Highlights of this issue [CMAJ

Canadian Medical Association Journal

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Highlights of this issue

CMAJ 2001;164(3):321

Cognitive psychology in medicine

Problems for clinical judgement: introducing cognitive psychology as one more basic science [Commentary]

A modern science is applied to an old art in the newest CMAJ series. Cognitive psychology is the basic science that explores how people reason, formulate judgements and make decisions. Clinical judgement involves a synthesis of knowledge, experience, patient perspectives and other insights in situations when information may be conflicting or absent, time short and long-term trade-offs required. Donald Redelmeier and colleagues introduce a series of articles dedicated to the application of cognitive psychology to problems of clinical judgement. Knowledge of the predictable errors inherent in human reasoning may allow physicians to anticipate and prevent mistakes and analyze those that have occurred to avoid their repetition.

Health care suffrage in Saskatchewan

Past concerns and future roles for regional health boards [Commentary]

Since 1995 the majority of health care board members in Saskatchewan have been elected rather than appointed. In a 1997 survey of board members by Steven Lewis and colleagues, most of the respondents felt that devolution of authority to the health districts had improved the quality of decisions and services, although 92% believed substantial reforms were still needed. Many stated that boards were legally responsible for areas over which they had insufficient control (76%) and that government regulation was overly restrictive (63%). Respondents with experience as health care providers were less likely than others to believe that nonphysician health care providers support board decisions. Jonathan Lomas comments on the future of elected health care boards, given the meagre 10% turnout at the most recent elections and the changing political attitudes toward health care.

Predictors of mammography use

Predictors of mammography use among Canadian women aged 50-69: findings from the 1996/97 National Population Health Survey [Research]

Women aged 50–69 are currently advised to undergo mammography every 2 years. To determine whether these women are receiving appropriate screening, Colleen Maxwell and colleagues analyzed data from the 1996/97 National Population Health Survey. In all, 79.1% (95% confidence interval [CI] 76.9%–81.2%) of the women in this age group reported ever having had a mammogram, and 53.6% (95% CI 51.4%–55.9%) had had a recent one (< 2 years before the survey). Of those who had not had a recent mammogram, over 50% thought it was unnecessary. Only 28.2% of those who had never had a mammogram planned to have one within 2 years. Significant predictors of nonparticipation included age over 69, residence in a rural area, Asia as birth place, no involvement in volunteer groups, no regular physician or recent medical consultations, current smoking, infrequent physical activity and no hormone replacement therapy.

Sustainable health care for the environment

Environment and health: 8. Sustainable health care and emerging ethical responsibilities [Review]

Our Environment and Health series continues with an examination of the impact of health care on the environment. Health care consumes natural resources, involves complex manufacturing systems that can emit toxic by-products, requires energy-expensive buildings and transportation systems, and generates vast quantities of infectious, toxic and radioactive waste. Andrew Jameton and Jessica Pierce describe initiatives toward making health care environmentally sustainable. They also examine the ethical principles involved in balancing human interests with those of the environment in health care planning and development.

Vitamin C and cancer reconsidered

[Commentary]

New insights into the physiology and pharmacology of vitamin C [Commentary]

One of the durable controversies in medicine concerns the treatment of cancer with vitamin C. Early optimism prompted by remissions observed in a few patients with advanced, untreatable cancer was not supported by later results from randomized controlled trials. One of the principal criticisms of vitamin C treatment is that the early trials involved intravenous administration and the later ones, oral. Increasing understanding of the absorption and metabolism of vitamin C, reviewed by Sebastian Padayatty and Mark Levine, suggests that the 2 routes of administration are not equivalent. In a related commentary, John Hoffer reflects on the need for "rules of engagement" in the debate between alternative and clinical medicine, to ensure that alternative therapies are appropriately evaluated.