Highlights

HPV vaccine and cervical cancer screening

In this nested case–control study in Alberta, quadrivalent human papillomavirus (HPV) vaccination significantly reduced high-grade cervical abnormalities, but required three doses. Vaccination against HPV was also associated with screening uptake. Population-based vaccination and screening programs should work together to optimize cervical cancer prevention, say the authors. See Research, page E281

In Canada, cervical cancer screening continues to be underutilized among hard-to-reach women. A growing body of evidence supports self-sampling for HPV, the virus that causes cervical cancer, as a method to increase screening participation. We need to evaluate properly the potential effect of this innovative approach in Canada, say Lofters and Vahabi. See Commentary, page 853

Electroacupuncture for carpal tunnel syndrome

In patients with primary carpal tunnel syndrome, mild to moderate symptoms and no indication for surgery, electroacupunture produced small but significant improvements in symptoms and function compared with splinting alone. This randomized trial enrolled 181 patients at a single academic centre and followed them for 17 weeks. The results suggest a potential role for electrocupuncture in treatment of carpal tunnel syndrome, and future trials should examine this modality in combination with steriod injections, say the authors. See Research, page 867

Predicting adverse events after syncope

Among adults who presented to the emergency department within 24 hours after an episode of syncope, the Canadian Syncope Risk Score, a clinical decision tool composed of 9 variables, accurately predicted the risk of serious adverse events within 30 days after disposition from the emergency department. This prospective study enrolled 4030 patients from six Canadian academic emergency departments between September 2010 and February 2014 and evaluated 43 candidate clinical variables from these patients to derive the score. Once validated, this tool will improve risk stratification and disposition decisions for patients with syncope, say the authors. See Research, page E289

HPV vaccination for males in Canada

Human papillomavirus (HPV)–related disease is common in men as well as women. Re-evaluation of cost-effectiveness, reduction of vaccine costs and altered dosing schedules, and consideration of principles of equity, combine to strengthen the case for universal HPV vaccination for boys in Canada, argue Shapiro and colleagues. See Analysis, page 881

Eosinophilic esophagitis

Eosinophilic esophagitis should be considered in atopic adults less than 50 years of age who have a history of intermittent dysphagia to only solids with associated chronic heartburn. A history of food impaction substantially increases the likelihood of the diagnosis. See Decisions, page 893

Botulism in the Canadian Arctic

Botulism in some communities in the Canadian Artic is 1600 times more common than in the rest of Canada. In this case, a 58-year-old woman in a western Canadian Arctic community developed rapidly progressing respiratory failure from botulism after eating beluga blubber. Once foodborne botulism is suspected, antitoxin should be administered as soon as possible without awaiting confirmatory testing. See Cases, page 896

Urinary tract infection in older adults

Diagnosing urinary tract infection in older adults in long-term care facilities requires the presence of both relevant clinical symptoms and laboratory evidence of bacteria or pyuria. Treating asymptomatic bacteriuria can result in adverse events and does not improve outcomes, say Ajayi and Radhakrishnan. See Five things to know about …, page 899