British Medical Journal articles from September 1993

British Medical Journal archives from September 1993

The psychology of multiple allergy: encouraging return to active life is better than reinforcing social withdrawal and disability. (Editorial)
September 25, 1993... Encouraging return to active life is better than reinforcing social withdrawal and disability Many people present to their doctors with multiple unexplained symptoms which they attribute to allergy. Such subjects develop symptoms in...

Death from occupational disease. (reporting) (Editorial)
September 25, 1993... Report it to the coroner or procurator fiscal; when in doubt request a necropsy Pressure groups campaigning on behalf of victims of industrial lung disease are understandably keen that when a patient dies of such a condition a necropsy...

Will the new antipsychotics improve the treatment of schizophrenia? (Editorial)
September 25, 1993... Depot preparations still hold the key to compliance Non-compliance with neuroleptic treatment is an obstacle to the success of community care for patients with mental illness. It occurs in 8-16% of inpatients but in 33-54% of outpatients...

Public opinion and the NHS: the unaccountable in pursuit of the uninformed. (the United Kingdom's National Health Service) (Editorial)
September 25, 1993... The unaccountable in pursuit of the uninformed Criticising the current enthusiasm for gauging the public's opinion about the NHS and its services can easily sound undemocratic. Yet why public opinion should matter to the people running...

Tuberculosis and poverty.
September 25, 1993... Abstract Objective--To examine whether the historical link between tuberculosis and poverty still exists. Design--Retrospective study examining the notifications of all forms of tuberculosis by council ward over a six year period...

Investigation of urinary tract infection in childhood.
September 25, 1993... Abstract Objectives--To determine the number of laboratory confirmed urinary tract infections in children and to ascertain general practitioners' practices and attitudes towards their investigation and management. ...

Prospective study of prenatal screening for Down's syndrome with free beta-human chorionic gonadotrophin.
September 25, 1993... Abstract Objective--To assess the value and impact of a screening programme for Down's syndrome that uses the two maternal serum markers: [alpha] fetoprotein and free [beta] human chorionic gonadotrophin. Design--All women booked...

Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination.
September 25, 1993... Abstract Objectives--To compare the efficacy and cost effectiveness of a senna-fibre combination and lactu-lose in treating constipation in long stay elderly patients. Design--Randomised, double blind, cross over study. ...

Problems in assessing contents of metered dose inhalers.
September 25, 1993... Treatment of asthma with [beta] agonists delivered via metered dose aerosol inhalers has been associated with excess mortality from asthma.[1] The canisters of these inhalers are opaque, and patients cannot see how much medication remains in...

Smoking and periductal mastitis.
September 25, 1993... Periductal mastitis and duct ectasia are well recognised,[1 2] presenting either with acute inflammation of the breast or with chronic breast symptoms such as nipple discharge. The acute inflammatory changes seen in younger women are...

Colourings, flavourings, and sugars in children's medicines in India.
September 25, 1993... Most liquid medicines are for children and are usually coloured, flavoured, and sweetened with various additives. The complex role of these additives in producing unwanted effects is generally not well appreciated and often ignored. Despite...

Impact of introducing near patient testing for standard investigations in general practice. (testing performed at the doctor's office)
September 25, 1993... Abstract Objective--To assess the clinical and economic impact of surgery based near patient testing in general practice for six commonly used biochemical and bacteriological tests. Design--After four months' monitoring, equipment...

Alzheimer's disease.
September 25, 1993... Alzheimer's disease affects 400 000 people in the United Kingdom and as such is the commonest cause of dementia. Although predominantly a disease of old age, it is not confined to the elderly population; about 18 000 of those affected are...

Health care in Moscow.
September 25, 1993... In the Russian Federation privatisation is affecting the health care sector as much as it is industry and commerce. That the general public support the transfer of state clinics to the private sector is a mark of their dissatisfaction with...

Cervical spine. (ABC of Emergency Radiology, part 1)
September 25, 1993... This chapter describes an effective system by which non-radiologists can analyse cervical spine radiographs and detect even the subtle signs caused by ligamental injuries. The system requires the clinician to be familiar with the basic...

Should a sexual offender be allowed castration? (five medical professionals debate the issue)
September 25, 1993... A 59 year old man with a persistent history of sexual abuse of children has requested castration to stop himself from reoffending. Dr Malcolm Alexander presents the man's case and highlights some of the ethical issues, and three...

Cost-effectiveness analysis. (Economic Evaluation and Health Care, part 3)
September 25, 1993... When different health care interventions are not expected to produce the same outcomes both the costs and the consequences of the options need to be assessed. This can be done by cost-effectiveness analysis, whereby the costs are compared...

How dangerous is heroin? (Soundings) (Editorial)
September 25, 1993... The hierarchy of parents' anxieties for their teenage children has gradually changed in the past 20 or so years. Road accidents and unwanted pregnancy remain the most likely disasters, but families seem to worry more about HIV infection and...

Lessons from a major incident. (an anesthetist discusses being prepared for a major disaster)(Personal View) (Column)
September 25, 1993... Most short stay hospitals now have major incident policies, which enable the efficient call up of essential personnel in the event of a major disaster. But they are detailed and make turgid reading for junior doctors, who have well defined...

Thoughts on Pye. (a general practitioner discusses textbook revisions)(Pye's Surgical Handicraft)(Personal View) (Column)
September 25, 1993... I wonder how many of us have a systematic approach to the buying of journals, textbooks, and books of reference? My own approach has always been haphazard, with choices usually prompted by reading reviews or advertisements. Casual visits to...

The Aftermath of Stroke: The Experience of Patients and Their Families.
September 25, 1993... There have been astonishing advances in our understanding and treatment of stroke in recent times. We can reduce the risk of stroke by lowering raised blood pressure and by giving warfarin to selected people with atrial fibrillation. We can...

Health care reform: the global search for Utopia. (Editorial)
September 25, 1993... No single resolution is likely to work everywhere Health care reform is rapidly becoming a global epidemic. President Clinton has just announced his plans for dealing with America's twin problems of inadequate coverage and escalating...

Age of exposure to infections and risk of childhood leukaemia.
September 25, 1993... Building on previous suggestions,[1-3] we speculated that childhood leukaemia might be a rare manifestation of an infection that would have remained subclinical at an earlier age. Several ecological studies have produced evidence to support...

Designer Children.
September 25, 1993... It's all in the genes As human genetic research marches relentlessly on and its pace quickens, so the number of newspaper articles and television programmes about the associated ethical dilemmas increases too. This is to be welcomed....

Coronary Heart Disease Epidemiology: From Aetiology to Public Health.
September 25, 1993... Epidemiology has always been unique among academic subjects in having two lofty pursuits--the quest for knowledge and the betterment of the public's health, grandly conceived. As a result, epidemiologists are classically both scientists and...

Unhealthy Housing: Research, Remedies and Reform.
September 25, 1993... Everyone knows that poor housing conditions are harmful to health. Yet, faced with a request to provide the evidence for that statement, many would run into difficulties. One practical obstacle is that the relevant studies cover many...

Homelessness, Health Care and Welfare Provision.
September 25, 1993... There is a depressing timelessness about the problems of the homeless. When I was working in the health care service at St Botolph's Aldgate Crypt in its early days I was struck by the similarity of what I saw to the descriptions by George...

Retinopathy of prematurity: increasing as survival of extremely premature babies increases. (Editorial)
September 18, 1993... Retinopathy of prematurity (previously called retrolental fibroplasia) has been a known and feared cause of visual impairment in children born prematurely since 1942.[1] In the early '50s oxygen was identified as an aetiological factor, and...

Deregulating emergency contraception: justified on current information. (Editorial)
September 18, 1993... Justified on current information The statistics on unintended pregnancy in Britain make worrying reading. Almost half of all conceptions are unplanned.[1] Over 170 000 pregnancies are terminated every year, and soon a quarter of 25 year...

Rituals in antenatal care - do we need them? A conflict between consumer demand and cost effectiveness. (Editorial)
September 18, 1993... A conflict between consumer demand and cost effectiveness Pregnant women in Britain traditionally have an average of 15 antenatal checks during pregnancy.[1-3] At each visit, the woman is likely to be weighed and have her blood pressure...

Consultants outraged by league tables. (doctors in England upset over publication of comparison of waiting times and treatments )
September 18, 1993... Doctors in the West Midlands region are angry about the publication in two newspapers of lists comparing waiting times for treatment by individual consultants. West Midlands Regional Health Authority took space in the Wolverhampton Express...

Prevalence of neural tube defects in South Australia, 1966 - 91: effectiveness and impact of prenatal diagnosis.
September 18, 1993... Introduction Neural tube defects, which include anencephaly, spina bifida, and encephalocele, are an important group of severe birth defects whose prevalence has fallen over the past six decades in many countries. The fall has been...

Outcome in colorectal adenocarcinoma: two seven-year studies of a population.
September 18, 1993... Introduction Carcinoma of the large bowel is the neoplasm most often treated by general surgeons. Its management is now receiving much attention, with reports opening with the statement that over 20 000 people die each year in...

Medicine and Global Survival: a new journal for the world's most pressing problems. (Editorial)
September 18, 1993... A new journal for the world's most pressing problems "Human kind," said T S Eliot, "cannot bear very much reality." Most of us are well aware that 12 million children die of poverty each year, that the gap between the world's rich and...

Serum albumin concentration, arm circumference, and oedema and subsequent risk of dying in children in central Africa.
September 18, 1993... Introduction In developing countries protein energy malnutrition is common among children admitted to hospital and is associated with a high morbidity and mortality.[1-4] A nutritional assessment is mandatory to treat and follow...

Comparison of medical abortion with surgical vacuum aspiration: women's preferences and acceptability of treatment.
September 18, 1993... Objectives--To assess women's preferences for, and the acceptability of, medical abortion and vacuum aspiration in the early first trimester. Design--Patient centred, partially randomised trial. Medical abortion was performed with...

Clinical features, risk factors, and referral delay in British patients of Indian and European origin with angina matched for age and extent of coronary atheroma.
September 18, 1993... Coronary artery disease is disproportionately prevalent in the United Kingdom in people originating from the Indian subcontinent[1 2] and there are apparent differences in the risk factor profile.[3 4] We have compared the clinical features...

We lost the vote. (the ethics of the pharmaceutical industry) (Column)
September 18, 1993... The venue was the Oxford Union Debating Society. The motion was "This house believes the NHS is well served by the pharmaceutical industry." The proposer was Trevor Jones, research director of the Wellcome Foundation, and his seconder John...

One pink dress. (the differences between patients in England and South Africa) (Column)
September 18, 1993... Bonisiwe is 17. She is admitted to our ward with an episode of abdominal pain of uncertain cause, which settles rapidly. On arrival, like all the other patients, she exchanges her clothes, her property, and her individuality for a standard...

A model ahead of its time. (The Royal College of General Practitioners' patient liaison group)(Personal View) (Column)
September 18, 1993... The idea of lay and professional people discussing professional practice together can seem uncomfortable to professionals. But 10 years ago the Royal College of General Practitioners set up its patients' liaison group to do just that. The...

Climbing back up. ( patient interactions with doctors unsympathetic to emotional needs) (Column)
September 18, 1993... Someone once said to me that life is like playing a game of snakes and ladders; sometimes it can seem that no sooner have you climbed that ladder then something happens and you slide straight down the snake. That is exactly as I saw my life...

Century.
September 18, 1993... The medical research film is starting to evolve into a genre of its own. The ingredients have begun to crystallise: big ideas, whose grip can be readily transmitted to a willing audience; brave, usually young, idealists, who battle against a...

And the Band Played On.
September 18, 1993... The medical research film is starting to evolve into a genre of its own. The ingredients have begun to crystallise: big ideas, whose grip can be readily transmitted to a willing audience; brave, usually young, idealists, who battle against a...

Cardiac Surgery and the Brain.
September 18, 1993... The editors of this book start with a prejudice--"Perhaps the most important morbidity suffered by cardiac surgery patients post-operatively is that associated with the brain"--which has moved them to draw together, with some force, a series...

Thrombosis and Its Management.
September 18, 1993... The success of a symposium to mark the retirement of an eminent colleague surely has two aims: firstly, to gather distinguished speakers to provide "state of the art" lectures and, secondly, to highlight the contribution of their colleague....

The Execution Protocol.
September 18, 1993... Doctor Death, otherwise Mr Fred Leuchter, is so named because he develops and sells sanitised execution equipment to state penitentiaries under the slogan "capital punishment, not capital torture." By medicalising antiquated technology,...

Torture and Its Consequences: Current Treatment Approaches.
September 18, 1993... I approached this book with some trepidation. There is a narrow line between necessary information and unnecessary stress to the health professionals who read into this subject (also, for the post-traumatic symptoms there is a certain fear of...

The academic base for general practice: the case for change.
September 18, 1993... Education in general practice has made great advances over the past 30 years. The establishment of vocational training has led to the formation of a group of experienced teachers with skills in the teaching of trainees and trainers. Over...

"Natural family planning": effective birth control supported by the Catholic Church.
September 18, 1993... During 20-22 September Manchester is to host the 1993 follow up to last year's "earth summit" in Rio de Janeiro. At that summit the threat posed by world overpopulation received considerable attention. Catholicism was perceived as opposed to...

Costs and cost-minimisation analysis. (health care costs)
September 18, 1993... Whatever kind of economic evaluation you plan to undertake, the costs must be assessed. In health care these are first of all divided into costs borne by the NHS (like drugs), by patients and their families (like travel), and by the rest of...

Re-establishing health care in Chile. (the author is the former minister of health in Chile)
September 18, 1993... Chile's long term social policy has produced very impressive outcomes in general health indicators, with a national health service established as early as 1952. During the years of the Pinochet dictatorship (1973-89) public health...

Educating general practitioners. (medical education) (Editorial)
September 18, 1993... The new demands of general practice require substantial educational change The need to change the structure of education for general practice is becoming even more apparent. Currently university departments provide undergraduate...

Wide-Eyed and Legless, Screen One.
September 11, 1993... The Screen One production of the play based on journalist Deric Longden's biography of his wife, Diana's Story (Corgi, 1989) reissued this year, must be the high point of the "Action for ME" campaign. The assembly of some of Britain's most...

Fatal Protein, Equinox.
September 11, 1993... Question: What is the connection between dead sheep, children treated with growth hormone, and the Fore people of Papua New Guinea? For those who can't answer, Equinox has provided a painless introduction to prion disease. One of...

Prevention of Progressive Chronic Renal Failure.
September 11, 1993... Prevention is always better than cure, and chronic renal failure is a case in point. The end result of this process is terminal uraemia and death unless treatment by dialysis or renal transplantation is available. The numbers of new patients...

Concepts for the Ideal Diabetes Clinic.
September 11, 1993... The publication of a book on establishing and organising an ideal diabetes clinic is timely for two main reasons. Firstly, the St Vincent Declaration, which originated from a meeting of European government health department officials,...

Preconception and Preimplantation Diagnosis of Human Genetic Disease.
September 11, 1993... Before the development of prenatal diagnostic tests, couples whose pregnancies would be at high risk for serious genetic disorders generally chose not to have further children. Prenatal tests provided the necessary reassurance to embark on a...

When Illness Strikes the Leader: the Dilemma of the Captive King.
September 11, 1993... For the first time this century both Britain and the United States have political leaders who may reasonably be described as being in good physical and mental health. They do not smoke and apparently drink little alcohol--a marked contrast...

New Zealand's health care reforms. (Editorial)
September 11, 1993... Until the election the battle is over image The possibility that some hospital managers will receive pay bonuses for column inches of good press coverage and penalties for negative news[1] is just one example of a preoccupation with...

Faecal incontinence. (incontinence in women after childbirth) (Editorial)
September 11, 1993... Childbirth is responsible for most cases Continence and defecation require functional integration of the pelvic floor musculature and its striated, voluntary sphincter muscles; of the involuntary muscle of the internal anal sphincter;...

Organs from animals. (use of animal organs for human transplantation) (Editorial)
September 11, 1993... Unlikely for a decade As the results of organ transplantation improve, so the demand for organs increases. In Europe, North America, and Australasia there is considerable public good will towards organ donation after death, but even...

Intraoperative use of thrombolytic agents. (Editorial)
September 11, 1993... Should be available in every hospital treating acute limb ischaemia Thrombolysis is an important advance in the treatment of acute limb ischaemia, and most district general hospitals now use the technique.[1] The changing pattern of...

The fish odour syndrome. (Editorial)
September 11, 1993... The problems are psychosocial The fish odour syndrome is characterised by an offensive body odour of rotting fish and abnormal excretion of trimethylamine in the breath, urine, sweat, saliva, and vaginal secretions. Since its...

Drugs: from prescription only to pharmacy only. (increase in number of drugs available over-the-counter in the UK) (Editorial)
September 11, 1993... The benefits are clearer than the risks The range of medicines available over the pharmacy counter is set to increase.[1] The Medicines Control Agency has revised its procedures to speed up the reclassification from prescription only...

Inquiry says depot injections can kill. (death of psychiatric patient caused by forcible injection of antipsychotic drug)
September 11, 1993... A clear link exists between sudden death in psychiatric patients and depot injections of antipsychotic drugs, said an inquiry last week into the death of Orville Blackwood, a young Afro-Caribbean man. Mr Blackwood died immediately after he...

Patients are still dying unnecessarily, says NCEPOD. (National Confidential Enquiry into Perioperative Deaths)
September 11, 1993... Patients in Britain are still dying unnecesarily from operations that are organised in a rush by trainee surgeons at night. The latest report of the National Confidential Enquiry into Perioperative Deaths (NCEPOD) finds that elderly patients...

Birth pains. (medical research scientist advocates high tech obstetrics)(Sounding Board) (Column)
September 11, 1993... My wife was writhing in pain on the examination couch in hospital and the midwife had lost her air of calm don't-worry-dear omniscience. She left the room, returned briefly, hurrying, and I heard the words "emergency section" thrown not in my...

Facing the future backwards. (physician prepares for retirement)(Personal View) (Column)
September 11, 1993... When I was a young man, newly qualified in medicine, retirement was as far from my mind as the man in the moon. How many times since then have I come across patients who had retired? More often than not it seemed to me that it was...

Comparison of terbinafine and clotrimazole in treating tinea pedis.
September 11, 1993... Introduction Tinea pedis (athlete's foot) is estimated to occur in 15% of the population with the highest incidence among regular users of communal bathing places. The most common and usually successful treatment for tinea pedis is a...

Illegibility of drug ampoule labels.
September 11, 1993... Complaints about the difficulty in reading drug ampoule labels are common in both published reports[1] and casual conversation. By contrast the Medicines Control Agency informed us: "The Medicines (Labelling) Regulations of 1976 as amended...

Value of pulsus paradoxus in assessing acute severe asthma. (on behalf of the British Thoracic Standards of Care Committee)
September 11, 1993... The "pulsus paradoxus" of acute severe asthma is an exaggeration of the normal fall in systolic blood pressure during inspiration. Its size is thought to relate to the severity of the attack.[1-3] Disagreement exists about how often it is...

The fish odour syndrome: biochemical, familial, and clinical aspects.
September 11, 1993... Introduction Although problems with body malodour have received little attention, they can cause much distress and may induce a variety of psychosocial reactions. We have been studying the incidence and biochemical nature of...

Psychiatric consequences of road traffic accidents.
September 11, 1993... Introduction Road traffic accidents are a major cause of morbidity and are the main cause of death in people under 30. Little is known about the detailed consequences for mental state or other aspects of quality of life but they are...

Parents' perceptions of taking babies' rectal temperature.
September 11, 1993... Introduction Consultations about ill young children comprise a major part of the workload in general practice and most of out of hours calls.[1] Parents often assess their child's temperature before deciding about management and...

Diagnosis and treatment of systemic lupus erythematosus. (review article)
September 11, 1993... The definitive diagnosis of a disease depends on knowledge either of its aetiology or on recognition of a unique pattern of clinical features. Neither applies to systemic lupus erythematosus. Its aetiology is unknown and many of its...

Taking babies' temperatures: science versus social taboos in battle over Baby Check.
September 11, 1993... Baby Check, a scoring system for assessing the severity of illness in babies under 6 months old, has not met with the success its developers expected. The inclusion of rectal temperature in the assessment was strongly opposed by the Royal...

What does it mean? (Economic Evaluation and Health Care, part 1)
September 11, 1993... Ever since the concept of value for money in health care was introduced into the NHS, economic terms and jargon have become part of our everyday lives--but do we understand what the different types of economic evaluation all mean,...

Iron and coronary heart disease: iron's role is undecided. (Editorial)
September 4, 1993... Iron's role is undecided Several strands of evidence suggest a role for iron in heart disease. For example, the massive accumulation of iron that occurs in genetic haemochromatosis and thalassaemia is a well recognised cause of...

From specialist care to self directed treatment: empower the patient and spare the clinician. (Editorial)
September 4, 1993... Empower the patient and spare the clinician We can no longer escape the conclusion that the number of patients who can be helped by treatment that depends on technology is limited by constraints on resources. This applies as much to...

Apheresis in the 1990s: technological innovations are opening up new therapeutic vistas. (Editorial)
September 4, 1993... Technological innovations are opening up new therapeutic vistas Apheresis is the removal of selected components from the blood by using cell separators. Medical technology has not yet, however, reached the future as envisaged by...

Leukaemia: a genetic disorder of haemopoietic cells. (Editorial)
September 4, 1993... Understanding the mechanism can help management and may one day improve treatment The change of a cell from normal to malignant is generally accepted to be a multistep process. Interestingly, the first evidence from this came not from...

Birmingham pathologist criticised for misdiagnoses. (Birmingham, England)
September 4, 1993... Doctors who do not report colleagues whom they know are making mistakes that could harm patients risk having to justify their actions to the General Medical Council and could be found guilty of serious professional miscomduct, the council...

Should purchasers pay for psychotherapy? (Editorial)
September 4, 1993... All therapies must prove their worth; some have found this easier than others Psychotherapy is a nebulous term referring to a seemingly infinite variety of "talking cures" of differing intensity, duration, and theoretical sophisticated....

Influence of oral magnesium supplementation on cardiac events among survivors of an acute myocardial infarction.
September 4, 1993... Introduction Several studies have shown that intravenous infusion of magnesium in the acute phase of a myocardial infarction results in a significant reduction in mortality and in the incidence of serious arrhythmias.[1] In our study...