Highlights

Ebola epidemic and travel restrictions

Canada is among 30 countries to have instituted restrictions on travel from three West African countries affected by the Ebola virus disease. These restrictions disregard best practice as advised in the International Health Regulations treaty and are not supported by evidence. Their institution degrades the global social contract and harms our ability to respond appropriately to future epidemics. See Commentary, page 166

Clarithromycin and statins

Older adults taking a statin not metabolized by cytochrome P450 3A4 (CYP3A4) are at increased risk of adverse outcomes when prescribed clarithromycin versus azithromycin. Using large databases of routine health information, the authors compared the rates of hospital admission and death among more than 100 000 people co-prescribed either of the antibiotics and a statin not metabolized by CYP3A4. Their findings may not apply to younger people, who may be less susceptible to drug interactions, suggest the authors. See Research, page 174

The linked study shows small increased risks of serious adverse events associated with co-prescription of a statin not appreciably metabolized by cytochrome P450 3A4 (CYP3A4) and the antibiotic clarithromycin, a strong CYP3A4 inhibior. Streetman and Stout raise questions about the plausibility of the findings. See Commentary, page 163

Effective ventilation during surgery

Anesthetized patients who received ventilation with lower tidal volumes during surgery had a lower risk of lung injury and pulmonary infection than those given conventional ventilation with higher tidal volumes. These findings come from a systematic review of 19 randomized controlled trials. However, doubts remain about the effect of lung-protective ventilation on mortality, atelectasis and length of stay, say the authors. See Research, page E101

Screening for hepatitis C

Screening for hepatitis C in middle-aged Canadians followed by appropriate treatment will save lives and money. The authors of this cost-effectiveness study found that the same was true for new (and more expensive) non–interferon-based therapies. See Research, page E110

Adult obesity guideline

The latest guideline from the Canadian Task Force on Preventive Health Care focuses on the growing epidemic of obesity in adults. What is the role of the primary care physician in preventing obesity in this age group? What interventions are recommended in managing overweight and obesity? See Review, page 184

Concussion in sports

In this installment of the Choosing Wisely Canada series, Pham and Zemek discuss the case of a 15-year-old girl who experienced a head injury while playing rugby. Does she require computed tomography of her head? Should she stay at home from school? When is it safe for her to return to sport? See Decisions, page 200

Sofosbuvir for HCV infection

Health Canada has recently approved the use of sofosbuvir as part of combination therapy for HCV genotype 1–4 infection. Rolland and Vachon review the available evidence for use of this new medication. See Innovations, page 203

Hypothyroidism

Part of the Choosing Wisely Canada series, this article stresses that thyroid-stimulating hormone (TSH) is the only test required for first-line screening for primary hypothyroidism. Maintenance of a normal serum TSH is the goal in biochemical follow-up of this condition, rather than measurement of other thyroid indices. See Five things to know about .… page 205