Releases Saturday 30 October 1999
No 7218 Volume 319

Please remember to credit the BMJ as source when publicising an
article and to tell your readers that they can read its full text on the
journal's web site (http://www.bmj.com).

If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).


(1)PREVENTIVE DETENTION FOR PEOPLE WITH
PERSONALITY DISORDER IS WRONG

(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


FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact Jill Shepherd;pressoffice@bma.org.uk)

and from:

the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)