BMJ No 7119 Volume 315 Saturday 22 November 1997 This Week in BMJ | Editor's Choice | Press releases Editorials 1321 Regional trauma systems David Yates 1322 Emergency medical admissions: taking stock and planning for winter Oliver Blatchford, Simon Capewell 1323 Commissioning specialist services in the NHS Nick Black 1324 Lumbar puncture needn't be a headache Simon A Broadley, Geraint N Fuller 1325 UK government fails its first test on public health Tony Delamothe 1326 Climate change: decision time in Kyoto Richard Smith News 1327 Specialist treatments need clearing house Medical decision must be logically defensible Cancer unit faces ministerial inquiry BMA calls for change to cannabis licensing US journal finds lower risk from diet pills Cataract targets not met in Scotland US hospital mergers threaten services Neonatal screening for hearing impairment Team to look at NHS waiting lists Cutting calories may retard cancers UK needs more cancer specialists UK government consults on clinical disputes GPs will be pivotal in NHS overhaul Papers 1333 Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study T M MacDonald, S V Morant, G C Robinson, M J Shield, M M McGilchrist, F E Murray, D G McDevitt 1338 Randomised trial of octreotide for long term management of cirrhosis after variceal haemorrhage Spencer A Jenkins, John N Baxter, Mair Critchley, Andrew N Kingsnorth, Carol A Makin, Simon Ellenbogen, J Steven Grime, Janet G Love, Robert Sutton 1342 Does malnutrition in utero determine diabetes and coronary heart disease in adulthood? Results from the Leningrad siege study, a cross sectional study S A Stanner, K Bulmer, C Andrès, O E Lantseva, V Borodina, V V Poteen, J S Yudkin Commentary: A hypothesis challenged Janet W Rich-Edwards, Matthew W Gillman 1349 Effectiveness of a regional trauma system in reducing mortality from major trauma: before and after study Jon Nicholl, Janette Turner 1354 Effect of a strict HLA matching policy on distribution of cadaveric kidney transplants to Indo-Asian and white European recipients: regional study R M Higgins, N West, M E Edmunds, D C Dukes, H Kashi, A Jurewicz, F T Lam General practice 1356 Improving uptake of breast screening in multiethnic populations: a randomised controlled trial using practice reception staff to contact non-attenders J Atri, M Falshaw, R Gregg, J Robson, R Z Omar, S Dixon Clinical review 1360 Fortnightly review: Work factors and upper limb disorders Peter W Buckle 1363 Lesson of the week: Oxybutynin and cognitive dysfunction C A Donnellan, L Fook, P McDonald, J R Playfer 1365 ABC of palliative care: Depression, anxiety, and confusion Jennifer Barraclough Education and debate 1369 Personal paper: Disclosure of clinical audit records in law: risks and possible defences Christopher Womack, Susan Roger, Mandie Lavin 1371 Meta-analysis: Potentials and promise Matthias Egger, George Davey Smith Letters 1375 New method for expressing survival in cancer L B Tan; J Harrison; E Marubini and L Mariani; J Cresswell; O A Adedeji; David Cameron; A Messori, P Becagli, S Trippoli; Mark Middleton; W D J Ryder 1376 Cognitive behaviour therapy M Sharpe and S Wessely; S Thelander 1377 Patients with implants should be given implant cards for reference S Purkayastha 1377 General practice should be central to community mental health services J P Kingsland and R Williams 1377 Treating diarrhoea S J Taylor; A R Cadamy; G Parkes; E R Blay; L A McCowat and others; J W Inglesfield; D Leung and P Venkatesan; S L Gorbach 1380 Study linking enteroviral infection with motor neurone disease is not confirmed S Rice and R Pamphlett 1380 Charity helps doctors with addictive diseases to obtain treatment C McKendrick and I Joiner 1380 Family secrets S Bewley; A Barnett and S Stott 1381 Nicotine replacement therapy on the NHS N Bradley; A Mitchell 1381 Old fashioned methods of diagnosis have their place A Savage Obituaries 1382 D W Cammock, R L Cormie, J C Fulford, W H Jopling, S Leibowitz, W McNaught, R M Miller, H C Osborn, A P Riley, H G Robinson, R A M B Simpson, D B B Whitehouse Medicopolitical digest 1384 Specialist medical order Progress on The New Doctor Medical students' fees Children's health services BMA council elections Views & reviews Soundings 1385 Remember them well Liam Farrell Personal view 1385 The other side of the fence Anthea Tinker Medicine and the media 1386 The spin on sperm Kamran Abbasi Medicine and books 1387 Mechanisms of Disease: An Introduction to Clinical Science Ed S Tomlinson, A M Heagerty, A P Weetman E R Chilvers A Sceptic's Medical Dictionary Michael O'Donnell J P Bunker Minerva 1388 S2 Career Focus Classified supplement Family practitioner in the United States Roy L Bishop Editor's choice The BMJ loves surgeons: true The BMJ loves surgeons. We would like to publish research and information every week that surgeons will find relevant and interesting. But to do so can be hard. It doesn't make sense for us to publish details on surgical technique, and we are always reluctant to publish series of surgical cases because of the impossibility of generalising the results to other patients and other surgeons. And randomised controlled trials are hard to do in surgery. So we have great pleasure in publishing two trials that should be of interest to surgeons - together with other pieces that should appeal to them. The Royal College of Surgeons estimated 10 years ago that about a third of patients who died of major trauma who were admitted to accident and emergency departments could have been saved. It recommended the creation of major trauma centres. The Department of Health set up such a centre in the North West Midlands, and today we publish the results of an independent "before and after" study (p 1349). The authors conclude that such centres could at best produce only a small saving in deaths. These results are disappointing, particularly as trauma centres do seem to have reduced deaths in the United States and Germany, but David Yates insists in an editorial that this paper cannot be the end of the story (p 1321). Our other surgical trial, one that is randomised and controlled, produces positive results. It shows that patients with bleeding varices do better when their varices are injected if they are also given octreotide, a synthetic analogue of somatostatin (p 1338). The drug works by causing splanchnic arteriolar constriction and reducing the release of peptides that contribute to the hyperdynamic circulatory syndrome of portal hypertension. Surgeons may also be interested in the letters about a suggestion - from surgeons - that, instead of giving patients with cancer 10 year survival rates, doctors might tell them what fraction of normal life expectancy remains to them (p 1375). A research registrar who had breast cancer two years ago when aged 33 approves of the method. Those who have less interest in surgery should not be left feeling neglected by this week's journal. We start a new series on meta-analyses, a statistical technique that evokes great passion among doctors (p 1371). The first paper points out that the number of meta-analyses published each year in journals indexed on Medline has grown steadily from under 50 in 1987 to 800 in 1996. Meanwhile, Kamran Abbasi investigates a company that promises prospective parents near 100% accuracy in choosing the sex of their baby by using a method that the fertility expert Lord Winston calls "complete nonsense" (p 1386). Yet the company achieved extensive media coverage and has had 1,300 inquiries. Home | Current contents | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline