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The 17th annual Western Canadian Gastrointestinal Cancer Consensus Conference (wcgccc) was held in Edmonton, Alberta, 11–12 September 2015. The wcgccc is an interactive multidisciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management of gastric cancer.

Background Microsatellite-stable metastatic colorectal cancer is typically unresponsive to immunotherapy. This phase 3 study was designed to assess atezolizumab plus cobimetinib in metastatic colorectal cancer. Here, we report the comparison of atezolizumab plus cobimetinib or atezolizumab monotherapy versus regorafenib in the third-line setting. Methods IMblaze 370 is a multicentre, open-label, phase 3, randomised, controlled trial, done at 73 academic medical centres and community oncology practices in 11 countries. Patients aged at least 18 years with unresectable locally advanced or metastatic colorectal cancer, baseline Eastern Cooperative Oncology Group performance status of 0–1, and disease progression on or intolerance to at least two previous systemic chemotherapy regimens were enrolled. We used permuted-block randomisation (block size four) to assign patients (2:1:1) via an interactive voice and web response system to atezolizumab (840 mg intravenously every 2 weeks) plus cobimetinib (60 mg orally once daily for days 1–21 of a 28-day cycle), atezolizumab monotherapy (1200 mg intravenously every 3 weeks), or regorafenib (160 mg orally once daily for days 1–21 of a 28-day cycle). Stratification factors were extended RAS status (wild-type vs mutant) and time since diagnosis of first metastasis (

The 16th annual Western Canadian Gastrointestinal Cancer Consensus Conference was held in Saskatoon, Saskatchewan, September 4–5, 2014. The Consensus Conference is an interactive, multidisciplinary event attended by health care professionals from across western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) involved in the care of gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer.

The National Heart Foundation of Australia has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (updated December 2010). Main recommendations For patients at low absolute cardiovascular disease risk with persistent blood pressure (BP) ≥ 160/100 mmHg, start antihypertensive therapy. The decision to treat at lower BP levels should consider absolute cardiovascular disease risk and/or evidence of end-organ damage, together with accurate BP assessment. For patients at moderate absolute cardiovascular disease risk with persistent systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, start antihypertensive therapy. Treat patients with uncomplicated hypertension to a target BP of < 140/90 mmHg or lower if tolerated. Changes in management as a result of the guideline Ambulatory and/or home BP monitoring should be offered if clinic BP is ≥ 140/90 mmHg, as out-of-clinic BP is a stronger predictor of outcome. In selected high cardiovascular risk populations, aiming for a target of < 120 mmHg systolic can improve cardiovascular outcomes. If targeting < 120 mmHg, close follow-up is recommended to identify treatment-related adverse effects including hypotension, syncope, electrolyte abnormalities and acute kidney injury. Why the changes have been made A 2015 meta-analysis of patients with uncomplicated mild hypertension (systolic BP range, 140-169 mmHg) demonstrated that BP-lowering therapy is beneficial (reduced stroke, cardiovascular death and all-cause mortality). A 2015 trial comparing lower with higher blood pressure targets in selected high cardiovascular risk populations found improved cardiovascular outcomes and reduced mortality, with an increase in some treatment-related adverse events.

Competing interests are everywhere. Everyone has a range of interests and these interests have the potential to conflict with each other. These conflicts are of particular concern in medical publishing because biased information can have adverse effects on practice. The competing interest may be personal, academic or intellectual, but most attention is paid to direct financial conflicts of interest.1 For many medical journals, particularly those focused on therapeutics, the influence of the pharmaceutical industry has to be considered. There is evidence of the widespread influence of the industry. A systematic review found that 23–28% of academic investigators receive industry funding, and industry-funded studies are likely to produce pro-industry conclusions.2 An Australian study of 1500 clinicians found that while only 6% had been paid by industry, 23% had served on an industry advisory panel, 52% had accepted travel sponsorship and 96% had accepted gifts.3 The gifts that have been commonly offered to Australian medical specialists include food and items for the office or for personal use.4 Conflicts of interest may be hidden or not reported. A review of 29 meta-analyses of 509 drug trials found that the authors’ financial interests were only disclosed in 26% of the trials. None of the meta-analyses reported on the financial links between authors and industry in the trials they analysed.5 A 2011 review of guidelines listed by the National Health and Medical Research Council found that only 15% had published conflict of interest statements.6 While many Australian universities have policies on conflicts of interest, few require their staff to make regular declarations of their interests.7 Asking authors to declare their interests over the previous three years is one way medical journals identify competing interests. The International Committee of Medical Journal Editors has produced a standard form authors can use.1 Since 1996, Australian Prescriber has been asking authors to declare any conflicts of interest. This policy was later extended to include the specialist referees who review the articles. The members of the Editorial Executive Committee have to make annual declarations of their interests in accordance with the policies of our publisher NPS MedicineWise. The International Society of Drug Bulletins (ISDB), of which Australian Prescriber is a founder member, encourages its members to have policies on conflicts of interest. Members without their own policies can use an adapted version of the conflict of interest form produced by the International Committee of Medical Journal Editors. There is, however, now a view within ISDB that this is insufficient to prevent the publication of possibly biased information. A proposal that member bulletins should not publish material written by authors with competing interests is being considered. This would include the editorial team as well as external authors. While only publishing articles written by authors with no competing interest is a noble aim, is it practical? In the 1990s, the New England Journal of Medicine decided that authors of its editorials and review articles should have no financial interests in the companies whose products are discussed in the journal. This policy had to be revised in 2002 because of the difficulties in finding authors with no conflicts of interest. In a two-year period the journal was only able to publish one article about a new drug therapy.8 If finding authors with no conflict of interest is difficult in the USA, with its huge population, how hard will it be in Australia? With limited access to other sources of funding, it is highly likely that anyone involved in researching new drugs in Australia will have received some support from a pharmaceutical company. During 2014 Australian Prescriber published 35 editorials and articles. In 11 of these, one or more authors declared an interest. Should we be as concerned about an author who declares funding from the National Health and Medical Research Council as we might be about someone who obtains research funding from a pharmaceutical company? What about an author who works in an academic institution that holds a global licence for a product? Should we exclude someone who is an adviser to the Therapeutic Goods Administration, but has also been an adviser to industry? There are many possible questions about potential conflicts of interest, but the Editorial Executive Committee believes that those 11 articles should still have been published. While publishing declarations of interest at the end of articles may not solve all the difficulties of competing interests, it informs readers. Journal readers are quick to comment if their perceptions about a conflict of interest differ from those of the authors.9-12 The Editorial Executive Committee does not think it should refuse to deal with people who may be very knowledgeable about a treatment because they have participated in industry-funded research. Often their expertise is the source of the conflict. Although assessing conflicts of interest can be difficult, the Editorial Executive Committee believes that the disclosure and peer-review processes of Australian Prescriber should mitigate the risk of bias. Competing interests are everywhere, but they can be managed.

SummaryRituximab (Mabthera® , Rituxan® ) is a genetically engineered chimeric murine/human monoclonal antibody directed against the CD20 antigen found on the surface

The first edition of Australian Prescriber was published in the spring of 1975 by the Australian Department of Health. It aimed to ‘assist clinicians, whatever their field, to prescribe the most appropriate treatment’.1 Forty years on, Australian Prescriber has become a trusted part of Australian practice. A whole generation of health professionals has grown up with access to independent information about therapeutics. Despite its national and international influence, the existence of Australian Prescriber has sometimes been in doubt. In 1982, budget cuts led to the brief disappearance of Australian Prescriber while plans were made to privatise the journal. One possibility was that Australian Prescriber would be taken over by the Australian Medical Association, the publisher of the Medical Journal of Australia. However, the Editor of that journal correctly pointed out that you could not have Australian Prescriber associated with advertisements from pharmaceutical companies. It has recently emerged that this comment contributed to that Editor’s premature departure from the Medical Journal of Australia.2 At the 30th anniversary of Australian Prescriber in 2005 the problems of the past appeared to have been resolved.3 The National Prescribing Service (now known as NPS MedicineWise) had taken over responsibility for the publication of Australian Prescriber in 2002. Certain safeguards were built into the contract as the Executive Editorial Board had concerns over editorial independence.4 The contract included distributing Australian Prescriber in print and electronic formats, free of charge and free of advertising, six times a year. This routine is now well established. Over the past 10 years Australian Prescriber has continued to grow. While the print distribution has remained stable, at around 50 000 copies, most of the growth has been in the online readership with approximately 250 000 unique visitors to the Australian Prescriber website each month. A website for mobile devices was established in 2013 and this attracts a further 125 000 unique users each month. Social media was in its infancy in 2005, but since 2012 readers have been able to get updates by following Australian Prescriber on Twitter. In 2015 the first Australian Prescriber smartphone ‘app’ was launched. This was a new way to deliver information, about anaphylaxis management and the doses of emergency drugs, that had previously been available in print. The Doctor’s Bag app has been well received with over 2500 downloads in the first month. Work is also underway to meet the new standards of scholarly publication. These standards are partially a response to the recent rise of predatory medical journals.5 While people value open-access journals, authors usually have to pay fees to have their work published in commercial publications. However, this publishing model has resulted in the emergence of new journals which appear willing to publish anything for money. Predatory journals can exploit people who are desperate to publish their work. There are even alleged cases of fake peer-review.6 Although Australian Prescriber has always met the standards for MEDLINE listing, the journal has not been given priority for inclusion in that database. To facilitate increased access, we are currently working to make the journal available through PubMed Central. This should make it easier for readers and researchers to find the articles they want. Maintaining the quality of Australian Prescriber requires investment. The growth of Australian Prescriber has been achieved despite funding being unchanged for many years. While this has been a challenge over the past decade, the journal is reaching a point where future development may be constrained. In 2005 the Australian Prescriber website was considered advanced, but now needs to be upgraded, not least because of the huge numbers of people visiting the website. In view of the increasing costs of distributing a paper journal, NPS MedicineWise is investigating a range of publishing solutions to ensure that health professionals continue to receive the high-quality, evidence-based information they need. This may include seeking additional sources of funding and reducing the print distribution of NPS MedicineWise publications. Evidence from previous Australian Prescriber readership surveys supports the continuation of the print publication. Other publishers have also found that many health professionals prefer a paper journal. Approximately a third of our online readers also like to read Australian Prescriber in print. A common scenario is for health professionals to go to the website when they want information quickly and to read the paper copy when they want more detail about a topic. While there is increasing use of the internet, is it too soon to expect health professionals to read only online information? In a recent readership survey 85% of the readers of the print journal said Australian Prescriber had influenced their practice. Significant changes to print distribution may therefore have implications for prescribing. It is important that we continue to provide balance to the printed information supplied directly or indirectly by the pharmaceutical industry. The Editorial Executive Committee is concerned that all those readers who have opted for the paper journal will not make the switch to the electronic journal. Before making any changes it is essential to seek your views on how Australian Prescriber can continue to reach as many health professionals as possible. There will therefore be a survey of a sample of the readers in the coming weeks. Even if you are not part of the readership survey the Editorial Executive Committee will welcome your comments on the future of the journal. The 21st century has seen a transformation in publishing. Australian Prescriber has introduced many innovations over the years and will continue to look for new ways to deliver independent drug information to busy health professionals. However, as Australian Prescriber moves forward into its fifth decade, it will be important not to forget the lessons of the past.

A safe and inexpensive, hand-held reflectometer has been developed to provide reflectivity measurements near one wavelength for mirrors in the field and laboratory. The principle used is: the specular reflection of a parallel collimated light beam from an LED, focused onto a large area pin diode, so that the beam throughout is always intercepted. The beam is chopped and filtered by an electronic circuit to make it immune to fluorescent and other ambient light conditions except bright sunlight. The response is shown to be linear and the 100% point can be calibrated by an extension tube which brings the beam in line with the detector, or a fresh aluminium mirror can be used. The small power drain enables the calibration to be retained.

As Australia slipped towards a constitutional crisis in late 1975, a new medical journal slipped into letter boxes...

A new experience awaits health professionals in 1996. In July, we will be part of the first National Medicines Week....

Sustained-release floating drug delivery systems (FDDSs) enable prolonged and continuous input of the drug to the upper parts of the gastrointestinal tract have been designed and fabricated using three dimensional printing (3DP) technology. A new strategy is proposed for the development of FDDSs. The design of FDDSs was based on the sustained release formulation, with low density and floating features in order to prolong the gastric retention time, with special surface textures and variations of drug distribution in the FDDSs for constant release profiles. The local variations of drug in the FDDSs were traced by methylene blue. To measure the floating force, a novel apparatus was developed. Duration of buoyancy and drug release profiles were determined in vitro. It was found that FDDSs were able to float on the dissolution medium 12h, which was the whole tests time periods, and free out the model drug metformin hydrochloride in a way of near zero-order kinetics. 3DP is able to offer possibility for developing FDDSs with complicated design features for providing long-time gastro-retention and desired drug release profiles.

EDITOR—The Drug and Therapeutics Bulletin is too important to disappear.1 If there was a need for a drug bulletin in the 1960s, that need must be greater now, considering the greater choice of drugs available. Health professionals are busy people and …

A recent case involves a health professional being sued for questioning the efficacy of a complementary medicine.

PURPOSE: A phase II trial was performed to evaluate the safety and efficacy of rituximab, a chimeric anti-CD20 monoclonal antibody, in patients with bulky (> 10-cm lesion) relapsed or refractory low-grade or follicular non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: Thirty-one patients received intravenous infusions of rituximab 375 mg/m2 weekly for four doses. All patients had at least one prior therapy (median, three; range, one to 13) and had progressive disease at study entry. Patients were a median of 4 years from diagnosis. RESULTS: No patient had treatment discontinued because of an adverse event. No patient developed human antichimeric antibody. The overall response rate in 28 assessable patients was 43% with a median time to progression of 8.1 months (range, 4.5 to 18.6+ months) and median duration of response of 5.9 months (range, 2.8 to 12.1+ months). The average decrease in lesion size in patients who achieved a partial response was 76%, and patients with stable disease had a decrease in average lesion size of 26%. Median serum antibody concentration was higher in responders compared with nonresponders, and a negative correlation was shown between antibody concentration and tumor bulk at baseline. CONCLUSION: Rituximab single-agent outpatient therapy is safe and shows significant clinical activity in patients with bulky relapsed or refractory low-grade or follicular B-cell NHL.

Australia and the USA signed a free trade agreement in February 2004.1The USA has negotiated duty-free access for all...

John S Dowden, Editor-in-Chief, Australian Prescriber The Australian Adverse Drug Reactions Bulletin was first...

John S Dowden, Editor, Australian Prescriber In August 1907 the Parliament of the Commonwealth of Australia...

The origins of the National Prescribing Service (NPS) lie in the Australian National Medicinal Drug Policy,...

A Federal Court injunction has stopped the publication of a review criticising a medicinal product. The injunction...

An advertising campaign for vardenafil encouraged men with erection difficulties to seek treatment. The advertisement...

The 'New drugs' section of Australian Prescriber has been a consistent feature of the journal since 1975. Health...

By the year 2020, paper biomedical journals will be extinct. This was a view expressed at an international meeting of...

Aspirin has been available without prescription for many years. Although it is readily available, it is not free of...

Operator services position system (OSPS) architecture builds on the 5ESS® switch Integrated Services Digital Network (ISDN) base to provide modern, flexible operator services. This article details some major operator system innovations provided by the OSPS system architecture.

Publisher Summary This chapter describes image intensifiers, in which the photocathode and electron sensitive emulsion are separated by a thin membrane through which the accelerated photoelectrons can pass but which is impermeable to the vapors that poison the photocathode. Cesium—which is used in the preparation of the majority of high-sensitivity photoemissive cathodes—reduces the work function of most surfaces exposed to it, and, as a consequence, if cesium were excluded from the working space of the tube, it would be possible to use higher accelerating fields without breakdown and the level of spurious light background at the phosphor screen would be diminished. Cesium vapor is excluded from the working region by having a separate processing compartment and a reversible photocathode. Another development proposed is that an additional thin mica window should be used at the photocathode end of a single-stage tube, where the cathode is formed on the inner surface. Such a tube would be useful as a first stage tube in nuclear particle-track observation.