bluuebunny/crossref_metadata_2025_split huggingface dataset:
N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project
Authors: Hyland Meaghen , Ofner-Agostini Marianna , Miller Mark , Paton Shirley , Gourdeau Marie , Ishak Magued , the Canadian Hospital Epidemiology Committee  , the Canadian Nosocomial Infection Surveillance Program (Heal  
Published: March 2016

BACKGROUND: A 1996 preproject survey among Canadian Hospital Epidemiology Committee (CHEC) sites revealed variations in the prevention, detection, management and surveillance of Clostridium difficile‐associated diarrhea (CDAD). Facilities wanted to establish national rates of nosocomially acquired CDAD (N‐CDAD) to understand the impact of control or prevention measures, and the burden of N‐CDAD on health care resources. The CHEC, in collaboration with the Laboratory Centre for Disease Control (Health Canada) and under the Canadian Nosocomial Infection Surveillance Program, undertook a prevalence surveillance project among selected hospitals throughout Canada.OBJECTIVE: To establish national prevalence rates of N‐CDAD.METHODS: For six weeks in 1997, selected CHEC sites tested all diarrheal stools from inpatients for either C difficile toxin or C difficile bacteria with evidence of toxin production. Questionnaires were completed for patients with positive stool assays who met the case definitions.RESULTS: Nineteen health care facilities in eight provinces participated in the project. The overall prevalence of N‐CDAD was 13.0% (95% CI 9.5% to 16.5%). The mean number of N‐CDAD cases were 66.3 cases/100,000 patient days (95% CI
Sputum Cell Counts and Exhaled Nitric Oxide in Patients with Gastroesophageal Reflux, and Cough or Asthma
Authors: Parameswaran Krishnan , Allen Christopher J , Kamada Dennis , Efthimiadis Ann , Anvari Mehran , Hargreave Frederick E 
Published: March 2016

BACKGROUND: Gastroesophageal reflux (GER) is commonly associated with chronic cough and asthma, but there is little or no information on the nature of any associated airway inflammation.OBJECTIVE: To observe whether the association with GER worsens airway inflammation in patients with chronic cough or asthma.PATIENTS AND METHODS: The airway inflammatory indexes in induced sputum and exhaled air were examined in a cross‐sectional study of 11 patients with cough and GER, nine patients with mildly symptomatic asthma and GER, nine patients with mildly symptomatic asthma without GER and nine normal, healthy control subjects. GER was shown objectively by 24 h ambulatory pH recording.RESULTS: The sputum total cell count, the proportion of neutrophils and macrophages, and the fibrinogen level were normal in all four groups, with no significant differences among the groups. The sputum eosinophil and metachromatic cell percentages, and eosinophil cationic protein levels were normal in patients with cough and GER. They were significantly increased in patients with asthma compared with healthy subjects (P<0.01) and patients with cough (P<0.01), but were not different between groups with and without GER. Exhaled nitric oxide levels showed similar results (P<0.01). The correlations between the number of episodes of reflux and the proportion of sputum eosinophils, neutrophils or exhaled nitric oxide were modest but not significant.CONCLUSIONS: GER, when associated with cough or mildly symptomatic asthma, does not cause or aggravate existing airway inflammation as measured by induced sputum cell counts and fibrinogen level, or by exhaled nitric oxide.
Medicinal Use of Cannabis: History and Current Status
Authors: Kalant Harold 
Published: March 2016

OBJECTIVE: To provide an overview of the history and pharmacology of cannabis in relation to current scientific knowledge concerning actual and potential therapeutic uses of cannabis preparations and pure cannabinoids.METHODS: The literature on therapeutic uses of cannabis and cannabinoids was assessed with respect to type of study design, quality and variability of data, independent replications by the same or other investigators, magnitude of effects, comparison with other available treatments and reported adverse effects. The results of this review were also compared with those of major international reviews of this topic in the past five years.CONCLUSIONS: Pure tetrahydrocannabinol and several analogues have shown significant therapeutic benefits in the relief of nausea and vomiting, and stimulation of appetite in patients with wasting syndrome. Recent evidence clearly demonstrates analgesic and antispasticity effects that will probably prove to be clinically useful. Reduction of intraocular pressure in glaucoma and bronchodilation in asthma are not sufficiently strong, long lasting or reliable to provide a valid basis for therapeutic use. The anticonvulsant effect of cannabidiol is sufficiently promising to warrant further properly designed clinical trials. There is still a major lack of long term pharmacokinetic data and information on drug interactions. For all the present and probable future uses, pure cannabinoids, administered orally, rectally or parenterally, have been shown to be effective, and they are free of the risks of chronic inflammatory disease of the airways and upper repiratory cancer that are associated with the smoking of crude cannabis. Smoking might be justified on compassionate grounds in terminally ill patients who are already accustomed to using cannabis in this manner. Future research will probably yield new synthetic analogues with better separation of therapeutic effects from undesired psychoactivity and other side effects, and with solubility properties that may permit topical administration in the eye, or aerosol inhalation for rapid systemic effect without the risks associated with smoke inhalation.
Susceptibility of Community Gram‐Negative Urinary Tract Isolates to Mecillinam and Other Oral Agents
Authors: Mazzulli Tony , Skulnick Martin , Small Glen , Marshall Wayne , Hoban Darryl J , Zhanel George G , Finn Susan , Low Donald E 
Published: March 2016

OBJECTIVE: To determine the susceptibility of community outpatient Gram‐negative urinary tract isolates to mecillinam and other commonly used oral agents.DESIGN AND SETTING: The study was a laboratory‐based study of consecutive Gram‐negative urinary tract isolates. Only those isolates considered to be significant pathogens were included in the study. Susceptibility testing was performed using agar dilution methodology following guidelines published by the National Committee for Clinical Laboratory Standards.POPULATION STUDIED: Outpatients presenting to a family physician or clinic with signs or symptoms suggestive of a urinary tract infection were included in the study.MAIN RESULTS: Of 2000 consecutive community isolates (91.8% Escherichia coli, 3.9% Klebsiella species, 2.0% Proteus species, 2.3% others), in vitro susceptibilities were: mecillinam 98.8%, ampicillin 77.0%, ciprofloxacin 100%, trimethoprim/sulfamethoxazole 91.6% and nitrofurantoin 95.4%. Susceptibility to mecillinam was significantly better than all other agents except ciprofloxacin (P<0.001, McNemar′s test). Organisms with reduced susceptibility to mecillinam included Citrobacter species, Pseudomonas aeruginosa and Providencia species.CONCLUSIONS: Community Gram‐negative urinary tract isolates remain highly sensitive to mecillinam and ciprofloxacin, but a significant number have developed resistance to trimethoprim/sulfamethoxazole. Further studies are required to determine the clinical significance of these results.
Are all Older Adults with Persistent Pain Created Equal? Preliminary Evidence for a Multiaxial Taxonomy
Authors: Weiner Debra K , Rudy Thomas E , Gaur Swati 
Published: March 2016

BACKGROUND: Persistent pain is grossly undertreated in older adult sufferers, despite its high prevalence in this age group. Because of its multidimensional impacts, including depression, sleep disruption and physical disability, patients with persistent pain often benefit from interdisciplinary pain clinic treatment. This treatment is expensive, however, and may not be required by all patients. The Multiaxial Assessment of Pain (MAP) has demonstrated value in predicting response to treatment in younger adults with persistent pain.OBJECTIVE: To examine the feasibility of a MAP taxonomy for community‐dwelling adults age 65 years or older.PARTICIPANTS AND PROCEDURES: One hundred eight subjects with persistent pain (mean age 73.8 years, SD=8.4 years) were interviewed and data collected on demographics, pain intensity, depressive symptoms, sleep disruption, pain interference with performance of basic and instrumental activities of daily living, frequency of engagement in advanced activities of daily living, cognitive function and comorbidity. A subset of these subjects underwent physical capacities testing, including maximal isometric lift strength, dynamic lifting endurance, timed chair rise and balance.RESULTS: Analyses derived three primary clusters of patients. Cluster 1 (24%) reported less intense pain, less depression and sleep disruption, and higher activity levels. Cluster 3 (30%) suffered from more pain and were more functionally disabled. Cluster 2 (46%) had characteristics of cluster 1 and cluster 3, but with some characteristics that were clearly unique.CONCLUSIONS: While these results are preliminary and require further validation, they indicate that older adults are heterogeneous in their response to persistent pain. Future studies should be performed to examine whether the MAP taxonomy is applicable to older adults regardless of medical diagnosis. Ultimately, this information may have meaning with regard to both treatment prescribing, and the design and interpretation of intervention studies.
Severe Complications Associated with Varicella: Province of Quebec, April 1994 to March 1996
Authors: Rivest Paul , Bédard Lucie , Valiquette Louise , Mills Elaine , Lebel Marc H , Lavoie Gilles , Carsley John 
Published: March 2016

OBJECTIVE: To determine the frequency and severity of serious complications associated with varicella in Quebec; the frequency and severity of cases of congenital varicella; and hospital costs associated with hospitalizations for varicella.STUDY DESIGN: All hospitalizations related to varicella were identified through the use of a hospital data bank and pertinent data were collected from hospital records.SETTING: Province of Quebec with a population of 6,895,960 people.STUDY POPULATION: All cases with a principal or secondary diagnosis of varicella hospitalized in Quebec between April 1, 1994 and March 31, 1996.OUTCOME MEASURES: Types of complications and reason for hospitalization, risk of complications and calculation of associated costs were studied.RESULTS: Nine hundred nine eligible hospitalizations were identified between April 1, 1994 and March 31, 1996. In all, 583 (64.1%) hospitalizations were for the treatment of complications, 127 (14.0%) for administration of intravenous acyclovir and 199 (21.9%) for supportive care. Healthy people accounted for 644 (70.8%) hospitalizations and immunosuppressed individuals for 136 (15.0%). Among children, one‐half of the principal complications were skin infections, while 13.5% and 8.4% of principal complications were pneumonia and neurological complications, respectively. Among adults, the most common complication was pneumonia, with a rate of 43.5%, followed by thrombocytopenia and skin infections, with rates of 22.2% and 14.8%, respectively. The complication rate was 29.2 cases/10,000 cases of varicella.CONCLUSIONS: Although perceived as a benign childhood disease by the general population, varicella may be accompanied by severe complications. Morbidity associated with varicella is one of the elements that must be considered when evaluating the usefulness of varicella vaccine.
Etiology of Exudative Pleural Effusions in Adults in North Lebanon
Authors: Kalaajieh Wassim Khalil 
Published: March 2016

OBJECTIVE: To establish the clinical pattern and etiology of exudative pleural effusions in adults in North Lebanon.MATERIALS AND METHODS: All patients aged 21 years and older who were admitted with exudative pleural effusions to the Husseini Hospital, Tripoli, North Lebanon, between 1997 and 1999 were studied prospectively.RESULTS: Of 165 patients with exudative pleural effusions, 114 (69.1%) were men and 51 (30.9%) were women. The most frequent cause of exudative pleural effusions was tuberculosis (43.7%), followed by malignancy (32.1%). The majority (88.7%) of malignant pleural effusions were due to lung cancer. Tuberculous effusions were more frequent in the first five decades of life (66.7%) and were the most common type of pleural effusion, accounting for 68.6% of patients younger than 50 years of age. Malignant effusions were more frequent among the older age groups, with 73.6% of patients with malignant effusions being older than 50 years of age. Most types of exudative pleural effusions showed a preference for the right side of the thorax. Of the diagnostic procedures used in the present study, the most useful were histological examination and culture of pleural biopsies.CONCLUSIONS: In North Lebanon, the clinical pattern and etiology of exudative pleural effusions are similar to those in the developing countries; the most frequent cause of pleural exudates is tuberculosis, followed by malignancy, particularly malignancy due to lung cancer.
Spirometric Predictors for the Exclusion of Severe Hypoxemia in Chronic Obstructive Pulmonary Disease
Authors: Gunen Hakan , Kosar Feridun 
Published: March 2016

BACKGROUND: Controversy has existed over the need for routine arterial blood gas (ABG) analysis in patients with chronic obstructive pulmonary disease (COPD). Some authors recommend it in all patients with COPD, but others find it unnecessary if the forced expiratory volume in 1 s (FEV1) is 50% of predicted or greater.OBJECTIVES: To clarify this controversy, and to investigate correlations between severe hypoxemia and multiple spirometric parameters in patients with COPD with FEV1 50% of predicted or greater.PATIENTS AND METHODS: In 103 consecutive patients with COPD with FEV1 50% of predicted or greater, and without any other cardiopulmonary disorder, the incidence of severe hypoxemia (partial pressure of arterial oxygen less than 60 mmHg) was established by ABG analysis. Positive and negative predictive values (PPVs and NPVs, respectively) for severe hypoxemia for multiple spirometric parameters (FEV1, FEV1/forced vital capacity [FVC], peak expiratory flow [PEF], maximal midexpiratory flow rate [FEF25-75]) were evaluated in a stepwise manner.RESULTS: Twenty‐two patients (21%) were found to be severely hypoxemic. In the severely hypoxemic group, the mean values for FEV1, FEV1/FVC, PEF and FEF25-75 were 59.0±8.19%, 53.6±11.3, 50.6±9.3 and 34.4±14.2% of predicted, respectively. The mean values for the same parameters in the other patients were 58.0±4.6%, 52.7±7.8, 51.5±7.5 and 39.1±7.7% of predicted, respectively. Comparing these parameters between the two groups, only the difference in FEF25-75 was statistically significant (P<0.01). Valid PPVs and NPVs could not be established for any of the parameters at any level, except for the NPV for FEF25-75 50% of predicted or greater, which was 92%. This threshold value resulted in a false negative finding in less than 5% of the patients with hypoxemia.CONCLUSIONS: The results of the present study showed that one in five patients with COPD with FEV1 50% of predicted or greater was severely hypoxemic. In such patients, hypoxemia may be excluded, and ABG analysis may not be needed when the FEF25-75 is also 50% of predicted or greater. The FEV1, FEV1/FVC and PEF parameters failed to predict or exclude severe hypoxemia.
The McGill Pain Questionnaire, Japanese Version, Reconsidered: Confirming the Theoretical Structure
Authors: Hasegawa Mamoru , Hattori Suguru , Mishima Masaru , Matsumoto Isao , Kimura Takashi , Baba Yasuko , Takano Osami , Sasaki Toshio , Kanemura Kazue , Senami Katsuhiko , Shibata Toshinari 
Published: March 2016

BACKGROUND: Based on a tripartite theoretical model of pain, the Pain Rating Index (PRI) of the McGill Pain Questionnaire (MPQ) continues to be one of the most frequently used instruments to measure clinical pain. However, language and cultural barriers have hindered its wide use and standardization in Japan. Although a number of exploratory factor analysis studies have failed to support consistently the theoretical structure of the MPQ, a few previous confirmatory factor analysis studies did statistically support the a priori model.OBJECTIVE: To test, through confirmatory factor analysis (CFA), the theoretical structure of a Japanese version of the MPQ (JMPQ), which followed a format similar to that of the original MPQ.DESIGN: This study used CFA on prospectively collected data from 199 consecutive outpatients with chronic pain at a university hospital to test the theoretical structure of the JMPQ.RESULTS AND CONCLUSIONS: CFA was completed on the first 16 PRI subclass scores; this process yielded a well fitting final model that explained 92% of the covariance in the observed data. The results supported the hypothesis that the sensory, affective and evaluative subscales of the PRI are representative of the multidimensionality of the pain experience, with minimal overlap. It is suggested that the theoretical structure of the MPQ is maintained in the JMPQ used in this study. Therefore, this study is the first step toward standardization of the JMPQ, serving as a cultural bridge in the field of pain medicine between Japan and English‐speaking nations such as Canada.
Enhanced Surveillance of Acute Hepatitis B and C in Four Health Regions in Canada, 1998 TO 1999
Authors: Zou Shimian , Zhang Jun , Tepper Martin , Giulivi Antonio , Baptiste Beverley , Predy Gerry , Poliquin Darlene , Morin Manon , Jones Donna , Loewen Joy , Ogonowski Margaret , Moses Stephen , Elliott Lawrence 
Published: March 2016

OBJECTIVE: To assess the incidence and risk factors for acute hepatitis B and acute hepatitis C in a defined Canadian population.PATIENTS AND METHODS: An enhanced surveillance system was established in October 1998 to identify cases of acute hepatitis B and C infections in four regions in Canada, with a total population of approximately 3.2 million people. Information on demographic and clinical characteristics, laboratory results and potential risk factors was collected using predefined questionnaires.RESULTS: A total of 79 cases of acute hepatitis B and 102 cases of acute hepatitis C were identified from October 1998 to December 1999, resulting in an incidence rate of 2.3 and 2.9/100,000 person‐years, respectively. Males had higher incidence rates than females. The incidence of acute hepatitis B peaked at age 30 to 39 years for both males and females, whereas acute hepatitis C peaked at 30 to 39 years for males and 15 to 29 years for females. At least 34% of acute hepatitis B and 63% of acute hepatitis C were associated with injection drug use. Persons who were 15 to 39 years of age were more likely to report injection drug use as a risk factor. Heterosexual contact was reported to be a risk factor for 36.6% of acute hepatitis B cases and 3.5% of acute hepatitis C cases.CONCLUSIONS: The surveillance provides national incidence estimates of clinically recognized acute hepatitis B and C. Both hepatitis B and C are important public health threats to Canadians. Prevention efforts for both diseases should focus on injection drug use, especially for people aged 15 to 39 years. Risky sexual behaviour is also a major concern in prevention of hepatitis B in Canada.
Alpha1‐Antitrypsin Deficiency: A Position Statement of the Canadian Thoracic Society
Authors: Abboud RT , Ford GT , Chapman KR 
Published: March 2016

OBJECTIVE: To prepare new guidelines for the Canadian Thoracic Society (CTS) regarding severe alpha1‐antitrypsin (AAT) deficiency and AAT replacement therapy.MATERIALS AND METHODS: Previously published guidelines and the medical literature about AAT deficiency and AAT replacement were reviewed. The prepared statement was reviewed and approved by the CTS Standards and Executive Committees.RESULTS: Three studies evaluated AAT replacement. The National Heart, Lung and Blood Institute’s AAT Registry was a nonrandomized comparison of patients receiving and not receiving AAT replacement, and evaluated the decline in forced expiratory volume in 1 s (FEV1) in 927 subjects. The rate of FEV1 decline was significantly less in those receiving AAT treatment (66 ± SE 5 mL/year versus 93 ± SE 11 mL/year; P=0.03) only in the subgroup with FEV1 35% to 49% predicted. In another study comparing 198 German patients receiving weekly AAT infusions and 97 untreated Danish patients, the mean annual decline in FEV1 was significantly less in treated patients only in the subgroup with FEV1 31% to 65% predicted (62 mL versus 83 mL, P=0.04). Neither of these studies was a randomized, controlled study and, thus, cannot be taken as proof of efficacy. A randomized, double‐blind, placebo controlled trial of monthly replacement therapy over three years in 56 exsmokers with severe AAT deficiency and moderate emphysema showed a trend (P=0.07) favouring slower progression of emphysema by computed tomography scan in the group receiving AAT replacement.CONCLUSIONS: AAT replacement therapy has not been proven definitively to be clinically effective in reducing the progression of disease in AAT‐deficient patients, but there is a possible benefit to selected patients. A placebo controlled, randomized clinical trial of AAT replacement therapy is required. The authors recommend reserving AAT replacement therapy for AAT‐deficient patients with impaired FEV1 of 35% to 50% predicted who have quit smoking and are on optimal medical therapy but continue to show a rapid decline in FEV1, and participation of all AAT‐deficient subjects in the Canadian AAT Registry.
Previous Creatinine Levels Safely Predict Amantadine Dose for Influenza a Outbreak Control
Authors: Buxton Jane A , Skowronski Danuta M , Ng Helen , Marion Steve A , Williams Michele , Forbes Anna , King Arlene , Hockin Jamie 
Published: March 2016

BACKGROUND: Amantadine, an antiviral agent, is the only drug currently approved in Canada for prophylaxis of influenza A virus infection. To minimize side effects, the amantadine dose is adjusted for age and estimated creatinine clearance (CrCl) based on plasma creatinine (Cr) levels. As amantadine is used more frequently for influenza A outbreak control in care facilities for elderly people, physicians are increasingly called on to prescribe it for residents and to consider the necessity of requesting plasma Cr levels.OBJECTIVE: To determine whether previous Cr levels are predictive in estimating current CrCl and safe amantadine dose determination.DESIGN AND SETTING: Residents′ charts were reviewed in two facilities in Vancouver, British Columbia. CrCl estimated using previous or current Cr results, current weight and age, as well as recommended amantadine doses based on Canadian National Advisory Committee on Immunization guidelines, were studied.RESULTS: 165 charts with Cr results in March 1998 were included; 122 had results before March 1998, and 103 had Cr results after March 1998. Pearson′s correlation coefficient for CrCl estimated from current and previous Cr values was 0.929 for results less than six months previously, 0.974 for six to 12 months previously and 0.952 for 12 to 18 months previously. The same or a more conservative dose of amantadine was predicted in 92% of cases when using a Cr result taken within the previous year and in 76% of cases when using a Cr result taken 12 to 18 months previously.CONCLUSION: In long term care facilities, Cr levels measured up to 12 months previously can usually safely be used to estimate CrCl. Using previous Cr results permits advance preparation of doctor′s orders for amantadine prophylaxis and avoids repeating Cr testing on every resident when an outbreak occurs, reducing related staff time and cost.