BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b2496 (Published 19 June 2009) Cite this as: BMJ 2009;338:b2496

Despite recent criticisms of the quality and outcomes framework (QOF) used in British general practice, at least one area of medicine seems to have benefited. In one NHS trust, the introduction of glomerular filtration rate reporting and chronic kidney disease QOF domains brought about a rapid 61% increase in new patient referrals to a nephrology service, and an increase in the average age of patients at the time of referral. Of these referrals, 36% were deemed inappropriate or inadequate in terms of clinical information provided (QJM 2009;102:415-23, doi:10.1093/qjmed/hcp030).

Smoking light cigarettes (with low nicotine, tar, or carbon monoxide content) did not seem to reduce the atherogenic effect of smoking on carotid intima-medial thickness in patients attending a lipid monitoring clinic. Thickness was highest in current smokers and lowest in never smokers, and it was positively related to the number of pack years in both former and current smokers. Diabetes and hypertension strengthened the association between smoking and cardiovascular risk (Stroke 2009;40:1991-8, doi:10.1161/strokeaha.108.543413).

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