bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community‐Associated Methicillin‐Resistant Staphylococcus aureus in Northwest Ontario: A Five‐Year Report of Incidence and Antibiotic Resistance
Authors: Muileboom Jill , Hamilton Marsha , Parent Karen , Makahnouk Donna , Kirlew Michael , Saginur Raphael , Lam Freda , Kelly Len 
Published: March 2016

BACKGROUND: The incidence of community‐associated methicillin‐resistant Staphylococcus aureus (CA‐MRSA) is traditionally high in remote areas of Canada with large Aboriginal populations. Northwestern Ontario is home to 28,000 First Nations people in more than 30 remote communities; rates of CA‐MRSA are unknown.OBJECTIVE: To determine the CA‐MRSA rates and antibiotic susceptibilities in this region.METHODS: A five‐year review of laboratory and patient CA‐MRSA data and antibiotic susceptibility was undertaken.RESULTS: In 2012, 56% of S aureus isolates were CA‐MRSA strains, an increase from 31% in 2008 (P=0.06). Reinfection rates have been increasing faster than new cases and, currrently, 25% of infections are reinfections. CA‐MRSA isolates continue to be susceptible to many common antibiotics (nearly 100%), particularly trimethoprim/sulfamethoxazole, clindamycin and tetracycline. Erythromycin susceptibility stands at 58%.DISCUSSION: Rates of CA‐MRSA, as a percentage of all S aureus isolates, were higher than those reported in other primary care series. The infection rate per 100,000 is one the highest reported in Canada. Antibiotic susceptibilities were unchanged during the study period; the 99% susceptibility rate to clindamycin differs from a 2010 Vancouver (British Columbia) study that reported only a 79% susceptibility to this antibiotic.CONCLUSION: There are very high rates of CA‐MRSA infections in northwestern Ontario. Disease surveillance and ongoing attention to antibiotic resistance is important in understanding the changing profile of MRSA infections. Social determinants of health, specifically improved housing and sanitation, remain important regional issues.
The Ethics of Canadian Entry‐To‐Practice Pain Competencies: How Are We Doing?
Authors: Watt-Watson Judy , Peter Elizabeth , Clark A John , Dewar Anne , Hadjistavropoulos Thomas , Morley-Forster Pat , O’Leary Christine , Raman-Wilms Lalitha , Unruh Anita , Webber Karen , Campbell-Yeo Marsha 
Published: March 2016

BACKGROUND: Although unrelieved pain continues to represent a significant problem, prelicensure educational programs tend to include little content related to pain. Standards for professional competence strongly influence curricula and have the potential to ensure that health science students have the knowledge and skill to manage pain in a way that also allows them to meet professional ethical standards.OBJECTIVES: To perform a systematic, comprehensive examination to determine the entry‐to‐practice competencies related to pain required for Canadian health science and veterinary students, and to examine how the presence and absence of pain competencies relate to key competencies of an ethical nature.METHODS: Entry‐to‐practice competency requirements related to pain knowledge, skill and judgment were surveyed from national, provincial and territorial documents for dentistry, medicine, nursing, pharmacy, occupational therapy, physiotherapy, psychology and veterinary medicine.RESULTS: Dentistry included two and nursing included nine specific pain competencies. No references to competencies related to pain were found in the remaining health science documents. In contrast, the national competency requirements for veterinary medicine, surveyed as a comparison, included nine pain competencies. All documents included competencies pertaining to ethics.CONCLUSIONS: The lack of competencies related to pain has implications for advancing skillful and ethical practice. The lack of attention to pain competencies limits the capacity of health care professionals to alleviate suffering, foster autonomy and use resources justly. Influencing professional bodies to increase the number of required entry‐to‐practice pain competencies may ultimately have the greatest impact on education and practice.
Integrated Interdisciplinary Care for Patients with Chronic Obstructive Pulmonary Disease Reduces Emergency Department Visits and Admissions: A Quality Assurance Study
Authors: Dajczman Esther , Robitaille Chantal , Ernst Pierre , Hirsch Andrew Michael , Wolkove Norman , Small David , Bianco Judy , Stern Hartley , Palayew Mark 
Published: March 2016

BACKGROUND: Dedicated programs for the management of chronic obstructive pulmonary disease (COPD) can reduce hospitalizations and improve quality of life.OBJECTIVE: To investigate whether health care utilization could be reduced by a newly developed integrated, interdisciplinary initiative that included a COPD nurse navigator who educates patients and families, transitions patients through various points of care and integrates services.METHODS: The present quality assurance, pre‐post study included patients followed by a COPD nurse navigator from January 25, 2010 to November 5, 2011. Information regarding emergency department visits and hospitalizations, including lengths of stay, were obtained from hospital databases. Diagnoses were classified as respiratory or nonrespiratory, and used primary and secondary hospitalization diagnoses to identify acute exacerbations of COPD (AECOPD). Paired sign tests were performed.RESULTS: The sample consisted of 202 patients. Following nurse navigator intervention, significantly more patients experienced a decrease in the number of respiratory‐cause emergency department visits (P<0.05), number of respiratory hospitalizations (P<0.001), total hospital days for respiratory admissions (P<0.001), number of hospitalizations with AECOPD (P<0.001) and total hospital days for admissions with AECOPD (P<0.001). Financial modelling estimated annual savings in excess of $260,000.CONCLUSION: The present quality assurance study indicated that the implementation of an integrated interdisciplinary program for the care of patients with COPD can improve patient outcomes despite the tendency of COPD to worsen over time.
Physician Variability in Treating Pain and Irritability of Unknown Origin in Children with Severe Neurological Impairment
Authors: Siden Harold B , Carleton Bruce C , Oberlander Tim F 
Published: March 2016

BACKGROUND: Pain and irritability of unknown origin (PIUO) is a challenging problem for nonverbal children with severe neurological impairments. PIUO is not associated with an identifiable source of nociceptive‐inflammatory or neuropathic pain.OBJECTIVE: To assess how physicians use pharmacotherapy to treat PIUO, and to report a pilot study of a standardized approach to investigating and treating PIUO.METHOD: Part 1 of the present study involved independently presenting a case vignette of a patient with PIUO to six experienced physicians who care for children with neurological impairments. They were asked for medication choices and sequences to empirically treat PIUO. Part 2 was a pilot study of a PIUO protocol. Patients followed a standard pathway for PIUO, referred to as the pathway for unknown pain (PUP). The initial drug sequence for the PUP was based on Part 1.RESULTS: In Part 1, physicians responding to the case vignette listed eight medications (atypical antipsychotics, benzodiazepines, gabapentin, methadone, opioids, selective serotonin reuptake inhibitors, tramadol and tricylic antidepressants) and eight empiric drug sequences. In Part 2, eight children with PIUO (six to 17 years of age; five females, three males) were enrolled in a pilot clinic. Only two had been fully evaluated for nociceptive‐inflammatory pain sources before enrollment. At the end of the pilot study, four patients were clinically improved and only three required a study medication.DISCUSSION AND CONCLUSION: Even experienced physicians do not agree on a common approach for medical treatment of PIUO. A standardized pathway is feasible and readily implemented. The proposed PUP has the potential to address PIUO and be the basis for future intervention studies.
Evaluation of MRSASelect™ Chromogenic Medium for the Early Detection of Methicillin‐Resistant Staphylococcus aureus from Blood Cultures
Authors: Manickam Kanchana , Walkty Andrew , Lagacé-Wiens Philippe RS , Adam Heather , Swan Barbara , McAdam Brenda , Pieroni Peter , Alfa Michelle , Karlowsky James A 
Published: March 2016

INTRODUCTION: Staphylococcus aureus bacteremia is associated with considerable morbidity and mortality. In theory, reducing the turnaround time in reporting of methicillin‐resistant S aureus (MRSA) among patients with bactermia could assist with the rapid optimization of antimicrobial therapy.OBJECTIVE: To evaluate the sensitivity and specificity of MRSASelect (Bio‐Rad Laboratories, USA), a chromogenic medium, in the early detection of MRSA from blood cultures growing Gram‐positive cocci in clusters, and to confirm that routine use of this medium would, in fact, reduce turnaround time for MRSA identification.METHODS: The present study was conducted at three microbiology laboratories in Manitoba. Between April 2010 and May 2011, positive blood cultures with Gram‐positive cocci in clusters visualized on Gram stain were subcultured to both MRSASelect and routine media. MRSA isolates were identified using conventional microbiological methods from routine media and using growth with the typical colony morphology (pink colony) on MRSASelect medium.RESULTS: A total of 490 blood cultures demonstrating Gram‐positive cocci in clusters on Gram stain were evaluated. S aureus was recovered from 274 blood cultures, with 51 S aureus isolates (51 of 274 [18.6%]) identified as MRSA. MRSASelect medium had a sensitivity of 98%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 99.8% for the recovery and identification of MRSA directly from positive blood culture bottles. In addition, use of MRSASelect medium was found to improve turnaround time in the detection of MRSA by almost 24 h relative to conventional methods.DISCUSSION: These data support the utility of MRSASelect medium for the rapid identification of MRSA from positive blood cultures. Further clinical studies are warranted to determine whether the improvement in turnaround time will result in a measurable reduction in suboptimal antimicrobial therapy and/or improvement in patient outcome.
Peripheral Blood Leukocytes and Serum Nested Polymerase Chain Reaction Are Complementary Methods for Monitoring Active Cytomegalovirus Infection in Transplant Patients
Authors: Andrade PD , Fioravanti MT , Anjos EBV , De Oliveira C , Albuquerque DM , Costa SCB 
Published: March 2016

BACKGROUND: Human cytomegalovirus is an important cause of morbidity and mortality in immunocompromised patients. Qualitative polymerase chain reaction (PCR) has proven to be a sensitive and effective technique in defining active cytomegalovirus infection, in addition to having low cost and being a useful test for situations in which there is no need for quantification. Real‐time PCR has the advantage of quantification; however, the high cost of this methodology makes it impractical for routine use.OBJECTIVE: To apply a nested PCR assay to serum (sPCR) and to evaluate its efficiency to diagnose active cytomegalovirus infection compared with PCR of peripheral blood leukocytes (L‐PCR).METHODS: Samples of 37 patients were prospectively evaluated. An internal control was created and applied to sPCR to exclude false‐negative results.RESULTS: In total, 21 patients (57%) developed active cytomegalovirus infection. After analyzing the two methods for the diagnosis of active infection, higher sensitivity and negative predictive value of the L‐PCR versus sPCR (100% versus 62%), and higher specificity and positive predictive value of sPCR versus L‐PCR (81% versus 50% and 72%, respectively) were observed. Discordant results were observed in 11 patients who were L‐PCR‐positive but sPCR‐negative for active cytomegalovirus infection, five of whom developed clinical symptoms of cytomegalovirus. Clinical symptoms were observed in 14 patients, 12 of whom were diagnosed with active infection by nested L‐PCR (P=0.007) and seven by nested sPCR (P=0.02). Higher specificity and a positive predictive value for sPCR were observed.CONCLUSION: Nested L‐PCR and sPCR were considered to be complementary methods for the diagnosis and management of symptomatic cytomegalovirus infection.
Colorectal Cancer Surveillance after Index Colonoscopy: Guidance from the Canadian Association of Gastroenterology
Authors: Leddin Desmond , Enns Robert , Hilsden Robert , Fallone Carlo A , Rabeneck Linda , Sadowski Daniel C , Singh Harminder 
Published: March 2016

BACKGROUND: Differences between American (United States [US]) and European guidelines for colonoscopy surveillance may create confusion for the practicing clinician. Under- or overutilization of surveillance colonoscopy can impact patient care.METHODS: The Canadian Association of Gastroenterology (CAG) convened a working group (CAG-WG) to review available guidelines and provide unified guidance to Canadian clinicians regarding appropriate follow-up for colorectal cancer (CRC) surveillance after index colonoscopy. A literature search was conducted for relevant data that postdated the published guidelines.RESULTS: The CAG-WG chose the 2012 US Multi-Society Task Force (MSTF) on Colorectal Cancer to serve as the basis for the Canadian position, primarily because the US approach was the simplest and comprehensively addressed the issue of serrated polyps. Aspects of other guidelines were incorporated where relevant. The CAG-WG recommendations differed from the US MSTF guidelines in three main areas: patients with negative index colonoscopy should be followed-up at 10 years using any of the appropriate screening tests, including colonos-copy, for average-risk individuals; among patients with >10 adenomas, a one-year interval for subsequent colonoscopy is recommended; and for long-term follow-up, patients with low-risk adenomas on both the index and first follow-up procedures can undergo second follow-up colonos-copy at an interval of five to 10 years.DISCUSSION: The CAG-WG adapted the US MSTF guidelines for colonoscopy surveillance to the Canadian health care environment with a few modifications. It is anticipated that the present article will provide unified guidance that will enhance physician acceptance and encourage appropriate utilization of recommended surveillance intervals.
Do We EradicateHelicobacter pyloriin Hospitalized Patients with Peptic Ulcer Disease?
Authors: Wong Frank , Ou George , Svarta Sigrid , Kwok Ricky , Donaldson Kieran , Frenette Joe , Enns Robert 
Published: March 2016

BACKGROUND:Helicobacter pyloriinfection is the most common chronic infection in humans. It is a major contributor to the cause of duodenal and gastric ulcers worldwide. Its eradication has been shown to reduce rates ofH pylori-related ulcers as well as other complications such as gastric cancer.OBJECTIVE: To determine the rate of appropriate treatment in patients following a diagnosis ofH pyloriinfection on biopsy during esophagoduodenoscopy for upper gastrointestinal bleeding over a four-year period at a tertiary centre in Vancouver, British Columbia. Also evaluated was the rate of eradication confirmation using the urea breath test.METHODS: A retrospective review of 1501 inpatients who underwent esophagoduodenoscopy for upper gastrointestinal bleeding (January 2006 to December 2010) was undertaken. Patients who were biopsy stain positive forH pyloriwere selected for drug review either via a provincial database (PharmaNet) or via records from patients’ family practitioners. Data were also obtained via two provincial laboratories that perform the urea breath test to determine the rates of confirmation of eradication.RESULTS: Ninety-eight patients had biopsy-provenH pylori. The mean (± SD) age was 56.13±17.9 years and 65 were male. Data were not available for 22 patients; the treatment rate was 52.6% (40 of 76). Of those treated, 12 patients underwent a post-treatment urea breath test for eradication confirmation.CONCLUSION: There was substantial discrepancy between the number of diagnosedH pyloriinfections and the rate of treatment as well as confirmation of eradication. Numerous approaches could be taken to improve treatment and eradication confirmation.
Molecular Identification and Susceptibility Pattern of Clinical Nocardia Species: Emergence of Nocardia crassostreae as an Agent of Invasive Nocardiosis
Authors: Taj-Aldeen Saad J , Deshmukh Anand , Doiphode Sanjay , Abdul Wahab Atqah , Allangawi Mona , AlMuzrkchi Ahmed , Klaassen Corné H , Meis Jacques F 
Published: March 2016

BACKGROUND: Nocardia species are rare, opportunistic organisms that cause disease in both immunocompetent and immunocompromised individuals.OBJECTIVE: To investigate the clinical presentations of various Nocardia infections based on the 16S ribosomal RNA gene of the isolate, as well as related risk factors and susceptibility patterns to antimicrobial agentsMETHODS: Thirteen patients with a diagnosis of nocardiosis were included in the present study. Seven Nocardia species were identified by 16S ribosomal RNA. Susceptibility testing was performed using six antimicrobial agents.RESULTS: Five patients were immunocompromised, and eight were immunocompetent with predisposing factors including cystic fibrosis, tuberculosis and ophthalmic infections. Nocardia caused pulmonary infections in eight patients (61.5%), invasive systemic infections in three patients (23%) and local (ophthalmic) infections in two patients (15.4%). In the patients with pulmonary disease, nocardiosis was caused by six species (Nocardia cyriacigeorgica, Nocardia otitidiscaviarum, Nocardia farcinica, Nocardia carnea, Nocardia testacea and Nocardia asiatica). The seventh species identified in the present study was Nocardia crassostreae.DISCUSSION: N crassostreae is a multidrug‐resistant organism that was reported to be an emerging human pathogen causing invasive nocardiosis in a patient with non‐Hodgkin’s lymphoma. N farcinica was isolated from blood in a patient with breast cancer. None of the Nocardia isolates were resistant to linezolid. One N otitidiscaviarum isolate was a multidrug‐resistant organism. All patients in the present study were treated with the appropriate antibiotics and their condition resolved without further sequelae.CONCLUSIONS: The present study is the first report on N crassostreae as a human pathogen. The detection of multidrug‐resistant species necessitate molecular identification and susceptibility testing, and should be performed for all Nocardia infections. Nocardiosis manifests various clinical features depending on the Nocardia species and underlying conditions.
Low Seroconversion after One Dose of AS03‐Adjuvanted H1N1 Pandemic Influenza Vaccine in Solid‐Organ Transplant Recipients
Authors: Resende Mariangela R , Husain Shahid , Gubbay Jonathan , Singer Lianne , Cole Edward , Renner Eberhard L , Rotstein Coleman 
Published: March 2016

BACKGROUND: Immunocompromised individuals are more susceptible to complications produced by influenza infection. As a result, solid‐organ transplant (SOT) recipients were targeted as a priority group to receive AS03‐adjuvanted H1N1 influenza vaccine during 2009.OBJECTIVE: To evaluate seroconversion after one dose of adjuvanted pandemic influenza H1N1 (pH1N1) vaccine in SOT recipients.METHODS: Adult SOT recipients were enrolled to receive one 3.75 μg dose of adjuvanted pH1N1 vaccine. Serological status was tested using a hemagglutination inhibition assay before and two and four weeks postvaccination.RESULTS: The five SOT recipients (one liver, two kidney and two lung transplants) had a median age of 50 years (range 36 to 53 years), and three were male, who were a median time of three years (range two months to 15 years) post‐transplant. All patients were on a double or triple immunosuppressive regimen. The prevaccination pH1N1 titre was 1:10 in four patients and 1:40 in one patient. Seroprotection was observed only in one patient, with a rise in titre from 1:40 at baseline to 1:320 at both two and four weeks after vaccination. This lung transplant recipient had documented previous infection with pH1N1.CONCLUSION: Results of the present small study call into question whether one dose of adjuvanted pH1N1 vaccine can provide seroprotection in SOT recipients.
Validation and Evaluation of Two Observational Pain Assessment Tools in a Trauma and Neurosurgical Intensive Care Unit
Authors: Topolovec-Vranic Jane , Gélinas Celine , Li Yangmei , Pollmann-Mudryj Mary Ann , Innis Jennifer , McFarlan Amanda , Canzian Sonya 
Published: March 2016

BACKGROUND: Studies have demonstrated that patients in the intensive care unit experience high levels of pain. While many of these patients are nonverbal at some point during their stay, there are few valid tools available to assess pain in this group.OBJECTIVES: To evaluate the validity and clinical utility of two pain assessment tools, the revised Adult Non‐Verbal Pain Scale (NVPS‐R) and the Critical Care Pain Observation Tool (CPOT), in a trauma and neurosurgical patient population.METHODS: Patients were assessed using the NVPS‐R and CPOT by trained intensive care unit nurses (n=23) and research assistants before, during and after two procedures: turning of the patient (nociceptive procedure) and noninvasive blood pressure cuff inflation (non‐nociceptive procedure). Communicative patients were also asked to report their level of pain during each assessment.RESULTS: A total of 66 patients (34 communicative, 32 noncommunicative) were included in the study. CPOT and NVPS‐R scores increased significantly when participants were exposed to turning, but not during noninvasive blood pressure measurement (repeated measures ANOVA: CPOT, F=5.81, P=0.019; NVPS‐R, F=5.32, P=0.025) supporting discriminant validity. CPOT and NVPS‐R scores were significantly higher during the turning procedure for patients who had indicated that they were in pain versus those who were not, indicating criterion validity. Inter‐rater reliability was generally higher for the CPOT than NVPS‐R. Nurses rated the feasibility of the two tools as comparable but provided higher ratings of acceptability for the CPOT.CONCLUSIONS: While the present study supports the use of the CPOT and the NVPS‐R with critically ill trauma and neurosurgical patients, further research should explore the role of vital signs in pain.