bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infrared Therapy for Chronic Low Back Pain: A Randomized, Controlled Trial
Authors: Gale George D , Rothbart Peter J , Li Ye 
Published: March 2016

OBJECTIVE: The objective of the present study was to assess the degree of pain relief obtained by applying infrared (IR) energy to the low back in patients with chronic, intractable low back pain.METHODS: Forty patients with chronic low back pain of over six years’ duration were recruited from patients attending the Rothbart Pain Management Clinic, North York, Ontario. They came from the patient lists of three physicians at the clinic, and were randomly assigned to IR therapy or placebo treatment. One patient dropped out of the placebo group; as a result, 21 patients received IR therapy and 18 recieved placebo therapy. The IR therapy was provided by two small, portable units in a sturdy waistband powered by small, rechargeable batteries made by MSCT Infrared Wraps Inc (Canada). These units met safety standards for Food and Drug Administration portability, and are registered with the Food and Drug Administration as a therapeutic device. The unit converted electricity to IR energy at 800 nm to 1200 nm wavelength. The treated group received IR therapy. The placebo group had identical units, but the power was not connected to the circuit‐board within the IR pad. Patients attended seven weekly sessions. One baseline and six weekly sets of values were recorded. The principle measure of outcome was pain rated on the numerical rating scale (NRS). The pain was assessed overall, then rotating and bending in different directions.RESULTS: The mean NRS scores in the treatment group fell from 6.9 of 10 to 3 of 10 at the end of the study. The mean NRS in the placebo group fell from 7.4 of 10 to 6 of 10.CONCLUSION: The IR therapy unit used was demonstrated to be effective in reducing chronic low back pain, and no adverse effects were observed.
Commonly Used Preparations for Colonoscopy: Efficacy, Tolerability and Safety – A Canadian Association of Gastroenterology Position Paper
Authors: Barkun Alan , Chiba Naoki , Enns Robert , Marcon Margaret , Natsheh Susan , Pham Co , Sadowski Dan , Vanner Stephen 
Published: March 2016

INTRODUCTION: The increased demand for colonoscopy, coupled with the introduction of new bowel cleansing preparations and recent caution advisories in Canada, has prompted a review of bowel preparations by the Canadian Association of Gastroenterology.METHODS: The present review was conducted by the Clinical Affairs group of committees including the endoscopy, hepatobiliary/transplant, liaison, pediatrics, practice affairs and regional representation committees, along with the assistance of Canadian experts in the field. An effort was made to systematically assess randomized prospective trials evaluating commonly used bowel cleansing preparations in Canada.RESULTS: Polyethylene glycol (PEG)-; sodium phosphate (NaP)-; magnesium citrate (Mg-citrate)-; and sodium picosulphate, citric acid and magnesium oxide (PSMC)-containing preparations were reviewed. Regimens of PEG 2 L with bisacodyl (10 mg to 20 mg) or Mg-citrate (296 mL) are as effective as standard PEG 4 L regimens, but are better tolerated. NaP preparations appear more effective and better tolerated than standard PEG solutions. PSMC has good efficacy and tolerability but head-to-head trials with NaP solutions remain few, and conclusions equivocal. Adequate hydration during preparation and up to the time of colonoscopy is critical in minimizing side effects and improving bowel cleansing in patients receiving NaP and PSMC preparations. All preparations may cause adverse events, including rare, serious outcomes. NaP should not be used in patients with cardiac or renal dysfunction (PEG solution is preferable in these patients), bowel obstruction or ascites, and caution should be exercised when used in patients with pre-existing electrolyte disturbances, those taking medications that may affect electrolyte levels and elderly or debilitated patients. Health Canada’s recommended NaP dosing for most patients is two 45 mL doses 24 h apart. However, both safety and efficacy data on this dosing schedule are lacking. Many members of the Canadian Association of Gastroenterology expert panel administer both doses within 24 h, as studied in clinical trials, after careful one-on-one discussion of risks and benefits in carefully selected patients. Safety data on PSMC and combination preparations in North America are limited and clinicians are encouraged to keep abreast of developments in this area.CONCLUSIONS: All four preparations reviewed provided effective bowel cleansing for colonoscopy in the majority of patients, with varying tolerability. Adequate hydration is essential in patients receiving the preparations.
Oral Corticosteroid Use and the Risk of Acute Myocardial Infarction in Chronic Obstructive Pulmonary Disease
Authors: Huiart Laetitia , Ernst Pierre , Ranouil Xavier , Suissa Samy 
Published: March 2016

BACKGROUND: Given the limited efficacy of oral corticosteroids in treating chronic obstructive pulmonary disease (COPD), the possible cardiac side effects of oral corticosteroids are of particular concern in an elderly population. The impact of the use of oral corticosteroids on the risk of acute myocardial infarction (AMI) in a cohort of patients with COPD was studied.METHODS: The Saskatchewan health services databases were used to form a population‐based cohort of 5648 patients aged 55 years or older who received a first treatment for COPD between 1990 and 1997. A nested case‐control analysis was conducted: 371 cases presenting with a first myocardial infarction were matched with 1864 controls according to the length of follow‐up, the date of cohort entry and age. Conditional logistic regression was used to adjust for sex, severity of COPD, systemic hypertension, diabetes and prior cardiovascular disease.RESULTS: Only the current use of corticosteroids was associated with an increased risk of AMI (adjusted RR=2.01 [95% CI 1.13 to 3.58]), particularly when the current dose was larger than 25 mg/day of prednisone or the equivalent (adjusted RR=3.22 [95% CI 1.42 to 7.34]). This observed increase in risk rapidly returned to baseline after the cessation of the medication, suggesting that the use of such high doses reflected the treatment of acute exacerbations of the disease.CONCLUSIONS: An association was found between the current use of oral corticosteroids and the occurrence of an AMI, suggesting that acute exacerbations of COPD are associated with an increased risk of acute coronary syndromes.
Prevalence of Work‐Related Respiratory Symptoms in Iranian Farmers
Authors: Hashemi N , Mirsadraee M , Shakeri MT , Varasteh AR 
Published: March 2016

BACKGROUND: Animal exposure may be an important trigger for work‐related symptoms among farmers.OBJECTIVE: To estimate the prevalence of work‐related respiratory symptoms (WRS) in sheep breeders and agricultural farmers and to determine work‐related risk factors.METHODS: A family doctor used a questionnaire to interview a cohort of 173 farmers comprised of 127 sheep breeders and 46 agricultural farmers in the rural area of Rokh (northeast Iran). The questionnaire pertained to recurrent wheezing, cough, breathlessness or chronic phlegm while at work (these symptoms define WRS), flu‐like illness and physician‐diagnosed asthma.RESULTS: There were 71 subjects (41%) with WRS: 10 of 46 agricultural farmers (21.7%) and 61 of 127 sheep breeders (48.0%). The proportions of sheep breeders with wheezing (16.5%), asthma (14%), cough (29%), breathlessness (31.5%) and flu‐like illness (38%) were higher than in agricultural farmers. A significant dose‐response relationship among the daily hours worked with animals, the number of animals and the prevalence of symptoms was established for sheep farmers. Sheep shearing and the use of pesticide were associated with an increased risk of wheezing and phlegm.CONCLUSIONS: The results suggest that sheep farmers in general have higher rates of work‐related symptoms than agricultural farmers. The severity of work‐related symptoms will increase with an increase in frequency of animal contact; therefore, these results may underestimate the impact of this exposure.
Canadian Physicians’ Choices for Their Own Colon Cancer Screening
Authors: Raza Mamoon , Bernstein Charles N , Ilnyckyj Alexandra 
Published: March 2016

INTRODUCTION: Compliance with colorectal cancer (CRC) screening in Canada is low. The aim of the present survey was to determine whether Canadian physicians older than 50 years were pursuing colon cancer screening. Specifically, physicians were asked to identify their modality of choice and identify their barriers to screening.METHODS: Surveys were mailed to members, older than 50 years, of the Canadian Association of Gastroenterology, the Society of Obstetricians and Gynaecologists of Canada, the Canadian Society of Internal Medicine, the Canadian Psychiatric Association and the Canadian Association of Radiologists.RESULTS: Of 2807 surveys, 46% were returned. Screening for CRC was reported by 53% of respondents. The Canadian Association of Radiologists members (61%) and the Canadian Association of Gastroenterology members (61%) were more likely to be screened than other specialties (P<0.01 and P<0.05, respectively). Members of the Society of Obstetricians and Gynaecologists of Canada (44%) were least likely to be screened (P<0.001). Men (P<0.001) and Ontario physicians (P<0.01) were more likely to be screened than women and Canadian physicians from other provinces, respectively. Colonoscopy (56%) was the most common screening modality used, followed by fecal occult blood testing (27%). Respondents who had not been screened cited a lack of personal time (47%) and insufficient data to warrant screening (14%).DISCUSSION: More than one-half of all respondents were screened for CRC. Colonoscopy is the most common screening modality used. Lack of time is the most common reason cited for not participating in CRC screening.
Antimicrobial Resistance among Salmonella and Shigella Isolates in Five Canadian Provinces (1997 to 2000)
Authors: Martin Leah J , Flint James , Ravel André , Dutil Lucie , Doré Kathryn , Louie Marie , Jamieson Frances , Ratnam Sam 
Published: March 2016

OBJECTIVE: To describe rates of antimicrobial resistance (AMR) among Salmonella and Shigella isolates reported in five Canadian provinces, focusing on clinically important antimicrobials.METHODS: The authors retrospectively investigated AMR rates among 6219 Salmonella and 1673 Shigella isolates submitted to provincial public health laboratories in Alberta, Newfoundland and Labrador, Ontario, Prince Edward Island and Saskatchewan from 1997 to 2000; these isolates were estimated to represent 41% of Salmonella cases and 72% of Shigella cases reported by the study provinces.RESULTS: Among Salmonella isolates, 27% (1704 of 6215) were resistant to ampicillin, 2.2% (135 of 6122) to trimethoprim/sulfamethoxazole, 1.5% (14 of 938) to nalidixic acid, 1.2% (one of 84) to lomafloxacin and 0.08% (five of 6163) to ciprofloxacin. Among Shigella isolates, 70% (1144 of 1643) were resistant to trimethoprim/sulfamethoxazole, 65% (1079 of 1672) to ampicillin, 3.1% (eight of 262) to nalidixic acid, 0.49% (eight of 1636) to ciprofloxacin, 0.14% (one of 700) to ceftriaxone and 0.08% (one of 1292) to ceftazidime.CONCLUSIONS: Higher rates of resistance to clinically important antimicrobials (including ciprofloxacin) were observed among both Salmonella and Shigella isolates than has previously been reported. Current Canadian data on rates of AMR for these pathogens are required.
Pain Due to Multiple Sclerosis: Analysis of the Prevalence and Economic Burden in Canada
Authors: Piwko Charles , Desjardins Olivier B , Bereza Basil G , Machado Marcio , Jaszewski Barbara , Freedman Mark S , Einarson Thomas R , Iskedjian Michael 
Published: March 2016

BACKGROUND: Multiple sclerosis (MS) is a neurological disease affecting approximately 50,000 Canadians. Although studies have described overall MS costs, none have focused specifically on MS‐related pain.OBJECTIVES: To estimate the prevalence of MS‐related pain in Canada, the proportion of patients treated and responding to treatment for MS‐related pain, and the associated economic burden.METHODS: Results were captured through physician and patient surveys. Patients were recruited through MS clinics and the MS Society. Patient‐reported outcomes and resource utilization over the previous six months were collected by telephone interview. Costs were measured in 2004 Canadian dollars. The economic burden was extrapolated to the population using national demographics and prevalence. Spearman’s ρ assessed the relationship between cost and pain severity.RESULTS: Physicians estimated that 46% of their MS patients experienced MS‐related pain, and that 35% received treatment for pain. Pain was reported to be relieved somewhat in 29%±10% of their patients, adequately in 26%±19% and poorly in 27%±13%, while 17%±9% received no relief. Two hundred ninety‐seven participants completed the patient survey. Seventy‐one per cent (211 of 297 patients) experienced MS‐related pain. Eighty per cent of patients reported taking some type of medication to manage their pain, and of these, 82% reported some reduction in pain. The mean ± SD direct cost per patient of MS‐related pain was $2,528±5,695. The mean ± SD indirect cost per patient was $669±875. Total costs were positively correlated with levels of self‐reported pain (ρ=0.291, P<0.0001). The estimated six‐month burden of pain of MS patients in Canada was $79,444,888.CONCLUSIONS: The prevalence of pain is high in MS patients. This condition may be underdiagnosed and undertreated, and results in a significant economic burden on society.
Usefulness and Impact on Management of Positive and Negative Capsule Endoscopy
Authors: Chami George , Raza Mamoon , Bernstein Charles N 
Published: March 2016

OBJECITIVE: To determine the usefulness of positive and negative capsule endoscopies (CEs), and the impact of each on short- and long-term patient management.METHODS: Medical records were reviewed for 70 consecutive CE patients. Based on outcomes from referring physicians, it was determined whether CE was useful, partially useful or not useful at all in the overall patient management, and whether CE assisted in providing a diagnosis, and impacted on short-term long-term management.RESULTS: CE indications included overt bleeding (37%), occult bleeding (20%), iron deficiency (17%), abdominal pain and weight loss (13%), assessing the extent of or confirming a diagnosis of Crohn’s disease (9%) and screening for familial adenomatous polyposis (4%). Positive studies were seen in 58% of overt bleeds, 50% of occult bleeds, 33% of iron deficiencies and 33% of Crohn’s diseases. Overall, 28 studies (40%) were positive studies and 42 (60%) were negative studies. CE aided in diagnosis in 11 of 28 (39%) positive and 12 of 42 (29%) negative studies (P=0.35). Positive and negative CEs had an impact on short-term management in 12 of 28 (43%) versus 18 of 42 (43%) cases, respectively (P=1.0), and on long-term management in 14 of 28 (50%) versus 15 of 42 (36%) cases, respectively (P=0.23). For positive and negative studies, respectively, CE was considered useful in 12 of 28 (43%) versus 15 of 42 (36%) cases (39% overall), partially useful in 10 of 28 (36%) versus 10 of 42 (24%) cases (28% overall), and not useful at all in six of 28 (21%) versus 17 of 42 (40%) cases (33% overall).CONCLUSIONs: Although a negative CE may aid in making a definitive diagnosis in only 29% of patients, its effect on management and overall usefulness is similar to that of a positive CE. A physician’s decision on whether to order CE should not be based solely on the pretest probability of a positive examination but also on the clinical utility of a negative study.
Sputum Neutrophilia Can Mask Eosinophilic Bronchitis During Exacerbations
Authors: D’silva Liesel , Allen Christopher J , Hargreave Frederick E , Parameswaran Krishnan 
Published: March 2016

BACKGROUND: Exacerbations of airway disease are eosinophilic, neutrophilic, both or neither. The primary objective of the present study was to identify whether the treatment of a neutrophilic bronchitis can unmask an associated eosinophilia.METHODS: A retrospective survey of 2160 consecutive sputum cell counts from 1343 patients with airway disease was conducted to identify patients with an isolated neutrophilic bronchitis, which was defined as a sputum total cell count of greater than or equal to 12×106 cells/g of sputum and a proportion of neutrophils of 80% or greater. The characteristics of the patients who subsequently demonstrated sputum eosinophilia (3% or greater) within eight weeks of resolving the neutrophilia were compared with the patients who subsequently did not have sputum eosinophilia.RESULTS: Two hundred thirty‐seven patients had 273 neutrophilic exacerbations. The sputum was re‐examined within eight weeks in 65 patients (27.4%), of whom 38 (58.5%) had resolution of the neutrophilic bronchitis after treatment with an antibiotic. Of these 38 patients, 13 (34%) showed eosinophilia.CONCLUSIONS: A neutrophilic exacerbation of airway disease was observed to mask sputum eosinophilia in one‐third of patients who had sputum cell counts available before and after antibiotic therapy. Hence, the absence of sputum eosinophilia during an infective exacerbation should not be used as an indication to reduce the dose of corticosteroids. To optimize therapy, repeat sputum cell count measurements are recommended after antibiotic treatment before changing corticosteroid treatment.
A Randomized Controlled Trial to Assess the Efficacy of Tiotropium in Canadian Patients with Chronic Obstructive Pulmonary Disease
Authors: Chan Charles KN , Maltais François , Sigouin Chris , Haddon Jennifer M , Ford Gordon T , on behalf of the SAFE Study Group  
Published: March 2016

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) who smoke have a greater annual rate of decline in forced expiratory volume in 1 s (FEV1) than those patients who have stopped smoking.OBJECTIVES: To assess the effect of tiotropium on pre‐dose (trough) FEV1 in patients with COPD followed in Canada.METHODS: A total of 913 patients were randomly assigned to receive either tiotropium 18 μg once daily (n=608) or placebo (usual care minus inhaled anticholinergics) (n=305) for 48 weeks in the present randomized, double‐blind, parallel‐group study. The effect of tiotropium on measurements of lung function (FEV1, FEV6 and forced vital capacity), symptoms, health‐related quality of life (St George’s Respiratory Questionnaire) and exacerbations were examined.RESULTS: Tiotropium improved trough FEV1 in both current and ex‐smokers compared with placebo. Baseline FEV1 in smokers and ex‐smokers was 1.03 L and 0.93 L, respectively (P<0.001). At week 48, the mean difference between the tiotropium and placebo groups was 0.14±0.04 L (P<0.001) in the smoker group and 0.08±0.02 L (P<0.0001) in the ex‐smoker group. Tiotropium also significantly improved trough forced vital capacity and FEV6 compared with placebo throughout the treatment period (P<0.05, for all). Furthermore, tiotropium significantly improved the St George’s Respiratory Questionnaire total score compared with placebo at week 48 (40.9 versus 43.7 units, P<0.005).CONCLUSIONS: Compared with the placebo group, tiotropium provides sustained improvements in lung function in patients with COPD, with improvements for smokers and ex‐smokers.
Cost‐Effectiveness of Various Diagnostic Approaches for Occupational Asthma
Authors: Kennedy Wendy A , Girard Frédéric , Chaboillez Simone , Cartier André , Côté Johanne , Hargreave Frederick , Labrecque Manon , Malo Jean-Luc , Tarlo Susan M , Redlich Carrie A , Lemière Catherine 
Published: March 2016

BACKGROUND: Diagnosis of occupational asthma (OA) by specific inhalation challenge (SIC) can be costly and is not always available. The use of sputum testing to avoid this in some patients may be a more cost‐effective alternative.OBJECTIVES: To compare the cost‐effectiveness of SIC with serial measurements of sputum cell counts (sputum testing) and peak expiratory flow (PEF) monitoring.METHODS: Clinical data and testing costs for OA in 49 patients were collected during a previously published trial, modelled and compared using TreeAge Pro. Clinical outcome was the percentage of accurately diagnosed patients, using SIC as the gold standard. The PEF approach used the most accurate assessment of five experts who were blinded to SIC results. Differences in the proportion of eosinophils during periods on and off work were used for the sputum testing approach and in PEF/sputum for the combined approach. Unit costs were estimated from charges in Canadian hospitals. Data were analyzed by one‐way and two‐way analyses, and by probabilistic sensitivity analysis using a Monte Carlo simulation technique.RESULTS: The PEF approach had an estimated accuracy of 52% and cost $365 per patient tested. Compared with PEF monitoring, sputum testing was more accurate and cost an estimated $255 for each additional OA patient correctly diagnosed. SIC costs per additional correct diagnosis were $11,032 compared with sputum testing and $6,458 compared with PEF monitoring. The combined PEF/sputum testing approach was not cost‐effective in the base case analysis, but cannot be excluded according to probabilistic sensitivity analyses.CONCLUSIONS: Although SIC remains the reference test to diagnose OA, when this test is not available, sputum testing is a cost‐effective alternative to PEF for diagnosis of OA.
Prevalence of Screening in Patients Newly Diagnosed with Colorectal Cancer in Ontario
Authors: Taylor Chelsea , Schultz Susan E , Paszat Lawrence F , Bondy Susan , Rabeneck Linda 
Published: March 2016

OBJECTIVES: The primary objective was to determine the proportion of individuals with a new diagnosis of colorectal cancer (CRC) in Ontario in whom the cancer was screen detected. The secondary objectives were to determine the cancer stage at diagnosis and the indications for the procedure in patients who received their first colonoscopy.PATIENTS AND METHODS: Individuals admitted to a hospital with a new diagnosis of CRC were randomly selected after stratifying by hospital type (teaching or community). The Canadian Institute for Health Information’s Discharge Abstract Database was used to identify individuals with a first diagnosis of CRC during calendar year (CY) 2000, and Ontario Health Insurance Plan data were used to identify people 50 to 74 years of age who had their first colonoscopy during CY 2000. Up to 20 individuals were selected for each group (CRC or colonoscopy) in each of seven randomly selected community hospitals and three randomly selected teaching hospitals. Data were abstracted from the hospital charts.RESULTS: The hospital charts of 152 patients with a new diagnosis of CRC were examined. Of the 133 patients in whom screening status could be determined, eight had screen-detected cancers (6.0%). Of the 99 patients (65% of the sample) in whom stage could be determined, 43 (43.4%) had advanced disease (tumour-node-metastasis stage III or IV) at diagnosis. The hospital charts of 184 patients who underwent their first colonoscopy were examined. Of the 175 patients in whom the indication for colonoscopy could be determined, 45 underwent the procedure for screening purposes, 10 were for diagnostic workup of anemia and 120 for evaluation of symptoms.CONCLUSIONS: The low proportion (6%) of screen-detected CRC and the high proportion of patients (43.4%) with advanced disease at diagnosis reflect the lack of an organized screening program.