British Medical Journal articles from June 1999

British Medical Journal archives from June 1999

England publishes first tables of hospital performance.
June 26, 1999... The Department of Health has published "league tables" for England allowing health professionals and their patients to scrutinise hospitals' performance for the first time since the NHS was established. Two reports published last week...

US research funding depends on lobbying, not need.
June 26, 1999... The first systematic comparison of the US National Institutes of Health spending on research shows that some diseases backed by strong political lobbies, particularly AIDS and breast cancer, may be receiving a disproportionately large share...

In brief.
June 26, 1999... Safer environment: Fifty countries in the WHO's European region have signed up to the protocol on water and health, a legal instrument for the protection of clean, safe water. At the WHO's third ministerial conference on environment and...

EU plans more antibiotic resistance surveillance.
June 26, 1999... European Union health ministers, concerned about the spread of antibiotic resistance, have approved a set of measures to try to counter the trend. Ministers agreed earlier this month to make the surveillance of antibiotic resistance in...

UK will ban tobacco advertisements by December.
June 26, 1999... The UK government has brought in regulations to ban tobacco advertisements on billboards and in newspapers and magazines from 10 December, two years ahead of the timetable agreed by the European Union last July. Direct mailing promotions of...

BMA calls for extra safeguards for life and death decisions.
June 26, 1999... Decisions to withhold or withdraw life prolonging treatment can often be taken without referral to the law courts, but there is a need for extra safeguards, according to a BMA report. At present, proposals to withdraw artificial nutrition...

Closed circuit television does not reduce violence.
June 26, 1999... Closed circuit television in city centres had no obvious influence on the level of assaults recorded in inner city hospitals' accident and emergency departments in Wales, according to research based on studies at three large hospital units....

Oestrogen modulator reduces risk of breast cancer.
June 26, 1999... The selective oestrogen receptor modulator raloxifene, currently licensed to treat osteoporosis in postmenopausal women, significantly reduced the risk of breast cancer, according to a study published this week. In the three year...

NHS ombudsman will name doctors who do not accept ruling.
June 26, 1999... The health service ombudsman for England, Scotland, and Wales, Michael Buckley, has warned doctors that in future he intends to name clinicians who refuse to accept his recommendations or who remove patients from their lists for no reason...

Wellcome Trust boosts pay to keep researchers in Britain.
June 26, 1999... The decision by the British research charity the Wellcome Trust to give its 270 senior researchers a 30% pay rise has put pressure on the UK government to follow suit with its academic researchers; the move is unlikely, however, to provoke a...

Food safety remains high on EU agenda.
June 26, 1999... Food safety, and the way governments react to unexpected health scares, is emerging as one of the major issues on the European Union's agenda. Only three years after Europe was hit by the crisis over bovine spongiform encephalopathy, the...

Model predicts who benefits from carotid endarterectomy.
June 26, 1999... A risk modelling study has been developed to identify which patients stand to benefit most from carotid endarterectomy. Evidence from large trials on the use of carotid surgery has previously shown that most patients who undergo carotid...

WHO's cancer chief resigns.
June 26, 1999... The chief of the World Health Organisation's cancer programme has resigned over disagreements about the way the UN agency is tackling the growing global burden of non-communicable diseases. Karol Sikora, a clinical oncologist at the...

Bristol inquiry reveals that inspections were inadequate.
June 26, 1999... A committee from the Royal College of Surgeons of England which visited the Bristol Royal Infirmary in July 1994 gave it a "glowing report," the public inquiry into children's heart surgery at the hospital heard last week. Eleanor Grey,...

Kansas sues internet medicine suppliers.
June 26, 1999... The US state of Kansas is taking legal action against companies selling prescription-only medicines on the internet, in the first action of this kind. The Kansas attorney general, Carla Stovall, has joined the Kansas State Board of...

England gets more medical students.
June 26, 1999... Altogether 684 extra places for medical students have been allocated to 13 English medical schools as part of the government's initiative to train 1000 more doctors each year. The first stage of the process was announced earlier this year,...

Men using IVF inadequately screened for cystic fibrosis.
June 26, 1999... Infertile men who have used in vitro fertilisation or had successful surgery to enable them to father a child, could be putting their offspring at risk of cystic fibrosis because standard screening methods cannot detect many genetic mutations...

Stillbirth as risk factor for depression and anxiety in the subsequent pregnancy: cohort study.
June 26, 1999... Abstract Objective To assess women's symptoms of depression and anxiety during pregnancy and the postpartum year in the pregnancy after stillbirth; to assess relevance of time since loss. Design Cohort study with four assessments: in...

Corrections and clarifications.(To Letter from Morten Lindbaek in April 24, 1999 issue, pp 1138-9)(To Letter from Peter Bourdillon in April 24, 1999 issue, p 1143)(To "Sexual health of teenagers in England and Wales: analysis of national data," in May 15, 1999 issue, pp 1321-2)(To "Obituaries" in April 17, 1999 issue, p 1080)(To "Obituaries" in May 1, 1999 issue, p 1217)
June 26, 1999... Prescribing antibiotics for sore throats In this letter by Morten Lindbaek (24 April, pp 1138-9) the author's name was misspelt as Morten Lindbaek. Dutch system of peer review is different and effective At the end of the first paragraph...

Alcohol consumption and mortality from all causes, coronary heart disease, and stroke: results from a prospective cohort study of Scottish men with 21 years of follow up.
June 26, 1999... Abstract Objectives To relate alcohol consumption to mortality. Design Prospective cohort study. Setting 27 workplaces in the west of Scotland. Participants 5766 men aged 35-64 when screened in 1970-3 who answered questions...

Three very unwise men.
June 26, 1999... Three men sharing accommodation decided to make a fresh vegetable salad, and the oldest convinced his junior flatmates that a plant growing in the back garden was Russian comfrey. Having made the salad the senior member ate three mouthfuls of...

[Beta] Blockade after myocardial infarction: systematic review and meta regression analysis.
June 26, 1999... Abstract Objectives To assess the effectiveness of [Beta] blockers in short term treatment for acute myocardial infarction and in longer term secondary prevention; to examine predictive factors that may influence outcome and therefore...

Risk factors for human hantavirus infection: Franco-Belgian collaborative case-control study during 1995-6 epidemic.
June 26, 1999... Puumala hantavirus is the most common human hantavirus infection in Europe.[1 2] It is transmitted to humans by inhalation or contamination of skin breaches by urine or faeces of infected bank voles. Infection ranges from subclinical to a...

Improvement in clinical work through feedback: intervention study.
June 26, 1999... We have frequently found an unacceptable number of hospital records and discharge reports lacking even the most basic information. To improve on this, we reviewed our hospital records and discharge reports on a regular basis, and we sent out...

Correction.(To "Oral contraceptives and myocardial infarction: results of the MICA case-control study," in June 12, 1999 issue, pp 1579-84)
June 26, 1999... Oral contraceptives and myocardial infarction: results of the MICA case-control study An editorial error occurred in this paper by Nicholas Dunn and colleagues (12 June, pp 1579-84). The first sentence of the results under the heading...

Randomised controlled trial of effect of Baby Check on use of health services in first 6 months of life.
June 26, 1999... Abstract Objective To evaluate the effect of Baby Check, an illness scoring system for babies of 6 months or less, on parents' use of health services for their baby. Design Randomised controlled trial. Setting 13 general...

A painful lesson.
June 26, 1999... I sustained a spiral fracture of my tibia while on holiday when I was 14. This was manipulated under sedation, and I was admitted to the local hospital in the south of England. I passed a sleepless night in great pain when the analgesia I had...

Gallbladder disease.
June 26, 1999... Summary points Operations to remove gall stones have become more common, probably because indications for these have changed 70% of stones in the gall bladder do not cause symptoms Cholecystectomy relieves pain, but 50% of...

Email submissions from outside the United Kingdom.
June 26, 1999... We are now offering an email submission service for authors from outside the UK. The address is papers@bmj.com Ideally our email server would link seamlessly with our manuscript tracking system, but for now it does not, which is why we...

Circulatory support.
June 26, 1999... Circulatory support is required not only for hypotension or shock but also to prevent complications in patients at risk of organ failure. Shock can be defined as "acute circulatory failure with inadequate or inappropriately distributed tissue...

Discontinuation of ventilation after brain stem death.
June 26, 1999... Confusion among the public over the difference between brain stem death and a persistent vegetative state can make it difficult to obtain consent to withdraw ventilation. Clinicians who have been faced with this dilemma outline their...

We do need a new word for patients?
June 26, 1999... In these days of public involvement and active participation, has the term "patient" become an offensive anachronism or does it capture what is positive about the special relationship between health workers and ill people? A former chairman...

Oranges and grapefruit.
June 26, 1999... Something in grapefruit juice inhibits an isoform, CYP3A4, of cytochrome P450, causing drug interactions. That is why terfenadine was last year removed from over the counter sales: grapefruit juice inhibits its metabolism, and that can lead...

Caring for and about acute general medicine.
June 26, 1999... Expansion in consultant numbers is needed EDITOR--Forgacs's review provides an excellent picture of the unpleasant reality of acute medicine, as practised at present.[1] The Royal College of Physicians is well aware of the need to cost...

Developments have been made on cardiac surgical audit in Bristol.
June 26, 1999... EDITOR--The cardiac surgical community is trying to address some of Shortis and Winkler's concerns about the Bristol affair.[1] Congenital cardiac surgery represents a tenth of cardiac surgery in the United Kingdom. Its complexity and...

Cooperative language in consultations by male and female doctors.
June 26, 1999... Paper can be interpreted in two ways depending on reader's viewpoint EDITOR--In their descriptive study of cooperative language by male and female doctors Skelton and Hobbs show that communication style does not differ with respect to...

Onset of adolescent eating disorders.
June 26, 1999... Dieting may be an early sign, rather than a cause, of eating disorder EDITOR--Patton et al reported a positive association between dieting mid the development of eating disorders in adolescents.[1] A causal effect of dieting on the...

Job applications could be electronic.
June 26, 1999... EDITOR--I have been working in Asia for five years and, planning a return to the United Kingdom, I began perusing the classified advertisement section of the BMJ on the internet, looking for a suitable position. I was pleased to see that the...

Sponsored trials do not necessarily give more-favourable results.
June 26, 1999... EDITOR--Wahlbeck and Adams report a review of randomised studies comparing clozapine with other antipsychotic drugs in schizophrenia.[1] They argue that trials that reported some connection with the manufacturer of clozapine (sponsored...

Patients must be told of unintended injuries during treatment.
June 26, 1999... EDITOR--Hingorani et al state that doctors are not legally obliged to provide patients with an explanation after an adverse event.[1] This may be so in the United Kingdom but is not so in Canada. For example, the case of Stamos v Davies...

Politicians may not have same goals as clinicians with regard to mergers.
June 26, 1999... EDITOR--Garside's editorial on evidence based mergers confuses outcomes and process.[1] She wants to collect evidence on "how to manage the process of merging" as well as to assemble "evidence on the benefits of NHS merged organisations" ...

Views on rationing of treatments for erectile dysfunction are mixed.
June 26, 1999... EDITOR--As the Department of Health consults on the NHS use of treatments for erectile dysfunction[1] we sought the views of the general practitioners and members of a health panel in South Staffordshire. The health panel is made up of...

Doctors can benefit from spending time with their dying patients.
June 26, 1999... EDITOR--Haas's observation that few junior doctors witness peaceful expected death mirrors my own experience in a district general hospital.[1] I am frequently involved in both suggesting and confirming that a patient is dying and then...

Spacer devices increase dose of inhaled corticosteroids delivered.
June 26, 1999... EDITOR--In their editorial O'Callaghan and Barry highlight several important points regarding the use of inhaled corticosteroids.[1] We wish to clarify two important statements that they make. It is incorrect to state that use of a...

Needs of patients with learning disabilities are not being met.
June 26, 1999... EDITOR--Aspray et al are right to warn of the risk of "community chaos" in the management of patients with learning disabilities.[1] We are a small practice with 31 such patients. Our practice has acquired a reputation for offering a caring...

Ethics of GMC's decision to suspend doctor need to be explained.
June 26, 1999... EDITOR--When I heard that a doctor had been suspended by the General Medical Council for starving to death a patient with dementia I assumed that he had done this against the expressed wishes of the relatives and the implied wishes of the...

Confidence intervals for the number needed to treat.
June 26, 1999... Pooling numbers needed to treat may not be reliable EDITOR--The number needed to treat has become a popular summary statistic for the results of randomised controlled trials because it combines the treatment effect with the background...

Assessment of competence to complete advance directives.
June 26, 1999... Standardised instruments are needed to guide the measurement of competence EDITOR--Fazel et al described an instrument for the assessment of competency to complete advance directives that seems to be reliable, valid, and ready for use in...

Role of the routine neonatal examination.
June 26, 1999... It probably makes more sense for other staff to carry out neonatal examinations EDITOR--As a senior house officer in a neonatal unit with over 7000 births a year, I can confirm Hall's remarks that needless delays in the discharge of...

"Health care is a human right" is a meaningless and devastating manifesto.
June 26, 1999... EDITOR--"Health care is a human right," declares the Tavistock Group.[1] If the group accepts the World Health Organisation's definition of health as a "state of complete physical, mental and social well-being" then the demand that the...

Obituaries.
June 26, 1999... John William Laws Former clinical director of radiology King's College Hospital (b 1921; q Cambridge/ Sheffield 1944; FRCP, FRCR; CBE), died from cancer on 20 March 1999. He was an outstanding radiologist, combining the qualities of a...

Medical academic staffs conference.
June 26, 1999... Chairman warns of threats to academic medicine "Unless there is a dramatic change in the way we recruit and retain people there will be no future for academic medicine" Dr Colin Smith warned the BMA's medical academic staffs conference...

Consultant contract talks move forward.
June 26, 1999... Representatives of the BMA's Central Consultants and Specialists Committee and the Department of Health hope to make enough progress in negotiations to give joint evidence to the doctors' review body. The consultant contract working...

BMA criticises report on prescribing.
June 26, 1999... The BMA has criticised some of the main recommendations in the Crown report on the prescribing, supply, and administration of medicines. The BMA believes that the report "fails to establish a case for a change to pharmacy prescribing" On the...

Health bodies could improve financial management.
June 26, 1999... Management of the NHS's financial resources is a key element in providing effective healthcare resources and could be improved, according to a report from the Audit Commission. A Healthy Balance sets out the financial position of health...

Action needed to help demoralised consultants.
June 26, 1999... Without urgent remedial action there is a danger that the NHS will find itself with a deeply demoralised consultant workforce, with an increasing number seeking early retirement or alternative employment. This is the conclusion of a...

Doctors Talking.(Review)
June 26, 1999... Doctors Talking Ed Hellen Matthews, John Bain Scottish Cultural Press, 7.95 [pounds sterling], pp 126 ISBN 1 84017 0301 Rating: *** Resistance to the health reforms of the 1990s has taken many forms, but among general practitioners a...

Time of Our Lives.(Review)
June 26, 1999... Time of Our Lives Tom Kirkwood Weidenfeld and Nicolson, 20 [pounds sterling], pp 287 ISBN 0 297 842471 Rating: *** No matter how much our lives have improved over the past century, the never ending search for health and longevity...

Kerala's Demographic Transition: Determinants and Consequences.(Review)
June 26, 1999... Kerala's Demographic Transition: Determinants and Consequences Eds K C Zachariah, S Iruduya Rajan Sage Publications, 29.99 [pounds sterling], pp 367 ISBN 0 8039 9392 7 Rating: *** The achievement of demographic transition--with...

BOOKCASE.(Review)
June 26, 1999... * The man or woman on the Clapham omnibus feels instinctively that screening must be a good thing. Many clinicians think the same--especially when it concerns diseases that they happen to have a special interest in. Read Screening (C Reckham,...

Popularising hospital performance data.
June 26, 1999... The publication last week of the first set of performance tables for hospitals in England provoked a storm of comparisons between hospitals by the media. England's Department of Health is keen, however, to stress that comparative death rate...

WEBSITE OF THE WEEK.
June 26, 1999... www.doh.gov.uk/indicat/indicat.htm This week the government launched its scheme to publish "on the issue that really matters to the public"--quality and performance in the NHS. Naturally, part of its strategy is to release the information on...

Abandoning diastole.
June 26, 1999... Whenever possible medical practice should be evidence based. Hypertension is one of the world's most common causes of premature morbidity and mortality, and national and international bodies have published guidelines on hypertension...

Bed blocking for beginners.
June 26, 1999... For many years now our students have returned to base from their scattered clinical attachments with a case presentation for their final session. We are not looking for traditional grand rounds material--in which the obscurity of the...

Minerva.
June 26, 1999... Vancomycin is a therapeutic last resort against antibiotic resistant Streptococcus pneumoniae, a leading cause of meningitis. Now scientists from Sweden have isolated a strain of the pathogen tolerant to a wide range of antibiotics including...

Doctors advised to take special care with human albumin.
June 19, 1999... The Committee on Safety of Medicines has advised doctors to restrict the use of, and take special care when using, human albumin after concerns that far from saving life the preparation may actually increase mortality. A systematic...

New research demolishes link between MMR vaccine and autism.(Review)
June 19, 1999... A leading virologist is calling on the scientific community to spend no more time investigating alleged links between the MMR (measles, mumps, and rubella) vaccine, inflammatory bowel disease, and autism after the publication last week of two...

In Brief.
June 19, 1999... Government to regulate private sector: Proposals for a single, independent body to regulate the private health sector were put forward by the health secretary, Frank Dobson, this week. The new body would have the power to stop hospitals...

Dutch regulate sponsorship of hospitals.
June 19, 1999... Dutch hospitals and health institutions are being urged to sign a new code of conduct regulating sponsorship and fundraising, which researchers estimate now raise more than 200m [pounds sterling] ($320m) a year. The code, backed by the...

Clinton proposes coverage of prescription drugs by Medicare.
June 19, 1999... President Clinton is proposing to offer prescription drug coverage to all Medicare beneficiaries. Medicare, the healthcare programme for Americans aged over 65 years, covers hospital and doctors' costs, but does not pay for prescription drugs...

AMA's scheme to protect JAMA's independence has drawbacks.
June 19, 1999... The American Medical Association's new scheme to protect the editorial independence of its journal (JAMA) from interference by the association's management has several weak points, according to Dr George Lundberg, the journal's former editor....

"Wrong" women taking HRT.
June 19, 1999... Australian menopausal women may be the largest users of oestrogen-based hormone replacement therapy in the world, according to an Australian university study published in the Medical Journal of Australia. However, according to the...

HRT raises risk of rare, treatable breast cancer.
June 19, 1999... A study of women using hormone replacement therapy after menopause found that the treatment does not increase the risk of highly malignant breast cancer but does raise the risk of some uncommon forms of the disease that are slow growing and...

England launches campaign on teenage pregnancies.
June 19, 1999... A 60m [pounds sterling] ($96m) campaign to halve the rate of teenage pregnancy in England over the next 10 years was launched by the government this week, after a year long investigation into the problem by the prime minister's Social...

Restoring medical services in Kosovo will be a massive task.
June 19, 1999... Re-establishing medical services in Kosovo is going to be extremely difficult, Bruce Laurence, medical director of Medical Emergency Relief International (MERLIN), warned last week. "The scale of destruction has been large and has been made...

The carnage wrought by major economic change: ecological study of traffic related mortality and the reunification of Germany.
June 19, 1999... Abstract Objective To document the effects of sudden economic change on death rates for occupants of cars in the former German Democratic Republic (East Germany). Design Ecological time series study of East Germany in comparison...

Prevention of vertical transmission of HIV: analysis of cost effectiveness of options available in South Africa.
June 19, 1999... Abstract Objective To assess the cost effectiveness of vertical transmission prevention strategies by using a mathematical simulation model. Design A Markov chain model was used to simulate the cost effectiveness of four formula...

Universal HIV screening of pregnant women in England: cost effectiveness analysis.
June 19, 1999... Introduction In England the uptake of antenatal HIV screening is comparatively low despite the existence of guidelines on antenatal screening for pregnant women[1] Detection of HIV infection in pregnant women allows the risk of mother to...

Antenatal HIV testing: assessment of a routine voluntary approach.
June 19, 1999... The benefits of testing pregnant women for HIV are increasingly assured, particularly with regard to reducing vertical transmission.[1] Yet uptake of antenatal HIV testing in Britain remains low.[2] Our previous study examined an opt-in...

Predicting who develops chronic low back pain in primary care: a prospective study.
June 19, 1999... Abstract Objectives To quantify the relative contribution of premorbid and episode specific factors in determining the long term persistence of disabling symptoms of low back pain. Design Prospective cohort study. Setting Two...

Variables and parameters.
June 19, 1999... Like all specialist areas, statistics has developed its own language. As we have noted before,[1] much confusion may arise when a word in common use is also given a technical meaning. Statistics abounds in such terms, including normal,...

Paediatric surgery.
June 19, 1999... Introduction Paediatric surgery--the surgical care of children from the fetus to adolescent--is a comparatively new surgical specialty, which began shortly after the second world war.[1 2] Pioneering work during the formative years of...

Importance of distinguishing between cellulitis and varicose eczema of the leg.
June 19, 1999... Differentiating varicose (gravitational) eczema and cellulitis can help reduce morbidity and the costs of hospital stay and antibiotics Dermatologists often see patients with gravitational (varicose) eczema that has been treated...

Corrections and clarifications.(To "ABC of labour care: Physiology and management of normal labour" in March 20, 1999 issue, pp 793-6.)(To "Fertility patterns after appendicectomy : historical cohort study" in April 10, 1999 issue, pp 963-7.)(To "Recent advances in haematology" in April 10, 1999 issue, pp 991-4.)(To "More on the Bristol affair: What went wrong and how can we move forward?" in April 10, 1999 issu, p 1011.)(To "Evidence based case report: Use of prostaglandins to induce labour in women with a caesarean section scar" in April 17, 1999 issue, pp 1056-8.)(To "Victorian medicine: Our grandfather's patient" in April 24, 1999 issue, p 1117.)(To "Influence of hospital and clinician workload on survival from colorectal cancer: cohort study" in My 22, 1999 issue, pp 1381-6.)
June 19, 1999... ABC of labour care: Physiology and management of normal labour This article by Philip Steer and Caroline Flint (20 March, pp 793-6) shows photographs of delivery positions (p 796) in which the birthing attendants' personal protective...