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Highlights of this issue

Figure. Photo by: Source: IS2006-1058, courtesy of the Canadian Forces Image Gallery, National Defence. Reproduced with the permission of the Minister of Public Works and Government Services, 2006.

November is a month of remembrance. In this issue, we mark the occasion by looking at the care of wounded soldiers in Afghanistan and how Canadian military surgeons prepare for the challenges facing them in Kandahar.

See pages 1345, 1357 and 1365

A triage protocol for critical care during a pandemic

An influenza pandemic or, as SARS demonstrated, any catastrophic outbreak of infectious disease will have profound effects upon the availability and delivery of health care services and the functioning of health care institutions. Christian and coauthors have developed a triage protocol for prioritizing access in Ontario to critical care resources during a pandemic. They note that the development of the protocol was a complex process, which would not be possible during a pandemic. In a related commentary, Melnychuk and Kenny review the ethical challenges that arise during the development of triage protocols.

See pages 1377 and 1393

Changes in illicit opioid use in Canada

For almost a century, heroin addiction has been a core element of the illicit drug use problem in Canada. Recently, isolated reports have pointed to substantial increases in prescription opioid abuse. To determine the impact on usage patterns among street drug users, Fischer and colleagues analyzed data from the multisite OPICAN cohort study. They found that heroin use has become an increasingly marginal form of drug use and that, instead, prescription opioid use is the predominant form of illicit opioid use. The authors suggest that these changes in usage patterns may require adjustments to opioid addiction treatment programs.

See page 1385

Canada leads the world in research productivity

Falagas and coauthors present a comparative analysis of the research productivity of 9 world regions in the following 3 broad scientific disciplines: infectious diseases, cardiopulmonary diseases and preventive medicine. After adjustments for gross domestic product, Canada was found to rank first.

See page 1389

Vancouver's safer injecting facility: The evidence is in

In September 2003 Vancouver opened a safer injecting facility, a place where people inject pre-obtained illicit drugs under medical supervision and have access to addiction counselling and other community resources. Legal exemption by the federal government was granted on the condition that a 3-year scientific evaluation of the facility's impacts be conducted. Wood and colleagues summarize the findings from evaluations in those 3 years. They found an array of community and public health benefits and no evidence of adverse impacts. In a related commentary, Wainberg reviews the findings, as well as those reported by Fischer and associates on illicit opioid use across Canada (page 1385). He calls on the federal government to continue its support of Vancouver's safer injecting facility and allow similar facilities to operate in other cities, as well as to fund research into harm reduction strategies.

See pages 1395 and 1399

Practice

Figure.

Inverted nipples, abnormal fat pads and cerebellar hypoplasia are some of the clues pointing toward an underrecognized congenital disorder in a 7-month-old infant with developmental delay (page 1369).

In Public Health, Majury and colleagues outline the measures required to test for human infection with avian influenza (page 1371).

In the Clinical Vistas, Schattner and coauthors describe a rare complication of diverticulitis that leads to fever, chills and little else to indicate potentially lethal infection in a 69-year-old man (page 1372).

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Can. Med. Assoc. J. 2006 175: 1345. [Full Text] [PDF]

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