CMAJ: Canadian Medical Association Journal articles from October 2004

CMAJ: Canadian Medical Association Journal archives from October 2004

Randomized clinical trials: slow death by a thousand unnecessary policies?(Viewpoint)
October 12, 2004... Before 1950 the practice of medicine was based largely on observations of outcomes in one individual or in small groups of patients. With the development of the randomized controlled trial (RCT) around the middle of the 20th century, medicine...

Deaths/Necrologie.
October 12, 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, barbara.sibbald@cma.ca; fax 613 565-2382. Atcheson, John D.,...

Query.
October 12, 2004... Clare was 300 pounds, middle-aged and short of breath. She was a longtime smoker who looked as if she'd puffed in the womb. She suffered from a crippling emphysema and was noncompliant with her medication regimen. She regularly missed...

The Romanow gaps: some closing, others still open/ Les ecarts Romanow : certains se referment, d'autres pas.(Editorial)
October 12, 2004... With considerable relief, Canada's First Ministers announced in the small hours of Sept. 16 that they had gotten the message that taxpayers were fed up with long waiting lists and wanted more (of their own) money spent on health care. The...

Nuts, omega-3s and food labels.(Letters/Correspondance)(Letter to the Editor)
October 12, 2004... It is misleading to suggest, as Erica Weir and associates (1) have done in a recent Public Health article, that nuts and seeds (other than flaxseed) are sources of omega-3 fatty acids. One hundred grams of the oil extracted from the most common...

Canadian adverse events study.(Letters/Correspondance)(Letter to the Editor)
October 12, 2004... Ross Baker and associates, in their study of adverse events (AEs) in Canadian hospitals, (1) used a method that has been used in other countries to characterize this problem, but we feel that this method underestimates the impact of adverse...

FDA urges "black box" warning on pediatric antidepressants.(Drug Safety)
October 12, 2004... A blue-ribbon scientific advisory panel has urged the US Food and Drug Administration (FDA) to include "black box" warnings on selective serotonin reuptake inhibitors (SSRIs) advising of the increased risk of suicidal behaviour among pediatric...

New online medical journal challenges conventions.(Access To Research)
October 12, 2004... A new scholarly journal joins the galaxy of medical publications this month, but unlike nearly all the others, it's Web-based and access is free. PLoS Medicine (www.plos medicine.org/) goes online Oct. 19. Like its sister publication, PLoS...

New standard of disclosure set for clinical trials.(Pharmaceutical Industry)
October 12, 2004... The New York State Attorney General's office is heralding a "new standard of disclosure" for clinical trial findings after reaching an agreement with GlaxoSmithKline to settle a lawsuit that alleged GSK committed consumer fraud by concealing...

MRIs more accurate than mammograms but expensive.(Diagnostic Tests)
October 12, 2004... Two new studies that indicate MRIs are more accurate than mammograms for detecting early breast cancer contribute to a "small, but growing" body of evidence that points to MRIs as a screening tool in high-risk women, the Canadian Cancer Society...

Slow progress to reproductive rights.(Global Health)
October 12, 2004... Religious fundamentalism and a lack of resources are the chief barriers to achieving sexual and reproductive rights for all by 2015, concluded the 2004 International Conference on Population and Development (ICPD) Seven hundred...

Tuition, taxes and death.(News @ a glance)(Brief Article)
October 12, 2004... Tuition, taxes and death: Tuition fees for medical school went up 9.2% this fall, the largest increase of any faculty, Statistics Canada reports. Fees for undergraduate university students generally rose 3.9%. The average tuition fees for...

Lung transplants doubled.(News @ a glance)(Brief Article)
October 12, 2004... Lung transplants doubled: In the past decade the number of lung transplants performed in Canada has increased 58%. The Canadian Institute for Health Information reports that preliminary data show there were 141 lung transplants in 2002, up from...

Book 'em yourself.(News @ a glance)(Brief Article)
October 12, 2004... Book 'em yourself: Many British patients will soon be able to book their own appointments with their family physician online. EMIS Access, software developed in Leeds, has been successfully tested by 150 practices, and 55% of FPs now have...

Human rights course.(News @ a glance)(Brief Article)
October 12, 2004... Human rights course: The World Medical Association has started a Web-based course on human rights and ethics to help doctors working in prisons (www.wma.net). The course, which has been under development for 2 years, was launched coincidently...

Medicine, not missiles.(News @ a glance)(Brief Article)
October 12, 2004... Medicine, not missiles: Students with Physicians for Global Survival (PGS), part of an international physician-based peace movement, recently took aim at the newly minted secretary to the minister of national defence. The PGS students presented...

Intracytoplasmic sperm injection: promises and challenges.(Reproductive Technologies)
October 12, 2004... Intracytoplasmic sperm injection (ICSI) was first developed in 1993 as a treatment for male factor infertility--specifically, to overcome problems with penetration of an oocyte by a sperm cell. It is estimated that 150 000 couples sought...

Still waiting for health reform.(Health Care Sustainability)
October 12, 2004... Although Prime Minister Paul Martin had hailed the Sept. 16 health agreement as a "deal for a decade," some premiers warn they may place demands on the federal coffers before the 10 years are up, and the architects of the deal consider it a...

Sports dermatology part 1: common dermatoses.(Dermatology)
October 12, 2004... Sports and physical exercise have become integral to modern life. Although their benefits are plentiful, participation in athletic activities can also be associated with a wide variety of skin problems. Sports dermatoses can result from...

Upsurge of genital Chlamydia trachomatis infection.(Public Health)
October 12, 2004... Background and epidemiology: Since 1997 the rate of genital Chlamydia trachomatis infection in Canada has increased by more than 60%, up from 114 per 100 000 population in 1997 to 188 per 100 000 in 2003 (www.hc-sc.gc.ca/pphbdgspsp/...

Should a statin be routinely prescribed for primary prevention of cardiovascular disease in diabetes mellitus?(In the Literature)
October 12, 2004... Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HAW, Livingstone SJ, et al; CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study...

Fever after aortic valve replacement in a 71-year-old man.(Clinical Vistas)
October 12, 2004... Three weeks after receiving a prosthetic aortic valve because of severe aortic stenosis, a 71-year-old man was admitted to hospital with a 3-day history of gradually increasing temperature. His temperature was 38.3[degrees]C, but the results of...

Apolipoprotein E [epsilon] 4 genotype as a risk factor for cognitive decline and dementia: data from the Canadian Study of Health and Aging.(Research/Recherche)
October 12, 2004... Abstract Background: Apolipoprotein E (ApoE) [epsilon] 4 genotype is a well-established risk factor for Alzheimer's disease (AD). However, its effect on predicting conversion from normal to "cognitive impairment, no dementia" (CIND) and...

Fracture risk among First Nations people: a retrospective matched cohort study.(Research/Recherche)
October 12, 2004... Abstract Background: Canadian First Nations people have unique cultural, socioeconomic and health-related factors that may affect fracture rates. We sought to determine the overall and site-specific fracture rates of First Nations people...

Informed consent for uninsured services: a primary care perspective on the new childhood vaccines.(Commentary/Commentaire)
October 12, 2004... Universal childhood vaccination programs have been key to reductions in child morbidity and mortality caused by common infectious diseases over the past half century. In Ontario, other than the hepatitis B vaccine (which is funded and...

The benefits of apolipoprotein E [epsilon]4 screening to research.(Commentary)(Editorial)
October 12, 2004... In this issue of CMAJ, Hsiung and colleagues report results from a subanalysis of the data generated by the Canadian Study of Health and Aging (CSHA). (1) The CSHA involved more than 10 000 Canadians aged 65 and over, and it has given us...

Physician remuneration in industry-sponsored clinical trials: the case for standardized clinical trial budgets.(Viewpoint)
October 12, 2004... Physicians who participate in clinical trials can contribute to the evidentiary base for practice and can offer their patients a chance to receive cutting-edge therapies and the close follow-up that often accompanies a trial protocol. As well,...

Rebuttal.(Viewpoint)
October 12, 2004... We are encouraged (but not surprised) that an investigator of Salim Yusuf's stature and considerable experience in leading large multicentre international randomized controlled trials (RCTs) has not seen financial conflicts of interest in his...

Homocysteine and cognitive function in elderly people.(Review/Synthese)
October 12, 2004... Abstract DEMENTIA IS HIGHLY PREVALENT AMONG ELDERLY PEOPLE, and projections show that the number of people affected might triple over the next 50 years, mainly because of a large increase in the oldest-old segment of the population....

Journal of the AIDS year.(Book Review)
October 12, 2004... AIDS activist: Michael Lynch and the politics of community Ann Silversides Toronto: Between the Lines; 2003 pp 273 $24.95 (paper) ISBN 1-896357-73-3 Journal of the AIDS years More than twenty years after the first puzzling reports of...

First night.(Room for a view)
October 12, 2004... It was my first real night of clerkship. Memories of a slow, urban summer were fading after three days of plane-hopping from Ottawa to Sioux Lookout to Pikangikum. After a busy day of clinic in the nursing station, my supervisor and I were...

Song of the ICU resident.(Brief Article)(Poem)
October 12, 2004... Song of the ICU resident The intravenous lines slung low over a broken-down chariot, the effluent of a bed-ridden man drained by plastic tubes to the tune of sedate monitors bleeping death, death. In the ICU...

Contagion.(Illness and metaphor)(Brief Article)(Excerpt)
October 12, 2004... ... [T]he calamity was spread by infection; that is to say, by some certain steams or fumes, which the physicians call effluvia, by the breath, or by the sweat, or by the stench of the sores of the sick persons, or some other way, perhaps,...

Achilles' heel.
October 12, 2004... Have you ever experienced an uncontrollable visceral response on seeing a patient? I had such a reaction during my very first encounter with medicine from the physician's side. I was 15 years old and shadowing a general surgeon for a high...

Extreme nursing.(Theater Review)
October 26, 2004... Extreme nursing Tempting Providence A play by Robert Chafe Directed by Jillian Keiley Original lighting design by Walter J. Snow Costume design by Barry Buckle A Theatre Newfoundland Labrador Production National...

My twins.
October 26, 2004... I was looking after twins, twins with bronchiolitis. At morning signover, whoever had been on call would tell me how much trouble the twins, those terrible twins, had been overnight. During morning rounds, I'd joke that I had only bothered...

Multiple diagnoses.(Lifeworks)
October 26, 2004... This summer, the temporary exhibition spaces at the Ottawa Art Gallery were devoted to three contemporary Canadian artists who have explored the physiological and psychological impact of medical practice and experience. Titled Medical Imprints,...

Canada's programs to prevent mental health problems in children: the research-practice gap.(Commentary/Commentaire)
October 26, 2004... The increased number of prevention activities directed at reducing child mental health problems in Canada is welcome. However, practitioners and policy-makers should reflect on 2 questions that were posed 20 years ago by Michael Rutter: "How...

Applying the new STEMI guidelines: 1. Reperfusion in acute ST-segment elevation myocardial infarction.(Cardiology)
October 26, 2004... B See related article page 1042 Case A 50-year-old woman experiences jaw discomfort while at work. It increases in intensity, accompanied by diaphoresis and nausea. An ambulance is called 40 minutes after symptom onset. On arrival to...

Applying the new STEMI guidelines: 2. Disturbances of cardiac rhythm after ST-segment elevation myocardial infarction.(Cardiology)
October 26, 2004... B See related article page 1039 Case 1 A 52-year-old man with hypertension and hyperlipidemia experiences chest pain and summons medical help. Thirty minutes later, in the presence of paramedics, he collapses with ventricular...

Infliximab and serious hematologic events.(Health And Drug Alerts)
October 26, 2004... B See related article page 1063 Reason for posting: Remicade (infliximab), a tumour necrosis factor-[alpha] (TNF-[alpha]) antagonist, is used in the treatment of rheumatoid arthritis and Crohn's disease. However, the US Food and Drug...

Is routine early invasive management of non-ST-segment elevation myocardial infarction beneficial in elderly patients?(In The Literature)
October 26, 2004... Bach RG, Cannon CP, Weintraub WS, DiBasttiste PM, Demopoulos LA, Anderson HV, et al. The effect of routine, early invasive management on outcome for elderly patients with non-ST-segment elevation acute coronary syndromes. Ann Intern Med...

An unusual structure near the porta hepatis: what's your diagnosis?(Clinical Conundrum)
October 26, 2004... An 87-year-old man with chronic obstructive pulmonary disease and asbestosis experienced progressive weight loss, asthenia, dyspnea and increased productive cough in May 2003. He appeared chronically ill. CT imaging of the lung and diagnostic...

Preventing cold chain failure: vaccine storage and handling.(Public Health)
October 26, 2004... Background and epidemiology: Most of the currently available publicly funded vaccines in Canada (Box 1) must be stored between 2[degrees]C and 8[degrees]C to maintain their potency. The "cold chain" refers to the continuum of safe handling...

Tilting at windmills: health reform and the 2004 US presidential election.(US Health Policy)
October 26, 2004... Health reform is once again a front-page story in the United States. This is hardly a surprise: since 1970, US health policy has followed a predictable (and seemingly unending) cycle of discovering a crisis in the health system, identifying and...

Implantable cardioverter defibrillators: therapy against Canada's leading killer.(Cardiology)
October 26, 2004... Every year, sudden cardiac death claims the lives of 45 000 Canadians. This translates into 120 deaths a day, or 1 death every 14 minutes--a higher toll than is taken by lung cancer, stroke, AIDs and breast cancer combined. (1) Implanted...

Rofecoxib (Vioxx) voluntarily withdrawn from market.(Drug Regulation)
October 26, 2004... Published at www.cmaj.ca on Sept. 30, 2004. Merck & Co. announced Sept. 30 a voluntary worldwide withdrawal of rofecoxib (Vioxx) after a study showed patients taking the drug on a long-term basis face twice the risk of a heart attack...

Lack of Aboriginal health professionals a "huge issue".(Aboriginal Health)
October 26, 2004... The federal government's announcement of $100-million over 5 years to train Aboriginal health professionals is welcome news, but unlikely to make a big dent in the shortfall, medical insiders say. "It sounds like a lot of money, but in fact...

Massive aid mobilization needed in Darfur: MSF.(Humanitarian Crisis)
October 26, 2004... Despite the WHO's declaration that the conflict in Sudan has resulted in the world's largest ongoing humanitarian emergency, aid is still desperately needed, says the president of Medecins Sans Frontieres (MSF) Canada. "There simply aren't...

Temporary shortage of DPTP-Hib.(Vaccine Supply)(Brief Article)
October 26, 2004... A temporary shortage of DPTP-Hib vaccine has resulted in deferred booster shots and reallocated supplies. During routine pre-market testing in July, Health Canada uncovered a problem with a batch of Pentacel, a vaccine produced by Aventis...

Canada achieves lowest perinatal mortality ever.(Childbirth)
October 26, 2004... The increasing medicalization of childbirth in Canada isn't surprising and does have its benefits, says the Society of Obstetricians and Gynaecologists of Canada (SOGC). President-elect Dr. Michael Helewa says rising rates of cesarean...

$10-million malpractice award largest ever.(Court Decision)
October 26, 2004... The largest medical malpractice award in Canada is "an isolated case" and will not set a precedent for similar malpractice cases in the future, says the president of the Society of Obstetricians and Gynaecologists of Canada (SOGC). In a...

Manitoba to fast-track less critical emergency patients.(Waiting Times)
October 26, 2004... Manitoba has implemented a fast-lane system to keep less critical patients moving through the emergency department more rapidly, making way for more urgent cases. The new fast-lane system, which is being piloted at the Health Sciences...

C. diff compensation.(News @ a glance)(Brief Article)
October 26, 2004... The Quebec government should compensate victims of Clostridium difficile and other nosocomial infections, a new patient advocacy group is demanding. The Association to Defend Victims of Nosocomial Infections wants Quebec to follow France's lead...

Brain function.(News @ a glance)(Brief Article)
October 26, 2004... Targeted to assess and evaluate Down syndrome and other brain-related disabilities, a new $3.5-million magnetoencephalograph (MEG) neuroscience unit recently opened in Burnaby, BC. The MEG, located at the Down Syndrome Research Foundation...

Vein to vein standards.(News @ a glance)(Brief Article)
October 26, 2004... The Canadian Standards Association (CSA) has issued new national standards for the safe handling of blood, from collection to transfusion. The standards, which fulfill a recommendation from the Krever inquiry into tainted blood, draw on best...

Toxic metals.(News @ a glance)
October 26, 2004... A study reveals that levels of toxic metals are higher in a group of employees from the New Waterford Consolidated Hospital in Cape Breton than in a similar group of employees from the nearby Strait Richmond Hospital. The New Waterford Hospital...

Suicide toll.(News @ a glance)(Brief Article)
October 26, 2004... Worldwide, nearly a million people commit suicide annually, more than deaths from homicide (500 000) and war (230 000) combined. The WHO estimates that suicide fatalities could rise to 1.5 million by 2020. The biggest problem appears to be in...

Social and economic justice: the road to health.(Letters/Correspondance)(Letter to the Editor)
October 26, 2004... I disagree with Prabhat Jha and James Lavery (1) that technological advances, rather than improvements in income and education, have been responsible for improvements in health care in the developing world. Sri Lanka and the state of Kerala...

Seeking clarification of osteoporosis guidelines.(Letters/Correspondance)(Letter to the Editor)
October 26, 2004... The recent statement of the Canadian Task Force on Preventive Health Care regarding prevention of osteoporosis and osteoporotic fractures in postmenopausal women (1) contains some confusing information. One example is the statement that...

Mapping malaria.(Letters/Correspondance)(Letter to the Editor)
October 26, 2004... Congratulations to Kathryn Suh and colleagues (1) for their recent comprehensive review of malaria. I have 2 corrections for their Fig. 1, the map showing global distribution of malaria. First, malaria is not endemic to Uruguay. Second, in...

To self-cite or not to self-cite.(Letters/Correspondance)(Letter to the Editor)
October 26, 2004... The article by Apoor Gami and associates (1) on self-citation in the diabetes literature included 1 self-citation (out of a total of 9 references), which involved 3 of the study's authors (reference 6 in the original article). Thus,...

How children see themselves.(Letters/Correspondance)(Letter to the Editor)
October 26, 2004... In their recent research letter, Gail McVey and associates (1) suggest that fear of being overweight and the desire to be thinner lead to behaviours such as "dieting and other extreme weight control methods." Their proposed solution is to...

Correction.(Letters/Correspondance)(Correction Notice)
October 26, 2004... In an In the Literature article on the benefit of tight glycemic control in diabetic patients undergoing coronary artery bypass grafting, (1) the table should have included a footnote stating that it was adapted, with permission, from the study...

Query.
October 26, 2004... Last week in the hospital I was surrounded by grieving nurses and doctors; some gently wept, some sobbed outright, others had impassive faces that eventually cracked. Periodically someone broke down and left the grief-counselling session, only...

Deaths.(Necrologie/Deaths)
October 26, 2004... Adlerova, Esfira, Vancouver; Oxford University (England), 1943; former staff, British Columbia TB Control Agency. Died Mar. 7, 2004, aged 85; survived by 3 sons. Blackwell, Gilbert L., Bradford, Ont.; University of Toronto, 1944; former...

Adrenomyeloneuropathy as a cause of primary adrenal insufficiency and spastic paraparesis.(Review/Synthese)
October 26, 2004... Abstract ADRENOMYELONEUROPATHY IS A VARIENT OF ADRENOLEUKODYSTROPHY, both of which are rare inherited disorders of peroxisomes characterized by the accumulation of very-long-chain fatty acids in plasma, the central and peripheral nervous...

The impact of new guidelines for glucose tolerance testing on clinical practice and laboratory services.(Commentary/Commentaire)
October 26, 2004... The Canadian Diabetes Association's 2003 clinical practice guidelines for diabetes mellitus were published in mid-December 2003. (1) These guidelines retain the fasting plasma glucose test for the diagnosis of diabetes, and the criterion for...

Cutaneous nocardiosis complicating management of Crohn's disease with infliximab and prednisone.(Case report)
October 26, 2004... Abstract INFLIXIMAB IS A CHIMERIC ANTI-TUMOUR NECROSIS FACTOR-[alpha] antibody that is efficacious in treating Crohn's disease. However, its immunomodulatory properties increase susceptibility to opportunistic infections. We present a case...

Effect of periodic letters on evidence-based drug therapy on prescribing behaviour: a randomized trial.(Research/Recherche)
October 26, 2004... Abstract Background: The effect of regular and expected printed educational materials on physician prescribing behaviour has not been studied. We sought to measure the impact of a series of evidence-based drug therapy letters mailed to...

Use of implantable cardioverter defibrillators after out-of-hospital cardiac arrest: a prospective follow-up study.(Research/Recherche)
October 26, 2004... Abstract Background: Survivors of out-of-hospital cardiac arrest are at high risk of recurrent arrests, many of which could be prevented with implantable cardioverter defibrillators (ICDs). We sought to determine the ICD insertion rate...

Carrots and sticks for quality health care/Soins de qualite: la carotte et le baton.(Editorial)(Editorial)
October 26, 2004... Everyone agrees that the medical care physicians deliver and the public purse pays for should be of the highest quality. Yet quality is constantly being called into question: reports of preventable adverse events in hospitals, nosocomial...