bluuebunny/crossref_metadata_2025_split huggingface dataset:
Triage and Protocol Recommendations for the Parasitology Laboratory Based on an Epidemiological Investigation of Parasite Diagnostics in Ontario Laboratories
Authors: Maier Allison , Krolik Julia , Majury Anna 
Published: March 2016

OBJECTIVES:A study was performed using a subset of Ontario laboratory parasitology data, with three objectives: to describe parasitic infections in Ontario; to identify risk factors for acquiring a parasitic infection using routinely collected information; and to use this information to assess current protocols for parasite testing in laboratories and, in turn, to propose alternatives to optimize the allocation of laboratory resources.METHODS: All parasitology records from January 4, 2010 to September 14, 2010 were reviewed descriptively and risk factor analyses were performed using information collected from requisitions. These results were used to develop preliminary alternative protocols, which considered high‐throughput screening tests and inclusion/exclusion criteria for ova and parasite testing; these were then retrospectively analyzed with the dataset to determine appropriateness.RESULTS: Of the 29,260 records analyzed, 10% were multiple samples from single patients submitted on the same day, of which 98% had the same result. Three percent of all parasite tests were positive, with the most prevalent parasites being (in ascending order) Dientamoeba fragilis, Giardia lamblia, Cryptosporidium species and Entamoeba histolytica/dispar. Age and sex were found to be weak risk factors, while rural living was found to be a moderate risk factor for D fragilis, G lamblia and Cryptosporidium infections. The strongest risk factor was travel history, especially for nonendemic parasites. The retrospective analysis of six alternative protocols identified four that may be more efficient than current procedures.CONCLUSIONS: The present study demonstrated that current protocols may be redundant and can be optimized to target prevalent parasites and populations with high risk factors.
One‐Year Results of an Algorithmic Approach to Managing Failed Back Surgery Syndrome
Authors: Avellanal Martín , Diaz-Reganon Gonzalo , Orts Alejandro , Soto Silvia 
Published: March 2016

BACKGROUND: Failed back surgery syndrome (FBSS) is a major clinical problem. Different etiologies with different incidence rates have been proposed. There are currently no standards regarding the management of these patients. Epiduroscopy is an endoscopic technique that may play a role in the management of FBSS.OBJECTIVE: To evaluate an algorithm for management of severe FBSS including epiduroscopy as a diagnostic and therapeutic tool.METHODS: A total of 133 patients with severe symptoms of FBSS (visual analogue scale score ≥7) and no response to pharmacological treatment and physical therapy were included. A six‐step management algorithm was applied. Data, including patient demographics, pain and surgical procedure, were analyzed. In all cases, one or more objective causes of pain were established. Treatment success was defined as ≥50% long‐term pain relief maintained during the first year of follow‐up. Final allocation of patients was registered: good outcome with conservative treatment, surgical reintervention and palliative treatment with implantable devices.RESULTS: Of 122 patients enrolled, 59.84% underwent instrumented surgery and 40.16% a noninstrumented procedure. Most (64.75%) experienced significant pain relief with conventional pain clinic treatments; 15.57% required surgical treatment. Palliative spinal cord stimulation and spinal analgesia were applied in 9.84% and 2.46% of the cases, respectively. The most common diagnosis was epidural fibrosis, followed by disc herniation, global or lateral stenosis, and foraminal stenosis.CONCLUSIONS: A new six‐step ladder approach to severe FBSS management that includes epiduroscopy was analyzed. Etiologies are accurately described and a useful role of epiduroscopy was confirmed.
Autonomic Arousal And Experimentally Induced Pain: A Critical Review of the Literature
Authors: Kyle Brandon N , McNeil Daniel W 
Published: March 2016

BACKGROUND: Autonomic arousal frequently is assumed to be a component of the pain response, perhaps because physiological mechanisms connecting pain and autonomic reactivity can be easily conceptualized. The evidence clarifying autonomic responses specific to painful stimulation, however, has been rather sporadic and lacks coherence; thus, a summary and critical review is needed in this area.OBJECTIVES: To summarize and integrate findings from 39 experimental investigations from 1970 to 2012 of pain‐induced autonomic arousal in humans.METHODS: Medline and PsycINFO databases were searched for relevant articles. References from these articles were also considered for review.RESULTS: Painful stimuli increase respiration rate, induce muscle tension, intensify electrodermal activity and dilate the pupils. Cardiovascular activity also increases, but the pattern displayed in response to pain is complex; peripheral vasoconstriction and sympathetically mediated cardiac responses are most typical. Additionally, autonomic expression of pain shows inconsistent relations with verbal and overt motor responses.CONCLUSIONS: Autonomic arousal can be legitimately measured and modified as one facet of the pain response. Future research should particularly focus on increasing sample size and broadening the diversity of participants. To improve the ability to compare and contrast findings across studies, as well as to increase the applicability of laboratory findings to naturalistic pain, investigators also must enhance experimental design by increasing uniformity or accounting for differences in methodology. Finally, further work remains to utilize more specific assessments of autonomic response and to assess relationships of autonomic reactivity with other cognitive (eg, attention) and affective (eg, anxiety) variables.
Predictors of Mortality among Patients Undergoing Colectomy for Ischemic Colitis: A Population-Based, United States Study
Authors: Sadler Matthew D , Ravindran Nikila C , Hubbard James , Myers Robert P , Ghosh Subrata , Beck Paul L , Dixon Elijah , Ball Chad , Prusinkiewicz Chris , Heitman Steven J , Kaplan Gilaad G 
Published: March 2016

BACKGROUND: Ischemic colitis is a potentially life-threatening condition that can require colectomy for management.OBJECTIVE: To assess independent predictors of mortality following colectomy for ischemic colitis using a nationally representative sample of hospitals in the United States.METHODS: The Nationwide Inpatient Sample was used to identify all patients with a primary diagnosis of acute vascular insufficiency of the colon (International Classification of Diseases, Ninth Revision codes 557.0 and 557.9) who underwent a colectomy between 1993 and 2008. Incidence and mortality are described; multivariate logistic regression analysis was performed to determine predictors of mortality.RESULTS: The incidence of colectomy for ischemic colitis was 1.43 cases (95% CI 1.40 cases to 1.47 cases) per 100,000. The incidence of colectomy for ischemic colitis increased by 3.1% per year (95% CI 2.3% to 3.9%) from 1993 to 2003, and stabilized thereafter. The postoperative mortality rate was 21.0% (95% CI 20.2% to 21.8%). After 1997, the mortality rate significantly decreased at an estimated annual rate of 4.5% (95% CI −6.3% to −2.7%). Mortality was associated with older age, 65 to 84 years (OR 5.45 [95% CI 2.91 to 10.22]) versus 18 to 34 years; health insurance, Medicaid (OR 1.69 [95% CI 1.29 to 2.21]) and Medicare (OR 1.33 [95% CI 1.12 to 1.58]) versus private health insurance; and comorbidities such as liver disease (OR 3.54 [95% CI 2.79 to 4.50]). Patients who underwent colonoscopy or sigmoidoscopy (OR 0.78 [95% CI 0.65 to 0.93]) had lower mortality.CONCLUSIONS: Colectomy for ischemic colitis was associated with considerable mortality. The explanation for the stable incidence and decreasing mortality rates observed in the latter part of the present study should be explored in future studies.
Sleep Laboratory Test Referrals in Canada: Sleep Apnea Rapid Response Survey
Authors: Evans Jessica , Skomro Robert , Driver Helen , Graham Brian , Mayers Irvin , McRae Louise , Reisman Joseph , Rusu Corneliu , To Teresa , Fleetham John 
Published: March 2016

BACKGROUND: An estimated 5.4 million Canadian adults have been diagnosed with sleep apnea or are at high risk of experiencing obstructive sleep apnea (OSA). There are no recent Canadian data regarding access to and predictors of referral for diagnostic testing in these populations.METHODS: The Sleep Apnea Rapid Response survey sampled 8647 Canadian adults and captured information about risk, testing, diagnosis and treatment of sleep apnea. Predictors of sleep laboratory test referrals were assessed using log‐linked binomial regression modelling. Information regarding sleep testing facilities was updated at the provincial and regional levels.RESULTS: Approximately 76.8% (95% CI 70.1% to 83.6%) of adult Canadians with sleep apnea and 5.1% (95% CI 3.4% to 6.7%) of those at high risk for OSA reported being referred to a sleep laboratory. Significant predictors of sleep laboratory referral in the general population were male sex, middle age, overweight or obese, a chronic condition, having a regular medical doctor and reporting symptoms of sleep apnea. Region of residence was also a predictor of reported sleep laboratory referral, with individuals from Ontario being more likely to report being referred to a sleep laboratory versus individuals from other regions.CONCLUSION: Individuals reporting risk factors and symptoms associated with OSA were more likely to report a sleep laboratory testing referral compared with those without risk factors or symptoms. However, Canada’s diagnostic sleep laboratory testing capacity varies across regions and is believed to be inadequate given the number of individuals at high risk for OSA who did not report testing referral.
Evaluation of an Internal Review Process for Grants And Manuscripts in the Canadian Critical Care Trials Group
Authors: Burns Karen EA , Caon Elaine , Dodek Peter M 
Published: March 2016

RATIONALE AND OBJECTIVES: All grants and manuscripts bearing the Canadian Critical Care Trials Group name are submitted for internal peer review before submission. The authors sought to formally evaluate authors’ and reviewers’ perceptions of this process.METHODS: The authors developed, tested and administered two electronic nine‐item questionnaires for authors and two electronic 13‐item questionnaires for reviewers. Likert scale, multiple choice and free‐text responses were used.RESULTS: Twenty‐one of 29 (72%) grant authors and 16 of 22 (73%) manuscript authors responded. Most author respondents were somewhat or very satisfied with the turnaround time, quality of the review and the review process. Two‐thirds of grant (13 of 20 [65%]) and manuscript authors (11 of 16 [69%]) reported one or more successful submissions after review. Changes made to grants based on reviews were predominantly editorial and involved the background, rationale, significance/relevance and the methods/protocol sections. Twenty‐one of 47 (45%) grant reviewers and 32 of 44 (73%) manuscript reviewers responded. Most reviewer respondents reported a good to excellent overall impression of the review process, good fit between their expertise and interests and the grants reviewed, and ample time to review. Although most respondents agreed with the current nonblinded review process, more grant than manuscript reviewers preferred a structured review format.CONCLUSIONS: The authors report a highly favourable evaluation of an existing internal review process. The present evaluation has assisted in understanding and improving the current internal review process.
Nutritional Supplementation with the Mushroom Agaricus sylvaticus Reduces Oxidative Stress in Children with HIV
Authors: Figueira Marcela S , Sá Luana A , Vasconcelos Amanda S , Moreira Danilo R , Laurindo Paula SOC , Ribeiro Danielle RG , Santos Rogério S , Guzzo Paulo , Dolabela Maria F , Percario Sandro 
Published: March 2016

BACKGROUND: The involvement of free radicals and oxidative stress in HIV infection has been extensively studied, and the benefits of antioxidant supplementation in animal studies have been demonstrated. However, few studies have demonstrated a benefit in clinical studies.OBJECTIVE: To verify the effects of dietary supplementation with Agaricus sylvaticus, a mushroom rich in antioxidants, on the oxidative profile of children born with HIV undergoing antiretroviral therapy.DESIGN: The sample included 24 children (both boys and girls) between two and eight years of age, of whom 10 were HIV positive and received supplementation with Agaricus sylvaticus for a three‐month period, and 14 were HIV negative and received no supplementation. At the beginning and conclusion of the study, thiobarbituric acid‐reactive substances (TBARS), nitrite and nitrate (NN), Trolox equivalent antioxidant capacity, and the antioxidant capacity of inhibition of diphenyl‐picrilhidrazil (DPPH) free radicals were analyzed.RESULTS: Before supplementation, significantly higher values of TBARS and NN, but decreased values of DPPH, were observed in infected subjects when compared with HIV‐negative subjects. After supplementation, a reduction of TBARS and NN values and an increase in DPPH and Trolox equivalent antioxidant capacity values were observed in HIV‐positive subjects.CONCLUSIONS: The results of the present study suggest the involvement of oxidative stress in HIV infection, with the participation of NN synthesis. Additionally, supplementation reversed oxidative alterations and improved antioxidant defense in infected individuals, and may become a complementary strategy in the treatment of these patients.
The Antiallodynic Action of Pregabalin May Depend on the Suppression of Spinal Neuronal Hyperexcitability in Rats with Spared Nerve Injury
Authors: Ding Lei , Cai Jie , Guo Xiang-Yang , Meng Xiu-Li , Xing Guo-Gang 
Published: March 2016

BACKGROUND: Pregabalin (PGB) is a novel antiepileptic drug and is also used as a first‐line medication for the treatment of neuropathic pain. However, the mechanisms of its analgesic effects remain largely unknown.OBJECTIVES: To elucidate the mechanisms underlying the antiallodynic action of PGB in rats with neuropathic pain.METHODS: In a rat model of neuropathic pain induced by spared nerve injury, mechanical allodynia, as a behavioural sign of neuropathic pain, was assessed by measuring 50% paw withdrawal threshold with von Frey filaments. Activities of dorsal horn wide dynamic range (WDR) neurons were examined by extracellular electrophysiological recording in vivo.RESULTS: Spinal administration of PGB exerted a significant antiallodynic effect and a prominent inhibitory effect on the hypersensitivity of dorsal horn WDR neurons in rats with spared nerve injury.CONCLUSION: The antiallodynic action of PGB is likely dependent on the suppression of WDR neuron hyperexcitability in rats with neuropathic pain.
Hospital ward design and prevention of hospital‐acquired infections: A prospective clinical trial
Authors: Ellison Jennifer , Southern Danielle , Holton Donna , Henderson Elizabeth , Wallace Jean , Faris Peter , Ghali William A , Conly John 
Published: March 2016

BACKGROUND: Renovation of a general medical ward provided an opportunity to study health care facility design as a factor for preventing hospital‐acquired infections.OBJECTIVE: To determine whether a hospital ward designed with predominantly single rooms was associated with lower event rates of hospital‐acquired infection and colonization.METHODS: A prospective controlled trial with patient allocation incorporating randomness was designed with outcomes on multiple ‘historic design’ wards (mainly four‐bed rooms with shared bathrooms) compared with outcomes on a newly renovated ‘new design’ ward (predominantly single rooms with private bathrooms).RESULTS: Using Poisson regression analysis and adjusting for time at risk, there were no differences (P=0.18) in the primary outcome (2.96 versus 1.85 events/1000 patient‐days, respectively). After adjustment for age, sex, Charlson score, admitted from care facility, previous hospitalization within six months, isolation requirement and the duration on antibiotics, the incidence rate ratio was 1.44 (95% CI 0.71 to 2.94) for the new design versus the historic design wards. A restricted analysis on the numbers of events occurring in single‐bed versus multibed wings within the new design ward revealed an event incidence density of 1.89 versus 3.47 events/1000 patient‐days, respectively (P=0.18), and an incidence rate ratio of 0.54 (95% CI 0.15 to 1.30).CONCLUSIONS: No difference in the incidence density of hospital‐acquired infections or colonizations was observed for medical patients admitted to a new design ward versus historic design wards. A restricted analysis of events occurring in single‐bed versus multibed wings suggests that ward design warrants further study.
Efficacy and Safety of, and Patient Satisfaction with, Colonoscopic-Administered Fecal Microbiota Transplantation in Relapsing and Refractory Community- and Hospital-Acquired Clostridium difficile Infection
Authors: Khan Muhammad Ali , Sofi Aijaz Ahmed , Ahmad Usman , Alaradi Osama , Khan Abdur Rahman , Hammad Tariq , Pratt Jennifer , Sodeman Thomas , Sodeman William , Kamal Sehrish , Nawras Ali 
Published: March 2016

OBJECTIVE: To report the efficacy and safety of, and patient satisfaction with, colonoscopic fecal microbiota transplantation (FMT) for community- and hospital-acquired Clostridium difficile infection (CDI).METHODS: A retrospective medical records review of patients who underwent FMT between July 1, 2012 and August 31, 2013 was conducted. A total of 22 FMTs were performed on 20 patients via colonoscopy. The patients were divided into ‘community-acquired’ and ‘hospital-acquired’ CDI. Telephone surveys were conducted to determine procedure outcome and patient satisfaction. Primary cure rate was defined as resolution of diarrhea without recurrence within three months of FMT, whereas secondary cure rate described patients who experienced resolution of diarrhea and return of normal bowel function after a second course of FMT.RESULTS: Nine patients met the criteria for community-acquired CDI whereas 11 were categorized as hospital-acquired CDI. A female predominance in the community-acquired group (88.89% [eight of nine]) was found (P=0.048). The primary cure rate was 100% (nine of nine) and 81.8% (nine of 11 patients) in community- and hospital-acquired CDI groups, respectively (P=0.189). Two patients in the hospital-acquired group had to undergo a repeat FMT for persistent symptomatic infection; the secondary cure rate was 100%. During the six-month follow-up, all patients were extremely satisfied with the procedure and no complications or adverse events were reported.CONCLUSION: FMT was a highly successful and very acceptable treatment modality for treating both community- and hospital-acquired CDI.
Reliability of Subjective Pain Ratings and Nociceptive Flexion Reflex Responses as Measures of Conditioned Pain Modulation
Authors: Jurth Carlo , Rehberg Benno , von Dincklage Falk 
Published: March 2016

BACKGROUND: The endogenous modulation of pain can be assessed through conditioned pain modulation (CPM), which can be quantified using subjective pain ratings or nociceptive flexion reflexes. However, to date, the test‐retest reliability has only been investigated for subjective pain ratings.OBJECTIVE: To compare the test‐retest reliability of CPM‐induced changes, measured using subjective pain ratings and nociceptive flexion reflexes, to provide a reliable scoring parameter for future studies.METHOD: A total of 40 healthy volunteers each received painful electrical stimuli to the sural nerve to elicit nociceptive flexion reflexes. Reflex sizes and subjective pain ratings were recorded before and during the immersion of the contralateral hand in hot water to induce CPM as well as innocuous water as control. Measurements were repeated in a retest 28 days later.RESULTS: Intraclass correlation coefficients showed good test‐retest reliabilities of CPM during the hot water stimulus for both scoring parameters. Subjective pain ratings also correlated between test and retest during the control stimulus.CONCLUSIONS: Subjective pain ratings and nociceptive flexion reflexes show comparable test‐retest reliabilities, but they reflect different components of CPM. While subjective pain ratings appear to incorporate cognitive influences to a larger degree, reflex responses appear to reflect spinal nociception more purely.
Pain Prevalence in a Pediatric Hospital: Raising Awareness during Pain Awareness Week
Authors: Harrison Denise , Joly Cynthia , Chretien Christine , Cochrane Sarah , Ellis Jacqueline , Lamontagne Christine , Regis Vaillancourt 
Published: March 2016

BACKGROUND: Despite the evidence and availability of numerous validated pain assessment tools and pain management strategies for infants and children, their use remains inconsistent in clinical practice.OBJECTIVES: To describe the prevalence of pain, pain assessment and pain management practices at a tertiary pediatric hospital in Canada.METHODS: The cross‐sectional study design involved a combination of interviews with children and/or caregivers, and chart audits in five inpatient units. Information regarding pain intensity, painful procedures and pain management strategies was obtained from children and/or caregivers by interview. Patient charts were reviewed for information regarding pain assessment, pain scores, and pharmacological and nonpharmacological interventions.RESULTS: Sixty‐two children (four days to 17 years of age) participated. Most children or their caregivers (n=51 [84%]) reported that pain was experienced during their hospitalization, with 40 (66%) reporting their worst pain as moderate or severe. Almost one‐half reported analgesics were administered before or during their most recent painful procedure. Nineteen (32%) reported sucrose, topical anesthetics or nonpharmacological interventions were used; however, they were documented in only 17% of charts. Pain scores were documented in 34 (55%) charts in the previous 24 h. The majority of the children or their caregiver (n=44 [71%]) were satisfied with pain management at the study hospital.CONCLUSIONS: Most infants and children had experienced moderate or severe pain during their hospitalization. Analgesics were frequently used, and although nonpharmacological strategies were reported to be used, they were rarely documented. Most parents and children were satisfied with their pain management.
Pain Relief as a Primary Treatment Goal: at What Point does Functioning and Well‐Being Become more Important? a Case Study of an Adolescent with Debilitating Chronic Pain
Authors: Tseng Andrew S , Weiss Karen , Harrison Tracy , Hansen Dan , Bruce Barbara 
Published: March 2016

BACKGROUND: Pediatric chronic pain is a common problem with significant economic implications and devastating consequences on quality of life. The present report describes a case involving a 15‐year‐old girl with severe and debilitating chronic pain.RESULTS: Before her referral to a pain rehabilitation program, the patient saw numerous specialists who treated her with an aggressive medical regimen and two spinal cord stimulators. She was then referred for intensive interdisciplinary treatment and, after three weeks of rehabilitation, she reported clinically significant changes in anxiety, pain catastrophizing and functional disability. The patient was successfully titrated off all of her opioid medications and, eventually, both neurostimulator implants were removed.DISCUSSION: Interdisciplinary pain rehabilitation is a useful treatment for patients with chronic pain. With its primary emphasis on functional restoration as opposed to strictly pain reduction, patients can regain a higher quality of life with reduced pain and fewer medications, surgeries and hospitalizations.