Highlights of this issue
CMAJ 1999;160:9
© 1999 Canadian Medical Association
Diuretics, ß-blockers, calcium-channel blockers or ACE inhibitors: Who cares?
Study shows that initial choice of therapy may affect long-term compliance
See also:
- Evidence: Persistence with treatment for hypertension in actual practice
- Evidence: Effect of initial drug choice on persistence with antihypertensive therapy
- Editorial: Compliance in hypertension
Using the Saskatchewan administrative database, Jaime Caro and colleagues tracked the use of medication by almost 80 000 hypertensive patients for 1 year. Of the 27 364 adults with newly diagnosed hypertension, over 20% appeared to have stopped taking their drugs at the end of the first year of therapy. In a companion paper, the authors look at the class of drug initially prescribed. At 6 months after diagnosis, 20% of patients for whom a diuretic was initially prescribed were not taking any antihypertensive drug. For ß-blockers the figure was 15%, for calcium-channel blockers 14% and for angiotensin-converting-enzyme inhibitors 11%. Although persistence with therapy was greater for some classes of drugs, it is important to remember that other factors may have played a role in the patients' decision to abandon therapy. Martin Meyers provides an editorial perspective on these important studies.
How expensive is PSA testing?
Expensive, but less so than previously reported
See also:
Murray Krahn and colleagues estimate that if all eligible men in Canada had been screened with PSA tests in 1995, the cost would have been greater than the cost of all prostate cancer care in that year, at $317 million. They estimate the actual cost of PSA screening in 1995 to have been $45 million — treatment accounting for over 61% of the cost, and screening, diagnosis and staging accounting for 35% — and expect that this figure will rise to $66 million by the year 2000. However, even with projected demographic shifts and increased use of PSA testing by 2000, the authors predict that the costs of PSA screening will account for less than 0.15% of Canada's direct health care costs, a much smaller proportion than previously reported.
PSA testing: different docs, different reasons
Most physicians order PSA tests to screen for prostate
cancer, often at the patient's request
See also:
In their survey of over 200 physicians caring for patients without diagnosed prostate cancer, Peter Bunting and colleagues found that 63% ordered PSA tests to screen for prostate cancer, 40% to investigate urinary symptoms and 33% to follow up a medical procedure or drug therapy. Tests for screening were initiated by the patient in 63% of cases. There also appear to be important differences across specialties, with urologists and family physicians differing in their reasons for ordering a PSA test.
Life after prostatectomy
Coping with urinary incontinence and erectile dysfunction
See also:
Continuing our Clinical Basics series on prostate cancer, Magdy Hassouna and Jeremy Heaton focus on 2 of the most frequent and troubling complications following treatment of prostate cancer: urinary incontinence and erectile dysfunction. For each, they describe prevention, pathophysiology, diagnosis and treatment.
The loneliest people
Two doctors strangely relieved that their malpractice suit has hit the press
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No physician wants to see his or her name in the paper because of a malpractice suit, but Arlene Rosenbloom of Ottawa breathed a sigh of relief when this happened to her in 1996. Rosenbloom and her partner, Gary Viner, faced a legal battle that lasted almost 5 years after a "wrongful-birth" suit was filed against them. The hardest part for Rosenbloom was being under lawyers' orders not to discuss the case with anyone. "The silence brings out the shame," she explained. With the ordeal finally over, she muses that there should be a network of physicians who have faced malpractice suits to help colleagues who now have to deal with this stress.
The big chill
For some patients, winter's cold is more than a nuisance
See also:
- Public health: The big chill: diseases exacerbated by exposure to cold
Patients with a variety of conditions — from Raynaud's disease to coronary artery disease to asthma — should take special precautions to avoid exposure to the cold winter air.
