Highlights of this issue

Implementing computer information systems: What works, what doesn't?

The success or failure of a computer information system (CIS) to request lab tests and results and to prescribe treatments depends on whether physicians accept or resist its implementation. Lapointe and Rivard analyze the reactions to CIS implementations at 3 hospitals to understand better the dynamics of physicians' resistance and why implementations may fail. In a related commentary, Zitner maintains that resistance is not due to power and politics but rather to the fact that physicians often end up having less time to spend with patients.

See pages 1573 and 1583

COX-2 inhibitors and the timing of cardiovascular risk

In a large, population-based cohort study involving elderly people with no history of myocardial infarction (MI) taking NSAIDs published last year, Lévesque and colleagues found an increased risk of acute MI among those taking rofecoxib. In this follow-up study, the authors used patient data on the patterns and duration of rofecoxib and celecoxib use to determine the temporal nature of the risk of a first MI. The risk was highest following first-time use of rofecoxib, and about one-quarter of those who had an MI experienced it within the first few weeks of use. In a related commentary, Armstrong discusses how NSAIDs can best be used.

See pages 1563 and 1581

Opioids for chronic noncancer pain

Although opioids are a useful option to treat chronic noncancer pain (CNCP), use of these drugs is still controversial. This meta-analysis answers questions about their efficacy and side effects, and identifies categories of CNCP for which opioids have been shown to be more effective.

See page 1589

Disabled medicine

A medical student with a disability reviews the issue of medical students with disabilities and how medical education must respond to students and residents with special needs. Manders urges medical schools to increase instruction about disabilities as well as communication among schools.

See page 1585

Analysis •Practice

Recommended maximum wait times have been published that were arrived at by consensus of panels of experts. Schaafsma suggests instead that a more transparent method be developed for calculating optimal wait times (once a decision to treat has been made) that is based on overall cost minimization (page 1551).

Kurji and colleagues describe the pros, cons, and public-health and other concerns related to use of a piscicide to halt the spread of the round goby fish, a recent invader of the Great Lakes system, in order to protect the angling industry in Lake Simcoe (page 1557).

Although respiratory distress in neonates is not uncommon, Wong and Lin describe a rare and possibly underrecognized cause — bilateral midnasal stenoses — and how they treated it (page 1558).