British Medical Journal articles from January 1998

British Medical Journal archives from January 1998

Research in support of tobacco control.(Editorial)
January 31, 1998... Enough evidence exists already for all countries to implement a strong package of measures to control tobacco consumption and its harmful effects. These include banning advertising, restricting smoking in public, taxing tobacco, and...

Measuring performance in the NHS. (United Kingdom, National Health Service)(Editorial)
January 31, 1998... Last Wednesday the government launched its consultation paper on assessing performance,[1] the latest element of its strategy to reform the NHS.[2] It proposes moving from a narrow focus on activity and financial targets to a wider view of...

Linking education, research, and service in general practice.(Editorial)
January 31, 1998... Over the past decade general practice has undergone major changes that have placed it theoretically in the forefront of a "primary care led NHS" and increasingly in the mainstream for providing undergraduate medical education.[1 2] Thus...

Research in general practice.(Editorial)
January 31, 1998... In the borderland between health, illness, and disease, general practice assumes a principal role in securing the smooth working of a complex health care system and satisfying the needs of patients, purchasers, and providers alike.[1 2]...

Chinese avian influenza: the H5N1 virus will probably not result in a pandemic.(Editorial)
January 31, 1998... Influenza viruses are unique among respiratory viruses in exhibiting "drift," which is change in surface antigens as a result of host immunological pressure. In addition, influenza A viruses exhibit "shift"--which is the genetic...

Trends in facial injury: increasing violence more than compensates for decreasing road trauma.(Editorial)
January 31, 1998... Next week 200 of Britain's oral and maxillofacial surgeons will visit secondary schools to warn pupils about the risks of facial injury from drinking and fighting and, with the help of patients, to show them the consequences of such...

Possible new test for detecting men at risk of prostate cancer.
January 31, 1998... Researchers in North America have discovered that measuring plasma concentrations of insulin-like growth factor-1 could help to identify men who are at high risk of developing prostate cancer. The research may also offer a due to explain why...

Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs.
January 31, 1998... Introduction Some topical non-steroidal drugs are available without prescription and are widely advertised for acute and chronic painful conditions. There are 20-24 million prescriptions (predominantly oral) for non-steroidal...

Epilepsy in young people: 23 year follow up of the British national child development study.
January 31, 1998... Introduction Epilepsy is a common neurological disorder in childhood[1] and can have a major impact on a child's development.[2 3] In many children the seizures remit,[4] but in others the disorder continues and may affect adult...

Unlicensed and off label drug use in paediatric wards: prospective study.
January 31, 1998... Introduction Many drugs used to treat children in hospital are either not licensed for use in children (unlicensed) or are being prescribed outside the terms of the product licence (off label prescribing).[1 2] There is considerable...

Clinical experience, performance in final examinations, and learning style in medical students: prospective study.
January 31, 1998... Introduction "To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all." Sir William Osler[1] Medical training--and...

Home sampling versus conventional contact tracing for detecting Chlamydia trachomatis infection in male partners of infected women: randomised study.
January 31, 1998... Urogenital infections with Chlamydia trachomatis are widespread and usually asymptomatic. Major complications from infection include ectopic pregnancies and female infertility.[1] Although contact tracing reduces the prevalence of chlamydia...

Opportunistic screening for chlamydial infection at time of cervical smear testing in general practice: prevalence study.
January 31, 1998... Genital infection with Chlamydia trachomatis is the most common, curable sexually transmitted disease in England and Wales.[1] In the United States and Sweden screening programmes have been shown to be effective in reducing the prevalence both...

Management of suspected myocardial infarction before admission: updated audit.
January 31, 1998... Although the timing of aspirin administration is not as critical as thrombolytic treatment in patients with suspected acute myocardial infarction, aspirin should be given as soon as possible after the onset of symptoms.[1 2] We reported a low...

Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy.
January 31, 1998... Introduction There are many accepted standard forms of conservative treatment for shoulder disorders, including non-steroidal anti-inflammatory drugs, corticosteroid injections, and physiotherapy, yet evidence of their efficacy is not...

What is a patient preference trial? (Understanding Controlled Trials, part 3)
January 31, 1998... A common problem in randomised controlled trials arises when patients (or their clinicians) have such strong treatment preferences that they refuse randomisation.[1] The absence of these patients from trials may restrict generalisation of the...

General practitioners' perceptions of the route to evidence based medicine: a questionnaire survey.
January 31, 1998... Introduction Evidence based medicine is being promoted in general practice as throughout the NHS. General practitioners can attend workshops on how to practice and teach it, research networks promote its use, the Cochrane Library has an...

Physicians' attitude toward evidence based obstetric practice: a questionnaire survey.
January 31, 1998... Evidence based medicine integrates the best available data from clinical research into clinical practice to enhance the quality of clinical decisions and achieve the best possible outcome.[1 2] With a lack of awareness of relevant research, a...

Netlines. (online sources of medical information)
January 31, 1998... Office of Alternative Medicine * Many conventional doctors are sceptical of alternative medicine, so it is perhaps surprising to see that the American government's National Institutes of Health host an Office of Alternative Medicine...

Diagnosis and treatment of Meniere's disease. (Fortnightly Review)
January 31, 1998... In 1861 Prosper Meniere described a syndrome characterised by deafness, tinnitus, and episodic vertigo. Contrary to the thinking at that time, he correctly thought that the condition was a disorder of the inner ear.[1] In 1938 the principal...

Care in the community. (ABC of Palliative Care)
January 31, 1998... The physical complexities of progressive and life threatening disease, coupled with attendant emotional and psychological consequences, demand careful coordination between primary, secondary, and tertiary care. Across the whole range of health...

Challenging times for specialist services.(The New NHS: Commentaries on the White paper. From Specialist Services to Special Groups. (United Kingdom, National Health Service))
January 31, 1998... The white paper focuses to a large extent on dismantling the internal market and the development of primary care. The provision of specialist services--which investigate and treat the bulk of serious ill health--get scant mention, despite their...

Involving clinical professionals in managing and planning services.(The New NHS: Commentaries on the White paper. From Specialist Services to Special Groups. (United Kingdom, National Health Service))
January 31, 1998... A change of government should bring a new and fresh approach to the problems of the NHS, which in turn will invigorate the service and go some way towards correcting the inequities of the past. It is in this spirit that the new white paper on...

Meeting the needs of black and minority ethnic groups.(The New NHS: Commentaries on the White paper. From Specialist Services to Special Groups. (United Kingdom, National Health Service))
January 31, 1998... The first paragraph of The New NHS highlights the government's commitment to reduce health inequalities. Access to health services is to be based on "need and need alone." The white paper explicitly notes the importance of addressing variation...

Staff in the NHS.(The New NHS: Commentaries on the White paper. From Specialist Services to Special Groups. (United Kingdom, National Health Service))
January 31, 1998... Concerns about the well being of staff in the NHS are nothing new. Many have blamed the organisation of the NHS in the past decade, especially the purchaser-provider split, and the underfunding of the service. The white paper outlines...

How much of the relation between population mortality and unequal distribution of income is a statistical artefact?
January 31, 1998... The absolute income hypothesis--that holding other factors constant, the higher an individual's income the better is their health--is supported by a considerable body of evidence.[1-3] However, according to the more recent relative income...

Global health, global learning. (Continuing Medical Education, part 2)
January 31, 1998... CME--continuing medical education--has become an international discipline. Defined as any and all ways by which doctors learn after the formal completion of their training,[1] CME is being shaped by several forces. Foremost among these are the...

I lost my breast but is anyone to blame? (Personal View)
January 31, 1998... I often wonder why people cannot accept the risks in life. Please don't get me wrong; I do believe that medical negligence should be exposed and punished. Its just that I also feel that, all too often, patients and their relatives look to blame...

Antenatal HIV testing: has been done badly in Britain and needs to improve.(Editorial)
January 24, 1998... The advantages of ascertaining a pregnant woman's HIV positive status before delivery are clear: transmission to the baby can be roughly halved by avoiding breast feeding[1] and reduced by a further two thirds by the administration of...

Reducing road traffic: would improve quality of life as well as preventing injury.(Editorial)
January 24, 1998... On a balmy summer afternoon in London in 1896 Bridget Driscoll stepped off the kerb and into history as the first person to be killed by a car in Britain. At her inquest the coroner said he hoped such a thing would never happen again. Over...

Is clinical effectiveness a management issue?(Editorial)
January 24, 1998... Action on clinical effectiveness is showing that success in implementing evidence based practice is achieved only when there are real local partnerships between clinicians and managers. The challenge is not to turn clinicians into managers...

Steroids and depression: glucocorticoid steroids affect behavior and mood.(Editorial)
January 24, 1998... Adrenal steroids are commonly prescribed drugs, the central effects of which are rarely alluded to in routine clinical practice or systematically investigated in medical research. Glucocorticoids are important in the pathogenesis of...

Continuing medical education: needs to be more effective, accountable, and responsive to all stakeholders in health.(Editorial)
January 24, 1998... Medical education is unfit for the millennium. Professional conservatism, inertia, and poor leadership have left it struggling to cope with rapidly changing health care systems. Those universities that have adopted new educational programmes...

US scientists extend the life of human cells.
January 24, 1998... Scientists in the United States have significantly extended the life span of cultured human cells, with no sign of abnormalities, by adding an enzyme called telomerase. The work has sparked widespread excitement, leading some to believe that...

A crusader with a sense of humor. (George Alberti, president of Royal College of Physicians in London, UK)
January 24, 1998... In his first year as president of the Royal College of Physicians of London, George Alberti is on a crusade of reform. Kamran Abbasi spoke to him The Royal College of Physicians of London has been criticised for being stuck in the 19th...

Epidemiology and detection of HIV-1 among pregnant women in the United Kingdom: results from national surveillance 1988-96.
January 24, 1998... Introduction Information about infection with human immunodeficiency virus among pregnant women is important for public health, obstetrics, and paediatrics. Time trends in maternal prevalence reflect the general prevalence of HIV...

Factors affecting uptake of antenatal HIV testing in London: results of a multicentre study.
January 24, 1998... Introduction Antiretroviral therapy[1] and avoidance of breastfeeding' can reduce the risk of mother to child transmission of HIV from 25-30% to 5-8%.[3 4] In the United Kingdom, women who know their HIV status are increasingly taking...

Uptake and acceptability of antenatal HIV testing: randomised controlled trial of different methods of offering the test.
January 24, 1998... Introduction With increasing optimism about the benefits of antenatal HIV testing in terms of measures that can greatly reduce the chance of the baby being infected,[1 3] there is a demand for effective, acceptable programmes of testing...

Review of uptake of interventions to reduce mother to child transmission of HIV by women aware of their HIV status.
January 24, 1998... Introduction The Paediatric AIDS Clinical Trials Group published the results of their ACTG 076 study of zidovudine (AZT) versus placebo for prevention of vertical transmission of HIV in 1994, and use of zidovudine in pregnancy was...

Antenatal HIV testing: current problems, future solutions: survey of uptake in one London hospital.
January 24, 1998... Pregnant women attending Guy's and St Thomas's Hospitals Trust have one of the highest prevalence rates for HIV-1 in inner London (0.53% in 1996).[1] In 1992 we showed that this was associated with African ethnic origin.[2] However, despite the...

Late diagnosis of paediatric infection in south west London.
January 24, 1998... The family clinic at St George's Hospital provides care for HIV positive children throughout south west London. We are increasingly concerned about the late presentation of many children. This is particularly worrying because in 1992 the...

Does uptake of antenatal HIV testing depend on the individual midwife? Cross sectional study.
January 24, 1998... The risk of vertical transmission of HIV infection can be reduced by at least two thirds with perinatal interventions, including antiretroviral treatment and abstention from breastfeeding.[1] The Department of Health recommends offering HIV...

Questionnaire survey of thrombolytic treatment in accident and emergency departments in the United Kingdom.
January 24, 1998... Numerous randomised trials have shown that thrombolytic treatment reduces mortality from acute myocardial infarction irrespective of the patients age, sex, blood pressure, and previous history of myocardial infarction or diabetes.[1] Maximum...

Prospective comparative study of culture specimens and methods in diagnosing influenza in adults.
January 24, 1998... Influenza is diagnosed by culturing influenza virus in respiratory secretions.[1] Although childhood infection with respiratory syncytial virus is detected by culturing nasopharyngeal aspirates, in adults with influenza throat swabs are...

Recognising meningococcal disease in primary care: qualitative study of how general practitioners process clinical and contextual information.
January 24, 1998... Introduction Current knowledge on the presentation of meningococcal disease has been defined largely from the results of studies based in hospitals, where the disease is seen at a late stage.[1-8] General practitioners encounter...

Treatment of myocardial infarction. (Recent Advances)
January 24, 1998... Coronary artery occlusion is responsible for 180 000 admissions to hospital each year in the United Kingdom. Vessel obstruction is commonly caused by the formation of a thrombus, and timely treatment with thrombolytic drugs such as...

What are pragmatic trials?(Methods of Randomised Controlled Trials, part 2)
January 24, 1998... Trials of healthcare interventions are often described as either explanatory or pragmatic. Explanatory trials generally measure efficacy--the benefit a treatment produces under ideal conditions, often using carefully defined subjects in a...

Non-malignant conditions. (ABC of Palliative Care)
January 24, 1998... Much medical practice is still concerned with control of symptoms rather than cure, and doctors spend considerable time palliating and modifying symptoms associated with incurable disease. The role of specialists in palliative medicine is...

From exceptionalism to normalisation: a reappraisal of attitudes and practice around HIV testing.
January 24, 1998... Since recognition of the first cases in 1981, AIDS has been handled differently from other infectious diseases. Recently, therapeutic interventions that influence the clinical course and perinatal transmission of human immunodeficiency virus...

HIV testing and HIV prevention in Sweden.
January 24, 1998... HIV testing is central to Sweden's programme of preventing the spread of HIV infection. It has been widely promoted and encouraged on the grounds that once HIV infected people are aware of their serostatus and receive appropriate counselling,...

Commentary: promoting testing is no substitute for recognising risk.
January 24, 1998... Given the continuing transmission of HIV infection in western Europe, preventing new infections and mitigating the effects of infections that have already occurred are major public health priorities. Testing blood donations for HIV has an...

Counting and accounting in the new NHS.(The New NHS: Commentaries on the White Paper. Encouraging Responsibility: Different Paths to Accountability (United Kingdom, National Health Service))
January 24, 1998... The new Labour government came into power in May 1997 intent on abolishing the market in health care, correcting inequities in provision, and improving public input into the planning of services. To what extent does the new white paper achieve...

Clinical governance: fine words or action?(The New NHS: commentaries on the WHite Paper. Encouraging Responsibility: different paths to accountability. (United Kingdom, National Health Service))
January 24, 1998... The current purchaser efficiency index has resulted in perverse incentives and a distortion of clinical priorities.[1] In the name of increased efficiency, cost saving measures have been rewarded while few attempts have been made to assess the...

Will improved clinical information help realise the new NHS?(The New NHS: commentaries on the WHite Paper. Encouraging Responsibility: different paths to accountability. (United Kingdom, National Health Service))
January 24, 1998... In 1995 the Audit Commission urged the NHS to revise its information systems, changing their goal from managing financial data to improving clinical information.[1] In his foreword to the white paper Tony Blair promises "a new NHS information...

Guidelines and quality of clinical services in the new NHS.(The New NHS: commentaries on the WHite Paper. Encouraging Responsibility: different paths to accountability. (United Kingdom, National Health Service))
January 24, 1998... The English white paper emphasises the importance of national leadership by the Department of Health and the NHS Executive (including the regional offices) in supporting local developments. The NHS Executive will be charged with ensuring that...

From health care to health.(The New NHS: commentaries on the WHite Paper. Encouraging Responsibility: different paths to accountability. (United Kingdom, National Health Service))
January 24, 1998... Health is not merely the absence of disease; nor is the role of the NHS only within health care. This message is made very clearly on the first page of the white paper, with the vision of "an NHS that does not just treat people when they are...

Changes in health care and continuing medical education for the 21st century.(Continuing Medical Education, part 1)
January 24, 1998... Major trends in health care A revolution in health care is occurring as a result of changes in the practice of medicine and in society. These include changing demographics and the pattern of disease; new technologies; changes in health...

Correction. (to 'Competition: What might an online scientific paper look like in five years' time?' in December 20, 1997 issue)(Correction Notice)
January 24, 1998... Readers may have spotted and been confused by our deliberate mistake in asking for your predictions of what an outline scientific paper will look like in five years' time (20-27 December, p 1696). We mean, of course, an online scientific paper,...

Why we chose a medical career. (Personal View)
January 24, 1998... "Your baby is suffering from a genetic skin disorder, her skin is too fragile, she'll probably not make it over the next few days." Shock and bewilderment summed up our family's emotions. Now, 10 years later, although not cured, our niece Myra...

Cancer's killing fields. (Medicine and the Media)
January 24, 1998... Nazi scientists working sinisterly in dark laboratories; a whole town suffering the harsh discipline of the Third Reich; the triumphant Allies showering gifts on liberated townsfolk. It might sound like the storyline from a second world war...

New Themes in Palliative Care.
January 24, 1998... Ed David Clark, Jo Hockley, Sam Ahmedzai Open University Press, 15.99 [pounds sterling], pp, 306 ISBN 0 335 19605 5 When I qualified, in the mid-1970s, teaching of symptom control and care of dying patients usually consisted of a lecture in...

Making Palliative Care Better.
January 24, 1998... M Glickman National Council for Hospice and Specialist Palliative Care Services ISBN 1 898915 13 X When I qualified, in the mid-1970s, teaching of symptom control and care of dying patients usually consisted of a lecture in the pharmacology...

Intelligence, Heredity, and Environment.
January 24, 1998... Ed Robert J Sternberg, Elena Grigorenko Cambridge University Press 24.95 [pounds sterling], pp 608 ISBN 0 521 46904 X Few scientific discussions generate so much heat as those regarding intelligence. Argument rages as to whether there is a...

Neonatal vitamin K prophylaxis: the Gordian knot still awaits untying. (do vitamin K injections for newborns cause childhood cancer?)
January 17, 1998... Since 1990 the issue has remained unresolved of whether prophylactic vitamin K, given to newborn infants to prevent bleeding, causes childhood cancer. Four more studies appear in this week's issue. Do they finally conclude the vitamin K and...

The management of H. pylori infection: most straightforward cases can be managed in primary care with eradication treatment.
January 17, 1998... Helicobacter pylori is the single most important pathogen in peptic ulcer disease since its eradication leads to cure.[1] As a result, a National Institutes of Health consensus meeting in 1994 recommended giving anti-H pylori treatment to...

Health action zones. (a way to reduce inequalities in health care)
January 17, 1998... Reducing inequalities in health and moving away from the competitive market in health care are both important elements of government policy. Health action zones, mentioned in last month's white paper[1] but announced beforehand, are one...

Distinction awards and racial discrimination.
January 17, 1998... Distinction awards are as old as the NHS. They were established in 1948 to reward specialists for "more than ordinary ability and effort"[1] by increasing their salaries, and this aim has remained essentially unchanged. Any system that tries...

Is measles infection associated with Crohn's disease?
January 17, 1998... The cause of Crohn's disease is likely to be multifactorial, and great interest was generated by two Swedish studies suggesting a high risk of Crohn's disease in those exposed to measles in utero.[1 2] The report in this week's issue from...

US scientist plans human cloning clinic.
January 17, 1998... A Chicago scientist plans to open a human cloning clinic within the year and hopes to produce the first human clone within 18 months. The scientist. Richard Seed, wants to offer the procedure to infertile couples. Dr Seed holds a doctorate...

Case-control study of childhood leukaemia and cancer in Scotland: findings for neonatal intramuscular vitamin K.
January 17, 1998... Introduction The issue of whether the prophylactic administration of intramuscular vitamin K to neonates increases the risk of childhood cancer continues to be of importance both clinically and in the public health arena. Prophylactic...

Case-control studies of relation between childhood cancer and neonatal vitamin K administration.
January 17, 1998... Introduction In the early 1990s Golding et al published two studies suggesting a link between intramuscular vitamin K (usually Konakion) given to babies for the prevention of vitamin K deficiency bleeding and subsequent childhood...

Ecological studies of relation between hospital policies on neonatal vitamin K administration and subsequent occurrence of childhood cancer.
January 17, 1998... Introduction Research carried out after the publication of papers by Golding et al, which reported a possible doubling of risk of childhood cancer after the administration of intramuscular vitamin K,[1 2] has suggested that the risk, if...

Neonatal vitamin K administration and childhood cancer in the north of England: retrospective case-control study.
January 17, 1998... Introduction Recent studies[1-5] have been interpreted[6] as providing no support for Professor Golding's suggestion that neonatal intramuscular administration of vitamin K is associated with a subsequently increased risk of childhood...

Racial discrimination in the allocation of distinction awards? Analysis of list of award holders by type of award, specialty and region.
January 17, 1998... There has been much concern about the possibility of discrimination in the allocation of distinction awards to consultants. The aim of this study was to assess whether there is any disparity between white and non-White consultants in the...

Association between use of a quilt and sudden infant death syndrome: case-control study.
January 17, 1998... The relation between an infant's sleeping environment and development of the sudden infant death syndrome depends on the infant's sleep position.[1] We report how the association between the use of a quilt and the syndrome depends on sleep...

Correction. (to 'Comparison of blood or urine testing by patients with newly diagnosed non-insulin dependent diabetes: patient survey after randomised crossover trial' in August 9, 1997 issue)(Correction Notice)
January 17, 1998... Comparison of blood or urine testing by patients with newly diagnosed non-insulin dependent diabetes: patient survey after randomised crossover trial An error occurred in this paper by Pat Miles and colleagues (9 August 1997, pp 348-9). The...

Exposure to measles in utero and Crohn's disease: Danish register study.
January 17, 1998... It has been suggested that people exposed to measles in utero may be at high risk of developing Crohn's disease in adulthood.[1 2] Swedish investigators have reported an increased incidence of Crohn's disease in individuals born shortly after a...

Relation between sexual abuse in childhood and adult depression: case-control study.
January 17, 1998... Introduction Research into the psychosocial consequences of sexual abuse in childhood has focused mainly on disturbances that arise shortly after the abusive experience. Long term effects have proved more difficult to investigate. The...

Why are randomised controlled trials important?
January 17, 1998... Randomised controlled trials are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment. They have several important features: *...

Aggressive behavior in childhood. (Fortnightly Review)
January 17, 1998... Increasing numbers of children who behave in a defiant and aggressive way are being excluded from school. Outside school the victims of these children's aggression have included young children and elderly people. At the extreme, two children...

Emergence of classic enteropathy after longstanding gluten sensitive oral ulceration.
January 17, 1998... The mechanisms responsible for recurrent oral ulcers have yet to be defined. Oral ulcers occur in several conditions, including connective tissue disease, viral infections, and gastrointestinal disorders such as inflammatory bowel disease and...

The carers. (ABC of Palliative Care)
January 17, 1998... In general, most of the final year of life is spent at home, although 90% of patients spend some time in hospital and about 55% of all deaths occur there. The burdens and rewards of caring for people in their last year of life are shared...

Financing the NHS.(The New NHS: Commentaries on the White Paper - from Command Economy to Demand Management. (United Kingdom. National Health Service))
January 17, 1998... The white paper sets out a bold and imaginative vision for the organisation and provision of health care. The unanswered question is whether the money will be available to turn this vision into reality. Taking the optimistic view--the view...

A third way? England - yes; Scotland - maybe.(The New NHS: Commentaries on the White Paper - from Command Economy to Demand Management. (United Kingdom. National Health Service))
January 17, 1998... Much of the comment on the white paper so far has ignored general intention and focused on details of employment, cash flow, and management-or rather the lack of them. Little is being said about the government's bold attempt to construct "a...