British Medical Journal articles from May 1997

British Medical Journal archives from May 1997

Stroke prevention in atrial fibrillation: warfarin is most effective when the INR lies between 2.0 and 4.0. (international normalized ratio)(Editorial)
May 31, 1997... Epidemiological research has established that non-rheumatic atrial fibrillation is an important risk factor for stroke. It increases the risk about fivefold and is particularly important in elderly people, in whom the prevalence of atrial...

Medical associations: guilds or leaders?(Editorial)
May 31, 1997... In many Western nations traditional medical associations are encountering an opportunity in threat's clothing. If they see through the disguise, and act accordingly, they can lead health care. If they do not, they may find themselves...

Should trusts be allowed to fail? (trust hospitals)(Editorial)
May 31, 1997... The logic of competition and the inevitable product of collaboration in healthcare markets is that there will be winners and losers. At present, Britain's self governing NHS trust hospitals compete to provide services for patients, and the...

British doctors are not disappearing: but career patterns are changing.
May 31, 1997... Rumours abound that recent graduates are leaving medicine. Last autumn, for example, BMA News Review declared, "Atrocious conditions force new doctors out of medicine" after an interview with the chairman of the General Medical Council's...

Tackling deficient doctors: mentoring and appraisal may stave off calls for reaccreditation.(Editorial)
May 31, 1997... When asked "Have we lost faith?" George Bernard Shaw replied, "Certainly not; but we have transferred it from God to the General Medical Council."[1] The UK continues to rely on self regulation among doctors, but, in the wake of increasing...

Tobacco industry memo reveals passive smoking strategy.
May 31, 1997... A leaked industry memo promises to blow apart the facade that the tobacco industry carries out neutral research into passive smoking. The memo plainly sets out the details of the Philip Morris company's worldwide strategy to "coordinate and pay...

Glass ceiling confirmed in biomedical research.
May 31, 1997... Anyone who has ever said that women have to be twice as good as men to succeed is wrong. In biomedical science they have to be up to four times as good, according to a study from Sweden published last week. Based on data from Sweden's...

Medical Research Council is to abolish grants.
May 31, 1997... The Medical Research Council (MRC) has announced the first major shake up of research funding for 30 years. Stand alone project grants will be abolished from 1998, and in their place will be five new funding schemes (see "New MRC funding...

Passive smoking doubles risk of heart disease.
May 31, 1997... Regular exposure to second hand smoke nearly doubles the risk of coronary artery disease, according to a major study which is bound to have profound public health implications. The study, led by Ichiro Kawachi of the Harvard School of...

Population based study of prevalence of islet cell autoantibodies in monozygotic and dizygotic Danish twin pairs with insulin dependent diabetes mellitus.
May 31, 1997... Introduction Much is known about the autoimmune phenomena associated with insulin dependent diabetes mellitus, but little is known about the nature or the time of initiating aetiologicat events. The crude concordance rates of insulin...

Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis.
May 31, 1997... Introduction Optimal assessment of the efficacy of a clinical intervention depends on the natural course of the disease under study. Sometimes it may be reasonable simply to measure the effect of treatment on case fatality or the risk...

Influence of cholesterol on survival after stroke: retrospective study.
May 31, 1997... Introduction The association between total serum cholesterol concentration and coronary artery disease is well established, but the relation between stroke and cholesterol remains elusive. Epidemiological studies in Japanese[1 2] and...

Review by a local medical research ethics committee of the conduct of approved research projects, by examination of patients' case notes, consent forms, and research records and by interview.
May 31, 1997... Introduction Medical research on patients or healthy volunteers in Britain is subject to appraisal by local medical research ethics committees, which may impose conditions on or changes to the proposed protocols. Follow up is not...

Intentions of newly qualified doctors to practise in the United Kingdom.
May 31, 1997... In a series of cohort studies of newly qualified British medical graduates, respondents were asked about intentions to practice in the United Kingdom.[1 2] We compared the intentions of those who qualified in 1993 with the intentions and...

Role of medical factors in 1000 fatal aviation accidents: case note study.
May 31, 1997... Sudden illness in flight is said to cause 1.5% of fatal general aviation accidents.[1] This study reviews the experience from the United Kingdom. Methods and results We reviewed the findings of 1000 consecutive accidents between 1956...

Postal survey of patients' satisfaction with a general practice out of hours cooperative. (related article on page 1598)
May 31, 1997... Introduction The recent growth in general practice cooperatives for out of hours care has been accompanied by important changes in the way that care is delivered. Many cooperatives have established primary care centres to which patients...

Evaluation of a general practice out of hours cooperative: a questionnaire survey of general practitioners.
May 31, 1997... Introduction General practitioners are increasingly working together in cooperatives to provide out of hours care. What might be the reasons for this development and how satisfied are doctors with this new way of working? I compared an...

Using the technology of the world wide web to manage clinical information. (includes guide to useful sites)
May 31, 1997... Practising medicine increasingly requires managing information, particularly in hospital settings. A glance at a typical physician's pile of laboratory results, request forms, reports, and pending discharge summaries is sufficient reminder of...

Substance use disorders. (Science, Medicine, and the Future)
May 31, 1997... Consumption of alcohol and other intoxicating drugs has serious public health implications relevant to a wide range of people. Recent decades have seen large advances in the understanding of substance intoxication and subsequent problems. The...

Common mental health problems in primary care. (ABC of Mental Health)
May 31, 1997... The size of the problem Psychiatric symptoms are common in the general population: worry, tiredness, and sleepless nights affect more than half of adults at some time, while as many as one person m seven experiences some form of...

Maintaining good practice, protecting patients from poor performance. (The performance of doctors, part 2)(Education and Debate)
May 31, 1997... The public now seeks assurances that doctors remain capable and safe throughout their practicing lives. For the profession this means refocusing self regulation on fully established doctors.[1] For the General Medical Council it means that all...

The healthcare market. (Health in China, part 2)
May 31, 1997... The major changes of the market The economic reforms of the early 1980s resulted in major changes in the way that health care is financed (The box shows the structure of agencies that provide health care in China) [ILLUSTRATION...

And the band played on....(Personal View)
May 31, 1997... A woman from Sierra Leone has a one in seven chance of dying as a direct result of pregnancy. In Britain it is one in 6000. It is the biggest health differential between rich and poor countries, estimated to kill 3000 women every day. Another...

Media focus on failures of screening programme.(Medicine and the Media)
May 31, 1997... Channel 4's recent Dispatches programme on cervical screening focused on one poorly performing laboratory. Dr Jane Johnson says it is important that the whole screening programme is not tarred with the same brush. The NHS cervical screening...

Anatomy of a media backlash.(Medicine and the Media)
May 31, 1997... The Labour party manifesto said: "Smoking is the greatest single cause of preventable illness and premature death in the UK We will therefore ban tobacco advertising" In the Queen's speech this manifesto commitment was reiterated. There then...

A Decent Proposal: Ethical Review of Clinical Research.
May 31, 1997... D Evans, M Evans John Wiley and Sons, 24.95 [pounds sterling], pp 230 ISBN 0471 96334 8 All of us like to think that we practice to high ethical standards and that these standards carry over to our research activities. I am not alone in...

Dying Well: A Holistic Guide for the Dying and Their Carers.
May 31, 1997... Richard Reoch Gaia Books, 11.99 [pounds sterling], pp 191 ISBN 185675 019 1 Death comes to us all, and many of us--either in our professional or individual capacities--will have to care for terminally ill people and their carers. This is a...

Regulating Medical Work.
May 31, 1997... Judith Alsop, Linda Mulcahy Open University Press, 45 [pounds sterling], pp 230 ISBN 0 335 19404 4 Monopoly over medical knowledge lies at the heart of any meaningful discussion of professional regulation. And medical uncertainty lies in the...

The future of healthcare systems: information technology and consumerism will transform health care worldwide.(Editorial)
May 24, 1997... Extrapolation of current trends is a poor way to think about the future, particularly at times of great change. The best method, according to Ian Morrison, former president of the Institute for the Future in California, seems to be to bring...

Managing diabetes after myocardial infarction: time for a more aggressive approach.(Editorial)
May 24, 1997... The Diabetes Control and Complications Trial (DCCT) produced clear evidence that intensive management of insulin dependent diabetes helped delay the onset or progression of microangiopathic complications of diabetes.[1] This major randomised...

At last, a public health minister: now we need a new public health act.(UK's first public health minister, Tessa Jowell)(Editorial)
May 24, 1997... The appointment of Britain's first minister of public health, Tessa Jowell, is a sign that the new Labour administration recognises that the health of the population depends on more than the provision of good healthcare services. Health also...

Requesting necropsies: greater humanity and awareness of suffering will help doctors and patients alike.(Editorial)
May 24, 1997... As medicine increasingly acknowledges and even welcomes the active participation of patients and their families in medical care, it is timely to investigate the attitudes of relatives towards necropsies. Any request for a necropsy is...

Meet Minerva in cyberspace: the BMJ's web site celebrates it second birthday.(British Medical Journal)(www.bmj.com)(Editorial)
May 24, 1997... Minerva is the BMJ's best loved section. Unsurprisingly, it is also the section that visitors most want to read on our internet web site. To mark the site's second birthday we have decided to grant them their wish. From this week Minerva...

Cardiologist admits research misconduct.
May 24, 1997... A 2m [pounds sterling] libel action brought against Channel 4 by a former consultant cardiologist at one of London's leading teaching hospitals collapsed last week after he admitted that errors in scientific papers coauthored by him appeared to...

Britain declares war on smoking.
May 24, 1997... A concerted programme of action to reduce smoking in Britain, with a ban on tobacco advertising, was among proposals by the new Labour government in the Queen's speech at the opening of parliament last week. But the process is less...

High amounts of chemicals found in breast milk.
May 24, 1997... Breast fed infants are receiving up to 17 times the tolerable amount of dioxins and polychlorinated biphenyls (PCBs), according to a report submitted to the Department of Health. High intakes of dioxins and PCBs have caused a wide spectrum...

Risk of testicular cancer in cohort of boys with cryptorchidism.
May 24, 1997... Introduction Cryptorchidism is the most common congenital genitourinary abnormality in males and is important because of its associations with infertility and malignancy. Patients usually receive orchidopexy or hormonal treatment to...

Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus.
May 24, 1997... Introduction It is well established that patients with diabetes mellitus are more likely than patients without diabetes to die after an acute myocardial infarction. The increased mortality is seen both in the acute phase and during one...

Case-control study of sudden infant death syndrome in Scotland, 1992-5.
May 24, 1997... Introduction There has been considerable interest in recent years about the role of infant care practices and environment in the sudden infant death syndrome. Previous studies showed the risk associated with sleeping prone,[1 2] and...

Reproductive pattern, perinatal mortality, and sex preference in rural Tamil Nadu, South India: community based, cross sectional study.
May 24, 1997... Introduction During the past three decades, death and birth rates in India have declined considerably.[1 2] This decline is more pronounced in Tamil Nadu than in many of the other Indian states.[3] The decline in fecundity is in line...

Eye disease associated with handling pet tarantulas: three case reports.
May 24, 1997... Tarantulas are becoming increasingly popular as pets. They are widely available, easily maintained, and considered harmless as many are non-venomous. Unfortunately the popular American varieties that are less venomous have evolved highly...

Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis.
May 24, 1997... Introduction Acute otitis media is extremely common in children. By the age of 3 months, 10% of children will have suffered at least one episode. The incidence peaks between 6 and 15 months.[1] In Western countries mortality is low, but...

Population based study of use of anticoagulants among patients with atrial fibrillation in the community.
May 24, 1997... Several randomised controlled trials have shown that warfarin treatment for patients with atrial fibrillation substantially reduces their risk of stroke.[1] Studies have found low treatment rates among patients with atrial fibrillation in...

Treating acute pain in hospital.(Fortnightly Review)
May 24, 1997... In treating acute pain, tradition and ill informed prejudice sometimes hold sway over evidence and common sense In this review we concentrate on simple, clinically appropriate, and evidence based treatments. Methods Whenever possible...

Correction.(to "Grand Round: Hazards of running a marathon" in April 5, 1997 issue)(Correction Notice)
May 24, 1997... An author's error occurred in this article by G R Thompson (5 April, pp 1023-5). The authors gave the wrong date for the year in which the physician ran the London and New York marathons. The first line of the case history should therefore have...

Mental health assessment.(ABC of Mental Health)
May 24, 1997... Psychiatry in health care Psychiatry is a branch of medicine: it deals with those disorders in which mental (emotional or cognitive) or behavioural features are most prominent. The cause, presentation, and course of such disorders are...

Professionalism and self regulation in a changing world. (The Performance of Doctors, part 1)
May 24, 1997... The performance of doctors embraces attitudes to practice, knowledge, and skills. It is the outward and visible expression of our professionalism. In general, people think highly of the medical profession in Britain; rising expectations are a...

From Mao to market reform.(Health in China)
May 24, 1997... Summary After the Liberation by Mao Ze Dong's Communist army in 1949, China experienced massive social and economic change. The dramatic reductions in mortality and morbidity of the next two decades were brought about through...

The contribution of nutrition to inequalities in health.(Socioeconomic Determinants of Health, part 8)
May 24, 1997... Summary Social class differences in health are seen at all ages, with lower socioeconomic groups having greater incidence of premature and low birthweight babies, heart disease, stroke, and some cancers in adults. Risk factors including...

Stigma.(hiding mental illness)(Personal View)(Column)
May 24, 1997... I had known Mary since she was a teenager and had supported her through the time when she struggled with the decision to marry in view of what had been done to her when she was younger. She now had three fine strapping lads but she was worried...

Soap tackles stigma of schizophrenia.(Medicine and the Media)
May 24, 1997... Dr Adrianne Reveley has been a professional adviser to the National Schizophrenia Fellowship for many years. When the BBC soap opera Eastenders decided that a character would have schizophrenia, the charity asked Dr Reveley to help Advising...

The Wellcome Trust Illustrated History of Tropical Diseases.
May 24, 1997... Ed F E G Cox Wellcome Trust, 35 [pounds sterling], pp 454 ISBN 1 869835 86 7 Within tropical medicine a spirited debate is taking place about this specialty's future. This debate arises out of the particular history of tropical medicine. The...

Bodies in Glass: Genetics, Eugenics, Embryo Ethics.
May 24, 1997... Deborah Lynn Steinberg Manchester University Press, 35 [pounds sterling], pp 224 ISBN 0 7190 4667 X It may be of some interest to members of the medical profession hitherto unacquainted with postmodernist feminism to grapple with this book....

Learning from asthma deaths: need to relate deaths to prevalence, severity, and treatment in different populations.(Editorial)
May 17, 1997... There seems little doubt chat the prevalence of asthma in children and adolescents is increasing all over the world,[1] and several epidemics of deaths in the past 30 years have aroused vigorous debate about the possible causes. Awareness of...

Valvular heart disease: putting guidelines into practice.(Editorial)
May 17, 1997... Like many areas of medical care, the management of valvular heart disease has undergone a revolution within the practicing lifetime of many doctors. AS improved interventions have become available, so has the need to investigate correctly...

Antenatal HIV testing: what now?(Editorial)
May 17, 1997... If a pregnant woman has access to antiretroviral treatment she and her unborn child may benefit greatly from her knowledge of her HIV status early in pregnancy. Zidovudine given during pregnancy and to the infant has been shown to reduce the...

Helicobacter gastroduodenitis: a serious infectious disease.(Editorial)
May 17, 1997... Infection with Helicobacter pylori is the main cause of human gastritis,[1] the major cause of peptic ulcer,[2] and an important risk factor for gastric cancer.[3] In 1994 the US National Institutes of Health recommended antibiotic treatment...

Sexual medicine: towards an integrated discipline.(Editorial)
May 17, 1997... Sexual dysfunction is common at any age. The most common problems are loss of sexual drive, anorgasmia, vaginismus in women, and erectile failure and premature ejaculation in men. Up to 38% of women report anxiety and inhibition during...

HIV may be eliminated from reservoirs of infection in the body.
May 17, 1997... HIV-1 could be totally eradicated from CD4 T cells and lymphoid tissue by a combination of antiretroviral drugs, claimed two research groups in Nature and one in Science last week. David Ho and his team at the Aaron Diamond Aids Research...

Age specific trends in asthma mortality in England and Wales, 1983-95: results of an observational study.
May 17, 1997... Introduction It is now over 10 years since trends and seasonality in asthma mortality were investigated in England and Wales,[1-3] and the long term trends over the period 1974-84 were found to be increasing. We aimed at updating these...

Effect of long term treatment with salmeterol on asthma control: a double blind, randomised crossover study.
May 17, 1997... Introduction Salmeterol, a long acting [[Beta].sub.2] agonist, when inhaled twice daily, causes bronchodilatation that is maintained over 24 hours.[1 2] The findings by Sears et al that asthma control was worse when subjects took the...

Molecular investigation into outbreak of HIV in a Scottish prison.
May 17, 1997... Introduction Inmates who inject drugs in prison are at risk of acquiring HIV and other bloodborne infections.[1] Although several investigations into the prevalence of HIV infection have been conducted in correctional institutions,[2-4]...

Residential and occupational exposure to sunlight and mortality from non-Hodgkin's lymphoma: composite (threefold) case-control study.
May 17, 1997... Introduction Incidence and death rates for non-Hodgkin's lymphoma have risen rapidly in recent decades throughout the world.[1] Neither changes in diagnostic practices nor known and suspected risk factors seem to account fully for the...

Transfer of adults between intensive care units in the United Kingdom: postal survey.
May 17, 1997... In 1986, at least 10000 seriously ill patients in the United Kingdom required secondary transfer to adult intensive care units in other hospitals.[1] Although 75 of 181 (41%) intensive care consultants were dissatisfied with transfer...

Chlamydia pneumoniae antibodies and serum lipids in Finnish men: cross sectional study.
May 17, 1997... Chlamydia pneumoniae is an intracellular Gram negative bacterium that commonly causes respiratory infections. C pneumoniae infection has been associated with atherosclerosis in seroepidemiological studies, and the organism was recently found...

The effect of deprivation on variations in general practitioners' referral rates: a cross sectional study of computerised data on new medical and surgical outpatient referrals in Nottinghamshire.
May 17, 1997... Introduction Many studies have failed to explain the 25-fold variation in general practitioners referral rates.[1] Much of this research has been motivated by the considerable cost of referrals to secondary care, rather than the effect...

Cardiopulmonary resuscitation: recent advances.
May 17, 1997... Coronary artery disease is the leading cause of death in most developed countries. In the United States alone, 500 000 deaths a year are caused by coronary artery disease, over half of which are due to sudden cardiac arrest.[1] Often cardiac...

Persistent itching due to etherified starch plasma expander.(Lesson of the Week)
May 17, 1997... Etherified (hydroxyethyl) starch is a plasma expander commonly used in the treatment of hypovolaemia due to surgery, trauma, sepsis, or burns. It is also used to prime cardiopulmonary bypass machines,[1] as a sedimenting agent to increase...

Run a preparation course for postgraduate examinations.(How to Do It)
May 17, 1997... Introduction Accreditation and reaccreditation are of increasing importance in all specialties, and success in postgraduate examinations forms an important part of these processes. The number of preparation and revision courses for...

Stress and the biology of inequality.(Socioeconomic Determinants of Health, part 7)
May 17, 1997... Impact of early experience The quality of nurturing seems to have long term effects relevant to health inequalities. Deprivation in childhood is linked to poor educational attainment and behavioural problems such as hyperactivity and...

Memoirs of a service reduction survivor.(Personal View)(Column)
May 17, 1997... There was a strange irony surrounding the gestation time of the reduction in the family planning service. Nine months from conception to birth or, perhaps less prosaically, from proposal to implementation. Perhaps the unconscious at work in...

The Surgery - an insider's view.(documentary about general practice features physician)(Medicine and the Media)
May 17, 1997... "So what's it like being filmed?" That's what I kept hearing from fellow professionals during my brief spell in the limelight as one of the doctors featured in The Surgery, a three part documentary shown on Channel 4's Cutting Edge series in...

The Right to Refuse Mental Health Treatment.
May 17, 1997... Bruce J Winick American Psychological Association, 47.95 [pounds sterling], pp 425 ISBN 1 55798 369 0 The right to make our own decisions, foolish or wise, is at the heart of the concept of liberty. The sanest people marry the wrong spouse,...

Essential Medical Procedures.
May 17, 1997... Ed Peter J Toghill Arnold, 19.99 [pounds sterling], pp 147 ISBN 0 340 63187 2 There surely cannot be a single house officer anywhere in the country whose heart has not been filled with foreboding at some stage when sent to do an unfamiliar...

Our Stolen Future.
May 17, 1997... Theo Colborn, Dianne Dumanoski, John Peterson Myers Abacus, 7.99 [pounds sterling], pp 306 ISBN 0 349 10878 1 Chemical pollutants with oestrogenic effects might threaten the survival of our species. This is an extreme view, but the questions...

WHO reform and global health: radical restructuring is the only way ahead.(World Health Organization)(Editorial)
May 10, 1997... The world has changed since the World Health Organisation was founded nearly 50 years ago, and the pressure on WHO to change in response has never been greater. Continuing financial constraints, growing demands on the international health...

Pulmonary rehabilitation: improves quality of life in chronic disease, but evaluation must continue.(Editorial)
May 10, 1997... Chronic lung diseases cause considerable disability. In Britain, one in 10 men and one in 20 women aged over 65 suffer from chronic obstructive pulmonary disease alone, and chronic lung disease is estimated to be responsible for over 25...

Acupuncture: safety first.(focus on training programs for acupuncturists)(Editorial)
May 10, 1997... Acupuncture has been used for more than 3000 years, and many proponents claim that this fact sufficiently demonstrates its safety. Yet evidence of serious, potentially life threatening complications does exist. The use of non-sterile...

Gestational trophoblastic disease: neoplasia or pregnancy failure?(Editorial)
May 10, 1997... The term gestational trophoblastic disease includes hydatidiform moles, invasive hydatidiform moles, and choriocarcinoma. However, many gynaecologists and oncologists seem to consider that these conditions represent a neoplastic spectrum,...

Ice cream headache: no need for abstinence.(Editorial)
May 10, 1997... All sorts of things can cause headache. For migraineurs, attacks can be provoked by chocolate, cheese, cured meats, or non-food such as stress or changes in sleep habits. Headaches can herald serious neurological disease. Some people have a...

Specialists criticise treatment for heroin addiction.
May 10, 1997... Addiction specialists in Britain are calling for a careful review of a technique for rapid opiate detoxification using general anaesthesia, after a patient died undergoing the procedure in a private London clinic. Brendan Woolhead, the...

Effectiveness of antismoking telephone helpline: follow up survey.
May 10, 1997... Introduction Smoking remains the largest single cause of preventable death and serious ill health in Scotland.[1] It is estimated that some 10 600 people in Scotland die each year as a result of their smoking,[2] and the extent of...

Mothers' birth weight and survival of their offspring: population based study.
May 10, 1997... Introduction Low birth weight is strongly associated with poor perinatal survival and may be related to poor health outcomes much later in life.[1 2] A woman's birth weight is known to be directly related to the weight of her...

Cost effectiveness of day and inpatient psychiatric treatment: results of a randomised controlled trial.
May 10, 1997... Introduction The Manchester Royal Infirmary's psychiatric day hospital has treated acutely ill patients as an alternative to inpatient treatment for over a decade.[1-3] Roughly 40% of potential admissions can be treated in this way....