Highlights

CMAJ’s policy on competing interests

Several changes have been made to CMAJ ’s policy on competing interests. Among the changes is the need to declare the competing interests of the organization that the authors represent, in addition to those of the individual authors. See Editorial, page 11

Myopathy, statins and normal creatine phosphokinase

Structural muscle damage may be present in patients with statin-associated myopathy even if the levels of serum creatine phosphokinase are normal. Increased expression of ryanodine receptor 3 may indicate muscle damage in some of these patients, find Draeger and colleagues. See Research, page E11

Electronic tracking system hits target of diabetes care

An individualized, web-based decision-support system shared by 253 patients with diabetes and their primary care providers improved the processes of care of diabetes and some risk factors for cardiovascular disease. Holbrook and colleagues successfully implemented their system in the community and interfaced it with 5 different types of electronic health records. See Research, page 37

Electronic decision-support systems need to be patient centred, with common standards of data exchange, to facilitate clinical management of complex diseases, say Grant and Middleton. See Commentary, page 17

Costs of cardiovascular drugs

Costs of cardiovascular drugs have escalated during the past decade and may reach unsustainable levels, say Jackevicius and colleagues. They also note differences in provincial spending, with eastern Canada having the highest costs. See Research, page E19

The higher costs of cardiovascular medications might indicate a health benefit that would be worth the increases in spending, says Califf. Using electronic health records may be one way of reducing these costs, he adds. See Commentary, page 15

Oseltamivir recommended during pregnancy

Pregnant woman are at high risk of complications related to influenza. The currently used seasonal influenza vaccine does not protect against novel influenza A (H1N1). Os-eltamivir can be recommended for the treatment of H1N1 in pregnant women, say Tanaka and colleagues, because there is more data about its safety during pregnancy than about the safety of other neuraminidase inhibitors. See Practice, page 55

Bisoprolol flares psoriasis

Bisoprolol led to exacerbation of psoriasis and life-threatening shock in a patient recovering from routine cardiac bypass surgery. See Clinical images, page 60

Perils of poultry

Off-label use of cephalosporins by poultry farmers is triggering human resistance to the entire class of drugs. See News, page 21

Reusing syringes

Dirty syringes remain a major health problem globally, according to the World Health Organization. More than 300 000 lives are lost annually in India from the use of unclean syringes, WHO adds. See News, page 26

We are changing!

As part of CMAJ ’s move to expand our online publishing, there will be no print issues on July 21, August 18 and September 29. Instead, we will invest the savings into an improved website with easier navigation and increased content. Visit cmaj.ca, starting July 21, and find what you need more easily and more often.