CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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To describe the various components of the delay to thrombolytic treatment for patients with acute myocardial infarction (MI) and to identify the hospital and patient characteristics related to these delays. ⋯ Despite certain improvements, there remain substantial delays between symptom onset and the administration of thrombolysis for patients with acute MI. A large part of the delay is due to the hesitation of patients (particularly women, older patients and patients with diabetes) to seek medical attention. Although the median time for medical decision-making appears reasonable, care must be taken to ensure that all patient groups receive timely evaluation and therapy. The delay associated with having the treatment decision made by a cardiologist probably represents a marker for more difficult, complex cases. Methods should be developed to permit specialty consultation, if needed, while minimizing treatment delays. Community and low-volume hospitals may require special attention.
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The remarkable ice storm that brought life to a standstill in most of Eastern Ontario and Quebec in January had a huge impact on medical services. Hospitals that lost power found themselves serving as shelters not only for patients but also for staff members and nearby residents. Doctors' offices were forced to close and a large number of operations were cancelled. The 2 articles that follow detail the huge impact the "ice storm of the century" had on health care.
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Editorial Review Case Reports
Cardiopulmonary resuscitation for patients in a persistent vegetative state: futile or acceptable?
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Review Practice Guideline Guideline
The management of chronic pain in patients with breast cancer. The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Canadian Society of Palliative Care Physicians. Canadian Association of Radiation Oncologists.
To help health professionals develop optimal strategies for controlling the chronic pain caused by breast cancer. ⋯ The guidelines were reviewed and revised by a writing committee, expert primary reviewers, secondary reviewers selected from all regions of Canada and by the Steering Committee. The present guidelines reflect a consensus of all of these contributors. They have been reviewed and endorsed by the Canadian Society of Palliative Care Physicians and the Canadian Association of Radiation Oncologists.