CMAJ: Canadian Medical Association Journal articles from August 2004

CMAJ: Canadian Medical Association Journal archives from August 2004

Pound of prevention, ounce of cure?(Editorial)(Editorial)
August 3, 2004... Medical research aimed at identifying nascent disease is yielding some spectacular findings: findings that show, for example, that smaller and smaller nests of cancerous cells can be discovered earlier and earlier in the course of the disease;...

Are the recommendations to use perioperative [beta]-blocker therapy in patients undergoing noncardiac surgery based on reliable evidence?(Commentary)
August 3, 2004... Of the approximately 26 million North Americans who undergo noncardiac surgical procedures every year, (1,2) 1%-5% suffer a major perioperative cardiovascular event. (1,3) Perioperative ischemic events prolong hospital stays by a mean of 11...

Treatment of locally advanced breast cancer.(Correspondence)(Letter to the Editor)
August 3, 2004... As the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer points out, (1) locally advanced breast cancer comprises a heterogeneous group of breast tumours. Because of the complex needs of these...

Correction.(Letters)(Correction Notice)
August 3, 2004... Because of an error during editing, incorrect information appeared in Table 1 of a recent article about the career choices of new medical students by Bruce Wright and associates. (1) The number of male students at the University of Alberta was...

Crisis in orthopedic care: surgeon and resource shortage.(Waiting Times)
August 3, 2004... A national shortage of at least 400 orthopedic surgeons is compounded by greater demand from an aging population and a "critical" lack of orthopedic resources, such as operating room time, that is steadily worsening, concludes a Canadian...

Immigration could strain EU health services.(European Union)
August 3, 2004... Physicians and politicians are warning that the new European Union membership of former East Bloc countries with high rates of infectious diseases could strain the continent's public health resources. In May, 10 countries, many of them...

Czech Republic fears EU membership will lure doctors.(Human Resources)
August 3, 2004... The Czech Republic's health insurance system is braced for an onslaught of new claims following the Eastern European country's entrance into the European Union in May. Generally regarded as practising the highest standard of medical care...

OCFP pesticide study triggered by complaint.(Environmental Health)
August 3, 2004... The Ontario College of Family Physicians' conclusion that there are no safe pesticide exposure levels, which garnered unprecedented national coverage, was sparked by a pesticide industry lobby group's insistence that there is not enough...

Alberta continues cat-and-mouse game with reform.(Health Care Policy)
August 3, 2004... A caucus revolt stopped a pair of private orthopedic clinics but 2 weeks later a defiant Premier Ralph Klein reiterated his vow to introduce radical health care reforms if voters give him a renewed mandate in an election, anticipated this fall....

Germany's new user fee cuts doctor visits.(Health Care Finance)
August 3, 2004... Visits to physicians have decreased after the German government introduced a controversial 10 [pounds sterling] (about Cdn$16.50) user fee in January. Patients must pay for their first doctor's appointment each quarter. During the first...

BC contracting-out a threat to privacy and health acts.(Privacy)
August 3, 2004... The BC government is facing a court challenge over its decision to hire a US firm to help manage its medical and pharmaceutical plans. The contract with Maximus Inc., to be finalized in late summer, could ultimately give the US government...

Canadian inmates unhealthy and high risk.(Baseline Study)(Brief Article)
August 3, 2004... Men and women in Canadian jails are unhealthier--often significantly so--than the general population, according to the first-ever study of their health. The baseline data provided in Health Care Needs Assessment of Federal Inmates Report...

Surgeons negotiating AFP.(News @ a glance)(Brief Article)
August 3, 2004... Surgeons negotiating AFP: Doctors Nova Scotia (formerly known as the Medical Society of Nova Scotia) is negotiating an alternative funding plan for 46 surgeons at the Queen Elizabeth II Health Sciences Centre in Halifax. The surgeons would...

Tax pot.(News @ a glance)(Brief Article)
August 3, 2004... Tax pot: A study from the Fraser Institute, a right-wing think-tank group, suggests that if marijuana were decriminalized, treated like any legal product and taxed, it would reap the government over $2 billion. The study, Marijuana Growth in...

Swill is swell.(News @ a glance)(Brief Article)
August 3, 2004... Swill is swell: Letting kids get dirty may be the best thing you can do for their immune systems, research from Scripps Research Institute in California suggests. After studying the way bacteria helped mice resist the onset of type 1 diabetes,...

Drug spending increases.(News @ a glance)(Brief Article)
August 3, 2004... Drug spending increases: Total spending on drugs is expected to reach $19.6 billion in 2003, an increase of 8.1% over the previous year, reports the Canadian Institute for Health Information (CIHI). Its 4th annual report on drug expenditures...

Oxycodone tracking.(News @ a glance)(Brief Article)
August 3, 2004... Oxycodone tracking: Pharmacists in Atlantic Canada are making a list of oxycodone products and checking it twice. The inventory comes at the request of Health Canada. Carole Bouchard, director of the Office of Controlled Substances, informed...

UK prescribers.(News @ a glance)(Brief Article)
August 3, 2004... UK prescribers: A greater range of health professionals will be able to prescribe drugs under plans recently announced by the UK Health Secretary. Supplementary prescribing rights would be given to optometrists, chiropodists, physiotherapists...

Inadequate vaccination.(News @ a glance)(Brief Article)
August 3, 2004... Inadequate vaccination: Current staff vaccination rates in aged care facilities (ACFs) are inadequate, according to the Medical Journal of Australia (2004;180[12]:640-2). Researchers from Melbourne reviewed 2 outbreaks of influenza in ACFs in...

New directions in drug approval.(Drug Regulation)
August 3, 2004... Major changes underway in Canada's drug regulatory system will have significant implications for how quickly new drugs are approved and how well Health Canada monitors the safety of drugs already on the market. The Throne Speech that...

New outbreaks of polio: WHO issues travel warning.(Public Health)
August 3, 2004... Background and epidemiology: In late May, a child was diagnosed with paralytic poliomyelitis in the Darfur region of Sudan, a country that has not seen the disease in over 3 years. The Global Polio Eradication Initiative warns that the case...

Should we use albumin or saline for fluid resuscitation of critically ill patients?(In The Literature)
August 3, 2004... Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R; SAFE (Saline versus Albumin Fluid Evaluation) Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med...

Pulmonary abscess with bacteremia in a young man.(Clinical Vistas)
August 3, 2004... OfOA 37-year-old man who had been living for 2 years in an unheated parking garage in Western Europe presented to an emergency department with a 4-week history of severe interscapular pleuritic pain, hemoptysis, malaise and fever. He had...

Determinants of overdose incidents among illicit opioid users in 5 Canadian cities.(Research)
August 3, 2004... Abstract Background: Drug overdose is a major cause of death and illness among illicit drug users. Previous research has indicated that most illicit drug users experience nonfatal overdoses and has suggested a variety of factors that are...

Prevalence of overweight and obesity in a provincial population of Canadian preschool children.(Research)
August 3, 2004... Abstract Background: More and more school-aged children in Canada and elsewhere are becoming overweight or obese. Many countries are now reporting a similar trend among preschool children. However, little information is available on the...

Early childhood obesity: a call for early surveillance and preventive measures.(Commentary)
August 3, 2004... The study of preschool children in Newfoundland and Labrador reported by Canning, Courage and Frizzell (1) in this issue (see page 240) indicates that about 8% of preschool children in Newfoundland and Labrador aged 3.5 to 5.5 years are obese,...

Ethics review procedures for research in developing countries: a basic presumption of guilt.(Commentaire)
August 3, 2004... There is a marked disparity between the burden of disease in developing countries and the proportion of medical research that is devoted to the diseases of the developing world. (1) Although it is heartening that 25% of scientific publications...

Vitamin [B.sub.12] (cobalamin) deficiency in elderly patients.
August 3, 2004... Abstract VITAMIN [B.sub.12] OR COBALAMIN DEFICIENCY occurs frequently (> 20%) among elderly people, but it is often unrecognized because the clinical manifestations are subtle; they are also potentially serious, particularly from a...

Digital bodies.(Movie Review)
August 3, 2004... Corpus callosum Written, directed and produced by Michael Snow Directors of photography: Robbi Hinds and Harald Bachman Editor: Paul Cormack Special-effects supervisor: Greg Hermanovic Senior animator: Rob del Ciancio ...

Napalm.(Room for a view)
August 3, 2004... I have never smelled napalm, and I pray I never will. But I have never arrived on the wards in the morning without being reminded of it, or rather of Robert Duvall's famous quip from Apocalypse Now. But the smell of the wards in the morning is...

Tough night for call.
August 3, 2004... Tough night for call Rounds were taking too long. There were circles under the resident's eyes, shadows under an unshaved beard. Post call. He wanted to get the job done and go home. Tough night, he said. ...

The man who kept his wife in a box.
August 3, 2004... That man haunts me still, even though it was twenty years ago when I met him. His wife was the patient, but I cannot recall her features. She was in an advanced stage of dementia and was suffering from bedsores. Her husband had brought her in...

Deaths.(Obituary)
August 3, 2004... Burnes, John S., Penticton, BC; University of Manitoba, 1945; general surgery; FRCSC; RCAMC, WW II. Died Jan. 24, 2004, aged 82; survived by Jane, John and Ian. Connor, James, London, Ont.; University of Glasgow (Scotland), 1943; former...

Query.
August 3, 2004... I've just attended the first funeral of my medical career. Mr. Coldger was an elderly gentleman I'd been seeing for a constellation of problems: diabetic neuropathy, congestive heart failure, ischemic heart disease, atrial fibrillation and...

Opportunities and challenges for improving the quality of reporting clinical research: CONSORT and beyond.(Commentary)
August 17, 2004... Reports of randomized controlled trials (RCTs) are the only tangible evidence of their conduct. Yet historians may well view the first 50 years of reporting of RCTs with some surprise. They will encounter what might be described as a cognitive...

College certification and recertification.(Editorial)
August 17, 2004... Few physicians have passed their final specialty examinations without thinking to themselves in relief, "Well, that's the last exam I'll ever have to take." It is a relief, but it may not be the last exam: the 2 Canadian colleges and many...

Informing the public.(Letters)(Letter to the Editor)
August 17, 2004... As described by Laura Eggertson and Barbara Sibbald, (1) several Canadian health care institutions are struggling to contain an outbreak of Clostridium difficile infection. Because this disease is not reportable, it is up to individual...

Letter from the Himalayas.(Letters)(Letter to the Editor)
August 17, 2004... It was with great enthusiasm tempered by sadness that I read Geoff Ibbotson's description of his experiences in Nepal (1) as I prepared to head home to Nepal this year. The beginning of February is a good time to take a peek at the Himalayas,...

Test for defective afferent pupillary response.(Letters)(Letter to the Editor)
August 17, 2004... As an ophthalmologist, I have a question regarding the clinical history for the 16-year-old boy with progressive vision loss described by Shaun Morris and associates: (1) Was the patient tested for a defective afferent pupillary response in the...

It's not the law.(Letters)(Letter to the Editor)
August 17, 2004... Malvinder Parmar's Clinical Vistas article (1) illustrates a Courvoisier gallbladder handsomely. Parmar aptly and carefully notes the occurrence of exceptions, whereby nothing more ominous than cholelithiasis and chronic cholecystitis underlie...

Time management.(Letters)(Letter to the Editor)
August 17, 2004... Here are some additional time-management suggestions to add to those of John Crosby. (1) If a patient has more than 3 prescriptions, I use a square of carbon paper to copy my script directly into the chart. A bonus of this system is that it...

A national public health system.(Letters)
August 17, 2004... It was with surprise and disappointment that I read the commentary by Carolyn Bennett, (1) the minister of state for public health. The mandate of Canada's new Public Health Agency is to improve Canada's ability to deal with new and emerging...

Match or mismatch?(Letters)(Letter to the Editor)
August 17, 2004... Patrick Sullivan (1) reports that 177 residency positions remained unfilled after the first iteration of this year's resident match, but I am unclear why he believes that the 71 unmatched Canadian medical students "should match easily when the...

Correction.(Letters)(Author Abstract)(Correction Notice)
August 17, 2004... An article about the Jean Chretien Pledge to Africa Act (1) incorrectly stated that developing nations that will be permitted to import generic versions of brand-name patented drugs can only do so for public health emergencies. In fact, there...

Lifelong medical licences may end in 5 years.(Professional Development)
August 17, 2004... Mandatory revalidation of medical licences will likely be introduced across Canada within 5 years in response to the demands for improved patient safety, regulatory officials say. "It's coming. It's just a question of how it's going to be...

New "point man" for federal health negotiations.(Medicare Politics)
August 17, 2004... Newly appointed Health Minister Ujjal Dosanjh will be the behind-the-scenes point man for tough health care negotiations this summer before Prime Minister Paul Martin meets provincial premiers Sept. 13 to achieve what he calls "a fix for a...

BMJ's legendary leader moves on.(Journal News)
August 17, 2004... In December 2003 the BMJ published a devastating critique of clinical research in the form of a spoof article about a new research company called HARLOT Plc (How to Achieve positive Results without actually Lying to Overcome the Truth), which...

China connection.(Medical Publishing)
August 17, 2004... A Chinese cardiologist, researcher and medical school instructor is bringing the latest in English medical publishing to Jiujiang. Dr. Luo Yusheng (Louis), who teaches cardiology and internal medicine at Jiujiang Medical College and Hospital,...

Rodeo docs hope to lasso recognition.(Specialty Medicine)(rodeo physicians' conference)
August 17, 2004... Rodeo health professionals want their brand of medicine recognized, say organizers of the first international rodeo medicine conference. About 70 rodeo physicians and other health care professionals from across Western North America...

SARS vaccine undergoing animal testing.(Infectious Disease)(severe acute respiratory syndrome)
August 17, 2004... Canadian researchers have developed 2 potential SARS vaccines now undergoing animal testing. Both prototypes have produced antibody responses in animals, a first step toward the eventual development of a human vaccine, said Dr. Lorne...

Public health a top priority for new CMA president.(CMA President)(Canadian Medical Association)
August 17, 2004... Advocating for the restoration of federal funding and helping to ensure the new Ministry of Public Health is established are top priorities the CMA's new President, Dr. Albert Schumacher. The 45-year-old family physician from Windsor, Ont....

Disciplinary action pending after ED patient turned away.(Medical Legal)(Emergency Department)
August 17, 2004... The Quebec College of Physicians' disciplinary committee will soon hand down disciplinary action against Dr. Linda Cloutier, a Shawinigan-Sud general practitioner. The committee found Cloutier guilty in late June of not coming to a...

Adoption advice.(News @ a glance)
August 17, 2004... Adoption advice: Canadian physicians are being warned that the medical advice they provide to parents adopting children abroad may be accompanied by legal risk. Over the past decade nearly 20 000 children living overseas have been adopted by...

Saskatoon ER.(News @ a glance)
August 17, 2004... Saskatoon ER: A report prepared for the Saskatoon Health Region concludes that 1 patient may have died prematurely because of long delays to see an emergency physician, and 3 other cases were too poorly documented to rule out the possibility....

Smoking treaty.(News @ a glance)
August 17, 2004... Smoking treaty: Nearly 90% (167) of WHO-member states, including Canada, had signed the Framework Convention on Tobacco Control by the June 29 deadline. But the treaty won't come into force until at least 40 nations have ratified it. So far 21...

Manitoba pays.(News @ a glance)
August 17, 2004... Manitoba pays: Manitoba is now fully funding abortions at Jane's Clinic, the non-profit facility established in Winnipeg 2 decades ago by Dr. Henry Morgentaler (CMAJ 2004;171[1]: 25). After years of stormy debate, the Winnipeg Regional Health...

Uninsured Americans.(News @ a glance)
August 17, 2004... Uninsured Americans: The percentage of children in the US without health insurance dropped to the lowest level on record in 2003, according to a report by the US Centers for Disease Control and Prevention. The study, Health Insurance Coverage:...

Ovarian cancer screening.(Oncology)
August 17, 2004... Ovarian cancer is generally detected at an advanced stage and is associated with a 5-year survival rate of about 30%. However, survival rates of greater than 90% have been reported with stage I disease, thus fuelling efforts to determine the...

The patient with rhabdomyolysis: have you considered quail poisoning?(Teaching Case Report)
August 17, 2004... THE CASES Patient 1: A 62-year-old woman was admitted with nausea, vomiting, weakness and leg muscle pain. The symptoms had begun 7 hours after a meal of fresh roasted quail. She was not taking any medications, had no allergies to food or...

Rabies after solid organ transplantation.(Public Health)
August 17, 2004... Background and epidemiology: The US Centers for Disease Control and Prevention has confirmed that rabies was the cause of death in 3 transplant organ recipients (liver and kidneys) in whom encephalitis developed 3-4 weeks after transplantation....

Does perioperative lipid-lowering therapy reduce in-hospital mortality after major noncardiac surgery?(In The Literature)
August 17, 2004... Lindenauer PK, Pekow P, Wang K, Gutierrez B, Benjamin EM. Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery. JAMA 2004;291(17):2092-9. Background: Cardiovascular complications are an important source of...

An unusual cause of goitre and hypothyroidism.(Clinical Vistas)
August 17, 2004... A 54-year-old woman was referred to the endocrinology service for evaluation of thyromegaly detected incidentally on physical examination. She was asymptomatic at the time, but 48 months earlier she had been found to have estrogen/progesterone...

Effect of a topical diclofenac solution for relieving symptoms of primary osteoarthritis of the knee: a randomized controlled trial.(Research)
August 17, 2004... Abstract Background: Treatment of osteoarthritis with oral NSAID therapy provides pain relief but carries a substantial risk of adverse effects. Topical NSAID therapy offers an alternative to oral treatment, with the potential for a...

Family physician workloads and access to care in Winnipeg: 1991 to 2001.(Research)
August 17, 2004... Abstract Background: Current perceptions of family physician (FP) shortages in Canada have prompted policies to expand medical schools. Our objective was to assess how FP supply, workloads and access to care have changed over the past...

Maternal ethnicity and risk of neural tube defects: a population-based study.(Research)
August 17, 2004... Abstract Background: Maternal body mass and the presence of diabetes mellitus are probable risk factors for neural tube defects (NTDs). The association between maternal ethnicity and the risk of NTDs remains poorly understood, however. ...

Tips for learning and teaching evidence-based medicine: introduction to the series.(Commentary)
August 17, 2004... Medical educators have embraced evidence-based medicine (EBM) since its introduction as an innovative approach to medical practice and education in the early 1990s. (1,2) The Royal College of Physicians and Surgeons of Canada, the College of...

Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat.
August 17, 2004... Physicians, patients and policy-makers are influenced not only by the results of studies but also by how authors present the results. (1-4) Depending on which measures of effect authors choose, the impact of an intervention may appear very...

The resident condition.(The Resident Condition Staying Human During Residency Training)(Book Review)
August 17, 2004... The resident condition Staying human during residency training, third edition Allan D. Peterkin Toronto, Buffalo, London: University of Toronto Press; 2004 166 pp $16 ISBN 0-8020-81487 Not long ago I completed what for me was a pretty major...

For whom the bell tolls.(Room for a view)
August 17, 2004... It is a long drive to this small town, so we wait until there are enough new referrals to our geriatric psychiatry service to make the trip worthwhile. It has been six weeks since we were last here at the nursing home, and we have four new...

The eyes.(Room for a view)(psychiatric trauma care)
August 17, 2004... The husband and wife were brought in on a weekday morning. The smell was overwhelming. Despite their years of experience, the horror in the eyes of those around me--firefighters, paramedics, nurses, physicians --was striking. She was completely...

Looking death in the face.(Lifeworks)
August 17, 2004... Ah! Seigneur! donnez-moi la force et le courage De contempler mon coeur et mon corps sans degout. --Charles Baudelaire, Les Fleurs du mal (1857) Images of the dead have always been used in art to shock, horrify, sadden and awe....

Deaths.(Obituary)
August 17, 2004... Notice--CMAJ welcomes obituaries submitted within 60 days of a death. These should be no longer than 200 words, and colourful writing is encouraged. Send to barbara .sibbald@cma.ca; fax 613 565-2382. Derome, Leon, Montreal (Que.);...

Query.
August 17, 2004... Today I celebrate my own ineptness by paying tribute to the mentors who deserve better, the people who--no names--are not responsible for the sorry amalgam that is my knowledge, the desert of my skill set. Let no important informational bit be...

Nosocomial infections: what needs to be done?(Editorial)(Editorial)
August 31, 2004... Published at www.cmaj.ca on Aug. 4, 2004. "At the hospital the ambulance is unloaded and then thoroughly disinfected; the nurse changes her outer clothing, and all blankets are left at the hospital for washing.... Besides this disinfection...

Lead poisoning in children.(Letters)(Letter to the Editor)
August 31, 2004... The case history of lead poisoning presented by Pascal Lavoie and Benoit Bailey (1) illustrates the surreal state of political responses to this issue in Canada today. The authors assert that lead poisoning is now rare in Canada, (1) but...

Possible causes of cognitive decline.(Letters)(Letter to the Editor)
August 31, 2004... Two things came to mind from reading the report by Jessica Simon and associates, (1) which thoroughly documents the cause of cognitive decline, seizure and stroke in a 52-year-old man as a rare genetic variation. My questions are inspired in...

Genetics and insurance.(Letters)(Letter to the Editor)
August 31, 2004... I was pleased to read the commentary by Bartha Knoppers and Yann Joly (1) and the accompanying article by the Canadian Genetics and Life Insurance Task Force. (2) I agree that there is an urgent need to systematically address the issues of...

Correction.(Letters)(Correction Notice)
August 31, 2004... In an article about cervical cancer mortality in Canada by Edward Ng and associates, (1) the 3-year moving mortality averages were based on data obtained from the International Agency for Research on Cancer. The agency name was given...

Credentialing body needed for foreign-trained doctors.(Physician Supply)
August 31, 2004... Canada needs a US-style "national credentialing body" to assess the educational credentials of all foreign physicians and other health professionals seeking entrance to Canada, says the Medical Council of Canada. Dr. Dale Dauphinee, who...

C. difficile hits Sherbrooke, Que., hospital: 100 deaths.(Hospital Infections)(Clostridium difficile)
August 31, 2004... Published at www.cmaj.ca on Aug. 4, 2004. Doctors at a Sherbrooke, Que., hospital have lost 100 patients in the last 18 months to Clostridium difficile, the same infection that is dogging wards in Montreal and Calgary hospitals, CMAJ has...

Eleven million adults co-infected with AIDS, TB.(HIV/AIDS)(tuberculosis)
August 31, 2004... Eleven million adults are now estimated to be co-infected with HIV and tuberculosis, delegates to the recent 15th International AIDS Conference learned. Many of these people live in sub-Saharan Africa, where 70% of those suffering from...

Prairie First Nations groups planning 8 private MRI clinics.(Private Health Care)
August 31, 2004... At least 8 First Nations are considering establishing for-profit MRI clinics, through agreements with the Canadian Association of Radiologists (CAR). CAR Chief Executive Normand Laberge is talking with the bands through the Association of...

Independent inquiry needed into firing of whistleblowers.(Federal Secrecy)(Health Canada scientists)
August 31, 2004... A Manitoba senator is pressing Prime Minister Paul Martin for an independent inquiry into Health Canada's decision to fire 3 scientists who have publicly criticized the department's drug review policies. Shiv Chopra, Margaret Haydon and...

Cross-border malpractice coverage cancelled.(Medicolegal)
August 31, 2004... After more than a decade of warning members about the litigation risks of treating Americans, the Canadian Medical Protective Association (CMPA) will no longer cover doctors who willingly take them on. The association cites an "unstable"...