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Pet-associated infections
Health care providers should counsel patients regarding safe pet ownership, particularly those who are pregnant or who have altered immunity, and families with exotic pets and very young children. Stull and colleagues’ review of pet-associated infections provides practitioners with the tools to do this. See Review, page 736
Most Canadians choose to own a pet. Varied evidence supports the idea that owning a pet enhances health. Cardiovascular, cognitive and mental health benefits are most notable. See Commentary, page 715
Tool to predict death after hospital admission
The Hospital-patient One-year Mortality Risk (HOMR) model, a prediction model incorporating patient demographics, comorbidities and severity of illness, accurately estimated risk of death within one year after hospital admission. This validation study used health administrative data for more than 3.1 million patients in Ontario, Alberta and Boston between 2010 and 2012 who were admitted to hospital for acute nonpsychiatric indications. The HOMR model can be used to adjust for risk of death in analyses involving a broad range of hospital patients. See Research, page 725
Reasons for variation in angina therapy
There is a twofold variation in the ratio of revascularization to medical therapy for the initial treatment of stable ischemic heart disease across hospitals in Ontario. This study, involving more than 39 000 patients receiving angiography in 18 cardiac centres between 2008 and 2011, found that two-thirds of the variation was explained by patient characteristics. Nonetheless, the variation was associated with potentially important differences in clinical outcomes, say the authors. See Research, page E317
Cardiac testing in an asymptomatic man
A 42-year-old asymptomatic man wonders if he requires screening for cardiac disease. He is a nonsmoker and exercises regularly, but he has a family history of premature cardiac disease. Does he need further investigations? If so, which ones? In this installment of the Choosing Wisely Canada series, Bhatia and colleagues outline a practical approach to this common situation. See Decisions, page 747
Cognitive decline and bilateral deficits
A 78-year-old physician presented to the emergency department with progressive memory impairment and acute onset of left-sided weakness. Careful examination demonstrated deficits that raised the possibility of bilateral hemispheric involvement. Day and colleagues tells us more about this intriguing case. See What is your call?, page 750
Resurgence of pertussis
Waning immunity is linked to the resurgence of pertussis in Canada. All adults in Canada should have a single booster dose of the tetanus–diphtheria–acellular pertussis vaccine, says the National Advisory Committee on Immunization. Wiggers and colleagues discuss the diagnostic test of choice and antibiotic options for treatment and prophylaxis. See Five things to know about … , page 755
Phytophotodermatitis from sangria
A 26-year-old woman presented to the emergency department with a painful blistering eruption on her hands after making sangria the previous day. See Clinical images, page 756
What’s new in Humanities?
Why do key opinion leaders work with pharma? Does it matter? See Medicine and Society, page 759
The grotesque details of this case are unfathomable: “She is oddly calm as she describes what happened before she came to the hospital. I don’t believe anything she is telling me.” See Encounters, page 761