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(2)REVALIDATION
THE INTERNATIONAL
EXPERIENCE
(3)POSSIBLE
LINK BETWEEN HEART ATTACK AND
HELICOBACTER
PYLORI INFECTION
(4)INCREASED
EMERGENCY ADMISSIONS ARE REAL
PATIENTS NOT
STATISTICAL QUIRKS
(5)HOME BLOOD
PRESSURE MEASUREMENTS ARE
USUALLY ACCEPTABLE
(1)PREVENTIVE DETENTION
FOR PEOPLE WITH
PERSONALITY DISORDER IS WRONG
(Dangerous people with severe personality
disorder: British
proposals for managing them are
glaringly wrong and
unethical)
http://www.bmj.com/cgi/content/full/319/7218/1146
Government proposals for detaining indefinitely
people with
dangerous severe personality disorder
masquerade as
extensions to mental health services but
are in fact unethical
proposals for preventive detention, says
an editorial in this
week's BMJ.
Forensic Psychiatrist Professor Paul Mullen
of Victoria,
Australia, writes that the UK Government
paper Framework
for the Future is intended to circumvent
the European
Convention on human rights which prohibits
preventive
detention except in those of unsound mind.
Of the Government's proposals, Professor
Mullen says:
"With their promises of new money and
research funding they
hope to bribe doctors into complicity
in the indefinite detention
of certain selected offenders."
He adds "There is a crying need for mental
health services for
severely personality disordered individuals
..The British
Government's proposals largely ignore
the central issue of
developing appropriate treatment services
in favour of creating
a system for locking up men and women
who frighten
officials".
Contact:
Professor Paul Mullen, Professor Forensic
Psychiatry,
Monash University and Institute of Forensic
Mental Health,
Victoria, Australia.
Email: pmullen@vicnet.net.au
(2)REVALIDATION - THE
INTERNATIONAL
EXPERIENCE
(Revalidation in the United Kingdom:
general principles based
on experience in general practice)
http://www.bmj.com/cgi/content/full/319/7218/1180
(Revalidation is the answer)
http://www.bmj.com/cgi/content/full/319/7218/1145
A collection of articles in this week's
BMJ , pp 1180 - 92,
describe the processes of revalidation
in the USA, Canada,
Australia, New Zealand and the Netherlands.
Professor
Lesley Southgate and RCGP Chairman Dr
Mike Pringle
outline their proposals for how the British
system might work
using the example of general practitioners.
A local process
involving both peers and lay people is
envisaged.
In an editorial, Graham Buckley, executive
director of the
Scottish Council for Postgraduate Medical
and Dental
Education says that British medicine is
coming rather late to an
acceptance of revalidation. Buckley argues
that revalidation
will have a profound effect on the practice
of medicine but that
hard effort will be required to prevent
it becoming an empty
chore.
(3)POSSIBLE LINK BETWEEN
HEART ATTACK AND
HELICOBACTER PYLORI INFECTION
(Helicobacter pylori infection and
early onset myocardial
infarction : case control and sibling
pairs study)
http://www.bmj.com/cgi/content/full/319/7218/1157
John Danesh et al of the International
Studies of Infarct
Survival (ISIS) Collaborative Group at
the Radcliffe Infirmary,
Oxford report a moderate association between
coronary heart
disease and testing positive for helicobacter
pylori infection.
The team conducted both a case-control
study at ages 30 -
49 and a study of sibling pairs comparing
patients between the
ages of 30-49 who had survived a myocardial
infarction with
controls who had no history of coronary
heart disease.
The case-control study found that myocardial
infarction was
twice as common in people with H pylori
infection than in
those not infected and that among sibling
pairs myocardial
infarction was a third more common. The
authors say a large
randomised control trial would be needed
to establish a causal
link.
Contact :
Dr John Danesh, Merton College junior research
fellow,
Clinical trial Service Unit and Epidemiological
Studies Unit,
Nuffield Department of Clinical Medicine,
Radcliffe Infirmary,
Oxford OX2 6HE
Email:
john.danesh@balliol.ox.ac.uk
(4)INCREASED EMERGENCY
ADMISSIONS ARE REAL
PATIENTS NOT STATISTICAL QUIRKS
(Trends in emergency admissions)
http://www.bmj.com/cgi/content/full/319/7218/1201
Two letters in this week's BMJ challenge
a July paper which
suggested that an apparent increase in
emergency admissions
is due to internal transfers between consultants
generating
multiple finished consultant episodes
in relation to an individual
patient. Andrew Volans, A & E consultant
at Scarborough
hospital has documented an 85 per cent
increase in
emergency admissions between 1986 and
1997. Oliver
Blatchford et al from Glasgow say that
the Scottish morbidity
record differentiates between admissions
and internal transfers
and they can report a 3.9 per cent increase
year on year
between 1994 and 1997.
Contact :
Dr Andrew Volans, Consultant in Accident
and Emergency
Medicine, Scarborough Hospital, Scarborough
YO12 6QL
or
Dr Oliver Blatchford, Department of Public
Health, Argyll and
Clyde Health Board, Ross House, Hawkhead
Road, Paisley
Email : oliver.blatchford@achb.scot.nhs.uk
(5)HOME BLOOD PRESSURE
MEASUREMENTS ARE
USUALLY ACCEPTABLE
(Reliability of patients measuring
blood pressure at home:
prospective observational study)
http://www.bmj.com/cgi/content/full/319/7218/1172
Asking patients to measure their blood
pressure at home
avoids the problem of "white coat hypertension"
where blood
pressure rises in the presence of a doctor,
and in most patients
is sufficiently accurate, says a paper
by Battegay et al in this
week's BMJ.
In a sample of 54 patients asked to take
twice daily blood
pressure readings for 30 days using an
automated monitor,
73% of measurements were reported correctly.
Their readings
were checked against automatic recordings
within the
monitors.. Low educational level was the
only independent
predictor of poor reporting accuracy.
Dr Edouard Battegay
reports that for patients in this category,
other methods of
recording blood pressure may be preferable
to self reported
measurements.
Contact :
Dr Edouard Battegay, Assistant Professor,
Dept Internal
Medicine, University Hospital, Basel,
Switzerland
Email: ebattegay@uhbs.ch
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