Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April

BMJ No 7131 Volume 316 21 February 1998 This Week in BMJ | Editor's Choice | Press releases Receive this page by email each week Editorials 563 Early identification of variant Creutzfeldt-Jakob disease Maurizio Pocchiari 564 Medically unexplained neurological symptoms Michael D O'Brien 565 Not one academy but two Richard Smith 566 At last - maternity statistics for England Alison Macfarlane 567 Drug treatment in heart failure Richard P Steeds, Kevin S Channer 569 Rewarding healthcare teams Karen Bloor, Alan Maynard 570 Meeting the challenge of genetic advance Mike Gill, Tessa Richards News 571 British patients can sue tobacco companies Asian finance crisis threatens vaccinations Dutch face disclosure of medical records Accrediting screening laboratories Dolly the sheep was a clone Low fat diets may harm some people Bills on human cloning have faults Judge misled over call for caesarean section Canadians win award over breast implants Investing in rehabilitation is beneficial RSI patients have vibration loss Choice of bone marrow donors could improve Cancer is main cause of death in Britain GMC reviews assessor's appointment Office surgery in Florida to be reviewed In brief Papers 577 Diagnosis of Creutzfeldt-Jakob disease by measurement of S100 protein in serum: prospective case-control study Markus Otto, Jens Wiltfang, Ekkehard Schütz, Inga Zerr, Anke Otto, Annette Pfahlberg, Olaf Gefeller, Manfred Uhr, Armin Giese, Thomas Weber, Hans A Kretzschmar, Sigrid Poser 582 Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms Helen L Crimlisk, Kailash Bhatia, Helen Cope, Anthony David, C David Marsden, Maria A Ron 587 Effect of temazepam on oxygen saturation and sleep quality at high altitude: randomised placebo controlled crossover trial Gerald Dubowitz 589 Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users who are carriers of hereditary prothrombotic conditions S F T M de Bruijn, J Stam, M M W Koopman, J P Vandenbroucke for the Cerebral Venous Sinus Thrombosis Study Group 593 Single photon emission computed tomography in the identification of new variant Creutzfeldt-Jakob disease: case reports Rajith de Silva, James Patterson, Donald Hadley, Aline Russell, Martin Turner, Martin Zeidler 594 Social alcohol consumption and low Lp(a) lipoprotein concentrations in middle aged Finnish men: population based study Marita Paassilta, Kari Kervinen, Asko O Rantala, Markku J Savolainen, Mauno Lilja, Antti Reunanen, Y Antero Kesäniemi 595 Drug points: Postural hypotension induced by paroxetine C Andrews, G Pinner General practice 596 Development and evaluation of a community based, multiagency course for medical students: descriptive survey Angela Lennox, Stewart Petersen Clinical review 600 Recent advances: Immunology Mike Kemeny, Mark Peakman 604 Lesson of the week: Central venous air embolism causing pulmonary oedema mimicking left ventricular failure Alan Fitchet, Adam P Fitzpatrick 606 Understanding controlled trials: What is Zelen's design? David J Torgerson, Martin Roland 607 ABC of allergies: The epidemiology of allergic disease D Jarvis, P Burney Education and debate 611 Why do we need randomised controlled trials to assess behavioural interventions? Judith Stephenson, John Imrie 614 Hypertension treatment and control in sub-Saharan Africa: the epidemiological basis for policy Richard S Cooper, Charles N Rotimi, Jay S Kaufman, Walinjom F T Muna, George A Mensah 618 The new genetics: The new genetics in clinical practice John Bell 621 Continuing medical education: Quality issues in continuing medical education Hans Asbjørn Holm Letters 625 One fifth of samples of unpasteurised milk are contaminated with bacteria J de Louvois and A Rampling 625 Ethics and international research E C O Edi-Osagie and N E Edi-Osagie; P Lurie and S M Wolfe; J Burdon; R Baraza; M J Landray; N A Halsey and others; P Godfrey-Faussett and others 628 Serum samples in clinical study were manipulated R Szibor and others 628 Rebound sodium and water retention occurs when diuretic treatment is stopped C G Missouris and G A MacGregor 628 Should stroke medicine be a separate subspecialty? R L Hewer; G J Hankey; R A Rosin 629 Where is scientific evidence supporting EU policy on BSE and pharmaceuticals? A Earl-Slater 630 CJD was not diagnosed until eight months after organ donor's death G D Morrice 630 Acute otitis media in children T Fahey and D Sharp; A Majeed and T Harris 631 SSRIs may well be best treatment for elderly depressed subjects R J Porter and J T O'Brien 631 Writing to authors of systematic reviews elicited further data in 17 of cases J McGrath and others 631 Trial of prescribing strategies for sore throat R Simo and others; P Little and others 632 Words matter J Mossman; C G Winearls; T O Cheng Obituaries 633 L Healy, J B Lawson, P Marsden, M K Mead Medicopolitical digest 634 Health action zones Health of ethnic minorities Quality of care standards Patients' appointments Consultants' contract Views & reviews Soundings 635 Perils of primary care George Dunea Personal view 635 Have we reached crisis management in outpatient clinics? David Sellu Medicine and books 637 Culture and Health Malcolm MacLachlan Kamran Abbasi Feed your head Tony Delamothe Minerva 638 S2 Career Focus Classified supplement Improving quality in hospital induction programmes Simon Ward Editor's choice Researching laterally Just as the most interesting art may depend on a lateral leap so may the most interesting research. At least two papers in this week's journal are far from routine. Gerald Dubowitz carried out his research at base camp on Mount Everest (p 582). Mountaineers sleep poorly at high altitude because of low temperatures and incipient acute mountain sickness. They have been warned against using hypnotics because of a theoretical fear of depressing the respiratory system. But Dubowitz has shown in a randomised placebo controlled trial that temazepam improves sleep and reduces changes in oxygen saturation without changing mean saturation. Helen Crimlisk and others looked to history for their inspiration (p 587). Elliott Slater published a highly influential paper in the BMJ30 years ago showing that half of a series of patients diagnosed as "hysterical" developed clear cut neurological or psychiatric diagnoses over the next 10 years. Neurologists and psychiatrists are thus wary of diagnosing hysteria in patients with medically unexplained motor symptoms. Yet these patients are common. Crimlisk and others have repeated Slater's study and this time found a low incidence of subsequent physical or psychiatric diagnoses but a high level of psychiatric comorbidity. Today we start a new series on the broad implications of the new genetics for medicine and society (p 618), and the first article sits comfortably alongside an article on lifelong learning in our series on continuing medical education (p 621). John Bell writes that the new genetics will transform medical practice, creating deep understanding and opening up new methods of predicting, diagnosing, and treating disease. Many doctors practising today graduated when the new genetics had hardly begun. Doctors will not serve their patients well if they don't understand something about the new genetics, yet, says Hans Holm, medical colleges and societies have done a poor job of delivering effective education. Better understanding of how adults learn is opening up new possibilities, and internal motivation seems to work better than external sticks. Our books pages contain the results of our competition to identify books that might broaden the horizons of doctors and medical students and so make them better doctors (p 637). The most obvious feature was the sheer diversity. Our website lists all 314 books that were recommended, and 236 were mentioned by only one person. C S Lewis, Steinbeck, and Tolstoy all had three books nominated, but Jonathan Livingston Seagullby Richard Bach came top with House of Godby Samuel Shem and 1984by George Orwell joint second. The website is still open, and you might care to visit and add your suggestions or vote for those already there. You'll also find much else of interest on www.bmj.com. Home | Current contents | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline