bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization of Serogroup A Neisseria meningitidis from Invasive Meningococcal Disease Cases in Canada Between 1979 and 2006: Epidemiological Links to Returning Travellers
Authors: Sloan Angela M , Henderson Averil M , Tsang Raymond SW 
Published: March 2016

INTRODUCTION: Serogroup A Neisseria meningitidis has repeatedly caused epidemics of invasive meningococcal disease (IMD) in developing nations since the 1960s. The present study is the first detailed study of serogroup A bacteria isolated in Canada.METHODS: Thirty‐four serogroup A meningococcal isolates collected from individuals with IMD in Canada between 1979 and 2006 were characterized by serology and multilocus sequence typing of seven housekeeping enzyme genes and genes encoding three outer membrane protein antigens.RESULTS: Isolates were assigned to either the sequence type (ST)‐1 or the ST‐5 clonal complex. Clones within the ST‐1 complex were recovered between 1979 and 1992, while clones of the ST‐5 complex were isolated between 1987 and 2006; respectively, they accounted for 70.6% and 29.4% of all isolates studied. Isolates of the ST‐1 complex were characterized by serosubtype antigen P1.3 or P1.3,6 with PorB allele 60 (serotype 4) and FetA sequence F5‐1, while isolates of the ST‐5 complex were characterized by serosubtype antigen P1.9 with PorB allele 47 (also serotype 4) and FetA sequence F3‐1.CONCLUSIONS: The Canadian serogroup A IMD isolates likely originated in travellers returning from hyperendemic or epidemic areas of the globe where serogroup A bacteria circulate. Although the Canadian cases of serogroup A IMD were caused by clones known to have caused epidemics in developing countries, disease incidence remained low in Canada.
Long‐Term Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea
Authors: Wolkove Norman , Baltzan Marc , Kamel Hany , Dabrusin Richard , Palayew Mark 
Published: March 2016

BACKGROUND: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA). However, compliance is a significant problem and has been incompletely assessed in long‐term studies.OBJECTIVE: To assess the long‐term compliance of OSA patients with CPAP therapy.SUBJECTS: Eighty patients who had had a diagnosis of OSA at least four years previously and received a written prescription for CPAP were evaluated.METHODS: Subjects were identified by reviewing sleep laboratory records. Participants were contacted by telephone and were asked to quantitate their CPAP use (hours per night, nights per week) and to evaluate whether there had been improvement in symptoms. Those who commenced but subsequently abandoned therapy and those who never initiated treatment were questioned about their reasons for noncompliance.RESULTS: Patient demographics included mean (± SD) age (58±11 years), male sex (70 of 80 patients [88%]) and mean apnea‐hypopnea index (70±44 events/h). At the time of the interview (64.0±3.7 months after diagnosis), 43 of 80 patients (54%) were still using CPAP and most reported an improvement in symptoms. Twelve of 80 patients (15%) had abandoned CPAP after using it for 10.1±15.5 months, and 25 of 80 patients (31%) had never commenced therapy after initial diagnosis and CPAP titration. Analysis of scores reflecting initial patient sleepiness revealed a significant association of this symptom with subsequent CPAP compliance.CONCLUSION: Although many patients with OSA derive subjective benefit from, and adhere to treatment with CPAP, a significant proportion of those so diagnosed either do not initiate or eventually abandon therapy. Initial experience with CPAP appears to be important, reinforcing the need for early education and support in these patients.
Capsule Endoscopy in the Investigation of Patients with Portal Hypertension and Anemia
Authors: Goulas Spyros , Triantafyllidou Konstantina , Karagiannis Stephanos , Nicolaou Panayiota , Galanis Petros , Vafiadis Irene , Tzivras Michael , Mavrogiannis Christos 
Published: March 2016

INTRODUCTION: Data on small bowel abnormalities in patients with portal hypertension (PHT) are limited. Bleeding from the gastrointestinal tract and anemia are common complications in these patients. Capsule endoscopy (CE) was used to evaluate small bowel (SB) pathology in patients with PHT and anemia, and possible associations with various parameters were examined.METHODS: Thirty-five patients with PHT referred for CE investigation of the SB for anemia were prospectively enrolled in the study, as well as 70 age- and sex-matched control patients with anemia, normal liver function and no evidence of PHT who underwent CE.RESULTS: Findings compatible with portal hypertensive enteropathy (PHE) were detected in 65.7% of the patients and in 15.7% of the controls (χ2=26.641, P=0.000). Abnormalities in PHT patients included varices in 25.7%, diffuse changes of mucosa with inflammatory-like appearance in 42.9%, and angiodysplasias and/or spider angiomas in 22.9% of cases. The presence of PHE was significantly associated only with the presence of severe portal hypertensive gastropathy, while the presence of SB varices alone was significantly associated with the presence of severe portal hypertensive gastropathy, larger esophageal varices and the presence of colonic varices.CONCLUSIONS: Varices, diffuse changes of mucosa with inflammatory-like appearance, and angiodysplasias and/or spider angiomas are detected more often in patients with PHT than in controls, and probably constitute the endoscopic characteristics of PHE. CE of the SB added a significant number of likely important findings to those detected by conventional endoscopic techniques for the clinical management of patients with PHT and anemia.
Clinical Practice Guidelines for Hospital‐Acquired Pneumonia and Ventilator‐Associated Pneumonia in Adults
Authors: Rotstein Coleman , Evans Gerald , Born Abraham , Grossman Ronald , Light R Bruce , Magder Sheldon , McTaggart Barrie , Weiss Karl , Zhanel George G 
Published: March 2016

Hospital‐acquired pneumonia (HAP) and ventilator‐associated pneumonia (VAP) are important causes of morbidity and mortality, with mortality rates approaching 62%. HAP and VAP are the second most common cause of nosocomial infection overall, but are the most common cause documented in the intensive care unit setting. In addition, HAP and VAP produce the highest mortality associated with nosocomial infection. As a result, evidence‐based guidelines were prepared detailing the epidemiology, microbial etiology, risk factors and clinical manifestations of HAP and VAP. Furthermore, an approach based on the available data, expert opinion and current practice for the provision of care within the Canadian health care system was used to determine risk stratification schemas to enable appropriate diagnosis, antimicrobial management and nonantimicrobial management of HAP and VAP. Finally, prevention and risk‐reduction strategies to reduce the risk of acquiring these infections were collated. Future initiatives to enhance more rapid diagnosis and to effect better treatment for resistant pathogens are necessary to reduce morbidity and improve survival.Erratum to “Clinical Practice Guidelines for Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia in Adults”dx.doi.org/10.1155/2008/191398
An Outbreak of Vancomycin‐Resistant Enterococcus faecium in an Acute Care Pediatric Hospital: Lessons from Environmental Screening and a Case‐Control Study
Authors: Drews Steven J , Richardson Susan E , Wray Rick , Freeman Renee , Goldman Carol , Streitenberger Laurie , Stevens Derek , Goia Cristina , Kovach Danuta , Brophy Jason , Matlow Anne G 
Published: March 2016

BACKGROUND: The present study describes a vancomycin‐resistant enterococci (VRE) outbreak investigation and a case‐control study to identify risk factors for VRE acquisition in a tertiary care pediatric hospital.OBJECTIVE: To report an outbreak investigation and a case‐control study to identify risk factors for VRE colonization or infection in hospitalized children.METHODS: Screening for VRE cases was performed by culture or polymerase chain reaction. A case‐control study of VRE‐colonized patients was undertaken. Environmental screening was performed using standard culture and susceptibility methods, with pulsed‐field gel electrophoresis to determine relationships between VRE isolates. Statistical analysis was performed using SAS version 9.0 (SAS Institute Inc, USA).RESULTS: Thirty‐four VRE‐positive cases were identified on 10 wards between February 28, 2005, and May 27, 2005. Pulsed‐field gel electrophoresis analysis confirmed a single outbreak strain that was also isolated from a video game found on one affected ward. Multivariate analysis identified cephalosporin use as the major risk factor for VRE colonization.CONCLUSIONS: In the present study outbreak, VRE colonization was significantly associated with cephalosporin use. Because shared recreational items and environmental surfaces may be colonized by VRE, they warrant particular attention in housekeeping protocols, particularly in pediatric institutions.
Postprocedural Interpretation of Endoscopic Retrograde Cholangiopancreatography by Radiology
Authors: Khanna Nitin , May Gary , Bass Sydney , Cole Marty , Romagnuolo Joseph 
Published: March 2016

BACKGROUND: With the increase in the use of endoscopic retrograde cholangiopancreatography (ERCP) (necessitating real-time interpretation), it is unknown whether post-ERCP radiologist reporting is still necessary or helpful.OBJECTIVES: To determine the rate of discrepancy of results, and the rate of clinically relevant misses and additions, by the radiology report in a blinded setting.METHODS: A retrospective analysis of the procedure and blinded postprocedure radiology reports of 100 consecutive ERCP cases was performed. A list of clinically relevant pathology and subgroups was made a priori. Discrepancies are described as proportions, with 95% CIs. The radiology yield regarding pathology that was clearly demonstrated at ERCP (bile leaks and stones removed) was calculated. Clinical follow-up was used to clarify additional abnormalities reported by radiology.RESULTS: Clinically relevant discrepancies in report pairs occurred in 29.0% of cases (95% CI 20% to 39%), or 40.0% if discrepancies regarding bile duct dilation are considered (95% CI 30% to 50%). In 15 of 30 cases (50.0% [95% CI 31% to 69%]) in which bile duct stones were removed, the radiologist did not report a stone. The radiologist did not report five of eight bile leaks (62.5% [95% CI 24% to 91%]). In seven cases (7.0% [95% CI 2.9% to 13.9%]), an additional abnormality was noted by radiology, including a biliary stricture, bile duct and pancreatic duct stones, as well as sclerosing cholangitis. However, during a mean follow-up period of 5.6 months, it appeared that these radiology interpretations were likely incorrect. Discrepancy rates did not vary among the ERCP attendings or by radiology volume.CONCLUSIONS: Discrepancies between endoscopists’ and radiologists’ ERCP reports are common. Blinded radiology interpretation frequently misses important pathology, and falsely positive additional diagnoses may be made.
Diagnosis of Multidrug‐Resistant Tuberculosis and Extensively Drug‐Resistant Tuberculosis: Current Standards and Challenges
Authors: Migliori Giovanni Battista , Matteelli Alberto , Cirillo Daniela , Pai Madhukar 
Published: March 2016

INTRODUCTION: The emergence of multidrug‐resistant tuberculosis (MDR‐TB) and, more recently, extensively drug‐resistant TB (XDR‐TB) is widely considered a serious threat to global TB control. Over 400,000 new cases of MDR‐TB occur each year and, although their rates are currently unknown, XDR‐TB cases have been detected in every country where there is capacity to detect them (including Canada).METHODS: The present article provides a narrative overview of the various diagnostic options available for XDR‐TB, including conventional tools and newer rapid tests for drug resistance. Available data suggest that automated liquid cultures are highly accurate and their use is rapidly expanding. Newly developed phenotypic tests include TK Medium (Salubris Inc, USA), microscopic‐observation drug‐susceptibility assay, FASTPlaque‐Response bacteriophage assay (Biotec Laboratories Ltd, UK), colorimetric redox indicator methods and the microcolony method. These tests are usually cheaper but not always simple to perform, with some requiring high standards of biosafety and quality control. Among the newly developed phenotypic methods, reverse hybridization‐based assays, referred to as line probe assays, represent a useful tool because of their superior accuracy and cost‐effectiveness.CONCLUSIONS: To effectively address the threats of MDR‐TB and XDR‐TB, global initiatives are required to scale‐up culture and drug susceptibility testing capacities, especially in high‐burden countries where such capacity is scarce. In parallel, efforts are needed to expand the use of novel and emerging technologies (ie, molecular diagnostics) for the rapid determination of drug resistance.
Second‐Hand Smoke Exposure in Canada: Prevalence, Risk Factors, and Association with Respiratory And Cardiovascular Diseases
Authors: Vozoris Nicholas , Lougheed M Diane 
Published: March 2016

OBJECTIVES: The aims of the present study were to estimate the prevalence of second‐hand smoke exposure in Canada, to identify sociodemographic risk factors for second‐hand smoke exposure, and to examine the relationship between second‐hand smoke exposure and respiratory and cardiovascular diseases.METHODS: Data from the 2000/2001 Statistics Canada Canadian Community Health Survey (n=130,880, aged 12 years or older) were analyzed. Second‐hand smoke exposure was based on self‐report within the past month. The presence of chronic health conditions was also based on self‐report. Because ex‐smokers would be expected a priori to have poorer health than never‐smokers, the analysis was stratified by previous smoking status.RESULTS: Approximately 25% of never‐smokers and 30% of ex‐smokers self‐reported recent second‐hand smoke exposure. The following factors were identified as risk factors for second‐hand smoke exposure: men; residences in Quebec, Atlantic Canada and the Territories; younger ages; nonimmigrant status; low education and income levels; social assistance receipt; and households without children younger than 12 years of age. After controlling for potential confounders, both never‐ and ex‐smokers exposed to second‐hand smoke had significantly higher odds of self‐reporting asthma (20% to 30%) and chronic bronchitis (50%) than those not exposed to secondhand smoke. Among ex‐smokers, those exposed to second‐hand smoke also had significantly higher odds of self‐reporting hypertension (20%) than those not exposed to second‐hand smoke. No associations were observed between second‐hand smoke exposure and emphysema or heart disease.CONCLUSIONS: Self‐reported recent second‐hand smoke exposure in Canada in 2000/2001 was high, and was associated with asthma, chronic bronchitis and hypertension in never‐ and ex‐smokers. Potential causal associations and public health implications warrant additional research.
Barriers to Hepatitis C Virus Treatment in a Canadian HIV-Hepatitis C Virus Coinfection Tertiary Care Clinic
Authors: McLaren Meaghan , Garber Gary , Cooper Curtis 
Published: March 2016

BACKGROUND: Despite demonstrated efficacy in HIV-hepatitis C virus (HCV) coinfection, not all patients initiate, complete or achieve success with HCV antiviral therapy.PATIENTS AND METHODS: All HIV-HCV coinfected patient consults received at The Ottawa Hospital Viral Hepatitis Clinic (Ottawa, Ontario) between June 2000 and September 2006 were identified using a clinical database. A descriptive analysis of primary and contributing factors accounting for why patients did not initiate HCV therapy, as well as the therapeutic outcomes of treated patients, was conducted.RESULTS: One hundred two consults were received. Sixty-seven per cent of patients did not initiate HCV therapy. The key primary reasons included: HIV therapy was more urgently needed (22%), loss to follow-up (12%), patients were deemed unlikely to progress to advanced liver disease (18%) and patient refusal (12%). Many patients had secondary factors contributing to the decision not to treat, including substance abuse (23%) and psychiatric illness (14%). Overall, 59% of untreated patients (40 of 68) were eventually lost to follow-up. Thirty-three per cent of referred patients started HCV therapy. Twenty-seven of 42 courses (64%) were interrupted prematurely for reasons such as virological nonresponse (48%), psychiatric complications (10%) and physical side effects (7%). Of all treatment recipients, 12 of 42 full courses of therapy were completed and three remained on HCV medication. Overall, eight of the 102 coinfected patients studied (8%) achieved a sustained virological response.DISCUSSION: Not all HIV-HCV coinfected patients who are deemed to be in need of HCV treatment are initiating therapy. Only a minority of patients who do receive treatment achieve success. Implementation of HIV treatment, patient retention, attention to substance abuse and mental health care should be the focus of efforts designed to increase HCV treatment uptake and success. This can be best achieved within a multidisciplinary model of health care delivery.
Montelukast as Add‐On Therapy with Inhaled Corticosteroids or Inhaled Corticosteroids and Long‐Acting Beta‐2‐Agonists in the Management of Patients Diagnosed with Asthma and Concurrent Allergic Rhinitis (The RADAR Trial)
Authors: Keith Paul K , Koch Caroline , Djandji Michel , Bouchard Jacques , Psaradellis Eliofotisti , Sampalis John S , Schellenberg R Robert , McIvor R Andrew 
Published: March 2016

OBJECTIVE: To evaluate the effectiveness of montelukast as add‐on therapy for patients diagnosed with asthma and concurrent allergic rhinitis who remain uncontrolled while receiving inhaled corticosteroid (ICS) monotherapy or ICS/long‐acting beta‐2‐agonist (LABA) therapy in a community practice setting.DESIGN: An eight‐week, multicentre, open‐label, observational study. Patients were 15 years of age or older and, while treated with an ICS or ICS/LABA, had allergic rhinitis and uncontrolled asthma symptoms by at least two criteria as per the Canadian Asthma Consensus Guidelines. The primary outcome measure was the percentage of patients with controlled asthma symptoms after eight weeks of treatment with montelukast 10 mg once daily added to ICS or ICS/LABA therapy.RESULTS: In total, 1004 patients participated in the survey phase of the study. Of these patients, 319 continued in the treatment phase and 301 (94.4%) completed the eight‐week assessment. At baseline, all patients had uncontrolled asthma symptoms based on the Canadian Asthma Consensus Guidelines; at the eight‐week assessment, 229 patients (76.1%) achieved asthma control. According to the Asthma Control Questionnaire (as determined by scores of 0.75 or less), 164 patients (54.7%) achieved well‐controlled asthma at week 8. The mean (± SD) Asthma Control Questionnaire score decreased from 2.03±0.80 to 0.92±0.80 (P<0.001) for all patients, representing a clinically significant improvement. A statistically and clinically significant reduction in the overall Mini Rhinitis Quality of Life Questionnaire score was achieved with a decrease from 2.57±1.20 to 1.12±1.00 (–1.45±1.35; P<0.001). Patient and physician satisfaction rates with montelukast add‐on therapy were also significantly increased when compared with baseline treatment.CONCLUSION: Montelukast add‐on therapy is effective for managing asthma and allergic rhinitis symptoms in patients who were previously uncontrolled with ICS or ICS/LABA treatment.
Variation in Physician Reimbursement for Endoscopy across Canada
Authors: Roth Lee S , Adams Paul C 
Published: March 2016

BACKGROUND: Endoscopy accounts for a significant proportion of income for physicians practicing gastroenterology. Fees are set provincially, and the consistency with regard to compensation for colonoscopy and gastroscopy across the provinces has yet to be established.OBJECTIVE: To compare and contrast provincial endoscopy fees across Canada and internationally.METHODS: Provincial and territorial ministries responsible for health care were contacted for their most current fee schedule. This was reviewed, and the billing amounts for colonoscopy and endoscopy collected. International contacts were made with regard to rates outside of Canada.RESULTS: The mean (± SD) national fee for gastroscopy was $114.19±$31.47 per procedure, with a range of $52.50 to $156.10. Physician billing nationally averaged $170.99±$33.49 per colonoscopy procedure, with a range of $105.00 to $223.00. The province of Quebec provided the least amount of compensation for both procedures, and the province of Nova Scotia provided the most for both procedures.CONCLUSION: Physician fees for gastroscopy and colonoscopy vary widely among the provinces, and, on average, seem to be less than international rates.
Assessing the Educational Needs of Canadian Gastroenterologists and Gastroenterology Nurses: Challenges to Optimal Care in Crohn’s Disease
Authors: Dupuis Martin , Marshall John K , Hayes Sean M , Cytryn Kayla , Murray Suzanne 
Published: March 2016

OBJECTIVE: A national needs assessment of Canadian gastroenterologists and gastroenterology nurses was undertaken to determine the perceived and unperceived educational and performance barriers to caring for patients with Crohn’s disease (CD).METHODS: A triangulated, mixed-method approach (qualitative and quantitative) was used to determine the nature and extent of knowledge gaps and barriers in the care of patients with CD.RESULTS: Qualitative interviews were conducted with nine gastroenterologists, four gastroenterology nurses and nine patients with CD. Based on this exploratory research, a survey was designed and launched nationally (37 gastroenterologists, 36 gastroenterology nurses). Findings indicated that Canadian gastroenterologists and gastroenterology nurses lacked clarity regarding their roles and responsibilities across the continuum of CD care, and face communication gaps within the health care team, undermining their effectiveness. Gastroenterologists identified challenges in optimal diagnosis due to unclear testing and diagnostic criteria. They recognized knowledge gaps when treating patient subgroups and in prescribing biological therapies. Furthermore, gastroenterologists self-identified gaps in skill, knowledge, and confidence in monitoring disease progression and effectively assessing response to therapy. When managing patients with CD, gastroenterologists expressed challenges with patient issues outside their domain of medical expertise, particularly with the skills needed to facilitate effective patient communication and education that would enhance adherence to recommended treatments.CONCLUSIONS: Educational initiatives should address diagnostic and treatment guidelines, as well as enhancement of clinical performance gaps in health care team processes and the patient-professional therapeutic relationship. To impact care and patient outcomes, these initiatives must be relevant to clinical practice settings and applicable to the practice context.