Highlights

Science and patient safety

Efforts to improve patient safety are impeded by a lack of grounding in basic science. According to renowned expert Vincent, health care professionals must engage in scientific analyses of safety behaviour and interventions, and collaborate with scientists in other disciplines such as psychology and human factors engineering. He advocates establishing multidisciplinary centres in every country to support research and implementation. See Commentary, page 110

Depression and ill health are linked

Older men with symptoms of depression are more likely to be admitted to hospital for nonpsychiatric conditions, to stay longer and to have worse outcomes than those without symptoms of depression. These findings are from a community-based cohort of men aged 69 years and older who were followed up for 2 years using linked routine health data. It may be possible to prevent admissions and ill health by targeting older men with depression, suggest the authors. See Research, page 117

Rates of hemorrhage and warfarin

Warfarin therapy is effective and reasonably safe for preventing embolic stroke and other peripheral emboli in atrial fibrillation in research and resource-intensive settings. Gomes and colleagues give us a population-based estimate of the risk of hemorrhage in ordinary practice. The average risk is a bit higher, but not more than can be expected in this setting. Extra caution is required in the first 30 days after starting warfarin therapy. See Research, page E121

PCOS and thromboembolism risk

Women with polycystic ovary syndrome (PCOS) benefit from combined oral contraceptives. However, PCOS is associated with increased cardiovascular risk factors. Noting that the use of combined oral contraceptives increases thromboembolic risk for all women, Bird and colleagues set out to measure this risk in women with PCOS, both those using and not using combined oral contraceptives. Combined oral contraceptive treatment adds to the already increased risk of thromboembolism in those with PCOS. See Research, page E115

Hypertrophic cardiomyopathy

The understanding of hypertrophic cardiomyopathy has shifted over the years. What was initially viewed as a rare disease is now known to be a relatively common cardiomyopathy with variable and an often benign or manageable clinical course, say Jacoby and colleagues. Although genotyping can be very useful to allow cascade screening of family members, those with a positive genotype but who do not meet diagnostic criteria should not be considered to have the disease. See Review, page 127

Defining diagnostic tissue

Image courtesy of National Surgical Adjuvant Breast and Bowel Project

Excised human tissue is used for both diagnostic and research purposes, but the distinction between these two is often muddy, leading to confusion over which rules governing acquisition, handling, storage and use apply. Cheung and colleagues provide definitional clarity between the two, with an emphasis on the issue of ownership of the tissue and court rulings, as well as privacy and informed consent. See Analysis, page 135

Iodide-induced thyrotoxicosis

A 72-year-old man with treated toxic multinodular goitre experienced severe thyrotoxicosis after coronary angioplasty. The culprit? The large load of iodide in the contrast medium used during the procedure. The authors caution that exposure to an acute iodide load up to several hundred thousand times the recommended daily intake can overwhelm physiologic thyroid hormone regulation in susceptible individuals. See Practice, page 144

Osteoarthritis of the thumb

Osteoarthritis of the carpometacarpal joint of the thumb occurs in about 1 in 10 people. Because the symptoms can mimic other disorders, radiographic examination and the grind test can help confirm the diagnosis. Although conservative therapy may relieve symptoms in early-stage disease, patients with severe disease may require surgery, say Li and White. See Practice, page 149