NDM-1 in Canada
The enzyme associated with multiple antibiotic resistance in common bacteria, New Delhi metallo-β-lactamase-1 (NDM-1), has for the first time been detected in a patient in Canada who had not travelled to India in the past 10 years. This case report suggests that bacteria with NDM-1 are now spreading from person to person in Canada, say the authors. Better screening tests are needed to detect these organisms and ensure early adoption of appropriate measures of infection control. See Research, page 1257
The spread of such bacteria to the international community such that direct links to southern Asia cannot be confirmed is inevitable. See Commentary, page 1240
Bodychecking and injury in youth hockey
Previous experience with bodychecking in Pee Wee leagues (ages 11–12 years) decreases the risk of more serious injury (resulting in more than seven days of lost time from play) among hockey players in Bantam leagues (ages 13–14 years). This finding comes from a prospective cohort study by Emery and colleagues, who compared rates of concussion and other injury among 995 Bantam players with two years of bodychecking experience in Pee Wee and 976 Bantam players introduced to bodychecking for the first time. This decreased risk comes at a cost of increased injuries at a younger age. Policy regarding the age at which hockey players are introduced to bodychecking requires further consideration. See Research, page 1249
Preventing lifelong disability from sports injuries in children demands a coordinated, multifaceted approach involving awareness, education and rule changes. See Editorial, page 1235
Better care for elderly people
Planned multidisciplinary care in residential care homes for the elderly can result in better care. This is the finding of a cluster randomized controlled trial of a complex management intervention in 10 care facilities that assessed a range of outcomes among 340 elderly residents. There was variable uptake of the complete protocol of care, and this is a limitation to wider implementation, say the authors. See Research, page E724
Models of care for chronic disease show promise as a strategy to improve care in nursing homes, say Stadnyk and colleagues. Research into these models may provide tools for empowering staff and for improving the lives of residents in nursing homes. See Commentary, page 1238
Accuracy of claims data for polypectomy
Administrative claims data underestimate the number of polypectomies performed by more than 15%. Wyse and colleagues found this difference by evaluating the level of agreement between physician claims for polypectomy and documentation of the procedure in endoscopy reports for 689 patients who underwent colonoscopy. Without quantification of accuracy rates, audits and evaluations of colorectal cancer screening programs may be misleading. See Research, page E743
Precautionary principle for bisphenol A
Bisphenol A, a chemical that is widely used in plastics, has estrogenic properties that have been linked to reduced fertility and predisposition to certain cancers, among other conditions, in animal studies. Last year, Canada became the first country to adopt the precautionary principle in declaring bisphenol A a toxic substance. But American expert Vandenberg argues that Health Canada must now follow through with strong legislation to protect Canadians from continued exposure. See Analysis, page 1265
Long QT syndrome
Given the high rate of long QT syndrome in First Nation communities in northern British Columbia, clinicians should consider the possibility of this syndrome when caring for patients from this area. Diagnosis and appropriate management can be life-saving. See Practice, page 1272
Acute primary HIV infection
Although tests can detect HIV infection within 22 days after exposure, patients are often advised to wait 12 weeks after risky behaviour before testing. The risk of transmission may be greatest within three months after acute infection, stress Rekart and MacIntosh. See Practice, page 1280