CMAJ: Canadian Medical Association Journal articles from September 2004

CMAJ: Canadian Medical Association Journal archives from September 2004

Tips for learners of evidence-based medicine: 2. Measures of precision (confidence intervals).(Review/Synthese)
September 14, 2004... In the first article in this series, (1) we presented an approach to understanding how to estimate a treatment's effectiveness that covered relative risk reduction, absolute risk reduction and number needed to treat. But how precise are these...

The two-step to two-tier/La medicine a deux vitesses en deux temps.(Editorial)(Editorial)
September 14, 2004... 1954 Doctor: "Your son needs an appendectomy. Do you have $100?" 2004 Doctor: "Yes, MRI will detect breast cancer earlier than mammography, but it isn't covered by medicare. Patient: "No problem--I'll pay for it." ...

Dealing with incompetence.(Letters/correspondance)(Letter to the Editor)
September 14, 2004... The description in a recent "Query" of the longest-serving physician in Dr. Ursus's hospital (1) raises numerous questions. In particular, where were Dr. C's departmental head, the chief of staff, the hospital's quality assurance committee and...

Adverse events: past and future.(Letters/correspondance)(Letter to the Editor)
September 14, 2004... The article by Alan Forster and associates (1) on adverse events among patients admitted to a Canadian teaching hospital might suggest that this aspect of patient safety is of only recent interest and concern. However, CMAJ readers may be...

Use of Eprex in Canada.(Letters/correspondance)(Letter to the Editor)
September 14, 2004... We are writing to correct and clarify several points in Barbara Sibbald's article on recombinant human erythropoietin (epoetin alfa [Eprex]). (1) Sibbald erroneously states that Health Canada has advised practitioners "against intravenous...

Does testosterone affect effect?(Letters/correspondance)(Letter to the Editor)
September 14, 2004... When Luke Fazio and Gerald Brock (1) write that "Testosterone... does not effect [sic] reflexogenic or psychogenic erections," do they mean that testosterone does not directly cause (i.e., effect) such erections? Or did they mean to use...

Corrections.(Letters/correspondance)(Correction Notice)
September 14, 2004... The report on the subcutaneous use of Eprex (1) contained 3 errors. The most serious appeared in the first sentence of paragraph 2: in fact, Health Canada advised against subcutaneous injection of the drug, not intravenous as printed. The...

Ban on cage beds premature: Czech officials.(Patient Right)
September 14, 2004... Mental health advocates across Central Europe are celebrating the death of the cage bed, a device used in the Czech Republic, Slovenia and Hungary to restrain patients with mental disabilities. However, a lack of staff and resources to deal...

Butting out in Canada: five down, eight to go.(Addictions)
September 14, 2004... Toronto smokers forced by a new bylaw to puff outside bars and public buildings should count themselves lucky. Consider the fate of die-hard smokers across the chilly expanses of Nunavut and the Northwest Territories, who have been lighting up...

Waiting lists not pharmacare main issue: feds.(Health Policy)
September 14, 2004... The federal government, Roy Romanow and Dr. David Naylor all purport that waiting lists--not pharmacare--should dominate the agenda at this week's (Sept. 13-16) First Ministers' conference on health care. Federal Health Minister Ujjal...

Pregnant aboriginals more likely to be HIV positive.(Infectious Disease)(Brief Article)
September 14, 2004... A public health advisor wants physicians to be aware of new research showing a relatively high rate of HIV infection among pregnant Aboriginal women. Patients in this group should be tested and if necessary treated to reduce the possibility of...

Doctor fined $25 000 over internet prescriptions.(Internet Pharmacy)
September 14, 2004... The BC college's decision to levy its maximum fine against a doctor for countersigning prescriptions originally written by US doctors has again focused attention on the Internet pharmacy industry. Dr. Satnam Singh Gandham, a Richmond FP,...

BC cuts cardiac wait-list by one-third.(Resource Allocation)
September 14, 2004... An initiative that successfully cut BC's cardiac waiting list by one-third during a 10-month period will continue for another year, said an official with the Provincial Health Services Authority. The cardiac waiting list was reduced through...

Growing well in PEI.(News @ a glance)(Brief Article)
September 14, 2004... Growing well in PEI: Children in PEI are often healthier than other Canadian kids, according to a new report from the Premier's Council on Healthy Child Development (www.gov .pe.ca/). Canada's smallest province leads the country is terms of...

West Nile capital.(News @ a glance)(Brief Article)
September 14, 2004... West Nile capital: Last year, the rate of West Nile virus infection in Saskatchewan's Five Hills Health Region was the highest in North America and over 4 times the provincial average. During the summer of 2004, 224 people in the region, which...

Here come the brides.(News @ a glance)(Brief Article)
September 14, 2004... Here come the brides: Faced with a socially destabilizing shortage of women (CMAJ 2004;170[10]:1527), senior family planning officials in China are considering offering welfare incentives to couples with 2 daughters, and tightening the...

He shoots, he collides.(News @ a glance)(Brief Article)
September 14, 2004... He shoots, he collides: Significantly fewer collisions occur when hockey games are played on international-size ice surfaces, which are more than 3000 square feet larger, reveals a new study (Can J Neurol Sci 2004;31:373-7). Dr. Richard...

Contamination an vCJD.(News @ a glance)(Brief Article)
September 14, 2004... Contamination and vCJD: The UK's second documented case of human-to-human transmission of variant Creutzfeldt-Jakob disease has led to an urgent call for new surgical instrument decontamination procedures. The Lancet (2004; 364[9433]:527-9)...

National pharmacare: a dog's tale.(Health Care Funding)
September 14, 2004... Even before the first parliament of our newly elected government is in session, health care funding is once again under the spotlight as the provincial premiers call on the new federal government to fund and manage a national pharmacare...

The storied case report.(Narrative Medicine)
September 14, 2004... How should doctors present case reports? Medical tradition, our mentors and our textbooks teach a standard format that starts with identifying information, followed by the chief complaint, history of present illness (HPI), past history,...

Vaccine misadventure: inadvertent administration of tetanus toxoid.(Public Health)
September 14, 2004... Background and epidemiology: A recent Morbidity and Mortality Weekly Report on inadvertent intradermal administration of tetanus toxoid (1) highlights the importance of reporting adverse events that arise from vaccine administration. The US...

What is the prevalence of prostate cancer among men with low prostate-specific antigen levels?(In The Literature)
September 14, 2004... Background: Screening for prostate cancer usually involves measuring prostate-specific antigen (PSA) levels and performing prostate biopsies if the PSA level is above a certain cutoff level (usually 4 ng/mL [[micro]g/L]). There has been no...

A 36-year-old man with hemoptysis.(Clinical Vistas)
September 14, 2004... A 36-year-old previously healthy man from southwestern Ontario presented to the emergency department with an episode of cough producing 50 mL of bright red blood after 2-week history of coughing up green sputum. He was otherwise asymptomatic,...

Death and renal transplantation among Aboriginal people undergoing dialysis.(Research/Recherche)
September 14, 2004... Abstract Background: Despite the increase in the number of Aboriginal people with end-stage renal disease around the world, little is known about their health outcomes when undergoing renal replacement therapy. We evaluated differences in...

A prospective cohort study of pregnancy risk factors and birth outcomes in Aboriginal women.(Research/Recherche)
September 14, 2004... Abstract Background: Aboriginal women have been identified as having poorer pregnancy outcomes than other Canadian women, but information on risk factors and outcomes has been acquired mostly from retrospective databases. We compared...

Thunderclap headache and reversible segmental cerebral vasoconstriction associated with use of oxymetazoline nasal spray.(Case Report)
September 14, 2004... Abstract OXYMETAZOLINE IS A SYMPATHOMIMETIC amine found in over-the-counter nasal decongestants. We report a case of chronic use of nasal oxymetazoline associated with thunderclap headache due to reversible segmental intracranial...

Health outcomes in Aboriginal populations.(Commentary/Commentaire)
September 14, 2004... Why do Aboriginal Canadian, Maori New Zealander, Aboriginal Australian and Native American babies born today share a pattern of premature morbidity and mortality rather than the expected healthy life-course of the nonindigenous baby in the next...

Single-payer, universal health insurance: still sound after all these years.(Commentary/Commentaire)
September 14, 2004... Hardly a week goes by without yet another report or media release from a think tank, politician or commentator declaring that our health care system is unsustainable in its current form. The case is roughly this: Health care is choking off...

The arithmetic of health care.(Commentary/Commentaire)
September 14, 2004... There is a simple arithmetic to the rising costs of health care, just as there was to the federal deficit in the 1990s. Health care costs are increasing at faster rate than the revenue of any government in Canada, and the scramble by...

Clinical trial registration: a statement from the International Committee of Medical Journal Editors.(Commentary/Commentaire)
September 14, 2004... Altruism and trust lie at the heart of research on human subjects. Altruistic individuals volunteer for research because they trust that their participation will contribute to improved health for others and that researchers will minimize risks...

Agit-doc.(The Left Atrium)(The Fog of War)(The Corporation)(Fahrenheit 9/11)(Movie Review)
September 14, 2004... Agit-doc The Fog of War Directed by Errol Morris Columbia TriStar, 2003, 106 min The Corporation Directed by Mark Achbar and Jennifer Abbott Big Picture Media Corporation, 2004, 145 min Fahrenheit 9/11 Written, produced and...

Where orchids bloom: medicine on the border.(Room for a view)
September 14, 2004... The patient is a 27-year-old man. He is the last patient of a long day here on the Thai-Burmese border in large medical clinic founded by Karen refugees of the Burmese civil war--one of the longest-running civil wars in the world. He is...

Unfit to live.(History of medicine)
September 14, 2004... The permanent exhibition War Against the Inferior: the History Nazi Medicine in Vienna at the Otto Wagner Hospital of Vienna documents the medical atrocities committed during the Nazi era. Now named after the Secessionist architect Otto Wagner,...

Deaths/Necrologie.(Obituary)
September 14, 2004... Ares-Duquette, Renee, Verdun, Que.; Laval University, 1956. Died Mar. 24, 2004, aged 75; survived by her husband, Dr. Jacques, and 4 children. Berg, Morton D., Toronto; University of Toronto, 1950; DAPA; former staff, Mount Sinai Hospital;...

Query.
September 14, 2004... Two convenience stores: a duelling Irving and Esso. A single supermarket. Two schools. One arena. One cottage hospital perennially understaffed with physicians. Everywhereville. I'm doing a locum for a week in a strange yet familiar land....

Antiarrhythmic drugs for atrial fibrillation: do we need better use, better drugs or a randomized trial of ablation as primary therapy?(Commentary/Commentaire)
September 28, 2004... A trial fibrillation (AF) is the most common cardiac arrhythmia seen in clinical practice, and it contributes substantially to both morbidity and medical costs. (1) In this issue Humphries and associates present an analysis of antiarrhythmic...

The Cochrane Collaboration at 10: kudos and challenges/La Cochrane Collaboration a 10 ans: realisation et defis.(Editorial)(Editorial)
September 28, 2004... The logic of the Cochrane Collaboration remains unassailable. No one individual or group can keep abreast of the thousands of randomized trials that appear in the medical literature each year. The origin of the Collaboration dates to the late...

Preparing physicians for the real world.(Letters/Correspondance)(Letter to the Editor)
September 28, 2004... I read with interest the article by Christopher Parshuram and associates (1) about fellowship training. My question is this: How do you prepare a 60-year-old physician to work 30 hours continuously with no sleep, in a job where he or she is the...

TB and adrenal insufficiency.(Letters/Correspondance)(Letter to the Editor)
September 28, 2004... Ronik Kanani and Aleixo Muise (1) describe a case of intra-abdominal peritonitis associated with abdominal pain and hypotension secondary to intra-abdominal tuberculosis (TB). The clinical presentation in this case is suspicious for adrenal...

Privacy of pharmacy prescription records.(Letters/Correspondance)(Letter to the Editor)
September 28, 2004... On behalf of the National Association of Pharmacy Regulatory Authorities (NAPRA), Canada's voluntary umbrella association of provincial and territorial pharmacy regulatory bodies, I am writing to respond to the commentary by Dick Zoutman and...

Correction.(Letters/Correspondance)(Correction Notice)
September 28, 2004... The Health and Drug Alerts article on Zelnorm (1) contained 2 errors. First, the complete description for Zelnorm is "the serotonin 5-HT4 receptor partial agonist, tegaserod (Zelnorm)." Second, the approximate number of people who will have...

Quebec to report on Clostridium difficile in 2005.(Infectious Disease)
September 28, 2004... Quebecers will have to wait until at least February 2005 to find out whether Montreal hospitals facing an outbreak of Clostridium difficile cases in the past 18 months have successfully reduced the infection and death rate. A surveillance...

From CMJ to CMAJ.(Canadian Medical Association Journal)(Aleksandra Misak)(Brief Article)
September 28, 2004... CMAJ breaks a 6-year tradition with its new editorial fellow. Dr. Aleksandra (Sasa) Misak is the first fellow from abroad and the first with substantial editorial experience. Misak has been a manuscript editor at the Croatian Medical...

Telemedicine: on, under and out of this world.(New Technology)(Brief Article)
September 28, 2004... New Canadian telemedicine technology being tested in an underwater laboratory off the coast of Key Largo in Florida could be used to deliver emergency diagnostic and surgical care to astronauts in space--and to patients in remote areas on...

US Medicare opens door to covering obesity treatments.(Public Health)
September 28, 2004... After prompting from the Centers for Disease Control and Prevention in 2001, the US Department of Health and Human Services (HHS) finally removed a clause from its Medicare Coverage Issues Manual in July that stated obesity is not an illness....

Indigenous health.(News @ a glance)(requirement for Australian aboriginal health professionals)(Brief Article)
September 28, 2004... Indigenous health: Australian indigenous health services urgently need 430 doctors and 450 allied health professionals. A report from the Australian Medical Association (AMA), "Healing Hands: Aboriginal and Torres Strait Islander Workforce...

Northern school accredited.(News @ a glance)(Northern Ontario School of Medicine)(Brief Article)
September 28, 2004... Northern school accredited: It has been a productive summer at the Northern Ontario School of Medicine. Canada's first new medical school in over 30 years is now accredited, accepting student applications and seeking more faculty for a planned...

R&D rises.(News @ a glance)(Brief Article)
September 28, 2004... R&D rises: The proportion of research and development dollars spent on health is steadily rising, reports Statistics Canada. In 1996, health accounted for about 18% of all research and development expenditures in Canada. By 2003, it reached...

Global Fund wants you.(News @ a glance)(Brief Article)
September 28, 2004... Global Fund wants you: The Global Fund to Fight AIDS, Tuberculosis and Malaria is now tapping the public's shoulder. Since it was established in 2002 by the G8 and the United Nations, more than US$3billion has been committed to programs to...

CPP invests in tobacco.(News @ a glance)(Brief Article)
September 28, 2004... CPP invests in tobacco: The CMA is calling on the Canada Pension Plan to stop investing in the stock of tobacco companies. The investment in tobacco, which totals almost $95 million, "undermines our national tobacco strategy," said Dr. Jay...

"Abortion pill" use.(News @ a glance)(Brief Article)
September 28, 2004... "Abortion pill" use: Three years after the US government approved mifepristone (Mifeprex or RU-486), use of the so-called "abortion pill" has increased 70%. Planned Parenthood, which provides the drug at 201 sites, reports that 43 153 American...

ALLHAT: what has it taught us so far?(Hypertension)
September 28, 2004... By the end of the 1980s and early 1990s a major shift occurred in the choice of pharmacologic therapy for hypertension. Many physicians stopped prescribing diuretics for older patients with hypertension in favour of...

Antibiotics for sore throat to prevent rheumatic fever: yes or no? How the Cochrane Library can help.(The Cochrane Library)
September 28, 2004... With the winter season just around the corner you anticipate numerous patient enquiries and visits related to the use of antibiotics for the common cold and associated morbidities. One day a 45-year-old woman, a recent immigrant from India,...

Fall prevention in the elderly population.(Public Health)
September 28, 2004... Background and epidemiology: A quick visit to the Quick Stats section on the Canadian Institute of Health Information Web site (http://secure.cihi.ca/cihi web/splash.html) stopped us short: falls accounted for 85% of the 73 113 injury-related...

Domperidone for lactating women.(Health and Drug Alerts)
September 28, 2004... Reason for posting: Domperidone has been widely used as a motility and antiemetic agent. (1) In oral form it is also used off label to improve lactation in breast-feeding women. Intravenous domperidone has been withdrawn from the market...

Should people with asymptomatic carotid artery stenosis undergo endarterectomy for primary stroke prevention?(In the Literature)
September 28, 2004... Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, et al; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent...

Books received.(Practice)
September 28, 2004... Campen RB. Blueprints: dermatology. Malden (MA): Blackwell; 2004. 175 pp. US$28.95 ISBN 1-4051-0441-4 Furlong DJ. Medicare myths: 50 myths we've endured about the Canadian health care system. Saint John (NB): Dreamcatcher; 2004. 156 pp....

Volvulus: a rare twist on small-bowel obstruction.(Clinical Vistas)
September 28, 2004... A 61-year-old woman presented to the emergency department with acute abdominal pain of several hours' duration accompanied by nausea but no vomiting. Her past medical history was significant for adenocarcinoma of the sigmoid colon treated with...

Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users.(Research/Recherche)
September 28, 2004... Abstract Background: North America's first medically supervised safer injecting facility for illicit injection drug users was opened in Vancouver on Sept. 22, 2003. Although similar facilities exist in a number of European cities and in...

Outcome reporting bias in randomized trials funded by the Canadian Institutes of Health Research.(Research/Recherche)
September 28, 2004... Abstract Background: The reporting of outcomes within published randomized trials has previously been shown to be incomplete, biased and inconsistent with study protocols. We sought to determine whether outcome reporting bias would be...

Limitations to antiarrhythmic drug use in patients with atrial fibrillation.(Research/Recherche)
September 28, 2004... Abstract Background: Of the antiarrhythmic agents currently marketed in Canada, 5 are commonly used to treat atrial fibrillation (AF). The impact of contraindications, warnings and precautions for the use of these drugs in patients with AF...

So what has the Cochrane Collaboration ever done for us? A report card on the first 10 years.(Commentary/Commentaire)
September 28, 2004... The Cochrane Collaboration is a unique, worldwide not-for-profit organization that aims to help people make well-informed decisions about health care by preparing, maintaining, and promoting the accessibility of, systematic reviews of the...

Registering CIHR-funded randomized controlled trials: a global public good.(Commentary/Commentaire)
September 28, 2004... On July 26, 2004, the Canadian Institutes of Health Research (CIHR), the largest publicly funded granting agency in Canada, announced that all new CIHR-funded randomized controlled trials (RCTs) must be registered with an International Standard...

Atrial fibrillation.(Mechanisms of disease)
September 28, 2004... Abstract ATRIAL FIBRILLATION (AF) is the most common sustained dysrhythmia in adults. It is ironic, then, that although mechanisms and effective treatments for most other supraventricular tachyarrhythmias have been discovered, AF remains...

Photographs at war.(The Left Atrium/Cote coeur)(Regarding the Pain of Others)(Book Review)
September 28, 2004... Regarding the pain of others Susan Sontag New York: Picador / Farrar, Straus and Giroux; 2003 $16 (paper) 131 pp ISBN 0-312-42219-9 Photographs at war The US-led war and occupation in Iraq has produced many surprises--the absence of...

Self-portraits of illness: the gift of the gaze.(Lifeworks)
September 28, 2004... One of our projects at the Centre for Global eHealth Innovation is to collaborate with people with colorectal cancer as they represent their experiences through visual and text-based narratives. Participants are provided with cameras and asked...

Deaths/Necrologie.(Obituary)
September 28, 2004... Boskovic, Aleksandar D., Montreal; University of Belgrade (Yugoslavia), 1952; nuclear medicine; ABNM; former chief, Department of Nuclear Medicine, Sacre-Coeur Hospital; teaching staff, University of Montreal. Died Apr. 4, 2004, aged 81. ...

Query.
September 28, 2004... I sat in the converted camp ten kilometres outside a small northern town. It was snowing heavily on the third day of our trip and, except for the occasional foray for firewood, we remained inside. The wind pushed past the poor insulation and...