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During the 2000–2001 flu season, a new adverse event was associated with vaccination: oculorespiratory syndrome (ORS). Ninety-six percent of the 960 ORS cases were linked to one manufacturer's brand of vaccine, and precautions were taken for the 2001–2002 season to avoid its use in the revaccination of previously affected individuals. Danuta Skowronski and coworkers surveyed 609 people who reported adverse events in the 2000–2001 season to better understand the risk of recurrence of ORS. They found that, in 2001–2002, 122 of those whose adverse reaction was ORS were revaccinated and showed only a 5% recurrence rate of ORS, with most reactions being milder than they had been before.
See page 853
Family physicians and emergency medicine
Since 1982 the College of Family Physicians of Canada has offered emergency medicine certification, CCFP(EM), with the aim of providing family physicians with extra emergency medicine skills, allowing the Royal College of Physicians and Surgeons of Canada to train dedicated emergency specialists. According to a survey carried out by Benjamin Chan, there is an incongruity between the CCFP(EM) program's objective and the practice choices of its graduates, with the majority practising emergency medicine almost exclusively.
See page 869
Bugs bite back
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Bacteria are becoming more resilient, and their capacity to change threatens both our armamentarium of therapeutic options and our patients. In addition to being more difficult to treat, resistant bacteria are also more expensive. Annual overall costs to the Canadian health system are estimated to be as much as $200 million. The number of antibiotic prescriptions decreased 11% from 1995 to 2000, yet resistance rates continue to rise. In this review, John Conly discusses the reasons why bacteria change, how they do it and what might be done to slow the process.
See page 885
The clock-drawing test
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People may have a normal Mini-Mental State Examination (MMSE) score, yet have significant cognitive dysfunction. Early diagnosis might allow for prompt treatment, or facilitate future planning. Angela Juby and colleagues describe how clock drawing was analyzed as an adjunct test in 22 patients who had a normal MMSE score but were diagnosed as having cognitive changes based on in-depth interviews. Clock drawing was found to be both moderately sensitive and specific for detecting executive cognitive dysfunction, and might be a useful tool to assist in early diagnosis.
See page 859
Searching for El Dorado
One of our greatest challenges is to provide cost-efficient health care. But to whom do we offer our most expensive procedures? What about procedures of marginal benefit? Norman Frohlich and Noralou Roos suggest that finding the appropriate rate and distribution of procedures is currently an impossible task. They argue that further insight is needed into the cost-effectiveness of interventions, and once such information is gained, it should fall to health care providers to establish priorities.
See page 880
Related Articles
Can. Med. Assoc. J. 2002 167: 853-858.
Can. Med. Assoc. J. 2002 167: 859-864.
Can. Med. Assoc. J. 2002 167: 869-870.
Can. Med. Assoc. J. 2002 167: 880-881.
Can. Med. Assoc. J. 2002 167: 885-891.
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Copyright 1995-2002, Canadian Medical Association. All rights reserved. ISSN 1488-2329
(e) 0820-3946 (p)
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association. |
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