bluuebunny/crossref_metadata_2025_split huggingface dataset:
Catastrophizing, Functional Disability and Pain Reports in Adults with Chronic Low Back Pain
Authors: Vienneau Theresa L , Clark Alexander J , Lynch Mary E , Sullivan Michael JL 
Published: March 2016

OBJECTIVE: To test the hypothesis that subjective reports of pain severity, pain intensity and functional disability correlate positively with catastrophizing.PATIENTS: Adults with chronic low back pain for six months or longer presenting to a tertiary care Pain Management Unit.METHODS: Catastrophizing was measured with the Pain Catastrophizing Scale (PCS) in 40 subjects (23 males, 17 females). Functional disability was measured with the Pain Disability Index and pain severity/intensity was quantified with the McGill Pain Questionnaire. Statistical analysis included Student′s t test and Pearson correlation analysis.RESULTS: Student′s t tests on all dependent variables showed no significant sex differences. Correlational analysis revealed a significant relationship between catastrophizing and pain severity (r=0.35, P<0.05), between catastrophizing and pain intensity (r=0.39, P<0.05), and between catastrophizing and disability (r=0.55, P<0.001). Further analysis revealed the helplessness component of the PCS correlated most strongly with functional disability. Analysis of the relationship between pain intensity and disability revealed no significant relationship.CONCLUSIONS: These observations support the finding that disability in chronic pain results from various causes, and is not solely a function of pain or pathology. The helplessness component of catastrophizing is most strongly related to disability. The implication of this finding is that psychological variables need proper assessment when there is significant disability. The PCS appears to be a useful tool to delineate further psychological components of chronic pain.
A Survey of Suctioning Practices among Physical Therapists, Respiratory Therapists and Nurses
Authors: Brooks Dina , Solway Sherra , Graham Ian , Downes Laurie , Carter Margaret 
Published: March 2016

OBJECTIVE: To assess the current tracheal and oropharyngeal suctioning practice variability within and among the professions of physical therapy, respiratory therapy and nursing.DESIGN: A mail survey of physical therapists, respiratory therapists and registered nurses who perform suctioning. The survey instrument consisted of questions about professional characteristics, clinical suctioning practice and sociodemographics.SETTING: The survey was restricted to professionals practising within the province of Ontario.PARTICIPANTS: Random samples (n=448) were drawn from membership of the regulatory boards of all three professions.MAIN RESULTS: Fifty‐eight per cent of respondents returned completed questionnaires. There was large variation in reports of gloving procedure (eg, double clean: 26% for physical therapists, 5% for respiratory therapists, 55% for registered nurses, P<0.0001) and technique of catheter use (sterile, inline or clean, P<0.01). There was also discrepancy in the techniques used to minimize harmful effects, ie, prelubrication with gel (83% for physical therapists, 54% for respiratory therapists, 17% for registered nurses, P<0.0001), use of hyperinflation (12% of physical therapists, 25% of respiratory therapists, 39% of registered nurses never hyperinflate) and use of instillation (7% of physical therapists, 0% of respiratory therapists, 19% of registered nurses never instill). However, there was agreement about the routine application of hyperoxygenation (74% or more) and there was almost perfect agreement (99% or more) within and across the three professions that secretion removal was the main indication for suctioning.CONCLUSIONS: The results of this study indicate a wide variation in suctioning techniques among physical therapists, respiratory therapists and registered nurses. Comparisons among professions revealed inconsistencies in some areas, such as the use of in‐line catheters, gloving procedures, prelubrication and hyperinflation.
Interaction of Staphylococcal Toxic Shock Syndrome Toxin‐1 and Enterotoxin A on T Cell Proliferation and TNFα Secretion in Human Blood Mononuclear Cells
Authors: De Boer Monica L , Kum Winnie WS , Chow Anthony W 
Published: March 2016

BACKGROUND: The majority of menstrual toxic shock syndrome (MTSS) cases are caused by a single clone of Staphylococcus aureus that produces both toxic shock syndrome toxin‐1 (TSST‐1) and staphylococcal enterotoxin A (SEA).OBJECTIVE: To determine whether the two superantigens interact to cause an enhancement of biological activity in human peripheral blood mononuclear cells (PBMCs).DESIGN: PBMCs from nine healthy donors were stimulated with TSST‐1 or SEA, either alone or in combination at their minimum effective concentrations.SETTING: In vitro study.INTERVENTIONS: Human PBMCs were stimulated in vitro with TSST‐1 (1 pg/mL), SEA (0.1 pg/mL) or combination for 20 to 72 h. Mitogenic response was determined by [3H]‐thymidine incorporation. PBMC culture supernatants were assayed for the presence of tumour necrosis factor‐alpha (TNFα), interleukin (IL)‐1β and IL‐6 by ELISA.MAIN RESULTS: The combination of TSST‐1 and SEA induced significantly greater mitogenesis in human PBMCs compared with either toxin alone (P<0.05, paired Student’s t test, two‐tailed). Similarly, the production of TNFα in culture supernatants was significantly greater in the combination of TSST‐1 and SEA compared with either TSST‐1 or SEA alone (P<0.05). In contrast, no enhancement in the levels IL‐1 or IL‐6 was observed.CONCLUSIONS: These data suggest that the co‐production of TSST‐1 and SEA by S aureus may provide some biological advantage to the organism throughs an enhanced effect of these superantigens on T cell activation and TNF secretion.
Effect of Dead Volume on the Efficiency and the Cost to Deliver Medications in Cystic Fibrosis with Four Disposable Nebulizers
Authors: Ho Sharon L , Coates Allan L 
Published: March 2016

OBJECTIVES: To evaluate the factors that affect nebulizer efficiency and to compare the relative cost effectiveness of nebulized medications used in the treatment of cystic fibrosis (CF), delivered by four types of disposable jet nebulizers that are widely used in hospitals.DESIGN: The Hudson 1730 Updraft II, Baxter Misty‐Neb, Marquest Whisper Jet (WJ), and Marquest Acorn II were evaluated in terms of respirable aerosol output (particles 5 µm or less), nebulizer dead (residual) volume (VD), and time for complete nebulization using saline, salbutamol and tobramycin at flows of 6 and 8 L/min. The respirable fraction (RF) was determined by laser diffraction, and drug output was calculated from the initial volume and concentration of the drug in the nebulizer minus the product of final drug concentration and the VD following nebulization.COST ANALYSIS: The expected pulmonary deposition (DE) was estimated, and incorporated with the material and labour costs to determine the cost effectiveness of each type of nebulizer.RESULTS: With a DE greater than two times that of the WJ at a cost of 2.4 times less, the Updraft II proved most efficient and cost effective of all the nebulizers evaluated in this study.CONCLUSIONS: The cost effectiveness of each nebulizer was determined by its efficiency, which in turn was predominantly related to its VD and RF at each flow. The efficiencies of these four devices were different and could not have been predicted from specifications provided by the respective manufacturers.
A Cross‐Canada Surveillance of Antimicrobial Resistance in Respiratory Tract Pathogens
Authors: Davidson Ross J , Canadian Bacterial Surveillance Network  , Low Donald E 
Published: March 2016

OBJECTIVE: To determine the prevalence of antimicrobial resistance in clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis from medical centres across Canada.METHODS: Fifty laboratories from across Canada were asked to collect up to 25 consecutive clinical isolates of S pneumoniae, H influenzae and M catarrhalis at some time between September 1994 and May 1995, and then again between September and December of 1996. A total of 2364 S pneumoniae, 575 H influenzae and 200 M catarrhalis samples were collected. H influenzae and M catarrhalis isolates were tested for the production of beta‐lactamase. S pneumoniae isolates were characterized as penicillin susceptible, intermediately resistant or high level penicillin‐resistant. Minimal inhibitory concentrations (MICs) were determined using a microbroth dilution technique described by the National Committee of Clinical Laboratory Standards.RESULTS: Between the two collection periods, there was a significant increase in highly penicillin‐resistant S pneumoniae from 2.1% to 4.4% (P<0.05) and an increase in intermediately penicillin‐resistant strains from 6.4% to 8.9% (P<0.05). A significant increase in high level penicillin‐resistant S pneumoniae was noted among paediatric isolates. No significant difference in the susceptibilities of comparator agents was detected. A significant increase in the number of beta‐lactamase producing H influenzae, 34% to 43% (P<0.05) was observed. Ninety‐five per cent of M catarrhalis isolates were beta‐lactamase producers in both time periods.CONCLUSIONS: During the course of this study, the incidence of penicillin resistance in S pneumoniae doubled. As a result of this increase, infections due to this organism in sites where poor penetration of beta‐lactam antibiotics occur may become increasingly difficult to manage.
The Quebec Task Force on Whiplash‐Associated Disorders and the British Columbia Whiplash Initiative: A Study of Insurance Industry Initiatives
Authors: Teasell Robert W , Merskey Harold 
Published: March 2016

Two studies on whiplash‐associated disorders that were generated by insurance companies were reviewed. The Quebec Task Force (QTF) report was comprised of a cohort study, a best evidence synthesis and consensus recommendations. The British Columbia Whiplash Initiative (BCWI) propagated the QTF recommendations.The Quebec Task Force Cohort Study: This study was designed to determine retrospectively the natural history of whiplash injuries, however, recovery from whiplash injuries was determined by the discontinuation of payments and not by the resolution of symptoms. Patients complaining of ′recurrences′, who comprised a substantial percentage of the total number of patients studied, were specifically excluded from the data set. When these patients were included in the data set, the percentage of patients who failed to recover (based on whether they were still receiving compensation) had risen from the reported 2.9% to as high as 12.4% after one year. It is impossible to draw valid conclusions about the natural history of whiplash injuries from this study because it did not study recovery from whiplash symptoms and excluded the majority of patients who were classified as ′recurrences′ from the final study analysis.The Quebec Task Force Best Evidence Synthesis Including Interventions: This analysis identified the paucity of conclusive research regarding treatments for whiplash. The paucity of conclusive research limited the number of conclusions that could be drawn.The Quebec Task Force Consensus Recommendations: Despite a recognized lack of quality research, a consensus report that focused on therapeutic interventions was made. This consensus report is of concern because there was limited evidence to support the consensus, the classifications and recommendations were entirely arbitrary, the cohort data that the consensus panel relied upon to identify a natural history was seriously flawed, funding for the study was partisan, there was potential for abuse of guidelines, and there was a failure to deal with chronic whiplash injuries.The British Columbia Whiplash Initiative: This report, which was designed as a set of educational modules, relied heavily on the QTF, particularly the cohort study and the consensus recommendations. As a result, the report was based upon a flawed and overly optimistic picture of the natural history of whiplash disorders, and an arbitrary classification and management system. Both the QTF and the BCWI draw attention to the potential dangers of insurance industry initiatives designed to persuade medical and allied health professionals to accept viewpoints that appear overoptimistic and potentially self‐serving.
Protease Inhibitor Phenotype BsaskatoonM Is Not Associated with Emphysema – A 20‐Year Follow‐Up Study
Authors: Jokic Ruzica , Fisher Kendra L , Cockcroft Donald W 
Published: March 2016

OBJECTIVE: To investigate the association between the PiBsaskatoon variant of alpha‐1 protease inhibitor (α1 Pi), present in the heterozygous state and the development of emphysema.DESIGN: Twenty‐year follow‐up in the third generation of a family with the variant, naturally controlled with regard to both environmental influences and other genetic factors.SETTING: University teaching hospital.POPULATION STUDIED: Ten siblings, five with PiBsaskatoonM phenotype and five with PiM phenotype, 33 to 46 years of age.INTERVENTIONS: Respiratory symptoms and smoking histories; pulmonary function tests, including static lung volumes, dynamic lung volumes before and after salbutamol 200 μg, and diffusing capacity; allergen prick skin tests; serum α1 Pi level, chest radiographs and high resolution computerized tomography lung scans.MAIN RESULTS: The two groups of siblings had similar mean ages, smoking histories and prevalence of current mild respiratory symptoms. Pulmonary function data showed normal mean values and no statistically significant differences for all the variables between the two groups. Chest radiographs were normal in all subjects. High resolution computerized tomography scans were normal in eight subjects, and demonstrated mild and very mild centrilobular emphysema in the two subjects with greatest smoking histories (approximately 30 pack‐year each); both of these were PiBsaskatoonM phenotype.CONCLUSION: There is no evidence of an association between α1 Pi phenotype PiBsaskatoonM and the development of emphysema.
Observations from a Multicentre Study on the Use of the Sputum Specimen in Patients Hospitalized with Community‐Acquired Pneumonia
Authors: Taylor EL , Marrie TJ , Fine MJ , Obroskyl DS , Kapoor WN , Coley C , Singer DE 
Published: March 2016

OBJECTIVE: To describe the use of sputum Gram stain and culture in patients with community‐acquired pneumonia (CAP) and to determine the factors that are associated with obtaining sputum for culture.TYPE OF STUDY: Prospective observational cohort study of patients hospitalized for treatment of CAP at four medical institutions in three geographic locations.MAIN MEASUREMENTS: Results of Gram stain and culture of sputum; comparison of patients who had sputum processed for culture within 24 h of admission with those who did not have such a specimen processed during the first week of hospitalization; and the results of investigator assignment of etiology of pneumonia according to predefined criteria.RESULTS: Four hundred and seventy‐eight of 1339 (36%) patients had a sputum specimen processed for culture within 24 h of admission. Patients who had a sputum specimen processed within 24 h of admission were more likely to be hospitalized at the Boston site (odds ratio [OR] 20.6) or Pittsburgh sites (3.4) and to have current sputum production, chronic obstructive lung disease and moderate or large amount of sputum. Female sex (0.4), neutropenia (0.05), and do not resuscitate status (0.36) were important predictors of failure to have a sputum processed for culture. The rate of Streptococcus pneumoniae isolation was highest in Boston, 53 of 269 (19.3 %) patients (P<0.001) compared with the other sites; Moraxella catarrhalis was isolated only at the Boston site. Sputum culture results served as the basis for the assignment of an etiological diagnosis of the pneumonia by investigators in 67% of 397 patients. CONCLUSIONS: Sputum is not processed for culture in the majority of patients with CAP. The factors that determine whether sputum is processed for culture within 24 h of admission are site of care and a variety of patient factors. Common respiratory pathogens when present in sputum culture tend to be used to assign an etiological diagnosis. A positive sputum culture result appears not to result in a more favourable outcome.
Nonasthmatic Chronic Cough: No Effect of Treatment with an Inhaled Corticosteriod in Patients without Sputum Eosinophilia
Authors: Pizzichini Marcia MM , Pizzichini Emilio , Parameswaran Krishnan , Clelland Lynda , Efthimiadis Ann , Dolovich Jerry , Hargreave Frederick E 
Published: March 2016

BACKGROUND: Inhaled corticosteroids are effective in suppressing a chronic cough without asthma associated with sputum eosinophilia.OBJECTIVE: To investigate the inflammatory characteristics in the induced sputum of patients with a chronic cough without asthma or known cause and the effects of budesonide treatment on chronic cough in those patients.PATIENTS AND METHODS: Forty‐four adults (mean [minimum, maximum] age of 45 years [20,75], 28 women, 17 atopic subjects and 32 nonsmokers]), with a daily bothersome cough for at least one year and who had no evidence of asthma or other known cause for the cough, were consecutively enrolled. The trial was a randomized, double‐blind, controlled parallel group trial of budesonide 400 mg twice daily for two weeks versus placebo. Patients then received open administration of the same dose of budesonide for a further two weeks. Sputum was induced before and at the end of each treatment period. Cough severity was documented by a visual analogue scale.RESULTS: Thirty‐nine (89%) patients produced mucoid sputum after induction on at least one study visit. At baseline, the majority (59%) had a mild elevation in the median proportion of neutrophils (65%). All had elevated fluid phase levels of fibrinogen (3200 µg/L) and albumin (880 µg/L), and high levels of interleukin‐8 and substance P. Interleukin‐8 correlated with neutrophils (rho=0.72, P<0.001), fibrinogen (rho=0.65, P<0.001), albumin (rho=0.67, P=0.001) and eosinophil cationic protein (rho=0.60, P=0.001). Substance P correlated with albumin (rho=0.60, P=0.006). No subject had an increase in eosino‐phils. Treatment with budesonide did not affect cough or sputum measurements.CONCLUSIONS: Patients with nonasthmatic chronic cough enrolled in this study had evidence of a mild neutrophilia and/or microvascular leakage. Chronic cough did not respond to treatment with budesonide, perhaps because the cause was not associated with sputum eosinophilia.
Enterococcal Bacteremia in a Tertiary Care Centre in Winnipeg
Authors: Madani Tariq AA , Kabani Amin , Orr Pamela , Nicolle Lindsay 
Published: March 2016

OBJECTIVE: To review experience with enterococcal bacteremia before the emergence of vancomycin‐resistant enterococcus at a tertiary care teaching hospital.DESIGN: Retrospective chart review of episodes of enterococcal bacteremia identified through the clinical microbiology laboratory from January 1990 to December 1994. Antimicrobial susceptibilities were performed for all isolates and pulsed‐field gel electrophoresis for genetic typing of selected strains.RESULTS: One hundred and twenty‐six episodes of bacteremia were identified in 109 patients: 108 Enterococcus faecalis, 13 Enterococcus faecium, four both E faecalis and E faecium, and one Enterococcus durans. Enterococcal isolates occurred with polymicrobial bacteremia in 62 (49%) episodes. The most common sites of infection were central venous catheters (45%) and the urinary tract (21%). Enterococcal bacteremia was usually nosocomially acquired (88%), and associated with older age, instrumentation, and prior or current antimicrobial therapy. Overall mortality was 22%, and 7.2% was partially or fully attributable to enterococcal bacteremia. Resistance to ampicillin, high level gentamicin and high level streptomycin were 0%, 32% and 31% for E faecalis, respectively, and 44%, 0% and 47% for E faecium, respectively.CONCLUSIONS: During this review, the frequency and impact of enterococcal bacteremia at this institution was relatively limited. Isolates resistant to ampicillin and aminoglycosides were emerging, but differences in patient outcomes were similar for resistant and susceptible isolates.
Multidrug‐Resistant Tuberculosis in Alberta and British Columbia, 1989 to 1998
Authors: Hersi Ahmed , Elwood Kevin , Cowie Robert , Kunimoto Dennis , Long Richard 
Published: March 2016

OBJECTIVE: To describe the extent of the problem of multidrug‐resistant tuberculosis (MDR‐TB) in Alberta and British Columbia from 1989 to 1998.DESIGN: A retrospective, population‐based descriptive study of all notified MDR‐TB cases in the context of all notified TB cases, all notified culture‐positive TB cases and all notified drug‐resistant TB cases.SETTING: Provinces of Alberta and British Columbia, and their TB registries.PATIENTS: All people with TB reported to the TB registries of Alberta and British Columbia between January 1, 1989 and June 30, 1998.MAIN OUTCOME MEASURES: Drug susceptibility testing was performed in all cases of culture‐positive TB. Demographic, clinical and laboratory data on all cases of MDR‐TB were recorded.RESULTS: Of 4606 notified cases of TB, 3553 (77.1%) were culture positive. Of these, 365 (10.3%) were drug resistant; of the drug‐resistant cases, 24 (6.6%) were MDR. Most MDR‐TB patients were foreign‐born; of the four Canadian‐born patients, two were infected while travelling abroad. Although foreign‐born patients were significantly more likely to harbour drug‐resistant strains, 14.3% versus 4.8%, respectively (P<0.001), among those who were harbouring a drug‐resistant strain, the proportion of Canadian‐born versus foreign‐born patients with an MDR strain was the same (6.7% versus 6.6%, respectively). From 1994 to 1998 versus 1989 to 1993, the proportion of all drug‐resistant strains that were MDR was greater (9.0% versus 4.3%, respectively), but the difference was not statistically significant. Isolates from 16 of the 24 MDR‐TB cases had been archived. Each of these was fingerprinted and found to be unique. Most MDR‐TB cases (88%) were respiratory. Of those tested for human immunodeficiency virus (n=17), only one was seropositive. MDR‐TB was ‘acquired’ in 67% and ‘primary’ in 33% of cases. Eight (33%) of the MDR‐TB cases received curative courses of treatment, six (25%) are still being treated, and the remainder have either died (five, 21%), transferred out (four, 17%) or become ‘chronic’ (one, 4%). No secondary case of MDR‐TB has been identified in Alberta and British Columbia.CONCLUSIONS: Most MDR‐TB in Alberta and British Columbia is imported. The proportion of all drug‐resistant cases that are MDR appears to be increasing, but not because of disease acquired from recent contact with MDR‐TB in Canada.