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BMJ 2003; 327 doi: (Published 23 October 2003) Cite this as: BMJ 2003;327:998

Respect for the four principles of medical ethics, and autonomy in particular, should remain at the heart of ordinary medicine, according to an editorial written by a doctor in the Journal of Medical Ethics ( 2003;29: 265-6). He describes how he had to fight off the hordes of medical staff and friends who tried to convince him to have a blood transfusion at a time of acute injury, even though he was medically stable. He concludes from his experience in hospital that many doctors still lack any concept of what it is to respect a patient as a person.

Trials from specialist centres indicate that given the choice of immediate angioplasty or immediate thrombolysis for an acute myocardial infarction, angioplasty comes out on top. Wondering if the same holds true if patients have to be transferred to another place to have the angioplasty, the authors of a meta-analysis say angioplasty is still the winning option. Organising ambulance systems and developing adequate capacity to perform primary percutaneous coronary interventions are what counts now ( Circulation 2003;108: 1809-14).

In a prospective study, older women with breast cancer were randomly allocated to receive either conventional follow up or “case management” by nurses for the first 12 months after diagnosis. …

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