Highlights

Choosing Wisely Canada

Reducing unnecessary tests and procedures has important implications for the quality of patient care and sustainability of the health care system. Levinson and Huynh explain how Choosing Wisely Canada will engage physicians, patients and medical learners in talking about this. See Commentary, page 325

HRT may cause pancreatitis

The use of postmenopausal hormone replacement therapy was associated with increased risk of acute pancreatitis in a cohort study of 31 494 postmenopausal women. After completing a baseline questionnaire, women were followed for up to 13 years by linkage to routine health records. The role of the preparation, dose and route of administration merits further investigation, suggest Oskarsson and colleagues. See Research, page 338

NSAIDs and spontaneous abortion

The use of NSAIDs during pregnancy was not found to be associated with spontaneous abortion in this retrospective cohort study involving 65 457 pregnant women. Although one type of NSAID showed an association with early spontaneous abortion, this was thought to be a reverse association because of its use as a treatment for threatened miscarriage. These results add to other studies suggesting the safety of NSAIDs; however, the authors caution that more research is needed about the risk of spontaneous abortion following exposure to selective COX-2 inhibitors. See Research, page E177

Surgery for hip osteoarthritis

With aging of the population and rising obesity, the demand for surgical treatment for hip osteoarthritis is set to rise. Gandhi and colleagues present the latest evidence to guide the choice of procedure and materials for the individual patient, and discuss potential complications and risks of various approaches. See Review, page 347

Posttraumatic stress disorder (PTSD)

A 28-year-old military veteran presents with insomnia and nightmares, two years after returning from deployment in Afghanistan. Does he have posttraumatic stress disorder? Is he at increased risk of suicide? What interventions might help? Crawford answers these and other questions about the diagnosis and management of PTSD. See Practice, page 360

Endocrine causes of cardiac disease

A 71-year-old woman with confusion and a history of falls was found to have elevated cardiac troponin levels, electrocardiogram changes consistent with an acute coronary syndrome and severe left ventricular dysfunction, despite normal coronary arteries on angiogram. Her cardiac findings resolved with treatment for panhypopituitarism. The authors caution that endocrine disorders can result in substantial cardiac involvement and that failure to recognize their presence can result in patient morbidity and death. See Practice, page 366

HPV in head and neck cancer

The incidence of head and neck cancers related to human papillomavirus is rising, say Palma and Nichols. Likely preventable by vaccination, these tumours occur earlier than smoking- and alcohol-related oropharyngeal cancers, but survival outcomes are better. See Practice, page 370

Habit-tic deformity

A seven-year-old girl had median depressions in both thumbnails with superimposed parallel, transverse ridging related to frequent scratching and rubbing of her nail folds. Habit-tic deformity, a nail dystrophy caused by habitual external trauma to the nail matrix, was diagnosed. Effective interventions include instant glue or tape applied to the nail folds. Because habit-tic deformity is related to obsessive–compulsive behaviours, cognitive-behavioural therapy or medications may be necessary in refractory cases, say Perrin and Lam. See Practice, page 371