- © 2008 Canadian Medical Association
Pulmonary embolism, hospital volume and patient outcomes
In this retrospective study of data for 15 531 patients with pulmonary embolism admitted to 186 hospitals in Pennsylvania, Aujesky and colleagues found that hospitals with the lowest volume of pulmonary embolism cases had the highest patient mortality rates. The authors speculate that greater physician experience and better processes of care at hospitals with higher volumes may account for these differences. In a related commentary, Carrier and Wells discuss whether the management of pulmonary embolism should be regionalized.
Problem-based learning in medical school and physician competency
In this systematic review, Koh and colleagues synthesized the evidence regarding the effects of a problem-based learning curriculum in medical school on physician competencies after graduation. They found moderate to strong evidence favouring problem-based learning for several competencies, especially in social and cognitive domains. In a related commentary, Norman reviews the development of problem-based learning and calls for further investigation to establish why the method works. Also related, this issue's editorial challenges the need for medical school to last the traditional 4 years given the apparent success of schools with 3-year curricula.
Errors during preparation of intravenous medication
In a prospective study conducted in a structured, nonclinical environment, Parshuram and colleagues observed 118 health care professionals perform tasks involved in preparing morphine infusions. They found errors in drug-volume calculation, rounding, mixing and measuring volume. The authors identified multiple factors associated with errors. In a related commentary, Etchells and colleagues discuss approaches to reducing medication errors.
Reducing the need for blood transfusions in critically ill patients
Anemia is common among critically ill patients, yet blood transfusions carry important risks. In this narrative review, Tinmouth and colleagues discuss available therapeutic options for reducing acute blood loss and preventing subacute anemia in critically ill patients.
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Practice
In this Teaching Case Report, Bercovitch and Luo describe a case of contact dermatitis with nickel allergy related to cellphone use in an 18-year-old man (page 23).
In this issue's Clinical Vistas Briefs, readers are asked to determine the cause of chronic sinusitis and intermittent hemoptysis in a 59-year-old man and to diagnose a rapidly growing lesion on the ankle of a 51-year-old woman (page 25).