Highlights of this issue

CMAJ 2000;162:1117

• Surveillance for outbreaks of respiratory tract infections in nursing homes [Research]

To determine the frequency and epidemiological features of outbreaks of respiratory tract infections in nursing homes, Mark Loeb and colleagues conducted a prospective surveillance study and a retrospective audit in 5 nursing homes in Toronto over 3 years. Despite surveillance, 65% (30/46) of the outbreaks were not detected prospectively. Outbreaks occurred year round and were often due to multiple organisms. The authors were reassured that all influenza outbreaks were identified prospectively, but they concluded that there was substantial room for improvement in surveillance. Given concerns about antibiotic resistance, they emphasize the value of obtaining an adequate number of nasopharyngeal swabs during an outbreak to enable early identification of the pathogens.

• Reducing medication errors [Commentary]

The tragic death of an infant in a Toronto-area hospital that involved the mistaken administration postoperatively of morphine instead of meperidene raises the disturbing issue of medication errors. The death was considered a homicide. Beverley Orser describes 2 major initiatives to reduce the likelihood of medication errors in Canada: a new Canadian standard for drug labels and the establishment of a Canadian agency for reporting medication errors.

• An outbreak of hepatitis B associated with reusable subdermal electroencephalogram electrodes [Research]

In early 1996 an investigation of an outbreak of hepatitis B identified 75 cases among patients who had attended 6 electroencephalogram (EEG) clinics between 1990 and 1996. The same technician had performed all of the EEGs and was found to be positive for hepatitis B e antigen. Viral DNA sequencing suggested that he was the likely source of the outbreak. Subdermal EEG electrodes were the likely vehicles of transmission. This outbreak demonstrates the need for stringent infection control, the desirability of noninvasive techniques (e.g., the use of disk electrodes) and the importance of hepatitis B vaccination.

• Ethics through the looking glass [Commentary]
• Ethics and human rights in South African medicine [Review]

The role of the South African medical profession in apartheid is now acknowledged as generally shameful. The South African Truth and Reconciliation Commission revealed 2 failings: toleration or active promotion of inequities in health care and complicity in violations of human rights. John Williams reviews the country's contrariness to the basic principles of medical ethics under apartheid and the efforts since 1994 to develop a human rights ethos for the profession. Both he and editorialist Peter Craighead ask Canadian physicians to examine their own basic principles.

• Biochemical markers in acute ischemic stroke [Research Letter]

Brain proteins are released into the blood after stroke. This is the conclusion of Michael Hill and colleagues, who tested a panel of 4 biochemical markers in a series of blood samples from 28 patients with confirmed ischemic stroke. On admission to hospital elevated levels of neuron-specific enolase were found in 89% of the patients, thrombomodulin in 43%, myelin basic protein in 39% and S-100ß protein in 32%. Further research is under way to test whether the panel may help to diagnose stroke in the first few hours of onset, when thrombolytic therapy might be indicated, or to identify stroke subtypes.

© 2000 Canadian Medical Association or its licensors