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This analysis indicates that implementing an NHS England–style diabetes prevention programme in Ontario and Quebec would be cost-effective — and likely cost saving — over a 35-year horizon for adults with prediabetes. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260187

The National Health Service (NHS) England’s Diabetes Prevention Programme (DPP) is a cost-effective, publicly funded program of structured dietary and physical activity counselling that has been shown to reduce the incidence of progression from prediabetes to type 2 diabetes.

Diabetes prevention programme
DOI: 10.1503/cmaj.260187

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CMAJ @cmaj.ca · 2h

Periprosthetic joint infection complicates 1% to 2% of primary arthroplasties and often presents with pain, swelling, erythema, and wound drainage. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251720

Unexplained new pain after total hip or knee arthroplasty should raise concern for periprosthetic joint infection.

Periprosthetic hip and knee infections
DOI: 10.1503/cmaj.251720

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CMAJ @cmaj.ca · 25/09/2026

Distress (pain, fear) is the most common adverse reaction associated with vaccination. This clinical practice guideline presents evidence-based strategies to manage vaccination-related distress. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260123

Implementing the recommendations from the guideline on reducing distress during vaccine injections can improve the quality of vaccine delivery and promote person-centred care by aligning interventions with vaccine recipient and support person preferences.

Guideline on reducing distress during vaccine injections
DOI: 10.1503/cmaj.260123

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CMAJ @cmaj.ca · 24/09/2026

Reframing chromic homelessness as a cognitive impairment crisis is essential but will require investment in diagnostic services, guardianship systems, interdisciplinary medical supports, and the construction of intensive housing facilities. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.252022

People experiencing homelessness have high rates of cognitive and functional impairment that may be severe, with several causes compounding each other over time.

Cognitive impairment and homelessness
DOI: 10.1503/cmaj.252022

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CMAJ @cmaj.ca · 23/09/2026

Sarcoidosis: Cutaneous lesions occur in approximately 25% to 33% of patients and are often the presenting feature. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260254

(A) Yellow-red plaques infiltrating tattoos, and psoriasiform plaques along the hairline, of a 57-year-old woman with sarcoidosis. (B) Marked resolution of both lesions after 3 months of oral prednisone and hydroxychloroquine.

Sarcoidosis
DOI: 10.1503/cmaj.260254

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CMAJ @cmaj.ca · 22/09/2026

Did you know: Engineered stone as used for countertops contains high concentrations of silica and carries a substantial risk of silicosis in exposed workers. Learn more about silicosis from countertop work ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260081

Chest radiograph 2 years after the initial presentation showing progressive changes with diffuse small nodules typical of silicosis.

Silicosis from countertop work
DOI: 10.1503/cmaj.260081

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CMAJ @cmaj.ca · 22/09/2026

Silicosis: what are the occupational risks? CMAJ Volume 198, Issue 32, features new articles on silicosis from countertop work; bile acid diarrhea; guideline on reducing distress during vaccine injections, and more. ➡️ www.cmaj.ca/content/198/32

Silicosis: what are the occupational risks?

New articles on silicosis from countertop work; bile acid diarrhea; guideline on reducing distress during vaccine injections, and more.

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CMAJ @cmaj.ca · 22/09/2026

Bile acid diarrhea, an underrecognized cause of chronic diarrhea, occurs when excess bile acids reach the colon, causing increased fluid secretion and accelerated intestinal transit. Here are 5 things to know about bile acid diarrhea ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260665

Typical presentations of bile acid diarrhea include chronic watery diarrhea, increased stool frequency, fecal urgency, and bloating.

Bile acid diarrhea
DOI: 10.1503/cmaj.260665

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CMAJ @cmaj.ca · 17/09/2026

A medical student reflects on moving through clinical environments as a wheelchair user, and on the quiet labour required to navigate spaces that were not designed with every body in mind. ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260779

Hands land on the back of your chair before you can answer. The frame jolts forward. Your balance shifts. For a brief, sharp second, your body is no longer yours.

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CMAJ @cmaj.ca · 16/09/2026

Left circumflex myocardial infarction, a subtype of acute coronary syndrome, is under-recognized and undertreated. Here are 5 things to know ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260030

Of left circumflex myocardial infarctions, 33% lack ST-segment elevation and are misclassified as non–ST segment elevation myocardial infarction.

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CMAJ @cmaj.ca · 15/09/2026

What causes severe dyslipidemia in children, and what further investigations are needed? What therapeutic lifestyle modifications should be recommended? When should pharmacologic therapy be considered? What follow-up actions are needed? Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260584

Many monogenic processes cause primary dyslipidemia, the most common of which is familial hypercholesterolemia, an autosomal codominant condition.

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CMAJ @cmaj.ca · 14/09/2026

The clearest benefit of British Columbia’s decriminalization policy is reduced arrests for drug possession, which represents a meaningful change in how people who use drugs experience and interact with the justice system. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.261198

The lesson from BC is not that decriminalization is irrelevant, but that such policies must be supported within prepared, trusted, and adequately resourced systems.

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CMAJ @cmaj.ca · 14/09/2026

Drug decriminalization and health outcomes: The research findings suggest that decriminalization effectively reduced criminalization of drug possession but did not, in isolation, produce direct impacts on outcomes related to drug toxicity. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260038

Drug decriminalization and recriminalization in BC were associated with substantial changes in police-reported drug possession incidents but no corresponding changes in drug toxicity deaths or hospitalizations when compared to other regions in Canada.

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CMAJ @cmaj.ca · 14/09/2026

Drug decriminalization: what are the impacts on crime and health outcomes? CMAJ Volume 198, Issue 31, features new articles on drug decriminalization and health outcomes; familial hypercholesterolemia; left circumflex myocardial infarction, and more. ➡️ www.cmaj.ca/content/198/31

2 police officers leading a woman away with handcuffs

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CMAJ @cmaj.ca · 11/09/2026

Recombinant herpes zoster vaccination: Herpes zoster (shingles) is associated with major neuro- and cardiovascular events, and recombinant zoster vaccine is associated with lower risk of acute myocardial infarction and stroke. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.252032

Recombinant zoster vaccine is the only authorized shingles vaccine in Canada. A 2-dose series yields 85% to 90% efficacy over 11 years. The vaccine is recommended for all adults aged 50 years and older (regardless of previous
chickenpox, shingles, or receipt of the discontinued live-attenuated vaccine) and 18 years and older if immunocompromised or due to be.

Recombinant herpes zoster vaccination
DOI: 10.1503/cmaj.252032

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CMAJ @cmaj.ca · 10/09/2026

We don't talk about our dead: A neurosurgeon reflects on unwritten rules of his profession ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260727

“No one teaches physicians how to carry a child’s death. Everyone improvises privately and calls it coping.”
— Mirko Micovic MD PhD

We don't talk about our dead
DOI: 10.1503/cmaj.260727

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CMAJ @cmaj.ca · 10/09/2026

Patients with epidemiologic risk factors for TB infection and a high risk to reactivate, or patients with epidemiologic, clinical, and radiologic features of TB disease, should be promptly assessed and treated for TB infection or disease as appropriate. ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260343

New or worsening hemoptysis during antituberculous treatment warrants urgent re-evaluation to assess for vascular complications like Rasmussen aneurysm.

Cavitary pulmonary tuberculosis
DOI: 10.1503/cmaj.260343

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CMAJ @cmaj.ca · 09/09/2026

Outpatient hyperkalemia and risk of death: Research findings support urgent emergency department referrals and underscore the need for standardized reporting and management guidelines. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.252008

Presentation to the emergency department within 24 hours of a severe outpatient hyperkalemia result is associated with lower rates of immediate and short-term death.

Outpatient hyperkalemia and risk of death
DOI: 10.1503/cmaj.252008

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CMAJ @cmaj.ca · 08/09/2026

Regulatory oversight of ice arena air quality: At least 12 poisoning incidents from carbon monoxide (CO) and nitrogen dioxide (NO2) at Canadian ice arenas have been reported in the media in the past 10 years. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.261120

Health Canada has indicated best practices regarding air quality in ice arenas, but these are not enforced in most provinces and territories. Implementation and enforcement of air quality regulations in
ice arenas have been effective in preventing CO and NO2 poisonings in Minnesota; such enforcement is needed in Canada.

Regulatory oversight of ice arena air quality
DOI: 10.1503/cmaj.261120

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CMAJ @cmaj.ca · 28/08/2026

Serotonin toxicity: The condition results from acute, excessive serotonergic activity at serotonin receptors following initiation or dose escalation of a serotonergic agent, overdose, or through drug–drug interactions. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260159

Serotonin toxicity is a potentially life-threatening adverse reaction to serotonergic agents.

Serotonin toxicity
DOI: 10.1503/cmaj.260159

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CMAJ @cmaj.ca · 27/08/2026

Tinea incognito: Topical corticosteroid application over dermatophytosis (fungal infections) can lead to tinea incognito. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260512

(A) Multiple erythematous plaques with interspersed pustules over the malar region and forehead of a 38-year-old woman. (B) Resolution of tthe erythematous plaques following 7 days of oral and topical antifungal therapy.

Tinea incognito
DOI: 10.1503/cmaj.260512

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CMAJ @cmaj.ca · 26/08/2026

What features differentiate a new stroke from post-stroke recrudescence? What causes post-stroke recrudescence? What investigations are recommended? What should patients and families be told about management and prognosis? Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251837

Post-stroke recrudescence is the transient recurrence of stroke deficits after initial improvement.

Post-stroke recrudescence
DOI: 10.1503/cmaj.251837

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CMAJ @cmaj.ca · 25/08/2026

Hypertriglyceridemia-induced pancreatitis: Diabetic ketoacidosis with severe hypertriglyceridemia-induced acute pancreatitis as the initial presentation of type 2 diabetes is a rare, severe metabolic emergency. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260244

Hypertriglyceridemia should be considered in all patients presenting with acute pancreatitis.

Hypertriglyceridemia-induced pancreatitis
DOI: 10.1503/cmaj.260244

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CMAJ @cmaj.ca · 25/08/2026

Dependent on the immunity of others: A father reflects on his medical student son’s death from measles Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260060

“I want people to understand what declining immunization rates mean for individuals who cannot receive all vaccines.”
— Pascal Muijtjens

Dependent on the immunity of others
DOI: 10.1503/cmaj.260060

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CMAJ @cmaj.ca · 24/08/2026

This qualitative research study describes restrictive policies that challenge blood donation among Black people in Canada and underscore deep mistrust in the health care and blood donation systems owing to historical and current racial discrimination ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.250123

Blood donation supports critical treatments; however, Black people in Canada face multiple barriers to donating blood, including restrictive blood donation policies, institutional and systemic racism in health systems, historic anti-Black racism, and lack of confidence in blood donation systems.

Systemic racial barriers to blood donation
DOI: 10.1503/cmaj.250123

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CMAJ @cmaj.ca · 24/08/2026

Updated HIV prophylaxis guidelines: what clinicians need to know This week on #CMAJPodcasts, we discuss HIV prophylaxis guidelines with Dr. Darrell Tan and Natasha Lawrence ➡️ www.cmaj.ca/transcript-250511

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CMAJ @cmaj.ca · 24/08/2026

Serotonin syndrome: what is the latest on management? CMAJ Volume 198, Issue 29, features new articles on serotonin toxicity; tinea incognito; systemic racial barriers to blood donation, and more. ➡️ www.cmaj.ca/content/198/29

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CMAJ @cmaj.ca · 14/08/2026

Metacarpophalangeal joint dislocation: Metacarpophalangeal joint dislocations may be missed if they are subtle or if the appropriate 3-view radiographs are not obtained. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251814

"Figure 1
(A) Anterior–posterior and (B) lateral radiographic images of the left index finger of a 15-year-old boy showing dorsal dislocation at the metacarpophalangeal joint. The proximal phalanx (white arrow) is not articulating with the metacarpal head (asterisk)."

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CMAJ @cmaj.ca · 13/08/2026

Children with medical complexity: Early conversations about what a safe discharge requires, including caregiver readiness and home care realities, can shape clinical decisions. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260404

Families describe feeling most supported when discharge planning begins early and is framed as a shared goal, not a sudden event.

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CMAJ @cmaj.ca · 12/08/2026

Telemetry monitoring: Telemetry (continuous remote cardiac rhythm monitoring) can detect arrhythmias, abnormal QT intervals, and electrocardiographic changes suggestive of myocardial ischemia. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.252113

Between 30% and 90% of noncritical care telemetry use is inappropriate or is continued longer than recommended.

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CMAJ @cmaj.ca · 11/08/2026

Vancomycin infusion reaction is an idiopathic, non immunoglobulin E-mediated anaphylactoid reaction that results in endogenous histamine release from mast cells. Never use the term “red man syndrome” to describe it. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251714

Vancomycin infusion reaction was once named “red man syndrome” because manifestations include flushing that shows red in those who are White, but this term has long been used as a racial slur toward people of Indigenous decent in North America and is not acceptable.

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CMAJ @cmaj.ca · 11/08/2026

Emergency departments across Canada are seeing record patient volumes, bed shortages and overcrowding. This week on #CMAJPodcasts, we discuss emergency physician burnout and attrition with Drs. Kerstin de Wit and Jillian Horton ➡️ www.cmaj.ca/transcript-251863

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CMAJ @cmaj.ca · 11/08/2026

Hemoperitoneum pregnancy: Uterine fibroids in pregnancy are mostly asymptomatic, but as many as 20% will develop complications such as degeneration, torsion of a pedunculated fibroid, or spontaneous rupture. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251938

Ultrasound of a 36-year-old primigravida woman with an exophytic fibroid (arrow) at point of maximal tenderness. Approximate myometrial thickness and distance from fibroid to gestational sac (arrowhead) ranged from 5 mm to 12 mm (double arrow).

Hemoperitoneum pregnancy
DOI: 10.1503/cmaj.251938

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CMAJ @cmaj.ca · 10/08/2026

Deaf community experiences in health care: Deaf community experiences highlight how the privileging of spoken language and hearing norms operates both structurally and interpersonally to shape and constrain health care access and navigation. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251945

In Canada, approximately 357 000 people identify as culturally Deaf, which is a distinct cultural and linguistic identity rather than a deficit requiring correction.

Deaf community experiences in health care
DOI: 10.1503/cmaj.251945

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CMAJ @cmaj.ca · 10/08/2026

Health care access and navigation: what are the experiences of culturally Deaf people? CMAJ Volume 198, Issue 28, features new articles on Deaf community experiences in health care; children with medical complexity; telemetry monitoring, and more. ➡️ www.cmaj.ca/content/198/28

Cover of CMAJ featuring a healthcare professional interacting with a patient and a caregiver in a clinical setting.

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CMAJ @cmaj.ca · 31/07/2026

Every wrinkle holds a thousand tales: A physician reflects on caring for an Inuk man in his final illness ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260356

As clinicians, we often think in terms of what we can fix. The North taught me to also think in terms of what we can receive. It taught me that listening itself — careful, reverent listening — is a form of care, a form of honouring.

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CMAJ @cmaj.ca · 30/07/2026

Pacemaker lead failure: Pacemaker lead failure is broadly categorized into 2 types: conductor fracture and insulation failure. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260045

(A) Chest radiograph of an 89-year-old woman showing an abnormal configuration of the atrial pacing lead near the sternoclavicular region (B, black arrow), consistent with suspected insulation damage.

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CMAJ @cmaj.ca · 29/07/2026

Pyoderma gangrenosum: Pyoderma gangrenosum is a rare but serious neutrophilic dermatosis that often presents as a rapidly expanding ulcer. Images provided in article. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260050

Pyoderma gangrenosum often mimics infectious or vascular disease, which can contribute to its diagnostic difficulty and delay in management.

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CMAJ @cmaj.ca · 29/07/2026

The narrow promise of lecanemab for Alzheimer disease This week on #CMAJPodcasts, we discuss lecanemab for Alzheimer disease with Drs. Sophie Weiss and Vivian Ewa ➡️ www.cmaj.ca/transcript-260193

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CMAJ @cmaj.ca · 28/07/2026

What are the risks associated with bipolar disorder in the perinatal period? How can these risks be managed during pregnancy and lactation? What monitoring is required for a pregnant person taking mood stabilizers? Find out in our latest decisions article ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251879

Pregnancies in patients with bipolar disorder are at a higher risk of obstetric and fetal complications than unaffected pregnancies.

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CMAJ @cmaj.ca · 27/07/2026

"Health care system leaders must not use individuals as convenient human shields to avoid taking accountability for a complex system problem." How to stop Canada’s emergency physicians from leaving their profession: an editorial by Dr. Catherine Varner ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.261030

Emergency physician attrition will continue until emergency department overcrowding is mitigated. Given the multifaceted problem that this overcrowding poses, solving it will require substantial investment in acute care and long-term care capacity.

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CMAJ @cmaj.ca · 27/07/2026

Emergency physician burnout: In a survey of Canadian emergency physicians, burnout remains high, with almost half of respondents having reduced their work hours, and 10% having left the profession. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251863

Canadian emergency staff have been dealing with record patient attendances, long wait times, bed blocking, and department overcrowding.

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CMAJ @cmaj.ca · 27/07/2026

Burnout and attrition: how are emergency physicians faring? CMAJ Volume 198, Issue 27, features new articles on emergency physician burnout; pacemaker lead failure; bipolar disorder and pregnancy, and more. ➡️ www.cmaj.ca/content/198/27

Exhausted male physician standing against wall in hospital corridor

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CMAJ @cmaj.ca · 20/07/2026

Did you know wildfire smoke can be more toxic than pollution from other sources? Wildfire seasons are getting longer and more severe in Canada. Here are 5 things to know about wildfire smoke ➡️ doi.org/10.1503/cmaj.240135

Man wearing glasses and a protective mask stands outdoors amid heavy yellowish smog or haze, looking into the distance.

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CMAJ @cmaj.ca · 20/07/2026

On wildfire smoke air pollution: “Relying on people to protect themselves is not enough, and top–down strategies ... are also needed to protect human health as the climate continues to change.” ➡️ doi.org/10.1503/cmaj.250510

Woman wearing a mask walks through a neighborhood shrouded in thick orange smoke from wildfires.

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CMAJ @cmaj.ca · 17/07/2026

Medetomidine: Medetomidine should be suspected when patients present with features of opioid intoxication but do not respond to naloxone. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260399

Medetomidine is increasingly present in the unregulated drug supply, and people who abruptly discontinue use of unregulated opioids are at risk of medetomidine withdrawal.

Medetomidine
DOI: 10.1503/cmaj.260399

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CMAJ @cmaj.ca · 16/07/2026

New diagnosis of hepatitis B: What are the current recommendations for hepatitis B virus (HBV) screening in adult patients? What are the recommendations for management and treatment? Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260032

The 2025 Canadian guideline on hepatitis B virus recommends that all adults have 1-time triple serology, which includes hepatitis B surface antigen (HBsAg), HB surface antibody (HBsAb), and HB core antibody (HBcAb), irrespective of risk or clinical history.

New diagnosis of hepatitis B
DOI: 10.1503/cmaj.260032

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CMAJ @cmaj.ca · 15/07/2026

Anaplasmosis and myocarditis: Anaplasmosis should be suspected when patients living in endemic regions present with fever, malaise, headache, and gastrointestinal symptoms, even if they do not recall any tick bites. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260142

Anaplasmosis is the second most common tick-borne disease in Canada, with rapidly rising incidence owing to the expanding geographic distribution of the blacklegged tick, Ixodes scapularis.

Anaplasmosis and myocarditis
DOI: 10.1503/cmaj.260142

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CMAJ @cmaj.ca · 14/07/2026

Combined therapy versus monotherapy in type 2 diabetes: Assessing cardiovascular and kidney outcomes of combined SGLT2i and GLP-1RA therapy versus monotherapy in the management of type 2 diabetes mellitus using network meta-analysis. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.250369

Compared with SGLT2 inhibitors or GLP-1 receptor agonists alone, combined therapy did not significantly reduce the risk of major adverse cardiovascular or kidney events but was associated with lower risks of hospitalized heart failure.

Combined therapy versus monotherapy in type 2 diabetes
DOI: 10.1503/cmaj.250369

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CMAJ @cmaj.ca · 13/07/2026

This week on #CMAJPodcasts, we discuss rethinking the contrast allergy label with Drs. Samira Jeimy and Amit Katyan. ➡️ www.cmaj.ca/transcript-260319

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