News @ a glance

Stent update: Patients with drug-eluting stents (DES) may lower their risks of MI or death by taking clopidogrel, an anti-platelet medication, longer than the currently recommended 3–6 months (JAMA 2006:297;early release Dec. 5, 2006). Among patients with DES who were event free at 12 months, those taking clopidogrel were less likely than those not taking clopidogrel to die during the next 12 months (0% v. 3.5%, p = 0.004) and less likely to either die or have a MI (0% v. 4.5%, p < 0.001). The researchers conclude that the appropriate duration for clopidogrel administration can only be determined within the context of a large-scale RCT.

Aid to India: The University of Manitoba has been awarded US$22 million for a program to stem the rising tide of HIV/AIDS in southern India. The award, provided by the US Agency for International Aid (USAID), is expected to provide 5 years of stability for a program whose future was unclear after Canadian support was withdrawn 8 months ago. The U of M project provides front-line prevention, counselling and treatment in 2 southern Indian provinces with more than 110 million people, says Dr. Stephen Moses, a professor and a lead scientist on the project. “The US government is signing on for the long-term,” says Moses. The university has been involved in India since 1998, and has been providing similar programming in Kenya for more than 25 years (where scientists are working with Oxford University on a promising HIV vaccine initiative). The program in India is a critical component of the national strategy to control the spread of HIV/AIDS, Moses says. Although infection rates are less than 1%, infectious disease experts are extremely concerned about the social and economic impact of an outbreak of African magnitude in the world's most populated country, he added. It is believed that more than 5.7 million Indians are infected with HIV, Moses says. — Dan Lett, Winnipeg

NS doctor sues: Halifax cardiologist Dr. Gabrielle Horne is suing Capital Health, Nova Scotia's largest health authority, claiming she has suffered loss of reputation, loss of a research program and lost remuneration as a result of a suspension that should have lasted roughly 2 weeks but ultimately took 4 years to resolve (CMAJ 2006;175:1845). Damages have not been specified but could be in the millions according to Horne's lawyer, Ron Pizzo. — Donalee Moulton, Halifax

Ultra Vires: BC Premier Gordon Campbell says the province will introduce legislation in 2007 to specifically define the 5 principles of the Canada Health Act (comprehensive, universal, portable, accessible and publicly administered), while adding a sixth: sustainability. Although that's entirely outside the jurisdiction of a provincial government, Campbell blithely noted that Ottawa only contributes about 6% of BC's $12-billion annual health budget and that “if the federal government feels that our legislation isn't appropriate, I'm sure they'll let us know.” British Columbians will be given an opportunity to voice their views on the legislation during a $10-million, 1-year health care consultation exercise.

Figure. Photo by: Brand X Pictures

Nursing pool: There's a widespread regional variation in the number of working nurses across the country, according to a new Canadian Institute for Health Information report, Highlights from the Regulated Nursing Workforce in Canada, 2005. The crude national average is 1004 per 100 000 population. But that ranges from a high of 1585 in Newfoundland and Labrador to lows of 916 in Ontario and 823 in BC. The study also shows that the nation's nursing pool is expanding slowly. The total number of nurses working in Canada in 2005 was 321 590, a 2% increase over 2004. RNs now make up nearly 80% of the total nursing workforce. Their average age is 44.7 years, as compared to 41 in 1994.

Stickhandling: Composite hockey sticks, comprised of materials such as fibreglass, carbon graphite and aluminum, may pose a higher risk of causing penetrating chest trauma, surmise medical student Joel Kennedy and colleagues in a case report published by the Canadian Journal of Emergency Medicine (2006;8[6]:437-40). The composite sticks “are thought to be lighter and more rigid, which unfortunately may result in stick fracture with sharp penetrable fragments. It is possible that fractured composite sticks may more easily allow penetrating trauma, as seen in our case.”

Product monitoring: A new computerized system to monitor adverse reactions to health products will give Health Canada greater capability to detect potential safety issues and analyze data. The new system, due to be implemented by October 2007, will monitor adverse reactions over the entire life cycle of a product. The internationally compliant system can also be expanded to include premarket adverse reaction reports from clinical trials. Minister of Health Tony Clement said the new system will allow Health Canada to “better protect the health and safety of Canadians.”

Required rural reading: The Society of Rural Physicians of Canada's new Manual of Rural Practice provides a lowdown on 40 rural practice procedures, “ranging from rapid sequence intubation to ingrown toenail removal.” See www.srpc.ca/books. — Compiled by Wayne Kondro, CMAJ