CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Multicenter Study Comparative Study
Appropriateness of primary total hip and knee replacements in regions of Ontario with high and low utilization rates.
To compare the appropriateness of case selection for primary hip and knee replacements between two regions in Ontario: one with a high population-based utilization rate and one with a low rate. ⋯ Patients selected for primary hip or knee replacement are similar in the high- and low-rate regions of Ontario. Inappropriate use of this procedure does not account for the high rate of surgery in some areas. Further studies will be required to determine which other factors account for the regional variations in the utilization rates and whether there is underservicing in low-rate areas.
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The XI International Conference on AIDS brought hope to people infected with HIV and to their physicians. The amount of HIV RNA in an infected person's plasma--the viral load--can be quantified to predict the course of the disease and provide a basis for therapeutic decisions. ⋯ Speakers at the conference explained the dynamics of viral replication and the immune response to HIV infection, and provided preliminary results of studies designed to test the feasibility of eradicating HIV from the body. New guidelines for antiretroviral therapy were presented at a satellite symposium, but the prospects for the long-term success of antiretroviral therapy are unknown.
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To review reported cases of hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with the use of selective serotonin reuptake inhibitors (SSRIs). ⋯ Elderly people may be at increased risk for hyponatremia associated with SSRI use. Physicians caring for elderly patients should be aware of this potentially serious but reversible adverse effect. Further research is required to determine the incidence of this adverse effect, the relative risk of hyponatremia and SIADH in different age groups and the risk associated with different SSRI drugs.
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Comparative Study
Multicultural health care requires adjustments by doctors and patients.
Canada has become a multicultural society, and more physicians have patients who are immigrants or refugees from the Third World. While doctors are aware of the need for culturally sensitive health care, there is still room for improving the delivery of medical treatment to those of other cultures. Janice Hamilton spoke with physicians who have multicultural practices to get an idea of the challenges they have faced and the problems they have solved.