bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Practice Guideline for Suctioning the Airway of the Intubated and Non-Intubated Patient
Authors: Brooks Dina , Anderson Cathy M , Carter Margaret A , Downes Laurie A , Keenan Sean P , Kelsey Carol J , Lacy Janet B 
Published: March 2016

OBJECTIVE: To provide physicians, physiotherapists, nurses and respiratory therapists with guidelines for the application of airway suctioning.DESIGN: This clinical practice guideline was developed using the model by Browman and colleagues. A working group of representatives from four professional colleges (nurses, physicians and surgeons, physiotherapists and respiratory therapists) and research experts was formed to conduct a systematic review, develop evidence-based recommendations and generate clinical practice guidelines. MEDLINE (1966 to 1998), CINAHL (1982 to 1997) and EMBASE (1974 to 1996) as well as the reference lists of identified articles were searched. Inclusion of articles was determined by at least two group members, and studies were classified according to type. Randomized, controlled; randomized; and nonrandomized crossover and comparative cohort trials were grouped by type of intervention and population for use in the development of recommendations. Other observational and animal studies dealing with adverse effects of suctioning were included in the review but were not used in the development of recommendations. Input on the evidence-based recommendations was sought and incorporated from members of all four professions and from experts on content and methodology.SETTING: Any setting (hospital or home) where suctioning is performed.POPULATION: Intubated and nonintubated adults, infants and children.RESULTS AND CONCLUSIONS: An attempt was made to develop recommendations in each of the subcategories of suctioning techniques addressed by at least one study. In some subcategories, definite recommendations were made (13 in adults, and three in children and infants); in other subcategories, insufficient evidence precluded recommendations. The recommendations addressed the following aspects of suctioning: preoxygenation, hyperinflation, insufflation, hyperoxygenation, hyperventilation, saline instillation, adaptor use, medication use, open and closed systems, and various types of catheters.
Pain and Cognitive Status among Nursing Home Residents in Canada
Authors: Proctor Wendey R , Hirdes John P 
Published: March 2016

BACKGROUND: There is little information available on the rates of pain in institutionalized elderly persons, and this is particularly true for Canada.OBJECTIVES: To provide information about the prevalence and clinical correlates of pain in a sample of Canadian nursing homes, to determine whether residents with cognitive impairment experience lower rates of health conditions associated with pain (eg, arthritis) than residents without cognitive impairment and to determine whether the associations (ie, odds ratios) for pain with such health conditions vary as a function of cognitive status.DESIGN: The study is based on a secondary analysis of data collected with the minimum data set (MDS 2.0).SETTING AND PARTICIPANTS: The study comprised 3195 nursing home residents in Ontario, Manitoba and Saskatchewan.SUBJECTS AND METHODS: All residents were assessed with the MDS 2.0 by trained clinicians (usually nurses). Pain was documented if it had occurred within the seven days before the assessment. Assessors were trained to look for overt signs of discomfort, such as wincing or verbalizations. Self‐report ratings were obtained when possible.RESULTS: The overall prevalence of pain in this sample was 49.7%, and 23.7% of residents experienced pain daily. Persons with and persons without cognitive impairments did not differ with respect to the prevalence of conditions likely to cause pain and the associations of pain with such health conditions. Regional differences were found, with Ontario residents having a higher frequency and intensity of pain than their counterparts in Saskatchewan and Manitoba. This may be due, at least in part, to regional differences in nursing home admission criteria.CONCLUSIONS: The findings suggest that the prevalence of identified pain is lower among nursing home residents with higher levels of cognitive impairment. These results do not support the notion that this is a function of lower prevalence rates of pain‐causing conditions in nursing home residents with dementia. Furthermore, the results do not support the view that residents with cognitive impairments are less sensitive to pain. This study highlights the need for more comprehensive tools to assess pain in persons with cognitive impairments. Nonetheless, the MDS may be a useful instrument for detecting pain in such populations, because it does not rely exclusively on self‐report.
Reduced Susceptibility to Penicillin among Pneumococci Causing Invasive Infection in Children ‐ Canada, 1991‐1998
Authors: Scheifele David , Halperin Scott , Pelletier Louise , Talbot James , Lovgren Marguerite , Vaudry Wendy , Jadavji Taj , Law Barbara , MacDonald Noni , Gold Ron , Wang Elaine , Mills Elaine , Lebel Marc , Déry Pierre , Morris Rob 
Published: March 2016

OBJECTIVE: To determine, over time, the rate and serotypes of pneumococci with reduced penicillin susceptibility obtained from children with invasive infection.DESIGN: Active, hospital‐based, multicentre surveillance spanning from 1991 to 1998.SETTING: Eleven Canadian tertiary care paediatric facilities located from coast to coast.POPULATION STUDIED: 1847 children with invasive pneumococcal infection whose isolates (from a normally sterile site) were available for serotyping and standardized testing for penicillin susceptibility at the National Centre for Streptococcus.MAIN RESULTS: The prevalence of reduced penicillin susceptibility increased from 2.5% of 197 cases in 1991 to 13.0% of 276 cases in 1998. In the latter year, 8.7% of isolates had intermediate level resistance, and 4.3% had high level resistance. Since they were first detected in 1992, strains with high level resistance have been encountered only sporadically at most centres, but by 1998, all centres but two had encountered examples. Of 40 isolates with high level resistance and 101 isolates with intermediate level resistance, serotypes matched those included in new seven‐valent conjugate vaccines for children in 97.5% and 79.2% of cases, respectively.CONCLUSIONS: Pneumococci with reduced susceptibility to penicillin are increasing in frequency across Canada among children with invasive infection. The Immunization Monitoring Program, Active data indicate that new conjugate vaccines could help to curb infections due to pneumococci with reduced susceptibility to penicillin but are unlikely to control completely the problem of antibiotic resistance.
Increased Levels of Airway Neutrophils Reduces the Inhibitory Effects of Inhaled Glucocorticosteroids on Allergen‐Induced Airway Eosinophils
Authors: Gauvreau Gail M , Inman Mark D , Kelly Margaret , Watson Richard M , Dorman Sandra C , O’Byrne Paul M 
Published: March 2016

BACKGROUND: Treatment with inhaled glucocorticosteroids attenuates allergen‐induced airway inflammation but is less effective in people with asthma who have noneosinophilic airway inflammation.OBJECTIVE: Studies in which glucocorticosteroid treatment was used before allergen challenges were re‐examined to determine whether the efficacy of steroid treatment could be predicted by baseline levels of sputum inflammatory cells.PATIENTS AND METHODS: Twenty‐eight nonsmoking subjects with atopic asthma controlled by beta2‐agonists participated in only one of three studies, each carried out with a double‐blind, placebo controlled, randomized, crossover design. Subjects were treated with glucocorticosteroids or placebo for six to eight days and then underwent allergen inhalation challenge. Spirometry was measured for 7 h after allergen challenge, and then sputum inflammatory cells were measured. Sputum inflammatory cells were also measured before and after treatment, and 24 h after allergen challenge. The per cent inhibition of the allergen‐induced airway responses by glucocorticosteroids was calculated.RESULTS: Inhaled gluticocorticosteroids significantly attenuated the early and late asthmatic responses, and the number of allergen‐induced sputum eosinophils (P<0.05). There was a significant negative relationship between the number of sputum neutrophils at baseline, and the per cent inhibition of allergen‐induced sputum eosinophils measured at 7 h (r=‐0.61, P<0.001) and 24 h (r=‐0.73, P<0.0001) after challenge, suggesting that glucocorticosteroids are less effective in attenuating allergen‐induced airway inflammation in subjects with high levels of neutrophils. There was no correlation between the number of sputum eosinophils at baseline and the per cent inhibition of allergen‐induced responses.CONCLUSIONS: Baseline airway neutrophils, not eosinophils, can be used to predict the efficacy of inhaled steroids on allergen‐induced sputum eosinophils.
Diagnosis and Analysis of a Recent Case of Human Rabies in Canada
Authors: Elmgren Lindsay D , Nadin-Davis Susan A , Muldoon Frances T , Wandeler Alexander I 
Published: March 2016

BACKGROUND: On September 30, 2000, staff at the Canadian Food Inspection Agency's Centre of Expertise for Rabies, located at the Animal Diseases Research Institute in Ottawa, Ontario, diagnosed rabies in a child from Quebec. This was the first case of rabies in a human in Canada in 15 years and in 36 years in the province of Quebec. After spending a week in intensive care in a Montreal hospital, the nine-year-old boy succumbed to this nearly always fatal disease. The boy had been exposed to a bat in late August 2000, while vacationing with his family in the Quebec countryside.METHODS: Antemortem specimens taken from the patient were sent to the Canadian Food Inspection Agency laboratory for rabies diagnosis. Samples included saliva, eye secretions, corneal impressions, cerebral spinal fluid and skin. Specimens were examined by direct immunofluorescence microscopy, and results were confirmed using molecular biological techniques. Virus strain identification was performed by both genetic methods and phenotypic analysis with monoclonal antibodies.RESULTS: Initial results from direct immunofluorescence staining indicated that rabies virus was present in the skin biopsy specimen but not in the corneal impressions. This diagnosis of rabies was confirmed by polymerase chain reaction product analysis from several of the submitted specimens. Virus isolation from postmortem samples was not possible because fresh brain tissue was not available. Rabies virus was isolated from saliva and was determined to be similar to a variant that circulates in populations of silver-haired bats.INTERPRETATION: Intravitam diagnosis of rabies in humans is very dependent on the samples submitted for diagnosis and the method used for testing. Upon first examination, only skin specimens were positive for rabies virus antigen; using polymerase chain reaction analysis, only saliva yielded positive results for rabies virus genome. Extensive testing and retesting of specimens submitted for rabies diagnosis in humans must be done to avoid false negative results.
Cannabis for Chronic Pain: Case Series and Implications for Clinicians
Authors: Ware Mark A , Gamsa Ann , Persson Jan , Fitzcharles Mary-Ann 
Published: March 2016

BACKGROUND: Chronic pain is one of the most common reasons for therapeutic cannabis use.OBJECTIVES: To describe therapeutic cannabis use among patients with chronic pain.METHODS: Patients with chronic pain who voluntarily indicated that they used cannabis therapeutically completed a questionnaire about the type of cannabis used, the mode of administration, the amount used and the frequency of use, and their perception of the effectiveness of cannabis on a set of pain‐associated symptoms and side effects. The study was approved by the McGill University Health Centre Research Ethics Board.RESULTS: Fifteen patients (10 male) were interviewed (median age 49.5 years, range 24 to 68 years). All patients smoked herbal cannabis for therapeutic reasons (median duration of use six years, range two weeks to 37 years). Seven patients only smoked at night‐time (median dose eight puffs, range two to eight puffs), and eight patients used cannabis mainly during the day (median dose three puffs, range two to eight puffs); the median frequency of use was four times per day (range one to 16 times per day). Twelve patients reported improvement in pain and mood, while 11 reported improvement in sleep. Eight patients reported a ′high′; six denied a ′high′. Tolerance to cannabis was not reported.CONCLUSIONS: The results of this self‐selected case series must be interpreted with caution. Small doses of smoked cannabis may improve pain, mood and sleep in some patients with chronic pain. Clinical trials are warranted to test these effects. Further prospective studies should examine the patterns and prevalence of cannabis use among chronic pain populations.
The Addition of Salmeterol 50 µg Bid to Anticholinergenic Treatment in Patients with COPD: A Randomized Placebo Controlled Trial
Authors: Chapman Kenneth R , Arvidsson Peter , Chuchalin AG , Dhillon DP , Faurschou Peter , Goldstein Roger S , Kuipers AF 
Published: March 2016

BACKGROUND: In the past, the role of long‐acting beta2‐agonists in chronic obstructive pulmonary disease (COPD) relative to other agents has been unclear.OBJECTIVES: To compare the effect of adding salmeterol (50 µg bid) or placebo to concurrent anticholinergic therapy on symptom scores, quality of life, prebronchodilator lung function and exacerbations in patients with moderately severe COPD.METHODS: This was a double‐blind, randomized, parallel‐group study in patients aged 40 years or older receiving anticholinergic medication. Patients were randomly assigned to treatment with placebo (n=207) or salmeterol (n=201) via a Diskus/Accuhaler inhaler for 24 weeks.RESULTS: The morning trough (prestudy drug) forced expiratory volume in 1 s (FEV1) increased significantly above baseline levels among the salmeterol‐treated patients. Improvement in FEV1 was greater in the salmeterol group than in the placebo group at four weeks (difference 0.06 L, P <0.005), eight weeks (0.06 L, P <0.005) and 16 weeks (0.05 L, P <0.05) after the start of treatment. There was a nonsignificant trend in favour of salmeterol after 24 weeks of treatment (P=0.198). Improvements in morning peak flow were significantly greater in the salmeterol group over 24 weeks (P <0.01). Although symptom scores were numerically higher in the salmeterol group than in the placebo group and there was less requirement for rescue bronchodilator use, these differences were not statistically significant. In the salmeterol group, fewer patients had exacerbations of COPD, and there was a trend toward an improved quality of life. The safety profile of the two groups was similar.CONCLUSIONS: Salmeterol has a beneficial effect when added to existing anticholinergic therapy in patients with COPD. The regular use of salmeterol for six months was not associated with worsening of the underlying airflow obstruction; rather, there was a tendency for the trough FEV1 to improve above the baseline levels over the treatment period.
Demographic, Clinical and Microbiological Characteristics of Maternity Patients: A Canadian Clinical Cohort Study
Authors: Wenman Wanda M , Tataryn Ivanna V , Joffres Michel R , Pearson Rachelle , Grace Michael GA , Albritton William L , Prasad Errol , The Edmonton Perinatal Infections Group  
Published: March 2016

OBJECTIVE: To determine the demographic, clinical and microbiological characteristics of a representative Canadian obstetrical population.DESIGN: A one‐year cohort study of all maternity patients who were followed to delivery, using detailed patient questionnaires containing more than 60 demographic and clinical variables, and three microbiological evaluations during gestation ‐ first trimester, 26 to 30 weeks, and labour and delivery. Outcome measurements included birth weight and gestational age.SETTING: Labour and delivery suites of all office obstetrical practices affiliated with a single hospital.POPULATION STUDIED: A consecutive sample of pregnant women in the study practices during one year were eligible for enrolment; 2237 consecutive patients were approached for consent, 2047 enrolled and 1811 completed the study through delivery.RESULTS: The average patient was white, married and 29 years of age. Slightly more than half of the patients had postsecondary education, but 10% fell below the national poverty line for income. Frequency of factors linked to adverse pregnancy outcomes included cigarette smoking (19%), alcohol ingestion (18%), previously having had a premature infant (7%), and maternal diabetes (2%). Overall prevalence of genital microbes variously implicated in prematurity was 37% for ureaplasma, 11% for group B streptococcus and 4% for Mycoplasma hominis. Prevalence of bacterial vaginosis was 14%. The median gestational age for the cohort was 39 weeks, with 7% of infants born less than 37 weeks′ gestation. Mean birth weight was 3415 g.CONCLUSIONS: The present clinical cohort represents demographic and medical characteristics of the Canadian obstetrical population. The birth outcomes are consistent with national data. This database provides valuable information about a general obstetrical population that is managed by a universal health care system.
Long Term Follow‐up of Ventilated Patients with Thoracic Restriction and Neuromuscular Disease
Authors: Brooks Dina , De Rosie James , Mousseau Margaret , Avendano Monica , Goldstein Roger S 
Published: March 2016

OBJECTIVE: To evaluate the long term effects of home mechanical ventilation (HMV) on pulmonary function, nighttime gas exchange, daytime arterial blood gases, sleep architecture and functional exercise capacity (6 min walk). Patients with respiratory failure attributable to thoracic restrictive disease (TRD) (kyphoscoliosis) or neuromuscular disease (NMD) were assessed, ventilated, trained and followed in a dedicated unit for the care of patients requiring long term ventilation.DESIGN: All patients admitted for home ventilation training since 1988 were reviewed. Measurements of lung function, gas exchange during wakefulness and sleep, as well as functional exercise capacity, were recorded before and immediately after the establishment of HMV. Measurements were repeated one to two years, five years and eight to 10 years later.PATIENTS: Seventy‐four individuals with TRD or NMD who completed the home ventilation training program and continued with HMV during all or part of the day for at least one year were studied.RESULTS: Forty patients had TRD. The characteristics of these patients were (mean ± SE) as follows: age 58±2.4 years; vital capacity (VC) 27%±1.6% predicted, forced expiratory volume in 1 s (FEV1) 25%±1.5% predicted; FEV1/forced VC (FVC) 78%±1.8%. Thirty‐four patients had NMD. The characteristics of these patients were as follows: age 44±3.1 years; VC 41%±4.9% predicted, FEV1 44±5.3% predicted; FEV1/FVC 83%±4.2%. There was a significant improvement in distance walked in 6 min (maximum change 51.2 m in patients with NMD and 93.0 m in patients with TRD), daytime partial pressure of arterial carbon dioxide (maximum change 12.9 mmHg in patients with NMD and 10.4 mmHg in patients with TRD) and nighttime partial pressure of arterial carbon dioxide (maximum change 11.7 mmHg in patients with NMD and 18.0 mmHg in patients with TRD) over time (P≤0.004). Ventilation resulted in an improvement in partial pressure of arterial oxygen in patients with TRD (68.1±2.8 mmHg to 80.1±3.5 mmHg) and in patients with NMD (52.9±1.7 mmHg to 65.3±2.1 mmHg), although the change was not statistically significant in patients with NMD (P=0.001 in patients with TRD; P=0.105 in patients with NMD). The improvement after ventilation was maintained over several years. Sleep efficiency (75%±18%, 79%±2.2%), the arousal index (13.4±13 events/h, 28.2±17 events/h) and the apnea‐hypopnea index (10.1±11.3 events/h, 13.9±9.5 events/h) did not change with time in either patients with TRD or patients with NMD, respectively (P≥0.5).CONCLUSIONS: HMV was associated with sustained, long term improvements in nighttime and daytime gas exchange in patients with TRD and NMD. Function exercise capacity increased in patients with TRD and in a subgroup of ambulatory patients with NMD. In patients with TRD, these improvements were maintained for up to 10 years after HMV was established.
Combined Topical and Oral Antimicrobial Therapy for the Eradication of Methicillin‐Resistant Staphylococcus aureus (Mrsa) Colonization in Hospitalized Patients
Authors: Fung Scott K , Louie Marie , Simor Andrew E 
Published: March 2016

OBJECTIVE: How to eradicate methicillin‐resistant Staphylo-coccus aureus (MRSA) colonization in hospitalized patients is uncertain. We reviewed our experience with MRSA decolonization therapy in hospitalized patients.SETTING: An 1100‐bed, university‐affiliated tertiary care teaching hospital in Toronto, Ontario.DESIGN: Retrospective chart review of 207 adult inpatients with MRSA colonization hospitalized between February 1996 and March 1999.INTERVENTIONS: All patients with MRSA colonization were assessed for possible decolonization therapy with a combination of 4% chlorhexidine soap for bathing and washing, 2% mupirocin ointment applied to the anterior nares three times/day, rifampin (300 mg twice daily) and either trimethoprim/sulfamethoxazole (160 mg/800 mg twice daily) or doxycycline (100 mg twice daily). This treatment was given for seven days.RESULTS: A total of 207 hospitalized patients with MRSA colonization were identified and 103 (50%) received decolonization therapy. Patients who received decolonization therapy were less likely than untreated patientsto have intravenous (P=0.004) or urinary catheters (P<0.001), or extranasal sites of colonization (P=0.001). Successful decolonization was achieved in 90% of the 43 patients who were available for at least three months of follow‐up.CONCLUSIONS: Combined topical and oral antimicrobial therapy was found to be effective in eradicating MRSA colonization in selected hospitalized patients, especially those without indwelling medical devices or extranasal sites of colonization.