BMJ NO 7075 Volume 314 Saturday 18 January 1997

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


Editorials
157 Out of hours primary care Lesley Hallam

158 Epilepsy: getting the diagnosis right J W A S Sander M F O'Donoghue

159 Lack of oats toxicity in coeliac disease Jacques Schmitz

160 Hysterectomy: will it pay the bills in 2007? R J Lilford

162 Drinking before sedation S M Greenfield G J M Webster F R Vicary

163 Non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease David R Baldwin Martin B Allen

164 Don't treat shackled patients Richard Smith


News
165 India to limit foreign research * Physician assisted suicide bill gets hearing * Human rights abuses in Kenya * Growth hormone scandal hits France * Baby milk companies breach code * Gulf war syndrome linked to chemicals * New York ends control of health costs * Hong Kong university refuses tobacco cash * Belgium bans tobacco advertising * No breast cancer risk with abortion * Fetal bone marrow transplants offer hope * Tonsil test possible for CJD * Israeli doctors urge CJD tests
Papers
171 Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology and outcome Paul R McCrory, Peter F Bladin, Samuel F Berkovic

174 Popularity of less frequent follow up for breast cancer in randomised study: initial findings from the hotline study Tim Gulliford, Magi Opomu, Elena Wilson, Iain Hanham, Richard Epstein

178 Weight loss in people with Alzheimer's disease: a prospective population based analysis Diane Cronin-Stubbs, Laurel A Beckett, Paul A Scherr, Terry S Field, Marilyn J Chown, David M Pilgrim, David A Bennett, Denis A Evans

179 Prevalence of hepatitis C Antibodies among healthcare workers of two teaching hospitals. Who is at risk? Keith R Neal, John Dornan, Will L Irving

180 Severe persistent visual field constriction associated with vigabatrin T Eke, J F Talbot, M C Lawden


General Practice
182 Observational study of a general practice out of hours cooperative: measures of activity Chris Salisbury

187 Comparison of out of hours care provided by patients' own general practitioners and commercial deputising services: a randomised controlled trial. I: The process of care D K Cragg, R K McKinley, M O Roland, S M Campbell, F Van, A M Hastings, D P French, T K Manku-Scott, C Roberts

190 Comparison of out of hours care provided by patients' own general practitioners and commercial deputising services: a randomised controlled trial.II: The outcome of care R K McKinley, D K Cragg, A M Hastings, D P French, T K Manku-Scott, S M Campbell, F Van, M O Roland, C Roberts

193 Reliability and validity of a new measure of patient satisfaction with out of hours primary medical care in the United Kingdom: development of a patient questionnaire Robert K McKinley, Terjinder Manku-Scott, Adrian M Hastings, David P French, Richard Baker

198 Nurse telephone triage in out of hours primary care: a pilot study South Wiltshire Out of Hours Project (SWOOP) Group

199 Changing the pattern out of hours: a survey of general practice cooperatives Lynda Jessopp, Imogen Beck, Lisa Rollins, Cathy Shipman, Mark Reynolds, Jeremy Dale


Clinical review
200 Child B: a personal view J A Dowey

201 Recent advances: Paediatric anaesthesia S C S Russell, E Doyle

203 Science, medicine, and the future: Role of molecular cell biology in understanding disease John Savill

206 Lesson of the week: Prevalence of concomitant disease in patients with iron deficiency anaemia Simon H Till, Michael J Grundman


Education and debate
209 Diabetes and hypertension in Britain's ethnic minorities: implications for the future of renal services Veena Soni Raleigh

213 Association of use of a log book and experience as a preregistration house officer: interview survey Elisabeth Paice, Fiona Moss, Georgina West, Janet Grant

216 Commentary David Machin

216 Funding the NHS: A little local difficulty? Jennifer Dixon, Anthony Harrison


Letters
220 Data are not now collected by ethnic group in South Africa AR P Walker

220 Dealing with patients with HIV infection H Curtis; P P Walker; E F Fox and others; P Daggen

221 Activists in India are promoting good health of babies through breast feeding N B Kumta

222 Having some lifesaving skills must be better than having none A Wills

222 Clinical effects of anticoagulants in suspected acute myocardial infarction M A James; S Hood and D Birnie; R Collins and others; D Ketley and K L Woods

223 Metabolic effects of antihypertensive treatment should not be overstated P H Winocour

224 Authors' arguments about infertility services were based on a misunderstanding S McCarthy

224 Investigations to diagnose cause of dizziness in elderly people S Caine and M MacMahon; P Evans and others; N Colledge and J Wilson

225 Implementing guidance on hepatitis B for applicants to medical school is time consuming S Williams and others

225 Predicting adverse cardiac events after myocardial infarction and thrombolysis A Archbold and A D Timmis; S Grant and others; S Basu and others

226 Varicella vaccine in pregnancy P V Coyle and others; W L Irving

227 Methods of surveying patients' satisfaction K T Gavin and M J Turner; R Fielding and others

227 Deprivation payments to general practitioners M Bajekal; R Lyons and others; M Ashworth and others; B Jarman; M Oliver

229 Microbiologists are available 24 hours a day to give advice D S Reeves

229 Decision to resect an adrenal mass depends on size of mass and age of patient A K Sharma and M H Wheeler

230 Pessimistic views of the NHS N Watson; K Checkland

230 First patient was airlifted from highlands of Scotland in 1933, not 1953 A M Campbell


Obituaries
231 H Angelman, S A Ayoub, W Calvert, S M Ross Dronfield, J L Hallum, E Harford-Rees, F E Hobbs, T C Macdonald, T G Owen, A N B Stott, B Strickland, J A Thomson


Medicopolitical digest
233 NHS funding problems * BMA calls for meeting with health secretary * NHS (Primary Care) Bill


Views & reviews

Personal views

234 Mangia meno (eat less) George Dunea

From catamaran to Cantabrigia P Badrinath


Medicine and the media
235 French angst over nuclear power Alexander Dorozynski

Hospital closures: for good or for ill? Liam J Donaldson


Medicine and books
237 Helping Children with Ill or Disabled Parents Julia Segal, John Simkins
Anna Sharma

Minefields in their Hearts Ed Roberta J Apfel, Bennet Simon
Manuel Carballo


Minerva
238


S2 Career Focus
Audiological medicine Cliodna O'Mahoney


Editors Choice

Television can help medicine

Television can help medicine, this issue shows. Watching somebody have a fit during a televised sporting event is distressing. One second you are excited by the game. The next you are watching a fellow human in distress.

But is the fit that players have on a pitch after a collision a true epileptic fit? Doctors have assumed that they are a form of post-traumatic epileptic seizure secondary to underlying brain injury. Now Melbourne neurologists suggest that these convulsions are not epileptic (p 171). They identified 22 cases that had occurred over 15 years in Australian rules football (one of the world's roughest games) and rugby league. Four had been captured on video. Most of the fits began within 2 seconds. Tonic stiffening was followed by myoclonic jerks of all limbs. None of the players suffered structural brain damage, and none developed epilepsy in a mean of 3.5 years' follow up. The authors think that these are syncopal rather than epileptic episodes. Players don't need to be away from the game for long and don't need antiepileptic drugs. An accompanying editorial looks at the difficulties of diagnosing epilepsy (p 158). About a fifth of patients referred to specialists with "intractable epilepsy" do not have epilepsy.

Television can also help sometimes through its content Liam Donaldson describes the dread with which health service managers sit down to watch programmes on the health service (p 236). Imagine his surprise therefore at a programme that argued that perhaps rather than more hospitals Britain might need fewer. Days later he listened to a radio programme that suggested that Britain needed 40 rather than 1600 hospitals. Something is happening with the media debate over the health service.

Television began the British debate over whether nuclear installations cause leukaemia, but the French media gave a rough ride to last week's BMJ paper suggesting that a leukaemia cluster around a French nuclear installation may be caused by environmental contamination (11 January, p 101). France gets 80% of its electricity from nuclear power Alexander Doroznyski describes (p 235) how INSERM, the National Institute of Health and Medical Research, put out a press release doubting the validity of the study. Jacqueline Clavel, author of the press release, also suggested that "the BMJ publishes scientifically dubious articles because polemic interests them. Possibly they want to launch the debate in Britain" Clearly she hasn't looked over the English Channel in the past decade.

The BMJ is also attacked in our letters pages. Paul Walker is "sickened" that the BMJ should publish bigotry on AIDS (p 221), while Neil Watson (p 230) suggests that by publishing a personal view by a former college president we are "moving into the wasteland that is the impoverished mental environment of the victim mentality."


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