- © 2008 Canadian Medical Association
Clostridium difficile infection in the community
Community-acquired Clostridium difficile infection occurred in a significant proportion of elderly people who had not been recently exposed to antibiotics. Dial and coauthors found this in their matched, nested case–control study of linked data from 2 databases. See Research, page 767
Photo by: Biomedical Imaging Unit, Southampton General Hospital/Science Photo Library
Kuijper and van Dissel say that testing for C. difficile in patients with diarrhea who have no known risk factors is worthwhile because the absence of classic risk factors is unreliable for ruling out community-acquired infection by this organism. See Commentary, page 747
Pneumococcal vaccine and myocardial infarction
Vaccination against Streptococcus pneumoniae is associated with a decreased risk of myocardial infarction. Lamontagne and colleagues report this association in their hospital-based case–control study based on 2 databases. Cases were less likely than controls to have received a pneumococcal vaccine. See Research, page 773
In a related commentary, Madjid says that multiple mechanisms could contribute to the cardioprotective effect seen with pneumococcal vaccination. He discusses the pivotal role of inflammation in the development of acute coronary syndromes. See Commentary, page 749
Head injury and homeless people
Over half of homeless people have had a prior traumatic brain injury, and 12% of them had a moderate to severe brain injury. Hwang and colleagues report these findings from a survey of over 900 homeless people in Toronto, Ontario. They report that prior head injury is associated with poorer current health. See Research, page 779
Managing mild to moderate dementia
The management of mild to moderate dementia presents complex and evolving challenges. Hogan and colleagues provide practical guidance for clinicians based on the recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. See Review, page 787
What is “last observation carried forward”?
It is the most inappropriate analytical technique commonly used in research on drugs for the treatment of dementia, say Molnar and colleagues. The technique can introduce bias that may exaggerate the effectiveness of drugs or generate false-positive findings. See Commentary, page 751
Vulvar papules
What is the cause of multiple, tiny, filiform, rosy papules on the labia minora of a 24-year-old woman? See Practice, page 799
Gallstone ileus
Images reveal the triad of signs, including air in the biliary tree, that was used to diagnose gallstone ileus in an elderly woman. See Clinical images, page 859
Campaign Canada
In the run-up to the October election, Canada's political parties describe their views on pressing medical issues, including the physician shortage, pharmacare, progressive licensing, privatization and public health infrastructure. See News, page 757
Photo by: Photos.com
Switching swine for simulators
In most Canadian provinces, training to manage trauma still involves the use of live pigs, primarily because the alternative, simulators, has long been viewed as excessively costly. What are the ethical, financial and pedagogic consequences of using swine or simulators? See News, page 759