bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying Patients with Physician‐Diagnosed Asthma in Health Administrative Databases
Authors: Gershon Andrea S , Wang Chengning , Guan Jun , Vasilevska-Ristovska Jovanka , Cicutto Lisa , To Teresa 
Published: March 2016

BACKGROUND: Asthma imposes a heavy and expensive burden on individuals and populations. A population‐based surveillance and research program based on health administrative data could measure and study the burden of asthma; however, the validity of a health administrative data diagnosis of asthma must first be confirmed.OBJECTIVE: To evaluate the accuracy of population‐based provincial health administrative data in identifying adult patients with asthma for ongoing surveillance and research.METHODS: Patients from randomly selected primary care practices were assigned to four categories according to their previous diagnoses: asthma, chronic obstructive pulmonary disease, related respiratory conditions and nonasthma conditions. In each practice, 10 charts from each category were randomly selected, abstracted, then reviewed by a blinded expert panel who identified them as asthma or nonasthma. These reference standard diagnoses were then linked to the patients’ provincial records and compared with health administrative algorithms designed to identify asthma. Analyses were performed using the concepts of diagnostic test evaluation.RESULTS: A total of 518 charts, including 160 from individuals with asthma, were reviewed. The algorithm of two or more ambulatory care visits and/or one or more hospitalization(s) for asthma in two years had a sensitivity of 83.8% (95% CI 77.1% to 89.1%) and a specificity of 76.5% (95% CI 71.8% to 80.8%).CONCLUSION: Definitions of adult asthma using health administrative data are sensitive and specific for identifying adults with asthma. Using these definitions, cohorts of adults with asthma for ongoing population‐based surveillance and research can be developed.
Epidemiology of Enteric Disease in C‐EnterNet’s Pilot Site – Waterloo Region, Ontario, 1990 to 2004
Authors: Keegan Victoria A , Majowicz Shannon E , Pearl David L , Marshall Barbara J , Sittler Nancy , Knowles Lewinda , Wilson Jeffery B 
Published: March 2016

OBJECTIVE: The objective of the present study was to describe the epidemiology of reportable enteric illness in Ontario’s Waterloo region, including comparing calculated incidence rates with published rates, and adjusting for under‐reporting to determine the number of community cases, where published data were available.METHODS: Descriptive analyses were performed on reportable disease data for 13 enteric diseases collected in the Waterloo region from 1990 to 2004. Poisson and negative binomial regression analyses were used to investigate differences in incidence rates among age, sex, the 15 years of data and seasons. Disease‐specific incidence rates were calculated and compared with the literature, where possible. Under‐reporting ratios from the literature were applied to estimate the number of cases of campylobacteriosis, nontyphoidal salmonellosis and verotoxigenic Escherichia coli infection at the community level.RESULTS: Over the study period, the average annual age‐ and sex‐adjusted incidence rates per 100,000 population were highest for campylobacteriosis (49.69 cases), followed by giardiasis (31.87 cases) and nontyphoidal salmonellosis (25.97 cases). The incidence of most enteric illnesses peaked in the summer. The highest incidence occurred in young children, followed by adults in their 20s. Diarrhea (85.4%) was the most frequently reported symptom, food (57.4%) was the most commonly reported probable source, and home (41.7%) and travel (37.0%) were the two most frequently reported risk settings.CONCLUSIONS: Enteric illness was a significant health burden in the Waterloo region from 1990 to 2004. Because reportable disease data are subject to under‐reporting, it is likely that the true burden is greater than estimated in the present study.
Predictive Factors for Local Recurrence and Incomplete Resection of Early Gastric Cancer Treated by Endoscopic Resection: A Western Experience
Authors: Hondo Fábio Yuji , Maluf-Filho Fauze , Kishi Humberto Setsuo , Uemura Ricardo Sato , Okawa Luciano , Cecconello Ivan , Sakai Paulo 
Published: March 2016

BACKGROUND: Early gastric cancer (EGC) is defined as adenocarcinoma limited to the mucosa or submucosa regardless of lymph node involvement. Local EGC recurrence rates have been described in up to 6% of cases.OBJECTIVES: To evaluate predictive factors for incomplete resection and local recurrence of EGC treated by endoscopic mucosal resection (EMR) that was followed up for at least one year.METHODS: From June 1994 to December 2005, 46 patients with EGC underwent EMR. Possible predictive factors for incomplete endoscopic resection and local recurrence were identified by medical chart analysis. Demographic, endoscopic and histopathological data were retrospectively evaluated. EMR was considered complete or incomplete. Patients from the complete resection group were divided into subgroups (with and without local EGC recurrence).RESULTS: Complete resection was possible in 36 cases (76.6%). Predictive factors for incomplete resection were tumour location (P=0.035), histological type (P=0.021), lesion size (P=0.022) and number of resected fragments (P=0.013). On multivariate analysis, undifferentiated histological type (OR 0.8; 95% CI 0.036 to 0.897) and number of resected fragments (OR 7.34; 95% CI 1.266 to 42.629) were independent predictive factors for incomplete resection. In the complete resection group, a larger lesion size was associated with a higher the number of resected fragments (P=0.018). Local recurrence occurred in nine cases (25%). Use of the cap technique was the only predictive factor for local recurrence in five of seven cases (71.4%) (P=0.006).CONCLUSIONS: A larger lesion size was associated with a higher number of resected fragments. Undifferentiated adenocarcinoma and piecemeal resection were predictive factors for incomplete resection. Technique type was a predictive factor for local EGC recurrence.
Trends in Nosocomial Bloodstream Infections following Health Care Restructuring in Alberta between 1999 and 2005
Authors: Lee Mao-Cheng , Saxinger Lynora , Forgie Sarah E , Taylor Geoffrey 
Published: March 2016

OBJECTIVE: A previous study at the University of Alberta Hospital/Stollery Children’s Hospital in Edmonton, Alberta, revealed an increase in hospital‐acquired bloodstream infection (BSI) rates associated with an increase in patient acuity during a period of public health care delivery restructuring between 1993 and 1996. The present study assessed trends in BSIs since the end of the restructuring.DESIGN: Prospective surveillance for BSIs was performed using Centers for Disease Control and Prevention (USA) criteria for infection. BSI cases between January 1, 1999, and December 31, 2005, were reviewed. Available measures of patient volumes, acuity and BSI risk factors between 1999 and 2005 were also reviewed from hospital records.SETTING: The University of Alberta Hospital/Stollery Children’s Hospital (617 adult and 139 pediatric beds, respectively).PATIENTS: All pediatric and adult patients admitted during the above‐specified period with one or more episodes of BSIs.RESULTS: There was a significant overall decline in the BSI number and rate over the study period between 1999 and 2005. The downward trend was widespread, involving both adult and pediatric populations, as well as primary and secondary BSIs. During this period, the number of hospital‐wide and intensive care unit admissions, intensive care unit central venous catheter‐days, total parenteral nutrition days and number of solid‐organ transplants were either unchanged or increased. Gram‐positive bacterial causes of BSIs showed significant downward trends, but Gram‐negative bacterial and fungal etiologies were unchanged.CONCLUSIONS: These data imply that, over time, hospitals can gradually adjust to changing patient care circumstances and, in this example, control infectious complications of health care delivery.
Managing Low Back Pain in the Primary Care Setting: The Know‐Do Gap
Authors: Scott N Ann , Moga Carmen , Harstall Christa 
Published: March 2016

OBJECTIVE: To ascertain knowledge gaps in the diagnosis and treatment of acute and chronic low back pain (LBP) in the primary care setting to prepare a scoping survey for identifying knowledge gaps in LBP management among Alberta’s primary care practitioners, and to identify potential barriers to implementing a multidisciplinary LBP guideline.METHODS: English language studies, published from 1996 to 2008, comparing the clinical practice patterns of primary care practitioners with guideline recommendations were identified by systematically searching literature databases, the websites of various health technology assessment agencies and libraries, and the Internet. Data were synthesized qualitatively.RESULTS: The literature search identified 14 relevant studies. Knowledge gaps were reported among various primary care practitioner groups in the assessment of red flags, use of diagnostic imaging, provision of advice regarding sick leave and continuing activity, administration of some medications (muscle relaxants, oral steroids and opioids) and recommendation of particular treatments (acupuncture, physiotherapy, spinal manipulation, traction, ultrasound, transcutaneous electrical nerve stimulation and spinal mobilization).CONCLUSIONS: A know‐do gap clearly exists among primary care practitioners with respect to the diagnosis and treatment of LBP. The information on know‐do gaps will be used to construct a survey tool for unearthing the local knowledge gaps extant among Alberta’s primary care practitioners, and to develop a dissemination strategy for a locally produced multidisciplinary LBP guideline, with the aim of ensuring that the know‐do gaps inherent within each primary practice discipline are specifically targeted.
Adherence to Pediatric Asthma Guidelines in the Emergency Department: A Survey of Knowledge, Attitudes and Behaviour among Health Care Professionals
Authors: Bhogal Sanjit K , Bourbeau Jean , McGillivray David , Benedetti Andrea , Bartlett Susan J , Ducharme Francine M 
Published: March 2016

BACKGROUND: Despite strong evidence for using clinical care pathways to manage acute pediatric asthma, adherence remains suboptimal.OBJECTIVES: To elicit information from health care professionals regarding their knowledge, attitudes and use of a care pathway for acute childhood asthma.METHODS: A cross-sectional, self-administered survey of physicians, nurses and respiratory therapists who worked in the emergency department at the Montreal Children’s Hospital (Montreal, Quebec) from August to December 2007 was conducted. The survey assessed knowledge, attitude toward and agreement with the care pathway, as well as its use four years after its implementation.RESULTS: Of the 128 health care professionals surveyed, 72 (56%) responded. Of these, 99% reported being familiar with the pathway, more than 90% agreed with its use for mild and moderate asthma, while 79% agreed with its use for severe asthma. For 99% of health care professionals, the advantages of using the pathway outweighed the disadvantages; however, 64% admitted to making variations to the pathway. Although 92% of respondents reported that they were quite comfortable with using the asthma severity Pediatric Respiratory Assessment Measure, only 53% and 36% correctly identified the severity score cut-offs for moderate and severe asthma, respectively. Seventeen per cent of respondents underestimated the delay of onset of action of oral corticosteroids, while 36% of physicians incorrectly believed that a higher than necessary dose was recommended for ipratropium bromide.CONCLUSIONS: Results of the survey confirmed that the health care professionals queried had a positive attitude toward the pediatric asthma care pathway. Knowledge gaps and the balance between standardization versus individualization of care may be key elements to explain suboptimal adherence to the pathway.
Canadian Consensus Guidelines for the Optimal Use of Maraviroc in the Treatment of HIV‐Infected Adults
Authors: Rachlis Anita , Harris Marianne , Lalonde Richard , Shafran Stephen D , Tremblay Cécile , Wainberg Mark A , Walmsley Sharon 
Published: March 2016

BACKGROUND AND OBJECTIVES: A Canadian group, consisting of six physicians and an HIV researcher with significant experience and knowledge in HIV management, reviewed the available data and developed guidelines for Canadian health care providers (who treat HIV infection) on the appropriate use of maraviroc (UK‐427,857) in HIV‐infected adults.METHODS: Evidence from the published literature and conference presentations, as well as the expert opinions of the group members were considered and evaluated to develop the recommendations. Feedback on the draft recommendations was obtained from this core group, as well as from four other physicians across Canada with expertise in HIV treatment and experience with the use of maraviroc. The final recommendations represent the core group’s consensus agreement once all feedback was considered.RESULTS/CONCLUSIONS: Recommendations were developed to guide physicians and other health care providers in the optimal use of maraviroc. The recommendations were considered in light of the fact that the decision to include maraviroc in an antiretroviral regimen depends not only on issues that concern all antiretroviral agents, such as efficacy, safety, resistance and drug interactions, but also on the issue of viral tropism, which is unique to maraviroc and other CCR5 inhibitors.
Direct Health Care Costs Associated with Asthma in British Columbia
Authors: Sadatsafavi Mohsen , Lynd Larry , Marra Carlo , Carleton Bruce , Tan Wan C , Sullivan Sean , FitzGerald J Mark 
Published: March 2016

BACKGROUND: A better understanding of health care costs associated with asthma would enable the estimation of the economic burden of this increasingly common disease.OBJECTIVE: To determine the direct medical costs of asthma‐related health care in British Columbia (BC).METHODS: Administrative health care data from the BC Linked Health Database and PharmaNet database from 1996 to 2000 were analyzed for BC residents five to 55 years of age, including the billing information for physician visits, drug dispensations and hospital discharge records. A unit cost was assigned to physician/emergency department visits, and government reimbursement fees for prescribed medications were applied. The case mix method was used to calculate hospitalization costs. All costs were reported in inflation‐adjusted 2006 Canadian dollars.RESULTS: Asthma resulted in $41,858,610 in annual health care‐related costs during the study period ($331 per patient‐year). The major cost component was medications, which accounted for 63.9% of total costs, followed by physician visits (18.3%) and hospitalization (17.8%). When broader definitions of asthma‐related hospitalizations and physician visits were used, total costs increased to $56,114,574 annually ($444 per patient‐year). There was a statistically significant decrease in the annual per patient cost of hospitalizations (P<0.01) over the study period. Asthma was poorly controlled in 63.5% of patients, with this group being responsible for 94% of asthma‐related resource use.CONCLUSION: The economic burden of asthma is significant in BC, with the majority of the cost attributed to poor asthma control. Policy makers should investigate the reason for lack of proper asthma control and adjust their policies accordingly to improve asthma management.
Counselling by Primary Care Physicians May Help Patients with Heartburn-Predominant Uninvestigated Dyspepsia
Authors: Paré Pierre , Math Joanna Lee M , Hawes Ian A 
Published: March 2016

OBJECTIVE: To determine whether strategies to counsel and empower patients with heartburn-predominant dyspepsia could improve health-related quality of life.METHODS: Using a cluster randomized, parallel group, multicentre design, nine centres were assigned to provide either basic or comprehensive counselling to patients (age range 18 to 50 years) presenting with heartburn-predominant upper gastrointestinal symptoms, who would be considered for drug therapy without further investigation. Patients were treated for four weeks with esomeprazole 40 mg once daily, followed by six months of treatment that was at the physician’s discretion. The primary end point was the baseline change in Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire score.RESULTS: A total of 135 patients from nine centres were included in the intention-to-treat analysis. There was a statistically significant baseline improvement in all domains of the QOLRAD questionnaire in both study arms at four and seven months (P<0.0001). After four months, the overall mean change in QOLRAD score appeared greater in the comprehensive counselling group than in the basic counselling group (1.77 versus 1.47, respectively); however, this difference was not statistically significant (P=0.07). After seven months, the overall mean baseline change in QOLRAD score between the comprehensive and basic counselling groups was not statistically significant (1.69 versus 1.56, respectively; P=0.63).CONCLUSIONS: A standardized, comprehensive counselling intervention showed a positive initial trend in improving quality of life in patients with heartburn-predominant uninvestigated dyspepsia. Further investigation is needed to confirm the potential benefits of providing patients with comprehensive counselling regarding disease management.
A One-Year Economic Evaluation of Six Alternative Strategies for the Management of Uninvestigated Upper Gastrointestinal Symptoms in Canadian Primary Care
Authors: Barkun Alan N , Crott Ralph , Fallone Carlo A , Kennedy Wendy A , Lachaine Jean , Levinton Carey , Armstrong David , Chiba Naoki , Thomson Alan , van Zanten Sander Veldhuyzen , Sinclair Paul , Escobedo Sergio , Chakraborty Bijan , Smyth Sandra , White Robert , Kalra Helen , Nevin Krista 
Published: March 2016

BACKGROUND: The cost-effectiveness of initial strategies in managing Canadian patients with uninvestigated upper gastrointestinal symptoms remains controversial.OBJECTIVE: To assess the cost-effectiveness of six management approaches to uninvestigated upper gastrointestinal symptoms in the Canadian setting.METHODS: The present study analyzed data from four randomized trials assessing homogeneous and complementary populations of Canadian patients with uninvestigated upper gastrointestinal symptoms with comparable outcomes. Symptom-free months, quality-adjusted life-years (QALYs) and direct costs in Canadian dollars of two management approaches based on the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool, and four additional strategies (two empirical antisecretory agents, and two prompt endoscopy) were examined and compared. Prevalence data, probabilities, utilities and costs were included in a Markov model, while sensitivity analysis used Monte Carlo simulations. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were determined.RESULTS: Empirical omeprazole cost $226 per QALY ($49 per symptom-free month) per patient. CanDys omeprazole and endoscopy approaches were more effective than empirical omeprazole, but more costly. Alternatives using H2-receptor antagonists were less effective than those using a proton pump inhibitor. No significant differences were found for most incremental cost-effectiveness ratios. As willingness to pay (WTP) thresholds rose from $226 to $24,000 per QALY, empirical antisecretory approaches were less likely to be the most cost-effective choice, with CanDys omeprazole progressively becoming a more likely option. For WTP values ranging from $24,000 to $70,000 per QALY, the most clinically relevant range, CanDys omeprazole was the most cost-effective strategy (32% to 46% of the time), with prompt endoscopy-proton pump inhibitor favoured at higher WTP values.CONCLUSIONS: Although no strategy was the indisputable cost-effective option, CanDys omeprazole may be the strategy of choice over a clinically relevant range of WTP assumptions in the initial management of Canadian patients with uninvestigated dyspepsia.
A Qualitative Systematic Review of Head‐to‐Head Randomized Controlled Trials of Oral Analgesics in Neuropathic Pain
Authors: Watson C Peter N , Gilron Ian , Sawynok Jana 
Published: March 2016

BACKGROUND: Neuropathic pain (NP) encompasses many difficult‐to‐treat disorders. There are few head‐to‐head, comparative, randomized controlled trials (RCTs) of drugs for NP in different analgesic categories, or of different drugs within a category, despite many placebo‐controlled RCTs for individual agents. Well‐designed head‐to‐head comparative trials are an effective way to determine the relative efficacy and safety of a new drug.OBJECTIVE: To perform a systematic review of head‐to‐head RCTs of oral analgesics in NP.METHODS: A systematic review of RCTs involving NP patients was performed, of which head‐to‐head comparative trials were selected. Reference lists from published systematic reviews were searched. These studies were rated according to the Jadad scale for quality.RESULTS AND CONCLUSIONS: Twenty‐seven such trials were identified. Seventeen were comparisons of different analgesics, and 10 were of different drugs within an analgesic class. Important information was obtained about the relative efficacy and safety of drugs in different categories and within a category. Some significant differences between active treatments were reported. Trial inadequacies were identified. More and improved head‐to‐head RCTs are needed to inform clinical choices.
The Epworth Sleepiness Scale: Self‐Administration Versus Administration by the Physician, and Validation of a French Version
Authors: Kaminska Marta , Jobin Vincent , Mayer Pierre , Amyot Robert , Perraton-Brillon Mélanie , Bellemare François 
Published: March 2016

BACKGROUND/OBJECTIVES: The Epworth Sleepiness Scale (ESS) measures sleepiness and is used for, among others, patients with obstructive sleep apnea (OSA). The questionnaire is usually self‐administered, but may be physician administered. The aim was to compare the two methods of administration and to validate a French version.METHODS: Consecutive patients presenting to the sleep clinic at a tertiary care centre completed a self‐administered questionnaire containing the ESS. During the medical interview the same day, one of three pulmonologists who specialized in sleep medicine administered the ESS. Correlations with the apnea‐hypopnea index and mean sleep latencies were used to assess construct validity, while results of previous self‐administered ESS questionnnaires in untreated and recently treated OSA patients were used to test reproducibility and longitudinal construct validity, respectively.RESULTS: In OSA patients, the ESS weakly correlated with the apnea‐hypopnea index (r=0.224; P=0.05; n=120) and negatively with mean sleep latency. For untreated patients (test‐retest), the mean (± SD) average score was unchanged (10.3±6.0 to 10.8±6.5; P=0.35; n=56) after a median of seven months. With continuous positive airway pressure use, the mean score decreased from 12.4±6.8 to 7.6±5.0 after 40.2 months (P<0.0001; n=68). For all subjects, the ESS score obtained by the physician was less than that of the self‐administered result (9.4±5.9 versus 8.5±5.8; P<0.0001 [paired t test]; n=188).CONCLUSIONS: In a sleep clinic population, the French version of the ESS performed similarly to the English version. However, the systematic underscoring during physician administration may be important to consider in the research setting if questionnaire administration methods are not consistent.