CMAJ: Canadian Medical Association Journal articles from January 2009

CMAJ: Canadian Medical Association Journal archives from January 2009

Medical errors, apologies and apology laws/Erreurs medicales, excuses et lois sur les excuses.(Editorial)
January 6, 2009... In everyday life when an error occurs, disclosure, apology and restitution are expected. In health care when a medical error occurs, disclosure and apology are often overridden by the fear of malpractice litigation. Full disclosure to the...

Facial swelling after a dental procedure.(Clinical images)(Case study)(Brief article)
January 6, 2009... [FIGURE 1 OMITTED] A 59-year-old woman experienced acute facial swelling about 1 hour after dental repair of a left lower molar cap. The repair had been performed under local anesthetic using a high-pressure drill in the periodontal space....

Doctors don't own medical knowledge.(Salon)
January 6, 2009... As the debate continues over whether a private-sector health care system should be implemented in Canada, I am left pondering a fundamental question: Who are the rightful owners of the vast compendium of medical knowledge: doctors or the...

Thiazolidinediones: do harms outweigh benefits?(Commentary)
January 6, 2009... There has been recent debate about the risks and benefits of the use of thiazolidinediones (rosiglitazone and pioglitazone) to treat diabetes. Similar to all other drugs used to treat diabetes, thiazolidinediones were approved by drug...

The controversy over the efficacy of pneumococcal vaccine.(Commentary)
January 6, 2009... In this issue of CMAJ, Huss and colleagues (1) report the results of their meta-analysis of the efficacy of pneumococcal polysaccharide vaccine in adults. By our reckoning, this is the twelfth of such meta-analyses, including the current...

Clinical trials: the muddled Canadian landscape.(News)
January 6, 2009... This overview of the landscape of Canadian clinical trials, along with a historical primer (page 23), is the first in a series of articles CMAJ will present this year on the state of clinical trials in Canada and abroad. Many believe the system...

Legumes, lemons and streptomycin: a short history of the clinical trial.(News)
January 6, 2009... The first documented experiment resembling a clinical trial was not conducted by a scientist or doctor, but by an ingenious military leader who dabbled in architecture and is perhaps best known for the 7 years he spent roaming the wilderness...

Physician allocation system in Quebec inhibits recruitment.(News)
January 6, 2009... A citizens' committee in southern Quebec is calling for a change to the way doctors are allocated within the province. "The doctor shortage in Brome-Missisquoi"--a county in the Eastern Townships, south of Montreal--"is one of the worst in...

Incremental change, rather than wholesale reform, expected from new US president Barack Obama.(News)
January 6, 2009... It is election day in Chicago, Illinois, and Harold Jackson, 63, sits on a park bench in Hyde Park--just a few minutes' walk from Barack Obama's home--surveying those who have shown up in swarms to cast their ballots. As the sun glints...

Ex-provincial health minister sees red.(News)
January 6, 2009... The rash is gone. The wrath, however, remains. Last fall, Jim Wilson, a former Ontario health minister, was asked to pay $125 to make an appointment with his dermatologist to deal with a persistent rash under his arm. The Conservative MPP...

Throne speech.(Briefly)(Brief article)
January 6, 2009... Throne Speech: Conservative Prime Minister Stephen Harper opened the 44th Parliament by vowing not to cut Canada Health Transfer payments to provinces in an attempt to constrain spending in a recession. "Our government will ensure that the...

Editor's competing interest.(Briefly)(Brief article)
January 6, 2009... Editor's competing interest: CMAJ Editor-in-chief, Dr. Paul Hebert, has taken a part-time role to lead the National Strategy on Patient-Oriented Research at the Canadian Institute of Health Research. The aim of this initiative is to set up a...

Somali symbiosis, part 3: how it affects me.(Dispatch from the medical front)(Column)
January 6, 2009... The first effect that I noticed is that my preconceived opinions softened. I began to take more factors into consideration. What I originally saw as "disarray" were often strategies that had enabled the town to survive. Complex and...

Arctic health research.(For the record)
January 6, 2009... Proposed research programs for Canada's ballyhooed arctic research initiative should include a major component on "individual and community health" within the indigenous populations of the North, says a blue-ribbon international panel. ...

Health spending.(For the record)(Brief article)
January 6, 2009... Pharmaceutical firms gobbled up a larger chunk of the Canadian health care dollar in 2008 as the growth rate for spending on drugs rose faster (8.3%) than it did for physicians (6.2%) and hospitals (5.8%), according to the Canadian Institute...

Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis.(Research)(Clinical report)
January 6, 2009... Recent systematic reviews have focused on the adverse cardiovascular effects of the thiazolidinediones rosiglitazone and pioglitazone. (1-5) In late 2006, the risk of fractures with the use of rosiglitazone was raised in a footnote of the...

Comparison of prognosis for men with type 2 diabetes mellitus and men with cardiovascular disease.(Research)(Clinical report)
January 6, 2009... In 1971, type 2 diabetes mellitus was already considered an epidemic, affecting more than 170 million people worldwide. (1) In 2001, it was estimated that diabetes prevalence would increase by nearly 50% by the year 2010. (1) Epidemiologic...

Efficacy of pneumococcal vaccination in adults: a meta-analysis.(Research)(Clinical report)
January 6, 2009... The burden of disease due to Streptococcus pneumoniae falls mainly on children, elderly people and people with underlying conditions such as HIV infection. (1) Pneumococcal polysaccharide vaccines were developed more than 50 years ago and have...

Acute monoarthritis: what is the cause of my patient's painful swollen joint?(Case study)
January 6, 2009... The case Early in the evening, a 50-year-old man presents to the emergency department with a 24-hour history of pain and swelling in his right knee. He denies recent injury or trauma. He has no prior history of joint disease or joint...

Making early childhood count.(Analysis)
January 6, 2009... A strong case has been built in support of the importance of early child development based on the "new neuroscience." (1-3) We now understand that health, emotional well-being and life success have their roots in early childhood. This has...

Painful swelling in the thigh: diabetic muscle infarction.(Teaching cases)(Case study)
January 6, 2009... The case: A 52-year-old woman was admitted with painful swelling in her left thigh. She had a 12-year history of type 2 diabetes mellitus and hypertension, and she was a smoker (40 pack-year smoking history). At her last examination, her...

Migratory pulmonary infiltrates.(What is your call?)(Case study)
January 6, 2009... [FIGURE 1 OMITTED] A 24-year-old man presented with severe anemia (hemoglobin 62 g/L). He had a 1-month history of dry cough, chest pain that was intermittent and pleuritic, and progressive breathlessness on exertion. The patient reported...

Use administrative databases with caution.(Letter to the editor)
January 6, 2009... There were 2 striking results in the article by Sandra Dial and colleagues: a sharp increase in the number of cases of community-acquired Clostridium difficile-associated diarrhea in 2003 and 2004 in Quebec and a low rate of antibiotic exposure...

Corrections.(Correction notice)
January 6, 2009... An article (1) in the November 18 issue contained 2 errors. First, in Table 3, the average annual percentage change in mortality for liver cancer should have been listed as a 2.2% increase. Second, text was omitted from the first and second...

Imagined lives.(Creative works)(Brief article)
January 6, 2009... Many historic photographic portraits have endured, but more often than not the narrative account of the portrayed person has been lost. John Wood, an award-winning poet and photographic historian, has melded 19th century photographs by O.G....

Syphiloderma Tuberculosum: Lady in a hat.(Humanities)(Poem)
January 6, 2009... Syphiloderma Tuberculosum: Lady in a hat The crescentic and circular arrangement of the lesions left no doubt as to the nature of the affection. There is scarcely a more unmistakable eruption figured in the whole series. Well,...

Syphiloderma ulcerativum perforans.(Humanities)(Poem)
January 6, 2009... Syphiloderma ulcerativum perforans Overwhelmed by her days, her neighbors' talk and her son's shame, she goes about her house as she has always done, doing the things that she has always done--the usual things women...

C.R., age 20, U.S.: acne.(Humanities)(Poem)
January 6, 2009... C.R., age 20, U.S.: acne The patient was of fair complexion, with a naturally delicate skin. A marked flushing of the face ensued upon mental excitement or slight external irritation. If you would understand this classic face, ...

Ellen Collins, age 37: skin graft.(Humanities)(Poem)
January 6, 2009... Ellen Collins was admitted to Bellevue Hospital, October 1871, for a burn from kerosene oil. After 5 months' treatment the wound assumed the appearance seen in the illustration. On March 10, 1872, I immersed an amputated leg in hot water and...

A note from the Humanities' editor.(Editorial)
January 6, 2009... You may have noticed that The Left Atrium has morphed, in this issue, into Humanities. The change in name highlights systemic changes throughout the section that are designed to make it a more accessible and pertinent source of inspiration,...

Achieving self-definition.(Book review)
January 6, 2009... The Lily Pond: A Memoir of Madness, Myth and Metamorphosis Mike Barnes Biblioasis; 2008.192 pp $19.95 [ILLUSTRATION OMITTED] Memoirs of madness are now part of a tradition: There's Andrew Solomon's overrated The Noonday Demon;...

Obama and the opportunity to eliminate nuclear weapons.(Editorial)
January 20, 2009... As US President Barack Obama assumes office on this historic day, we would like to remind him of his recent statement that "A world without nuclear weapons is profoundly in America's interest and the world's interest. It is our...

Are drug-eluting stents safe in the long term?(Commentary)(Clinical report)
January 20, 2009... The use of drug-eluting stents has become widespread globally. However, in the last 2 years concerns have been raised regarding their long-term safety. (1,2) Recent registry studies and meta-analyses seem to have provided reassuring results...

Defining and disseminating the hospital-at-home model.(Commentary)
January 20, 2009... The hospital, which is the "gold standard" for the delivery of acute medical care, is not an ideal care environment for many patients. (1) Iatrogenic events such as nosocomial infections, pressure sores, falls and delirium are common. (2) New...

Doctors crossing borders: Europe's new reality.(News)
January 20, 2009... Freedom of movement is one of the European Union's greatest promises and, increasingly, doctors and patients are making liberal use of that freedom. In the United Kingdom, for example, the General Medical Council reports that 2205 Polish...

Colour-coded wristbands confusing.(News)
January 20, 2009... Think of them as a form of hospital shorthand. Commonly used in American hospitals to instantly communicate conditions of patient care, colour-coded hospital wristbands were becoming the norm to signify allergies or do-not-resuscitate orders....

Alternative isotope sources.(For the record)
January 20, 2009... Accelerator-driven photo-fission could be used to generate molybdenum-99 to meet medical demand in Canada and abroad, concluded a task force struck to explore alternatives to medical-isotope production following controversies surrounding the...

Lack of competition.(For the record)(Brief article)
January 20, 2009... Public drug plans, businesses and individual payers could reap savings of up to $800 million a year if there were more competition in the sale of generic drugs, according to a federal Competition Bureau report. The bulk of potential...

Midwest medicinal marijuana.(For the record)(Brief article)
January 20, 2009... The state of Michigan has become the 14th in the United States, and the first in the American Midwest, to approve the use of marijuana for registered patients with debilitating medical conditions. The proposition allows for medicinal...

Bamako call to action.(For the record)(Conference news)(Brief article)
January 20, 2009... National governments have been urged to allocate 2% of the budgets of their health ministries to research under a "call to action" issued by the Global Ministerial Forum on Research for Health held in Bamako, Mali, from Nov. 17-19, 2008. ...

Detailing.(prescription data rule)(Brief article)
January 20, 2009... The United States Court of Appeals for the First Circuit has upheld the rights of states to prohibit the sale of computerized data showing which doctors prescribe what drugs. The purchase of such prescription data, based on information gathered...

Denial.(Brief article)
January 20, 2009... Ousted South Africa President Thabo Mbeki's refusal to acknowledge the viral cause of AIDS and the usefulness of antiretroviral drugs in treating the disease caused the premature deaths of more than 330 000 people between 2000-2005, according...

Death with dignity.(assisted-suicide law )(Brief article)
January 20, 2009... The state of Washington will become the second American jurisdiction to adopt an assisted-suicide law after approving a ballot proposition (by a 59% to 41% margin) known as Initiative 1000, which permits terminally ill, competent adults who are...

Aboriginal curriculum.
January 20, 2009... The Association of Faculties of Medicine of Canada and Indigenous Physicians Association of Canada have unveiled a new Aboriginal health curriculum framework for medical schools (CMAJ 2008;178 [13]:1650) that familiarizes physicians with the...

Awards.(Brief article)
January 20, 2009... University of Ottawa professor of medicine Dr. Peter Tugwell has been named recipient of the prestigious Canadian Institutes of Health Research Michael Smith Prize as Canada's 2008 Health Researcher of the Year for Health Services and Systems...

Perfect predilections.(News)(Family medicine)(Viewpoint essay)
January 20, 2009... There's a glint in her eyes as she talks about the appeal of family practice--daily diversity, pedagogical and international doors opened, and, of course, the opportunity to occasionally perform a bit of surgery. "That is what I love about...

Research foundations tight-lipped about investment losses.(News)(Financial report)
January 20, 2009... Fears that the ongoing international financial crisis may mean tougher grant competitions at health research agencies and foundations this year may be unwarranted as officials at several organizations say they're weathering the market turmoil...

Irish eyes smiling as dispensing fees are lifted.(News)
January 20, 2009... Canadians have long envied the United Kingdom's national pharmaceutical program, which covers about 95% of all drugs--all but a notorious "black list" of about 3000 drugs--and typically leaves patients on the hook only for dispensing fees. ...

Hard hearts and horse-drawn carts.(Dispatch from the medical front)(Viewpoint essay)
January 20, 2009... The signs are what first caught my attention: "Welcome to Chesley --Population: 5000. Don't park here--Horse Drawn Carts only." I am in Chesley, Ontario, for Discovery Week--a program organized by the medical school at The University of...

Long-term outcomes of patients receiving drug-eluting stents.(Research)(Clinical report)
January 20, 2009... Drug-eluting stents now comprise at least 85% of stents used in the United States and up to 40% or more of stents elsewhere. The overwhelming worldwide use of drug-eluting stents has, however, been tempered by the cost differential to...

Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data.(Research)
January 20, 2009... In many countries, programs in which hospital care is provided in the patient's own home continue to be a popular response to the increasing demand for acute care hospital beds. Patients who received care through such programs, after assessment...

The safety of aprotinin and lysine-derived antifibrinolytic drugs in cardiac surgery: a meta-analysis.(Research)(Report)
January 20, 2009... Antifibrinolytic drugs, such as the bovine-derived polypeptide aprotinin, have been used to minimize blood loss during cardiac surgery for many years. (1) Meta-analyses of randomized controlled trials have shown convincing and consistent...

Hepatitis B immunization strategies: timing is everything.(Population and public health)(Report)
January 20, 2009... Since the launch of the first universal vaccination program against hepatitis B virus (HBV) in Taiwan in 1984, there has been ongoing research and debate about the most appropriate vaccination schedule. Vaccine advisory bodies continue to...

A patient with loss of vision in the right eye and neurofibromatosis type 1.(Teaching cases)(Case study)
January 20, 2009... Case: A 75-year-old man with long-standing neurofibromatosis type 1 was admitted because the vision in his right eye had decreased progressively over 3 months. Physical examination showed disseminated cutaneous and subcutaneous neurofibromas of...

Information exchange between provider and patient.(Letters)(Letter to the editor)
January 20, 2009... Carl van Walraven and colleagues recently presented a timely article about the information gaps that impede continuity of care for Canadian patients. (1) Both the article and the accompanying commentary (2) discussed the potential of electronic...

Mental health from the inside.(Letters)(Letter to the editor)
January 20, 2009... Deirdre Maultsaid's poem (1) struck a warm chord within me, despite its icy cold message. It reminded me of a poem by Sylvia Plath entitled Tulips, (2) which provides an impression of mental health from the inside. Plath's clear, vivid and...

Correction.(Letters)(Correction notice)
January 20, 2009... A recent News article (1) featured a photograph with a misleading caption. Although at least 1 advocacy group estimates that 90 Canadians die annually from drinking contaminated water, experts, including Steve Hrudey, say that this figure is...

Quieten your inner critic.(Viewpoint essay)
January 20, 2009... [ILLUSTRATION OMITTED] There wasn't a medical humanities program at the university I attended in the 1970s, but I wish there had been. It might have prevented me from burning out in family practice--a growing problem among physicians. (1)...

Diabetic Neuropathy.(Creative works)(Poem)
January 20, 2009... Diabetic Neuropathy Today I traced my foot with a pencil, Took a second made my toes feel bold, essential again. So good, legs straight as pencils on 3-holed lines Everything lame, white, wrinkled ...

From high-flying hero to eugenics advocate.(The Immortalists: Charles Lindbergh, Dr. Alexis Carrel, and Their Daring Quest to Live Forever )(Book review)
January 20, 2009... The Immortalists: Charles Lindbergh, Dr. Alexis Carrel, and Their Daring Quest to Live Forever David M. Friedman Ecco/HarperCollins Publishers; 2007. 338 pp $26.95 [ILLUSTRATION OMITTED] I will never forget how...

The holy trinity of Canadian health policy.(Exploring Social Insurance: Can a Dose of Europe Cure Canadian Health Care Finance?)(Book review)
January 20, 2009... Exploring Social Insurance: Can a Dose of Europe Cure Canadian Health Care Finance? Colleen M. Flood, Mark Stabile and Carolyn Hughes Tuohy, Eds. McGill-Queen's University Press; 2008. 290 pp $34.95 [ILLUSTRATION...

Discoloration of skin and urine after treatment with hydroxocobalamin for cyanide poisoning.(Case study)
January 20, 2009... [ILLUSTRATION OMITTED] A 54-year-old woman was brought to hospital from an apartment fire. She had altered mental status, hypotension and evidence of inhalational injury, but no burns. Her carboxyhemoglobin level was 29%, and her lactate...

The overnight smackdown: avoiding on-call arguments.(Salon)
January 20, 2009... Andy, the general surgery resident on-call, has had an exhausting night. His head finally touches the pillow at 4 am. At 4:10 am he's paged. When he returns the page, it is clear from his tone of voice that he's annoyed. It's Mark, the senior...