Inadequate evaluation of potential side effects of sildenafil in preterm stopped Dutch trial.

Recently a drug trial in the Netherlands in which the efficacy of oral sildenafil was compared to placebo in women bearing children with fetal growth restriction was stopped early because of very harmful side effects to the babies. There were quite some unwanted and unscientific aspects related to this study and the manner in which the side effects were communicated to the patients and the community. These have not gained the attention they ought to have.

[How transparent is the new Dutch guideline on cardiovascular risk management?].

The new Dutch guideline on cardiovascular risk management has lowered the target value for LDL cholesterol from 2.5 to 1.8 mmol/L.

Drug information by public health and regulatory institutions: Results of an 8-country survey in Europe.

Purpose: To evaluate the framework of drug information produced by public health and regulatory institutions in Europe.

Materials And Methods: We carried out a short survey asking editors of ISDB bulletins of the European region to indicate the main sources of drug information provided by public health and regulatory authorities in their countries, the specific kind of information produced and their opinions about strengths and weaknesses of such information. The availability of evaluations about the added therapeutic value of drugs and of tools facilitating the implementation of such information were particularly addressed and checked on the websites of those institutions.

[New medicines at an acceptable cost?].

The Dutch minister of Health, Welfare and Sport recently informed the Dutch Parliament that the current system of access to new medicines has failed because it is becoming too costly. She plans to tackle the pricing-problem within the current system by e.g.

[Problems with the availability of drugs in The Netherlands].

The withdrawal ofa license to trade can result in problems with the availability of drugs. The reasons for withdrawal can be ofan economic nature, but the balance between effectiveness and side effects of a drug can also, after a period of time, prove disappointing and the drug can, as a result, be withdrawn from sale. A scarcity of basic materials, too, can play a role in availability, as can the inability of the manufacturer to meet the standards of the relevant authority.

The sponsored pandemic of the Mexican flu?

The first reports of the New Influenza A (H1N1) spoke of a markedly increased morbidity and mortality. Later it turned out that this flu was a very mild flu. Gradually the role of the WHO was questioned.

Pandemic influenza vaccines and neuraminidase inhibitors: efficacy and side effects.

At the time of the outbreak of the pandemic of New Influenza A (H1N1) pandemic influenza vaccines became available via an accelerated registration procedure. In 2005 large stocks of the neuraminidase inhibitor oseltamivir were built up in the Netherlands and other western countries. There was considerable doubt about the efficacy of this medicine.

[The workings of the Drug Bulletin].

The Dutch Drug Bulletin (Geneesmiddelenbulletin) is a monthly journal with a unique approach which, after a hectic period in which its independence and even its right to exist were threatened, has now reached calm water The continued existence of the Dutch Drug Bulletin is now guaranteed, independently of the pharmaceutical industry, the government, professional organizations and patient organizations. Articles appear in the Dutch Drug Bulletin after extensive consultation among various experts. Conclusions are based on the published (and hence controllable) results of randomized, preferably double-blind, studies with an appropriate control group.

Surgical smoke and infection control.

Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as 'surgical smoke'. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of infection (human immunodeficiency virus, hepatitis B virus, human papillomavirus) and causes irritation to the lungs leading to acute and chronic inflammatory changes. Furthermore, cytotoxic, genotoxic and mutagenic effects have been demonstrated.

The serotonin syndrome.

The serotonin syndrome is a complex of symptoms that are thought to be largely attributable to changes in sensitivity in the serotonin receptor systems in the brainstem and the spinal cord due to drugs. Severe cases are almost always caused by a combination of two or more 'serotonergic' drugs, of which at least one is a selective serotonin reuptake inhibitor or a monoamine oxidase inhibitor. Usually, the syndrome heals spontaneously after withdrawal of the medication.

Effectiveness of disease management programmes for recognition, diagnosis and treatment of depression in primary care.

Objectives: Screening is advocated to improve the recognition of patients with major depression in primary care. Furthermore, disease management programmes are advocated to improve the quality of care and outcome for these patients. But is screening and the subsequent implementation of a disease management programme more effective than usual care?

Methods: Review of the literature on the effects of disease management programmes that include screening for major depression in general practice.

Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis.

Objective: This systematic review summarizes the evidence on the accuracy of tests for assessing ACL ruptures of the knee.

Search Strategy: A computerized search of MEDLINE (1966-2003) and EMBASE (1980-2003) with additional reference tracking.

Selection Criteria: Articles included were written in English, French, German, or Dutch, and addressed the accuracy of at least 1 physical diagnostic test for ACL rupture, using arthrotomy, arthroscopy, or magnetic resonance imaging as the gold standard.

The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis.

Objective: Our systematic review summarizes the evidence about the accuracy of those tests.

Search Strategy: We performed a literature search of MEDLINE (1966-1999) and EMBASE (1988-1999) with additional reference tracking.

Selection Criteria: Articles written in English, French, German, or Dutch, that addressed the accuracy of at least one physical diagnostic test for meniscus injury with arthrotomy, arthroscopy, or magnetic resonance imaging as the gold standard were included.

Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months' follow up.

Objective: To determine whether the effects of an exercise programme in patients with osteoarthritis of hip or knee are sustained at six and nine months' follow up.

Methods: A randomised, single blind, clinical trial was conducted in a primary care setting. Patients with osteoarthritis of hip or knee (ACR criteria) were selected.

Antidepressant prescription for depression in general practice in The Netherlands.

Objective: To evaluate diagnoses and the prescription of antidepressants drugs for depression, based on data from 1993 to 1998 related to consultations for depression in general practice in the Netherlands.

Method: An exploratory analysis of data provided by IMS Health. Consecutive annual representative samples of 640 GPs regularly registered data on morbidity and (drug) treatment for specific medical problems in special booklets for a period of one week.

The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial.

Objective: To determine the effectiveness of exercise therapy in patients with osteoarthritis (OA) of the hip or knee.

Methods: A randomized single blind, clinical trial was conducted in a primary care setting. Patients with hip or knee OA by American College of Rheumatology criteria were selected.

Validity of Cyriax's concept capsular pattern for the diagnosis of osteoarthritis of hip and/or knee.

To analyse the validity of Cyriax's concept of the "capsular pattern" in the diagnosis of osteoarthritis (OA) of hip and knee, data on 200 patients were analysed. The capsular pattern with limitations of medial rotation, flexion, and abduction, was not present as a distinct pattern in patients with OA of the hip. In patients with OA of the knee, an indication of the existence of a capsular pattern of the knee, with limited ranges of motion for both flexion and extension was found in subgroups of patients.

Prescription changes and drug costs at the interface between primary and specialist care.

Objective: To explore the relevance of prescription changes and related drug costs when patients are referred from primary to secondary care.

Patients And Methods: Secondary analysis of data derived from a study on the quality of referrals, which was performed in 1989-1990. New and non-acute referrals of ambulatory patients were studied for internal medicine, neurology, and dermatology.

Pseudo-outbreak of multiresistant Pseudomonas aeruginosa in a hematology unit.

Objective: To describe the investigation of a pseudo-outbreak of multiresistant Pseudomonas aeruginosa fecal colonization in a hematology unit.

Design: Retrospective chart review; prospective environmental sampling and observation of stool culture technique; genotyping by random arbitrary primer polymorphic DNA polymerase chain reaction (RAPD-PCR).

Setting: An academic tertiary-care hospital.