Use of automated reminder letters to improve diabetes management in primary care: outcomes of a quality improvement initiative.

Background: Effective management of patients with diabetes mellitus (DM) can be time-consuming and costly. One patient-centred quality improvement strategy is to generate reminder letters to prompt patient action(s), but this strategy's effect on DM outcomes is uncertain.

Aim: To determine whether using the electronic medical record to automatically generate reminder letters for patients not meeting recommended DM targets is associated with improvement in practice level quality metrics for DM management.

Extrapericardial cardiac compression syndrome.

A case report is described of a patient presenting with extrapericardial cardiac compression resulting from massive ascites. The history and electrocardiographic findings initially obscured the proper diagnosis. Extrapericardial cardiac compression syndromes resulting from massive ascites pose a particular challenge in that even when the diagnosis of tamponade is made, failure to recognize the true cause of impaired cardiac filling can lead to unnecessary instrumentation of an otherwise incidental pericardial effusion.