bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pilot Study of Salbutamol in the Treatment of Acute Asthma – Little Apparent Benefit to Dose and Frequency Adjustments
Authors: Sinclair Douglas , MacKenzie MG , Bowie Dennis M 
Published: March 2016

STUDY OBJECTIVE: To compare two dosing regimens of salbutamol in acute asthma.DESIGN: Prospective randomized double‐blind trial.SETTING: Urban emergency department.TYPE OF PARTICIPANTS: Patients who presented to the emergency department with moderate to severe asthma.INTERVENTIONS: All patients had pulmonary function testing and were randomized to group A (control; n=25) or group B (experimental; n=23). Group A (control) patients received salbutamol 2.5 mg delivered by wet aerosol at 0, 1 and 2 h (total dose 7.5 mg). At 20, 40, 80 and 100 mins a placebo aerosol was given. Group B patients received salbutamol 5 mg at 0 min and one‐third the initial dose every 20 mins for a total of six doses by wet aerosol (total dose 15 mg).RESULTS: There were no differences in age, sex, preadmission medications or initial forced expiratory volume in 1 s (FEV1) between the groups. Forty‐eight patients completed the study. Both groups of patients improved with mean absolute change in FEV1 of 700 mL in group A and 590 mL in group B. There were no statistical differences between the two groups in terms of treatment response, admission rates or side effects.CONCLUSIONS: This study of patients presenting with acute asthma demonstrated no differences in improvement during the initial 3 h of treatment with a standard dose of aerosolized salbutamol given at hourly intervals (total dose 7.5 mg) compared with a higher total dose given at 20 min intervals (total dose 15 mg).
Effect of High Dose Inhaled Acetic Acid on Airway Responsiveness in Fischer Rats
Authors: Ariel AP , Furlott HG , Chapman KR , Slutsky AS , Webster P , Zamel N , Tarlo SM 
Published: March 2016

BACKGROUND: Sudden, severe airway injury has been associated with an acute, and at times persisting, airway hyper‐responsiveness with clinical features of asthma, termed reactive airways dysfunction syndrome (RADS). An attempt was made to develop a rat model of RADS by exposing inbred Fischer rats to inhaled 8 N acetic acid for 2 mins (13 N inhalation was lethal).METHODS: Lung resistance (RL) and lung elastance (EL) were measured in 14 eight‐ to 10‐week old male rats. Baseline responsiveness to methacholine was quantified by calculating the dose required for doubling of RL. The next day, the study group (n=11) was exposed to aerosolized acetic acid. Control animals (n=3) were similarly exposed to buffered saline solution.RESULTS: Acetic acid exposure resulted in a significant (P	<0.02) increase in RL (by 80%) and EL (by 67%), lasting less than 10 mins postexposure, but no significant change in methacholine responsiveness at one day and seven days postexposure.CONCLUSIONS: Failure to induce persistent airway hyper‐responsiveness may relate to the choice of animal, choice of irritant, or insufficient level or duration of exposure, or may reflect a lack of individual predisposing cofactors such as smoking or underlying asthmatic predisposition.
Ciprofloxacin or Imipenem Use Correlates with Resistance in Pseudomonas aeruginosa
Authors: Zhanel George G , Nicolle Lindsay E , Gin Alfred S , Karlowsky James , Kabani Amin , Hoban Daryl J 
Published: March 2016

OBJECTIVE: To investigate the relationship between ciprofloxacin or imipenem use and antimicrobial resistance in Pseudomonas aeruginosa.METHODS: A retrospective review of monthly antimicrobial susceptibility reports for ciprofloxacin (1988 to 1995) and imipenem (1987 to 1995) against P aeruginosa and hospital antimicrobial use records at a tertiary care teaching hospital in Winnipeg, Manitoba. Data were entered into a relational database, R:Base 4.5++, collated, transferred to a spreadsheet and subjected to linear regression analysis. The relationship between ciprofloxacin or imipenem use and resistance was assessed using a Pearson correlation.RESULTS: Ciprofloxacin‐resistant P aeruginosa increased from 1.0% of all isolates in 1988 to 10.0% in 1995. A significant (P=0.05) correlation was demonstrated between the amount of ciprofloxacin use and prevalence of ciprofloxacin‐resistant P aeruginosa (r=0.73, P=0.05). Imipenem‐resistant P aeruginosa increased from 1.0% of isolates in 1987 to a maximum of 10.4% in 1991, and subsequently decreased to 5.4% in 1995. Imipenem use and the prevalence of imipenem‐resistant P aeruginosa were significantly correlated (r=0.85, P=0.014).CONCLUSIONS: Ciprofloxacin use was directly associated with ciprofloxacin resistance, and imipenem use was directly associated with imipenem resistance in P aeruginosa.
Relationship Between Pressure Pain Threshold and Coping Strategies in Patients with Fibromyalgia
Authors: Song Ji-Young , Noh Samuel , Harth Manfred , Merskey Harold 
Published: March 2016

OBJECTIVE: To explore the hypothesis that the intensity of pain, pain thresholds and coping mechanisms differ between patients with fibromyalgia and those with rheumatoid arthritis (RA) in order to determine whether pain coping strategies contribute to the understanding of how patients adjust to fibromyalgia.METHODS: Thirty‐eight fibromyalgia patients were compared with 15 RA patients regarding severity of pain, pain history, pressure pain thresholds (measured with a pressure algometer) and pain coping strategies (measured with the Coping Strategies Questionnaire [CSQ]).RESULTS: Fibromyalgia patients scored significantly higher than RA patients on severity of pain and had lower pain thresholds at three pairs of nontender sites than the RA group. Fibromyalgia patients were significantly different from RA patients with respect to catastrophizing and increasing behavioural activity, but this differentiation was not maintained with respect to the three main factors of the CSQ. Overall, both the fibromyalgia and RA groups resembled previous chronic pain populations. Depression and anxiety had strong negative correlations with the combined coping scores on the seven subscales (P<0.001).CONCLUSIONS: Patients with fibromyalgia may use some distinctive coping strategies and tend to manage their pain in many of the same ways as other patients with chronic pain.
Noninvasive Screening for Genital Chlamydial Infections in Asymptomatic Men: Strategies and Costs Using a Urine PCR Assay
Authors: Peeling Rosanna W , Toye Baldwin , Jessamine Peter , Gemmill Ian 
Published: March 2016

OBJECTIVE: To evaluate cost saving strategies to screen for genital chlamydial infection in men using polymerase chain reaction (PCR) technology.METHODS: Men with no urethral symptoms presenting to a sexually transmitted disease (STD) clinic were recruited. Study participants underwent a questionnaire interview. Urethral swabs were taken to perform a smear for polymorphonuclear leucocytes (PMN) and for the detection of Chlamydia trachomatis by culture and PCR. First‐catch urine was collected for a leukocyte esterase test (LET) and PCR.RESULTS: C trachomatis infection was detected in 36 of 463 (7.8%) men. LET and PMN were positive in 10 (28%) and 12 (33%) infected men, respectively. Risk factors for chlamydial infection were younger than age 25 years, LET‐positive, PMN‐positive and STD contact (P<0.001). The direct cost of genital chlamydial infection in men in Canada has been previously estimated at $381/case. Based on a sensitivity of 90% for urine PCR, the estimated direct cost of testing all participants to detect 32 cases was $453/case. Using risk factors recommended in the Canadian STD Guidelines (age younger than 25 years, new partner, STD contact or unprotected sex), the same number of cases would have been detected by testing only 384 men at $376/case. Using age younger than 25 years or STD contact as the screening criterion, 78% of those infected would have been detected at $259/case, and no new cases would have been detected by adding LET‐positive or PMN‐positive as risk factors.CONCLUSION: Targeted screening for chlamydial infection using urine PCR assay and risk factors recommended in the Canadian guidelines could substantially reduce the cost of screening at a STD clinic setting. LET and PMN smear did not appear to be useful indicators of chlamydial infection in this population.
Meal Induced Oxygen Desaturation and Dyspnea in Chronic Obstructive Pulmonary Disease
Authors: Wolkove Norman , Fu Li Yi , Purohit Ashok , Colacone Antoinette , Kreisman Harvey 
Published: March 2016

OBJECTIVE: To study arterial oxygen saturation (SpO2) obtained by pulse oximetry and dyspnea during active eating (AE) and passive eating (PE) in patients with severe chronic obstructive pulmonary disease (COPD).DESIGN: Patients were studied on two consecutive days with AE and PE, which occurred in random order. SpO2 was recorded for 20 mins before and during eating, and dyspnea was recorded by the patient using a 10 cm visual analogue scale before and upon completion of eating.SETTING: Subjects were in‐patients at an intermediate care facility who were hospitalized for pulmonary rehabilitation or for convalescence after an exacerbation of COPD.POPULATION STUDIED: Thirty‐five patients with severe COPD (forced expiratory volume in 1 s [FEV1] less than 50% predicted, FEV1 to forced vital capacity ratio less than 65%) were studied. Mean age was 70.5±7.1 years.MAIN RESULTS: Mean SpO2 decreased significantly (P<0.05) from 91.7±3.4% to 90.1±4.0% during AE, and 91.7±3.2% to 90.8±3.6% during PE. Mean lowest SpO2 was lower and percentage of time with SpO2 less than 90% was greater during eating compared with corresponding control periods during both AE and PE. Dyspnea increased significantly (P<0.05) from 1.4±1.2 to 3.3±2.3 cm during AE, and from 1.5±1.5 to 2.4±2.2 cm during PE. The increase in dyspnea was significantly greater during AE than PE.CONCLUSIONS: Eating is an activity that can adversely affect SpO2 and increase dyspnea in patients with severe COPD. Oxygen desaturation and particularly increased dyspnea may at least in part relate to the recruitment of upper extremity muscles during eating.
Pain Correlates of Depressed Mood
Authors: Walsh Trudi M , Smith Chloé P , McGrath Patrick J 
Published: March 2016

OBJECTIVE: To provide an initial indication of the intensity and quality of pain in young adults reporting depressed mood and to investigate possible underlying mechanisms.DESIGN: Case‐control study.SETTING: University undergraduate subject pool.PARTICIPANTS: Sixty introductory psychology undergraduates classified as either reporting high levels of depressed mood (n=30; age 18.7±0.87 years, mean ± SD) or reporting low levels of depressed mood (n=30; age 18.6±0.81 years).MAIN OUTCOME MEASURES: Beck Depression Inventory, Short‐Form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pittsburgh Sleep Quality Index and pressure dolorimeter pain thresholds.RESULTS: Young adults reporting high levels of depressed mood had significantly higher pain intensity at testing time, as measured by a visual analogue scale (P=0.015) and a present pain index (P=0.002), affective pain intensity for the previous month (P=0.000), pain catastrophizing (P=0.025) and global sleep disturbance (P=0.000) than young adults reporting low levels of depressed mood. Within the group of young adults reporting high levels of depressed mood, significantly higher sleep disturbance scores (P=0.020) were identified in those reporting high levels of overall pain intensity.CONCLUSIONS: The results are discussed in terms of their implications for research as well as for the assessment and treatment of pain in individuals with depression.
How Much Does It Cost to Manage Paediatric Tuberculosis? One‐Year Experience from The Hospital for Sick Children
Authors: Main Cheryl L , Ying Ethel , Wang Elaine EL 
Published: March 2016

BACKGROUND: Tuberculosis (TB) is a major infection with nearly eight million cases annually worldwide. Although the majority of these cases are in the developing world, TB is also a problem in Canada.OBJECTIVE: To determine the cost of diagnosis and management of paediatric TB in Canada.DESIGN: Cross‐sectional study.SETTING: In‐patients and out‐patients at The Hospital for Sick Children, Toronto, a tertiary care centre.PATIENTS: Patients were included if they had clinical or radiological evidence of TB infection with a positive tuberculin skin test or a positive culture result, and were treated from July 1, 1995, to June 30, 1996. Twenty‐two patients met the criteria for inclusion in the study.OUTCOME MEASURES: Patient characteristics, types of disease, types and numbers of investigations, number of in‐patient days and out‐patient appointments, course of TB treatment, TB‐related complications and antimicrobial resistance were obtained from charts. Costs were derived from allocated hospital costs, Ontario Health Insurance Plan billings and costs provided by the Pharmacy Department at The Hospital for Sick Children.RESULTS: The total cost for one year of management of paediatric TB in a tertiary care centre was $211,576. Pulmonary TB affected one‐half of the study patients but accounted for one‐quarter of the cost. One case of meningitis resulted in almost the same costs as all cases of pulmonary TB. Hospitalization was the largest contributor to overall cost, accounting for three‐quarters of the total. The remaining costs in order of their contribution to overall costs were antimicrobial treatment, out‐patient appointments, diagnostic imaging and TB cultures.CONCLUSIONS: From a hospital’s perspective, the costs of managing each of the 22 patients was approximately $10,000. However, there was great variability between patients, with much greater costs for those who required hospitalization or numerous investigations because TB was not suspected. To the authors’ knowledge, this is the first time that such a cost analysis has been performed for a paediatric population. A cost analysis provides a better measure of the burden of illness than is indicated by the absolute number of patients.
Lung volumes 24 Hours after Laparoscopic Cholecystectomy — Justification for Early Discharge
Authors: Ali Jameel , Gana Theophilus J 
Published: March 2016

OBJECTIVE: To compare lung volumes after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC).DESIGN: Prospective study with matched historical controls.SETTING: Referral teaching hospital.SUBJECTS: Twenty‐six healthy female subjects (age 20 to 40 years), 13 of whom had LC.MAIN OUTCOME MEASURES: Vital capacity (VC, % predicted), functional residual capacity (FRC, % predicted) and analgesic frequency (mean ± SD) over the first 24 h.RESULTS: Immediately after operation, FRC was similarly depressed to 80.4±1.8% in the OC group and 80.8±2.3% in the LC group. After 24 h FRC fell to 70.5±1.9% in the OC group and increased to 91.3±2.4% in the LC group. VC fell immediately postoperation to 41.4±4.8% in the OC group but to only 62.2±1.9% in the LC group. By 24 h, VC improved slightly to 52.5±2.7% in the OC group but returned to normal, 99.0±3.2%, in the LC group. Postoperative analgesic frequency over 24 h was less in the LC group, 3.3±0.8 versus 5.0±0.8.CONCLUSION: Depression in lung volume is less with LC. A VC that returned to normal and a FRC level not usually associated with pulmonary complications support the practice of discharging LC patients by 24 h postoperation.
Comparison of Methods of Sampling for Toxocara Species and Fecal Coliforms in an Outdoor Day Care Environment
Authors: Carabin Hélène , Gyorkos Theresa W , Kokoskin Evelyne , Payment Pierre , Joseph Lawrence , Soto Julio 
Published: March 2016

OBJECTIVE: To compare three sampling methods and to pretest methods for the determination of fecal coliform (FC) counts and Toxocara species from sand in the day care outdoor environment.DESIGN: The sand samples were obtained from the play area and the sandbox of a day care centre and examined for the presence of FC and Toxocara species, the common roundworm of dogs and cats. The sampling methods included random selection and two types of judgement methods. The latter included one method where domestic animals were judged to be likely to defecate and the other where children would be likely to be playing. In addition, to obtain a global estimate of contamination, the entire areas of both the sandbox and the play area were sampled on the last day.SETTING: Outdoor day care environment.MAIN RESULTS: The most representative levels of bacterial contamination and Toxocara species originated from the combined sample of the entire surface areas rather than from any separate random or judgement method of sampling. FCs were found in all sampled areas of the sandbox (median 910 FCs/g of sand) and of the play area (median 350 FCs/g of sand). Toxocara species were recovered from a number of areas in both the sandbox and the play area.CONCLUSIONS: Research on environmental microbial contamination of outdoor day care settings would benefit from the application of standardized and validated sampling and laboratory methods.
Cross‐Canada Survey of Resistance of 2747 Aerobic Blood Culture Isolates to Piperacillin/Tazobactam and Other Antibiotics
Authors: Forward Kevin R , Franks Patricia A , Low Donald E , Rennie Robert , Simor Andrew E , the Canadian Piperacillin/Tazobactam Study Group  
Published: March 2016

OBJECTIVE: To compare the activity of piperacillin/tazobactam with that of other broad parenteral antibiotics against aerobic and facultative anaerobic blood culture isolates in a Canada‐wide survey.DESIGN: Fifty‐eight laboratories in nine provinces each contributed up to 50 consecutive clinically significant aerobic and facultative anaerobic isolates for susceptibility testing.SETTING: Participating hospitals included both tertiary care and community hospitals.MATERIALS AND METHODS: Testing was performed in five regional centres by using the same microbroth dilution method, and results were interpreted according to National Commitee for Clinical Laboratory Standards M7‐A3 and M100‐S5 guidelines.RESULTS: Piperacillin/tazobactam and imipenem were both active against more than 99% of the 1616 strains of Enterobacteriaceae species tested. The minimum inhibitory concentration of 90% of isolates (MIC90) of all Enterobacteriaceae species was 2 mg/L for piperacillin/tazobactam compared with 64 mg/L for piperacillin alone. Seventeen per cent of strains of Enterobacteriaceae species were susceptible to piperacillin/tazobactam but resistant to piperacillin. Piperacillin/tazobactam was highly active against Pseudomonas aeruginosa, inhibiting 99.1% of strains. MIC90 was 8 mg/L. Nine per cent of P aeruginosa strains were not susceptible to imipenem. Most of these strains had a MIC of 8 mg/L, which falls in the intermediate category. Ninety‐seven per cent of P aeruginosa were susceptible to ciprofloxacin and 97.3% to tobramycin. Ninety‐six per cent of strains of Actinobacter species were susceptible to piperacillin/tazobactam, whereas only 76% of strains were susceptible to piperacillin alone. Overall, piperacillin/tazobactam was the most active agent tested; 98% of all strains were susceptible, followed closely by imipenem, to which 97.8% of strains were susceptible.CONCLUSIONS: Aerobic blood culture isolates from Canadian centres continue to be highly susceptible to a variety of antibiotics. The broad spectrum of activity of piperacillin/tazobactam suggests that this combination should be considered for empirical treatment of sepsis while awaiting results of cultures and susceptibility testing.
In Vitro Activity of Cefepime against Multidrug‐Resistant Gram‐Negative Bacilli, Viridans Group Streptococci and Streptococcus pneumoniae from a Cross‐Canada Surveillance Study
Authors: Low Donald E , de Azavedo Joyce , Canadian Bacterial Surveillance Network  , Davidson Ross 
Published: March 2016

OBJECTIVE: To determine the in vitro activity of cefepime against multidrug‐resistant Gram‐negative bacilli and Gram‐positive cocci obtained from an ongoing cross‐Canada surveillance study.DESIGN: Clinical isolates of aerobic Gram‐negative bacilli with inducible and constitutive chromosomally mediated cephalosporinases, viridans group streptococci and Streptococcus pneumoniae were collected from laboratories serving hospitals, nursing homes and physician offices in the community from across Canada during 1996 and 1997. Laboratories were asked to submit only clinically relevant nonduplicate isolates for susceptibility testing. In vitro antimicrobial susceptibility testing was carried out on all isolates of Gram‐negative and viridans group streptococci. S pneumoniae were characterized as penicillin susceptible, intermediately resistant or highly resistant. Nonsusceptible isolates were defined as being intermediately or highly resistant (minimal inhibitory concentrations [MIC] greater than 0.06 mg/L). Only isolates of S pneumoniae that were nonsusceptible to penicillin were selected for further study. MICs were determined using a microbroth dilution technique according to the National Committee of Clinical Laboratory Standards.RESULTS: A total of 727 Gram‐negative bacilli samples were collected. No resistance to cefepime was detected with Citrobacter freundii, Serratia marcescens, Morganella morganii and Enterobacter species. Of these strains, Enterobacter species and C freundii were the most resistant to ceftazidime, cefotaxime and ceftriaxone with MIC90S of 32 mg/L or greater and resistance rates of 6% or greater. Resistance rates of Pseudomonas aeruginosa and Acinetobacter species to cefepime were 4.8% and 3%, respectively. The two organisms had similar rates of resistance to ceftazidime. Less than 3% of the Gram‐negative bacilli were resistant to imipenem and meropenem. There were 153 viridans group streptococci, of which 22 (14.4%) were resistant to penicillin. Of 1287 S pneumoniae samples, 193 (15%) were nonsusceptible to penicillin. Cefepime, ceftriaxone and cefotaxime had comparable activity against all isolates of viridans group streptococci and S pneumoniae.CONCLUSIONS: Cefepime demonstrated excellent in vitro activity against Gram‐negative bacilli with inducible and constitutive chromosomally mediated cephalosporinases, and had equal or superior activity versus comparator beta‐lactams against all isolates of viridans group streptococci and S pneumoniae.
What Do Nurses and Residents Know about Childhood Asthma?
Authors: Lemay Jean-François , Moore Sean I , Zegray Michele , Ducharme Francine M 
Published: March 2016

OBJECTIVES: To assess residents’ and pediatric nurses’ basic knowledge of childhood asthma and to identify areas needing educational reinforcement.DESIGN: Survey using a validated self‐administered questionnaire containing 25 true‐false and six short open‐ended questions.PARTICIPANTS: Pediatric residents and family medicine residents who were on rotation at a tertiary care pediatric hospital over a six‐month period, and pediatric nurses on duty in the emergency department, on the wards and on the pediatric intensive care unit over a month period.RESULTS: The participation rate was 80% (28 of 35) of pediatric residents, 89% (33 of 37) of family medicine residents, and 50% (81 of 163) of pediatric nurses. The mean score (± standard deviation) on the 31‐point questionnaire was 27.7±1.8 for pediatric residents, 25.5±3.6 for family medicine residents, and 22.3±3.8 for pediatric nurses (ANOVA, P<0.001). Most (at least 75%) participants correctly identified bronchospasm and airway inflammation as two potential mechanisms of asthma and were able to list three routinely used drugs to treat exacerbations. However, 32% of pediatric residents, 12% of family medicine residents and 72% of pediatric nurses failed to identify all three main symptoms of asthma (wheezing, cough, dyspnea). Although most participants recognized that children with frequent exacerbations should receive prophylactic therapy, 25% of pediatric residents, 52% of family medicine residents and 81% of pediatric nurses were unable to name at least two preventive asthma medications. More than 50% of participants could not name two drugs used in the prevention of exercise‐induced asthma.CONCLUSIONS: Residents and nurses had adequate basic knowledge of the treatment of acute exacerbations. However, most individuals needed reinforcement in preventive asthma therapy and daily management.