[American judge preserves confidentiality in the peer review process]. / Amerikaanse rechter bevestigt het vertrouwelijke karakter van 'peer review'.

Pharmaceutical concern Pfizer subpoenaed various medical journals, including JAMA and Annals of Internal Medicine, to hand over confidential documents relating to studies on its cyclo-oxygenase-2 inhibitors celecoxib and valdecoxib. Pfizer wanted this information to help defend 3000 product liability lawsuits over alleged side effects of the 2 drugs. However, a federal judge in Chicago rejected the company's bid, thereby preserving the confidentiality of the peer review process. It is unlikely that subpoenas like this will take place in the Netherlands.

[Emergency procedures for taking care of the victims of bomb attacks: logistical and medical aspects]. / De opvang van slachtoffers van bomaanslagen: logistieke en medisch-inhoudelijke aspecten.

In The Netherlands the threat of terrorist attacks also exist. Both doctors and hospitals alike should be prepared for such attacks both on the logistical as well as the medical level. Most terrorist attacks are carried out with explosives. This results in many victims and in cases of explosions in closed or semi-closed areas, often results in complex medical problems in many of the victims. An explosion that occurs as the result ofa bomb detonating can result in 4 patterns of injury: the primary explosion injury caused by the pressure of the blast, the secondary injuries caused by flying debris, the tertiary injuries caused by the explosion wind, and the quaternary caused by heat and fire. Common injuries seen following an explosion include: lung damage, neurological damage, abdominal injuries, bone fractures and skeletal damage and crush-syndrome. The triage occurs at the site of the explosion as well as on arrival in hospital. One especially important aspect of this is the sorting and selecting between victims who are likely to develop complex problems and who therefore need to receive aggressive treatment in a specially equipped centre and those patients for whom the nearest emergency department will suffice their needs. The triage should be repeated considering the possibility that initial estimates on these points may have been wrong. Epidemiological research should be carried out for each attack in order to make an inventory of the number of victims, the injuries incurred, the assessment of the effects of the medical help received and an assessment of the effectiveness of the total aid received.

[Questionnaires on the quality of life in other than the Dutch language used in the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine): the translation procedure and arguments for the choice of the questionnaire]. / Niet-Nederlandse vragenlijsten over levenskwaliteit gebruikt in het Nederlands Tijdschrift voor Geneeskunde: vertaalprocedure en argumenten voor de keuze van de vragenlijst.

OBJECTIVE: To determine how the authors of research published in the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine; NTvG) translated the questionnaires that they used in other than the Dutch language and to review the arguments on the basis of which the authors chose the questionnaires used. DESIGN: Bibliometric study and a survey. METHOD: All of the authors who had published an article in the NTvG up to and including January 2006 in which a questionnaire was used that was originally not in the Dutch language were approached by means ofa survey. In this survey, they were asked about the translation procedure and the factors that had contributed to the choice of the particular questionnaire. RESULTS: The authors of 38 articles in which a translated non-Dutch questionnaire had been used returned 31 survey forms (response: 82%). Among the 31 authors, who had used a total of 39 questionnaires, 24 (77%) were aware of the proper translation procedure. Of the 9 authors who had translated the questionnaire themselves, 6 had used the technique of translation and back-translation. In the choice of the questionnaire used, an important factor for many authors (64%) was the use of the questionnaire in previously published comparable research. CONCLUSION: A large proportion of the authors (77%) was aware of the current guidelines for the translation of questionnaires.

[Deficient information in developing countries: Internet alone is no solution]. / Gebrekkige informatie in ontwikkelingslanden: internet alleen is geen oplossing.

Health-care personnel in developing countries have poor access to information, partly because the books are out of date and journals and Internet access are lacking, and partly because the information that is available is not appropriate for the local situation. There is too little research aimed at the problems of the Third World. This is due to a lack of interest in Western countries and because local scientists have done too little research. Internet solves the problem of access to information for health-care personnel in large hospitals and institutes, but there is still a shortage of relevant information for them as well. The editorial boards of professional journals could make a contribution by facilitating the publication of relevant research. Health-care personnel in rural areas will remain dependent upon basic books. This basic component of the provision of information should continue to receive attention. For the time being, Internet will remain inaccessible for rural health-care personnel. One of the initiatives being undertaken in order to improve the provision of information to health-care personnel in developing countries is the distribution of the 'blue trunk library' of the WHO with a selection of more than 100 basic books in every trunk. A number of journals have also taken action: the BMJ Publishing Group offers access to its journals free of charge to the 118 poorest countries and the Canadian Medical Association Journal provides free copies to libraries in developing countries. Moreover, a number ofwebsites have been started with a view to enlarging the information for health-care personnel in the Third World.

[Dutch authors in international medical journals are also authors of publications in the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine)]. / Nederlandse auteurs in internationale medische tijdschriften ook auteurs van publicaties in het Nederlands Tijdschrift voor Geneeskunde.

OBJECTIVES: To determine whether Dutch medical scientists who frequently publish in international journals with high impact factors also publish in Dutch in the Nederlands Tijdschrit voor Geneeskunde (NTvG). DESIGN: Bibliometric study. METHODS: By means of a search in Medline, the Dutch authors were selected who had published the largest number of articles in 20 medical journals with high impact factors from 5 different specialties: general medicine, surgery, dermatology, psychiatry and ophthalmology. Subsequently, it was determined how often these authors had published in the NTvG in the same period. Moreover, a countwas made of the number of articles the first authors of original articles in the NTvG in 1991 and 2000 had published in international journals in 1993-1997 and 1998-2002, respectively. RESULTS: A large proportion of the Dutch investigators with many publications in international journals also published in the NTvG: in 1988-1992, 46 authors wrote 219 international publications and 35 of these published 151 articles in the NTvG; in 1998-2002, 55 authors wrote 326 international publications and 41 of these published 145 articles in the NTvG. The proportion of original articles published by these authors in the NTvG was lower than in the international journals: 83% for the international journals in 1998-2002 versus 39% for the NTvG in 2000. In 2001, 93 original articles by 87 different first authors appeared in the NTvG. Of these 87 authors, 67 (77%) published at least one article and 18 (21%) published more than 10 articles in an international journal in the period 1998 to 2002, as either the first author or a co-author. CONCLUSION: Authors that publish many articles in frequently cited international journals also write articles for the NTvG and, vice versa, the authors of articles in the NTvG also publish in international journals.

[Registration of clinical trials: a statement from the International Committee of Medical Journal Editors]. / Registratie van klinische trials: een verklaring van het International Committee of Medical Journal Editors.

Altruistic motives and trust are central to scientific investigations involving people. These prompt volunteers to participate in clinical trials. However, publication bias and other causes of the failure to report trial results may lead to an overly positive view of medical interventions in the published evidence available. Registration of randomised controlled trials right from the start is therefore warranted. The International Committee of Medical Journal Editors has issued a statement to the effect that the 11 journals represented in the Committee will not consider publication of the results of trials that have not been registered in a publicly accessible register such as www.clinicaltrials.gov. Patients who voluntarily participate in clinical trials need to know that their contribution to better human healthcare is available for decision making in clinical practice.

[Fraud in fundamental and clinical investigations. The necessity for an independent commission for scientific integrity]. / Fraude bij fundamenteel en klinisch onderzoek. De noodzaak voor een onafhankelijke commissie voor wetenschappelijke integriteit.

Scientific misconduct takes various different forms and is real fraud only if there is evidence of intention. There are many forms of scientific dishonesty ranging from very serious to just below the limit of what is permissible, and it occurs at all stages of scientific research. Tracing fraud is by no means easy and its discovery is often only accidental. American, British and Dutch incidences are reported. We know the causes of fraud to be profit-seeking in all its forms, vanity and sloppy research practice. Oddly enough, the consequences of fraud are often more advantageous to the perpetrators than to the whistle-blowers. Literature becomes polluted and faith in scientific knowledge is damaged. In summary the measures and sanctions employed to combat fraud in the United States, Scandinavia, the United Kingdom and The Netherlands, are described. In The Netherlands are recently two commissions appointed. Points of discussion include: a governmental or other commission organized at a national or regional level, what protocol should be implemented, should the commission have powers of sanction, for how long should the members of commission be appointed and how is the extent of their liabilities to be decided upon?

[Increased number of systematic reviews in the Netherlands in the period 1991-2000]. / Toename van het aantal Nederlandse systematische reviews in de periode 1991-2000.

OBJECTIVE: To survey systematic reviews (SRs) as publication type in the Netherlands, with emphasis on differences between Cochrane reviews and SRs in printed journals. DESIGN: Bibliometric study. METHOD: A systematic search was carried out in Medline, EMBASE and the Cochrane Library for published systematic reviews of Dutch origin in the period 1991-2000. For each SR, the year of publication, the number of original articles included, the subject matter and the impact factor of the journal were identified. RESULTS: A total of 289 SRs were retrieved, of which 12% were Cochrane reviews. The number of SRs increased exponentially during this decade. The majority (56%) of the SRs concerned a therapeutic intervention. SRs were published in journals with a moderate to good impact factor (median impact factor 2.59). On average, compared to SRs published in the Cochrane Library, the SRs published in the general medical literature included significantly more original articles (28.8 versus 13.7; p < 0.05). This may be caused by the fact that the clinical questions for Cochrane reviews are more focused as compared with non-Cochrane SRs or by the fact that Cochrane review groups may have more stringent quality requirements for inclusion of an article in a review. CONCLUSIONS: The SR as a publication type showed a rapid growth in one decade and was published in important medical journals. Cochrane reviews represented a substantial proportion of the overall number of SRs in the Netherlands.

[Clinical reasoning and decision making in practice. A man with pneumonia and ill smelling watery sputum: the truth revealed after 80 years]. / Klinisch denken en beslissen in de praktijk. Een man met een pneumonie en stinkend waterig sputum; de waarheid 80 jaar later.

A 24-year-old man was admitted to hospital with pneumonia. On admission he was seen to have an asymmetrical build. During treatment of the lung infiltrate his clinical condition deteriorated. On the third day he coughed up great quantities of fluid which had a urine-like smell. The concentration of creatinine in this fluid was the same as in urine. On X-ray of the thorax, a massive accumulation of pleural fluid was seen. Shortly after aspiration of 1000 ml of pleural fluid the patient died. At autopsy, an ectopic kidney was found in the left thoracic cavity. The pneumonia had caused an abscess that had broken into the pelvis of this ectopic kidney causing the loss of urine into the pleural cavity (urothorax) and 'uroptysis'. On the basis of anatomical and embryological aspects it is debatable if this case was genuine. It is in fact a duplication of a case report published in this journal in 1923 the reliability of which was never clarified. Biographical information from Professor A. Querido (1901-1983) which has since become available indicates that the case was faked by mischievous medical students preparing for their examinations. They had never imagined that the editors might actually accept it for publication. The case report of 1923 has now been retracted.

[Reporting of scientific misconduct in health care research]. / Melden van wetenschappelijk wangedrag in gezondheidsonderzoek.

The incidence of scientific dishonesty in the Netherlands is not known, yet experiences at both the NWO (the Netherlands Organization for Scientific Research) and Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine) indicate that there must be several cases per year. For scientific fraud to be prevented students and researchers should receive thorough teaching, and in research laboratories an emphasis should be placed upon integrity. The Academic Medical Centre in Amsterdam has published a research protocol which is perfect for internal use. The Royal Netherlands Academy of Arts and Sciences publishes brochures on good research practice for researchers, teachers and students. The NWO and the Vereniging van Universiteiten (Dutch Association of Universities) have set up a committee for scientific integrity to function as a fallback mechanism and to assess the institutional procedures or to repeat the inquiries. As healthcare research institutions other than universities are involved since authorities are not always objective, an independent committee has been established to assess complaints about scientific dishonesty, the Scientific Integrity Health Research. Like the Committee on Publication Ethics it will publish its cases anonymously on an annual basis. Its judgments will be communicated to the people involved and the proper authorities.