bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Assessment of the Effects of Iyengar Yoga Practice on the Health‐Related Quality of Life of Patients with Chronic Respiratory Diseases: A Pilot Study
Authors: Santana Maria-Jose , S-Parrilla Julia , Mirus Judith , Loadman Martha A , Lien Dale C , Feeny David 
Published: March 2016

OBJECTIVE: To assess the effects of an Iyengar yoga program (IYP) on patients with chronic respiratory diseases.METHODS: Patients attending lung transplant clinics in a tertiary institution were invited to participate in a two‐phase, 12‐week IYP that included 2 h biweekly classes. Doctors completed a formal physical and clinical assessment on candidates before enrollment. Patients with New York Association Class III or IV, or dyspnea grade IV were excluded. At baseline and at the end of 12‐weeks, patients completed the Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Questionnaire (CRQ) and Health Utilities Index (HUI). Medication(s), 6 min walk test results and other clinical parameters were also recorded. Patients recorded the effects of the IYP on their daily living in journals. Nonparametric and qualitative methods were used to analyze the data.RESULTS: Twenty‐five patients diagnosed with pulmonary arterial hypertension and chronic obstructive pulmonary disease (mean age 60 years) were invited to participate. At the end of the 12‐week period, changes in HADS anxiety and CRQ fatigue scores were statistically significant (P<0.05) and changes in HUI ambulation, pain, emotion and overall score were clinically important. The content of the journals revealed patients’ improvement in breathing capacity, mobility, energy, sleep and included positive feedback such as: “increased tidal volume with slowing expiration”, “I have an overall feeling of wellbeing” and “excellent amount of energy”.CONCLUSIONS: The findings suggest that yoga has significant potential to produce benefits. Potential benefits will be further explored in a national multisite study.
The Utility of Thiopurine Methyltransferase Enzyme Testing in Inflammatory Bowel Disease
Authors: Chisick Laura , Oleschuk Curtis , Bernstein Charles N 
Published: March 2016

OBJECTIVE: To assess the levels of red blood cell thiopurine methyltransferase (TPMT) in subjects with inflammatory bowel disease (IBD) and to determine how these levels impacted thiopurine dosing and leukopenia over the first six months of therapy.METHODS: A retrospective chart review was performed on all adult IBD patients (n=423, 88.2% Caucasian) who had TPMT levels measured by 11 participating gastroenterologists in Manitoba between 2008 and 2010. In addition to descriptive data, white blood cell count, dose and reason for discontinuation were analyzed for the first six months of therapy. Patients receiving ≥2.0 mg/kg of azathioprine (AZA) or ≥1.0 mg/kg of 6-mercapatopurine were considered to be ‘substantially’ dosed.RESULTS: Of the 423 patients, 8.3% had intermediate levels and 93.4% had normal levels of TPMT. Only one subject had a low level. A total of 216 patients had sufficient data to be included for full analysis. Patients with intermediate TPMT levels were generally started at lower doses of thiopurine than patients with normal TPMT levels (mean [± SD] 1.0±0.6 mg/kg versus 1.8±0.5 mg/kg). Of the subjects with normal TPMT levels, only 37.8% were dosed with ≥2.0 mg/kg of AZA. Each month, approximately 5% of subjects were leukopenic. These subjects received a mean overall AZA dose of 1.9±0.3 mg/kg and had a mean white blood cell count of 3.8±0.4×109/L.CONCLUSIONS: Normal TPMT levels did not prevent the development of leukopenia, although life-threatening leukopenia was rare. Physicians are not using TPMT levels to substantially dose thiopurines at the outset, which may limit the speed at which adequate doses are reached to facilitate remission.
Infant Pain Regulation as an Early Indicator of Childhood Temperament
Authors: Stevens Sara A , Racine Nicole , Riddell Rebecca Pillai , Horton Rachel , Garfield Hartley , Greenberg Saul 
Published: March 2016

BACKGROUND: There is considerable variability in infants’ responses to painful stimuli, including facial and vocal expressions. This variability in pain‐related distress response may be an indicator of temperament styles in childhood.OBJECTIVE: To examine the relationships among immunization pain outcomes (pain reactivity, pain regulation and parent ratings of infant pain) over the first year of life and parent report of early temperament.METHODS: A subset of parent‐infant dyads in an ongoing Canadian longitudinal cohort was studied. Infant pain behaviours were coded using the Modified Behavior Pain Scale. Parental judgments of infant pain were recorded using the Numeric Rating Scale. Infant temperament was measured using the Infant Behaviour Questionnaire‐Revised. Correlational analyses and multiple regressions were conducted.RESULTS: Multiple regressions revealed that the 12‐month regulatory pain scores predicted parent ratings of the Negative Affectivity temperament dimension at 14 months of age. Parent ratings of infant pain at 12 months of age predicted parent ratings of the Orienting/Affiliation temperament dimension, with sex differences observed in this substrate.CONCLUSION: Pain‐related distress regulation at one year of age appears to be a novel indicator of parent report of temperament ratings. Pain outcomes in the first six months of life were not related to parent temperament ratings.
Open-Access Colonoscopy in Ontario: Associated Factors and Quality
Authors: Hadlock Shane , Rabeneck Linda , Paszat Lawrence F , Sutradhar Rinku , Wilton Andrew S , Tinmouth Jill 
Published: March 2016

BACKGROUND Open-access (OA) colonoscopy may increase efficiency and decrease wait times; however, because the patient is seen for the first time at the endoscopy appointment, previous processes, such as information about the procedure, preparation and appropriate triage, may be suboptimal.OBJECTIVE: To identify factors associated with OA colonoscopy and to determine the relationship between OA colonoscopy and an important quality measure, incomplete colonoscopy.METHODS: A population-based analysis of all adult outpatients undergoing a first-time colonoscopy between 1997 and 2007 in Ontario was performed. Colonoscopy was considered to be OA if there were no visits in the preceding five years with the physician performing the colonoscopy. Using logistic regression, patient, physician and institution factors associated with OA colonoscopy were identified. Using propensity score matching, the relationship between OA colonoscopy and incomplete colonoscopy in 2006 was examined.RESULTS: A total of 1,079,259 colonoscopies were performed. Of these, 14% were OA in 1997 compared with 26% in 2007. Patients 50 to 69 years of age, those from higher-income neighbourhoods and those with less comorbidity were more likely to undergo OA colonoscopy. The odds of receiving OA colonoscopy were six times greater in a nonhospital clinic compared with a community hospital. Colonoscopy was more likely to be complete if the procedure was OA (OR 1.3 [95% CI 1.2 to 1.4]; P<0.0001).CONCLUSIONS: Rates of OA colonoscopy have increased substantially since 1997. Institution type was most strongly associated with OA colonoscopy. Colonoscopy completeness, a recognized quality indicator, does not appear to be compromised by OA colonoscopy.
A Qualitative Review of the Psychometric Properties and Feasibility of Electronic Headache Diaries for Children and Adults: Where We Are and Where We Need to Go
Authors: Stinson Jennifer N , Huguet Anna , McGrath Patrick , Rosenbloom Brittany , Soobiah Charlene , White Meghan , Coburn Geraldine 
Published: March 2016

BACKGROUND: While paper headache pain diaries have been used to determine the effectiveness of headache treatments in clinical trials, recent advances in information and communication technologies have resulted in the burgeoning use of electronic diaries (e‐diaries) for headache pain.OBJECTIVE: To qualitatively review headache e‐diaries, assess their measurement properties, examine measurement components and compare these components with recommended reporting guidelines.METHODS: The databases Medline, the Cumulative Index to Nursing and Allied Health Literature, Embase, PsychInfo, the Education Resources Information Centre and ISI Web of Science were searched for self‐report headache e‐diaries for children and adults. A total of 21 publications that involved e‐diaries were found; five articles reported on the development of an e‐diary and 16 used an e‐diary as an outcome measure in randomized controlled trials or observational studies. The diary measures’ components, features and psychometric properties, as well as the quality of evidence of their psychometric properties, were evaluated.RESULTS: Five headache e‐diaries met the a priori criteria and were included in the final analysis. None of these e‐diaries had well‐developed evidence of reliability and validity. Three e‐diaries showed evidence of feasibility. E‐diaries with ad hoc measures developed by the study investigators were most common, with little to no supportive evidence of reliability and/or validity. Compliance with the reporting guidelines was variable, with only one‐half of the e‐diaries measuring the recommended primary outcome of headache frequency.CONCLUSIONS: Specific recommendations regarding the development (including essential components) and testing of headache e‐diaries are discussed. Further research is needed to strengthen the measurement of headache pain in clinical trials using headache e‐diaries.
Does Vigilance to Pain Make Individuals Experts in Facial Recognition of Pain?
Authors: Baum Corinna , Kappesser Judith , Schneider Raphaela , Lautenbacher Stefan 
Published: March 2016

BACKGROUND: It is well known that individual factors are important in the facial recognition of pain. However, it is unclear whether vigilance to pain as a pain‐related attentional mechanism is among these relevant factors.OBJECTIVES: Vigilance to pain may have two different effects on the recognition of facial pain expressions: pain‐vigilant individuals may detect pain faces better but overinclude other facial displays, misinterpreting them as expressing pain; or they may be true experts in discriminating between pain and other facial expressions. The present study aimed to test these two hypotheses. Furthermore, pain vigilance was assumed to be a distinct predictor, the impact of which on recognition cannot be completely replaced by related concepts such as pain catastrophizing and fear of pain.METHODS: Photographs of neutral, happy, angry and pain facial expressions were presented to 40 healthy participants, who were asked to classify them into the appropriate emotion categories and provide a confidence rating for each classification. Additionally, potential predictors of the discrimination performance for pain and anger faces – pain vigilance, pain‐related catastrophizing, fear of pain – were assessed using self‐report questionnaires.RESULTS: Pain‐vigilant participants classified pain faces more accurately and did not misclassify anger as pain faces more frequently. However, vigilance to pain was not related to the confidence of recognition ratings. Pain catastrophizing and fear of pain did not account for the recognition performance.CONCLUSIONS: Moderate pain vigilance, as assessed in the present study, appears to be associated with appropriate detection of pain‐related cues and not necessarily with the overinclusion of other negative cues.
Long-Term Follow-Up of Patients with Malignant Pedunculated Colon Polyps after Colonoscopic Polypectomy
Authors: Freeman Hugh James 
Published: March 2016

BACKGROUND: Previously published studies have suggested that patients with resected colon cancer have an increased risk for early metachronous colon cancer. Current screening guidelines recommend intense surveillance by colonoscopy for the initial five years after the initial colon cancer has been resected. Information regarding endoscopically removed malignant polyps is limited.METHODS: In the present study, 25 consecutive patients (14 male, 11 female) with malignant pedunculated colon polyps treated with snare cautery polypectomy were followed for more than one decade up to 20 years. Five patients required an additional resection to ensure that removal of the original cancer was complete. Annual colonoscopies were planned for five years. If an adenoma was detected in the fifth year, colonoscopy was performed annually until no adenomas were detected. Otherwise, colonoscopy was planned every three years after five years.RESULTS: In the present study, there was no mortality from colon cancer and no patient developed either recurrent colon cancer or an early metachronous colon cancer during the initial five-year period of surveillance. Two patients (one male, one female) ultimately developed late cecal cancers almost one decade after the original colon cancers were resected. One had an early stage cancer that was resected, while the other had an infiltrating mucinous carcinoma complicating a small tubulovillous adenoma with extension to a single lymph node. After surgical removal and adjuvant chemotherapy, no further neoplastic disease has been detected.CONCLUSIONS: Overall, patients with malignant pedunculated polyps do extremely well if appropriately managed at the time of the initial polypectomy. Short-term outcomes after removal of a malignant polyp(s) appear to be similar to those with a nonmalignant polyp. However, late metachronous colon cancer may still occur. Long-term follow-up should be considered in each patient, assuming reasonable life expectancy, because risk of additional adenomas and metachronous colon cancer persists even after the initial five years of currently recommended surveillance. Patients with resected malignant polyps may represent a special patient subgroup that requires surveillance for more extended periods than current guidelines have recommended.
Toy‐Mediated Distraction: Clarifying the Role of Distraction Agent and Preneedle Distress in Toddlers
Authors: Hillgrove-Stuart Jessica , Pillai Riddell Rebecca , Horton Rachel , Greenberg Saul 
Published: March 2016

BACKGROUND: Distraction has recently gained attention as a technique that may help reduce acute pain in infants and toddlers; however, results remain equivocal. It appears that these mixed results stem from a variety of methodological differences with regard to how distraction is implemented.OBJECTIVES: To offer more definitive conclusions regarding the efficacy and mechanisms of distraction for pain management during infancy. Specifically, the goal was to examine whether the agent of distraction (ie, the specific person conducting the distraction) and preneedle distress behaviours impact the efficacy of distraction when toddlers were held by parents.METHODS: A total of 99 toddlers were randomly assigned to one of three conditions (typical care, research assistant‐directed distraction or parent‐directed distraction). Toddler distress behaviours were assessed pre‐ and postneedle. Toddlers were further grouped according to distress behaviours preneedle (low/no distress versus high distress). Parental soothing behaviours were also assessed as a manipulation check.RESULTS: Toddler postneedle pain did not significantly differ among groups. However, toddlers who were distressed preneedle displayed significantly more pain postneedle, regardless of the treatment group. There were no significant interactions between treatment group and preneedle distress behaviours.CONCLUSIONS: These results suggest that, when being held by a parent, distraction using a toy does not result in lower pain scores in the context of immunization, regardless of who offers the distraction. Furthermore, these findings raise the notion that if clinicians ensured toddlers were regulated before attempting an immunization, postneedle pain may be significantly reduced.
Twenty-Four Hour Noninvasive Ventilation in Duchenne Muscular Dystrophy: A Safe Alternative to Tracheostomy
Authors: McKim Douglas A , Griller Nadia , LeBlanc Carole , Woolnough Andrew , King Judy 
Published: March 2016

BACKGROUND: Almost all patients with Duchenne muscular dystrophy (DMD) eventually develop respiratory failure. Once 24 h ventilation is required, either due to incomplete effectiveness of nocturnal noninvasive ventilation (NIV) or bulbar weakness, it is common practice to recommend invasive tracheostomy ventilation; however, noninvasive daytime mouthpiece ventilation (MPV) as an addition to nocturnal mask ventilation is also an alternative.METHODS: The authors’ experience with 12 DMD patients who used 24 h NIV with mask NIV at night and MPV during daytime hours is reported.RESULTS: The mean (± SD) age and vital capacity (VC) at initiation of nocturnal (only) NIV subjects were 17.8±3.5 years and 0.90±0.40 L (21% predicted), respectively; and, at the time of MPV, 19.8±3.4 years and 0.57 L (13.2% predicted), respectively. In clinical practice, carbon dioxide (CO2) levels were measured using different methods: arterial blood gas analysis, transcutaneous partial pressure of CO2and, predominantly, by end-tidal CO2. While the results suggested improved CO2levels, these were not frequently confirmed by arterial blood gas measurement. The mean survival on 24 h NIV has been 5.7 years (range 0.17 to 12 years). Of the 12 patients, two deaths occurred after 3.75 and four years, respectively, on MPV; the remaining patients continue on 24 h NIV (range two months to 12 years; mean 5.3 years; median 3.5 years).CONCLUSIONS: Twenty-four hour NIV should be considered a safe alternative for patients with DMD because its use may obviate the need for tracheostomy in patients with chronic respiratory failure requiring more than nocturnal ventilation alone.
Cancer‐Related Pain in Older Adults Receiving Palliative Care: Patient and Family Caregiver Perspectives on the Experience of Pain
Authors: McPherson Christine J , Hadjistavropoulos Thomas , Lobchuk Michelle M , Kilgour Kelly N 
Published: March 2016

BACKGROUND: Despite an emphasis on pain management in palliative care, pain continues to be a common problem for individuals with advanced cancer. Many of those affected are older due to the disproportionate incidence of cancer in this age group. There remains little understanding of how older patients and their family caregivers perceive patients’ cancer‐related pain, despite its significance for pain management in the home setting.OBJECTIVES: To explore and describe the cancer pain perceptions and experiences of older adults with advanced cancer and their family caregivers.METHODS: A qualitative descriptive approach was used to describe and interpret data collected from semistructured interviews with 18 patients (≥65 years of age) with advanced cancer receiving palliative care at home and their family caregivers.RESULTS: The main category ‘Experiencing cancer pain’ incorporated three themes. The theme ‘Feeling cancer pain’ included the sensory aspects of the pain, its origin and meanings attributed to the pain. A second theme, ‘Reacting to cancer pain’, included patients’ and family caregivers’ behavioural, cognitive (ie, attitudes, beliefs and control) and emotional responses to the pain. A third theme, ‘Living with cancer pain’ incorporated individual and social‐relational changes that resulted from living with cancer pain.CONCLUSIONS: The findings provide an awareness of cancer pain experienced by older patients and their family caregivers within the wider context of ongoing relationships, increased patient morbidity and other losses common in the aged.
A Pilot Study Examining the Relationship among Crohn Disease Activity, Glucagon-Like Peptide-2 Signalling and Intestinal Function in Pediatric Patients
Authors: Sigalet David L , Kravarusic Dragan , Butzner Decker , Hartmann Bolette , Holst Jens J , Meddings Jon 
Published: March 2016

BACKGROUND/OBJECTIVES: The relationship between the enteroendocrine hormone glucagon-like peptide 2 (GLP-2) and intestinal inflammation is unclear. GLP-2 promotes mucosal growth, decreases permeability and reduces inflammation in the intestine; physiological stimulation of GLP-2 release is triggered by nutrient contact. The authors hypothesized that ileal Crohn disease (CD) affects GLP-2 release.METHODS: With ethics board approval, pediatric patients hospitalized with CD were studied; controls were recruited from local schools. Inclusion criteria were endoscopy-confirmed CD (primarily of the small intestine) with a disease activity index >150. Fasting and post-prandial GLP-2 levels and quantitative urinary recovery of orally administered 3-O-methyl-glucose (active transport) and lactulose/mannitol (passive) were quantified during the acute and remission phases.RESULTS: Seven patients (mean [± SD] age 15.3±1.3 years) and 10 controls (10.3±1.6 years) were studied. In patients with active disease, fasting levels of GLP-2 remained stable but postprandial levels were reduced. Patients with active disease exhibited reduced glucose absorption and increased lactulose/mannitol recovery; all normalized with disease remission. The change in the lactulose/mannitol ratio was due to both reduced lactulose and increased mannitol absorption.CONCLUSIONS: These findings suggest that pediatric patients with acute ileal CD have decreased postprandial GLP-2 release, reduced glucose absorption and increased intestinal permeability. Healing of CD resulted in normalization of postprandial GLP-2 release and mucosal functioning (nutrient absorption and permeability), the latter due to an increase in mucosal surface area. These findings have implications for the use of GLP-2 and feeding strategies as a therapy in CD patients; further studies of the effects of inflammation and the GLP-2 axis are recommended.
Loud Snoring is A Risk Factor for Occupational Injury in Farmers
Authors: Dosman James A , Hagel Louise , Skomro Robert , Sun Xiaoqun , Day Andrew G , Pickett William 
Published: March 2016

BACKGROUND: Loud snoring is a common symptom in the general population. The evidence-based literature indicates that snoring may be associated with sleep fragmentation and sleep apnea, which may affect cognitive function and predispose to occupational injury. High rates of occupational injury occur on farms and may be related to personal and health factors. Thus, loud snoring may not be a trivial symptom and should be considered as important in medical assessments.METHODS: A prospective cohort study was conducted in Saskatchewan. Baseline questionnaires were completed for 5502 individuals by representatives from 2390 farms. Sleep patterns at baseline were categorized as the following: no reported sleep disorders; physician-diagnosed sleep apnea (treatment unknown); and loud snoring. Survival analyses were used to relate sleep patterns with subsequent injury.RESULTS: A total of 6.7% (369 of 5502) of participants reported a possible sleep disorder. Of these, 69.4% (256 of 369) reported loud snoring only. Loud snoring was only associated with a consistent increase in risk (eg, HR 1.45 [95 CI 1.07 to 1.99 for work-related injury]) for five farm injury outcomes. Relationships between physician-diagnosed sleep apnea and time to first injury were not significant, presumably because a diagnosis of sleep apnea implied treatment for sleep apnea.DISCUSSION: Sleep disorders are an important potential risk factor for occupational injury on farms. Substantial proportions of farm residents report loud snoring and this is related to subsequent injury. Some of these cases may represent sleep fragmentation or undiagnosed obstructive sleep apnea. Identification and clinical management of sleep disorders related to snoring should be part of health assessments conducted by physicians.