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BMJ No 7124 Volume 316 Saturday 3 January 1998 This Week in BMJ | Editor's Choice | Press releases
Editorials 1
Effective screening in child health
2 Ultrasound for the diagnosis of deep vein thrombosis:
where to now?
3 Audit Commission tackles anaesthetic services
4 Who should be the next head of the WHO?
5 The effect of speed cameras on injuries from road
accidents
6 1948: a turbulent gestation for the NHS
News 7 Kyoto agreement gets mixed response
Papers 17 Compression ultrasonography for diagnostic management
of patients with clinically suspected deep vein thrombosis: prospective
cohort study
21 Relation of infant diet to childhood health: seven
year follow up of cohort of children in Dundee infant feeding study
26 Preventing fatal diseases increases healthcare
costs: cause elimination life table approach
29 First sexual intercourse: age, coercion, and later
regrets reported by a birth cohort
General practice 34 Can primary prevention or selective screening
for melanoma be more precisely targeted through general practice? A prospective
study to validate a self administered risk score
Commentary: Start with the KISS principle
39 Taking equity seriously: a dilemma for government
from allocating resources to primary care groups Commentary: Equity in the allocation of resources
to general practices will be difficult to achieve
Clinical review 44 Fortnightly review: Acute pancreatitis 49 ABC of palliative care: Special problems
of children 52 Lesson of the week: Early diagnosis of pyoderma
gangrenosum is important to prevent disfigurement 54 Statistics notes: Analysis of a trial randomised
in clusters
Education and debate The woman who wanted to see her paediatric hospital
records Social services can act on anonymous information
about abuse Confidentiality may be overvalued
Wider public interest may come before issues of
confidentiality 58 Meeting the challenges facing research ethics
committees: some practical suggestions
61 Meta-analysis: Bias in location and selection
of studies
Letters 67 Omepraxole and ocular damage
68 Reducing morbidity from insertion of chest drains
69 Sensitivity and specificity can both improve as
more investigations are used
69 Voluntary agreement for tobacco advertising at
retail premises not being adhered to
69 Epidural analgesia does not cause long term
backache
70 Over half of proposed indicators for hospitals'
performance relate to surgery
70 User fees would both yield money and encourage
more responsible use of NHS
70 Mental health and the law
71 All women with abnormal genital tract bleeding
should have gynaecological examination
71 Physician assisted suicide, euthanasia, and withdrawal
of treatment 72 Epidemiological data can be gathered with world
wide web
72 Paper in BMJ influenced prescribing
of minocycline
73 Experience of clinical risk management in obstetrics
in Oxford
73 Compensation for victims of medical accidents
74 Benefits of an honest admission
75 Career guidance for doctors
75 Payment of financial incentives to GPs may invalidate
informed consent process
76 Humanitarian issues
Obituaries 77 G Boyd, A M R Cann, B Devlin, A C Dickie, C Koo-Seen-Lin, M Watson
Medicopolitical digest 78 GPs debate white paper
Views & reviews Soundings 80 A date with the doctor
Personal views 80 Conflict Mount Everest: a deadly playground
Medicine and the media 82 Headlines: more perilous than pills?
Medicine and books 83 From Cradle to Grave: Fifty Years of the NHS Geoffrey
Rivett
Britain on the Couch: Treating a Low Serotonin
Society Oliver James
Minerva 84
S2 Career Focus Classified supplement Biomedical translation
Editor's choiceA year of anniversaries and happeningsAnd so into a year of anniversaries. Britain's National Health Service will be 50 years old on 5 July 1998. The BMJ plans to cast a critical and international eye over the achievements and failures of the NHS in a theme issue, but during the year we will publish short extracts from the BMJ of 1948. Every issue of that year contained pages and pages on the birth pangs of the NHS. Gordon Macpherson describes how the year began with 90% of doctors responding to a plebiscite opposing joining the NHS on the government's terms (p 6). A deal was done, and by the end of the year doctors were complaining about being overworked in the new NHS. On p 83 Charles Webster, the official historian of the NHS, reviews a new book on the service by Geoffrey Rivett. "It is," says Webster, "the only book to provide both a survey of policy change and a full account of professional and clinical developments." October will see the 50th anniversary of the publication in the BMJ of one of the first randomised controlled trials - of using streptomycin to treat tuberculosis. Randomised trials have been described as the most important discovery of the century. We will produce a theme issue and hold an international conference on the past, present, and future of trials. Some of the happenings of the year can also be foreseen. Most important - perhaps - will be the appointment in January of the new director general of the World Health Organisation. The BMJ's diagnosis is that the WHO is a poorly led organisation with demoralised staff that lacks a clear vision of where it is headed. Yet we need the WHO more than ever. The treatment must be radical change. It is thus encouraging that there are seven candidates to be director general, three from outside the organisation. Fiona Godlee discusses what qualities the new leader will need (p 4) and surveys the field (p 11). Five of the seven candidates have answered our questions. The one snag is that the selection will be made by the WHO's executive board, a highly politicised group. We invite BMJ readers to help the board by registering your choice for director general on our website. A smaller happening - but very important for us - will be the appearance in March of the full text of the BMJ on our relaunched website. There will be other innovations, including a searchable archive. Everything will be free, at least at the start. Finally, some insight on the influence of the BMJ. Conventional wisdom is that journals are good at stirring up debate and setting agendas but do not have direct and immediate effects on behaviour. A letter on p 73 shows, however, that prescriptions for minocycline fell by 35% after the BMJ published a paper describing side effects of the drug and an editorial advised that it should not be first line treatment for acne.
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