Highlights of this issue

Occupational asthma

Figure. Photo by: John McLean / Science Photo Library

Occupational asthma, or asthma caused by an aspect of the workplace environment, is being diagnosed with increasing frequency. More than 250 agents have been found to trigger occupational asthma, including the natural rubber latex gloves worn by health care workers, the acrylic glues handled by workers in electronics manufacturing plants, the dusts from red cedar and other woods inhaled by woodworkers and the plant allergens to which farmers are exposed. Susan Tarlo and Gary Liss review the classification of the various types of occupational asthma and offer guidance on how to diagnose, investigate and manage cases.

See page 867

Moral development in medical school

Concerns are growing about ethics in medical practice, beginning with the ethical development of students during their medical education. One would expect that maturation and involvement in university studies would result in improved moral reasoning, but studies in the United States have suggested that ethical skills deteriorate during medical training. Johane Patenaude and colleagues questioned a cohort of Quebec students in the first and third years of medical school and found that the students' ethical skills levelled over the course of their studies to a lower threshold of development than that expected for their age group. In a related commentary, Peter Singer discusses ways to strengthen the role of ethics in medical education.

See pages 840 and 854

Prescribing benzodiazepines

Benzodiazepine use by elderly patients is associated with adverse outcomes including increased risk of falls and fractures, motor vehicle accidents and cognitive impairment. Nicholas Pimlott and colleagues describe how they provided individualized feedback and education to a group of primary care physicians in an attempt to address the inappropriate prescribing of benzodiazepines for elderly patients. They found that their intervention had no significant impact on prescribing patterns in contrast to a similar program that improved antibiotic prescribing. They discuss the reasons for this difference.

See page 835

Complications of diabetes

Figure. Photo by: Chesley Sheppard

Diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS) are the most serious acute metabolic complications of diabetes mellitus and are associated with excess mortality. Based on the estimated diabetic population in Canada, Jean-Louis Chiasson and colleagues anticipate that some 5000–10 000 patients will be admitted to hospital because of DKA each year and 500–1000 because of HHS. The estimated mortality rate for DKA is between 4% and 10%, whereas the rate for HHS varies from 10% to 50%. Chiasson and colleagues discuss the diagnosis and treatment of DKA and HHS and emphasize that much needs to be done to lower their incidence and improve the outcome of patients with these conditions.

See page 859