Highlights of this issue

On the road

For many, the ability to drive is an integral part of their independence. Unfortunately, a number of medical conditions are associated with increased risks of motor vehicle accidents. To decrease the risk of collisions without completely revoking driving privileges, some jurisdictions offer restricted licences for those with medical impairments. In a retrospective study of a cohort of drivers in Saskatchewan over a period of 7 years, Shawn Marshall and colleagues examined the rates of crashes and traffic violations for drivers with restricted licences compared with those with general licences, and the rates before and after driving restrictions were imposed.

Figure. Photo by: Health Canada

Figure. Photo by: Fred Sebastian

Road rage is a curious and unfortunate manifestation of our modern society. Despite its widespread recognition as a serious phenomenon, there is a dearth of scientific research on its consequences because information about this problem is not collected routinely by health care facilities or the police. Because of this, Reginald Smart and Robert Mann examined the archives of the Canadian Press for 1998–2000 and found that 59 separate cases of road rage had been reported that resulted in injuries to 59 individuals and 4 deaths.

Most childhood deaths in Canada are a result of traffic injuries. Automobile restraints are one of the most effective ways of preventing fatalities that result from collisions, yet child restraints are often not used or are inappropriately used. Andrew Howard reviews current knowledge about the use and misuse of child restraints, describes their effect on injury patterns and gives the most current recommendations on how children should be seated in vehicles.

See pages 747, 761 and 769

Palm reading

Although criticized for being slow to embrace them, the medical profession is gradually making handheld computers as familiar in white coats as reflex hammers. They obviate the clutter of medical textbooks, allow frequent formulary updates, track patients (as well as stocks) and calculate the transtubular potassium gradient. The possibilities are endless. Unfortunately, so seem the choices. In the first of 2 papers on handheld computers, Feisal Adatia and Philippe Bedard describe and compare the features of different models, from screen resolution to built-in cameras.

Figure. Photo by: Christine Kenney

See page 775

Detecting delirium

Delirium is common but poorly diagnosed in populations of older patients admitted to medical services. It is associated with longer hospital stays and bad outcomes. Martin Cole and colleagues investigated the potential benefit of early systematic detection and multidisciplinary care of delirium in older patients who had been admitted to hospital. Their results suggest that such an approach is no more effective than the standard one of diagnosis and management of the contributing medical conditions.

See pages 753 and 763