bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influenza Infection Screening Tools Fail to Accurately Predict Influenza Status for Hospitalized Patients During Pandemic H1N1 Influenza Season
Authors: Mulpuru Sunita , Roth Virginia R , Lawrence Nadine , Forster Alan J 
Published: March 2016

BACKGROUND: Following the severe acute respiratory syndrome outbreak in 2003, hospitals have been mandated to use infection screening questionnaires to determine which patients have infectious respiratory illness and, therefore, require isolation precautions. Despite widespread use of symptom‐based screening tools in Ontario, there are no data supporting the accuracy of these screening tools in hospitalized patients.OBJECTIVE: To measure the performance characteristics of infection screening tools used during the H1N1 influenza season.METHODS: The present retrospective cohort study was conducted at The Ottawa Hospital (Ottawa, Ontario) between October and December, 2009. Consecutive inpatients admitted from the emergency department were included if they were ≥18 years of age, underwent a screening tool assessment at presentation and had a most responsible diagnosis that was cardiac, respiratory or infectious. The gold‐standard outcome was laboratory diagnosis of influenza.RESULTS: The prevalence of laboratory‐confirmed influenza was 23.5%. The sensitivity and specificity of the febrile respiratory illness screening tool were 74.5% (95% CI 60.5% to 84.8%) and 32.7% (95% CI 25.8% to 40.5%), respectively. The sensitivity and specificity of the influenza‐like illness screening tool were 75.6% (95% CI 61.3% to 85.8%) and 46.3% (95% CI 38.2% to 54.7%), respectively.CONCLUSIONS: The febrile respiratory illness screening tool missed 26% of active influenza cases, while 67% of noninfluenza patients were unnecessarily placed under respiratory isolation. Results of the present study suggest that infection‐control practitioners should re‐evaluate their strategy of screening patients at admission for contagious respiratory illness using symptom‐ and sign‐based tests. Future efforts should focus on the derivation and validation of clinical decision rules that combine clinical features with laboratory tests.
Peripheral Interleukin‐1β Levels are Elevated in Chronic Tension‐Type Headache Patients
Authors: Vedova Chris Della , Cathcart Stuart , Dohnalek Alan , Lee Vanessa , Hutchinson Mark R , Immink Maarten A , Hayball John 
Published: March 2016

BACKGROUND: Tension‐type headache is the most common form of headache and its chronic form, chronic tension‐type headache (CTTH), is one of the most difficult to treat. The etiology of CTTH is not well understood, but is believed to be multifactorial and to vary among individuals. In the present study, the authors sought to identify common mechanisms of CTTH pathology. Empirical studies have implicated various immunomodulatory cytokines as mediators of chronic pain disorders, including CTTH.OBJECTIVES: To determine the role of peripheral cytokines and genetic factors in the development of CTTH.METHODS: A panel of cytokines hypothesized to play a role in the pathogenesis of CTTH was measured using cytometric bead arrays and ELISAs in 56 individuals with CTTH and 42 healthy control participants between 18 and 65 years of age.RESULTS: Levels of interleukin (IL)‐1β were significantly elevated in participants diagnosed with CTTH relative to healthy controls, while IL‐18 levels were found to be significantly elevated in men with CTTH. Because the levels of these immune mediators were increased in the apparent absence of injury or infection, the authors sought to determine whether genetic changes were responsible for fluctuations in cytokine levels. Polymerase chain reaction and restriction fragment length polymorphism analyses were used to determine individual genotypes at key single nucleotide polymorphism positions in the IL-1B gene. No association was observed between CTTH and single nucleotide polymorphisms in the IL‐1β gene.CONCLUSIONS: These findings suggest that increases in key proinflammatory cytokine levels are associated with CTTH and the pathology of the disorder involves sterile neurovascular inflammation.
Prolonged Treatment Duration is Required for SuccessfulHelicobacter pyloriEradication with Proton Pump Inhibitor Triple Therapy in Canada
Authors: Fallone Carlo A , Barkun Alan N , Szilagyi Andrew , Herba Karl M , Sewitch Maida , Martel Myriam , Fallone Stefanie S 
Published: March 2016

BACKGROUND: Traditional seven-day proton pump inhibitor triple therapy forHelicobacter pylorieradication has recently shown disappointing results outside of Canada. Prolonging therapy may be associated with poorer compliance and, hence, may not have a better outcome in a real-world setting.OBJECTIVE: To compare the outcomes of seven- and 14-day triple therapy for first-line treatment ofH pyloriinfection in an effectiveness setting in Canada.METHODS: A total of 314 consecutive treatment-naive, adultH pylori-infected patients were allocated to either a seven- or 14-day triple therapy regimen, with a subgroup of 172 consecutive patients quasi-randomized to treatment according to date of visit. Eradication was confirmed using either urea breath test or gastric biopsies. Analysis was by intention to treat.RESULTS: Eradication was achieved in a higher proportion of patients who underwent 14-day versus seven-day treatment regimens (overall: 85% versus 70% [P≤0.001]; subgroup: 83% versus 64% [P≤0.01]). Although successful eradication was also associated with older age and a diagnosis of ulcer disease, multivariate analysis revealed only longer treatment duration and lack of yogurt ingestion as independent predictors of successful eradication. There was a trend toward reduced success in the latter years of the study. Side effects were similar in both groups and were not prevented by yogurt ingestion.CONCLUSIONS: The currently recommended duration of proton pump inhibitor triple therapy in Canada should be increased from seven to 14 days, the latter having achieved an excellent result in this particular real-world setting. Yogurt added no benefit. Further study is required to compare 10-day with 14-day treatment regimens.
The Effects of Mindful Attention on Cold Pressor Pain in Children
Authors: Petter Mark , Chambers Christine T , Chorney Jill MacLaren 
Published: March 2016

BACKGROUND: Typical interventions for acute pain in children attempt to reduce pain by directing attention away from pain. Conversely, mindfulness involves devoting attention to one’s experience in an accepting and nonjudgmental way. However, the effect that instructing children to mindfully devote attention to acute pain has on pain outcomes is unknown.OBJECTIVES: To examine whether mindful attention can help children attend to pain without increasing pain intensity or decreasing pain tolerance; to compare the effects of mindful attention with a well‐established intervention designed to take attention away from pain (guided imagery); and to test whether baseline coping style or trait mindfulness alter the effects of these interventions.METHODS: A total of 82 children (10 to 14 years of age) completed measures of coping style and trait mindfulness. Participants then received either mindful attention or guided imagery instructions designed to direct attention toward or away from pain, respectively, before participating in a cold pressor task.RESULTS: The mindful attention group reported more awareness of the physical sensations of pain and thoughts about those sensations. Overall, there were no between‐group differences in measures of pain intensity or pain tolerance during the cold pressor task, and no evidence of an interaction between baseline characteristics of the child and experimental condition.CONCLUSIONS: Mindful attention was successful in helping children focus attention on experimental pain without increasing pain intensity or decreasing tolerance compared with a well‐established intervention for acute pain reduction.
Liver Transplantation for Alcoholic Liver Disease among Canadian Transplant Centres: A National Study
Authors: Chandok Natasha , Aljawad Mohammed , White Angela , Hernandez-Alejandro Roberto , Marotta Paul , Yoshida Eric M 
Published: March 2016

BACKGROUND/OBJECTIVE: Alcoholic liver disease (ALD) is a controversial yet established indication for liver transplantation (LT), and there is emerging evidence supporting a survival benefit in selected patients with severe acute alcoholic hepatitis. The aim of the present survey was to describe policies among Canadian transplant centres for patients with ALD.METHODS: A survey was distributed to the medical directors of all seven liver transplant centres in Canada.RESULTS: All seven liver transplant programs in Canada participated in the survey. Every centre requires patients to have a minimum of six months of abstinence from alcohol before listing for LT. Completion of a rehabilitation program is only mandatory in one program; the remaining programs do not mandate this if patients have demonstrated prolonged abstinence, and sufficient insight and social supports. No program considers LT for patients with severe acute alcoholic hepatitis, although six of the seven programs are interested in exploring a national policy. Random alcohol checks for waitlisted patients are performed routinely on patients listed for ALD at only one centre; the remaining centres only perform checks if there is clinical suspicion. In the past five years, the mean (± SD) number of patients per centre with graft dysfunction from recidivism was 10±4.36; a mean of 2.5±4.36 patients per centre developed graft failure.CONCLUSIONS: With minor exceptions, LT policies for subjects with ALD are uniform across Canadian transplant programs. Presently, no centres perform LT for acute alcoholic hepatitis, although there is broad interest in exploring a national policy. Recidivism resulting in graft loss is a rare phenomenon.
Development and pilot testing of a mobile health solution for asthma self‐management: Asthma action plan smartphone application pilot study
Authors: Licskai Christopher J , Sands Todd W , Ferrone Madonna 
Published: March 2016

BACKGROUND: Collaborative self‐management is a core recommendation of national asthma guidelines; the written action plan is the knowledge tool that supports this objective. Mobile health technologies have the potential to enhance the effectiveness of the action plan as a knowledge translation tool.OBJECTIVE: To design, develop and pilot a mobile health system to support asthma self‐management.METHODS: The present study was a prospective, single‐centre, nonrandomized, pilot preintervention‐postintervention analysis. System design and development were guided by an expert steering committee. The network included an agnostic web browser‐based asthma action plan smart‐phone application (SPA). Subjects securely transmitted symptoms and peak flow data daily, and received automated control assessment, treatment advice and environmental alerts.RESULTS: Twenty‐two adult subjects (mean age 47 years, 82% women) completed the study. Biophysical data were received on 84% of subject days (subject day = 1 subject × 1 day). Subjects viewed their action plan current zone of control on 54% and current air quality on 61% of subject days, 86% followed self‐management advice and 50% acted to reduce exposure risks. A large majority affirmed ease of use, clarity and timeliness, and 95% desired SPA use after the study. At baseline, 91% had at least one symptom criterion for uncontrolled asthma and 64% had ≥2, compared with 45% (P=0.006) and 27% (P=0.022) at study close. Mean Asthma Quality of Life Questionnaire score improved from 4.3 to 4.8 (P=0.047).CONCLUSIONS: A dynamic, real‐time, interactive, mobile health system with an integrated asthma action plan SPA can support knowledge translation at the patient and provider levels.
Burden of Rotavirus Disease: A Population‐Based Study in Eastern Townships, Quebec
Authors: Bernard Sylvain , Valiquette Louis , De Wals Philippe , Nault Vincent , Babakissa Corentin , Cyr Claude , Boileau Thérèse Côté , Gagneur Arnaud 
Published: March 2016

BACKGROUND: Since July 2010, the National Advisory Committee on Immunization of Canada has recommended rotavirus vaccination for all healthy infants. However, before implementing this vaccine in routine health programs, Canadian provinces need to establish current epidemiological data on rotavirus‐associated acute gastroenteritis (AGE).METHODS: A retrospective cohort study of children <5 years of age with AGE from 2002 to 2008 was performed in Eastern Townships, Quebec (population in 2006: 298,780). Data were collected on visits to outpatient clinics, emergency department (ED) visits, hospitalizations (standard and short‐stay units) and nosocomial AGE. The winter residual estimation and Brandt methods were used to estimate the proportion of AGE attributable to rotaviruses.RESULTS: During the six‐year study period, a total of 1435 hospitalizations, 3631 ED visits and 6220 ambulatory care visits were attributed to AGE. The specific rotavirus burden was estimated to be 449 to 666 for hospitalizations, 1050 to 1361 for ED visits and 1633 to 1687 for outpatient visits. The epidemic curve showed a periodicity with higher incidence in March and April. Short‐stay unit hospitalizations represented 58% of all hospitalizations. The annual incidence rate of rotaviruses was estimated to be 50 to 74 per 10,000 children for hospitalizations, 117 to 152 per 10,000 children for ED visits and 182 to 188 per 10,000 children for outpatient visits.CONCLUSION: Most available retrospective studies probably underestimate rotavirus‐associated hospitalizations because they do not take into account short‐stay unit hospitalizations. Furthermore, these data on emergency and outpatient visits provide an exhaustive appraisal of the rotavirus burden, which serves as crucial information for the evaluation of immunization programs.
Local and Systemic Oxidative Stress and Glucocorticoid Receptor Levels in Chronic Obstructive Pulmonary Disease Patients
Authors: Zeng Mian , Li Yue , Jiang Yujie , Lu Guifang , Huang Xiaomei , Guan Kaipan 
Published: March 2016

BACKGROUND: Previous studies have indicated that oxidative stress plays an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD).OBJECTIVES: To study local and systemic oxidative stress status in COPD patients, and to clarify the relationship between local and systemic oxidative stress.METHODS: Lipid peroxide malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD) and GSH peroxidase (GSH-PX) levels in induced sputum and plasma, as well as glucocorticoid receptor (GR) levels in peripheral blood leukocytes were examined in 43 acute exacerbation of COPD patients (group A), 35 patients with stable COPD (group B) and 28 healthy controls (14 smokers [group C]; 14 nonsmokers [group D]).RESULTS: MDA levels in induced sputum and plasma decreased progressively in groups A to D, with significant differences between any two groups (P<0.001). GSH, SOD and GSH-PX levels in both induced sputum and plasma increased progressively in groups A to D, with significant differences between any two groups (P<0.001). GR levels in peripheral blood leukocytes decreased progressively in groups D to A (all comparisons P<0.001). Pearson analysis revealed strong correlations between MDA, GSH, SOD and GSH-PX levels in plasma and induced sputum. The activity of SOD in plasma and sputum were both positively correlated with GR levels (partial correlation coefficients 0.522 and 0.574, respectively [P<0.001]).CONCLUSIONS: Oxidative stress levels were elevated in COPD patients. There was a correlation between local and systemic oxidative status in COPD, and between decreased SOD activity and decreased GR levels in COPD patients.
Vaccine Knowledge in Students in Paris, France, and surrounding Regions
Authors: Mellon Guillaume , Rigal Laurent , Partouche Henri , Aoun Olivier , Jaury Philippe , Joannard Nathalie , Guthmann Jean Paul , Cochereau Delphine , Caumes Eric , Bricaire Francois , Salmon-Céron Dominique 
Published: March 2016

INTRODUCTION: In France, young adults are legally freed from parental authority at the age of 18 years and are, thus, responsible for their own vaccine record. This young adult population is more frequently exposed to vaccine‐preventable infectious diseases.OBJECTIVE: To determine the factors associated with students’ knowledge of the interval between two antitetanus boosters and their report of having up‐to‐date vaccinations.METHODS: In April 2009, a survey was conducted involving a random sample of students between 18 and 25 years of age eating lunch at university dining facilities in Paris and its suburbs (Ile de France).RESULTS: Among the 677 students approached, 583 agreed to participate. Only 207 (36%) of respondents knew the recommended dosing interval between two doses of tetanus vaccine booster (10 years). The majority of students (69%) reported having up‐to‐date vaccinations. Declaring having up‐to‐date vaccinations was significantly associated with having a general practitioner (OR 3.03 [95% CI 1.69 to 5.55]). Health care students were significantly more likely to know the decennial interval between two antitetanus boosters (OR 2 [95% CI 1.28 to 3.25]). Most of responding students (n=519 [89%]) believed that vaccines were very useful.CONCLUSIONS: An overall lack of knowledge of vaccines was observed among this student population. Health care providers, such as GPs and university medical practice staff, who interact with these young individuals have an essential role to promote better vaccination coverage in this population.
Airway Pressure and Transpulmonary Pressure During High-Frequency Oscillation for Acute Respiratory Distress Syndrome
Authors: Henderson William R , Dominelli Paolo B , Griesdale Donald EG , Talmor Daniel , Sheel A William 
Published: March 2016

BACKGROUND: High-frequency oscillation (HFO) is used for the treatment of refractory hypoxic respiratory failure.OBJECTIVE: To demonstrate that the mean transpulmonary pressure (PL) cannot be inferred from mean airway pressure (mPaw).METHODS: In seven patients already undergoing HFO for refractory acute respiratory distress syndrome, esophageal pressure (Pes) was measured using an esophageal balloon catheter. Pleural pressure (Ppl) and PLwere calculated from Pes.MAIN RESULTS: In the seven patients (mean [± SD] age 59±9 years) treated with HFO at 5±1 Hz and amplitude 75±10 cmH2O, the mPaw was 27±6 cmH2O, Ppl was 9±6 cmH2O and PLwas 18±11 cmH2O. Successful catheter placement and measurement of Pes occurred in 100% of subjects. There was no correlation between PLand mPaw. The majority of subjects required hemodynamic support during the use of HFO; the frequency and degree of support during the study period was no different than that before the study.CONCLUSION: The present report is the first to describe measuring Pes and calculating Ppl during HFO for acute respiratory distress syndrome. While both current guidelines and recent trials have titrated treatment based on mPaw and oxygenation, there is wide variability in PLduring HFO and PLcannot be predicted from mPaw.
The Process of Acceptance among Rheumatoid Arthritis Patients in Switzerland: A Qualitative Study
Authors: Kostova Zlatina , Caiata-Zufferey Maria , Schulz Peter J 
Published: March 2016

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, painful disease with many injurious psychological effects. Acceptance is an important component of pain management and is associated with improved quality of life, and lower levels of pain and depression. While studies have begun to identify the stages of acceptance, little is known about factors influencing the ease and speed with which patients pass through these stages.OBJECTIVE: To explore the main stages through which RA patients pass and the strategies they adopt to learn to live with the pain, and to identify factors shaping patients’ capacities to achieve acceptance.METHODS: A qualitative study involving 20 semistructured interviews with RA patients in the Italian‐speaking region of Switzerland was conducted. Analysis of the data followed the precepts of grounded theory.RESULTS: Although the present study revealed that acceptance is not a smooth or linear process, five main stages in patients’ struggles to accommodate the newly imposed limitations were, nonetheless, identified: naming the illness; realizing the illness; resisting the illness; ‘hitting the bottom’; and integrating the illness. Diagnosis proved to be an especially tortuous stage in the case of RA, and the effects of delayed diagnosis continued to be felt during the subsequent stages. Patients’ understanding of the notion of acceptance and the strategies that they used to achieve it were also explored.CONCLUSIONS: Diagnosis of RA is notoriously difficult. Beyond the clinical difficulties, structural reasons for late diagnosis (symptoms being neglected by patients and medical professionals) were identifed. Delayed diagnosis hindered the acceptance process throughout, and led to more resistant behaviour and to a struggle to achieve the optimal formula for acceptance – accepting the losses of prepain life while still pursuing personal goals.
Initial Pain Management Plans in Response to Severe Pain Indicators on Oncology Clinic Previsit Questionnaires
Authors: Sanatani Michael S , Kattan Maan , Moulin Dwight E 
Published: March 2016

BACKGROUND: The issue of how to address patient pain in the outpatient setting remains challenging. At the London Regional Cancer Program (London, Ontario), patients complete the Edmonton Symptom Assessment System (ESAS) before most visits.OBJECTIVES:To perform a chart review assessing the frequency and, if applicable, the type of a clinical care plan that was developed if a patient indicated pain ≥7 on a 10‐point scaleMETHODS: The charts of 100 eligible sequential outpatient visits were reviewed and the initial pain management approaches were documented.RESULTS: Between December 2011 and May 2012, visits by 7265 unique patients included 100 eligible visits (pain ≥7 of 10). In 83 cases, active pain management plans, ranging from counselling to hospital admission, were proposed. Active pain management plans were more likely if the cause was believed to be cancer/treatment related: 63 of 65 (96.9%) versus 20 of 35 (57.1%, noncancer/unknown pain cause); P<0.001. There were no differences depending on cancer treatment intent or medical service.CONCLUSIONS: Active pain management plans were documented in 83% of visits. However, patients who reported severe pain that was assessed as benign or unknown in etiology received intervention less frequently, perhaps indicating that oncologists either consider themselves less responsible for noncancer pain, or believe that pain chronicity may lead to a higher ESAS pain score without indicating a need for acute intervention. Further study is needed to determine the subsequent effect of the care plans on patient‐reported ESAS pain scores at future clinic visits.Erratum to “Initial Pain Management Plans in Response to Severe Pain Indicators on Oncology Clinic Previsit Questionnaires”dx.doi.org/10.1155/2015/404187