bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does a Rapid Decline in the Hematological and Biochemical Parameters Induced by Interferon and Ribavirin Combination Therapy for the Hepatitis C Virus Predict a Sustained Viral Response?
Authors: Turbide Christian , Soulellis Constantine A , Deschênes Marc , Hilzenrat Nir 
Published: March 2016

BACKGROUND AND OBJECTIVES: To analyze whether rapid myelosuppression and a decrease in alanine aminotransferase (ALT) induced by standard interferon (IFN) and ribavirin (RBV) combination therapy predict a sustained viral response (SVR) in hepatitis C virus patients.PATIENTS AND METHODS: Data from 111 patients (mean age 48.1 years) with chronic hepatitis C virus were retrospectively analyzed. All patients were treated with the same initial doses of IFN and RBV combination therapy. The following laboratory values were measured at baseline, and then at weeks 2, 4, 8, 12 and 24 of treatment: hemoglobin, white blood cells (WBCs), neutrophils, platelets and ALT. A delta value was then calculated for each interval from baseline (baseline values minus two weeks, etc). The delta value of each variable was then compared between the responders and nonresponders using Wilcoxon’s signed rank test.RESULTS: Sixty patients (54%) achieved an SVR. There were no significant differences between the responder and nonresponder groups for baseline variables. The delta value of ALT was the only significant marker in the prediction of an SVR. The mean ± SD delta values for the ALT at week 2 of treatment were 71±92 U/L and 44±85 U/L for the responders and nonresponders, respectively (P<0.0046). At week 4, the values were 101±96 U/L and 84±100 U/L for the responders and nonresponders, respectively (P<0.0154). The decline was then calculated for the ALT as a percentage decrease from baseline: at weeks 2 and 4, the decreases were 64% and 66%, respectively, for the responders, and 43% and 41%, respectively, for the nonresponders. At week 2, the delta values for WBC count were found to be significant in predicting failure to achieve an SVR, with mean ± SD delta values of 0.85× 109/L±1.48× 109/L and 1.53× 109/L±2.16× 109/L for the responders and nonresponders, respectively (P<0.0173). The same trend emerged at two weeks for neutrophils: 0.72× 109/L±1.33× 109/L for the responders and 1.02× 109/L±1.20× 109/L for the nonresponders (P<0.0150). The delta values were insignificant for hemoglobin, lowest hemoglobin values and platelets.CONCLUSIONS: The decline rates of ALT from baseline to week 2 and 4 of IFN and RBV combination therapy are good predictors of an SVR. A significant drop in WBC and neutrophil values is a predictor of failure to achieve an SVR. The hemoglobin, platelets and lowest hemoglobin values failed to predict an SVR.
A Review of Systematic Reviews on Pain Interventions in Hospitalized Infants
Authors: Yamada Janet , Stinson Jennifer , Lamba Jasmine , Dickson Alison , McGrath Patrick J , Stevens Bonnie 
Published: March 2016

BACKGROUND: Hospitalized infants undergo multiple, repeated painful procedures. Despite continued efforts to prevent procedural pain and improve pain management, clinical guidelines and standards frequently do not reflect the highest quality evidence from systematic reviews.OBJECTIVE: To critically appraise all systematic reviews on the effectiveness of procedural pain interventions in hospitalized infants.METHODS: A structured review was conducted on published systematic reviews and meta‐analyses of pharmacological and nonpharmacological interventions of acute procedural pain in hospitalized infants. Searches were completed in the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL and PsycINFO. Two reviewers independently selected articles for review and rated the methodological quality of the included reviews using a validated seven‐point quality assessment measure. Any discrepancies were resolved by a third reviewer.RESULTS: Of 1469 potential systematic reviews on interventions for painful procedures in hospitalized infants, 11 high‐quality reviews were included in the analysis. Pharmacological interventions supported by research evidence included premedication for intubation, dorsal penile nerve block and EMLA (AstraZeneca Canada, Inc) for circumcision, and sucrose for single painful procedures. Non‐nutritive sucking, swaddling, holding, touching, positioning, facilitative tucking, breast feeding and supplemental breast milk were nonpharmacological interventions supported for procedural pain.CONCLUSION: There is a growing number of high‐quality reviews supporting procedural pain management in infants. Ongoing research of single, repeated and combined pharmacological and nonpharmacological interventions is required to provide the highest quality evidence to clinicians for decision‐making on optimal pain management.
Asthma Counselling Targeted to Removal of Domestic Animals
Authors: Hagan Louise , Valois Pierre , Patenaude Hélène , Boutin Hélène , Boulet Louis-Philippe , Lafrenière France 
Published: March 2016

OBJECTIVES: To create and evaluate the efficacy of a short individualized educational intervention program, based on Prochaska’s transtheoretical model, for a six‐month period in a population of adult asthma patients living with domestic animals but sensitized to these pets.METHODS: A randomized, controlled study using a pretested questionnaire was conducted at three different times (pretest, and at three and six months postintervention).RESULTS: Eleven members (29%) of the intervention group and eight members (21%) of the control group removed their pets within six months (χ2=3.23; P>0.35). The two groups showed similar improvements in their perception of the benefits of pet removal and in their level of belief that they could do it. The experimental group showed a greater improvement in knowledge acquisition about asthma and allergies than the control group (P<0.05). Both experimental and standard educational interventions were effective in facilitating progression through the stages of behavioural change.CONCLUSION: Overall, the results do not support the utility of behavioural change educational intervention, tailored to the transtheoretical model stage of the individual, in the context of convincing patients to remove their pets from their homes. However, the decision‐making aid appears to be helpful in raising awareness of the problem of asthma and allergy in the patient, and in developing appropriate knowledge.
Cost‐Effectiveness of Combination Therapy for Chronic Obstructive Pulmonary Disease
Authors: Chuck Anderson , Jacobs Philip , Mayers Irvin , Marciniuk Darcy 
Published: March 2016

BACKGROUND: There is evidence that combination therapy (CT) in the form of long‐acting beta2‐agonists (LABAs) and inhaled corticosteroids can improve lung function for patients with chronic obstructive pulmonary disease (COPD).OBJECTIVE: To determine the cost‐effectiveness of using CT in none, all or a selected group of COPD patients.METHODS: A Markov model was designed to compare four treatment strategies: no use of CT regardless of COPD severity (patients receive LABA only); use of CT in patients with stage 3 disease only (forced expiratory volume in 1 s [FEV1] less than 35% of predicted); use of CT in patients with stages 2 and 3 disease only (FEV1 less than 50% of predicted); and use of CT in all patients regardless of severity of COPD. Estimates of mortality, exacerbation and disease progression rates, quality‐adjusted life years (QALYs) and costs were derived from the literature. Three‐year and lifetime time horizons were used. The analysis was conducted from a health systems perspective.RESULTS: CT was associated with a cost of $39,000 per QALY if given to patients with stage 3 disease, $47,500 per QALY if given to patients with stages 2 and 3 disease, and $450,333 per QALY if given to all COPD patients. Results were robust to various assumptions tested in a Monte Carlo simulation.CONCLUSION: Providing CT for COPD patients in stage 2 or 3 disease is cost‐effective. The message to family physicians and specialists is that as FEV1 worsens and reaches 50% of predicted values, CT is recommended.
Endoscopist-Administered Propofol: A Retrospective Safety Study
Authors: Morse John WI , Fowler Sharyle A , Morse Amy L 
Published: March 2016

BACKGROUND: Propofol is an anesthetic agent that is commonly used for conscious sedation. Propofol has advantages as a sedative agent for endoscopic procedures including rapid onset, short half-life and rapid recovery time. However, concerns exist regarding the potential for respiratory depression, hypotension, perforation due to deep sedation and the need for monitoring by an anesthetist. Propofol has been used under endoscopist supervision at the Stanton Territorial Hospital in Yellowknife, Northwest Territories since 1996 (approximately 7000 cases).METHODS: A retrospective chart review of endoscopic procedures conducted at the Stanton Territorial Hospital between January 1996 and May 2007 was performed. A random sample of 680 procedures was reviewed from a total of 6396 procedures.RESULTS: The mean (± SD) baseline systolic blood pressure (SBP) was 122.8±17.0 mmHg. The mean lowest SBP was 101.7±14.5 mmHg. The mean absolute drop in SBP was 21.1±16.7 mmHg, with a mean per cent drop of 16.3%±11.7%. Eighty-eight patients (12.9%) developed transient hypotension (SBP lower than 90 mmHg). All patients regained normal blood pressure spontaneously on repeated measurement. No patients required intravenous fluid resuscitation. The mean O2saturation was 96.4%±2.1%. One patient (0.1%) transiently desaturated (O2saturation 89%), but recovered spontaneously on repeat measurement with no intervention. No procedures were aborted for patient safety. There were no major complications, including perforation or death. There was one mucosal tear during nontherapeutic colonoscopy (0.1%).CONCLUSIONS: Propofol can be safely administered in a community hospital setting under endoscopist supervision, with no additional support or monitoring.
Access to Specialist Gastroenterology Care in Canada: The Practice Audit in Gastroenterology (PAGE) Wait Times Program
Authors: Armstrong David , Barkun Alan NG , Chen Ying , Daniels Sandra , Hollingworth Roger , Hunt Richard H , Leddin Desmond 
Published: March 2016

BACKGROUND: Canadian wait time data are available for the treatment of cancer and heart disease, as well as for joint replacement, cataract surgery and diagnostic imaging procedures. Wait times for gastroenterology consultation and procedures have not been studied, although digestive diseases pose a greater economic burden in Canada than cancer or heart disease.METHODS: Specialist physicians completed the practice audit if they provided digestive health care, accepted new patients and recorded referral dates. For patients seen for consultation or investigation over a one-week period, preprogrammed personal digital assistants were used to collect data including the main reason for referral, initial referral and consultation dates, procedure dates (if performed), personal and family history, and patient symptoms, signs and test results. Patient triaging, appropriateness of the referral and timeliness of care were noted.RESULTS: Over 10 months, 199 physicians recorded details of 5559 referrals, including 1903 visits for procedures. The distribution of total wait times (from referral to procedure) nationally was highly skewed at 91/203 days (median/75th percentile), with substantial interprovincial variation: British Columbia, 66/185 days; Alberta, 134/284 days; Ontario, 110/208 days; Quebec, 71/149 days; New Brunswick, 104/234 days; and Nova Scotia, 42/84 days. The percentage of physicians by province offering average-risk screening colonoscopy varied from 29% to 100%.DISCUSSION: Access to specialist gastroenterology care in Canada is limited by long wait times, which exceed clinically reasonable waits for specialist treatment. Although exhibiting some methodological limitations, this large practice audit sampling offers broadly generalized results, as well as a means to identify barriers to health care delivery and evaluate strategies to address these barriers, with the goals of expediting appropriate care for patients with digestive health disorders and ameliorating the personal and societal burdens imposed by digestive diseases.
Early Experience with Unsedated Ultrathin 4.9 mm Transnasal Gastroscopy: A Pilot Study
Authors: Cheung Justin , Bailey Robert , van Zanten Sander Veldhuyzen , McLean Ross , Fedorak Richard N , Morse John , Millan Mario , Guzowski Tom , Goodman Karen J , for the CANHelp working group  
Published: March 2016

BACKGROUND: Unsedated transnasal gastroscopy is a technique with unverified clinical advantages.OBJECTIVE: To evaluate the efficacy and procedure times with transnasal gastroscopy by physicians with no previous experience in transnasal endoscopy.METHODS: Unsedated transnasal gastroscopy using 4.9 mm ultrathin transnasal gastroscopes with randomization to two different biopsy forceps was prospectively evaluated during a single day in January 2008. The outcomes included patient tolerance (scale: 1, no discomfort; 10, severe discomfort), physician technical assessment (1, excellent; 10, very poor), gastric biopsy quality, adverse events and procedure times.RESULTS: Twenty patients underwent transnasal gastroscopy. Nineteen patients (95%) successfully completed transnasal gastroscopy. The patient-reported mean (± SD) overall discomfort level during the procedure was 4.0±1.9 compared with a physician-estimated level of 3.2±1.7 (P=0.04). Only 10% (n=2) reported they would have preferred sedated over unsedated gastroscopy. Mean total encounter time from anesthesia to discharge was 33.5±9.3 min. The time from anesthesia to insertion was 7.0±5.3 min and from room exit to discharge 6.2±2.9 min. No patients who had gastric biopsies taken (zero of 14) had any of unacceptable quality. The only adverse event was distressing sensations (dyspnea, dizziness) in one patient that started during pre-endoscopy anesthetic application, persisting postendoscopy, but without any abnormalities in vital signs.CONCLUSION: Assuming the adverse event was a rare reaction, early experience with unsedated ultrathin transnasal gastroscopy was an efficient, effective and well-tolerated procedure for evaluation of the upper gastrointestinal tract.
Towards Excellence in Asthma Management: Final Report of an Eight‐Year Program Aimed at Reducing Care Gaps in Asthma Management in Quebec
Authors: Boulet Louis-Philippe , Dorval Eileen , Labrecque Manon , Turgeon Michel , Montague Terrence , Thivierge Robert L 
Published: March 2016

BACKGROUND AND OBJECTIVES: Asthma care in Canada and around the world persistently falls short of optimal treatment. To optimize care, a systematic approach to identifying such shortfalls or ‘care gaps’, in which all stakeholders of the health care system (including patients) are involved, was proposed.METHODS: Several projects of a multipartner, multidisciplinary disease management program, developed to optimize asthma care in Quebec, was conducted in a period of eight years. First, two population maps were produced to identify regional variations in asthma‐related morbidity and to prioritize interventions for improving treatment. Second, current care was evaluated in a physician‐patient cohort, confirming the many care gaps in asthma management. Third, two series of peer‐reviewed outcome studies, targeting high‐risk populations and specific asthma care gaps, were conducted. Finally, a process to integrate the best interventions into the health care system and an agenda for further research on optimal asthma management were proposed.RESULTS: Key observations from these studies included the identification of specific patterns of noncompliance in using inhaled corticosteroids, the failure of increased access to spirometry in asthma education centres to increase the number of education referrals, the transient improvement in educational abilities of nurses involved with an asthma hotline telephone service, and the beneficial effects of practice tools aimed at facilitating the assessment of asthma control and treatment needs by general practitioners.CONCLUSIONS: Disease management programs such as Towards Excellence in Asthma Management can provide valuable information on optimal strategies for improving treatment of asthma and other chronic diseases by identifying care gaps, improving guidelines implementation and optimizing care.
Direct Costs of Occupational Asthma in Quebec between 1988 and 2002
Authors: Malo Jean-Luc , L’Archevêque Jocelyne , Ghezzo Heberto 
Published: March 2016

BACKGROUND: Forty to 70 cases of occupational asthma due to sensitization to an agent present in the workplace are accepted each year by the Commission de la santé et de la sécurité du travail, the Quebec medicolegal agency.OBJECTIVES AND METHODS: In a random sample of eight to 10 accepted claims per year from 1988 to 2002, the direct costs of compensation for loss of income (CLI) and compensation for functional impairment (CFI), as well as the associations of these costs with selected variables, were assessed.RESULTS: Mean costs (presented as Canadian dollars ×103) of CLI, CFI and total were 72.5, 11.7 and 92.8, respectively, while the median costs were 40.7, 7.6 and 61.3 for CLI, CFI and total, respectively. Median CLI costs were significantly higher in men than women (69.9 versus 13.1), workers aged 40 years or older versus those younger than 40 years (90.1 versus 27.4), workers with occupational asthma due to workplace exposure to low versus high molecular weight agents (51.2 versus 38.6), and workers taking inhaled steroids at diagnosis (92 versus 52) and reassessment (81 versus 35). Median CFI costs were also higher in those requiring retraining (10.4) and taking early retirement (61.8) than workers who stayed with the same employer but in a different job (5.4). Median CFI costs were significantly higher for individuals being treated with inhaled steroids at the time of diagnosis (14.0 versus 5.2) and reassessment (13 versus 6), and for those left with bronchial hyperresponsiveness (9.5 versus 0.8) related to forced expiratory volume in 1 s and forced expiratory volume in 1 s/forced vital capacity.CONCLUSION: Age, sex, nature of occupational agent, treatment with inhaled steroids and type of rehabilitation all affect CLI, whereas lung function status at baseline and reassessment is related to CFI.
Increasing the Use of Anti‐Inflammatory Agents for Acute Asthma in the Emergency Department: Experience with an Asthma Care Map
Authors: Rowe Brian H , Chahal Anthony M , Spooner Carol H , Blitz Sandra , Senthilselvan Ambikaipakan , Wilson Deborah , Holroyd Brian R , Bullard Michael 
Published: March 2016

PURPOSE: Acute asthma is a common emergency department (ED) presentation and variation in its management is well recognized. The present study examined the use of an asthma care map (ACM) in one Canadian ED to improve adherence to acute asthma guidelines, emphasizing the use of systemic corticosteroids (SCSs) and inhaled corticosteroids (ICSs).METHODS: Three time periods were studied: the 15 months before ACM introduction (PRE), the 15 months following a three‐month introduction of the ACM (POST1) and the 18 months after POST1 (POST2). Randomly selected patient charts from each period were included from patients who were 18 to 60 years of age and presented with a primary diagnosis of acute asthma. A priori criteria were established to determine the degree of completion and success of the ACM. Primary outcomes included documentation, use of SCSs in the ED, and prescription of SCSs and ICSs at ED discharge.RESULTS: A total of 387 patient charts were included (PRE, n=150; POST1, n=150; POST2, n=87). Patient characteristics in the three groups were similar; however, patients in POST1 and POST2 showed higher use of newer agents than those in the PRE group. Overall, more women (n=209; 54%) than men were seen; the mean age was 32.4 years. The care map was used in 67% of cases during POST1 and 70% during POST2. The use of peak expiratory flow (PEF) was high during the PRE, POST1 and POST2 periods (91%, 89% and 91%, respectively); however, documentation of other markers of severity increased in the POST periods. Use of SCSs occurred earlier (P<0.01) and more often (57% PRE, 68% POST1 and 75% POST2; P<0.01) in the POST1,2 periods than the PRE period. There was a significant increase in use of SCSs on discharge (55% PRE, 66% POST1 and 69% POST2; P<0.05), and prescription of ICSs significantly increased (24% PRE, 45% POST1 and 61% POST2; P<0.001) in the POST1,2 periods. Discharge with‐out any corticosteroids decreased over the three periods (32% PRE, 21% POST1 and 17% POST2; P<0.05). The length of stay in the ED increased over the study periods (181 min PRE, 209 min POST1 and 265 min POST2; P<0.01) and admissions were infrequent (9% PRE, 13% POST1 and 6% POST2; P=0.50).CONCLUSIONS: The present study provides evidence that the standardized ED ACM was widely accepted, improved chart documentation, improved some aspects of ED care and increased prescribing of discharge preventive medications.
VSL#3 Probiotic Upregulates Intestinal Mucosal Alkaline Sphingomyelinase and Reduces Inflammation
Authors: Soo Isaac , Madsen Karen L , Tejpar Qassim , Sydora Beate C , Sherbaniuk Richard , Cinque Benedetta , Di Marzio Luisa , Cifone Maria Grazia , Desimone Claudio , Fedorak Richard N 
Published: March 2016

BACKGROUND: Alkaline sphingomyelinase, an enzyme found exclusively in bile and the intestinal brush border, hydrolyzes sphingomyelin into ceramide, sphingosine and sphingosine-1-phosphate, thereby inducing epithelial apoptosis. Reduced levels of alkaline sphingomyelinase have been found in premalignant and malignant intestinal epithelia and in ulcerative colitis tissue. Probiotic bacteria can be a source of sphingomyelinase.OBJECTIVE: To determine the effect of VSL#3 probiotic therapy on mucosal levels of alkaline sphingomyelinase, both in a mouse model of colitis and in patients with ulcerative colitis.METHODS: Interleukin-10 gene-deficient (IL10KO) and wild type control mice were treated with VSL#3 (109colony-forming units per day) for three weeks, after which alkaline sphingomyelinase activity was measured in ileal and colonic tissue. As well, 15 patients with ulcerative colitis were treated with VSL#3 (900 billion bacteria two times per day for five weeks). Alkaline sphingomyelinase activity was measured through biopsies and comparison of ulcerative colitis disease activity index scores obtained before and after treatment.RESULTS: Lowered alkaline sphingomyelinase levels were seen in the colon (P=0.02) and ileum (P=0.04) of IL10KO mice, as compared with controls. Treatment of these mice with VSL#3 resulted in upregulation of mucosal alkaline sphingomyelinase activity in both the colon (P=0.04) and the ileum (P=0.01). VSL#3 treatment of human patients who had ulcerative colitis decreased mean (± SEM) ulcerative colitis disease activity index scores from 5.3±1.8946 to 0.70±0.34 (P=0.02) and increased mucosal alkaline sphingomyelinase activity.CONCLUSION: Mucosal alkaline sphingomyelinase activity is reduced in the intestine of IL10KO mice with colitis and in humans with ulcerative colitis. VSL#3 probiotic therapy upregulates mucosal alkaline sphingomyelinase activity.