British Medical Journal articles from May 2001

British Medical Journal archives from May 2001

Change: both desired and resisted.(Editor's Choice)
May 26, 2001... Change is a bugger. People often don't want to change even if they are unhappy with their lot. Nobody has described this better than Giuseppe Tomasi di Lampedusa in The Leopard, the story of the Sicilian Prince of Salina threatened with...

Redesigning health care: radical redesign is a way to radically improve.(Editorial)
May 26, 2001... Radical redesign is a way to radically improve A decade or so ago car manufacturers completely transformed the way they made motor cars: they stopped stockpiling components and supplied them "just in time"; they drastically reduced the...

Implementing national guidelines at local level: changes in clinicians'behaviour in primary care need to be reflected in secondary care.(Editorial)
May 26, 2001... Changes in clinicians'behaviour in primary care need to be reflected in secondary care Both internationally and nationally, the introduction of clinical guidelines is seen as a means of D improving healthcare outcomes and reducing...

Preventing exacerbations of chronic bronchitis and COPD: two recent Cochrane reviews report effective regimens.(chronic obstructive pulmonary disease)(Editorial)
May 26, 2001... Two recent Cochrane reviews report effective regimens Exacerbations of chronic obstructive pulmonary disease affect quality of life and the cost of managing the disease. Though the long term effects of hypersecretion on the deterioration...

Safer discharge from intensive care to hospital wards: randomisation is necessary to disentangle intrinsic patient risk from effects of care.(Editorial)
May 26, 2001... Randomisation is necessary to disentangle intrinsic patient risk from effects of care Intensive care in the United Kingdom is certainly underprovided relative to many developed counties. The United States spends over 1% of its gross...

Continuous subcutaneous insulin infusion in type 1 diabetes: is beneficial in selected patients and should be more widely available.(Editorial)
May 26, 2001... Is beneficial in selected patients and should be more widely available Almost 25 years ago the BMJ published our account of a new technique for achieving long term strict blood glucose control in type 1 diabetes. Continuous subcutaneous...

The BMJ's ethics committee is open for business: editors face a surprising number of ethical problems.(British Medical Journal)(Editorial)
May 26, 2001... Editors face a surprising number of ethical problems About a year ago the BMJ decided to form an ethics committee to help us with the increasing number of ethical problems we face.[1] The chairman and members were appointed last year,[2]...

Paediatric pathology service close to collapse after Alder Hey.(News)
May 26, 2001... Women who miscarry or lose a baby shortly after birth but are refusing to allow a postmortem examination to be carried out are missing out on vital information that could help them to have a healthy baby, doctors have warned. Public...

Kofi Annan describes new health fund for developing countries.(The Global AIDS and Health Fund)(News)
May 26, 2001... The United Nations' secretary general, Kofi Annan, began last week to describe the details of a planned fund to combat major diseases in developing countries. The Global AIDS and Health Fund, first mentioned by Mr Annan last month at an...

In brief.(News)
May 26, 2001... Leprosy reduced by 90% since 1991: The World Health Organization announced this week that it had attained its goal, announced in 1991, of reducing leprosy by more than 90%. But leprosy still remains in Brazil, India, Madagascar, Mozambique,...

Hospital chief was right to release patient consent forms to media.(Keith Prowse, to prove patient's signature was not forged)(News)
May 26, 2001... The acting chief executive of North Staffordshire hospital, who released signed patient consent forms to a reporter when the hospital was embroiled in a controversy over the trial of a new ventilation system for premature babies, was cleared...

European Union toughens antismoking stance.(News)
May 26, 2001... The European Union is preparing to put in place some of the world's toughest antismoking legislation in a bid to reduce drastically the number of deaths and illnesses related to tobacco. Under EU rules agreed this month, national...

GMC revalidation scheme passes first hurdle.(General Medical Council)(News)
May 26, 2001... Inspectors have declared the proposed scheme to revalidate all UK doctors a success after a pilot study showed the "folder and appraisal" method to be relatively straightforward both to assemble and to assess. A team of experts assigned...

Chemotherapy may be overused at the end of life.(News)
May 26, 2001... Many patients with cancer receive chemotherapy at the end of life, even if their kind of cancer is known to be unresponsive to the drugs, according to a study reported at the recent annual meeting of the American Society of Clinical...

Liberal Democrats pledge to pay for long term personal care.(News)
May 26, 2001... The Liberal Democrats, with an ambitious "tax and spend" programme, can afford to put improvements in the health service at the heart of their manifesto. Critics say that it is easy for them to promise the earth because they have such a small...

Northern Ireland's parties call for more cash and less administration.(News)
May 26, 2001... Since the establishment of Northern Ireland's coalition assembly in December 1999, the province's health portfolio has been held, not without controversy, by Sinn Fein's Bairbre de Brun. Nevertheless, health is one of the few areas on...

Political parties promise more north of the border.(Scotland)(News)
May 26, 2001... The arrival of devolution in Scotland means that the coming general election is quite different from anything that has gone before. Health is now run by the Scottish parliament, which means that candidates standing for election will have no...

Plaid Cymru demands third medical school campus in Wales.(News)
May 26, 2001... Wales's Plaid Cymru party wants better funding for the NHS, more doctors and nurses, more beds, and a reduction in waiting lists. It wants a third medical school campus in the principality to increase the number of "home grown" doctors...

Doctors object to patients' access to notes.(News)
May 26, 2001... The Australian Medical Association is fighting plans by the federal privacy commissioner to make doctors surrender all their medical records to patients who demand them within 30 days and at no cost. The association wants some parts of...

Cholesterol guidelines will triple numbers taking drugs.(News)(Statistical Data Included)
May 26, 2001... The US National Institutes of Health, through its national cholesterol education programme, has issued sweeping new clinical practice and management guidelines designed to lower cholesterol levels. The guidelines call for more aggressive...

Attempts to ban DDT have increased deaths.(from malaria)(News)
May 26, 2001... Pressures on poor countries to ban the insecticide DDT because of fears that its use would harm the environment have led to a resurgence of malaria in the world, yet the environmental impact of its use are "negligible," a study published this...

Row over Nottingham tobacco cash deepens.(News)
May 26, 2001... The decision by Nottingham University to accept a 3.8m [pounds sterling] ($5.3m) donation from British American Tobacco has led directly to the loss of cancer research funding and prestigious research staff from the university. The...

US drug firms resist over the counter sales.(of Claritin, Zyrtec, and Allegra)(News)
May 26, 2001... An advisory panel of the US Food and Drug Administration (FDA) has voted overwhelmingly that three allergy remedies--loratadine, cetirizine, and fexofenadine--are safe enough to be bought at pharmacies and supermarkets without a doctor's...

Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary disease: systematic review.
May 26, 2001... Abstract Objective To assess the effects of oral mucolytics in adults with stable chronic bronchitis and chronic obstructive pulmonary disease. Design Systematic review of randomised controlled trials that compared at least two...

Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model.
May 26, 2001... Abstract Objective To develop a predictive model to triage patients for discharge from intensive care units to reduce mortality after discharge. Design Logistic regression analyses and modelling of data from patients who were...

Perineal massage in labour and prevention of perineal trauma: randomised controlled trial.
May 26, 2001... Abstract Objective To determine the effects of perineal massage in the second stage of labour on perineal outcomes. Design Randomised controlled trial. Participants At 36 weeks' gestation, women expecting normal birth of a...

The medical regulation of marriage.(One Hundred Years Ago)
May 26, 2001... Indiana has now joined in the endeavour to make marriages healthy by Act of Parliament. On March 4th the Senate of that State passed a Bill intended to limit divorces in the State by preventing ill-chosen marriages. The Bill provides for the...

Peak expiratory flow sequence in acute exacerbations of asthma.(Research Pointers)
May 26, 2001... The effect of deep inspiration on airway calibre in asthma may be a marker of the pathophysiology of airflow obstruction. Dilator responses occur with predominant airway smooth muscle spasm,[1] and constrictor responses with more severe...

Pragmatic randomised controlled trial to evaluate guidelines for the management of infertility across the primary care-secondary care interface.
May 26, 2001... Abstract Objective To investigate the effect of clinical guidelines on the management of infertility across the primary care-secondary care interface. Design Cluster randomised controlled trial. Setting General practices and NHS...

Point of care testing.(Clinical Review)
May 26, 2001... Summary points Point of care testing requires trained operators to ensure a good quality service Testing is effective only if action taken on the result Testing has been shown to reduce hospital stay, improve adherence to...

Delayed presentation of handlebar injuries in children.(Lesson of the Week)
May 26, 2001... Initial assessment of children with abdominal trauma from bicycle handlebars may provide false reassurances Accidents represent the largest single cause of death in childhood. Although head injuries are the major cause of mortality and...

Natural history and management of early HIV infection.(ABC of AIDS)
May 26, 2001... Introduction Infection with HIV causes a spectrum of clinical problems beginning at the time of seroconversion (primary HIV) and terminating with AIDS and death. It is now recognised that it may take 10 years or more for AIDS to develop...

Ethics behind closed doors: do research ethics committees need secrecy?(Education and Debate)
May 26, 2001... Summary points Research ethics committees have a vital role in protecting the public and facilitating useful research but are increasingly under attack In many countries, including the United Kingdom, research ethics committees meet...

Using quality of life measures in the clinical setting.(Measuring Quality of Life, part 2)
May 26, 2001... This is the second in a series of five articles Summary points Using quality of life measures in clinical practice ensures that treatment and evaluations focus on the patient rather than the disease The measures are potentially...

Athlete's foot and fungally infected toenails.
May 26, 2001... Authors should use familiar drug names EDITOR--The review of effectiveness of treatments for athlete's foot seemed perfectly timed[1]: my shopping list for that Saturday morning included a fungicide to control the infection under my...

Obituaries.(Obituary)
May 26, 2001... Lydia Anne Burcher Consultant anaesthetist Birmingham C hildren's Hospital 1997-2000 (b 1962; q Birmingham 1984; MRCP, FRCA), d 16 October 2000. Lydia trained in general medicine before embarking on her anaesthetic career and...

Serious Shopping: Essays in Psychotherapy and Consumerism.(Review)
May 26, 2001... Serious Shopping: Essays in Psychotherapy and Consumerism Ed Adrienne Baker Free Association Books, 15.95 [pounds sterling], pp 220 ISBN 1 85343 483 3 Rating: ** I have often wondered whether the BMJ should have a fashion column for...

Male Infertility: A Guide for the Clinician.(Review)
May 26, 2001... Male Infertility: A Guide for the Clinician Anne M Jequier Blackwell Science, 79.50 [pounds sterling], pp 384 ISBN 0 632 0512 9 Rating: *** As a result of the rapid development of in vitro fertilisation for treating both male and...

Smothering truth.(Sarah Lawson )
May 26, 2001... Did the NHS fail Sarah Lawson? The story of the killing of Sarah Lawson by her father was on the front page of two of the biggest selling newspapers and featured prominently in all the others. It dominated broadcast news bulletins, and...

NETLINES.
May 26, 2001... * The internet can help a busy practitioner keep abreast of the burgeoning volume of medical literature in many ways. www.amedeo.com/ index.htm is a simple yet effective resource. Choose a topic--there is a fair selection--pick your preferred...

Are you being duped?(May issue of Pharmaceutical Marketing magazine urges salesmen to seek out and cultivate medical opinion leaders)
May 26, 2001... How drug companies use opinion leaders We all know that there is no such thing as a flee drugs company lunch, but, what the hell, the food's good, those marketing people seem ever so nice, and, anyway, there doesn't really seem to be any...

Medicinal use of cannabis.(Website of the Week)
May 26, 2001... Medicinal use of cannabis The medicinal use of cannabis (p 1313) seems to bother the internet community. Many sites report on the medicinal use of marijuana, weed, ganja, kif, pot, and other trusting names. These sites are, however, mainly...

Extra pharmacopoeia.(medical use of marijuana)(Personal Views)
May 26, 2001... I am not now nor have I ever been nor do I have any intention of becoming a user of illicit drugs. I routinely advise against the use of LSD, amphetamines, Ecstasy, cocaine, and the like. However... I have no doubt that I could secure...

Secretaries for PRHOs.(preregistration house officer)(Soundings)
May 26, 2001... My son the trainee solicitor, in his first salaried post after five years at university, is the equivalent, I suppose, of a preregistration house officer (PRHO). Nevertheless, he has his own telephone and an answering machine that suggests to...

Minerva.
May 26, 2001... A two year follow up of 447 Finnish hospital doctors and their senior nurse controls has found that the doctors took about one third of the amount of sick leave taken by their controls. But there were no differences in health outcomes, self...

From paracetamol packets to bed nets.(Editor's Choice)
May 19, 2001... Social engineering got a bad name in the 1980s, but all politics and most public health is social engineering. Rather than deny they are doing it, those who engage in it should ensure they do it well--and evaluate its effects. A good...

Global campaign to eradicate malaria: Roll Back Malaria has achieved a high profile but little real action.(Editorial)
May 19, 2001... Roll Back Malaria has achieved a high profile but little real action Three years have passed since the launch of Roll Back Malaria, the global campaign to halve the burden of malaria by 2010, and one year since its high profile African...

Routine home treatment of deep vein thrombosis.(Editorial)
May 19, 2001... Is now a reality Heparin therapy for at least five days followed by long term oral anticoagulation has been the standard care for patients with acute deep vein thrombosis.[1] Initiation of treatment usually requires patients to be...

Written information for treating minor illness.(Editorial)
May 19, 2001... Alone, it's not very valuable--but we shouldn't expect it to be Written information, particularly in the form of leaflets, has usually been seen as an adjunct to verbal information in the treatment of specific illnesses, such as back...

Protecting travellers from hepatitis A: vaccine should be used for almost every occasion when prevention is required.(Editorial)
May 19, 2001... Vaccine should be used for almost every occasion when prevention is required Infection with hepatitis A virus, an RNA virus of the picornoviridae family, remains an important public health problem in many regions of the world and is...

GMC: approaching the abyss.(Editorial)
May 19, 2001... Still worth saving? Perhaps, perhaps not The General Medical Council--unloved by patients, government, and doctors--is close to the abyss. What might push it over the edge in the next two months is the issue of its governance,[1 2] or if...

GP dossier says patients getting "second rate" service.(general practice)(News)
May 19, 2001... Intolerable working conditions in general practice mean that many patients are receiving a "second rate-or worse" health service, and unless extra resources are pumped into the system patient care will continue to be compromised, warned the...

Doctors explain their unhappiness.(News)
May 19, 2001... More than 1400 people voted in the BMJ poll on why doctors are unhappy. The poll was set up after an editorial in the BMJ, in which the editor, Dr Richard Smith, put forward his views on why the profession was miserable (5 May, p 1073). ...

In brief.(News)
May 19, 2001... US Supreme Court bans medical use of marijuana: The Supreme Court in Washington state ruled this week that marijuana was a controlled substance under federal law and could be used legally only in government approved research projects. It...

US spending on prescription drugs rose by 19% in 2000.(News)(Statistical Data Included)
May 19, 2001... Americans spent $132bn (94bn [pounds sterling]) on prescription drugs last year, an increase of $20.8bn (18.8%) over 1999. Spending on prescription drugs in the United Kingdom in 2000 was 7bn [pounds sterling]. A study by the National...

Foreigners flock to Cuba for medical care.(News)
May 19, 2001... Foreigners seeking medical treatment are flocking to Havana, lured by advertisements and lower costs. Cuban officials have said that 3500 foreigners came for health care last year. "People with a lot of money are looking for our...

Registries will have to apply for right to collect patients' data without consent.(News)
May 19, 2001... An amendment to the Health and Social Care Bill passed by parliament last week should clear the way for health registries in the United Kingdom to continue collecting data on public health without patients' consent, the General Medical...

Community health councils temporarily reprieved.(News)
May 19, 2001... The government managed to rush the Health and Social Care Bill through its last stages in parliament last week when it agreed a temporary reprieve for community health councils and a statutory body to safeguard patient confidentiality. ...

Correction.(Correction Notice)
May 19, 2001... Audit shows weaknesses in cervical cancer screening The first sentence of this news story by Annabel Ferriman (12 May, p 1141) should have read: "An audit of cervical cancer screening in Leicestershire has shown that 1 in 3 women who...

Compression stockings may help prevent deep vein thrombosis.(News)
May 19, 2001... Symptomless deep venous thrombosis might occur in up to 10% of long haul airline travellers, concluded the authors of a new study published last week, which assessed the overall frequency of the condition in long haul airline passengers...

Ireland orders inquiry into "barbaric" obstetric practices.(symphysiotomy and pubiotomy)(News)
May 19, 2001... The Irish health minister has ordered an investigation by the Institute of Obstetricians and Gynaecologists into the use by some surgeons, 40 to 50 years ago, of procedures to open the pelvis as an alternative to caesarean sections. The...

Editor resigns from post after tobacco gift.(Richard Smith, BMJ editor and professor of medical journalism at the University of Nottingham)(News)
May 19, 2001... Dr Richard Smith, editor of the BMJ, last week resigned from his position as professor of medical journalism at the University of Nottingham. His resignation follows the acceptance by the university of 3.8m [pounds sterling] ($5.3m) from...

GMC to hold a meeting with its critics.(General Medical Council)(News)
May 19, 2001... The General Medical Council has organised a special one day consultative conference next month, when it will discuss its modernisation plans with its critics in an attempt to forge an agreement. The initiative has been welcomed by the...

Parathyroid hormone may prevent osteoporosis.(News)
May 19, 2001... A recombinant human parathyroid hormone significantly reduced the risk of new fractures in postmenopausal women with previous osteoporotic fractures and significantly increased bone density, in a phase III study of the new compound. In...

Canada's parliament calls for tighter water standards.(News)
May 19, 2001... Alarmed by growing fears of widespread pollution of drinking water, Canada's parliament has passed a resolution calling for a national law setting out enforceable national standards for water quality. Forty six people have recently become...

US approves new anti-leukaemia drug.(Gleevec)(News)
May 19, 2001... A new oral drug to treat chronic myeloid leukaemia has been approved in record time by the US Food and Drug Administration. At a news conference in Washington, DC, attended by the US secretary of health and human services, Tommy Thompson,...

US cancer care is worse due to more paperwork.(News)
May 19, 2001... US cancer specialists are calling for reform of administrative measures designed to reduce healthcare fraud that have resulted in so much paperwork that patient care is suffering, according to results from a survey presented earlier this...

Shipman inquiry to investigate 466 deaths.(Harold Shipman)(News)
May 19, 2001... At least 466 deaths will be investigated by the public inquiry into the British serial killer GP Harold Shipman, the inquiry chairwoman, High Court judge Dame Janet Smith, announced last week. Dame Janet said that the inquiry would try to...

Outfoxing the government.(News)
May 19, 2001... Weighing up the Conservatives' health policies and their past record on the NHS, Jo Revill believes that the best the party can hope for is to neutralise the issue As Britain prepares for a general election, there are few signs that any...

Effects of legislation restricting pack sizes of paracetamol and salicylate on self poisoning in the United Kingdom: before and after study.
May 19, 2001... Abstract Objective To evaluate the effects on suicidal behaviour of legislation limiting the size of packs of paracetamol and salicylates sold over the counter. Setting UK population, with detailed monitoring of data from five liver...

Antipsychotic drugs and heart muscle disorder in international pharmacovigilance: data mining study.
May 19, 2001... Abstract Objectives To examine the relation between antipsychotic drugs and myocarditis and cardiomyopathy. Design Data mining using bayesian statistics implemented in a neural network architecture. Setting International...

Effect of improved housing on illness in children under 5 years old in northern Malawi: cross sectional study.
May 19, 2001... Abstract Objective To evaluate the effects of a Habitat for Humanity housing improvement programme in northern Malawi on the prevalence of childhood illnesses. Design Household based cross sectional study. Setting Rural...

Eligibility for home treatment of deep vein thrombosis: prospective study.
May 19, 2001... Low molecular weight heparin is safe and effective for the treatment of deep vein thrombosis.[1] We have recently shown in a randomised study that immobilisation is not necessary.[2] The results challenge the traditional notion that these...

Pseudophaeochromocytoma syndrome associated with clozapine.
May 19, 2001... Clozapine (Clozaril, Novartis), a tricyclic dibenzodiazepine derivative, has an established role in the treatment of refractory schizophrenia. In the United Kingdom the drug may only be prescribed by consultant psychiatrists registered with...

Randomised controlled trial of self management leaflets and booklets for minor illness provided by post.
May 19, 2001... Abstract Objective To assess the effectiveness of providing information by post about managing minor illnesses. Design Randomised controlled trial. Setting Six general practices. Participants Random sample of 4002 patients...

Assessment of impact of information booklets on use of healthcare services: randomised controlled trial.
May 19, 2001... Introduction There is a general perception among healthcare professionals that increasing demand for health services is caused partly by lack of knowledge about self management of minor illness. This view of help seeking behaviour, which...

On being 60.(Poem)
May 19, 2001... Endpiece Now Charito is 60. But her hair is dark: Her ample bosoms firm and fair: Her skin is like a young girl's, warm and white: Her legs and thighs are fashioned to delight. Her years are in her favor, for she...

Microbubble contrast agents: a new era in ultrasound.(Science, Medicine and the Future)
May 19, 2001... Science, medicine and the future Contrast agents are widely used in imaging, but until recently they had little place in ultrasonography. This has changed with the introduction of microbubbles--small (typically 3 [micro]m in diameter)...

Development of the epidemic.(ABC of AIDS)
May 19, 2001... ABC of AIDS The first recognised cases of the acquired immune deficiency syndrome (AIDS) occurred in the summer of 1981 in America. Reports began to appear of Pneumocystis carinii pneumonia and Kaposi's sarcoma in young men, who it was...

What to do when blood pressure is difficult to control.(Evidence Based Management of Hypertension)
May 19, 2001... Summary points Consider the following causes for apparently resistant blood pressure: inaccurate measurement, antagonising substances such as non-steroidal anti-inflammatory drugs, aggravating conditions such as obesity or sleep apnoea,...

My namesake.(A Memorable Patient)
May 19, 2001... A memorable patient While reading in Mikhail Bulgakov's A Country, Doctor's Notebook about the author's experiences of clinical situations that, as a newly qualified doctor in 1916, he was really quite unqualified to deal with, both in...

Psychosocial and material pathways in the relation between income and health: a response to Lynch et al.(Education and Debate)
May 19, 2001... Summary points Economic and social circumstances affect health through the physiological effects of their emotional and social meanings and the direct effects of material circumstances Material conditions do not adequately explain...

Medical errors and medical culture: an ethical dilemma.
May 19, 2001... An ethical dilemma A junior doctor fails to read an electrocardiogram that has been ordered and the patient dies, undiagnosed and in pain, from a myocardial infarction. We asked a professor of medical ethics, an expert in medical errors,...

Is quality of life determined by expectations or experience?
May 19, 2001... Summary points Health related quality of life is the gap between our expectations of health and our experience of it Perception of quality of life varies between individuals and is dynamic within them People with different...