Highlights

Gestational diabetes and later diabetes

Diabetes developed within 9 years after the index pregnancy in nearly 20% of women with previous gestational diabetes, according to a study by Feig and colleagues. The comparable rate among women without gestational diabetes was 2%. The researchers used a large population-based database to identify all deliveries in Ontario over a 7-year period and linked them to another database of people with diabetes. See Research, page 229

In a related commentary, Simmons asks for more screening of pregnant women for gestational diabetes and better monitoring of women postpartum for diabetes. See Commentary, page 215

Oral anticoagulants

The risks of hemorrhage and thromboemboli are minimized at international normalized ratios of 2–3, but ratios that are moderately higher than this range appear to be relatively safe and more effective than subtherapeutic ratios. This is the finding of a meta-analysis by Oake and colleagues that included 19 studies. Avoiding underanticoagulation will improve patient outcomes, say the researchers. See Research, page 235

In a related commentary, Buller says that physicians tend to underdose patients taking anticoagulants. The careful approach of slowly increasing the dose of anticoagulants used to treat patients with international normalized ratios below 2 needs to be revisited. See Commentary, page 217

Surveying clinicians' knowledge, attitudes and practices

Burns and colleagues describe a systematic approach that will help investigators to design and conduct valid surveys of clinician's knowledge, attitudes and practices. This approach will also help readers to appraise published surveys. See Review, page 245

Lead in drinking water

Payne explains the public health relevance of lead in drinking water. He adds that the onus is on the homeowner to have household water tested and to seek remediation if lead is present. See Practice, page 253

What is your call?

A 75-year-old woman with lung cancer complained of dyspnea and dull retrosternal pain within 1 hour of the start of a transfusion via a pressure infusor into a Port-a-Cath. What is the cause of the pain and what is your next step? See Practice, page 255

Tracheal calcification

See extensive calcification of the trachea and bronchi in the chest radiograph of a 92-year-old woman. See Clinical images, page 291