bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Survey of Sedation Practices for Colonoscopy in Canada
Authors: Porostocky Peter , Chiba Naoki , Colacino Palma , Sadowski Dan , Singh Harminder 
Published: March 2016

BACKGROUND: There are limited data regarding the use of sedation for colonoscopy and concomitant monitoring practices in different countries.METHODS: A survey was mailed to 445 clinician members of the Canadian Association of Gastroenterology and 80 members of the Canadian Society of Colon and Rectal Surgeons in May and June 2009.RESULTS: Sixty-five per cent of Canadian Association of Gastroenterology members and 69% of Canadian Society of Colon and Rectal Surgeons members responded with the full survey. Most endoscopists reported using sedation for more than 90% of colonoscopies. The most common sedation regimen was a combination of midazolam and fentanyl. Propofol, either alone or with another drug, was used in 12% of cases. A higher proportion (94%) of adult gastroenterologists who routinely used propofol were highly satisfied compared with those using other sedative agents (45%; P<0.001). Fifty per cent of adult gastroenterologists and 29% of surgeons who were not currently using propofol expressed interest in starting to use it for routine colonoscopies. Only a single nurse was present in the endoscopy room during colonoscopy performed by two-thirds of the endoscopists.CONCLUSIONS: Results of the present survey suggest that gastroenterologists in Canada use sedation for colonoscopy in more than 90% of their patients. There was higher satisfaction among gastroenterologists who used propofol routinely for all colonoscopies. Most endoscopy rooms were staffed by a single nurse, which may limit further increases in the use of propofol. Further studies are needed to determine optimal staffing of endoscopy units with and without the use of propofol. Sedation practices of general surgery endoscopists need to be evaluated.
Gastrostomy Tube Insertion in Children: The Edmonton Experience
Authors: Ackroyd Ryan , Saincher Meghana , Cheng Simon , El-Matary Wael 
Published: March 2016

BACKGROUND: Although gastrostomy tube insertion – whether endoscopic or open – is generally safe, procedure-related complications have been reported.OBJECTIVE: To compare gastrostomy tube insertion-related complications between percutaneous endoscopic gastrostomy and open gastrostomy at a single pediatric centre.METHODS: The charts of children (younger than 17 years of age at the time of tube insertion) who underwent endoscopic or open gastrostomy tube insertion from January 2005 to December 2007 at the Stollery Children’s Hospital (Edmonton, Alberta) were examined.RESULTS: A total of 298 children underwent gastrostomy tube insertion over a period of three years. After excluding patients with incomplete charts, 160 children (91 boys, mean [± SD] age 3.18±4.73 years) were included. Eighty-five children (mean age 4.50±5.40 years) had their gastrostomy tube inserted endoscopically, while the remaining 75 (mean age 1.68±3.27 years; P<0.001) underwent an open procedure. The overall rate of major complications was 10.2% for the endoscopic technique and 8.6% for the open technique (P=0.1). Major infections were higher in the endoscopic technique group, while persistent gastrocutaneous fistulas after tube removal were more common in the open technique group.CONCLUSION: Although the rate of major complications was similar between the endoscopic and open tube insertion groups, major infections were more common among children who underwent endoscopic gastrostomy. The decision for gastrostomy tube insertion was primarily based on clinical background.
Impact of Candida Species on Clinical Outcomes in Patients with Suspected Ventilator‐Associated Pneumonia
Authors: Delisle Marie-Soleil , Williamson David R , Albert Martin , Perreault Marc M , Jiang Xuran , Day Andrew G , Heyland Daren K 
Published: March 2016

BACKGROUND: The significance of Candida species in respiratory tract (RT) secretions in critically ill patients is unclear.METHODS: A retrospective analysis of the Canadian ventilator‐associated pneumonia (VAP) trial was conducted. Only patients with suspected VAP whose initial cultures failed to grow any known pathogens were included. Using two fundamentally different statistical techniques that adjusted for important confounding variables, the clinical outcomes of patients with Candida species recovered from RT cultures were compared with patients whose RT cultures were not positive for Candida species.RESULTS: RT cultures yielded no identifiable bacterial pathogens in 274 patients; 68 patients had Candida species in the RT alone, while 206 patients did not have Candida species recovered from any site. The unadjusted OR of hospital mortality for patients with Candida species was 2.9 (95% CI 1.6 to 5.2; P<0.001). The hazard ratio of time to hospital discharge was 0.54 (95% CI 0.38 to 0.77; P=0.001). Logistic regression analysis demonstrated that age, Acute Physiology score and Chronic Health Evaluation (APACHE) II score, primary diagnosis of respiratory failure, two or more comorbidities and Candida species were independently associated with increased hospital mortality. Similar trends were observed with time to hospital discharge. The association between Candida species and increased mortality remained after controlling for potential confounders using both propensity score stratification and multivariable modelling approaches.CONCLUSIONS: Patients with suspected VAP, in whom no bacterial pathogen was identified and in whom Candida species were isolated from RT cultures, exhibited a greater burden of illness compared with similar patients without Candida. Whether Candida species colonization of RT secretions is a marker of disease severity or actually contributes to poorer clinical outcomes remains unclear.
The Prevalence of Chronic Pain in Canada
Authors: Schopflocher Donald , Taenzer Paul , Jovey Roman 
Published: March 2016

Published population estimates of the prevalence of chronic pain have been highly variable due, in part, to differences in definitions and study methodologies. Designing health care delivery models that address chronic pain and reduce its impact, however, require accurate, up‐to‐date prevalence data. This article first reviews studies that examined the prevalence of chronic pain both internationally and in Canada. The ensuing sections describe a telephone‐based survey of a well‐defined population of adults using a detailed and sequential definition of chronic pain, and well‐validated and reliable data collection tools for establishing the prevalence of chronic pain in Canada.BACKGROUND: While chronic pain appears to be relatively common, published population prevalence estimates have been highly variable, partly due to differences in the definition of chronic pain and in survey methodologies.OBJECTIVES: To estimate the prevalence of chronic pain in Canada using clear case definitions and a validated survey instrument.METHODS: A telephone survey was administered to a representative sample of adults from across Canada using the same screening questionnaire that had been used in a recent large, multicountry study conducted in Europe.RESULTS: The prevalence of chronic pain prevalence for adults older than 18 years of age was 18.9%. This was comparable with the overall mean reported using identical survey questions and criteria for chronic pain used in the European study. Chronic pain prevalence was greater in older adults, and females had a higher prevalence at older ages compared with males. Approximately one‐half of those with chronic pain reported suffering for more than 10 years. Approximately one‐third of those reporting chronic pain rated the intensity in the very severe range. The lower back was the most common site of chronic pain, and arthritis was the most frequently named cause.CONCLUSIONS: A consensus is developing that there is a high prevalence of chronic pain within adult populations living in industrialized nations. Recent studies have formulated survey questions carefully and have used large samples. Unfortunately, a substantial proportion of Canadian adults continue to live with chronic pain that is longstanding and severe.
Persistent Sputum Cellularity and Neutrophils May Predict Bronchiectasis
Authors: Drost Nicole , D’silva Liesel , Rebello Ryan , Efthimiadis Ann , Hargreave Frederick E , Nair Parameswaran 
Published: March 2016

BACKGROUND: Quantitative cell counts in sputum provide an accurate assessment of the type and severity of bronchitis.OBJECTIVE: To examine whether sputum cell counts could identify bronchiectasis in patients with recurrent bronchitis.METHODS: A retrospective survey of a clinical database (January 2004 to January 2005) of quantitative cell counts from sputum selected from expectorate in patients with obstructive airways diseases was used to identify predictors of bronchiectasis using ROC curves. This was prospectively evaluated (February 2005 to April 2008) using high-resolution computed tomography scans of thorax that were independently scored by a radiologist who was blinded to the clinical details.RESULTS: The retrospective survey identified 41 patients with bronchiectasis among 490 patients with airway diseases. Total cell count of 60×106/g or greater of the selected sputum with predominant neutrophils on two occasions had a sensitivity of 86.7%, a specificity of 87.5%, and positive and negative predictive values of 93% and 78%, respectively, to identify bronchiectasis. In the prospective study, 10 of 14 (71%) patients who met these criteria were identified to have bronchiectasis. Both total cell count and the percentage of neutrophils correlated with radiographic bronchiectasis severity.CONCLUSIONS: Persistent or recurrent intense sputum cellularity with neutrophilia is suggestive of bronchiectasis.
Effect of Adalimumab on Work Productivity and Indirect Costs in Moderate to Severe Crohn’s Disease: A Meta-Analysis
Authors: Binion David G , Louis Edouard , Oldenburg Bas , Mulani Parvez , Bensimon Arielle G , Yang Mei , Chao Jingdong 
Published: March 2016

OBJECTIVE: To assess the effect of adalimumab on work productivity and indirect costs in patients with Crohn’s disease (CD) using a meta-analysis of clinical trials.METHODS: Study-level results were pooled from all clinical trials of adalimumab for moderate to severe CD in which work productivity outcomes were evaluated. Work Productivity and Activity Impairment Questionnaire outcomes (absenteeism, presenteeism and total work productivity impairment [TWPI]) were extracted from adalimumab trials. Meta-analyses were used to estimate pooled averages and 95% CIs of one-year accumulated reductions in work productivity impairment with adalimumab. Pooled averages were multiplied by the 2008 United States national average annual salary ($44,101) to estimate per-patient indirect cost savings during the year following adalimumab initiation.RESULTS: The four included trials (ACCESS, CARE, CHOICE and EXTEND) represented a total of 1202 employed adalimumab-treated patients at baseline. Each study followed patients for a minimum of 20 weeks. Pooled estimates (95% CIs) of one-year accumulated work productivity improvements were as follows: −9% (−10% to −7%) for absenteeism; −22% (−26% to −18%) for presenteeism; and −25% (−30% to −20%) for TWPI. Reductions in absenteeism and TWPI translated into per-patient indirect cost savings (95% CI) of $3,856 ($3,183 to $4,529) and $10,964 ($8,833 to $13,096), respectively.CONCLUSION: Adalimumab provided clinically meaningful improvements in work productivity among patients with moderate to severe CD, which may translate into substantial indirect cost savings from an employer’s perspective.
Identification of a Persistent Primitive Trigeminal Artery Following the Transposition Technique for Trigeminal Neuralgia: A Case Report
Authors: Kato Naoki , Tanaka Toshihide , Sakamoto Hiroki , Arai Takao , Hasegawa Yuzuru , Abe Toshiaki 
Published: March 2016

Trigeminal neuralgia is lancinating pain of a few seconds duration triggered by minor sensory stimuli such as speaking, chewing or even a breeze on the face. Vascular compression of the trigeminal nerve at the root entry zone and other vessels has been implicated in its cause. Despite the initial success of medical treatment in some cases, however, many patients become refractory over time and eventually require surgical intervention. This report describes a case involving a 62‐year‐old woman who presented with right orbital pain provoked by, among others, exercise and cold. Medication proved to be ineffective and, after magnetic resonance imaging, microvascular decompression and surgical observation, the diagnosis became clearer. The case highlights the importance of preoperative imaging and careful intraoperative findings to determine whether variant arteries are responsible for trigeminal neuralgia.A patient who presented with trigeminal neuralgia associated with a persistent primitive trigeminal artery (PPTA) is presented. A 62‐year‐old woman suffering from right orbital pain was admitted to the hospital. Medical treatment for three months was ineffective, and her neuralgia had deteriorated and gradually spread in the maxillary division. Magnetic resonance imaging demonstrated the flow void signal attached to the right trigeminal nerve. Thus, microvascular decompression was performed. The superior cerebellar artery was the responsible artery, and it was transposed to decompress the trigeminal nerve. After this manoeuvre, an artery was identified running parallel to the trigeminal nerve toward Meckel’s cave. The artery, which turned out to be a PPTA, communicated with the basilar artery. The PPTA was carefully observed, and it was found not to be the artery causing the neuralgia because it did not compress the nerve at surgical observation. No additional procedure between the PPTA and the trigeminal nerve was performed. The patient’s symptom improved dramatically following surgery, and her postoperative course was uneventful. Postoperative three‐dimensional computed tomography showed the PPTA. The findings in the present case suggest that transposition of the responsible artery effectively decompresses the root entry zone and assists in determining whether the PPTA is affecting the trigeminal nerve.
Parasitic Disease Screening among HIV Patients from Endemic Countries in a Toronto Clinic
Authors: Costiniuk Cecilia T , Cooper Curtis L , Doucette Steve , Kovacs Colin M 
Published: March 2016

BACKGROUND: Many North American‐based HIV patients originate from parasitic disease‐endemic regions. Strongyloidiasis, schistosomiasis and filariasis are important due to their wide distribution and potential for severe morbidity.OBJECTIVES: To determine the prevalence, as determined by serological screening, of strongyloidiasis, schistosomiasis and filariasis among patients in an HIV‐focused, primary care practice in Toronto, Ontario. A secondary objective was to determine factors associated with positive serological screens.METHODS: A retrospective review of electronic patient records was conducted. Results of serological screens for parasites and relevant laboratory data were collected.RESULTS: Ninety‐seven patients were identified. The patients’ mean CD4+ count was 0.45×109/L, median viral load was undetectable and 68% were on highly active antiretroviral therapy (HAART). Most originated from Africa (37%) and South America (35%). Of the 97 patients, 10.4% and 8.3% had positive or equivocal screening results for strongyloidiasis, respectively, 7.4% and 4.2% had positive or equivocal screening results for schistosomiasis and 5.5% and 6.8% had positive or equivocal screens for filariasis. Persons with positive parasitic serologies were more often female (28% versus 9%, P=0.03), younger in age (36 versus 43 years of age, P<0.01), had been in Canada for a shorter duration (5 versus 12 years, P<0.0001) and had a higher viral load (10,990 copies/mL versus <50 copies/mL, P <0.001). All patients were asymptomatic. Eosinophilia was not associated with positive screening results.CONCLUSIONS: Using symptoms and eosinophilia to identify parasitic infection was not reliable. Screening for strongyloidiasis and schistosomiasis among patients with HIV from parasite‐endemic countries is simple and benign, and may prevent future complications. The clinical benefits of screening for filariasis require further elucidation, but this practice appears to be the least warranted.
Gluten-Free Diet Does Not Appear to Induce Endoscopic Remission of Eosinophilic Esophagitis in Children with Coexistent Celiac Disease
Authors: Abraham Joseph R , Persad Rabin , Turner Justine M , Huynh Hien Q 
Published: March 2016

BACKGROUND: Celiac disease and eosinophilic esophagitis are usually considered to be separate gastrointestinal diseases; however, it appears that they may coexist more often than would be expected. It is unknown whether eosinophilic esophagitis in patients with celiac disease responds to a gluten-free diet.OBJEVTIVES: To examine the clinical, endoscopic and histological features of children with both conditions to evaluate whether eosinophilic esophagitis responds to a gluten-free diet.METHODS: From January 1, 2009, to June 30, 2011, the medical records of children <18 years of age diagnosed with eosinophilic esophagitis and/or celiac disease were reviewed. Patients with clinical, endoscopic and histological diagnoses of both diseases were identified and included. These findings were analyzed, as were laboratory results, treatment and follow-up.RESULTS: During the study period, there were 206 celiac disease patients, 86 eosinophilic esophagitis patients and nine (4.4% of total celiac) patients with both diagnoses. Gluten-free diet was the primary treatment for both conditions in seven of nine (78%) cases. In six of these seven (86%) patients, no endoscopic or histological improvement of eosinophilic esophagitis was observed, while in one patient, histological remission of esophageal eosinophilia occurred while on a gluten-free diet.CONCLUSION: The prevalence of eosinophilic esophagitis in patients with celiac disease was 4.4%, confirming a higher than expected prevalence of eosinophilic esophagitis compared with the general population. In patients with celiac disease, a gluten-free diet did not appear to induce remission of coexistent endoscopic and histological features of eosinophilic esophagitis.
Qualitative Study of Physician Perspectives on Classifying Screening and Nonscreening Colonoscopy using Administrative Health Data: Adding Practice Does Not Make Perfect
Authors: Sewitch Maida J , Hilsden Robert , Joseph Lawrence , Rabeneck Linda , Paszat Lawrence , Bitton Alain , Cooper Mary Anne 
Published: March 2016

BACKGROUND: Previously developed screening colonoscopy algorithms based on diagnostic and endoscopy procedural variables have not been sufficiently accurate for use in epidemiological and health services research.OBJECTIVE: To increase understanding of the administrative health database variables that could help to discern screening and nonscreening colonoscopy.METHODS: A qualitative study using physician focus groups was conducted in Montreal (Quebec), Calgary (Alberta) and Toronto (Ontario). Specialty-specific focus group sessions were held among family physicians and gastroenterologists – the physicians responsible for referring patients to and performing screening colonoscopy, respectively. Interview guides were developed to better understand physician clinical and billing practices. Discussions were audiotaped, transcribed verbatim and analyzed using the constant comparative approach.RESULTS: Forty family physicians and seven gastroenterologists participated in five focus group sessions. Patient variables included demographics (age) and medical history (colorectal cancer risk factors/symptoms, medication for colorectal cancer risk factors/symptoms, gastrointestinal disorders, severe disease). Clinical practice variables included timing of the colonoscopy (evenings, weekends, holidays, during hospitalization; same-day endoscopist consultation and colonoscopy), use of services (hospitalization, annual examination, transfer from other facility) and procedure use patterns (large bowel or other medical/surgical procedure before and subsequent to colonoscopy). However, wide variability in clinical and billing practices will likely preclude the development of a reasonably accurate screening colonoscopy algorithm. Physicians suggested adding a screening colonoscopy code to the administrative health data.CONCLUSIONS: Failure to acknowledge the limitations of the provincial administrative health databases to identify screening colonoscopy may lead to incorrect conclusions and the establishment of inappropriate health care policies.
Serious Events in Older Ontario Residents Receiving Bowel Preparations for Outpatient Colonoscopy with Various Comorbidity Profiles: A Descriptive, Population-Based Study
Authors: Ho Joanne M , Gruneir Andrea , Fischer Hadas D , Fu Longdi , Lipscombe Lorraine L , Bell Chaim M , Cavalcanti Rodrigo B , Anderson Geoffrey M , Rochon Paula A 
Published: March 2016

BACKGROUND: Polyethylene glycol-based bowel preparations (PEGBPs) and sodium picosulfate (NaPS) are commonly used for bowel cleansing before colonoscopy. Little is known about adverse events associated with these preparations, particularly in older patients or patients with medical comorbidities.OBJECTIVE: To characterize the incidence of serious events following outpatient colonoscopy in patients using PEGBPs or NaPS.METHODS: The present population-based retrospective cohort study examined data from Ontario health care databases between April 1, 2005 and December 31, 2007, including patients ≥66 years of age who received either PEGBP or NaPS for an outpatient colonoscopy. Patients with cardiac or renal disease, long-term care residents or patients receiving concurrent diuretic therapy were identified as high risk for adverse events. The primary outcome was a serious event (SE) defined as a composite of nonelective hospitalization, emergency department visit or death within seven days of the colonoscopy.RESULTS: Of the 50,660 outpatients ≥66 years of age who underwent a colonoscopy, SEs were observed in 675 (2.4%) and 543 (2.4%) patients in the PEGBP and NaPS groups, respectively. Among high-risk patients (n=30,168), SEs occurred in 481 (2.8%) and 367 (2.8%) of patients receiving PEGBP and NaPS, respectively.CONCLUSIONS: The SE rate within seven days of outpatient colonoscopy was 24 per 1000 procedures, and among high-risk patients was 28 per 1000 procedures. The rates were similar for PEGBP and NaPS. Clinicians should be aware of the risks associated with colonoscopy in older patients with comorbidities.