bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Nasal Cannulas and the OxyArm in Patients Requiring Chronic Domiciliary Oxygen Therapy
Authors: Paul James , Otvos Ted 
Published: March 2016

OBJECTIVES: The present study was designed to compare the performance of a new oxygen delivery device, the OxyArm (OA) (Southmedic Inc, Canada), with a standard nasal cannula (NC) (Salter‐Style 1600, Salter Labs, USA) for both oxygen delivery and patient preference in patients on long‐term oxygen therapy (LTOT).DESIGN AND SETTING: Randomized crossover study conducted in an outpatient setting.PATIENTS AND METHODS: Twenty‐five clinically stable LTOT patients were randomly assigned to an oxygen device (NC or OA) sequence. The baseline saturation level was determined, and patients were then treated at oxygen flow rates of 2 L/min, 3 L/min, 4 L/min, 5 L/min, 6 L/min and 7 L/min for 10 min each while at rest. Patients were then crossed over to the second device and the procedure was repeated. Oximetry values were then obtained following a 5 min walk test using the same device sequence. Lastly, the patients were sent home for a four‐week home OA trial, after which, they filled out a questionnaire.RESULTS: This sample of patients was primarily elderly ex‐smokers with severe chronic obstructive pulmonary disease on oxygen therapy for the majority of the day. The primary findings were that the OA and NC were equally effective in delivering oxygen to patients and maintaining their oxygen saturation at both rest (P=0.82) and during a 5 min walk test (P=0.83). A patient’s personal experience and comfort were identified as the most important factors in deciding on an oxygen device. Most patients felt that the OA was most suited for oxygen therapy while at rest.CONCLUSIONS: The OA proved to be similar to the NC in delivering oxygen and maintaining saturation in patients on LTOT. The OA is one of the few alternatives to using NCs for these patients and, with its current design, appears to be most suited for resting conditions.
The Life, Achievements and Legacy of a Great Canadian Investigator: Professor Boris Petrovich Babkin (1877–1950)
Authors: Beck Ivan T 
Published: March 2016

The present paper reviews the life and achievements of Professor Boris Petrovich Babkin (MD DSc LLD). History is only worth writing about if it teaches us about the future; therefore, this historical review concludes by describing what today’s and future gastrointestinal physiologists could learn from Dr Babkin’s life.Dr Babkin was born in Russia in 1877. He graduated with an MD degree from the Military Medical Academy in St Petersburg, Russia, in 1904. Not being attracted to clinical practice, and after some hesitation concerning whether he would continue in history or basic science of medicine, he entered the laboratory of Professor Ivan Petrovich Pavlov. Although he maintained an interest in history, in Pavlov’s exciting environment he became fully committed to physiology of the gastrointestinal system. He advanced quickly in Russia and was Professor of Physiology at the University of Odessa. In 1922, he was critical of the Bolshevik revolution, and after a short imprisonment, he was ordered to leave Russia. He was invited with his family by Professor EH Starling (the discoverer of secretin) to his department at University College, London, England. Two years later, he was offered a professorship in Canada at Dalhousie University, Halifax, Nova Scotia. After contributing there for four years, he joined McGill University, Montreal, Quebec, in 1928 as Research Professor. He remained there for the rest of his career. Between 1940 and 1941, he chaired the Department, and following retirement, he remained as Research Professor. At the invitation of the world-famous neurosurgeon, Wilder Penfield, Dr Babkin continued as Research Fellow in the Department of Neurosurgery until his death in 1950 at age 73.His major achievements were related to establishing the concept of brain-gut-brain interaction and the influence of this on motility, as well as on interface of multiple different cells, nerves and hormones on secretory function. He had a major role in the rediscovery of gastrin. He established a famous school of gastrointestinal physiologists at McGill University. He supported his trainees and helped them establish their careers. He received many honors: a DSc in London, England, and an LLD from Dalhousie University. Most importantly, he was the recipient of the Friedenwald Medal of the American Gastroenterological Association for lifelong contributions to the field. Dr Babkin taught us his philosophical aspect of approaching physiology, his devotion to his disciples and his overall kindness. Most importantly, he has proven that one can achieve international recognition by publishing mainly in Canadian journals. He is an example to follow.
13C Urea Breath Test forHelicobacter pylori: Evaluation of 10-minute Breath Collection
Authors: Mauro Marina , Radovic Vladimir , Wolfe Melanie , Kamath Markad , Bercik Premsyl , Armstrong David 
Published: March 2016

AIM: To determine whether a shortened13C urea breath test (13C UBT) (breath collection time of 10 min) is as reliable as the standard assay (30 min).METHODS: Two hundred ninety-seven patients (mean ± SD: 53±16 years, 57% female) completed a13C UBT. Breath samples were obtained at baseline and at 5 min intervals up to 30 min. Sixty-seven patients also underwent endoscopic biopsy. Cluster analysis was performed on the13C UBT data to determine the optimal cut-off point at each time interval. Sensitivity and specificity of the13C UBT at all intervals compared with histology and culture and against the standard 30 min interval were determined.RESULTS: The calculated optimal cut-off points for each time interval (T), expressed as delta over baseline (δ‰), were 3.29 δ‰ at T5, 3.15 δ‰ at T10, 3.42 δ‰ at T15, 3.17 δ‰ at T20, 2.99 δ‰ at T25and 2.82 δ ‰ at T30. Except at T5, the risk of false-positive and false-negative test results at each time interval was lower than 2.3% using these cut-off points. When replacing the cut-off points with 3.0 δ‰, the risk of error was still lower than 2.3%. The test at T10showed 98.6% sensitivity and 98.6% specificity compared with T30. T10and T30showed 100% sensitivity and 96% specificity compared with histology and culture.CONCLUSIONS: The13C UBT is an accurate, noninvasive test, even when the breath sample interval is reduced to 10 min. The present study confirms the validity of a cut-off point of 3.0 δ‰ for the 10 min and 30 min13C UBT.
Surgical Management of Acute Necrotizing Lung Infections
Authors: Reimel Beth Ann , Krishnadasen Baiya , Cuschieri Joseph , Klein Matthew B , Gross Joel , Karmy-Jones Riyad 
Published: March 2016

BACKGROUND: Surgical resection for acute necrotizing lung infections is not widely accepted due to unclear indications and high risk.OBJECTIVE: To review results of resection in the setting of acute necrotizing lung infections.METHODS: A retrospective review of patients who underwent parenchymal resection between January 1, 2000, and January 1, 2006, for management of necrotizing pneumonia or lung gangrene.RESULTS: Thirty-five patients underwent resection for lung necrosis. At the time of consultation, all patients presented with pulmonary sepsis, and also had the following: empyema (n=17), hemoptysis (n=5), air leak (n=7), septic shock requiring pressors (n=8) and inability to oxygenate adequately (n=7). Twenty-four patients were ventilated pre-operatively. Eleven patients had frank lobar gangrene, and the other patients had combinations of necrotizing pneumonia and abscesses. In 10 patients, preresection procedures were performed, including percutaneous drainage of an abscess (n=4), thoracoscopic decortication (n=4) and open decortication (n=2). Procedures included pneumonectomy (n=4), lobectomy (n=18), segmentectomy (n=2), wedge resection (n=4) and debridement (n=7). There were three (8.5%) postoperative deaths – two due to multiple organ failure and one due to anoxic brain injury. All patients not ventilated preoperatively were weaned from ventilatory support within three days. Of those ventilated preoperatively, three died, while four remained chronically ventilator dependent.CONCLUSIONS: Surgical resection for necrotizing lung infections is a reasonable option in patients with persistent sepsis who are failing medical therapy. Ventilated patients have a worse prognosis but can still be candidates for resection. Patients who are hemodynamically unstable appear to have better outcomes if they can be stabilized before resection.
Suppression of Pain by Exposure of Acupuncture Points to Polarized Light
Authors: Limansky Yuri P , Tamarova Zinaida A , Gulyar Sergiy A 
Published: March 2016

BACKGROUND: According to clinical studies, the stimulation of acupuncture points (APs) by a variety of methods (eg, needles, pressure, etc) is an effective method for the treatment of many pain syndromes. However, no experimental proof exists showing that the exposure of APs to low‐intensity incoherent polarized (P) light evokes an analgesic affect.OBJECTIVES: The authors’ previous work, using mice, shows that the exposure of APs to low‐intensity microwaves effectively decreases pain. The purpose of the present study was to determine whether exposure of APs to low‐intensity incoherent P light evokes a statistically significant reduction in pain.METHODS: The effects of P light on behavioural responses to acute and tonic pain were tested in mice. The threshold of vocalization during electrical stimulation of the foot (acute pain) was measured before and after exposure of AP E‐36 to P light. The duration of licking the formalin‐injected foot (tonic pain) was investigated in control mice and mice exposed to P light on APs E‐36, V‐56 and V‐60 or on skin that did not contain analgesic APs.RESULTS: Exposure of APs to P light evoked a statistically significant increase in pain threshold by 34.2% to 59.1%, and shortened the licking time by 32.3% to 50% in mice. The most effective AP was E‐36 in both the painful foot and the normal foot. After 2 min, 6 min and 10 min of P light exposure, analgesia was 7.6%, 30.9% and 50%, respectively. The exposure to P light on skin that did not contain analgesic APs did not evoke significant effect.CONCLUSIONS: The results show the efficacy of pain suppression by exposure of antinociceptive APs to P light.
Community‐Acquired Antibiotic Resistance in Urinary Isolates from Adult Women in Canada
Authors: McIsaac Warren J , Mazzulli Tony , Permaul Joanne , Moineddin Rahim , Low Donald E 
Published: March 2016

BACKGROUND: There are currently limited data regarding the prevalence of antimicrobial‐resistant organisms causing community‐acquired urinary tract infections among adult women in Canada. Trimethoprim‐sulfamethoxazole (TMP‐SMX) is the recommended first‐line empirical antibiotic treatment, unless resistance of Escherichia coli to TMP‐SMX exceeds 20%.OBJECTIVE: To assess current levels of TMP‐SMX‐resistant E coli in community‐acquired cases of urinary tract infection in adult women.METHOD: Assessment of urine culture reports obtained from 21 laboratories across Canada, submitted by family physicians for women aged 16 years and older.RESULTS: In 2199 adult women with a positive urine culture, 1079 (49.1%) of pathogens isolated were resistant to at least one antibiotic and 660 (30.0%) were multidrug‐resistant (resistant to two or more antibiotics). TMP‐SMX resistance was seen in 245 of 1613 (15.2%) E coli isolates (95% CI 13.5 to 17.0). This proportion was higher in women 50 years of age and older (155 of 863 isolates [18.0%]; P=0.001), in British Columbia (70 of 342 isolates [20.5%]) and in Ontario (62 of 370 isolates [16.8%]) when compared with eastern provinces (65 of 572 isolates [11.4%]; P=0.001). Fluoroquinolone‐resistant E coli occurred in 107 of 1557 (6.9%) isolates (95% CI 5.7 to 8.2), with the highest level found in British Columbia (54 of 341 isolates [15.8%]; P=0.001).CONCLUSION: TMP‐SMX continues to be appropriate as first‐line empirical treatment of acute cystitis in adult women in Canada, as resistance remains below 20%. However, TMP‐SMX resistance is higher in older women and in some provinces. The level of fluoroquinolone‐resistant E coli is highest in British Columbia.
Estimated Numbers of Community Cases of Illness Due to Salmonella, Campylobacter and Verotoxigenic Escherichia Coli: Pathogen‐Specific Community Rates
Authors: Thomas M Kate , Majowicz Shannon E , Sockett Paul N , Fazil Aamir , Pollari Frank , Doré Kathryn , Flint James A , Edge Victoria L 
Published: March 2016

OBJECTIVE: To estimate the annual number of cases of illness due to verotoxigenic Escherichia coli (VTEC), Salmonella and Campylobacter in the Canadian population, using data from the National Notifiable Disease registry (NND), estimates of under‐reporting derived from several National Studies on Acute Gastrointestinal Illness, and the literature.METHODS: For each of the three pathogens (VTEC, Salmonella and Campylobacter), data were used to estimate the percentage of cases reported at each step in the surveillance system. The number of reported cases in the NND for each pathogen was then divided by these percentages. In cases where the pathogen‐specific estimates were unavailable, data on acute gastrointestinal illness were used, accounting for differences between those with bloody and nonbloody diarrhea.RESULTS: For every case of VTEC, Salmonella and Campylobacter infection reported in the NND, there were an estimated 10 to 47, 13 to 37, and 23 to 49 cases annually in the Canadian population, respectively.CONCLUSIONS: The authors estimate that a significant number of infections due to VTEC, Salmonella and Campylobacter occur each year in Canada, highlighting the fact that these enteric pathogens still pose a significant health burden. Recognizing the significant amount of under‐reporting is essential to designing appropriate interventions and assessing the impact of these pathogens in the population.
A Survey of the Pain Experienced by Males and Females with Fabry Disease
Authors: Gibas Andrea L , Klatt Regan , Johnson Jack , Clarke Joe TR , Katz Joel 
Published: March 2016

BACKGROUND: The clinical onset of Fabry disease, a rare, X‐linked, multisystemic disorder, is marked by neuropathic pain. Males suffer extensively from this disease. Females, as genetic ‘carriers’, have traditionally been viewed as either asymptomatic or mildly afflicted with this disease.OBJECTIVES: To describe Fabry‐related pain and compare experiences between the sexes. Patients’ perceptions of physician pain assessments were also examined.METHODS: A disease‐specific questionnaire was accessible on‐line (www.fabry.org) and mailed to 552 members of a Fabry disease support group.RESULTS: The response rate was 14.3% for the support group‐based mail questionnaire. Females (58.0%) were significantly older (mean ± SD 45.9±13.5 years) than males (mean ± SD 40.0±12.1; t [86]=−2.11, P<0.05). Females were diagnosed with Fabry disease later (31.1±14.0 years) than males (24.2±11.9 years; t [86]=−2.43, P<0.05). Females (mean score for pain disability rating 3.0±1.4) suffered more extensive disability from migraine pain (mean score 2.2±1.3; F [1, 74]=45.0, P<0.005), and, unlike males, did not exhibit a decline in pain intensity with disease duration. Satisfaction with physician pain assessments was moderate.CONCLUSIONS: Contrary to the traditional view of females as carriers, females with Fabry disease experienced intense disease‐related pain; pain produced comparable distress and impairment in both sexes. The diagnostic delay and absence of a decline in pain symptoms over time in females suggest additional disease burden. Females may be triply disadvantaged in the health care system due to disease rarity, devalued carrier status and sex.
Pneumococcal Conjugate Vaccination in Canadian Infants and Children Younger than Five Years of Age: Recommendations and Expected Benefits
Authors: Mcclure Carol A , Ford Michael W , Wilson Jeff B , Aramini Jeff J 
Published: March 2016

INTRODUCTION: Streptococcus pneumoniae infection may result in invasive pneumococcal disease (IPD), such as bacteremia, meningitis and bacteremic pneumonia, or in non‐IPD, such as pneumonia, sinusitis and otitis media. In June 2001, a heptavalent pneumococcal conjugate vaccine (PCV7) (Prevnar, Wyeth Pharmaceuticals, Canada) was approved for use in children in Canada. The objective of the present paper is to review S pneumoniae‐induced disease incidence and vaccine recommendations in Canadian infants and children younger than five years of age. Particular attention is given to the expected benefits of vaccination in Canada based on postmarketing data and economic modelling.METHODS: Searches were performed on PubMed and Web of Science databases and specific Canadian journals using the key words ′pneumococc*′, ′vaccine′, ′conjugate′, ′infant′ and ′Canadian′.RESULTS AND DISCUSSION: PCV7 appears to be safe and effective against IPD and non‐IPD in children younger than five years of age and, more importantly, in children younger than two years of age (who are at highest risk for IPD). An examination of postmarketing data showed a reduction in incidence of pneumococcal disease in age groups that were vaccinated and in older age groups, indicating the likelihood of herd protection. Concurrently, there was a reduction in the occurrence of antimicrobial‐resistant isolates.CONCLUSIONS: The results from the present review suggest that PCV7 is currently benefiting Canadian children and society by lowering S pneumoniae‐associated disease. Additional gains from herd protection and further reductions in antimicrobial resistance will be achieved as more Canadian children younger than five years of age are routinely vaccinated with PCV7.
Serum Creatinine in Patients with Advanced Liver Disease Is of Limited Value for Identification of Moderate Renal Dysfunction: Are the Equations for Estimating Renal Function Better?
Authors: MacAulay Jillian , Thompson Kara , Kiberd Bryce A , Barnes David C , Peltekian Kevork M 
Published: March 2016

BACKGROUND: The Cockcroft-Gault formula (CGF) is used to estimate the glomerular filtration rate (GFR) based on serum creatinine (Cr) levels, age and sex. A new formula developed by the Modification of Diet in Renal Disease (MDRD) Study Group, based on the patient’s Cr levels, age, sex, race and serum urea nitrogen and serum albumin levels, has shown to be more accurate. However, the best formula to identify patients with advanced liver disease (ALD) and moderate renal dysfunction (GFR 60 mL/min/1.73 m2or less) is not known. The aim of the present study was to compare calculations of GFR, using published formulas (excluding those requiring urine collections) with standard radionuclide measurement of GFR in patients with ALD.METHODS: Fifty-seven consecutive subjects (40% women) with a mean age of 50 years (range 16 to 67 years) underwent 99m-technetium-diethylenetriamine pentaacetic acid (99mTc-DTPA) (single injection) radionuclide measurement of GFR. To calculate GFR, three formulas were used: the reciprocal of Cr multiplied by 100 (100/Cr), the CGF and the MDRD formulas. Pearson’s correlation coefficient (r) and Bland-Altman analyses of agreement were used to analyze the association between99mTc-DTPA clearance and the three equations for GFR.RESULTS: The mean99mTc-DTPA clearance was 83 mL/min/1.73 m2(range 28 mL/min/1.73 m2to 173 mL/min/1.73 m2). Mean calculated GFRs by 100/Cr, the CGF and the MDRD formula were 106 mL/min/1.73 m2, 98 mL/min/1.73 m2and 86 mL/min/1.73 m2, respectively. Regression analysis showed good correlation between radionuclide GFR and calculated GFR with r(100/Cr)=0.74, r(CGF)=0.80, r(MDRD)=0.87, all at P≤0.0001. The MDRD formula provided the least bias. The Bland-Altman plot showed best agreement between GFR calculated by the MDRD formula and99mTc-DTPA clearance, with only 3 mL/min/1.73 m2overestimation. There was higher variability between radionuclide GFR and calculated GFR by the CGF and by 100/Cr. Although there was no difference in precision, GFR calculated by the MDRD formula had the best overall accuracy. The sensitivity and specificity for detection of moderate renal dysfunction by the MDRD formulas were 73% and 87%, respectively.CONCLUSIONS: Among the Cr-based GFR formulas, the MDRD formula showed a larger proportion of agreement with radionuclide GFR in patients with ALD. In clinical practice, the MDRD is the best formula for detection of moderate renal dysfunction among those with ALD.
The Value of Thoracic Computed Tomography Scans in Clinical Diagnosis: A Prospective Study
Authors: Turner Mark O , Mayo John R , Müller Nestor L , Schulzer Michael , FitzGerald J Mark 
Published: March 2016

BACKGROUND: Computed tomography (CT) scans are used extensively to investigate chest disease because of their cross‐sectional perspective and superior contrast resolution compared with chest radiographs. These advantages lead to a more accurate imaging assessment of thoracic disease. The actual use and evaluation of the clinical impact of thoracic CT has not been assessed since scanners became widely available.OBJECTIVE: To identify patterns of utilization, waiting times and the impact of CT scan results on clinical diagnoses.DESIGN: A before and after survey of physicians who had ordered thoracic CT scans.SETTING: Vancouver General Hospital – a tertiary care teaching centre in Vancouver, British Columbia.SUBJECTS: Physicians who had ordered CT scans.INTERVENTION: Physicians completed a standard questionnaire before and after the CT scan result was available.MEASUREMENTS: Changes in the clinical diagnosis, estimates of the probabilities for the diagnosis both before and after the CT scan, and waiting times.RESULTS: Four hundred fifty‐four thoracic CT cases had completed questionnaires, of whom 80% were outpatients. A change in diagnosis was made in 48% of cases (25% with a normal CT scan and 23% with CT scan findings that indicated a different diagnosis). The largest change in probability scores for the clinical diagnosis before and after the CT scan was 43.9% for normal scans, while it was 36.3% for a different diagnosis and 26.3% for the same diagnosis. High‐priority scans were associated with decreased waiting time (−7.89 days for each unit increase in priority).CONCLUSIONS: The CT scan results were associated with a change in diagnosis in 48% of cases. Normal scans constituted 25% of the total and had the greatest impact scores. Waiting times were highly correlated with increased urgency of the presenting problem.