Highlights of this issue

Topical treatment of osteoarthritis

Figure. Photo by: CNRI / Science Photo Library

Oral NSAID therapy relieves pain in patients with osteoarthritis, but it also carries a substantial risk of adverse effects on the renal and gastrointestinal systems. These adverse events may be avoided by topical use of NSAIDs. Bookman and colleagues show that applying a topical NSAID, diclofenac solution, to a painful knee with primary osteoarthritis relieves the pain and stiffness and improves physical function of the joint while causing only minor and reversible adverse skin reactions at the application site.

See page 333

Maternal ethnicity and the risk of neural tube defects

According to Ray and colleagues' findings, in Ontario the risk of NTD-affected pregnancy is higher among women of First Nations origin than among women of other ethnic origins. The researchers recommend that the mechanisms for this discrepancy be explored.

See page 343

Family physician workloads and access to care

Figure. Photo by: © Chuck Savage/CORBIS/MAGMA

In light of perceived shortages of family physicians (FPs), many medical schools are expanding their student intake. However, a study of FP workloads and access to care in Winnipeg between 1991 and 2001 by Watson and colleagues shows that the number of FPs remained relatively stable over the decade, as did FP workloads and per capita visits. What did change was the volume of services provided by FPs of different age groups: younger FPs are providing fewer visits and older FPs are providing more visits than their same-age predecessors did 10 years ago. The issues of supply, workloads and access to care are complex, and the conventional focus on numbers of physicians alone is insufficient to address them.

See page 339

Tips for learners and teachers of evidence-based medicine

Many physicians still struggle with applying the basic skills of evidence-based medicine (EBM), and teachers of EBM can find those skills challenging to communicate to their students. The Evidence-Based Medicine Teaching Tips project presents the first in a series of articles aimed at both learners and teachers of EBM. Topics — in this issue, relative and absolute risk reduction and number needed to treat — are offered as “easily digestible bites” or mini-lessons and are presented in tandem with examples of clinical problem-solving. The tips are constructed to respond to learners' common struggles with understanding the concepts central to EBM, and the teachers' versions, which are offered online only, at www.cmaj.ca, describe the interactive process that unfolds when experienced EBM teachers use these tips.

See pages 353 and 347

In Synopsis

Figure. Photo by: CDC/Dr. Daniel P. Perl

Khandwala and Chibbar present a rare case of goitre caused by metastasis from ductal breast carcinoma (see page 329). Three cases of rabies transmitted via infected solid organ transplants have been identified postmortem (see page 327). Cavalcanti reviews a study that investigates whether perioperative lipid- lowering therapy reduced in-hospital mortality following major noncardiac surgery (see page 328). Menon comments on ovarian cancer screening (see page 323).