BMJ NO 7071 Volume 313 Saturday 14 December 1996

This Week in BMJ | Editor's Choice | Press releases


Editorials
1497 Sentencing mentally disordered offenders Derek Chiswick

1498 Rehabilitation after heart attack Richard Mayou

1499 Rationing health care Alan Maynard

1500 Radiotherapy for malignant glioma Anna Gregor, Ann Cull

1501 Talk the works: the rise of cognitive behaviour therapy Gavin Andrews

1502 Aging: a goal theme issue Paula Rochon, Richard Smith

1502 Correction: Hitler's plans for genocide: a speech from 1939 Donald Acheson


News
1503 British library axes medical journals * Medical research wins lottery funding * Drug approval times compared in US and UK * Magnesium sulphate cuts risk of cerebral palsy * Stress may disturb blood-brain barrier * Microbiologist wins libel damages * Skin lesion removal rationed in Florida * Health finally divides British political parties


Papers
1507 Malignant cerebral glioma-I: Survival, disability, and morbidity after radiotherapy Elizabeth Davies, Charles Clarke,Anthony Hopkins

1512 Malignant cerebral glioma-II: Perspectives of patients and relatives on the value of radiotherapy Elizabeth Davies, Charles Clarke, Anthony Hopkins

1517 Psychological rehabilitation after myocardial infarction: multi centre randomised controlled trial D A Jones, R R West

1521 Prevalence of mental disorder in remand prisoners: consecutive case study Luke Birmingham, Debbie Mason, Don Grubin

1524 Point prevalence of mental disorder in unconvicted male prisoners in England and Wales Deborah Brooke, Caecilia Taylor, John Gunn, Anthony Maden

1527 Video assessment of simple respiratory signs Mike English, Laura New, Norbert Peshu, Kevin Marsh

1528 An endoluminal brush to detect the infected central venous catheter in situ: a pilot study Mark J Tighe, Peter Kite, Warren N Fawley, Daniel Thomas, Michael J McMahon

1529 Prevalence of psychiatric disorders in young people in the care system Jacinta B McCann, Anthony James, Sylvia Wilson, Graham Dunn

1516 Correction: Causality, menopause, and depression: a critical review of the literature Louise Nicol-Smith


General Practice
1531 Fundholders' prescribing costs: the first five years Conrad M Harris, Glen Scrivener 1534 Atrial fibrillation in elderly patients: Prevalence and comorbidity in general practice M Langenberg, B S P Hellemons, J W van Ree, F Vermeer, J Lodder, H J A Schouten, J A Knottnerus


Education & Debate
1535 Fortnightly Review: Ambulatory blood pressure monitoring: a guide for general Neeraj Prasad, Christopher Isles

1541 Intravenous antimicrobial therapy in the community: underused, inadequately resourced, or irrelevant to health care in Britain? Dilip Nathwani, Peter Davey

1543 Grand Rounds-Hammersmith Hospital: Persistent fever in pulmonary tuberculosis Maha T Barakat


1546 Obituaries
T Mann, M J Curran, A T H Glanvill, W Laurie, C R Macdonald, T R Meredith


1547 Letters
1547 Routine follow up of breast cancer in primary care D Rainsbury; P Kirkbride and K Vallis; I Kunkier and others; S A Hall; J M Dixon and B Norman

1548 Audit Commission's report was based on large samples and up to date data R K Waite and I Cornwell

1548 Child protection D Fish; A F Mellon; I Butler

1549 Prodigy, a computer assisted prescribing scheme R Purves; P Leech

1550 Spinal cord injuries have fallen in rugby union players in New South Wales S F Wilson and others

1550 Relation between treatment benefit and underlying risk in meta-analysis S Senn; S Sharp and others

1551 Britain was healthier than Germany in 1914 T Kealey

1551 Influences of practice characteristics on prescribing in practices S I Roberta; R Wilson and others

1551 Postal surveys in general practice N Summerton; M Cottrill

1552 Scotland's new chief medical officer welcomes reforms of training D C Carter

1552 Adverse events associated with mefloquine B L Corben and others; M Phillips; L Traer-Clark; S Dollow; R Belsrens; P Barrett; I Warner; M R Evans

1554 Effect of deletion polymorphism of angiotensin converting enzyme gene on progression of diabetic nephropathy M Marre and others

1555 Course on basic surgical skills is being run by all surgical colleges J D Greig and others

1555 Conflict of interest C K Connolly; L Whitaker

1556 Summative assessment in general practice L M Campbell and others; O Houghton; P Sackin; O Roberts; T Coleman and others;

1557 Childbirth practice should take women's wishes into account A Oakley

1557 BMJ's audit should show actions planned to improve quality T Kemple

1557 Nucleus, not Student BMJ, was first international journal for medical students R Selwood


1558 Medicopolitical Digest
Physicians' future role * Community care standards * £300 000 for research * BMA backs EU commissioner * Doctors and computers * Commission on human genetics

1559 Soundings
Three wee kings Colin Douglas

Obstetrician's distress James Owen Drife


1560 Personal View
The facts must be available Jean Fooks

Recovery is possible Anonymous


1561 Medicine and the Media
The mind unleashed Sean Spence


1562 Medicine and Books
John Alexander-Williams: Clinical Surgery (Ed Alfred Cuscher, Thomas P J Hennessy, Roger M Greenhalgh, David I Rowley)

John Launer: Mind Readings: Writers' Journeys Through Mental States (Ed Sara Dunn, Blake Morrison, Michele Roberts)

Lill E Thistlethwaite: Patient: the True Story of a Rare Illness (Ben Watt)

Elizabeth Fee: Vamps Virgins and Victims: How Can Women Fight AIDS? (Robin Gorna)


1564 Minerva


S2 Career Focus
Psychiatry Anne Dean


Editors Choice

The real world of brain tumours and mentally ill prisoners

We are keen at the BMJ to be part of what is known as the real world-a place of pain, poverty, cruelty, compromise, and surprise, where things don't work out as they do in randomised controlled trials or textbooks. Several papers in this issue reek of the real world.

Randomised trials have shown that radiotherapy will prolong survival in adults with malignant glioma, the commonest primary brain tumour. But neurologists wonder whether the treatment is worth while when the prognosis is so bleak. Elizabeth Davies and others have not done a randomised trial but rather followed 105 consecutive patients with malignant glioma (p 1507). They found that the sickest patients gain little from radiotherapy, while the less disabled patients experience considerable adverse effects. So is the treatment worth it? Only the patients and their relatives can decide, and so the researchers look at their views in a second paper (p 1512). This proved to be difficult as most patients didn't fully understand the poor prognosis, although their relatives were more aware. The authors conclude that "rational choices" are not to be expected in such circumstances and that doctors are providing hope at a high cost. What price hope in the real world of healthcare rationing (p 1499)?

British prisons are unremittingly grim places, unsuitable for mentally ill people. Yet many such people end up in prison because inadequate provision exists for them elsewhere. Luke Birmingham and others show that in Durham prison a quarter of 569 consecutive remand prisoners had current mental disorders-and 24 were acutely psychotic (p 1521). Screening failed to pick up most of the patients with problems, and subsequent management was poor. A second study found psychiatric disorder in two thirds of 750 unconvicted prisoners (p 1524), while a third study found psychiatric disorder in two thirds of adolescents in care in Oxfordshire (p 1529). These youngsters are-sadly likely to be filling the prisons of the future.


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