bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Access to Care by Allowing Self-Referral to a Hepatitis C Clinic
Authors: Doucette Karen , Robson Vicki , Shafran Stephen , Kunimoto Dennis 
Published: March 2016

BACKGROUND: Estimates suggest that more than 250,000 Canadians are infected with hepatitis C virus (HCV), but less than 10% have been treated. Access to specialists in Canada is usually via health care professional (HCP) referral and, therefore, may be a barrier to HCV care. However, clinics that operate in conjunction with the Hepatitis Support Program, Edmonton, Alberta, allow self-referral. It is hypothesized that this improves access to care without increasing inappropriate referrals.OBJECTIVE: To compare the baseline characteristcs and outcomes of HCV patients who self-referred with those who were HCP-referred.METHODS: Data were collected from the Hepatitis Support Program HCV database and chart reviews.RESULTS: Between December 17, 2002, and December 31, 2007, 1563 patients were referred including 336 self- (21.5%) and 1227 HCP- referrals (78.5%). Self- and HCP-referred patients were similar in terms of age (mean [± SD] 43.0±10.3 years versus 43.9±10.0 years, respectively; P=0.18), sex (56.8% versus 62.0% [men], respectively; P=0.08) and risk factors for HCV (P=0.3), with 49.7% and 52.6%, respectively, identifying injection drug use as the primary risk factor. The two groups had similar HCV genotype distributions and liver biopsy fibrosis scores with similar treatment rates (31.3% versus 33.2%; P=0.6). Treatment outcomes were excellent (sustained virological response 40.2% for genotype 1, 67% for genotypes 2 and 3) in patients completing therapy and were similar between the two groups.Conclusion: Self-referred patients comprised 21.5% of patients accessing care in the clinic. Self- and HCP-referred patients had similar characteristics, treatment rates and outcomes. Facilitating self- referral to an HCV clinic can improve access to care, including risk reduction education and HCV treatment.
Hepatitis C Virus-Infected Patients Are ‘Spared’ from the Metabolic Syndrome but Not from Insulin Resistance. A Comparative Study of Nonalcoholic Fatty Liver Disease and Hepatitis C Virus-Related Steatosis
Authors: Lonardo Amedeo , Ballestri Stefano , Adinolfi Luigi E , Violi Enrico , Carulli Lucia , Lombardini Silvia , Scaglioni Federica , Ricchi Matteo , Ruggiero Giuseppe , Loria Paola 
Published: March 2016

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis C feature steatosis and insulin resistance (IR), conditions associated with the metabolic syndrome (MS).OBJECTIVES: To assess the prevalence of MS and determinants of IR in patients with NAFLD and chronic hepatitis C.METHODS: Ninety-three consecutive patients with NAFLD, 97 with chronic hepatitis C virus (HCV) genotypes 1 and 2, and 182 ‘healthy’ controls without steatosis were enrolled in the present study. The prevalence of MS was assessed by modified Adult Treatment Panel III criteria and IR by the homeostasis model assessment of insulin resistance (HOMA-IR). IR was defined as the 75th percentile of the HOMA-IR of control subjects.RESULTS: While the prevalence of IR was similar in NAFLD and HCV-infected subjects (70.0% and 78.7%, respectively), the prevalence of MS was significantly higher in NAFLD patients than in HCV-infected patients (27.9% versus 4.1%) and in controls (5.6%). With multivariate analysis, IR was predicted by body mass index (OR 1.263; 95% CI 1.078 to 1.480) and triglyceridemia (OR 1.011; 95% CI 1.002 to 1.020) in NAFLD and by sex (OR for female sex 0.297; 95% CI 0.094 to 0.940) and fibrosis stage (OR 2.751; 95% CI 1.417 to 5.340) in chronic hepatitis C.CONCLUSIONS: IR is independently associated with body mass index and triglyceridemia in NAFLD, sex and fibrosis in chronic HCV infection, and has a higher prevalence in NAFLD and chronic hepatitis C than in controls. However, the frequency of MS in HCV-infected patients, similar to that of controls, is significantly lower than that seen in NAFLD patients. The current diagnostic criteria of MS are more likely to ‘capture’ patients with NAFLD than with chronic hepatitis C, although both groups are insulin resistant.
Assessing Pain in Infancy: The Caregiver Context
Authors: Riddell R Pillai , Racine Nicole 
Published: March 2016

BACKGROUND: Pain is largely accepted as being influenced by social context. Unlike most other developmental stages throughout the lifespan, infancy is marked by complete dependence on the caregiver. The present paper discusses the primary importance of understanding the caregiver context when assessing infant pain expression.OBJECTIVES: Based on a review of research from both the infant pain and infant mental health fields, three lines of evidence are presented. First, pain assessment is as subjective as the pain experience itself. Second, assessors must be cognizant of the relationship between infant pain expression, and caregiver sensitivity and emotional displays. Finally, larger systemic factors of the infant (such as caregiver relationship styles, caregiver psychological distress or caregiver acculturative stress) directly impact on infant expression.CONCLUSIONS: As a result of infants’ inability to give a self‐report of their pain experience, caregivers play a crucial role in assessing the pain and taking appropriate action to manage it. Caregiver behaviours and predispositions have been shown to have a significant impact on infant pain reactivity and, accordingly, should not be ignored when assessing the infant in pain.
Development and Psychometric Evaluation of a New Measure of Pain‐Related Support Preferences: The Pain Response Preference Questionnaire
Authors: McWilliams Lachlan A , Saldanha Kate M , Dick Bruce D , Watt Margo C 
Published: March 2016

BACKGROUND: Behavioural conceptualizations of chronic pain posit that solicitous responses to pain behaviours are positively reinforcing and play a role in the development of chronic pain and disability. Recent research suggests that studies investigating this model were likely limited by the use of only a few narrowly defined categories of responses to pain behaviour. A measure of preferences regarding pain‐related social support has the potential to improve behavioural models of chronic pain by identifying other potentially reinforcing responses to pain behaviour.OBJECTIVE: The Pain Response Preference Questionnaire (PRPQ) was created to assess preferences regarding pain‐related social support. The purpose of the present study was to empirically develop PRPQ scales and examine their psychometric properties.METHODS: A large university student sample (n=487) free of chronic pain completed the 39‐item PRPQ. Factor analysis was applied to the data from the present sample to empirically develop PRPQ scales. Using a second student sample (n=87), relationships between the PRPQ scales and theoretically related measures were examined to evaluate the construct validity of the scales. Factor analysis supported four factors that reflected preferences for emotional and instrumental support, assistance in managing pain and emotions, having one’s pain ignored, and being encouraged to persist with one’s activities. Based on this analysis, scales labelled solicitude, management, suppression and encouragement were created. Correlation analyses supported the construct validity of these scales.CONCLUSIONS: The PRPQ is a psychometrically sound measure of preferences of pain‐related social support. Research with clinical samples is needed to further evaluate its psychometric properties and clinical utility.
Anxiety Influences Children’s Memory for Procedural Pain
Authors: Rocha Elizabete M , Marche Tammy A , von Baeyer Carl L 
Published: March 2016

OBJECTIVE: To examine the effects of temperament and trait anxiety on memory for pain.METHODS: Three dimensions of temperament, as well as trait anxiety, were assessed in 36 children (five to 12 years of age) undergoing dental procedures; after the procedure, the children provided pain ratings. Following a six‐ to eight‐week delay, the children reported how much pain they remembered.RESULTS: Most children (85%) accurately recalled their pain. Temperament had no significant effect, but trait‐anxious children showed a greater likelihood of recalling more pain than they initially reported, suggesting that they may negatively distort recollections of painful experiences.CONCLUSIONS: When treating children, in particular trait‐anxious children, clinicians should consider what children remember as part of pain management intervention.
Mortality in a Heterogeneous Population of Low‐Risk Febrile Neutropenic Patients Treated Initially with Cefazolin and Tobramycin
Authors: Le Piane Francesca , Walker Sandra AN , Walker Scott E , Lathia Nina , De Angelis Carlo , Simor Andrew 
Published: March 2016

BACKGROUND: At Sunnybrook Health Sciences Centre in Toronto, Ontario, the recommended empiric regimen for febrile neutropenia has been cefazolin and tobramycin for at least 25 years. However, we had no objective data to reassure us that patient mortality had not increased over the past five years.METHODS: A retrospective chart review of 48 episodes occurring in 44 patients admitted for the treatment of febrile neutropenia secondary to chemotherapy in 2002, and initially managed with cefazolin and tobramycin was conducted. Prospective data from 48 episodes in 2007 had previously been collected. Patients who developed febrile neutropenia while in hospital were excluded. The primary objective of the present study was to compare the all‐cause mortality in 2007 with that from 2002.RESULTS: There were no statistically significant differences between the groups (P>0.05). All‐cause mortality in 2007 was 8.3% (four of 48) compared with 10.4% (five of 48) in 2002 (P=1). All deaths occurred in patients considered to be at high risk according to the Talcott score.CONCLUSION: Mortality has not increased in the past five years with the use of empiric cefazolin and tobramycin for the treatment of patients admitted with febrile neutropenia at Sunnybrook Health Sciences Centre. Rates are comparable with those reported in the literature for similar patients. The results of the present study provide reassurance that the regimen continues to be effective for lower‐risk febrile neutropenic patients.
Tuberculosis Screening and Active Tuberculosis among HIV‐Infected Persons in a Canadian Tertiary Care Centre
Authors: Brassard Paul , Hottes Travis Salway , Lalonde Richard G , Klein Marina B 
Published: March 2016

RATIONALE: HIV infection increases the risk of reactivation of latent tuberculosis (TB). The present study evaluates how latent TB is detected and treated to determine the effectiveness of screening in HIV‐infected patients with diverse risk profiles.METHOD: A retrospective medical record database review (1988 to 2007) was conducted at a tertiary care HIV clinic. The proportion of patients receiving tuberculin skin tests (TSTs) and the rate of active TB at each stage of screening and prevention were estimated. Predictors of receiving a TST at baseline, testing positive by TST and developing active TB were evaluated.RESULTS: In the present study, 2123 patients were observed for a total of 9412 person‐years. Four hundred seventy‐six (22.4%) patients were tested by TST within 90 days of first clinic visit. Having a first clinic visit during the highly active antiretroviral therapy era (OR 3.64; 95% CI 2.66 to 4.99), country of birth (ORs: Africa 3.11, Asia 2.79, Haiti 3.14, and Latin America and the Caribbean 2.38), time between HIV diagnosis and first visit (OR per one‐year change 0.97; 95% CI 0.94 to 0.99) and previous antiretroviral exposure (OR 0.61; 95% CI 0.45 to 0.81) were independent predictors of receiving a TST at baseline. Of the 17 patients who developed active TB during follow‐up, nine (53%) had no documented TSTs at baseline or during follow‐up. Forty‐one per cent of all TB patients and 56% of TB patients who were not screened were born in Canada.CONCLUSION: The administration of TSTs to newly diagnosed HIV patients was inconsistent and differential according to country of birth, among other factors, resulting in missed opportunities for TB prevention.
An Evaluation of Procedural Training in Canadian Respirology Fellowship Programs: Program Directors’ and Fellows’ Perspectives
Authors: Stather David Ryan , Jarand Julie , Silvestri Gerard A , Tremblay Alain 
Published: March 2016

BACKGROUND: In recent years, there has been a rapid growth in diagnostic and therapeutic procedures performed by respirologists.OBJECTIVES: To assess the number and type of procedures performed in Canadian respirology training programs, for comparison with the American College of Chest Physicians minimum competency guidelines, and to assess fellow satisfaction with procedural training during their fellowships.METHODS: Internet‐based surveys of Canadian respirology fellows and respirology fellowship program directors were conducted.RESULTS: Response rates for program director and respirology fellow surveys were 71% (10 of 14) and 62% (41 of 66), respectively. Thirty‐eight per cent of respirology fellows reported the presence of an interventional pulmonologist at their institution. Flexible bronchoscopy was the only procedure reported by a large majority of respirology fellows (79.5%) to meet American College of Chest Physicians recommendations (100 procedures). As reported by respirology fellows, recommended numbers of procedures were met by 59.5% of fellows for tube thoracostomy, 21% for transbronchial needle aspiration and 5.4% for closed pleural biopsy. Respirology fellows in programs with an interventional pulmonologist were more likely to have completed some form of additional interventional bronchoscopy training (80% versus 32%; P=0.003), had increased exposure to and expressed improved satisfaction with training in advanced diagnostic and therapeutic procedures, but did not increase their likelihood of achieving recommended numbers for any procedures.CONCLUSIONS: Canadian respirology fellows perform lower numbers of basic respiratory procedures, other than flexible bronchoscopy, than that suggested by the American College of Chest Physicians guidelines. Exposure and training in advanced diagnostic and therapeutic procedures is minimal. A concerted effort to improve procedural training is required to improve these results.
Transdermal Nitroglycerin as an Adjuvant to Patient‐Controlled Morphine Analgesia after Total Knee Arthroplasty
Authors: Orbach-Zinger Sharon , Lenchinsky Artium , Paul-Kesslin Lesley , Velks Steven , Salai Moses , Eidelman Leonid A 
Published: March 2016

BACKGROUND: Nitroglycerin (NTG) has been shown to be a useful adjunct for pain treatment without increasing adverse side effects. The effects of NTG on postoperative morphine consumption after knee replacement were evaluated.METHODS: After undergoing total knee replacement, patients receiving patient‐controlled morphine analgesia were randomly assigned to receive either an NTG or a placebo patch. The blinded investigator assessed each patient using a visual analogue scale at rest and while moving, as well as the patient’s morphine requirements, sedation score, sleep quality, nausea and vomiting, vital signs and postoperative bleeding.RESULTS: Two of the patients in the NTG group suffered postoperative myocardial infarctions after removal of the patch. Because of these two serious adverse effects, the study was stopped prematurely. In the subset of patients studied, NTG conferred no advantage over placebo in pain control (visual analogue scale at rest or during movement) and in satisfaction scores.CONCLUSIONS: The use of NTG patches conferred no advantage over the use of placebo in patients receiving patient‐controlled morphine analgesia after total knee replacement. Two myocardial infarcts occurred in this group. Therefore, the safety of postoperative NTG patch use for pain control must be questioned.
Patient Satisfaction with Colonoscopy: A Literature Review and Pilot Study
Authors: Chartier Lucas , Arthurs Erin , Sewitch Maida J 
Published: March 2016

BACKGROUND: Current guidelines recommend that colonoscopic colorectal cancer screening be undertaken every 10 years after the age of 50 years. However, because the procedure does not meet criteria that promote screening uptake, patient satisfaction with colonoscopy may encourage repeat screening.OBJECTIVE: To systematically review the literature and conduct a pilot study of patient satisfaction with the colonoscopy experience.METHODS: All cohort studies from January 1997 to August 2008 in the MEDLINE database that measured either patient satisfaction with colonoscopy, patient willingness to return for colonoscopy under the same conditions or patient preference for colonoscopy compared with other large bowel procedures were identified. The search was supplemented by journal citation lists in the retrieved articles.RESULTS: Of the 29 studies identified, 15 met the inclusion criteria. Consistently, the vast majority of patients (approximately 95%) were very satisfied with their colonoscopy experience. Patient satisfaction was similar for screening and nonscreening colonoscopy. Patient willingness to return for the procedure ranged from 73% to 100%. Of the five studies that examined modality preference, three studies reported the majority of patients preferred colonography to colonoscopy and two studies reported the reverse. Our pilot study findings mirrored those of other studies that were conducted in the United States. The major limitation of the included studies was that patients who were most dissatisfied may have gone elsewhere to have their colonoscopy.CONCLUSIONS: Patients were very satisfied with colonoscopy. The majority were willing to return for repeat testing under the same conditions, and colonoscopy was not preferred over other modalities. However, studies were limited by methodological shortcomings.
Comparison of Per Cent Predicted and Percentile Values for Pulmonary Function Test Interpretation
Authors: Pakhale Smita , Bshouty Zoheir , Marras Theodore K 
Published: March 2016

BACKGROUND: Pulmonary function tests (PFTs) are commonly interpreted as a fraction of predicted normal values, with an abnormal test often defined as less than 80% or greater than 120% of the predicted value. However, recommendations of the American Thoracic Society/European Respiratory Society suggest using a percentile‐based approach to define an abnormal test (less than the fifth or greater than the 95th percentiles).OBJECTIVE: To compare PFT values obtained by the per cent predicted method with the percentile‐based method for lung function parameters.METHODS: Full PFTs performed between January 2000 and July 2004, at the Health Sciences Centre (Winnipeg, Manitoba) were analyzed. Using the Crapo and Gutierrez equations, per cent predicted and percentile values were calculated. An abnormal test was defined as less than 80% or greater than 120% of predicted (per cent predicted method) or as less than the fifth or greater than the 95th percentiles (percentile method). Using the percentile method as reference standard, the diagnostic test characteristics of the per cent predicted method were calculated.RESULTS: The full PFTs of 2176 men and 1658 women were analyzed using the Crapo and Gutierrez equations. The mean (± SD) age of all subjects was 52±15 years. Per cent agreement between the two tests was more than 94% for all parameters except for reduced residual volume (88%). Per cent predicted methods had suboptimal sensitivity for abnormal total lung capacity (88% to 89%), increased residual volume (83% to 89%) and reduced diffusion capacity (89% with Crapo equations). Suboptimal specificity (83% to 86%) was observed for decreased residual volume.CONCLUSION: The results of the per cent predicted and percentile‐based approaches for PFT interpretation were similar for the majority of lung function parameters. These two methods can be used interchangeably for spirometry. However, caution may be warranted in relying solely on per cent predicted methods for assessing lung volume or diffusion capacity.
Factors Associated with Colonoscopy Performed in Nonhospital Settings
Authors: Alharbi Othman , Rabeneck Linda , Paszat Lawrence F , Wijeysundera Duminda N , Sutradhar Rinku , Yun Lingsong , Vinden Christopher M , Tinmouth Jill 
Published: March 2016

BACKGROUND: Colonoscopy is being increasingly performed in facilities outside of hospitals. Regulation of these facilities is variable, and concerns regarding the quality of procedures in nonhospital (NH) settings have been raised. Further study is needed to better understand endoscopic practice in these facilities.OBJECTIVES: To describe NH-based colonoscopy practice in Ontario from 1993 to 2005, and to identify patient (age, sex, income quintile and comorbidity) and physician (specialty and colonoscopy volume) factors associated with this practice.METHODS: The present study was a population-based, cross-sectional analysis using health administrative data from Ontario adults who underwent at least one outpatient colonoscopy between 1993 and 2005. A total of 1,240,781 patients underwent 1,917,714 colonoscopies. The main outcome measure was the receipt of colonoscopy in an NH facility.RESULTS: An increase in NH-based colonoscopy from 10.0% in 1993 to 15.1% in 2005 (P<0.0001) was found. In the multivariate model, younger, healthier men living in higher income areas were significantly more likely to undergo NH-based colonoscopy. Surgeons and other practitioners (eg, nongastroenterologists and noninternists) were significantly more likely to practice in NH settings. Physicians in the highest colonoscopy volume quintile were 25 times more likely to practice in NH settings than those in the lowest volume quintile (P<0.0001).CONCLUSION: Rates of NH-based colonoscopy are rising in Ontario. High-volume endoscopists and surgeons are most likely to practice in NH settings. Given its increasing use, further study of the practice and the regulation of NH colonoscopy is warranted.
Diagnostic Performance of Gastric Imprint Smear for Determination ofHelicobacter pyloriInfection
Authors: Al-Ali J , Al-Asfar F , Dhar R , Dhar PM , Kapila K 
Published: March 2016

BACKGROUND: Despite the availability of several methods (invasive and noninvasive) for the diagnosis ofHelicobacter pyloriinfection, no test is considered to be the ‘gold standard’. Endoscopy-based tests are regarded as the reference method in most studies.OBJECTIVE: To evaluate the diagnostic performance of imprint cytology smears of antral biopsies compared with Gram-stained smears, the rapid urease test and culture methods, separately and in combination.METHODS: Antral biopsies were obtained from consecutive patients undergoing upper gastrointestinal endoscopy at a single centre. The biopsies were examined for the presence ofH pyloriby Gram-stained smear, the rapid urease test, culture methods and imprint cytology smear.RESULTS: A total of 273 biopsies were studied. All tests were positive in 36% of the patients. Of 252 biopsies tested, 73% were positive using the imprint cytology technique. Using Gram-stained smear, the rapid urease test and culture methods individually, the sensitivity and specificity of imprint cytology smears for the detection ofH pyloriwere found to be 92.7% and 50%; 92.7% and 49%; and 92.4% and 38.5%, respectively. Combining the three microbiological methods resulted in a sensitivity of 92.1%, a specificity of 51.0% and an efficiency of 71.7% for imprint cytology smears.CONCLUSIONS: Endoscopic examination provides useful clinical information. Imprint gastric cytology can be used as a rapid test to establish the diagnosis ofH pyloriinfection at the time endoscopy is performed, enabling the endoscopist to start treatment with immediate effect.