bluuebunny/crossref_metadata_2025_split huggingface dataset:
Employment Prospects and Trends for Gastroenterology Trainees in Canada: A Nationwide Survey
Authors: Razik Roshan , Cino Maria ,   the Canadian Gastroenterology Program Directors, Nguyen Geoffrey C 
Published: March 2016

BACKGROUND: Many gastroenterology (GI) trainees face a variety of barriers to stable employment and are finding it increasingly difficult to secure employment in their chosen field.OBJECTIVE: To elucidate factors that contribute to the burden of unemployment and underemployment, and to examine solutions that may remedy this growing problem in the field of GI.METHODS: A nationwide survey of current, incoming and recently graduated individuals of GI training programs in Canada was conducted. Trainees in pediatric GI programs and those enrolled in sub-specialty programs within GI were also included.RESULTS: The response rate was 62%, with 93% of respondents enrolled in an adult GI training program. Many (73%) respondents planned to pursue further subspecialty training and the majority (53%) reported concerns regarding job security after graduation as contributory factors. Only 35% of respondents were confident that they would secure employment within six months of completing their training. Regarding barriers to employment, the most cited perceived reasons were lack of funding (both from hospitals and provincial governments) and senior physicians who continue to practice beyond retirement years. Sixty-nine per cent perceived a greater need for career guidance and 49% believed there were too many GI trainees relative to the current job market in their area. Most residents had a contingency plan if they remained unemployed >18 months, which often included moving to another province or to the United States.CONCLUSION: GI trainees throughout Canada reported substantial concerns about securing employment, citing national retirement trends and lack of funding as primary barriers to employment. Although these issues are not easily modifiable, certain problems should be targeted including optimizing training quotas, tailoring career guidance to the needs of the population, and emphasizing credentialing and quality control in endoscopy.
Assessing the Subjective and Physiological Effects of Intranasally Administered Crushed Extended‐Release Morphine Formulations with and without a Sequestered Naltrexone Core in Recreational Opioid Users
Authors: Setnik Beatrice , Goli Veeraindar , Levy-Cooperman Naama , Mills Catherine , Shram Megan , Smith Ira 
Published: March 2016

OBJECTIVE: To evaluate the pharmacodynamic (PD) effects of morphine sulfate and naltrexone hydrochloride extended‐release (MSN) capsules compared with controlled‐release morphine sulfate (MS) and placebo when crushed and administered intranasally.METHODS: The present study was a randomized, double‐blinded, placebo‐controlled, single‐dose (30 mg), three‐way crossover study in healthy, nondependent recreational opioid users. PD measures included assessment of subjective drug effects using visual analogue scales (VAS) ranging from 0 to 100 and assessments of pupil diameter. Blood samples were collected for pharmacokinetic analyses.RESULTS: Both MS and MSN showed significantly higher PD values compared with placebo. MSN showed significantly lower scores for drug liking and high VAS scores on both mean peak effect (Emax) (69.6 and 55.2, respectively) and in area under the effect curve over 2 h (86.3 and 66.7, respectively) following dosing compared with MS (Emax 87.6 and 86.6, respectively; area under the curve over 2 h 120.6 and 132.9, respectively; P<0.001). MSN showed significantly lower Emax for all other positive subjective effects (good drug effects, overall drug liking, and take drug again VAS scores) compared with MS (P<0.001). Peak minimum pupil diameter was significantly larger for MSN than MS (P=0.002). Mean peak plasma concentration (Cmax) and median time to Cmax for morphine following administration of MSN and MS were similar (27.3 ng/mL and 0.57 h versus 27.7 ng/mL and 0.6 h, respectively). Naltrexone mean Cmax was 1497 pg/mL after MSN and median time to Cmax was 0.55 h.CONCLUSIONS: When crushed and administered intranasally, MSN was associated with significantly lower ratings of drug liking and other positive subjective effects compared with MS.
A Systematic Review and Meta‐Analyses of Nonsucrose Sweet Solutions for Pain Relief in Neonates
Authors: Bueno Mariana , Yamada Janet , Harrison Denise , Khan Sobia , Ohlsson Arne , Adams-Webber Thomasin , Beyene Joseph , Stevens Bonnie 
Published: March 2016

BACKGROUND: Sucrose has been demonstrated to provide analgesia for minor painful procedures in infants. However, results of trials investigating other sweet solutions for neonatal pain relief have not yet been synthesized.OBJECTIVE: To establish the efficacy of nonsucrose sweet‐tasting solutions for pain relief during painful procedures in neonates.METHOD: The present article is a systematic review and meta‐analyses of the literature. Standard methods of the Cochrane Neonatal Collaborative Review Group were used. Literature searches were reviewed for randomized controlled trials investigating the use of sweet solutions, except sucrose, for procedural pain management in neonates. Outcomes assessed included validated pain measures and behavioural and physiological indicators.RESULTS: Thirty‐eight studies (3785 neonates) were included, 35 of which investigated glucose. Heel lancing was performed in 21/38 studies and venipuncture in 11/38 studies. A 3.6‐point reduction in Premature Infant Pain Profile scores during heel lances was observed in studies comparing 20% to 30% glucose with no intervention (two studies, 124 neonates; mean difference −3.6 [95% CI −4.6 to −2.6]; P<0.001; I2=54%). A significant reduction in the incidence of cry after venipuncture for infants receiving 25% to 30% glucose versus water or no intervention was observed (three studies, 130 infants; risk difference −0.18 [95% CI −0.31 to −0.05]; P=0.008, number needed to treat = 6 [95% CI 3 to 20]; I2=63%).CONCLUSIONS: The present systematic review and meta‐analyses demonstrate that glucose reduces pain scores and crying during single heel lances and venipunctures. Results indicate that 20% to 30% glucose solutions have analgesic effects and can be recommended as an alternative to sucrose for procedural pain reduction in healthy term and preterm neonates.
Children and Adolescents with Complex Regional Pain Syndrome: More Psychologically Distressed than Other Children in Pain?
Authors: Logan Deirdre E , Williams Sara E , Carullo Veronica P , Claar Robyn Lewis , Bruehl Stephen , Berde Charles B 
Published: March 2016

BACKGROUND: Historically, in both adult and pediatric populations, a lack of knowledge regarding complex regional pain syndrome (CRPS) and absence of clear diagnostic criteria have contributed to the view that this is a primarily psychiatric condition.OBJECTIVE: To test the hypothesis that children with CRPS are more functionally disabled, have more pain and are more psychologically distressed than children with other pain conditions.METHODS: A total of 101 children evaluated in a tertiary care pediatric pain clinic who met the International Association for the Study of Pain consensus diagnostic criteria for CRPS participated in the present retrospective study. Comparison groups included 103 children with abdominal pain, 291 with headache and 119 with back pain. Children and parents completed self‐report questionnaires assessing disability, somatization, pain coping, depression, anxiety and school attendance.RESULTS: Children with CRPS reported higher pain intensity and more recent onset of pain at the initial tertiary pain clinic evaluation compared with children with other chronic pain conditions. They reported greater functional disability and more somatic symptoms than children with headaches or back pain. Scores on measures of depression and anxiety were within normal limits and similar to those of children in other pain diagnostic groups.CONCLUSIONS: As a group, clinic‐referred children with CRPS may be more functionally impaired and experience more somatic symptoms compared with children with other pain conditions. However, overall psychological functioning as assessed by self‐report appears to be similar to that of children with other chronic pain diagnoses. Comprehensive assessment using a biopsychosocial framework is essential to understanding and appropriately treating children with symptoms of CRPS.
Challenges in the Diagnosis and Management of Autoimmune Hepatitis
Authors: Czaja Albert J 
Published: March 2016

BACKGROUND: Autoimmune hepatitis has diverse clinical phenotypes and outcomes that challenge current diagnostic criteria and management algorithms.OBJECTIVES: To highlight the major difficulties in diagnosis and management, describe the efforts to ease them and encourage further progress in problem solving.METHODS: The MEDLINE database was reviewed for published experiences from 1984 to 2013.RESULTS: Acute or acute severe (fulminant) hepatitis, asymptomatic mild disease, and histological findings of centrilobular necrosis or bile duct injury can confound diagnosis and treatment. Continuation of conventional therapy until normal liver test results and liver tissue reduces the frequency of relapse, but does not prevent its occurrence. Problematic patients can be identified using mathematical models, clinical phenotype, serological markers and the speed of improvement after treatment; however, their recognition and treatment are inconsistent. Mycophenolate mofetil can rescue patients with azathioprine intolerance but is less effective for refractory disease. Budesonide in combination with azathioprine can be used frontline, but is effective primarily in noncirrhotic, uncomplicated disease. Molecular and cellular interventions are feasible but largely unevaluated.DISCUSSION: Resolution of the current challenges requires revision of diagnostic criteria, characterization of biological markers that reflect pathogenic pathways, development of dynamic indexes based on changes in disease behaviour, and introduction of new pharmacological, molecular and cellular interventions that have undergone rigorous evaluation.CONCLUSION: These challenges reflect important remediable deficiencies in current management.
Obesity and Chronic Obstructive Pulmonary Disease: Is Fatter Really Better?
Authors: Galesanu Roxana G , Bernard Sarah , Marquis Karine , Lacasse Yves , Poirier Paul , Bourbeau Jean , Maltais François 
Published: March 2016

BACKGROUND: Overweight/obesity is associated with longer survival in chronically ill patients, a phenomenon referred to as the ‘obesity paradox’.OBJECTIVE: To investigate whether the obesity paradox in patients with chronic obstructive pulmonary disease (COPD) is due to fat accumulation or confounding factors.METHODS: A total of 190 patients with stable COPD who underwent a mean (± SD) follow‐up period of 72±34 months were enrolled. Anthropometry, pulmonary function tests, midthigh muscle cross‐sectional area obtained using computed tomography (MTCSACT), arterial blood gas and exercise testing data were measured at baseline. Patients were categorized into two subgroups according to body mass index (BMI) <25 kg/m2 or ≥25 kg/m2 (normal and overweight/obese, respectively).RESULTS: Seventy‐two patients (38%) died during the follow‐up period. Survival tended to be better in the overweight/obese patients but this difference did not reach statistical significance. Overweight/obese patients had better lung function and a larger MTCSACT than those with normal BMI (P<0.001). Overweight/obese patients also had a significantly higher peak work rate than patients with normal BMI (P<0.001). PaO2 and PaCO2 were not significantly different in the two groups. When adjusted for PaCO2, peak work rate and MTCSACT, the tendency for improved survival in overweight/obese patients disappeared. In fact, when these variables were considered in the survival analysis, patients with lower BMI tended to have better survival.CONCLUSION: These results suggest that important confounders, such as hypercapnia, exercise capacity and muscle mass, should be considered when interpreting the association between increased BMI and survival in patients with COPD.
Screening, Detecting and Enhancing the Yield of Previously Undiagnosed Hepatitis B and C In Patients with Acute Medical Admissions to Hospital: A Pilot Project Undertaken at the Vancouver General Hospital
Authors: Kapeluto Jordanna E , Kadatz Matthew , Wormsbecker Andrew , Sidhu Kiran , Yoshida Eric M 
Published: March 2016

BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) represent an increasing health burden and morbidity in Canada. Viral hepatitis, specifically HCV, has high prevalence among persons born between 1945 and 1965, with 45% to 85% of infected adults asymptomatic and unaware of their infection. Screening has been shown to be cost effective in the detection and treatment of viral hepatitis.OBJECTIVE: To quantify incidence and identify undocumented HBV and HCV infection in hospitalized patients at a single centre with secondary analysis of risk factors as part of a quality improvement initiative.METHODS: A one-time antibody test was conducted in patients admitted to the acute medicine and gastroenterology services.RESULTS: Over a 12-week period, hospital screening for HBV and HCV was performed in 37.3% of 995 admitted patients. There was identification of 15 previously undiagnosed cases of HCV (4%) and 36 undocumented cases of occult (ie, antihepatitis B core antigen seropositive) or active (ie, hepatitis B surface antigen seropositive) HBV (9.7%). Among patients with positive screens, 60% of seropositive HCV patients had no identifiable risk factors.CONCLUSIONS: The prevalence of HBV and HCV infection among hospitalized patients in Vancouver was higher than that of the general population. Risk factors for contraction are often not identified. These results can be used as part of an ongoing discussion regarding a ‘seek and treat’ approach to the detection and treatment of chronic blood-borne viral illnesses.
The Influence of Communicative Relations on Facial Responses to Pain: Does It Matter Who Is Watching?
Authors: Karmann Anna J , Lautenbacher Stefan , Bauer Florian , Kunz Miriam 
Published: March 2016

BACKGROUND: Facial responses to pain are believed to be an act of communication and, as such, are likely to be affected by the relationship between sender and receiver.OBJECTIVES: To investigate this effect by examining the impact that variations in communicative relations (from being alone to being with an intimate other) have on the elements of the facial language used to communicate pain (types of facial responses), and on the degree of facial expressiveness.METHODS: Facial responses of 126 healthy participants to phasic heat pain were assessed in three different social situations: alone, but aware of video recording; in the presence of an experimenter; and in the presence of an intimate other. Furthermore, pain catastrophizing and sex (of participant and experimenter) were considered as additional influences.RESULTS: Whereas similar types of facial responses were elicited independent of the relationship between sender and observer, the degree of facial expressiveness varied significantly, with increased expressiveness occurring in the presence of the partner. Interestingly, being with an experimenter decreased facial expressiveness only in women. Pain catastrophizing and the sex of the experimenter exhibited no substantial influence on facial responses.CONCLUSION: Variations in communicative relations had no effect on the elements of the facial pain language. The degree of facial expressiveness, however, was adapted to the relationship between sender and observer. Individuals suppressed their facial communication of pain toward unfamiliar persons, whereas they overtly displayed it in the presence of an intimate other. Furthermore, when confronted with an unfamiliar person, different situational demands appeared to apply for both sexes.
Clinical Features and Outcomes of Serotype 19A Invasive Pneumococcal Disease in Calgary, Alberta
Authors: Ricketson Leah J , Vanderkooi Otto G , Wood Melissa L , Leal Jenine , Kellner James D 
Published: March 2016

BACKGROUND: Streptoccocus pneumoniae serotype 19A (ST19A) became an important cause of invasive pneumococcal disease (IPD) after the introduction of the conjugate vaccine.OBJECTIVE: To examine the severity and outcome of ST19A IPD compared with non‐ST19A IPD.METHODS: The Calgary Area Streptococcus pneumoniae Epidemiology Research (CASPER) study collects clinical and laboratory data on all IPD cases in Calgary, Alberta. Analysis was performed on data from 2000 to 2010 comparing ST19A and non‐ST19A IPD cases. Adjusted linear and logistic regression models were used to examine outcomes of duration of appropriate intravenous antibiotic therapy and intensive care unit admission, respectively.RESULTS: ST19A tended to cause disease in younger patients. ST19A isolates were more often multidrug resistant (19% versus 0.3%; P<0.001). Adjusted logistic regression showed no difference in intensive care unit admission between ST19A and non‐ST19A IPD cases (OR 1.4 [95% CI 0.8 to 2.7]). An adjusted linear regression model showed patients <18 years of age with a diagnosis of bacteremia and no risk factors infected with ST19A were, on average, treated with antibiotics 1.4 times (95% CI 1.1 to 1.9) as long as patients with non‐19A IPD and the same baseline characteristics.DISCUSSION: ST19A IPD was associated with an increase in average time on antibiotics. Although many of the infecting strains of ST19A were within the threshold for susceptibility, they may be sufficiently resilient to require a longer duration of antibiotic therapy or higher dose to clear the infection.CONCLUSIONS: ST19A is more common in younger individuals, is more antibiotic resistant and may require longer average treatment duration.
Development, Implementation and Evaluation of A Pain Management and Palliative Care Educational Seminar for Medical Students
Authors: Paneduro Denise , Pink Leah R , Smith Andrew J , Chakraborty Anita , Kirshen Albert J , Backstein David , Woods Nicole N , Gordon Allan S 
Published: March 2016

BACKGROUND: Despite calls for the development and evaluation of pain education programs during early medical student training, little research has been dedicated to this initiative.OBJECTIVES: To develop a pain management and palliative care seminar for medical students during their surgical clerkship and evaluate its impact on knowledge over time.METHODS: A multidisciplinary team of palliative care and pain experts worked collaboratively and developed the seminar over one year. Teaching methods included didactic and case‐based instruction, as well as small and large group discussions. A total of 292 medical students attended a seminar during their third‐ or fourth‐year surgical rotation. A 10‐item test on knowledge regarding pain and palliative care topics was administered before the seminar, immediately following the seminar and up to one year following the seminar. Ninety‐five percent (n=277) of students completed the post‐test and 31% (n=90) completed the follow‐up test.RESULTS: The mean pretest, post‐test and one‐year follow‐up test scores were 51%, 75% and 73%, respectively. Mean test scores at post‐test and follow‐up were significantly higher than pretest scores (all P<0.001). No significant difference was observed in mean test scores between follow‐up and post‐test (P=0.559), indicating that students retained knowledge gained from the seminar.CONCLUSIONS: A high‐quality educational seminar using interactive and case‐based instruction can enhance students’ knowledge of pain management and palliative care. These findings highlight the feasibility of developing and implementing pain education material for medical students during their training.
Increased Moxifloxacin Utilization Associated with an Unrestricted Addition to a Drug Reimbursement Formulary: A Population‐Based Analysis
Authors: Wright Alissa Jade , Marra Fawziah , Chong Mei , Chambers Catharine , Bowie William R , Patrick David M 
Published: March 2016

OBJECTIVES:To determine whether utilization of moxifloxacin, a broad‐spectrum fluoroquinolone antibiotic, has changed since its addition to the British Columbia provincial formulary in 2009 and to determine whether utilization was guideline concordant.METHODS: BC PharmaNet prescriptions for moxifloxacin from 2001 to 2010 were anonymously linked to associated Medical Services Plan fee‐for‐service practitioner claims for indication‐specific analysis. Prescribing trends for adults ≥18 years of age were described using defined daily dose (DDD) per 1000 person‐years. Monthly utilization rates were fit to a linear regression model that controlled for seasonal variation to examine the effect of the formulary addition.RESULTS: Utilization rose more than sevenfold throughout the study period, from 21.3 DDD per 1000 person‐years in 2001 to 163.3 DDD per 1000 person‐years in 2010. Although the formulary addition was not associated with an immediate increase in utilization (7.5% [95% CI −4.4% to 20.9%]; P=0.226), it was associated with an overall increase in utilization of 2.1% (95% CI 1.3% to 3.0%; P<0.001) for every month after 2009. Overall, only 29% of moxifloxacin prescriptions could be linked to a diagnostic code that was considered to be guideline concordant. In more than one‐half of moxifloxacin prescriptions, the patient had not used another antibiotic in the previous 90 days. Among moxifloxacin prescriptions in which another antibiotic had been used in the previous 90 days, 41.5% were prescriptions for an alternative fluoroquinolone.CONCLUSIONS: The formulary addition was associated with a sustained increase in moxifloxacin utilization over time. Moxifloxacin is often prescribed to patients for indications that are not guideline concordant or to patients who have not previously received first‐line antibiotics.
Can the Presence of Endoscopic High-Risk Stigmata be Bredicted before Endoscopy? A Multivariable Analysis Using the RUGBE Database
Authors: Chen Yen-I , Wyse Jonathan , Barkun Alan , Bardou Marc , Gralnek Ian M , Martel Myriam 
Published: March 2016

BACKGROUND: Many aspects in the management of acute upper gastrointestinal bleeding rely on pre-esophagogastroduodenoscopy (EGD) stratification of patients likely to exhibit high-risk stigmata (HRS); however, data predicting the presence of HRS are lacking.OBJECTIVE: To determine clinical and laboratory predictors of HRS at the index EGD in patients presenting with acute upper gastrointestinal bleeding using retrospective data from a validated national database – the Canadian Registry in Upper Gastrointestinal Bleeding and Endoscopy registry.METHODS: Relevant clinical and laboratory parameters were evaluated. HRS was defined as spurting, oozing, nonbleeding visible vessel or adherent clot after vigorous irrigation. Multivariable modelling was used to identify predictors of HRS including age, sex, hematemesis, use of antiplatelet agents, American Society of Anesthesiologists (ASA) classification, nasogastric tube aspirate, hemoglobin level and elapsed time from the onset of bleeding to EGD.RESULTS: Of the 1677 patients (mean [± SD] age 66.2±16.8 years; 38.3% female), 28.7% had hematemesis, 57.8% had an ASA score of 3 to 5, and the mean hemoglobin level was 96.8±27.3 g/L. The mean time from presentation to endoscopy was 22.2±37.5 h. The best fitting multivariable model included the following significant predictors: ASA score 3 to 5 (OR 2.16 [95% CI 1.71 to 2.74]), a shorter time to endoscopy (OR 0.99 [95% CI 0.98 to 0.99]) and a lower initial hemoglobin level (OR 0.99 [95% CI 0.99 to 0.99]).CONCLUSION: A higher ASA score, a shorter time to endoscopy and lower initial hemoglobin level all significantly predicted the presence of endoscopic HRS. These criteria could be used to improve the optimal selection of patients requiring more urgent endoscopy.