Highlights

New osteoporosis guidelines for Canada

The management of osteoporosis should be guided by an assessment of the patient’s absolute risk of osteoporosis-related fractures is one of the main messages in the 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada from Osteoporosis Canada. See Review, page 1864

The new guidelines are timely because of important advances in the assessment of fracture risk that enable more effective targeting of treatments. See Commentary, page 1829

Has the time come to phase out codeine?

Codeine’s metabolism to morphine is not only unpredictable but also potentially dangerous, say MacDonald and colleagues. Expanded warnings and further evidence characterizing risks should be a priority for health regulators. Until then, hospitals should suspend its use, the authors add. See Editorial, page 1825

Nutritional assessment and length of hospital stay

Impaired nutrition at the time of admission and weight loss while in hospital were factors associated with prolonged hospital stay. Caccialanza and colleagues report this finding from their prospective study involving 1274 ambulatory adult patients in which they assessed the Nutritional Risk Index at admission and collected clinical information during hospital stay until death or discharge. Clinicians should be aware of the risks of poor nutrition, although more research is needed to assess the impact of nutritional interventions on length of hospital stay. See Research, page 1843

Maintaining or improving the nutritional status of patients admitted to hospital will likely improve clinical outcomes and help contain health care costs, say Kyle and Coss-Bu. See Commentary, page 1831

Prevalence of seroprotection against the pandemic (H1N1) virus after the 2009 pandemic

Antibody levels to pandemic (H1N1) influenza were much higher in spring 2010 than before the 2009 pandemic, but they were low among people aged 50–79 years. These findings come from a cross-sectional study of antibody levels in blood samples left over from routine blood tests for 1127 people in the Lower Mainland region of British Columbia. A third pandemic wave is unlikely, say the authors, unless immunity fades quickly or the virus changes, but more studies in other areas are needed to confirm this. See Research, page 1851

Soy may reduce recurrence of breast cancer

A diet high in soy isoflavones had no overall effect on breast cancer survival but may have been associated with lower rates of recurrence in postmenopausal women. This is the finding of a follow-up study of 524 women who had undergone surgery for breast cancer and who were receiving adjuvant endocrine therapy. These findings need to be confirmed in other studies before firm recommendations can be given to patients. See Research, page 1857

Pandemic (H1N1) 2009: the heat is on

Canada’s initial decision to order 60 million doses of adjuvant vaccine for pandemic (H1N1) 2009 was reasonable, but subsequent decisions and problems led to huge difficulties, report Low and McGeer. “The vaccine could not be made quickly enough to protect Canadians from the second wave, the complexity of delivering vaccine was badly underestimated, and attempts to deliver rapid public education about vaccination with an adjuvant vaccine failed,” state the authors. See Analysis, page 1874

Bilateral pleural effusions

Bilateral pleural effusions developed in a 50-year-old woman with large B-cell lymphoma. Aspiration at thoracentesis showed milky off-white to yellow fluid. What is your diagnosis? See Practice, page 1879