British Medical Journal articles from September 1999

British Medical Journal archives from September 1999

Report suggests that NHS is unsustainable in present form.(News)(Statistical Data Included)
September 25, 1999... A new report that questions the sustainability of the NHS in its present form was published last week by the Nuffield Trust and Cambridge University's Judge Institute of Management Studies. The report, which is the distillation of 10...

Professor accused of covering up mistakes in drug trial.(News)(Statistical Data Included)
September 25, 1999... An "eminent professor" at a London medical school tried to cover up mistakes in a drug trial and warned a research registrar that he was "finished" if he told anyone, the General Medical Council heard this week. Robert Davies, professor...

In brief.(News)(Statistical Data Included)
September 25, 1999... UK government pledges to end child poverty: The UK's Labour government has pledged to end child poverty within a generation. The government's poverty audit sets out 32 poverty indicators including the number of households with below average...

UK GPs will be consulted on revalidation proposals.(News)(Statistical Data Included)
September 25, 1999... GPs will have to prove that they are good communicators if proposals on revalidation, which are to be sent to all GPs in the United Kingdom before the end of the year, are adopted. The proposals, which were drawn up by a working group of...

Royal College battles for more women surgeons.(News)(Statistical Data Included)
September 25, 1999... The Royal College of Surgeons has announced plans to increase the number of women consultants but it will be many years before domination by men comes to an end. Currently, only 5% of the United Kingdom's 4190 consultant surgeons are...

Study identifies why child heart operations go wrong.(News)(Statistical Data Included)
September 25, 1999... Human and organisational factors have a significant role in determining whether a surgical operation has a good or bad outcome, according to research outlined last week to the public inquiry into child heart surgery at Bristol. Marc de...

Israel wants to abolish private medicine in public hospitals.(News)(Statistical Data Included)
September 25, 1999... Israeli doctors say they will "revolt" if the treasury pushes through the Knesset (parliament) a bill to abolish private medical services in public hospitals. Such services, known by their Hebrew acronym Sharap, have been legally and...

Report condemns NHS complaints procedure.(News)(Statistical Data Included)
September 25, 1999... An independent study by the Public Law Project, a national legal charity, has identified serious failings in the NHS's complaints procedure and called for urgent reform. The procedure, introduced in April 1996 after an inquiry by the...

Complaints mechanism fails older patients.(News)(Statistical Data Included)
September 25, 1999... Help the Aged has published its own analysis of the NHS complaints procedure. As part of the charity's Dignity on the Ward campaign, the report highlights the concern that there is no "fast track" procedure in place to deal with urgent...

WHO nominates new regional director for Europe.(News)(Statistical Data Included)
September 25, 1999... The World Health Organisation's 50 European member states have nominated their regional director for the next five years. Dr Marc Danzon, whose background is in public health and health administration, won a decisive--and, to some people,...

Direct to consumer drug advertising is billion dollar business in US.(News)(Statistical Data Included)
September 25, 1999... Advertising prescription drugs to consumers benefits the public, improves their knowledge of health, and may reduce healthcare costs, Mike Magee, senior medical adviser to Pfizer and a urologist at Jefferson Medical College in Philadelphia,...

AIDS cuts life expectancy in sub-Saharan Africa by a quarter.(News)(Statistical Data Included)
September 25, 1999... The spread of HIV and AIDS in sub-Saharan Africa has far exceeded the worst projections, according to speakers at the 11th international conference on AIDS and sexually transmitted diseases in Africa. In 13 countries the prevalence of HIV...

AMA sets up "union" for employed doctors.(News)(Statistical Data Included)
September 25, 1999... The American Medical Association's Board of Trustees took definitive steps towards launching next month its national negotiating organisation for doctors employed by managed care and health maintenance organisations. In a special meeting...

Calcium channel blockers affect cognitive function in older people.(News)(Statistical Data Included)
September 25, 1999... Declines in cognitive function were significantly greater among elderly people using calcium channel blockers than among those using other antihypertensive agents, according to a study published in the Canadian Medical Association Journal...

Disturbance of cerebral function in people exposed to drinking water contaminated with aluminium sulphate: retrospective study of the Camelford water incident.
September 25, 1999... Abstract Objective To establish whether people exposed to drinking water contaminated with 20 tonnes of aluminium sulphate in the Camelford area of Cornwall in the south west of England in July 1988 had suffered organic brain damage as...

Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study.
September 25, 1999... Abstract Objective To evaluate whether measuring fasting plasma glucose concentration is an easier screening procedure for gestational diabetes mellitus than the 1 hour 50 g glucose challenge test. Design Prospective population based...

Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study.
September 25, 1999... Abstract Objectives To investigate the association between the duration of exclusive breast feeding and the development of asthma related outcomes in children at age 6 years. Design Prospective cohort study. Setting Western...

Admission for and mortality from primary venous thromboembolism in women of fertile age in Denmark, 1977-95.(Statistical Data Included)
September 25, 1999... Epidemiological studies indicate that use of third generation oral contraceptives increases the risk of venous thromboembolism more than does use of second generation oral contraceptives.[1-3] Critics have suggested that this finding may be...

Association between alcohol consumption and mortality, myocardial infarction, and stroke in 25 year follow up of 49 618 young Swedish men.(Statistical Data Included)
September 25, 1999... Several epidemiological studies have shown that moderate alcohol consumption is associated with reduced mortality from cardiovascular diseases in middle aged and elderly subjects,[1] but its effect in younger people is unknown. High alcohol...

Helicobacter pylori and childhood recurrent abdominal pain: community based case-control study.(Statistical Data Included)
September 25, 1999... Recurrent abdominal pain (at least three discrete episodes of abdominal pain over a period of three or more months, and of sufficient severity to interrupt normal activities) is a common childhood complaint We set out to determine the...

Correction.(To "Ethnic and sex differences in selection for admission to Nottingham University Medical School" in August 7, 1999 issue, pp 351-2)(Statistical Data Included)(Correction Notice)
September 25, 1999... Ethnic and sex differences in selection for admission to Nottingham University Medical School The wrong table was published for this paper by James and Driver (7 August 1999, pp 351-2). The correct table is published below. The results...

Systematic review of near patient test evaluations in primary care.(General Practice)(Statistical Data Included)
September 25, 1999... Abstract Objective To identify and qualitatively synthesise the findings from all studies that have examined the performance and effect of near patient tests in the primary care setting. Design Systematic review of published and...

Email submissions from outside the United Kingdom.(Statistical Data Included)
September 25, 1999... We are now offering an email submission service for authors from outside the UK. The address is papers@bmj.com Ideally our email server would link seamlessly with our manuscript tracking system, but for now it does not, which is why we...

The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care.
September 25, 1999... Abstract Objective To evaluate the effectiveness of combinations of three methods to promote physical activity. Design Randomised controlled trial. Baseline assessment with post-intervention follow up at 12 weeks and 1 year. ...

Acute otitis media.
September 25, 1999... This review of the effects of treatment for otitis media and of the effects of preventive interventions is one of over 60 chapters included in the first issue of Clinical Evidence, which is published by the BMJ Publishing Group. Future issues...

Users and practitioners of complementary medicine.
September 25, 1999... Complementary medicine seems to be becoming more popular in Britain. Media coverage, specialist publications, and numbers of complementary therapists have all increased dramatically in the past 20 years. In this chapter we analyse this...

Everywhere and nowhere--a Socratic dialogue on the new public health.(Statistical Data Included)
September 25, 1999... This is a dialogue between Hylas and Philonous, the design of which is plainly to demonstrate the reality and perfection of partnership working and the immediate providence of a minister for health in opposition to the sceptics and atheists...

The permanent vegetative state: practical guidance on diagnosis and management.
September 25, 1999... Patients who survive catastrophic brain damage may be left permanently unaware--in the permanent vegetative state. Many doctors are likely to manage these patients at some point in their career.[1] The diagnosis has been the subject of...

Reasons to be thankful.(A Memorable Teacher)(Statistical Data Included)
September 25, 1999... Big Bob Torrance is dead. I last saw him in 1990. Knowing that he was to retire and that, fortuitously, the Physiological Society was meeting in Oxford that summer, I went to the meeting. At a similar meeting, under his tutelage, I had made...

International trends in the provision and utilisation of hospital care.(Statistical Data Included)
September 25, 1999... This article examines the pattern of change in hospital provision in established market economies, the countries of eastern Europe and the former Soviet Union, and lower income countries. Despite the great differences between these areas,...

Dangerous lunatics.(One Hundred Years Ago)(Statistical Data Included)
September 25, 1999... A medical correspondent writes to say that while travelling from Scotland recently in a corridor railway carriage he was attacked by a powerful man suffering from homicidal mania. This very unpleasant experience leads our correspondent to...

Cancellation of debt must ensure maximum benefit to vulnerable.(Statistical Data Included)
September 25, 1999... EDITOR--It should be difficult for any doctor to ignore Abbasi's recent article on "third world" debt.[1] The state of health care available to families in between half and two thirds of the world is unacceptable, and the great differences in...

Developing countries cannot afford high fees for speakers.(Statistical Data Included)
September 25, 1999... EDITOR--Doctors visit Thailand to give lectures at the invitation of Thai universities or royal colleges or are invited by drug firms. Some pay all of their own expenses, or only claim minimal expenses, and give generously of their time....

Low molecular weight heparins could be important in cancer.(Statistical Data Included)
September 25, 1999... EDITOR--Kakkar and Williamson clearly state the need for well conducted prospective clinical trials to evaluate the potential role of low molecular weight heparins in improving survival in cancer patients.[1] In the absence of properly...

Hypoalbuminaemia and transcapillary pressures have role in nephrotic syndrome.(Statistical Data Included)
September 25, 1999... EDITOR--In their article on understanding oedema Diskin et al have overlooked an important body of work that challenges the traditional pathophysiological explanation for the development of oedema in the nephrotic syndrome secondary to renal...

Mibefradil was not rushed to market in United States.(Statistical Data Included)
September 25, 1999... EDITOR--Landow gave a misleading impression of the discussion about mibefradil at the US Food and Drug Administration's Cardio-Renal Advisory Committee meeting of 28 February 1997 and the subsequent withdrawal of the drug from the market in...

General practitioners' experiences of patients' complaints.(Statistical Data Included)
September 25, 1999... In-house mediation can help in reducing general practitioners' stress EDITOR--I work as a principal in general practice, with part of my list in Lambeth, and was summoned to a service hearing by Lambeth, Southwark and Lewisham Health...

Prison officers can recognise hidden psychiatric morbidity in prisoners.(Statistical Data Included)
September 25, 1999... EDITOR--Prisons in England and Wales are known to house a considerable number of mentally ill people,[1-3] Many of these people probably pass through health screening undetected when they are received into prison and remain on ordinary...

Reducing risk of recurrent coronary heart disease in Cornwall.(Statistical Data Included)
September 25, 1999... EDITOR--Bradley and Cupples end their editorial on reducing recurrent coronary heart disease by asking whether anyone has a better idea of how to improve performance in this area[1] Earlier they say that adequate resources would be needed to...

Is recruitment more difficult with a placebo arm in RCTs?
September 25, 1999... Methodological issues will have affected results EDITOR--Welton et al found that the proportion of women who were willing to participate in a randomised controlled trial of hormone replacement therapy was higher if participation in a...

Differences in death rates in English hospitals.(Statistical Data Included)
September 25, 1999... Effects of admission rates may have been understated EDITOR--Unlike Jarman et al, I do not yet think that we can state with confidence that "more doctors means fewer deaths."[1] As the authors make clear, there has been a lively...

Competing interests are relevant to lectures approved for PGEA.(Statistical Data Included)
September 25, 1999... EDITOR--In journals authors are expected to declare any competing interests. In the context of lectures or workshops that are approved for postgraduate education allowance, however, when a group of general practitioners gather specifically to...

Policy must separate need for hospital beds from demand.
September 25, 1999... EDITOR--Whether or not the private finance initiative has any real advantages (and I have yet to meet a defender of it) is one question; the appropriate number of hospital beds is another.[1] There is of course no right number of hospital...

GPs should be balloted on primary care trusts.(Medicopolitical Digest)(Statistical Data Included)
September 25, 1999... The General Practitioners Committee has reiterated its belief that primary care groups (PCGs) in England should not proceed to primary care trusts until there has been a ballot of local GPs. Ministers have made it clear that they do not...

GMC delays guidelines on confidentiality.(Medicopolitical Digest)(Statistical Data Included)
September 25, 1999... The General Medical Council is to delay the publication of its guidelines on confidentiality until the outcome of an appeal against the judgment in the Source Informatics Ltd versus the Department of Health case is known. In May the...

Health secretary refuses moratorium on bed closures.(Medicopolitical Digest)(Statistical Data Included)
September 25, 1999... The United Kingdom health secretary, Mr Frank Dobson, has turned down a suggestion from the BMA for a moratorium on bed closures to help to avert a crisis in NHS provision in the forthcoming winter months. Mr Dobson says that a total...

Health department sets up clinical governance team.(Medicopolitical Digest)(Statistical Data Included)
September 25, 1999... The Department of Health in England has set up a multidisciplinary team to work with NHS organisations to develop practical approaches to implementing clinical governance. The team will be led by Professor Aidan Halligan, professor of...

BMA sets deadline for working time directive.(Medicopolitical Digest)(Statistical Data Included)
September 25, 1999... The senior hospitals staffs' negotiators have given notice that unless real progress is made by 1 October the BMA will take steps to enforce the European Union's working time directive by legal means. Under the directive employees cannot be...

Drug Treatment Systems in an International Perspective: Drugs, Demons, and Delinquents.(Medicopolitical Digest)(Statistical Data Included)(Review)
September 25, 1999... Drug Treatment Systems in an International Perspective: Drugs, Demons, and Delinquents Eds Harald Klingemann, Geoffrey Hunt Sage Publications, 15.99 [pounds sterling], pp 327 ISBN 0 7619 0543 X Rating: * The contrived subtitle,...

Law Without Enforcement.(Statistical Data Included)(Review)
September 25, 1999... Law Without Enforcement Eds Nigel Eastman, Jill Peay Hart Publishing, 20 [pounds sterling], pp 256 ISBN 1901362752 Rating: *** Mental health legislation in England and Wales is currently undergoing a major review. Some would say that...

Vital Signs.(Radio)(Statistical Data Included)(Review)
September 25, 1999... Vital Signs 10 45 am and 7 45 pm, 13 September to 8 October, BBC Radio 4 What do everyday country folk make of the Archers? Do they mutter about Tony's planting decisions, spot inconsistencies in the interpretation of MAFF rulings?...

WEBSITE OF THE WEEK: Women in Surgery.(Statistical Data Included)(Review)
September 25, 1999... Women in surgery It is an embarrassment that the percentage of women consultant surgeons remains in single figures despite almost two decades of sex balanced intake to medical school, and last week the Royal College of Surgeons announced its...

Peer review: thinking the unthinkable.(Personal Views)(Statistical Data Included)
September 25, 1999... I have just been asked to review an article. It has taken between two and three hours of my time. It has cost me 100 [pounds sterling] or more (I am self employed). In order to return the unsolicited favour, I had to buy a stamp. I am now...

Pinot Noir powders.(Soundings)(Statistical Data Included)
September 25, 1999... In the early 1950s posters informed Parisians of the health risks of drinking wine. The Academy of Medicine had found it was definitely unhealthy to drink more than one litre of wine a day. Since those halcyon days the dose deemed...

Minerva.(Statistical Data Included)
September 25, 1999... Women in Detroit can now get more than hot rollers and highlights at their weekly trip to the hair salon. In a campaign to cut high rates of hypertension, diabetes, and renal disease among the city's African-Americans, the National Kidney...

Entering the minds of the elderly.(Statistical Data Included)(Review)
September 18, 1999... I was sorting things out pretty well. They had been attending for only a few weeks, but I had managed to reduce their multiple drug regimens and to diagnose and control his atrial fibrillation. Bill and Netty were a delightful couple, always...

Quality at general practice consultations: cross sectional survey.(General Practice)
September 18, 1999... Abstract Objectives To measure quality of care at general practice consultations in diverse geographical areas, and to determine the principal correlates associated with enablement as an outcome measure. Design Cross sectional...

DrKoop.com criticised for mixing information with advertising.(News)(Statistical Data Included)
September 18, 1999... One year ago, the former US Surgeon General, C Everett Koop, opened his own health website (www.DrKoop.com), which became a public company last June (19 June, p 1644). With its 80 000 electronic pages, it quickly became the most popular...

Unbalanced presentation of facts breaks UK drug adverts code.(News)(Statistical Data Included)
September 18, 1999... The unbalanced presentation of information and the potentially misleading use of words formed the basis of most of the cases heard by the UK's Prescription Medicines Code of Practice Authority during the first quarter of this year. The...

In brief.(News)(Statistical Data Included)
September 18, 1999... UK junior doctors seek further talks with government: The BMA will continue negotiations with the government on junior doctors' pay. The BMA wants to end the system under which junior doctors are paid 50% of the standard rate for overtime (28...

Patients satisfied with nurse run practices.(News)(Statistical Data Included)
September 18, 1999... Half term reports on two nurse led, primary care practice projects in the United Kingdom have found high levels of patient satisfaction. The two projects, run by independent contractors and launched in Salford and Derby under the Primary Care...

Doctor disciplined for "grossly undertreating" pain.(News)(Statistical Data Included)
September 18, 1999... In what seems to be the first such action in the United States, the Oregon Board of Medical Examiners has approved a disciplinary plan for a doctor who "grossly undertreated" pain in six patients between 1993 and 1998. The board is made...

Patients asked to judge quality of care they receive in hospital.(News)(Statistical Data Included)
September 18, 1999... Five thousand patients at one of Scotland's biggest hospital trusts are to be asked to judge the quality of the care that they have been given in what is said to be the most in depth project of its kind established in Great Britain. The...

Review clears Brompton surgeons.(News)(Statistical Data Included)
September 18, 1999... A review of the surgical outcomes at the Royal Brompton Hospital has cleared the hospital over allegations of excessive mortality in children undergoing cardiac surgery. The independent review of paediatric surgery, comprising paediatric...

Australia's consumer champion.(News)(Statistical Data Included)
September 18, 1999... Ms Hilda Bastian, chairwoman of the Australian Consumers' Health Forum, talked to Tessa Richards, associate editor of the BMJ, about how doctors need to work more equitably and effectively with patients. Public debate on health issues is...

Decision aids for patients facing health treatment or screening decisions: systematic review.(Statistical Data Included)
September 18, 1999... Abstract Objective To conduct a systematic review of randomised trials of patient decision aids in improving decision making and outcomes. Design We included randomised trials of interventions providing structured, detailed, and...

Staff and family attitudes to keeping joint medical and nursing notes at the foot of the bed: questionnaire survey.(Statistical Data Included)
September 18, 1999... Some years ago we introduced joint medical and nursing notes in our children's department.[1] In 1995, to promote openness and teamwork with families, we started placing these notes at the foot of the bed and encouraged parents to read them....

Clinical and psychosocial predictors of illness duration from randomised controlled trial of prescribing strategies for sore throat.(Statistical Data Included)
September 18, 1999... Sore throat is one of the commonest reasons for visiting general practitioners yet little is known about what factors are important in its natural course. This is important since people with prolonged illness after the consultation--the 36%...

Rapid appraisal of needs in reproductive health care in southern Sudan: qualitative study.(General Practice)
September 18, 1999... Abstract Objectives To identify the need for reproductive health care among a community affected by conflict, and to ascertain the priority given by the community to reproductive health issues. Design Rapid appraisal. This comprised...

Next best thing.(Statistical Data Included)
September 18, 1999... When W H Auden once found him playing that game [patience] and asked him why he seemed to relish it, he reflected gravely and then replied, "Well, I suppose it's the nearest thing to being dead." Peter Ackroyd, T S Eliot, Penguin, 1993

General practice registrar responses to the use of different risk communication tools in simulated consultations: a focus group study.(General Practice)
September 18, 1999... Abstract Objectives To pilot the use of a range of complementary risk communication tools in simulated general practice consultations; to gauge the responses of general practitioners in training to these new consultation aids. ...

Multiple operations on a single patient.(One Hundred Years Ago)(Statistical Data Included)
September 18, 1999... Sir,--The following case, reported by Mercanton, seems to throw into the shade even Munde's remarkable performance.[1] I mention it here as an example for the prevention of the Continental furor secandi spreading among ourselves. The...

Towards a feasible model for shared decision making: focus group study with general practice registrars.(General Practice)
September 18, 1999... Abstract Objectives To explore the views of general practice registrars about involving patients in decisions and to assess the feasibility of using the shared decision making model by means of simulated general practice consultations....

Evaluation of questionnaire on cancer family history in identifying patients at increased genetic risk in general practice.(Statistical Data Included)
September 18, 1999... Patients at increased genetic risk of breast or colorectal cancer who may benefit from screening can be identified from their family histories.[1 2] For those at risk of colorectal cancer, colonoscopic surveillance reduces the incidence of...

There is another way.(Statistical Data Included)
September 18, 1999... I first encountered Jean-Claude in 1976 during a meeting organised by Le Comite de Defense contre l'Alcoolisme (national antialcoholism defence committee). The meeting comprised doctors, lawyers, social workers, and representatives from...

Guided self management of asthma--how to do it.(Clinical Review)(Statistical Data Included)
September 18, 1999... Summary points Self management of asthma prevents exacerbations, improves care, and is a cost effective investment Patient education is crucial and should be given in a structured way Patients should be taught to understand...

Promoting partnerships: challenges for the internet age.(Education and Debate)(Statistical Data Included)
September 18, 1999... Summary points The internet provides opportunities to build strong partnerships between patients and clinicians There should be more collaboration between consumer groups and professional organisations To be effective,...

Helping patients access high quality health information.(Education and Debate)(Statistical Data Included)
September 18, 1999... Summary points Patients require access to good quality, evidence based information so they can take an active part in decisions about their health care The amount of information available to patients is increasing, particularly...

Framework for teaching and learning informed shared decision making.(Education and Debate)(Includes:)("Commentary: Competencies for informed shared decision making")("Commentary: Proposals based on too many assumptions")(Statistical Data Included)
September 18, 1999... Summary points Competencies for the practice of informed shared decision making by physicians and patients are proposed The competencies are a framework for teaching, learning, practice, and research Challenges to putting...

Acknowledging the expertise of patients and their organisations.(Education and Debate)(Statistical Data Included)
September 18, 1999... Summary points People living with a long term illness develop expertise and wisdom about their condition and want to play a part making decisions about their own health care Partnerships should be encouraged between individual...

Participatory research maximises community and lay involvement.(General Practice)
September 18, 1999... Summary points The knowledge, expertise, and resources of the involved community are often key to successful research Three primary features of participatory research include collaboration, mutual education, and acting on results...

Partnerships with children.(General Practice)
September 18, 1999... Summary points Child partnerships have been debated largely in the context of discussions about children's rights or high profile court decisions Many obstacles to forging partnership with children could be overcome with better...

What do we mean by partnership in making decisions about treatment?(General Practice)
September 18, 1999... Summary points Doctor-patient partnerships in making decisions about treatment can take different forms Three theoretical treatment decision making models are the paternalistic, the shared, and the informed Most clinical...

On the power of communication.(A Memorable Patient)(Statistical Data Included)
September 18, 1999... Let us call her Frederica for the sake of anonymity. I had been the family doctor for many years, and had attended to her late parents as well as her siblings. She was a 40 year old unmarried woman with a great zest for living, a unique sense...