Highlights

Labour induction and cesarean delivery

Women with a term or post-term singleton pregnancy are 12% less likely to undergo cesarean delivery if their labour is induced than if it is managed expectantly. Mishanina and colleagues report this finding from their meta-analysis of 157 randomized controlled trials. Labour induction was associated with a reduced risk of fetal death and admission of the neonate to intensive care, and no increased risk of maternal death. These findings may help to align guidelines that currently contradict each other. See Research, page 665

Extending nurses’ roles in emergency orthopedics

Although nurses can successfully treat children with radial-head subluxation, or “pulled elbow,” the results were not as successful as those of doctors. This randomized controlled trial involving 245 children showed an 85% success rate for nurses and a 97% success rate for physicians, although treatment by nurses was given much sooner. This trade-off has the potential to improve efficiency in emergency departments, suggest the authors. See Research, page E317

Child abuse and mental disorders

Canadians who reported a history of child abuse were more likely to experience a wide range of mental disorders. Associations of child abuse with attention-deficit/hyperactivity disorder, suicidal ideation and suicide attempts were stronger among women than men. This cross-sectional study analyzed data from 23 395 adult participants in the nationally representative 2012 Canadian Community Health Survey. The study’s findings will help health care providers in assessing patients with mental disorders and also suggest that prevention of child abuse may reduce the prevalence of such disorders, say the authors. See Research, page E324

Atypical diabetes

It is becoming clear that the overarching term “diabetes mellitus” represents not just two distinct disorders of glucose metabolism but a heterogeneous group of conditions having different features associated with the core characteristic, hyperglycemia. Steenkamp and colleagues guide us through the diagnosis and treatment of the more common atypical variants of diabetes. See Review, page 678

Lichen sclerosus

A 62-year-old woman presents with chronic vulvar pruritus and findings on examination are consistent with lichen sclerosus. Caro-Bruce and Flaxman review the diagnosis and therapeutic options for this condition. Because there is a 2%–5% risk of developing squamous cell carcinoma, they caution that patients with lichen sclerosus should be monitored every 6–12 months. See Practice, page 688

CPA–EE use in a woman with stroke

Agents containing cyproterone acetate–ethinyl estradiol (CPA–EE) should not be used off-label for contraception or as a first-line treatment for acne, Kromm and Jeerakathil remind us. They discuss a case of stroke in a young, fit woman that was probably related to use of this drug. See Practice, page 690

Anaphylaxis in the acute care setting

Do antihistamines and corticosteroids have a place in the treatment of acute anaphylaxis? Can epinephrine autoinjectors be used in children? How long should a patient be monitored in the emergency department after treatment for an acute episode? Cook and Chan address these and other issues in the management of acute anaphylaxis. See Practice, page 694

Amyloid imaging in dementia

A 55-year-old man presented with behavioural changes and a low score on mental state examination. Laforce and Rabinovici discuss how imaging can be used to distinguish Alzheimer disease from frontotemporal dementia. See Practice, page 695