bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes Following Chronic Obstructive Pulmonary Disease Presentations to Emergency Departments in Alberta: A Population-Based Study
Authors: Rowe Brian H , Voaklander Donald C , Marrie Thomas J , Senthilselvan Ambikaipakan , Klassen Terry P , Rosychuk Rhonda J 
Published: March 2016

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a complex, multisystem disorder that often results in exacerbations requiring emergency department (ED) management. Following an exacerbation and discharge from the ED, reassessment and management adjustment with a health care provider are recommended to re-establish control of the disease.OBJECTIVES: To describe outcomes of all COPD presentations to EDs made by adults in Alberta including the time spent in the ED and the physician visits following the ED visit.METHODS: Provincial administrative databases were used to obtain all ED encounters for COPD during six fiscal years (1999 to 2005). The information extracted included demographics, ED visit timing, and acute and subacute outcomes (physician visits up to 365 days after discharge for all 7302 discharged individuals during a one-year period). Data analysis included descriptive summaries and survival curves.RESULTS: There were 85,330 ED visits for acute COPD, of which 67% were discharged from the ED. Median ED length of stay was longer in large urban areas (Calgary: 5 h 9 min; Edmonton: 4 h 58 min) than in other regions of Alberta (1 h 17 min). Admissions resulted from 32% of visits and varied among regions; however, few were admitted to the intensive care unit (1%) or died (0.1%). Following discharge, the median time to first follow-up with a physician was 13 days; however, only 40% of patients had follow-up visits in the first seven days. Repeat ED visits within seven days occurred in 5.7% of discharged patients, while 25.6% of discharged patients had repeat ED visits within 365 days of discharge.CONCLUSIONS: More than 30% of COPD ED visits resulted in admission; regional variation was significant. Moreover, discharged patients experienced delayed follow-up and often required repeat ED visits. Interventions to improve reassessment and reduce COPD-related repeat ED visits should be explored.
Management of Hepatitis B: A Longitudinal National Survey – Impact of the Canadian Hepatitis B Consensus Guidelines
Authors: Marotta Paul , Lucas Kurt 
Published: March 2016

BACKGROUND: The Canadian Association for the Study of the Liver, and The Association of Medical Microbiology and Infectious Diseases Canada, jointly developed the Canadian Chronic Hepatitis B (HBV) Consensus Guidelines to assist practitioners involved in the management of this complex disease. These guidelines were published in The Canadian Journal of Gastroenterology in June 2007 and distributed to all Canadian gastroenterologists and hepatologists.OBJECTIVE: To assess the degree to which Canadian specialist physicians were able to incorporate the recommendations from the Canadian HBV Consensus Guidelines into their daily practice.METHODS: A 30 min telephone survey probing the management strategies of 80 key HBV specialists was completed on three occasions, eight months apart, to longitudinally assess the impact of the Canadian HBV Consensus Guidelines on the management of HBV. The questionnaire detailed HBV practice patterns, the impact of the Canadian HBV Consensus Guidelines on clinical practice and HBV management.RESULTS: The majority of specialists incorporated many of the published recommendations outlined in the Canadian HBV Consensus Guidelines into their daily practice for patients with HBV. However, because public drug coverage is a major hurdle in the management of HBV, patients are provided markedly different HBV treatments depending on whether they have public or private drug insurance coverage.CONCLUSIONS: The management of HBV is growing in complexity and continues to evolve rapidly. The Canadian HBV Consensus Guidelines have served as a valuable tool for many physicians in the management of HBV. However, effective treatment algorithms continue to be rendered irrelevant by restrictive drug coverage issues. Coverage for effective therapies and, therefore, management of HBV, differs widely across Canada depending on therapy reimbursement criteria rather than patient characteristics.
The Relationship among Antibiotic Consumption, Socioeconomic Factors and Climatic Conditions
Authors: Marra Fawziah , Mak Sunny , Chong Mei , Patrick David M 
Published: March 2016

BACKGROUND: Antibiotic consumption in human populations is one of the factors responsible for the emergence of resistant organisms. It is important to track population‐based data on an ongoing basis, and to explore the determinants of regional variation in antibiotic consumption.METHODS: Population‐level data were obtained on all outpatient oral antibiotic prescriptions dispensed within British Columbia (BC) between 1996 and 2007. Prescriptions were expressed as the defined daily dose per 1000 inhabitants. Geographical information systems mapping was used to display the spatial variations of antibiotic consumption in BC. The relationships among antibiotic consumption, socioeconomic factors and climatic conditions were explored using Pearson’s correlation and regression modelling.RESULTS: Overall antibiotic consumption was highest in the northern regions of BC. Higher rates of consumption were associated with a greater proportion of the Aboriginal population, lower levels of education and individuals younger than 15 years of age. An inverse correlation was found between some classes of antibiotics and the following factors: individuals older than 65 years of age, mortality rate, doctor‐to‐population ratio, household size and higher July temperatures. The adjusted regression analyses indicated that higher antibiotic consumption was associated with a higher proportion of Aboriginals and household income.CONCLUSION: Different rates of antibiotic consumption exist within BC. The use of antibiotics is correlated with several socioeconomic factors and climatic conditions. It may be useful to consider these factors when designing policies to address antibiotic consumption in the community.
The Changing Frequency of Celiac Disease Diagnosed at the Stollery Children’s Hospital
Authors: Rajani Seema , Huynh Hien Q , Turner Justine 
Published: March 2016

BACKGROUND: Celiac disease (CD) is recognized as one of the most common and important autoimmune gastrointestinal disorders affecting children. There is evidence that a diagnosis of CD during childhood improves health outcomes. The increasing prevalence of CD is due to increased awareness of the wide range of extraintestinal symptoms associated with CD.OBJECTIVE: To determine whether there has been a temporal increase in the diagnosis of CD associated with an increased diagnosis of children without typical gastrointestinal symptoms at the Stollery Children’s Hospital (Edmonton, Alberta).METHODS: Patients with biopsy‐proven CD diagnosed at the Stollery Children’s Hospital from 1998 to 2007, were identified by retrospective chart review. Baseline and follow‐up data, including demographics, symptoms, risk factors, anthropometrics and laboratory investigations, were collected.RESULTS: An increase in the frequency of diagnosis of CD was noted during the study period, particularly from January 2003 onward. Before January 2003, nine children were diagnosed with CD – all with typical symptoms. Between January 2003 and January 2007, inclusive, 149 children were diagnosed with CD, of whom 46% had absent or atypical symptoms. At follow‐up, 96% of patients reported improved symptoms, including 53% of individuals who reported being asymptomatic before diagnosis.CONCLUSIONS: In the last four years of the period studied, the number of children diagnosed with CD at Stollery Children’s Hospital increased 11‐fold. Screening children at risk for CD, and those with atypical presentations, contributed to the increased number of diagnoses. Identification of CD and establishment of lifelong, dietary gluten avoidance during childhood has important health benefits and should be encouraged.
Treatment of Chronic Phantom Limb Pain Using a Trauma‐Focused Psychological Approach
Authors: de Roos C , Veenstra AC , de Jongh A , den Hollander-Gijsman ME , van der Wee NJA , Zitman FG , van Rood YR 
Published: March 2016

BACKGROUND: Chronic phantom limb pain (PLP) is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long‐lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP.OBJECTIVE: To investigate whether a psychological treatment directed at processing the emotional and somatosensory memories associated with amputation reduces PLP.METHODS: Ten consecutive participants (six men and four women) with chronic PLP after leg amputation were treated with eye movement desensitization and reprocessing (EMDR). Pain intensity was assessed during a two‐week period before and after treatment (mean number of sessions = 5.9), and at short‐ (three months) and long‐term (mean 2.8 years) follow‐up.RESULTS: Multivariate ANOVA for repeated measures revealed an overall time effect (F[2, 8]=6.7; P<0.02) for pain intensity. Pairwise comparison showed a significant decrease in mean pain score before and after treatment (P=0.00), which was maintained three months later. All but two participants improved and four were considered to be completely pain free at three months follow‐up. Of the six participants available at long‐term follow‐up (mean 2.8 years), three were pain free and two had reduced pain intensity.CONCLUSIONS: These preliminary results suggest that, following a psychological intervention focused on trauma or pain‐related memories, substantial long‐term reduction of chronic PLP can be achieved. However, larger outcome studies are required.
Effects of a Short Course of Inhaled Corticosteroids in Noneosinophilic Asthmatic Subjects
Authors: Lemière Catherine , Tremblay Caroline , FitzGerald Mark , Aaron Shawn D , Leigh Richard , Boulet Louis-Philippe , Martin James G , Nair Parameswaran , Olivenstein Ronald , Chaboillez Simone 
Published: March 2016

BACKGROUND: Noneosinophilic asthma has been regarded as a distinct phenotype characterized by a poor response to inhaled corticosteroids (ICS).OBJECTIVE: To determine whether noneosinophilic, steroid‐naive asthmatic subjects show an improvement in asthma control, asthma symptoms and spirometry after four weeks of treatment with ICS, and whether they further benefit from the addition of a long‐acting beta‐2 agonists to ICS.METHODS: A randomized, double‐blind, placebo‐controlled, multicentre study comparing the efficacy of placebo versus inhaled fluticasone propionate 250 μg twice daily for four weeks in mildly uncontrolled, steroid‐naive asthmatic subjects with a sputum eosinophil count ≤2%. This was followed by an open‐label, four‐week treatment period with fluticasone propionate 250 μg/salmeterol 50 μg, twice daily for all subjects.RESULTS: After four weeks of double‐blind treatment, there was a statistically significant and clinically relevant improvement in the mean (± SD) Asthma Control Questionnaire score in the ICS‐treated group (n=6) (decrease of 1.0±0.5) compared with the placebo group (n=6) (decrease of 0.09±0.4) (P=0.008). Forced expiratory volume in 1 s declined in the placebo group (−0.2±0.2 L) and did not change in the ICS group (0.04±0.1 L) after four weeks of treatment (P=0.02). The open‐label treatment with fluticasone propionate 250 μg/salmeterol 50 μg did not produce additional improvements in those who were previously treated for four weeks with inhaled fluticasone alone.CONCLUSION: A clinically important and statistically significant response to ICS was observed in mildly uncontrolled noneosinophilic asthmatic subjects.
Treatment of Gastric Epithelial Tumours by Endoscopic Submucosal Dissection Using an Insulated‐Tip Diathermic Knife
Authors: Hua Xu Li , Bo Qian Jun , Gen Gu Liu , Fei Lu , Min Wang Ya , Ming Li Yu , Sheng Lu Hua 
Published: March 2016

BACKGROUND: Endoscopic submucosal dissection (ESD) is a promising technique for the treatment of large, pre‐ and early malignant gastrointestinal lesions.OBJECTIVE: To assess the rates of en bloc resection, incidence of complications, procedure times and therapeutic outcomes of ESD using an insulated‐tip diathermic knife; and to investigate predictors of these outcomes based on the final pathological features of biopsy specimens.METHODS: One hundred twenty patients with endoscopically suspected gastric epithelial tumours who were treated with ESD from January 2006 to December 2009 were evaluated.RESULTS: The mean diameter of the gastric epithelial tumours in the present cohort was 1.88 cm. The mean diameter of the resected specimens was 3.33 cm. The en bloc resection rate was 90% (108 of 120). The median length of the operation was 64.6 min. The bleeding and perforation complication rates were 5.0% (six of 120) and 2.5% (three of 120), respectively. Of 10 gastric tumours initially diagnosed as adenocarcinoma on biopsy, four were found to be low‐grade dysplasia and six were found to be high‐grade dysplasia after resection and final pathological examination. A total of 112 (93.33%) patients underwent curative treatment, eight patients (6.67%) underwent noncurative treatment with ESD, and two patients (1.67%) experienced local recurrence and subsequently underwent surgery.CONCLUSIONS: ESD is a promising local curative treatment option for gastric epithelial tumours, but still carries the risks of bleeding and/or perforation. Differences in the interpretation of histological results among different pathologists and/or between biopsy specimens before ESD and the en bloc tissue specimens after ESD will result in discrepancies.
Examination of Migraine Management in Emergency Departments
Authors: Nijjar Satnam S , Pink Leah , Gordon Allan S 
Published: March 2016

BACKGROUND: Despite advances in treatment, patients with migraine have been underdiagnosed and undertreated, specifically in emergency departments. In addition, great variability exists with respect to the diagnosis, management and treatment of migraine patients in emergency departments. In particular, migraine‐specific treatments, including serotonin receptor agonists, appear to be rarely used.OBJECTIVE: To examine the diagnosis and management of migraine patients within Ontario emergency departments.METHODS: A prospective survey was designed to inquire how emergency physicians diagnose and manage patients with migraine. Questions focused on the use of serotonin receptor agonists, the rationale behind their use or nonuse, and acute headache protocols. The survey also inquired about the use of International Classification Of Headache Disorders‐2 criteria in diagnosing migraine by emergency physicians, medication prescribed on discharge, and referrals made to outpatient specialists. These surveys were distributed to and anonymously completed by emergency physicians in several departments in Ontario.RESULTS: Migraine‐specific treatments were underused in emergency departments. Furthermore, many departments lacked headache protocols and, often, migraine‐specific treatment was not included in the few departments with protocols.CONCLUSIONS: Diagnosis and management of migraines can be improved within emergency departments, and patients can be more effectively channelled toward appropriate outpatient care.
Comparing the Efficacy of Biofeedback and Balloon‐Assisted Training in the Treatment of Dyssynergic Defecation
Authors: Pourmomeny Abbs Ali , Emami Mohammad Hassan , Amooshahi Mahboobeh , Adibi Peyman 
Published: March 2016

BACKGROUND: Dyssynergic defecation does not respond appropriately to routine treatments for constipation. Recently, research has shown that biofeedback therapy is useful in anorectal dyssynergia.OBJECTIVE: To compare two treatment modalities for patients experiencing dyssynergic defecation.METHODS: Sixty‐five subjects with dyssynergic defecation were recruited and randomly allocated to one of two treatment groups: balloon defecation training and biofeedback therapy. In the first group, a balloon was inserted into the rectum and inflated by water injection so that the patient experienced the sensation of a full rectum and, thus, the need to defecate. The patient was subsequently asked to reject the balloon. In the biofeedback group, the pen electrode of an electromyographic biofeedback device was inserted into the rectum, with the patient subsequently being asked to increase abdominal pressure and relax the rectal muscles accordingly.RESULTS: The findings showed a reduction in constipation in both groups. The ability to reject the balloon (volume and time) was significantly better in postintervention measurements; however, better results were found in the biofeedback arm of the study. Patient satisfaction after treatment reached 52% with balloon training and 79% in the biofeedback group. Reports of incomplete evacuation and the need for digit use during defecation remained constant after treatment in balloon‐trained patients.CONCLUSION: Biofeedback training appeared to be superior to balloon defecation training and resulted in measurable changes in subjective and objective variables of dyssynergia.
Post Hoc Analyses of Data from a 90‐Day Clinical Trial Evaluating the Tolerability and Efficacy of Tapentadol Immediate Release and Oxycodone Immediate Release for the Relief of Moderate to Severe Pain in Elderly and Nonelderly Patients
Authors: Vorsanger Gary , Xiang Jim , Biondi David , Upmalis David , Delfgaauw Jacqueline , Allard René , Moskovitz Bruce 
Published: March 2016

OBJECTIVE: To evaluate the tolerability and efficacy of tapentadol immediate release (IR) and oxycodone IR for relief of moderate to severe pain in elderly and nonelderly patients.METHODS: Post hoc data analyses were conducted on a 90‐day randomized, phase 3, double‐blind, flexible‐dose study (ClinicalTrials.gov: NCT00364546) of adults with moderate to severe lower back pain or osteoarthritis pain who received tapentadol IR 50 mg or 100 mg, or oxycodone HCl IR 10 mg or 15 mg every 4 h to 6 h as needed for pain relief. Treatment‐emergent adverse events and study discontinuations were recorded.RESULTS: Data from 849 patients randomly assigned (4:1 ratio) to treatment with a study drug (tapentadol IR [n=679] or oxycodone IR [n=170]) were analyzed according to age (younger than 65 years of age [nonelderly], or 65 years of age or older [elderly]) and treatment group. Among elderly patients, incidences of constipation (19.0% versus 35.6%) and nausea or vomiting (30.4% versus 51.1%) were significantly lower with tapentadol IR versus oxycodone IR (all P<0.05). Initial onsets of nausea and constipation occurred significantly later with tapentadol IR versus oxycodone IR (both P≤0.031). Tapentadol IR‐treated elderly patients had a lower percentage of days with constipation than oxycodone IR‐treated patients (P=0.020). For tapentadol IR‐ and oxycodone IR‐treated elderly patients, respectively, incidences of study discontinuation due to gastrointestinal treatment‐emergent adverse events were 15.8% and 24.4% (P=0.190). Tapentadol IR and oxycodone IR provided similar pain relief, with no overall age‐dependent efficacy differences (mean pain scores [11‐point numerical rating scale] decreased from 7.0 and 7.2 at baseline, to 4.9 and 5.2 at end point, respectively).CONCLUSIONS: Tapentadol IR was safe and effective for the relief of lower back pain and osteoarthritis pain in elderly patients, and was associated with a better gastrointestinal tolerability profile than oxycodone IR.
Direct Costs of Occupational Asthma due to Sensitization in Quebec (1988 to 2002): Revisited
Authors: Malo Jean-Luc , Zunzunegui Maria-Victoria , L’Archevêque Jocelyne , Cardinal Shélanie , Ghezzo Heberto 
Published: March 2016

BACKGROUND: In a previous study, the authors assessed direct costs for occupational asthma (OA) in a random sample of eight to 10 accepted claims per year for OA between 1988 and 2002. Compensation for loss of income (CLI) was found to be significantly higher for men and for OA caused by low-molecular-weight agents.OBJECTIVES AND METHODS: To identify sociodemographic factors that modulate CLI, the dossier of each claimant in the previous study was re-examined.RESULTS: Higher CLI costs were directly related to the duration of CLI (over which loss of income was reimbursed) (r=0.65). Costs of CLI were higher in patients 30 years of age or older at diagnosis, married subjects and individuals who were offered early retirement or were enrolled in an active interventional rehabilitation program. Higher CLI costs in men, but not in women, were associated with the following sociodemographic factors: older age, different rehabilitation program (early retirement and active program versus no specific program) and married status. Older age was found to be significant in the multivariate analysis performed for men. The cost of CLI was higher in workers with OA caused by low-molecular-weight agents. Although proportionally fewer men and younger workers were affected with OA caused by low-molecular-weight agents, the longer duration of CLI for this category of agent could explain the higher costs.CONCLUSION: Higher costs for CLI were associated in men (but not women) with older age, married status and type of rehabilitation program (early retirement and active rehabilitation). Higher costs of CLI for OA caused by low-molecular-weight agents were associated with a longer duration of CLI per se, and not with sociodemographic factors.
Innovation and Design of a Web‐Based Pain Education Interprofessional Resource
Authors: Lax Leila , Watt-Watson Judy , Lui Michelle , Dubrowski Adam , McGillion Michael , Hunter Judith , MacLennan Cameron , Knickle Kerry , Robb Anja , Lapeyre Jaime 
Published: March 2016

INTRODUCTION: The present article describes educational innovation processes and design of a web‐based pain interprofessional resource for prelicensure health science students in universities across Canada. Operationalization of educational theory in design coupled with formative evaluation of design are discussed, along with strategies that support collaborative innovation.METHODS: Educational design was driven by content, theory and evaluation. Pain misbeliefs and teaching points along the continuum from acute to persistent pain were identified. Knowledge‐building theory, situated learning, reflection and novel designs for cognitive scaffolding were then employed. Design research principles were incorporated to inform iterative and ongoing design.RESULTS: An authentic patient case was constructed, situated in inter‐professional complex care to highlight learning objectives related to pre‐operative, postoperative and treatment up to one year, for a surgical cancer patient. Pain mechanisms, assessment and management framed content creation. Knowledge building scaffolds were used, which included video simulations, embedded resources, concurrent feedback, practice‐based reflective exercises and commentaries. Scaffolds were refined to specifically support knowledge translation. Illustrative commentaries were designed to explicate pain misbeliefs and best practices. Architecture of the resource was mapped; a multimedia, interactive prototype was created. This pain education resource was developed primarily for individual use, with extensions for interprofessional collective discourse.DISCUSSION: Translation of curricular content scripts into representation maps supported the collaborative design process by establishing a common visual language. The web‐based prototype will be formatively and summatively evaluated to assess pedagogic design, knowledge‐translation scaffolds, pain knowledge gains, relevance, feasibility and fidelity of this educational innovation.