bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Efficacy of HFA‐134a Beclomethasone Dipropionate Extra‐Fine Aerosol over Six Months
Authors: Boulet Louis-Philippe , Cartier André , Ernst Pierre , Larivée Pierre , Laviolette Michel 
Published: March 2016

OBJECTIVE: To compare the systemic safety and efficacy of hydrofluoroalkane beclomethasone dipropionate (HFA‐BDP) extra‐fine aerosol 800 µg/day with chlorofluorocarbon (CFC)‐BDP 1500 µg/day.DESIGN: Six‐month, randomized, parallel‐group, double‐blind, double‐dummy study.PATIENTS: Patients (n=141) with moderate to severe asthma adequately controlled by CFC‐BDP 1000 µg/day to 2000 µg/day.INTERVENTIONS: Patients received CFC‐BDP 1500 µg/day during a two‐week run‐in period and were then randomized to either HFA‐BDP (n=70) or CFC‐BDP (n=71).RESULTS: Similar proportions of HFA‐BDP and CFC‐BDP patients had a 24 h urinary free cortisol values below the reference range at month 6 (15% versus 25%, P=0.35). Measures of adrenocorticotrophic hormone stimulation and morning plasma cortisol levels were also similar in each group. The frequency of skin bruising and oral candidiasis was low for both treatments. No change in intraocular pressure was reported for either treatment. Pulmonary function was similar in both groups; however, the onset of the first asthma exacerbation or increased asthma symptoms tended to be earlier for CFC‐BDP than for HFA‐BDP (P=0.076); 27% of CFC‐BDP patients reported increased asthma symptoms, compared with 14% of HFA‐BDP patients (P=0.095).CONCLUSIONS: HFA‐BDP 800 µg/day has a systemic adverse event profile comparable to that of CFC‐BDP 1500 µg/day, and further control of asthma symptoms may be achieved after a switch from CFC‐BDP 1500 µg/day to HFA‐BDP 800 µg/day.
Outcomes of Asthma Education: Results of a Multisite Evaluation
Authors: Hopman Wilma M , Garvey Nancy , Olajos-Clow Jennifer , White-Markham Andrea , Lougheed M Diane 
Published: March 2016

BACKGROUND: This observational study compared the effectiveness of a standardized adult asthma education program administered in a variety of sites and practice settings on health care utilization, absenteeism, amount of leisure time missed and quality of life (using the Medical Outcomes Study 36‐Item Short Form 1.0 [SF‐36]).METHODS: Seven asthma centres participated in an uncontrolled, multicentre, prospective, observational study using a pre‐post design. Variables included hospital‐ and community‐based centres, an academic hospital setting and the presence or absence of physician attendance. Trained asthma educators administered a guided self‐ management education program, and standardized questionnaires were used for patient assessment at baseline and six months after education.RESULTS: Of the 517 patients enrolled at baseline, 396 were eligible for the six‐month follow‐up. Follow‐up data were available for 252 patients. SF‐36 data were collected for 241 patients at six sites, with follow‐up data available for 103 of 155 eligible patients. Asthma education was associated with substantial improvements in scheduled and unscheduled physician visits, unscheduled specialist visits, emergency department visits, hospital admissions, hospitalized days, missed work or school days and missed days of leisure time. There were also statistically significant improvements in all but one SF‐36 domain. These improvements were comparable across all geographical sites and physical settings.CONCLUSIONS: Standardized asthma education appears to be effective when administered in a variety of practice settings, and may be associated with significant improvements in patient outcomes. The significant decline in health care utilization implies that substantial health care savings may occur as a result of the implementation of standardized asthma education programs.
Inhaled Corticosteroid Therapy Does Not Control Asthma
Authors: Cowie Robert L , Underwood Margot F , Field Stephen K 
Published: March 2016

BACKGROUND: Randomized clinical trials demonstrate efficacy and show that inhaled corticosteroid therapy can control asthma, but details concerning their effectiveness in achieving this goal in the community are lacking.OBJECTIVES: To determine whether inhaled corticosteroid therapy is effective in controlling asthma and to examine the rates of asthma control in relation to inhaled corticosteroid use outside the realm of randomized controlled trials.METHODS: Different populations were examined cross‐sectionally to determine whether self‐reported use of inhaled corticosteroids was associated with control of asthma. Subjects with asthma in the community and those attending a university‐based asthma program were studied. The definition of asthma control was based on the recommendations of the Canadian Consensus Report. The elements of asthma control were examined in the context of the subject′s stated use and dose of the inhaled corticosteroid.RESULTS: Asthma was controlled in 20% (95% CI 18.7% to 21.3%) of the 3427 subjects included in the present study. Only 15% (95% CI 13.5% to 16.5%) of the 2437 subjects using inhaled corticosteroids exhibited asthma control compared with 33% (95% CI 31.1% to 35.9%) of the 990 subjects not using inhaled corticosteroids (P<0.000001).CONCLUSIONS: Although it is known that inhaled corticosteroid therapy can result in asthma control in most individuals with asthma, the present study has shown that this result may not be attained outside the realm of randomized clinical trials. Inhaled corticosteroid use for asthma in a ′real world′ setting appears to reflect disease severity.
Effects of Inhaled Fenoterol and Positive End‐Expiratory Pressure on the Respiratory Mechanics of Patients with Chronic Obstructive Pulmonary Disease
Authors: Guerin Claude , Durand Pierre-Guy , Pereira Cécile , Richard Jean-Christophe , Poupelin Jean-Charles , Lemasson Stéphane , Badet Michel , Philit François , Vecellio Laurent , Chantrel Gilles 
Published: March 2016

BACKGROUND: During acute ventilatory failure in patients with chronic obstructive pulmonary disease (COPD), applying external positive end‐expiratory pressure (PEEPe) will reopen small airways and, thus, may enhance peripheral deposition as well as the physiological effects of inhaled beta‐2 agonists.OBJECTIVE: To investigate the efficacy of inhaled fenoterol applied by zero end‐expiratory pressure (ZEEPe) or PEEPe.METHODS: Ten patients with COPD who were intubated and mechanically ventilated received fenoterol (10 mg/4 mL) via the ventilator using a jet nebulizer for 30 min on ZEEPe and PEEPe set at 80% of the total PEEP in a random order. The total resistance of the respiratory system (rapid airway occlusion technique), change in end‐expiratory lung volume and expiratory flow limitation were assessed before and 5 min, 15 min, 30 min, 60 min and 240 min after fenoterol inhalation.RESULTS: Before inhalation and 60 min after inhalation, the total PEEP, the change in end‐expiratory lung volume and the total resistance of the respiratory system were 8±3 cmH2O and 6±3 cmH2O, 0.61±0.34 L and 0.43±0.32 L, and 26±7 cmH2O/L/s and 23±6 cmH2O/L/s, respectively, with ZEEPe, and 9±3 cmH2O and 8±3 cmH2O (P<0.05 versus ZEEPe), 0.62±0.34 L and 0.62±0.37 L (P<0.05 versus ZEEPe), and 26±9 H2O/L/s and 25±9 H2O/L/s, respectively, with PEEPe. Three patients became not flow‐limited under the combination of PEEPe and fenoterol.CONCLUSIONS: In patients with COPD, fenoterol combined with PEEPe has opposing effects on respiratory mechanics. First, it does not significantly reduce lung hyperinflation or inspiratory resistances. Second, it allows expiratory flow limitation reversal in some patients. These findings result from the net effect on end‐expiratory lung volume of each intervention. This implies that if fenoterol is used in combination with PEEPe, the level of PEEPe should be reassessed during the time course of the drug to prevent any further lung hyperinflation.
Patterns and Determinants of Compliance with Inhaled Steroids in Adults with Asthma
Authors: Lacasse Yves , Archibald Hélène , Ernst Pierre , Boulet Louis-Philippe 
Published: March 2016

BACKGROUND: Patient compliance with inhaled corticosteroids (ICS) in asthma is considered to be suboptimal.OBJECTIVES: To describe the patterns of compliance with ICS and identify factors determining the compliance to ICS in adults with asthma.METHODS: Based on a review of the literature and interviews with asthmatic patients who require the regular use of ICS, potential determinants of compliance to ICS were identified. Questionnaires related to these determinants were then administered to a cohort of patients from three subspecialty clinics, including two from university‐affiliated centres. Patients with mild‐to‐moderate asthma who were 15 years of age and older and required (from the physician′s point of view) ICS as maintenance medication because of persistent asthma were included in the study. Patients were followed for a period of 12 weeks. Compliance was measured using electronic devices.RESULTS: Data from 124 patients (51 men; mean age 47±15 years; mean prescribed daily dose of ICS [fluticasone propionate] 643±385 µg) were analyzed. On average, the patients took 72±24% of their prescription. Four patterns of compliance were observed and are described: 1A ‐‐ regular compliance (n=29); 1B ‐‐ irregular compliance (n=37); 2A ‐‐ regular noncompliance (n=24); and 2B ‐‐ irregular noncompliance (n=34). Among the potential predictors of noncompliance, age was the only significant predictor (compliance increased with increasing age). There was no difference in asthma control between compliant and noncompliant patients.CONCLUSION: Compliance to ICS in patients with asthma is often suboptimal and difficult to predict. The observations suggest that some asthmatics may be overtreated with ICS.
Does Sex Influence the Impact That Smoking, Treatment Interruption and Impaired Pulmonary Function Have on Outcomes in Limited Stage Small Cell Lung Cancer Treatment?
Authors: Videtic Gregory MM , Truong Pauline T , Ash Robert B , W Yu Edward , Kocha Walter I , Vincent Mark D , Tomiak Anna T , Dar A Rashid , Whiston Frances , Stitt Larry W 
Published: March 2016

PURPOSE: To look for survival differences between men and women with limited stage small cell lung cancer (LS‐SCLC) by examining stratified variables that impair treatment efficacy.METHODS: A retrospective review of 215 LS‐SCLC patients treated from 1989 to 1999 with concurrent chemotherapy‐radiotherapy modelled on the ′early‐start′ thoracic radiotherapy arm of a National Cancer Institute of Canada randomized trial.RESULTS: Of 215 LS‐SCLC patients, 126 (58.6%) were men and 89 (41.4%) were women. Smoking status during treatment for 186 patients (86.5%) was: 107 (58%) nonsmoking (NS) (76 [71%] male [M]; 31 [29%] female [F]) and 79 (42%) smoking (S) (36 M [46%]; 43 F [54%]) (continuing‐to‐smoke F versus M, P=0.001). Fifty‐six patients (26%) had radiotherapy interruptions (RTI) during chemotherapy‐radiotherapy because of toxicity. Radiotherapy breaks were not associated with sex (P=0.95). Survival by sex and smoking status at two years was: F + NS = 38.7%; F + S = 21.6%; M + NS = 22.9%; and M + S = 9.1% (P=0.0046). Survival by sex and RTI status at two years was: F + no RTI = 32.4%; F + RTI = 23.6%; M + no RTI = 23.0%; and M + RTI = 3.8% (P=0.0025). Diffusion capacity for carbon monoxide (DLCO) was recorded for 86 patients (40%) and median survival by sex and DLCO was F = 16.7 months and M = 12.1 months for a DLCO less than 60%; and for a DLCO 60% or more, F = 15.1 months and M = 15.3 months. First relapses were recorded in 132 cases (61%), with chest failure in men (45%) greater than for women (35%) and cranial failure rates similar between sexes (48%). Upon multivariable analysis, continued smoking was the strongest negative factor affecting survival.CONCLUSIONS: In LS‐SCLC, women overall do better than men, with or without a negative variable. The largest quantifiable improvement in survival for women came from smoking cessation, and for men from avoidance of breaks during treatment.
The Prevalence of Hepatitis A in Children in British Columbia
Authors: Ochnio Jan J , Scheifele David W , Fyfe Murray , Bigham Mark , Bowering David , Martiquet Paul , Ho Margaret , Talling Douglas N 
Published: March 2016

BACKGROUND: The risk of hepatitis A virus (HAV) infection during childhood is difficult to estimate without population serosurveys because HAV‐related symptoms are often mild at this age. Few serosurveys have been conducted in Canada. The present study surveyed teenagers in two nonurban regions of British Columbia where the historical rate of reported HAV either exceeded (region A) or was less than (region B) the historical provincial rate.METHODS: A point prevalence survey of salivary HAV‐specific immunoglobulin G was conducted in high schools among grade 9 students in regions A and B. A questionnaire was used to gather sociodemographic data. The survey was extended to grade 1 and grade 5 students in community 1 of region B. Associations between risk factors and prior infection were evaluated by logistic regression.RESULTS: Eight hundred eleven grade 9 students were tested. Antibody to HAV was detected in 4.7% of students in region A (95% CI 2.9% to 7.2%) and 9.6% of students in region B (95% CI 6.9% to 12.9%). The region B figure reflected HAV antibody prevalence rates of 19.5% in community 1 and 2.5% in the remainder of the region. Younger students in community 1 had low HAV antibody to HAV prevalence rates (3.9% for grade 1 and 3.1% for grade 5), and positive tests in this community were associated with a particular school, foreign travel and brief residence. The risk factors for HAV infection in grade 9 students were not determined.CONCLUSIONS: Children in nonurban areas of British Columbia are generally at low risk of HAV infection during the first decade of life regardless of the reported population rates, thereby permitting the consideration of school‐based HAV immunization programs.
Treatment of Whiplash‐Associated Disorders ‐ Part I: Non‐Invasive Interventions
Authors: Conlin Anne , Teasell Robert , Bhogal Sanjit , Sequeira Keith 
Published: March 2016

BACKGROUND: A whiplash‐associated disorder (WAD) is an injury due to an acceleration‐deceleration mechanism at the neck. WAD represents a very common and costly condition, both economically and socially. In 1995, the Quebec Task Force published a report that contained evidence‐based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus‐based recommendations.OBJECTIVE: The objective of the present article ‐ the first installment of a two‐part series on interventions for WAD ‐ is to provide a systematic review of the literature published between January 1993 and July 2003 on noninvasive interventions for WAD using meta‐analytical techniques.METHODS OF THE REVIEW: Three medical literature databases were searched for identification of all studies on the treatment of WAD. Randomized controlled trials (RCTs) and epidemiological studies were categorized by treatment modality and analyzed by outcome measure. The methodological quality of the RCTs was assessed. When possible, pooled analyses of the RCTs were completed for meta‐analyses of the data. The results of all the studies were compiled and systematically reviewed.RESULTS: Studies were categorized as exercise alone, multimodal intervention with exercise, mobilization, strength training, pulsed magnetic field treatment and chiropractic manipulation. A total of eight RCTs and 10 non‐RCTs were evaluated. The mean score of methodological quality of the RCTs was five out of 10. Pooled analyses were completed across all treatment modalities and outcome measures. The outcomes of each study were summarized in tables.CONCLUSIONS: There exists consistent evidence (published in two RCTs) in support of mobilization as an effective noninvasive intervention for acute WAD. Two RCTs also reported consistent evidence that exercise alone does not improve range of motion in patients with acute WAD. One RCT reported improvements in pain and range of motion in patients with WAD of undefined duration who underwent pulsed electromagnetic field treatment. Conflicting evidence in two RCTs exists regarding the effectiveness of multimodal intervention with exercise. Limited evidence, in the form of three non‐RCTs, exists in support of chiropractic manipulation. Future research should be directed toward clarifying the role of exercise and manipulation in the treatment of WAD, and supporting or refuting the benefit of pulsed electromagnetic field treatment. Mobilization is recommended for the treatment of pain and compromised cervical range of motion in the acute WAD patient.
Treatment of Whiplash‐Associated Disorders ‐ Part II: Medical and Surgical Interventions
Authors: Conlin Anne , Bhogal Sanjit , Sequeira Keith , Teasell Robert 
Published: March 2016

BACKGROUND: Whiplash‐associated disorder (WAD) is a term used to describe injury due to an acceleration‐deceleration mechanism at the neck. In 1995, the Quebec Task Force published a report that contained evidence‐based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus‐based recommendations.OBJECTIVE: The objective of the present article ‐ the second installment of a two part review on WAD ‐ is to provide a systematic review of the literature published between January 1993 and July 2003 on medical and surgical interventions for WAD using meta‐analytical techniques.METHODS OF THE REVIEW: Three medical literature databases were searched for identification of all clinical trials on the treatment of WAD. Randomized controlled trials (RCTs) and epidemiological studies were categorized by treatment modality and analyzed by outcome measures. The methodological quality of the RCTs was assessed. When possible, pooled analyses of the RCTs were completed for meta‐analyses of the data. The results of all the studies were compiled and systematically reviewed.RESULTS: The studies were categorized as medical or surgical interventions. A total of five RCTs and six non‐RCTs were evaluated. The mean methodological quality of the RCTs was 7.3 among studies on medical interventions and 7.5 for studies on surgical intervention. Pooled analyses were completed across all treatment modalities and outcome measures. The outcomes of each study were summarized in tables.CONCLUSIONS: While several quality RCTs and epidemiological studies have been published since 1993 on medical and surgical interventions, the cumulative evidence is lacking. Moderate evidence exists in support of radiofrequency neurotomy. Evidence for steroid injections, botulinum treatments, carpal tunnel decompression and cervical discectomy is conflicting or unclear. Future research is required to clarify the utility of radiofrequency neurotomy and pulsed electromagnetic field treatment for WAD.
The Prevalence and Incidence of Sexually Transmitted Infections in a Prospective Cohort of Injection Drug Users in Vancouver, British Columbia
Authors: Kuyper Laura M , Collins Courtney LC , Kerr Thomas , Hogg Robert S , Li Kathy , Tyndall Mark W , Montaner Julio SG , Wood Evan 
Published: March 2016

BACKGROUND: While several studies have reported on sexual risk behaviours and the prevalence of sexually transmitted infections (STIs) among injection drug users (IDUs), there are fewer prospective studies that have been able to examine populations of IDUs with no history of STIs. Therefore, the authors examined prevalence, correlates and factors associated with time to first STI infection in a prospective cohort of IDUs in Vancouver, British Columbia.METHODS: The authors examined the prevalence and correlates of STIs among IDUs at the time of recruitment into a prospective cohort study. The authors also evaluated the cumulative rate of time to first STI among IDUs with no history of STIs at baseline using the Kaplan‐Meier method, and modelled factors independently associated with first STI using Cox regression.RESULTS: Between May 1996 and November 2003, 1560 individuals were recruited into the cohort; of these individuals, 745 reported a history of STI at baseline. Among the 815 who did not report an STI at baseline, 671 (82%) had at least one follow‐up visit and were eligible for the analysis of time to first STI. After 36 months of follow‐up, the cumulative rate of first STI was 8.2% for men and 15.9% for women (log‐rank P<0.001), whereas the cumulative rate of first STI was 8.0% for IDUs who did not report sex trade involvement versus 19.8% for IDUs who reported sex trade involvement (log‐rank P<0.001). In multivariate analyses, the risk of first STI remained independently associated with unprotected sex with regular partners (relative hazard=2.04, 95% CI 1.29 to 3.23; P=0.001) and unprotected sex with sex trade clients (relative hazard=2.36, 95% CI 1.46 to 3.82; P=0.005).CONCLUSIONS: In the present study, the authors found that STIs were associated with both regular sex partnerships and sex trade involvement. These findings are of particular concern because both unprotected sex with regular partners and sex trade involvement is common among IDUs. Interventions to encourage condom use among IDUs, particularly those with regular sex partners and those involved in the sex trade, should be further developed.
Determinants of Hospital Length of Stay among Patients with Pneumonia Admitted to a Large Canadian Hospital from 1991 to 2001
Authors: McGregor Margaret J , FitzGerald J Mark , Reid Robert J , Levy Adrian R , Schulzer Michael , Jung David , Groshaus Horacio E , Cox Michelle B 
Published: March 2016

BACKGROUND: Pneumonia is a common reason for hospital admission, and the cost of treatment is primarily determined by length of stay (LOS).OBJECTIVES: To explore the changes to and determinants of hospital LOS for patients admitted for the treatment of community‐acquired pneumonia over a decade of acute hospital downsizing.METHODS: Data were extracted from the database of Vancouver General Hospital, Vancouver, British Columbia, on patients admitted with community‐acquired pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 481.xx, 482.xx, 483.xx, 485.xx and 486.xx) from January 1, 1991 to March 31, 2001. The effects of sociodemographic factors, the specialty of the admitting physician (family practice versus specialist), admission from and/or discharge to a long‐term care facility (nursing home) and year of admission, adjusted for comorbidity, illness severity measures and other potential confounders were examined. Longitudinal changes in these factors over the 10‐year period were also investigated.RESULTS: The study population (n=2495) had a median age of 73 years, 53% were male and the median LOS was six days. Adjusted LOS was longer for women (10% increase, 95% CI 3 to 16), increasing age group (7% increase, 95% CI 4 to 10), admission under a family physician versus specialist (42% increase, 95% CI 32 to 52) and admission from home with subsequent discharge to a long‐term care facility (75% increase, 95% CI 47 to 108). Adjusted hospital LOS decreased by an estimated 2% (95% CI 1 to 3) per annum. The mean age at admission and the proportion admitted from long‐term care facilities both increased significantly over the decade (P<0.05).CONCLUSIONS: Results suggest that the management of hospitalized patients with pneumonia changed substantially between 1991 and 2001. The interface of long‐term care facilities with acute care would be an important future area to explore potential efficiencies in caring for patients with pneumonia.