Highlights of this issue
All pain, no gain
Older adults are in pain, and research is lacking.
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In their systematic review, Fox and colleagues found that the prevalence of pain among older adults living in nursing homes and long-term care institutions is high, ranging from 49% to 83% in 6 studies with data from self-reporting or chart reviews and from 27% to 44% in 5 studies with data on analgesic use only. Of the 14 studies identified, only 3 evaluated a treatment for pain. Calling for randomized controlled trials, the authors provide recommendations to guide future research.
Has the Screening Mammography Program of British Columbia made a difference?
Study shows that substantial increases in health care expenditures have been avoided.
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Using provincial databases, Olivotto and colleagues found that the BC screening program has provided an increasing proportion of bilateral mammograms in BC since 1988 — 65% in fiscal year 1996/97 — with 21% of new breast cancers diagnosed through the screening program in 1996. Although 30% more bilateral mammograms were done in 1996/97 than in 1991/92, expenditures for these services increased by only 4%, because of the lower cost per visit within the screening program.
Discharge summaries: Should we move beyond conventional dictation?
Database-generated summaries may have advantages.
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- Evidence: Dictated versus database-generated discharge summaries
- Editorial: "Conventional" dictated versus database-generated discharge summaries
In a randomized trial comparing 2 types of discharge summaries generated at a tertiary care hospital in Ottawa, 151 summaries were created by voice dictation and 142 from a database. The 2 types of summaries were rated similarly with regard to quality, completeness, organization and timeliness by physicians receiving the summaries. However, the database method was more likely to generate summaries within 4 weeks of discharge, to include many information items of interest and to be preferred by housestaff. In an accompanying editorial, Dougherty points out that neither method is perfect.
Sexism in medicine: How does medical school affect values?
Cohort study suggests medical schools reinforce nonsexist attitudes
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- Editorial: Medical students' attitudes toward women
- Education: Do students' attitudes toward women change during medical school?
Examining attitudes toward women in 70 first-year students at Queen's University medical school, Phillips and Ferguson found that the students tended not to accept sex-role stereotypes and that these attitudes did not differ significantly from those of 166 students at 2 other Ontario medical schools. Resurvey of 54 of the Queen's students 3 years later showed that they had become somewhat less accepting of sex-role stereotypes and less controlling in interactions with female patients over the course of medical school, although they continued not to equate femaleness with adulthood. Women were somewhat more open-minded at baseline and at follow-up. In an accompanying editorial, Woodward suggests reasons for guarded hope and continued vigilance.
The wintertime blues
About 5% of people suffer from winter depression.
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- Public health: The wintertime blues
In our public health column, Caplan describes the clinical features of seasonal affective disorder and explores theories to explain the mechanism of action of light therapy, the first-line treatment for the disorder.
