bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Fecal Occult Blood Testing in Hospitalized Patients: Results of an Audit
Authors: Ip Stephen , Sokoro AbdulRazaq AH , Kaita Lisa , Ruiz Claudia , McIntyre Elaine , Singh Harminder 
Published: March 2016

BACKGROUND: The fecal occult blood test (FOBT), widely used as a colorectal cancer screening tool, continues to be used in hospitalized patients. However, the utility of this test for hospitalized patients is unclear.OBJECTIVE: To assess FOBT use in a large urban regional health authority.METHODS: Reports of all FOBTs performed between April 1, 2011 and March 30, 2012 from two academic and four community hospitals in Winnipeg (Manitoba) were extracted. Of 650 hospitalizations with a positive FOBT result and 1254 with a negative FOBT result, random samples of 230 and 97 charts, respectively, were reviewed. Information including demographics, admission diagnos(es), indication(s) for ordering the FOBT and clinical management was extracted.RESULTS: Thirty-four percent (650 of 1904) of hospitalizations with an FOBT had a positive FOBT result. Family medicine physicians ordered approximately one-half of the reviewed FOBTs. The most common indication for ordering an FOBT was anemia. Of those with a positive FOBT, 66% did not undergo further gastrointestinal investigations. Of those with a positive FOBT and overt gastrointestinal bleeding and/or melena who underwent endoscopy, 60% had their endoscopy performed before the FOBT result being reported while 38% underwent their endoscopy ≥3 days after the stool sample was collected. There were minimal differences in clinical practices between academic and community hospitals.CONCLUSIONS: The present study suggests that FOBT results in hospitalized patients may have little beneficial impact on clinical management. Hospital laboratories may be better served in directing resources to other tests.
Mortality Related to Coagulase‐Negative Staphylococcal Bacteremia in Febrile Neutropenia: A Cohort Study
Authors: Rosa Regis G , dos Santos Rodrigo P , Goldani Luciano Z 
Published: March 2016

BACKGROUND: Coagulase‐negative staphylococci (CoNS) are currently the most common isolates recovered from the blood of patients with cancer and febrile neutropenia (FN).OBJECTIVES:To assess the mortality associated with bloodstream infections (BSIs) caused by CoNS in cancer patients with FN.METHODS: A prospective cohort study was conducted in a single tertiary hospital from October 2009 to August 2011. Follow‐ups were performed on all of the adult patients who were admitted to the hematology ward with cancer and FN. Bacteremia caused by CoNS was defined as two positive results of two independent cultures. Twenty‐eight days after the onset of FN, the mortality rates of the patients with BSIs caused by CoNS were compared with those of patients with BSIs caused by other pathogens.RESULTS: A total of 169 subjects were evaluated. During the study period, 78 patients with BSIs were documented. Twenty‐three BSIs (29.4%) were a result of CoNS. CoNS‐induced bacteremia resulted in lower 28‐day mortality compared with bacteremia caused by other pathogens (4.3% versus 32.7%; log‐rank P=0.009). In a Cox proportional hazards regression analysis, BSIs caused by CoNS were independently associated with lower mortality (HR 0.09 [95% CI 0.01 to 0.74]).CONCLUSIONS:In adult patients with cancer and FN, BSIs caused by CoNS were associated with lower mortality compared with BSIs caused by other pathogens.
Patient Versus Parental Perceptions about Pain and Disability in Children and Adolescents with a Variety of Chronic Pain Conditions
Authors: Vetter Thomas R , Bridgewater Cynthia L , Ascherman Lee I , Madan-Swain Avi , McGwin Gerald L 
Published: March 2016

BACKGROUND: Cross‐informant variance is often observed in patient self‐reports versus parent proxy reports of pediatric chronic pain and disability.OBJECTIVE: To assess the relationship and merit of the child versus parent perspective.METHODS: A total of 99 patients (eight to 17 years of age [mean 13.2 years]; 71% female, 81% Caucasian) and parents completed the Pediatric Pain Questionnaire and Functional Disability Inventory at their initial clinic visit. Patients’ and parents’ pain intensity and disability scores were analyzed using an intraclass correlation coefficient (ICC), Wilcoxon signed‐rank test, Bland‐Altman plot and Spearman’s correlation coefficient. The association between clinical/demographic variables and differences in patient/parent pain intensity and disability scores was assessed using multivariable regression.RESULTS: There was significant agreement between patients’ self‐reports and parents’ proxy reports of their child’s pain intensity (ICC=0.52; P<0.001) and disability (ICC=0.57; P=0.004) at the individual level. There were no significant group differences in patient versus parent‐proxy pain intensity scores (P=0.40) and disability scores (P=0.54). The difference between patient and parent‐proxy pain intensity was associated with patients’ self‐reported pain intensity (P<0.001). The difference between patient and parent‐proxy disability was associated with patient’s self‐reported pain disability (P<0.001). Bland‐Altman plots revealed major inter‐rater variation in the Pediatric Pain Questionnaire and Functional Disability Inventory across their score ranges. A significant relationship (r=0.38; P<0.001) was observed between patients’ self‐reported pain intensity and disability.CONCLUSIONS: While equal merit should ideally be given to pediatric chronic pain patients’ self‐reports and their parents’ proxy reports of pain intensity and disability, it would appear that, as needed, pediatric patients or parents can offer a clinically valid, single clinical perspective.
Association Between Proton Pump Inhibitor Use and Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites
Authors: Ratelle Mélissa , Perreault Sylvie , Villeneuve Jean-Pierre , Tremblay Lydjie 
Published: March 2016

BACKGROUND: There are data suggesting a link between proton pump inhibitor (PPI) use and the development of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites; however, these data are controversial.OBJECTIVE: To assess whether the use of PPIs in cirrhotic patients with ascites is associated with an increased risk for SBP.METHODS: A retrospective case-control study (June 2004 to June 2010) was conducted at theCentre Hospitalier de l’Université de Montréalin Montreal, Quebec. Fifty-one cirrhotic patients admitted with paracentesis-proven SBP (≥250 neutrophils/mm3), occurring within seven days of hospital admission, met the inclusion criteria. These patients were matched 1:2 (for age, Child-Pugh class and year of admission) with 102 comparable cirrhotic patients with ascites who were admitted for conditions other than SBP.RESULTS: Patients with SBP had a significantly higher rate of pre-hospital PPI use (60.8%) compared with cirrhotic patients without SBP (42.2%; P=0.03). On multivariate analysis, PPI use was the only factor independently associated with SBP (OR 2.09 [95% CI 1.04 to 4.23]; P=0.04). Thirty-five (35%) patients in both groups had no documented indication for PPI use in their charts. Forty-five percent of the remaining cirrhotic patients with SBP had an inappropriate indication, as defined in the protocol, for PPI use compared with 25% of controls.CONCLUSIONS: Cirrhotic patients with SBP were twice as likely to have taken PPIs than patients without SBP. These findings reinforce the association between PPI use and SBP observed in other studies. A high percentage of cirrhotic patients were taking a PPI without any documented indication.
Hepatitis B and Hepatitis C Viral Infections in Patients with Chronic Lymphocytic Leukemia
Authors: Minuk Gerald Y , Lerner Betty , Gibson Spencer B , Johnston James B , Uhanova Julia , Andonov Anton , Wu Jun 
Published: March 2016

BACKGROUND: Whether chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections contribute to the pathogenesis and/or course of chronic lymphocytic leukemia is unclear.OBJECTIVE: To document the prevalences of HBV and HCV infections in chronic lymphocytic leukemia patients, and to determine whether infected patients experience more aggressive disease than those without infection.METHODS: Patient sera were screened for antibodies to HBV core antigen and HCV (anti-HCV) using ELISA; both sera and peripheral blood lymphocytes were further tested (regardless of antibody results) for HBV-DNA and HCV-RNA using real-time polymerase chain reaction. Prognostic markers for chronic lymphocytic leukemia included Rai stage,IgVHmutational status, β2-microglobulin levels, Zap-70 and CD38 status.RESULTS: Fourteen of 222 (6.3%) chronic lymphocytic leukemia patients and two of 72 (2.8%) healthy controls tested positive for previous or ongoing HBV infection (OR 2.4 [95% CI 0.5 to 7.7]; P=0.25) while four of 222 (1.8%) chronic lymphocytic leukemia patients and one of 72 (1.4%) controls tested positive for HCV markers (OR 1.3 [95% CI 0.2 to 6.4]; P=0.81). The levels and distribution of the various indicators of aggressive chronic lymphocytic leukemia disease were similar among HBV- and HCV-infected and uninfected patients. Survival times were also similar. Occult HBV and HCV infection (HBV-DNA or HCV-RNA positive in the absence of diagnostic serological markers) were uncommon in chronic lymphocytic leukemia patients (0.5% and 1.8%, respectively).CONCLUSIONS: The results of the present study do not support the hypothesis that HBV or HCV infections play an important role in the pathogenesis or course of chronic lymphocytic leukemia.
Clinical and Economic Consequences of Vancomycin and Fidaxomicin for the Treatment of Clostridium difficile Infection in Canada
Authors: Wagner Monika , Lavoie Louis , Goetghebeur Mireille 
Published: March 2016

BACKGROUND:
Clostridium difficile infection (CDI) represents a public health problem with increasing incidence and severity.OBJECTIVE: To evaluate the clinical and economic consequences of vancomycin compared with fidaxomicin in the treatment of CDI from the Canadian health care system perspective.METHODS: A decision‐tree model was developed to compare vancomycin and fidaxomicin for the treatment of severe CDI. The model assumed identical initial cure rates and included first recurrent episodes of CDI (base case). Treatment of patients presenting with recurrent CDI was examined as an alternative analysis. Costs included were for study medication, physician services and hospitalization. Cost effectiveness was measured as incremental cost per recurrence avoided. Sensitivity analyses of key input parameters were performed.RESULTS: In a cohort of 1000 patients with an initial episode of severe CDI, treatment with fidaxomicin led to 137 fewer recurrences at an incremental cost of $1.81 million, resulting in an incremental cost of $13,202 per recurrence avoided. Among 1000 patients with recurrent CDI, 113 second recurrences were avoided at an incremental cost of $18,190 per second recurrence avoided. Incremental costs per recurrence avoided increased with increasing proportion of cases caused by the NAP1/B1/027 strain. Results were sensitive to variations in recurrence rates and treatment duration but were robust to variations in other parameters.CONCLUSIONS: The use of fidaxomicin is associated with a cost increase for the Canadian health care system. Clinical benefits of fidaxomicin compared with vancomycin depend on the proportion of cases caused by the NAP1/B1/027 strain in patients with severe CDI.
Desquamative Interstitial Pneumonitis in a Healthy Non-Smoker: A Rare Diagnosis
Authors: Kroll Ryan R , Flood Diane A , Srigley John 
Published: March 2016

This article reports a rare condition first described in 1965 and is most commonly associated with smoking and certain occupations. Onset of nonspecific symptoms is typically insidious and, while bloodwork and imaging may be valuable, tissue sampling is required for diagnosis. Desquamative interstitial pneumonitis most commonly affects tobacco smokers in their fourth or fifth decades of life; this article, however, describes the condition in a 27-year-old who worked in a potato chip factory.Desquamative interstitial pneumonitis is an interstitial lung disease most commonly associated with smoking. It causes respiratory symptoms including indolent cough and dyspnea. Characteristic findings on computed tomography include bilateral ground-glass opacities, septal thickening and preserved structure. Diagnosis is made by tissue sampling, which classically demonstrates alveolar macrophages, and thickened alveolar septa with an eosinophilic infiltrate lined with hyperplastic type II pneumocytes. Treatment is immune suppression with steroids or other agents, and avoiding the causal agent. The case reported describes a 27-year-old woman with no smoking history who worked in a potato chip factory, presenting with cough, dyspnea and dizziness. The patient had characteristic findings on imaging and was diagnosed via biopsy with desquamative interstitial pneumonitis. She improved clinically with reduced exposure and steroid therapy. While food production workers are at risk for respiratory illness, there are no reported cases of desquamative interstitial pneumonitis in this setting.
Computer-Based Virtual Reality Colonoscopy Simulation Improves Patient-Based Colonoscopy Performance
Authors: McIntosh Keith S , Gregor James C , Khanna Nitin V 
Published: March 2016

BACKGROUND: Colonoscopy simulators that enable one to perform computer-based virtual colonoscopy now exist. However, data regarding the effectiveness of this virtual training are limited.OBJECTIVE: To determine whether virtual reality simulator training translates into improved patient-based colonoscopy performance.METHODS: The present study was a prospective controlled trial involving 18 residents between postgraduate years 2 and 4 with no previous colonoscopy experience. These residents were assigned to receive 16 h of virtual reality simulator training or no training. Both groups were evaluated on their first five patient-based colonoscopies. The primary outcome was the number of proctor ‘assists’ required per colonoscopy. Secondary outcomes included insertion time, depth of insertion, cecal intubation rate, proctor- and nurse-rated competence, and patient-rated pain.RESULTS: The simulator group required significantly fewer proctor assists than the control group (1.94 versus 3.43; P≤0.001), inserted the colonoscope further unassisted (43 cm versus 24 cm; P=0.003) and there was a trend to intubate the cecum more often (26% versus 10%; P=0.06). The simulator group received higher ratings of competence from both the proctors (2.28 versus 1.88 of 5; P=0.02) and the endoscopy nurses (2.56 versus 2.05 of 5; P=0.001). There were no significant differences in proctor-, nurse- or patient-rated pain, or attention to discomfort.CONCLUSIONS: Computer-based colonoscopy simulation in the initial stages of training improved novice trainees’ patient-based colonoscopy performance.
Marijuana Use in Hepatitis C Infection does not Affect Liver Biopsy Histology or Treatment Outcomes
Authors: Liu Theresa , Howell Glen T , Turner Lucy , Corace Kimberley , Garber Gary , Cooper Curtis 
Published: March 2016

BACKGROUND: Marijuana smoking is prevalent among hepatitis C virus-infected patients. The literature assessing the influence of marijuana on liver disease progression and hepatitis C virus antiviral treatment outcomes is conflicting.METHODS: The authors evaluated hepatitis C virus RNA-positive patients followed at The Ottawa Hospital Viral Hepatitis Clinic (Ottawa, Ontario) from 2000 to 2009. Using The Ottawa Hospital Viral Hepatitis Clinic database and charts, information regarding demographics, HIV coinfection, alcohol use, liver biopsy results, treatment outcomes and self-reported marijuana use was extracted. Biopsy characteristics and hepatitis C virus antiviral treatment outcomes were assessed for association with categorized marijuana use by adjusted logistic regression; covariates were specified according to clinical relevance a priori.RESULTS: Information regarding marijuana use was available for 550 patients, 159 (28.9%) of whom were using marijuana at the time of first assessment. Biopsy fibrosis stage and marijuana use data were available for 377 of these 550 (F0-2=72.3%). Overall, marijuana use did not predict fibrosis stage, inflammation grade or steatosis. Sustained virological response and marijuana use data were available for 359 of the 550 cohort participants; a total of 211 (58.8%) achieved a sustained virological response. Marijuana use was not associated with premature interruption of therapy for side effects, the likelihood of completing a full course of therapy or sustained virological response.CONCLUSION: Marijuana use did not influence biopsy histology or alter key hard outcomes of hepatitis C virus antiviral therapy.
Radiofrequency Ablation for Chronic Low Back Pain: A Systematic Review of Randomized Controlled Trials
Authors: Leggett Laura E , Soril Lesley JJ , Lorenzetti Diane L , Noseworthy Tom , Steadman Rodney , Tiwana Simrandeep , Clement Fiona 
Published: March 2016

BACKGROUND: Radiofrequency ablation (RFA), a procedure using heat to interrupt pain signals in spinal nerves, is an emerging treatment option for chronic low back pain. Its clinical efficacy has not yet been established.OBJECTIVE: To determine the efficacy of RFA for chronic low back pain associated with lumbar facet joints, sacroiliac joints, discogenic low back pain and the coccyx.METHODS: A systematic review was conducted. Medline, EMBASE, PubMed, SPORTDiscus, CINAHL and the Cochrane Library were searched up to August 2013. Abstracts and full‐text articles were reviewed in duplicate. Included articles were sham‐controlled randomized controlled trials (RCTs), assessed the efficacy of RFA, reported at least one month of follow‐up and included participants who had experienced back pain for at least three months. Data were extracted in duplicate and quality was assessed using the Cochrane Risk of Bias tool. Due to heterogeneity, as well as a lack of reported mean differences and SDs, meta‐analysis was not possible using these data.RESULTS: The present systematic review retrieved 1063 abstracts. Eleven sham‐controlled RCTs were included: three studies involving discogenic back pain; six studies involving lumbar facet joint pain; and two studies involving sacroiliac joint pain. No studies were identified assessing the coccyx. The evidence supports RFA as an efficacious treatment for lumbar facet joint and sacroiliac joint pain, with five of six and both of the RCTs demonstrating statistically significant pain reductions, respectively. The evidence supporting RFA for the treatment of discogenic pain is mixed.CONCLUSIONS: While the majority of the studies focusing on lumbar facet joints and sacroiliac joints suggest that RFA significantly reduces pain in short‐term follow‐up, the evidence base for discogenic low back pain is mixed. There is no RCT evidence for RFA for the coccyx. Future studies should examine the clinical significance of the achieved pain reduction and the long‐term efficacy of RFA.
Characterization of Methicillin‐Resistant Staphylococcus aureus Isolates from Patients with Persistent or Recurrent Bacteremia
Authors: Wong Henry , Watt Christine , Elsayed Sameer , John Michael , Johnson Glen , Katz Kevin , Krajden Sigmund , Lee Christine , Mazzulli Tony , Ostrowska Krystyna , Richardson David , Toye Baldwin , Vermeiren Christie , Yamamura Deborah , Simor Andrew E 
Published: March 2016

BACKGROUND: Methicillin‐resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) are associated with considerable morbidity and mortality, especially with persistent (PB) or recurrent bacteremia (RB).OBJECTIVE: To determine the frequency of PB and RB in patients with MRSA BSI, and to characterize the isolates from these patients.METHODS: Surveillance for MRSA BSI was performed for one year in 13 Canadian hospitals. PB was defined as a positive blood culture that persisted for ≥7 days; RB was defined as the recurrence of a positive blood culture ≥14 days following a negative culture. Isolates were typed using pulsed‐field gel electrophoresis (PFGE). Vancomycin susceptibility was determined using Etest.RESULTS: A total of 183 patients with MRSA BSI were identified; 14 (7.7%) had PB and five (2.7%) had RB. Ten (5.5%) patients were known to have infective endocarditis, and five of these patients had PB or RB. Initial and subsequent MRSA isolates from patients with PB and RB had the same PFGE type. There were no significant differences in the distribution of PFGE types in patients with PB or RB (37% CMRSA‐2/USA100; 37% CMRSA‐10/USA300) compared with that in other patients (56% CMRSA‐2/USA100; 32% CMRSA‐10/USA300). All isolates were susceptible to vancomycin, but patients with PB or RB were more likely to have initial isolates with vancomycin minimum inhibitory concentration = 2.0 μg/mL (26% versus 10%; P=0.06).CONCLUSIONS: Persistent or recurrent MRSA bacteremia occurred in 10.4% of patients with MRSA BSIs. Initial isolates from patients with persistent or recurrent MRSA BSIs were more likely to exhibit reduced susceptibility to vancomcyin, but were not associated with any genotype.
Le Domaine des Co‐infections et des Maladies Concomitantes du Réseau Canadien pour les Essais VIH des IRSC : Lignes Directrices Canadiennes pour la Prise en Charge et le Traitement de la Co‐Infection par le VIH et l’Hépatite C chez les Adultes
Authors: Hull Mark , Giguère Pierre , Klein Marina , Shafran Stephen , Tseng Alice , Côté Pierre , Poliquin Marc , Cooper Curtis 
Published: March 2016

HISTORIQUE: De 20 % à 30 % des Canadiens qui vivent avec le VIH sont co‐infectés par le virus de l’hépatite C (VHC), lequel est responsable d’une morbidité et d’une mortalité importantes. La prise en charge du VIH et du VHC est plus complexe en raison de l’évolution accélérée de la maladie hépatique, du choix et des critères d’initiation de la thérapie antirétrovirale et du traitement anti‐VHC, de la prise en charge de la santé mentale et des toxicomanies, des obstacles socioéconomiques et des interactions entre les nouvelles thérapies antivirales à action directe du VHC et les antirétrovirauxOBJECTIF: Élaborer des normes nationales de prise en charge des adultes co‐infectés par le VHC et le VIH dans le contexte canadien.MÉTHODOLOGIE: Le Réseau canadien pour les essais VIH des Instituts de recherche en santé du Canada a réuni un groupe d’experts possédant des compétences cliniques en co‐infection par le VIH et le VHC pour réviser les publications à jour ainsi que les lignes directrices et les protocoles en place. Après une vaste sollicitation afin d’obtenir des points de vue, le groupe de travail a approuvé des recommandations consensuelles, qu’il a caractérisées au moyen d’une échelle de qualité des preuves fondée sur la classe (bienfaits par rapport aux préjudices) et sur la catégorie (degré de certitude).RÉSULTATS: Toutes les personnes co‐infectées par le VIH et le VHC devraient subir une évaluation en vue de recevoir un traitement du VHC. Les personnes qui ne sont pas en mesure d’entreprendre un traitement du VHC devraient être soignées pour le VIH afin de ralentir l’évolution de la maladie hépatique. La norme de traitement du VHC de génotype 1 est un régime comprenant de l’interféron pégylé et de la ribavirine dosée en fonction du poids, associés à un inhibiteur de la protéase du VHC. Pour les génotypes 2 ou 3, une bithérapie classique est recommandée pendant 24 semaines s’il y a clairance virologique à la semaine 4 ou, pour les génotypes 2 à 6, à 48 semaines. On peut envisager de reporter le traitement chez les personnes ayant une maladie hépatique légère. Le VIH ne devrait pas être considéré comme un obstacle à la transplantation hépatique chez les patients co‐infectés.EXPOSÉ: Les recommandations ne se substituent pas au jugement clinique personnel.