British Medical Journal articles from September 1998

British Medical Journal archives from September 1998

Viagra: on release.(Editorial)
September 19, 1998... The popular interest in Viagra (sildenafil) is not solely the result of media hype and the drug's association with sex: the demand for treatment has been enormous. Since its launch in the United States in March it has become the fastest...

Viagra and rationing.(Editorial)
September 19, 1998... The inability of Britain's government to come to terms with rationing is exposed by this week's "interim guidance" that doctors should not prescribe sildenafil (Viagra) (pp 000, 000).[1 2] The government should use this opportunity to lead...

Thalassaemia in Britain: a tale of two communities.(Editorial)
September 19, 1998... The thalassaemias are recessively inherited haemoglobin disorders with profound implications for individuals, families, and health services.[1] In the United Kingdom they occur mainly in certain minority ethnic communities, but prevalence...

Implantable defibrillators for life threatening ventricular arrhythmias are more effective than antiarrhythmic drugs in selected high risk patients.(Editorial)
September 19, 1998... Increasing numbers of patients are surviving a first episode of life threatening ventricular arrhythmia. In the absence of an acute myocardial infarction, patients who survive either ventricular fibrillation or sustained ventricular...

An amnesty for unpublished trials.(Editorial)
September 19, 1998... A year ago the editors of 50-100 medical journals called an amnesty for unpublished trials,[1] Investigators with unreported trial data were invited to register their trials by completing an unreported trial registration form. The aim was to...

Action on antimicrobial resistance: not easy but Europe can do it.
September 19, 1998... "We screwed up, and we ought to say so and apologise. Doctors were handed the wonderful gift of antibiotics but are destroying them through indiscriminate use. We don't need another committee. We know what to do: we should just use them...

Viagra is licensed in Europe but rationed in Britain.
September 19, 1998... The long awaited licence for sildenafil citrate (Viagra) was granted this week by the European Medicines Evaluation Agency, but British patients will not be able to get the drug on the NHS, at least for the time being. Following the...

Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews.
September 19, 1998... Introduction Lung cancer is a common disease that is difficult to treat successfully. In the United States each year about 178 000 people are diagnosed with lung cancer and about 160 000 die of the disease, making it the leading cause...

Working hours as a risk factor for acute myocardial infarction in Japan: case-control study.
September 19, 1998... Introduction The occurrence of disease that may relate to working hours is an important consideration in Japan, where working hours have been unusually long.[1] Uehata has reported that two thirds of 203 victims of sudden death who were...

As seen on TV: observational study of cardiopulmonary resuscitation in British television medical dramas.
September 19, 1998... Introduction Since Kouwenhoven's original description of modern cardiopulmonary resuscitation[1] and the obvious early successes of the technique,[2] resuscitation has become increasingly commonplace in hospitals and the community. The...

Dietary intake of schizophrenic patients in Nithsdale, Scotland: case control study.
September 19, 1998... The move to community care means that most schizophrenic patients now live outside hospital. Patients in the community are supported in various ways--for example, through drugs and nursing support. However, schizophrenic patients die early,...

Effect of fundholding on removing patients from general practitioners' lists: retrospective study.
September 19, 1998... Fundholding by general practitioners was introduced during NHS reforms in 1989. Little is known about its impact on the quality of patient care[1] One measure of this impact is the rate at which practices decide they do not wish to continue to...

Corrections. (to "Will the fudge on equity sustain the NHS into the next millenium?" in July 4, 1998 issue)(Correction Notice)
September 19, 1998... Will the fudge on equity sustain the NHS into the next millennium? In the article by Mays and Keen (4 July, pp 66-9) the third sentence in the first paragraph of the section about arguments for changes, contained an error. The sentence should...

Corrections. (to "Excess mortality after human albumin administration in critically ill patients." in July 25, 1998 issue)(Correction Notice)
September 19, 1998... In the editorial by Martin Offringa (25 July, pp 223-4) the reference cited towards the end of the penultimate paragraph should have been reference 4, not 2.

Corrections. (to "Cardiac arrests outside hospital." in April 4, 1998 issue)(Correction Notice)
September 19, 1998... The opening sentence of the editorial by Tom Evans (4 April, pp 1031-2) should have read: "Twenty five years after the original epidemiological studies[1 2] two thirds of all patients who die with acute coronary events still do so before...

Corrections. (to "Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care." in June 13, 1998 issue)(Correction Notice)
September 19, 1998... An error occurred in this article by Suzanne H Richards and colleagues (13 June, pp 1796-801). In table 6 (p 1800) the difference (95% confidence interval) for "Information on treatment (as much as wanted)" should have been -3.2 (-15.7 to 9.3)...

A multidisciplinary approach for improving services in primary care: randomised controlled trial of screening for haemoglobin disorders.
September 19, 1998... Screening for carriers of thalassaemias and sickle cell disorders (haemoglobin disorders) is established in the United Kingdom,[1] where over 6% of residents and 10% of newborns are of Asian, black, Mediterranean, or mixed parentage.[2] On...

General medicine: recent advances.
September 19, 1998... One review could not encompass all the noteworthy recent advances in general medicine, but research findings relevant to the treatment of HIV, congestive heart failure, prostatic hypertrophy, hypertension, hypercholesterolaemia, oestrogen...

Late onset interstitial nephritis associated with mesalazine treatment.
September 19, 1998... Mesalazine is widely prescribed for the treatment of inflammatory bowel disease. It is a single molecule of 5-aminosalicylic acid (5-ASA), and is structurally similar to phenacetin and aspirin. Occasionally, treatment with mesalazine may lead...

Acute oxygen therapy. (ABC of Oxygen)
September 19, 1998... Oxygen is widely available and commonly prescribed by medical and paramedical staff. When administered correctly it may be life saving, but oxygen is often given without careful evaluation of its potential benefits and side effects. Like any...

North of England evidence based guidelines development project: guideline for the primary care management of dementia.
September 19, 1998... This guideline aims to provide recommendations to assist general practitioners manage people with all forms of dementia and help their carets. This is a summary version of the full guideline.[1] The areas covered were developed in conjunction...

Best of motives, worst of consequences.(Competency, consent, and the Duty of Care.)
September 19, 1998... My patient was a 62 year man who was looked after by his mother. He was a "burnt out" schizophrenic of low intelligence and used to spend most of his time on long walks on his own. He was always hyperactive and communicated with staccato...

Let the courts decide.(Competency, consent, and the Duty of Care.)
September 19, 1998... The Hippocratic oath, which instructs doctors to do good and refrain from harm, needs to be moderated by respect for patient autonomy. The declaration of Lisbon (1981) states that "the patient has the right to accept or refuse treatment after...

The only failure was the outcome.(Competency, consent, and the Duty of Care.)
September 19, 1998... Is it possible to fail even if every step you take is the right decision? Indeed it is, but it needs shouting from the roof tops that those who manage to negotiate such a difficult course are not failures--it is only the outcome that can in any...

The discovery of cortisone: a personal memory.(Personal View)
September 19, 1998... Fifty years ago this week, Philip Hench showed that "compound E" (cortisone) was capable of reversing the inflammation of rheumatoid arthritis. This discovery resulted from 19 years of imaginative and deductive observation together, perhaps,...

The rise and fall of Viagra.(Medicine and the Media.)
September 19, 1998... Viagra has probably received more media hype than any other drug. Abi Berger examines how this massive publicity will affect general practitioners, who may eventually have to prescribe the impotence treatment It must surely be every drug...

Before I Say Goodbye.
September 19, 1998... Ruth Picardie Penguin, 5.99 [pounds sterling], pp 116 ISBN 0 140 27630 0 The door into the private world of those with cancer has opened in recent years with the development of a confessional form of writing, often born of journalism, in...

C. Because Cowards Get Cancer Too.
September 19, 1998... John Diamond Vermillion, 9.99 [pounds sterling], pp 240 ISBN 0 09 181664 5 The door into the private world of those with cancer has opened in recent years with the development of a confessional form of writing, often born of journalism, in...

The Human Rights, Ethical and Moral Dimensions of Health Care: 120 Practical Case Studies.
September 19, 1998... Ed Pierre Cuer, Jean-Pierre Massue Council of Europe Publishing, from Stationery Office Bookshops, 30 [pounds sterling], pp 486 ISBN 928 713055 8 First impressions count. I have worries about xenotransplantation, so I turned to the index of...

Diabetes: a time for excitement - and concern.(Editorial)
September 12, 1998... Hopeful signs exist that the ravages of diabetes can be tamed These are exciting, and exasperating, times for people interested in diabetes. On the one hand, a tremendous volume of research is underway assessing both new prevention and new...

Combined high blood pressure and glucose in type 2 diabetes: double jeopardy.(Editorial)
September 12, 1998... British trial shows clear effects of treatment, especially blood pressure reduction More than three decades ago Harry Keen pinpointed two "bad companions" to diabetes: high blood glucose concentrations and high blood pressure, both...

First trimester ultrasound screening carries ethical and psychological implications.(Editorial)
September 12, 1998... Carries ethical and psychological implications Ultrasound scanning has been an integral part of antenatal care in industrialised countries for some time,[1] but until recently detection of fetal abnormalities by this method has been...

Avoiding the consequences of deep vein thrombosis: elevation and compression are important - and too often forgotten.(Editorial)
September 12, 1998... Elevation and compression are important--and too often forgotten Deep vein thrombosis has never been managed well. Before the use of anticoagulants it carried a substantial mortality, rising to over 50% for pulmonary embolism.[1] Doctors...

Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. (United Kingdom Prospective Diabetes Study Group)
September 12, 1998... Introduction Type 2 diabetes and hypertension are commonly associated conditions, both of which carry an increased risk of cardiovascular and renal disease[1-6] The prevalence of hypertension in type 2 diabetes is higher than that in...

Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. (United Kingdom Prospective Diabetes Study Group)
September 12, 1998... Introduction Most randomised controlled trials of treatment for hypertension in patients with diabetes have evaluated blood pressure lowering in comparison with a conventionally treated group of patients who had higher blood...

Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40. (United Kingdom Prospective Diabetes Study Group)
September 12, 1998... Introduction Hypertension in people with type 2 diabetes is associated with an increased risk of macrovascular complications. The systolic hypertension in the elderly programme showed the effectiveness of improved blood pressure in...

Relation between iron stores and non-insulin dependent diabetes in men: case-control study.
September 12, 1998... Non-insulin dependent diabetes mellitus is a common complication of diseases of iron overload such as haemochromatosis; 53-80% of patients with haemochromatosis develop diabetes.[1] The development of diabetes in haemochromatosis is related to...

Trends in smoking during pregnancy in England, 1992-7: quota sampling surveys.
September 12, 1998... The dangers of smoking during pregnancy are widely established.[1] The Health of the Nation set the following target: "In addition to the overall reduction in [smoking] prevalence, at least a third of women smokers to stop smoking at the start...

Risk of testicular cancer with cryptorchidism and with testicular biopsy: cohort study.
September 12, 1998... Swerdlow et al studied a cohort of 1075 men who had been treated for cryptorchidism.[1] In 120 testes that had been biopsied at the time of orchiopexy the relative risk of subsequent development of testicular cancer was 66.7. The corresponding...

Is general practice in need of a career structure?
September 12, 1998... With nearly 1000 vacancies for general practitioners in the United Kingdom in 1998,[1] the recruitment problem--exacerbated by early retirement by doctors keen to leave a discipline under pressure--is high on the professional agenda....

Ductal carcinoma in situ of the breast.
September 12, 1998... Ductal carcinoma in situ is a proliferation of malignant epithelial cells within the ductolobular system of the breast that show no light microscopic evidence of invasion through the basement membrane into the surrounding stroma (fig 1)....

Childhood Cushing's syndrome induced by betamethasone nose drops, and repeat prescriptions.(Lesson of the Week)
September 12, 1998... Iatrogenic Cushing's syndrome secondary to oral corticosteroid treatment is well documented, as is systemic absorption of topical steroid preparations that are potent or used for a long time. However, frank Cushing's syndrome as a result of...

Otherwise it might be convenient.(Reforming the Russian Health Service)
September 12, 1998... Health service reform is an important part of the growth of democracy in Russia, and several Western groups have been helping the Russians tackle this huge task. Since 1992, general practitioners in the United Kingdom and medical teachers at...

Urgent aid, chronic penalties.(Reforming the Russian Health Service)
September 12, 1998... There are two emergency medical services in Russia. Quick aid attends accidents and patients with life threatening conditions. I work for urgent aid, a service that arranges visits to patients in their homes for other urgent medical conditions....

Professional law breakers.(Reforming the Russian Health Service)
September 12, 1998... In Russia, a patient who guesses that his problem concerns his nervous system can go directly to the neurologist. Or he can go to his district physician who (if he or she is competent enough to know that the pain in the back is caused by...

Training general practitioners in St. Petersburg.(Reforming the Russian Health Service)
September 12, 1998... Every doctor has to have an "improvement" course at least every five years in order to remain authorised and accredited. Institutions such as ours provide almost all these courses, as well as courses for doctors who decide to change their...

Training general practitioners in Gatchina.(Reforming the Russian Health Service)
September 12, 1998... Our department has been training marine doctors since 1982. Since the situations of general practitioners and marine doctors are similar--the need to provide comprehensive care with a minimum of technical equipment and support--we concluded...

Late onset genetic disease: where ignorance is bliss, is it folly to inform relatives?
September 12, 1998... One aspect of the rapid advances in molecular genetics is the capacity to identify genetic predispositions in a particular individual, where previously we made risk assessments based on aggregate or population observations.[1 2] Specific...

Corrections. (to 'The Anatomy of a Clinical Information System' in the May 30, 1998 issue)(Correction Notice)
September 12, 1998... The anatomy of a clinical information system Three errors occurred in the reference list of this article by Keith Simpson and Mike Gordon (30 May, pp 1655-8). The references should have read: 14 Campbell JR, Payne TH. A comport of four...

Corrections. (to 'Underperforming doctors: a postal survey of the Northern Deanery' in June 6, 1998 issue)(Correction Notice)
September 12, 1998... Underperforming doctors: a postal survey of the Northern Deanery In this paper by George Taylor (6 June, pp 1705-8), the date in the first line of the methods section should have been 1998 [not 1988].

Corrections. (to 'A Social Experiment The Keeps Adapting' in the July 4, 1998 issue)(Correction Notice)
September 12, 1998... A social experiment that keeps adapting The date that Australians elected a socialist labour government was 1972--not 1975, as stated in this article by Peter J McDonald (4 July, pp 55-6).

Anna: too much, too young.(Personal View)
September 12, 1998... "It's great having you as friends because the chances of us getting ill must be really small." My good friend was reflecting on a run of illness and injury that we had suffered. It sounded clumsy but was well meant and I hope is true. That was...

Antimicrobial resistance is a major threat to public health.
September 5, 1998... There is an incoming tide of concern about the problems of antimicrobial resistance. For several years alarm has been expressed in the United States,[1] and the past 12 months have seen two World Health Orgamsation meetings prompted by...

Antimicrobial resistance: a veterinary perspective.
September 5, 1998... Antimicrobals are important for animal welfare but need to be used prudently Bacterial disease is a major constraint on the efficient production of animal derived food land causes ill health and suffering in both food producing and...

Antimicrobial resistance: bacteria on the defence: resistance stems from misguided efforts to try to sterilise our environment.
September 5, 1998... Resistance stems from misguided efforts to try to sterilise out environment Bacterial resistance to multiple antibiotics characterises the present decade. Finding organisms insensitive to over 10 different antibiotics is not unusual....

Control of antimicrobial resistance: time for action.
September 5, 1998... The essentials of control are already well known Until recently the medical community world wide has seemed incapable of reacting to the imminent crisis of antibiotic resistance. Several explanations exist for this lack of action,...

Surveillance of microbial resistance.
September 5, 1998... Centralised surveys to validate routine data offer a practical approach Antibiotic resistance is increasing and significant public health problems are feted. Actions to mitigate the problem include development of new antimicrobials,...

Lessons from New York's tuberculosis epidemic: tuberculosis is a political as much as a medical problem - and so are the solutions.
September 5, 1998... Tuberculosis is a political as much as medical problem--and so are the solutions In the late 1980s New York city witnessed a dramatic epidemic of tuberculosis. By 1990, with 3% of the US population, the city had 15% of the country's...

Facing the microbial threat. (Observations by Dr. Einar Krag)
September 5, 1998... With European chief medical officers set to discuss antimicrobial resistance in Copenhagen next week, Kamran Abbasi asked Einar Krag what all the fuss is about A nightmare scenario of multidrag resistant bacteria laying waste the human race...

Which contacts of patients with meningococcal disease carry the pathogenic strain of Neisseria meningitidis? A population based study.
September 5, 1998... Introduction Contacts of patients with meningococcal disease have an increased risk of contracting the disease (relative risk for household members between 1000 and 4000).[1-3] When meningococcal disease occurs, often carriers of the...

Antibiotic resistance among enterococci causing endocarditis in the UK: analysis of isolates referred to a reference laboratory.
September 5, 1998... Enterococci account for 5-15% of cases of bacterial endocarditis.[1] They are the most resistant bacteria commonly encountered in this type of infection, which is still associated with a mortality of 20-30%.[2] The treatment regimen for...

Multidrug resistant tuberculosis in France 1992-4: two case-control studies.
September 5, 1998... Since 1988 several outbreaks of multidrug resistant tuberculosis have occurred in the United States and Europe. We surveyed the national network of laboratories serving 80% of public hospital beds in France to measure the prevalence of...

Correction. (to 'Confidential inquiry into quality of care before admission to intensive care' in June 20, 1998 issue)(Correction Notice)
September 5, 1998... Confidential inquiry into quality of care before admission to intensive care An authors' error occurred in this paper by P McQuillan and colleagues (20 June, pp1853-8). Dr C H Collins, consultant anaesthetist at the Royal Devon and Exeter...

Correction. (to "Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost" in July 11, 1998 issue)(Correction Notice)
September 5, 1998... Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost An error occurred in the labelling of one of the figures in this paper by Wellwood and colleagues (11 July, pp 103-10). In figure 3 the...

Are amoxycillin and folate inhibitors as effective as other antibiotics for acute sinusitis? A meta-analysis.
September 5, 1998... Introduction Acute sinusitis is a common infection. It is usually treated with antibiotics, often in conjunction with decongestants. A wide variety of antibiotics are used, but there is little information to allow doctors to determine...

Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats.
September 5, 1998... Introduction It has been known for many years that antibiotics modify the course of most sore throats only slightly if at all.[1 2] Nevertheless, they are often prescribed[3-6] despite accumulating evidence from trials.[7-12] When...

The development of new antimicrobial agents.(Science, Medicine, and the Future)
September 5, 1998... The past 50 years have shown how successful tile pharmaceutical industry has been in developing antimicrobial agents. Until the 1980s a steady stream of new agents (or at least older modified agents) had become available. The 1980s saw little...

What can be done about resistance to antibiotics?
September 5, 1998... Antibiotic resistance is now generally accepted as a major public health issue, but it is less clear which interventions should be used and which will work. Our principal objective is to minimise antibiotic resistance and increase the...

Antimicrobial resistance in developing countries.
September 5, 1998... In 1990 it was estimated that 4123 million of the world's 5267 million population--78%--lived in developing countries. Of the 39.5 million deaths in the developing world, 9.2 million were estimated to have been caused by infectious and...

Surveillance of antimicrobial resistance - an international perspective.
September 5, 1998... Surveillance is essential for containing antimicrobial resistance.[1] Information on resistance is needed at local, national, and international levels to guide decision making and responses. Local information should be used in clinical...

The epidemiology of antimicrobial resistance in hospital acquired infections: problems and possible solutions.
September 5, 1998... Hospitals, and particularly intensive care units, are an important breeding ground for the development and spread of antibiotic resistant bacteria. This is the consequence of exposing to heavy antibiotic use a high density patient population in...

Community acquired infections and bacterial resistance.
September 5, 1998... In this paper we review the problems of antibiotic resistance in community acquired infections. We discuss pathogens that have a large impact on morbidity and mortality in the community such as Streptococcus pneumoniae, Streptococcus pyogenes,...

The origins and molecular basis of antibiotic resistance.
September 5, 1998... We frequently refer to bacteria as being resistant to antibiotics, but rarely do we consider what that means. Even the most resistant bacterium can be inhibited or killed by a sufficiently high concentration of antibiotic; patients, however,...

Antiviral drug resistance.
September 5, 1998... The development of effective antiviral drugs is an important biomedical scientific achievement of the late 20th century. Highly potent drugs are now available against herpes viruses, HIV, hepatitis B virus, and influenza virus. This list will...

Regulating the use of antibiotics in the community.
September 5, 1998... All parties perceive antibiotic resistance as a global threat.[1] We examined the literature on the use of antibiotics in the community to establish how the issue of antibiotic resistance might be managed. We chose illustrative examples from...

Use of antimicrobial drugs in veterinary practice.
September 5, 1998... Shortly after antimicrobial drugs were developed they were used in veterinary medicine to treat mastitis in dairy cows.[1 2] Disease is inevitable in all animals, whether Farm animals or pets, and healthy animals may also be carriers and...

Strategies for promoting judicious use of antibiotics by doctors and patients.
September 5, 1998... Recent antibiotic use is a well documented risk factor for infection or colonisation with resistant pathogens.[1-7] Despite this recognition, unnecessary antibiotic prescribing remains common. In the United States more than a fifth of all...

Community based approaches to the control of multidrug resistant tuberculosis: introducing "DOTS-plus."
September 5, 1998... Tuberculosis remains the world's leading infectious cause of adult deaths, most of which are due not to multidrug resistant tuberculosis but to lack of access to effective treatment for drug susceptible tuberculous disease? New data suggest,...

The government's initiative may be stillborn.(Personal View)
September 5, 1998... In one of the numerous documents I have received on the NHS white paper for England I read the following: "Clinical governance encompasses all the processes needed to achieve the highest quality clinical practice possible within available...

Emerging Infections.
September 5, 1998... Ed Richard M Krause Academic Press, 55 [pounds sterling], pp 513 ISBN 0 212 425930 8 Micro-organisms find Homo a promising habitat: it is the most numerous mammal, its domesticated quadrupeds outnumber animals of similar size remaining in...

Effective Commissioning: Lessons from Purchasing in American Managed Care.
September 5, 1998... Donald W Light Office of Health Economics, 7.50 [pounds sterling], pp 90 ISBN 1 899040 552 In some ways the NHS has changed enormously since 1991. Purchasers were put in the driving seat, needs were assessed, explicit priorities were drawn...