No abstract

Objective. To determine the generalizability of randomized controlled trials (RCTs) in the treatment of systemic sclerosis (SSc) using the Canadian Scleroderma Research Group (CSRG) database. Methods. We identified articles related to SSc published from 1958 to 2006. Key points on trial design were recorded. The inclusion/exclusion criteria were used in conjunction with the CSRG database to determine the proportion of patients with SSc who would theoretically be eligible for these trials. Articles were classified into subcategories according to the target system. The CSRG database contains 438 patients with SSc from 14 Canadian centers. Results were in median (%) and mean (%) with 95% confidence intervals (95% CIs). Results. In total, 210 articles were evaluated and 73 were selected for inclusion in this study. The mean percentage of eligible patients with SSc associated with other conditions was 35% (95% CI 17-53) for Raynaud's phenomenon, 24% (95% CI 1-47) for digital ulcers, 48% (95% CI 27-68) for gastrointestinal (GI) involvement, 32% (95% CI 20 -43) for overall disease modification, 6% (95% CI 4 -8) for pulmonary arterial hypertension, 2% (95% CI 0 -4) for interstitial lung disease, and 38% (95% CI 12-64) for other categories. Conclusion. Except for GI trials, <38% of the identified patients with SSc would have been suitable to enter the RCTs. Although some patients would be ineligible because they lack certain organ involvement, RCTs designed to include appropriate patients with SSc are needed; there are few proven treatments and trials typically do not include the majority of those who could potentially benefit from the intervention.

The University of Western Ontario has incorporated ecosystem health as an integral component of its Community Health course for medical students. There is increasing concern regarding the negative health effects of pesticides. The issue of pesticides is, therefore, an obvious topic for the Community Health course. The goal of this pilot study was to compare the attitudes of medical students about cosmetic pesticide use before and after attending a special seminar on that topic. Sixty-three students were surveyed on their opinions before and after the pesticides seminar. After the seminar, the students' attitudes shifted towards a more negative view of unrestrained cosmetic pesticide use. The students also felt that there were greater risks involved with the use of pesticides (P < 0.001) after attending the seminar. The results of this pilot study demonstrate the need and the effectiveness of including ecosystem health topics in medical curricula.