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BMJ No 7128 Volume 316 31 January 1998 This Week in BMJ | Editor's Choice | Press releases Receive this page by email each week Editorials 321 Research in support of tobacco control Jonathan M Samet, Carl E Taylor, Karen M Becker, Derek Yach 322 Measuring performance in the NHS Martin McKee, Trevor Sheldon 323 Linking education, research, and service in general practice Paul Wallace, Stewart Drage, Neil Jackson 324 Research in general practice Frede Olesen 325 Chinese avian influenza E Walker, P Christie 325 Trends in facial injury Patrick Magennis, Jonathan Shepherd, Iain Hutchison, Andrew Brown News 327 Gro Harlem Brundtland wins WHO election Italy bows to pressure over cancer therapy Lethal injection is medicalising execution Doctors who default on loans are shamed New test for detecting prostate cancer risk Tobacco campaign targeted teenagers Aspirin and warfarin for primary prevention UK peers warn of threat to academic medicine Miners win historic battle for compensation Deaths from heroin overdose are preventable Performance framework launched for NHS Community care is failing elderly in UK Papers 333 Quantitive systematic review of topically applied non-steroidal anti-inflammatory drugs R A Moore, M R Tram`r, D Carroll, P J Wiffen, H J McQuay 339 Epilepsy in young people: 23 year follow up of the British national child development study Zarrina Kurtz, Pat Tookey, Euan Ross 343 Unlicensed and off label drug use in paediatric wards: prospective study Sean Turner, Alexandra Longworth, Anthony J Nunn, Imti Choonara 345 Clinical experience, performance in final examinations, and learning style in medical students: prospective study I C McManus, P Richards, B C Winder, K A Sproston 350 Home sampling versus conventional contact tracing for detecting Chlamydia trachomatis infection in male partners of infected women: randomised study Berit Andersen, Lars Østergaard, Jens K Møller, Frede Olesen 351 Opportunistic screening for chlamydial infection at time of cervical smear testing in general practice: prevalence study Pippa Oakeshott, Sally Kerry, Sima Hay, Phillip Hay 353 Management of suspected myocardial infarction before admission: updated audit N Prasad, V S Srikanthan, A Wright, F G Dunn General practice 354 Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy Sally Green, Rachelle Buchbinder, Richard Glazier, Andrew Forbes 360 Understanding controlled trials: What is a patient preference trial? David J Torgerson, Bonnie Sibbald Information in practice 361 General practitioners' perceptions of the route to evidence based medicine: a questionnaire survey Alastair McColl, Helen Smith, Peter White, Jenny Field 365 Physicians' attitudes toward evidence based obstetric practice: a questionnaire survey Olufemi A Olatunbosun, Lindsay Edouard, Roger A Pierson 367 Netlines Mark Pallen 367 Notice for Information in practice advisers Clinical review 368 Fortnightly review: Diagnosis and treatment of Méenère's disease Shakeel R Saeed 373 ABC of palliative care: Care in the community Bill O'Neill, Ann Rodway Education and debate 378 The New NHS: commentaries on the white paper. From specialist services to special groups Challenging times for specialist services Christopher Bunch Involving clinical professionals in managing and planning services S T Atherton Meeting the needs of black and minority ethnic groups Caroline Free, Martin McKee Staff in the NHS Anne Cockcroft, Siân Williams 382 How much of the relation between population mortality and unequal distribution of income is a statistical artefact? Hugh Gravelle 385 Continuing medical education: Global health, global learning Dave Davis Letters 390 Racism continues among doctors in Europe H K Khan 390 More openness needed in palliative care A M Smith; P Edmonds and A Davies; A Thorns 391 Patient's sex does not affect use of thrombolysis R Raine and others 391 Childhood insulin dependent diabetes: Oxford may not be representative J J Rangasami and others 392 Profiting from closure M J S Langman; D Price 392 Informed consent in medical research: the ethics committee's view E M Barker 393 Two actions are possible for doctors wanting to promote human welfare in Africa G Johnson 393 Timing of initiation of induction of labour can affect out of hours work R Matijevic and others 393 Enhancing patients' compliance P A Meredith; A E Raffle and K Morgan; A Giuffrida and D J Torgerson 394 The anguish of teenage mental illness A Clark and others 395 Agencies need to work together on general practitioner staffing M Leigh 395 Managing pain in hospital E L Lloyd; N Simpson and F Finlay 396 Corticosteroids in acute traumatic brain injury D W Newell and others; P Alderson and I Roberts 397 Consent for transfusion P E Hewitt and M de Silva; S H Cray; R A Cocks 397 "Poor historians" are often found to have cognitive impairment J Rowe Obituaries 398 S E Ellison, H D A Gray, J E Hardwick-Smith, M A Harrop, S Lazarus, D Oakley Medicopolitical digest 399 NHS complaints Advice on pilot schemes Health professions' regulatory body Dismantling of fundholding Scrutiny of nursing homes Views & reviews Soundings 400 Everything must go Colin Douglas Personal view 400 I lost my breast but is anyone to blame? Jacky Reed Minerva 402 S2 Career Focus Classified supplement Flexible training is possible as a senior house officer Nancy Redfern and Patsy Scriven Editor's choice Undermining some beliefs, confirming others Many weeks we publish systematic reviews that show that the evidence for the effectiveness of one treatment or another just doesn't exist. Indeed, we have one this week: on p 354 Sally Green and colleagues show little evidence to support or refute the efficacy of common interventions for shoulder pain. However, we publish another systematic review that not only has a positive finding but also undermines the common belief that topical non-steroidal anti-inflammatory drugs have little effect in relieving pain in either strains and sprains or chronic conditions such as arthritis and rheumatism (p 333). R A Moore and colleagues show that these topical drugs are significantly more effective than placebo - and that the effect is not just due to the beneficial effect of rubbing on the ointment. Many doctors believe that their final exams as medical students never tested anything useful, and on p 345 Chris McManus and colleagues suggest that they are probably right. They show not only that there is little correlation between the amount of clinical experience of students and their performance in their final examination but also that students' studying habits at the time of application are a much better predictor than A levels of how much knowledge students gain from their clinical experience. Two articles in the Information in Practice section deal with the related subject of evidence based medicine and show that general practitioners are more welcoming of it than doctors in obstetric practice. Alastair McColl and colleagues suggest that improving access to summaries of evidence may be more appropriate than teaching all general practitioners critical appraisal (p 361). Olufemi Olatanbosun and colleagues comment, however, on the Canadian doctors whom they surveyed that "most thought evidence based medicine was only partially ... applicable to obstetric practice" (p 365). Another reflection on general practice comes in two editorials. On p 324 Frede Olesen considers two recent British reports on developing research in primary care. He comments that the ambitious proposals have wide organisational implications and that academic general practice has to stop being a cottage industry: departments "must be sufficiently staffed with near full time senior researchers and they need to be bigger." A related message comes from Paul Wallace and colleagues, who suggest developing university linked practices and giving general practitioners protected time for academic activities. They do, however, ask whether there are enough general practitioners and practices to do all this work - and a letter provides a bleak response (p 394). Recruitment to general practice continues to fall just as the demands are getting ever greater. Home | Current contents | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline