British Medical Journal articles from July 1998

British Medical Journal archives from July 1998

Excess mortality after human albumin administration in critically ill patients: clinical and pathophysiological evidence suggests albumin is harmful.(Editorial)
July 25, 1998... Clinical and pathophysiological evidence suggests albumin is harmful Albumin is a medium weight colloid which plays an essential role in generating the colloidosmotic pressure. It facilitates fluid retention in the intravascular space....

A generous birthday present to the NHS. (United Kingdom, National Health Service)(Editorial)
July 25, 1998... But spending it wisely may be difficult New Labour has paid its tribute to the one symbol of Old Labour's achievements that has stood the test of time. The British government's 50th birthday present to the National Health Service has, at...

Evidence based patient information is important, so there needs to be a national strategy to ensure it.(Editorial)
July 25, 1998... Is important, so there needs to be a national strategy to ensure it Leaflets and other information packages (video and audio tapes, computer programs, and websites) have long been seen as integral to educational strategies designed to...

Intravenous Beta blockade in acute myocardial infarction should be used in combination with thrombolysis.(Editorial)
July 25, 1998... Should be used in combination with thrombolysis In the 1980s two large randomised controlled trials showed a reduction in early mortality when intravenous [Beta] blockers were given acutely to patients presenting with suspected myocardial...

Objective measures and the diagnosis of asthma: we need a simple diagnostic test - but don't yet have one.(Editorial)
July 25, 1998... We need a simple diagnostic test-but don't yet have one Diseases represent extremes of continuously distributed characteristics, and defining exactly where and why in that distribution normality ends and disease begins may be difficult....

Brundtland replaces top staff at the WHO. (World Health Organization)(News)
July 25, 1998... The World Health Organisation's top staff has been replaced by an entirely new team. The announcement came on 21 July--the day Dr Gro Harlem Brundtland, former prime minister of Norway, assumed office as the WHO's new director general. ...

NHS gets more cash to modernise. (United Kingdom, National Health Service)(News)
July 25, 1998... The health services in Britain broadly welcomed the Labour government's increased, funding plans for the next three years, announced last week. Even though they may prove less generous than at first sight, they will underwrite many innovations...

The new 'nation's doctor' may find it lonely at the top.(News)
July 25, 1998... The new chief medical officer for England, Professor Liam Donaldson, who will take up his post in September, tells Hilary Bower that he wants to put quality at the top of the agenda Professor Liam Donaldson could not have arranged a better...

Human albumin administration in critically ill patients: systematic review of randomised controlled trials. (Includes commentary.)
July 25, 1998... Introduction In patients with acute and chronic illness serum albumin concentration is inversely related to risk of death. A systematic review of cohort studies meeting specified criteria estimated that for each 2.5 g/l decrement in...

Reduced fetal growth rate and increased risk of death from ischaemic heart disease: cohort study of 15,000 Swedish men and women born 1915-29.
July 25, 1998... Introduction In 1989 the first of a series of papers was published from a cohort study of men and women born in Hertfordshire in the 1920s and 1930s which suggested that cardiovascular disease, ischaemic heart disease in particular, was...

Deprivation and emergency admissions for cancers of colorectum, lung, and breast in south east England: ecological study.
July 25, 1998... Introduction Associations between social deprivation and cancer survival have been reported for many cancers.[1-4] For most cancers, stage at presentation remains the single most important source of variation in outcome, and early...

Mortality in people taking selegeline: observational study.
July 25, 1998... Introduction The Parkinson's Disease Research Group trial of drug treatments for Parkinson's disease began in 1985 following earlier indications of a beneficial effect of selegiline. The trial included 822 patients with early...

Inequality among men in standardised years of potential life lost, 1970-93.
July 25, 1998... Information was published last year about the social class distribution of premature deaths in England and Wales during 1991-3.[1] We analysed these deaths in terms of standardised years of potential life lost, a measure that takes account of...

Evaluation of total purchasing pilots in England and Scotland and implications for primary care groups in England: personal interviews and analysis of routine data.
July 25, 1998... Introduction The NHS Executive's initiative on total purchasing provided an opportunity for volunteer fundholding general practices throughout Britain to receive a delegated budget from their local health authority to purchase...

Patients' priorities.(Primary Care: Core Values, part 6.)
July 25, 1998... How to run a 24 hour system of general practice has been a bone of contention between general practitioners and the public in recent years.[1 2] Doctors are loath to continue doing their own on-call work at nights and weekends.[5 4] Patients,...

How risks of breast cancer and benefits of screening are communicated to women: analysis of 58 pamphlets.
July 25, 1998... Informed participation in population based screening programmes requires an explicit sharing of information about risks and benefits? However, many factors influence perceptions of risk and the value of risk reduction promised through...

Evaluation of readability and accuracy of information leaflets in general practice for patients with asthma.
July 25, 1998... Printed education materials are often used to augment healthcare professionals' verbal information to patients. Asthma is one of the commonest chronic diseases managed in general practice, and many leaflets have been produced on its diagnosis,...

Helping an obese patient make informed choices.(Clinical Review)
July 25, 1998... Not long ago, a patient, whom I will call Mrs Bariatrico, asked me to prescribe a diet pill for her. Mrs Bariatrico is a middle class woman aged 48 years. She is 1.6 m tall and weighs 77,2 kg. Her body mass index is 30.2 and her waist to hip...

A foodborne outbreak of organophosphate poisoning.(Lesson of the Week)
July 25, 1998... Indiscriminate use of organophosphates without public education on safety increases the potential threat of foodborne outbreaks of poisoning Foodborne diseases have a major impact on public health. Early and correct identification of the...

Provision of syringes: the cutting edge of harm reduction in prison?
July 25, 1998... When, in the summer of 1994, a pilot project on prevention of drug use and transmission of HIV was launched in Hindelbank, a Swiss prison for women, not many outsiders paid attention to it. Yet only a few months later, the prison director...

Barriers and bridges to evidence based clinical practice.(Getting Research Findings into Practice, part 4.)
July 25, 1998... Clinicians and healthcare planners who want to improve the quality and efficiency of healthcare services will find help in research evidence. This evidence is increasingly accessible through information services that combine high quality...

OCD - the answer to the ultimate question? (obsessive compulsive disorder)(Personal View)
July 25, 1998... Looking back, it must all have started at the age of 14 while I was at boarding school. I know this because I stopped writing my diary. The thoughts I was having were too painful or embarrassing to put down on paper, even in private. ...

Our NHS: A Celebration of 50 Years.
July 25, 1998... Ed Gordon Macpherson BMJ Books, 25 [pounds sterling], pp 227 ISBN 0 7279 1279 8 As an interested and largely admiring observer of the NHS, I have been perplexed by two aspects of its history. First, why are there so many audits, commissions,...

Assisted Reproductive Technologies: Analysis and Recommendations for Public Policy.
July 25, 1998... New York State Task Force on Life and the Law, $12, pp 474 ISBN 1 881268 03 9 This report is a well referenced synthesis of many perspectives, which presents the views of some religions, doctors, infertile patients, and the courts, within...

Fears over radiotherapy fractionation regimens in breast cancer: proposed UK trial needs to define techniques as well as numbers of treatments.(Editorial)
July 18, 1998... Proposed UK trial needs to define techniques as well as numbers of treatments In the early 1920s Regaud discovered the benefits of radiation treatment fractionation--that is, splitting the dose into several treatments over several...

A national target for reducing suicide: important for mental health strategy as well as for suicide prevention.(Editorial)
July 18, 1998... Important for mental health strategy as well as for suicide prevention The mental health target in the green paper Our Healthier Nation is "to reduce the death rate from suicide and undetermined injury by at least a further sixth (17%) by...

Capital charges: a tax on the NHS. (United Kingdom, National Health Service)(Editorial)
July 18, 1998... Worse may follow as NHS assets are privatised Under the new national framework for assessing performance in the NHS trusts will be compared partly on the basis of their costs per unit of care and of the productivity of capital estate.[1]...

Vaccination and its adverse effects: real or perceived.(Editorial)
July 18, 1998... Society should think about means of linking exposure to potential long-term effect Vaccines have been spuriously linked to sudden infant death syndrome,[1] paediatric asthma,[2] autism,[3] inflammatory bowel disease,[4] and permanent...

Chiropractic for low back pain: we don't know whether it does more good than harm.(Editorial)
July 18, 1998... Chiropractic includes various techniques used in the hope of correcting vertebral disc displacements, freeing spinal joint adhesion, inhibiting nociceptive impulses, or correcting spinal misalignment. Several national guidelines on the...

Correction. (to 'Getting evidence into practice,' in July 4, 1998 issue)(Correction Notice)
July 18, 1998... Getting evidence into practice An error occurred in this editorial by Fiona Godlee (4 July, p 6). Gina Radford was wrongly described as director of the National Institute for Clinical Excellence. She is head of the public health...

Latest studies fail to show that tamoxifen prevents breast cancer.
July 18, 1998... Attempts to map out the role of tamoxifen for the prevention of breast cancer were set back last week when two new European studies failed to show that prophylactic treatment is beneficial in high risk women. These latest findings...

Where now for AIDS vaccines?
July 18, 1998... The recent announcement that a promising vaccine, when tested in monkeys, caused AIDS rather than prevented it has produced a mixed reaction in the scientific community, writes Scott Gottlieb. Some leading researchers were critical of...

A new chairman for the BMA. (British Medical Association)
July 18, 1998... His idol is Sir James Cameron, one of the architects of the 1966 family doctors' charter. Like him, Dr Ian Bogle was chairman of the BMA's General Medical Services Committee before being elected as the chairman of the council. He talks to...

Survival in treated hypertension: follow up study after two decades.
July 18, 1998... Introduction Treatment of hypertension prolongs life and prevents or delays congestive heart failure and nephrosclerosis and reduces the incidence of stroke.[1-5] Antihypertensive treatment has, however, been less effective in...

Assessing priorities for allocation of donor liver grafts: survey of public and clinicians.
July 18, 1998... Introduction The number of patients being referred and accepted for liver transplantation is increasing. Thus, in the United Kingdom at the end of each year the number of patients waiting for a graft has increased from 83 in 1992 to 193...

Risk factors for development of sexually abusive behaviour in sexually victimised adolescent boys: cross sectional study.
July 18, 1998... Introduction A substantial proportion of both boys and girls are sexually abused during childhood. Prevalence figures vary (boys: 3% to 37%; girls: 6% to 62%),[1 2] but even the most conservative estimates indicate this to be an...

Facial structure in the sudden infant death syndrome: case-control study.
July 18, 1998... The cause of the sudden infant death syndrome is unclear. Polygraphic recordings of 30 infants who subsequently died of the syndrome showed a significant increase in mixed and obstructive apnoeas compared with well matched controls.[1]...

Disease activity and risk of lymphoma in patients with rheumatoid arthritis: nested case-control study.
July 18, 1998... Inflammatory diseases such as rheumatoid arthritis and their treatment may have a pathogenic relation with cancer. The possible relation also has practical implications for the care and control of rheumatic patients. Patients with...

Population based randomised study of uptake and yield of screening by flexible sigmoidoscopy compared with screening by faecal occult blood testing.
July 18, 1998... Introduction Colorectal cancer is the second highest cause of death from cancer in England and Wales.[1] Recent evidence suggests that removal of neoplastic lesions at sigmoidoscopy can reduce the incidence of and mortality from distal...

Correction. (to 'Depression as a risk factor for ischaemic heart disease in men: population based case-control study" in June 6, 1998 issue)
July 18, 1998... Depression as a risk factor for ischaemic heart disease in men: population based case-control study Two errors occurred in this article by Julia Hippisley-Cox and colleagues (6 June, pp 1714-9). The fourth sentence of the results in the...

Primary care in an imperfect market.(Primary Care: Core Values, part 5)
July 18, 1998... This is the fifth in a series of six articles reflecting on the core values that will underpin the development of primary care Doctors generally disdain the word "market" when it is applied to the work they do. A market is an encounter...

Temperomandibular disorders: a clinical update.(Fortnightly Review)
July 18, 1998... Temporomandibular disorders is a collective term used to describe a number of related disorders affecting the temporomandibular joints, masticatory muscles, and associated structures, all of which have common symptoms such as pain and limited...

We should strive to keep patients alive.(Does Palliative Care Have a Role in Treatment of Anorexia Nervosa?)
July 18, 1998... Controversies in management Does palliative care have a role in treatment of anorexia nervosa? A recent report in a palliative care journal described a patient with longstanding and severe anorexia nervosa who was transferred...

Palliative care does not mean giving up.(Does Palliative Care Have a Role in Treatment of Anorexia Nervosa?)
July 18, 1998... The World Health Organisation defines palliative care as: "The active total care of patients whose disease is not responsive to curative treatment Control of pain, of other symptoms and of psychological, social and spiritual problems is...

Has health economics lost its way?(Personal Paper)
July 18, 1998... Until recently, medicine was fairly straightforward. The doctor had limited therapeutic options, patients did as they were told, and mortality was an unequivocal outcome. Now medicine has become health care, an amalgam of psychology,...

Finding information on clinical effectiveness.(Getting Research Findings into Practice, part 3.)
July 18, 1998... This is the third in a series of eight articles analysing the gap between research and practice There is increasing pressure on healthcare professionals to ensure that their practice is based on evidence from good quality research, such as...

The death of a footballer, equality, and medicine.(Personal View)
July 18, 1998... Doctors deal with death and inequality every day, yet attitudes persist within the medical profession that may contribute to both of these. The death of the football player, Justin Fashanu, was reported in an uncharacteristically...

Pulmonary embolism: hospitals should develop their own strategies for diagnosis and management.(Editorial)
July 11, 1998... The management of suspected pulmonary embolism is a subject in which consensus has been difficult to achieve due to the lack of firm evidence.[1] Against this background, the British Thoracic Society has suggested a "practical approach to...

Vitamin B-6: food or medicine?(Editorial)
July 11, 1998... The rules--and the politics--are different The recent spat between the House of Commons Agriculture Select Committee and the government's Food Advisory Committee about vitamin B-6 was inevitable.[1] The problem started in June 1997 when...

Improving the management of soft tissue sarcoma.(Editorial)
July 11, 1998... Diagnosis and treatment should be given in specialist centres "Musculoskeletal sarcomas comprise 1% of all malignancies and have traditionally been associated with a poor prognosis. However, the past two decades have shown a dramatic...

Bournewood: an indefensible gap in mental health law.(Editorial)
July 11, 1998... Capacity is set to become a major clinicolegal issue In December 1997 the Court of Appeal ruled that it was unlawful to admit an autistic adult to a psychiatric hospital on an informal basis when the patient lacked the capacity to take...

Quality to the fore in health policy - at last.(Editorial)
July 11, 1998... But the NHS mustn't encourage quality improvement with punitive approaches In its own words, the consultation document on quality in the English NHS sets out a formidable agenda for change. Nevertheless, it constitutes a major advance,...

Government gives details of quality drive in the NHS in England. (National Health Service)
July 11, 1998... Details of two new quangos to be superimposed on the NHS in England--one to set clinical standards, the other to enforce them--are given in a government green paper, A First Class Service: Quality in the New NHS, issued last week for...

Amyloid clearly implicated in Alzheimer's disease.
July 11, 1998... The role of amyloid in Alzheimer's disease looks destined to rise from bit part to lead player with the publication of three papers in the July edition of Nature Medicine. Scientists from three centres have found new evidence that dearly...

Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost.
July 11, 1998... Introduction The use of preformed mesh to repair inguinal hernias is gaining wide acceptance[1] and is replacing repairs by suturing such as the Shouldice repair[2] or Maloney darn.[3] There is, however, disagreement about the relative...

Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study.
July 11, 1998... Introduction The debate on containing the cost of health care is mainly focused on the supply side and the financing of health care.[1] Little attention is given to changes in population health, which is another important determinant of...

Poverty, unemployment, and common mental disorders: population based cohort study.
July 11, 1998... Introduction Symptoms of anxiety and depression are common, co-occur frequently, and are continuously distributed in the general population.[1 2] At the top end of this distribution are disorders recognised by psychiatrists, with an...

Underreporting of suspected adverse drug reactions to newly marketed ("black triangle") drugs in general practice: observational study.
July 11, 1998... Data on side effects of newly launched drugs are limited,[1] highlighting the need for effective postmarketing surveillance. An inverted black triangle (??) on product literature identifies new products. Suspected adverse reactions to these...

Neglect of growth and development in the clinical monitoring of children and teenagers with inflammatory bowel disease: review of case records.
July 11, 1998... Failure of growth and retarded sexual development are serious and common problems in children and teenagers with inflammatory bowel disease, particularly Crohn's disease. Thus height, weight, sexual staging, and bone age should be closely...

From collaboration to commissioning: developing relationships between primary health and social services.
July 11, 1998... Since the publication in 1989 of the white paper, Caring for People, the benefits of collaboration between primary health and social services have been emphasised--albeit with little guidance on how to achieve [1 2] The success of emergency...

Developing primary care: gatekeeping, commissioning, and managed care.(Primary Care: Core Values, part 4.)
July 11, 1998... If Nye Bevan were around today, he might be surprised to find that the basic features of British general practice, not least its administrative separation from hospital care, are still in place half a century after the genesis of the NHS. But...

Sexually transmitted infections: recent advances.
July 11, 1998... Sexually transmitted infections are an important cause of morbidity and mortality throughout the world. Over 300 000 cases of sexually transmitted infection were diagnosed in genitourinary medicine clinics in England in 1996.[1] Among these...

Deliberate self harm in Sri Lanka: an overlooked tragedy in the developing world.
July 11, 1998... The World Health Organisation's definition of health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" clearly relates social and mental well-being to physical health.[1] For many...

Managing demand for secondary care services: the changing context.(Managing Demand for Health Care, part 5.)
July 11, 1998... Little strong evidence exists to explain the sustained growth in demand for hospital services shown in the table, but changes in population structure, numbers of people living alone, pressures on primary care, risk management, patient...

When to act on the evidence.(Getting Research Findings Into Practice, Part 2.)
July 11, 1998... Trevor A Sheldon, Gordon H Guyatt, Andrew Haines There is increasing interest in providing evidence based health care--that is, care in which healthcare professionals, provider managers, those who commission health care, the public, and...

Plus ca change...(Personal View)
July 11, 1998... Over 10 years ago a disgruntled registrar in obstetrics and gynaecology wrote a personal view about training in the specialty (BMJ 1987;294:570). I thought it would be interesting to reflect on the intervening decade. I decided on my...

New safeguards planned for psychiatric patients.
July 4, 1998... The Department of Health is expected to introduce new safeguards for psychiatric patients admitted informally to hospitals and residential homes, after a House of Lords ruling last week which was greeted with huge relief by NHS managers and...

Dobson promises extra cash for NHS.
July 4, 1998... "Substantial" extra funding for the NHS was foreshadowed by the health secretary, Frank Dobson, after weekend press speculation ranged from 8bn [pounds sterling] to 12bn [pounds sterling] ($13bn-$19bn) over three years. He said that the...

Our love-hate relationship with the NHS.(National Health Service)
July 4, 1998... When the BMJ invited a number of people to tell us briefly what they most like and dislike about the NHS in Britain it became obvious that on its 50th anniversary the NHS still excites passionate feelings. Some common themes arose--people...

In brief.
July 4, 1998... New plan to speed AIDS vaccine development: The International AIDS Vaccine initiative unveiled a new strategy for accelerating the development of an AIDS vaccine. It will receive some new grants--from the World Bank, the UK government, and a...

Ombudsman criticised GPs.
July 4, 1998... The health service ombudsman for England, Scotland, and Wales has criticised GPs who remove patients from their lists too readily or without an explanation. The ombudsman, Michael Buckley, has new powers to investigate complaints about...

Regional networks for Scotland.
July 4, 1998... The most detailed examination of hospital services in Scotland since the NHS was established 50 years ago has produced radical proposals to shift the focus of care away from individual hospitals and on to regional networks. The...

Elective caesarean and zidovudine cuts HIV transmission.
July 4, 1998... Pregnant women who are HIV positive can dramatically reduce the likelihood of transmission of disease to their newborns by having an elective caesarean delivery while undergoing treatment with the antiretroviral drug zidovudine, according to...

FDA approves tuberculosis drug.
July 4, 1998... The US Food and Drug Administration has approved rifapentine (Priffin)--the first new antituberculosis drug to be licensed in 25 years. Rifapentine is indicated for pulmonary tuberculosis but must be used in conjunction with other...

Gap in HIV infection widens.
July 4, 1998... While most industrialised nations and a handful of developing countries are seeing the spread of HIV infection level off or even decline, infection rates are reaching alarming new highs in much of the developing world, according to the first...

Government row flares up over vitamin B-6.
July 4, 1998... Restrictions on vitamin B-6 proposed by the British government on the advice of its own experts have been repudiated by a Commons select committee on the grounds that the advice was scientifically unjustified and palpably wrong The...

Electromagnetic fields may be carcinogenic.
July 4, 1998... Electromagnetic fields, like those surrounding electric power lines, should be regarded as "a possible human carcinogen" a working group drawn together by the US National Institute of Environmental Health Sciences reported this week. The...

Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments.
July 4, 1998... Abstract Objective: To evaluate an experimental heroin maintenance programme. Design: Randomised trial. Setting: Outpatient clinic in Geneva, Switzerland. Subjects: Heroin addicts recruited from the community who were...

Malignant spinal cord compression: prospective study of delays in referral and treatment.
July 4, 1998... Abstract Objectives: To examine the delay in presentation, diagnosis, and treatment of malignant spinal cord compression and to define the effect of this delay on motor and bladder function at the time of treatment. Design:...

Reactions of participants to the results of a randomised controlled trial: exploratory study.
July 4, 1998... Abstract Objectives: To assess views of parents of babies who participated in a neonatal trial, about feedback of trial results. Design: Qualitative analysis of interviews. Setting: Parents' homes. Subjects: Parents of 24...

Efficacy of home sampling for screening of Chlamydia trachomatis: randomised study.(Includes related article with questions to doctors )(concerning consultation with patients.)
July 4, 1998... Urogenital infections caused by Chlamydia trachomatis are common and may cause female infertility and ectopic pregnancy. Such infections are treatable but as C trachomatis often causes no symptoms they may' remain undetected. As screening for...

Influence of social problems on management in general practice: multipractice questionnaire survey.
July 4, 1998... Abstract Objectives: To find how often social problems influence clinical management in general practice, how management is changed, and how the characteristics of patients, doctors, and the doctor-patient relationship influence this...

Treatment of the common cold.
July 4, 1998... Summary points Alleviation of symptoms remains the only proved way to treat the common cold. First generation antihistamines, anticholinergics, and ([Alpha] agonists effectively reduce rhinorrhea and sneezing, but have minimal effects on...

The Bevan legacy.(Aneurin Bevan, UK Minister of Health (1945) and creator of the National Health Service)(National Health Service 50th anniversary)
July 4, 1998... Summary points After the war Britain would probably have created a national health service without Aneurin Bevan. He made relatively few big decisions, but those he did make had a profound effect on the way the NHS developed His...