Design - Two year prospective study with home interviews with patients and relatives.

Setting - Seven neurosurgical and radiotherapy centres in London.

Subjects - 105 patients aged 21 to 75: 59 had biopsy; 46 had partial macroscopic resection; 92 received radiotherapy; and 13 received steroids alone.

Main outcome measures - Survival, time free from disability, and changes in disability after treatment.

Results - Six and 12 month survival for radiotherapy patients was 70% and 39%, respectively. Age, World Health Organisation clinical performance status, extent of surgery, and history of seizures before diagnosis each influenced survival. The Medical Research Council prognostic index was also significantly related to survival. Multivariate analysis showed that initial clinical performance status was the most important component of the index. Most (80%; 49/61) patients with a clinical performance status of 0, 1, or 2 lived at least six months before becoming permanently disabled. Most patients who had initially had a good clinical performance status (0-2) and who were alive six months after radiotherapy (68%; 36/52), however, had experienced either clinical deterioration or severe tiredness after treatment. In 17% (9/52) of these some permanent loss of function remained. These adverse effects were associated with increasing radiotherapy dose. Severely disabled patients (clinical performance status 3 or 4) gained little benefit.

Conclusion - Severely disabled patients gain little physical benefit from radiotherapy, whereas those not so disabled may experience considerable adverse effects.

Directorate of Neurosurgery and Clinical Neurosciences,
St Bartholomew's Hospital,
London EC1A 7BE
Elizabeth Davies, clinical research fellow
Charles Clarke, consultant neurologist

Research Unit,
Royal College of Physicians,
London NW1 4LE
Anthony Hopkins, director

Correspondence to: Dr E Davies,
Research Unit,
Royal College of Physicians,
London NW1 4LE.

Design - Randomised controlled trial of rehabilitation in unselected myocardial infarction patients in six centres, baseline data being collected on admission and by structured interview (of patients and spouses) shortly after discharge and outcome being assessed by structured interview at six months and clinical examination at 12 months.

Setting - Six district general hospitals.

Subjects - All 2328 eligible patients admitted over two years with confirmed myocardial infarction and discharged home within 28 days.

Interventions - Rehabilitation programmes comprising psychological therapy, counselling, relaxation training, and stress management training over seven weekly group outpatient sessions for patients and spouses.

Main outcome measures - Anxiety, depression, quality of life, morbidity, use of medication, and mortality.

Results - At six months there were no significant differences between rehabilitation patients and controls in reported anxiety (prevalence 33%) or depression (19%). Rehabilitation patients reported a lower frequency of angina (median three versus four episodes a week), medication, and physical activity. At 12 months there were no differences in clinical complications, clinical sequelae, or mortality.

Conclusions - Rehabilitation programmes based on psychological therapy, counselling, relaxation training, and stress management seem to offer little objective benefit to patients who have experienced myocardial infarction compared with previous reports of smaller trials.

University of Wales College of Medicine,
Llandough Hospital,
Cardiff CF64 2XX
D A Jones, senior research fellow

University of Wales College of Medicine,
Cardiff CF4 4XN
R R West, reader in epidemiology

Correspondence to: Dee Jones.

Design - Study of consecutive male remand prisoners at reception using a semistructured psychiatric interview.

Setting - Large remand prison for men (HMP Durham).

Subjects - 569 men aged 21 years and over on remand, awaiting trial.

Main outcome measures - Prevalence of mental disorder at reception, prisoners need for psychiatric treatment, identification of mental disorder by prison reception screening, and numbers placed appropriately in the prison hospital.

Results - 148 (26%) men had one or more current mental disorders (excluding substance misuse) including 24 who were acutely psychotic. The prison reception screening identified 34 of the men with mental disorder and six of those with acute psychosis. 168 men required psychiatric treatment, 50 of whom required urgent intervention; 16 required immediate transfer to psychiatric hospital. Of these 50, 17 were placed on the hospital wing because of mental disorder recognised at prison screening.

Conclusion - Not only is the prevalence of mental disorder, in particular severe mental illness, high in this population, but the numbers identified at reception are low and subsequent management in prison is poor.

Department of Forensic Psychiatry,
University of Newcastle upon Tyne,
St Nicholas's Hospital,
Gosforth NE3 3XT
Luke Birmingham, research associate
Debbie Mason, research associate
Don Grubin, senior lecturer

Correspondence to: Luke Birmingham.

Design - Analysis of item and cost data for all general practices in England in the six years from April 1990 to March 1996. The practices of each of the first five waves were identified at the Prescription Pricing Authority.

Setting - All general practices in England.

Main outcome measures - Changes and rates of change in net ingredient cost per prescribing unit, and changes in number of items per prescribing unit in fundholding practices, before and after fundholding, relative to continuing non-fundholders.

Results - Absolute prescribing costs increased over the six years, by 66% in the continuing non-fundholders and by 56-59% for fundholders. Successive waves of fundholders showed a similar pattern of change: a small relative reduction in the pre-fundholding year, maximum relative reduction in the first year, and a declining relative reduction in the second and third years. After this, their increases in costs were largely similar to those of non-fundholders. The number of items dispensed remained stable over the six years in all groups.

Conclusions - The real budgets operated by fundholders were associated with a reduction in costs of about 6% relative to continuing nonfundholders, and this saving seemed to be retained during the study. The relative reduction was small compared with the absolute increase seen in all groups and disappeared after the third year of fundholding. It was brought about by lowering the average cost per item rather than by giving fewer items.

Prescribing Research Unit,
University of Leeds Research School of Medicine,
Leeds LS2 9NZ
Conrad M Harris, director
Glen Scrivener, social geographer

Correspondence to: Professor C M Harris,
Academic Unit of General Practice,
Leeds LS2 9LN