bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blood Cultures in Ambulatory Patients Who Are Discharged from Emergency with Community‐Acquired Pneumonia
Authors: Marrie Thomas J 
Published: March 2016

OBJECTIVES: To determine the factors that predict whether or not ambulatory patients with community‐acquired pneumonia (CAP) treated in an emergency room (ER) setting will have blood cultures drawn and the factors that predict a positive blood culture.METHODS: Prospective observational study of all patients with a diagnosis of CAP, as made by an ER physician, who presented to any of seven Edmonton‐area ERs over a two‐year period.RESULTS: Seven hundred ninety‐three (19.2%) of 4124 patients with CAP had blood cultures drawn. The site‐specific blood culture rates ranged from 7.8% to 25% (P<0.001); 41 of 793 (5.1%) were positive. Streptococcus pneumoniae accounted for 58.5% of the isolates while Staphylococcus aureus and Escherichia coli each accounted for 14.6%, or six patients each. Only two of the 24 patients with S pneumoniae bacteremia were subsequently admitted to hospital while all six of the patients with S aureus were admitted. Only one of the six patients with E coli bacteremia was treated at home. No factors were predictive of positive blood cultures on multivariate analysis.CONCLUSIONS: Physicians are selective in ordering blood cultures on patients with ambulatory pneumonia who present to an ER, and the positivity rate of 5.1% is quite high. No factors are predictive of positive blood cultures on multivariate analysis, thus clinical judgment has to prevail in the decision to perform blood cultures. Breakthrough bacteremia can occur with microorganisms susceptible to the antibiotics that the patient is receiving.
Seasonal Fluctuations in Airway Responsiveness in Elite Endurance Athletes
Authors: Hemingson Howard B , Davis Beth E , Cockcroft Donald W 
Published: March 2016

BACKGROUND: It has been suggested that exposure to winter training conditions (irritants in indoor facilities and/or cold, dry air in the outdoors) can increase airway responsiveness in elite endurance athletes.OBJECTIVES: It has yet to be elucidated whether elite endurance athletes experience seasonal fluctuations in their airway responsiveness.METHODS: Eighteen members of a varsity cross‐country running team underwent screening procedures and five members were enrolled in the study. Each athlete completed a respiratory and training questionnaire, and underwent allergy skin prick testing. Airway responsiveness was evaluated using a methacholine challenge on four occasions.RESULTS: The participants demonstrated a significant (more than twofold) increase in airway responsiveness (P=0.0496) during the first winter evaluation compared with the autumn baseline. The second winter evaluation still showed an increase but it was not statistically significant. Airway responsiveness had returned to baseline (autumn) values at spring testing.CONCLUSION: Elite endurance athletes experience seasonal fluctuations in airway responsiveness. The specific stimuli that cause this are unknown, but it is speculated to be due to exposure to cold, dry air and/or inhaled irritants that may be present in indoor training facilities.
Hospitalization for Community Acquired Pneumonia in Alberta First Nations Aboriginals Compared with Non‐First Nations Albertans
Authors: Marrie Thomas J , Carriere Keumhee C , Jin Yan , Johnson David H 
Published: March 2016

BACKGROUND: The rates and outcomes of hospital admission for community‐acquired pneumonia between First Nations Aboriginal and non‐First Nations groups were compared.METHODS: Alberta administrative hospital abstracts from April 1, 1997, to March 31, 1999, were analyzed, and each case of a First Nations Aboriginal person with pneumonia was matched by age and sex with three non‐First Nations persons with pneumonia.RESULTS: The First Nations Aboriginal age and sex‐adjusted hospital discharge rate was 22 per 1000 (95% CI 20.7 to 23.6) compared with 4.4 per 1000 (95% CI 4.4 to 4.5) for the general population of Alberta. After accounting for comorbidity and severity of pneumonia, in‐hospital mortality and hospital length of stay were lower for First Nations Aboriginals compared with the matched non‐First Nations group (odds ratio 0.49; 95% CI 0.37 to 0.66, and odds ratio 0.87; 95% CI 0.79 to 0.97, respectively). The odds for 30‐day hospital readmission were higher in First Nations Aboriginals compared with the non‐First Nations group (odds ratio 1.42; 95% CI 1.21 to 1.68). The cost per hospital admission for First Nations Aboriginals was 94% of the average cost for the matched non‐First Nations group (CDN$4,206). However, their median daily cost was 1.25 times higher (95% CI 1.14 to 1.36) than the matched non‐First Nations group.CONCLUSIONS: First Nations Aboriginals had higher rates of hospitalization, rehospitalization and hospital costs for community‐acquired pneumonia than non‐First Nations Albertans. It was unlikely that the high rate of hospitalizations in First Nations Aboriginals was due to more severe pneumonia or greater comorbidity. Other unexplained factors increase the burden of this disease in First Nation Aboriginals.
The Asthma Quiz for Kidz: A Validated Tool to Appreciate the Level of Asthma Control in Children
Authors: Ducharme Francine M , Davis G Michael , Noya Francisco , Rich Harold , Ernst Pierre 
Published: March 2016

BACKGROUND: There is an urgent need to bridge the large gap between optimal and observed asthma control among Canadian children.OBJECTIVES: To adapt the criteria of asthma control proposed in the 1999 Asthma Consensus Statement for children and validate the proposed cut‐offs in children with asthma.METHODS: Six clinical criteria of asthma control were phrased as questions and response options, and pretested for clarity. A cross‐sectional study was conducted in children one to 17 years of age presenting to the hospital′s asthma clinics. Children nine years of age or older and their parents were asked to complete The Asthma Quiz for Kidz separately, and then together, before the medical visit. Parents of younger children completed the questionnaire with their child. Physicians were not informed of the results of the quiz.RESULTS: The mean age of the 343 participants was 8.0±4.4 (SD) years with a mean baseline forced expiratory volume in 1 s of 96±15% of predicted values. Asthma severity was rated as mild (67%), moderate (29%) or severe (4%). Overall, 57% of subjects endorsed at least two of the six criteria of poor control. The median (interquartile range) Asthma Quiz score was significantly higher when the physician′s assessment of asthma control was poor than when the physician′s assessment of asthma control was good (3 [1, 5] versus 1 [0, 2], P<0.001), but it did not correlate with the spirometry. A score of at least 2 out of 6 had 73% sensitivity and 59% specificity for identifying poor control.INTERPRETATION: The Asthma Quiz score provides complementary information to, but does not replace, lung function testing. A score of 2 or more out of 6 suggests poor asthma control and should prompt patients to consult their physician for reassessment.
Do Patients with Chronic Noncancer Pain Accept Treatment of Questionable Benefit More Readily that those Who Are Pain Free?
Authors: Simmonds Mark K , Rashiq Saifee , Klemka Philip , Sclanachan Alexander S 
Published: March 2016

BACKGROUND: The efficacy of some common, questionable chronic pain interventions has been debated and it is unclear why sufferers of chronic noncancer pain agree to receive them. This study attempts to determine if chronic pain sufferers characteristically more readily accept treatment with questionable benefit.OBJECTIVES: This study aims to compare the strength of acceptance or rejection of a hypothetical, mock chronic pain treatment of debatable value by two groups of patients: those reporting chronic noncancer pain and those who are ′pain free′.METHODS: A questionnaire proposing a hypothetical treatment for chronic pain was distributed to two groups: Group 1 (n=160), patients attending a chronic pain centre, and Group 2 (n=240), patients attending a family practice centre. Patients were asked to score their ′treatment acceptance′ using a modified Likert scale. The treatment was based on the risks and benefits of epidural steroids.RESULTS: Ninety‐three patients in Group 1 were eligible for inclusion in the ′chronic pain′ group and 92 patients from Group 2, for the ′pain free′ group. The median scores were identical at +3; nonparametric testing revealed no significant difference between the groups in their acceptance of the treatment.CONCLUSIONS: An analogue study such as this removes the potential bias of clinical interaction with a physician, but lacks some reality. Nonetheless, the results from this study did not support the hypothesis that patients with chronic noncancer pain accept treatment of questionable benefit more readily than those who are ′pain‐free′.
Inpatient Care of Community‐Acquired Pneumonia: The Effect of Antimicrobial Guidelines on Clinical Outcomes and Drug Costs in Canadian Teaching Hospitals
Authors: Marras Theodore K , Jamieson Linda , Chan Charles K 
Published: March 2016

BACKGROUND: Evidence supporting antibiotic treatment guidelines and respiratory quinolones (RQs) in community‐acquired pneumonia (CAP) is limited.OBJECTIVE: To study associations among guideline adherence, specific antibiotics, clinical outcomes and antibiotic costs.METHODS: A retrospective cohort study in three tertiary care university
teaching hospitals in Toronto, Ontario, studying CAP inpatients
between November 1997 and June 2000. The period
encompassed 12 months when an early version of empirical antibiotic
guidelines was used (early cohort) and 18 months when recent guidelines
(including RQs) were used (recent cohort).RESULTS: Six hundred ninety‐eight cases of CAP were reviewed,
and 91% were guideline adherent. In multivariable analyses, no association
was observed between guideline adherence and mortality or
duration of hospitalization. Guideline‐adherent cases received fewer
antibiotics in both cohorts and 0.9 days less of intravenous antibiotics
(P=0.04) in the recent cohort. There was no significant difference in
antibiotic cost according to guideline adherence, but recent cohort
guideline‐adherent cases had lower drug costs than early cohort
guideline‐adherent cases. Antibiotic selection was associated with illness
severity and was mirrored by clinical outcomes, despite controlling
for the pneumonia severity index (PSI). Treatment with
anaerobic agents (odds ratio 2.7, P=0.001) or cephalosporin plus
macrolide (odds ratio 2.7, P=0.02) was associated with higher mortality.
Treatment with RQ monotherapy was associated with a 2.3 day
shorter duration of intravenous therapy (P<0.0001) and a $19.19
lower total antibiotic cost (P<0.0001).CONCLUSION: Findings support empirical treatment guidelines
for CAP and their recommendations regarding RQs. The association
between mortality and anaerobic coverage or combination therapy
may reflect prognostic information available at presentation but not
captured by the PSI.
Identifying Children with Persistent Asthma from Health Care Administrative Records
Authors: Kozyrskyj Anita L , Mustard Cameron A , Becker Allan B 
Published: March 2016

BACKGROUND: Investigation into the origins of asthma is contingent on definitions of asthma, which can differentiate asthma from transient wheezing syndromes in children.OBJECTIVES: This research was undertaken to develop a definition for asthma derived from health care administrative records, which would identify children with persistent asthma.PATIENTS AND METHODS: Using population‐based, health
care administrative data, children with possible asthma were identified
as having one or more physician visits or hospitalizations for
asthma or bronchitis diagnoses from January 1995 to December 1995,
or, in the absence of asthma‐like diagnoses, one or more prescriptions
for asthma prophylaxis drugs or ketotifen concomitant with a betaagonist,
or two or more prescriptions for beta‐agonists.RESULTS: The likelihood of persistent asthma, defined as repeated
health care and prescription use for asthma from 1996 to 1998, was
assessed for various asthma markers and risk factors in 29,198 children
with possible asthma. Children with asthma prescription drugs
or asthma health care use not limited to the winter season were
three to six times more likely than children without these characteristics
to have persistent asthma. The likelihood of persistent asthma
was elevated to a substantial degree in the presence of both of these
markers.CONCLUSIONS:The inclusion of these measures in a diagnosisbased definition improves the ability to identify persistent asthma in children.
A Triage Approach to Managing a Two Year Wait‐List in a Chronic Pain Program
Authors: Clark Alexander J , Beauprie Ian , Clark Lynne B , Lynch Mary E 
Published: March 2016

OBJECTIVE: Individuals with chronic pain referred to specialist chronic pain management programs frequently wait months to years for assessment and care. In the authors′ pain management program, approximately 600 patients are on the waiting list. An innovative recommendation program to encourage and educate referring physicians to continue active care of pain during this waiting period was developed.METHODS: All referrals to the Queen Elizabeth II Health Sciences Centre′s Pain Management Unit for a one‐year period were reviewed and triaged as either ′regular waiting list′ or ′fast track′. Patients in the fast track group were seen within four months and required limited interventions or were urgent in nature. The regular waiting list group waited up to 27 months for assessment and development of a treatment plan. Treatment recommendations were faxed to the referring physician. A follow‐up questionnaire was sent to each physician to assess whether these treatment recommendations were useful.RESULTS: Recommendations were faxed for 297 patients. One hundred forty‐nine physicians returned the follow‐up questionnaire. Ninety‐five physicians used the recommendations and 68 patients followed the recommendations. Seventy‐nine physicians felt that the recommendations were helpful to them in their care of the patient. For 39 patients, the recommendations were helpful. The most frequently used recommendations were those on medications (eg, tricylic antidepressants, anticonvulsants, nonsteroidal anti‐inflammatory drugs and controlled‐release opioids). Other modalities included participation in an interdisciplinary group program and physiotherapy.CONCLUSIONS: A triage review process with recommendations faxed to referring physicians was developed and put into action for one year. The recommendations were used by 32% of the physicians (64% of responding physicians). Fifty‐three per cent of responding physicians felt that the recommendations were helpful in the care of their patient. This process led to a benefit in care, as perceived by the physician, in 26% of patients (of physicians who returned the questionnaire [13% of all patients]) on the waiting list for a tertiary care pain management unit.
Deep Inspiration Avoidance and Airway Response to Methacholine: Influence of Body Mass Index
Authors: Boulet Louis-Philippe , Turcotte Hélène , Boulet Geneviève , Simard Barbara , Robichaud Patricia 
Published: March 2016

OBJECTIVE: To evaluate the effects of deep inspiration avoidance response to methacholine inhalation in 23 nonobese (body mass index between 18 kg/m2 and 30 kg/m2) and 27 obese (body mass index 30 kg/m2 or greater), nonatopic, nonasthmatic normal subjects.METHODS: Each subject had four methacholine challenges. In tests A and B, the first postmethacholine forced expiratory volume in 1 s (FEV1) was measured at 30 s and 3 min postinhalation, respectively; tests C and D were single‐dose tests (using the final dose of test B), with the first postmethacholine FEV1 being obtained at 3 min, without (test C) or with (test D) 20 min of deep inspiration avoidance before inhalation.RESULTS: The mean provocative concentrations inducing a 20% fall in FEV1 on tests A and B were 80.6 mg/mL and 28.5 mg/mL (P<0.0001) in nonobese subjects, respectively, and 56.3 mg/mL and 21.5 mg/mL (P<0.0001) in obese subjects, respectively. No significant differences were observed in test A or B between control and obese subjects. Mean falls in FEV1 for tests C and D were 20.3% and 40.0% (P=0.0003) in nonobese subjects, respectively, and 18.5% and 23.6% (P>0.05) in obese subjects, respectively.CONCLUSIONS: As previously observed in patients with asthma, the present study found that nonasthmatic obese subjects had no increase in the fall in FEV1 after deep inspiration avoidance before methacholine, whereas nonobese subjects did, suggesting that obesity alters airway function. No significant changes were found between groups for symptom perception.
A Canadian, Multicentre, Randomized Clinical Trial of Home‐Based Pulmonary Rehabilitation in Copd: Rationale and Methods
Authors: Maltais François , Bourbeau Jean , Lacasse Yves , Shapiro Stan , Perrault Hélène , Penrod John R , Baltzan Marc , Rouleau Michel , Julien Marcel , Paradis Bruno , Audet Richard , Hernandez Paul , Levy Robert D , Camp Pat , Lecours Richard , Picard Danielle , Bernard Sarah 
Published: March 2016

BACKGROUND: Pulmonary rehabilitation remains largely underused. Self‐monitored, home‐based rehabilitation is a promising approach to improving the availability of pulmonary rehabilitation.OBJECTIVE: To report the rationale and methods of a trial comparing the effectiveness of self‐monitored, home‐based rehabilitation with hospital‐based, outpatient rehabilitation in patients with chronic obstructive pulmonary disease (COPD).STUDY DESIGN: A parallel‐group, randomized, noninferiority, multicentre trial will be performed with 240 patients with moderate to severe COPD.INTERVENTION: Patients will be randomly assigned to conventional, supervised, hospital‐based outpatient rehabilitation or self‐monitored, home‐based rehabilitation. Both interventions will include a standardized, comprehensive self‐management program, in addition to the hospital‐based outpatient or home‐based exercise program. After the three‐month intervention, patients in both groups will be encouraged to continue exercising at home. Patients will be assessed monthy with telephone interviews and in person at enrollment, three months and 12 months.OUTCOMES: The dyspnea domain of the Chronic Respiratory Questionnaire (CRQ) at 12 months is the primary outcome variable. Secondary outcome variables include total and domain‐specific CRQ scores; exercise tolerance and activity of daily living; health service use over the one‐year study period; and direct and indirect costs of COPD treatment.ANALYSIS: An intent‐to‐treat approach will be used as the primary analysis. The primary analysis will focus on the change in the CRQ dyspnea score using a two‐sided t distribution based on 95% CIs. The same approach will be used for secondary continuous outcome variables.CONCLUSION: The present trial will address two unresolved issues in pulmonary rehabilitation for patients with COPD: the short‐term and long‐term effectiveness of home‐based pulmonary rehabilitation strategies. The authors will also determine if home‐based pulmonary rehabilitation can reduce health service use (eg, hospitalizations and emergency visits) and if it can be done at a lower cost than the traditional hospital‐based outpatient pulmonary rehabilitation.
Cost Effectiveness of Positron Emission Tomography for the Management of Potentially Operable Non‐Small Cell Lung Cancer in Quebec
Authors: Nguyen Van Hung , Péloquin Serge , Lacasse Yves 
Published: March 2016

BACKGROUND: The potential benefits of positron emission tomography (PET) scanning stem from the fact that it can reduce the number of diagnostic examinations; particularly, the number of unnecessary thoracic surgeries.OBJECTIVE: To evaluate the economic impact and cost‐effectiveness of PET scanning in the management of potentially operable non‐small cell lung cancer in Quebec.METHODS: A decision tree was developed. Two strategies were compared: chest computed tomography (CT) alone or CT and whole‐body PET. The various paths of each strategy were dependent on the numerous variables that were determined from a literature review. The costs and life expectancy were determined for each strategy under consideration. Life expectancy was calculated using the declining exponential approximation of life expectancy. Costs were obtained from the Quebec diagnosis‐related group database and Quebec physician fee schedules.RESULTS: The mean cost of the CT strategy was $8,455 per patient compared with $9,723 for the PET strategy, for a cost differential of $1,268. The PET strategy extended life expectancy by slightly more than three months (0.27 years) compared with the survival of the CT strategy. The incremental cost‐effectiveness ratio was $4,689. Considering the number of new cases and the prevalence of mediastinal metastases, the budget impact would be $8,613,693.CONCLUSION: The use of PET to detect local and distant metastases in non‐small cell lung cancer is an intervention that would require an acceptable investment for each life‐year gained.
The Face of Pain ‐ A Pilot Study to Validate the Measurement of Facial Pain Expression with an Improved EMG Method
Authors: Wolf Karsten , Raedler Thomas , Henke Kai , Kiefer Falk , Mass Reinhard , Quante Markus , Wiedemann Klaus 
Published: March 2016

OBJECTIVE: The purpose of this pilot study was to establish the validity of an improved facial electromyogram (EMG) method for the measurement of facial pain expression.BACKGROUND: Darwin defined pain in connection with fear as a simultaneous occurrence of eye staring, brow contraction and teeth chattering. Prkachin was the first to use the video‐based Facial Action Coding System to measure facial expressions while using four different types of pain triggers, identifying a group of facial muscles around the eyes.METHOD: The activity of nine facial muscles in 10 healthy male subjects was analyzed. Pain was induced through a laser system with a randomized sequence of different intensities. Muscle activity was measured with a new, highly sensitive and selective facial EMG.RESULTS: The results indicate two groups of muscles as key for pain expression. These results are in concordance with Darwin′s definition. As in Prkachin′s findings, one muscle group is assembled around the orbicularis oculi muscle, initiating eye staring. The second group consists of the mentalis and depressor anguli oris muscles, which trigger mouth movements.CONCLUSIONS: The results demonstrate the validity of the facial EMG method for measuring facial pain expression. Further studies with psychometric measurements, a larger sample size and a female test group should be conducted.