bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain Catastrophizing Predicts Poor Response to Topical Analgesics in Patients with Neuropathic Pain
Authors: Mankovsky Tsipora , Lynch Mary E , Clark AJ , Sawynok J , Sullivan Michael JL 
Published: March 2016

The prevalence of neuropathic pain approaches 10% in Canada and the United States. Given the aging population and the increasing survival rates following interventions for neuropathic pain, the prevalence of neuropathic pain conditions is expected to rise significantly over the next 20 years. Although pharmacological interventions represent the dominant treatment approach for neuropathic pain, as many as 50% of patients are partially or completely refractory to the available treatments. Pain catastrophizing has been associated with heightened pain experiences in patients with neuropathic pain conditions; however, the clinical relevance of the relationship between catastrophizing and poor treatment outcomes is, to date, unclear. Accordingly, using a numerical rating scale, this study aimed to examine this relationship in patients with varied neuropathic pain conditions who completed a measure of catastrophizing before initiating a course of topical analgesic.BACKGROUND: Previous research suggests that high levels of pain catastrophizing might predict poorer response to pharmacological interventions for neuropathic pain.OBJECTIVE: The present study sought to examine the clinical relevance of the relation between catastrophizing and analgesic response in individuals with neuropathic pain. Clinically meaningful reductions were defined in terms of the magnitude of reductions in pain through the course of treatment, and in terms of the number of patients whose end‐of‐treatment pain ratings were below 4/10.METHODS: Patients (n=82) with neuropathic pain conditions completed a measure of pain catastrophizing at the beginning of a three‐week trial examining the efficacy of topical analgesics for neuropathic pain.RESULTS: Consistent with previous research, high scores on the measure of pain catastrophizing prospectively predicted poorer response to treatment. Fewer catastrophizers than noncatastrophizers showed moderate (≥2 points) or substantial reductions in pain ratings through the course of treatment. Fewer catastrophizers than noncatastrophizers achieved end‐of‐treatment pain ratings below 4/10.CONCLUSIONS: The results of the present study suggest that the development of brief interventions specifically targeting catastrophic thinking might be useful for enhancing the effects of pharmacological interventions for neuropathic pain. Furthermore, failure to account for the level of catastrophizing might contribute to null findings in clinical trials of analgesic medication.
Yoga for Chronic Low Back Pain: A Meta‐Analysis of Randomized Controlled Trials
Authors: Holtzman Susan , Beggs R Thomas 
Published: March 2016

OBJECTIVES: To evaluate the efficacy of yoga as an intervention for chronic low back pain (CLBP) using a meta‐analytical approach. Randomized controlled trials (RCTs) that examined pain and/or functional disability as treatment outcomes were included. Post‐treatment and follow‐up outcomes were assessed.METHODS: A comprehensive search of relevant electronic databases, from the time of their inception until November 2011, was conducted. Cohen’s d effect sizes were calculated and entered in a random‐effects model.RESULTS: Eight RCTs met the criteria for inclusion (eight assessing functional disability and five assessing pain) and involved a total of 743 patients. At post‐treatment, yoga had a medium to large effect on functional disability (d=0.645) and pain (d=0.623). Despite a wide range of yoga styles and treatment durations, heterogeneity in post‐treatment effect sizes was low. Follow‐up effect sizes for functional disability and pain were smaller, but remained significant (d=0.397 and d=0.486, respectively); however, there was a moderate to high level of variability in these effect sizes.DISCUSSION: The results of the present study indicate that yoga may be an efficacious adjunctive treatment for CLBP. The strongest and most consistent evidence emerged for the short‐term benefits of yoga on functional disability. However, before any definitive conclusions can be drawn, there are a number of methodological concerns that need to be addressed. In particular, it is recommended that future RCTs include an active control group to determine whether yoga has specific treatment effects and whether yoga offers any advantages over traditional exercise programs and other alternative therapies for CLBP.
Prevalence of Self-Reported Spondyloarthritis Features in a Cohort of Patients with Inflammatory Bowel Disease
Authors: Stolwijk Carmen , Pierik Marieke , Landewé Robert , Masclee Ad , van Tubergen Astrid 
Published: March 2016

BACKGROUND: Musculoskeletal symptoms belonging to the spectrum of ‘seronegative spondyloarthritis’ (SpA) are the most common extraintestinal manifestations in patients with inflammatory bowel disease (IBD) and may lead to important disease burden. Patients with suspected SpA should be referred to a rheumatologist for further evaluation.OBJECTIVE: To investigate the self-reported prevalence of musculoskeletal SpA features in a cohort of patients with IBD and to compare this with actual referrals to a rheumatologist.METHODS: Consecutive patients with IBD visiting the outpatient clinic were interviewed by a trained research nurse about possible SpA features using a standardized questionnaire regarding the presence or history of inflammatory back pain, peripheral arthritis, enthesitis, dactylitis, psoriasis, uveitis and response to nonsteroidal anti-inflammatory drugs. All patient files were verified for previous visits to a rheumatologist and any rheumatic diagnosis.RESULTS: At least one musculoskeletal SpA feature was reported by 129 of 350 (36.9%) patients. No significant differences between patients with Crohn disease and ulcerative colitis were found. Review of medical records showed that 66 (51.2%) patients had ever visited a rheumatologist. Axial SpA was diagnosed in 18 (27.3%) patients, peripheral SpA in 20 (30.3%) patients and another rheumatic disorder in 14 (21.2%) patients.CONCLUSION: Musculoskeletal SpA features are frequently present in patients with IBD. However, a substantial group of patients is not evaluated by a rheumatologist. Gastroenterologists play a key role in early referral of this often debilitating disease.
Safe and Effective Prescription of Exercise in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Rationale and Methods for an Integrated Knowledge Translation Study
Authors: Camp Pat G , Reid W Darlene , Yamabayashi Cristiane , Brooks Dina , Goodridge Donna , Chung Frank , Marciniuk Darcy D , Neufeld Andrea , Hoens Alison 
Published: March 2016

BACKGROUND: Patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) engage in low levels of activity, putting them at risk for relapse and future readmissions. There is little direction for health care providers regarding the parameters for safe exercise during an AECOPD that is effective for increasing activity tolerance before discharge from hospital, especially for patients with associated comorbid conditions.OBJECTIVE: To report the rationale for and methods of a study to develop evidence‐informed care recommendations that guide health care providers in the assessment, prescription, monitoring and progression of exercise for patients hospitalized with AECOPD.METHODS: The present study was a multicomponent knowledge translation project incorporating evidence from systematic reviews of exercise involving populations with chronic obstructive pulmonary disease and/or common comorbidities. A Delphi process was then used to obtain expert opinion from clinicians, academics and patients to identify the parameters of safe and effective exercise for patients with AECOPD.RESULTS: Clinical decision‐making tool(s) for patients and practitioners supported by a detailed knowledge dissemination, implementation and evaluation framework.CONCLUSION: The present study addressed an important knowledge gap: the lack of availability of parameters to guide safe and effective exercise prescription for hospitalized patients with AECOPD, with or without comorbid conditions. In the absence of such parameters, health care professionals may adopt an ‘activity as tolerated’ approach, which may not improve physical activity levels in their patients. The present study synthesizes the best available evidence and expert opinion, and will generate decision‐making tools for use by patients and their health care providers.
Endoscopy Reporting Standards
Authors: Beaulieu Daphnée , Barkun Alan N , Dubé Catherine , Tinmouth Jill , Hallé Pierre , Martel Myriam 
Published: March 2016

OBJECTIVES: The Canadian Association of Gastroenterology (CAG) recently published consensus recommendations for safety and quality indicators in digestive endoscopy. The present article focuses specifically on the identification of key elements that should be found in all electronic endoscopy reports detailing recommendations adopted by the CAG consensus group.METHODS: A committee of nine individuals steered the CAG Safety and Quality Indicators in Endoscopy Consensus Group, which had a total membership of 35 voting individuals with knowledge on the subject relating to endoscopic services. A comprehensive literature search was performed with regard to the key elements that should be found in an electronic endoscopy report. A task force reviewed all published, full-text, adult and human studies in French or English.RESULTS: Components to be entered into the standardized report include identification of procedure, timing, procedural personnel, patient demographics and history, indication(s) for procedure, comorbidities, type of bowel preparation, consent for the procedure, pre-endoscopic administration of medications, type and dose of sedation used, extent and completeness of examination, quality of bowel preparation, relevant findings and pertinent negatives, adverse events and resulting interventions, patient comfort, diagnoses, endoscopic interventions performed, details of pathology specimens, details of follow-up arrangements, appended pathology report(s) and, when available, management recommendations. Summary information should be provided to the patient or family.CONCLUSION: Continuous quality improvement should be the responsibility of every endoscopist and endoscopy facility to ensure improved patient care. Appropriate documentation of endoscopic procedures is a critical component of such activities.
Facilitators and Solutions for Practicing Optimal Guided Asthma Self‐Management: The Physician Perspective
Authors: Lamontagne Alexandrine J , Peláez Sandra , Grad Roland , Blais Lucie , Lavoie Kim L , Bacon Simon L , Guay Hélène , Gauthier Annie , McKinney Martha L , Ernst Pierre , Collin Johanne , Ducharme Francine M 
Published: March 2016

OBJECTIVE: To identify key solutions that facilitate the prescription of long‐term asthma controller and provision of written self‐management plans by physicians.METHODS: One hour individualized semistructured interviews were conducted with physicians. Interviews were transcribed verbatim and analyzed independently by two trained qualitative researchers. A taxonomy of facilitators (contemplated solutions) and experienced solutions was achieved by consensus within the research team.RESULTS: Forty‐two physicians (family physicians, pediatricians, emergency physicians, pulmonologists and allergists) were interviewed. The 867 facilitators and solutions, grouped in 10 categories, addressed three physician needs: support physicians in delivering optimal care (guideline dissemination, workplace culture, physician training and experience, physician attitudes toward optimal practice, tools and resources supporting physicians’ decision making); assist patients with following recommendations (patient characteristics, experiences and attitudes; physician behaviour; and tools and resources supporting patient self‐management); and offer efficient services (reorganization of care; interprofessional patient management). Suggestions pertaining to the latter two categories were most frequently cited to optimize asthma management and use of self‐management plans (eg, access to self‐management plans; education by allied health care professionals). The most cited suggestions to support prescribing long‐term controller pertained to physician behaviour (eg, involvement in patient education, personalization of prescriptions, feedback to patients of the benefits of long‐term controller). The distribution of facilitators and solutions varied across specialties.CONCLUSIONS: Physicians proposed multiple facilitators and solutions to support optimal practice, leading to the development of a novel taxonomy. Key suggestions varied across physician specialties and behaviours sought, emphasizing the need to carefully select the most promising knowledge translation interventions.
Feasibility and Success of Hiv Point‐of‐Care Testing in an Emergency Department in an Urban Canadian Setting
Authors: Becker Marissa L , Thompson Laura H , Pindera Carla , Bridger Natalie , Lopez Carmen , Keynan Yoav , Bullard Jared , Van Caseele Paul , Kasper Ken 
Published: March 2016

BACKGROUND: Approximately 26% of Canadians living with HIV are unaware of their status. Point‐of‐care (POC) HIV tests have been introduced to simplify and expand HIV testing.OBJECTIVE: To evaluate the feasibility and acceptability of POC testing in an emergency department (ED) setting in Winnipeg, Manitoba.METHODS: A cross‐sectional study of unselected adults presenting to the ED at the Health Sciences Centre Hospital (Winnipeg, Manitoba) was performed. Study procedures included pre‐ and post‐test counselling, administration of the INSTI HIV‐1/HIV‐2 Antibody Test (bioLytical Laboratories, Canada) and a brief questionnaire. Venous blood samples were collected from participants for confirmatory testing on all reactive and indeterminate specimens.RESULTS: In total, 501 adults participated in the study. The majority of participants were younger than 40 years of age, approximately one‐half (48.5%) were women and 53% self‐identified as Aboriginal. Nearly one‐half (49.1%) of the participants had undergone previous HIV testing, although 63% of these tests were performed more than a year earlier. A total of seven individuals tested reactive with the POC test, all of whom were confirmed positive using serological testing (1.4%) and were linked to an HIV specialist within 24 h. Nearly all of the participants (96%) reported satisfaction with the test and believed it belonged in the ED (93%).CONCLUSIONS: Of the participants tested, 1.4% tested reactive for HIV, which is significantly higher than the reported prevalence in Manitoba and in other similar studies conducted in North America. Furthermore, all individuals were linked to timely care. The present study demonstrated that this particular busy tertiary care ED is an important and feasible location for HIV POC testing.
Biliary Drainage Method and Temporal Trends in Patients Admitted with Cholangitis: A National Audit
Authors: McNabb-Baltar Julia , Trinh Quoc-Dien , Barkun Alan N 
Published: March 2016

BACKGROUND: In patients presenting with ascending cholangitis, better outcomes are reported in those undergoing endoscopic retrograde cholangiopancreatography (ERCP) compared with surgical drainage.OBJECTIVE: To identify factors associated with the type of intervention, and to examine temporal trends in the treatment of ascending cholangitis.METHODS: Data were extracted from the Nationwide Inpatient Sample. Patients ≥18 years of age with a diagnosis of cholangitis between 1998 and 2009 were selected. Temporal trends were assessed using Poisson regression models. Multivariable models were fitted to predict the likelihood of a patient undergoing ERCP, percutaneous or surgical drainage, or no drainage.RESULTS: A weighted estimate of 248,942 patients admitted for cholangitis was identified. Overall, 131,052 patients were treated with ERCP (52.6%), 10,486 with percutaneous drainage (4.2%) and 12,460 with surgical drainage (5.0%); 43.0% did not receive drainage during the admission. Temporal trends between 1998 and 2009 showed a decline in surgical and percutaneous drainage, and a rise in ERCP. In multivariable analyses adjusted for clustering, ERCP and percutaneous drainage were more often performed in institutions with a high volume of admissions for cholangitis, those with a greater bed number and hospitals located in urban areas.CONCLUSION: Over the past decade, the use of surgical and percutaneous drainage has decreased while that of ERCP has risen. Patients treated at institutions with a low volume of admissions for cholangitis, small bed number and in rural areas were less likely to undergo ERCP or percutaneous drainage.
Antimicrobial Resistance and Antimicrobial Use Associated with Laboratory‐Confirmed Cases of Campylobacter Infection in Two Health Units in Ontario
Authors: Deckert Anne E , Reid-Smith Richard J , Tamblyn Susan E , Morrell Larry , Seliske Patrick , Jamieson Frances B , Irwin Rebecca , Dewey Catherine E , Boerlin Patrick , McEwen Scott A 
Published: March 2016

AIM: A population‐based study was conducted over a two‐year period in the Perth District (PD) and Wellington‐Dufferin‐Guelph (WDG) health units in Ontario to document antimicrobial resistance and antimicrobial use associated with clinical cases of laboratory‐confirmed campylobacteriosis.METHODS: Etest (bioMérieux SA, France) was used to determine the minimum inhibitory concentration of amoxicillin/clavulanic acid, ampicillin, chloramphenicol, ciprofloxacin (CIP), clindamycin, erythromycin (ERY), gentamicin, nalidixic acid and tetracycline. Data regarding antimicrobial use were collected from 250 cases.RESULTS: Of the 250 cases, 165 (65.7%) reported staying home or being hospitalized due to campylobacteriosis. Fifty‐four per cent of cases (135 of 249) reported taking antimicrobials to treat campylobacteriosis. In 115 cases (51.1%), fecal culture results were not used for treatment decisions because they were not available before the initiation of antimicrobial treatment and/or they were not available before the cessation of symptoms. Of the 250 cases, 124 (49.6%) had available Campylobacter isolates, of which 66 (53.2%) were resistant to at least one of the antimicrobials tested. No resistance to ampicillin, chloramphenicol or gentamicin was found in these isolates. Six isolates (4.8%) were resistant to CIP. Two isolates (1.6%) were resistant to ERY; however, no isolates were resistant to both CIP and ERY.CONCLUSION: Prudent use practices should be promoted among physicians to reduce the use of antimicrobials for the treatment of gastroenteritis in general and campylobacteriosis in particular, as well as to minimize the future development of resistance to these antimicrobials in Campylobacter species.
Current Status of Core and Advanced Adult Gastrointestinal Endoscopy Training in Canada: Survey of Existing Accredited Programs
Authors: Xiong Xin , Barkun Alan N , Waschke Kevin , Martel Myriam ,   the Canadian Gastroenterology Training Program Directors
Published: March 2016

OBJECTIVE: To determine the current status of core and advanced adult gastroenterology training in Canada.METHODS: A survey consisting of 20 questions pertaining to core and advanced endoscopy training was circulated to 14 accredited adult gastroenterology residency program directors. For continuous variables, median and range were analyzed; for categorical variables, percentage and associated 95% CIs were analyzed.RESULTS: All 14 programs responded to the survey. The median number of core trainees was six (range four to 16). The median (range) procedural volumes for gastroscopy, colonoscopy, percutaneous endoscopic gastrostomy and sigmoidoscopy, respectively, were 400 (150 to 1000), 325 (200 to 1500), 15 (zero to 250) and 60 (25 to 300). Eleven of 13 (84.6%) programs used endoscopy simulators in their curriculum. Eight of 14 programs (57%) provided a structured advanced endoscopy training fellowship. The majority (88%) offered training of combined endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography. The median number of positions offered yearly for advanced endoscopy fellowship was one (range one to three). The median (range) procedural volumes for ERCP, endoscopic ultrasonography and endoscopic mucosal resection, respectively, were 325 (200 to 750), 250 (80 to 400) and 20 (10 to 63). None of the current programs offered training in endoscopic submucosal dissection or natural orifice transluminal endoscopic surgery.CONCLUSION: Most accredited adult Canadian gastroenterology programs met the minimal procedural requirements recommended by the Canadian Association of Gastroenterology during core training. However, a more heterogeneous experience has been observed for advanced training. Additional studies would be required to validate and standardize evaluation tools used during gastroenterology curricula.
Diagnosis and Management of the Overlap Syndromes of Autoimmune Hepatitis
Authors: Czaja Albert J 
Published: March 2016

BACKGROUND: Autoimmune hepatitis may have cholestatic features that are outside the classical phenotype and that resemble findings in other immune-mediated liver diseases. These cholestatic phenotypes have been designated ‘overlap syndromes’.OBJECTIVES: To recognize the overlap syndromes in adults and manage them appropriately.METHODS: The MEDLINE database was reviewed for published experiences from 1984 to 2013.RESULTS: Patients with autoimmune hepatitis may exhibit features of primary biliary cirrhosis (7% to 13%), primary sclerosing cholangitis (6% to 11%) or a cholestatic syndrome without other diagnostic features (5% to 11%). These mixed phenotypes may represent classical autoimmune hepatitis with atypical features, transition states in the evolution of classical cholestatic syndromes, concurrent separate diseases or pathogenically distinct disorders. The ‘Paris criteria’ have been endorsed for the diagnosis of the overlap syndrome with primary biliary cirrhosis, and treatment with conventional immunosuppressive therapy alone or in combination with low-dose ursodeoxycholic acid can be guided by the serum alkaline phosphatase level. The overlap syndrome with primary sclerosing cholangitis or with cholestasis without diagnostic features is commonly treated with immunosuppressive therapy and ursodeoxycholic acid. Responses are variable and commonly incomplete (20% to 100% improvement) depending on the degree of cholestasis.DISCUSSION: The overlap syndromes are clinical descriptions rather than pathological entities, and the dominant component of the disease determines its designation and therapy. Cholestatic findings in autoimmune hepatitis influence the response to immunosuppressive therapy.CONCLUSION: The overlap syndromes must be considered in patients with autoimmune hepatitis and cholestatic findings, concurrent inflammatory bowel disease or steroid-refractory disease.