bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can We Improve Parents’ Management of their Children’S Postoperative Pain at Home?
Authors: Chorney Jill MacLaren , Twycross Alison , Mifflin Katherine , Archibald Karen 
Published: March 2016

BACKGROUND: Thousands of children undergo surgery each year, and a shift toward same‐day surgeries and decreased lengths of hospital stay results in parents being increasingly responsible for their child’s postoperative care. Recent studies have tested interventions designed to improve parent management of their children’s postoperative pain at home, but progress in this area has been limited by a lack of synthesis of these findings.OBJECTIVE: To conduct a systematic review of interventions aimed at improving parent management of children’s postoperative pain at home.METHODS: Articles evaluating interventions to improve management of their children’s postoperative pain were identified using a library scientist‐designed search strategy applied in EMBASE, PubMed, CINAHL and PsycINFO. Two independent raters assessed each study for eligibility and extracted data.RESULTS: Of the 147 articles identified for the review, eight met the inclusion criteria. Interventions included pain education, training in pain assessment, education on distraction, instruction in around‐the‐clock dosing and nurse coaching. Overall, results of comparisons of pain intensity and analgesic administration were modest. The intervention with the largest effect size was instruction in around‐the‐clock dosing, either alone or in combination with nurse coaching. Results of studies investigating pain assessment, pain education and distraction trials revealed small to medium effect sizes.CONCLUSIONS: Results of trials investigating interventions to improve parent management of their children’s postoperative pain at home were modest. Future studies should further examine barriers and facilitators to pain management to design more effective interventions.
Defining Quality Indicators for Best-Practice Management of Inflammatory Bowel Disease in Canada
Authors: Nguyen Geoffrey C , Devlin Shane M , Afif Waqqas , Bressler Brian , Gruchy Steven E , Kaplan Gilaad G , Oliveira Liliana , Plamondon Sophie , Seow Cynthia H , Williams Chadwick , Wong Karen , Yan Brian M , Jones Jennifer 
Published: March 2016

BACKGROUND: There is a paucity of published data regarding the quality of care of inflammatory bowel disease (IBD) in Canada. Clinical quality indicators are quantitative end points used to guide, monitor and improve the quality of patient care. In Canada, where universal health care can vary significantly among provinces, quality indicators can be used to identify potential gaps in the delivery of IBD care and standardize the approach to interprovincial management.METHODS: The Emerging Practice in IBD Collaborative (EPIC) group generated a shortlist of IBD quality indicators based on a comprehensive literature review. An iterative voting process was used to select quality indicators to take forward. In a face-to-face meeting with the EPIC group, available evidence to support each quality indicator was presented by the EPIC member aligned to it, followed by group discussion to agree on the wording of the statements. The selected quality indicators were then ratified in a final vote by all EPIC members.RESULTS: Eleven quality indicators for the management of IBD within the single-payer health care system of Canada were developed. These focus on accurate diagnosis, appropriate and timely management, disease monitoring, and prevention or treatment of complications of IBD or its therapy.CONCLUSIONS: These quality indicators are measurable, reflective of the evidence base and expert opinion, and define a standard of care that is at least a minimum that should be expected for IBD management in Canada. The next steps for the EPIC group involve conducting research to assess current practice across Canada as it pertains to these quality indicators and to measure the impact of each of these indicators on patient outcomes.
Micafungin Compared with Caspofungin for the Treatment of Febrile Episodes in Neutropenic Patients with Hematological Malignancies: A Retrospective Study
Authors: Shalhoub Sarah , Wang Luchen , Ching Arthur , Husain Shahid , Rotstein Coleman 
Published: March 2016

BACKGROUND: Invasive fungal infections are associated with morbidity and mortality in neutropenia secondary to hematological malignancies. Empirical antifungal agents are used to reduce their consequences. Caspofungin is the only echinocandin approved for this indication. Micafungin was compared with caspofungin for the treatment of patients with hematological malignancies and prolonged neutropenia.METHODS: A retrospective cohort study was conducted involving patients who had hematological malignancies with profound neutropenia for a minimum of 10 days, and received empirical micafungin or caspofungin for a minimum of five days, between April 2005 and November 2009. Successful outcome was based on a composite end point: survival for a minimum of seven days following antifungal cessation, successful treatment of baseline fungal infection, absence of adverse events and absence of breakthrough fungal infection. Fungal infections were defined according to revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC‐MSG) criteria, with modification of the diagnostic imaging criteria.RESULTS: Micafungin had similar overall success to caspofungin (60.4% [29 of 48] versus 57.3% [47 of 82], respectively; P=0.729). Survival was higher in the micafungin group compared with the caspofungin group (100% [48 of 48] versus 89% [73 of 82]; P=0.02). No baseline invasive fungal infections were identified in the micafungin group, compared with three proven infections treated successfully with caspofungin (3.7%; P=0.18). Three proven breakthrough infections were observed in the micafungin group (three of 48 [27.3%]) compared with none in the caspofungin group (zero of 82; P=0.02).CONCLUSION: Micafungin has similar efficacy to caspofungin as empirical antifungal therapy in febrile neutropenic patients with hematological malignancies. Verification of these results in a prospective trial is warranted.
Identifying Factors Associated with Changes in CD4+ Count in HIV‐Infected Adults in Saskatoon, Saskatchewan
Authors: Hunt Kelsey , Mondal Prosanta , Konrad Stephanie , Skinner Stuart , Gartner Kali , Lim Hyun J 
Published: March 2016

OBJECTIVE: To assess the impact of clinical and social factors unique to HIV‐infected adults in Saskatoon, Saskatchewan, regarding the rate of CD4+ count change, and to identify factors associated with a risk of CD4+ count decline.METHODS: A retrospective longitudinal cohort study from medical chart reviews at two clinics was conducted in Saskatoon. Univariate and multivariate linear mixed effects models were used to assess the impact of selected factors on CD4+ count change.RESULTS: Four hundred eleven HIV‐infected patients were identified from January 1, 2003 to November 30, 2011. Two hundred eighteen (53%) were male, mean (± SD) age was 35.6 ±10.1 years, 257 (70.8%) were First Nations or Métis, 312 (80.2%) were hepatitis C virus (HCV) coinfected and 300 (73.3%) had a history of injection drug use (IDU). In univariate models, age, ethnicity, HCV, IDU, antiretroviral therapy and social assistance were significant. Using ethnicity, HCV and IDU, three multivariate models (models 1, 2, 3) were built due to high correlation. First Nations or Métis ethnicity, HCV coinfection and a history of IDU were associated with significantly lower CD4+ counts in multivariate models. Older age and social assistance were associated with significantly lower CD4+ counts in models 1 and 3. Age was marginally significant in model 2 (P=0.055). Not prescribed antiretroviral therapy was associated with a significantly negative CD4+ count slope in all multivariate models.CONCLUSION: The unique epidemiology of this HIV‐infected population may be contributing to CD4+ count change. Increased attention and resources focused on this high‐risk population are needed to prevent disease progression and to improve overall health and quality of life.
Noninvasive Methods, including Transient Elastography, for the Detection of Liver Disease in Adults with Cystic Fibrosis
Authors: Sadler Matthew D , Crotty Pam , Fatovich Linda , Wilson Stephanie , Rabin Harvey R , Myers Robert P 
Published: March 2016

BACKGROUND: Liver disease is the third leading cause of mortality in patients with cystic fibrosis (CF). However, detection of CF-associated liver disease (CFLD) is challenging.OBJECTIVE: To evaluate the diagnostic performance of noninvasive methods for the detection of CFLD with a focus on transient elastography (TE).METHODS: Patients at the Adult CF Clinic of Calgary and Southern Alberta (n=127) underwent liver stiffness measurement (LSM) by TE using the FibroScan (FS, Ecosens, France) M probe; aspartate amino-transferase to platelet ratio index (APRI) and FibroTest (FT) scores were also calculated. The diagnostic performance of these tools for the detection of CFLD (defined as two or more the following criteria: abnormal liver biochemistry, hepatomegaly or sonographic abnormalities other than steatosis) were compared using the area under ROC curves.RESULTS: Forty-seven percent of the cohort was male. The median age was 27 years (interquartile range [IQR] 22 to 37 years) and body mass index 21 kg/m2(IQR 19 kg/m2to 23 kg/m2); 25% of patients were on ursodeoxycholic acid and 12% had undergone lung transplantation. The prevalence of CFLD was 14% (n=18). FS was successful in all patients; one (0.8%) patient had poorly reliable results (IQR/M >30% and LSM ≥7.1kPa). Compared with patients without CFLD (n=109), individuals with CFLD had higher median LSM according to FS (3.9 kPa [IQR 3.4 to 4.9 kPa] versus 6.4 kPa [IQR 4.4 to 8.0 kPa]), APRI (0.24 [IQR 0.17 to 0.31] versus 0.50 [IQR 0.22 to 1.18]) and FT scores (0.08 [IQR 0.05 to 1.5] versus 0.18 [IQR 0.11 to 0.35]; all P<0.05). Area under ROC curve for FS, APRI and FT for the detection of CFLD were 0.78 (95% CI 0.65 to 0.92), 0.72 (95% CI 0.56 to 0.87) and 0.76 (95% CI 0.62 to 0.90) (P not significant). At a threshold of >5.2 kPa, the sensitivity, specificity, positive and negative predictive values of LSM according to FS for detecting CFLD were 67%, 83%, 40% and 94%, respectively.CONCLUSIONS: FS, APRI and FT were useful noninvasive methods for detecting CFLD in adults.
Do Photographic Images of Pain Improve Communication during Pain Consultations?
Authors: Padfield Deborah , Zakrzewska Joanna M. , de C Williams Amanda C 
Published: March 2016

BACKGROUND: Visual images may facilitate the communication of pain during consultations.OBJECTIVES: To assess whether photographic images of pain enrich the content and/or process of pain consultation by comparing patients’ and clinicians’ ratings of the consultation experience.METHODS: Photographic images of pain previously co‐created by patients with a photographer were provided to new patients attending pain clinic consultations. Seventeen patients selected and used images that best expressed their pain and were compared with 21 patients who were not shown images. Ten clinicians conducted assessments in each condition. After consultation, patients and clinicians completed ratings of aspects of communication and, when images were used, how they influenced the consultation.RESULTS: The majority of both patients and clinicians reported that images enhanced the consultation. Ratings of communication were generally high, with no differences between those with and without images (with the exception of confidence in treatment plan, which was rated more highly in the image group). However, patients’ and clinicians’ ratings of communication were inversely related only in consultations with images. Methodological shortcomings may underlie the present findings of no difference. It is also possible that using images raised patients’ and clinicians’ expectations and encouraged emotional disclosure, in response to which clinicians were dissatisfied with their performance.CONCLUSIONS: Using images in clinical encounters did not have a negative impact on the consultation, nor did it improve communication or satisfaction. These findings will inform future analysis of behaviour in the video‐recorded consultations.
A Novel Pain Interprofessional Education Strategy for Trainees: Assessing Impact on Interprofessional Competencies and Pediatric Pain Knowledge
Authors: Hunter Judith P. , Stinson Jennifer , Campbell Fiona , Stevens Bonnie , Wagner Susan J. , Simmons Brian , White Meghan , van Wyk Margaret 
Published: March 2016

BACKGROUND: Health care trainees/students lack knowledge and skills for the comprehensive clinical assessment and management of pain. Moreover, most teaching has been limited to classroom settings within each profession.OBJECTIVES: To develop and evaluate the feasibility and preliminary outcomes of the ‘Pain‐Interprofessional Education (IPE) Placement’, a five‐week pain IPE implemented in the clinical setting. The utility (content validity, readability, internal consistency and practical considerations) of the outcome measures was also evaluated.METHODS: A convenience sample of 21 trainees from eight professions was recruited over three Pain‐IPE Placement cycles. Pre‐ and postcurriculum assessment included: pain knowledge (Pediatric Pain Knowledge and Attitudes Survey), IPE attitudes (Interdisciplinary Education Perception Scale [IEPS]) and IPE competencies (Interprofessional Care Core Competencies Global Rating Scales [IPC‐GRS]), and qualitative feedback on process/acceptability.RESULTS: Recruitment and retention met expectations. Qualitative feedback was excellent. IPE measures (IEPS and IPC‐GRS) exhibited satisfactory utility. Postcurriculum scores improved significantly: IEPS, P<0.05; IPC‐GRS constructs, P<0.01; and competencies, P<0.001. However, the Pediatric Pain Knowledge and Attitudes Survey exhibited poor utility in professions without formal pharmacology training. Scores improved in the remaining professions (n=14; P<0.01).DISCUSSION: There was significant improvement in educational outcomes. The IEPS and IPC‐GRS are useful measures of IPE‐related learning. At more advanced training levels, a single pain‐knowledge questionnaire may not accurately reflect learning across diverse professions.CONCLUSION: The Pain‐IPE Placement is a successful collaborative learning model within a clinical context that successfully changed interprofessional competencies. The present study represents a first step at defining and assessing change in interprofessional competencies gained from Pain‐IPE.
Patient Preference and Willingness to Pay for Transient Elastography versus Liver Biopsy: A Perspective from British Columbia
Authors: Kan Victoria Y , Azalgara Vladimir Marquez , Ford Jo-Ann E , Kwan WC Peter , Erb Siegfried R , Yoshida Eric M 
Published: March 2016

BACKGROUND: The cost of liver biopsy (LB) is publicly funded in British Columbia, while the cost of transient elastography (FibroScan [FS], Echosens, France) is not. Consequently, there is regional variation regarding FS access and monitoring of liver disease progression.OBJECTIVE: To evaluate patient preference for FS versus LB and to assess the willingness to self-pay for FS.METHODS: Questionnaires were distributed in clinic and via mail to LB-experienced and LB-naive patients who underwent FS at Vancouver General Hospital, Vancouver, British Columbia.RESULTS: The overall response rate was 76%. Of the 422 respondents, 205 were LB-experienced. The mean age was 53.5 years, 50.2% were male, 54.7% were Caucasian, 38.2% had hepatitis C and 26.3% had an annual household income >$75,000. Overall, 95.4% of patients preferred FS to LB. FS was associated with greater comfort than LB, with the majority reporting no discomfort during FS (84.1% versus 7.8% for LB), no discomfort after (96.2% versus 14.6% LB) and no feelings of anxiety after FS explanation (78.2% versus 12.7% LB). FS was also associated with greater speed, with the majority reporting short test duration (97.2% versus 48.3% LB) and short wait for the test result (95.5% versus 30.2% LB). Most (75.3%) respondents were willing to self-pay for FS, with 26.3% willing to pay $25 to $49. Patients with unknown liver disease preferred LB (OR [FS preference] 0.20 [95% CI 0.07 to 0.53]).CONCLUSIONS: FS was the preferred method of assessing liver fibrosis among patients, with the majority willing to self-pay. To ensure consistency in access, provincial funding for FS is needed. However, LB remains the procedure of choice for individuals with an unknown diagnosis.
Usefulness of Previous Methicillin‐resistant Staphylococcus aureus Screening Results in Guiding Empirical Therapy for S Aureus Bacteremia
Authors: Bai Anthony D , Burry Lisa , Showler Adrienne , Steinberg Marilyn , Ricciuto Daniel , Fernandes Tania , Chiu Anna , Raybardhan Sumit , Tomlinson George A , Bell Chaim M , Morris Andrew M 
Published: March 2016

BACKGROUND: Staphylococcus aureus bacteremia (SAB) is an important infection. Methicillin‐resistant S aureus (MRSA) screening is performed on hospitalized patients for infection control purposes.OBJECTIVE: To assess the usefulness of past MRSA screening for guiding empirical antibiotic therapy for SAB.METHODS: A retrospective cohort study examined consecutive patients with confirmed SAB and previous MRSA screening swab from six academic and community hospitals between 2007 and 2010. Diagnostic test properties were calculated for MRSA screening swab for predicting methicillin resistance of SAB.RESULTS: A total of 799 patients underwent MRSA screening swabs before SAB. Of the 799 patients, 95 (12%) had a positive and 704 (88%) had a negative previous MRSA screening swab. There were 150 (19%) patients with MRSA bacteremia. Overall, previous MRSA screening swabs had a positive likelihood ratio of 33 (95% CI 18 to 60) and a negative likelihood ratio of 0.45 (95% CI 0.37 to 0.54). Diagnostic accuracy differed depending on mode of acquisition (ie, community‐acquired, nosocomial or health care‐associated infection) (P<0.0001) and hospital (P=0.0002). At best, for health care‐associated infection, prior MRSA screening swab had a positive likelihood ratio of 16 (95% CI 9 to 28) and a negative likelihood ratio of 0.27 (95% CI 0.17 to 0.41).CONCLUSIONS: A negative prior MRSA screening swab cannot reliably rule out MRSA bacteremia and should not be used to guide empirical antibiotic therapy for SAB. A positive prior MRSA screening swab greatly increases likelihood of MRSA, necessitating MRSA coverage in empirical antibiotic therapy for SAB.
Impact on Health‐Related Quality of Life and Costs of Managing Chronic Neuropathic Pain in Academic Pain Centres: Results from a One‐Year Prospective Observational Canadian Study
Authors: Tarride J-E , Moulin DE , Lynch M , Clark AJ , Stitt L. , Gordon A , Morley-Forster PK , Nathan H , Smyth C , Toth C , Ware MA 
Published: March 2016

BACKGROUND: The management of chronic pain, including neuropathic pain (NeP), is a major public health issue. However, there is a paucity of data evaluating pain management strategies in real‐life settings.OBJECTIVE: To inform policy makers about the economic value of managing chronic NeP in academic centres by conducting a subeconomic assessment of a Canadian multicentre cohort study aimed at determining the long‐term outcomes of the management of chronic NeP in academic pain centres. Specific questions regarding the economic value of this type of program were answered by a subset of patients to provide further information to policy makers.METHODS: Baseline demographic information and several pain‐related measurements were collected at baseline, three, six and 12 months in the main study. A resource use questionnaire aimed at determining NeP‐related costs and the EuroQoL‐5 Dimension were collected in the subset study from consenting patients. Statistical analyses were conducted to compare outcomes over time and according to responder status.RESULTS: A total of 298 patients were evaluated in the present economic evaluation. The mean (± SD) age of the participants was 53.7±14.0 years, and 56% were female. At intake, the mean duration of NeP was >5 years. Statistically significant improvements in all pain and health‐related quality of life outcomes were observed between the baseline and one‐year visits. Use decreased over time for many health care resources (eg, visits to the emergency room decreased by one‐half), which resulted in overall cost savings.CONCLUSION: The results suggest that increased access to academic pain centres should be facilitated in Canada.
Grey Zones in the Diagnosis of Adult Migraine without Aura Based on the International Classification of Headache Disorders‐Iii Beta: Exploring the Covariates of Possible Migraine without Aura
Authors: Ozge Aynur , Aydinlar Elif , Tasdelen Bahar 
Published: March 2016

BACKGROUND: Exploring clinical characteristics and migraine covariates may be useful in the diagnosis of migraine without aura.OBJECTIVE: To evaluate the diagnostic value of the International Classification of Headache Disorders (ICHD)‐III beta‐based diagnosis of migraine without aura; to explore the covariates of possible migraine without aura using an analysis of grey zones in this area; and, finally, to make suggestions for the final version of the ICHD‐III.METHODS: A total of 1365 patients (mean [± SD] age 38.5±10.4 years, 82.8% female) diagnosed with migraine without aura according to the criteria of the ICHD‐III beta were included in the present tertiary care‐based retrospective study. Patients meeting all of the criteria of the ICHD‐III beta were classified as having full migraine without aura, while those who did not meet one, two or ≥3 of the diagnostic criteria were classified as zones I, II and III, respectively. The diagnostic value of the clinical characteristics and covariates of migraine were determined.RESULTS: Full migraine without aura was evident in 25.7% of the migraineurs. A higher likelihood of zone I classification was shown for an attack lasting 4 h to 72 h (OR 1.560; P=0.002), with pulsating quality (OR 4.096; P<0.001), concomitant nausea/vomiting (OR 2.300; P<0.001) and photophobia/phonophobia (OR 4.865; P<0.001). The first‐rank determinants for full migraine without aura were sleep irregularities (OR 1.596; P=0.005) and periodic vomiting (OR 1.464; P=0.026). However, even if not mentioned in ICHD‐III beta, the authors determined that motion sickness, abdominal pain or infantile colic attacks in childhood, associated dizziness and osmophobia have important diagnostic value.CONCLUSIONS: In cases that do not fulfill all of the diagnostic criteria although they are largely consistent with the characteristics of migraine in clinical terms, the authors believe that a history of infantile colic; periodic vomiting (but not periodic vomiting syndrome); recurrent abdominal pain; the presence of motion sickness or vertigo, dizziness or osmophobia accompanying the pain; and comorbid atopic disorder are characteristics that should to be discussed and considered as additional diagnostic criteria (covariates) in the preparation of the final version of ICHD‐III.