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PubMedDate not supplied

New drugs of 2002.

OBJECTIVE: To provide information regarding the most important properties of the new therapeutic agents marketed in 2002. DATA SOURCES: Published studies, drug information reference sources, and product labeling. DATA SYNTHESIS: In 2002, 26 new therapeutic agents were marketed. The indications and information on dosage and administration for the new agents are reviewed, as are the most important pharmacokinetic properties, adverse events, drug interactions, and other precautions. Practical considerations for the use of the new agents are also discussed. Where possible, the properties of the new drugs are compared with those of other drugs marketed for the same indications. CONCLUSION: A number of the new therapeutic agents marketed in 2002 have important advantages over older medications. An understanding of the properties of these agents is important for the pharmacist to effectively counsel patients about their use and to serve as a valuable source of information for other health professionals regarding these drugs.

Drug Approval↗
PubMedDate not supplied

New drugs of 2000.

OBJECTIVE: To provide information regarding the most important properties of the new therapeutic agents marketed in 2000. DATA SOURCES: Published studies, drug information reference sources, and product labeling. DATA SYNTHESIS: In 2000, 33 new therapeutic agents were marketed. The indications and information on dosage and administration for the new agents are reviewed, as are the most important pharmacokinetic properties, adverse events, drug interactions, and other precautions. Practical considerations for the use of the new agents are also discussed. Where possible, the properties of the new drugs are compared with those of older drugs marketed for the same indications. CONCLUSION: A number of the new therapeutic agents marketed in 2000 have important advantages over older medications. An understanding of the properties of these agents is important if the pharmacist is to effectively counsel patients about their use and to serve as a valuable source of information for other health care professionals regarding these drugs.

Animals↗
PubMedDate not supplied

New drugs of 2001.

OBJECTIVE: To provide information regarding the most important properties of the new therapeutic agents marketed in 2001. DATA SOURCES: Published studies, drug information reference sources, and product labeling. DATA SYNTHESIS: In 2001, 26 new therapeutic agents were marketed. The indications and information on dosage and administration for the new agents are reviewed, as are the most important pharmacokinetic properties, adverse events, drug interactions, and other precautions. Practical considerations for the use of the new agents are also discussed. Where possible, the properties of the new drugs are compared with those of older drugs marketed for the same indications. CONCLUSION: A number of the new therapeutic agents marketed in 2001 have important advantages over older medications. An understanding of the properties of these agents is important if the pharmacist is to effectively counsel patients about their use and to serve as a valuable source of information for other health professionals regarding these drugs.

Animals↗
PubMed2003

Drotrecogin alfa (activated) (recombinant human activated protein C) for the treatment of severe sepsis.

OBJECTIVE: To review the data supporting drotrecogin alfa (activated) for severe sepsis treatment. DATA SOURCES: Published research and data from the Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial. DATA EXTRACTION AND SYNTHESIS: The coagulation cascade and intense inflammation play a central role in the development of organ failure due to severe sepsis. Drotrecogin alfa (activated) has anti-inflammatory, antithrombotic, profibrinolytic, and other properties that may explain the beneficial results seen in both animal models and humans with severe sepsis. Drotrecogin alfa (activated) produces a robust reduction in the mortality rate of patients with severe sepsis that is evident across nearly every subgroup examined in the phase III clinical trial and has an acceptable safety profile with bleeding during infusion as the only significant risk associated with therapy. The relative risk reductions for mortality seen in Gram-negative, Gram-positive, pneumonia, abdominal sources, shock, and nonshock are similar to the intent-to-treat population, 19.4%. Treatment also increases days alive and free from mechanical ventilation and shock. CONCLUSIONS: Coagulopathy and systemic inflammation are almost universal in patients with severe sepsis. Treatment of this disorder with drotrecogin alfa (activated) directly addresses these derangements and substantially reduces morbidity and mortality rates with potential for bleeding during infusion as the only known risk.

Animals↗
PubMedDate not supplied

New drugs of 1997.

OBJECTIVE: To provide information regarding the most important properties of the new therapeutic agents marketed in 1997. DATA SOURCES: Published studies, drug information reference sources, and product labeling. DATA SYNTHESIS: A record-setting number of 45 new therapeutic agents were marketed in 1997. The indications and information on dosage and administration for each new agent are reviewed, as are the most important pharmacokinetic properties, adverse events, drug interactions, and other precautions. Practical considerations for the use of the new agents are also discussed. Where possible, the properties of the new drugs are compared with those of older drugs marketed for the same indications. CONCLUSION: A number of the new therapeutic agents marketed in 1997 have important advantages over older medications. An understanding of the properties of these agents is important for the pharmacist to effectively counsel patients about their use and to serve as a valuable source of information for other health professionals regarding these drugs.

Alzheimer Disease↗
PubMed1996

Torque: an appraisal of misuse of terminology in chiropractic literature and technique.

OBJECTIVE: To assess the use of the term "torque" in the chiropractic literature and to analyze its usage in chiropractic technique procedures. DATA SOURCES, STUDY SELECTION AND DATA EXTRACTION: Articles were retrieved through literature searches of several indexing services [(MEDLINE, Index to Chiropractic Literature, Chiropractic Research Archives Collection (CRAC) and Chiropractic Literature Analysis and Retrieval System (ChiroLARS)] and hand searches in the technique section of a chiropractic college library. From textbooks, key terms included: Torque, Torsion, Biomechanics, Physics, Chiropractic, Nomenclature and Manipulation. For MEDLINE: Torque, Chiropractic Methods, Manipulation-Spinal Methods, Biomechanics, Nomenclature and Chiropractic Terminology. Texts and papers that discussed the word "torque" were reviewed for their association with the thrust of a spinal adjustment. Inferences of "torque" and its application were included to represent the present-day usage of the term in chiropractic. CONCLUSIONS: We believe that the term torque is misused in chiropractic literature. This misuse has been perpetuated in chiropractic college courses, student clinic examinations and state and national board examinations. We strongly suggest that references to the term torque that are not biomechanically correct must be removed from all such sources.

Chiropractic↗
PubMed2000

Pattern and experience with cancers treated with the Chinese GWGP80 cobalt unit at Mulago Hospital, Kampala.

OBJECTIVES: To review the pattern of cancers treated at Mulago hospital with the new Chinese GWGP80 Cobalt-60 unit and to analyse its breakdowns, downtime and attempts at repairs during its first two years of operation and to assess its reliability and safety. DESIGN: A retrospective cross-sectional study. DATA SOURCE: This involved analysing data from the radiotherapy records book, the patient's case notes and a "fault's Log book" which was opened on the day the machine was commissioned. All causes of non-performance were documented in this book and an assessment of the severity of breakdowns, period of downtime and repairs carried out was done. Faults requiring only a few minutes maintenance work or non-performance due to general power failure were however excluded. All patients who had been treated earlier on the orthovoltage machine and were re-treated on the cobalt unit were also excluded from the analysis. SETTING: Department of Radiotherapy, Mulago Hospital, Kampala, Uganda. RESULTS: One thousand and forty eight new patients were treated during this period. Three hundred and fifty nine were males and 689 were females. Cancer of the cervix was by far the commonest cancer seen (37.2%) followed by head and neck cancers (16.0%), breast cancers (13.8%) and Kaposi's sarcoma (10.5%). There were 47 machine faults. Most of these were relatively minor requiring only a few hours of maintenance work. Two of these faults were however major with downtime of more than a week. These were due to a failure of the "force back system" of the radioactive source necessitating it to be hammered back into the safe position. CONCLUSION: The Chinese GWGP80 Cobalt unit has effectively treated a large number of cancer patients but the failures of the "force back system" of its radioactive source compromise its radiation safety and ideally would require a change in the engineering design to decrease on the associated radiation hazards.

Adolescent↗
PubMed1999

Consumption and production waste: another externality of tobacco use.

OBJECTIVE: To describe the waste produced by and environmental implications of individual cigarette consumption (filter tips, packages, and cartons) and tobacco manufacturing. STUDY SELECTION: All available articles and reports published since 1970 related to cigarette consumption and production waste were reviewed. DATA SOURCES: Global cigarette consumption data were used to estimate cigarette butt and packaging waste quantities. Data from the Center for Marine Conservation's International Coastal Cleanup Project were used to describe some environmental impacts of tobacco-related trash. Data from the United States Environmental Protection Agency's (EPA's) Toxics Release Inventory and reported global cigarette consumption totals were used to estimate waste production from cigarette manufacturing. DATA EXTRACTION AND SYNTHESIS: In 1995, an estimated 5.535 trillion cigarettes (27,675 million cartons and 276,753 million packages) were sold by the tobacco industry globally. Some of the wastes from these products were properly deposited, but a large amount of tobacco consumption waste ends up in the environment. Some is recovered during environmental clean-up days. For the past eight years (1990-1997), cigarette butts have been the leading item found during the International Coastal Cleanup Project; they accounted for 19.1% of all items collected in 1997. The tobacco manufacturing process produces liquid, solid, and airborne waste. Among those wastes, some materials, including nicotine, are designated by the EPA as Toxics Release Inventory (TRI) chemicals. These are possible environmental health hazards. In 1995, the global tobacco industry produced an estimated 2262 million kilograms of manufacturing waste and 209 million kilograms of chemical waste. In addition, total nicotine waste produced in the manufacture of reduced nicotine cigarettes was estimated at 300 million kilograms. CONCLUSIONS: Laws against littering relative to cigarette butts could be better enforced. Additional taxes might be levied on cigarette products that would then be directed to environmental clean-up efforts. The tobacco industry should improve the biodegradability of filters, reduce packaging waste, and educate its customers. Worksites and public buildings should be encouraged or required to supply appropriate disposal mechanisms at all building entrances. Public awareness campaigns about the magnitude and prevention of cigarette consumption waste could be developed through partnerships among environmental groups, health organisations, and environmental protection agencies. Tobacco production waste should be a source of concern and regulation by governments throughout the world; it contains numerous chemicals which may be considered health hazards, not the least of which is nicotine produced in the manufacture of low-nicotine cigarettes.

Environmental Monitoring↗
PubMed1999

Burden of migraine in the United States: disability and economic costs.

BACKGROUND: Migraine is a common disabling disease but its economic burden has not been adequately quantified. OBJECTIVE: To estimate the burden of migraine in the United States with respect to disability and economic costs. METHODS: The following data sources were used: published data, the Baltimore County Migraine Study, MEDSTAT's MarketScan medical claims data set, and statistics from the Census Bureau and the Bureau of Labor Statistics. Disability was expressed as bedridden days. Charges for migraine-related treatment were used as direct cost inputs. The human capital approach was used in the estimation of indirect costs. RESULTS: Migraineurs required 3.8 bed rest days for men and 5.6 days for women each year, resulting in a total of 112 million bedridden days. Migraine costs American employers about $13 billion a year because of missed workdays and impaired work function; close to $8 billion was directly due to missed workdays. Patients of both sexes aged 30 to 49 years incurred higher indirect costs compared with younger or older employed patients. Annual direct medical costs for migraine care were about $1 billion and about $100 was spent per diagnosed patient. Physician office visits accounted for about 60% of all costs; in contrast, emergency department visits contributed less than 1% of the direct costs. CONCLUSIONS: The economic burden of migraine predominantly falls on patients and their employers in the form of bedridden days and lost productivity. Various screening and treatment regimens should be evaluated to identify opportunities to reduce the disease burden.

Absenteeism↗
PubMed1993

Anxiety-related reactions associated with magnetic resonance imaging examinations.

OBJECTIVE: To review the epidemiology of anxiety-related reactions during magnetic resonance imaging (MRI) examinations, the feasibility of identifying patients at risk, and the management strategies that have been applied. DATA SOURCES: Published original articles were retrieved using computerized MEDLINE searches encompassing 1980 through April 1993. Further references were obtained from the primary sources. STUDY SELECTION AND DATA EXTRACTION: All studies obtained through the data search were chosen for review. All data relevant to anxiety-related reactions were analyzed. DATA SYNTHESIS: Anxiety-related reactions occur in approximately 4% to 30% of patients undergoing MRI, ranging from apprehension to severe reactions that interfere with the performance of the test. Criteria for diagnosis or categorization of the reactions and identification of patients at risk are scanty. Several management strategies have been proposed, including patient education, drug therapy, and cognitive-behavioral intervention. CONCLUSIONS: While a more precise characterization of the nature and incidence of anxiety-related reactions during MRI examinations and better methods of recognizing patients at risk are desirable, a strategy for general and individual prophylaxis, identification of patients at risk, and individual patient management can be developed on the basis of current knowledge.

Anxiety↗
PubMed2004

Mixed dementia: emerging concepts and therapeutic implications.

CONTEXT: The prevalence of mixed dementia, defined as the coexistence of Alzheimer disease (AD) and vascular dementia (VaD), is likely to increase as the population ages. OBJECTIVES: To provide an overview of the diagnosis, pathophysiology, and interaction of AD and VaD in mixed dementia, and to provide a systematic literature review of the current evidence for the pharmacologic therapy of mixed dementia. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: The Cochrane Database of Systematic Reviews was searched using the keyword dementia. MEDLINE was searched for English-language articles published within the last 10 years using the keywords mixed dementia, the combination of keywords Alzheimer disease, cerebrovascular disorders, and drug therapy, and the combination of keywords vascular dementia and drug therapy. EVIDENCE SYNTHESIS: Dementia is more likely to be present when vascular and AD lesions coexist, a situation that is especially common with increasing age. The measured benefits in clinical trials for the treatment of mixed dementia are best described as statistically significant differences in cognitive test scores and clinician and caregiver impressions of change. In these studies, the control groups' scores typically decline while the treatment groups improve slightly or decline to a lesser degree over the study period. Nevertheless, even the patients who experience treatment benefits eventually decline. Cholinesterase inhibitor (ChI) therapy for mixed dementia shows modest clinical benefits that are similar to those found for ChI treatment of AD. The N-methyl-D-aspartate (NMDA) antagonist memantine also shows modest clinical benefits for the treatment of moderate to severe AD and mild to moderate VaD, but it has not been studied specifically in mixed dementia. The treatment of cardiovascular risk factors, especially hypertension, may be a more effective way to protect brain function as primary, secondary, and tertiary prevention for mixed dementia. CONCLUSIONS: Currently available medications provide only modest clinical benefits once a patient has developed mixed dementia. Cardiovascular risk factor control, especially for hypertension and hyperlipidemia, as well as other interventions to prevent recurrent stroke, likely represent important strategies for preventing or slowing the progression of mixed dementia. Additional research is needed to define better what individuals and families hope to achieve from dementia treatment and to determine the most appropriate use of medication to achieve these goals.

Alzheimer Disease↗
PubMed2004

Benefits of adding a drug to a single-agent or a 2-agent chemotherapy regimen in advanced non-small-cell lung cancer: a meta-analysis.

CONTEXT: Randomized trials have demonstrated that adding a drug to a single-agent or to a 2-agent regimen increased the tumor response rate in patients with advanced non-small-cell lung cancer (NSCLC), although its impact on survival remains controversial. OBJECTIVE: To evaluate the clinical benefit of adding a drug to a single-agent or 2-agent chemotherapy regimen in terms of tumor response rate, survival, and toxicity in patients with advanced NSCLC. DATA SOURCES AND STUDY SELECTION: Data from all randomized controlled trials performed between 1980 and 2001 (published between January 1980 and October 2003) comparing a doublet regimen with a single-agent regimen or comparing a triplet regimen with a doublet regimen in patients with advanced NSCLC. There were no language restrictions. Searches of MEDLINE and EMBASE were performed using the search terms non-small-cell lung carcinoma/drug therapy, adenocarcinoma, large-cell carcinoma, squamous-cell carcinoma, lung, neoplasms, clinical trial phase III, and randomized trial. Manual searches were also performed to find conference proceedings published between January 1982 and October 2003. DATA EXTRACTION: Two independent investigators reviewed the publications and extracted the data. Pooled odds ratios (ORs) for the objective tumor response rate, 1-year survival rate, and toxicity rate were calculated using the fixed-effect model. Pooled median ratios (MRs) for median survival also were calculated using the fixed-effect model. ORs and MRs lower than unity (<1.0) indicate a benefit of a doublet regimen compared with a single-agent regimen (or a triplet regimen compared with a doublet regimen). DATA SYNTHESIS: Sixty-five trials (13 601 patients) were eligible. In the trials comparing a doublet regimen with a single-agent regimen, a significant increase was observed in tumor response (OR, 0.42; 95% confidence interval [CI], 0.37-0.47; P<.001) and 1-year survival (OR, 0.80; 95% CI, 0.70-0.91; P<.001) in favor of the doublet regimen. The median survival ratio was 0.83 (95% CI, 0.79-0.89; P<.001). An increase also was observed in the tumor response rate (OR, 0.66; 95% CI, 0.58-0.75; P<.001) in favor of the triplet regimen, but not for 1-year survival (OR, 1.01; 95% CI, 0.85-1.21; P =.88). The median survival ratio was 1.00 (95% CI, 0.94-1.06; P =.97). CONCLUSION: Adding a second drug improved tumor response and survival rate. Adding a third drug had a weaker effect on tumor response and no effect on survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Preventing foot ulcers in patients with diabetes.

CONTEXT: Among persons diagnosed as having diabetes mellitus, the prevalence of foot ulcers is 4% to 10%, the annual population-based incidence is 1.0% to 4.1%, and the lifetime incidence may be as high as 25%. These ulcers frequently become infected, cause great morbidity, engender considerable financial costs, and are the usual first step to lower extremity amputation. OBJECTIVE: To systematically review the evidence on the efficacy of methods advocated for preventing diabetic foot ulcers in the primary care setting. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: The EBSCO, MEDLINE, and the National Guideline Clearinghouse databases were searched for articles published between January 1980 and April 2004 using database-specific keywords. Bibliographies of retrieved articles were also searched, along with the Cochrane Library and relevant Web sites. We reviewed the retrieved literature for pertinent information, paying particular attention to prospective cohort studies and randomized clinical trials. DATA SYNTHESIS: Prevention of diabetic foot ulcers begins with screening for loss of protective sensation, which is best accomplished in the primary care setting with a brief history and the Semmes-Weinstein monofilament. Specialist clinics may quantify neuropathy with biothesiometry, measure plantar foot pressure, and assess lower extremity vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings from the history and physical examination, enable clinicians to stratify patients based on risk and to determine the type of intervention. Educating patients about proper foot care and periodic foot examinations are effective interventions to prevent ulceration. Other possibly effective clinical interventions include optimizing glycemic control, smoking cessation, intensive podiatric care, debridement of calluses, and certain types of prophylactic foot surgery. The value of various types of prescription footwear for ulcer prevention is not clear. CONCLUSIONS: Substantial evidence supports screening all patients with diabetes to identify those at risk for foot ulceration. These patients might benefit from certain prophylactic interventions, including patient education, prescription footwear, intensive podiatric care, and evaluation for surgical interventions.

Cost-Benefit Analysis↗
PubMed2006

Does the clinical examination predict lower extremity peripheral arterial disease?

CONTEXT: Lower extremity peripheral arterial disease (PAD) is common and associated with significant increases in morbidity and mortality. Physicians typically depend on the clinical examination to identify patients who need further diagnostic testing. OBJECTIVE: To systematically review the accuracy and precision of the clinical examination for PAD. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: MEDLINE (January 1966 to March 2005) and Cochrane databases were searched for articles on the diagnosis of PAD based on physical examination published in the English language. Included studies compared an element of the history or physical examination with a reference standard of ankle-brachial index, duplex sonography, or angiogram. Seventeen of the 51 potential articles identified met inclusion criteria. Two of the authors independently extracted data, performed quality review, and used consensus to resolve any discrepancies. DATA SYNTHESIS: For asymptomatic patients, the most useful clinical findings to diagnose PAD are the presence of claudication (likelihood ratio [LR], 3.30; 95% confidence interval [CI], 2.30-4.80), femoral bruit (LR, 4.80; 95% CI, 2.40-9.50), or any pulse abnormality (LR, 3.10; 95% CI, 1.40-6.60). While none of the clinical examination features help to lower the likelihood of any degree of PAD, the absence of claudication or the presence of normal pulses decreases the likelihood of moderate to severe disease. When considering patients who are symptomatic with leg complaints, the most useful clinical findings are the presence of cool skin (LR, 5.90; 95% CI, 4.10-8.60), the presence of at least 1 bruit (LR, 5.60; 95% CI, 4.70-6.70), or any palpable pulse abnormality (LR, 4.70; 95% CI, 2.20-9.90). The absence of any bruits (iliac, femoral, or popliteal) (LR, 0.39; 95% CI, 0.34-0.45) or pulse abnormality (LR, 0.38; 95% CI, 0.23-0.64) reduces the likelihood of PAD. Combinations of physical examination findings do not increase the likelihood of PAD beyond that of individual clinical findings. However, when combinations of clinical findings are all normal, the likelihood of disease is lower than when individual symptoms or signs are normal. A PAD scoring system, which includes auscultation of arterial components by handheld Doppler, provides greater diagnostic accuracy. CONCLUSIONS: Clinical examination findings must be used in the context of the pretest probability because they are not independently sufficient to include or exclude a diagnosis of PAD with certainty. The PAD screening score using the hand-held Doppler has the greatest diagnostic accuracy.

Ankle↗
PubMed2004

The role of aromatase inhibitors in the adjuvant treatment of breast carcinoma: the M. D. Anderson Cancer Center evidence-based approach.

BACKGROUND: The authors examined the published evidence on the use of aromatase inhibitors (AIs) in the adjuvant setting in postmenopausal, hormone receptor-positive patients, and they provide recommendations for clinical management in 3 different situations: newly diagnosed women, women who have already received tamoxifen for 2-3 years, and women who have completed 5-years of tamoxifen and are disease free. METHODS: All double-blind, randomized, prospective studies were reviewed. Data sources included the MEDLINE data base, reviews, editorials, and experts. RESULTS: The Arimidex, Tamoxifen Alone or in Combination (ATAC) trial, the Intergroup Exemestane Study (IES), and the MA-17 trial confirmed the superiority of AIs over tamoxifen in women with early-stage breast carcinoma, improving disease-free survival (DFS) considerably. In the ATAC trial, the 4-year DFS rate was 86.9% on anastrozole and 84.5% on tamoxifen (P = 0.03); in the IES, the 3-year DFS rate was 91.5% on exemestane and 86.8% on tamoxifen (P = 0.00005); and, in MA-17, the 4-year estimated DFS rate was 93% on letrozole and 87% on placebo (P < or = 0.001). All studies were limited because of the immaturity of data, particularly concerning long-term safety. A negative impact on bone health was observed in all three trials. However short-term side effects were acceptable. In addition, the studies demonstrated a significant reduction in the frequency of new primary tumors in the contralateral breast. CONCLUSIONS: Current data support anastrozole as first-line adjuvant hormonal therapy, or a change to AIs after 2-3 years of tamoxifen, or the use of letrozole at the end of a 5-year course of tamoxifen as first-choice treatment options for the management of hormone receptor-positive breast carcinoma in postmenopausal women. Ongoing clinical trials should help to define the precise timing, duration, and sequencing of AI therapy, in addition to the long-term tolerability profile and potential differences between anastrozole, letrozole, and exemestane.

Anastrozole↗
PubMed2005

Trends and influences on use of antidiabetic drugs in England, 1992-2003.

OBJECTIVE: To describe trends in prescribing for glycaemic control in diabetes mellitus in England, 1993-2003, and to examine the effects of new clinical evidence or national guidance on these. DESIGN: Observational study of prescribing adjusted for extrapolated changes in epidemiology of insulin and non-insulin treated diabetes. SETTING: Primary care in England, 1992-2003. DATA SOURCES: Three monthly prescribing data from the Prescription Pricing Authority. MAIN OUTCOME MEASURES: Defined daily doses/patient/quarter of oral hypoglycaemics and of insulin. RESULTS: There was an increase in the prevalence of both insulin treated (85%) and non-insulin treated (80%) diabetes. There were increases in all drug use, which were largely explained by this: for example, sulphonylurea use increased by 101% in total but only 11% after correction for change in prevalence and population; insulin use increased by 140% in total, but 33% after correction. Neither guidances from the National Institute of Clinical Excellence nor new clinical evidence had any discernible effect on this. An exception was metformin use, which increased by 495% in total, and by 277% after correction. This increase occurred mainly from early 1998 and seemed to coincide with the publication of evidence of the specific benefits of metformin. CONCLUSIONS: There has been a trend towards more aggressive treatment of diabetes. National guidance may have reinforced this but has not altered the trend. Specific evidence around metformin may have been very influential in increasing its use.

Diabetes Mellitus↗
PubMed1993

Childhood leukaemia in Switzerland: comparison of different sources of data.

Since 1976 the Swiss Paediatric Oncology Groups (SPOG) has registered leukaemia cases occurring in Switzerland. The registration was set up for clinical research; however, since 1985 efforts have been made to complete the registers with cases not taking part in a clinical trial. The data of the SPOG register between 1976 and 1989 are compared to data from cancer registers and the mortality statistics of the Federal Office of Statistics. Between 1985 and 1988 the SPOG register included 91% of the cases recorded by the six cantonal registries. Compared to mortality data, registration was 100% in 1989. The SPOG data file can therefore be assumed to be complete enough to be used for epidemiological studies on incidence of leukaemias and on time trends of leukaemias in Switzerland.

Child↗