British Medical Journal articles from May 1999

British Medical Journal archives from May 1999

WHO agrees measures to stop global spread of tobacco use.
May 29, 1999... After intensive preparations, the World Health Organisation finally gained permission from its member states this week to start negotiating an international legal instrument to curb the global spread of tobacco use. The Framework Convention...

Dutch launch plan to combat legionnaires' disease.
May 29, 1999... The Dutch government has launched a plan to combat legionnaires' disease, emphasising the need for greater vigilance by GPs and community health services, following one of the worst epidemics recorded. The plans, which were developed...

In brief.
May 29, 1999... US keeps smallpox stock: The United States has decided to keep its stock of smallpox and to delay the global destruction of the virus. President Clinton and Donna Shalala, director of the Department of Health and Human Services, cited the...

Explanations shift attitudes to animal experiments.
May 29, 1999... Attitudes on animal experimentation shift dramatically when people are told about the potential medical benefits, according to results of a major new poll. Sixty four per cent of a representative sample of 2009 people in Britain aged 15...

Hungary passes non-smokers' rights bill.
May 29, 1999... After almost a two year passage through the Hungarian parliament, and many revisions, a non-smokers' rights bill will become law on 1 December. The law will require restaurants, pubs, and cafes where food is served to provide continuous...

Bristol inquiry reveals lack of data on service quality.
May 29, 1999... The chief medical officer of the Welsh Office went to see the civil servant responsible for regional hospital services to raise concerns about children's heart surgery at Bristol Royal Infirmary as long ago as 1986, the public inquiry into...

European Union considers new plan to help refugees.
May 29, 1999... Faced with the large numbers of people leaving Kosovo, the European Union is being forced to look for new ways to cope and to help neighbouring countries cope with the economic and social strain that arises from taking in refugees. The...

High dose chemotherapy offers little benefit in breast cancer.
May 29, 1999... The use of high dose chemotherapy with bone marrow rescue for women with breast cancer seems to offer little improvement in outcome compared with standard chemotherapy. Early, disappointing, results from international trials were...

Time to devolve the BMJ?
May 29, 1999... The BMJ should be as international as possible while attempting comprehensive coverage of what happens in Britain, within a single edition. This was the majority opinion of an online questionnaire that ran for a fortnight following the...

Trial of steroids for treating head injury begins.
May 29, 1999... A major international trial has been launched to determine whether the delivery of corticosteroids shortly after head injury can reduce deaths and disability after accidents. Corticosteroid randomisation after significant head injury...

Kent private finance initiative scheme will not save money.
May 29, 1999... The National Audit Office has warned that the new Dartford and Gravesham Hospital in Kent, to be built under the private finance initiative (PFI) scheme, may prove more expensive than it would be under traditional methods. The report on...

Chief medical officer clears genetically modified foods.
May 29, 1999... The chief medical officer for England, Dr Liam Donaldson, has said that there is no evidence to suggest that the technologies used to produce genetically modified foods are harmful to health. In a report published last week, Dr Donaldson...

EU says growth hormones pose health risk.
May 29, 1999... Scientific research commissioned by the European Union has concluded that six growth hormones used for growth promotion in cattle pose a risk to consumers. The adverse consequences include developmental, neurobiological, genetoxic, and...

US drug trials expand outside academic centres.
May 29, 1999... Since the emergence of managed care in the United States in 1990, clinical trials of new drugs have shifted from researchers working in university hospitals and medical schools to individual doctors with little experience in clinical...

Cancer in children of nuclear industry employees: report on children aged under 25 years from nuclear industry family study.
May 29, 1999... Introduction The incidence of leukaemia and non-Hodgkin's lymphoma in young people living near certain nuclear establishments in the United Kingdom has been the subject of much research. [1-23] Of particular concern has been the...

Spitting of blood.
May 29, 1999... Probably most doctors would agree that haemoptysis is a significant symptom and an indication for full investigation to discover the cause. I was interested, therefore, to read an 18th century list of possible causes in The Family Companion...

Sequential randomised and double blind trial of promethazine prophylaxis against early anaphylactic reactions to antivenom for bothrops snake bites.
May 29, 1999... Abstract Objective To investigate the efficacy of the H1 antihistamine promethazine against early anaphylactic reactions to antivenom. Design Sequential randomised, double blind, placebo controlled trial. Setting Public hospital...

The nuclear industry family study: linkage of occupational exposures to reproduction and child health.
May 29, 1999... Concern about high rates of leukemia and non-Hodgkin's lymphoma among children and young adults living near certain nuclear establishments in the United Kingdom has led to a series of population based case-control studies.[1 2] All these...

Incidence of non-specific abdominal pain in children during school term: population survey based on discharge diagnoses.
May 29, 1999... Abdominal pain remains a common problem in childhood and often results in admission to hospital.[1] Of these children, however, only 30-40% will require surgical intervention.[2 3] Most are discharged with a diagnosis of non-specific...

Advising parents of asthmatic children on passive smoking: randomised controlled trial.
May 29, 1999... Abstract Objective To investigate whether parents of asthmatic children would stop smoking or alter their smoking habits to protect their children from environmental tobacco smoke. Design Randomised controlled trial. Setting...

More than reason.
May 29, 1999... Many things escape the reason, and a person who should attempt to understand life by merely using his reason would be like a man trying to take hold of a flame with the tongs. Nothing remains but a bit of charred wood, which immediately stops...

Psychosocial factors in the aetiology and prognosis of coronary heart disease: systematic review of prospective cohort studies.
May 29, 1999... Summary points In healthy populations, prospective cohort studies show a possible aetiological role for type A/hostility (6/14 studies), depression and anxiety (11/11 studies), psychosocial work characteristics (6/10 studies), social...

Studying for the MRCP--was it worth while?
May 29, 1999... When in 19961 decided to do part of my further vocational training in Britain, I also decided to attempt the membership examination of the Royal College of Physicians. I knew it was said to be difficult, but as I was advanced in my training...

ABC of intensive care Organisation of intensive care.
May 29, 1999... Intensive care dates from the polio epidemic in Copenhagen in 1952. Doctors reduced the 90% mortality in patients receiving respiratory support with the cuirass ventilator to 40% by a combination of manual positive pressure ventilation...

Why heart disease mortality is low in France: the time lag explanation.
May 29, 1999... Malcolm Law, Nicholas Wald Summary points Mortality from ischaemic heart disease in France is about a quarter of that in Britain, but the major risk factors are similar Undercertification of ischaemic heart disease in France...

Not playing with a full DEC: why development and evaluation committee methods for appraising new drugs may be inadequate.
May 29, 1999... Summary points The National Institute for Clinical Excellence will appraise 30-50 drugs and technologies each year to inform decisions on whether these should be accepted or refused NHS reimbursement The appraisal process will mirror...

Left ventricular dysfunction among elderly patients in general practice.
May 29, 1999... Electrocardiograms are useful in these patients... EDITOR--Morgan et al have shown that left ventricular systolic dysfunction is common in elderly patients in a general practice setting.[1] They mention that an optimal method of...

Evidence exists for some advertising claims made on the internet.
May 29, 1999... EDITOR--Although I agree with many of the points raised by Troger and Meyer,[1] I think they have underemphasised the evidence supporting the role of antioxidant vitamins in protecting against heart disease. This evidence has been thoroughly...

Clinical trials in primary care.
May 29, 1999... Costs of research should not be borne by service practitioners EDITOR--Foy et al debate the role of financial incentives to improve the recruitment of patients to primary care based trials.[1] The critical issue should more properly be...

Migraine and stroke in young women.
May 29, 1999... Authors' results suggest that all types of migraine are contraindications to oral contraceptives EDITOR--Chang et al report that the odds ratios for ischaemic stroke in young women with classical migraine (with aura) and simple migraine...

Authors may have underestimated number of young doctors still working in NHS.
May 29, 1999... EDITOR--Lambert and Goldacre estimate that about 17% of doctors who qualified from British medical schools in 1983 and 1988 are not now working in the NHS.[l] Their calculation, which was based on the capture-recapture method, depends on the...

Hereditary haemochromatosis should be more widely known about.
May 29, 1999... EDITOR--McCurdie and Perry draw attention to hereditary haemochromatosis, the commonest autosomal recessive genetic disorder in the United Kingdom.[1,2] Estimates suggest that 70 000 people in the United Kingdom have symptomatic hereditary...

Vaccines and their real or perceived adverse effects.
May 29, 1999... Authors' conclusions are at odds with investigators' EDITOR--In responding to Jefferson's editorial about vaccination and its adverse effects Classen and Classen say that present immunisation schedules may exacerbate the development of...

Neurogenetic determinism and the new euphenics.
May 29, 1999... Psychosocial and ethical issues in psychiatric genetics require constructive debate EDITOR--Various implications of advances in understanding of the genetic contribution to susceptibility to neuropsychiatric disorders must be debated....

Scanning during pregnancy is often for doctors' benefit rather than parents'.
May 29, 1999... EDITOR--Nine years ago I was expecting a baby and was excited about my first scan. Everything seemed normal until the hospital asked me to return, with my husband, because they wanted to discuss the scan. Immediately I felt alarmed and...

Radiosurgery for brain tumours.
May 29, 1999... Editorial was wrong to denigrate radiosurgery so strongly EDITOR--Brada and Cruickshank criticise the use of radiosurgery in general and gamma knife radiosurgery in particular, apparently because of the lack of any controlled trials or...

Presumed consent.
May 29, 1999... If this is introduced, people will have to have all relevant information EDITOR--Beecham reports that the BMA wants to start a debate on presumed consent to organ donation.[1] Ethically, consent should be informed, whether it is...

Speaking sign language from birth can make deaf children confident.
May 29, 1999... EDITOR--We were perturbed to read O'Donoghue's one sided account of the range of communication methods and languages available to deaf children.[1] O'Donoghue states that any language other than spoken language "leads to lifelong linguistic...

Assisted suicide law in Oregon.
May 29, 1999... EDITOR--In his balanced editorial Brody noted that during the first year of Oregon's physician assisted suicide law 15 terminally ill patients had received prescriptions for lethal drugs and successfully ended their lives.[1] Incidentally,...

Airline passenger dies after being sedated.
May 29, 1999... Death may have been due to positional asphyxia... EDITOR--Kovac describes how a disturbed man on a plane who had probably taken drugs and alcohol died after being restrained and given intravenous sedation with diazepam.[1] This would...

Obituaries.
May 29, 1999... George Duncan Stewart Beechey Former general practitioner Chorley, Lancashire (b Missoorie, India, 1910; q Glasgow 1938), died after a cerebral vascular accident on 13 January 1999. Duncan had a degree in forestry from Oxford, intending...

GPs oppose MPs' proposals on removing patients from lists.
May 29, 1999... The General Practitioners Committee opposes the suggestion of the select committee on public administration that GPs' powers to remove patients from their lists should be qualified by changing their terms of service. In their response to...

Clinical governance needs time and money.
May 29, 1999... Clinical governance needs time and money to improve standards of care, a report from the King's Fund says. In Experience, Evidence and Everyday Practice the fund shows that guidance from the National Institute for Clinical Excellence will...

GPs given guidance over millennium planning.
May 29, 1999... The General Practitioners Committee is pressing the UK government for additional resources to support NHS services over the millennium, and has made the case for a substantial patient education campaign. The guidance points out that 12...

BMA NOTICES.
May 29, 1999... BMA council election A casual vacancy has occurred on the council of the association for a representative of hospital doctors in the training grades and general practice registrars in Scotland for the remainder of the sessions 1998-9 and...

Informing Patients: An Assessment of the Quality of Patient Information Materials.
May 29, 1999... King's Fund, 16.95 [pounds sterling], pp 216 ISBN 1 8571 7214 0 Pamphlets and, recently, audiotapes and videos have become a usual, visible, and promoted source of information for patients in general practice, in specialist consulting...

Should Health Screening be Private?(Review)
May 29, 1999... Institute of Economic Affairs, 5.60 [pounds sterling], pp 78 ISBN 0 255 36451 2 The NHS should stop screening for breast and cervical cancer. Indeed, the NHS should offer screening only in very limited circumstances, such as for adults...

Mobiles on the brain.(Review)
May 29, 1999... "The Mobile Mystery," Panorama, BBC1, Monday 24 May, 10 05 pm Media attention has once again focused on alleged links between use of mobile phones and an increased risk of brain tumours. Panorama used two case histories to illustrate the...

Making a mess of sex.
May 29, 1999... The British press loves nothing better than a story about sex. So it proved again when the national newspapers devoted nearly 350 column inches to adolescents' sexual health after a recent paper by consultant epidemiologist Angus Nicoll and...

WEBSITE OF THE WEEK.
May 29, 1999... www.york.ac.uk/inst/crd/ehc41.pdf The French seem to have just as many risk factors for coronary heart disease as the British, yet its incidence in France is lower than in Britain--the so called French paradox. In this week's BMJ the...

Anything else, sir?
May 29, 1999... Yes, condoms supplied in general practice. I was never quite sure whether pure altruism led general practitioners to support gents' hairdressers, by refusing the possibility of prescribing condoms, when women's contraception went on...

Basic science.
May 29, 1999... In this second part I have selected more answers given by junior high, high school, and college students in their exams (94 April, p 1153), but this time in the basic sciences. Science, after all, is the order of the day; for without it...

Minerva.
May 29, 1999... Acne may be common, but it is not trivial. A team of British epidemiologists and dermatologists compared the health and well being of 111 patients with moderately severe acne with a random community sample of over 9000 people (British Journal...

Thorough cancer surgery may make radiation unnecessary.
May 22, 1999... Women who undergo localised breast surgery for the removal of a common form of non-invasive breast carcinoma may have their need for follow up radiotherapy eliminated if surgeons remove an extra centimetre of tissue around the cancer,...

Children who sleep with light on may damage their sight.
May 22, 1999... Small children and babies who sleep with the light on are more likely to grow up shortsighted than children who sleep in the dark, a team of US researchers reported last week. A study of 479 children aged between 2 and 16 years shows that...

In brief.
May 22, 1999... NHS has new research director: Professor Sir John Pattison has been appointed director of research and development at the UK Department of Health. Sir John, aged 56, is currently vice provost and professor of medical microbiology at...

Hungarians spurn private health insurance.
May 22, 1999... Hungarians apparently have yet to become enthusiastic about private hospitals and buying their own health insurance. Over the past six months, Providencia Austrian-Hungarian Insurance, under exclusive contract to Hungary's first private...

Welsh Assembly appoints health secretary.
May 22, 1999... Dealing with the health inequalities in Wales is top of the agenda for Jane Hutt, the newly appointed Welsh Assembly secretary for health and social services. Labour, the biggest party in the assembly but lacking an overall majority,...

Doctors resist adopting clinical guidelines.
May 22, 1999... On their own, education sessions about clinical practice guidelines do little to foster their adoption by doctors and other health providers. A recently published Canadian study found that use of ankle radiography changed little in 10...

Pennsylvania plans to reward organ donation.
May 22, 1999... Pennsylvania is planning to be the first US state to offer a financial reward for organ donation. The state will pay a stipend of about $300 (187 [pounds sterling]) towards the funeral expenses of an organ donor under a plan being worked out...

BMA calls for halt on GM crops.
May 22, 1999... The BMA has called for a moratorium on the commercial planting of genetically modified (GM) crops. This should continue until there is a scientific consensus about the potential long term environmental effects. The association accepts...

Langlands defends NHS information technology strategy.
May 22, 1999... Alan Langlands, chief of the NHS Executive, was due to appear before the House of Commons Public Accounts Committee on Wednesday (as the journal went to press) to defend the NHS strategy on information technology, after criticism had been...

Fluid intake affects the risk of bladder cancer in men.
May 22, 1999... A clear link between increased fluid intake and a decreased risk of bladder cancer has been shown in a paper in the New England Journal of Medicine by Dominique Michaud and her colleagues at the Department of Nutrition, Harvard School of...

Dyslexia may be associated with cerebellar abnormalities.
May 22, 1999... Poor functioning of the cerebellum, the part of the brain concerned with information processing and the automatisation of motor skills, is a key factor in dyslexia, according to a study in the Lancet (1999;353:1662-7). Nearly one in 20...

Belgium is to regulate complementary medicine.
May 22, 1999... Belgium's parliament has paved the way for formal recognition in the country for four types of complementary medicine: acupuncture, homeopathy, osteopathy, and chiropractic. The decision was one of the last taken by the outgoing...

Warning letter not seen by relevant body, Bristol inquiry told.
May 22, 1999... A letter sent in July 1992 to the Royal College of Surgeons of England raising serious concerns about death rates for babies undergoing heart surgery in Bristol was not passed on to the NHS body responsible for deciding whether hospitals...

Savage challenges Irvine for GMC presidency.
May 22, 1999... Sir Donald Irvine, president of the General Medical Council, is facing an attempt to unseat him, in part over his role in the Bristol heart surgery saga. The high profile obstetrician and gynaecologist Wendy Savage is to stand against Sir...

US survey reveals deficits in women's health care.
May 22, 1999... A study of women's health in the United States by the Commonwealth Fund, a philanthropic organisation, has indicated worsening health care for poorer women and revealed widespread violence and abuse. The study, conducted by a national...

Women with epilepsy are not getting pregnancy advice.
May 22, 1999... Women with epilepsy are not getting the advice they need on issues relating to contraception and pregnancy, according to a survey of women members of the British Epilepsy Association (Seizure 1999;8:135-9). A total of 1855 women aged 16...

Ashworth announces its reform plan.
May 22, 1999... Ashworth Hospital, which was recommended for closure in January in a damning report (23 January, p 211), has produced an action plan to overcome its failings. The Merseyside hospital, which has a personality disorder unit that houses...

Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review.
May 22, 1999... Abstract Objective To evaluate the efficacy of vitamin B-6 in the treatment of premenstrual syndrome. Design Systematic review of published and unpublished randomised placebo controlled trials of the effectiveness of vitamin B-6 in...

Influence of hospital and clinician workload on survival from colorectal cancer: cohort study.
May 22, 1999... Abstract Objective To determine whether clinician or hospital caseload affects mortality from colorectal cancer. Design Cohort study of cases ascertained between 1990 and 1994 by a region-wide colorectal cancer register. Outcome...

Commentary: How experienced should a colorectal surgeon be?
May 22, 1999... A question that a patient with colorectal cancer will naturally ask is, "Will my chances of being alive in two years' time be enhanced by my choice of surgeon?" Intuitively we feel that this is so, and that the patients of a more experienced...

Corrections and clarifications.(To "Double blind, cluster randomised trial of low dose supplementation with vitamin A or [Beta] carotene on mortality related to pregnancy in Nepal," in February 27, 1999 issue, pp 570-75)
May 22, 1999... Double blind, cluster randomised trial of low dose supplementation with vitamin A or [Beta] carotene on mortality related to pregnancy in Nepal This general practice paper by Keith P West Jr and colleagues (27 February, pp 570-5)...

Systematic review of the effectiveness of planned short hospital stays for mental health care.
May 22, 1999... Abstract Objective To determine the effectiveness of planned short hospital stays versus standard care for people with serious mental illness. Design Systematic review of all randomised controlled trials comparing planned short...

Endpieces.
May 22, 1999... Plus ca change... A deal is a commercial transaction between purchaser and provider, involving prohibited or strictly controlled items of exchange, conducted in neutral indeterminate spaces not intended for such use, by means of tacit...

Dietary management of hepatic encephalopathy in cirrhotic patients: survey of current practice in United Kingdom.
May 22, 1999... In the early 1950s it was shown that some patients with cirrhosis given "nitrogenous substances," including excess dietary protein, developed hepatic "precoma."[1] These largely uncontrolled observations led to the introduction of dietary...

Effect on hospital attendance rates of giving patients a copy of their referral letter: randomised controlled trial.
May 22, 1999... Abstract Objectives To investigate whether sending patients a copy of their referral letter can reduce non-attendance at outpatient departments. Design Blinded randomised controlled trial. Setting 13 general practices in Exeter,...

Treatment of shoulder complaints in general practice: long term results of a randomised, single blind study comparing physiotherapy, manipulation, and corticosteroid injection.
May 22, 1999... Descriptive studies have shown that shoulder complaints can be persistent and recurrent, requiring long term evaluation of treatment.[1] Unfortunately, in most randomised studies comparing treatments for shoulder complaints the study period...

Email submissions from outside the United Kingdom.
May 22, 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...

Occupational disease.
May 22, 1999... Summary points An understanding of the causes of occupational disease requires both good epidemiology and detailed knowledge of the nature of exposure and the susceptibility of those exposed Concern about the effects of workplace...

Prevention of congestive heart failure and management of asymptomatic left ventricular dysfunction.
May 22, 1999... Summary points Asymptomatic left ventricular dysfunction seems to be common Risk factors for the development of heart failure exist and may be used to determine those patients at greatest risk of left ventricular dysfunction ...

Care of the newborn in the delivery room.
May 22, 1999... It is the duty of those attending a delivery to ensure that the baby is given any resuscitation that may be needed and to do a brief external examination of the baby to exclude immediate problems. Any risk factors for sepsis or other neonatal...

Ethical issues in the design and conduct of cluster randomised controlled trials.
May 22, 1999... Summary points Need for cluster trials will increase with concern over health service evaluation, but issues of ethics and guardianship must be addressed In some cluster trials the intervention can be targeted at individuals...