bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of a Single Dose Montelukast Sodium on Methacholine Chloride PC20
Authors: Davis Beth E , Cockcroft Donald W 
Published: March 2016

BACKGROUND: It is currently recommended that leukotriene modifiers (receptor antagonists and synthesis inhibitors) be withheld for a minimum of 24 h before direct bronchoprovocation testing, but there is little evidence to support this recommendation.OBJECTIVE: To examine the effect of a single oral dose of montelukast sodium 10 mg on airway response to methacholine chloride‐induced bronchoconstriction.METHODS: A double‐blind, placebo‐controlled, randomized crossover trial was performed in 12 subjects with asthma whose methacholine chloride concentration causing a 20% decrease in the forced expiratory volume during the first second of exhalation (PC20) was 8 mg/mL or lower and a baseline forced expiratory volume during the first second of exhalation of 70% predicted or greater. Two‐minute tidal breathing methacholine chloride inhalation challenges were performed 1 h and 25 h after both 10 mg montelukast sodium and identical‐appearing placebo.RESULTS: There were no significant differences in the methacholine chloride PC20 between active treatment and placebo at 1 h post‐10 mg montelukast sodium (1.0 mg/mL versus 1.3 mg/mL; n=12; P=0.17, respectively) or at 25 h post‐10 mg montelukast sodium (1.4 mg/mL versus 1.9 mg/mL; n=11; P=0.15, respectively).CONCLUSION: A single dose of montelukast sodium did not affect methacholine chloride‐induced bronchoconstriction measured after 1 h and 25 h.
Asthma Management at Discharge from the Emergency Department: A Descriptive Study
Authors: Gervais Pascale , Larouche Isabelle , Blais Lucie , Fillion Anne , Beauchesne Marie-France 
Published: March 2016

BACKGROUND: The management of asthma remains suboptimal despite the publication of Canadian asthma guidelines in 1999.OBJECTIVES AND METHODS: A descriptive study was conducted to estimate the proportion of patients admitted to the emergency department (ED) for an asthma exacerbation who received a management plan at discharge that was in accordance with seven criteria stated in the Canadian asthma guidelines. The present study took place in two tertiary care hospitals in Montreal, Quebec.RESULTS: A total of 37 patients were enrolled. Three (8%) patients received a management plan at discharge that was in accordance with all seven criteria. Inhaled corticosteroids and oral corticosteroids were prescribed at discharge for 29 (78%) and 35 (95%) patients, respectively. Minimal asthma education was provided for 29 (78%) patients and a medical follow‐up was recommended to 22 (60%) patients. Airflow obstruction was evaluated at discharge for only 20 (54%) patients.CONCLUSION: Overall, asthma management at discharge from the ED was generally not in accordance with the 1999 Canadian asthma guidelines. A standardized management plan should be implemented in the ED to improve the care of patients with asthma exacerbations.
Enhanced Surveillance for Acute and Likely Acute Hepatitis B in Canada: 1999 to 2002
Authors: Boulos David , Goedhuis Neil J , Wu Jun , Baptiste Beverley , Poliquin Darlene , Furseth Janet , Chan Jessica Ip , Bolesnikov Grlica , Barichello Faye , Andonov Anton , Giulivi Antonio 
Published: March 2016

OBJECTIVE: To assess the incidence of clinically identified hepatitis B cases, as well as the demographic and risk behaviour profiles of these cases in a defined Canadian population.METHODS: An enhanced hepatitis surveillance system was established in October 1998 to identify acute hepatitis B and C cases in Canada. Acute and likely acute cases, as determined by laboratory testing, collectively defined incident clinical hepatitis B cases. Data from 1999 to 2002 on incidence, demographic characteristics and risk behaviour characteristics were collected and analyzed.RESULTS: During the 1999 to 2002 surveillance period, 379 cases were identified in a target population ranging from 3,128,179 to 8,576,071 individuals. The observed hepatitis B incidence rate was 1.93/100,000 person‐years in the surveillance area. The incidence rate was 2.74 times higher in men. The observed incidence rates decreased for all age groups over the surveillance period but remained high in the 20‐ to 29‐year‐old and 30‐ to 39‐year‐old age groups, as well as in men. Of the incident cases, 55.9% self‐identified as being born in Canada and 18.5% as being born in Asia, while 18.7% did not identify a birth area. Of the Canadian‐born cases, 61.3% identified themselves as Caucasian, 11.3% as Aboriginal and 23.6% as no ethnic category. Injection drug use was the most reported risk behaviour (19.1%), followed closely by sex‐associated risk behaviours. A large proportion, 24%, indicated none of the known risk behaviours.CONCLUSIONS: The hepatitis B incidence rate has shown some decrease in the surveillance population from 1999 to 2002 and this may be due, in part, to past intervention programs (eg, vaccination programs and health promotion campaigns). The authors′ results identify some high‐risk groups that would benefit from additional prevention and control programs, and further targeted research and intervention.
A Comparison of Pertussis Rates in the Northwest Territories: Pre‐ and Postacellular Pertussis Vaccine Introduction in Children and Adolescents
Authors: Kandola Kami , Lea Amy , White Wanda , Santos Maria 
Published: March 2016

INTRODUCTION: During the past decade, a trend toward increasing cases of Bordetella pertussis in older children and adults has been witnessed in Canada. The National Advisory Committee on Immunization now recommends that the adult formulation of the acellular pertussis (adult dTap) vaccine combined with diphtheria and tetanus toxoids be substituted for diphtheria and tetanus toxoids alone for the 14‐ to 16‐year‐old booster dose. In October 2000, the government of the Northwest Territories was one of the first to adopt adult dTap into their territorial immunization program free of charge.OBJECTIVE: To evaluate the effect of the acellular pertussis vaccine in children and adolescents on the epidemiology of pertussis in the Northwest Territories.METHODS: Pertussis is a reportable disease in the Northwest Territories, and data on the incidence rates of pertussis are available from 1989 to 2004. The present study reviews pertussis cases during three four‐year periods: the whole‐cell vaccine era (1993 to 1996); the preadult dTap era (1997 to 2000); and the postadult dTap era (2001 to 2004).RESULTS: The incidence of pertussis decreased from 18.0 cases per 10,000 population in 1993 to 0.2 cases per 10,000 population in 2004. The number of cases decreased from 186 to 129 to 19 cases in the three chronological time periods (ie, whole‐cell vaccine era, preadult dTap era and postadult dTap era, respectively), with the most substantial reduction coming with the introduction of postadult dTap.CONCLUSIONS: There appears to be a decrease in the incidence of pertussis with the targeted introduction of adult dTap in the Northwest Territories.
Toll Like Receptors 4 and 2 Expression in the Bronchial Mucosa of Patients with Cystic Fibrosis
Authors: Hauber Hans-Peter , Tulic Meri K , Tsicopoulos Anne , Wallaert Benoit , Olivenstein Ron , Daigneault Patrick , Hamid Qutayba 
Published: March 2016

BACKGROUND: Cystic fibrosis (CF) is a lung disease characterized by chronic infection with Gram‐negative bacteria Pseudomonas aeruginosa and Gram‐positive bacteria Staphylococcus aureus. Recently, toll‐like receptor (TLR) 4 has been shown to be responsible for the lipopolysaccharide (LPS)‐mediated immune response. While TLR2 mediates responses driven by bacterial lipoproteins and peptidoglycans from Gram‐positive bacteria, LPS derived from P aeruginosa may stimulate the immune response in the airways of patients with CF via activation of TLR4.OBJECTIVES: To investigate TLR4 and TLR2 expression in the bronchial mucosa of patients with CF and normal control subjects.PATIENTS AND METHODS: Endoscopic bronchial biopsies from seven patients with CF and six healthy control subjects were obtained. TLR4 and TLR2 expression was assessed using immmunocytochemistry. Real‐time polymerase chain reaction was used to detect TLR4 messenger RNA in blood cells from patients with CF and to compare TLR4 expression in CF bronchial epithelial cells with non‐CF bronchial epithelial cells.RESULTS: In patients with CF, the number of TLR4‐positive cells was significantly increased in their submucosa (P<0.05) but significantly reduced in their epithelium compared with control subjects (P<0.05). The majority of TLR4‐positive cells were neutrophils. Patients with CF (n=4) and control subjects (n=4) had a similar percentage of TLR4‐expressing neutrophils and monocytes/lymphocytes in peripheral blood. CF cells (IB‐3) had significantly decreased basal TLR4 messenger RNA expression compared with non‐CF cells (Calu‐3) (P<0.05). Although there was a trend toward reduced TLR2 expression in the airway epithelium of patients with CF (P=0.07), there was no significant difference in TLR2 expression in the submucosa of patients with CF compared with that of control subjects.CONCLUSIONS: Both TLR4 and TLR2 expression in the bronchial epithelium of patients with CF were significantly reduced compared with healthy control subjects. In contrast, the number of TLR4‐positive neutrophils in the submucosa of patients with CF was higher than in control subjects. This may suggest that the loss of epithelial TLR expression may contribute to the impaired defense against LPS.
The Use of Noninvasive Mechanical Ventilation for the Treatment of Acute Exacerbations of Copd in Canada
Authors: Drummond Jennifer , Rowe Brian , Cheung Lawrence , Mayers Irvin 
Published: March 2016

BACKGROUND: Noninvasive mechanical ventilation (NIMV) is accepted as a life‐saving treatment for patients presenting to the emergency department and other acute care settings with severe exacerbations of chronic obstructive pulmonary disease (COPD).OBJECTIVE: It was hypothesized that there is marked national variability in the use of NIMV. Therefore, the use of NIMV for COPD exacerbations in urban centres across Canada was evaluated.METHODS: All Canadian hospitals affiliated with a university training program were surveyed, and a request for involvement in this survey was posted on the Canadian Society of Respiratory Therapy professional practice listserv. Survey information was received from all 33 sites (100%) that were contacted.RESULTS: Marked differences in the application of NIMV were identified across all regions in Canada, ranging from requiring extensive monitoring in the intensive care unit to application on a general internal medical unit with intermittent noninvasive blood pressure monitoring. There were sites that rarely used NIMV for COPD exacerbations and others where it was routine practice.CONCLUSIONS: NIMV is a life‐saving treatment for acute exacerbations of COPD. Despite clear clinical evidence, its use has not penetrated throughout all the larger urban hospitals in Canada. This may be more problematic in sites without 24 h respiratory therapy support. There are barriers to the routine application of NIMV that can be overcome using established guidelines and available evidence.
Cost‐Effectiveness of Treprostinil Versus Epoprostenol in Patients with Pulmonary Arterial Hypertension: A Canadian Analysis
Authors: Einarson Thomas R , Granton John T , Vicente Colin , Walker John H , Engel Greg , Iskedjian Michael 
Published: March 2016

BACKGROUND: Pulmonary arterial hypertension (PAH) is associated with substantial morbidity and mortality, exerting a tremendous health and economic impact on patients. In the present study, an economic evaluation of patients with PAH treated with either treprostinil or epoprostenol was performed.METHODS: A cost‐minimization analysis (a cost‐effectiveness subtype) was performed under the assumption that treprostinil and epoprostenol were clinically equivalent. Two cohorts of 60 patients, treated with treprostinil or epoprostenol, were evaluated over three years by using a dynamic spreadsheet model. The evaluation included both the provincial ministries of health and societal perspectives. Resource valuation data for drugs, medical supplies, consultations, and surgical and diagnostic procedures were obtained from standard lists. Costs of hospitalizations and adverse events were derived from published sources. Additional outpatient costs were considered equivalent and, therefore, were excluded from the analysis. Costs are presented in 2003 Canadian dollars discounted at 3%. Sensitivity analyses were performed testing all uncertainties in the model.RESULTS: In the base‐case analysis (over three years), treatment with treprostinil resulted in an expected savings of $2,610,642 and $2,781,438 from the ministries of health and societal perspectives, respectively. On a per‐patient level, treatment with treprostinil resulted in an average annual savings of $14,504 and $15,452, respectively. The greatest savings with treprostinil came from reduced hospitalizations. Multivariate sensitivity analyses estimated cost savings in greater than 99% of scenarios.CONCLUSIONS: By initiating and continuing treprostinil treatment over a three‐year period, the economic burden associated with PAH may be reduced compared with epoprostenol treatment.
Ventrolateral Partial Dorsal Root Entry Zone Rhizotomy for Occipital Neuralgia
Authors: Rasskazoff Serge , Kaufmann Anthony M 
Published: March 2016

OBJECTIVE AND IMPORTANCE: Medically refractory occipital neuralgia (ON) has been treated with a variety of neuroablative procedures. The present case report supports the effectiveness of ventrolateral partial rhizotomy (pVL‐DREZ) of the C1 to C3 cervical dorsal roots, a relatively unknown procedure.CLINICAL PRESENTATION: A 46‐year‐old woman had a 14‐month history of severe right‐sided ON. Multiple trials of medical treatments, nerve blocks and local steroid injections had failed. Her daily opioid requirements had escalated to include frequent injections in addition to prescribed oral opiates.INTERVENTION AND RESULTS: A pVL‐DREZ at the right C1 to C3 level was performed through a C1 laminectomy and C2 right laminotomy. The ipsilateral upper cervical dorsal roots were exposed and a 1 mm deep incision was made at a 45° angle to the sagittal midline at the ventrolateral aspect of each dorsal rootlet entry. The patient experienced postoperative opioid withdrawal seizure and transient disequilibrium for two weeks. Touch sensation was preserved and complete abolition of ON over a four year follow‐up was achieved.CONCLUSION: The pVL‐DREZ procedure provided complete pain relief for the patient and avoided the potential complications often encountered with other destructive interventions. pVL‐DREZ should be considered among the available options for the treatment of refractory ON.
Private Costs of Patients Hospitalized with Community‐Acquired Pneumonia
Authors: Jacobs Philip , Marrie Thomas J , Calder Peter 
Published: March 2016

BACKGROUND: Community‐acquired pneumonia (CAP) is a condition which frequently requires hospitalization and consequently, can result in high costs. Little is known of the additional personal resources that are used by patients hospitalized for CAP.OBJECTIVE: To measure the private costs for persons who were hospitalized with CAP for the 30 days after being admitted to hospital using a systematic method of measurement.METHODS: Potential personal cost items were identified by nurses familiar with the treatment of CAP and categorized. Using telephone interviews in conjunction with the cost‐identification framework, 60 patients from the Edmonton, Alberta area were surveyed for their private costs associated with CAP for 30 days after admission to hospital.RESULTS: Of the 60 patients surveyed, 49 were older than 65 years of age. The mean private cost was $505, which amounted to 5.6% of the total societal costs of $8,970. The distribution was skewed with a small number of patients that had high costs.CONCLUSIONS: This method allows the determination of the societal costs for patients hospitalized with pneumonia, and the costs were not much greater than those to the health care system.
A Cross-Sectional Analysis of Acute Hepatitis B Virus Reported to the Vancouver Coastal Health Authority from 2000 to 2003
Authors: Leung Yvette , Ip Chan Jessica , Yoshida Eric , Wu Hong-Xing , Daly Patricia C 
Published: March 2016

BACKGROUND: Acute hepatitis B virus (HBV) transmission remains a significant public health problem despite effective vaccination and prophylaxis strategies. Vancouver, British Columbia, has a large ethnic community from endemic areas, which may further impact on the epidemiology of acute HBV. A cross-sectional study of factors associated with acute HBV cases reported to the Vancouver Coastal Health Authority (Vancouver, British Columbia) from 2000 to 2003 is reported.METHODS: New seropositive cases of hepatitis B surface antigen were reported to the Vancouver Coastal Health Authority Office of Communicable Disease Control. Patients meeting both clinical and laboratory criteria for acute HBV were interviewed by telephone for demographic and risk behaviour information. Risk behaviours within the last six months before disease onset were ranked on efficiency of transmission in a mutually exclusive risk category.RESULTS: There were 78 patients of identified acute HBV in Vancouver from 2000 to 2003. The overall incidence rate was 3.38 per 100,000 person years. Outside of Canada, Asia was the most common place of birth (29.5%). The three most frequently identified risk factors were men who have sex with men (21.9%), heterosexual activity with two or more partners (14.0%) and intravenous drug use (14.0%). Sexual contact with an HBV carrier was identified in 9.4% of patients.CONCLUSIONS: Sexual transmission is a major mode in the spread of HBV in Vancouver. Existing public education, surveillance and vaccination strategies for HBV need to be strengthened to address those engaging in risky behaviours.
Increasing Incidence of Adenocarcinoma of the Gastroesophageal Junction and Distal Stomach in Canada – An Epidemiological Study from 1964 to 2002
Authors: Parfitt Jeremy R , Miladinovic Zoran , Driman David K 
Published: March 2016

BACKGROUND: The increasing incidence of esophageal and proximal gastric (cardia) adenocarcinoma and the decreasing incidence of distal gastric (antropyloric) adenocarcinoma has been documented in several populations. The aim of the present study was to examine incidence trends of these neoplasms in Ontario, Canada’s most populous province, over a 39-year period.METHODS: Analyses were based on data obtained from the Ontario Cancer Registry of Cancer Care Ontario. Number of cases and rates per 100,000, age-adjusted to the 1996 Canadian standard, were obtained for all esophageal and gastric carcinoma cases reported between 1964 and 2002. Rates were grouped into five-year periods to analyze trends over the 39-year period. Point and 95% CI estimates of average annual percentage change in incidence rates were calculated with a log-linear regression model.RESULTS: The incidence of adenocarcinoma of the distal esophagus increased in men and women (average annual increase of 9.5% in men; 4.3% in women). The incidence of adenocarcinoma of the cardia increased in men and women (average annual increase of 7.3% in men; 5.8% in women). The incidence of antropyloric adenocarcinoma increased in men and women (average annual increase of 4.4% in men; 5.3% in women). The incidence of esophageal squamous cell carcinoma remained stable.CONCLUSIONS: There has been a significant increase in the incidence of adenocarcinoma around the gastroesophageal junction in men over the 39-year study period. The increase in incidence of distal gastric adenocarcinoma is unexpected and may relate to a reclassification phenomenon, immigration trends in Ontario and a rising incidence of diffuse/signet ring cell adenocarcinoma.
Pneumonia Severity Index in the Immunocompromised
Authors: Sanders Kevin M , Marras Theodore K , Chan Charles KN 
Published: March 2016

BACKGROUND: The pneumonia severity index (PSI) accounts for many comorbidities, but not immunosuppression.OBJECTIVES: To document the utility of the PSI to predict mortality in immunocompromised patients (IP) with community‐acquired pneumonia (CAP).METHODS: Charts of 284 patients with immunosuppression and CAP were reviewed, and these patients were compared with a contemporary sample of non‐IP with CAP. The ability of the PSI to predict mortality was assessed by using multiple logistic regression. Discrimination of the PSI was studied by using the concordance index.RESULTS: Thirty‐nine of 284 IP died. Mortality varied according to the etiology of the immunosuppression. Patients with HIV, solid organ transplantation or treatment with immunosuppressive drugs (n=118) had a low in‐hospital mortality (4.3%) and were classified as low risk. IP with hematological malignancies, chemotherapy, chest radiation or marrow transplantation (n=166) had a high mortality (20%) and were classified as high risk. Compared with non‐IP, low‐risk IP had similar PSI‐controlled mortality (OR=0.9, P=0.80), whereas high‐risk IP had significantly greater mortality (OR=2.8, P<0.0001). The concordance index revealed similar discrimination for the PSI in low‐risk IP (0.77) and in non‐IP (0.7), but inferior discrimination in high‐risk patients (0.6).CONCLUSIONS: Patients with CAP and immunosuppression can be divided into low‐risk and high‐risk groups. The low‐risk IP have mortality similar to non‐IP and can be risk stratified by using the PSI.
Prenatal Screening for HIV in Nova Scotia: Survey of Postpartum Women and Audit of Current Prenatal Screening Practices
Authors: Downing Mark , Youden Laura , Halperin Beth A , Scott Heather , Smith Bruce , Halperin Scott A 
Published: March 2016

BACKGROUND: Current guidelines for screening for HIV infections in Nova Scotia recommend an opt‐in approach in which patients are counselled and consent to testing. The objectives of the present study were to measure adherence to these recommendations, to explore women′s knowledge, attitudes, beliefs and behaviours concerning HIV screening, and to compare these results with prenatal screening practices for rubella, hepatitis B and group B streptococcus.METHODS: All women who gave birth consecutively during a seven‐week period were recruited. Study participants were interviewed to determine their knowledge, attitudes and beliefs concerning prenatal screening. Hospital and laboratory records were reviewed for information concerning prenatal screening and perinatal treatment to audit screening practices.RESULTS: A total of 279 patients were enrolled in the study, representing 58% of those eligible. The HIV screening rate was 72%, compared with 95% for rubella, 89% for hepatitis B and 24% for group B streptococcus. Of the participants tested for HIV, 80% were aware of being tested. Of all the study participants, 17% indicated having received pretest counselling about HIV, 56% volunteered to be tested for HIV, 78% received the test results, and 3.8% received post‐test counselling. More participants preferred an opt‐out approach to HIV screening (50%), where testing is routinely performed on everyone, rather than the opt‐in approach (43%). Participants displayed a similar preference for screening for the other infections.INTERPRETATION: HIV prenatal testing rates in Nova Scotia are comparable with those of other provinces that recommend an opt‐in approach, but are lower than testing rates for opt‐out programs. Most study participants were not screened using the recommended opt‐in approach.