British Medical Journal articles from June 1995

British Medical Journal archives from June 1995

Treating hyperkinetic disorders in childhood: treatment needs care but is worth while.
June 24, 1995... British doctors are nowadays more likely to diagnose and treat hyperactivity in children. There are three reasons for the change. Firstly, the International Classification of Diseases, 10th revision (ICD-10) includes a definition of...

Do we need an Ofhealth? Other services have regulatory bodies to promote competition.(Office of health to prevent monopoly formation)
June 24, 1995... The internal market was introduced into the NHS to improve patient care by freeing relationships between purchasers and providers. As markets in gas, water, and telephone services have been liberalised, regulatory bodies have been set up to...

Hepatitis C and haemophilia: coinfection with HIV is common and will demand great resources.
June 24, 1995... The haemophilic community in Britain, already hit by HIV infection, is now facing the problem of chronic hepatitis C. The high incidence of hepatitis after treatment with clotting factor concentrate from a large pool was first identified by...

Integrating pharmacy fully into the primary care team: much to recommend it.
June 24, 1995... Since teamwork, especially in small, cohesive task specific groups,[1] is the central plank on which primary care is now being built, greater interaction between pharmacists and general practitioners could be fruitful. Nevertheless, personal...

Chemoprophylaxis in tuberculosis and HIV infection: is it feasible in developing countries?
June 24, 1995... Should chemoprophylaxis with a course of antituberculous drugs be given to people infected with Mycobacterium tuberculosis and HIV to prevent the reactivation of latent tuberculosis? The decision depends on three factors: the efficacy of the...

Reasons for non-uptake of measles, mumps, and rubella catch up immunisation in measles epidemic and side effects of the vaccine.
June 24, 1995... Abstract Objectives - To investigate the reasons for poor uptake of immunisation (non-inmmunisation) and the possible side effects of measles, mumps, and rubella vaccine in a catch up immunisation campaign during a community outbreak of...

Serum cholesterol concentrations in parasuicide.(suicide attempts)
June 24, 1995... Abstract Objective - To evaluate whether people who have committed parasuicide have low serum cholester concentrations. Design - Results of blood tests in subjects admitted to hospital for parasuicide compared with those of a control group...

Strategies for dealing with problems associated with use of services for HIV infection and AIDS out of region: views of providers and users.
June 24, 1995... Abstract Objectives - To identify reasons why people with HIV infection and AIDS living within the former South West Thames Regional Health Authority use HIV and AIDS services outside the region, and to identify strategies for dealing with...

ABO and Rh blood groups in patients with cholelithiasis and carcinoma of the gall bladder.
June 24, 1995... Carcinoma of the gall bladder is a common malignancy in Eastern Uttar Pradesh and Western Bihar regions of India, constituting 4-4% of all malignancies and 0-3% of admissions to University Hospital, Varanasi.[1] Since the first report by Aird...

GR106642X: a new, non-ozone depleting propellant for inhalers.
June 24, 1995... Metered dose inhalers are the most popular choice of drug delivery system for treating asthma and chronic airflow limitation. Unfortunately, they contain chlorofluorocarbon propellants, which contribute to the depletion of stratospheric...

Contraceptive services for teenagers: do we need family planning clinics?
June 24, 1995... Abstract Objective - To determine whether the effectiveness of contraceptive services for teenagers is related to the balance of service provision between general practitioners and specialist family planning services. Design - Cross...

Pregnant teenagers' knowledge and use of emergency contraception.
June 24, 1995... Despite interest in preventing pregnancy among teenagers little is known about the most effective strategies.[1] An effective way of preventing pregnancy is to use emergency contraception after unprotected intercourse. We report a descriptive...

Reflex sympathetic dystrophy.
June 24, 1995... Reflex sympathetic dystrophy indicates the syndrome of a painful, swollen, discoloured, abnormally sensitive, and useless extremity, usually developing after trauma, and first described as a complication of gunshot wounds in the American Civil...

Reflex sympathetic dystrophy in children.
June 24, 1995... Reflex sympathetic dystrophy is well recognised in adults. It occurs in children but is rarely mentioned in paediatric textbooks. Children presenting with painful limbs often have many investigations and the diagnosis may be considerably...

An introduction to computing in medical practice.(ABC of Medical Computing)
June 24, 1995... The past decade has seen an explosive growth in the number of computers, and in Britain alone there are now over 10 million in use. The capability of computers has also increased so that today's desktop PC is far more powerful than older main...

Interview with Alain Enthoven: is there convergence between Britain and the United States in the organisation of health services?(Interview)
June 24, 1995... Is the organisation of health care in Britain becoming similar to that in the United States? Since the introduction of the internal market radical change has gripped the NHS. In the United States, despite the failure to implement coherent...

Dilemmas in rationing health care services: the case for implicit rationing.
June 24, 1995... With tension between the demand for health services and the cost of providing them, rationing is increasingly evident in all medical systems. Until recently, rationing was primarily through the ability to pay or achieved implicitly by doctors...

Financial ties as part of informed consent to postmarketing research.(An Ethical Debate)
June 24, 1995... Postmarketing research, often called phase IV trials, is intended to familiarise doctors and patients with newly approved drugs. La Puma and colleagues, in Chicago, studied doctors' and patients' attitudes to whether doctors should receive...

Remembrance of conversations past: oral advance statements about medical treatment.
June 24, 1995... Polls show increasing public interest in advance statements or directives about medical treatment ("living wills") but that few people, apart from Jehovah's Witnesses, carry such documents. Patients' firm, witnessed oral decisions are often...

Correction.(to 'Healthy eating: clarifying advice about fruit and vegetables' in June 3, 1995 issue)(Correction Notice)
June 24, 1995... Healthy eating: clarifying advice about fruit and vegetables An editorial error occurred in this article by Carol Williams (3 June, pp 1453-5). In table II the last sentence of the rationale for including fruit juice should read: "Most of the...

Extracting the history.(advice on taking medical history)(Soundings)(Column)
June 24, 1995... The house doctor at a private hospital was extracting a medical history - slowly, painfully, like pulling teeth - from an irritated bored woman who by the sound of it had been through it all before. "Have you had chest pain or anything like...

Gene genies.(arguments against genetic research)
June 24, 1995... The American social psychologist Kurt Lewin found that the best way to change attitudes was to get people to argue out opinions contrary to the ones they actually held. I had forgotten this dusty old finding until recently, when I agreed to...

Reflex sympathetic dystrophy syndrome - from the inside.(Personal View)(Column)
June 24, 1995... After a period of grieving and adjustment amputees eventually accept their loss, picking up the threads of their life. Their loss is obvious and evokes understanding and support. But when someone becomes the victim of a rare disabling condition...

True Stories: The Making of a Doctor.(British broadcast of US program)
June 24, 1995... Channel 4's latest offering to the greater public understanding of medical training, made by the respected Public Broadcasting Service in the United States, comes in a standard format. A small (n=6) cohort of first year Harvard medical students...

Health Professions and the State in Europe.
June 24, 1995... There is an imbalance of power in all relationships. The challenge is to minimise it and ensure that both parties benefit. Health Professions and the State in Europe charts the changing relationship between the state and the medical professions...

Deadly Compassion: The Death of Ann Humphry and the Case Against Euthanasia.
June 24, 1995... Ann Humphry committed suicide on 2 October 1991, with tablets from the same supply of barbiturates that she had provided for her frail and elderly parents in their "self deliverance" five years earlier. Was it a fitting end for this noted...

Best books on geriatrics: a personal choice.(Bibliography)
June 24, 1995... Books for undergraduates and junior trainees * Lecture Notes on Geriatrics. 4th edn. N Coni, W Davison, S Webster. (13.50[pounds].) Blackwell Scientific Publications, 1993. ISBN 063203369X *** The Essentials of Health Care of the Elderly. G....

Lessons from the Pearce affair: handling scientific fraud; belatedly, Britain should abandon its lax approach to scientific fraud.(case of British gynecologist Malcolm Pearce)
June 17, 1995... Last week Malcolm Pearce, a British gynaecologist, was removed from the medical register for fraud: he had published two papers in the British Journal of Obstetrics and Gynaecology describing work that had never taken place (p 1554).(1) Less...

Vitamin C and vascular disease: be cautious about the association until large randomised trials have been done.
June 17, 1995... Stroke, coronary heart disease, and peripheral vascular disease have many risk factors, or risk indicators, in common, yet some factors are more important for one vascular bed than another. Cigarette smoking is a stronger determinant of...

Psychiatric services for people with learning disabilities: specialist knowledge and services are needed.
June 17, 1995... Psychiatric disorder is more common in people with learning disabilities than in the general population. Organic, social, and educational reasons account for this increase. Nearly all adults with severe mental retardation have structural brain...

Family mediation: doctors should consider referring divorcing couples for this service.
June 17, 1995... The government's recent white paper on divorce, Looking to the Future. Mediation and the Grounds for Divorce, puts family mediation at the heart of a new one year, no fault procedure of "reflection and consideration." Family mediation has been...

Their lordships on medical research: too backward looking.(report from House of Lords on importance of clinical research in hospitals)
June 17, 1995... Historically research policy swings between two poles. One pole is research driven by researchers pursuing what makes them curious and the opposite pole is research directed by politicians and managers to solve the problems that most concern...

British GPs reject out of hours offer.(general practitioners)
June 17, 1995... British family doctors have rejected by 5 to 1 the government's proposals for restructuring out of hours services. They have told their negotiators to make one more attempt to resolve the crisis with an "immediate approach" to the Department of...

Consultant struck off for fraudulent claims.(obstetrician Malcolm Pearce disciplined for research fraud)
June 17, 1995... Malcolm Pearce, a British consultant obstetrician, was last week found guilty by the General Medical Council of serious professional misconduct after fraudulently claiming to have performed a pioneering operation (see also p 1547). The scandal...

Interrelation of vitamin C, infection, haemostatic factors, and cardiovascular disease.
June 17, 1995... Abstract Objective--To examine the hypothesis that the increase in fibrinogen concentration and respiratory infections in winter is related to seasonal variations in vitamin C status (assessed with serum ascorbate concentration)....

Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people.
June 17, 1995... Abstract Objectives--To determine whether vitamin C status, as measured by dietary intake and plasma ascorbic acid concentration, is related to mortality from stroke and coronary heart disease in people aged 65 and over. Design--A 20 year...

Risk factors for acanthamoeba keratitis in contact lens users: a case control study.
June 17, 1995... Abstract Objective--To investigate reasons for an increase in cases of Acanthamoeba keratitis related to contact lenses. Design--Case-control study. Cases were contact lens related acanthamoeba keratitis patients treated between 1...

Macular degeneration and early menopause: a case-control study.
June 17, 1995... Age related macular degeneration is a main cause of blindness in elderly people. The disease affects the macula lutea and results in a central scotoma in the visual field. The cause of the disease is poorly understood, and treatment is only...

Lower respiratory infection and inflammation in infants with newly diagnosed cystic fibrosis.
June 17, 1995... The nature and timing of lower respiratory infections in infants with cystic fibrosis is largely unknown(1) because infants do not produce sputum and throat cultures may not predict lower respiratory pathogens.(2) We performed a prospective...

Extracontractual referrals: safety valve or administrative paperchase?
June 17, 1995... Abstract Objective--To describe the extracontractual referrals of residents of a health authority during a six month period in 1994, identifying the number and cost of emergency and non-emergency referrals, including the number of cases...

Hospital investigation of men and women treated for angina.
June 17, 1995... Recent studies suggest that women suffering a myocardial infarction and those discharged from hospital with a diagnosis of coronary heart disease receive poorer treatment than men.(1)(2) We looked at cases of treated angina in two general...

Integrating undergraduate and postgraduate education in general practice: experience in Tayside.
June 17, 1995... Several forces have resulted in the creation in Tayside of the first formally integrated unit of undergraduate and postgraduate education in general practice in the United Kingdom. Forces that helped this integration included the desire for...

Where should health services go: local authorities versus the NHS?(National Health Service)
June 17, 1995... The Association of Metropolitan Authorities has recently proposed that responsibility for the NHS should pass from health authorities to local authorities. One of the fiercest debates at the outset of the NHS was whether the hospitals should be...

Local government and health care: the historical perspective.
June 17, 1995... Local government administration of health services is prevalent in Scandinavia, and the tradition was equally deepseated in Britain, brought to an end only in 1948. It is generally thought that the local government alternative was decisively...

The case for closer cooperation between local authorities and the NHS.(National Health Service)
June 17, 1995... The need for the NHS to work closely with local government is not a new one. Since the first major reorganisation of the NHS in 1974, the development of effective interorganisational relationships has been a priority.(1) The principal interface...

Female genital mutilation in Britain.
June 17, 1995... Much has been written about female genital mutilation in Africa, but little attention has been paid to its existence in Britain. Though it has been illegal in this country since 1985, it is practised secretly or children are sent abroad to have...

Female genital mutilation in France.
June 17, 1995... The French Family Planning Association first protested to the World Health Organisation in 1977 about its continuing silence concerning the genital mutilation of girls in Africa and the Far East; that same year the French delegate to the...

Why the problem continues in Britain.(of female genital mutilation)
June 17, 1995... Female genital mutilation has been outlawed in Britain for nearly 10 years, and yet there are an estimated 10 000 girls and young women still at risk of the dangerous practice in this country. Why? According to its proponents, female genital...

Respiratory medicine.
June 17, 1995... Clinical and molecular technological advances have transformed our understanding and knowledge of the complexities of respiratory disease over the past 20 years. Set against this background of rapid advances, this review will highlight some of...

Everyman: Get a Life.
June 17, 1995... Teenagers are expected to be undisciplined, moody, and rebellious. It is part of growing up and growing away from the restrictions of childhood. Most adolescents manage this period of transition successfully, emerging with grace into adulthood....

Intensive care.
June 17, 1995... In many ways intensive care flies in the face of the current philosophy of health care delivery. It provides expensive rescue care to a small number of people, of whom a substantial minority do not benefit, with minimal impact on the health of...

General practice's last stand.(overview on current and future states of the medical profession)(Personal View)(Column)
June 17, 1995... Adiscussion document from the BMA's General Medical Services Committee, which was circulated in July, defines the core content of general practice. The intention is to ensure that all general practitioners provide a basic standard of service...

A Literature Review of th Cost-Effectiveness of Nuclear Medicine.
June 17, 1995... With the growth in imaging techniques and concern about resource limits, an overview of studies on nuclear medicine is highly topical. Jan Carter reports the results of a project aimed at describing what is known about the economics of nuclear...

Private Decisions, Public Debate: Women, Reproduction and Population.
June 17, 1995... Abatch of publications came out in time for the international congress on population and development held in Cairo last September. Private Decisions, Public Debate was produced as part of this effort and describes the reproductive health needs...

Management of Disasters and Their Aftermath.
June 17, 1995... Having previously been fascinated by air disasters and read, at length, various reports on them, I automatically assumed that Management of Disasters would be the usual self congratulatory internal report. I was wrong. I read this book from...

The Prisoners' Handbook 1995.
June 17, 1995... Normally I avoid cliches. But the phrase "Everything you ever wanted to know about..." really can be applied to The Prisoners' Handbook except that the second half should read: "and didn't even know you needed to ask." Mark Leech, the book's...

Correction.(to 'Practical procedures in anesthesia and critical care' in May 20, 1995 issue)(Correction Notice)
June 17, 1995... There were two editorial errors in the caption to the illustration reproduced from Practical Procedures in Anesthesia and Critical Care (20 May, p1340). The first author is Baskett [not Basket,] and the procedure is surgical criothyrotomy [not...

Does debriefing after psychological trauma work?(randomized controlled trials)(Editorial)
June 10, 1995... Time for randomised controlled trials Some people believe strongly that talking through traumatic or stressful experiences may help the psychological recovery of those who have suffered psychological wounding. This belief has led to military...

New equities of information in an electronic age.(lack of Third World literature)(Editorial)
June 10, 1995... The developing countries of the Third World are far from homogeneous. Nevertheless, as consumers of information the countries have a stark regularity of features that allows for convenient grouping: most of their medical libraries subscribe to...

Reliability of the Snellen chart: better charts are now available.
June 10, 1995... Historically, visual function has been assessed by determining the finest spatial detail that the visual system can discriminate. A letter acuity chart, such as the Snellen chart, is commonly used. This type of test is simple to perform and is...

Genetic traits in common diseases.(Editorial)
June 10, 1995... An important current topic of medical research is the localisation of genes implicated in the susceptibility to common chronic diseases such as insulin dependent diabetes, rheumatoid arthritis, and multiple sclerosis. This has been greatly...

Health care rationing: the British approach seems likely to be based on guidelines.(Editorial)
June 10, 1995... The recent decision of Cambridge Health Authority not to fund a second bone marrow transplant operation for a 10 year old girl has brought to public attention what has long been clear to doctors, managers, and politicians. Rationing or priority...

Dutch drop plans for contraceptive pill payments.
June 10, 1995... The Dutch government has dropped its controversial plan to make women pay for the contraceptive pill. The plan would have removed oral contraception for adult women from basic health insurance as part of a 35m[pounds] savings package. The U...

Republicans turn health reform into a revolution.(Column)
June 10, 1995... American politicians, especially the Republicans who sank last year's health care reform, love to boast that America has the best health care system in the world. Among patients covered by insurance, they would get little argument. But that...

Evidence of an association between non-Hodgkin's lymphoma and skin cancer.(includes related information)
June 10, 1995... Abstract Objective - To investigate a possible link between exposure to ultraviolet light and the almost epidemic increase in non-Hodgkin's lymphoma worldwide. Because ultraviolet light is known to cause skin cancers, the association between...

Somatostatin v placebo in bleeding oesophageal varices: randomised trial and meta-analysis.
June 10, 1995... Introduction Somatostatin is a ubiquitous tetradecapeptide hormone. In most experimental studies, both in animals and in humans, it has reduced portal blood flow,[1 2] while the effect on intraoesophageal pressure has been more equivocal.[2...

The analgesic effect of sucrose in full term infants: a randomised controlled trial.
June 10, 1995... Introduction The ability of neonates to perceive and react to pain has been much debated in recent years. We know that most of the anatomical pathways and neurotransmitter function necessary for pain perception are fully or nearly fully...

Community care for demented and non-demented elderly people: a comparison study of financial burden, service use, and unmet needs in family supporters.
June 10, 1995... Abstract Objective - To measure and compare perceived financial burden, use of services, and perceived unmet service needs of supporters of demented and non-demented elderly people. Design - Comparison study of age and sex matched demented...

Bone densitometry in clinical practice.(Education & Debate)
June 10, 1995... Osteoporosis is characterised by low bone mass and disruption of bone architecture resulting in reduced bone strength and increased risk of fracture.[1] The fractures which arise are widely recognised as a major health problem in the developed...

Using data from the 1991 census.
June 10, 1995... The 1991 census for England and Wales provides substantial amount of data on demography, ethnicity housing tenure, employment status, and other social factors for geographical areas ranging in size from enumeration districts upwards. Many in...

The future of the GMC: an interview with Donald Irvine, the new president.(the UK's General Medical Council)(Interview)
June 10, 1995... Donald Irvine is the first general practitioner to be elected president of the General Medical Council (GMC). Richard Smith spoke to him half an hour after he completed his last ever surgery at his practice in Ashington, Northumberland. RS:...

World Health Organisation: change and progress.
June 10, 1995... As it nears its 50th anniversary, the World Health Organisation today is being subjected to closer scrutiny than at any other stage of its history. In a world that has changed immeasurably since the late 1940s, WHO's role as the leading...

Minocycline and pulmonary eosinophilia.
June 10, 1995... Minocycline hydrochloride, a semisynthetic tetracycline derivative, is often prescribed by general practitioners and dermatologists for acne vulgaris in young people. It is also useful in treating bronchopulmonary and urinary tract infections....

Asthma in children: treatment.
June 10, 1995... The aims of treatment should be: * to abolish symptoms and allow children to lead a full and active life at home and at school * to restore normal lung function * to minimise the requirement for relief medication * to enable normal growth...

And finally.... (testing M.D. candidates)(Soundings)(Column)
June 10, 1995... So you want to be a doctor? Good. We too want you to be a doctor and we wish you well. If we can just get through the next half hour together without a major mishap we are well on your way. Please try to help as much as you can. You are not...

The call of the wild (rabbit). (a medical case of a rabbit bite and other trivial cases)(Soundings)(rabbit bite)(Column)
June 10, 1995... The BMJ Christmas issue reported cases of squirrel and mouse bites but I can do much better than that. A patient came in recently with a rabbit bite, I kid you not. If the abrasion had been any more superficial it would have been protuberance....

Obsoletely hopeless. (author of medical review article frustrated by length of time to publication)(Personal view)
June 10, 1995... In March 1991 I was invited to contribute a chapter to a book on physical activity and obesity. As many other colleagues would have been I was flattered by the invitation as well as irritated by the additional workload. As many other colleagues...

Patient suicide (physician unassisted).(Personal View)
June 10, 1995... The first time I met Hoke he was sitting in a bed in the cardiac care unit, bare from the waist up except for a diamond necklace. He was an obese man in his mid-60s. His wide bald head was surrounded by a fringe of long grey hair. Festooned...

Bramwell.
June 10, 1995... In the opening credits, Dr Eleanor Bramwell strides in a grim and purposeful manner to her post as surgical dresser in a hospital in London's east end in 1895. She is a young woman with a mission, pushing against barriers. Her first task is to...

Medical Negligence Litigation: A Practitioner's Guide.
June 10, 1995... Few who are concerned with medical negligence litigation, either as practitioners or as academics, can fail to be struck by the comparative dearth of lawyers specialising in the subject, especially as medical negligence has become "big...

The Incompetent Doctor: Behind Closed Doors.
June 10, 1995... Marilynn Rosenthal spent several years in England and in Sweden and patients, and The Incompetent Doctor is full of anecdotes (some of them repeated) that result from this research. Naturally Rosenthal wants to know what is a forgivable error...

Pulse Oximetry.
June 10, 1995... Pulse oximetry is not new - the principles of operation are well described, and its use during general anaesthesia and in intensive care units is now routine in many countries. Indeed, in some places its use is required by law. So do we need...

A Summer Plague: Polio and its Survivors.
June 10, 1995... Tony Gould and I started our adult lives with quite a lot in common. He is nine years younger but we both caught polio at the age of about 20. We both experienced breathing problems and a spell in a respirator; he can walk, where I failed. We...

The Health Authorities Bill: great care will be needed to avoid exacerbating unresolved and destructive tensions.(pending bill restructuring the UK's National Health Service)
June 3, 1995... Behind the Health Authorities Bill (about to complete its parliamentary stages) seethes a mass of unresolved tensions. On the face of it, all the bill will do is streamline the upper echelons of management in the NHS. It follows a major review...