Highlights

Improving quality in practice

The use of a multifaceted quality-improvement package reduced nosocomial infections and bronchopulmonary dysplasia in preterm infants in neonatal intensive care units. This is the finding of a randomized controlled trial by Lee and colleagues. Their method for continuous quality improvement was based on the use of evidence from published literature, the identification of hospital specific practices for targeted interventions and the sharing of expertise in a national network. See Research, page 469

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The costs, benefits and cost-effectiveness of such strategies need to be established, say McGuire and Fowlie. See Commentary, page 457

Research achievements

From male circumcision to reduce HIV transmission to a citywide program for treatment of myocardial infarction: the 8 projects celebrated as the top Canadian achievements in health research by the Canadian Institutes of Health Research and CMAJ. See Special report, page E138

Heparin-induced skin lesions

In this prospective study, heparin-induced skin lesions developed in 24 of 320 patients who had received subcutaneous heparin. The lesions were commonly caused by delayed-type hypersensitivity to the drug, say Schindewolf and colleagues. Obesity, female sex and duration of treatment were risk factors. See Research, page 477

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Is time of year a predictor of mortality?

Analysis of all-cause mortality rates from 11 countries showed a decline in mortality in the late summer and early fall months. Monthly mortality was lowest in September in the 5 European Mediterranean countries studied by Falagas and colleagues. See Research, page 484

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Umbrella reviews

Umbrella reviews are systematic reviews that consider many treatment comparisons for the management of one disease, says Ioannidis. These are needed when multiple treatments exist for one condition. He further explains what treatment networks are and how to analyze them. See Analysis, page 488

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Endogenous endophthalmitis caused by Klebsiella

A 54-year-old carpenter presented with a 13-day history of redness, tearing and pain in his left eye associated with progressive decrease in visual acuity caused by endophthalmitis. Klebsiella pneumoniae grew in a culture from the vitreous. See Practice, page 495

Dysphagia lusoria

An aberrant right subclavian artery was the cause of esophageal compression and dysphagia in a 76-year-old woman. Her symptoms resolved after carotico-subclavian bypass surgery. See Clinical image, page 498