CMAJ: Canadian Medical Association Journal articles from April 2009

CMAJ: Canadian Medical Association Journal archives from April 2009

A pause for thought on lung cancer screening.(Editorial)
April 14, 2009... More effective clinical strategies are badly needed to combat lung cancer, the leading cause of both cancer incidence and cancer death. A novel screening strategy based on low-dose computed tomography (CT) scanning is being studied in large...

Does smoking marijuana increase the risk of chronic obstructive pulmonary disease?(Commentary)
April 14, 2009... Marijuana is the second most commonly smoked substance worldwide after tobacco. (1) The constituents of marijuana smoke are qualitatively and, to a large extent, quantitatively similar to those of tobacco smoke, with the exceptions of...

Intensive insulin therapy in the intensive care unit.(Commentary)
April 14, 2009... Hyperglycemia in response to critical illness has long been associated with adverse outcomes. Large observational studies have recently confirmed and fine-tuned this association, reporting the lowest risk of death with blood glucose levels...

The National Pharmaceuticals Strategy: rest in peace, revive or renew?(Commentary)
April 14, 2009... The fact that one of the main treatment modalities in health care--prescription drugs used outside the hospital setting--remains outside the medicare envelope in 2009 perplexes many clinicians, academics and the general public. Canada has an...

Digital Rx: Obama pushing for paperless prescriptions.(News)(e-prescribing)
April 14, 2009... The United States government is telling doctors it's time to set aside their legendarily lousy handwriting and convert to electronic prescriptions. To drive home the point, it's rewarding those who switch now, penalizing those who wait and...

Obama sparks an ideological donnybrook with his push to compare medical treatments.(News)
April 14, 2009... The proposition sounds simple: pick a disease, study ways to treat it and see which works best. Yet President Barack Obama's proposal to do a great deal of that has set off a political tempest in the United States. [ILLUSTRATION OMITTED]...

More isotope woes forecast.(For the record)(Brief article)
April 14, 2009... The fragility of the world's medical isotope production chain is again expected to disrupt supply this summer. Europe's Association of Imaging Producers and Equipment Suppliers issued an "urgent update" indicating that 2 of Europe's 3...

Pharma bears responsibility for labelling.(For the record)(Brief article)
April 14, 2009... The United States Supreme Court has ruled that compliance with Food and Drug Administration label warnings does not imbue pharmaceutical companies with immunity from lawsuits seeking redress for injuries caused by adverse drug reactions. ...

Global burden of food-borne disease.(For the record)(Brief article)(Conference notes)
April 14, 2009... Interim data about threats from food-borne disease should be more rapidly and broadly disseminated via the Internet, while clear and simple messages about those threats must become the norm, according to a World Health Organization gathering....

The meteorology of the human body.(News)(www.mediclim.com)(Website overview)
April 14, 2009... Achy joints, according to folklore, point to the arrival of rain. It's a tale told by many an arthritic grandmother, but it also holds true in medicine. Weather can influence a variety of medical conditions, worsening symptoms and, in some...

Resident hours.(rules for medical interns and residents(medicine))(Brief article)
April 14, 2009... Resident hours: The United States Accreditation Council for Graduate Medical Education has approved an 18-month review (www.acgme.org/acWebsite/home/nascaletter_feb2009.pdf) of resident duty hour standards in light of an Institute of Medicine...

Mobility.(Brief article)
April 14, 2009... Mobility: Doctors, nurses, pharmacists, paramedics and a host of other health professionals will obtain increased portability of their professional licences as of April 1 as a result of an amendment to the Agreement of Internal Trade reached by...

FDA commissioner.(Margaret Hamburg appointed as the Food and Drug Administration's commissioner)(Brief article)
April 14, 2009... FDA commissioner: United States President Barack Obama has appointed former New York City health commission Dr. Margaret "Peggy" Hamburg as the Food and Drug Administration's commissioner. Obama also indicated that his new administration will...

Sport supplements.(Brief article)
April 14, 2009... Sport supplements: The not-for-profit organization NSF International has launched an online initiative (www.nsfsport.com) aimed at providing athletes and coaches with a list of dietary supplements and sports nutrition products that can be...

Ease of traffic.(More news @ www.cmaj.ca)
April 14, 2009... Ease of traffic: Calls are being made for a global health credentialing system that expedites physician migration. --Erin Driscoll, CMAJ

Dementia.(More news @ www.cmaj.ca)(Brief article)
April 14, 2009... Dementia: The British government hopes to mitigate the effects of a forecast dementia crisis by opening memory clinics in every town and training general practitioners to spot early warning signs. --Mary Helen Spooner, London, England

Hospital tracking.(More news @ www.cmaj.ca)
April 14, 2009... [ILLUSTRATION OMITTED] Hospital tracking: Radio frequency identification readers are becoming all the rage in United States health care facilities. --Milan Korcok, Fort Lauderdale, Florida, USA

Dispatch.(More news @ www.cmaj.ca)
April 14, 2009... Dispatch: Amid the repetitive thumping of approaching helicopters, a Kingston, Ontario, physician admires the ingenuity of the Canadian-led multinational medical unit in Khandahar, Afghanistan. [ILLUSTRATION OMITTED] --Jorge Enrique...

Sachets.(More news @ www.cmaj.ca)
April 14, 2009... Sachets: The manufacturer of an oral tobacco product now available in Sweden and Norway and parts of Canada claims it encourages harm reduction. --Erika Gilbert, Ottawa, Ont.

Marijuana and chronic obstructive lung disease: a population-based study.(Research)
April 14, 2009... Cannabis, commonly known as marijuana, is the most widely used illegal drug in the world. After tobacco, it is the second most widely smoked substance in the general population, with a conservatively estimated 11 million users in the United...

Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data.(RESEARCH)(Clinical report)
April 14, 2009... Hyperglycemia is associated with adverse outcomes, including increased mortality, in acutely ill patients. (1-7) In 2001, a randomized trial involving patients admitted to a surgical intensive care unit (ICU) showed that intensive insulin...

Early detection of disease outbreaks using the Internet.(Analysis)(Report)
April 14, 2009... Rapidly identifying an infectious disease outbreak is critical, both for effective initiation of public health intervention measures and timely alerting of government agencies and the general public. Surveillance capacity for such detection can...

Hereditary hemorrhagic telangiectasia: transient ischemic attacks.(Cases)(Case study)
April 14, 2009... A 39-year-old right-handed man presented to his family physician with sudden-onset weakness in his right arm and leg that had lasted 10 minutes and resolved completely. In the year before presentation, he had an episode of weakness on the right...

Hereditary hemorrhagic telangiectasia: epistaxis and hemoptysis.(Clinical images)(Case study)
April 14, 2009... A 51-year-old woman with a 30-year history of recurrent epistaxis presented to the emergency department with a nosebleed. Her nosebleeds were initially mild but had gradually progressed in severity and frequency, and she had been admitted to...

Hereditary hemorrhagic telangiectasia: fatigue and dyspnea.(Practice)(Case study)
April 14, 2009... A 49-year-old man presented to the emergency department with a 2-week history of progressive fatigue and dyspnea, as well as recurrent epistaxis. Laboratory investigations revealed severe hypochromic microcytic anemia, with a hemoglobin level...

Thiazolidinedione use and the risk of fractures.
April 14, 2009... The recent commentary by Lorraine Lipscombe (1) gave the impression that the 10-study meta-analysis by Loke and colleagues yields a new finding that there might be an association between thiazolidinediones and an increased risk of fractures in...

Untitled.(thiazolidinediones is associated with a higher risk of fractures)(Report)
April 14, 2009... In their recent meta-analysis, Loke and colleagues provided evidence that long-term use of thiazolidinediones is associated with a higher risk of fractures among women but not men. (1) Potentially important clinical implications of this study...

Two of the authors respond.(Letters)(diabetics does not get risk of fracture)(Report)
April 14, 2009... Konstantinos Toulis and colleagues reanalyzed some of the data we presented in our meta-analysis (1) and concluded that pioglitazone use does not carry a fracture risk (in contrast to the finding for rosiglitazone). Their conclusion illustrates...

Correction.(Letters)(Correction notice)
April 14, 2009... A recent News article (1) mistakenly identified Derek Jones as an ex-officio member of the Inter-Agency Advisory Panel on Research Ethics. In fact, Jones is the former executive director of the panel, who was interviewed for the article but was...

Whole person care: encompassing the two faces of medicine.(Viewpoint essay)
April 14, 2009... "I would go without shirt or shoe Friend, tobacco or bread, Sooner than lose for a minute the two Separate sides of my head!" --Rudyard Kipling, The Two-Sided Man What is Kipling talking about and what, if anything, does it have to do...

Art is science made clear.(Review)
April 14, 2009... Medical humanities visual arts have come of age in Canada through a special double issue of RACAR: Revue d'art canadienne/ Canadian Art Review (2008:33 [1-2]), which provides a well-rounded melange of 8 scholarly papers and 7 contemporary...

Orange discoloration of the palms.(Clinical images)(Clinical report)
April 14, 2009... [FIGURE 1 OMITTED] [FIGURE 2 OMITTED] A 40-year-old woman presented with orange discoloration of both palms (Figure 1) that had begun several days earlier. The rest of her skin, her sclera and other mucous membranes were normally...

Shame and simplicity in Afghanistan.(Salon)(Report)
April 14, 2009... While working in Kabul this past November, I had an enlightening conversation with an Afghan doctor, an intelligent man who excelled in his work with international organizations and had recently moved from a remote village to Kabul. He told me...

Reflexion sur le depistage du cancer du poumon.(Editorial)(screening for lung cancer)
April 14, 2009... Des strategies cliniques plus efficaces s'imposent pour lutter contre le cancer du poumon, forme de cancer dont l'incidence est la plus elevee et qui cause le plus grand nombre de deces. De grands essais randomises etudient une nouvelle...

Administrator calls for global health credentialing.(News)
April 14, 2009... There's a need to establish a global health credentialing system that expedites physician migration and credentialing around the planet, says a Canadian medical school administrator. [ILLUSTRATION OMITTED] "Why don't we have a system...

Britain grappling with dementia prevalence.(News)(Report)
April 14, 2009... With as many as 1.7 million Brits projected to be diagnosed with dementia by 2051, and the average cost of caring for those afflicted pegged at roughly $25 000 [pounds sterling] a year, it's no surprise the British government has unveiled a...

Tracking itinerant patients and surgical sponges.(News)
April 14, 2009... Hospitals in the United States have increased their spending by more than 200% since 2005 on electronic tracking systems that can locate wandering patients and misplaced equipment, detect errant blood transfusions and prevent medication errors,...

The best care anywhere: dispatch from the medical front.(News)
April 14, 2009... I remember how well everyone worked together and the patients that we cared for as if it were yesterday. Despite the decreasing coverage of events in the media, military activities were almost always occurring and resulted in a constant stream...

Manufacturer claims new tobacco product encourages harm reduction.(News)
April 14, 2009... Imperial Tobacco Canada is selling a new smokeless tobacco product in Canada, advocating its use as part of a harm reduction response to nicotine addiction. Snus, which rhymes with "loose," is an oral tobacco packaged in small sachets that...

An open letter to the minister of health/Lettre ouverte a l'honorable Leona Aglukkaq, ministre de la Sante.(Editorial)
April 28, 2009... Dear Honourable Leona Aglukkaq, Belated congratulations on your appointment. We are heartened by the appointment of someone with your experience as a health minister in Nunavut. By now, you will have settled in, been brought up to speed by...

Cardiovascular risk and glycemic control.(Commentary)(Report)
April 28, 2009... The use of a multifactorial approach to the treatment of diabetes mellitus is associated with dramatic reductions in both macrovascular and microvascular complications of diabetes. (1,2) Nevertheless, intensive glycemic control, with a target...

Can anticoagulation care be improved with technology?(Commentary)
April 28, 2009... In this issue of CMAJ, Oake and colleagues (1) report the results of an observational study of an interactive voice response system to assist in managing the care of low-risk patients receiving warfarin. The system communicated results of...

Personalized medicine: a transformative approach is needed.(Commentary)
April 28, 2009... Published at www.cmaj.ca on Feb. 18, 2009. The sequencing of the human genome has paved the way for discoveries that are providing new insight into the causes of human diseases. The medical application of this knowledge to individuals is...

Industry-led committee urges delay in closing loophole allowing import of unapproved antibiotics for animals.(News)
April 28, 2009... Published at www.cmaj.ca on Apr. 8, 2009. Seven years after Canadian experts called for tighter rules governing unrestricted imports of unapproved and untested antibiotics used in meat production due to worries that their use contributes to...

Tainted weight-loss products.(For the record)
April 28, 2009... The United States Food and Drug Administration (FDA) has expanded its list of tainted, over-the-counter weight-loss products that consumers should not purchase or consume because they contain undeclared and unapproved "active pharmaceutical...

Just like books.(Briefly)(Brief article)
April 28, 2009... Just like books: Arguing that customers who use Amazon. com or iTunes have better access to comparative measures than patients, United Kingdom Prime Minister Gordon Brown announced that the UK's National Health Service will roll out online...

Earnings.(Briefly)(Brief article)
April 28, 2009... Earnings: Fee-for-service payments to Canadian physicians rose 4.7% in 2006/07, with the average family physician grossing $216 575, the average medical specialist $262 429 and the average surgical specialist $362 878, according to the Canadian...

Trans fat.(Briefly)(Report)(Brief article)
April 28, 2009... Trans fat: British Columbia will become the first province to restrict trans fat in health care institutions, hospital cafeterias, restaurants and other food service establishments. Minister of Healthy Living and Sport Mary Polak announced in...

Health snoops.(Briefly)(Brief article)
April 28, 2009... Health snoops: United Kingdom Secretary of State for Health Alan Johnson says the government should recruit snoops within communities to badger smokers, drinkers and heavy eaters into making healthier lifestyle choices. Messages from peers are...

Residents claim 24-hour call violates Charter rights.(News)
April 28, 2009... Medical residents in the province of Quebec have launched a grievance contending that the 24-hour on-call schedule permitted under their provincial contract violates the Canadian Charter of Rights and Freedoms. The dispute began with a...

Effect of interactions between C peptide levels and insulin treatment on clinical outcomes among patients with type 2 diabetes mellitus.(Research)(Clinical report)
April 28, 2009... Type 2 diabetes mellitus is reaching epidemic proportions, with major implications on quality of life and societal productivity. (1,2) Chronic hyperglycemia is the cardinal feature of diabetes and is directly linked to its associated...

Effect of an interactive voice response system on oral anticoagulant management.(Research)(Report)
April 28, 2009... Health care institutions are increasingly using interactive voice response systems. Applications of this technology include screening for disease (e.g., depression), (1) monitoring disease symptoms, (2) monitoring behaviour (e.g., substance...

Medication errors in critical care: risk factors, prevention and disclosure.(Clinical report)
April 28, 2009... An abridged version of this article appeared in the Apr. 28, 2009, issue of CMAJ and is available online at www.cmaj.ca/cgi/content/full/180/9/936/DC2 The case Mr. S, a 63-year-old man with a recent history of peptic ulcer disease who...

Managing evidence-based knowledge: the need for reliable, relevant and readable resources.(Analysis)
April 28, 2009... Nowadays few would argue against the need to base clinical decisions on the best available evidence. In practice, however, clinicians face serious challenges when they seek such evidence. Research-based evidence is generated at an...

The toddler with 1 striped leg: a linear papular rash.(What is your call?)(Report)
April 28, 2009... A previously healthy 15-month-old boy presented with a papular, erythematous rash that had developed over the previous 5 weeks. The papules were arranged in a thin vertical line that extended along the inner side of his right leg from his foot...

Pancreas divisum: a cause of idiopathic acute pancreatitis.(Case study)
April 28, 2009... A previously healthy 23-year-old woman presented to hospital with 2 months of intermittent dyspepsia following meals and acute-onset epigastric pain, nausea and vomiting. Based on the results of laboratory investigations (lipase > 1900 [normal...

Diastolic heart failure.
April 28, 2009... Katina Tzanetos and colleagues comprehensively reviewed the literature on the phenomenon that has become known as diastolic heart failure. (1) It is becoming recognized that the binary categorization of heart failure as either systolic or...

Corrections.(Letters)(Correction notice)
April 28, 2009... In a recent Cases article, (1) the following contact information for the corresponding author should have appeared at the end of the article: Dr. Jorge Burneo, Assistant Professor of Neurology, Epidemiology and Biostatistics, Epilepsy...

Clarification.(Letters)(Correction notice)
April 28, 2009... A recent Dispatch from the medical front (1) in the News section also appears on 2 Medecins Sans Frontieres websites. (2,3) REFERENCES (1.) Dumont F. On the ground in the Gaza Strip. CMAJ 2009;180:610. (2.) Every single inhabitant...

A picture of global health.(Creative works)
April 28, 2009... If a picture is worth a thousand words then these images speak volumes about the conditions endured by women and children in India and Indonesia. These 3 images were among 5 finalists in an annual contest sponsored by the International...

Making sense of the senseless.(Six Months in Sudan: A Young Doctor in a War-torn Village )(Book review)
April 28, 2009... Six Months in Sudan: A Young Doctor in a War-torn Village James Maskalyk Doubleday Canada; 2009. 352 pp $29.95 [ILLUSTRATION OMITTED] James Maskalyk is a fool. But in the finest tradition of the wise fool, he challenges...

A body-based art.(In Whatever Houses We May Visit: An Anthology of Poems That Have Inspired Physicians)(Book review)
April 28, 2009... In Whatever Houses We May Visit: An Anthology of Poems That Have Inspired Physicians Michael A. LaCombe MD and Thomas V. Harman, editors. American College of Physicians Press; 2008. 257 pp $34.95 [ILLUSTRATION OMITTED] ...

Orbinski awarded book prize.(Humanities)(Brief article)
April 28, 2009... Dr. James Orbinski, the former international president of Medecins Sans Frontieres, has been awarded the Shaughnessy Cohen Prize for nonfiction, for An Imperfect Offering: Humanitarian Action in the 21st Century (CMAJ 2008;178:1192). The $25...

Tension gastrothorax: a life-threatening cause of acute abdominal pain.(Clinical images)(Report)
April 28, 2009... An otherwise healthy 52-year-old man was admitted to hospital following a motor vehicle crash in which he had suffered a contusion on the left side of his chest, multiple rib fractures and a hemothorax. After 18 days of conservative management,...

Scrubs: what you don't see is what you get.(Salon)
April 28, 2009... I hung the stethoscope around my neck, tucked the reflex hammer into my scrub pocket and clipped the pager onto my shirt. It was my first night on-call as a medical student on the general surgery service. My first page was to attend to a...

High-profile death throws spotlight on error reports.(News)
April 28, 2009... Manitoba's medical error reporting system--thought to be among the most progressive in the country--has been rocked by allegations that senior regional health officials failed to disclose key facts surrounding the high-profile death of a man...

Radiologists virtually unwrap mummy's secrets.(News)
April 28, 2009... In 1997, a radiologist in Montreal, Quebec examined a woman and found that her left femur had once been broken. That finding is now under suspicion. The radiologist said the woman's bad teeth stemmed from too much beer. That also appears to be...

Canada lags US in adoption of e-prescribing.(News)
April 28, 2009... E-prescribing is "inextricably tied" to the implementation of electronic health records, which is proceeding across the country, "albeit at a very slow pace," says the Health Council of Canada, a government-funded, non-profit agency that was...

The routine of death.(Dispatch from the medical front)
April 28, 2009... Every morning report gives a revealing and sobering glimpse into the workings of a district hospital in Malawi: From Maternity Ward: "... 16 SVDs [spontaneous vaginal deliveries], 2 breech deliveries, 3 caesarean sections, 2 vacuum...