British Medical Journal articles from April 1995

British Medical Journal archives from April 1995

Anti-therapeutic community mental health law: rules cannot substitute for resources.(the United Kingdom's Mental Health (Patients in the Community) Bill)(Editorial)
April 29, 1995... The government's Mental Health (Patients in the Community) Bill is apparently designed to prevent mentally disordered patients in the community from harming themselves and others. It is one of the measures announced in the government's 10 point...

Cigarettes and addiction: regulation of tobacco products is inconsistent with their effects on health.(Editorial)
April 29, 1995... Unless the prevalence of smoking falls substantially, 0.5 billion of the world's present population will die prematurely from disease caused by tobacco.[1] Without considerable changes in the regulation of products that deliver nicotine it will...

Health checks in general practice: time to review their role.(Editorial)
April 29, 1995... The NHS has changed a lot since the late Denis Burkitt (who linked high fibre diets with preventing bowel disease) compared illness to an overflowing bath and suggested that doctors and nurses might be better employed turning off taps than...

Patients' demands for prescriptions in primary care: patients cannot take all the blame for overprescribing.(Editorial)
April 29, 1995... The Audit Commission's recent report on prescribing in general practice in England and Wales estimated that up to 275m[pounds] could be saved from the NHS drugs bill if overprescribing was reduced.[1] The report lists several overprescribed...

Evidence Based Medicine: a new journal to help doctors identify the information they need.(Editorial)
April 29, 1995... Busy doctors have never had time to read all the journals in their disciplines. There are, for example, about 20 clinical journals in adult internal medicine that report studies of direct importance to clinical practice, and in 1992 these...

GPs to be balloted on proposals for night visits.(general practitioners in the United Kingdom)
April 29, 1995... Leaders of Britain's general practitioners are to seek clarification of the government's latest proposals for restructuring out of hours services and will ballot doctors "as soon as practicable. "The ballot will go to all 32 000 principals in...

"The first thing we do, let's kill all the lawyers."(large malpractice award seen as unjustified in Australia)
April 29, 1995... A recent judgment in the New South Wales supreme court has added substantially to Australian doctors' fears that the medicolegal climate here may be going the way of America's. Last month Acting justice Spender awarded 36 year old Cecily...

Paramedics and technicians are equally successful at managing cardiac arrest outside hospital.
April 29, 1995... Abstract Objective - To examine the effect on survival of treatment by ambulance paramedics and ambulance technicians after cardiac arrest outside hospital. Design - Prospective study over two years from 1 April 1992 to 31 March 1994....

Stopping drinking and risk of oesophageal cancer.
April 29, 1995... Introduction Alcoholic beverages have been shown by many epidemiological studies to increase the risk of oesophageal cancer.[1] Largely on the basis of epidemiological findings, a working group of the International Agency for Research on...

Repeated oral vitamin K prophylaxis in West Germany: acceptance and efficacy.
April 29, 1995... Owing to concern that neonatal vitamin K prophylaxis might cause childhood cancer,[1] parenteral vitamin K prophylaxis for all newborn infants has been abandoned in the United Kingdom[2] and Germany.[3] In its place three oral doses of vitamin...

Effectiveness of health checks conducted by nurses in primary care: final results of the OXCHECK study.(Oxford and Collaborators Health Check trial)(Imperial Cancer Research Fund OXCHECK Study Group)
April 29, 1995... Abstract Objective - to determine the effectiveness of health checks, performed by nurses in primary care, in reducing risk factors for cardiovascular disease and cancer. Design - Randomised controlled trial. Setting - Five urban...

The impact of health care advice given in primary care on cardiovascular risk.
April 29, 1995... Abstract Objective - To evaluate the additional benefit of "intensive" health care advice through six group sessions, compared with the advice usually offered to subjects with multiple risk factors for cardiovascular disease. Design -...

Strategies for reducing coronary risk factors in primary care: which is most cost effective?
April 29, 1995... Abstract Objective - to examine the relative cost effectiveness of a range of screening and intervention strategies for preventing coronary heart disease primary care. Subjects - 7840 patients aged 35-64 years who were participants in a...

Managing lower urinary tract symptoms in older men.
April 29, 1995... The BMJ recently published an article on the place of transurethral resection of the prostate for benign prostatic hyperplasia in the "Controversies of Management" series.[1] Although the debate focused on the active management of benign...

Insulin dependent diabetes in nonagenarians.
April 29, 1995... The National Diabetes Data Group's definition of insulin dependent diabetes misleadingly talks of "predominant onset in youth."[1] Over 40 years ago Lawrence wrote that many diabetic patients aged over 70 were insulin deficient.[2] It has...

Impressions of health in the new South Africa: a period of convalescence.(South Africa's Health, part 1)
April 29, 1995... South Africa is a fledgling democracy. With a fair, and generally peaceful, first election in April 1994 it has shown the world that its people can make decisions that would do credit to a more mature democracy. Fears that the end of apartheid...

Evidence based medicine: an approach to clinical problem-solving.
April 29, 1995... Doctors within the NHS are confronting major changes at work. While we endeavour to improve the quality of health care, junior doctors' hours have been reduced and the emphasis on continuing medical education has increased. We are confronted by...

Evidence based medicine: Socratic dissent.
April 29, 1995... SOCRATES: Tell me, Enthusiasticus (Meta-analyticus), they say you are espousing a new form of medical practice. Is that so? ENTHUSIASTICUS: Indeed Socrates, and very effective it is. SOCRATES: Does it have a name or description?...

Rashes and vasculitis.(ABC of Rheumatology)
April 29, 1995... Many patients with rheumatological disorders either present with a rash or develop a rash in the course of the disease. This is particularly true of the connective tissue diseases and psoriasis, which have been described elsewhere in this...

Lord Adrian.(Richard Hume Adrian)(Obituary)
April 29, 1995... Richard Hume Adrian, who died after a two year fight against cancer, was the only son of E D Adrian, who had been the leading neurophysiologist of his generation. E D Adrian's work began with the electrophysiological study of peripheral nerve...

The war is over.(a Russian physician is invited to visit the United Kingdom)(Soundings)(Column)
April 29, 1995... The dinner in honour of our guest is an impromptu one. There is no special menu and only a very restrained presence of mess silver. And since anything other than lounge suits would certainly embarrass him, lounge suits it is. He is tall and...

Bloody kids.(the UK's attitude toward child welfare threatens children's health)(Soundings)(Column)
April 29, 1995... Recent protests about unpleasant veal crate practices have given government ministers and others plenty of opportunity to make disparaging remarks about southern Europe's poor attitudes to animal welfare. Yet within such self righteousness, to...

Rites of passage of a medical career.(Personal View)(Column)
April 29, 1995... This is being written on a Saturday night while on call. I have just walked down from the doctors' residence on the other side of the hospital. I first stopped by the other two wards I am covering this weekend; all was quiet, so far at least....

Continuity of care - sacred cow or vital necessity?(Personal View)(Column)
April 29, 1995... The new deal on junior doctors' hours and the recommendations of the Calman report on specialist medical training will require a radical review of working practices in hospital. Not only will juniors be working fewer hours but as a result of...

Circles of Madness.
April 29, 1995... I've been waiting so long for this bus that I should have expected 26 to come at once. The bus is a full television airing of the subject of mental illness, the 26 that have come make up BBC2's States of Mind series - a two week orgy of...

Tipping the Balance Towards Primary Health Care.
April 29, 1995... Health care in the 1970s and early 1980s was characterised by the growth of high tech hospital medicine. However, the current decade has seen the pendulum swing back towards a renewed emphasis on a strong primary health care sector. The WHO...

Evidence-Based General Practice: A Critical Reader.
April 29, 1995... Evidence based medicine is often touted by its proponents as the new paradigm in medicine, but criticised by its opponents as being hopelessly out of touch with reality and totally impractical in real life. There are some good examples of its...

Adverse Events Associated with Childhood Vaccines: Evidence Bearing on Causality.
April 29, 1995... Together with a companion volume, this book reviews possible causal relations between childhood vaccines and adverse effects. The reviews, undertaken by committees established by the United States Institute of Medicine, considered published...

Folic acid and the prevention of neural tube defects: a population strategy is needed.(Editorial)
April 22, 1995... A population strategy is needed Over three years have passed since an increase in the intake of folic acid among women planning a pregnancy was shown to prevent most neural tube defects.[1] The evidence is conclusive; prevention is effective...

Unified training grade: many rivers still to cross.(Editorial)
April 22, 1995... The report of the working party on the unified training grade[1] is the first piece of a jigsaw that will provide the picture for higher specialist training recommended in the Calman report.[2] But even after elision of the registrar and senior...

Toxoplasma and the eye: diagnosis, treatment, and prevention are all difficult.(Editorial)
April 22, 1995... Diagnosis, treatment, and prevention are all difficult The dual role of small rodents and domestic cats in the natural course of toxoplasma infection has been known for some 25 years,[1] but the nature of the interplay between the protozoan...

Radiation and women of child bearing potential: moves to revive the "10 day rule" may be premature. (restriction of routine x-ray examinations that involve pelvic irradiation to the first 10 days of the menstrual cycle)(Editorial)
April 22, 1995... Moves to revive "10 day rule" may be premature The "10 day rule" recommended that, in women of childbearing potential, non-urgent x ray examinations that entailed pelvic irradiation should be restricted to the first 10 days of the menstrual...

Should herbal medicine-like products be licensed as medicines: special licensing seems the best way forward.(Editorial)
April 22, 1995... Special herbal medicine-like products be licensed as medicines Herbal remedies form a potpourri that ranges from plants that people collect themselves and then take for health reasons to approved medicinal products. Many herbal products...

New draft on European directive on confidential data: at last, a step forward for epidemiological research.(Editorial)
April 22, 1995... At last, a step forward for epidemiological research The council of the European Union has just agreed and published a new draft of the European directive on "protection of individuals with regard to the processing of personal data and on the...

Tropical diseases move north with global warming.
April 22, 1995... Scientists who study global warming are preparing a new report on its effects, including the spread of tropical diseases northwards, particularly those borne by insects. The report will be published at the end of this year. It represents...

The French way of controlling drug costs.
April 22, 1995... As governments search for ways of reducing burgeoning health costs they should watch an experiment introduced in France last year to reduce the annual rise in public expenditure on drugs without affecting health care. The principle is to...

Health and cancer prevention: knowledge and beliefs of children and young people.
April 22, 1995... Abstract Objective - To collect information from children and young people about their knowledge of and attitudes towards cancer and their understanding of health and health related behaviours to inform future health promotion work....

Multicentre study of cancer pain and its treatment in France.
April 22, 1995... Abstract Objective - To describe the treatment of cancer pain in France and to evaluate the predictive factors for inadequate management. Design - Multicentre, representative cross sectional survey. Setting - 20 treatment centres,...

Incidence of acute symptomatic toxoplasma retinochoroiditis in south London according to country of birth.
April 22, 1995... Abstract Objective - to determine the incidence of acute symptomatic toxoplasma retinochoroiditis presenting to ophthalmologists for patients born in Britain and elsewhere. Design - population based, cross sectional study. Setting - 11...

Randomised clinical trial of ultrasound treatment for pressure ulcers.
April 22, 1995... One in four Dutch doctors and supervisory nurses in nursing homes thinks that ultrasound treatment is effective for pressure ulcers.[1] McDiarmid et al found positive results only in a subgroup of patients with infected ulcers.[2] We performed...

The wizard and the gatekeeper: of castles and contracts.(fairy tale relates how demands on medical practice cannot be met fairly)
April 22, 1995... The wizards and the gatekeepers were unhappy. There were many reasons for their unhappiness. They worked hard but felt that too much was being demanded of them. The poorly people's charter was resulting in unrealistic expectations, and changes...

NHS "indicators of success": what do they tell us?(National Health Service)(Radical Statistics Health Group)
April 22, 1995... In the absence of any systematic evaluation of the changes it has made to the NHS, the government cites three "indicators of success." These are record numbers of patients treated, shorter waiting times for hospital treatment, and more children...

Vitamin A deficiency and xerophthalmia in the United Kingdom.
April 22, 1995... Vitamin A was discovered at the turn of the century.[1] It is required for normal cellular growth and differentiation and has an important role in the visual process.[2] The effects on the eye of vitamin A deficiency are often seen in...

On a front line.(mental health services in Sarajevo)
April 22, 1995... Like the patients, doctors in Sarajevo depend largely on humanitarian aid; everyone in the public sector has worked without pay for almost three years. The hospital is on a front line; yet the psychiatric department continues to function, even...

Handling the conflicting cultures in the NHS.(National Health Service)(Management for Doctors, conclusion)
April 22, 1995... Case study: working to contract St Duncan's and St Kenneth's United Hospitals Trust, like other hospitals, is now funded by contracts which specify how much work is to be undertaken in each specialty or subspecialty. Like many hospitals in...

Correction. (to 'The number needed to treat: a clinically useful measure of treatment effect' in February 18, 1995 issue)(Correction Notice)
April 22, 1995... An authors' error occurred in this article by Richard J Cook and David L Sackett (18 February, pp 452-4). In the table the event rate for moderate hypertension in the control group should be 0.02 and not 0.2, leading to a number needed to treat...

Polymyalgia rheumatica and giant cell arteritis.(ABC of Rheumatology)
April 22, 1995... In recent years giant cell arteritis and polymyalgia rheumatica have increasingly been considered as closely related conditions. The two syndromes form a spectrum of disease and affect the same types of patient. The conditions may occur...

Should patients positive for HIV infection receive pneumococcal vaccine?
April 22, 1995... Pneumococcal vaccination effectively reduces the incidence of invasive pneumococcal disease in normal subjects. Such invasive pneumococcal disease is 100 times more common in patients with HIV infection than in healthy people, so it seems...

The way we eat now. (care and treatment of obesity)(Soundings)
April 22, 1995... The Gargantuan woman at the supermarket smiled, showing her huge unevenly spaced teeth. We were both studying cheeses - mostly valued at two to four dollars per package and some as high as 200 calories per ounce. Already her shopping cart was...

Eat, drink, and be ...? (standardization of food handling laws)(Soundings)
April 22, 1995... Should we report dodgy looking foods and food shops to the authorities? Public spiritedness surely demands that we contact the local environmental health officer whenever we spot a suspect pie, a grubby meat counter, or a chilled compartment...

The two faces of Eve. (society's view of premenstrual tension)
April 22, 1995... One of the things that especially appeals to me about general practice is the way that people continue to present me with angles on their problems that I have not met before. Sometimes this causes me to re-evaluate my own assumptions and...

Psoriasis - how we coped.
April 22, 1995... I never knew my grandfather, who came to England from Russia at the turn of the century and settled in the east end of London, working as a doll manufacturer. My mother tells me that he was so ashamed of his psoriasis that he always covered it...

Dying for a reason.
April 22, 1995... The popular image of the typical heart attack patient used to be of a middle aged, middle class man living an unhealthy life and subject to executive stress - a cross between the Chancellor of the Exchequer and Rumpole of the Bailey. This has...

An Introduction to Health: Policy, Planning and Financing.
April 22, 1995... There is a paradox confronting bio-medicine. Most informed opinion about health development relegates clinical practice to a marginal position. The engines of health development are better nutrition, education (especially of women), sanitation,...

Regulation of the Market in the National Health Service: Competition and the Common Good.
April 22, 1995... It is a sign of how far and how fast the organisational framework of the NHS is changing that this book, based on a conference held in 1993, already seems so out of date. Its concerns relate largely to the relation between health authority...

The True Cost of Conflict.
April 22, 1995... There are more regional conflicts and civil wars now, five years after the end of the cold war, than at any time this century. Since 1945, 22 million people have been killed in wars, and the proportion of civilian casualties has risen from 50%...

Qualitative Studies in Health and Medicine.
April 22, 1995... Despite their strength in mainstream medical sociology, qualitative studies have always struggled to find favour in health services research and health care evaluation. Bloor and Taraborrelli's short collection of papers fits into this...

Education and dementia: research evidence supports the concept "use it or lose it."(Editorial)
April 15, 1995... As long ago as the 2nd century BC poets and philosophers considered that an active mental life might forestall or delay the enfeeblement of old age.[1] In "De Senecute" Cicero suggested that old men preserved their intellects if they preserved...

Hospital doctors' work: managers should ensure that doctors know what is expected of them.(Editorial)
April 15, 1995... The working practice of hospital doctors is not immune from the rapid changes occurring in the NHS. Already initiatives are eroding the traditional model of the consultant led medical firm. The combined effect of Achieving a Balance,[1] the new...

Consultants of the future: need to acknowledge organisational goals and play to their strengths.(Editorial)
April 15, 1995... Few people disagree that the work of British consultants is changing rapidly. The questions revolve around how consultants should organise their work to meet a set of apparently conflicting demands on their time. Over the past four weeks we...

Tuberculosis: old reasons for a new increase?(Editorial)
April 15, 1995... Notifications of tuberculosis have increased in England and Wales over the past few years, as in other European countries and the United States.[1-3] An estimated 8000 extra cases occurred between 1982 and 1993 in England and Wales, but the 95%...

Promoting cost effective prescribing: Britain lags behind.(Editorial)
April 15, 1995... In many countries the cost effectiveness of drugs is receiving increasing attention. Rising budgets have heightened concerns about containing costs and whether resources are used efficiently.[1] The need for rigorous examination of cost...

Researchers in US dispute first case of AIDS.
April 15, 1995... American scientists claim to have uncovered flaws in research published in the Lancet in 1990 that purported to prove the world's first case of AIDS and HIV infection. Using the powerful new tools of molecular biology, scientists from the New...

Mrs Bottomley and the London lynch mob. (Britain's health secretary Virginia Bottomley and the Parliament)
April 15, 1995... Virginia Bottomley, the health secretary, now knows what it's like to fall victim to a parliamentary lynch mob. It does not happen often but when it does it is ugly and unpredictable. Sometimes the lynched minister survives, sometimes not....

Socioeconomic deprivation and notification rates for tuberculosis in London during 1982-91.
April 15, 1995... Abstract Objectives - To investigate the association between four sociodemographic measures (unemployment, overcrowding, low social class, and the proportion of migrants from areas of high prevalence of tuberculosis) and average level and...

Increasing incidence of tuberculosis in England and Wales: a study of the likely causes.
April 15, 1995... Introduction The annual notification rate of tuberculosis in England and Wales has declined steadily for over a century. It levelled in the mid-1980s and increased by 12% between 1988 (5162 notifications) and 1992 5798).[1 2] The increase...

Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study.
April 15, 1995... Abstract Objective - To estimate the prevalence of dementia and its subtypes in the general population and examine the relation of the disease to education. Design - Population based cross sectional study. Setting - Ommoord, a suburb of...

Severity of heart failure and dosage of angiotensin converting enzyme inhibitors.
April 15, 1995... Large studies have shown improved survival of patients with heart failure[1 2] and of those recovering from acute myocardial infarction[3 4] after treatment with high doses of angiotensin converting enzyme inhibitors. We studied the usage of...

Improving notification rates for tuberculosis.
April 15, 1995... Notification of cases of tuberculosis is a legal requirement to permit calculation of accurate incidence figures and efficient contact tracing. We previously found considerable undernotification of cases at our hospitals.[1] To improve the...

Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study.
April 15, 1995... Abstract Objective - To evaluate the ability of doctors in primary care to assess risk patients' risk of coronary heart disease. Design - Questionnaire survey. Setting - Continuing medical education meetings, Ontario and Quebec, Canada....

Treating myopia with the excimer laser: the present position.(review article)
April 15, 1995... Background It has been estimated that 8-10 million people in the United Kingdom suffer the inconvenience of myopia (short sightedness).[1 2] In this refractive error rays of light from a distant object entering the eye are brought to a focus...

The rhetoric of research.
April 15, 1995... A naturalist's life would be a happy one if he had only to observe and never to write. Be careful while reading this article. My purpose is to persuade. To achieve this goal I must not only appeal to your intellect and seek your sympathy...

Commentary: scientific heads are not turned by rhetoric.(response to 'The rhetoric of research' in same issue)
April 15, 1995... Dear Dr Horton, When I read a scientific paper, either for its own sake or when wearing an editorial hat, I usually drink in the introduction (to whet my appetite for the subject matter), skim the methods, eyeball the figures and tables, and...

Osteoporosis.(ABC of Rheumatology)
April 15, 1995... Osteoporosis causes considerable morbidity and mortality, and there is evidence that the burden of this condition is increasing out of proportion to the changing demographic structure of populations in Western countries. Osteoporosis may be...

Continuing medical education: a personal view.
April 15, 1995... Over many generations doctors have kept up to date in ways which reflect their own learning styles. The current fashion for formalised and policed continuing medical education may prove ineffective unless it is recognised that individual needs...

The importance of quality: sharing responsibility for improving patient care.(Management for Doctors, part 14)
April 15, 1995... In health care quality is usually understood in the context of "clinical quality" and an implicit distinction is drawn between managerial and clinical activity. The separate introduction and development of quality initiatives within the NHS has...

Three cases of anorexia nervosa.(Soundings)(Column)
April 15, 1995... She is an intelligent 18 year old who has reluctantly agreed to see me with her mother, who is consumed with anxiety over her daughter's abnormal eating habits. Alexia denies there's a problem and we arrange a new appointment alone. She is on...

A meeting too far.(doctors' role in reform of UK's National Health Service)(Personal View)(Column)
April 15, 1995... Everyone agrees that doctors should be involved in management in the reformed health service but it depends what you mean by management. Since the 1991 reorganisation there has been an enormous increase in the number of non-medical managers....

Cheating in medical school.(Personal View)(Column)
April 15, 1995... I caught a medical student cheating. It was in the easiest course in the medical school, an elective in philosophy for first year students. We discuss proofs of God's existence, whether or not we have souls, the meaning of life, and...

Outbreak.
April 15, 1995... Infectious diseases seem to affect Hollywood the same way they affect the human body. Temperatures rise, pulses race; sometimes the patient goes into a full blown septic shock and delirium sets in. Epidemic movies can be thrilling, but they are...

Doctors, Dilemmas, Decisions.
April 15, 1995... From time to time most of us feel the urge to keep a casebook. A typical general practitioner does at least 5000 consultations a year. What a treasure trove for a thoughtful author. Pickles, Balint, Byrne and Long, Huygen - all these figures...

Health Care, Health Promotion and the Future General Practice.
April 15, 1995... David Taylor and Karen Bloor are health economists at the Centre for Health Economics, University of York. The purpose of their book is to describe what determines health and ill health in the community and to discuss the part that...

Promise and Performance in Managed Care: The Prepaid Group Practice Model.
April 15, 1995... The prepaid group practice is but one of the various systems of financing and delivering health care that make up the managed care industry in the United States. Most definitions of managed care include some reference to the use of contracts...

Epilepsy and driving: British regulations have recently been eased.(Editorial)
April 8, 1995... Many countries restrict the issue of driving licences to people prone to epileptic seizures. Regulations are deemed necessary because research has repeatedly shown an increased rate of road traffic accidents (and accidental deaths) in drivers...