Highlights of this issue [CMAJ

Highlights of this issue

Paying for prostate cancer
The economic burden of prostate cancer is large — and growing

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Education: Prostate cancer: 12. The economic burden

Continuing our Clinical Basics series on prostate cancer, Grover and colleagues describe the crucial roles of cost-of-illness and cost-effectiveness studies in an era when the number of men at risk for prostate cancer is on the rise. Although Canadian data are lacking, the authors extrapolate from studies elsewhere that the direct costs of treating prostate cancer in Canada could be $193 million and the indirect costs perhaps up to $334 million.

Triple-drug antiretroviral regimens promising
Population-based cohort study replicates positive results of randomized trials

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Hogg and colleagues followed 500 men and women 18 years of age and older for whom antiretroviral therapy was first prescribed between Oct. 1, 1994, and Dec. 31, 1996; 312 were receiving a double-drug regimen (ERA-II group) and 188 were receiving a triple-drug regimen (ERA-III group). The cumulative mortality rates at 12 months were 7.4% in the ERA-II group and 1.6% in the ERA-III group. The likelihood of death or of progression to AIDS or death at 12 months was more than 2 times higher in the ERA-II group than in the ERA-III group. In an accompanying editorial, Millson and Rachlis applaud the authors for their use of a strong administrative database in their attempt to move beyond clinical trials in determining the effectiveness of triple-drug antiretroviral regimens.

Greater volume, higher quality?
Patients undergoing pancreatic resection for neoplasm may have better outcomes at hospitals with higher surgical volumes

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In their retrospective analysis of 842 pancreatic resections at 68 centres in Ontario over a 7-year period, Simunovic and colleagues found that the likelihood of death after pancreatic resection for neoplasm was higher in low- and medium-volume centres than in high-volume centres (odds ratio 5.1 and 4.5 respectively). Mean length of stay was also greater (by 7.7 and 9.2 days respectively). The study replicates, in a publicly financed health care system, findings of similar studies in the US. In an accompanying editorial, Wexler focuses on study methodology, insisting that the need for regionalization of pancreatic resection for neoplasm is far from proven.

The horse doctor
A British Columbia physician makes his ranch their sanctuary

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Heart & Soul: The horse rescuer

In Heart & Soul, we meet Ray Kellosalmi, who travels across the country buying "Premarin foals" that would otherwise end up as pet food or on dinner tables in Europe.

Acute alcohol withdrawal
A meta-analysis and review to help physicians to help their patients

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In their meta-analysis of the evidence on the efficacy of benzodiazepines in the treatment of acute alcohol withdrawal, Holbrook and colleagues identified 23 trials, of which 11 met the inclusion criteria. Therapeutic benefit within 2 days was more likely with benzodiazepines than with placebo (odds ratio 3.28), and there were no significant differences in adverse events or drop-out rates between benzodiazepines and alternative drugs. In their companion review, the authors emphasize the importance of the CAGE questionnaire as a screening tool for alcohol abuse and dependence, and describe the diagnosis and management of acute alcohol withdrawal, including assessment of severity, administration of thiamine, sedation with benzodiazepines and follow-up monitoring.