well-designed and well-executed study involving a number of relevant variables will often yield unexpected findings of considerable magnitude but not large enough to be statistically significant. I don't think investigators should be discouraged from reporting these findings as observations, as long as this is done objectively, without unsupported claims or unjustified conclusions. Further studies may show that those findings are not only real but important. I do not think that reviewers and readers should be wary of Should trends be authors just because they report reported? some results that bear watching in future work but lacked statistical I agree with most of what Dr. significance within their study. Bruce P. Squires says in his editorial "Statistics in bio- Arthur S. Kraus, ScD Ave. medical manuscripts: What edi- 163 Casterton Ont. Kingston, tors want from authors and peer reviewers" (Can Med Assoc J 1990; 142: 213-214). However, I disagree with some of the section near the end that starts: "Review- Nonprescription cough ers and readers should be equally and cold remedies wary of authors who describe I n early 1985 an expert adviso'trends' ". ry committee was formed by I agree that it is objectionable the Health Protection Branch, for an author to report a "trend that was not statistically signifi- Department of National Health cant" in the results section and and Welfare, to review the safety, then to use that trend to justify a efficacy, labelling and availability particular conclusion that the au- of the drug ingredients in nonprethor is pushing in the discussion scription cough and cold remedies and the abstract. However, I do on the Canadian market. The not agree with the argument of the committee was composed of eight last two sentences of the para- people with expertise in various graph: "True, an observed trend aspects of medicine, pharmacy may ultimately be real. If authors and drug manufacturing. The committee has finished believe that to be so they should and submitted its deliberations the calculate, before they begin to the Health rerecommendations is size study, what sample which is pubBranch, Protection their hypotheses quired to verify in reports. The three them lishing their experiment and then design exon antitussives, second report, or trial accordingly." A prestudy calculation should pectorants and bronchodilators, determine the sample size needed has just been published and is to result in a specified high proba- available to interested physicians. bility of detecting a true long-run Copies of the first report, on antioutcome of a certain magnitude in histamines, nasal decongestants regard to the main hypothesis that and anticholinergics, published in is statistically significant at a spe- August 1989, are also available. cific level of signifilcance. But a The third report, on phenyl13: 298-304 9. Stehbens WE: An appraisal of cholesterol feeding in experimental atherogenesis. Prog Cardiovasc Dis 1986; 29: 107-128 10. Idem: Vascular complications in experimental atherosclerosis. Ibid: 221237 11. Stehbens WE, Wierzbicki E: The relationship of hypercholesterolemia to atherosclerosis with particular emphasis on familial hypercholesterolemia, diabetes mellitus, obstructive jaundice, myxedema and the nephrotic syndrome. Prog Cardiovasc Dis 1988; 30: 289-306

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For prescribing information see page 895

propanolamine, lozenges and combinations, will be published in the near future. Copies of the reports have been sent to medical and pharmacy associations and to other interested groups for comments. After reviewing the reports and comments the Health Protection Branch intends to publish its proposals in an information letter. Copies of the reports can be obtained by contacting the director of the Bureau of Nonprescription Drugs at Place Vanier, Tower A, 333 River Rd., Vanier, Ont. KIA 1B8, or (613) 954-6493. Flora J. Rathbun, MSc, MD, CCFP Executive secretary Expert Advisory Committee on Nonprescription Cough and Cold

Remedies Drug Evaluation Division Bureau of Nonprescription Drugs Health Protection Branch Department of National Health and Welfare Vanier, Ont.

Making hockey safer I wholeheartedly support the Canadian Academy of Sport

Medicine's recommendations in their Position Statement on Violence and Injuries in Ice Hockey, as reported by Patrick Sullivan in his article "Sports MDs seek CMA support in bid to make hockey safer" (Can Med Assoc J 1990; 142: 157-159). As a player, coach and father in a hockey-playing family I believe that these recommendations, and action on them, are long overdue. In particular, I strongly support a rule change with respect to checking from behind. The excellent review of catastrophic sports injuries conducted by Dr. Charles Tator and colleagues clearly identified this mechanism as singularly causative in major spinal cord injuries in ice hockey.' While recently touring the Soviet Union with an old-timer CAN MED ASSOC J 1990; 142 (8)

801

hockey team composed of doctors I came to realize that such injuries do not occur in European and Soviet hockey, in which hitting from behind is not a recognized part of the style of play. Unfortunately, the reality is that the National Hockey League will be slow to exact significant rule changes to prevent such infractions and resultant injuries, and whether we like it or not our children will continue to emulate their onscreen hockey heroes. Murray J. Girotti, MD, FRCSC Director of trauma services Toronto General Division Toronto Hospital Corporation Toronto, Ont.

Reference 1. Tator CH, Edmonds VE, Duncan EG et al: Danger upstream: catastrophic sports and recreational injury in Ontar-

io. Ont Med Rev 1988; 5 5: 7-12

"Carnaption" versus "conniption" D_ r. James McSherry (Can Med Assoc J 1990; 142: I100) has taken Dr. Robert D. Grist (Can Med Assoc J 1989; 141: 1125-1126) to task for his improper pluralization of "locum tenens". In doing so McSherry misuses "carnaption", which should be used only in the sense of a vehicle for moving condensed milk and never in the sense of "conniption" or "fit". Because he works at a university and functions therefore in loco parentis, one would think McSherry would be more careful. His English is pure loco.

colleague Dr. Peter Smith enjoys that honour. My usage is none the less correct and the explanation simple. A carnaption fit is a conniption fit that takes place in Maryhill, the northwestern district of Glasgow. My time there as a family doctor made such an impression on me that even now I frequently lapse into the native vernacular; hence my rendering of conniption in the urban patois so familiar to and so beloved of native Glaswegians. Let me assure Ruddock that there has been a severe shortage of locos in Kingston since Jan. 1. We must now travel via means other than rail, a fact that will no doubt cause trouble for those chantywrastlers in Ottawa come the next election. James McSherry, MB, ChB Director Student Health Service

Queen's University Kingston, Ont.

Bedside testing of the blood glucose level in neonates: What to use?

L r ike many hospitals in Canada we use a reflectance meter for bedside testing of the blood glucose level. There are many brands; ours happens to be the Accuchek II (Boehringer Mannheim, Laval, PQ). One of the areas in which such testing is most essential in our hospital is the neonatal unit. Critical results are, of course, confirmed by laboratory testing, but Nicholas Ruddock, MD sending all specimens to the la306-85 Norfolk St. boratory would be impractical beGuelph, Ont. cause of their number, the slow turnaround and the amount of [Dr. McSherry replies.] blood required by the laboratory, Dr. Ruddock is not the first to which is too great for a routine take me to task for my use of procedure in neonates. "carnaption fit"; my friend and Recently Lin and colleagues' 802

CAN MED ASSOC J 1990; 142 (8)

indicated that such testing is not valid in neonates. Their solution to the problem is the YSI analyser (Yellow Springs Instruments, Yellow Springs, Ohio). This company is poorly represented in Atlantic Canada. We have found only one other device, the Vision machine (Abbott Laboratories Ltd., Mississauga, Ont.), that is sufficiently simple for people other than laboratory personnel to use. The company assured us that it was being used in other neonatal units in Canada and that it works on whole blood and icteric blood (both are mandatory for this setting). A unit was brought in for evaluation, but soon we saw that the combination of whole blood and icterus was defeating it: more than 50% of the specimens yielded an "icteric specimen" error message and no glucose reading. The bilirubin levels in the babies were 100 to 200 ,umol/L, well within the manufacturer's stated limit of 340. The company then recommended that all specimens be centrifuged first, which would preclude the device's use in the neonatal unit. The machine was removed. We are left with a conundrum: we have only the reflectance meter to rely on, and the literature condemns it for use in neonates; yet sending specimens to the laboratory on every occasion is impractical. What's a harried laboratorian to do? Surely we're not alone. We appeal to other Canadian hospitals for their solutions. Henry M. Taylor, MD Chief, clinical pathology Arvind Mujoomdar, BSc Clinical specialist, chemistry Moncton Hospital Moncton, NB

Reference 1. Lin HC, Maguire C, Oh W et al: Accuracy and reliability of glucose reflectance meters in the high-risk neonate. J Pediatr 1989; 1 15: 998-1000