bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac Work-Up Protocol for Liver Transplant Candidates: Experience from a Single Liver Transplant Centre
Authors: Ye Carrie , Saincher Meghana , Tandon Puneeta , Meeberg Glenda , Williams Randy , Burak Kelly W , Bain Vincent G 
Published: March 2016

BACKGROUND: Ischemic cardiac events can cause significant morbidity and mortality postliver transplantation; however, no validated protocols to screen patients before transplantation exist.OBJECTIVES: To report the introduction of a noninvasive cardiac screening protocol used at the Liver Unit, University of Calgary (Calgary, Alberta); to determine whether the protocol decreases use of coronary angiograms; and to compare cardiac outcomes using the new protocol with an appropriately matched historical control group.METHODS: A new cardiac screening protocol was introduced into the program in 2005, which uses perfusion scintigraphy to screen high-risk cardiac patients, reserving coronary angiograms for abnormal results. Transplanted patients screened using this protocol were compared with matched historical controls. Electronic charts were reviewed for cardiac outcomes intra- and postliver transplantation.RESULTS: A total of 396 patients were screened between April 2005 and February 2009. Eighty-two were transplanted by February 2009 and included in the study. Eighty-one patients were successfully matched according to age, sex, cardiac history and presence of diabetes. Twelve of 82 (14.6%) and 11 of 81 (13.6%) in the study and control groups, respectively, underwent coronary angiograms (P=0.85). Coronary artery disease was found in six of 12 (50.0%) study patients and three of 11 (27.3%) control patients who underwent coronary angiography (P=0.27). The mean (± SD) length of the follow-up period was 1.87±0.91 years and 4.45±1.89 years in the study and control groups, respectively. One of 81 in the control group and zero of 82 in the study group experienced an acute coronary syndrome event postoperatively.CONCLUSIONS: Coronary events are infrequent in liver transplant recipients. The described protocol is an effective method of coronary artery disease screening before liver transplant but does not reduce the number of cardiac investigations performed.
Why Do Mortality Rates for Nonvariceal Upper Gastrointestinal Bleeding Differ around the World? A Systematic Review of Cohort Studies
Authors: Jairath Vipul , Martel Myriam , Logan Richard FA , Barkun Alan N 
Published: March 2016

BACKGROUND: Discrepancies exist in reported mortality rates of nonvariceal upper gastrointestinal bleeding (NVUGIB).OBJECTIVE: To perform a systematic review assessing possible reasons for these disparate findings and to more reliably compare them.METHODS: The MEDLINE, EMBASE and ISI Web of Knowledge databases were searched for studies reporting mortality rates in NVUGIB involving adults and published in English. To ensure robust and contemporary estimates, studies spanning 1996 to January 2011 that included more than 1000 patients were selected.RESULTS: Eighteen of 3077 studies were selected. Ten studies used administrative databases and the remaining eight used registries. The mortality rates reported in these studies ranged from 1.1% in Japan to 11% in Denmark. There were variations in reported mortality rates among countries and also within countries. Reasons for these disparities included a spectrum of quality in reporting as well as heterogeneous definitions of case ascertainment, differing patient populations with regard to severity of presentation and associated comorbidities, varying durations of follow-up and different health care system-related practices.CONCLUSIONS: Wide differences in reported NVUGIB mortality rates are attributable to differences in adopted methodologies and populations studied. More uniform standards in reporting are needed; only then can true observed variations enable a better understanding of causes of death and pave the way to improved patient outcomes.
A Cross-Sectional Study of the Association between Overnight Call and Irritable Bowel Syndrome in Medical Students
Authors: Wells Malcolm , Roth Lee , McWilliam Morgan , Thompson Kim , Chande Nilesh 
Published: March 2016

BACKGROUND: Shift work has been associated with irritable bowel syndrome (IBS), which includes gastrointestinal symptoms such as abdominal pain, constipation and diarrhea. Overnight call shifts also lead to a disruption of the endogenous circadian rhythm.HYPOTHESIS: Medical students who perform intermittent overnight call shifts will demonstrate a higher prevalence of IBS symptoms when compared with medical students who perform no overnight call shifts.METHODS: First- and second-year (preclinical) medical students have no overnight call requirements, whereas third- and fourth-year medical (clerkship) students do have overnight call requirements. All medical students at the Schulich School of Medicine and Dentistry (London, Ontario) were invited to complete an anonymous, web-based survey or an identical paper copy that included demographic data, the Rome III questionnaire and the IBS-Quality of Life measure (IBS-QOL). The prevalence of IBS symptoms and quality of life secondary to those symptoms were determined.RESULTS: Data were available for 247 medical students (110 pre-clinical students, 118 clerkship students and 19 excluded surveys). There was no significant difference in the presence of IBS between preclinical and clerkship students (21 of 110 [19.1%] versus 26 of 118 [22.0%]; P=0.58). The were no significant differences in mean (± SD) IBS-QOL score of those with IBS between preclinical (43.5±8.3) and clerkship students (45.7±13.8) (P=0.53).CONCLUSIONS: Participation in overnight call was not associated with the development of IBS or a lower quality of life secondary to IBS in medical students.
The Epidemiology of Chronic Pain in Canadian Men and Women between 1994 and 2007: Results from the Longitudinal Component of the National Population Health Survey
Authors: Reitsma Michelle L , Tranmer Joan E , Buchanan Diane M , VanDenKerkhof Elizabeth G 
Published: March 2016

BACKGROUND: The epidemiology of chronic pain is poorly understood due to a paucity of longitudinal studies limiting the ability to develop prevention strategies for a condition resistant to many current therapies.OBJECTIVES: To identify the incidence of and sociodemographic risk factors for chronic pain in Canadian women and men over a 12‐year period.METHODS: Using data from the National Population Health Survey, individuals who developed chronic pain, defined as the presence of “usual pain” were identified. The cumulative incidence of chronic pain was calculated separately for men and women followed from 1994 to 2007. Biannual incidence and prevalence estimates of chronic pain were calculated during the same time period. Logistic regression analysis was used to examine predictors of chronic pain in men and women.RESULTS: The cumulative incidence over the 12‐year period was 35.6% (women 39.0%; men 32.2%). Women had a higher biannual prevalence, but not incidence, of chronic pain compared with men. In women, being older, having lower education and being widowed, separated or divorced, increased the risk of chronic pain. There were no sociodemographic risk factors for chronic pain in men.CONCLUSION: Women had a higher prevalence – but not incidence – of chronic pain compared with men, indicative of longer duration of illness in women. Risk factors also differed according to sex, supporting current literature reporting potentially different mechanisms for men and women. A better understanding of risk factors is necessary to develop population‐based preventive interventions. The former can only be achieved with population‐based, longitudinal studies.
The Use of Antiviral Drugs for Influenza: Guidance for Practitioners 2012/2013
Authors: Aoki Fred Y , Allen Upton D , Stiver H Grant , Evans Gerald A 
Published: March 2016

The present article addresses the use of antiviral drugs in the management of seasonal influenza illness for the 2012/2013 season. It updates the previous document published in 2011 (1). Noteworthy guidance updates since 2011 include the following:

Seasonal influenza in 2012/2013 is predicted to be caused by two human influenza A and one influenza B strain, all of which are anticipated to remain generally susceptible to oseltamivir.
The predicted strains are A/California/7/2009 (H1N1) pdm09‐like, A/Victoria/361/2011 (H3N2)‐like and B/Wisconsin/1/2010‐like (Yamagata lineage). All are included in the seasonal influenza vaccine and are susceptible to oseltamivir.
Swine‐variant H3N2v, which has rarely caused infection in humans exposed to infected swine within the past year in the United States, is susceptible to oseltamivir. It is not included in the current seasonal influenza vaccine.
It is still considered that initiation of antiviral therapy more than 36 h to 48 h after onset of symptoms is beneficial in patients hospitalized with complicated influenza and severe illness.
Oseltamivir continues to be recommended for the treatment of influenza in pregnant women.
The use of antiviral drugs among measures to control outbreaks of influenza in closed facilities such as correctional institutions is now included in the present document.
A Cohort Study for the Derivation and Validation of a Clinical Prediction Scale for Hospital-OnsetClostridium difficileInfection
Authors: Chandra Subhash , Latt Nyan , Jariwala Ujjval , Palabindala Venkataraman , Thapa Rameet , Alamelumangapuram Chidamber B , Noel Margarita , Marur Surendra , Jani Niraj 
Published: March 2016

OBJECTIVE: To develop and validate a clinical prediction scale for hospital-onsetClostridium difficileinfection (CDI).METHODS: A community-based, 360-bed hospital located in the suburbs of a metropolitan area in the United States served as the setting for the present retrospective cohort study. The cohort consisted of patients admitted to the adult medical service over a six-year period from October 2005 to September 2011. The cohort was divided into derivation (October 2005 to September 2009) and validation (October 2009 to September 2011) groups. The primary outcome measure was hospital-onset CDIs identified as stool positive forC difficileafter 48 h of hospital admission ordered for new-onset unformed stool by the treating physician.RESULTS: In the derivation phase, 35,588 patients were admitted to the medical service and 21,541 stayed in hospital beyond 48 h. A total of 266 cases of CDI were identified, 121 of which were hospital onset. The developed clinical prediction scale included the onset of unformed stool (5 points), length of hospital stay beyond seven days (4 points), age >65 years (3 points), long-term care facility residence (2 points), high-risk antibiotic use (1 point) and hypoalbuminemia (1 point). The scale had an area under the receiver operating curve (AUC) of 0.93 (95% CI 0.82 to 0.94) in predicting hospital-onset CDI, with a sensitivity of 0.94 (95% CI 0.88 to 0.97) and a specificity of 0.80 (95% CI 0.79 to 0.80) at a cut-off score of 9 on the scale. During the validation phase, 16,477 patients were admitted, of whom 10,793 stayed beyond 48 h and 58 acquired CDI during hospitalization. The predictive performance of the score was maintained in the validation cohort (AUC 0.95 [95% CI 0.93 to 0.96]) and the goodness-to-fit model demonstrated good calibration.CONCLUSION: The authors developed and validated a simple clinical prediction scale for hospital-onset CDI. This score can be used for periodical evaluation of hospitalized patients for early initiation of contact precautions and empirical treatment once it is validated externally in a prospective manner.
Comparison of Late HIV Diagnosis as a Marker of Care for Aboriginal Versus Non‐Aboriginal People Living with HIV in Ontario
Authors: Jaworsky Denise , Monette LaVerne , Raboud Janet , O’Brien-Teengs Doe , Diong Christina , Blitz Sandra , Rourke Sean B , Loutfy Mona R , OHTN Cohort Study Team  
Published: March 2016

BACKGROUND: Studies have found that Aboriginal people living with HIV/AIDS (APHAs) are more likely than non‐APHAs to receive suboptimal HIV care, yet achieve similar clinical outcomes with proper care.OBJECTIVE: To compare the proportions of individuals diagnosed late with HIV between APHAs and non‐APHAs within the Ontario HIV Treatment Network Cohort Study (OCS).METHODS: The analysis included OCS participants who completed the baseline visit by November 2009. Two definitions of the outcome of late HIV diagnosis were used: the proportion of participants with an AIDS‐defining illness (ADI) before or within three months of HIV diagnosis; and the proportion of participants with a CD4+ count <200 cells/mL at diagnosis. Logistic regression analysis was used to assess the association between Aboriginal ethnicity and late HIV diagnosis.RESULTS: APHAs were more likely to be female and have lower income, education and employment. No statistically significant differences were noted in the proportions receiving a late HIV diagnosis defined by ADI (Aboriginal 5.2% versus non‐Aboriginal 6.3%; P=0.40). Multivariate logistic regression analysis revealed a significant association between Aboriginal ethnicity and late HIV diagnosis defined by CD4+ count after adjusting for age and HIV risk factor (OR 1.55; P=0.04).DISCUSSION: APHAs were more likely to have a CD4+ count <200 cells/mL at diagnosis but had similar clinical outcomes from late diagnosis when defined by ADI. However, differences may be underestimated due to recruitment limitations and selection bias.CONCLUSION: Additional work is needed to address the socioeconomic and health care needs of APHAs.
Reassessing the Role for Lamivudine in Chronic Hepatitis B Infection: A Four-Year Cohort Analysis
Authors: Shaikh Tahir , Cooper Curtis 
Published: March 2016

The data supporting the use of antiviral agents other than lamivudine in the management of patients with hepatitis B virus (HBV) infection are based on highly selected clinical trial populations that may not be representative of typical HBV-infected populations encountered in many clinics. Despite its limitations, however, lamivudine is relatively inexpensive and widely available and, in carefully selected patients, can still be successfully used to achieve long-term HBV suppression. This study investigated the long-term effectiveness of lamivudine in an adherent, frequently monitored, noninvestigational HBV-infected cohort.BACKGROUND/OBJECTIVES: Lamivudine is readily available and inexpensive. Guidelines recommend other antiviral medications because they achieve superior virological suppression with less resistance. These data are based on clinical trial populations and may not be representative of typical hepatitis B virus (HBV) populations. The authors assessed lamivudine in maintaining long-term viral suppression in an adherent, frequently monitored, noninvestigational HBV-infected population.METHODS: All HBV patients (n=369) between 2000 and 2010 were evaluated in a retrospective, single-centre study. Virological response was defined by complete suppression of HBV DNA (<400 copies/mL) and was assessed at six to 12 month intervals over four years. Enzymatic and serological outcomes, as well as treatment failures were assessed.RESULTS: Forty-seven patients (36 men; mean age 44 years, mean alanine aminotransferase level 123 U/L; METAVIR stage 3/4 [n=21], treatment naive [n=41]) received lamivudine 100 mg to 300 mg daily. The mean pretreatment viremia was 5.19 log10copies/mL, and was above the limit of detection (>6.91 log10copies/mL) in 11 patients (23%). The mean (± SD) dosing duration was 32±22 months. Virological suppression was achieved in 45 (96%) patients. Mean viremia declined to 3.06 log10copies/mL (n=27) and 2.68 log10copies/mL (n=18) at 12 and 48 months, respectively, with 78% and 88% with undetectable viremia at these time points, respectively. The mean alanine aminotransferase level declined to 31 U/L and 36 U/L at 12 and 48 months, respectively. Seven of 13 (54%) hepatitis B e antigen-positive patients seroconverted. The treatment failure rate was 11%.CONCLUSIONS: In a selected group of HBV patients, successful long-term viremia suppression was achieved with low treatment failure rates. With strict dosing adherence and monitoring for virological breakthrough, sustained virological suppression can be reliably achieved with lamivudine in carefully selected patients.
A Meta-Analysis of Nutritional Supplementation for Management of Hospitalized Alcoholic Hepatitis
Authors: Antar Ramy , Wong Phil , Ghali Peter 
Published: March 2016

BACKGROUND: Alcoholic liver disease (ALD) is associated with a high risk of morbidity and mortality. Malnutrition accompanies this condition and may be both a consequence of and contributor to the pathology. Many trials have investigated the benefits of providing supplemental nutrition in the management of patients with ALD. The present study is a meta-analysis of the available evidence.METHOD: A meta-analysis of randomized controlled studies comparing nutritional supplementation plus a normal hospital diet versus diet alone.RESULTS: Seven randomized controlled studies including 262 patients with ALD were identified. Pooled analysis revealed no statistical difference in mortality between groups given special nutritional therapy versus a normal balanced diet (OR 0.80 [95% CI 0.42 to 1.52]). In addition, nutrition did not significantly improve ascites (OR 1.29 [95% CI 0.52 to 3.20]) or any biochemical parameters. However, encephalopathy showed a significant improvement or resolution (OR 0.24 [95% CI 0.06 to 0.93]).CONCLUSION: Nutritional supplementation provided no mortality benefit in patients with ALD, and neither ascites nor biochemical parameters significantly improved. However, encephalopathy was significantly ameliorated and, therefore, nutritional supplementation should be encouraged in that setting.
Health Care Professionals’ Pain Narratives in Hospitalized Children’s Medical Records. Part 1: Pain Descriptors
Authors: Rashotte Judy , Coburn Geraldine , Harrison Denise , Stevens Bonnie J , Yamada Janet , Abbott Laura K , the CIHR Team in Children’s Pain  
Published: March 2016

BACKGROUND: Although documentation of children’s pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children.OBJECTIVES: To describe health care professionals’ use of written language related to the quality and quantity of pain experienced by hospitalized children.METHODS: Free‐text pain narratives documented during a 24 h period were collected from the medical records of 3822 children (0 to 18 years of age) hospitalized on 32 inpatient units in eight Canadian pediatric hospitals. A qualitative descriptive exploration using a content analysis approach was used.RESULTS: Pain narratives were documented a total of 5390 times in 1518 of the 3822 children’s medical records (40%). Overall, word choices represented objective and subjective descriptors. Two major categories were identified, with their respective subcategories of word indicators and associated cues: indicators of pain, including behavioural (eg, vocal, motor, facial and activities cues), affective and physiological cues, and children’s descriptors; and word qualifiers, including intensity, comparator and temporal qualifiers.CONCLUSIONS: The richness and complexity of vocabulary used by clinicians to document children’s pain lend support to the concept that the word ‘pain’ is a label that represents a myriad of different experiences. There is potential to refine pediatric pain assessment measures to be inclusive of other cues used to identify children’s pain. The results enhance the discussion concerning the development of standardized nomenclature. Further research is warranted to determine whether there is congruence in interpretation across time, place and individuals.
Assessment of Pain Response in Capsaicin‐Induced Dynamic Mechanical Allodynia Using a Novel and Fully Automated Brushing Device
Authors: du Jardin Kristian G , Gregersen Lise S , Røsland Turid , Uggerhøj Kathrine H , Petersen Lars J , Arendt-Nielsen Lars , Gazerani Parisa 
Published: March 2016

BACKGROUND: Dynamic mechanical allodynia is traditionally induced by manual brushing of the skin. Brushing force and speed have been shown to influence the intensity of brush‐evoked pain. There are still limited data available with respect to the optimal stroke number, length, force, angle and speed. Therefore, an automated brushing device (ABD) was developed, for which brushing angle and speed could be controlled to enable quantitative assessment of dynamic mechanical allodynia.OBJECTIVES: To compare the ABD with manual brushing using capsaicin‐induced allodynia, and to investigate the role of stroke angle and speed on pain intensity.METHODS: Experimental dynamic mechanical allodynia was induced by an intradermal injection of capsaicin (100 μg) into the volar forearm of 12 healthy, male volunteers. Dynamic mechanical allodynia was rated on a 10 cm visual analogue scale (VAS) after each set of strokes at angles of 30°, 60° and 90° with speeds of 17 mm/s, 21 mm/s and 25 mm/s for each angle. A two‐way ANOVA with repeated measures was performed to assess the influence of brushing parameters. To evaluate test‐retest reliability, Bland‐Altman 95% limits of agreement, including a coefficient of repeatability and an intraclass correlation coefficient (ICC), were determined.RESULTS: The angle and speed exhibited a significant impact on pain intensity (P<0.001 and P<0.015, respectively). Post hoc analysis showed that the highest pain intensity was recorded with an angle of 30° regardless of brushing speed. The ABD demonstrated superior test‐retest reliability (coefficient of repeatability = 1.9 VAS; ICC=0.91) compared with manual brushing (coefficient of repeatability = 2.8 VAS; ICC=0.80; P<0.05). The most reliable combination of parameters (coefficient of repeatability = 1.3 VAS; ICC=0.97) was an angle of 60° and a speed of 21 mm/s.CONCLUSIONS: A controlled, automatic brushing method can be used for quantitative investigations of allodynic reactions, and is more reliable for quantitative assessment of dynamic mechanical allodynia compared with traditional manual brushing.
Methicillin‐Resistant Staphylococcus aureus Colonization among Medical Residents
Authors: Trépanier Pascale , Tremblay Claude , Ruest Annie 
Published: March 2016

BACKGROUND: Medical residents may be at risk of becoming colonized by methicillin‐resistant Staphylococcus aureus (MRSA) during their training. The occupational risk of this specific population is unknown. Furthermore, there are no data regarding MRSA colonization among health care professionals in Quebec.OBJECTIVE: To determine the MRSA colonization rate in Laval University (Quebec City, Quebec) medical residents and compare it with the MRSA colonization rate of a control group.METHODS: A controlled cross‐sectional study of MRSA prevalence among medical residents of Laval University was performed. The control group consisted of Laval University undergraduate medical students without previous clinical rotations in their curriculum. After informed consent was obtained, participants were screened for MRSA with a nasal swab in both anterior nares. They also completed a questionnaire regarding relevant risk factors and demographic data.RESULTS: A total of 250 residents of all residency levels from medical and surgical specialties and 247 controls were recruited between February and April 2010. One case of MRSA colonization was detected among the residents and none in the control group (prevalence of 0.4% versus 0.0%; P=1.00).DISCUSSION: MRSA nasal carriage was very low among Laval University residents. This may reflect the decreasing rate of health care‐associated MRSA in Quebec City. Young age and good health may also explain this low risk. The strict infection control policies for MRSA patients (including cohorting, use of gloves, gown and patient‐dedicated equipment) may also contribute to prevent MRSA transmission.CONCLUSIONS: Medical residents in Quebec City appeared to be at very low risk of contracting MRSA through professional activities.