CMAJ: Canadian Medical Association Journal articles from July 2008

CMAJ: Canadian Medical Association Journal archives from July 2008

Kaposi sarcoma of the lung.(Clinical Images)(Case study)
July 1, 2008... [FIGURE 1 OMITTED] A 33-year-old HIV-positive man with a history of immune thrombocytopenia presented with a 1-week history of hemoptysis. He had a Pneumocystis jirovecii pneumonia 1 year before, and he had been receiving highly active...

Numbers are nice, but stories matter.(Salon)(Report)
July 1, 2008... The media love a good story and the most important characteristic of a good story is bad news. Doctors at the Hospital for Sick Children in Toronto, Ontario, demonstrated this truth in 1991 with an elegantly simple study. (1) The doctors...

Analgesia for skin-breaking procedures in newborns and children: what works best?(Commentary)(Report)
July 1, 2008... Healthy newborns routinely experience acute pain during blood sampling for metabolic screening, injection of vitamin K or hepatitis vaccine, or circumcision. Children are similarly exposed to acute pain due to vaccination, invasive procedures...

The use of highly active retroviral therapy to reduce HIV incidence at the population level.(Medicine and society)(Report)
July 1, 2008... In this article, we will argue that the widespread use of highly active antiretroviral therapy has the potential to reduce the incidence of HIV at the individual and population level (Table 1). However, this approach has been overlooked by...

Public engagement in setting priorities in health care.(Medicine and society)(Report)
July 1, 2008... Setting priorities in health care means allocating limited resources so that some programs are supported and others are not (Box 1). For more than a decade, patients, scholars and government reports have asserted that the public should have...

The gambling take: balancing revenues and responsibilities.(News)(Report)
July 1, 2008... People who frequent casinos are likely familiar with an old gambling adage: you can't beat the house. There is, however, a way to profit handsomely from gambling without beating the house--by running the house. Government-operated gaming...

Do slot machines play mind games with gamblers?(News)(Report)
July 1, 2008... The room is abuzz with beeps, bells and flashing lights. Well-dressed men and women wander about, pushing buttons and pulling levers, watching cherries and sevens spin on liquid crystal displays. But these men and women aren't here for fun....

Take the highway.(For the record)
July 1, 2008... First, there was the "third way." And now, it seems, there is but one way. Odd though it seems to see the Alberta government waving the banner of central planning, Health Minister Ron Liepert has launched Wild Rose country's most recent foray...

Spawning satellites.(News)(Brief article)
July 1, 2008... Advocates are hoping that a chronic shortage of physicians in the Outaouais region of Quebec, will be relieved by a new satellite medical school. The partnership between McGill University's Faculty of Medicine, in Montreal, Quebec, and...

Buying time.(News)(Brief article)
July 1, 2008... The Vancouver-based InSite safe injection site has become even more deeply embroiled in the miasma of ideology and politics after the federal government announced it will appeal a May 27, 2008, British Columbia Supreme Court ruling that the...

Highly lauded drug assessment program under attack.(News)
July 1, 2008... International experts are condemning a British Columbia report's recommendation that an independent prescription drug watchdog based at the University of British Columbia be dismantled. The 14-year-old Therapeutics Initiative "is the only...

Immigrant workers flood training program.(News)
July 1, 2008... Faced with a growing shortage of medical professionals, the Alberta government is spending $1.4 million over 3 years on groundbreaking programs designed to get more foreign-trained workers into the health care system. The Bredin Centre in...

Breast cancer rises in India.(News)(Brief article)(Clinical report)
July 1, 2008... India faces a potential breast cancer epidemic over the next decade as women adopt Western lifestyles by marrying and bearing children later in life, oncology experts say. With women nursing fewer children and weaning them earlier,...

Pens, mugs, clocks, notepads and other handouts: "clean sweep" initiative ships industry goodies to the Cameroon.(News)(medical ethics guidelines banned staff from accepting gifts from drug companies or using items adorned with their logos)
July 1, 2008... Earlier this year, a Minnesota-based operator of hospitals and clinics collected 20 shopping carts of drug company trinkets and shipped them to the west African nation of Cameroon. The idea for the roundup emanated from SMDC Health System's own...

MRI study.(Brief article)
July 1, 2008... MRI study: Great Britain's Health Protection Agency has announced that it will undertake a major epidemiological study on adverse health effects from high static field Magnetic Resonance Imaging machines, particularly with regard to the impact...

Diagnostically elusive.(disease management)(Disease/Disorder overview)(Brief article)
July 1, 2008... Diagnostically elusive: The US National Institutes of Health has unveiled a pilot clinical research project aimed at improved disease management for patients with "mysterious conditions that have long eluded diagnosis." The pilot will take 100...

Second look.(Alberta Cancer Board)(Report)
July 1, 2008... Second look: The Alberta Cancer Board says it will re-examine its 2006 study which concluded there isn't a higher incidence of blood, colon, bile-duct and liver cancers in Fort Chipewyan, a small community downstream from Alberta's oilsands...

Play the odds.(Brief article)
July 1, 2008... Play the odds: A 37-member task force initiated by the American College of Chest Physicians has recommended an algorithm for rationing care in the event of a flu pandemic or natural disaster (Chest 2008;133:1S-7S). It urges that in cases where...

Website launch.(Brief article)
July 1, 2008... Website launch: Medecins Sans Frontieres has launched a free website compiling research based on the work of its volunteer physicians. The website (www .fieldresearch.msf.org) has more than 350 articles, many previously published in...

Recruiting.(Brief article)
July 1, 2008... Recruiting: The Global Health Workforce Alliance has unveiled guidelines for providing incentives for the retention and recruitment of health professionals (www.who.int). The wide-ranging guidelines cover such financial incentives as tax...

Home wanted.(Brief article)
July 1, 2008... Home wanted: The New Brunswick government is hoping a private sector donor will step forward to fund a building for the medical school the province has pledged to establish. The launch of the new medical program, originally scheduled for 2007,...

Six days in the delta.(Dispatch from the medical front)
July 1, 2008... It is 5 am, Tuesday, May 7, 2008. We are approaching Heyngyi, our destination in the Delta region, struck 3 days earlier by a deadly cyclone. It is slowly getting light and along the banks we see looming skeletons. Tree skeletons. They are bent...

The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial.(Research)
July 1, 2008... Abstract Background: Established noninvasive pharmacologic means of alleviating pain and anxiety in children undergoing intravenous cannulation are time-consuming, and thus impractical for routine use in the emergency department....

Effectiveness of sucrose analgesia in newborns undergoing painful medical procedures.(Research)
July 1, 2008... Abstract Background: Sucrose is widely used to manage procedural pain in term newborns despite a lack of evidence of its effectiveness for different procedures and infant populations. Our objectives were to evaluate the effectiveness and...

Protecting global health security through the International Health Regulations: requirements and challenges.(Analysis)
July 1, 2008... The International Health Regulations, the principle document governing the response to public health emergencies that pose an international threat, were revised in 2005 and became binding international law on June 15, 2007. (1) These new...

Nonrotation of the intestine.(Clinical vistas)(Case study)
July 1, 2008... A 20-year-old man presented to our department with complaints of abdominal pain over his epigastrium and around his umbilicus that had lasted for several years. He reported vomiting for 2 hours after each meal in the 2 days before presentation....

Pruritic, serpiginous eruption in a returning traveller.(What is your call?)(Case study)
July 1, 2008... A 28-year-old woman presented with a pruritic, erythematous and serpiginous eruption on her lower back that appeared 1 week after returning from travel in Thailand (Figure 1). The results of laboratory tests (complete blood count, renal and...

Use of Doppler ultrasonography to predict pre-eclampsia.(Letters)(Letter to the editor)
July 1, 2008... We enjoyed Jeltsje Cnossen and colleagues' systematic review of the use of uterine artery Doppler ultrasonography to predict pre-eclampsia. (1) They concluded that an increased pulsatility index with notching during the second trimester is the...

Electronic medical records.(Letters)(Letter to the editor)
July 1, 2008... We wish to comment on the editorial about electronic medical records. (1) Adoption of electronic health records has been slow in Canada. In some provinces fewer than 30% of medical practices use an electronic health record as their primary...

Medical isotope production and nuclear terrorism.(Letters)(Letter to the editor)
July 1, 2008... Two recent CMAJ news articles gave good insights into last December's medical isotope crisis. (1,2) It was inspiring to read how our colleagues in nuclear medicine coped with the interruption in the isotope supply. It may not be widely...

Safe drinking water for rural Canadians.(Letters)(Letter to the editor)
July 1, 2008... In a recent CMAJ editorial, Steve Hrudey correctly stated that Canadian water quality is a rural versus urban issue. (1) Canadian cities have some of the best-quality sources of raw water in the world and the financial and technical resources...

Faith and the end of life.(Letters)(Letter to the editor)
July 1, 2008... The recent CMAJ editorial about the problems associated with ending life support against the wishes of the patient's family was a pleasure to read. (1) However, a few key issues were not addressed. First, Samuel Golubchuk was an orthodox...

Prehospital and in-hospital advanced life-support.(Letters)(Letter to the editor)
July 1, 2008... The recent article by Ian Stiell and colleagues on prehospital care was excellent. (1) However, as we question the value of prehospital advanced life-support we also need to determine whether in-hospital emergency advanced life-support makes a...

Corrections.(Letters)(Correction notice)
July 1, 2008... In the Practice article "Toward a more effective approach to stroke: Canadian Best Practice Recommendations for Stroke Care," (1) the URL in the footnote of Box 1 should have been included as www.canadianstrokestrategy.ca. REFERENCE ...

Honouring the dead.(Book review)
July 1, 2008... A Doctor's Calling: a matter of conscience Hazel J. Magnussen RN BScN Wembley Publishing: 2006 182 pp $26.95 ISBN 0-9739843-0-9 [ILLUSTRATION OMITTED] Medicine has taken to heart the need to take care of its own. Most...

Skeptic's delight.(Book review)
July 1, 2008... The ABCs of Disease Mongering: An Epidemic in 26 Letters Alan Cassels Emdash Book Publishing; 2007 116 pp $9.95 ISBN 978-0-9780182-3-8 [ILLUSTRATION OMITTED] The Greek philosopher Zeno once convincingly proved that motion...

Hospital design: form and function.(Book review)
July 1, 2008... Medicine by Design: The Architect and the Modern Hospital, 1893-1943 Annmarie Adams University of Minnesota Press; 2008 169 pp $27.50 ISBN 978-0-8166-5114-6 [ILLUSTRATION OMITTED] Medicine by Design: The Architect and the...

Moments of insight.(Book review)
July 1, 2008... Selected Portraits Ron Charach MD Wolsak and Wynn Publishers Limited; 2007 128 pp $17 ISBN 978-1-894987-20-2 [ILLUSTRATION OMITTED] In his Selected Portraits, Dr. Ron Charach presents a reprise of his poetic...

A legislative failure of epidemic proportions/Un echec legislatif de proportions epidemiques.(Editorial)
July 1, 2008... Thrice in a decade--in 1999, 2002 and now in 2008--the Auditor General of Canada has slammed Ottawa and the provinces for doing an indolent job of protecting Canadians from epidemic emergencies. And thrice in a decade, she has been ignored. ...

Direct-to-consumer advertising: end the compromise/La publicite directe au consommateur : fini les compromis.(Editorial)(Editorial)
July 15, 2008... Despite federal regulations forbidding direct-to-consumer advertising for drugs and medical devices, it has become commonplace in Canada. From the pages of People, Ladies' Home Journal, Redbook and other US-based publications, you can glean how...

The missing link in tobacco control.(Commentary)
July 15, 2008... Smoking is the single most preventable cause of death and disability. The World Health Organization estimates that, around the globe, 1.3 billion smokers purchase 10 million cigarettes every minute, and that every 8 seconds somebody dies from a...

Canada lags in standardized protocols for medical labs.(News)
July 15, 2008... A spate of high-profile scandals involving shoddy laboratory medicine across the nation may serve as a wake-up call for governments and the medical profession to restore and enhance a critical but overlooked link in Canada's health care system....

Gambling treatment options: a roll of the dice.(News)
July 15, 2008... People end up in Mike Lynch's office for many reasons. Some have money problems. Others are suffering mood swings, or are neglecting their jobs and families. In rare cases, police send people arrested for theft Lynch's way. Their stories vary,...

The 15% ruling.(Briefly)(Brief article)
July 15, 2008... The 15% ruling: Taser International Inc. suffered its first product liability suit loss in roughly 70 instances after a California district court ruled that it was 15% responsible in the death of a 40-year-old drug suspect who died after...

Organ removal ambulance.(Briefly)(Brief article)
July 15, 2008... Organ removal ambulance: In a bid to boost organ supply, New York City, New York, says it will deploy a special ambulance later this year to collect the bodies of people who die from heart attacks, accidents and other emergencies. Organizers...

Public-private health care delivery becoming the norm in Sweden.(News)
July 15, 2008... At first glance, the Sabbatsbergs Narsjukhus Hospital in central Stockholm is indistinguishable from the medical centres that together form the front line of Sweden's vaunted health care system. Its facilities, offering specialized services...

Open doors.(For the record)(Brief article)
July 15, 2008... Fast-tracking the licensing of doctors already certified in the United States or other countries that have practice and education standards equivalent to those of Ontario, and modifying the transitional licensing system to ease entry for...

FDA goes global.(For the record)(United States. Food and Drug Administration)(Brief article)
July 15, 2008... The US Food and Drug Administration (FDA) is proposing to establish inspection offices in 5 regions of the developing world to enhance its capacity to monitor the safety of drugs, food and medical devices being exported to America. The...

Secret shame.(News)(artificial food dyes)(Brief article)
July 15, 2008... Calling artificial food dyes the "secret shame" of the food industry and regulators, the non-profit Centre for Science in the Public Interest has formally petitioned the US Food and Drug Administration to ban Yellow 5, Red 50 and 6 other...

The verdict's in: citizens are the solution.(News)
July 15, 2008... They've become a virtual staple of the health reporter's repertoire: heart-wrenching stories about innocent people on death watch because they simply can't afford the exorbitant cost of the pharmaceutical solution to their ailments. The...

Congo ceasefire brings little relief for women.(News)
July 15, 2008... Sexual terrorism. It's the only way to describe what is happening to women in the Democratic Republic of Congo, according to doctors at Panzi Hospital in the eastern province of South Kivu. "If you combine HIV and sexual violence in Eastern...

Darfur: arrival.(Dispatch from the medical front)
July 15, 2008... Two days into my mission with Medecins Sans Frontieres (MSF) and it is clear that my body's Dutch constitution is not yet acclimated to the country of Sudan. The never-ending heat (40 degrees Celsius) reminds me of a hair dryer. There is no...

Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials.(Research)(Clinical report)
July 15, 2008... ABSTRACT Background: Many placebo-controlled trials have demonstrated the efficacy of individual pharmacotherapies approved for smoking cessation. However, few direct or indirect comparisons of such interventions have been conducted. We...

Intentions of smokers to use free nicotine replacement therapy.(Research letter)(Report)
July 15, 2008... ABSTRACT Public health initiatives to distribute nicotine replacement therapy free of charge as a means of promoting smoking cessation are ongoing. Are there enough smokers interested in using nicotine replacement therapy to have a...

Quality of indoor residential air and health.
July 15, 2008... ABSTRACT About 90% of our time is spent indoors where we are exposed to chemical and biological contaminants and possibly to carcinogens. These agents may influence the risk of developing nonspecific respiratory and neurologic symptoms,...

Hospital mortality: when failure is not a good measure of success.(Analysis)
July 15, 2008... Mortality for specific conditions and procedures has figured prominently among outcomes-based performance measures. (1-3) However, in recent years there has been renewed interest in overall hospital mortality, specifically the hospital...

Caterpillar-induced bleeding syndrome in a returning traveller.(Teaching cases)(Case study)
July 15, 2008... The case: A 22-year-old woman who was previously healthy presented with a 4-day history of expanding ecchymoses. She had no other bleeding manifestations and denied any constitutional symptoms, myalgias, arthralgias or rashes. Her medical...

Watermelon stomach.(Clinical images)(Case study)
July 15, 2008... [FIGURE 1 OMITTED] [FIGURE 2 OMITTED] A 65-year-old man with diffuse systemic sclerosis presented with severe anemia (hemoglobin 50 g/L) and heme in his stool. He had been taking 30 mg of lansoprazole daily for 5 months for symptomatic...

Disease surveillance.(Letters)(Letter to the editor)
July 15, 2008... I read the June 13 editorial in CMAJ (1) on infectious disease surveillance and felt compelled to respond to its conclusions about our country's ability to deal with infectious disease outbreaks and an influenza pandemic. Disease...

Distressing news on the Therapeutics Initiative.(Letters)(Letter to the editor)
July 15, 2008... It was deeply distressing to read Ann Silversides' report on the Therapeutics Initiative and discover that the British Columbia minister of health is yielding to pressures from the pharmaceutical industry and "other vested interest groups" to...

Dangers for children in the care of drug users.(Letters)(Letter to the editor)
July 15, 2008... I commend Jane Buxton and Naomi Dove for their brief summary of an important public health issue, crystal methamphetamine (crystal meth) use. (1) Unfortunately, the authors did not mention a very important concern associated with the use and...

Missed opportunity.(Letters)(Letter to the editor)
July 15, 2008... With the retinal photograph on the cover of a recent issue of CMAJ (May 20) you missed a superb opportunity to point out the many abnormal features in this image and to educate physicians on the value of a careful examination of the eye. One of...

Monsters of scientific reason.(Lifeworks)
July 15, 2008... The 1930s: The Making of the "New Man" Curator: Jean Clair National Gallery of Canada June 6-Sept. 7, 2008 Goya was only half right. His famous etching, The Sleep of Reason Produces Monsters showed a man slumped over in sleep...

Guidance for the family, friends and caregivers of patients with brain injuries.(Room for a view)
July 15, 2008... What happens to an already hyperactive mind, when the brain receives an injury? Interestingly, rather than slowing down, it becomes even more hyperactive "Elizabeth! Stop the train, I wanna get off," she yelled. "What are you talking...

Quarantine lessons from islands to airports.(Book review)
July 15, 2008... Quarantine: What is Old is New Halifax and the Lawlor's Island Quarantine Station: 1866-1938 Ian Arthur Cameron MD New World Publishing; 2007 206 pp $19.95 ISBN 13 978-1-895814-34-7 [ILLUSTRATION OMITTED] This...

Osler quotes redux.(Brief article)(Book review)
July 15, 2008... The Quotable Osler Deluxe Edition Mark E. Silverman, T. Jock Murray, Charles S. Bryan, editors; $89.95 This deluxe release of the 2003 paperback "repository of Oslerian sound bites" (CMAJ 2003;168:745-6), at twice the price, is...

Gallstone ileus.(Clinical images)(Case study)
July 15, 2008... [FIGURE 1 OMITTED] An 80-year-old man presented to the emergency department with a 1-day history of nausea, vomiting and epigastric pain. He reported having similar but milder episodes of abdominal pain in the past. The patient had no...

Thin police.(Salon)(young woman starving herself in the name of beauty is indicative of a societal problem)
July 15, 2008... Is it possible to legislate an aesthetic? This is the question that countries are beginning to ask as they wage an ongoing battle to promote healthy body weight and discourage eating disorders like anorexia and bulimia. In April 2008,...

Frying up hospital cafeteria food/La friture dans les cafeterias d'hopital.(Editorial)
July 29, 2008... Would you like fries with that angioplasty?" Sadly, this is not as far fetched as you might imagine. Although hospitals are the front line for delivering medical treatment, health promotion and education, paradoxically, the foods they sell are...

Diabetes during and after pregnancy: screen more, monitor better.(Commentary)
July 29, 2008... Key points * The prevalence of gestational diabetes is increasing, and the time from occurrence to progression to permanent diabetes appears to be shortening. * Current evidence supports intensive lifestyle intervention for women with...

A higher international normalized ratio may be better for your patient.(Commentary)
July 29, 2008... Key points * The purpose of anticoagulant therapy is to reduce the risk of thrombosis with the lowest possible risk of bleeding. * Slowly increasing the dose of vitamin K antagonists should be reconsidered, since the risk of adverse...

Gold medals, vitamin V and miscreant sports.(News)
July 29, 2008... It's all but become an unofficial Olympic sport: garnering gold by eluding doping authorities. Ever-craftier miscreants dabble in performance-boosting pharmaceuticals one step ahead of testing capabilities, leaving viewers to marvel at freakish...

Medical Team Canada: bouncing to Beijing in aid of the medal haul.(News)
July 29, 2008... When Canadian athletes arrive in Beijing to compete in the upcoming Summer Olympics, it will not necessarily be pulled hamstrings, broken bones or other traditional ailments that keep Team Canada's medical staff up at night. Instead, their...

Cost recovery trumps concerns about conflicted interest.(News)
July 29, 2008... Although there's widespread variation in the policies that Canadian medical schools have toward pharmaceutical and medical devices industry handouts for medical education and in some cases, seemingly no policies at all, administrators say there...

Ranking solutions to global problems.(News)
July 29, 2008... What do you get when you ask 8 economists, including 5 Nobel Prize winners, to rank solutions to 10 global problems, if they had $75 billion at their disposal? Eight different lists? Not according to Bjorn Lomborg, a Danish business...

Public health primer.(For the record)(Report)
July 29, 2008... Canada's first annual report on the state of public health raised nary a political ripple as Chief Public Health Officer of Canada Dr. David Butler-Jones sketched the socioeconomic factors that underlie inequalities in health status among...

Pharma R&D spending remains in doldrums.(News)(Brief article)
July 29, 2008... Pharmaceutical industry spending on research & development (R&D) in Canada continues to lag well below the 10% of sales level promised when drug patent protection was extended in 1987, while Canadian spending on patented drugs rose 3% to $12.3...

Medical tourism.(Brief article)
July 29, 2008... Medical tourism: With US health insurance providers and employers now urging people to seek cheaper medical care abroad, the American Medical Association has adopted guidelines for medical tourism. At their core lie the propositions that care...

Checklist.(Brief article)
July 29, 2008... Checklist: Mark the surgical site. Count the implements and sponges. The basics are in a 1-page "Surgical Safety Checklist" (www.who.int) unveiled by the World Health Organization in a bid to prevent complications and deaths during surgery. The...

Online auctions.(Brief article)
July 29, 2008... Online auctions: American hospitals have begun using online auctions to sell their patients' debts or accept guaranteed payments for access to unpaid accounts by collection agencies. Thus far, the online auctions (run by ARxChange.com and...

Obstetric trends.(Brief article)
July 29, 2008... Obstetric trends: With 26.3% of children now being born in Canada by cesarean section, the Society of Obstetricians and Gynaecologists of Canada is urging physicians to scale back recommending the operation out of convenience, instead of...

Darfur: Christmas.(Dispatch from the medical front)(Column)
July 29, 2008... It is 4 weeks into my mission with Medecins Sans Frontieres (MSF) and I am in the rebel-held village of Feina in the mountains of South Darfur. But there is little fighting here and it is a relatively safe place to work. I arrived by...

Risk of development of diabetes mellitus after diagnosis of gestational diabetes.(Research)(Clinical report)
July 29, 2008... ABSTRACT Background: It is generally appreciated that gestational diabetes is a risk factor for type 2 diabetes. However, the precise relation between these 2 conditions remains unknown. We sought to determine the incidence of diabetes...

Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis.(Research)
July 29, 2008... ABSTRACT Background: Patients taking oral anticoagulant therapy balance the risks of hemorrhage and thromboembolism. We sought to determine the association between anticoagulation intensity and the risk of hemorrhagic and thromboembolic...