Highlights

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Impact of frailty after discharge

Frailty is associated with an increased risk of early readmission or death after discharge from medical wards. In a study that followed 495 patients for 30 days after discharge from seven medical wards, the composite outcome of readmission or death within 30 days was higher among patients with moderate to severe frailty than among nonfrail patients (adjusted odds ratio 2.19). The Clinical Frailty Scale could be useful in identifying high-risk patients being discharged from medical wards, suggest the authors. See Research, page 799

Wide variation for pre-op ECGs and chest x-rays

Preoperative ECG and chest radiography were performed more frequently than suggested in guidelines. Using routine health records for 1.5 million people, the authors found considerable variation in rates across institutions, which was not explained by patient- or institution-level factors. Feeding institution-level data back to administrators may help to improve local processes, suggest the authors. See Research, page E349

UTIs in patients with spinal cord injury

Urinary tract infections are common in patients with spinal cord injury, usually as a consequence of neurogenic bladder and urinary stasis. Complications are frequent. Salameh and colleagues review established and novel approaches to preventing and treating such infections in this population. See Review, page 807

Ethics of offering surgical add-ons

Cataract surgery is insured in Canada; however, there are many add-on services available such as specialized diagnostics, procedures and special-feature intraocular lenses for which patients must pay. It is important to discuss noninsured services transparently, declaring all conflicts of interest, say McAlister and colleagues. See Analysis, page 813

Hemochromatosis

A 42-year-old man presented with fatigue and joint pain in his hands and wrists. Investigations showed elevated ferritin and hemoglobin. What additional investigations should be considered? Lanktree and colleagues review the latest on the diagnosis, genetic testing and management of hemochromatosis. See Decision, page 820

Wild mushroom poisoning

Within 12 hours after eating wild mushrooms found in a local park, a 52-year-old woman had gastrointestinal symptoms. Within several days, she had fulminant liver failure and required an urgent liver transplant. This article reviews the management of Amanita mushroom poisoning, for which there is no known antidote. The authors caution that poisonous and edible mushrooms can be very similar in appearance. See Cases, page 822

The human microbiome

The human microbiome is essential for healthy development, metabolism and immunity but can be affected by host behaviours and external factors, such as diet, exercise and medications. Therapeutic manipulation of the microbiome for the treatment of infectious and noninfectious diseases is an area of active and expanding investigation. See Five things to know about …, page 825

Mandibular tori

This bony outgrowth on the floor of the mouth is common and frequently bilateral. Surgical resection is seldom necessary, say Mermod and Hoarau. See Clinical images, page 826