bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antimicrobial Regimens Prescribed by Canadian Physicians for Chemotherapy‐Induced Febrile Neutropenic Episodes
Authors: Laverdière Michel , Bow Eric J , Rotstein Coleman , Ioannou Stratis , Carr Danielle , Moghaddam Narguess , the Canadian Fluconazole Study Group  
Published: March 2016

OBJECTIVE: To study the antimicrobial management of cancer patients with chemotherapy‐induced neutropenia by Canadian physicians.SETTING: A cohort of 274 cancer patients with severe neutropenia (ie, less than 0.5×109 neutrophils/L) who participated in a prospective double‐blind, placebo controlled study on antifungal prophylaxis conducted in 14 Canadian university‐affiliated centres. Antifungal prophylaxis (oral fluconazole 400 mg daily) was administered to 153 of 274 (56%) patients.RESULTS: Antibacterial prophylaxis with a quinolone was given to 87 patients (32%) at the onset of chemotherapy whereas trimethoprim/sulphamethoxazole was given to 56 (20%) patients. Fever (ie, 38°C or over) occurred in 216 (79%) patients after a median duration of neutropenia of four days (range one to 31 days). Empirical antibacterial antibiotics were administered in 214 febrile patients. In 164 (77%) patients antibiotics were started during the first 24 h of fever. Monotherapy with a third generation cephalosporin and duotherapy with a antipseudomonal beta‐lactam and an aminoglycoside were prescribed in 69 (32%) and 61 (28%) of the febrile patients, respectively. Inclusion of vancomycin in the initial empirical regimen was noted in 32 (15%) patients. Modifications of the initial regimen occurred in 187 (87%) patients after a median of five days (range one to 28 days). Empirical systemic amphotericin B was added after a median duration of nine days (range one to 34 days) of the empirical antibacterial regimen.CONCLUSIONS: Overall, the antimicrobial management of cancer patients with chemotherapy‐induced neutropenia by Canadian physicians follows the current guidelines promulgated by the Infectious Diseases Society of America.
Factors that Influence Emergency Department Visits for Asthma
Authors: Tough SC , Hessel PA , Green FHY , Mitchell I , Rose S , Aronson H , Butt JC 
Published: March 2016

BACKGROUND: Asthma can usually be controlled through allergen avoidance and/or appropriate medication. An emergency department visit for an acute exacerbation of asthma often represents a breakdown in asthma management. Emergency department treatment results in significant health care expenditures and reflects a compromised quality of life.OBJECTIVES: To identify risk factors associated with an emergency department visit for asthma.METHODS: This case‐control study compared 299 people (76% of 390 cases contacted) who attended one of two emergency departments in Alberta in 1992 and 1993 for an acute exacerbation of asthma (cases) with 212 unmatched community controls with asthma who were located by random digit dialing. Cases and controls were asked to complete a mailed questionnaire to obtain data regarding severity, visits to doctors and emergency departments, medication use, allergies and other triggers, and smoking history. Data analysis included bivariate analysis of risk factors and multivariate model development using logistic regression.RESULTS: The response rate was similar between cases and controls. Cases were younger than controls (odds ratio [OR] 2.16, 95% CI 1.34 to 3.48) and more often reported their asthma to be severe (OR 4.25, 95% CI 2.24 to 8.06), and had experienced nocturnal symptoms (stratified OR range 1.36 to 6.82). Cases used more health care services in the previous year, had been admitted to hospital at some time for asthma (OR 1.62, 95% CI 1.10 to 2.38) and used more medication than controls.CONCLUSIONS: Physicians and other health care workers should be sensitive to the risk factors and target interventions to high risk individuals.
Reasons for Choice of Antibiotic for the Empirical Treatment of CAP by Canadian Infectious Disease Physicians
Authors: Pendergrast Jacob , Marrie Thomas 
Published: March 2016

BACKGROUND: Previous studies have documented substantial variation in physician prescribing practices for the treatment of community‐acquired pneumonia. Much of this variation is the result of empirical treatment, in which physicians must choose antibiotics in the a8bsence of culture and sensitivity data.OBJECTIVE: To explore the factors that influence antibiotic choice for the empirical treatment of community‐acquired pneumonia.MATERIALS AND METHODS: Case‐based questionnaires were mailed to all 157 members of the Canadian Infectious Disease Society in June 1996. The questionnaires presented three clinical cases and asked respondents which antibiotics they would most likely prescribe. Half the questionnaires were closed‐ended, and half were open‐ended. In the former, respondents were asked to explain their antibiotic choice by assigning weights to a list of clinical factors. In the latter, respondents were asked to explain their antibiotic choice by providing a short written answer. Respondents were grouped by the class of antibiotics they selected. These groups were then compared with regards to respondent characteristics (age, years of infectious disease experience, adult versus pediatric practice, country of training, province of practice) and rationale for the treatment chosen. Rationale for drug choice was analyzed statistically for the closed‐ended questionnaires and qualitatively for the open‐ended questionnaires.RESULTS: A response rate of 84.6% was obtained. For the first clinical case, in which the patient was young and had no underlying illness, the majority of respondents chose a macrolide (74.7%). In the second case, in which the patient was older and had evidence of comorbidity, the most common choice of antibiotic was a penicillin (40.8%). In the third case, in which the patient had intensive care unit‐requiring pneumonia, the most popular choice was combination therapy of a third‐generation cephalosporin and a macrolide (43.2%). There was decreasing consensus regarding the choice of antibiotics as the complexity of the cases increased. There was evidence that prescribing variation could occasionally be attributed to both respondent characteristics and the use of different decision‐making strategies.CONCLUSIONS: Despite the relative homogeneity of the physicians studied, considerable variation in antibiotic choice was observed. In the first case, this variation was based on the issue of whether the patient had a typical or atypical infection. In the second case, the choice of antibiotic was related to the issue of infection by Haemophilus influenzae, although the results of the Gram stain suggested a pneumococcal infection. In the third case, variance appeared to be based more on the respondent’s age and province of practice than on any difference in decision‐making strategy.
PCR Detection of Viral Nucleic Acid in Fatal Asthma: Is the Lower Respiratory Tract a Reservoir for Common Viruses?
Authors: Macek Vasilija , Dakhama Azzeddine , Hogg James C , Green Francis HY , Rubin Bruce K , Hegele Richard G 
Published: March 2016

BACKGROUND: There is indirect evidence implicating viral respiratory tract infections in the pathogenesis of fatal asthma. However, it is unknown whether viruses are present within the lower respiratory tract in fatal asthma.OBJECTIVES: To apply a nine‐virus polymerase chain reaction (PCR) panel to postmortem specimens of lower airway secretions and compare the prevalence of viral nucleic acid among patients who died of asthma, asthmatic patients who died of other causes and persons who died without lung disease.PATIENTS AND METHODS: Postmortem specimens of lower airway secretions from patients who died of asthma (fatal asthma [n=10]), asthmatic patients who died of other causes (n=4) and nonasthma controls (n=6) underwent PCR for nine common respiratory viruses. The prevalence of each virus was compared among the three groups.RESULTS: PCR was positive for at least one virus in 19 of 20 cases, and multiple viruses were detected in 14 of 20 cases. The prevalence of each virus was similar in the three groups studied.CONCLUSIONS: In fatal asthma, lower airway secretions do not show a specific pattern of viral nucleic acid. Intriguingly, these results suggest that the lower respiratory tract may act as a potential reservoir for common respiratory viruses.
Leptospira Infections in Trappers from Ontario
Authors: Warshawsky Bryna , Lindsay L Robbin , Artsob Harvey 
Published: March 2016

BACKGROUND: Four trappers presented to the Middlesex‐London Health Unit in November, 1997 with similar clinical presentations. All four complained of fever, chills and headache, and three of the four had severe muscle aches. All gave histories of trapping raccoons before the onset of illness. Three of the four men exhibited diagnostic seroconversions to Leptospira grippotyphosa.OBJECTIVE: To describe the four suspected cases of leptospira infections and to determine whether raccoons might serve as a reservoir of infection using field studies.DESIGN: Raccoon serology were undertaken using the microscopic agglutination test against eight serovars of Leptospira interrogans including L grippotyphosa. Raccoons were trapped using Tomahawk live traps, anaesthetized with intramuscular injection of ketamine and acepromazine, bled by cardiac puncture and released.RESULTS: Forty‐two raccoons were trapped in Middlesex (n=36) and Kent counties (n=6) from April 25 to May 2, 1998, and 10 (23.8%) of these animals had antibodies to L grippotyphosa.CONCLUSIONS: Infections due to L grippotyphosa or a closely related serovar are a risk for trappers in Ontario, and raccoons are a likely reservoir of this bacterium.
Long Term Trends in the Occurrence of Nosocomial Blood Stream Infection
Authors: Taylor Geoffrey , Buchanan-Chell Maureen , Kirkland Teresa , McKenzie Margaret , Wiens Rhoda 
Published: March 2016

OBJECTIVE: To determine trends in the occurrence of nosocomial blood stream infection at the University of Alberta Hospital.METHODS: A prospective survey of nosocomial blood stream infection was conducted; cases from August 1986 to December 1996 were reviewed. Cases were detected by a review of positive blood cultures reported by the microbiology laboratory. Centers for Disease Control and Prevention definitions of nosocomial infection were used to categorize isolates as nosocomial, community acquired or contaminant.RESULTS: There were 2389 cases; primary bacteremia was the most common source (57%), followed by urinary tract, respiratory tract and surgical site sources (10% each). The nosocomial blood steam infection rate rose progressively from 6.0/1000 admissions and 4.59/10,000 patient days in 1986 to 11.2/1000 admissions and 14.31/10,000 days in 1996 (P<0.01); 48% of the total increase in rate occurred between 1995 and 1996. Significant increases occurred between 1986 and 1996 in primary infections (from 3.2 to 7.5/1000 admissions, P<0.01) and infections from all secondary sources (from 2.5 to 3.8/1000 admissions, P=0.01). Coagulase‐negative staphylococci (27%), Staphylococcus aureus (19%) and enterococci (9%) were the most common microbial causes. Aerobic Gram‐negative bacilli accounted for 28% and candida for 6%. Coagulase‐negative staphylococci, enterococci and candida all became more prevalent as causes of infection over the study period.CONCLUSIONS: The nosocomial blood stream infection rate in the hospital has nearly doubled in the past 10 years, largely due to increased primary bacteremia.
Evaluation of the Rubella Surveillance System in Quebec
Authors: Perron Lina , Wals Philippe De , Milord François 
Published: March 2016

OBJECTIVE: To evaluate the validity of information in the rubella surveillance system in Quebec.DATA AND METHODS: Cases of rubella in the provincial registry of notifiable diseases, "Maladies à declaration obligatoire" (MADO), from 1994 to 1996 were matched with laboratory‐identified cases and with cases in a reference file created from all case investigation records of regional departments of public health for the same period. Sensitivity and the proportion of cases in agreement were calculated.RESULTS: Compared with laboratories, the sensitivity of the provincial registry was 56%. Compared with the reference file, global sensitivity (confirmed cases plus clinical cases) was 58% and the positive predictive value was 50%. Of the 356 cases reported to regional public health departments, 65% were classified in the same diagnostic category (confirmed case, clinical case, excluded case) by public health professionals and a group of experts (weighted kappa=0.32). Information on rubella vaccination status was missing in 25% of cases in the MADO file for rubella.CONCLUSIONS: Notification of positive results for immunoglobulin M antibodies and viral cultures should be required of all laboratories. Uniform procedures should be adopted and applied for the validation of cases that are reported to regional departments of public health. In the context of the rarefaction of rubella, any immunoglobulin M‐positive result should be interpreted using all available epidemiological information.
Multidrug-Resistant Tuberculosis: Long Term Follow-Up of 40 Non-HIV-Infected Patients
Authors: Avendaño Monica , Goldstein RS 
Published: March 2016

BACKGROUND:There has been a steady increase in referrals of patients with multidrug-resistant tuberculosis (MDR-TB) who are human immunodeficiency virus (HIV) negative. Between 1986 and 1999, 40 patients were admitted to the authors' institution, eight of whom were admitted between January and June 1999. The management of such individuals is difficult. Although they are a clinically and epidemiologically important group of patients, few reports detail their management.OBJECTIVES:To review the demographics, clinical management and long term outcome of 40 non-HIV-infected individuals with MDR-TB referred to the only specialized TB inpatient service in Ontario.PATIENTS AND METHODS:Clinical hospital records were reviewed.RESULTS:Twenty-one men and 19 women (mean age 41±18 years) were admitted between January 1986 and June 1999 with MDR-TB and negative serology for HIV. Thirty-eight patients (95%) were born outside of Canada. Twenty-six patients (65%) had a history of previous TB. All were symptomatic with productive cough and positive sputum smears for acid-fast bacilli. There was a delay of 4.5 months between the initial diagnosis of TB and the recognition of the presence of MDR-TB. Four patients (10%) had TB resistant to isoniazid and rifampin only. Over 50% of patients had TB with additional resistance to streptomycin, and over 40% had additional resistance to ethambutol. Coexisting resistance was also found in significant numbers for pyrazinamide, ethionamide, para-aminosalicylic acid and cycloserine. Bacteriological conversion was achieved in 34 patients (85%). Six patients underwent surgical resection for localized lung disease. Twenty-four patients completed treatment and have remained free of disease for 33±25 months. All five patients (12%) who died had longstanding disease before their referral. CONCLUSIONS: MDR-TB is most frequently seen among immigrants with a previous history of TB, especially if they come from countries in which TB is highly prevalent. Outcome can be improved by a more timely recognition of MDR-TB.
Comparison of Once‐ with Twice‐Daily Dosing of Fluticasone Propionate in Mild and Moderate Asthma
Authors: Boulet Louis-Philippe , Cowie Robert L , Negro Roberto Dal , Brett Wade , Gold Milton , Marques Agostinho , Thorburn William S , Stepner Nate M , Bobson Reid 
Published: March 2016

OBJECTIVES: Two 12‐week, randomized, double‐blind, parallel‐group studies were performed to compare the efficacy and safety of once‐ and twice‐daily dosing of fluticasone propionate (FP) in the treatment of mild to moderate asthma, considered to require the equivalent of either 200 or 500 µg of FP daily.PATIENTS AND METHODS: In study A, 461 patients with asthma received FP either 200 µg once daily or 100 µg twice daily. In study B, 443 patients with asthma received FP, either 500 µg once daily or 250 µg twice daily.RESULTS: In both studies, regardless of the treatment regimen to which patients were randomly assigned, small improvements over baseline were observed in morning peak expiratory flows (PEF) and forced expiratory volume in 1 s (FEV1) following 12 weeks of treatment. In study A, the mean morning PEF improved by 2.4% and 4.3% (once daily versus twice daily, P=0.008). In study B, the mean morning PEF improvement was 0.2% and 3.7% (once daily versus twice daily, PÃ0.001). For both studies, the increases observed in FEV1 were not significantly different between the two groups (P = not significant). The incidence of exacerbations of asthma and related events was 13% and 5%, respectively, in the patients with mild asthma for the once‐daily group versus the twice‐daily group; these exacerbations were 12% and 10%, respectively, in patients with moderate asthma. Otherwise, the incidence and types of adverse events were comparable for the two treatment regimens. Although twice‐daily dosing demonstrated small but statistically significant improvements over once‐daily dosing, patients of both groups generally maintained a good level of asthma control on both regimens according to current treatment guidelines. CONCLUSIONS: Twice‐daily dosing of FP is more effective than once‐daily dosing, although the latter can maintain asthma control in most patients.
A Randomised Controlled Trial of High Dose, Inhaled Budesonide Versus Oral Prednisone in Patients Discharged from the Emergency Department following an Acute Asthma Exacerbation
Authors: FitzGerald J Mark , Shragge David , Haddon Jennifer , Jennings Barbara , Math Joanna Lee M , Bai Tony , Pare Peter , Kassen David , Grunfeld Anton 
Published: March 2016

OBJECTIVE: Prednisone (PRED) is recommended at discharge to reduce the relapse rate following emergency treatment for an asthmatic attack. However, PRED has systemic side effects. Inhaled anti‐inflammatory medications, such as budesonide (BUD), are well tolerated. This study was designed to compare the effectiveness of PRED and BUD on relapse rate.DESIGN: A prospective, randomized, double‐blind, double dummy, parallel group design.SETTING: Tertiary referral emergency departments.POPULATION STUDIED: One hundred and eighty‐five patients with acute asthma who received standard treatment with bronchodilators and systemic glucocorticosteroids in the emergency department, had a forced expiration volume in 1 s (FEV1) greater than 50% predicted and who were deemed well enough to be discharged from the emergency department.INTERVENTION: Patients were randomized to receive either BUD Turbuhaler 600 µg qid or PRED 40 mg in the morning for seven to 10 days. At discharge and final visit, symptoms, medication use, FEV1, peak expiratory flow (PEF) and quality of life (QoL) were assessed. Relapse rate to the emergency department during the follow‐up was determined by a yes and/or no questionnaire.MAIN RESULTS: The PRED (n=85) and BUD (n=90) treatment groups were comparable at baseline (emergency department discharge) for age (mean ± SD; 27.6±8.5 years and 29.2±8.7 years) and prebronchodilator FEV1 (1.77±0.79 L and 1.75±0.78 L), respectively. BUD was at least as effective as PRED in preventing a relapse to the hospital; relapse rate was 10 (11.8%) during PRED treatment and nine (10.0%) for BUD treatment (95% CI PRED‐BUD, ‐7.5% to 11.0%). Improvements in FEV1, asthma symptoms, PEF and QoL were not significantly different between treatments.CONCLUSIONS: In patients whose acute asthma has been stabilized in the emergency department, high dose BUD may be an alternate to PRED as a follow‐up treatment.
Double‐Blind, Randomized Study of the Effects of Influenza Vaccination on the Specific Antibody Response and Clinical Course of Patients with Chronic Fatigue Syndrome
Authors: Sleigh Kenna M , Danforth Donelda G , Hall Raymond T , Fleming Jonathan A , Stiver H Grant 
Published: March 2016

OBJECTIVE: To determine whether influenza immunization is associated with early side effects, a deleterious impact on the illness course and depressed antibody response in patients with chronic fatigue syndrome (CFS).DESIGN: Prospective, randomized, double‐blind, placebo controlled trial. CFS patients and healthy volunteers filled out a questionnaire on immunization side effects and had hemagglutination‐inhibiting (HI) antibody titres measured pre‐ and three weeks after immunization. CFS patients completed symptom and function questionnaires before and during the six‐week, postimmunization period.SETTING: Ambulatory care.POPULATION STUDIED: Convenience sample of 40 CFS patients fulfilling the Centers for Disease Control and Prevention criteria and 21 demographically matched healthy volunteers.INTERVENTIONS: CFS patients were randomly selected to receive commercially available whole virus influenza vaccine (n=19) or an injection of saline placebo (n=21). Healthy volunteers received vaccine only.MAIN RESULTS: As a group, immunized CFS patients had lower geometric mean HI antibody rises than healthy volunteers (P<0.001). However, there was no difference in the rates of fourfold titre rises, and immunization did achieve a probably protective titre (1:32 or greater) in most CFS patients. No difference could be detected between immunized and placebo CFS patients in immunization side effects, although CFS patients as a group reported four times as many side effects as healthy volunteers. Further, in the six weeks following immunization, placebo and immunized CFS patients did not demonstrate any differences in terms of functioning, symptom severity and sleep disturbance.CONCLUSIONS: In patients with CFS, influenza immunization is safe, not associated with any excess early reactions, and stimulates an immunizing response comparable with that of healthy volunteers.
Evaluating Treatment Outcome in an Interdisciplinary Pediatric Pain Service
Authors: Bennett Susan M , Chambers Christine T , Bellows Doria , Court Colleen A , Huntsman Elizabeth , Montgomery Carolyne , Oberlander Tim F , Sheriff Michelle , Siden Harold 
Published: March 2016

OBJECTIVE: To provide descriptive data evaluating outcome and treatment satisfaction among former pediatric patients and their parents seen in an interdisciplinary treatment program for complex pain syndromes.DESIGN: Retrospective telephone interview.SETTING: Pediatric academic health care centre.SUBJECTS AND METHODS: A semistructured interview designed for this study was administered by phone with 24 former patients (mean age 15.63 years) and parents, seen over the previous three years in the Complex Pain Consultation Service. Participants provided both qualitative and quantitative information about pre‐ and post‐treatment levels of pain and functioning, achievement of treatment goals and satisfaction with the treatment program.RESULTS: Findings indicated significantly lower frequency and intensity of pain, as rated by patients, when current pain levels were compared with recalled pretreatment levels. As well, improvements were reported in strategies for managing pain and participation in regular activities of daily living. Satisfaction with the team treatment was generally very high, and most felt that their goals were partially to completely met. Child and parent ratings of outcome and satisfaction were consistent.CONCLUSIONS: These descriptive data provide preliminary support for the application of an interdisciplinary model to treating disabling complex pain syndromes in children and youths.