bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Therapy Practice Patterns in Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Authors: Harth Leslie , Stuart Jennifer , Montgomery Catherine , Pintier Karol , Czyzo Susan , Hill Kylie , Goldstein Roger , Brooks Dina 
Published: March 2016

BACKGROUND AND OBJECTIVE: The importance of the multidisciplinary approach to the management of chronic obstructive pulmonary disease is increasingly emphasized. The present study aimed to examine the current practice patterns of physical therapists involved in the management of patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease.METHOD: A self‐administered postal survey was distributed to the rehabilitation departments of all Canadian acute care hospitals with more than 250 beds. The survey addressed patient assessment, treatment, education and discharge planning for intensive care unit and/or ward admissions.RESULTS: In total, 66% of hospitals (n=109) participated in the study, with provincial representation mainly from Ontario (n=36 [33%]) and Quebec (n=36 [33%]). Assessment and treatment techniques did not differ greatly between the ward and the intensive care unit. Assessment focused on patient observation, pulse oximetry and auscultation, and was reported to be used ‘always or frequently’ by 76%, 76% and 69% of respondents, respectively. Less than 18% of respondents used a measure of functional capacity, and health‐related quality of life measures were rarely used. Treatment focused on ambulatory techniques, with 78% and 75% of respondents using mobility and transfer training ‘always or frequently’, respectively. The most common educational topics were breathing exercises and positioning, which were addressed by 68% and 67% of respondents, respectively.CONCLUSION: Patient assessment focused on physical impairments, with little use of measures of function or health‐related quality of life, whereas treatment focused on mobility, with a lesser focus on airway clearance. Further study is needed to identify the factors that impact these practice patterns.
Clinicopathological Features Associated with Lymph Node Metastasis in Early Gastric Cancer: Analysis of a Single-Institution Experience in China
Authors: Shen Lizong , Huang Yiming , Sun Maocai , Xu Hao , Wei Wei , Wu Wenxi 
Published: March 2016

BACKGROUND: An accurate assessment of potential lymph node metastasis is an important issue for the appropriate treatment of early gastric cancer. Minimizing the number of invasive procedures used in cancer therapy is critical for improving the patient’s quality of life.OBJECTIVE: To evaluate the clinicopathological features associated with lymph node metastasis of early gastric cancer in patients from a single institution in China.METHODS: A retrospective review of data from 410 patients surgically treated for early gastric cancer at the First Affiliated Hospital (Nanjing, China) between 1998 and 2007, was conducted. The clinicopathological variables associated with lymph node metastasis were evaluated.RESULTS: Lymph node metastasis was observed in 12.20% of patients. The macroscopic type, tumour size, location in the stomach, depth of gastric carcinoma infiltration, and presence of vascular or lymphatic invasion showed a positive correlation with the incidence of lymph node metastasis by univariate analysis. Multivariate analyses revealed histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion to be significantly and independently related to lymph node metastasis. The depth of gastric carcinoma infiltration was the strongest predictive factor for lymph node metastasis. For intramucosal cancer, tumour size was the unique risk factor for lymph node metastasis. For submucosal cancer, histological classification and tumour size were independent risk factors for lymph node metastasis.CONCLUSIONS: Histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion are independent risk factors for lymph node metastasis in patients with early gastric cancer in China. Minimal invasive treatment, such as endoscopic mucosal resection, may be possible for highly selected cancers.
Disseminated Herpes Simplex Virus Type 1 Primary Infection in a Healthy Individual
Authors: Boivin Guy , Malette Brigitte , Goyette Nathalie 
Published: March 2016

BACKGROUND: Primary herpes simplex virus (HSV) infection usually involves one mucosal region.OBJECTIVE: To describe an unusual disseminated HSV‐1 infection involving two mucosal sites in a healthy man.RESULTS: Primary HSV infection involved oral and genital mucosa and was associated with viremia, hepatitis and rash. Phylogenetic analysis of genital and oral viruses revealed that the patient was infected by a single HSV‐1 strain.CONCLUSION: Use of polymerase chain reaction detection techniques for HSV may identify viremic patients in the absence of obvious immunosuppression.
Ultra Low‐Dose Naloxone and Tramadol/Acetaminophen in Elderly Patients Undergoing Joint Replacement Surgery: A Pilot Study
Authors: Imasogie Ngozi N , Singh Sudha , Watson James T , Hurley Debbie , Morley-Forster Patricia 
Published: March 2016

OBJECTIVE: A pilot study was conducted to assess whether both the rationale and feasibility exist for future randomized clinical trials to evaluate the combined use of naloxone infusion and tramadol/acetaminophen as opioid‐sparing drugs in elderly patients undergoing lower extremity joint replacement surgery.DESIGN: Ten patients 70 years of age or older undergoing either total knee (n=7) or total hip (n=3) arthroplasty were treated prospectively. Each patient received two tablets of tramadol/acetaminophen (Tramacet; Janssen‐Ortho Inc, Canada) preoperatively and every 6 h postoperatively, as well as a naloxone infusion started preoperatively at 0.25 μg/kg/h and continued up to 48 h postoperatively. In addition, standard intraoperative care was provided with 0.2 mg of intrathecal morphine, 1.4 mL of 0.75% bupivacaine, and an intra‐articular infiltration of 100 mL of 0.3% ropivacaine and 30 mg of ketorolac, as well as standard postoperative morphine via patient‐controlled analgesia orders and celecoxib 200 mg twice daily for five days.OUTCOME MEASURES: Compared with seven historical controls, also 70 years of age or older, who had undergone either a total knee (n=4) or total hip (n=3) arthroplasty, postoperative opioid use was reduced by 80%. Except for transient nausea and vomiting in 40% and 20% of patients, respectively, the 10 patients on tramadol/acetaminophen and naloxone tolerated the new regimen without difficulty.CONCLUSION: Consequently, a randomized, double‐blinded clinical trial comparing standard therapy versus standard therapy plus these two drugs seems warranted. In such a trial, it would require approximately 20 subjects per treatment arm to detect a 80% decrease in morphine use.
Reliability of Temporal Summation and Diffuse Noxious Inhibitory Control
Authors: Cathcart Stuart , Winefield Anthony H , Rolan Paul , Lushington Kurt 
Published: March 2016

BACKGROUND: The test‐retest reliability of temporal summation (TS) and diffuse noxious inhibitory control (DNIC) has not been reported to date. Establishing such reliability would support the possibility of future experimental studies examining factors affecting TS and DNIC. Similarly, the use of manual algometry to induce TS, or an occlusion cuff to induce DNIC of TS to mechanical stimuli, has not been reported to date. Such devices may offer a simpler method than current techniques for inducing TS and DNIC, affording assessment at more anatomical locations and in more varied research settings.METHOD: The present study assessed the test‐retest reliability of TS and DNIC using the above techniques. Sex differences on these measures were also investigated.RESULTS: Repeated measures ANOVA indicated successful induction of TS and DNIC, with no significant differences across test‐retest occasions. Sex effects were not significant for any measure or interaction. Intraclass correlations indicated high test‐retest reliability for all measures; however, there was large interindividual variation between test and retest measurements.CONCLUSION: The present results indicate acceptable within‐session test‐retest reliability of TS and DNIC. The results support the possibility of future experimental studies examining factors affecting TS and DNIC.
Sensorineural Hearing Loss and Celiac Disease: A Coincidental Finding
Authors: Volta Umberto , Ferri Gian Gaetano , De Giorgio Roberto , Fabbri Angela , Parisi Claudia , Sciajno Laura , Castellari Alessandra , Fiorini Erica , Piscaglia Maria , Barbara Giovanni , Granito Alessandro , Pirodda Antonio 
Published: March 2016

BACKGROUND: Celiac disease (CD) can be associated with a variety of extraintestinal manifestations, including neurological diseases. A new neurological correlation has been found between CD and sensorineural hearing loss (SNHL).OBJECTIVE: To verify the association between SNHL and CD, and to establish whether the neurological hearing impairment in CD is related to nonorgan-specific and antineuronal antibodies, as well as the presence of autoimmune disorders.METHODS: A sample of 59 consecutive biopsy- and serologically proven CD patients were studied. Among CD patients, 11 were newly diagnosed and 48 were on a gluten-free diet. Hearing function was assessed by audiometric analysis in all CD patients as well as in 59 age- and sex-matched controls. Patients were tested for a panel of immune markers including nonorgan-specific autoantibodies and antineuronal antibodies.RESULTS: SNHL was detected in five CD patients (8.5%) and in two controls (3.4%). In one patient, the SNHL was bilateral, whereas the remaining four had a monolateral impairment. The prevalence of SNHL was not significantly different between CD patients and controls. At least one of the antibodies tested for was positive in two of the five CD patients with SNHL and in 12 of the 54 CD patients without SNHL. Antineuronal antibodies to central nervous system antigens were consistently negative in the five CD patients with SNHL. Only one of the five CD patients with SNHL had Hashimoto thyroiditis.CONCLUSIONS: SNHL and CD occur coincidentally. Hearing function should be assessed only in CD patients with clinical signs of hearing deficiency.
Time to Endoscopy and Outcomes in Upper Gastrointestinal Bleeding
Authors: Sarin Nitin , Monga Neerav , Adams Paul C 
Published: March 2016

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common problem associated with significant morbidity and mortality. Previous studies show that immediate endoscopies do not affect outcomes in patients; however, endoscopic interventions have evolved. The present retrospective review of endoscopies performed at a large teaching hospital assessed the timing of endoscopy with respect to the morbidity and mortality of UGIB.METHODS: Diagnostic billing codes were used to assess all inpatients of gastroenterologists at the University Hospital of the London Health Sciences Centre, London, Ontario, from July 2004 to June 2006, using a centralized data recording system. Time to endoscopy (within 6 h, 6 h to 24 h and beyond 24 h) were compared for the outcomes of mortality, need for surgery and transfusion requirements.RESULTS: From July 2004 to June 2006, there were 502 upper endoscopies performed for the indication of suspected UGIB and 375 for overt acute nonvariceal UGIB. Approximately 10% of cases revealed variceal bleeding. When comparing endoscopy within 6 h with endoscopy at 6 h to 24 h, there were no significant differences in mortality, need for surgery (OR 3.6 and 2.8, respectively, compared with endoscopy beyond 24 h) or transfusion requirements. Even when assessing the group that received endoscopic hemostasis, time to endoscopy was not associated with better outcomes. Multivariate analysis did not demonstrate any advantages for early endoscopy (less than 6 h) compared with endoscopy within 24 h.CONCLUSIONS: Most patients with acute gastrointestinal bleeding can be effectively managed with endoscopy within 24 h.
Bone Mineral Densities in Individuals with Gilbert’s Syndrome: A Cross-Sectional, Case-Control Pilot Study
Authors: Minuk GY , Greenberg R , Uhanova J , Hawkins K , Leslie WD 
Published: March 2016

BACKGROUND: Unconjugated bilirubin inhibits osteoblastic proliferative activity in vitro, raising the possibility that Gilbert’s syndrome (GS) patients are at increased risk of osteoporosis.OBJECTIVES: To compare bone mineral density (BMD), serum parathyroid hormone (PTH), C-telopeptide (CTX) and osteocalcin levels in GS subjects versus matched controls in a cross-sectional, case-control study.METHODS: BMD determinations were obtained with central dual-energy x-ray absorptiometry. Serum PTH, CTX and osteocalcin levels were measured by enzyme immunoassay.RESULTS: A total of 17 GS and 30 control subjects were studied. Overall, there were no significant differences in BMD, PTH, CTX or osteocalcin levels between the two groups. However, when older (older than 40 years of age) and younger (40 years of age and younger) cohorts were considered separately, the older GS cohort had significantly decreased total hip BMD, T scores and Z scores, and femoral neck BMD, T scores and Z scores (P<0.005 for each parameter, respectively) compared with older control subjects. Serum osteocalcin levels were lower in the older versus younger GS cohort (P=0.006). An inverse correlation existed between all subjects’ serum unconjugated bilirubin levels and total body BMD determinations (r=−0.42; P=0.04). On univariate analysis, the association between serum unconjugated bilirubin and total body BMD was not significant (P=0.066), nor was serum unconjugated bilirubin identified as a risk factor for low BMD when entered into multivariate analyses.CONCLUSIONS: The results of the present pilot study warrant further research involving larger numbers of subjects and longitudinal measurements to determine whether GS is associated with decreased BMD, particularly in older GS subjects.
Does Routine Pain Assessment Result in Better Care?
Authors: Hadjistavropoulos Thomas , MacNab Ying C , Lints-Martindale Amanda , Martin Ronald , Hadjistavropoulos Heather 
Published: March 2016

BACKGROUND: Although a variety of national organizations such as the Canadian Pain Society, the American Pain Society and the Joint Commission on Accreditation of Health Care Organizations have advanced the idea that pain should be assessed on a routine basis, there is little evidence that systematic pain assessment information is used routinely by clinicians even when it is readily available.OBJECTIVE: To determine whether systematic pain assessment information alters medical practitioners’ clinical practices.METHODS: A population of seniors with complex medical problems who were evaluated by case coordinators was studied. Case coordinators were assigned to either an experimental or control patient assessment condition. Control condition patients were assessed as usual. In the experimental condition, a psychometrically valid pain assessment battery as well as the Geriatric Depression Scale – Short Form (because depression and chronic pain are frequently comorbid) were integrated into the routine case coordination assessment. A summary of the results of the depression and pain assessments was subsequently sent to physicians via mail and fax. Patients were also given copies of the assessment summaries and were asked to discuss these with their physicians. Physicians’ medication prescriptions were monitored over time through the database of the provincial ministry of health.RESULTS: At the end of the study, no significant differences between experimental and control patients were found with respect to medications prescribed or patient self‐reports of pain. Nonetheless, there was a significant relationship between Geriatric Depression Scale – Short Form scores and pain medications prescribed for patients in the experimental condition. Moreover, indexes of overall pain intensity did not change significantly over time.CONCLUSIONS: The findings do not support the idea that the availability of systematic pain assessment information leads to change in clinician’s medication practices. As such, educational interventions and public policy initiatives are needed to ensure that treatment providers do not only gather but also use pain assessment information.
The Effect of Heartburn and Acid Reflux on the Severity of Nausea and Vomiting of Pregnancy
Authors: Gill Simerpal Kaur , Maltepe Caroline , Koren Gideon 
Published: March 2016

BACKGROUND: Heartburn (HB) and acid reflux (RF) in the non-pregnant population can cause nausea and vomiting; therefore, it is plausible that in women with nausea and vomiting of pregnancy (NVP), HB/RF may increase the severity of symptoms.OBJECTIVE: To determine whether HB/RF during pregnancy contribute to increased severity of NVP.METHODS: A prospectively collected cohort of women who were experiencing NVP and HB, RF or both (n=194) was studied. The Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale and its Well-being scale was used to compare the severity of the study cohort’s symptoms. This cohort was compared with a group of women experiencing NVP but no HB/RF (n=188). Multiple linear regression was used to control for the effects of confounding factors.RESULTS: Women with HB/RF reported higher PUQE scores (9.6±2.6) compared with controls (8.9±2.6) (P=0.02). Similarly, Well-being scores for women experiencing HB/RF were lower (4.3±2.1) compared with controls (4.9±2.0) (P=0.01). Multiple linear regression analysis demonstrated that increased PUQE scores (P=0.003) and decreased Well-being scores (P=0.005) were due to the presence of HB/RF as opposed to confounding factors such as pre-existing gastrointestinal conditions/symptoms, hyperemesis gravidarum in previous pregnancies and comorbidities.CONCLUSION: The present cohort study is the first to demonstrate that HB/RF are associated with increased severity of NVP. Managing HB/RF may improve the severity of NVP.
Pyrosequencing Assay to Rapidly Detect Clarithromycin Resistance Mutations in CanadianHelicobacter pyloriIsolates
Authors: Slinger R , Yan L , Chan F , Forward K , Cooper-Lesins G , Best L , Haldane D , van Zanten S Veldhuyzen 
Published: March 2016

BACKGROUND: Mutations at positions 2142 or 2143 in the two-copy 23S ribosomal RNA gene ofHelicobacter pyloriare highly predictive of in vitro clarithromycin resistance and failure of clarithromycin-containing treatment regimens.OBJECTIVE: To design an assay to rapidly detect these mutations using rapid polymerase chain reaction and pyrosequencing, a novel method of ‘sequencing by synthesis’, and to test this assay with a collection of CanadianH pyloriisolates.METHODS: Forty-twoH pyloriisolates (24 clarithromycin-resistant, 18 clarithromycin-susceptible) were studied. A target region in the 23S gene was rapidly amplified and sequenced by pyrosequencing.RESULTS: Mutations at one of the two positions studied were present in 20 of the 24 (83%) clarithromycin-resistant isolates; 13 had double-copy A2143G mutations, four had double-copy A2142G mutations and three had single-copy A2143G mutations. There were no mutations in 17 of the 18 (94%) susceptible isolates. A single-copy A2142G mutation was detected in one susceptible isolate.CONCLUSIONS: The pyrosequencing assay developed was able to detect and differentiate mutations at positions 2142 and 2143 in either one or both copies of theH pylori23S ribosdomal RNA gene. Further study is needed to determine whether this pyrosequencing assay can be used to determineH pylorisusceptibility to clarithromycin from clinical specimens such as stools or gastric biopsies.
Perception of Asthma as a Factor in Career Choice among Young Adults with Asthma
Authors: Bhinder Sacha , Cicutto Lisa , Abdel-Qadir Husam M , Tarlo Susan M 
Published: March 2016

BACKGROUND/AIM: Asthma is a common chronic condition that can be aggravated by workplace exposures. Young adults with asthma should know how their future occupation might affect their asthma, and potentially, their quality of life. The aim of the present study was to assess the awareness of young adults to occupational risks for asthma and high‐risk occupations, as well as their perception of the role of asthma in career choice.METHODS: Young adults 16 to 22 years of age with reported physician‐diagnosed asthma were recruited to complete a questionnaire eliciting information regarding asthma control, career choice and awareness of occupational exposure risks.RESULTS: A small majority of the study cohort (56.4%) could identify occupations that cause or exacerbate asthma, and 34.7% indicated that asthma was an important factor in their career plans. Family physicians were most responsible for asthma management (80.2%), but young adults were more likely to discuss asthma and career plans with their parents (43.6%) or friends (29.7%) than with their family physician (13.9%; P<0.001).CONCLUSION: Young adults with asthma have suboptimal awareness of potential work‐related asthma risks. Family physicians most commonly provide asthma care to these young adults. However, few young adults are talking to their family physicians about career choices and asthma. This observation represents an area of asthma care that needs to be explored in young adults with asthma.
Risk Factors for Acquisition of Endemic Blastomycosis
Authors: Choptiany Maxym , Wiebe Lyle , Limerick Bill , Sarsfield Pete , Cheang Mary , Light Bruce , Hammond Greg , MacDonald Kerry , Trepman Elly , Pappas Peter , Embil John M 
Published: March 2016

BACKGROUND: Blastomycosis is potentially fatal, but environmental risk factors for acquiring blastomycosis are not well established.METHOD: Matched cross‐sectional questionnaire of 112 patients with history of blastomycosis and 118 control subjects in Manitoba and northwestern Ontario.RESULTS: The most common tissues involved with blastomycosis were pulmonary, skin and soft tissues, and bone. A significantly greater proportion of patients with blastomycosis than control subjects were involved in outdoor occupations. A significantly greater percentage of patients with blastomycosis were immunosuppressed either from collagen vascular disease or immunosuppressive therapy, or had hypothyroidism. A significant association between canine and human blastomycosis was not observed.CONCLUSIONS: Independent risk factors for development of blastomycosis included immunosuppression for any reason (including drugs or disease), collagen vascular disease, being an outdoor worker, and having a coworker with blastomycosis. Canine blastomycosis was not a risk factor for human disease in dog owners.