precises sur ce sujet avant la fin de 1991. Dans leur article Goldman et ses collegues affirment que certains medecins peuvent pratiquer un taux eeve de cesariennes a cause d'une clientele plus a risque. Une etude de la Corporation en 1987 et en 1989 sur des gestes obstetricaux, dont la cesarienne, n'a pas permis de tirer cette conclusion. ' Enfin, ltude de Goldman et de ses collegues a permis de situer le groupe d'age des femmes qui ont un AVAC. La majorite sont des femmes de plus de 30 ans. Les auteurs deplorent ne pas connaitre le niveau de scolarite de celles-ci. Nous sommes d'accord avec eux, car a notre avis le mouvement de 1'AVAC est venu d'une clientele feminine scolarisee. Gilles Bernier, MD, FRCSC Service d'inspection professionnelle Corporation professionnelle des medecins du Quebec Montreal (Que.)
Reference 1. Profil de l'utilisation des interventions obstetricales au Quebec. Bull Corp Prof Med Que 1990; 30 (4): 9-13
Looming manpower shortage has Canada's obstetricians worried his article (Can Med Assoc J 1991; 144: 478-479, 482), by Lynne Cohen, briefly addresses reasons for this development but focuses largely on the reasons family physicians are opting out of intrapartum care.
_r~
they might encounter, as newly qualified specialists, to share a portion of the abortion workload. Forgoing a career in obstetrics would be an understandable response to this dilemma. It would be most unfortunate if this reasoning played a muted role in the recruitment shortage. Perhaps this possibility should be researched.
John Biehn, MD, CCFP St. Joseph's Family Medical Centre 346 Platt's Lane London, Ont.
Preventing smoking among young people I t is surprising that US cigarette companies are spending $9 million daily in tobacco advertising, as noted in Patrick Sullivan's article "Tobacco companies have sights on teens, US activist warns Nova Scotia MDs" (Can Med Assoc J 1990; 143: SMOKING thru Sthe ceONE 19th
h
u-
CAN MED ASSOC J 1991; 144 (9)
Hiroshi Kawane, MD, DMS Department of Medicine Kawasaki Medical School Kurashiki City, Okayama, Japan
References
I,.
Gii,If I
I have wondered what role abortion may play in the obstet- ("pctre ofth flotin world"),; a rician-gynecologist recruitment shortage. For a variety of reasons increasing numbers of obstet- style of painting and wood-block prints rician-gynecologists are opting developed in Japan from the 17th out of performing therapeutic through the 19th centuries. The subabortions. Potential recruits could jects depict the world of pleasure plus not be oblivious to the pressure landscape. 1108
1351-1352). They are also advertising cigarettes aggressively in Japan, promoting them on television every night as a glamorous product. ' Another problem in Japan is the sale of tobacco through vending machines. It is estimated that there are 500 000 tobacco vending machines throughout the country.2 Children can get cigarettes as easily as they buy soft drinks. According to calculations by the Japan Tobacco Problem Information Center, underaged smokers smoked approximately 60 billion cigarettes last year, nearly twice as many as 6 years ago. Youngsters, especially teenage girls, tend to think that smoking is glamorous and fashionable. I have launched an antismoking campaign with the theme "Smoking is old-fashioned" (Fig. 1). The theme for last year's World No-Tobacco Day was "Growing up without tobacco." I hope that the government will take immediate action to prohibit tobacco advertising on television and restrict sales of cigarettes in vending machines.
1. Kawane H: Tobacco advertising in
Japan [C]. Can Med Assoc J 1988: 1 39: 193-194 2. Idem: A smoke-free hospital [C]. A4rcli InternAMed 1990: 150: 1350
Informed consent to HIV antibody testing I n response to the letter from Dr. D.P. Hill (Can Med Assoc J 1991; 144: 403) about the legal status of informed consent to HIV antibody testing, Dr. EikeHenner W. Kluge (ibid: 403-404) states that testing in the absence of consent should "Xbe approached LE I e
MAI 1991
with extreme caution."" This is consistent with the positions of medical associations in England, France, the Netherlands, Germany, Australia and Japan.' University Hospital, Vancouver, requires that before being tested for HIV antibody the patient sign a special consent form acknowledging that counselling and information have been provided. In the process of reviewing this policy we recently contacted by telephone 15 Canadian hospitals (7 in British Columbia) with more than 300 beds to determine whether similar policies were in place. In each institution the person contacted was the infection control nurse. Of the 15 hospitals I1 have a policy in place: 8 require chart documentation by the physician confirming that verbal consent was obtained; the remaining 3 require a signed consent form to be present in the hospital record. Of the four hospitals without a policy all stated that they were in the process of developing one and expected it to require signed consent. Thus, of the 15 hospitals 7 now require or will require signed consent, and 8 require documented consent. Five of the 10 teach-
ing hospitals allow documented consent. Of the seven BC hospitals only two, one a teaching hospital, allow documented consent. One Ontario teaching hospital requires documented consent; however, the documentation has to be confirmed by the infection control nurse before blood can be drawn. The infection control nurse noted that frequently house staff request patients to sign the progress note. In other hospitals in which documented confirmation is required it was noted that frequently documentation of consent is not present. Another hospital does not require signed consent by patients but has a special consent form to be used by Employee Health. MAY 1, 1991
In summary, there is or will soon be policy requiring signed consent before HIV antibody testing in almost half the Canadian hospitals surveyed, as well as ours, and in almost three-quarters of the BC hospitals surveyed. The balance accept a written note to document obtaining verbal consent. It therefore appears that across Canada there is consensus about the need for consent and diversity of opinion only about style. Micbael A. Noble, MD Head of microbiology and infection control David R. Burdge, MD Division of Infectious Disease Department of Medicine University Hospital Vancouver, BC
Reference 1. Charatan F: Doctors and HIV: an international perspective. BMJ 1991; 302: 195-198
Quality of abstracts of original research articles in CALJ in 1989 he report by Lutchmie Narine and colleagues (Can Med Assoc J 1991; 144: 449-453) affords a refreshing approach to the goal of conveying the maximum amount of useful information in abstracts of clinical research articles. When I encountered the report's Table 2, which lists criteria for evaluating abstracts, I pulled the latest clinical report of which I was a coauthor. The 92-word, unstructured abstract had an information content score of 0.69. I then recalled that an earlier version had been shortened. The 44 excised words contained little pertinent information, but they changed a "No" in my initial evaluation to a "Yes", for a score of 0.75. I then wrote a structured
abstract in accord with CMAJ's instructions for authors (ibid: 4748); it yielded a whopping 0.90 score for information content. I do not place great faith in these scores except as they denote a trend. I do not accept all the criteria in Table 2, and each evaluation requires subjective decisions on whether criteria are applicable. The authors judged 9 of the 32 criteria not applicable for 28 or more of the 33 abstracts they evaluated. This suggests to me that, in addition to the authors' recommended future studies, efforts should be directed toward evaluation of the criteria. Also, if the goal is to enable the busy clinician to quickly extract useful information, reader input should be solicited. I like the structured abstract. It is easy to write, and it keeps the author's thoughts focused. The reader also benefits from an orderly presentation. Narine and colleagues have performed a valuable service in bringing this concept to our attention. However, rather than refer to quality of abstracts, it is more productive to discuss information content, as was done by Haynes and associates.' Judgement of quality implies that the criteria employed and the subjective decisions made in the evaluation are absolute. The concept of the structured abstract is so novel and new that it must surely undergo evolution as additional data and reports appear. When viewed in the context of information content the article abstracts in CMAJ in 1989 do not appear to be as bad as Dr. Bruce P. Squires implies in his editorial "Abstracts: the need for improvement" (ibid: 421). The fact that 86% did not address study limitations may mean that this feature does not belong in an abstract designed for quick scanning by clinicians. Likewise, a 93% failure to recommend future study may not be too disconcerting to the CAN MED ASSOC J 1991; 144 (9)
1109
Reference 1. Profil de l'utilisation des interventions obstetricales au Quebec. Bull Corp Prof Med Que 1990; 30 (4): 9-13
Looming manpower shortage has Canada's obstetricians worried his article (Can Med Assoc J 1991; 144: 478-479, 482), by Lynne Cohen, briefly addresses reasons for this development but focuses largely on the reasons family physicians are opting out of intrapartum care.
_r~
they might encounter, as newly qualified specialists, to share a portion of the abortion workload. Forgoing a career in obstetrics would be an understandable response to this dilemma. It would be most unfortunate if this reasoning played a muted role in the recruitment shortage. Perhaps this possibility should be researched.
John Biehn, MD, CCFP St. Joseph's Family Medical Centre 346 Platt's Lane London, Ont.
Preventing smoking among young people I t is surprising that US cigarette companies are spending $9 million daily in tobacco advertising, as noted in Patrick Sullivan's article "Tobacco companies have sights on teens, US activist warns Nova Scotia MDs" (Can Med Assoc J 1990; 143: SMOKING thru Sthe ceONE 19th
h
u-
CAN MED ASSOC J 1991; 144 (9)
Hiroshi Kawane, MD, DMS Department of Medicine Kawasaki Medical School Kurashiki City, Okayama, Japan
References
I,.
Gii,If I
I have wondered what role abortion may play in the obstet- ("pctre ofth flotin world"),; a rician-gynecologist recruitment shortage. For a variety of reasons increasing numbers of obstet- style of painting and wood-block prints rician-gynecologists are opting developed in Japan from the 17th out of performing therapeutic through the 19th centuries. The subabortions. Potential recruits could jects depict the world of pleasure plus not be oblivious to the pressure landscape. 1108
1351-1352). They are also advertising cigarettes aggressively in Japan, promoting them on television every night as a glamorous product. ' Another problem in Japan is the sale of tobacco through vending machines. It is estimated that there are 500 000 tobacco vending machines throughout the country.2 Children can get cigarettes as easily as they buy soft drinks. According to calculations by the Japan Tobacco Problem Information Center, underaged smokers smoked approximately 60 billion cigarettes last year, nearly twice as many as 6 years ago. Youngsters, especially teenage girls, tend to think that smoking is glamorous and fashionable. I have launched an antismoking campaign with the theme "Smoking is old-fashioned" (Fig. 1). The theme for last year's World No-Tobacco Day was "Growing up without tobacco." I hope that the government will take immediate action to prohibit tobacco advertising on television and restrict sales of cigarettes in vending machines.
1. Kawane H: Tobacco advertising in
Japan [C]. Can Med Assoc J 1988: 1 39: 193-194 2. Idem: A smoke-free hospital [C]. A4rcli InternAMed 1990: 150: 1350
Informed consent to HIV antibody testing I n response to the letter from Dr. D.P. Hill (Can Med Assoc J 1991; 144: 403) about the legal status of informed consent to HIV antibody testing, Dr. EikeHenner W. Kluge (ibid: 403-404) states that testing in the absence of consent should "Xbe approached LE I e
MAI 1991
with extreme caution."" This is consistent with the positions of medical associations in England, France, the Netherlands, Germany, Australia and Japan.' University Hospital, Vancouver, requires that before being tested for HIV antibody the patient sign a special consent form acknowledging that counselling and information have been provided. In the process of reviewing this policy we recently contacted by telephone 15 Canadian hospitals (7 in British Columbia) with more than 300 beds to determine whether similar policies were in place. In each institution the person contacted was the infection control nurse. Of the 15 hospitals I1 have a policy in place: 8 require chart documentation by the physician confirming that verbal consent was obtained; the remaining 3 require a signed consent form to be present in the hospital record. Of the four hospitals without a policy all stated that they were in the process of developing one and expected it to require signed consent. Thus, of the 15 hospitals 7 now require or will require signed consent, and 8 require documented consent. Five of the 10 teach-
ing hospitals allow documented consent. Of the seven BC hospitals only two, one a teaching hospital, allow documented consent. One Ontario teaching hospital requires documented consent; however, the documentation has to be confirmed by the infection control nurse before blood can be drawn. The infection control nurse noted that frequently house staff request patients to sign the progress note. In other hospitals in which documented confirmation is required it was noted that frequently documentation of consent is not present. Another hospital does not require signed consent by patients but has a special consent form to be used by Employee Health. MAY 1, 1991
In summary, there is or will soon be policy requiring signed consent before HIV antibody testing in almost half the Canadian hospitals surveyed, as well as ours, and in almost three-quarters of the BC hospitals surveyed. The balance accept a written note to document obtaining verbal consent. It therefore appears that across Canada there is consensus about the need for consent and diversity of opinion only about style. Micbael A. Noble, MD Head of microbiology and infection control David R. Burdge, MD Division of Infectious Disease Department of Medicine University Hospital Vancouver, BC
Reference 1. Charatan F: Doctors and HIV: an international perspective. BMJ 1991; 302: 195-198
Quality of abstracts of original research articles in CALJ in 1989 he report by Lutchmie Narine and colleagues (Can Med Assoc J 1991; 144: 449-453) affords a refreshing approach to the goal of conveying the maximum amount of useful information in abstracts of clinical research articles. When I encountered the report's Table 2, which lists criteria for evaluating abstracts, I pulled the latest clinical report of which I was a coauthor. The 92-word, unstructured abstract had an information content score of 0.69. I then recalled that an earlier version had been shortened. The 44 excised words contained little pertinent information, but they changed a "No" in my initial evaluation to a "Yes", for a score of 0.75. I then wrote a structured
abstract in accord with CMAJ's instructions for authors (ibid: 4748); it yielded a whopping 0.90 score for information content. I do not place great faith in these scores except as they denote a trend. I do not accept all the criteria in Table 2, and each evaluation requires subjective decisions on whether criteria are applicable. The authors judged 9 of the 32 criteria not applicable for 28 or more of the 33 abstracts they evaluated. This suggests to me that, in addition to the authors' recommended future studies, efforts should be directed toward evaluation of the criteria. Also, if the goal is to enable the busy clinician to quickly extract useful information, reader input should be solicited. I like the structured abstract. It is easy to write, and it keeps the author's thoughts focused. The reader also benefits from an orderly presentation. Narine and colleagues have performed a valuable service in bringing this concept to our attention. However, rather than refer to quality of abstracts, it is more productive to discuss information content, as was done by Haynes and associates.' Judgement of quality implies that the criteria employed and the subjective decisions made in the evaluation are absolute. The concept of the structured abstract is so novel and new that it must surely undergo evolution as additional data and reports appear. When viewed in the context of information content the article abstracts in CMAJ in 1989 do not appear to be as bad as Dr. Bruce P. Squires implies in his editorial "Abstracts: the need for improvement" (ibid: 421). The fact that 86% did not address study limitations may mean that this feature does not belong in an abstract designed for quick scanning by clinicians. Likewise, a 93% failure to recommend future study may not be too disconcerting to the CAN MED ASSOC J 1991; 144 (9)
1109
