Can we improve the survival of tuberculosis patients?
As the incidence of tuberculosis in Canada declines, so too does the experience of physicians with this disease. What impact will this have on patient survival? Khan and colleagues looked at cases of active TB reported in Toronto over 3 years and found 2 modifiable factors that influenced all-cause mortality: use of directly observed therapy and physician experience with tuberculosis. In a related commentary, Long points out the changing demographics of patients with TB in Canada.
Proton pump inhibitors and the risk of Clostridium difficile-associated disease
The association between the use of proton pump inhibitors and the risk of Clostridium difficile-associated disease (CDAD) is controversial. In this study, Dial and colleagues challenge their earlier claim of an association between the use of these drugs and the development of community-acquired CDAD by re-examining the data, this time using the receipt of oral vancomycin therapy as a proxy for community-acquired CDAD. In a related commentary, Cunningham reviews the polarized debate around the pathogenesis of CDAD and highlights the need for a randomized interventional study to assess proton pump inhibitor use and risk of CDAD.
Interdisciplinary research in the health sciences in Canada: a meeting of minds
Brought together by the newly formed Canadian Academy of Health Sciences (CAHS), leaders of the 6 health sciences disciplines review the environment for conducting interdisciplinary health research in Canada. They find that although much progress has been made, health researchers still experience some barriers to interdisciplinary research. In a related commentary, Armstrong discusses the recommendations made and the need for the CAHS.
Analysis • Practice
Narayan and colleagues analyze the costs and likely benefits of implementing different types of diabetes care in developing countries (page 733).
Au describes the case of a 1-year-old girl with recurrent meningitis that was eventually discovered to be due to an occult spinal lesion. The author emphasizes the need to examine a newborn's back for signs that might suggest an underlying spinal defect (page 737).
In this issue's Clinical Vistas Briefs, readers are asked to diagnose a drum-stick–like congenital lesion in the umbilical region of a newborn; acute monoarthritis in the toe of a patient with a history of gout; and 2 gradually enlarging asymptomatic skin lesions on the thigh of an otherwise healthy elderly man (page 739).