CMAJ: Canadian Medical Association Journal articles from March 2009

CMAJ: Canadian Medical Association Journal archives from March 2009

The budget's message to medical science: quick! Get a shovel!/ Message que le budget fait passer a la science medicale : vite! Une pelle!(Editorial)
March 3, 2009... The fiscal stimulus package released by the Canadian government and supported by the official opposition is an attempt to resuscitate a critically ill economy. It is largely calculated to defend jobs, through "shovel-ready" infrastructure...

Should strategies for care of avalanche victims change?(Commentary)
March 3, 2009... In an average year, avalanches result in the death of 146 people in North America and Europe. (1) In the European alpine countries (Austria, France, Germany, Italy, Slovenia and Switzerland), there has been no major change over time in...

Drug-facilitated sexual assault.(Commentary)
March 3, 2009... The contribution of alcohol and other drugs to sexual assault has been increasingly recognized during the last 15-20 years. This phenomenon has various names, including drug-facilitated sexual assault, drug-and-alcohol facilitated rape, and...

Federal fiscal blueprint dodges health concerns.(News)
March 3, 2009... The rhetoric seemed as rushed as the economic plan. Kickstart. Quick fix. Immediate action. Even, enabling quick protective action. Some such form of hasty wording could be found on virtually every page of Finance Minister Jim Flaherty's...

Clinical trial participation poses ethical, practical issues.(News)
March 3, 2009... It could be called one of the dark and enduring secrets of modern practice. Several physicians say, on condition of absolute anonymity, that they earn tens of thousands of dollars annually by recruiting patients for clinical trials. One...

Academy pitches new approach for evaluating research investments.(News)
March 3, 2009... With accountability having become the latest bureaucratic and political buzzword in Ottawa, research agencies are under increasing pressure to develop measures to ensure that tax dollars are spent wisely, while simultaneously demonstrating the...

Federal listeriosis investigation has limited mandate.(News)(Stephen Harper )
March 3, 2009... Prime Minister Stephen Harper has appointed the former president of the Edmonton Health Authority to investigate last year's listeriosis outbreak, but she will not be able to subpoena witnesses or compel testimony. Sheila Weatherill will...

New clinical guidelines say misconceptions have surrounded hormone therapy.(News)(Report)
March 3, 2009... Hormone therapy is a safe, effective short-term treatment for women at the outset of menopause, and doctors should no longer be afraid to prescribe it, say Canada's obstetricians and gynecologists. The Society of Obstetricians and...

Ethical disclosure.(For the record)(Association for Medical Ethics )(Brief article)
March 3, 2009... The Association for Medical Ethics has issued guidelines for ethical rules of disclosure recommending that all physicians and scientists "disclose in all publications and presentations the precise nature and amount of any financial conflicting...

Shoddy production.(For the record)(Actavis, Inc)(Brief article)
March 3, 2009... In mid-January, the United States Food and Drug Administration (FDA) announced that the pharmaceutical firm Actavis Inc., which closed one of its plants because of shoddy manufacturing practices, could resume making and selling certain drugs...

Marketing.(Briefly)(Brief article)
March 3, 2009... Marketing: Pharmaceutical manufacturers in the United States will be allowed to resume the practice (outlawed in 2006) of distributing medical journal articles to physicians as part of marketing efforts to promote so-called "off-label" use of...

Olympic-FX.(Briefly)
March 3, 2009... Olympic-FX: Wonder of winter wonders, there is now an Official Cold and Flu Remedy of the Vancouver 2010 Olympic and Paralympic Winter Games. It's COLD-FX(R), an extract of North American ginseng (CMAJ 2005;173[9]:1043-8). Edmonton-based...

Stimulus.(Briefly)(Brief article)
March 3, 2009... Stimulus: The National Institutes of Health was a winner in both congressional economic stimulus packages unveiled in the United States in January. The Senate and House of Representatives each allocated the agency a US$3.9-billion...

Hypertension.(Briefly)(Report)(Brief article)
March 3, 2009... Hypertension: The Heart and Stroke Foundation has issued new guidelines urging that a combination of ACE inhibitors and angiotensin II receptor blockers not be simultaneously prescribed to people with high blood pressure because the combination...

Universal truths.(Dispatch from the medical front)(Viewpoint essay)
March 3, 2009... As a general practitioner working in the poor suburbs of Yemen, the "bread and butter" of my work is treating infectious diseases. You can never predict, however, what the next patient on the list will bring into consultation. One...

Patterns of death among avalanche fatalities: a 21-year review.(Research)(Report)
March 3, 2009... Over the past 30 years (1978-2007), avalanches have been responsible for 329 deaths in Canada, with a recent rate of 14 deaths per year. (1) Avalanches kill a disproportionate number of young people, with victims most commonly being in their...

Factors associated with suspected drug-facilitated sexual assault.(Research)
March 3, 2009... Since the mid-1990s, there has been a growing number of unconfirmed reports of assailants surreptitiously using prescription and nonprescription drugs to induce disinhibition, sedation and amnesia to facilitate rape. (1) This type of...

Office management of patients with diastolic heart failure.(Case study)
March 3, 2009... The case You have a 76-year-old patient with heart failure that was diagnosed 2 months ago. She has a history of hypertension, which is being treated with amlodipine. On her initial visit 2 months previously, you prescribed furosemide 40...

Health research: measuring the social, health and economic benefits.(Analysis)
March 3, 2009... Despite intense interest in defining the social, health and economic impacts of health research investments globally (1-5) and in Canada (6-10) as proof of value-for-money, no validated method for measuring return on investments yet exists....

Acute allergic interstitial nephritis after use of pantoprazole.(Cases)(Case study)
March 3, 2009... The case: A 57-year-old man presented to hospital with a 2-week history of progressive malaise, myalgia, fever, nausea, vomiting, diarrhea, polyuria and polydipsia. He had a history of gastresophageal reflux that did not respond to ranitidine....

Revalidation of Canadian physicians.(Letters)
March 3, 2009... We commend Wendy Levinson for her provocative suggestions regarding revalidation of Canadian physicians. (1) We also applaud CMAJ for publishing views that are more demanding and supportive of meaningful external verification of Canadian...

Correction.(Letters)(Correction notice)
March 3, 2009... In a recent article, (1) a parenthetical sentence in the fourth paragraph of the Interpretation section contained a misplaced percentage and reference citation. It should have read "To obtain this factor, we multiplied Ferrando's estimate by...

Medical manga comes to America.(Essay)(Viewpoint essay)
March 3, 2009... Black Jack, the brooding surgeon who operates outside of medical convention--and usually beyond the realm of scientific possibility--has finally come of age in America 25 years after his debut in Japan. We're talking about a comic hero, but one...

Trauma relived.(After Shocks: The Poetry of Recovery for Life-shattering Events)(Book review)
March 3, 2009... After Shocks: The Poetry of Recovery for Life-shattering Events Tom Lombardo, editor Santa Lucia Books; 2008 386 pp US$19.95 [ILLUSTRATION OMITTED] Within the medical humanities literature, After Shocks follows several...

Conflicting rights and the politics of privacy.(Searching Eyes: Privacy, the State, and Disease Surveillance in America )(Book review)
March 3, 2009... Searching Eyes: Privacy, the State, and Disease Surveillance in America Amy L. Fairchild, Ronald Bayer and James Colgrove with Daniel Wolfe University of California Press/Milbank Memorial Fund; 2007. 342 pp $50 [ILLUSTRATION...

Koplik spots in early measles.(Clinical images)(Case study)
March 3, 2009... A 30-year-old man presented with a 6-day history of fever, conjunctivitis, rhinitis, dry cough and dyspnea. A maculopapular rash had appeared on his face the day before presentation and had spread to his upper torso and shoulders. The patient...

This Wolfe isn't in sheep's clothing.(Salon)(drug safety)(Interview)
March 3, 2009... He's been called a drug safety gadfly, an extremist and an avowed anti-industry activist. He calls direct-to-consumer advertising of pharmaceuticals "emotion promotion" and his critics say he has never seen a drug he likes. Call him what...

Research ethics review: do it once and do it well/ Ethique de la recherche : l'examen doit se faire une seule fois et bien se faire.(Editorial)(Editorial)
March 17, 2009... Research ethics boards are essential for protecting the rights and well-being of research participants. Currently, however, investigators, research institutes and funders are complaining that the system does not work. A chief complaint is that...

Effective and efficient use of implantable defibrillators: sometimes it's over when it's over.(Commentary)(Report)
March 17, 2009... See related research paper by Setoguchi and colleagues, page 611 Patients with substantial left ventricular scarring are prone to sudden death, presumably from ventricular tachyarrhythmias (sustained ventricular tachycardia and ventricular...

Is diagnosing metabolic syndrome a uniquely simple way to predict incident type 2 diabetes mellitus?(Commentary)(Report)
March 17, 2009... See related research paper by Ley and colleagues, page 617 The perceived need for introducing metabolic syndrome as a diagnostic category was to identify individuals at increased risk of cardiovascular disease whose primary abnormality is...

Clinical trials: the balance between protecting participants and promoting drug and product development.(News)
March 17, 2009... They have been called bureaucratic, cumbersome, a liability to the drug and research industries, and even harmful to patients. In fact, so maligned have research ethics boards been in Canada that they have spurred demands for the introduction...

HIV scandal sinks Chilean health minister.(News)(Maria Soledad Barria resigns due to the HIV scandal)
March 17, 2009... Chilean authorities are overhauling the country's HIV/AIDS programs after more than 500 patients who tested positive for the virus were not informed of the results. The controversy has also resulted in the resignation of the country's...

Gaza's health care system crippled before--and after.(News)
March 17, 2009... When Israel began its "Operation Cast Lead" military campaign in the Gaza Strip on Dec. 27, 2008, the Gaza health care system was already crippled by underfunding and a border blockade that prevented needed medical supplies and personnel from...

On the ground in the Gaza strip.(Dispatch from the medical front)(Column)
March 17, 2009... Throughout the Israeli offensive on Gaza, Sana Rajab and Mohamed "Abu Abed" Mughaiseeb worked at the heart of the emergency health services run by Medecins Sans Frontieres (MSF). Sana, a nurse, and Abu Abed, a doctor, are first and foremost...

Maximum potential benefit of implantable defibrillators in preventing sudden death after hospital admission because of heart failure.(Research)(Clinical report)
March 17, 2009... The burden of heart failure is substantial, accounting for 106 130 related hospital admissions and 1.38 million days in hospital in 2001 in Canada. (1) In the United States it accounted for 1.09 million related hospital admissions in 2003. (2)...

Metabolic syndrome and its components as predictors of incident type 2 diabetes mellitus in an Aboriginal community.(Research)(Report)
March 17, 2009... See related commentary by Reaven, page 601 Type 2 diabetes mellitus has become an epidemic, particularly among Aboriginal Canadians, who have a prevalence of the disease 3-5 times higher than non-Aboriginal Canadians. (1) Although no cure...

Generalized tonic-clonic seizure after a taser shot to the head.(Case study)
March 17, 2009... The taser stun gun, manufactured by Taser International in Scottsdale, Arizona, is a weapon used increasingly among law enforcement personnel to temporarily incapacitate detainees. Questions have arisen in both the scientific literature and the...

Are dietary recommendations for the use of fish oils sustainable?(Analysis)(Report)
March 17, 2009... People in developed countries have been encouraged in recent years to increase their intakes of fatty fish by at least 2-3-fold. The goal is to consume adequate amounts of the long-chain polyunsaturated omega-3 fatty acids, eicosapentaenoic...

Neurocysticercosis in a patient in Canada.(Case study)
March 17, 2009... A 51-year-old man presented with a single episode of generalized tonic-clonic seizure after returning to Canada from a trip to Mexico. A farmer, he was originally from Mexico and had lived in Canada for several years. He reported no weight loss...

Proton pump inhibitors and osteoporosis-related fractures.
March 17, 2009... In an important and interesting study, Laura Targownik and colleagues (1) state that the effect of exposure to proton pump inhibitors on osteoporosis-related fractures might be "similar in size to [the effect of] other established...

Apology laws.(Letter to the editor)
March 17, 2009... In their editorial on medical errors and apology laws, MacDonald and Attaran stated that when a medical error has occurred, patients and their families seek disclosure, apology and restitution. (1) We must be clear, however, about what is meant...

In the face of cancer.(Cancer Connections photography exhibition)
March 17, 2009... Cancer Connections Photography exhibition Photosensitive, in partnership with the Canadian Cancer Society Online gallery and travelling exhibition www.photosensitive.com/ May 2008-December 2009 Everyday we are saturated...

Here be dragons?(Creative works)(psychology of parents who abuse children)
March 17, 2009... As I finished watching the grainy videotape of his police interview, I was more convinced than ever: this man was no monster. Although not a routine aspect of my work as a child abuse pediatrician, I had agreed to review a father's statement to...

The plot thickens.(Cutting for Stone)(Book review)
March 17, 2009... Cutting for Stone Abraham Verghese Random House of Canada Ltd.; 2009. 560 pp $26.95 [ILLUSTRATION OMITTED] Abraham Verghese's novel Cutting for Stone recounts the story of Marion Praise Stone's journey from before his...

Half-and-half nail.(Clinical images)(Report)
March 17, 2009... [FIGURE 1 OMITTED] A 61-year-old man with diabetes mellitus and chronic kidney disease presented with a 2-week history of nausea, vomiting and general malaise. Laboratory tests showed he had a hemoglobin level of 72 (normal 138-172) g/L, a...

Criminalizing HIV transmission may be a mistake.(Salon)(Case overview)
March 17, 2009... There is no way to defend the actions of individuals who transmit HIV to others while knowing that they themselves are HIV-infected. This is especially true if these transmitters have lied to their partners about their HIV status and/or refused...

A plea for clear language on vaccine safety/L'innocuite des vaccins : plaidoyer en faveur de la clarte.(Editorial)
March 31, 2009... "If you can't explain it simply, you don't understand it well enough."--Albert Einstein Most academics see their fellow academics as the main audience for their scientific work. But the Web and search engines such as Google have made...

The drug--drug interaction between proton pump inhibitors and clopidogrel.(Commentary)
March 31, 2009... The efficacy of clopidogrel in combination with acetylsalicylic acid (ASA) therapy has been clearly established in well-designed randomized controlled trials that have shown a reduction in recurrent coronary events following acute myocardial...

Tackling the epidemic of childhood obesity.(Commentary)
March 31, 2009... The rising prevalence of childhood obesity in most developed countries is well recognized, (1) as are the many short- and long-term complications that can occur as a result. (2) The past decade has seen a rapid growth in research into various...

Preventing head trauma from abuse in infants.(Commentary)
March 31, 2009... Head trauma from abuse in infants, including shaken baby syndrome, is the most common cause of death from physical abuse among children. (1) Most victims are under 1 year of age and are helpless to protect themselves. The outcomes for survivors...

Prenatal DNA test raises both hopes and worries.(News)
March 31, 2009... Twenty-one weeks into her pregnancy, Barbara Farlow discovered that her daughter Annie would be born with the genetic disorder trisomy 13, a chromosomal abnormality--and a label--that would determine her future medical care. In August...

United States government grows a family health tree, helping people trace hand-me-down genetic risks.(News)
March 31, 2009... Family trees are no longer just a display of crazy aunts, cousins thrice removed and great-grandfathers in stiff collars. They are also a rich picture of hereditary health risks that genetic testing and traditional consultations between...

Alberta creates electronic registry for personal directives.(News)
March 31, 2009... When Caroline Marion drafted her living will in 2006, she named her husband and a friend as her agents should she be incapacitated by an accident or an illness. Then she filed the will away in a desk drawer. But last month, Marion learned...

President-elect.(Briefly)(Jeff Turnbull)(Brief article)
March 31, 2009... President-elect: Ottawa, Ontario, internist Dr. Jeff Turnbull has been selected president-elect of the Canadian Medical Association for 2010/11. Turnbull, who emerged as the victor in a 3-candidate contest, is chief of staff at the Ottawa...

Rights review.(Briefly)(Brief article)
March 31, 2009... Rights review: Some 68 countries stepped up with criticisms of Canada's human rights record during a United Nations Human Rights Council review last month in Geneva, Switzerland. The Draft Report on the Working Group of the Universal Periodic...

Failed oversight.(For the record)(failed inspection of medical devices)(Brief article)
March 31, 2009... The United States Food and Drug Administration's process for approving high-risk class III medical devices is outdated and fails to ensure the safety and effectiveness of such products, according to a report by the highly respected US...

No more freebies.(For the record)(physicians receiving freebies from pharmaceutical companies)(Brief article)
March 31, 2009... The United Kingdom's Royal College of Physicians has joined the growing chorus calling for an end to the "culture" of doctors receiving freebies from the pharmaceutical industry (CMAJ 2008;178[13]:16512 and CMAJ 2008;179[3]:225-6). A...

Stalled strategy.(For the record)(National Pharmaceuticals Strategy)(Brief article)
March 31, 2009... The much-ballyhooed promise that the National Pharmaceuticals Strategy would reduce the financial burden that prescription medications placed on Canadians was essentially abandoned with the election of Conservative Prime Minister Stephen Harper...

Liability reform.(More news online (www.cmaj.ca))(Brief article)
March 31, 2009... Liability reform: Rising malpractice premiums have prompted calls for tort reforms, like caps on pain-and-suffering awards. But experts say the solution to endless litigation lies in measures to reduce medical errors.--Janet Rae Brooks, Salt...

Prayer.(More news online (www.cmaj.ca))(Brief article)
March 31, 2009... Prayer: After a British nurse was suspended without pay for offering to pray for a patient, the United Kingdom's National Health Service has sketched out when it's acceptable to offer spiritual support.--Mary Helen Spooner, London, England ...

Dengue.(More news online (www.cmaj.ca))
March 31, 2009... Dengue: The incidence of the viral disease dengue is skyrocketing in India, prompting calls for stronger measures to control mosquito vectors.--Sanjit Bagchi, MBBS, Kolkata, India

Dispatch.(More news online (www.cmaj.ca))(Brief article)
March 31, 2009... [ILLUSTRATION OMITTED] Dispatch: A Kingston, Ontario physician is struck by the Wild West feel of the Canadian-led multinational medical unit in Khandahar, Afghanistan.--Jorge Enrique Zamora, MD, Khandahar, Afghanistan

A population-based study of the drug interaction between proton pump inhibitors and clopidogrel.(Research)(Clinical report)
March 31, 2009... Platelet activation and aggregation are key elements of the pathogenesis of acute coronary syndromes. Drugs that impair platelet function are an important part of treatment for patients with ischemic heart disease. Compared with acetylsalicylic...

Effect of school-based physical activity interventions on body mass index in children: a meta-analysis.(Research)(Report)
March 31, 2009... Childhood obesity is a major public health problem, given its increasing prevalence and adverse health consequences. (1) In the United States, the prevalence of obesity among children, defined as body mass index (BMI) greater than or equal to...

Do educational materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized controlled trial.(Research)(Report)
March 31, 2009... Shaken baby syndrome, or inflicted traumatic brain injury, is caused by the violent shaking of a child with or without contact between the child's head and a hard surface. Such contact may result in head trauma, including subdural hematoma,...

True blue: a puzzling case of persistent cyanosis in a young child.(Cases)(Case study)
March 31, 2009... A 2-year-old twin boy was referred to a cardiology clinic for long-standing cyanosis. He had been born to a healthy 36-year-old mother. The diamnionic, dichorionic twin pregnancy had been complicated by maternal cholestasis, which had been...

Study conclusions should reflect results.(Letters)(Letter to the editor)
March 31, 2009... In their recent meta-analysis of the use of respiratory fluoroquinolones to treat community-acquired pneumonia, Vardakas and colleagues identified allcause mortality in the intention-to-treat population as their primary outcome measure, but...

Factual error.(Letters)(Letter to the editor)
March 31, 2009... Ann Silversides' article (1) about the accidental overdose death of Ryan Lucio in 2002 at The Children's Hospital of Eastern Ontario states "Some tragedies have become public, thanks to the US Food and Drug Administration (FDA) or a measure of...

Corrections.(Letters)(Correction notice)
March 31, 2009... In a recent News article, (1) we quoted John Bridle as an asbestos expert but were not aware that he had received a conditional discharge on 2 counts of making false claims under the United Kingdom Trade Descriptions Act (1968) in relation to...

Body mapping: embodying the self living with HIV/AIDS.(human immunodeficiency virus/acquired immunodeficiency syndrome)
March 31, 2009... The body offers a point of common, concentrated interest for both patients and physicians. For patients, disease progression, following trajectories of blood, muscle and bone, underscores one's dependence on the body. Following diagnosis,...

A beautiful heart.(Creative works)
March 31, 2009... Each weekday morning, I review my clinic schedule to see who will be visiting. With just a glance, I can predict the tenor of the day. Certain names evoke joy, others indifference, some dread. I still remember the first day of spring, some...

A shift in physician health.(The Physician as Patient: A Clinical Handbook for Mental Health Professionals)(Book review)
March 31, 2009... The Physician as Patient: A Clinical Handbook for Mental Health Professionals Michael F. Myers and Glen O. Gabbard American Psychiatric Publishing Inc.; 2008 242 pp $46.00 [ILLUSTRATION OMITTED] It's now about 25 years...

Tracheal bronchus.(Clinical images)
March 31, 2009... [FIGURE 1 OMITTED] [FIGURE 2 OMITTED] [FIGURE 3 OMITTED] A previously healthy 20-year-old man presented with a 4-day history of intractable cough and fever. A chest radiograph showed a right tracheal bronchus and a right...

Insecticides for public health.(Salon)
March 31, 2009... Paracelsus, the 16th-century Swiss physician, cottoned onto an important concept that has served humanity well: "The dose makes the poison." Most of us unknowingly accept this important observation as we drink our first cup of coffee in the...

US grapples with solutions to preventable medical errors.(News)
March 31, 2009... After years of warnings from former United States president George Bush that frivolous medical malpractice lawsuits were driving doctors out of practice and inflating the cost of US health care, the weight of evidence now points to preventable...

Patient catechism: no prayers please.(News)
March 31, 2009... A British nurse who was suspended without pay after offering to pray for a patient has been reinstated following an investigation by the National Health Service. Caroline Petrie, a part-time visiting nurse, had been accused of "failing to...

Dengue bites India.(News)(Brief article)
March 31, 2009... Dengue, a mosquito-borne and potentially fatal viral disease, has emerged as a huge threat in India, where the number of cases more than doubling in just one year. The latest estimates by the Ministry of Health and Family Welfare suggest...

Khandahar arrival.(Dispatch from the medical front)(Khandahar Airfield)
March 31, 2009... I remember awakening when the passenger beside me elbowed me in the ribs. The C-130 Hercules was filled to capacity. The engine noise and our earplugs made it impossible to hear each other unless we shouted. He gestured to "Put on your helmet...