Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Highlights of this issue

Highlights of this issue

CMAJ October 28, 2003 169 (9) 897;
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Rehabilitation medicine series

Figure1

Figure. Photo by: Fred Sebastian

A 3-part series on rehabilitation medicine begins in this issue of CMAJ. The series will cover 3 distinct clinical problems within this broad specialty: autonomic dysreflexia, dysphagia and spasticity. Maximizing independence in patients with physical disabilities will be the series' unifying theme.

In the first part of the series, Blackmer reviews the syndrome of autonomic dysreflexia. Usually occurring in patients with a spinal cord injury above the sixth thoracic vertebra, this syndrome is characterized by episodes of uncontrolled sympathetic output. Despite injury to the cord, preserved spinal reflexes mediate this response, which can result from any noxious stimuli below the level of the cord injury. Both pharmacologic and nonpharmacologic treatments for the syndrome are outlined.

See pages 928 and 931

The nature and severity of physical harm in child abuse

Figure2

Figure. Photo by: Tennyson Center for Children

Although physicians understand child abuse to be an important health and social problem, its epidemiology is poorly understood. Trocmé and colleagues present data from the Canadian Incidence Study of Reported Child Abuse and Neglect. They found that, among more than 60 000 substantiated cases of child abuse, 13% involved moderate injuries or health conditions, and 4% involved injuries or health concerns that were severe enough to require medical attention. The present mechanism for dealing with child abuse is predicated on the need for rapid intervention to ensure adequate protection of the child. However, because 96% of the cases did not involve serious physical harm, the authors suggest a need to consider a shift in priorities from rapid interventions to longer-term service needs.

In a related commentary, Ward and Bennett caution that the results of this study should not reassure physicians. They point out that the physical signs of abuse are often not obvious and that the emotional trauma that accompanies abuse goes beyond the 4% of children with severe injury or health conditions cited in the above study.

See pages 911 and 919

Treating acute myocardial infarction

Figure3

Figure.

No one disputes that the primary goal in the treatment of acute myocardial infarction is timely reperfusion of the infarct-related artery. However, the question of whether fibrinolysis or angioplasty is superior in achieving this outcome is the subject of intense research. In a commentary, Armstrong and Welsh caution against unbridled enthusiasm for mechanical reperfusion and raise important concerns regarding its wholesale use. Specifically, they point out that the evidence for its advantage over fibrinolysis in all situations has not been shown and that significant resource questions must be answered before timely round-the-clock angioplasty is considered the standard of care.

Long-term outcomes after MI also depend greatly on the care patients receive after they leave hospital. Young and colleagues show that inner-city patients who were followed by a community-based disease management program experienced better outcomes than those who received standard care: lower rates of admission for angina and congestive heart failure, and fewer emergency department visits.

See pages 905 and 925

Management of dyslipidemia

Genest and colleagues have updated the recommendations for the management of dyslipidemia first published in 2000 (CMAJ 2000;162:1441-7). The guidelines have been simplified, reflecting a modification in the risk equations used for cardiovascular disease. Also included is an assessment of factors that influence the risk of cardiovascular disease: apolipoprotein B, lipoprotein(a), homocysteine and high-sensitivity C-reactive protein. A summary of the recommendations is presented; the full set of guidelines is available at www.cmaj.ca.

See page 921

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 169 (9)
CMAJ
Vol. 169, Issue 9
28 Oct 2003
  • Table of Contents
  • Index by author

Article tools

Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Highlights of this issue
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Highlights of this issue
CMAJ Oct 2003, 169 (9) 897;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Highlights of this issue
CMAJ Oct 2003, 169 (9) 897;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Rehabilitation medicine series
    • The nature and severity of physical harm in child abuse
    • Treating acute myocardial infarction
    • Management of dyslipidemia
  • Responses
  • Metrics
  • PDF

Related Articles

  • Rehabilitation medicine: introduction to the series
  • Rehabilitation medicine: 1. Autonomic dysreflexia
  • Nature and severity of physical harm caused by child abuse and neglect: results from the Canadian Incidence Study
  • Studying child abuse and neglect in Canada: We are just at the beginning
  • Evaluation of a community-based inner-city disease management program for postmyocardial infarction patients: a randomized controlled trial
  • Tailoring therapy to best suit ST-segment elevation myocardial infarction: searching for the right fit
  • Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: summary of the 2003 update
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Highlights
  • Highlights
  • Highlights of this issue
Show more Highlights of this issue

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire