Highlights of this issue

Intensive statin therapy for coronary artery disease

In this meta-analysis of 7 randomized controlled trials involving 29 395 patients with coronary artery disease, Josan and colleagues found that more intensive statin regimens, compared with less intensive regimens, reduced myocardial infarction and stroke. Among patients with acute coronary syndromes, more intensive therapy also reduced mortality. However, the authors found insufficient evidence to recommend treating to a particular low-density lipoprotein cholesterol level.

See page 576

A multifaceted intervention to improve osteoporosis care

Fragility fractures identify patients at high risk for osteoporosis. In this randomized controlled trial involving 272 outpatients who had presented with wrist fracture, Majumdar and colleagues found that a multifaceted intervention consisting of patient education, physician reminders about their patient's osteoporosis risk and the provision of evidence-based treatment guidelines to the physicians improved rates of testing and treatment of osteoporosis. Nevertheless, a majority of patients were still not receiving appropriate osteoporosis care 6 months after the fracture.

See page 569

Blood pressure measurement over a sleeved versus a bare arm

In this randomized trial of 376 outpatients of an academic family medicine clinic in Montréal, Quebec, Ma and colleagues found that blood pressure measurements taken over a patient's sleeve did not differ from measurements taken on a bare arm. The authors conclude that measurement over a sleeved arm may be acceptable if desired for convenience or patient comfort. In a related commentary, McKay discusses factors affecting the accuracy of automated devices for measuring blood pressure.

See pages 585 and 591

Electronic medical record of the future

This issue's editorial discusses the tension between privacy and accessibility inherent in the electronic medical record. The editors argue that barriers created by privacy laws, which inhibit implementation of full electronic linkage of all records for each patient, are endangering patients.

See page 531

Disclosing genetic risks to patients' relatives

Should physicians warn patients' relatives of genetic risks without patient consent? In this commentary, Lacroix and colleagues use a hypothetical case of a woman with the BRCA1 mutation to discuss the ethical and legal issues surrounding disclosure of genetic risks to relatives.

See page 593

Practice

In the first article in CMAJ's series on dementia, Patterson and colleagues provide physicians with practical guidance on risk assessment and primary prevention of Alzheimer disease based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (page 548).

In this issue, we offer a collection of articles on human rabies in Canada and abroad. In the Teaching Case Report, McDermid and colleagues describe a patient with rabies encephalitis following a bat bite; the use of therapeutic coma (the Milwaukee Protocol), unsuccessful in this case, is discussed. In Public Health, Haider reviews the prevalence of human rabies globally as well as strategies for pre-and postexposure prophylaxis. In a second Public Health article, Menezes describes the unique challenges posed by the rabies epidemic in India, where the prevalence is extraordinarily high. A patient fact sheet on rabies risk among travellers rounds out the package (pages 557, 562, 564 and 567).

In Interesting Images, Tapiawala and colleagues provide images showing a knotted nasogastric tube in a 35-year-old man (page 568).