Use of benzodiazepines in the general population and their involvement in acute self-poisoning cases.

Benzodiazepines belong to the most widely prescribed group of drugs and are involved in a large proportion of the acute poisonings seen in emergency departments. The aim of the study was to examine whether a relationship exists between the number of poisonings with different types of benzodiazepines and the number of prescriptions for these benzodiazepines. A significant correlation was found between the type of benzodiazepine in cases of acute poisoning seen in the emergency department and (1) the benzodiazepines used as apparent from a sample of the population of the province of East Flanders (Spearman r=0.70, P=0.002), (2) benzodiazepine prescriptions made during a period of 7 weeks by 131 general practitioners (r=0.66, P=0.039, (3) the number of packages of the different benzodiazepines sold in Belgium (r=0.69, P=0.001) and (4) the number of packages sold in Belgium (expressed in DDD; r=0.58, P=0.047). This correlation was found despite the differences in age and geographic characteristics of the populations we studied. We observed more poisonings with diazepam, flunitrazepam and lormetazepam than would be expected from the data on their use in the population. The reason is unclear but the faster onset of action of the benzodiazepines may have led to more frequent hospitalization.

Gradual withdrawal from benzodiazepines in residents of homes for the elderly: experience and suggestions for future research.

OBJECTIVE: A randomised, controlled clinical trial was performed to study the long-term effect of gradual withdrawal from benzodiazepines on the daily functioning of residents of homes for the elderly. The planned sample size was not achieved due to recruitment and follow-up problems. RESULTS: The results in this small sample nevertheless suggest that gradual withdrawal from benzodiazepines is possible in residents of homes for the elderly, and that it can have a positive effect on their daily functioning. No major withdrawal symptoms were observed, although there was a decrease in sleep quality during withdrawal. CONCLUSION: The findings are promising for further research, but researchers should anticipate the problems inherent in executing a trial with institutionalised elderly subjects.

The effect of industry-independent drug information on the prescribing of benzodiazepines in general practice.

In order to measure the effect of industry-independent information on the prescribing of benzodiazepines in general practice, 128 primary practitioners were randomly allocated to three intervention groups after stratification by year of graduation. One third of the participating physicians were forwarded written information about the indications and limitations of benzodiazepines, another third received both written and oral information, and the remaining third (the control group) obtained no information at all. A comparison of the number of benzodiazepines prescribed per 100 patient contacts with prescription before and after the intervention showed an average decrease of 3% in the control group, of 14% in physicians who received only written information, and of 24% in physicians who were given additional oral information. Post hoc pair-wise comparisons revealed a significant difference at the 1% level in the number of benzodiazepines prescribed between physicians who received both written and oral information and the control group. A follow-up survey conducted 4 weeks after the intervention showed that the oral information campaign positively affected physicians' attitudes about the value of oral drug information from an industry-independent source.

Surgical treatment of tibial pseudarthrosis using the Ilizarov apparatus. A critical analysis.

Since November 1985 the authors have added the Ilizarov procedure to their armamentarium for the treatment of tibial pseudarthrosis. The results of a first clinical study of 10 patients are reported. The mean duration of follow-up is 17 months. The consolidation rate is higher with a transverse than with an oblique pseudarthrosis. The Ilizarov procedure combined with a corticotomy offers new perspectives in the management of massive bone defects. In the presence of severe malalignment, a gradual reduction can be carried out. The main complications are pin tract infections and algodystrophy.