bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacological Management of Chronic Neuropathic Pain: Revised Consensus Statement from the Canadian Pain Society
Authors: Moulin DE , Boulanger A , Clark AJ , Clarke H , Dao T , Finley GA , Furlan A , Gilron I , Gordon A , Morley-Forster PK , Sessle BJ , Squire P , Stinson J , Taenzer P , Velly A , Ware MA , Weinberg EL , Williamson OD 
Published: March 2016

BACKGROUND: Neuropathic pain (NeP), redefined as pain caused by a lesion or a disease of the somatosensory system, is a disabling condition that affects approximately two million Canadians.OBJECTIVE: To review the randomized controlled trials (RCTs) and systematic reviews related to the pharmacological management of NeP to develop a revised evidence‐based consensus statement on its management.METHODS: RCTs, systematic reviews and existing guidelines on the pharmacological management of NeP were evaluated at a consensus meeting in May 2012 and updated until September 2013. Medications were recommended in the consensus statement if their analgesic efficacy was supported by at least one methodologically sound RCT (class I or class II) showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment were based on the degree of evidence of analgesic efficacy, safety and ease of use.RESULTS: Analgesic agents recommended for first‐line treatments are gabapentinoids (gabapentin and pregabalin), tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors. Tramadol and controlled‐release opioid analgesics are recommended as second‐line treatments for moderate to severe pain. Cannabinoids are now recommended as third‐line treatments. Recommended fourth‐line treatments include methadone, anticonvulsants with lesser evidence of efficacy (eg, lamotrigine, lacos‐amide), tapentadol and botulinum toxin. There is support for some analgesic combinations in selected NeP conditions.CONCLUSIONS: These guidelines provide an updated, stepwise approach to the pharmacological management of NeP. Treatment should be individualized for each patient based on efficacy, side‐effect profile and drug accessibility, including cost. Additional studies are required to examine head‐to‐head comparisons among analgesics, combinations of analgesics, long‐term outcomes and treatment of pediatric, geriatric and central NeP.
Safety and Efficacy of Hemospray®in Upper Gastrointestinal Bleeding
Authors: Yau Alan Hoi Lun , Ou George , Galorport Cherry , Amar Jack , Bressler Brian , Donnellan Fergal , Ko Hin Hin , Lam Eric , Enns Robert Allan 
Published: March 2016

BACKGROUND: Hemospray (Cook Medical, USA) has recently been approved in Canada for the management of nonvariceal upper gastrointestional bleeding (UGIB).OBJECTIVE: To review the authors’ experience with the safety and efficacy of Hemospray for treating UGIB.METHODS: A retrospective chart review was performed on patients who required endoscopic evaluation for suspected UGIB and were treated with Hemospray.RESULTS: From February 2012 to July 2013, 19 patients (mean age 67.6 years) with UGIB were treated with Hemospray. A bleeding lesion was identified in the esophagus in one (5.3%) patient, the stomach in five (26.3%) and duodenum in 13 (68.4%). Bleeding was secondary to peptic ulcers in 12 (63.2%) patients, Dieulafoy lesions in two (10.5%), mucosal erosion in one (5.3%), angiodysplastic lesions in one (5.3%), ampullectomy in one (5.3%), polypectomy in one (5.3%) and an unidentified lesion in one (5.3%). The lesions showed spurting hemorrhage in four (21.1%) patients, oozing hemorrhage in 11 (57.9%) and no active bleeding in four (21.1%). Hemospray was administered as monotherapy in two (10.5%) patients, first-line modality in one (5.3%) and rescue modality in 16 (84.2%). Hemospray was applied prophylactically to nonbleeding lesions in four (21.1%) patients and therapeutically to bleeding lesions in 15 (78.9%). Acute hemostasis was achieved in 14 of 15 (93.3%) patients. Rebleeding within seven days occurred in seven of 18 (38.9%) patients. Potential adverse events occurred in two (10.5%) patients and included visceral perforation and splenic infarct. Mortality occurred in five (26.3%) patients but the cause of death was unrelated to gastrointestinal bleeding with the exception of one patient who developed hemoperitoneum.CONCLUSIONS: The high rates of both acute hemostasis and recurrent bleeding suggest that Hemospray may be used in high-risk cases as a temporary measure or a bridge toward more definitive therapy.
Knowledge, Attitudes and Beliefs about Chronic Noncancer Pain in Primary Care: a Canadian Survey of Physicians and Pharmacists
Authors: Lalonde Lyne , Leroux-Lapointe Vincent , Choinière Manon , Martin Elisabeth , Lussier David , Berbiche Djamal , Lamarre Diane , Thiffault Robert , Jouini Ghaya , Perreault Sylvie 
Published: March 2016

BACKGROUND: Primary care providers’ knowledge, attitudes and beliefs (KAB) regarding chronic noncancer pain (CNCP) are a barrier to optimal management.OBJECTIVES: To evaluate and identify the determinants of the KAB of primary care physicians and pharmacists, and to document clinician preferences regarding the content and format of a continuing education program (CEP).METHOD: Physicians and pharmacists of 486 CNCP patients participated. Physicians completed the original version of the KnowPain‐50 questionnaire. Pharmacists completed a modified version. A multivariate linear regression model was developed to identify the determinants of their KAB.RESULTS: A total of 137 of 387 (35.4%) physicians and 110 of 278 (39.5%) pharmacists completed the survey. Compared with the physicians, the pharmacists surveyed included more women (64% versus 38%) and had less clinical experience (15 years versus 26 years). The mean KnowPain‐50 score was 69.3% (95% CI 68.0% to 70.5%) for physicians and 63.8% (95% CI 62.5% to 65.1%) for pharmacists. Low scores were observed on all aspects of pain management: initial assessment (physicians, 68.3%; pharmacists, 65.4%); definition of treatment goals and expectations (76.1%; 61.6%); development of a treatment plan (66.4%; 59.0%); and reassessment and management of longitudinal care (64.3%; 53.1%). Ten hours of reported CEP sessions increased the KAB score by 0.3 points. All clinicians considered a CEP for CNCP to be essential. Physicians preferred an interactive format, while pharmacists had no clear preferences.CONCLUSION: A CEP to improve primary care providers’ knowledge and competency in managing CNCP, and to reduce false beliefs and inappropriate attitudes regarding CNCP is relevant and perceived as necessary by clinicians.
Evaluation of Amplification Targets for the Specific Detection of Bordetella pertussis Using Real‐Time Polymerase Chain Reaction
Authors: Hasan Mohammad Rubayet , Tan Rusung , Al-Rawahi Ghada N , Thomas Eva , Tilley Peter 
Published: March 2016

BACKGROUND:
Bordetella pertussis infections continue to be a major public health challenge in Canada. Polymerase chain reaction (PCR) assays to detect B pertussis are typically based on the multicopy insertion sequence IS481, which offers high sensitivity but lacks species specificity.METHODS: A novel B pertussis real‐time PCR assay based on the porin gene was tested in parallel with several previously published assays that target genes such as IS481, ptx‐promoter, pertactin and a putative thialase. The assays were evaluated using a reference panel of common respiratory bacteria including different Bordetella species and 107 clinical nasopharyngeal specimens. Discrepant results were confirmed by sequencing the PCR products.RESULTS: Analytical sensitivity was highest for the assay targeting the IS481 element; however, the assay lacked specificity for B pertussis in the reference panel and in the clinical samples. False‐positive results were also observed with assays targeting the ptx‐promoter and pertactin genes. A PCR assay based on the thialase gene was highly specific but failed to detect all reference strains of B pertussis. However, a novel assay targeting the porin gene demonstrated high specificity for B pertussis both in the reference panel and in clinical samples and, based on sequence‐confirmed results, correctly predicted all B pertussis‐positive cases in clinical samples. According to Probit regression analysis, the 95% detection limit of the new assay was 4 colony forming units/reaction.CONCLUSION: A novel porin assay for B pertussis demonstrated superior performance and may be useful for improved molecular detection of B pertussis in clinical specimens.
Poor ‘Real-Life’ Negative Predictive Value of Cross-Sectional Imaging in Obstructive Jaundice
Authors: Brunson Brian A , Hawes Robert , Hoffman Brenda , Vela Stacie , Romagnuolo Joseph 
Published: March 2016

BACKGROUND: Cross-sectional imaging remains the first-line test for obstructive jaundice despite high miss rates for pancreatobiliary tumours. Improvements in resolution and slice thickness of spiral computed tomography/magnetic resonance imaging/magnetic resonance cholangiopancreatography promised to increase accuracy.OBJECTIVE: To assess whether the post-test probability of neoplasm is truly altered by the presence or absence of a mass on computed tomography/magnetic resonance imaging in obstructive jaundice.METHODS: The institutional endoscopic ultrasound (EUS) database was retrospectively reviewed to stratify patients presenting to EUS over a two-year period for obstructive jaundice (suspicious for malignancy) according to their pre-EUS imaging results. The primary analysis involved the calculation of the positive predictive value and negative predictive value (NPV) of imaging with 95% binomial CIs. Test performance of EUS/fine-needle aspiration (FNA) was also calculated. Final diagnosis was determined by positive cytology/histology; negative EUS was supplemented by clinical follow-up.RESULTS: The positive predictive value (n=51) and NPV (n=53) of pre-EUS imaging was 98% (95% CI 90% to 100%) and 9% (95% CI 3% to 21%), respectively (accuracy 53%), with post-test suspicion of malignancy similar between imaging-positive and -negative groups. EUS demonstrated a mass in 96% of imaging-positive cases versus 85% in imaging-negative cases (exact P=0.09). Malignant or suspicious FNA cytology was obtained with EUS in 92% of the imaging-positive group, and 62% of the imaging-negative group (75% of subgroup with FNA) (P<0.001).CONCLUSION: Lack of a definite mass on pre-EUS imaging had low NPV, and was clearly not sufficiently accurate or reassuring in this clinical setting. In suspicious obstructive jaundice, EUS with FNA has a high diagnostic yield regardless of the findings of pre-EUS cross-sectional imaging and, as such, EUS may be a more reasonable first-line test in this high-suspicion setting.
Atypical Distribution of Inflammation in Newly Diagnosed Ulcerative Colitis is not Rare
Authors: Park Sang Hyoung , Yang Suk-Kyun , Park Soo-Kyung , Kim Jong Wook , Yang Dong-Hoon , Jung Kee Wook , Kim Kyung-Jo , Ye Byong Duk , Byeon Jeong-Sik , Myung Seung-Jae , Kim Jin-Ho 
Published: March 2016

BACKGROUND: Appendiceal orifice inflammation (AOI) is a common ‘skip lesion’ in patients with ulcerative colitis (UC). However, other skip lesions are less well known.OBJECTIVE: To evaluate the atypical distribution of UC lesions, other than AOI, in terms of their frequency, pattern, risk factors and prognostic implications.METHODS: A retrospective analysis of colonoscopic findings and clinical course of 240 adult UC patients who were initially diagnosed at Asan Medical Center (Seoul, South Korea) was performed.RESULTS: Of 240 patients, 46 (19.2%) showed an atypical distribution of lesions at initial colonoscopy: eight (3.3%) had rectal sparing (segmental-type UC); and 38 (15.8%) had patchy/segmental skip lesions other than AOI. Skip lesions were detected more frequently in proximal segments of the colon than in distal segments (P=0.001). An atypical distribution was more common in patients with AOI (31.3%) than in those without AOI (10.6%; P<0.001). The clinical course of patients with an atypical distribution was not different from that of patients with a typical distribution in terms of remission, relapse, disease extension, colectomy and mortality. In addition, of the 36 patients with an atypical distribution of lesions at diagnosis who underwent follow-up colonoscopy, 24 (66.7%) demonstrated a typical distribution of lesions.CONCLUSIONS: Patchy/segmental skip lesions and rectal sparing occur not infrequently in adult patients with newly diagnosed, untreated UC. As such, these features alone should not be considered to be definitive evidence against a diagnosis of UC. There does not appear to be a prognostic implication of an atypical distribution of lesions.
Pulsed Radiofrequency Treatment of Complex Regional Pain Syndrome: A Case Series
Authors: Djuric Vlad 
Published: March 2016

BACKGROUND: Various forms of sympathetic chain neurolysis (sympathectomy) have, at one time or another, held promise as effective treatment options for complex regional pain syndrome (CRPS). Complications, such as worsening pain and the development of new pain syndromes, have prevented sympathectomy from emerging as a standard intervention. In an effort to avoid poor outcomes associated with neurolysis, pulsed radiofrequency (PRF) has been proposed as a potential treatment alternative for a number of chronic neuropathic pain states, including some forms of CRPS.METHODS: The present report describes three cases in which patients diagnosed with lower extremity CRPS type I obtained substantial and lasting intervals of pain relief following PRF of the lumbar sympathetic chain. Over a period of four years, 14 fluoroscopically guided procedures using PRF lesioning of the lumbar sympathetic chain at L2, L3 and L4 were performed in three individuals with CRPS type I of the lower limb. Outcome measures included pre‐ and post‐treatment self‐reported pain and medication requirements.RESULTS: Substantial pain relief (>50%) was achieved in 91.7% of PRF applications at three months and 83.3% at six months, with some treatments resulting in persistent relief well beyond 12 months. Medication use decreased to a comparable degree, with discontinuation of opiates after all but three treatments.CONCLUSIONS: PRF lesioning of the lumbar sympathetic chain can be an effective treatment for patients with CRPS type I of the lower extremity, with the potential to provide ≥6 months of substantial pain relief.
Differential Prescribing of Opioid Analgesics According to Physician Specialty for Medicaid Patients with Chronic Noncancer Pain Diagnoses
Authors: Ringwalt Chris , Gugelmann Hallam , Garrettson Mariana , Dasgupta Nabarun , Chung Arlene E , Proescholdbell Scott K , Skinner Asheley Cockrell 
Published: March 2016

BACKGROUND: Despite >20 years of studies investigating the characteristics of patients seeking or receiving opioid analgesics, research characterizing factors associated with physicians’ opioid prescribing practices has been inconclusive, and the role of practitioner specialty in opioid prescribing practices remains largely unknown.OBJECTIVE: To examine the relationships between physicians’ and other providers’ primary specialties and their opioid prescribing practices among patients with chronic noncancer pain (CNCP).METHODS: Prescriptions for opioids filled by 81,459 Medicaid patients with CNCP in North Carolina (USA), 18 to 64 years of age, enrolled at any point during a one‐year study period were examined. χ2 statistics were used to examine bivariate differences in prescribing practices according to specialty. For multivariable analyses, maximum‐likelihood logistic regression models were used to examine the effect of specialty on prescribing practices, controlling for patients’ pain diagnoses and demographic characteristics.RESULTS: Of prescriptions filled by patients with CNCP, who constituted 6.4% of the total sample of 1.28 million individuals, 12.0% were for opioids. General practitioner/family medicine specialists and internists were least likely to prescribe opioids, and orthopedists were most likely. Across specialties, men were more likely to receive opioids than women, as were white individuals relative to other races/ethnicities. In multivariate analyses, all specialties except internal medicine had higher odds of prescribing an opioid than general practitioners: orthopedists, OR 7.1 (95% CI 6.7 to 7.5); dentists, OR 3.5 (95% CI 3.3 to 3.6); and emergency medicine physicians, OR 2.7 (95% CI 2.6 to 2.8).CONCLUSIONS: Significant differences in opioid prescribing practices across prescriber specialties may be reflective of differing norms concerning the appropriateness of opioids for the control of chronic pain. If so, sharing these norms across specialties may improve the care of patients with CNCP.
Relationship between Bone Mineral Density and the Frequent Administration of Epidural Steroid Injections in Postmenopausal Women with Low Back Pain
Authors: Kim Sungyun , Hwang Byeongmun 
Published: March 2016

BACKGROUND: Epidural steroid injection (ESI) is one of the most common nonsurgical treatments for low back pain. In general, corticosteroid therapy often results in bone loss and osteoporosis. In previous studies, bone mineral density (BMD) was evaluated after epidural injections of relatively small numbers and relatively low total doses of corticosteroids. However, the relationship between BMD and multiple ESIs remains to be elucidated.OBJECTIVE: To explore the relationship between BMD and multiple ESIs in postmenopausal women with low back pain.METHODS: Medical records of postmenopausal women with low back pain treated with or without ESIs were reviewed. BMD was measured in the lumbar spine, femoral neck and total femur after the treatments. A total of 71 patients were divided into two groups: group 1 included patients who had received non‐ESI medications; and group 2 included those who had received ESIs >10 times, with a cumulative administered triamcinolone dose >200 mg.RESULTS: Patients in group 2 showed lower BMD in the femoral neck and total femur. However, no significant intergroup differences in the BMD of the lumbar spine were observed. The prevalences of osteoporosis and osteopenia in the lumbar spine and femoral neck were significantly higher in group 2; these patients also had lower femoral neck BMD Z‐scores.CONCLUSIONS: Multiple ESIs (approximately 14 injections with a cumulative triamcinolone dose of approximately 400 mg) can reduce BMD in postmenopausal women with low back pain.
Helicobacter pyloriInfection and Markers of Gastric Cancer Risk in Alaska Native Persons: A Retrospective Case-Control Study
Authors: Keck James W , Miernyk Karen M , Bulkow Lisa R , Kelly Janet J , McMahon Brian J , Sacco Frank , Hennessy Thomas W , Bruce Michael G 
Published: March 2016

BACKGROUND: Alaska Native persons experience gastric cancer incidence and mortality rates that are three to four times higher than in the general United States population.OBJECTIVE: To evaluate pepsinogen I, pepsinogen I/II ratio, anti-Helicobacter pyloriand cytotoxin-associated gene A (CagA) antibody levels, and blood group for their associations with gastric cancer development in Alaska Native people.METHODS: The present analysis was a retrospective case-control study that matched gastric cancers reported to the Alaska Native Tumor Registry from 1969 to 2008 to three controls on known demographic risk factors forH pyloriinfection, using sera from the Alaska Area Specimen Bank. Conditional logistic regression evaluated associations between serum markers and gastric cancer.RESULTS: A total of 122 gastric cancer cases were included, with sera predating cancer diagnosis (mean = 13 years) and 346 matched controls. One hundred twelve cases (91.8%) and 285 controls (82.4%) had evidence of previous or ongoingH pyloriinfection as measured by anti-H pyloriantibody levels. Gastric cancer cases had a 2.63-fold increased odds of having positive anti-H pyloriantibodies compared with their matched controls (P=0.01). In a multivariate model, non-cardia gastric cancer (n=94) was associated with anti-H pyloriantibodies (adjusted OR 3.92; P=0.004) and low pepsinogen I level (adjusted OR 6.04; P=0.04). No association between gastric cancer and blood group, anti-CagA antibodies or pepsinogen I/II ratio was found.CONCLUSION: Alaska Native people with gastric cancer had increased odds of previousH pyloriinfection. Low pepsinogen I level may function as a precancer marker for noncardia cancer.
The Relationship Between Hepatopulmonary Syndrome and Altitude
Authors: Valley Morgan A , Trotter James F , Thomas Deborah , Ginde Adit A , Lowenstein Steven R , Honigman Benjamin 
Published: March 2016

BACKGROUND: In a previous small retrospective study, the authors reported that hepatopulmonary syndrome was less common among liver transplant candidates at high-altitude centres compared with low-altitude centres.OBJECTIVE: To further explore the relationship between hepatopulmonary syndrome and altitude of residence in a larger patient cohort.METHODS: A cohort of 65,264 liver transplant candidates in the Organ Procurement and Transplantation Network liver database between 1988 and 2006 was analyzed. Hepatopulmonary syndrome diagnosis was determined during a comprehensive evaluation at a liver transplant centre by physicians who were experienced in the diagnosis and treatment of hepatopulmonary syndrome. The altitude of residence was determined for each patient by assigning the mean altitude of the zip code of residence at the time of entry on the wait list. Mean zip code elevation was calculated using the National Elevation Dataset of the United States Geological Survey, which provides exact elevation measurements across the entire country.RESULTS: Hepatopulmonary syndrome was significantly less common at higher resident altitudes (P=0.015). After adjusting for age, sex and Model for End-Stage Liver Disease score, there was a 46% decrease in the odds of hepatopulmonary syndrome with every increase of 1000 m of resident elevation (OR 0.54 [95% CI 0.33 to 0.89]).CONCLUSION: There was a negative association between altitude and hepatopulmonary syndrome. One plausible explanation is that the lower ambient oxygen found at higher elevation leads to pulmonary vasoconstriction, which mitigates the primary physiological lesion of hepatopulmonary syndrome, namely, pulmonary vasodilation.