Highlights of this issue

CMAJ 2000;162:485

• Plastic bread-bag clips in the gastrointestinal tract: report of 5 cases and review of the literature [Review]

Ken Newell and associates describe 5 cases in which a plastic bread-bag clip was found in the gastrointestinal tract of patients at a London teaching hospital from 1991 to 1998. In 3 of the cases the patients presented with a small-bowel perforation and in 2 the clips were found incidentally. The authors postulate that elderly patients with dentures might be at increased risk for accidental ingestion. They recommend either the elimination or redesign of bread-bag clips.

• Effect of preventive home visits by a nurse on the outcomes of frail elderly people in the community: a randomized controlled trial [Research]
• Evaluating innovation in the care of Canada's frail elderly population [Commentary]

Dawn Dalby and colleagues conducted a randomized controlled trial to determine whether preventive home visits by a primary care nurse would reduce the rates of hospital admission, health care utilization and death in a sample of 73 frail elderly people. Surprisingly, not only was there no statistically significant benefit from the nurses' visits, there was a trend toward a higher combined rate of deaths and admissions to an institution in the intervention group than in the control group (10.0% v. 5.8%, p = 0.52). In an accompanying editorial Howard Bergman and François Béland comment on these results and the need for well-planned intervention studies that have the necessary funding to allow sufficient enrolment and follow-up.

• Time required for approval of new drugs in Canada, Australia, Sweden, the United Kingdom and the United States in 1996­1998 [Research]

Although the time taken to approve new drugs in Canada has decreased considerably since the early 1990s, it continues to be longer than that in countries with comparable approaches. This conclusion is drawn by Nigel Rawson after comparing the application and approval dates of 219 new drugs in Canada, Australia, Sweden, the United Kingdom and the United States during 1996­1998. Canada's median drug approval time of 518 days was similar to that in Australia (526 days), but it was significantly longer than the median times in Sweden (371), the UK (308) and the US (369).

• Pharmaceutical policies in Canada: another example of federal­provincial discord [Review]

One of the exceptions to the universality of Canada's health care system is the coverage provided for prescription drugs, which varies by province. Aslam Anis reviews the distinct federal and provincial roles and policies. He argues that since 1987, when amendments to the Patent Act were introduced that guaranteed patent-holding firms a 10-year exclusivity period before a generic firm could import or manufacture patented products, federal and provincial governments have been moving in opposite directions. Although Ottawa regulates drug prices and patent terms, it is the provinces and the public who pay the costs.

• Health-related quality of life among final-year medical students [Research letter]
• Jung at heart: assessing one's suitability for medical training [Commentary]

The quality of life of a clerk deteriorates over the clerkship year, according to a study conducted by Satish Raj and colleagues. They measured the self-reported quality of life of final-year medical students 4 times over 10 months. A significant deterioration was observed in 3 domains: vitality (F = 4.14; p = 0.01), role limitations due to physical problems (F = 4.13; p = 0.01) and role limitations due to emotional problems (F = 3.37; p = 0.025). In an accompanying editorial Erica Weir comments on the information a student needs to assess his or her suitability for medical training.

© 2000 Canadian Medical Association or its licensors