[40 years of medicines policy in the Netherlands: from financial constraints to medicines shortages?] / 40 jaar geneesmiddelenbeleid.

On a near daily basis, medicines make the news. Abstract topics such as international pricing policy or medicines patents, and concrete topics such as medicines shortages are regularly reported on. In this article, we summarise a 40-year-history of medicines policy in the Netherlands. Furthermore, we briefly touch upon future directions in this area.

[The increase in the use of drug treatment for diabetes mellitus in the Netherlands, 1998-2003]. / Toenemend gebruik van geneesmiddelen voor diabetes mellitus in Nederland, 1998-2003.

OBJECTIVE: To describe trends in the use of diabetes treatment from 1998-2003 and to compare prescribing in daily practice with the practice guideline 'Diabetes mellitus type 2' issued by the Dutch College of General Practitioners. DESIGN: Descriptive. METHOD: Prescribing data over the period 1998-2003 were taken from the database of the Drug Information Project of the Dutch Health Care Insurance Board. The database contains information on drugs prescribed extramurally and dispensed either by pharmacists or dispensing general practitioners, and reimbursed by health insurance funds. The data are aggregated into volume and cost variables for the general population and individual users were identified to monitor individual use of the medication and co-medication over a period of time. RESULTS: From 1998-2003 the use of medication for treating diabetes in the Netherlands increased from 2.8% to 3.6%. There were 565,000 users of diabetes medication in 2003. The rate of prescription of oral blood-glucose lowering drugs increased more than that for insulin. The rate of concurrent use of an oral drug as well as insulin rose sharply as did the use of more than one type of oral drugs and the use of co-medication, notably cholesterol reducers. With respect to the guidelines, nearly all newly diagnosed type-2 diabetics were initially prescribed metformin or a sulfonamid-urea derivative. In one-third of new patients, a second drug was also prescribed, the combination most used was metformin or a sulfonamid-urea derivative. Combinations of three or more drugs were rarely prescribed. The total cost of diabetes treatment increased from euros 122 million to euros 183 million. The increased use of thiazolidinediones played an important role in this increase. CONCLUSION: The use of oral blood-glucose lowering drugs and thiazolidinediones specifically, increased rapidly between 1998-2003. Individual treatment became more intensive, due to increased use of co-medication, combination therapy and the combined use of insulin and oral drugs. The compliance rate with the general practitioners' practice guidelines was high.

Location of port-wine stains and the likelihood of ophthalmic and/or central nervous system complications.

Of 310 patients with port-wine stains, 68% had more than one dermatome involved; 85% had unilateral and 15% had a bilateral distribution of their port-wine stain. At the time of examination, 8% of all patients with trigeminal port-wine stains had evidence of eye and/or central nervous system (CNS) involvement. Extensive involvement, with port-wine stain over the trunk and extremities as well as the head and neck, was observed in 12%. Patients who did not have port-wine stains on the areas served by branches V1 and V2 of the trigeminal nerve had no signs or symptoms of eye and/or CNS involvement. Port-wine stains of the eyelids, bilateral distribution of the birthmark, and unilateral port-wine stains involving all three branches of the trigeminal nerve were associated with a significantly higher likelihood of having eye and/or CNS complications. Twenty-four percent of those with bilateral trigeminal nerve port-wine stains had eye and/or CNS involvement compared with 6% of those with unilateral lesions. All those who had eye and/or CNS complications had port-wine stain involvement of the eyelids; in 91% both upper and lower eyelids were involved, whereas in 9% only the lower eyelid was involved. None of those with upper eyelid port-wine stains alone had eye and/or CNS complications. In addition, 3 (75%) of the 4 subjects with seizures alone had bilateral port-wine stain involvement. A third group, these with unilateral V1, V2, and V3 port-wine stains, had eye and/or CNS complications in 3 (19%) of 16 subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Focus on: Boston City Hospital Department of Clinical Engineering.

This paper describes the Clinical Engineering Department at the Boston City Hospital, Boston, Massachusetts. Boston City Hospital is the largest component of the City of Boston's Department of Health and Hospitals. The Clinical Engineering Department maintains in excess of 2,700 devices located at Boston City Hospital, Long Island Hospital, Mattapan Chronic Disease Hospital, and three neighborhood health centers that operate under the License of the Department of Health and Hospitals. The Clinical Engineering Department is responsible for the management, repair, testing, calibration, modification, and installation of medical equipment at each of the facilities. The department is also active in the training of clinical and professional staff members, and participates in anesthesia and laser research.

A real-time anesthesia record keeping system using video.

A real-time, Automated Anesthesia Record Keeping (AARK) system was constructed using commercially available video hardware. This system can acquire all of the information that is presented visually to an anesthesiologist directly from monitor screens. The information is recorded on VHS format tape. Use of such a system avoids the need for digital processing while capturing all waveforms, trends, data messages and numerics. Since the data are stored directly to tape, subsequent data analysis can be accomplished. This system can be used with virtually any medical monitor.

The use of video in anesthesia record keeping.

Although formal comparisons of record keeping systems are difficult, the authors are persuaded that a video system provides substantial advantages over AARK in several (though not all) of its aims and at a substantially reduced cost. The video system might be viewed as a parallel rather than a replacement system in some cases. The authors have been struck by certain capabilities such a video system offers. Not the least of these is the advantage of having a multiple OR monitoring system for use by the floor supervisor to check all rooms easily. The implications of a video technology in clinical research also are important. At present, a clinical trial involving 40 cases is being organized and will require that physiologic parameters be recorded in detail. Plans to use the ubiquitous multichannel strip recorder for logging the parameters have been changed. Video will be used instead, since it is more than adequate to meet most research needs of the department and greatly simplifies the recording of such data at reduced cost.