Highlights of this issue

Linking emergency departments and family physicians electronically

Does the electronic exchange of patient information between emergency departments (EDs) and family physicians' offices improve resource use? In a randomized controlled trial, Lang and colleagues found that the use of a Web-based system to send family physicians detailed reports of their patients' visits to the ED made no difference to any marker of resource use, including the number of repeat ED visits and diagnostic tests ordered at follow-up.

See page 313

Risk of amputation in diabetic patients

Taller diabetic patients are at higher risk of peripheral sensory loss than shorter diabetic patients and therefore may be at increased risk of lower-extremity ulcers and amputation. In an analysis of data reported by more than 93 000 diabetic patients during telephone interviews, Tseng found that height was significantly associated with lower-extremity amputation, even after controlling for other risk factors, including fasting plasma glucose and lipid levels.

See page 319

HbA _1C testing in eastern Ontario

Glycosylated hemoglobin (HbA_1C) measurements help determine whether diabetic patients' glucose control is adequate. When Woodward and colleagues looked at how many diabetic patients had HbA_IC tests during one year, they found that almost half (42%) had none. Of those who were tested, less than half had ideal or optimal glucose levels.

See page 327

Debating conflict of interest and clinical guidelines

CMAJ introduces a debate on conflict of interest and clinical practice guidelines between the Canadian Diabetes Association and the Common Drug Review panel. In an accompanying “good-guideline guide,” Ontario's Guidelines Advisory Committee adds its own opinion on the ideal setting for guideline development.

See pages 333, 335 and 337

Epigenetics and human disease

Genetics has become an integral part of modern medicine since Watson and Crick first described DNA. From it has emerged the field of epigenetics, the study of how information that regulates gene function is transmitted from one generation (of cells or organisms) to the next without changes to DNA sequences. Rodenhiser and Mann review the principles of epigenetics and how these relate to human disease.

See page 341

Analysis • Practice

Stewart asks whether Canada could be doing more to address maternal mortality (page 302). Zarandona and Yazer review the role of the Coombs test for evaluating hemolysis in adults (page 305). A recent study on the use of waist-to-hip ratio instead of body mass index to determine risk of myocardial infarction is reviewed by Murray (page 308). Murray highlights tobacco control as a global health concern (page 309). Vasu and colleagues describe a rare cause of hydropneumothorax (page 311).