bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Asm‐024, A Modulator of Acetylcholine Receptor Function, On Airway Responsiveness and Allergen‐Induced Responses in Patients with Mild Asthma
Authors: Boulet Louis-Philippe , Gauvreau Gail M , Cockcroft Donald W , Davis Beth , Vachon Luc , Cormier Yvon , O’Byrne Paul M 
Published: March 2016

OBJECTIVES: To evaluate the safety, tolerability and clinical activity of ASM‐024, a new cholinergic compound with dual nicotinic and muscarinic activity, in mild allergic asthma.METHODS: The present study involved 24 stable, mild allergic asthmatic subjects. In a cross‐over design, ASM‐024 (50 mg or 200 mg) or placebo were administered once daily by nebulization over three periods of nine consecutive days separated by a three‐week washout. The effect of each treatment on the forced expiratory volume in 1 s (FEV1), provocative concentration of methacholine causing a 20% decline in FEV1 (PC20), early and late asthmatic responses, and allergen‐induced inflammation were measured.RESULTS: Seventeen subjects completed the study. During treatment with ASM‐024 at 50 mg or 200 mg, the PC20 value increased respectively from a mean (± SD) 2.56±3.86 mg/mL to 4.11 mg/mL (P=0.007), and from 3.12±4.37 mg/mL to 5.23 mg/mL (P=0.005) (no change with placebo). On day 7 (day preceding allergen challenge), postdosing FEV1 increased by 2.0% with 50 mg (P=0.005) and 1.9% with 200 mg (P=0.008) (placebo −1.1%). ASM‐24 had no inhibitory effect on early and late asthmatic responses, nor on sputum eosinophil or neutrophil levels. ASM‐024 induced no serious adverse events, but caused cough in 22% and 48% of the subjects with 50 mg and 200 mg, respectively, compared with 10% who were on placebo.CONCLUSIONS: ASM‐024 did not inhibit allergen‐induced asthmatic response and related airway inflammation, but reduced methacholine airway responsiveness and slightly improved lung function. The mechanism by which ASM‐024 improves these outcomes requires further study.
Development and Validation of the French‐Canadian Chronic Pain Self‐Efficacy Scale
Authors: Lacasse Anaïs , Bourgault Patricia , Tousignant-Laflamme Yannick , Courtemanche-Harel Roxanne , Choinière Manon 
Published: March 2016

BACKGROUND: Perceived self‐efficacy is a non‐negligible outcome when measuring the impact of self‐management interventions for chronic pain patients. However, no validated, chronic pain‐specific self‐efficacy scales exist for studies conducted with French‐speaking populations.OBJECTIVES: To establish the validity of the use of the French‐Canadian Chronic Pain Self‐efficacy Scale (FC‐CPSES) among chronic pain patients.METHODS: The Chronic Disease Self‐Efficacy Scale is a validated 33‐item self‐administered questionnaire that measures perceived self‐efficacy to perform self‐management behaviours, manage chronic disease in general and achieve outcomes (a six‐item version is also available). This scale was adapted to the context of chronic pain patients following cross‐cultural adaptation guidelines. The FC‐CPSES was administered to 109 fibromyalgia and 34 chronic low back pain patients (n=143) who participated in an evidence‐based self‐management intervention (the PASSAGE program) offered in 10 health care centres across the province of Quebec. Cronbach’s alpha coefficients (α) were calculated to determine the internal consistency of the 33‐ and six‐item versions of the FC‐CPSES. With regard to convergent construct validity, the association between the FC‐CPSES baseline scores and related clinical outcomes was examined. With regard to the scale’s sensitivity to change, pre‐ and postintervention FC‐CPSES scores were compared.RESULTS: Internal consistency was high for both versions of the FC‐CPSES (α=0.86 to α=0.96). Higher self‐efficacy was significantly associated with higher mental health‐related quality of life and lower pain intensity and catastrophizing (P<0.05), supporting convergent validity of the scale. There was a statistically significant increase in FC‐CPSES scores between pre‐ and postintervention measures for both versions of the FC‐CPSES (P<0.003), which supports their sensitivity to clinical change during an intervention.CONCLUSIONS: These data suggest that both versions of the FC‐CPSES are reliable and valid for the measurement of pain management self‐efficacy among chronic pain patients.
Lyme Disease: Knowledge and Practices of Family Practitioners in Southern Quebec
Authors: Ferrouillet Cécile , Milord François , Lambert Louise , Vibien Anne , Ravel André 
Published: March 2016

BACKGROUND: Public health authorities in Quebec have responded to the progressive emergence of Lyme disease (LD) with surveillance activities and education for family physicians (FPs) who are key actors in both vigilance and case management.OBJECTIVES: To describe FPs’ clinical experience with LD, their degree of knowledge, and their practices in two areas, one with known infected tick populations (Montérégie) and one without (regions nearby Montérégie).METHODS: In the present descriptive cross‐sectional study, FPs were recruited during educational sessions. They were asked to complete a questionnaire assessing their clinical experience with Lyme disease, their knowledge of signs and symptoms of LD, and their familiarity with accepted guidelines for diagnosing and treating LD in two clinical scenarios (tick bite and erythema migrans).RESULTS: A total of 201 FPs participated, mostly from Montérégie (n=151). Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices. A majority of participants agreed to more education on LD. As expected, FPs from Montérégie had a higher clinical experience with tick bites (57% versus 25%), better knowledge of LD endemic areas in Canada and erythema migrans characteristics, and better management of erythema migrans (72% versus 50%).CONCLUSION: The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes. Such practices should be discouraged because they are unnecessary and overuse collective laboratory and medical resources. In addition, public health authorities must pursue their education efforts regarding FPs to optimize case management.
Prediction of Adaptive Self‐Regulatory Responses to Arthritis Pain Anxiety in Exercising Adults: Does Pain Acceptance Matter?
Authors: Cary Miranda A , Gyurcsik Nancy C , Brawley Lawrence R 
Published: March 2016

BACKGROUND: Exercising for ≥150 min/week is a recommended strategy for self‐managing arthritis. However, exercise nonadherence is a problem. Arthritis pain anxiety may interfere with regular exercise. According to the fear‐avoidance model, individuals may confront their pain anxiety by using adaptive self‐regulatory responses (eg, changing exercise type or duration). Furthermore, the anxiety‐self‐regulatory responses relationship may vary as a function of individuals’ pain acceptance levels.OBJECTIVES: To investigate pain acceptance as a moderator of the pain anxiety‐adaptive self‐regulatory responses relationship. The secondary objective was to examine whether groups of patients who differed in meeting exercise recommendations also differed in pain‐related and self‐regulatory responses.METHODS: Adults (mean [± SD] age 49.75±13.88 years) with medically diagnosed arthritis completed online measures of arthritis pain‐related variables and self‐regulatory responses at baseline, and exercise participation two weeks later. Individuals meeting (n=87) and not meeting (n=49) exercise recommendations were identified.RESULTS: Hierarchical multiple regression analysis revealed that pain acceptance moderated the anxiety‐adaptive self‐regulatory responses relationship. When pain anxiety was lower, greater pain acceptance was associated with less frequent use of adaptive responses. When anxiety was higher, adaptive responses were used regardless of pain acceptance level. MANOVA findings revealed that participants meeting the recommended exercise dose reported significantly lower pain and pain anxiety, and greater pain acceptance (P<0.05) than those not meeting the dose.CONCLUSIONS: Greater pain acceptance may help individuals to focus their efforts to adapt to their pain anxiety only when it is higher, leaving self‐regulatory capacity to cope with additional challenges to exercise adherence (eg, busy schedule).
Improving Health Care Efficiency Through the Integration of a Physician Assistant into an Infectious Diseases Consult Service at a Large Urban Community Hospital
Authors: Decloe Melissa , McCready Janine , Downey James , Powis Jeff 
Published: March 2016

BACKGROUND: Physician assistants (PAs) have recently been introduced into the Canadian health care system in some provinces; however, there are little data demonstrating their impact.METHODS: A retrospective case‐control study was conducted between January 2010 and December 2013. Length of stay (LOS) and mortality were examined in the infectious diseases consult service (IDCS) compared with hospital‐wide controls. The two‐year period before the introduction of the PA to the IDCS of a large urban community hospital in Canada (2010 to 2011) was compared with the two‐year period following the introduction of the PA (2012 to 2013).RESULTS: Following the introduction of a PA to the IDCS, there was a decrease in time to consultation from 21.4 h to 14.3 h (P<0.0001). LOS was significantly decreased among IDCS patients by 3.6 days more than that seen in matched hospital‐wide controls (P=0.0001). Mortality did not significantly change after PA introduction in either cases or controls.DISCUSSION/CONCLUSION: PAs can improve health efficiencies in the Canadian health care setting, leading to reduction in LOS.
A Pilot Randomized Controlled Trial of Smoking Cessation in an Outpatient Respirology Clinic
Authors: Pakhale Smita , Baron Justine , Armstrong Michael A , Garde Avanti , Reid Robert D , Alvarez Gonzalo , Aitken Debbie , Mullen Kerri-Anne , Wells George , Pipe Andrew 
Published: March 2016

OBJECTIVE: To assess the feasibility and potential effectiveness of a modified version of the Ottawa Model for Smoking Cessation in an outpatient respirology clinic.METHODS: Adult tobacco smokers attending the respirology clinic and willing to choose a quit date within one month of enrollment were randomly assigned to receive standard care or the intervention. Standard care participants received smoking cessation advice, a brochure and a prescription for smoking cessation medication if requested. Intervention participants received a $110 voucher to purchase smoking cessation pharmacotherapy and were registered to an automated calling system. Answers to automated calls determined which participants required nurse telephone counselling. Feasibility indicators included recruitment and retention rates, and intervention adherence. The effectiveness indicator was self‐reported smoking status at 26 to 52 weeks.RESULTS: Forty‐nine (54.4%) of 90 eligible smokers were randomly assigned to the intervention (n=23) or control (n=26) group. Self‐reported smoking status at 26 to 52 weeks was available for 32 (65.3%) participants. The quit rate for intervention participants was 18.2% compared with 7.7% for controls (OR2.36 [95% CI 0.39 to 14.15]).CONCLUSION: It would be feasible to evaluate this intervention in a larger trial. Alternatives to face‐to‐face follow‐up at the clinic are recommended.
Opioid Use among Same‐Day Surgery Patients: Prevalence, Management and Outcomes
Authors: Wilson Jennifer LC , Poulin Patricia A , Sikorski Robert , Nathan Howard J , Taljaard Monica , Smyth Catherine 
Published: March 2016

OBJECTIVES: To determine whether the prevalence of opioid use among patients requiring elective same‐day admission (SDA) surgery is greater than the 2.5% prevalence found in the general population. Secondary objectives were to assess compliance with expert recommendations on acute pain management in opioid‐tolerant patients and to examine clinical outcomes.METHODS: A retrospective review of 812 systematically sampled adult SDA surgical cases between April 1, 2008 and March 31, 2009 was conducted.RESULTS: Among 798 eligible patients, 148 (18.5% [95% CI 15.9% to 21.2%]) were prescribed opioids, with 4.4% prescribed long‐acting opioids (95% CI 3.0% to 5.8%). Use of opioids was most prevalent among orthopedic and neurosurgery patients. Among the 35 patients on long‐acting opioids who had a high likelihood of being tolerant, anesthesiologists correctly identified 33, but only 13 (37%) took their usual opioid preoperatively while 22 (63%) had opioids continued postoperatively. Acetaminophen, nonsteroidal anti‐inflammatory drugs and pregabalin were ordered preoperatively in 18 (51%), 15 (43%) and 18 (51%) cases, respectively, while ketamine was used in 15 (43%) patients intraoperatively. Acetaminophen, nonsteroidal anti‐inflammatory drugs and pregabalin were ordered postoperatively in 31 (89%), 15 (43%) and 17 (49%) of the cases, respectively. No differences in length of stay, readmissions and emergency room visits were found between opioid‐tolerant and opioid‐naïve patients.CONCLUSION: Opioid use is more common in SDA surgical patients than in the general population and is most prevalent within orthopedic and neurosurgery patients. Uptake of expert opinion on the management of acute pain in the opioid tolerant patient population is lacking.
Randomized Controlled Trial Comparing Outcomes of Video Capsule Endoscopy with Push Enteroscopy in Obscure Gastrointestinal Bleeding
Authors: Segarajasingam Dev S , Hanley Stephen C , Barkun Alan N , Waschke Kevin A , Burtin Pascal , Parent Josée , Mayrand Serge , Fallone Carlo A , Jobin Gilles , Seidman Ernest G , Martel Myriam 
Published: March 2016

BACKGROUND: Optimal management of obscure gastrointestinal bleeding (OGIB) remains unclear.OBJECTIVE: To evaluate diagnostic yields and downstream clinical outcomes comparing video capsule endoscopy (VCE) with push enteroscopy (PE).METHODS: Patients with OGIB and negative esophagogastroduodenoscopies and colonoscopies were randomly assigned to VCE or PE and followed for 12 months. End points included diagnostic yield, acute or chronic bleeding, health resource utilization and crossovers.RESULTS: Data from 79 patients were analyzed (VCE n=40; PE n=39; 82.3% overt OGIB). VCE had greater diagnostic yield (72.5% versus 48.7%; P<0.05), especially in the distal small bowel (58% versus 13%; P<0.01). More VCE-identified lesions were rated possible or certain causes of bleeding (79.3% versus 35.0%; P<0.05). During follow-up, there were no differences in the rates of ongoing bleeding (acute [40.0% versus 38.5%; P not significant], chronic [32.5% versus 45.6%; P not significant]), nor in health resource utilization. Fewer VCE-first patients crossed over due to ongoing bleeding (22.5% versus 48.7%; P<0.05).CONCLUSIONS: A VCE-first approach had a significant diagnostic advantage over PE-first in patients with OGIB, especially with regard to detecting small bowel lesions, affecting clinical certainty and subsequent further small bowel investigations, with no subsequent differences in bleeding or resource utilization outcomes in follow-up. These findings question the clinical relevance of many of the discovered endoscopic lesions or the ability to treat most of these effectively over time. Improved prognostication of both patient characteristics and endoscopic lesion appearance with regard to bleeding behaviour, coupled with the impact of therapeutic deep enteroscopy, is now required using adapted, high-quality study methodologies.
Supporting Chronic Pain Management across Provincial and Territorial Health Systems in Canada: Findings from Two Stakeholder Dialogues
Authors: Wilson Michael G , Lavis John N , Ellen Moriah E 
Published: March 2016

BACKGROUND: Chronic pain is a serious health problem given its prevalence, associated disability, impact on quality of life and the costs associated with the extensive use of health care services by individuals living with it.OBJECTIVE: To summarize the research evidence and elicit health system policymakers’, stakeholders’ and researchers’ tacit knowledge and views about improving chronic pain management in Canada and engaging provincial and territorial health system decision makers in supporting comprehensive chronic pain management in Canada.METHODS: For these two topics, the global and local research evidence regarding each of the two problems were synthesized in evidence briefs. Three options were generated for addressing each problem, and implementation considerations were assessed. A stakeholder dialogue regarding each topic was convened (with 29 participants in total) and the deliberations were synthesized.RESULTS: To inform the first stakeholder dialogue, the authors found that systematic reviews supported the use of evidence‐based tools for strengthening chronic pain management, including patient education, self‐management supports, interventions to implement guidelines and multidisciplinary approaches to pain management. While research evidence about patient registries/treatment‐monitoring systems is limited, many dialogue participants argued that a registry/system is needed. Many saw a registry as a precondition for moving forward with other options, including creating a national network of chronic pain centres with a coordinating ‘hub’ to provide chronic pain‐related decision support and a cross‐payer, cross‐discipline model of patient‐centred primary health care‐based chronic pain management. For the second dialogue, systematic reviews indicated that traditional media can be used to positively influence individual health‐related behaviours, and that multistakeholder partnerships can contribute to increasing attention devoted to issues on policy agendas. Dialogue participants emphasized the need to mobilize behind an effort to build a national network that would bring together existing organizations and committed individuals.CONCLUSIONS: Developing a national network and, thereafter, a national pain strategy are important initiatives that garnered broad‐based support during the dialogues. Efforts toward achieving this goal have been made since convening the dialogues.
Past, Present and Future of Respiratory Research: A Survey of Canadian Health Care Professionals
Authors: Nonoyama Mika Laura , Mathur Sunita , Herbert Rosemary , Jenkins Heather , Lobchuk Michelle , McEvoy Michelle 
Published: March 2016

BACKGROUND: The Canadian Respiratory Health Professionals (CRHP) is the multidisciplinary health care professional group of the Canadian Lung Association. Although the CRHP has a growing number of highly qualified researchers, the landscape of their research in Canada has not been described.OBJECTIVES: To describe the level of respiratory research engagement; identify barriers and facilitators to research engagement; describe the experience and interest in developing research skills; and identify priority areas of future respiratory research among health care professionals.METHODS: An online survey of CRHP members was used to collect demographic information; barriers and facilitators to conducting research; future directions in respiratory research; and research funding and mentorship. Experience with and interest in ‘upskilling’ research skills were also evaluated.RESULTS: A total of 119 surveys were completed (22% response rate), of which 69 (58%) respondents were engaged in respiratory research. Reasons for not being involved in respiratory research were lack of mentorship, support and funding. The top research areas were chronic obstructive pulmonary disease (74%) and asthma (41%). The top facilitators for research engagement were amount of funding (29%) and mentorship (28%). Respondents in research positions rated their experience in research skills as high; those in nonresearch positions as low. However, both groups expressed interest in improving their research skills.CONCLUSIONS: Areas of development, such as research skills, greater funding opportunities and mentorship to increase the research capacity of health care professionals in respiratory health were identified. Health professional researchers have an important role in the national respiratory research strategy to increase interdisciplinary engagement and build collaborative teams.
Multiple Interventions Improve Analgesic Treatment of Supracondylar Fractures in a Pediatric Emergency Department
Authors: Porter Robert N , Chafe Roger E , Newhook Leigh A , Murnaghan Kyle D 
Published: March 2016

BACKGROUND: Provision of appropriate and timely treatment for pain in the pediatric population has been challenging. Children with painful conditions commonly present to emergency departments (EDs), a setting in which it may be particularly difficult to consistently provide timely analgesic interventions.OBJECTIVES: To measure the effectiveness of a set of interventions in improving the rate and timeliness of analgesic medication administration, as well as appropriate backslab immobilization (application of a moldable plaster or fiberglass splint), in a pediatric ED.METHODS: Data regarding pain management were collected on a consecutive sample of cases of supracondylar fracture over a 13‐month period. This followed the implementation of a formal triage pain assessment and treatment medical directive, supplemented with relevant education of nursing and house staff, and posters in the ED. These data were compared with data previously collected from a similar cohort of cases, which presented before the interventions.RESULTS: Postintervention, the proportion of patients treated with an analgesic within 60 min of triage increased from 15% to 54% (P<0.001), and the median time to administration of an analgesic decreased from 72.5 min to 11 min (P<0.001). Rates for backslab application before radiography were similar before and after the intervention (29% and 33%, respectively; P=0.646).CONCLUSIONS: A multifaceted approach to improving early analgesic interventions was associated with considerably improved rates of early analgesic treatments for supracondylar fracture; however, no improvement in early immobilization was observed.
The Use of the Bispectral Index in the Detection of Pain in Mechanically Ventilated Adults in the Intensive Care Unit: A Review of the Literature
Authors: Coleman Robin Marie , Tousignant-Laflamme Yannick , Ouellet Paul , Parenteau-Goudreault Élizabeth , Cogan Jennifer , Bourgault Patricia 
Published: March 2016

BACKGROUND: Pain assessment is an immense challenge for clinicians, especially in the context of the intensive care unit, where the patient is often unable to communicate verbally. Several methods of pain assessment have been proposed to assess pain in this environment. These include both behavioural observation scales and evaluation of physiological measurements such as heart rate and blood pressure. Although numerous validation studies pertaining to behavioural observation scales have been published, several limitations associated with using these measures for pain assessment remain. Over the past few years, researchers have been interested in the use of the bispectral index monitoring system as a proxy for the evaluation of encephalography readings to assess the level of anesthesia and, potentially, analgesia.OBJECTIVES: To synthesize the main studies exploring the use of the bispectral index monitoring system for pain assessment, to guide future research in adults under sedation in the intensive care unit.METHOD: The EMBASE, Medline, CINAHL and PsycINFO databases were searched for studies published between 1996 and 2013 that evaluated the use of the bispectral index in assessing pain.RESULTS: Most studies conclude that nociceptive stimulation causes a significant increase in the bispectral index and revealed the importance of controlling certain confounding variables such as the level of sedation.DISCUSSION: Further studies are needed to clearly demonstrate the relationship between nociceptive stimuli and the bispectral index, as well as the specificity of the bispectral index in detecting pain.