinical practice guideline. A secondary search of the reference lists of retrieved articles was also performed. Two reviewers independently appraised each study before meeting to reach consensus. Study quality was evaluated using the Jadad and PEDro scales. When sufficient data were available, a meta‐analysis was conducted using a random effects model. Data are reported as ORs, weighted mean differences and 95% CIs. When no comparisons were possible, qualitative analyses of the data were completed.RESULTS: Eighty‐one studies were critically appraised from a pool of 123. A total of 28 randomized controlled trials or randomized crossover studies were accepted for inclusion. Meta‐analysis was possible for open versus closed suctioning only. Recommendations from 2001 with respect to hyperoxygenation, hyperinflation, use of a ventilator circuit adaptor and subglottic suctioning were confirmed. New evidence was identified with respect to indications for suctioning, open suction versus closed suction systems, use of medications and infection control.CONCLUSIONS: While new evidence continues to be varied in strength, and is still lacking in some areas of suctioning practice, the evidence base has improved since 2001. Members of the health care team should incorporate this evidence into their practice.
The Impact of Requiring Completion of an Online Infection Control Course on Health Professionals’ Intentions to Comply with Infection Control Guidelines: A Comparative Study
Authors: Yassi Annalee , Bryce Elizabeth A , Maultsaid Deirdre , Lauscher Helen Novak , Zhao Kun 
Published: March 2016

BACKGROUND: Ensuring good infection control practice in health care facilities is a constant concern, yet evidence shows that the compliance of health care professionals with proper procedures is lacking, despite the existence of guidelines and training programs. An online infection control module was developed to provide ready access to training. Controversy exists about whether successfully completing such a course should be mandatory or strongly encouraged for all health care professionals. The objective of the present study was to compare the perception of safety culture and intention to comply with infection control guidelines in professionals who were required by their supervisors to take the course, and those who did so voluntarily.METHODS: Survey responses on learning environment, safety climate and intention to comply with infection control guidelines in health care professionals who were required to take the course (supervisor‐required group [n=143]) and those who took the same course voluntarily (voluntary group [n=105]) were compared. Because randomization was thought to be too difficult to implement in the policy context in which the study was conducted, significant differences between the two groups were taken into account in the analysis.RESULTS: Those required to take the course had a significantly better perception of the institutional safety climate (P<0.001), and had a higher reported intention to comply with infection control guidelines (P=0.040) than those who took the course voluntarily.DISCUSSION: Requiring that staff complete a 30 min interactive online infection control module increased their intention to comply with infection control guidelines compared with those who voluntarily accessed this material based on promotional material. Consideration should be given to making the successful completion of an online infection control module a requirement for all health care professionals.
Rubella Immunity among Pregnant Women in a Canadian Provincial Screening Program
Authors: Kearns Mark J , Plitt Sabrina S , Lee Bonita E , Robinson Joan L 
Published: March 2016

BACKGROUND: There are limited recent data on rubella immunity in women of childbearing age in Canada. In the present paper, the proportion of rubella seroreactivity and redundant testing (testing of women previously seropositive when tested by the same physician) in the Alberta prenatal rubella screening program were studied.METHODS: In the present retrospective observational study, data on all specimens submitted for prenatal screening in Alberta between August 2002 and December 2005 were extracted from the Provincial Laboratory for Public Health database. The proportion of rubella screening and immunoglobulin G (IgG) seroreactivity were determined. Demographic variables were compared between rubella seroreactors and nonseroreactors. The proportion of redundant testing was determined.RESULTS: Of 159,046 prenatal specimens, 88.3% (n=140,473) were screened for rubella immunity. In total, 8.8% of specimens tested negative for rubella IgG. Younger women (23.2% of women younger than 20 years of age versus 4.7% of women between 35 and 39 years of age; P<0.001) and women from northern Alberta (11.9% versus 8.1% [overall]; P<0.001) were significantly more likely to have seronegative specimens. Of the 20,044 women who had multiple rubella immunity screenings, 88.1% (n=17,651) had multiple positive test results. In total, 20.7% of the 42,274 specimens submitted from women with multiple screenings were deemed redundant.DISCUSSION: Younger women were most likely to be seronegative for rubella. The public health significance of women entering their childbearing years with low or undetectable rubella IgG levels remains to be determined. A large number of women with documented rubella immunity were unnecessarily retested.
Optimal Use of Raltegravir (Isentress®) in the Treatment of HIV‐Infected Adults – Canadian Consensus Guidelines
Authors: Rachlis Anita , Angel Jonathan B , Harris Marianne , Shafran Stephen D , Therrien Rachel , Tremblay Cécile , Wainberg Mark A 
Published: March 2016

BACKGROUND AND OBJECTIVES: A meeting of a Canadian group with significant experience and knowledge in HIV management, consisting of five physicians, a pharmacist and an AIDS researcher, was convened. Their goal was to develop guidance for Canadian HIV‐treating physicians on the appropriate use of raltegravir (MK‐0518, Isentress®, Merck Frosst Canada Inc) in HIV‐infected adults.METHODS: Evidence from the published literature and conference presentations, as well as expert opinions of the group members, was considered and evaluated to develop the recommendations. Feedback on the draft recommendations was obtained from this core group, as well as from five other physicians and scientists across Canada with expertise in HIV treatment and antiretroviral drug resistance, and experience in the use of raltegravir. The final recommendations represent the core group’s consensus agreement once all feedback was considered.RESULTS/CONCLUSIONS: Recommendations were developed to guide physicians in the optimal use of raltegravir. The issues considered included raltegravir’s role in overall treatment strategy, efficacy, durability of effect, rate of viral load reduction, resistance, safety/toxicity, pharmacokinetics and drug interactions.
Pancreatic Cancer in Canada: Incidence and Mortality Trends from 1992 to 2005
Authors: Flook Robert , van Zanten Sander Veldhuyzen 
Published: March 2016

BACKGROUND: Pancreatic cancer is the fourth-ranking cause of death among all major malignancies in Canada and has the lowest five-year survival rate.AIM: To examine incidence and mortality trends of pancreatic cancer in Canada from 1992 to 2005, with particular emphasis on the role of cigarette smoking.METHODS: Data from Health Canada and Statistics Canada were analyzed for age-adjusted incidence and mortality trends from 1992 to 2005. The future burden of pancreatic cancer in Canada was based on population projections.RESULTS: The incidence rate of pancreatic cancer for women between 1992 and 2005 remained stable (8.49 and 8.48 cases per 100,000, respectively), and there was a decrease in the incidence for men from 11.1 per 100,000 in 1992 to 9.89 per 100,000 in 2005. This reduction may be the result of a decrease in smoking rates among Canadian men. The mortality rate of this cancer remains high. Approximately 99% of all pancreatic cancer cases occur in individuals older than 50 years of age. The total number of annual cases of pancreatic cancer in Canada is expected to more than double from 2636 cases in 2006 to 5619 in the year 2031.CONCLUSION: The incidence of pancreatic cancer in Canada from 1992 to 2005 remained relatively stable, although the incidence decreased somewhat in men, perhaps as a result of a change in smoking behaviour. The total number of cases of pancreatic cancer is expected to more than double by 2031.
Success in Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease
Authors: Scott Adrienne S , Baltzan Marcel A , Fox Joel , Wolkove Norman 
Published: March 2016

BACKGROUND: Pulmonary rehabilitation (PR) is beneficial for some, but not all, patients with chronic lung disease.OBJECTIVES: To determine the success rate of a comprehensive PR program for patients with chronic obstructive pulmonary disease (COPD) and to characterize the differences between responders and nonresponders.METHODS: A chart review was performed on patients with a clinical diagnosis of COPD who were referred for PR. Success was defined according to clinically important changes in St George’s Respiratory Questionnaire scores and/or 6 min walk test distance.RESULTS: The majority of subjects were men (58%) with a mean (± SD) age of 69±10 years (n=177). Sixty-two per cent of participants had a successful outcome with PR, with proportionally more responders noting subjective improvement than objective improvement on a 6 min walk test (73% versus 51%). Subjects with poor baseline St George’s Respiratory Questionnaire scores tended to improve the most (P=0.011 [ANOVA]). Successful participants had a greater forced expired volume in 1 s (1.1 L versus 0.9 L; P<0.05) and a lower BODE index (body mass index, airflow obstruction, dyspnea, and exercise capacity index) at baseline (9.6 versus 10.3; P<0.05). Success of PR was not correlated with age, sex, chronic hypoxemic respiratory failure or other chronic conditions. Successful participants were more likely to be compliant and to experience fewer adverse events (P≤0.001).CONCLUSIONS: Our study reinforced the belief that the majority of participants with COPD benefit from PR. Few baseline characteristics were predictive of success. Subjectively measured improvement occurred more frequently than objectively measured improvement and was greatest in those with the poorest baseline values.
Validation of Coding Algorithms for the Identification of Patients with Primary Biliary Cirrhosis Using Administrative Data
Authors: Myers Robert P , Shaheen Abdel Aziz M , Fong Andrew , Wan Alex F , Swain Mark G , Hilsden Robert J , Sutherland Lloyd , Quan Hude 
Published: March 2016

BACKGROUND: Large-scale epidemiological studies of primary biliary cirrhosis (PBC) have been hindered by difficulties in case ascertainment.OBJECTIVE: To develop coding algorithms for identifying PBC patients using administrative data – a widely available data source.METHODS: Population-based administrative databases were used to identify patients with a diagnosis code for PBC from 1994 to 2002. Coding algorithms for confirmed PBC (two or more of antimitochondrial antibody positivity, cholestatic liver biochemistry and/or compatible liver histology) were derived using chart abstraction data as the reference. Patients with a recorded PBC diagnosis but insufficient confirmatory data were classified as ‘suspected PBC’.RESULTS: Of 189 potential PBC cases, 119 (60%) had confirmed PBC and 28 (14%) had suspected PBC. The optimal algorithm including two or more uses of a PBC code had a sensitivity of 94% (95% CI 71% to 100%) and positive predictive values of 73% (95% CI 61% to 75%) for confirmed PBC, and 89% (95% CI 82% to 94%) for confirmed or suspected PBC. Sensitivity analyses revealed greater accuracy among women, and with the use of multiple data sources and one or more years of data. Inclusion of diagnosis codes for conditions frequently misclassified as PBC did not improve algorithm performance.CONCLUSIONS: Administrative databases can reliably identify patients with PBC and may facilitate epidemiological investigations of this condition.
Survey of Access to GastroEnterology in Canada: The SAGE Wait Times Program
Authors: Leddin Desmond , Bridges Ronald J , Morgan David G , Fallone Carlo , Render Craig , Plourde Victor , Gray Jim , Switzer Connie , McHattie Jim , Singh Harminder , Walli Eric , Murray Iain , Nestel Anthony , Sinclair Paul , Chen Ying , Irvine E Jan 
Published: March 2016

BACKGROUND: Assessment of current wait times for specialist health services in Canada is a key method that can assist government and health care providers to plan wisely for future health needs. These data are not readily available. A method to capture wait time data at the time of consultation or procedure has been developed, which should be applicable to other specialist groups and also allows for assessment of wait time trends over intervals of years.METHODS: In November 2008, gastroenterologists across Canada were asked to complete a questionnaire (online or by fax) that included personal demographics and data from one week on at least five consecutive new consultations and five consecutive procedure patients who had not previously undergone a procedure for the same indication. Wait times were collected for 18 primary indications and results were then compared with similar survey data collected in 2005.RESULTS: The longest wait times observed were for screening colonoscopy (201 days) and surveillance of previous colon cancer or polyps (272 days). The shortest wait times were for cancer-likely based on imaging or physical examination (82 days), severe or rapidly progressing dysphagia or odynophagia (83 days), documented iron-deficiency anemia (90 days) and dyspepsia with alarm symptoms (99 days). Compared with 2005 data, total wait times in 2008 were lengthened overall (127 days versus 155 days; P<0.05) and for most of the seven individual indications that permitted data comparison.CONCLUSION: Median wait times for gastroenterology services continue to exceed consensus conference recommended targets and have significantly worsened since 2005.
Identification and Epidemiology of Severe Respiratory Disease due to Novel Swine‐Origin Influenza A (H1N1) Virus Infection in Alberta
Authors: Zahariadis George , Joffe Ari R , Talbot James , deVilliers Albert , Campbell Patricia , Pabbaraju Kanti , Wong Sallene , Bastien Nathalie , Li Yan , Mitchell Robyn L , Pang Xiao-Li , Yanow Stephanie , Chui Linda , Predy Gerald , Willans David , Lee Bonita E , Preiksaitis Jutta K , Clement Bev , Jacobs Angela , Jaipaul Joy , Fonseca Kevin 
Published: March 2016

BACKGROUND: In March 2009, global surveillance started detecting cases of influenza‐like illness in Mexico. By mid‐April 2009, two pediatric patients were identified in the United States who were confirmed to be infected by a novel influenza A (H1N1) strain. The present article describes the first identified severe respiratory infection and the first death associated with pandemic H1N1 (pH1N1) in Canada.METHODS: Enhanced public health and laboratory surveillance for pH1N1 was implemented throughout Alberta on April 24, 2009. Respiratory specimens from all patients with a respiratory illness and travel history or those presenting with a severe respiratory infection requiring hospitalization underwent screening for respiratory viruses using molecular methods. For the first severe case identified and the first death due to pH1N1, histocompatibility leukocyte antigens were compared by molecular methods.RESULTS: The first death (a 39‐year‐old woman) occurred on April 28, 2009, and on May 1, 2009, a 10‐year‐old child presented with severe respiratory distress due to pH1N1. Both patients had no travel or contact with anyone who had travelled to Mexico; the cases were not linked. Histocompatibility antigen comparison of both patients did not identify any notable similarity. pH1N1 strains identified in Alberta did not differ from the Mexican strain.CONCLUSION: Rapid transmission of pH1N1 continued to occur in Alberta following the first death and the first severe respiratory infection in Canada, which were identified without any apparent connection to Mexico or the United States. Contact tracing follow‐up suggested that oseltamivir may have prevented ongoing transmission of pH1N1.
Diagnostic Yield of Repeat Capsule Endoscopy and the Effect on Subsequent Patient Management
Authors: Svarta Sigrid , Segal Brandon , Law Joanna , Sandhar Ajit , Kwok Ricky , Jacques Andrew , Lakzadeh Pardis , Enns Robert 
Published: March 2016

BACKGROUND: Capsule endoscopy (CE) has been shown to produce a high diagnostic yield in patients with obscure gastrointestinal bleeding (OGIB); however, in those with negative studies, management is controversial. Very few studies have reported on repeat CE in the same patient; data regarding this diagnostic strategy are limited.OBJECTIVE: To determine the diagnostic yield of repeated CE studies and how this yield affects subsequent patient management.METHODS: A retrospective chart review of all patients who underwent CE at St Paul’s Hospital (Vancouver, British Columbia) between December 2001 and June 2009 was conducted. Patients who underwent subsequent repeat CE were identified and divided into one of four subgroups. Findings were classified as positive or negative.RESULTS: Eighty-two of 676 patients underwent more than one CE study. Group 1 (incomplete study) included 22 patients (27%) and yielded 10 positive findings (45%). Group 2 (screening) comprised four patients (5%) and yielded two positive findings (50%). Group 3 (ongoing symptoms despite previous negative study) totalled 26 patients (32%) and yielded 10 positive findings (38%). Group 4 (previous positive study with treatment/investigation) included 30 patients (37%) and yielded 23 positive findings (77%). Overall, the present study found positive findings in 55% (45 of 82) of repeated CE cases, which resulted in a change in management in 39% (n=32) of the patients.CONCLUSION: Due to the high diagnostic yield and noninvasive nature of CE, repeat CE appears to be of benefit and should be considered for specific patients before other types of small bowel studies.
Induced Sputum for the Diagnosis of Pulmonary Tuberculosis: Is It Useful in Clinical Practice?
Authors: Olsen S-R , Long R , Tyrrell GJ , Kunimoto D 
Published: March 2016

BACKGROUND: Diagnosing pulmonary tuberculosis (PTB) is challenging in patients who are unable to spontaneously expectorate. Published evidence suggests that induced sputum (IS) is the least invasive and most cost-effective method of diagnosis, and should be used before fibre-optic bronchoscopy (FOB).METHODS: The medical records of 337 adults treated for PTB in northern Alberta between 1997 and 2007 were reviewed to determine whether local practice patterns reflect the evidence. Microbiological data were collected from the Provincial Laboratory for Public Health. Demographic information was collected from the patients’ charts.RESULTS: A total of 8.5% (26 of 307) of PTB patients had IS collected, whereas 35.8% (110 of 307) underwent FOB. Among FOB patients, 56.4% (62 of 110) had no sputum sent before the procedure and 29% (18 of 62) of these patients were smear positive. Only five patients referred for FOB had IS sent previously. There were no demographic factors predictive of IS use, whereas being an inpatient at a teaching facility or having a nodule or mass on chest x-ray was predictive of FOB referral. Because so few IS samples were available, not all patients had spontaneously expectorated sputum, IS and FOB tests performed; thus, the calculated yields were not comparable with one another.CONCLUSIONS: Despite published evidence recommending IS collection before FOB referral in suspected PTB patients, clinicians in our health region appeared to prefer early FOB over IS by a large margin. This practice pattern is less cost effective and exposes patients and health care workers to greater risk. Further research is needed to identify the reasons for the underuse of sputum induction.
Outcome of Occupational Asthma after Removal from Exposure: A Follow‐Up Study
Authors: Lemiere Catherine , Chaboillez Simone , Welman Mélanie , Maghni Karim 
Published: March 2016

BACKGROUND: Despite being removed from their workplace, the majority of workers with occupational asthma (OA) remain afflicted with asthma.OBJECTIVES: To assess the time course of clinical, functional and inflammatory parameters in subjects with OA over a four‐year period, and whether the airway inflammation observed at the time of the diagnosis predicts the outcome of OA.METHODS: The present study was a four‐year, prospective, longitudinal investigation of workers with OA. Spirometry, methacholine challenge and sputum induction were performed at two weeks, and followed up at six months, and one, two, three and four years after the performance of specific inhalation challenges.RESULTS: A total of 24 subjects were enrolled. Overall, clinical and functional characteristics remained stable during the four‐year follow‐up period. Sputum eosinophil (Eos) counts decreased within two weeks after exposure. Two groups of subjects were identified according to low (less than 2%, Eos−) or high (2% or greater, Eos+) Eos counts after exposure to the offending agent. The Eos+ group decreased their dose of inhaled corticosteroids, had a trend toward an improvement of airway responsiveness as well as a stable forced expiratory volume in 1 s (FEV1), whereas the Eos− group showed a decrease in FEV1, without any improvement in their functional parameters. The Eos− group also had an increase in sputum neutrophils after exposure to the occupational agents as well as during the follow‐up period.CONCLUSION: There was a rapid decrease in eosinophilic inflammation after removal from exposure. Subjects with a noneosinophilic asthmatic reaction during specific inhalation challenge seemed to have a poorer prognosis than subjects with eosinophilic airway inflammation.