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The new minister of health and the federal government must provide national leadership in health, says Hébert. Significant disparities in our fragmented health system should be addressed by enforcing the Canada Health Act and following the action plan of the health accords, he adds. See Editorial, page 903
Anticoagulant management through information technology
An interactive voice response system integrated with computerized decision support may be used to manage oral anticoagulant therapy for stable patients. In their observational study, which included 226 patients, Oake and colleagues found that use of such a system was associated with satisfaction for the majority of patients and reduced workload for staff. They also found that the proportion of time that patients spent in the therapeutic range did not differ between the baseline and intervention periods. See Research, page 927
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C peptide and diabetes
Therapy with insulin may increase the incidence of cardiovascular disease and death in patients with type 2 diabetes and normal to high levels of C peptide, a marker of insulin produced endogenously. Ko and colleagues conclude that the findings of their 9-year cohort study of 503 patients suggest a possible role for targeting therapy to phenotype. See Research, page 919
Measuring C peptide levels may not be a reliable method of differentiating which patients would benefit from insulin therapy, say Cheng and Leiter. They add that a multifactorial approach is needed to reduce cardiovascular complications in patients with diabetes. See Commentary, page 907
Medication errors
Checking and comparing medications on admission and discharge from intensive care units may reduce medication errors in critical care. Involving pharmacists in inpatient rounds may also decrease adverse drug events. These are 2 of the approaches suggested by Camiré and colleagues in their review. See Review, page 936
Better knowledge management
To improve their use of evidence-based interventions, clinicians need access to reliable, relevant and readable knowledge resources. Straus and Haynes describe a "5S" approach to seeking information that meets the 3Rs. See Analysis, page 942
A striped rash
A papular, erythematous rash forms a thin vertical line that extends along the length of the right leg of a 15-month-old child. What is your call?See Practice, page 947
Idiopathic pancreatitis
A 23-year-old woman experienced sudden-onset epigastric pain, nausea and vomiting. Magnetic resonance cholangiopancreatography showed pancreas divisum, a relatively common, but underrecognized, congenital ductal anomaly. See Practice, page 949
Tension gastrothorax
More than 1 year after being injured in a motor vehicle accident, a 52-year-old man presented with abdominal fullness, epigastric pain and intractable hiccups. A radiograph showed a large mass with an air–fluid level in the left side of the chest and a shift of the mediastinum to the right. See Clinical images, page 983
Regulation of antibiotics for animals
An industry-led task force urges the government to delay the regulation of imports of unapproved and untested antibiotics for animals. See News, page 914
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