Highlights of this issue [CMAJ

Highlights of this issue

CMAJ 2000;162:965

Rheumatology series launched

Rheumatology: introduction to the series [Commentary]

Rheumatology: 1. Is it arthritis? [Review]

At least 10% of patients with clinical presentations to primary care physicians have musculoskeletal complaints. Almost 50% of elderly people have symptomatic disease, and 25% of these patients are disabled. However, in medical school, only 3% of the curriculum before clinical training is dedicated to musculoskeletal disease, and only 12% of medical schools have mandatory clinical training in this area. In recognition of the need for an update on the diagnosis and management of rheumatological disease, CMAJ launches a new Clinical Basics series on rheumatology. In this issue we start with an introduction by series editor John Esdaile and an article by Stephanie Ensworth on the evaluation of joint pain. Each article in the series has been reviewed by the Therapeutics Committee of the Canadian Rheumatology Association.

Frequent users of the ER

Frequent users of the emergency department

In 1 year 24 patients visited a BC emergency department a total of 616 times (median 26.5). Dorothy Pope and colleagues describe an innovative program targeted at frequent users of the emergency department. Through the involvement of such people as social workers, emergency and family physicians, psychiatric nurses and community care providers, these same patients made a total of only 175 visits (median 6.5) in the year after the program was implemented.

Prostate cancer: a model disease

The clinical burden of prostate cancer in Canada

The economic burden of prostate cancer in Canada

Disease simulation models and health care decisions

Steven Grover and colleagues have developed the Montreal Prostate Cancer Model to follow annually a hypothetical cohort of men in order to estimate the probability of prostate cancer and the annual progression of the disease according to patient age, tumour stage and grade, and initial treatment. The authors describe the methodology and data sources for the model and validate the estimates through comparisons with available cohort data. In one comparison the 10-year disease-specific survival rates following prostatectomy for tumour grades 1, 2 and 3 were 98%, 91% and 76%, respectively, using data from the Surveillance, Epidemiology and End Results (SEER) Program, and 96%, 92% and 84% using the model.

In an accompanying article the authors use the model to estimate the economic burden of prostate cancer. In a 1997 cohort of 5.8 million Canadian men aged 40 to 80 years prostate cancer would eventually be diagnosed in an estimated 701 491 (12.1%) men over their lifetime, and the direct medical costs would total $9.76 billion.

In his commentary Jaime Caro suggests that society should collectively invest in such disease-simulation models, rendering them public tools, in order to facilitate scientific scrutiny and replication.

Dilution of the oral glucose tolerance test

Dilution of the 75-g oral glucose tolerance test increases postprandial glycemia

To test the effect of dilution on glycemic response, John Sievenpiper and colleagues administered a 75-g oral glucose tolerance test of 300 mL, 600 mL and 900 mL to 10 subjects on 3 occasions. The mean incremental changes in blood glucose levels at 30, 45 and 60 minutes were significantly higher with the 900-mL meal (4.9, 5.1 and 4.6 mmol/L) than with the 600-mL meal (4.0, 4.2 and 3.6 mmol/L) or the 300-mL meal (3.8, 4.0 and 3.2 mmol/L) (p < 0.05). The authors suggest that the increased volume or decreased osmolality increases the rate of gastric emptying and glycemia during the first half of the test but that it does not confound the 2-hour result.

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