British Medical Journal articles from October 1994

British Medical Journal archives from October 1994

The future of medicine: brighter than you think. (Editorial)
October 29, 1994... Next week the leaders of British doctors will meet to consider the future of medicine. The BMA, the General Medical Council, the royal colleges, and the departments of health will all be represented. This is the first time that these groups...

Divided we fall (yet again): the medical profession's need to speak with one voice. (Editorial)
October 29, 1994... "Hang together or, most assuredly, we shall all hang separately," "Unity is strength", "United we stand--divided we fall,"--all time worn cliches but relevant to doctors today, facing an intransigent government that has little regard for the...

Dietary protein and progression of chronic renal disease: large randomised controlled trial suggests no benefit from restriction. (Editorial)
October 29, 1994... Healthy people rightly consider food for its culinary rather than its biochemical value. With the present state of knowledge, only broad guidelines are appropriate as to what constitutes a healthy diet. In some conditions, however, diet can...

The new measles campaign: immunisation should prevent an epidemic predicted by modelling. (Editorial)
October 29, 1994... The national measles and rubella campaign that begins next month is one of the most ambitious vaccination initiatives that Britain has undertaken. The aim is to vaccinate 95% of the seven million schoolchildren aged between 5 and 16 within...

The eradication of gonorrhoea can be achieved. (Editorial)
October 29, 1994... The continued global survival of Neisseria gonorrhoeae is inevitable because of its immunobiology,(1) the seeming lack of natural or acquired immunity, human sexual behaviour, and the frequency of asymptomatic infection. Nevertheless, endemic...

Correction. (to 'Slowing the march of the Marlboro man' in October 8, 1994 issue) (Correction Notice)
October 29, 1994... Slowing the march of the Marlboro man An author's error occurred in this editorial by Ronald M Davis (8 October, p 889-90). The references numbered 3 and 6 were transposed; therefore reference 3 in the text refers to the World Bank's...

Commission calls for shake up in welfare state. (Commission on Social Justice)
October 29, 1994... A tax on child benefit for wealthier parents, a national minimum wage, and a guarantee of universal health care are part of the Commission on Social Justice's proposals for modernising Britain's welfare state. The commission, an independent...

Population need for renal replacement therapy in Thames regions: ethnic dimension.
October 29, 1994... Objectives--To determine the use of renal replacement therapy by ethnic origin and to ascertain the variation in provision of such therapy and to relate this to the distribution of ethnic minority populations. Design--Analysis of...

Incidence of psychotic illness in London: comparison of ethnic groups.
October 29, 1994... Objective--To compare annual incidences of psychosis in people from different ethnic groups as defined in the 1991 census. Setting--Catchment area of district psychiatric hospital. Design--All people aged 16 to 54 years who made...

Helicobacter pylori infection in childhood: risk factors and effect on growth.
October 29, 1994... Objective--To investigate the current prevalence of Helicobacter pylori infection in childhood, the risk factors for infection, and the effect of infection on grwoth in preadolescent schoolchildren. Design--Population based sample of 7 year...

Acyclovir and post-herpetic neuralgia and ocular involvement.
October 29, 1994... Herpes zoster infection is a common clinical problem in elderly people. Three of the consequences of such infection are acute rash, post-herpetic neuralgia, and, for those with trigeminal infection, ocular complications. Post-herpetic...

Ethnic variation in epidemiology and rehabilitation of hip fracture.
October 29, 1994... In Leicestershire 9.3% of the population is of Asian origin, most being from the Indian subcontinent. Only 4.3% of Asians in Leicesteshire are aged over 65 years compared with 16.3% of white people. The incidence of hip fracture in...

Intercultural consultations: investigation of factors that deter non-English speaking women from attending their general practitioners for cervical screening.
October 29, 1994... Objectives--To determine the factors that deter ethnic minority women living in east London from attending their general practitioner for cervical cytology screening. Design--Qualitative study by means of focus group discussions between...

Matching. (Statistics Notes, part 9)
October 29, 1994... In many medical studies a group of cases, people with a disease under investigation, are compared with a group of controls, people who do not have the disease but who are thought to be comparable in other respects. This happens in...

Management of patients after their first myocardial infarction.
October 29, 1994... In the past 20 years there has been a steady improvement in the short term prognosis of patients with myocardial infarction,(1) following the introduction of [beta] blockers, thrombolysis, and aspirin. Patients treated with thrombolytic drugs...

Cardiac transplantation for AL amyloidosis: good quality of life is possible for several years.
October 29, 1994... Systemic AL amyloidosis has a poor prognosis which corresponds closely with the severity of cardiac disease.(1)(2) Some patients benefit from chemotherapy directed at the underlying monoclonal gammopathy,(3) but the median period of treatment...

Scenario analysis of the future of medicines.
October 29, 1994... Planning future policy for medicines poses difficult problems. The main players in the drug business have their own views as to how the world around them functions and how the future of medicines should be shaped. In this paper we show how a...

The profession of medicine.
October 29, 1994... It seems timely to define the purpose of medicine and examine the concept of a profession. This paper does so in the wider context of health, values in society, and the need to involve patients and the public as a whole. The author looks...

Patient care and the general practitioner.
October 29, 1994... The role of general practitioners is being redefined in the light of the emphasis on more care in the community, economic factors, and patients' expectations. The strength of general practice lies in the doctor-patient relationship; this...

Public health 2020.
October 29, 1994... The aim of public health is to improve the health of people in communities and in populations (protection from environmental hazards and provision for health needs). The challenge for public health doctors is to re-establish public health...

Breast cancer. (ABC of Breast Diseases)
October 29, 1994... Breast cancers are derived from the epithelial cells that line the terminal duct lobular unit. Cancer cells that remain within the basement membrane of the elements of the terminal duct lobular unit and the draining duct are classified as in...

Back to basics: medical staffing in general hospitals. (Personal View) (Column)
October 29, 1994... There is a major crisis in medical staffing in hospitals in Britain and this is influencing other aspects of health care delivery. Before the new deal on junior doctors' hours the conventional pattern of staffing was the firm, usually of two...

Death by Prescription.
October 29, 1994... When drug company representatives come to tell me of another good reason for prescribing selective serotonin reuptake inhibitors (SSRIs) I feel like screaming. The unprecedented campaign to unseat tricyclic antidepressants from their...

The Fight for Public Health: Principles and Practice of Media Advocacy.
October 29, 1994... How do you translate the findings of epidemiological studies into policies that actually improve population health? Chapman and Lupton's ambitious efforts to "examine both the why and how of the ways that particular public health issues...

The Hot Zone.
October 29, 1994... The Hot Zone tells the filovirus story, from the first recorded outbreak of Marburg virus disease in Germany and Yugoslavia in 1967 to the author's trip along Africa's "AIDS highway" to Mount Elgon, on the border between Kenya and Uganda, in...

My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS.
October 29, 1994... The son of expatriate Indians who settled in Ethiopia, Abraham Verghese became an infectious disease specialist and settled in Tennessee, deep in the rural bible belt of America; then he gradually became more and more involved in the care of...

Art Injection: Youth Arts in Hospital.
October 29, 1994... To be an adolescent is to be disadvantaged, caught in a limbo between the child and adult worlds, misunderstood by almost everyone. To be a chronically ill adolescent is a double disadvantage. Adolescents often find it difficult to cope...

Improving Hospital Design.
October 29, 1994... We all want to live on Quality Street. Accessibility, privacy, confidentiality, dignity, choice, comfort, and security are the contemporary objectives in all services, especially health. And now that we take for granted the raw sufficiency of...

Surgical Case-Histories from the Past.
October 29, 1994... From the Bible to the Bhagavadgita, historical narrative has formed a central part of our collective psyche. There is a sense in which stories become important precisely because they define us and our current experience, as well as our...

When Helping Starts to Hurt.
October 29, 1994... Overwork is a serious problem for most health care professionals these days. Demands for improved clinical care exceed improvements in resources, and maintaining a balance between the two can be demoralising and exhausting. However, working...

Intermittent Journals.
October 29, 1994... The last time I walked along the beach at Ogmore in South Glamorgan I was depressed by the muddy Bristol Channel and by the debris--a disposable nappy wallowing at the water's edge, and a slight oily film on the rock pools. My youngest child...

A Bit on the Side.
October 29, 1994... It is often hard to know why one trusts some people and suspects others. In a close personal relationship the reasons are usually more obvious because there will have been time to observe, to confide, and to match words with deeds. With a...

Medicine, Money, and Morals: Physicians' Conflicts of Interest.
October 29, 1994... You need to have a very good reason for recommending a book in which almost half the text is taken up by notes and appendices devoted to the minutiae of the of the American health care delivery system. That I am prepared to do so reflects the...

Wealth Well-Given: The Enterprise and Benevolence of Lord Nuffield.
October 29, 1994... Lord Nuffield occupies a special place in the gallery of British benefactors. Indeed, he stands out this century as the pre-eminent home grown millionaire who was disposed to give his millions away at home. As often as not, the great 20th...

Eighty-Five Not Out: Essays to Honour Sir George Godber.
October 29, 1994... This brief collection of essays from a seminar celebrating the 85th birthday of Sir George Godber contains more ideas about the National Health Service than many heavy tomes. Although the emphasis is on how the present can inform the future,...

Professionalism Reborn: Theory, Prophecy, and Policy.
October 29, 1994... As doctors in the NHS find themselves increasingly forced to defend their professional status, Professionalism Reborn provides a welcome framework for debate. With the stated intention of exploring the general phenomenon of professionalism,...

Temperature and cardiovascular mortality: excess deaths from heart disease and stroke in northern Europe are due in part to the cold. (Editorial)
October 22, 1994... Cardiovascular disease is the most common cause of death in most developed countries, but mortality is particularly high in some parts of Britain. These high rates can be lowered only if the causes are understood. Preventive campaigns have...

Health implications of putting value added tax on fuel: time to combat fuel poverty. (VAT) (Editorial)
October 22, 1994... The American senator Hubert Humphrey said, "The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of...

A new approach to weighted capitation: more sensitive indicators of need but important policy questions remain unanswered. (in the United Kingdom's National Health Service) (Editorial)
October 22, 1994... Equity of access to health care on the basis of need alone is the central principle of the NHS. A corollary of this is that resources should be distributed among local health authorities in proportion to their relative health care needs. But...

The future of purchasing: tolerance of diversity will be necessary. (diversity in purchasing strategies in the United Kingdom's National Health Service) (Editorial)
October 22, 1994... At last week's Conservative party conference the government's plans for the future of fundholding were unveiled.(1) To understand the significance of these it is important to remember the history of purchasing so far. Working for Patients...

Pregnancy outcome and offspring after childhood cancer: data show no evidence of mutagenesis of the germ cells. (Editorial)
October 22, 1994... About two thirds of patients treated for childhood cancer in Britain survive at least five years, and over 90% of these survivors are probably cured.(1) Some survivors become infertile as a result of treatment, but many go on to have...

US family fights for son to die. (family of Jamie Butcher asks doctors to remove his feeding tube after 17 years)
October 22, 1994... A Minnesota family's decision to stop medical treatment of their son has erupted into a public battle over the rights of disabled people in the United States. Jamie Butcher was 17 when a car crash left him unconscious in October 1977. Five...

Trying to do right by health reform. (in the United States)
October 22, 1994... Congressional elections are two weeks away, and Republicans are mildly optimistic that for the first time in half a century they will recapture majorities in both the House and the Senate. Most commentators say that such a change would...

n of 1 trials comparing a non-steroidal anti-inflammatory drug with paracetamol in osteoarthritis. (diclofenac)
October 22, 1994... Objective--To evaluate the efficacy of paracetamol and a non-steroidal anti-inflammatory drug for symptom relief in osteoarthritis. Design--Double blind, randomised, controlled trials in individual patients (n of 1 trials). Three...

Commentary: n of 1 trials may be useful for informed decision making.
October 22, 1994... Statisticians and clinicians are often parodied as being at opposite ends of a spectrum. On the one hand, statisticians are interested in the effect of treatment only "on average" and they assume that either the treatment works for everyone...

Development of method for small area analysis of use of inpatient services. (in the United Kingdom's National Health Service)(Allocating Resources to Health Authorities, part 1)
October 22, 1994... Every year about [pound]22 billion is allocated to health authorities for hospital and community services in England. The distribution of most of these funds is based on a formula developed to reflect the population's needs, but the existing...

Results and policy implications of small area analysis of use of inpatient services. (in the United Kingdom's National Health Service)(Allocating Resources to Health Authorities, part 2)
October 22, 1994... A study designed to identify the principal determinants of use of inpatient facilities in NHS hospitals in England used the data and methods outlined in the previous paper. The model for the psychiatric sector contains mortality, self...

Relation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer.
October 22, 1994... Objective--To investigate the relation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer as a possible explanation for socioeconomic differences in survival. Design--Retrospective analysis...

Driving, glaucoma, and the law.
October 22, 1994... The Road Traffic Act 1988 requires drivers to inform the Driver and Vehicle Licensing Agency of any disability or condition that affects their fitness to drive or which might do so in the future. [TABULAR DATA OMITTED] Glaucoma...

Commentary: patients and doctors risk prosecution if they do not uphold the law.
October 22, 1994... Section 92 of the Road Traffic Act 1988 defines prescribed, relevant, and prospective disabilities. All three categories may include glaucoma. Prescribed disabilities bar people from driving. Relevant disabilities are prescribed disabilities...

Attempt at deriving a formula for setting general practitioner fundholding budgets.
October 22, 1994... Objective--To explore the possibility of using routine Hospital Episode Statistics, census data, and vital statistics to derive weights for an equitable capitation formula for setting general practitioner fundholding budgets for buying acute...

Development of a symptom based outcome measure for asthma.
October 22, 1994... Measuring symptom specific health outcome is complex, but the methodologies now exist to develop measures with the appropriate properties. As one element of a major programme to develop multidomain health outcome measures for chronic disease,...

Near fatal chickenpox during prednisolone treatment.
October 22, 1994... The incidence of chickenpox (varicella) is increasing; thus, the proportion of cases in England and Wales in those over 14 years of age has increased from 10% to 25% between 1970 and 1990.(1) Although usually mild among children, varicella is...

Psychotherapy - a luxury the NHS cannot afford? More expensive not to treat. (the United Kingdom's National Health Service)(Controversies in Management, part 8)
October 22, 1994... Psychotherapy is "the systematic use of a relationship between therapist and patient--as opposed to physical or social methods--to produce changes in cognition, feelings and behaviour."(1) Psychotherapy, or perhaps more usefully "the...

Unevaluated or inefficient approaches are hard to justify. (the United Kingdom's National Health Service, includes short rebuttal)(Psychotherapy - a Luxury the NHS Cannot Afford?)(Controversies in Management, part 8)
October 22, 1994... The limited resources available for health make it important that money is spent in the best interests of patients. If money is spent on inefficient treatments there is less available for good care, so routine methods should have had their...

Immunisation. (Myths in Medicine, part 1)
October 22, 1994... Myths in immunisation are as old as immunisation itself. When Edward Jenner first developed his smallpox vaccine in 1796 there was concern that material from cowpox sores was used. Cartoonists drew children growing horns and some...

Screening for breast cancer. (ABC of Breast Diseases)
October 22, 1994... Lack of knowledge of the pathogenesis of breast cancer means that primary prevention is currently a distant prospet. Screening represents an alternative approach to try to reduce mortality from breast cancer. Methods of screening ...

The doctor and the biographer. (a doctor who treated George Orwell meets Orwell's biographer)(Soundings) (Column)
October 22, 1994... Three of us happened to be standing together in the lounge bar before dinner: a senior colleague, the visitor from London, and me. In the absence of much common ground, talk was slow. It would be an exaggeration to say that at a particular...

Blind date. (medical tests are delayed for a patient believed to have a psychosomatic illness)(Soundings) (Column)
October 22, 1994... This is a true story and is reproduced with the patient's permission. They moved into our road last year. Within a week our husbands were jogging together. My wife runs as well, he said. Mine too. He agreed to send her round that evening...

Out of Darkness.
October 22, 1994... Recently released on video and in your patients' hands soon, Out of Darkness tells the story of a woman who makes a miraculous recovery from schizophrenia after treatment with clozapine. Diana Ross, international superstar and lead singer of...

Takin' Over the Asylum.
October 22, 1994... When failed double glazing salesman and part time disc jockey "Ready Eddy" agrees to revive the radio station at "St Jude's" hospital, he has little idea of what he is taking on: until his arch rival disc spinner informs him that "It's a...

Guilty of negligence? (a doctor recounts her experiences as a defendant in a medical malpractice trial in the US)(Personal View) (Column)
October 22, 1994... My husband and I grew up and qualified in England. In 1974 he was invited to join a family practice residency at the University of Western Ontario in Canada. We had planned to stay abroad for two years but we stayed for 15. We worked as...

Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies, 2 vols.
October 22, 1994... A profound change has occurred in societal attitudes towards participation in medical research, but it has gone almost unnoticed. Some sections of the community are actually queuing up and indeed demanding to be included as research subjects...

Children as Research Subjects: Science, Ethics and Law.
October 22, 1994... A profound change has occurred in societal attitudes towards participation in medical research, but it has gone almost unnoticed. Some sections of the community are actually queuing up and indeed demanding to be included as research subjects...

Mental Health in Mental Retardation.
October 22, 1994... Some experts in learning disability (mental retardation) can remember working in large overcrowded institutions where patients' rights and dignity were non-existent. The specialty was oriented towards physical aspects of learning disability...

The Certification and Recertification of Doctors: Issues in the Assessment of Clinical Competence.
October 22, 1994... It is a truth (almost) universally acknowledged that assessment of both postgraduate and undergraduate medical students should be valid, reliable, and fair, but unfortunately it is rarely any of these and never all. Why? Valid means that it...

Legal Medicine in History.
October 22, 1994... Legal Medicine in History is a series of essays on a wide range of forensic history, culled from a meeting at Lancaster University in 1987. The dozen or more subjects range from the corruption in the American coroner system at the turn of the...

Memory of intraoperative events: patients remember more than we think. (Editorial)
October 15, 1994... Considerable public interest and anxiety exist about patients waking up during general anaesthesia with explicit memories of painful and terrifying intraoperative events. Using conventional clinical signs, anaesthetists find it almost...

Controlling occupational exposure to anaesthetic gases: time to establish an exposure standard. (Editorial)
October 15, 1994... For 25 years epidemiological studies have associated occupational exposure to anaesthetic gases with a range of health effects, including neurological, renal, and hepatic disease; reduction in mental performance and manual dexterity; and...

The Cochrane Collaboration: deserves the support of doctors and governments. (the International Cochrane Collaboration synthesizes evidence from randomized, controlled clinical trials) (Editorial)
October 15, 1994... The International Cochrane Collaboration is two years old. From small beginnings in September 1992 its membership has grown to over 1000 people. It now has eight collaborating centres around the world and international review groups dealing...

How many psychiatric beds? The debate shouldn't be swayed by moral and political considerations. (Editorial)
October 15, 1994... Forty years ago Houston wrote: "By incarceration we were aggravating the natural process of the disease. At last a new era is dawning and the doors of despair are being unlocked."(1) Since 1954 the number of psychiatric beds in Britain has...

The limits to health promotion: they lie in individuals' readiness to change. (Editorial)
October 15, 1994... Everybody knows that prevention is better than cure, but the opposite, equally attractive, principle of paying tomorrow for what you can have today is an efficient way to use your resources: health economists call it "discounting."(1)...

Hospitals going the way of schools? (public confusion over changes in the United Kingdom's National Health Service)
October 15, 1994... The secretary for state for health will no doubt give an upbeat message about the health service at the Conservative party conference this week. But it is a message that increasingly is not recognised - either by the people who work in the...

Randomised trial of hysterectomy, endometrial laser ablation, and transcervical endometrial resection for dysfunctional uterine bleeding.
October 15, 1994... Objective--To evaluate the effectiveness and safety of endometrial laser ablation and transcervical resection of the endometrium compared with hysterectomy in the surgical treatment of women with dysfunctional uterine bleeding. ...

Glycated haemoglobin values: problems in assessing blood glucose control in diabetes mellitus.
October 15, 1994... Objective--To see whether two measures of glycated haemoglobin concentration--the haemoglobin [A.sub.1] ([HbA.sub.1]) value and the haemoglobin Alc ([HbA.sub.1c]) value--assess blood glucose control differently in diabetes. ...

Indication for computed tomography of the brain in patients with first uncomplicated generalised seizure.
October 15, 1994... Objectives--To assess the yield of emergency computed tomography of the brain in patients with a first generalised epileptic seizure and to evaluate a four item screening questionaire on alcohol misuse (CAGE questionnaire) as a triage tool to...

Managing injuries from sharp instruments in health care workers in Mersey. (England)
October 15, 1994... Exposure of health care workers to bloodborne viruses due to injuries from sharp instruments is of increasing concern. Guidelines exist on the action to be taken if a needlestick accident occurs.(1)(2) We carried out a postal questionnaire...

Commercial source of drug information: comparison between the United Kingdom and India.
October 15, 1994... The prescription of proprietary drugs and the lack of an independent formulary may contribute to the use of a commercial source of drug information by doctors. The Monthly Index of Medical Specialties (MIMS) is one such publication available...

Vertebral deformities as predictors of non-vertebral fractures.
October 15, 1994... The estimated number of people fracturing a hip will increase from 1.7 million in 1990 to 6.3 million in 2050.(1) It is therefore important to identify risk factors.(2) Previous vertebral fractures have been shown to increase the risk of...

Use of translated written material to communicate with non-English speaking patients.
October 15, 1994... To communicate with patients we must provide information in a form that they can understand. This is particularly true for patients from ethnic minority groups who do not understand written or spoken English.(1) For these patients documents...

Randomised controlled trial of health promotion in general practice for patients at high cardiovascular risk.
October 15, 1994... Objective--To assess the value of health education for patients with angina in reducing risk factors for cardiovascular disease and lessening the effect of angina on everyday activities. Design--Randomised controlled trial of personal...

Quartiles, quintiles, centiles, and other quantiles. (Statistics Notes, part 8)
October 15, 1994... When presenting or analysing measurements of a continuous variable it is sometimes helpful to group subjects into several equal groups. For example, to create four equal groups we need the values that split the data such that 25% of the...

Methadone maintenance treatment in opiate dependence: a review.
October 15, 1994... This paper examines the changes and advances in research and clinical practice and examines the role of treatment structure and programme characteristics in the delivery of methadone maintenance. Methadone prescribing has become much more...

Overdosage of opiate from patient controlled analgesia devices.
October 15, 1994... When Keeri-Szanto described patient controlled analgesia in 1971 he observed that, because a large, potentially fatal amount of a narcotic drug is "hooked up" to the patient, fail safe methods of administering such drugs should be...