Highlights

Should/floroquinolones be avoided?

Moxifloxacin and levofloxacin were associated with almost twice the risk of admission to hospital for acute liver injury compared with clarithromycin. Juurlink and colleagues linked routine data from several databases to measure drug exposure in patients with liver injury and those without. If confirmed in other studies, these results suggest that both moxifloxacin and levofloxacin be considered for regulatory warnings, say the authors. See Research, page 1565

The relative risk of severe drug-induced liver injury is probably higher with moxifloxacin and levofloxacin compared with clarithromycin. However, because the absolute risk is very low, clinicians should choose the most efficacious antibiotic rather than try to avoid a very uncommon adverse reaction, say Hayashi and Chalasani. See Commentary, page 1555

Training Canadian hospitalists

In contrast to the United States, most Canadian hospitalists are family physicians. Although the issues of training and certification have begun to be addressed, this process is still in its infancy. A clear definition of the scope of practice of Canadian hospitalists and research on the impact these physicians have on the quality of care are needed. See Commentary, page 1557

Steroids for sinusitis?

Systemic corticosteroid therapy showed no clinically important effect in reducing facial pain for patients with acute rhinosinusitis. In this randomized controlled trial, 185 patients received either oral prednisolone or placebo and kept a symptom diary for 14 days. Future studies may reveal subgroups more likely to benefit, but in the meantime, there is no rationale for using corticosteroids in patients with acute rhinosinusitis, say the authors. See Research, page E751

Heart failure in Ontario

Failing organs, especially hearts, are hard to cure; best to avoid the failure in the first place. That appears to be what is underway, at least in developed countries. In this population-based study using data from the publicly funded Ontario Health Insurance Plan, there is strong evidence of a declining incidence in heart failure. The disease itself, once established, has an undiminished ominous prognosis. The authors speculate that the decline is driven by a decrease in the incidence of ischemic heart disease. See Research, page E765

Canadian task force guideline process

The Canadian Task Force on Preventive Health Care has been re-established with a sustainable funding model. The authors outline the process for guideline development by the task force and compare it with those from other major guideline development groups. See Special Report, page 1575

Toward a patient charter with teeth

Many countries have adopted patient charters of rights, but to be meaningful, such charters must include an economical, accessible and independent complaints process. According to Flood and May, an ombudsman or commissioner can help reduce litigation and formal disciplinary proceedings against health care professionals. See Analysis, page 1583

Vitamin B₁₂ deficiency in infants

Vitamin B₁₂ deficiency in a breastfed infant usually results from a maternal deficiency in diet or through pernicious anemia. Symptoms can include poor feeding, weight loss and irritability, but neurologic manifestations (e.g., lethargy, gross motor developmental regression and slowing of brain growth) are most concerning, say Roumeliotis and colleagues. See Practice, page 1593

Contrast-enhanced ultrasonography

Using microbubbles that do not infiltrate interstitial spaces makes the technique ideal for assessing vascular flow in renal, hepatic and other abdominal masses. See Practice, page 1599