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Copyright of Canadian Water Resources Journal / Revue Canadienne des Ressources Hydriques is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A snow model forced by temperature and precipitation is used to simulate the spatial distribution of snow water equivalent (SWE) over a 600 000 km2 portion of the province of Quebec, Canada. We propose to improve model simulations by assimilating SWE data from sporadic manual snow surveys with a particle filter. A temporally and spatially correlated perturbation of the meteorological forcing is used to generate the set of particles. The magnitude of the perturbations is fixed objectively. First, the particle filter and direct insertion were both applied on 88 sites for which measured SWE consisted of more or less five values per year over a period of 17 years. The temporal correlation of perturbations enables us to improve the accuracy and the ensemble dispersion of the particle filter, while the spatial correlation leads to a spatial coherence in the particle weights. The spatial estimates of SWE obtained with the particle filter are compared with those obtained through optimal interpolation of the snow survey data, which is the current operational practice in Quebec. Cross-validation results as well as validation against an independent dataset show that the proposed particle filter enables us to improve the spatial distribution of the snow water equivalent compared with optimal interpolation. [ABSTRACT FROM AUTHOR]

Summary: An increasing number of publications show that ensemble hydrological forecasts exhibit good performance when compared to observed streamflow. Many studies also conclude that ensemble forecasts lead to a better performance than deterministic ones. This investigation takes one step further by not only comparing ensemble and deterministic forecasts to observed values, but by employing the forecasts in a stochastic decision-making assistance tool for hydroelectricity production, during a flood event on the Gatineau River in Canada. This allows the comparison between different types of forecasts according to their value in terms of energy, spillage and storage in a reservoir. The motivation for this is to adopt the point of view of an end-user, here a hydroelectricity production society. We show that ensemble forecasts exhibit excellent performances when compared to observations and are also satisfying when involved in operation management for electricity production. Further improvement in terms of productivity can be reached through the use of a simple post-processing method. [ABSTRACT FROM AUTHOR]

Hydrological forecasting consists in the assessment of future streamflow. Current deterministic forecasts do not give any information concerning the uncertainty, which might be limiting in a decision-making process. Ensemble forecasts are expected to fill this gap. In July 2007, the Meteorological Service of Canada has improved its ensemble prediction system, which has been operational since 1998. It uses the GEM model to generate a 20-member ensemble on a 100 km grid, at mid-latitudes. This improved system is used for the first time for hydrological ensemble predictions. Five watersheds in Quebec (Canada) are studied: Chaudière, Châteauguay, Du Nord, Kénogami and Du Lièvre. An interesting 17-day rainfall event has been selected in October 2007. Forecasts are produced in a 3 h time step for a 3-day forecast horizon. The deterministic forecast is also available and it is compared with the ensemble ones. In order to correct the bias of the ensemble, an updating procedure has been applied to the output data. Results showed that ensemble forecasts are more skilful than the deterministic ones, as measured by the Continuous Ranked Probability Score (CRPS), especially for 72 h forecasts. However, the hydrological ensemble forecasts are under dispersed: a situation that improves with the increasing length of the prediction horizons. We conjecture that this is due in part to the fact that uncertainty in the initial conditions of the hydrological model is not taken into account. [ABSTRACT FROM AUTHOR]

Alfalfa has a lower fiber digestibility and a greater concentration of degradable protein than grasses. Dairy cows could benefit from an increased digestibility of alfalfa fibers, or from a better match between nitrogen and energy supplies in the rumen. Alfalfa cultivars with improved fiber digestibility represent an opportunity to increase milk production, but no independent studies have tested these cultivars under the agroclimatic conditions of Canada. Moreover, decreasing metabolizable protein (MP) supply could increase N use efficiency while decreasing environmental impact, but it is often associated with a decrease in milk protein yield, possibly caused by a reduced supply of essential AA. This study evaluated the performance of dairy cows fed diets based on a regular or a reduced-lignin alfalfa cultivar and measured the effect of energy levels at low MP supply when digestible His (dHis), Lys (dLys), and Met (dMet) requirements were met. Eight Holstein cows were used in a double 4 × 4 Latin square design, each square representing an alfalfa cultivar. Within each square, 4 diets were tested: the control diet was formulated for an adequate supply of MP and energy (AMP_AE), whereas the 3 other diets were formulated to be deficient in MP (DMP; formulated to meet 90% of the MP requirement) with deficient (94% of requirement: DMP_DE), adequate (99% of requirement: DMP_AE), or excess energy supply (104% of requirement; DMP_EE). Alfalfa cultivars had no significant effect on all measured parameters. As compared with cows receiving AMP_AE, the dry matter intake of cows fed DMP_AE and DMP_EE was not significantly different but decreased for cows fed DMP_DE. The AMP_AE diet provided 103% of MP and 108% of NE L requirements whereas DMP_DE, DMP_AE, and DMP_EE diets provided 84, 87, and 87% of MP and 94, 101, and 107% of NE L requirements, respectively. In contrast to design, feeding DMP_EE resulted in a similar energy supply compared with AMP_AE, although MP supply has been effectively reduced. This resulted in a maintained milk and milk component yields and improved the efficiency of utilization of N, MP, and essential AA. The DMP diets decreased total N excretion, whereas DMP_AE and DMP_EE diets also decreased milk urea-N concentration. Reducing MP supply without negative effects on dairy cow performance is possible when energy, dHis, dLys, and dMet requirements are met. This could reduce N excretion and decrease the environmental impact of milk production. [ABSTRACT FROM AUTHOR]

Background: ReLiAM, Real-Life Assessment of Abilify Maintena, was the first reported long-term prospective non-interventional study for patients with schizophrenia treated with aripiprazole once-monthly injectable formulation (AOM) under real-life conditions. ReLiAM's primary aim was to evaluate the evolution of global functional status in patients treated with AOM for 12 months in Canada., Methods: The objective of this post hoc analysis of the ReLiAM study is to investigate the treatment effects of real-life use of AOM over a 1-year period in the subgroup of patients with reported substance use compared with patients without substance use., Results: The results of this post hoc analysis demonstrate that treatment with AOM for 12 months in patients with schizophrenia was comparably effective in improving global functioning in subgroups of patients with and without concomitant substance use., Conclusions: These results support the use of AOM for the treatment of schizophrenia in patients with or without concomitant substance use., Trial Registration: ClinicalTrials.gov NCT02131415, first posted on May 6, 2014. Overall trial status: Terminated., (© 2022. The Author(s).)

Objective: To evaluate the association of antiretroviral therapy (ART) type and duration of exposure with early placental function using biomarkers of aneuploidy screening. Study design: Three hundred thirty-eight pregnant women living with HIV were enrolled in two Canadian centers. Multiple linear regressions were performed adjusting for confounding factors (race, age, gestational age, body mass index, parity, smoking, and fetal sex). Results: Women receiving ART had significantly increased second trimester alpha-fetoprotein (AFP) levels ( β  = 0.147, 95% CI = [0.067-0.227] for protease inhibitor-based ART and β  = 0.176, 95% CI = [0.080-0.272] for ART without protease inhibitor) compared to women who received no treatment. However, there was no significant association between ART type and the levels of free β-human chorionic gonadotrophin (β-hCG), pregnancy-associated plasma protein-A (first trimester), unconjugated estriol, total hCG, and inhibin A (second trimester). No significant association was shown between biomarker levels and duration of ART exposure. Conclusion: Early placental function does not appear to be significantly affected by ART, except for AFP.

Objective: Little is known about pregnancy outcomes among women who have acquired human immunodeficiency virus (HIV) through perinatal infection and survived into adulthood. The objectives of this study were to describe pregnancy outcomes among women with perinatal HIV infection (PHIV) in Canada and to identify potential challenges in the prevention of perinatal HIV transmission in this population., Methods: A retrospective review of all pregnancies among women with PHIV who were previously followed as children at two tertiary care centres in Montréal, Québec, was conducted. Data were extracted from pediatric and obstetrical records., Results: There were 21 pregnancies among 11 women, and 18 of these pregnancies were unintentional. Mean age at first pregnancy was 19.5 years (range 15-29 years). At the first prenatal visit, 79% had a detectable viral load, 36% were immunosuppressed (CD4 T cell count <200 mm 3 ), and only 36% were receiving antiretroviral therapy (ART). At the time of delivery, although all were prescribed ART, 50% of these women still had a detectable viral load, and 36% remained immunosuppressed. All of the women harboured mutations conferring drug resistance to zidovudine and lamivudine, and the majority (73%) were also resistant to nevirapine. None of the infants were HIV infected, although all received prophylaxis with agents to which their mother's virus was resistant., Conclusion: Unplanned pregnancies, difficulties with adherence to ART, and drug resistance were identified challenges in the management of pregnancies among women with PHIV. This study highlights a gap in the reproductive counselling of adolescents with PHIV and the need for close follow-up and adherence support during pregnancy in this population., (Copyright © 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this report is to develop a consensus for Canadian national guidelines specific to a tele-medicine approach to screening for diabetic retinopathy (DR) using evidence-based and clinical data., Methods: Canadian Tele-Screening Grading Scales for DR and diabetic macular edema (DME) were created primarily based on severity grading scales outlined by the International Clinical Diabetic Retinopathy Disease Severity Scale (ICDR) and the Scottish DR Grading Scheme 2007. Other grading scales used in international screening programs and the clinical expertise of the Canadian Retina Research Network members and retina specialists nationwide were also used in the creation of the guidelines., Results: National Tele-Screening Guidelines for DR and DME with and without optical coherence tomography (OCT) images are proposed. These outline a diagnosis and management algorithm for patients presenting with different stages of DR and/or DME. General guidelines detailing the requirements for imaged retina fields, image quality, quality control, and follow-up care and the role of visual acuity, pupil dilation, OCT, ultra-wide-field imaging, and artificial intelligence are discussed., Conclusions: Tele-retina screening can help to address the need for timely and effective screening for DR, whose prevalence continues to rise. A standardized and evidence-based national approach to DR tele-screening has been proposed, based on DR/DME grading using two 45° image fields or a single widefield or ultra-wide-field image, preferable use of OCT imaging, and a focus on local quality control measures., (Copyright © 2020 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: hepatitis C virus (HCV) is an increasingly important public health problem worldwide. Health care workers providing care to women of childbearing age are uniquely placed in their practices to identify a significant proportion of at-risk patients and to provide appropriate screening and counselling. The primary objective of this guideline is to provide accurate, current information to those offering reproductive care to women living with HCV. This document is also intended to raise awareness of HCV in both the medical and general populations., Options: the areas of clinical practice considered in formulating this guideline are disease prevention, targeted screening of individuals at risk of contracting HCV, management of identified patients in the context of reproductive care, and the appropriate referral of patients to those with particular expertise., Outcomes: implementation of these guidelines should facilitate identification of infected individuals. It should also result in improved physical and mental well-being for patients and their families and reduction in transmission rates., Evidence: the literature between 1966 and 2000, including non- English language publications, was extensively searched utilizing Medline. A multidisciplinary group consisting of experts within the fields of obstetrics and gynaecology, infectious diseases, hepatology, and public health convened in Montreal in February 2000. The working group also included a patient and a representative from the Hepatitis C Society of Canada. The level of evidence for the recommendations has been determined using the criteria described by the Canadian Task Force on Periodic Health Examination., Benefits, Harms and Costs: the public health benefits of increased identification of at-risk individuals, diagnosis, treatment, implementation of risk reduction behaviours, and reduced transmission rates, both on an individual and at the community level, are significant. However, it must be remembered that the diagnosis of a chronic disease may have far reaching effects for the individual patient and her family., Recommendations: VALIDATION: references were collected through Medline searches and comparison made to existing current guidelines for assessment of consistency. External reviewers expert in their field were also consulted., (Copyright © 2017. Published by Elsevier Inc.)

We carried out a secondary analysis of a double-blind, placebo-controlled trial of desvenlafaxine for major depressive disorder (MDD) to explore the associations between depressive symptoms and subtypes, and functional outcomes, including work functioning. Employed outpatients with MDD were assigned randomly in a 2 : 1 ratio to receive desvenlafaxine 50 mg/day or placebo for 12 weeks. Analyses were carried out post-hoc with the intent-to-treat (ITT) sample (N=427) and a prospectively defined modified ITT sample (N=310), composed of patients with baseline 17-item Hamilton Rating Scale for Depression score of at least 20. Functional outcomes at week 12 included items and factors from the Montgomery-Åsberg Depression Rating Scale, Sheehan Disability Scale, and the Work Productivity and Activity Impairment questionnaire. In the modified ITT sample, but not in the ITT sample, desvenlafaxine-treated patients showed significantly greater improvement in several functional outcomes in the responder, nonanxious, and normal-energy patient subgroups. Improvement in the 17-item Hamilton Rating Scale for Depression total score at week 2 predicted change at week 12 in several functional outcomes. Functional improvement at 12 weeks was greater in subgroups of patients and was also significantly predicted by early improvement in depressive symptoms in employed patients with MDD treated with desvenlafaxine.

This article describes recent work in implementing a framework of abilities-based learning outcomes and related practices for assessing student learning in a Canadian Baccalaureate nursing degree program. The authors describe steps in implementing an abilities-based paradigm for nursing education, and subsequently developing an assessment framework based on abilities-based learning outcomes. The discussion reviews theoretical and policy-level influences involved in this initiative. The curriculum work is also discussed in terms of current trends in higher education emphasizing the assessment of student learning. The discussion concludes by linking these efforts to recent calls for a paradigm shift in the preparation of professionals, noting how the assessment of student learning can contribute to democratic professional formation in nursing.

Near full-length genomes of 4 unclassified HIV-1 variants infecting patients enrolled in an antenatal cohort in Canada were obtained by sequencing. All 4 variants showed original recombination profiles, including A1/A2/J, A1/D, and A1/G/J/CRF11&#95;cpx structures. Identification of these variants highlights the growing prevalence of unique recombinant forms of HIV-1 in North America.

Background: Listeriosis is one of the most severe foodborne illnesses worldwide. Most infections with Listeria are sporadic, but outbreaks do occur. Pregnant women exposed to this organism are at increased risk of chorioamnionitis, preterm labour, prematurity and intrauterine fetal demise. Severe neonatal infection can also occur., Cases: Two recent outbreaks in Canada prompted a reassessment of the prevalence and the perinatal impact of this disease. We describe here three cases of perinatal listeriosis. The aim of our report is to demonstrate the variable clinical presentations and to emphasize the difficulty in diagnosing perinatal listeriosis., Conclusion: Perinatal listeriosis is a severe disease with many possible clinical presentations. Clinical diagnosis may be difficult, so clinicians must maintain a high index of suspicion.

Background: There are many technologies designed to improve medication safety. Although limited evidence supports their use, there are pressures to implement them., Objective: To determine the uptake of technologies designed to improve medication safety, plans for adopting technologies, attitudes towards technology use, and perceptions of medication error. Methods We performed a cross-sectional survey of pharmacy directors at Canada's 100 largest acute-care hospitals., Results: Seventy-eight per cent of surveyed hospitals responded. Responding hospitals averaged 499 beds and 29% were teaching facilities. Hospital frequently used clinical pharmacy services (97% of hospitals), pharmacy-based intravenous admixture services (81%), computerized decision support modules for pharmacy order entry systems (77%), unit-dose drug distribution systems (75%) and computerized medication administration records (67%). Hospitals infrequently used bar-coding (9% of hospitals) and computerized physician order entry (9%). A majority of respondents and hospitals favoured expanded use of new technologies and planned for increased uptake. Respondents chose as their hospital's next investment: automated dispensing (33%), bar-coding (25%) and computerized physician order entry (12%)., Conclusion: Canadian hospitals appear poised to make sizeable investments in poorly evaluated technologies that address medication safety.

Objectives: This assessment sought to evaluate the comparative benefit and adverse effect profile of ximelagatran, as well as the clinical issues surrounding its potential use., Methods: We performed a Dialog OneSearch across BIOSIS Previews, EMBASE, MEDLINE, PASCAL, and ToxFile to identify published literature. PubMed and The Cochrane Library were also searched. Gray literature was identified by searching a variety of Web sites of health technology assessment and related agencies and their associated databases. The manufacturer's Canadian office, AstraZeneca, was invited to submit information., Results: Ximelagatran is the first oral agent from a new class of anticoagulants called direct thrombin inhibitors. Other oral anticoagulants require routine blood monitoring; ximelagatran does not. Ximelagatran has been evaluated in the areas of venous thromboembolism management, particularly after orthopedic surgery, and stroke prevention in patients with atrial fibrillation. Overall, ximelagatran's efficacy appears comparable to other anticoagulants in these clinical settings. Also, bleeding rates were generally similar between ximelagatran and comparators but, as for warfarin, bleeding risk increases with higher ximelagatran doses. In addition, there is no specific antidote to help manage ximelagatran-induced bleeding. Finally, significantly more patients exposed to long-term ximelagatran developed elevated liver enzymes more than three times the upper normal limit, compared with patients on comparator anticoagulants., Conclusions: Given its apparent simplicity of use, ximelagatran carries the potential to replace, at least in part, anticoagulants currently used in the management of venous thromboembolism or for preventing stroke in atrial fibrillation patients. However, the safety of ximelagatran will not be fully known without further evaluation and surveillance for potential liver toxicity. There is also a need to evaluate its use in special populations such as patients with renal failure and patients using several concurrent medications.

We studied HIV genetic diversity in a cohort of 127 pregnant, HIV-infected women who received prenatal care at Sainte-Justine Hospital in Montreal, Canada, between 1999 and 2003. Clade assignments were derived by phylogenetic analysis of amplified pol sequences. Genotyping was successful in 103 of 127 women, 59 (57.3%) of whom were infected with clade B HIV-1, and 44 (42.7%) with nonclade B viruses, including subtypes A, C, D, F, G, and H. Four sequences remained unassigned. Forty-three of 44 women infected with non-clade B viruses were newcomers from sub-Saharan Africa, and subtype identity was consistent with those circulating in their countries of origin. These results highlight the epidemiologic importance of non-B HIV-1 in antenatal populations in a large North American urban center, underscore the influence of population movements on clade intermixing, and identify a group of patients who could be targeted for surveillance and drug therapy followup.

Ximelagatran (Exanta (TM)) is the first oral agent in a new class of anticoagulants called direct thrombin inhibitors. Most of the available evidence regarding venous thromboembolism is from studies focusing on its prevention after major orthopedic surgery. Ximelagatran's efficacy is comparable to that of warfarin and low-molecular-weight heparin in this setting. The rates of bleeding complications for ximelagatran and its comparators were not statistically different. The elevation of liver enzymes was observed in longer term trials.

Enfuvirtide is the first in a new class of drugs called fusion inhibitors. It was recently approved in Canada for the treatment of patients with evidence of HIV-1 replication despite ongoing antiretroviral therapy. Current evidence on safety and efficacy is limited to 48-week studies. Two phase III trials found that in treatment-experienced patients failing antiretroviral treatment, the addition of subcutanous enfuvirtide to an optimized oral background antiretroviral regimen significantly reduced viral load and increased CD4 cell counts. Potential high cost and limited supply may reduce access to this treatment.

Purpose: To estimate the misclassification rate of self-reported visual disabilities in a hospital-based population with known visual impairment., Methods: Subjects (N=570) were recruited among patients aged 50 years and more and classified to three categories of visual impairment level. The questionnaire was administered to consenting patients through a telephone interview. Data collected from questionnaires and medical records were compared regarding severity of visual impairment. Sensitivity and specificity were determined for each question. Predictive ability and misclassification rates were computed for various prevalences., Results: Questions related to near and far distance visual acuity with glasses have both a good sensitivity (82.6% and 81.8%) and a good specificity (85.6% and 88.9%) for the presence of severe visual impairment., Conclusion: The findings allow the determination of the misclassification rate and predictive ability. This could be useful to estimate the prevalence of visual impairment from health surveys.

Study Objective: To compare the cost of contemporary outpatient and historical inpatient management of proximal lower limb deep vein thrombosis (DVT) in adults., Design: Prospective, observational study with historical inpatient cases as controls., Setting: Ambulatory thrombosis clinic of a tertiary care teaching center in Canada., Patients: Forty-nine inpatients with DVT from a previous study in 1996 at the same institution who would have been eligible for outpatient therapy if this option had been available, and 51 consecutive patients referred to the ambulatory thrombosis clinic for treatment of DVT between March 2000 and January 2001., Intervention: The 49 inpatients received unfractionated heparin, and the 51 outpatients received low-molecular-weight heparin (LMWH)., Measurements and Main Results: A cost-minimization analysis restricted to the hospital perspective was conducted. This design was justified based on the clinical equivalence of the two treatment strategies. All direct hospital costs for treating the 51 consecutive outpatients with LMWH were measured. These data were compared with the cost of treating the inpatients with unfractionated heparin. The analysis horizon was limited to 7 days, based on the duration of hospitalization and length of heparin therapy for DVT before conversion to oral warfarin. The mean cost (in Canadian dollars) per outpatient case was 248 Canadian dollars (95% confidence interval 216-280 Canadian dollars) and was significantly different from the mean cost/inpatient case of 2826 Canadian dollars (adjusted for the difference in fiscal years) (p<0.0005). A breakdown of the outpatient cost showed that nursing time contributed to 51% of the cost, monitoring laboratory tests 5%, drugs 2%, and other costs (diagnostic laboratory tests and medical imaging) 42%., Conclusion: Converting from inpatient to outpatient treatment of proximal DVT was associated with a significant cost savings for our institution. Accordingly, it is financially advantageous for hospitals to offer this service as it reduces direct costs and does not appear to compromise patient care.

Objectives: The primary objective was to evaluate the level of compliance of military prescribers (physician assistants, general practitioners and specialists) with treatment guidelines for commonly encountered community-based infections. The secondary objective was to identify infections encountered in the Canadian Forces ambulatory care services and to determine which ones were most frequently associated with noncompliance or partial compliance for the purpose of developing a training program for prescribers., Methods: Retrospective chart review was performed using prescriptions written within a predetermined time frame. Appropriateness of prescribing was evaluated by comparing the drug prescribed for the indication with two sets of guidelines., Results: A total of 704 charts were reviewed, of which 458 charts met inclusion criteria. From these, 477 prescriptions for anti-infectives were analyzed. Seventy-three per cent of the prescriptions analyzed were for the treatment of infections related to the respiratory system. Compliance rates were similar between physician assistants and general practitioners (ie, 86.2% and 85.3%, respectively). There were not enough data to assess accurately the compliance rate of specialists. The indications most commonly associated with noncompliance and/or partial compliance were bronchitis, community-acquired pneumonia, cellulitis, otitis media, pharyngitis, sinusitis and urinary tract infections., Conclusion: The majority of prescriptions met the criteria for compliance and the compliance rates among physician-assistants and general practitioners were similar. However, certain indications were associated with a significant level of partial or noncompliance. A training program should be developed to improve adherence to prescribing guidelines.

The authors describe in detail the modalities for the selection of students applying to the ophthalmology programs in the various Canadian universities; the university of Montréal will serve as a model. The characteristics of their 5-year training assured by numerous teachers and short training rotations as well as by a compulsory research project are explained. They highlight the meticulous organization and the compulsory constraints for students, teachers and universities. In absence of evaluation criteria on the efficiency of interventionist training compared to less detailed apprenticeship-program training such as that dispensed in France, they note the differences between the two systems, a necessary precursor to the standardization of training programs which would allow more complete recognition of degrees in the context of a globalization of professional activities.

Angiotensin II receptor blockers (ARBs) directly inhibit the angiotensin II type 1 receptors, which suppresses the renin-angiotensin-aldosterone system (RAAS). Six ARBs are approved in Canada for the treatment of hypertension, none are yet approved for the treatment of heart failure (HF). Evidence comparing ARBs to angiotensin converting enzyme inhibitors (ACEIs) in HF is still limited. A recent meta-analysis of 17 clinical trials could not confirm that ARBs are superior to ACEIs in reducing either mortality or hospitalization in HF patients. ARBs may be used as an alternative in HF patients intolerant of ACEIs. A meta-analysis indicates that, compared to using an ACEI alone, adding an ARB to an ACEI carries the potential for additional benefits in terms of reduced hospitalization, but not mortality. However, the FDA determined there is currently insufficient evidence of such additional benefit when valsartan is combined to an ACEI in patients with HF.

(1) Atopic dermatitis (AD) is a chronic dermatological condition characterized by pruritus (itchiness) and rash. Topical corticosteroids are the mainstay of pharmacotherapy. (2) Tacrolimus ointment is a new topical anti-inflammatory agent available in Canada through the Special Access Program. (3) It is approved as a second line agent for short or long term intermittent treatment of moderate to severe AD. (4) Clinical trials suggest it is both effective and safe, but comparative studies with corticosteroids and long-term information are limited.