Highlights

Smoked cannabis for chronic neuropathic pain

Cannabis smoked three times per day reduced the intensity of neuropathic pain, improved sleep and was well tolerated. In this randomized crossover trial of 23 patients, Ware and colleagues used three strengths of cannabis as well as placebo to test the effects of the drug. These findings need to be confirmed in larger long-term safety and efficacy studies, say the authors. See Research, page E694

The trial by Ware and colleagues supports the idea that cannabis is a potential second-line therapy for neuropathic pain, with perhaps more evidence for central neuropathic pain than for peripheral. See Commentary, page 1494

Cast versus splint in children with minimally angulated fractures

For minimally angulated wrist fractures in children, a splint produces comparable results to a cast. This is the finding of Boutis and colleagues in a randomized controlled trial involving 96 children that evaluated physical function, angulation, pain, range of motion, grip strength and treatment preference. Splints are easier to apply, their removal does not require a saw, and they allow better access for hygiene, say the authors. See Research, page 1507

H1N1 among pregnant women during the first wave of the 2009 pandemic

During the first wave of pandemic (H1N1) 2009, an estimated 8.6% of pregnant women in Manitoba were infected. Mahmud and colleagues compared antibody levels in stored serum obtained during routine prenatal care from 252 women before and 296 women after the first wave to arrive at this figure. Their findings provide a better gauge of pandemic (H1N1) influenza than do hospital admissions or numbers of laboratory-confirmed cases, say the authors. See Research, page 1522

The Canadian CT Head Rule in emergency departments

Despite a well-designed knowledge translation strategy, it was not possible to reduce inappropriate use of computed tomography (CT) scanning in emergency departments. In this randomized controlled trial involving 4500 people with minor head injury, Stiell and colleagues attempted to implement the Canadian CT Head Rule using education, policy and real-time reminders. The authors suggest that future studies should identify ways to deal with barriers to implementation of decision rules. See Research, page 1527

A framework for research ethics review during public emergencies

Public emergencies, such as the pandemic (H1N1) 2009, have illuminated the challenge of combining speed and flexibility with intense scrutiny in research ethics reviews. Tansey and colleagues propose a framework for emergency review of research protocols based on increased diligence and enhanced procedural flexibility in proportion to risks and circumstances. See Analysis, page 1533

Legionellosis: Why should I test and report?

Although sporadic cases of legionellosis are often treated without empiric testing to confirm the diagnosis, individual cases should be fully investigated because they may be the harbinger of a larger outbreak. Marrie and colleagues stress that detection of Legionella antigen in urine takes about an hour. Mapping of the timing and locations of cases may allow identification of the source of exposure and initiation of remediation measures. See Practice, page 1538

Painful testicle in a young boy

A 12-year-old boy presented with acute and severe testicular pain. Examination showed that the right side of the scrotum was swollen, red and tender. Does the boy have testicular torsion, torsion of a testicular appendage or epididymitis? Will sonography help? Is surgery indicated?See Practice, page 1543