Highlights of this issue

The risks of raves

Raves are all-night parties attended by large numbers of youths and are notorious for clandestine venues, hypnotic music and the liberal use of drugs such as "ecstasy" (3,4-methylenedioxymethamphetamine), "GHB" (gamma-hydroxybutyrate) and ketamine. Several rave-related deaths in Canada in 1999 point to the need for physicians to know about raves, the drugs used and the health risks involved. Erica Weir reviews the culture, the drugs and the strategies for harm reduction. In an accompanying commentary Michael Rieder discusses the implications for primary care physicians. FIGURE 1

Figure 1.

See pages 1829 and 1843

Update on stuttering

Stuttering is a disturbance in the normal fluency and time patterning of speech that is inappropriate for a person's age. The most common type of stuttering, developmental, has a gradual onset in childhood and resolves by puberty in 50% to 80% of cases. Daniel Costa and Robert Kroll provide a comprehensive review for clinicians about the diagnosis and management of patients with speech dysfluency.

See page 1849

Please join us for cocktails

The extraordinary revolution in health care informatics can be likened to the advent of printing during the 16th century. The Internet allows simultaneous and interactive exchange of information around the world. According to Alejandro Jadad and Murray Enkin, our discomfort with the pace of change may arise not from being too slow, but from being too fast to jump on the electronic bandwagon. We may be forsaking our primal sources of understanding, developed over thousands of years, such as our reliance on anecdotal knowledge. Jadad and Enkin set out to harness the power of the anecdote by blending anecdotal stories with evidence-based medicine. The result is a cocktail party conversation. Please join us (and join in). FIGURE 2

Figure 2.

See page 1826 and 1839

Questioning the validity of utilization review tools

Utilization review tools are used to assess the appropriateness of hospital admissions and lengths of stay. Norman Kalant and colleagues applied 3 tools - the ISD (Intensity of service, Severity of illness, Discharge screens), the MCAP (Managed Care Appropriateness Protocol) and the AEP (Appropriateness Evaluation Protocol) - to the retrospective review of 75 patients admitted to an acute cardiology service. Each case was also evaluated by a panel of cardiologists. The overall agreement between the tools and the panel was poor (kappa value 0.45 for the ISD, 0.24 for the MCAP and 0.25 for the AEP). In an accompanying commentary Jack Tu cautions that utilization review is not going away and advises physicians and researchers to work together to improve the methodology.

See pages 1809 and 1824

Massage therapy for low-back pain

Michele Preyde conducted a randomized controlled trial to study the effectiveness of massage therapy for subacute low-back pain. The 107 subjects were allocated to 1 of 4 treatment groups: comprehensive massage therapy, soft-tissue manipulation only, remedial exercise with posture education only, or a placebo of sham laser therapy. Changes in functionality and pain were measured before and after treatment sessions using the Roland Disability Questionnaire and the McGill Pain Questionnaire. The comprehensive massage therapy group reported the more improved function (1.54 v. 2.86-6.5, p < 0.001) and a greater reduction in pain intensity (0.42 v. 1.18-1.75, p < 0.001) than the other 3 groups. FIGURE 3