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In this article the authors reflect upon the need of health care reform in the U.S. They refer various statistics that reveal a better health care management in Canada as compared to the U.S. and criticize the announcement of the administration of the U.S. president Barack Obama to spend one trillion dollars to cover its uninsured population. They state that unlike U.S., citizens of Canada remain insured under a public system even while switching jobs.

The author reflects on the issue of breach of privacy of personal health information of Gulf War veteran Captain Sean Bruyea. The author contends that the complete disregard by federal institutions of privacy rights involving sensitive personal health information is disturbing, wherein he argues that U.S. Veterans Affairs must treat veterans like beneficiaries not like private insurance claimants. He believes that these veterans and their families deserve an apology to stop this kind of abuse.

The article presents a reprint of the article "Fixing the fatal flaw in emergency planning," by Roz D. Lasker, which appeared at www.cmaj.ca. The author reflects on the emergency response plans in the U.S. He notes that it is a fundamental flaw to develop plans without integrating the knowledge of people who must be protected. Accordingly, the author suggests the use of "Redefining Readiness" process, which offers a guidance to involve community residents in preparedness planning.

The article offers the author's comments on the off-label use of a drug called erythropoietin in the treatment of critically ill patients in the U.S. He states that the treatment may potentially result in thrombotic complications. He asserts that the treatment can be effective when physicians with understanding of the appropriate evidence, and clinical experience determine its usage. He further refers to the role of erythropoietin manufacturers in promoting widespread off-label usage.

Objective: Create practice guidelines for the appropriate use of red blood cell transfusions in hepatectomy., Background: Hepatectomy is associated with a high prevalence of transfusions. A transfusion can be life-saving, but can be associated with important adverse effects. Given the prevalence, the potential for benefit and harm, and the difficulty in conducting clinical trials, transfusion in hepatectomy is well-suited for a study of appropriateness., Methods: Using the RAND/UCLA appropriateness method, an international, multidisciplinary expert panel in hepatobiliary surgery, anesthesia, transfusion medicine, and critical care rated a series of 468 perioperative scenarios for transfusion appropriateness. Scenarios were rated individually, and again during an inperson group moderated session. Median scores and level of agreement were calculated to classify each scenario as appropriate, inappropriate, or uncertain., Results: Approximately, 47.4% of scenarios were rated as appropriate for transfusion, 28.2% were inappropriate, and 24.4% were uncertain. The key recommendations for intraoperative transfusion were (i) it is never inappropriate to transfuse for significant bleeding or ST segment changes; (ii) it is never inappropriate to transfuse for an intraoperative hemoglobin ≤75 g/L; and (iii) in the absence of significant bleeding or ST changes, transfusion for hemoglobin of ≥95 g/L is inappropriate, and transfusion for hemoglobin of ≥85 g/L requires strong justification. The key recommendations for postoperative transfusions were: (i) in a stable, asymptomatic patient, an appropriate transfusion trigger is 70 g/L (without coronary artery disease) or 80 g/L (with coronary artery disease) and (ii) it is appropriate to transfuse any patient for a hemoglobin of ≤75 g/L either immediately post-operative, or with a significant decrease from the previous day (>15 g/L)., Conclusions: Based on best available evidence and expert opinion, criteria for appropriate perioperative red blood cell transfusions in hepatectomy were determined.