British Medical Journal articles from November 1998

British Medical Journal archives from November 1998

UK report calls for policies to halt growing inequalities in health.
November 28, 1998... Health inequalities in England have increased over the past 20 years, reveals a report from an independent inquiry published this week. Inquiry members have recommended that all future policy development should consider the potential for...

UN report warns that AIDS epidemic is still out of control.
November 28, 1998... A report published this week by the United Nations and the World Health Organisation shows that there has been little progress in preventing the transmission of AIDS. New drugs have increased survival times for patients in developed...

Ombudsman calls for better communication.
November 28, 1998... Record numbers of complaints have been made to Britain's health service ombudsman, Michael Buckley, whose latest report published this week details investigations of clinical problems for the first time, as well as administrative failures. He...

UK charter aims to improve rights for the dead.
November 28, 1998... The Dead Citizens Charter, launched this week in the United Kingdom, warns that the average funeral in Britain is a "costly and miserable affair," and calls for wide reforms of the 840m [pounds sterling] funeral industry to allow informed...

Burrowing bacteria may explain recurrent urinary tract infections.
November 28, 1998... People who have recurrent urinary tract infections may have a chronic infection that is never fully eradicated, rather than having a new infection each time. Scientists have discovered that a strain of Escherichia coli that commonly causes...

Junior doctors look forward to shorter hours.
November 28, 1998... The European Commission has proposed that junior hospital doctors should be included in the directive on working time, which potentially limits their hours to an average of 48 a week. If the Council of Ministers, which is due to meet on 2...

Waiting times increase in English casualty departments.
November 28, 1998... Waiting times have increased in 70% of accident and emergency departments in England over the past two years, an Audit Commission report revealed last week. The Audit Commission, responsible for the external audit of the NHS in England...

Surgeons repair spina bifida before birth.
November 28, 1998... Surgeons have achieved the first correction of spina bifida in a 23 week old fetus, allowing the baby to be born with normal leg movements a few weeks later. The doctors who performed the surgery reported that by repairing the condition...

NHS bill to legislate against clinical lapses.
November 28, 1998... A drive to improve standards of clinical performance in the NHS throughout Britain was the focus of legislation foreshadowed in the Queen's speech at the opening of parliament last Tuesday. The bill--due to be published early next...

Indian Supreme Court rules that HIV positive people inform spouses.
November 28, 1998... The Indian Supreme Court has ruled that people who are HIV positive must inform future spouses of their infection. In a judgment made public last week, the court also said that hospitals could not be charged with violating medical ethics when...

WHO visit to China heralds closer links.
November 28, 1998... In her first visit to a member state of the WHO, Director General Gro Harlem Brundtland this week visited China, signalling "a revolution in the way the WHO looks at both Asia and health." Following her own prescription to put health...

Standards set to improve UK transplantation services.
November 28, 1998... The British Transplantation Society has published its first set of standards for best practice in an attempt to rationalise transplantation services across the country. Mr Bob Johnson, president of the society, explained that the...

GP found guilty of forging trial consent forms.
November 28, 1998... A UK general practitioner who forged patient consent forms for clinical research was paid over 23 000 [pounds sterling] ($36 800) before the fraud was uncovered, according to evidence presented last week to the General Medical Council. ...

The man from NICE.(Britain's National Institute for Clinical Excellence)
November 28, 1998... Kamran Abbasi spoke to Michael Rawlins, the new chairman designate of the National Institute for Clinical Excellence In 1997, Labour's Christmas presents to the NHS were NICE and CHIMP--a year later, these acronyms sound even less...

Carotid endarterectomy for asymptomatic carotid stenosis: a meta-analysis.
November 28, 1998... Abstract Objective To assess the value of carotid endarterectomy for prevention of stroke in patients with asymptomatic carotid stenosis. Design Systematic review and meta-analysis of randomised controlled trials in patients with...

Randomised trial of early diet in preterm babies and later intelligence quotient.
November 28, 1998... Abstract Objectives To determine whether perinatal nutrition influences cognitive function at 7 1/2-8 years in children born preterm. Design Randomised, blinded nutritional intervention trial. Blinded follow up at 7 1/2-8 years. ...

Randomised controlled trial of novel, simple, and well supervised weight reducing diets in outpatients.
November 28, 1998... Abstract Objectives To investigate the contribution of novelty and simplicity to compliance with a low energy diet among obese outpatients. Design Three arm randomised trial for 16 weeks. Setting NHS hospital obesity clinic. ...

Effect of government recommendations on methadone prescribing in south east England: comparison of 1995 and 1997 surveys.
November 28, 1998... On instruction from the Minister of Health, the Department of Health in England convened a task force on the effectiveness of treatment services for drug misusers, and widely distributed its recommendations in 1996.[1] Methadone constituted...

High dose inhaled corticosteroids and dose dependent loss of diabetic control.
November 28, 1998... High dose inhaled corticosteroids and dose dependent loss of diabetic control We report a case of loss of diabetic control in a patient given high doses of inhaled fluticasone propionate for asthma. A 67 year old man who had had...

Correction.(to `Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes,' in Feb 14, 1998 issue)(Correction Notice)
November 28, 1998... Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes An...

Value of breast imaging in women with painful breasts: observational follow up study.
November 28, 1998... Abstract Objectives To determine the value of breast imaging in patients with localised or diffuse pain in the breast in whom physical examination shows no abnormalities. Design Observational follow up study. Setting Radiology...

Towards quality management of medical information on the internet: evaluation, labelling, and filtering of information.
November 28, 1998... The principal dilemma of the internet is that, while its anarchic nature is desirable for fostering open debate without censorship, this raises questions about the quality of information available, which could inhibit its usefulness. While...

Hallmarks for quality of information.
November 28, 1998... The Goldsmiths' Company was founded in London in 1327 and has flourished for over 650 years. It never traded gold but specialised in the assay of gold and other precious metals. The Goldsmiths' Company has flourished because it has been an...

Quality on the internet.
November 28, 1998... Interest in searching the world wide web for health related information continues to increase, increasing the need for internet resources to be accountable to doctors and the public.[1] Function, structure, and content of a website are the...

Assuring quality and relevance of internet information in the real world.
November 28, 1998... Interest in how new information technology can be used to improve health is growing steadily. Telemedicine is making it possible to erase geographical constraints on the provision of health care. However, the information revolution is not a...

Drug treatment during pregnancy.
November 28, 1998... For most doctors prescribing a drug to a pregnant woman is like taking a journey through uncharted territory; navigation is made no easier by the darkness cast by "thalidomide's long shadow."[1] The usual benchmarks are absent because...

Malaria at Christmas: risks of prophylaxis versus risks of malaria.
November 28, 1998... There was a large increase in the number of cases of falciparum malaria imported into the United Kingdom and reported to the malaria reference laboratory in the first quarter of 1998.[1] The two factors cited to explain this increase were...

Science commentary: Protection against malaria.
November 28, 1998... Malaria can be prevented. Unfortunately, travellers to areas where malaria is common often put themselves at risk of contracting the disease by ignoring the key steps in malaria prevention. The steps are simple but if ignored can result in...

Management of sexual problems.
November 28, 1998... Sexual problems present in various ways, many indirect or covert. Patients do not like to come straight to the point. They fear looking stupid by using wrong words, or giving offence by being too explicit, or they have no way of...

"Healthy People 2010": national health objectives for the United States.
November 28, 1998... Establishing health objectives for a population is an important component of programmes aimed at improving and protecting public health. At whatever level it is used--community, state, country, or continent--a system to develop and attain...

Theories and studying the care of dying people.
November 28, 1998... The quality of care for dying people is often investigated by interviews with dying people, or with carers before or after the death. Conventionally the respondent's account is treated as a resource for learning about previous events....

Correction.(to `Implementing research findings in developing countries,' in August 22, 1998 issue)(Correction Notice)
November 28, 1998... Implementing research findings in developing countries An error during editing and checking has changed the sense of one section of this article by Paul Garner et al (22 August, pp 531-5). On page 532, the statement that "it is precisely...

Role of chief medical officer as indeed diminished.
November 28, 1998... EDITOR--Sir Donald Acheson's comments about how the post of chief medical officer for England has been diminished in recent years[1] seem entirely right to me; my term as chief medical officer ended 25 years ago. The chief medical officer's...

People should participate in, not be subjects of, research.
November 28, 1998... EDITOR--The use of the term "subjects" in the BMI's structured abstracts conflicts with current research policy. A Medline review of BMJ structured abstracts published in 1997 revealed that 202 abstracts included the term "subjects" as a...

Resistance to antibiotics.
November 28, 1998... Prescribing of antibiotics needs to be rational EDITOR--We agree with Hart that undergraduate and postgraduate medical education in the use of antimicrobials needs to be increased.[1] Abbasi's news article[2] is opposite a full page...

Videos, photographs, and patient consent.
November 28, 1998... Medical educationalists can free themselves from constraints of "real world" images EDITOR--Hood et al rightly emphasise that "the internet and electronic publishing are powerful tools for the dissemination of medical information and...

Consultants have sought to re-examine their contract.
November 28, 1998... EDITOR--In arguing for a new contract for consultants Richards confuses quality with quantity.[1] Although both issues need to be addressed, the way to improve quality is through the more rigorous mechanisms for professional self regulation...

More large trials needed to decide best duration of treatment with tamoxifen.
November 28, 1998... EDITOR--I agree with Rea et al that we do not know the optimum duration of adjuvant tamoxifen treatment.[1] The data that they presented, however, suggest that the trials they advocated--ATLAS (adjuvant tamoxifen longer against shorter) and...

Community acquired pneumonia in elderly people.
November 28, 1998... Addition of erythromycin is not currently justified EDITOR--I agree with Wort and Rogers that current British guidelines on community acquired pneumonia need revision, but I do not believe that the addition of erythromycin should always...

DNA methods should be used to detect Chlamydia trachomatis.
November 28, 1998... EDITOR--We agree with the comments[1] on Boag and Kelly's editorial[2] about the recommendations made by the chief medical officer's expert advisory group on Chlamydia trachomatis. We wish to raise another issue. The laboratories...

Rigid following of dogma will not be best for all patients.
November 28, 1998... EDITOR--As general practitioners who run a training scheme we found the series "Getting research findings into practice" thought provoking.[1] The most difficult part of general practice is arriving at a diagnosis, and the articles seem to...

Managing infertility in general practice must include screening for sexual infections.
November 28, 1998... EDITOR--Hargreave and Mills failed sufficiently to emphasise the importance of sexually transmitted infections in their review on investigating and managing infertility in general practice.[1] Genital tract infection with Chlamydia...

Effectiveness of antibiotic prophylaxis in critically ill patients.
November 28, 1998... Distinction must be made between tracheal inflammation and pneumonia EDITOR--It is ironic that D'Amico et al's meta-analysis of trials of antibiotic prophylaxis for respiratory infection[1] appears in the same issue as the House of...

Rationing.
November 28, 1998... Introduce new category of prescription charges, "full cost medicines" EDITOR--In the wake of the controversies surrounding the approval of sildenafil citrate[1 2] and orlistat[3] perhaps the time has come for the introduction of a new...

Medical students' electives abroad.
November 28, 1998... Students need extensive advice on planning electives EDITOR--Banatvala and Doyal's editorial on student electives abroad raised several issues.[1] As the elective tutor at the Royal Free Hospital School of Medicine I am responsible for...

Obituaries.(John Callander, Lucy Margaret Elsom, Ralph Harding Farrow, Monica M.M.M. Fisher, Lilian Frances Jones, Robert Noel Hall, Michael James Hunter, Susan Nicholls, Louis Jonah Opit, Ralph Schram)(Obituary)
November 28, 1998... First professor of surgery St George's Hospital (b 1915; q Cambridge/St Bartholomew's 1939; MD, FRCS), d 18 September 1998. After service in the Royal Army Medical Corps he decided to follow a career in academic surgery and joined Professor...

New guidance on PCGs expected in December.(primary care groups)
November 28, 1998... The Department of Health's autumn guidance on primary care groups (PCGs) is expected at the beginning of next month. The chairman of the General Practitioners Committee, Dr John Chisholm, told the committee last week that the guidance...

Review body agrees to its? revised remit.
November 28, 1998... The chairman of the review body on doctors' and dentists' remuneration, Mr Brandon Gough, has told the minister for health, Mr Alan Milburn, that the review body is content to work under the new terms of reference now that the BMA and the...

BMA juniors will meet in Bath.
November 28, 1998... The BMA's Junior Members Forum in 1999 will take place in Bath on 17 and 18 April. The subject is "The NHS at 50: counting the cost of change." There will be a symposium on the first day at which speakers will address the effects of change...

JCC is concerned about clinical academic medicine.(Joint Consultants Committee)
November 28, 1998... The Joint Consultants Committee wants to draw attention to the crisis in academic medicine and is considering convening a symposium next year. At its last meeting the committee supported a report from the Royal College of Pathologists in...

Where There Is No Doctor: A Village Health Care Handbook for Africa.(Review)
November 28, 1998... David Werner, Carol Thuman, Jane Maxwell Macmillan Education, 7.25 [pounds sterling], pp 446 ISBN 0 333 51652 4 Rating: **** Chances are that if you visited a remote district hospital in a developing country you would find a...

The General Practice Management Handbook.(Review)
November 28, 1998... Eds P Orton, C Hill W B Saunders, 18.95 [pounds sterling], pp 276 ISBN 0 7020 2204 7 Rating: ** Management handbooks are a peculiar literary genre. They are obliged to present management as straightforward and commonsensical (in...

The Alchemy of Culture: Intoxicants in Society.(Review)
November 28, 1998... Richard Rudgley British Museum Press, 9.99 [pounds sterling], pp 160 ISBN 0 7141 2711 6 Rating: ** A recent resurgence in the debate over legalisation of illicit drugs, notably cannabis, has tended to generate more heat than...

The Giant, O'Brien.(Review)
November 28, 1998... Hilary Mantel Fourth Estate, 14.99 [pounds sterling], pp 210 ISBN 1 85702 884 8 Rating: * This book is beautifully produced with clear, well spaced print, but what at first sight seems an artistic and original cover is almost...

NETLINES.(European Association for the Study of Diabetic Eye Complications, British Orthopaedic Association, research funds, Partnerships in Health Information, SETI)
November 28, 1998... * The European Association for the Study of Diabetic Eye Complications has a website on http://medweb.bham.ac.uk/ easdec/index.html. The site describes the different types of retinopathy and the treatment tot them with diagrams and some...

The RCSE SELECT Programme.(Royal College of Surgeons of Edinburgh)(Evaluation)
November 28, 1998... Royal College of Surgeons of Edinburgh Available from RCSE (free introductory sample of 3 modules, 400 [pounds sterling] for all 43 modules) Rating: *** Set at a level sufficient for the basic examinations of the UK Royal...

WEBSITE OF THE WEEK.(death and the funeral industry)
November 28, 1998... http://www.adec.org/Death and money are still taboo for open discussion with strangers, something that the Association for Death Education and Counselling is trying to do something about. One consequence of this dysfunctional communication is...

Homophobia in medicine.
November 28, 1998... Members of parliament and the bishops at the last Lambeth conference were circulated with an open letter on sexuality signed by 23 doctors. This gives dire warnings about the dangers of anal intercourse, and urges that the age of consent for...

Friday the 13th.
November 28, 1998... The breathing trouble had begun on Monday with an unusually poor showing in the Railtrack sprint. Then came difficulty going upstairs. Just a virus, said I, but on Friday the 13th I had unilateral calf pain and breathlessness going downstairs...

Minerva.
November 28, 1998... Prochlorperazine is better than ondansetron at preventing postoperative nausea and vomiting after total joint replacement (Archives of Internal Medicine 1998;158:2124-8). In a randomised controlled trial patients given ondansetron were over...

Height, early energy intake, and cancer.
November 14, 1998... Evidence mounts far the relation of energy intake to adult malignancies Study of the relation between human body size and cancer risk has its origins in both human observational studies and animal experiments. In his late 19th century...

Nuts to you (... and you, and you).
November 14, 1998... Eating nuts may be beneficial--though it is unclear why A generation ago the prudent diet for preventing coronary disease was dominated by negative advice. Poverty and food rationing in the 1930-50s had led to the promised land of the...

Violent suicide and obstetric complications.
November 14, 1998... The link is mental illness Each year in England and Wales there are 5500 suicides and deaths from undetermined external cause (these are mostly suicides leading to an open verdict at inquest), and almost half are by methods involving...

Age related outcome in acute myocardial infarction.
November 14, 1998... Elderly people benefit from thrombolysis and should be included in trials Patients older than 70 account for a third to a half of patients with acute myocardial infarction admitted to hospital,[1] and 80% of deaths due to acute...

Hours, sleep, teamwork, and stress.
November 14, 1998... Sleep and teamwork matter as much as hours in reducing doctors' stress For every complex problem there is a simple solution... and it's wrong H L Mencken Many studies show that the quality of patient care can be severely...

Scientists cultivate stem cells in the laboratory.
November 14, 1998... Scientists have achieved a major breakthrough in efforts to culture human cells, with this week's publication of the first successful harvesting of stem cells from human embryos and their culture in the laboratory. The step opens up the...

UK report recommends medical trials of cannabis.
November 14, 1998... Britain's House of Lords Science and Technology Committee recommended in a report published this week that cannabis should be reclassified as a schedule 2 drug, allowing research and prescription by doctors on a named patient basis. The...

Government gives NHS 250m [pounds sterling] for UK winter health pressures.
November 14, 1998... An immediate injection of 250m [pounds sterling] ($400m) to help the NHS meet winter pressures has been announced by Britain's chancellor of the exchequer, Gordon Brown. This is less than last year's allocation of 300m [pounds sterling] for...

Israel to increase fluoridated drinking water.
November 14, 1998... Nearly all Israelis will be drinking fluoridated water within the next few years after a Knesset (parliamentary) committee passed a regulation requiring all cities and towns with over 5000 residents to build fluoridation plants. The...

UK to limit legal aid for medical negligence cases to specialist lawyers.
November 14, 1998... Only solicitors with proved expertise in medical negligence cases will get legal aid funding for such claims in the future, under plans unveiled by Britain's lord chancellor last week. The UK government believes it is wasting millions of...

UK Human Rights Act will allow challenges to treatment refusals.
November 14, 1998... The Human Rights Act received royal assent in Britain this week, paving the way for patients to challenge the refusal of medical treatments on cost grounds. For the first time, British people will have the right to enforce a range of...

Sheep dip patients deserve better care.
November 14, 1998... Medical services have failed to respond adequately to the distress and severe symptoms of people exposed to sheep dip containing organophosphates, according to a report published this week by the UK Royal Colleges of Physicians and...

Californian voters increase cigarette tax.
November 14, 1998... California voters have approved a controversial initiative that will use money from an increase in cigarette tax to fund antismoking programmes and campaigns. Last week's initiative--known as Proposition 10--was passed by a tiny margin,...

Indian women's groups question contraceptive vaccine research.
November 14, 1998... Women's health groups in India have called on scientists to abandon research into contraceptive vaccines. Activists staged a protest outside the opening of the 10th international congress of immunology in New Delhi last week, describing...

Role of UK chief medical officer has been eroded.
November 14, 1998... An inside view on how the post of chief medical officer for England has been diminished in recent years has come from a former incumbent, Sir Donald Acheson, chief medical officer from 1983 to 1991. He stated last week--while presenting...

New UK hospital care plan for elderly.
November 14, 1998... New standards of care for older people are to be set for the NHS under a national framework to be in force by 2000, the health secretary, Frank Dobson, announced last week. The initiative follows an adverse report by the Health Advisory...

Obstetric care and proneness of offspring to suicide as adults: case-control study.
November 14, 1998... Introduction For decades millions of mothers in developed countries have been subjected to new obstetric procedures, but with limited knowledge of the long term effects from those interventions. It does seem that long term effects are...

The new NHS: NHS.
November 14, 1998... Fifty years ago No one expected that such a vast scheme as that outlined in the National Health Service Act of 1946 would begin in a way that would please everybody--least of all those upon whom the main burden of the work falls, the...

Leg length and risk of cancer in the Boyd Orr cohort.
November 14, 1998... Height is directly associated with mortality from cancer,[1] but the explanation for this association is unclear. Whereas adult height is a marker of nutrition and health throughout childhood, most growth before puberty is due to increases in...

Height and mortality from cancer among men: prospective observational study.
November 14, 1998... Experiments in animals have shown that energy intake during the growth period is positively associated with the later incidence of cancer.[1] Recently, direct evidence of an association between childhood energy intake and adult mortality from...

Initiating angiotensin converting enzyme inhibitors in mild to moderate heart failure in general practice: randomised, placebo controlled trial.
November 14, 1998... Less than 50% of patients will heart failure in community practice receive an angiotensin converting enzyme inhibitor and then only usually at the instigation of or when prescribed by a hospital doctor.[1-3] Fear of side effects seems to be a...

Correction.
November 14, 1998... Reporting on quality of lip in randomised controlled trials: bibliographic study An editorial error occurred in this article by Caroline Sanders and colleagues (31 October, pp 1191-4). Table 3 (referred to at the end of the Results...

The philosopher and the chicken.
November 14, 1998... Endpiece A story is told about Sir Isaac Newton when he was living in London toward the end of his life. His intimate friend Dr. [William] Stukel[e]y, who had been deputy to Dr. [Edmond] Halley as secretary to the Royal Society, was one...

Primary care groups and the right to prescribe.
November 14, 1998... In matters of NHS funding, politicians tend to say one thing and health economists another. Governments commit themselves to the Hippocratic ethic that patients should be treated solely on the basis of need. But economic reality has always...