Highlights of this issue
The price of CABG
Coronary artery bypass grafting is more expensive in older patients
See also:
- Evidence: Direct costs of coronary artery bypass grafting
- Editorial: Coronary artery bypass grafting in elderly patients
Naglie and colleagues have estimated direct medical costs for 205 older (age 65 or more) and 202 younger patients with triple-vessel or left main coronary artery disease who underwent isolated CABG at a tertiary care hospital in Toronto between 1991 and 1992. They found that the mean costs of CABG in the older and younger patients ranged from $16 500 and $15 600 respectively for elective, uncomplicated cases to $33 600 and $23 700 for nonelective, complicated cases. Even after adjustment for comorbidity and severity of heart disease, age remained a significant determinant of cost. Most of the difference was accounted for by higher intensive care unit and ward costs. In an accompanying editorial, Cohen suggests some reasons for the cost differences and looks at the future of revascularization in Canada's elderly population.
Remembering a surgical pioneer
A little-known Ontario surgeon brought Lister's antiseptic technique to North America
See also:
In 1864 a medical student from Queen's College (later Queen's University) travelled to Scotland and was fascinated by lectures on germ theory given by one of his professors at the University of Glasgow. The professor was Dr. Joseph Lister, founder of the antiseptic system for the treatment of wounds. The student was Dr. Archibald Edward Malloch, the first to use Lister's system in North America.
Sex is not the issue
Re-analysis shows that body size, not sex, determines type of dialysis
See also:
- Research letters: Body size and type of dialysis
- Editorial: Sex or body size? Selection of dialysis type revisited
Using new data from the Canadian Organ Replacement Registry, Florakas and colleagues have taken a closer look at their previous finding — that men were more likely than women to receive hemodialysis rather than peritoneal dialysis. Logistic regression analysis reveals that the apparent sex-related differences in treatment could be accounted for by differences in weight. In an accompanying editorial, Levin emphasizes the importance of assessing potential confounders when gender bias in medical practice is suspected.
Tuberculosis
Still a problem in Canada
See also:
- Evidence: Outcome of pulmonary tuberculosis treatment
- Evidence: Mycobacterium tuberculosis infection
- Editorial: Optimizing tuberculosis control in the inner city
- Education: Tuberculosis: 1. Introduction
In their cross-sectional study of TB in injection drug users, Rusen and colleagues screened 167 subjects recruited through a downtown Toronto needle-exchange program, of whom 155 returned for interpretation of the tuberculin skin test result within the designated 48 to 72 hours. The prevalence rate of positive test results was 31%. Older subjects and those born outside of Canada were most likely to have a positive result. Suggesting that TB screening among injection drug users is feasible, the authors provide direction for future programs.
Screening is useful, however, only if treatment is completed. Using information from patient charts, the local health unit and the provincial Reportable Disease Information System, Wobeser and colleagues determined treatment outcome in 145 consecutive cases of culture-proven pulmonary TB at 5 tertiary care centres in Toronto in 1992/93. The treatment completion rate was 58%, well below the WHO recommended rate of 85%. Independent predictors of failure to complete treatment were injection drug use, HIV infection and adverse drug reaction. Patients older than 50, with HIV infection, receiving immunosuppressive therapy or infected with multidrug-resistant bacteria were at greatest risk of death. In an accompanying editorial, FitzGerald suggests how we may improve TB control in the inner city.
Finally, Fanning launches our Clinical Basics series on TB, reminding physicians that with a disease that is 99% curable and 90% preventable, there is no excuse for complacency.
