[The path from science to the practicing surgeon. Engagement of documentation of the Swiss Academy of Medical Sciences for providing evidence-based medicine]. / Der Weg von der Wissenschaft zum praktizierenden Chirurgen. Das Engagement des Dokumentationsdienstes der Schweizerischen Akademie der Medizinischen Wissenschaften zur Vermittlung von Evidence Based Medicine.

The flood of information that comes along with the rise of electronic media has changed the expectations towards the Documentation Service of the Swiss Academy of Medical Sciences (DOKDI): Evidence Based Medicine (EMB) in particular not only demands procurement of information, but also a selection regarding quality and relevance: The question arising out of the clinical situation requires an answer correct in its content and helpful in the specific situation. Getting an idea of what evidence exists about the correctness of a certain procedure through critical lecture is an ideal often obstructed by lack of time and methodical problems in the practice; therefore, one often has to rely on evidence acquired through others and consult e.g. the Cochrane Library. DOKDI commits itself to the development of systematic reviews as well as to the dissemination of evidence found by using its experience in the documentation with electronic media and by providing the corresponding infrastructure. In addition to these activities, the Academy has spoken a grant for the training of EBM-Tutors. During a weekly workshop held in Oxford, clinicians will be trained as EBM-Tutors. This will allow an increasing number of EBM-Workshops held in Switzerland in the future.

The epidemiological situation of thyroid cancer in Belarus.

Starting in 1990, an increasing number of children in regions adjacent to the site of the Chernobyl nuclear accident have been diagnosed as suffering from thyroid cancer. Using available data up to 1994, the geographical distribution, time and cohort trends, age distribution and other characteristics of this epidemic are reviewed. The results show that the geographical distribution is similar to that of iodine-131 after the nuclear accident. When looking at cohorts of children born in the same years, one can see that the incidence has been increasing steadily since 1990; deviations from this pattern might be explained by active case finding. A causal relationship with the Chernobyl accident appears the most likely interpretation of these results. Possible modifying factors should, however, be examined closely.

Chernobyl-related thyroid cancer: what evidence for role of short-lived iodines?

Over 500 cases of thyroid cancer were diagnosed in Belarus between 1986 and 1995 among persons exposed as children (under 15 years of age) to radioactive contamination from the Chernobyl nuclear accident. There is little doubt that radioactive iodine isotopes emitted during the nuclear explosion and subsequent fire were instrumental in causing malignancy in this particular organ. Comparison of the observed geographic distribution of Chernobyl-associated thyroid cancer incidence rates by districts with contamination maps of radioactive fallout shows a better fit for estimated 131I contamination than for 137Cs. Because 131I used for medical purposes had not been considered carcinogenic in humans in the past, and in view of the unusually short latency period between exposure and clinical manifestation of cancer, it is suspected that not only 131I but also energy-rich shorter-lived radioiodines may have played a role in post-Chernobyl thyroid carcinogenesis. Measurements of iodine isotopes are not available, but reconstruction of geographic distributions and estimations of radioactive fallout based on meteorological observations immediately following the accident could provide a basis for comparison with the distribution of thyroid cancer cases. In this paper, data from the Epidemiological Cancer Register for Belarus will be used to show geographic and time trends of thyroid cancer incidence rates in the period from 1986 to 1995 among persons who were exposed as children, and these will be compared with the estimated contamination by radioiodines. Tentative conclusions are drawn from the available evidence and further research requirements discussed.