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 Canadian
Medical Association Journal
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Highlights of this issue
Breast cancer survival and teaching hospitals
Previous researchers have observed variation in breast cancer survival with region, patient socio-economic status and hospital and physician characteristics. Ruhee Chaudhry and coworkers carried out a retrospective population-based cohort study of the survival of women who were newly diagnosed with breast cancer in 1991. For a random sample of 938 cases, the crude 5-year survival rates were 88.7% versus 92.5% for women who had initial surgery in community versus teaching hospitals. There was a 53% relative reduction in risk of death in women with tumours 20 mm or less in diameter who were first treated in a teaching hospital. In a related commentary Roberto Grilli explores what exactly is meant by "specialization" in the treatment of cancer.
Osteonecrosis and corticosteroids Osteonecrosis has long been recognized as a complication of extended treatment (3 months or longer) with high-dose systemic steroids (equivalent to more than 4000 mg of prednisone). Michael McKee and colleagues describe a series of 15 cases of osteonecrosis of the femoral head in patients who had received relatively short courses of steroids. All patients were male, with a mean age of 32.2 years (range 20–41 years). The mean steroid dose in equivalent milligrams of prednisone was 850 mg (range 290–3300 mg), given for a mean duration of 20.5 days (7–39 days). The mean interval between steroid treatment and hip symptoms was 16.6 months (range 6–33 months). Only 3 of the patients had other potential risk factors, none of which was felt to be sufficient, in isolation, to cause osteonecrosis. Pap tests and follow-up On average, 24% of women with an abnormal Pap test result do not receive follow-up. Elizabeth Wagner and Máire Duggan report on the effectiveness of a laboratory-based computer system to improve follow-up. If laboratory records indicate an absence of follow-up results, a letter is sent to the health care provider who requested the test, seeking information about the recommended follow-up. Between Jan. 1 and June 30, 1997, 1500 such letters were sent. In all, 991 (66.1%) of health care providers responded: 238 (24.0%) of the patients had completed or were scheduled for follow-up, 199 (20.1%) could not be contacted and 154 (15.5%) had not kept booked appointments. The letter triggered follow-up for 104 (10.5%) of the women. The authors discuss possible improvements to the program. Breast cancer guidelines, new and updated
Homelessness and health
Estimates place the number of homeless people in Canada in the tens of thousands, including single adults, street youth and families with children. Stephen Hwang describes the health consequences of homelessness. Homeless people are at increased risk of premature death and suffer from a variety of medical conditions that are often premature, severe, unrecognized and undertreated. Homeless adults often obtain health care through emergency departments and are admitted to hospital up to 5 times more often and stay in hospital longer than the general population. They may be unable to afford prescription drugs or comply with medical recommendations because of cost or circumstance. In a related commentary Donald Wasylenki discusses the impact of homelessness and poverty on the health of inner city residents.
Copyright 2001 Canadian Medical Association or its licensors |
