bluuebunny/crossref_metadata_2025_split huggingface dataset:
Qualitative Assessment of Pain Management in Patients Undergoing Computed Tomography‐Guided Transthoracic Lung Biopsy
Authors: Wong Erin T , Dunham Carol , Patsios Demetris 
Published: March 2016

BACKGROUND: Unpublished questionnaire data collected by the authors’ institution (Toronto General Hospital, Toronto, Ontario) indicates that patients often experience significant pain while undergoing lung biopsy, yet receive only a fraction of the maximum allowable dosage of analgesic.OBJECTIVES: To qualitatively assess current pain management practices from the patient perspective. Patient education and patient satisfaction were also evaluated.METHODS: From March through June 2012, participants were contacted via telephone within one week of their procedure until data saturation was reached. The semistructured interviews were based on a study‐specific interview template. Thematic analysis of qualitative study data was used to identify recurring interview topics.RESULTS: A consecutive sample of 16 outpatients who had undergone image‐guided transthoracic lung biopsy at the authors’ institution were interviewed. None of the study participants reported noteworthy pain associated with the insertion of lung biopsy needles. The most significant pain was caused by positioning within the computed tomography scanner, particularly among participants who were in the prone position. All participants reported high satisfaction with the amount of analgesic received. Potential complications and recovery period details were identified as areas for improved patient education.CONCLUSIONS: At the authors’ institution, pain associated with lung biopsy needle insertion was well controlled. Positional pain is common for patients required to be in the prone position. Potential solutions include increasing awareness of positional pain and instituting additional supportive equipment.
Safety and Immunogenicity of Two Doses of Quadrivalent Meningococcal Conjugate Vaccine or One Dose of Meningococcal Group C Conjugate Vaccine, both Administered Concomitantly with Routine Immunization to 12‐ to 18‐Month‐Old Children
Authors: Noya Francisco , McCormack Deirdre , Reynolds Donna L , Neame Dion , Oster Philipp 
Published: March 2016

OBJECTIVES:To describe the immunogenicity and safety of a two‐dose series of a quadrivalent meningococcal (serogroups A, C, Y and W) polysaccharide diphtheria toxoid conjugate vaccine (MenACYW‐D) administered to toddlers.METHODS: Children were randomly assigned (1:1) at study entry to receive MenACYW‐D at 12 and 18 months of age (group 1; n=61) or meningococcal serogroup C conjugate vaccine (MCC) at 12 months of age (group 2; n=62). All received routine childhood immunizations. A, C, Y and W antibody titres were measured in group 1 before and one month after the 18‐month MenACYW‐D vaccination and were measured in group 2 at one and seven months post‐MCC vaccination. Antibodies elicited by diphtheria and tetanus toxoids, and acellular pertussis vaccine adsorbed combined with inactivated poliomyelitis vaccine and Haemophilus influenzae b conjugate (DTaP‐IPV‐Hib) vaccine coadministered at the 18‐month vaccination were measured one month later. Safety data were collected.RESULTS: At 19 months of age, ≥96% in group 1 achieved protective titres for the four meningococcal serogroups after dose 2; 67% in group 2 exhibited protective titres against serogroup C 28 days after MCC vaccination at 12 months of age, declining to 27% seven months later. DTaP‐IPV‐Hib elicited high antibody concentrations/titres in groups 1 and 2, consistent with historical values. The safety profiles after each dose generated no unexpected safety signals; no serious adverse events were related to vaccination.DISCUSSION: A two‐dose series of MenACYW‐D given concomitantly with a DTaP‐IPV‐Hib booster dose at 18 months of age demonstrated a good immunogenicity and safety profile. A two‐dose series of MenACYW‐D can be used as an alternative to one dose of MCC and provides protection against additional serogroups (NCT ID: NCT01359449).
Quality Indicators for the Assessment and Management of Pain in the Emergency Department: A Systematic Review
Authors: Stang Antonia S , Hartling Lisa , Fera Cassandra , Johnson David , Ali Samina 
Published: March 2016

BACKGROUND: Evidence indicates that pain is undertreated in the emergency department (ED). The first step in improving the pain experience for ED patients is to accurately and systematically assess the actual care being provided. Identifying gaps in the assessment and treatment of pain and improving patient outcomes requires relevant, evidence‐based performance measures.OBJECTIVE: To systematically review the literature and identify quality indicators specific to the assessment and management of pain in the ED.METHODS: Four major bibliographical databases were searched from January 1980 to December 2010, and relevant journals and conference proceedings were manually searched. Original research that described the development or collection of data on one or more quality indicators relevant to the assessment or management of pain in the ED was included.RESULTS: The search identified 18,078 citations. Twenty‐three articles were included: 15 observational (cohort) studies; three before‐after studies; three audits; one quality indicator development study; and one survey. Methodological quality was moderate, with weaknesses in the reporting of study design and methodology. Twenty unique indicators were identified, with the majority (16 of 20) measuring care processes. Overall, 91% (21 of 23) of the studies reported indicators for the assessment or management of presenting pain, as opposed to procedural pain. Three of the studies included children; however, none of the indicators were developed specifically for a pediatric population.CONCLUSION: Gaps in the existing literature include a lack of measures reflecting procedural pain, patient outcomes and the pediatric population. Future efforts should focus on developing indicators specific to these key areas.
Analysis of Cardiopulmonary Stress during Endoscopy: Is Unsedated Transnasal Esophagogastroduodenoscopy Appropriate for Elderly Patients?
Authors: Uchiyama Kazuhiko , Ishikawa Takeshi , Sakamoto Naoyuki , Kajikawa Hirokazu , Takagi Tomohisa , Handa Osamu , Tatsumi Yoshihide , Yagi Nobuaki , Naito Yuji , Itoh Yoshito , Takemura Shuhei 
Published: March 2016

BACKGROUND: Transnasal esophagogastroduodenoscopy (EGD) without sedation has been reported to be safe and tolerable. It has recently been used widely in Japan for the detection of upper gastrointestinal disease. Alternatively, transoral examination using a thin endoscope has also been reported to be highly tolerable.OBJECTIVE: To examine the cardiocirculatory effects of transoral versus transnasal EGD in an attempt to determine the most suitable endoscopic methods for patients ≥75 years of age.METHODS: Subjects who underwent monitoring of respiratory and circulatory dynamics without sedation during endoscopic screening examinations were enrolled at the New Ooe Hospital (Kyoto, Japan) between April 2008 and March 2009. A total of 165 patients (age ≥75 years) provided written informed consent and were investigated in the present study. Patients were randomly divided into three subgroups: UO group – thin endoscope; SO group – standard endoscope; and UT group – transnasal EGD. Percutaneous arterial blood oxygen saturation, heart rate and blood pressure were evaluated just before EGD and at five time points during EGD. After transnasal EGD, patients who had previously been examined using transoral EGD with a standard endoscope were asked about preferences for their next examination.RESULTS: There were no statistical differences in the characteristics among the groups. Percutaneous oxygen saturation in the UT group showed a transient drop compared with the SO and UO groups at the beginning of the endoscopic procedure. Heart rate showed no significant differences among the SO, UO and UT groups; Systolic blood pressure in the UO group was lower immediately after insertion compared with the SO and UT groups. The rate pressure product in the UO group was comparable with that in the UT group during endoscopy, and the SO group showed a continuously higher level than the UO and UT groups. More than one-half (54.4%) of patients were ‘willing to choose transnasal EGD for next examination’.CONCLUSIONS: For elderly patients, unsedated transnasal EGD failed to show an advantage over unsedated standard endoscopy. Transoral thin EGD was estimated to be safe and tolerable.
Does Low‐Level Laser Therapy Enhance The Efficacy of Intravenous Regional Anesthesia?
Authors: Nesioonpour Sholeh , Akhondzadeh Reza , Mokmeli Soheila , Moosavi Shahnam , Mackie Mandana , Naderan Morteza 
Published: March 2016

BACKGROUND: The use of intravenous regional anesthesia (IVRA) is limited by pain resulting from the application of tourniquets and postoperative pain.OBJECTIVE: To assess the efficacy of low‐level laser therapy added to IVRA for improving pain related to surgical fixation of distal radius fractures.METHODS: The present double‐blinded, placebo‐controlled, randomized clinical trial involved 48 patients who were undergoing surgical fixation of distal radius fractures. Participants were randomly assigned to either an intervention group (n=24), who received 808 nm laser irradiation as 4 J/point for 20 s over ipsilateral three nerve roots in the cervical region corresponding to C5–C8 vertebrae, and 808 nm laser irradiation as 0.1 J/cm2 for 5 min in a tangential scanning mode over the affected extremity; or a control group (n=24), who underwent the same protocol and timing of laser probe application with the laser switched off. Both groups received the same IVRA protocol using 2% lidocaine.RESULTS: The mean visual analogue scale scores were significantly lower in the laser‐assisted group than in the lidocaine‐only group on all measurements during and after operation (P<0.05). The mean time to the first need for fentanyl administration during the operation was longer in the laser group (P=0.04). The total amount of fentanyl administered to patients was significantly lower in the laser‐assisted group (P=0.003). The laser group needed significantly less pethidine for pain relief (P=0.001) and at a later time (P=0.002) compared with the lidocaine‐only group. There was no difference between the groups in terms of mean arterial pressure and heart rate.CONCLUSION: The addition of gallium‐aluminum‐arsenide laser irradiation to intravenous regional anesthesia is safe, and reduces pain during and after the operation.
Initial Management of Noncirrhotic Splanchnic Vein Thrombosis: When Is Anticoagulation Enough?
Authors: Ravichandran Pranavi , Croome Kris P , Kovacs Michael J , Lazo-Langner Alejandro , Hernandez-Alejandro Roberto 
Published: March 2016

BACKGROUND: The optimal initial treatment of splanchnic vein thrombosis is uncertain. Anticoagulant therapy has been shown to be associated with vessel recanalization and decreased recurrence. Furthermore, information regarding potential predictors of chronic complications is not well understood.METHODS: A retrospective cohort study involving consecutive patients diagnosed with first-episode noncirrhotic splanchnic vein thrombosis referred to the thrombosis clinic of the authors’ institution between 2008 and 2011 was conducted. Demographic and clinical information was collected. The response to initial anticoagulant therapy was evaluated by determining radiographic recanalization of vessels and clinical resolution (defined as the absence of ongoing splanchnic vein thrombosis symptoms or complications requiring treatment beyond anticoagulant therapy).RESULTS: Twenty-two patients were included. Anticoagulant therapy alone resulted in vessel recanalization in 41% of patients and 68% achieved clinical resolution. Two patients experienced bleeding events. Factors associated with a lack of clinical resolution included signs of portal hypertension/liver failure on presentation, complete vessel occlusion at diagnosis, presence of a myeloproliferative disorder orJAK2V617Ftyrosine kinase mutation and the absence of a local/transient predisposing factor.CONCLUSIONS: Anticoagulant therapy appeared to be an effective initial treatment in patients with splanchnic vein thrombosis. Clinical factors may help to identify patients who are at risk for developing complications thus requiring closer monitoring. These findings were limited by the small sample size and need to be explored in larger prospective studies.
Obstructive Sleep Apnea and Driving: A Canadian Thoracic Society and Canadian Sleep Society Position Paper
Authors: Ayas Najib , Skomro Robert , Blackman Adam , Curren Kristen , Fitzpatrick Michael , Fleetham John , George Charles , Hakemi Tom , Hanly Patrick , Li Christopher , Morrison Debra , Series Frédéric 
Published: March 2016

Individuals with obstructive sleep apnea (OSA) experience sleep fragmentation and poor sleep quality that results in daytime sleepiness, which impairs performance during driving and leads to an increased risk for collisions. Not surprisingly, observational studies have shown that patients with OSA experience a two- to 10-fold higher risk for collision compared with healthy controls. Although treatment would clearly mitigate these risks, there is no current Canadian position on driving and OSA. This article, the first Canadian position statement addressing the issue, provides an overview of provincial regulations and proposes recommendations with regard to driving in patients with OSA.Untreated patients with obstructive sleep apnea (OSA) are at increased risk for motor vehicle collisions; however, it is unclear how this should be translated into fitness-to-drive recommendations. Accordingly, the Canadian Thoracic Society (CTS) Sleep Disordered Breathing Clinical Assembly and the Canadian Sleep Society (CSS) assembled a CTS-CSS working group to propose recommendations with regard to driving in patients with OSA.Recommendations for assessing fitness to drive in noncommercial drivers: 1. Severity of OSA alone is not a reliable predictor of collision risk and, therefore, should not be used in isolation to assess fitness to drive; 2. The severity of sleep apnea should be considered in the context of other factors to assess fitness to drive; 3. The decision to restrict driving is ultimately made by the motor vehicle licensing authority; however, they should take into account the information and recommendations provided by the sleep medicine physician and should follow provincial guidelines; 4. For patients prescribed continuous positive airway pressure (CPAP) therapy, objective CPAP compliance should be documented. Efficacy should also be documented in terms of reversing the symptoms and improvement in sleep apnea based on physiological monitoring; 5. For patients treated with surgery or an oral appliance, verification of adequate sleep apnea treatment should be obtained; and 6. A driver diagnosed with OSA may be recertified as fit to drive based on assessment of symptoms and demonstrating compliance with treatment. The assessment should be aligned with the provincial driver’s license renewal period.Commercial vehicles: Assessment of fitness to drive should be more stringent for patients operating commercial vehicles. In general, the CTS-CSS working group was in agreement with the Medical Expert Panel recommendations to the Federal Motor Carrier Safety Administration in the United States; these recommendations were adapted for Canadian practitioners.
Pubertal Status Moderates the Association between Mother and Child Laboratory Pain Tolerance
Authors: Tsao Jennie CI , Li Ning , Parker Delana , Seidman Laura C , Zeltzer Lonnie K 
Published: March 2016

BACKGROUND:There is limited information regarding the relationship between parent and child responses to laboratory pain induction in the absence of experimental manipulation.OBJECTIVES: To assess the association between responses to cold and pressure pain tasks in 133 nonclinical mothers and children (mean age 13.0 years; 70 girls), and the moderating effects of child sex and pubertal status on these mother‐child relationships.METHODS: Mothers and children independently completed the cold and pressure pain tasks. Multiple linear regression analyses examined the association between mothers’ and children’s laboratory pain responses. The moderating effects of child sex and pubertal status were tested in the linear models by examining the interaction among mother laboratory pain responses, and child sex and pubertal status.RESULTS: Mothers’ cold pain anticipatory anxiety and pressure pain intensity were associated with children’s pressure pain anticipatory anxiety. Mothers’ pressure pain tolerance was associated with children’s pain tolerance for both the cold and pressure pain tasks. Mothers’ cold pain tolerance was associated with children’s pressure pain tolerance. Pubertal status moderated two of the three significant mother‐child pain tolerance relationships, such that the associations held for early pubertal but not for late pubertal children. Sex did not moderate mother‐child pain associations.CONCLUSIONS: The results indicate that mother‐child pain relationships are centred primarily on pain avoidance behaviour, particularly among prepubertal children. These findings may inform interventions focused on pain behaviours, with a particular emphasis on mothers of prepubertal children, to reduce acute pain responses in their children.
The Effect of Rapid Response Teams on End‐of‐Life Care: A Retrospective Chart Review
Authors: Tam Benjamin , Salib Mary , Fox-Robichaud Alison 
Published: March 2016

BACKGROUND: A subset of critically ill patients have end‐of‐life (EOL) goals that are unclear. Rapid response teams (RRTs) may aid in the identification of these patients and the delivery of their EOL care.OBJECTIVES: To characterize the impact of RRT discussion on EOL care, and to examine how a preprinted order (PPO) set for EOL care influenced EOL discussions and outcomes.METHODS: A single‐centre retrospective chart review of all RRT calls (January 2009 to December 2010) was performed. The effect of RRT EOL discussions and the effect of a hospital‐wide PPO set on EOL care was examined. Charts were from the Ontario Ministry of Health and Long‐Term Care Critical Care Information Systemic database, and were interrogated by two reviewers.RESULTS: In patients whose EOL status changed following RRT EOL discussion, there were fewer intensive care unit (ICU) transfers (8.4% versus 17%; P<0.001), decreased ICU length of stay (5.8 days versus 20 days; P=0.08), increased palliative care consultations (34% versus 5.3%; P<0.001) and an increased proportion who died within 24 h of consultation (25% versus 8.3%; P<0.001). More patients experienced a change in EOL status following the introduction of an EOL PPO, from 20% (before) to 31% (after) (P<0.05).CONCLUSIONS: A change in EOL status following RRT‐led EOL discussion was associated with reduced ICU transfers and enhanced access to palliative care services. Further study is required to identify and deconstruct barriers impairing timely and appropriate EOL discussions.
Blockade of Glutamate Release by Botulinum Neurotoxin Type A in Humans: A Dermal Microdialysis Study
Authors: Silva Larissa Bittencourt da , Karshenas Ali , Bach Flemming W , Rasmussen Sten , Arendt-Nielsen Lars , Gazerani Parisa 
Published: March 2016

BACKGROUND: The analgesic action of botulinum neurotoxin type A (BoNTA) has been linked to the blockade of peripheral release of neuropeptides and neurotransmitters in animal models; however, there is no direct evidence of this in humans.OBJECTIVES: To investigate the effect of BoNTA on glutamate release in humans, using an experimental model of pain and sensitization provoked by capsaicin plus mild heat.METHODS: Twelve healthy volunteers (six men, six women) were pretreated with BoNTA (10 U) on the volar forearm and with a saline control on the contralateral side. Dermal microdialysis was applied one week later to collect interstitial samples before and after the application of a capsaicin patch (8%) plus mild heat (40°C/60 min) to provoke glutamate release, pain and vasodilation. Samples were collected every hour for 3 h using linear microdialysis probes (10 mm, 100 kD). Dialysate was analyzed for glutamate concentration. Pain intensity and skin vasomotor reactions (temperature and blood flow changes) were also recorded.RESULTS: BoNTA significantly reduced glutamate release compared with saline (P<0.05). The provoked pain intensity was lower in the BoNTA‐pretreated arm (P<0.01). The reduction in pain scores was not correlated with glutamate level. Cutaneous blood flow (P<0.05), but not cutaneous temperature (P≥0.05), was significantly reduced by BoNTA. There was a correlation between glutamate level and skin blood flow (r=0.58/P<0.05) but not skin temperature (P≥0.05). No differences according to sex were observed in any response.CONCLUSIONS: The present study provided the first direct evidence supporting the inhibitory effect of BoNTA on glutamate release in human skin, which is potentially responsible for some of the analgesic action of BoNTA.
From the Mouth of Babes: Getting Vaccinated Doesn’t Have to Hurt
Authors: Taddio Anna , Ilersich Andrew F , Ilersich Anthony N , Wells Jenny 
Published: March 2016

BACKGROUND: Analgesic interventions are not commonly administered during childhood vaccination, despite the fact that two‐thirds of children are afraid of needles and one‐tenth are noncompliant with immunization.OBJECTIVE: To explore children’s experiences of vaccination and preferences for analgesia.METHODS: A total of 17 children (four to 14 years of age) at an independent school in Toronto (Ontario) participated in three focus‐group interviews. The majority had previous experience with pain management interventions during vaccination. Thematic content analysis was used to analyze interview transcripts.RESULTS: The findings were categorized into three main themes: experience of vaccination; roles and responsibilities regarding pain management; and impact of pain management. Children easily recalled previous vaccinations and discussed fear and distress experienced by themselves and others. Children believed that parents and immunizers should prepare them ahead of time and use interventions to manage and monitor pain. They also wanted adults to support their efforts to lead pain management. Children discussed benefits of managing pain, including reduced unnecessary suffering, improved vaccination experience, reduced risk of developing needle fears and reduced noncompliant behaviours. They were knowledgeable about strategies for reducing pain including distraction, topical anesthetics and injection techniques. They contrasted vaccination with and without pain management, and indicated a preference for pain management.CONCLUSION: Children reported that managing vaccination pain is important and that analgesic interventions should routinely be used. Incorporating pain management in the process of vaccination has the potential to improve children’s experiences with vaccination and promote more positive attitudes and behaviours.