British Medical Journal articles from June 1998

British Medical Journal archives from June 1998

All changed, changed utterly: British medicine will be transformed by the Bristol case.(Editorial)
June 27, 1998... British medicine will be transformed by the Bristol case "The Bristol case," in which judgment was passed last week[1] will probably prove much more important to the future of health care in Britain than the reforms suggested in the white...

Central venous catheters - time for a change? If you put them in properly you don't need to change them routinely.(Editorial)
June 27, 1998... If you put them in properly you don't need to change them routinely It is often difficult to ascertain exactly where a particular medical practice or policy originates. Thus it is with routine scheduled changes of central venous catheters...

Controversy in managing patients with prostate cancer: banish dogma, get more data.(Editorial)
June 27, 1998... Life is uncertain, and never more so than when serious illness like prostate cancer strikes and decision must be made about how to proceed Ideally, the clinician would find (or remember) the relevant research, interpret the findings as they...

Taking precautions with ACE inhibitors: a theoretical risk exists in patients with unilateral renal artery stenosis. (angiotensin converting enzyme inhibitors)(Editorial)
June 27, 1998... A theoretical risk exists in patients with unilateral renal artery stenosis Angiotensin converting enzyme inhibitors have revolutionised the treatment of congestive heart failure,[1] hypertension,[2] and diabetic nephropathy.[3] After...

Improving doctor-patient communication: not an option, but a necessity.(Editorial)
June 27, 1998... Not an option, but a necessity In most Western countries healthcare systems are changing; political and economic forces are behind the growth of profit driven medicine, managed care, and an increasingly technological focus. Paradoxically,...

Bristol doctors found guilty of serious professional misconduct.
June 27, 1998... The fallout from the Bristol heart surgery case, which ended last week with findings of serious professional misconduct against three doctors, continued this week when six consultants from Bristol Royal Infirmary hit back at suggestions that...

The new word in designer drugs: pharmacogenomics is the new buzz word in biotechnology.
June 27, 1998... Pharmacogenomics is the new buzz word in biotechnology, Janice Hopikins Tanne reports from a conference looking at how pharmacogenomics could be used to develop more effective drugs Pharmacogenomics means using human genetic variations to...

Annual league tables of mortality in neonatal intensive care units: longitudinal study.
June 27, 1998... Introduction Publication of the United Kingdom's patient's charter[1] has led to an increase in the direct comparisons of institutional performance using league tables.[2 3] The principle behind league tables, as formulated by the...

Effect of flutamide on survival in patients with pancreatic cancer: results of a prospective, randomised, double blind, placebo controlled trial.
June 27, 1998... Introduction Pancreatic cancer is difficult to diagnose and unsatisfactory to treat, with most patients dying within 6 months of diagnosis and virtually all by 1 year.[1 2] At present surgery offers the only prospect of longer survival....

Effectiveness of home care programmes for patients with incurable cancer on their quality of life and time spent in hospital: systematic review.
June 27, 1998... Introduction In developed countries cancer remains one of the major causes of death, despite all the highly sophisticated treatment methods.[1] Fifty per cent of all patients with cancer still cannot be cured.[2 3] The quality of life...

Routine replacement of central venous catheters: telephone survey of intensive care units in mainland Britain.
June 27, 1998... The incidence of sepsis with duration of central venous catheterisation remains controversial. Although some authors routinely replace central venous catheters,[1 2] this practice is not supported by data from randomised, controlled studies.[3...

Questionnaire study of effect of sex and age on the prevalence of wheeze and asthma in adolescence.
June 27, 1998... In early childhood wheezing and asthma are more common in boys than girls.[1] This difference has either disappeared or reversed by early adulthood,[2] although the age at which the change occurs is unclear. We therefore measured the age and...

Seasonal variation in coronary artery disease mortality in Hawaii: observational study.
June 27, 1998... A seasonal variation in cardiac mortality has been noted in both the northern[1 2] and southern[3] hemispheres, with higher death rates during whiter than summer. Previous studies reporting seasonal variation in mortality from coronary artery...

Correction. ( to 'Cumulative risk adjusted mortality chart for detecting changes in death rate: observational study of heart surgery' in June 6, 1998 issue, pp. 1697-1700)(Correction Notice)
June 27, 1998... Cumulative risk adjusted mortality chart for detecting changes in death rate: observational study of heart surgery An editorial error occurred in this paper by J Poloniecki et al (6 June, pp 1697-700). The authors and contributors were Jan...

Effect of educational leaflets and questions on knowledge of contraception in women taking the combined contraceptive pill: randomised controlled trial.
June 27, 1998... Introduction Poor knowledge of the combined contraceptive pill is well documented[1-5] particularly in women attending appointments in general practice, where most contraceptive pills are prescribed.[4] This lack of knowledge may be a...

Contracting for general practice: another turn of the wheel of history.(Primary Care: COre Values, part 3.)
June 27, 1998... British general practitioners often assert their pride at being "independent contractors" without remembering the origin of the term. Dr Ransome, pictured on his rounds as visiting physician to the local cottage hospital (box), was one of my...

Communicating the risk reduction achieved by cholesterol reducing drugs.
June 27, 1998... "When the facts change, I change my mind. What do you do?" asked Professor Michael Oliver at a presentation held in Stockholm on 6 June 1996. This is what readers of the New England Journal of Medicine were told in an advertisement for the...

Evaluating information technology in health care: barriers and challenges.
June 27, 1998... There is strong push for clinical leadership in the development and procurement of information technology in health care.[1] The lack of clinical input to date has been cited as a major factor in the failure of information technology in health...

Tuberculosis.(Science, Medicine, and the Future.)
June 27, 1998... Tuberculosis is the leading infectious cause of death worldwide, being responsible for 3 million deaths annually Among those aged over 5 years, tuberculosis kills more people than AIDS, malaria, diarrhoea, leprosy, and all other tropical...

Retracing the Oregon trail: the experience of rationing and the Oregon health plan.
June 27, 1998... A decade ago the state of Oregon attracted worldwide interest when it began an ambitious attempt to set priorities for health care on a systematic basis. Stimulated by the death of a 7 year old boy who had been waiting for a bone marrow...

Spectre of racism in health and health care: lessons from history and the United States.
June 27, 1998... Inequalities in health and health care in relation to race and ethnicity pose ethical problems of which racism is the most disquieting.[1 2] One controversial inequality is the poor health of African Americans--their life expectancy in 1993 was...

Managing demand at the interface between primary and secondary care.(Managing Demand for Health Care, part 4.)
June 27, 1998... General practitioners have acted as official gatekeepers to the United Kingdom hospital service since the inception of the NHS in 1948, but the roots of the referral system can be traced to the conflict between physicians, surgeons, and...

There must be a better way. (terminal care)(Personal View)
June 27, 1998... Some years ago I became the custodian for my grandmother's care, a woman with progressive multi-infarct dementia, congestive cardiac failure, and a litany of other medical problems, the common currency of older people. Remarkably, she coped at...

A profession on probation.(Medicine and the Media)
June 27, 1998... Medicine is a rough old trade. From doubtful origins in botany and violence, it has grown over the ages to biomedical respectability and considerable political clout Now there are about 100 000 of us at it in the United Kingdom--saints and...

Suboptimal care of patients before admission to intensive care is caused by a failure to appreciate or apply the ABCs of life support. (airway, breathing, circulation)(Editorial)
June 20, 1998... During the past decade deficiencies in the quality of medical care have precipitated detailed scrutiny in the form of national confidential inquiries. These inquiries have examined perioperative deaths (NCEPOD), maternal deaths, and more...

Hormone replacement therapy again: risk-benefit relation differs between populations and individuals.(Editorial)
June 20, 1998... Hormone replacement therapy is increasingly advocated not just for short term treatment of menopausal symptoms but as long term prophylactic therapy against heart disease, osteoporosis, even Alzheimer's disease--indeed, as the solution to...

1998 European guidelines on resuscitation: simplification should make them easier to teach and implement.(Editorial)
June 20, 1998... After a cardiac arrest the only interventions that have been proved to improve long term survival are basic life support and early defibrillation. They thus remain the focus of the most recent--and most internationally supported--set of...

Why all the fuss about genetically modified food? Much depends on who benefits.(Editorial)
June 20, 1998... Why are some consumers concerned about food from genetically modified plants? After all, we have been modifying crop plants for centuries by plant breeding. What is new is the recent development of biotechnology that makes it possible to...

Planning the United Kingdom's medical workforce: on present assumptions UK medical school intake needs to increase.(Editorial)
June 20, 1998... Without an appropriate workforce, health service delivery will fail. The function of medical workforce planning "is to ensure, so far as possible, that the right numbers of doctors, in the right specialties and grades, are in the right...

Making self regulation credible: through benchmarking, peer review, appraisal - and management.(Editorial)
June 20, 1998... Professional self regulation has so far been vested in the General Medical Council, which has done much recently to modernise its way of working. The new performance procedures go a long way to plug a major gap in its ability to deal with...

Confidential inquiry into quality of care before admission to intensive care.
June 20, 1998... Introduction Seriously ill patients may be identified by the clinical signs of life threatening dysfunction of the airway, breathing, or circulation, but these may be missed, misinterpreted, or mismanaged by clinicians of all grades....

Hormone replacement therapy and risk of hip fracture: population based case-control study.
June 20, 1998... Introduction Menopause is accompanied by accelerated bone loss[1 2] and by an increase in the incidence of fractures such as those of the hip.[3 4] Many studies have shown that hormone replacement therapy can reduce bone loss[5 6] and...

The 1998 European Resuscitation Council guidelines for adult advanced life support.
June 20, 1998... The publication of guidelines for advanced life support by the European Resuscitation Council in 1992 was a landmark in international cooperation and coordination.[1] Previously, individual countries or groups had produced guidelines,[2] but...

Correction. (to "Protecting children from armed conflict" editorial May 23, 1998, pp. 1549-50.)(Correction Notice)
June 20, 1998... General practitioners' self assessment of knowledge An error occurred in the letter by Adrian Edwards and colleagues (23 May, pp 1609-10). The second author's name should have been Michael Robling [not Michael Robling Matthews]. ...

The 1998 European Resuscitation Council guidelines for adult single rescuer basic life support.
June 20, 1998... The following guidelines were launched in Copenhagen in June 1998 and are based on an advisory statement by the Basic Life Support Working Group of the International Liaison Committee on Resuscitation.[1] The term basic life support refers...

Simple tests for septic bursitis: comparative study.
June 20, 1998... Differentiating septic from non-septic bursitis of the olecranon and prepatellar bursae is a common and important problem. Though septic cases may be identified clinically, laboratory tests have also been used.[1 2] However these tests are...

Qualitative study of patients' perceptions of doctors' advice to quit smoking: implications for opportunistic health promotion.
June 20, 1998... Introduction Smoking remains the single most important remediable cause of premature death in the Western world. For the first time in 25 years, its incidence is rising in British men aged 20-24 and women aged 25-34.[1 2] It is...

Correction. (to "Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish heart health study: cohort study" in September 20, 1997 issue, pp. 722 - 9.)(Correction Notice)
June 20, 1998... Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish heart health study: cohort study We regret that tables in this article by Tunstall-Pedoe et al (20 September...

Patient centred primary care.(Primary Care: Core Values, part 2.)
June 20, 1998... The importance and primacy of the clinician-patient relationship cannot be overstated. The perceived intrinsic quality of this relationship initially allows two individuals, previously unknown to each other, to feel comfortable with an often...

Postnatal depression.(Fortnightly Review)
June 20, 1998... There has been considerable recent clinical and research interest in postpartum depression. This has been largely provoked by the accumulating evidence that postnatal depression is associated with disturbances in child cognitive and emotional...

Acute obstructive hydrocephalus complicating bacterial meningitis in childhood.(Lesson of the Week)
June 20, 1998... Two children presented with signs of raised intracranial pressure and sepsis. Computed tomography showed relatively large ventricles, suggesting obstructive hydrocephalus. Raised intracranial pressure was confirmed at ventriculostomy, but...

Deadly charades.(Ethical Debate: Truth, the First Casualty.)
June 20, 1998... Truth, the first casualty In the past, patients with cancer were often not told the truth about their condition. This would be considered unacceptable nowadays. Yet Mitzi Blennerhassett's account of her treatment for anal cancer shows...

Communication is a vital part of care.(Ethical Debate: Truth, the First Casualty.)
June 20, 1998... Less than 25 years ago, McIntosh advocated that the diagnosis of cancer should not routinely be disclosed.[1] This stance would now be regarded as unacceptable in most westernised societies, where research over the past two decades has shown...

Doctors and patients should be fellow travellers.(Ethical Debate: Truth, the First Casualty.)
June 20, 1998... Doctors and their patients travel together on the long road of serious illness and its treatment. Mitzi Blennerhassett's account of her anal cancer and its treatment was a journey through hell. The doctors concerned will probably feel hurt by...

Action on clinical audit: progress report.
June 20, 1998... Every year in the United Kingdom, millions of pounds are spent on clinical audit, and the results are arguably disappointing. "Action on clinical audit" is a two year project, funded by the NHS Executive, with the aim of shedding light on why...

Managing demand in general practice.(Managing Demand, part 3)
June 20, 1998... Increasing patient expectations are placing strains on general medical services. While empirical evidence for increasing demand is difficult to establish, the population's use of primary care services has changed and will continue to change in...

Randomising groups of patients.(Understanding Controlled Trials, part 6.)
June 20, 1998... In a simple randomised trial each patient is assigned independently to a treatment group. Sometimes, however, randomising individual patients is either technically impossible or may compromise the evaluation. Some interventions can be...

The credibility gap. (Personal View)
June 20, 1998... "No offence," said the mother of the asthmatic child, "but you're a casualty doctor; I think my child ought to see a paediatrician," A few years ago this might have been an understandable request, but times have changed--haven't they? I was...

Science and the Retreat from Reason.
June 20, 1998... Monthly Review Press, 12-95 [pounds sterling], pp 248 ISBN 0 85345 987 8 Exaggerating the importance of science to modem industry, health care, transportation, communication, commerce, and so on would be difficult. This reliance on science,...

Wit and Fizz: Selected Works of Ruth Holland.
June 20, 1998... BMJ Books, 12.95 [pounds sterling], pp 128 ISBN 0 7279 12801 "He literally brought the house down," says Paul Crossley on Radio 3. "Yes," says Michael Berkeley. "It was very exciting the way he set the hall alight." Maybe the sporting...

Public confidence and cardiac surgical outcome - cardiac surgery: the fall guy in medical quality assurance.(Editorial)
June 13, 1998... Cardiac surgery: the fall guy in medical quality assurance The General Medical Council has recently been grappling with the problem of measuring and comparing surgical outcomes after complex surgery in a heterogeneous patient population...

Hospital at home: from red to amber? Data that will reassure advocates - but without satisfying the skeptics.(Editorial)
June 13, 1998... Data that will reassure advocates--but without satisfying the sceptics Hospital at home schemes providing care in the patient's home that is traditionally provided in hospital have grown in importance in health services in both Europe and...

Can an economic case be made for investing in health? No, but it's the wrong question.(Editorial)
June 13, 1998... No, but it's the wrong question Social insurance for health services grew out of voluntary schemes to ensure access to care for workers, especially to provide treatment for industrial injuries.[1] At least part of the reason was a desire...

Ethnicity, social inequality, and mental illness: in a community setting the picture is complex.(Editorial)
June 13, 1998... In a community setting the picture is complex The relative prevalence and treatment of mental illness among different ethnic groups in Britain is probably one of the most controversial issues in the field of health variations. The Policy...

Targeting subclinical atherosclerosis has the potential to reduce coronary events dramatically.(Editorial)
June 13, 1998... Has the potential to reduce coronary events dramatically A fifth of coronary deaths occur in those with no story of ischaemic heart disease, and the absolute number of coronary events is greater in the low risk population than in high risk...

ChildLine report reveals extent of children's health fears.
June 13, 1998... Children with a chronic illness, who are going through puberty, who wet the bed, or who have a sick parent feel depressed, miserable, worried, ashamed, and even suicidal, according to a review of callers to the free national telephone helpline,...

Clinical outcome in relation to care in centres specialising in cystic fibrosis: cross sectional study.
June 13, 1998... Introduction Cystic fibrosis is the commonest autosomal recessive genetic disorder in North Europeans. The complex multisystem nature of the disease has led to the management of affected individuals in centres specialising in cystic...

Management in paediatric and adult cystic fibrosis centres improves clinical outcome. (Response to Ravi Mahadeva and others in this issue, p. 1771)
June 13, 1998... Mahadeva et al provide evidence that management of cystic fibrosis in a paediatric centre specialising in such care and subsequent transfer to an adult centre results in better objective measures of clinical status (body mass index and forced...

Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis.
June 13, 1998... Introduction In industrialised countries Chlamydia trachomatis is the predominant infectious agent causing pelvic inflammatory disease[1-3] and, as a result of damage to the fallopian tubes, accounts for up to half of all ectopic...

Blood pressure and mortality in elderly people aged 85 and older: community based study.
June 13, 1998... Introduction In western societies blood pressure rises with age. It is not clear if this is the result of a pathological process that needs treatment or if it is part of the natural ageing process. Treating hypertension helps prevent...

Lone atrial fibrillation in vigorously exercising middle aged men: case-control study.
June 13, 1998... Introduction Regular physical exercise reduces cardiovascular morbidity.[1 2] However, our clinical impression is that atrial fibrillation is quite common in otherwise healthy middle aged men engaged in long term vigorous endurance...

Three month follow up of health outcomes.(Randomised controlled trial comparing hospital at home care with inpatient hospital care, part I.)
June 13, 1998... Introduction There is an increasing demand for acute hospital beds, partly because of rising numbers of emergency medical admissions.[1] Increased provision of services in the community is one proposed method for reducing the pressure...

Cost minimisation analysis.(Randomised controlled trial comparing hospital at home care with inpatient hospital care, part II.)
June 13, 1998... Introduction There is little evidence to justify the widespread adoption of hospital at home on the basis of cost. A review of the subject identified only one randomised controlled trial that compared the cost of hospital at home with...

Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care.
June 13, 1998... Introduction Alternatives to inpatient hospital care have become a focus of interest among health service strategists working towards a primary care led NHS.[1] They seem to offer potential for reducing both the number of admissions and...

Hospital at home or acute hospital care? A cost minimisation analysis.
June 13, 1998... Introduction Hospital at home is a generic term referring to home based nursing and rehabilitation services aiming to prevent admission or to facilitate early discharge from care in an acute hospital. Hospital at home schemes are often...

Core values in a changing world.(Primary Care: Core Values, part 1.)
June 13, 1998... This is the first in a series of six articles reflecting on the core values that will underpin the development of primary care In 1920, the Dawson report advocated a population based approach to the organisation of health services, the...

Rheumatology.
June 13, 1998... In this review of recent advances in rheumatology I focus on treatment This is not because our understanding of the pathogenesis or other aspects of rheumatology has progressed little but because there have been some particularly important...

Could boxing be banned? A legal and epidemiological perspective.
June 13, 1998... For some time the BMA has campaigned for stricter legal regulation of boxing.[1] Although two bills in the House of Lords to outlaw boxing for reward were defeated in 1995, parliament has never declared boxing illegal and no court has ever...

A patient led NHS: managing demand at the interface between lay and primary care.(Managing Demand for Health Care, part 2.)
June 13, 1998... People currently deal with many, if not most, health problems without consulting the health service. Relatively small decreases in these self care behaviours or increases in the accessibility of services could produce large changes in demand...

Assessing health needs in developing countries.(Health Needs Assessment, part 6.)
June 13, 1998... In most developing countries, the evolution of health services has been dominated by Western models of health care. These have rarely taken into account how local people explain illness, seek advice, or use traditional healing methods. The...

Why I practise in Montpelier.(Personal View)
June 13, 1998... Twenty four years ago I returned to Bristol after a spell abroad. Despite spectacular Canadian earnings, and the call of the wilderness, I hankered after English city life. A pub nearby, the arts centre handy, good bookshops, the harmonising...

Palliative Care Ethics: A Good Companion.
June 13, 1998... Palliative Care Ethics: A Good Companion Fiona Randall, R S Downie Oxford University Press, 19.50 [pounds sterling], pp 160 ISBN 0 19 262632 9 Currently, society is trying to cope with medicine's rapidly increasing knowledge base and...

Genetics: Society and Clinical Practice.
June 13, 1998... Genetics: Society and Clinical Practice Peter S Harper, Angus J Clarke Bios Scientific Publishers, 19.95 [pounds sterling], pp 264 ISBN 185996 206 Public interest in how genes determine both what we are and what may happen to us is...

Lessons from the Bristol case: more openness -- on risks and on individual surgeons' performance.(Editorial)
June 6, 1998... More openness--on risks and on individual surgeons' performance Cardiac surgery has changed within living memory from desperate attempts to achieve miracles for a few to the present situation where there is high expectation of a good...

The need for a national body for research misconduct: nothing less will reassure the public.(Editorial)
June 6, 1998... Nothing less will reassure the public The British medical research community is busy assembling its response to research misconduct The question is no longer, "Do we have a problem?" but rather, "How can we best respond?" The BMJ has thus...

Primary care and the NHS white papers: the right principles but bedevilled by the detail. (United Kingdom, National Health Service)(Editorial)
June 6, 1998... The right principles but bedevilled by the detail Before last year's election the Labour Party made much of its intention to move away from the fragmentation allegedly caused by the previous government's NHS reforms and to return to a...

Hydroxyurea therapy for sickle cell disease in Britain: disappointing recruitment despite promising results.(Editorial)
June 6, 1998... Disappointing recruitment despite promising results Sickle cell disease is the commonest inherited haemoglobinopathy in Britain and affects over 9000 people.[1] Clinical severity varies considerably, but, patients with the most severe...

Community acquired pneumonia in elderly people: current British guidelines need revision.(Editorial)
June 6, 1998... Current British guidelines need revision Community acquired pneumonia is the most common reason for acute admission to hospital, with an estimated 50 000 cases occurring each year in the United Kingdom.[1] Over 90% of these patients are...

Compensation claims expected to follow GMC's findings. (General Medical Council, United Kingdom)
June 6, 1998... Compensation claims totalling at least 10m [pounds sterling] ($16m) are expected to follow the General Medical Council's finding last week that two surgeons from Bristol Royal Infirmary, James Wisheart and Janardan Dhasmana, disregarded...

Who will be the next chief medical officer for England?
June 6, 1998... Hilary Bower looks at which of the candidates is likely to succeed Kenneth Calman when he steps down later this year On Tuesday a selection panel headed by the first civil service commissioner, Sir Michael Betts, will sit down to interview...

Cumulative risk adjusted mortality chart for detecting changes in death rate: observational study of heart surgery.
June 6, 1998... Introduction If a comparison of hospitals or surgeons is to be useful it must be based on a statistic that is relevant to prospective patients. For heart surgery a key question is: "What are the chances of the patient surviving the...

Retraction. (Of article titled "Evidence of unmet need in the care of physically disabled adults" by M.H. Williams and C. Bowie in Vol.306, 1993, pp. 95-98)
June 6, 1998... Evidence of unmet need in the care of physically disabled adults The BMJ is retracting the above paper by M H Williams and C Bowie (BMJ 1993;306:95-8) at the request of Dr Bowie. The General Medical Council found Dr Williams guilty of...

Reliability of league tables of in vitro fertilisation clinics: retrospective analysis of live birth rates. (Includes commentary)
June 6, 1998... Introduction There is increasing use of performance indicators in health care which may measure aspects of the process of care,[1] outcomes for health authorities and trusts,[2] and even the mortality for individual named surgeons.[3]...

Underperforming doctors: a postal survey of the Northern Deanery.
June 6, 1998... Introduction The General Medical Council's performance procedures were introduced in the summer of 1997.[1] These new procedures give the GMC, for the first time, the power to discipline doctors whose performance is found to be...