bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship Among Psychological Factors, Neglect‐Like Symptoms And Postoperative Pain After Total Knee Arthroplasty
Authors: Hirakawa Yoshiyuki , Hara Michiya , Fujiwara Akira , Hanada Hirofumi , Morioka Shu 
Published: March 2016

BACKGROUND: Persistent postoperative pain has a significant relationship with patient health and satisfaction.OBJECTIVES: To investigate the prevalence and association of neglect‐like symptoms (NLS) and other psychological factors on postoperative pain in patients following total knee arthroplasty (TKA). NLS are defined as the loss of perception of the limb with pain and excessive effort required to move the limb. The authors hypothesized that NLS were an important contributor to postoperative pain.METHODS: The factors influencing pain were investigated using a longitudinal study with assessments at three and six weeks postsurgery. The relationships among demographic factors (age, body weight, body mass index), psychological factors (State‐Trait Anxiety Inventory and Pain Catastrophizing Scale [PCS]) and NLS with postoperative pain were investigated in 90 patients after TKA. The associations among motor functions (muscle strength of knee extension, range of motion), sensory functions (joint position sense and two‐point discrimination in the thigh) and NLS were also investigated.RESULTS: At three and six weeks after surgery, 36% and 19% of patients, respectively, experienced NLS. In hierarchical multiple regression analysis, NLS and PCS scores were significantly associated with postoperative pain, while joint position sense and range of motion were significantly associated with NLS.CONCLUSIONS: These results suggest that facilitation of sensory integration is important in rehabilitation after TKA because NLS appears to result from impaired sensory integration. The association of PCS scores with postoperative pain and NLS suggests the need to provide appropriate postoperative education to reduce persistent negative thoughts regarding future pain.
Major Depressive Disorder and Sleep Disturbance in Patients with Chronic Pain
Authors: Emery Patricia C , Wilson Keith G , Kowal John 
Published: March 2016

BACKGROUND: Disturbed sleep is a common problem in both chronic pain and major depressive disorder (MDD). Moreover, many patients with chronic pain are depressed.OBJECTIVES: To examine the effects of depression on the sleep behaviour of chronic pain patients by comparing patients who did or did not meet diagnostic criteria for MDD.METHODS: A total of 60 patients with chronic musculoskeletal pain underwent structured diagnostic interviews for MDD and insomnia, and completed questionnaires assessing pain severity, disability, sleep quality, beliefs and attitudes about sleep, and sleep hygiene. For four consecutive days, they also completed a sleep diary, and reported on sleep hygiene practices and presleep arousal.RESULTS: Thirty‐three patients (55%) met diagnostic criteria for MDD, most of whom (n=32 [97%]) also fulfilled criteria for insomnia disorder. Insomnia was also common among patients without MDD (21 of 27 [78%]). Participants with MDD had higher self‐reports of pain, disability, dysfunctional beliefs about sleep, and, on a prospective basis, greater presleep arousal and poorer sleep hygiene. However, diary assessments of specific sleep parameters (eg, sleep onset latency, total sleep time, sleep efficiency) did not differ between the groups.DISCUSSION: Chronic pain patients with comorbid MDD exhibited more dysfunctional beliefs about sleep, poorer sleep hygiene practices and greater presleep arousal; however, diary‐recorded sleep characteristics may not differ from those of patients without MDD. Chronic pain itself may disturb sleep so extensively that MDD introduces little additive effect.CONCLUSION: MDD in chronic pain may be related to the cognitive and behavioural aspects of insomnia, rather than to an incremental disturbance in the initiation or maintenance of sleep.
Patient Transitions Relevant to Individuals Requiring Ongoing Ventilatory Assistance: A Delphi Study
Authors: Rose Louise , Fowler Robert A , Goldstein Roger , Katz Sherri , Leasa David , Pedersen Cheryl , McKim Douglas , the CANuVENT Group  
Published: March 2016

BACKGROUND: Various terms, including ‘prolonged mechanical ventilation’ (PMV) and ‘long‐term mechanical ventilation’ (LTMV), are used interchangeably to distinguish patient cohorts requiring ventilation, making comparisons and timing of clinical decision making problematic.OBJECTIVE: To develop expert, consensus‐based criteria associated with care transitions to distinguish cohorts of ventilated patients.METHODS: A four‐round (R), web‐based Delphi study with consensus defined as >70% was performed. In R1, participants listed, using free text, criteria perceived to should and should not define seven transitions. Transitions comprised: T1 – acute ventilation to PMV; T2 – PMV to LTMV; T3 – PMV or LTMV to acute ventilation (reverse transition); T4 – institutional to community care; T5 – no ventilation to requiring LTMV; T6 – pediatric to adult LTMV; and T7 – active treatment to end‐of‐life care. Subsequent Rs sought consensus.RESULTS: Experts from intensive care (n=14), long‐term care (n=14) and home ventilation (n=10), representing a variety of professional groups and geographical areas, completed all Rs. Consensus was reached on 14 of 20 statements defining T1 and 21 of 25 for T2. ‘Physiological stability’ had the highest consensus (97% and 100%, respectively). ‘Duration of ventilation’ did not achieve consensus. Consensus was achieved on 13 of 18 statements for T3 and 23 of 25 statements for T4. T4 statements reaching 100% consensus included: ‘informed choice’, ‘patient stability’, ‘informal caregiver support’, ‘caregiver knowledge’, ‘environment modification’, ‘supportive network’ and ‘access to interprofessional care’. Consensus was achieved for 15 of 17 T5, 16 of 20 T6 and 21 of 24 T7 items.CONCLUSION: Criteria to consider during key care transitions for ventilator‐assisted individuals were identified. Such information will assist in furthering the consistency of clinical care plans, research trials and health care resource allocation.
Canadian consensus statement on HIV and its transmission in the context of criminal law
Authors: Loutfy Mona , Tyndall Mark , Baril Jean-Guy , Montaner Julio SG , Kaul Rupert , Hankins Catherine 
Published: March 2016

INTRODUCTION: A poor appreciation of the science related to HIV contributes to an overly broad use of the criminal law against individuals living with HIV in cases of HIV nondisclosure.METHOD: To promote an evidence‐informed application of the law in Canada, a team of six Canadian medical experts on HIV and transmission led the development of a consensus statement on HIV sexual transmission, HIV transmission associated with biting and spitting, and the natural history of HIV infection. The statement is based on a literature review of the most recent and relevant scientific evidence (current as of December 2013) regarding HIV and its transmission. It has been endorsed by >70 additional Canadian HIV experts and the Association of Medical Microbiology and Infectious Disease Canada.RESULTS: Scientific and medical evidence clearly indicate that HIV is difficult to transmit during sex. For the purpose of informing the justice system, the per‐act possibility of HIV transmission through sex, biting or spitting is described along a continuum from low possibility, to negligible possibility, to no possibility of transmission. This possibility takes into account the impact of factors such as the type of sexual acts, condom use, antiretroviral therapy and viral load. Dramatic advances in HIV therapy have transformed HIV infection into a chronic manageable condition.DISCUSSION: HIV physicians and scientists have a professional and ethical responsibility to assist those in the criminal justice system to understand and interpret the science regarding HIV. This is critical to prevent miscarriage of justice and to remove unnecessary barriers to evidence‐based HIV prevention strategies.
Impaired Modulation of Pain in Patients with Postherpetic Neuralgia
Authors: Pickering Gisèle , Pereira Bruno , Dufour Elodie , Soule Sylvie , Dubray Claude 
Published: March 2016

BACKGROUND: The efficiency of inhibitory pain descending pathways (evaluated using conditioned pain modulation [CPM]) has not been studied in postherpetic neuralgia (PHN).OBJECTIVE: To compare CPM in PHN patients with healthy controls.METHODS: Nine PHN patients and nine control individuals were matched according to age and sex. Amplitudes of cortical thermal‐evoked potentials were recorded on the surface of the scalp; clinical pain and thermal pain were evaluated on a 0 to 10 numerical rating scale, at baseline and at intervals during the 6 min after CPM (elicited by a cold pressor test, 8°C). A battery of cognitive tests was performed. Amplitude differences, percentages and related areas under the curve (AUCCPM) were calculated and all data were compared between both groups; P<0.05 was considered to be statistically significant.RESULTS: AUCCPM0–6 min was significantly lower in PHN patients compared with controls (−39±51 μV/min versus −144±66 μV/min; P=0.0012) and correlated (P=0.04) with clinical pain intensity. Pain ratings before CPM were similar in both groups but were significantly lower in the control group 3 min after the cold pressor test. Cognitive test results were not significantly different.CONCLUSION: Psychophysical and electrophysiological approaches have shown that patients with PHN exhibit a deficiency of pain inhibition modulation, which could signal a predisposing factor to developing chronic pain. This deficiency was not linked to the cognitive performance but rather to subtle in situ cognitivoemotional adaptations, which remain to be investigated.
Critical Care Trainees’ Career Goals and Needs: A Canadian Survey
Authors: St-Onge Maude , Mandelzweig Keren , Marshall John C , Scales Damon C , Granton John 
Published: March 2016

BACKGROUND: For training programs to meet the needs of trainees, an understanding of their career goals and expectations is required.OBJECTIVES: Canadian critical care medicine (CCM) trainees were surveyed to understand their career goals in terms of clinical work, research, teaching, administration and management; and to identify their perceptions regarding the support they need to achieve their goals.METHODS: The online survey was sent to all trainees registered in a Canadian adult or pediatric CCM program. It documented the participants’ demographics; their career expectations; the perceived barriers and enablers to achieve their career goals; and their perceptions relating to their chances of developing a career in different areas.RESULTS: A response rate of 85% (66 of 78) was obtained. The majority expected to work in an academic centre. Only approximately one-third (31%) estimated their chances of obtaining a position in CCM as >75%. The majority planned to devote 25% to 75% of their time performing clinical work and <25% in education, research or administration. The trainees perceived that there were limited employment opportunities. Networking and having specialized expertise were mentioned as being facilitators for obtaining employment. They expressed a need for more protected time, resources and mentorship for nonclinical tasks during training.CONCLUSION: CCM trainees perceived having only limited support to help them to achieve their career goals and anticipate difficulties in obtaining successful employment. They identified several gaps that could be addressed by training programs, including more mentoring in the areas of research, education and administration.
Missed Opportunities for Prevention of Perinatal Transmission of Hepatitis B: A Retrospective Cohort Study
Authors: van Schalkwyk Julie , Nourmoussavi Melica , Massey Andrea , Gustafson Reka , Brodkin Elizabeth , Petric Martin , Krajden Mel , Dobson Simon , Buxton Jane , Bigham Mark , Pick Neora , Schreiber Richard , Sherlock Christopher H , Money Deborah , Yoshida Eric M 
Published: March 2016

BACKGROUND: Perinatal transmission of hepatitis B virus (HBV) can occur despite postexposure prophylaxis (PEP). Recent literature suggests that antiviral treatment during pregnancy when maternal HBV DNA levels are elevated can further decrease vertical transmission. However, HBV DNA screening is not routinely performed antenatally.OBJECTIVE: To determine the rates of HBV prevalence and perinatal transmission in an antenatal cohort.METHODS: A retrospective review of public health records (December 2008 to December 2010) was performed for both mothers and newborns.RESULTS: A total of 725 mother-infant pairs were included. Of these, 574 of 715 (80%) women had antenatal hepatitis B e antigen (HBeAg) testing performed, and 127 of 574 (22%) were HBeAg positive (HBeAg+). Of babies born to hepatitis B surface antigen-positive (HBsAg+) mothers, only 573 of 725 (79%) received complete PEP. In addition, 172 of 725 (24%) infants did not receive post-PEP blood testing or were lost to follow-up. Of the 552 infants with results available, seven cases (1.3%) of mother-to-child HBV transmission were observed, six of which involved infants born to HBeAg+ women.CONCLUSIONS: Our findings suggest that routine HBeAg screening could identify a subset of mother-infant pairs among HBsAg+ pregnant women who are at higher risk for vertical HBV transmission. Determination of viral load in expectant HBeAg+ mothers may provide more precise insight into HBV transmission to their infants.
Hospitalized Children Continue to Report Undertreated and Preventable Pain
Authors: Birnie Kathryn A , Chambers Christine T , Fernandez Conrad V , Forgeron Paula A , Latimer Margot A , McGrath Patrick J , Cummings Elizabeth A , Finley G Allen 
Published: March 2016

BACKGROUND: Published reports of substantial rates of moderate to severe pediatric inpatient pain tend to overlook lower‐intensity pain that may be clinically significant.OBJECTIVE: To document the prevalence of clinically significant pain in pediatric inpatients by considering the pain threshold at which each child desires intervention, and to assess sources of pain, pain assessment and intervention, and relationships among demographic and medical variables to reported pain.METHODS: Inpatients or their parents on four hospital units during four nonconsecutive days were eligible for inclusion. Interviews (76 parents; 31 patients) captured experiences of 107 inpatients (three weeks to 18 years of age) including current, worst and usual pain, pain treatment thresholds, sources of pain and help received during the previous 24 h. A chart review provided data regarding demographic and medical variables, and pain assessment and management.RESULTS: In total, 94% of patients experienced pain. The prevalence of clinically significant pain was 8% (current), 62% (worst) and 24% (usual). Current and worst pain was primarily procedural, and usual pain was primarily disease related. On average, patients had 4.03 documented pain assessments over 24 h. Caregiver responses (eg, reassurance) and nonpharmacological interventions were frequently reported (>90%) but infrequently documented (<50%); 66% of patients received pharmacological interventions. Younger patients received fewer pain assessments and opioids. Patients with clinically significant usual pain were more likely to have undergone surgery, and receive more pain assessments and interventions.CONCLUSIONS: While recent studies suggest reduced pain in pediatric inpatients, the present findings reveal a continued high frequency of undertreated pain. High rates of procedural pain are preventable and should be targeted given the underutilization of pain management strategies.
Exploring the Associations between Sleep Problems and Chronic Musculoskeletal Pain in Adolescents: A Prospective Cohort Study
Authors: Harrison Lee , Wilson Sue , Munafò Marcus R 
Published: March 2016

BACKGROUND: The prevalence of musculoskeletal chronic pain in adolescents is estimated to be approximately 4% to 40%. The development of musculoskeletal pain during teenage years could have a marked impact on physical, psychological and social well‐being.OBJECTIVE: To examine whether sleep problems during adolescence are associated with musculoskeletal pain, particularly chronic regional pain and chronic widespread pain.METHODS: Using data from the Avon Longitudinal Study of Children, the relationship between sleep problems at 15 years of age and the presence of chronic regional and widespread pain at 17 years of age was explored. Pain data were not available at 15 years of age. A total of 2493 participants with complete data were identified. Relationships among sleep problems and musculoskeletal pain were examined using logistic regression. ORs were calculated after adjusting for sex, ethnicity, socioeconomic position and depression (15 years of age).RESULTS: Sleep disturbance (usually wakes up more than two or three times), difficulties with hypersomnolence and poor subjective sleep perception were associated with the presence of both musculoskeletal regional and widespread pain. Finally, using ordered logistic regression, poor subjective sleep perception was also found to be associated with greater pain severity in participants with chronic musculoskeletal regional and widespread pain.DISCUSSION: The results of the present study suggest an association between sleep problems during adolescence and the presence of musculoskeletal pain at a later stage. These findings are consistent with adult literature suggesting a link between sleep problems and musculoskeletal pain. Given these associations, sleep problems in adolescence may be an important risk factor for musculoskeletal pain.
A Presentation of Massive Hemoptysis in a Patient with Churg‐Strauss Syndrome
Authors: Hikmat Fadi , Pearse David B , Damarla Mahendra 
Published: March 2016

Given that Churg‐Strauss syndrome is a systemic small‐vessel vasculitis, it is not usually considered in patients who present with massive hemoptysis, which is typically caused by bronchiectasis, cancer or, in some cases, aberrant bronchial arteries. This article, however, describes a novel case involving a 50‐year‐old Churg‐Strauss patient who presented with sudden‐onset massive hemoptysis. Details of the physical examination, laboratory investigations and several imaging studies, including computed tomography, bronchoscopy and three‐dimensional imaging, are presented.Churg‐Strauss syndrome (CSS) is a systemic small‐vessel vasculitis. When involving the lungs, small‐vessel vasculitides typically cause capillaritis, leading to diffuse alveolar hemorrhage and submassive hemoptysis. In contrast, massive hemoptysis primarily originates from the bronchial arteries; therefore, small‐vessel vasculitis is not considered when a patient presents with massive hemoptysis. The authors describe a patient with CSS who presented with the novel finding of massive hemoptysis. Computed tomography scans lacked alveolar infiltrates and bronchoalveolar lavage lacked hemosiderin‐laden macrophages. Bronchoscopy demonstrated a raised mucosal lesion in the right mainstem bronchus and computed tomography angiogram revealed aberrant dilated bronchial arteries underlying the same region, suggesting this as the source of the hemoptysis. To the authors’ knowledge, the present report describes the first reported case of CSS to present with massive hemoptysis with likely involvement of the bronchial arterial circulation. CSS should be considered in patients with unexplained massive hemoptysis.
Bringing Psychosocial Support to Headache Sufferers Using Information and Communication Technology: Lessons Learned from Asking Potential Users What they Want
Authors: Huguet Anna , Stinson Jennifer , MacKay Bonnie , Watters Carolyn , Tougas Michelle , White Meghan , McGrath Patrick J 
Published: March 2016

BACKGROUND: Headaches are a major concern for which psychosocial interventions are recommended. However, headache sufferers do not always have ready access to these interventions. Technology has been used to improve access, especially in young people.OBJECTIVES: To examine user preferences to inform the development of an Internet‐based psychosocial intervention including smartphone technology, referred to as the Wireless Headache Intervention.METHODS: The methodology followed a participatory design cycle, including 25 headache sufferers (14 to 28 years of age) who informed the prototype design. All participants were familiar with smartphones and the Internet. Through two iterative cycles of focus groups stratified according to age, qualitative data were collected by asking user preferences for the different planned components of the intervention (ie, smartphone pain diary, Internet‐based self‐management treatment, social support) and other relevant aspects (ie, smartphone versus computer delivery, and ways of reaching target audience). NVivo 8 with content analysis was used to analyze data and reflect themes as guided by the thematic survey.RESULTS: Participants reported a preference for completing the smart‐phone pain diary on a daily basis. Participants believed that the program should facilitate easy access to information regarding headaches and management strategies. They also wanted access to other headache sufferers and experts. Participants believed that the program should be customizable and interactive. They reinforced the need and value of an integrated smartphone and Internet‐based application.CONCLUSIONS: The results provide insight into a participatory design to guide design decisions for the type of intervention for which success relies largely on self‐motivation. The results also provide recommendations for design of similar interventions that may benefit from the integration of mobile applications to Internet‐based interventions. The present research contributes to the theoretical frameworks that have been formulated for the development of Internet‐based applications.
A Survey of Perceptions and Practices of Complementary Alternative Medicine among Canadian Gastroenterologists
Authors: Gallinger Zane , Bressler Brian , Devlin Shane M , Plamondon Sophie , Nguyen Geoffrey C 
Published: March 2016

BACKGROUND: Despite a high prevalence of complementary alternative medicine (CAM) use among inflammatory bowel disease (IBD) patients, there is a dearth of information about the attitudes and perceptions of CAM among the gastroenterologists who treat these patients.OBJECTIVE: To characterize the beliefs, perceptions and practices of gastroenterologists toward CAM use in patients with IBD.METHODS: A web-based survey was sent to member gastroenterologists of the Canadian Association of Gastroenterology. The survey included multiple-choice and Likert scale questions that queried physician knowledge and perceptions of CAM and their willingness to discuss CAM with patients.RESULTS: Fifty-three per cent of respondents considered themselves to be IBD subspecialists. The majority (86%) of gastroenterologists reported that less than one-half of their patient population had mentioned the use of CAM. Only 8% of physicians reported initiating a conversation about CAM in the majority of their patient encounters. Approximately one-half (51%) of respondents were comfortable with discussing CAM with their patients, with lack of knowledge being cited as the most common reason for discomfort with the topic. Most gastroenterologists (79%) reported no formal education in CAM. While there was uncertainty as to whether CAM interfered with conventional medications, most gastroenterologists believed it could be effective as an adjunct treatment.CONCLUSION: Our findings demonstrate that gastroenterologists were hesitant to initiate discussions about CAM with patients. Nearly one-half were uncomfortable or only somewhat comfortable with the topic, and most may benefit from CAM educational programs. Interestingly, most respondents appeared to be receptive to CAM as adjunct therapy alongside conventional IBD treatment.