Improving antimicrobial prescribing
A complex intervention, including audit reports combined with reminders, improved the quality of prescribing for urinary tract infection in Irish general practice. These results are based on a cluster randomized controlled trial of 30 practices involving over 3000 c onsultations. An unintended increase in antimicrobial prescribing was observed in the intervention arms, a result that warrants further study, suggest the authors. See Research, page 108
Interventions to influence prescribing behaviour among primary care doctors are often complex and may have unintended consequences. Ideally, potential consequences should be considered when designing any behavioural intervention so as to maximize the usefulness of research. See Commentary, page 94
Sharing clinical trial data
North American regulatory agencies treat submitted trial data as confidential business information. Health Canada and the US Food and Drug Administration should follow the lead of the European Medicines Agency and move toward full data disclosure in the interests of public safety, say Persaud and Doshi. See Commentary, page 96
Obstetric care for First Nations in BC
Nulliparous First Nations women in British Columbia, Canada, are less likely to get optimum quality obstetric care and key obstetric interventions than non-First Nations women, finds this database study of singleton deliveries from 1999 to 2011. See Research, page E36
Acne clinical practice guideline
Often acne is viewed as a minor problem affecting teens, yet acne can adversely affect quality of life and may lead to emotional distress and permanent scarring. This evidence-based guideline was developed to facilitate efficient diagnosis and effective treatment of acne vulgaris in the Canadian population. With early diagnosis, treatment of active lesions and prevention of adverse sequelae, the health of many Canadians with acne may be improved. See Guidelines, page 118
Crohn disease and pregnancy
Are medications such as anti–tumour necrosis factor drugs and azathioprine safe in pregnancy? Huang and Fedorak answer these and other questions in managing pregnancy and peripartum in patients with Crohn disease. See Decisions, page 131
A young woman concerned about mercury
A young woman is considering pregnancy and is concerned about mercury toxicity from her dental amalgam fillings. Does she need testing? Should she have her fillings changed? Kales and Thompson answer these and other questions related to mercury toxicity in this article, part of the Choosing Wisely Canada series in CMAJ. See Decisions, page 133
Heyde syndrome
An 82-year-old man with a history of lower gastrointestinal bleeding presented with worsening shortness of breath and exercise intolerance. The diagnosis was Heyde syndrome, in which an association exists between severe aortic stenosis and recurrent bleeding from intestinal angiodysplasia. These two conditions are most likely linked by acquired von Willebrand syndrome, say the authors. See Cases, page 135
Coronary CT angiography
Coronary computed tomography angiography (CTA) is a noninvasive imaging study that allows for the detection of coronary artery stenosis. Its diagnostic performance compares favourably to invasive coronary angiography for detecting stenosis. The authors caution that CTA is not appropriate for symptomatic patients with definite acute myocardial infarction or a high pretest likelihood for coronary stenosis. See Five things to know …, page 139
Not all fibroids should be morcellized
A 30-year-old woman, referred for treatment of uterine fibroids, also had multiple cutaneous leiomyomata. Although morcellation is a common treatment for uterine fibroids, it was not appropriate for this patient. Tulandi and Foulkes tell us why. See Clinical images, page 140