“ full and useful lives ” : La déficience intellectuelle au sein du discours médical canadien (1956–1972)

Les articles publiés entre 1956 et 1972 au sein du Canadian Medical Association Journal ( CMAJ) et du Canadian Psychiatric Association Journal ( CPAJ) témoignent d’un certain intérêt de la communauté médicale canadienne pour le retard mental au cours de cette période. Celle-ci se préoccupe tout particulièrement du poids économique que représente – d’après elle – le « retardé mental » et de la capacité de ce dernier à atteindre une autonomie suffisante pour être productif. Dans cet article, nous mettons en lumière l’ambition de disciplinarisation du retardé mental qui transparaît du corpus analysé. Nous analysons d’abord les propos tenus sur le diagnostic de retard mental, puis ceux portant sur les traitements, les soins et les services jugés pertinents. Enfin, nous examinons le discours véhiculé dans les deux revues sur les échecs de l’entreprise médicale d’autonomisation et de majoration économique du retardé mental.

The First Reported Case of Second Impact Syndrome: A Reexamination of Dr Fekete's Case Report from 1968

Background In the December 28, 1968 edition of the Canadian Medical Association Journal, Dr John Fekete described a 16-year-old hockey player with fatal cerebral edema following a brain impact while actively symptomatic of a concussion incurred 4 days ago. This case has been described as a “possible” case of second impact syndrome, an entity that was named in 1984 and purportedly first described by Schneider in 1973. Method An audit of material in the public register of Dr Fekete's case was undertaken. Information sources included the newspaper report of the death, transcripts from a coroner's inquest held 12 days later, including the autopsy report, genealogical data available online, and available internet resources. Results There was clear documentation of concussive symptomatology following an initial head injury and evidence of a medical assessment, thus fulfilling the “definite” clinical criteria for second impact syndrome as proposed. After 4 days of ongoing concussive symptomatology, a dramatic, rapid neurological deterioration took place following an apparently unremarkable body contact and fall on the ice while playing hockey. His primary brain pathology included cerebral edema. Conclusion Cerebral edema may follow primary or secondary head injury, the latter comprising second impact syndrome. Dr Fekete's case, as described in the December 28, 1968 edition of the Canadian Medical Association Journal, should be recognized as the first description of this condition.

Pain as the neglected patient safety concern

Five years ago, we published a commentary in the Canadian Medical Association Journal arguing that inadequately managed pain in children should be considered an adverse event, a harmful patient outcome. We argued that inadequately managed pain meets the definition of an adverse event and further hypothesized that treating pain as an adverse event may improve care by raising health care administrators and quality improvement experts’ awareness of this issue. In this article, we reflect on the progress made in both moving this proposition forward and testing out the concept. We then move on to look at what still needs to be done to ensure that children’s pain is managed effectively.

Understanding Recent Home-Birth Research: An Interview With Drs. Melissa Cheyney and Jonathan Snowden

ABSTRACTIn the past month, two new studies have been released—one in The New England Journal of Medicine (NEJM; Snowden et al., 2015) and the other in the Canadian Medical Association Journal (Hutton et al., 2015)—comparing out-of-hospital birth outcomes to hospital birth outcomes. These studies join a growing body of literature that consistently shows high rates of obstetric intervention in hospitals and also show low risk to neonates regardless of setting. However, the recent NEJM study found a small but statistically significant increase in risk for perinatal mortality for babies born out of hospital. Jeanette McCulloch of BirthSwell (http://www.birthswell.com) interviews Melissa Cheyney, PhD, CPM, LDM, medical anthropologist, chair of the Midwives Alliance Division of Research, and lead author on the largest study of outcomes for planned home births in the United States to date (Cheyney et al., 2014a), and Jonathan Snowden, PhD, epidemiologist and assistant professor in the Department of Obstetrics and Gynecology and School of Public Health at Oregon Health and Science University. Snowden is also the lead author of the recent NEJM study.

Clinical Guidelines 2.0: Translation of Tables 2 and 3 and Apendix 1 of Schünemann HJ et al. CMAJ. 2014; 186:E123-42.

<p>Clinical Practice Guidelines are instruments to support decision to improve the quality of clinical care. An expert group from McMaster University (Canada) has developed - from high-quality literature sources – a guidance on the practical steps for their development, dissemination, implementation and evaluation. This is the 1st time anyone seeks to bring together in one document all information regarding the Clinical Practice Guidelines. Due to the interest of this paper, the Centre for Evidence Based Medicine at the University of Lisbon School of Medicine contacted the authors of the article and the journal where it was published (the Canadian Medical Association Journal) in order to translate the most relevant parts of the article (including the practice tables), which was agreed. This guide should be useful to those who, being interested in the development, dissemination and implementation of Clinical Practice Guidelines, want to ensure their intrinsic quality based on relevant and updated evidence.</p>

Honorary Coauthorship: Does it Matter?

Objective To examine the perception of honorary coauthorship among medical academics and to determine whether a potential effect of honorary coauthorship exists on patient care. Methods Corresponding authors of every fourth primary research paper published in JAMA, Journal of the American Medical Association (2001−2003), Canadian Medical Association Journal (2001−2003), British Medical Journal (1998−2000), and Lancet (1998−2000) were surveyed electronically. Questions were focused on each author's personal experience and perception of honorary coauthorship. Results Sixty-five percent of corresponding authors responded (127/195). Fifty-five percent of respondents had published more than 50 peer-reviewed journal articles, and 52% had been listed with an honorary coauthor at some point in their career. Eighteen percent of respondents had been required at some point to list authors who had provided data via a commercial relationship. A majority of authors believed that there were potential negative effects of honorary coauthorship for both the authors themselves (73%) and for their coauthors (83%). These negative effects included personal liability for honorary authors (29%) and dilution of relative contribution for their coauthors (54%). Sixty-two percent of respondents said that honorary coauthorship may have a negative effect on patient care; however, only 2% had been involved in a case in which this phenomenon had actually occurred. Conclusion Honorary coauthorship remains prevalent in the medical literature, even among highly published authors, and has the potential to negatively affect patient care. Respondents believed that a number of possible negative consequences of this phenomenon exist for honorary authors, their coauthors, and patients. Efforts to understand the true influence of honorary authorship on patient care may help further curb this practice in the literature.