Guaranteeing accountability for quality care.

The quality gap in the management of chronic disease is an issue which must be addressed if we are to achieve sustainability of our health system and optimal health outcomes for Canadians. The delivery of quality care needs to be a fundamental expectation of providers, professional regulators, institutional leaders and senior government leaders. Success in the arena of quality improvement comes from clarity of accountability, "obsessive" tracking and action on key performance indicators, and results-based teamwork.

Hereditary angioedema managed with low-dose danazol and C1 esterase inhibitor concentrate: a case report.

Background: Hereditary angioedema (HAE) is a rare life-threatening disease that can occur in pregnancy.

Case: A nulliparous woman was diagnosed as having HAE at 22 weeks of gestation after a series of symptomatic episodes. Following an initial course of C1 esterase inhibitor (C1EI) therapy for an acute episode of HAE, she was treated with danazol for prophylaxis.

Treatment of antiphospholipid antibody syndrome (APS) in pregnancy: a randomized pilot trial comparing low molecular weight heparin to unfractionated heparin.

Objective: To compare low molecular weight heparin (LMWH), specifically dalteparin, to unfractionated heparin (UFH) for the treatment of antiphospholipid antibody syndrome (APS) in pregnancy.

Methods: In a tertiary referral centre, 28 women met the 1999 International Consensus Criteria for APS, based on their obstetrical history and APS serology. The women were randomized, using a random numbers table with blocks of 12, to receive either prophylactic dosing of dalteparin or UFH starting either preconceptionally or early in pregnancy.

Acquired thrombophilia in pregnancy.

Thromboembolic disease remains the most frequent cause of perinatal mortality in the Western world. Much has been written about the management of patients with underlying inherited thrombophilic disorders during pregnancy. However, a number of factors, such as age over 35 years, multiparity, and cesarean section are strong predictors of an increased risk of venous thrombosis and pulmonary embolus.