Highlights of this issue

End-of-life care

What matters most to patients and family members for end-of-life care? Heyland and colleagues asked older patients with end-stage disease and their family members which elements of quality end-of-life care were most important to them. Trust in the physician, freedom from unwanted life support, effective communication and continuity of care were key factors, although results varied among patient groups. In a related commentary, Teno and Dosa discuss how we can reform health care to meet the needs and expectations of older people and those who care for them.

See pages 627 and 643

Evidence on harms and trial design

Are the risks of harms that are estimated in large-scale randomized trials of medical interventions similar to the risks estimated in nonrandomized observational studies addressing the same harms? Papanikolaou and colleagues found more than a 2-fold difference in risk estimates between the study types for most of the harms studied, with the observational studies often offering more conservative estimates. However, they believe it is useful to compare and scrutinize evidence from both trial types. In a related commentary, Vandenbroucke agrees that observational studies likely underestimate risk, but he describes how they have identified important harms and why they should not be discounted.

See pages 635 and 645

Hepatitis C in review

Although chronic hepatitis C infection is becoming increasingly common in Canada, one-third of patients with the virus are unaware of their infection. Wong and Lee review the epidemiology, serologic testing and management of hepatitis C, with practical recommendations for family physician care.

See page 649

Analysis • Practice

Baxter discusses critical care outreach (page 613). Goll and Shapiro review sleep disorders that present as common pediatric problems (page 617). Murray describes the current state of global injury and violence (page 620). Kendall assesses a study in which patients with stable coronary artery disease given a short course of clarithromycin had a higher death rate than those given placebo (page 622). Kendall and Wooltorton discuss the role of rosiglitazone in causing macular edema (page 623). Yanai and colleagues describe a young woman with a small-bowel obstruction and soft-tissue emphysema caused by superior mesenteric artery syndrome (page 624).