bluuebunny/crossref_metadata_2025_split huggingface dataset:
iCanCope with Pain™: User‐Centred Design of a Web‐ and Mobile‐Based Self‐Management Program for Youth with Chronic Pain Based on Identified Health Care Needs
Authors: Stinson Jennifer N , Lalloo Chitra , Harris Lauren , Isaac Lisa , Campbell Fiona , Brown Stephen , Ruskin Danielle , Gordon Allan , Galonski Marilyn , Pink Leah R , Buckley Norman , Henry James L , White Meghan , Karim Allia 
Published: March 2016

BACKGROUND: While there are emerging web‐based self‐management programs for children and adolescents with chronic pain, there is currently not an integrated web‐ and smartphone‐based app that specifically addresses the needs of adolescents with chronic pain.OBJECTIVES: To conduct a needs assessment to inform the development of an online chronic pain self‐management program for adolescents, called iCanCope with Pain™.METHODS: A purposive sample of adolescents (n=23; 14 to 18 years of age) was recruited from two pediatric chronic pain clinics in Ontario. Interdisciplinary health care providers were also recruited from these sites. Three focus groups were conducted with adolescents (n=16) and one with pediatric health care providers (n=7). Individual adolescent interviews were also conducted (n=7).RESULTS: Qualitative analysis uncovered four major themes: pain impact; barriers to care; pain management strategies; and transition to adult care. Pain impacted social, emotional, physical and role functioning, as well as future goals. Barriers to care were revealed at the health care system, patient and societal levels. Pain management strategies included support systems, and pharmacological, physical and psychological approaches. Transition subthemes were: disconnect between pediatric and adult systems; skills development; parental role; and fear/anxiety. Based on these identified needs, the iCanCope with Pain™ architecture will include the core theory‐based functionalities of: symptom self‐monitoring; personalized goal setting; pain coping skills training; peer‐based social support; and chronic pain education.CONCLUSIONS: The proposed iCanCope with Pain™ program aims to address the self‐management needs of adolescents with chronic pain by improving access to disease information, strategies to manage symptoms and social support.
The Real‐Life Effectiveness of Palivizumab for Reducing Hospital Admissions for Respiratory Syncytial Virus in Infants Residing in Nunavut
Authors: Banerji Anna , Panzov Vladimir , Young Michael , Lee Bonita E , Mamdani Muhammad , Giles B Louise , Dennis Marguerite , Morel Johanne , Bisson Danny , Paes Bosco A , Hui Charles , Mahony Jim 
Published: March 2016

BACKGROUND/OBJECTIVE: Nunavut has the highest hospitalization rates for respiratory syncytial virus (RSV) worldwide, with rates of 166 per 1000 live births per year <1 year of age. Palivizumab was implemented in Nunavut primarily for premature infants, or those with hemodynamically significant cardiac or chronic lung disease; however, the effectiveness of the program is unknown. The objective of the present multisite, hospital‐based surveillance study was to estimate the effectiveness of palivizumab in infants <6 months of age in Nunavut for the 2009 and 2010 RSV seasons.METHODS: Infants identified as palivizumab candidates who were <6 months of age were compared with all admissions for lower respiratory tract infection through multisite, hospital‐based surveillance documenting the adequacy of palivizumab prophylaxis, admission for lower respiratory tract infection and the results of RSV testing. The OR for RSV admission in unprophylaxed infants was compared with those who were prophylaxed, and the effectiveness of palivizumab was estimated.RESULTS: Within the study cohort (n=101) during the two RSV seasons, five of the 10 eligible infants who did not receive adequate prophylaxis were admitted with RSV while two of the 91 infants <6 months of age eligible for palivizumab who were adequately prophylaxed were hospitalized with RSV (OR 22.3 [95% CI 3.8 to 130]; P=0.0005). The estimated effectiveness of palivizumab for the cohort was as high as 96%. Eight eligible infants were missed by the program and did not receive prophylaxis.CONCLUSION: Palivizumab was highly effective in reducing hospitalizations due to RSV infection in Nunavut. Further efforts need to be made to ensure that all eligible infants are identified.
Development and Validation of a Pneumocystis jirovecii Real‐time Polymerase Chain Reaction Assay for Diagnosis of Pneumocystis Pneumonia
Authors: Church Deirdre L , Ambasta Anshula , Wilmer Amanda , Williscroft Holly , Ritchie Gordon , Pillai Dylan R , Champagne Sylvie , Gregson Daniel G 
Published: March 2016

BACKGROUND: Pneumocystis jirovecii (PJ), a pathogenic fungus, causes severe interstitial Pneumocystis pneumonia (PCP) among immunocompromised patients. A laboratory‐developed real‐time polyermase chain reaction (PCR) assay was validated for PJ detection to improve diagnosis of PCP.METHODS: Forty stored bronchoalveolar lavage (BAL) samples (20 known PJ positive [PJ+] and 20 known PJ negative [PJ−]) were initially tested using the molecular assay. Ninety‐two sequentially collected BAL samples were then analyzed using an immunofluorescence assay (IFA) and secondarily tested using the PJ real‐time PCR assay. Discrepant results were resolved by retesting BAL samples using another real‐time PCR assay with a different target. PJ real‐time PCR assay performance was compared with the existing gold standard (ie, IFA) and a modified gold standard, in which a true positive was defined as a sample that tested positive in two of three methods in a patient suspected to have PCP.RESULTS: Ninety of 132 (68%) BAL fluid samples were collected from immunocompromised patients. Thirteen of 92 (14%) BALs collected were PJ+ when tested using IFA. A total of 40 BAL samples were PJ+ in the present study including: all IFA positive samples (n=13); all referred PJ+ BAL samples (n=20); and seven additional BAL samples that were IFA negative, but positive using the modified gold standard. Compared with IFA, the PJ real‐time PCR had sensitivity, specificity, and positive and negative predictive values of 100%, 91%, 65% and 100%, respectively. Compared with the modified gold standard, PJ real‐time PCR had a sensitivity, specificity, and positive and negative predictive values of 100%.CONCLUSION: PJ real‐time PCR improved detection of PJ in immunocompromised patients.
A Prospective Study of Percutaneous Vertebroplasty for Chronic Painful Osteoporotic Vertebral Compression Fracture
Authors: Tan Hong-Yu , Wang Li-Min , Zhao Liang , Liu Yi-Lin , Song Rui-Peng 
Published: March 2016

BACKGROUND: Percutaneous vertebroplasty (PVP) for patients with chronic painful osteoporotic compression fractures has not been extensively studied.OBJECTIVE: To prospectively evaluate the efficacy of PVP for patients with chronic painful osteoporotic vertebral compression fractures (VCFs).METHODS: Sixty‐two consecutive patients with chronic painful osteoporotic VCFs for ≥3 months underwent PVP. All procedures were performed under local anesthesia. The outcomes were pain relief at one week, one month, three months, six months and one year, as measured by visual analogue scale, Oswestry Disability Index, Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) and Roland Morris Disability Questionnaire scores.RESULTS: The PVP procedures were technically successful and well tolerated in all patients. Sixty‐two patients underwent PVP on 92 vertebrae in 73 procedures three to five days after referral, and no 30‐day mortality was observed. Compared with baseline scores, improvement in visual analogue scale, Oswestry Disability Index, QUALEFFO and Roland Morris Disability Questionnaire scores was significantly greater after PVP at one week (P<0.001), one month (P<0.001), three months (P<0.001), six months (P<0.001) and one year (P<0.001), and the number of patients using drugs for pain treatment was significantly reduced. Five new fractures were reported in five of 62 patients treated with PVP during follow‐up.CONCLUSION: PVP is effective in patients with chronic painful osteoporotic VCFs. Pain relief after PVP was immediate, was sustained for one year and may be an important factor for reducing persistent pain.
The Relationship between Fibromyalgia and Pressure Pain Threshold in Patients with Dyspareunia
Authors: Terzi Hasan , Terzi Rabia , Kale Ahmet 
Published: March 2016

OBJECTIVE: To evaluate the number of tender points, pressure pain threshold and presence of fibromyalgia among women with or without dyspareunia.METHODS: The present cross‐sectional study included 40 patients with dyspareunia and 30 healthy controls. The participants were asked if they had engaged in sexual intercourse during the previous four weeks, and dyspareunia was rated from 0 to 3 based on the Marinoff Dyspareunia Scale. A pressure algometer (dolorimeter) was used to measure the pressure pain threshold. Fibromyalgia was diagnosed based on the 1990 American College of Rheumatology criteria. The depression status of the participants was assessed using the Beck Depression Inventory.RESULTS: No statistically significant difference was found with regard to age, body mass index, habits (alcohol use and smoking), educational status and occupational status between the two groups. Total myalgic score, total control score and tender point mean pain threshold were significantly lower in the group with dyspareunia. The number of tender points was significantly higher in patients with dyspareunia. The mean Beck Depression Inventory score was 14.7 ±8.4 in the dyspareunia group compared with 11.2 ±7.1 in the control group. Five (12.5%) of the patients with dyspareunia were diagnosed with fibromyalgia, whereas no patients in the control group were diagnosed with fibromyalgia. There was no significant difference between the two groups with regard to the presence of fibromyalgia.CONCLUSION: The finding of lower pressure pain thresholds and a higher number of tender points among patients with dyspareunia suggests that these patients may have increased generalized pain thresholds. Additional studies involving a larger number of patients are required to investigate the presence of central mechanisms in the pathogenesis of dyspareunia.
Inflammatory Bowel Disease Patients Are Frequently Nonadherent to Scheduled Induction and Maintenance Infliximab Therapy: A Canadian Cohort Study
Authors: Ma Christopher , Evaschesen Chad J , Gracias Grenvil , Huang Vivian W , Fedorak Darryl K , Kroeker Karen I , Dieleman Levinus A , Halloran Brendan P , Fedorak Richard N 
Published: March 2016

BACKGROUND: Adherence to maintenance medication regimens in inflammatory bowel disease patients has traditionally been poor. Although infliximab has demonstrated efficacy in inducing and maintaining disease remission, adherence to regularly scheduled infliximab infusions is required to maintain therapeutic trough drug levels and prevent the development of anti-infliximab antibodies.OBJECTIVES: To characterize patient adherence to regularly scheduled induction and maintenance infliximab infusions.METHODS: A retrospective cohort study was conducted evaluating adult outpatients with Crohn disease or ulcerative colitis on an induction or maintenance regimen of regularly scheduled infliximab from 2008 to 2010 at the University of Alberta (Edmonton, Alberta). Nonadherence was defined by a discrepancy of >72 h between the scheduled date of infusion and the actual date of administration. Patients were defined as nonadherent if they received <80% of their infliximab infusions per schedule.RESULTS: A total of 215 patients (173 Crohn disease, 42 ulcerative colitis) met the inclusion criteria. Patients received a median of 12.0 infliximab infusions (interquartile range 7.0 to 13.0) during the study period; 412 induction and 1837 maintenance infliximab infusions were administered. Of 140 patients, 109 (77.9%) were adherent to their infliximab induction regimen, while 68 of 215 (31.6%) were adherent to their infliximab maintenance regimen. One hundred ninety-eight of 215 (92.1%) patients received at least one delayed maintenance infliximab infusion and 20 (10.1%) received maintenance infusions, on average, >1 week late.CONCLUSIONS: While three-quarters of patients are adherent to infliximab induction therapy, fewer than one-third remained adherent to their scheduled maintenance infliximab regimen.
Prospective Evaluation of Gastric Neurostimulation for Diabetic Gastroparesis in Canada
Authors: Panda Himanish , Mitchell Philip , Curley Michael , Buresi Michelle , Wilsack Lynn , Andrews Christopher N 
Published: March 2016

BACKGROUND: The efficacy of gastric neurostimulation therapy for diabetic gastroparesis (GP) in a ‘real-life’ Canadian setting has not been assessed.AIMS: To assess changes in health-related quality of life (QoL), weekly vomiting frequency (WVF), total symptom score (TSS) and health care utilization 12 months before and after gastric neurostimulator implantation in a diabetic GP cohort.METHODS: Medication-refractory diabetic GP patients (n=7, four female, mean age 42 years) were prospectively recruited from 2008 to 2012. QoL scores were self-administered and obtained at baseline, 24 and 48 weeks postimplantion. WVF and TSS were assessed similarly. Health care usage, measured as hospitalization frequency and medication cost, was obtained six and 12 months before and after implant. Changes from baseline to six and 12 months for all outcomes were compared.RESULTS: The mean (± SD) QoL according to EuroQol was significantly better at 24 weeks after the baseline measurement (baseline 29±5, 24 weeks 52±7; P=0.03). The mean improvement in TSS was significantly better at one year postintervention (baseline score 35±5 versus 12 months 27±3; P=0.03). Changes in Short-Form 36 Health Survey and WVF were not significant. Days of GP-related hospitalization were highly variable but decreased from a median of 71 days (range 0 to 227 days) to 29 days (range two to 334 days) one year before and after surgery, respectively (P=0.735). Outpatient medication costs did not decrease to a significant extent.CONCLUSION: Gastric neurostimulation for diabetic GP appeared to show some beneficial palliative effects overall in the present small open-label series, but the effect is highly variable among patients, and placebo effect cannot be ruled out.
Stakeholder Views Regarding Patient Discharge from Intensive Care: Suboptimal Quality and Opportunities for Improvement
Authors: Li Pin , Boyd Jamie M , Ghali William A , Stelfox Henry T 
Published: March 2016

OBJECTIVE: To provide the first description of intensive care unit (ICU) discharge practices from the perspective of Canadian ICU administrators, and ICU providers from Canada, the United States and the United Kingdom.METHODS: The authors identified 140 Canadian ICUs and administered a survey to ICU administrators (unit manager, director) to obtain an institutional perspective. Also surveyed were members of professional critical care associations in Canada, the United States and the United Kingdom, using membership distribution lists, to obtain a provider perspective.RESULTS: A total of 118 ICU administrators (114 ICUs [81%]) and 737 ICU providers (denominator unknown) responded to the survey. Administrator and provider respondents reported that ICU physicians are primarily responsible for determining the timing (70% and 77%, respectively) and safety (94% and 96%) for patients discharged from ICU. The majority of respondents indicated that patient summaries (87% and 85%) and medication reconciliation (78% and 79%) were part of their institutions’ discharge process. One‐half of respondents reported the use of discharge protocols, while a minority indicated that checklists (46% and 44%), electronic tools (19% and 28%) or outreach follow‐up (44% and 33%) were used. The majority of respondents rated current ICU discharge practices to be of medium quality (57% and 58% scored 3 on a five‐point scale). Suggested opportunities for improvement included the information provided to patients and families (71% and 59%) and collaboration among hospital units (65% and 66%).CONCLUSION: Findings from the present study revealed the complexity of the ICU discharge process, considerable practice variation, perception of only medium quality and several proposed opportunities for improvement.
Mild Clinical Behaviour of Crohn Disease in Elderly Patients in a Latin American Country: A Case-Control Study
Authors: Yamamoto-Furusho Jesús K , Sarmiento-Aguilar Andrea 
Published: March 2016

BACKGROUND: Crohn disease is characterized by fluctuating clinical behaviour, which is influenced by various factors. There are no data from Latin America that evaluate the clinical behaviour of Crohn disease in elderly patients.OBJECTIVE: To evaluate the clinical course of elderly onset Crohn disease compared with younger onset in the Mexican population.METHODS: The present analysis was a case-control study that included 132 patients with a histopathological diagnosis of Crohn disease between 1983 and 2013 in an inflammatory bowel disease clinic of a tertiary care centre. Statistical analysis was performed using SPSS version 17 (IBM Corporation, USA) and descriptive statistics, χ2and Fisher’s exact test for categorical variables and Student’sttest for numerical variables. Univariate and multivariate analysis were performed to identify associated risk factors and OR was calculated.RESULTS: A total of 132 patients (73 men and 59 women) were divided into two groups according to age at diagnosis: 27 cases (>60 years of age) and 105 controls (≤60 years of age). Factors influencing the clinical course of Crohn disease in the elderly were: female sex (OR 2.55 [95% CI 1.06 to 6.10]; P=0.02); colonic location (OR 0.22 [95% CI 0.03 to 0.89]; P=0.02); mild clinical behaviour of disease (OR 10.08 [95% CI 3.74 to 27.17]; P=0.0001); response to medical treatment (OR 2.85 [95% CI 1.08 to 7.48]; P=0.02); frequent use of sulfasalazine (OR 4.46 [95% CI 1.22 to 16.28]; P=0.03); less use of azathioprine (OR 0.38 [95% CI 0.13 to 1.03]; P=0.04); and long-term remission (OR 4.96 [95% CI 1.70 to 14.48]; P=0.002).CONCLUSION: Elderly patients with Crohn disease had a mild clinical course characterized by the lack of escalation to immunosuppressive and anti-tumour necrosis factor therapy, as well as long-term remission.
Is There an Association between Symptoms of Anxiety and Depression and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease?
Authors: Parreira Verônica F , Kirkwood Renata N , Towns Megan , Aganon Isabel , Barrett Lauren , Darling Catherine , Lee Michelle , Hill Kylie , Goldstein Roger S , Brooks Dina 
Published: March 2016

BACKGROUND: In addition to symptoms, such as dyspnea and fatigue, patients with chronic obstructive pulmonary disease (COPD) also experience mood disturbances.OBJECTIVE: To explore the relationships between health‐related quality of life measures collected from patients with stable COPD and a commonly used measure of depression and anxiety.METHODS: The present analysis was a retrospective study of patients with COPD enrolled in a pulmonary rehabilitation program. Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Disease Questionnaire (CRQ), Medical Research Council dyspnea scale and 6 min walk test data were collected. Statistical analyses were performed using Spearman’s correlations, and categorical regression and categorical principal component analysis were interpreted using the biplot methodology.RESULTS: HADS anxiety scores retrieved from 80 patients were grouped as ‘no anxiety’ (n=43 [54%]), ‘probable anxiety’ (n=21 [26%]) and ‘presence of anxiety’ (n=16 [20%]). HADS depression scores were similarly grouped. There was a moderate relationship between the anxiety subscale of the HADS and both the emotional function (r=−0.519; P<0.01) and mastery (r=−0.553; P<0.01) domains of the CRQ. Categorical regression showed that the CRQ‐mastery domain explained 40% of the total variation in anxiety. A principal component analysis biplot showed that the highest distance between the groups was along the mastery domain, which separated patients without feelings of anxiety from those with anxiety. However, none of the CRQ domains were able to discriminate the three depression groups.CONCLUSIONS: The CRQ‐mastery domain may identify symptoms of anxiety in patients with COPD; however, the relationship is not strong enough to use the CRQ‐mastery domain as a surrogate measure. None of the CRQ domains were able to discriminate the three depression groups (no depression, probable and presence); therefore, specific, validated tools to identify symptoms of depression should be used.
Venous Thromboprophylaxis in Gastrointestinal Bleeding
Authors: Malhotra Neel , Chande Nilesh 
Published: March 2016

OBJECTIVE: To study the use of venous thromboembolism (VTE) prophylaxis and the incidence of thrombotic events in patients with acute gastrointestinal (GI) bleeding.METHODS: Individuals admitted with a primary diagnosis of a GI bleed along with any endoscopically confirmed source (over a two-year period) were included. Patient comorbidity and data regarding anticoagulation or antiplatelet agent use before hospitalization were collected, in addition to type of VTE prophylaxis and duration of treatment. The primary end point was the development of VTE (deep vein thrombosis or pulmonary embolism) within one year of presentation.RESULTS: Data from 504 patients admitted with GI bleeding were eligible for review. The total number of VTE events was 20 (4%) while the mortality rate during hospitalization was 4.6%; 397 patients were not given VTE prophylaxis during their hospitalization. Of the patients who were given VTE prophylaxis, 68 received prophylactic heparin or heparin derivatives during their admission. One hundred sixty-five patients had at least one other significant risk factor for VTE including recent or subsequent surgery, past thrombotic event or malignancy. The incidence of thrombosis in those with significant risk factors for VTE was significantly higher than those without (8.5% versus 1.8%; P=0.0009). Overall, there was no significant difference in thrombotic events between individuals receiving pharmacological prophylaxis (1.2%) and those who did not (2.8%) (P=0.4).CONCLUSION: Overall, VTE prophylaxis did not significantly affect thrombotic events in patients admitted for an active GI bleed.