CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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To determine when respirologists approach patients with end-stage chronic obstructive pulmonary disease (COPD) to decide about the use of mechanical ventilation, what information they provide to patients and how they provide it. ⋯ Discussions with COPD patients concerning end-of-life decisions about mechanical ventilation are reported to occur in advanced stages of the disease or not at all, with patients' input where possible. Information presented to patients is often modified in order to influence the decision. Future studies should explore ways to involve patients further in the decision-making process and to improve the process for both patients and physicians.
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The standard of professional candour with patients has undergone a significant change over the past 30 years. Independent of their obligation to disclose information necessary for informed consent, physicians are increasingly expected to communicate important information to patients that is not immediately related to treatment decisions. ⋯ Truth telling fosters trust in the medical profession and rests on the respect owed to patients as persons. It also prevents harm, as patients who are uninformed about their situation may fail to get medical help when they should.
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To assess the effect of the tobacco tax cuts made in 1994 on the smoking habits of Canadians. ⋯ Although smoking rates are declining in Canada, tobacco tax cuts appear to have slowed the rate of decline by inducing more nonsmokers to take up smoking and leading fewer smokers to quit.
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The author comments on the report by Dr. Benjamin Chan and associates on spirometry utilization rates in Ontario (see pages 169 to 176 of this issue). ⋯ The author argues, however, that to a large extent the wrong type of spirometry is being done. Although the wider use of flow studies should be promoted, the utility of flow-volume loops rather than simple spirograms as an office procedure is highly questionable.
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Delegates attending a recent national conference on smoking and health learned that there are distinct differences in smoking habits between anglophones and francophones, and that Quebec has the world's highest smoking rate for adult women. Speakers said the high smoking rate in Quebec points to the need for francophone-specific antismoking messages, not simply messages that have been translated from English.