Evidence-based medicine as viewed by key decision-makers of health plans in southern Brazil.

Evidence-based Medicine (EBM) is a tool that is becoming increasingly important for management in the health-care system, particularly in managed care. However, there are several doubts over how health plan managers address this issue. This study was designed to verify the current status of EBM in health plans as viewed by their key administrative decision-makers in southern Brazil. We present and discuss participants' agreement to predefined statements about: their level of knowledge on EBM, practitioners' and consumers' behaviour regarding EBM, potential effects for health-care plans by implementing EBM, and attitudes and interest of health-care plans toward evidence-based guidelines. We conclude that there is a need to establish educational efforts oriented to health-care plan managers regarding EBM, considering its good acceptance by managers and an expectation that EBM can help solve several dilemmas faced by health-care plans in southern Brazil.

Comparative genotoxic effect of vincristine, vinblastine, and vinorelbine in somatic cells of Drosophila melanogaster.

In this study, the vinca alkaloids vincristine (VCR), vinblastine (VBL) and vinorelbine (VNR) were investigated for genotoxicity in the wing Somatic Mutation and Recombination Test (SMART) of Drosophila. Our in vivo experiments demonstrated that all drugs assessed induced genetic toxicity, causing increments in the incidence of mutational events, as well as in somatic recombination. Another point to be considered is the fact that VNR was able to induce, respectively, approximately 13.0 and 1.7 times more mutant clones per millimolar exposure unit as their analogues VCR and VBL. The replacement of a CH(3) attached to vindoline group in VBL by a CHO in VCR seems to be responsible for the approximately seven times higher potency of the former. In contrast, the structural modifications on VNR's catharantine group could be related to its higher genotoxic potency, as well as its similar mutagenic and recombinagenic action.

Trends in long-term survival following liver resection for hepatic colorectal metastases.

OBJECTIVE: To examine trends in outcomes of patients undergoing resection at a single tertiary care referral center over a 16-year period. SUMMARY BACKGROUND DATA: Hepatic resection is considered the treatment of choice in selected patients with colorectal metastasis confined to the liver. Although a variety of retrospective studies have demonstrated improvements in short-term outcomes in recent years, changes in long-term survival over time are less well-established. METHODS: Data from 226 consecutive patients undergoing potentially curative liver resection for colorectal metastases between 1984 and 1999 were analyzed. Actuarial survival rates related to prognostic determinants were analyzed using the log-rank test. RESULTS: The median survival for the entire cohort was 46 months, with 5- and 10-year survival rates of 40% and 26% respectively. Ninety-three patients operated on between 1984 and 1992 were found to have an overall survival of 31% at 5 years, compared to 58% for the 133 patients operated on during the more recent period (1993-1999). Both overall and disease-free survival were significantly better in the recent time period compared with the earlier period on both univariate and multivariate analyses. Other independent factors associated with improved survival included number of metastatic tumors < or = 3, negative resection margin, and CEA < 100. Comparisons were made between time periods for a variety of patient, tumor and treatment-related factors. Among all parameters studied, only resection type (anatomical versus nonanatomical), use of intraoperative ultrasonography, and perioperative chemotherapy administration differed between the early and recent time periods. CONCLUSIONS: Long-term survival following liver resection for colorectal metastases has improved significantly in recent years at our institution. Although the reasons for this survival trend are not clear, contributing factors may include the use of newer preoperative and intraoperative imaging, increased use of chemotherapy, and salvage surgical therapy.