Molecularly targeted agents for lung cancer
Molecularly targeted chemotherapeutic agents that are administered orally represent an important treatment opportunity for patients with lung cancer residing in remote northern communities, yet these treatments are not currently offered in remote settings. Spaans and colleagues argue for enhanced oncology training for rural health care professionals and strong linkages to regional cancer centres to allow cancer treatment with oral agents closer to patients’ community. See Commentary, page 485
Young women disadvantaged after heart attack
Among people 18 to 55 years of age who have had a heart attack, women received less timely care. In this cohort study of 1123 patients admitted to hospital, data on several process-of-care outcomes were compared in adjusted analyses that sought to identify determinants of poor care. Some gender-related personality traits and roles may identify patients at increased risk who should receive more effective initial management, suggest the authors. See Research, page 497
Postoperative nonanginal pain after cardiac surgery
Persistent postoperative pain of nonanginal origin was common after cardiac surgery in a large, prospective, multicentre cohort study that followed patients for 24 months. About 40% of patients had persistent pain at the 3-month follow-up, and almost 10% still reported pain at 24 months. The authors identified several significant risk factors, including two that can be managed (increased anxiety before surgery and acute postoperative pain one week after surgery). See Research, page E213
Autism spectrum disorder
The causes of autism spectrum disorder are now thought to be multifactorial, with genetic, epigenetic and nongenetic factors acting in combination through various pathways. Anagnostou and colleagues guide us through the best evidence and expert opinion regarding diagnosis and management of autism spectrum disorder. See Review, page 509
Benign prostatic hyperplasia
A 66-year-old man presents with a six-month history of urinary urgency, slow urinary stream and frequent voiding. His doctor suspects benign prostatic hyperplasia. What investigations are warranted? Does he require pharmacologic treatment? Elterman and Kaplan review the approach to lower urinary tract symptoms in an older man. See Practice, page 525
Do-not-resuscitate orders
A 90-year-old woman with pneumonia and renal failure and a 42-year-old woman with metastatic breast cancer died within a few days after admission to hospital. The patients had two things in common: their deaths were caused by an iatrogenic narcotic overdose, and resuscitation was not attempted because they had a do-not-resuscitate order on their charts. A palliative care physician and a clinical ethicist explore the implications of a do-not-resuscitate order in the context of a reversible, but lethal, incident. See Practice, page 528
Clostridium difficile infection
Do probiotics have a role in preventing or treating Clostridium difficile infection? What about the use of donor feces? Vaccines? The authors outline some recent advances in the management of this complex infection. See Practice, page 531
Lichen amyloidosis
A 26-year-old woman presented with a 10-year-history of multiple itchy tan-brown papules on the pretibial surfaces of her legs that were unresponsive to topical steroids and tazarotene cream. Lichen amyloidosis was diagnosed. Thought to be induced by scratching, this benign chronic condition requires treatment only for symptomatic or cosmetic complaints. See Practice, page 532