bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction Scores Do Not Correlate with Clinically Adjudicated Categories of Pulmonary Embolism in Critically Ill Patients
Authors: Katsios CM , Donadini M , Meade M , Mehta S , Hall R , Granton J , Kutsiogiannis J , Dodek P , Heels-Ansdell D , McIntyre L , Vlahakis N , Muscedere J , Friedrich J , Fowler R , Skrobik Y , Albert M , Cox M , Klinger J , Nates J , Bersten A , Doig C , Zytaruk N , Crowther M , Cook DJ 
Published: March 2016

BACKGROUND: Prediction scores for pretest probability of pulmonary embolism (PE) validated in outpatient settings are occasionally used in the intensive care unit (ICU).OBJECTIVE: To evaluate the correlation of Geneva and Wells scores with adjudicated categories of PE in ICU patients.METHODS: In a randomized trial of thromboprophylaxis, patients with suspected PE were adjudicated as possible, probable or definite PE. Data were then retrospectively abstracted for the Geneva Diagnostic PE score, Wells, Modified Wells and Simplified Wells Diagnostic scores. The chance‐corrected agreement between adjudicated categories and each score was calculated. ANOVA was used to compare values across the three adjudicated PE categories.RESULTS: Among 70 patients with suspected PE, agreement was poor between adjudicated categories and Geneva pretest probabilities (kappa 0.01 [95% CI −0.0643 to 0.0941]) or Wells pretest probabilities (kappa −0.03 [95% CI −0.1462 to 0.0914]). Among four possible, 16 probable and 50 definite PEs, there were no significant differences in Geneva scores (possible = 4.0, probable = 4.7, definite = 4.5; P=0.90), Wells scores (possible = 2.8, probable = 4.9, definite = 4.1; P=0.37), Modified Wells (possible = 2.0, probable = 3.4, definite = 2.9; P=0.34) or Simplified Wells (possible = 1.8, probable = 2.8, definite = 2.4; P=0.30).CONCLUSIONS: Pretest probability scores developed outside the ICU do not correlate with adjudicated PE categories in critically ill patients. Research is needed to develop prediction scores for this population.
Gender Expression, Sexual Orientation and Pain Sensitivity in Women
Authors: Vigil Jacob M , Rowell Lauren N , Lutz Charlotte 
Published: March 2016

BACKGROUND: Despite a growing body of literature investigating sex differences with regard to pain, surprisingly little research has been conducted on the influence of various aspects of self‐identity, including gender expression and sexual orientation, on pain sensitivity within each sex, particularly among women. In men, dispositional femininity is linked to greater clinical pain and trait masculinity is associated with higher pain thresholds.OBJECTIVES: To examine whether gender expression and sexual orientation are associated with within‐sex differences in ischemic pain sensitivity in healthy young women.METHODS: A convenience sample of 172 females (mean age 21.4 years; range 18 to 30 years of age; 56.0% white, 89% heterosexual) performed an ischemic pain task in counterbalanced order. Desired levels of dispositional femininity for a preferred romantic partner and self‐described levels of personal dispositional femininity were measured.RESULTS: Compared with heterosexual women, lesbian and bisexual women reported lower pain intensity ratings early in the discomfort task. Irrespective of sexual orientation, attraction to more feminine romantic partners and dispositional masculinity were correlated with lower pain intensity, and with higher pain thresholds and tolerance levels.DISCUSSION: These preliminary findings suggest that within‐sex differences in sexual orientation and other aspects of identity, irrespective of biological sex, may be important to consider when examining experimental pain performance and clinical pain experiences.CONCLUSION: Larger investigations of the psychophysiological relationships among sexual orientation, gender expression and pain sensitivity are warranted. These findings may have implications for differences in clinical pain sensitivity of lesbian and bisexual women compared with heterosexual women.
Patterns and Correlates of Cannabis Use among Individuals with HIV/AIDS in Maritime Canada
Authors: Harris Gregory E , Dupuis Lise , Mugford Gerald J , Johnston Lynn , Haase David , Page Ginny , Haldane Heather , Harris Nicholas , Midodzi William K , Dow Gordon 
Published: March 2016

BACKGROUND: The prevalence of cannabis use in HIV‐infected individuals is high and its long‐term effects are unclear.METHODS: The prevalence, perceived benefits and consequences, and predictors of cannabis use were studied using a cross‐sectional survey in two immunodeficiency clinics in Maritime Canada.RESULTS: Current cannabis use was identified in 38.5% (87 of 226) of participants. Almost all cannabis users (85 of 87 [97.7%]) acknowledged its use for recreational purposes, with 21.8% (19 of 87) reporting medicinal cannabis use. The majority of patients enrolled in the present study reported mild or no symptoms related to HIV (n=179). Overall, 80.5% (70 of 87) of the cannabis‐using participants reported a symptom‐relieving benefit, mostly for relief of stress, anorexia or pain. Participants consumed a mean (± SD) of 18.3±21.1 g of cannabis per month and spent an average of $105.15±109.87 on cannabis per month. Cannabis use was associated with rural residence, lower income level, driving under the influence of a substance, and consumption of ecstasy and tobacco. Income level, ecstasy use and tobacco use were retained as significant predictors in regression modelling. Cannabis use was not associated with adverse psychological outcomes.DISCUSSION: Prolonged previous cannabis consumption and the substantial overlap between recreational and medicinal cannabis use highlight the challenges in obtaining a tenable definition of medicinal cannabis therapy.
Burden of Disease and Cost of Chronic Hepatitis C Virus Infection in Canada
Authors: Myers Robert P , Krajden Mel , Bilodeau Marc , Kaita Kelly , Marotta Paul , Peltekian Kevork , Ramji Alnoor , Estes Chris , Razavi Homie , Sherman Morris 
Published: March 2016

BACKGROUND: Chronic infection with hepatitis C virus (HCV) is a major cause of cirrhosis, hepatocellular carcinoma and liver transplantation.OBJECTIVE: To estimate the burden of HCV-related disease and costs from a Canadian perspective.METHODS: Using a system dynamic framework, the authors quantified the HCV-infected population, disease progression and costs in Canada between 1950 and 2035. Specifically, 36 hypothetical, ageand sex-defined cohorts were tracked to define HCV prevalence, complications and direct medical costs (excluding the cost of antivirals). Model assumptions and costs were extracted from the literature with an emphasis on Canadian data. No incremental increase in antiviral treatment over current levels was assumed, despite the future availability of potent antivirals.RESULTS: The estimated prevalence of viremic hepatitis C cases peaked in 2003 at 260,000 individuals (uncertainty interval 192,460 to 319,880), reached 251,990 (uncertainty interval 177,890 to 314,800) by 2013 and is expected to decline to 188,190 (uncertainty interval 124,330 to 247,200) in 2035. However, the prevalence of advanced liver disease is increasing. The peak annual number of patients with compensated cirrhosis (n=36,210), decompensated cirrhosis (n=3380), hepatocellular carcinoma (n=2220) and liver-related deaths (n=1880) are expected to occur between 2031 and 2035. During this interval, an estimated 32,460 HCV-infected individuals will die of liver-related causes. Total health care costs associated with HCV (excluding treatment) are expected to increase by 60% from 2013 until the peak in 2032, with the majority attributable to cirrhosis and its complications (81% in 2032 versus 56% in 2013). The lifetime cost for an individual with HCV infection in 2013 was estimated to be $64,694.CONCLUSIONS: Although the prevalence of HCV in Canada is decreasing, cases of advanced liver disease and health care costs continue to rise. These results will facilitate disease forecasting, resource planning and the development of rational management strategies for HCV in Canada.
Timing of Rebleeding in High-Risk Peptic Ulcer Bleeding after Successful Hemostasis: A Systematic Review
Authors: Ouali Sara El , Barkun Alan N , Martel Myriam , Maggio Davide 
Published: March 2016

BACKGROUND: Peptic ulcer rebleeding (PUR) usually occurs within three days following endoscopic hemostasis. However, recent data have increasingly suggested delayed rebleeding.OBJECTIVE: To better characterize the timing of PUR (Forrest Ia to IIb) following initially successful endoscopic hemostasis.METHODS: An exhaustive literature search (1989 to 2013), with cross-referencing, was performed to identify pertinent randomized controlled trial (RCT) arms. Patients receiving high-dose proton pump inhibitor (PPI) infusion following successful modern-day endoscopic hemostasis were included. A sensitivity analysis included any patients receiving PPI doses >40 mg daily. The main outcome measure was 30-day rebleeding, while weighted mean averages at t = three, seven, 14 and 28 to 30 days are also reported.RESULTS: Of 756 citations, six RCTs were included (561 patients; 58.5% to 89.5% male; 55.3 to 67.5 years of age). Among patients receiving high-dose PPI (five RCTs [393 patients]), 11.5% (95% CI 8.4% to 14.7%) experienced rebleeding, 55.6% (95% CI 41.1% to 70.1%) rebled within three days, 20% (95% CI 8.3% to 31.7%) between four and seven days, 17.8% (95% CI 6.6% to 28.9%) at eight to 14 days, and 6.7% (95% CI 0% to 14%) at 15 to 28 to 30 days. Using the relaxed lower PPI dosing threshold, similar respective rates were 14.4% (95% CI 11.5% to 17.3%) overall, with interval rates of 39.5% (95% CI 28.9% to 50.15%), 34.6% (95% CI 24.2% to 44.9%), 19.7% (95% CI 11% to 28.4%) and 6.2% (95% CI 0.95% to 11.5%). Qualitative review of patient characteristics, limited by small sample size, possible bias and study heterogeneity, suggested increased patient comorbidity and postendoscopic use of lower PPI dosing may predict delayed rebleeding.CONCLUSION: In patients with high-risk PUR undergoing successful endoscopic hemostasis, most rebled within three days, with many experiencing later rebleeding. Additional research is needed to better predict such an outcome.
Serrated Adenoma Prevalence in Inflammatory Bowel Disease Surveillance Colonoscopy, And Characteristics Revealed by Chromoendoscopy and Virtual Chromoendoscopy
Authors: Iacucci Marietta , Hassan Cesare , Gasia Miriam Fort , Urbanski Stefan , Gui Xianyong , Eksteen Bertus , Eustace Gregory , Kaplan Gilaad G , Panaccione Remo 
Published: March 2016

BACKGROUND: Sessile or nonpolypoid neoplastic lesions, including sessile serrated adenomas (SSAs), are difficult to detect in patients with inflammatory bowel disease (IBD).OBJECTIVES: To assess the prevalence and endoscopic features of SSA in IBD patients undergoing surveillance colonoscopy using novel endoscopic techniques.METHODS: Histology results of biopsies from a cohort of 87 patients (47 men; median age 51.4 years; median duration of disease 16.9 years; ulcerative colitis [n=40], Crohn disease [n=43], ischemic colitis [n=4]) with longstanding colonic IBD undergoing surveillance colonoscopy were reviewed. Lesions of dysplasia (adenoma-like mass, or dysplasia-associated lesion or mass), SSAs, adenoma-like polyps, hyperplastic polyps and inflammatory polyps were identified. Surveillance colonoscopy using high-definition alone, or with iScan (Pentax, USA) dye-sprayed or virtual chromoendoscopy was performed. Lesion characteristics were described before histological diagnosis.RESULTS: Fourteen SSAs were detected in 87 (11%) IBD patients. The endoscopic characteristics of SSA lesions were: nonpolypoid appearance (86%), predominant localization in the proximal colon (79%), >6 mm in size (79%), cloudy cover (64%), Kudo pit pattern modified type IIO (86%) and irregular spiral vascular pattern (79%). Among the 44 SSAs and hyperplastic polyps found in the present study, the above characteristics of SSA at colonoscopy had a sensitivity of 92.86% (95% CI 66.06% to 98.8%) and specificity of 93.33% (95% CI 77.89% to 98.99%) in predicting a histological diagnosis of SSA (positive predictive value 86.67%, negative predictive value 96.55%).CONCLUSION: SSAs are a common finding at surveillance colonoscopy in IBD and have several characteristic features. Further studies are needed to evaluate the natural history of these lesions in IBD patients.
Physician Attitudes toward the Use of Fecal Microbiota Transplantation for the Treatment of RecurrentClostridium difficileInfection
Authors: Zipursky Jonathan S , Sidorsky Tivon I , Freedman Carolyn A , Sidorsky Misha N , Kirkland Kathryn B 
Published: March 2016

BACKGROUND: Fecal microbiota transplantation (FMT) is a safe and effective, yet infrequently used therapy for recurrentClostridium difficileinfection (CDI).OBJECTIVE: To characterize barriers to FMT adoption by surveying physicians about their experiences and attitudes toward the use of FMT.METHODS: An electronic survey was distributed to physicians to assess their experience with CDI and attitudes toward FMT.RESULTS: A total of 139 surveys were sent and 135 were completed, yielding a response rate of 97%. Twenty-five (20%) physicians had treated a patient with FMT, 10 (8%) offered to treat with FMT, nine (7%) referred a patient to receive FMT, and 83 (65%) had neither offered nor referred a patient for FMT. Physicians who had experience with FMT (performed, offered or referred) were more likely to be male, an infectious diseases specialist, >40 years of age, fellowship trained and practicing in an urban setting. The most common reasons for not offering or referring a patient for FMT were: not having ‘the right clinical situation’ (33%); the belief that patients would find it too unappealing (24%); and institutional or logistical barriers (23%). Only 8% of physicians predicted that the majority of patients would opt for FMT if given the option. Physicians predicted that patients would find all aspects of the FMT process more unappealing than they would as providers.CONCLUSIONS: Physicians have limited experience with FMT despite having treated patients with multiple recurrent CDIs. There is a clear discordance between physician beliefs about FMT and patient willingness to accept FMT as a treatment for recurrent CDI.
Determination of Real‐Time Polymerase Chain Reaction Uncertainty of Measurement Using Replicate Analysis and a Graphical User Interface with Fieller’s Theorem
Authors: Stuart James Ian , Delport Johan , Lannigan Robert , Zahariadis George 
Published: March 2016

BACKGROUND: Disease monitoring of viruses using real‐time polymerase chain reaction (PCR) requires knowledge of the precision of the test to determine what constitutes a significant change. Calculation of quantitative PCR confidence limits requires bivariate statistical methods.OBJECTIVE: To develop a simple‐to‐use graphical user interface to determine the uncertainty of measurement (UOM) of BK virus, cytomegalovirus (CMV) and Epstein‐Barr virus (EBV) real‐time PCR assays.METHODS: Thirty positive clinical samples for each of the three viral assays were repeated once. A graphical user interface was developed using a spreadsheet (Excel, Microsoft Corporation, USA) to enable data entry and calculation of the UOM (according to Fieller’s theorem) and PCR efficiency.RESULTS: The confidence limits for the BK virus, CMV and EBV tests were ∼0.5 log, 0.5 log to 1.0 log, and 0.5 log to 1.0 log, respectively. The efficiencies of these assays, in the same order were 105%, 119% and 90%. The confidence limits remained stable over the linear range of all three tests.DISCUSSION: A >5 fold (0.7 log) and a >3‐fold (0.5 log) change in viral load were significant for CMV and EBV when the results were ≤1000 copies/mL and >1000 copies/mL, respectively. A >3‐fold (0.5 log) change in viral load was significant for BK virus over its entire linear range. PCR efficiency was ideal for BK virus and EBV but not CMV. Standardized international reference materials and shared reporting of UOM among laboratories are required for the development of treatment guidelines for BK virus, CMV and EBV in the context of changes in viral load.
Pain‐Related and Negative Semantic Priming Enhances Perceived Pain Intensity
Authors: Richter Maria , Schroeter Christoph , Puensch Theresa , Straube Thomas , Hecht Holger , Ritter Alexander , Miltner Wolfgang HR , Weiss Thomas 
Published: March 2016

BACKGROUND: Negative affective and pain‐related cues, such as pictures or words, have been shown to act as primes and enhance the perceived intensity of subsequent painful events. For pain‐related semantic primes, it remains unclear whether this effect depends on negative valence itself or, specifically, on the pain‐relatedness of the words.OBJECTIVES: To investigate the effect of pain‐related, negative affective (pain‐unrelated) and neutral semantic primes on the perception of subsequent noxious target stimuli.METHODS: Pain ratings in response to noxious electrical stimulation of light and moderate intensity were examined in 39 healthy subjects after subjects were exposed to semantic primes of different meaning and valence (pain‐related, negative, positive and neutral adjectives) presented with different interstimulus intervals (0 ms, 500 ms and 1500 ms).RESULTS: Increased pain ratings of noxious stimuli were observed following pain‐related and negative compared with neutral primes.DISCUSSION: The results support the motivational priming theory for semantic stimuli, indicating that affectively negative semantic primes increase subjective pain intensity. However, a specific pain‐related priming effect was not reliably demonstrated. Additionally, it is shown that experimental parameters (ie, stimulus intensity and interstimulus interval) modify the extent of negative and pain‐related semantic priming.CONCLUSIONS: Verbal priming plays a role for the perception of noxious stimuli in a time‐dependent manner.
When in Doubt, Ask the Audience: Potential Users′ Perceptions of Internet‐Delivered Cognitive Behavioural Therapy for Chronic Pain
Authors: Schneider Luke H , Hadjistavropoulos Heather D 
Published: March 2016

BACKGROUND: Although research has demonstrated that Internet‐delivered cognitive behavioural therapy (ICBT) for chronic pain helps with adjustment to pain, it remains unclear how this treatment option would initially be perceived by individuals with chronic pain.OBJECTIVES: To explore initial perceptions of ICBT and to examine variables that correlate with an expressed interest in ICBT as a treatment option among individuals with chronic pain.METHODS: A total of 129 individuals with chronic pain completed a survey assessing perceptions of ICBT and individual difference variables that could be correlated with expressed interest in ICBT (eg, demographic characteristics, pain, computer self‐efficacy).RESULTS: Results showed that most participants perceived ICBT as a potentially valuable service with multiple benefits. Being female, having greater pain severity and interference, and having greater computer self‐efficacy and lower computer anxiety were positively correlated with interest in receiving ICBT.CONCLUSIONS: Combined with previous research on treatment efficacy of ICBT for chronic pain, the results should serve to stimulate further research on integrating ICBT within existing health care services.
Care of the Liver Transplant Patient
Authors: Bhat Mamatha , Al-Busafi Said A , Deschênes Marc , Ghali Peter 
Published: March 2016

OBJECTIVE: To provide an approach to the care of liver transplant (LT) patients, a growing patient population with unique needs.METHODS: A literature search of PubMed for guidelines and review articles using the keywords “liver transplantation”, “long term complications” and “medical management” was conducted, resulting in 77 articles.RESULTS: As a result of being on immunosuppression, LT recipients are at increased risk of infections and must be screened regularly for metabolic complications and malignancies.DISCUSSION: Although immunosuppression is key to maintaining allograft health after transplantation, it comes with its own set of medical issues to follow. Physicians following LT recipients must be aware of the greater risk for hypertension, diabetes, dyslipidemia, renal failure, metabolic bone disease and malignancies in these patients, all of whom require regular monitoring and screening. Vaccination, quality of life, sexual function and pregnancy must be specifically addressed in transplant patients.
How Many Individuals with Asthma Need to Be Vaccinated to Prevent One Case of Invasive Pneumococcal Disease?
Authors: Okapuu Julie M , Chétrit Estelle , Lefebvre Brigitte , Quach Caroline 
Published: March 2016

BACKGROUND: The American Advisory Committee on Immunization Practices recommended the inclusion of adults with asthma in the high‐risk category for pneumococcal vaccination based on a twofold increase in risk of invasive pneumococcal disease (IPD).OBJECTIVE: To determine whether, among individuals with asthma, the number needed to vaccinate (NNV) using pneumococcal conjugate vaccine (PCV)‐13 or 23‐valent pneumococcal polysaccharide vaccine (PPV‐23) warrants its addition to the high‐risk category for pneumococcal vaccination in Canada.METHODS: Using IPD incidence (per 10,000 individuals) figures from published articles (4.2 in high‐risk asthmatics, 2.3 in low‐risk asthmatics and 1.2 in healthy individuals), the NNV to prevent one case of IPD in asthmatics five to 17 years of age and 18 to 50 years of age was calculated, factoring in the proportion of pneumococcal serotypes included in vaccines (based on data from Quebec) and accounting for the possibility of waning vaccine efficacy (VE) using four scenarios.RESULTS: Assuming a VE of 65% for PCV‐13 in asthmatics, the NNV would be 704 to 820 in low‐risk and 386 to 449 in high‐risk children; and 355 to 1532 in low‐risk and 195 to 839 in high‐risk adults (range depends on waning scenario). Assuming a VE of 65% for PPV‐23 in asthmatics, the NNV would be 581 to 677 in low‐risk and 318 to 371 in high‐risk children; and 246 to 1059 in low‐risk and 135 to 580 in high‐risk adults.CONCLUSION: The NNV with both PCV‐13 and PPV‐23 in asthmatic children and adults is comparable with that of other high‐risk conditions such as age ≥65 years. Therefore, the addition of asthma to the list of high‐risk conditions for pneumococcal vaccination is warranted.