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Background: Response rates to surveys are declining and this threatens the validity and generalisability of their findings. We wanted to determine whether paper quality influences the response rate to postal surveysMethods: A postal questionnaire was sent to all members of the British Society of Gynaecological Endoscopy (BSGE). Recipients were randomised to receiving the questionnaire printed on standard quality paper or high quality paper.Results: The response rate for the recipients of high quality paper was 43/195 (22%) and 57/194 (29%) for standard quality paper (relative rate of response 0.75, 95% CI 0.33-1.05, p = 0.1Conclusion: The use of high quality paper did not increase response rates to a questionnaire survey of gynaecologists affiliated to an endoscopic society. [ABSTRACT FROM AUTHOR]

The article presents information on several papers discussed at a meeting of the Section of General Practice of the Royal Society of Medicine held in Great Britain on March 21, 1984. Doctor David Ryde tackled his own practice of recognizing patients who consult him. Doctor Gus Plaut highlighted his effort to remove cervical smears from all women in his practice to eliminate cervical cancer. Another paper outlined medical practice in East London.

Rationale This study focused on factors that most concern specialist societies when choosing an evidence grading system, such as methodological strengths and weaknesses, applicability and ease of use. The grading systems chosen were the Scottish Intercollegiate Guidelines Network (SIGN), the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the National Service Framework for long-term neurological conditions critical appraisal tool (NSF-LTC). Methodology Twelve assessors, representing typical members of society-based guideline development groups, graded papers and a recommendation using a key question as a guide. Key questions and recommendations were extracted from existing clinical guidelines representing a variety of research fields. Assessors were given 3 months to grade the papers using the grading systems and to complete a semi-structured qualitative questionnaire. The results were independently assessed for emerging themes. Results Assessors felt all three systems had strengths and weaknesses depending on the type of evidence being graded. GRADE was seen as the most complex but rigorous system, while SIGN and NSF were seen as easier and more flexible to use, but less methodologically rigorous. In grading the evidence, 10% of assessors used GRADE incorrectly, 33% used SIGN incorrectly and 75% used NSF-LTC incorrectly. In grading the recommendations, 60% used GRADE incorrectly, 50% used SIGN incorrectly and 50% used NSF-LTC incorrectly. Implications It is recommended that specialist societies consider the type of evidence they will be evaluating and the research experience of the appraisers before selecting a grading system. Additionally, appraisers should have training in appraising and grading evidence using the system to be employed. [ABSTRACT FROM AUTHOR]

The article provides information about the development of the journal "Archives of Disease in Childhood." The British Medical Association (BMA) has founded the journal in 1926. In 1977, the BMA and British Pediatric Association (BPA) became partners and shared profits and losses with up to 800 copies given to BPA members. Years passed by, the journal has adapted new technology and become more friendly to the reader. It has embraced standard approaches to assessment and criticisms of papers.

Purpose: This paper aims to make the case that there is a need to move beyond a focus on an approach to leadership development which is confined to health care only. It argues that, given the economic, financial, social and organisational context within which health and social care organisations in the UK operate, there is a need to develop leadership within health and social care systems, rather than within the existing "siloed" sectors. Design/methodology/approach: The paper considers the context within which health and social care organisations in the UK operate; examines the nature of those organisations; makes the case for focusing on the health and social car system through systems leadership; and identifies the need for leadership, rather than leader development. Findings: There is a danger of health and social care organisations "walking backwards into the future" with eyes fixed on the past. The future lies with treating health and social care as a system, rather than focusing on organisations. The current model is individual leader focused, but the emerging model is one of collective multi-agency teams. Originality/value: The paper seeks to go beyond a health-care-only focus, by asserting that there is a need to regard health and social care as a single system, delivered by a multiplicity of different organisations. This has implications for the kind of leadership involved and for how this might be developed. [ABSTRACT FROM AUTHOR]

Context As a contribution to this special issue commemorating the journal's 50th volume, this paper seeks to explore directions for national licensing examinations ( NLEs) in medicine. Increases in the numbers of new medical schools and the mobility of doctors across national borders mean that NLEs are becoming even more important to ensuring physician competence. Objectives The purpose of this paper is to explore the use of NLEs in the future in the context of global changes in medical education and health care delivery. Methods Because the literature related to NLEs is so large, we have not attempted a comprehensive review, but have focused instead on a small number of topics on which we think we have something useful to say. The paper is organised around five predicted trends for NLEs. Discussion The first section discusses reasons why we think the use of NLEs will increase in the coming years. The second section discusses the ongoing problem of content specificity and its implications for the design of NLEs. The third section examines the evolution of large-scale, standardised cognitive assessments in NLEs and suggests some future directions. Reflecting the fact that NLEs are, increasingly, attempting to assess more than just knowledge, the fourth section addresses the future of large-scale clinical skills assessments in NLEs, predicting both increases in their use and some shifts in the nature of the stations used. The fifth section discusses workplace-based assessments, predicting increases in their use for formative assessment and identifying some limitations in their direct application in NLEs. The concluding section discusses the cost of NLEs and indulges in some further speculations about their evolution. [ABSTRACT FROM AUTHOR]

Background: Childhood long‐term conditions are usually diagnosed in infancy or early childhood. Little is known about the particular experiences and needs of young people who receive a chronic illness diagnosis during adolescence or late childhood. This paper will examine this experience in relation to multiple sclerosis (MS), which is increasingly being diagnosed before adulthood. Aims: To explore how young people experience an MS diagnosis. Methods: Qualitative study using a grounded theory approach. In‐depth interviews were conducted with 21 young people diagnosed with MS. Participants were recruited through health service and voluntary sector organizations in the United Kingdom. Results: Young people's pre‐illness normality was disrupted by the diagnosis of a chronic illness (MS). Participants experienced their body as changed physically, cognitively, and emotionally and as changeable due to symptom unpredictability. This influenced how participants perceived and presented their identity, disrupted their relationships, and altered their future biography. Young people developed strategies to manage their condition and identities in order to incorporate MS into their current and future lives, which required continual illness and identity work in response to changing symptoms, social contexts, and relationships. Conclusions: Although young peoples' experience of living with chronic illness has been widely explored, the aftermath of diagnosis has been underresearched from their perspective. This study contributes to this knowledge gap by illuminating how young people experience a chronic illness diagnosis and negotiate the resulting changes to their identity, relationships, and future. The findings suggest that young people need preparation and support in disclosing their diagnosis to others. Professionals supporting young people with long‐term conditions need to work closely with specialist mental health services to ensure that they receive appropriate emotional support. Schools have an important role in ensuring young people with long‐term conditions achieve their academic potential and receive appropriate careers advice. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at a symposium which was held at the British Pharmacological Society in Great Britain in December 2005 is presented. The topics of the studies concentrated on the electronic-learning program, and on accounts of related issues and resources from a medical perspective. Furthermore, the second part of the conference tackled the different ways in which pharmacology education can be delivered effectively.

The ever-debated question of triage and allocating the life-saving ventilator during the COVID-19 pandemic has been repeatedly raised and challenged within the ethical community after shortages propelled doctors before life and death decisions (Anderson-Shaw and Zar 2020; Huxtable 2020; Jongepier 2020; Peterson, Largent, and Karlawish 2020). The British Medical Association's ethical guidance highlighted the possibility of an initial surge of patients that would outstrip the health system's ability to deliver care "to existing standards," where utilitarian measures have to be applied, and triage decisions need to maximize "overall benefit" (British Medical Association 2020, 3) In these emergency circumstances, triage that "grades according to their needs and the probable outcomes of intervention" will prioritize or eliminate patients for treatment, and health professionals may be faced with obligations to withhold or withdraw treatments to some patients in favour of others (British Medical Association 2020, 4). This piece is a response and extension to articles published on the manner of involvement for ethics and ethicists in pandemic triage decisions, particularly examining the ability and necessity of establishing triage committees to ameliorate scarce allocation decisions for physicians. [ABSTRACT FROM AUTHOR]

SUMMARY Background The Lancashire Teaching Hospitals NHS Trust in the UK has been providing renal care through video-as-a-service (VAAS) to patients since 2013, with support from the North West NHS Shared Infrastructure Service, a collaborative team that supports information and communication technology use in the UK National Health Service. Introduction Renal telemedicine offered remotely to patients on home dialysis supports renal care through the provision of a live high-quality video link directly to unsupported patients undergoing haemodialysis at home. Home haemodialysis is known to provide benefits to patients, particularly in making them more independent. The use of a telemedicine video-link in Lancashire and South Cumbria, UK, further reduces patient dependence on the professional team. Objective The purpose of this paper is to present the perspectives of the renal care team members using the renal telemedicine service to understand the perceived benefits and issues with the service. Method Ten semi-structured interviews with members of the renal care team (two renal specialists, one matron, two renal nurses, one business manager, one renal technical services manager, two IT technicians and one hardware maintenance technician) were conducted. Thematic analysis was undertaken to analyse the qualitative data. Results A range of incremental benefits to the renal team members were reported, including more efficient use of staff time, reduced travel, peace of mind and a strong sense of job satisfaction. Healthcare staff believed that remote renal care through video was useful, encouraged concordance and could nurture confidence in patients. Key technological issues and adjustments which would improve the renal telemedicine service were also identified. Conclusion The impact of renal telemedicine was positive on the renal team members. The use of telemedicine has been demonstrated to make home dialysis delivery more efficient and safe. The learning from staff feedback could inform development of services elsewhere. [ABSTRACT FROM AUTHOR]

Information on the papers discussed during the meeting held by the Sections of Oncology, Proctology and Surgery of the Royal Society of Medicine on March 24, 1982 in Great Britain is presented. Clair Chilvers from the Institute of Can Research presented her paper "The epidemiology of colorectal cancer." Dr. Michael Hill spoke about the dietary factors in cancer of the colon, while Dr. Michael Moore presented the study on the aspects of cell-mediated immunity in colonic cancer.

The progressive nature of Type 2 diabetes necessitates treatment intensification over time in order to maintain glycaemic control, with many patients ultimately requiring insulin therapy. While insulin has unlimited potential efficacy, its initiation is often delayed and improvements in glycaemic control are typically accompanied by weight gain and an increased risk of hypoglycaemia, particularly as HbA1c approaches and falls below target levels. This may account for the sub-optimal control often achieved after insulin initiation. Combining insulin with antihyperglycaemic therapies that have a low risk of hypoglycaemia and are weight-neutral or result in weight loss is a therapeutic strategy with the potential to improve Type 2 diabetes management. Although the effects differ with each individual class of therapy, clinical trials have shown that adding a glucagon-like peptide-1 receptor agonist, dipeptidyl peptidase-4 inhibitor or sodium-glucose co-transporter-2 inhibitor to insulin regimens can offer a significant reduction in HbA1c without substantially increasing hypoglycaemia risk, or weight. The evidence and merit of each approach are reviewed in this paper. Once-daily co-formulations of a basal insulin and a glucagon-like peptide-1 receptor agonist have been developed (insulin degludec/liraglutide) or are under development (lixisenatide/insulin glargine). Insulin degludec/liraglutide phase III trials and a lixisenatide/insulin glargine phase II trial have shown robust HbA1c reductions, with weight loss and a low risk of hypoglycaemia. With insulin degludec/liraglutide now approved in Europe, an important consideration will be the types of patients who may benefit most from a fixed-ratio combination; this is discussed in the present review, and we also take a look toward future developments in the field. [ABSTRACT FROM AUTHOR]

The present paper summarizes the key recommendations in a recent publication produced by the Joint British Diabetes Societies for Inpatient Care on the use of variable rate i.v. insulin infusion in 'medical' inpatients. The full guideline is available at and is designed to be a practical guide that can used by any healthcare professional who manages medical inpatients with hyperglycaemia. Its main aim is to allow variable rate i.v. insulin infusion to be used safely, effectively and efficiently for this specific group of inpatients. [ABSTRACT FROM AUTHOR]

Background Each year, 15 million people worldwide and 110 000 people in England have a stroke. Having a stroke increases the risk of having another. There are a number of additional known risk factors that can be modified by diet. The present study aimed to systematically review key nutrients and diets and their role in secondary prevention, as well as provide evidence-based guidelines for use in clinical practice. The work was conducted as part of the process to develop the 4th edition of the Royal College of Physicians' ( RCP) National Clinical Guideline ( NCG) for Stroke. Methods Questions were generated by the research team, in consultation with the Virtual Stroke Group, an online professional interest group, and the RCP Intercollegiate Stroke Working Party Guideline Development Group. Nine questions covering several individual nutrients and diet combinations were defined and searches conducted up until 31 October 2011 using five electronic databases ( Embase, Medline, Cumulative Index to Nursing and Allied Health Literature ( CINAHL), Cochrane Library and Web of Science). All included studies were assessed for quality and risk of bias using van Tulder criteria for randomised controlled trials ( RCTs) and Quality of Reporting of Meta-analyses (QUORUM) criteria for systematic reviews. Results Of 4287 abstracts were identified, 79 papers were reviewed and 29 systematic reviews and RCTs were included to provide evidence for the secondary prevention components of the guidelines. For each question, evidence statements, recommendations and practical considerations were developed. Conclusions This systematic review process has resulted in the development of evidence-based guidelines for use in clinical practice and has identified areas for further research. [ABSTRACT FROM AUTHOR]

The article presents a research paper which focuses on the validity of the Evaluation of Daily Activity Questionnaire measurement in patients with musculoskeletal disorders. Studied musculoskeletal conditions include osteoarthritis, systemic lupus erythematosus and systemic sclerosis. Explored is the content validity and acceptability of such conditions.

Patients, clinicians and managers all want to be reassured that their healthcare organisation is safe. But there is no consensus about what we mean when we ask whether a healthcare organisation is safe or how this is achieved. In the UK, the measurement of harm, so important in the evolution of patient safety, has been neglected in favour of incident reporting. The use of softer intelligence for monitoring and anticipation of problems receives little mention in official policy. The Francis Inquiry report into patient treatment at the Mid Staffordshire NHS Foundation Trust set out 29 recommendations on measurement, more than on any other topic, and set the measurement of safety an absolute priority for healthcare organisations. The Berwick review found that most healthcare organisations at present have very little capacity to analyse, monitor or learn from safety and quality information. This paper summarises the findings of a more extensive report and proposes a framework which can guide clinical teams and healthcare organisations in the measurement and monitoring of safety and in reviewing progress against safety objectives. The framework has been used so far to promote self-reflection at both board and clinical team level, to stimulate an organisational check or analysis in the gaps of information and to promote discussion of 'what could we do differently'. [ABSTRACT FROM AUTHOR]

Background Stroke affects 15 million people each year worldwide and is one of the world's leading causes of death and physical disability. Stroke can result in a decline in nutritional status and this is associated with increased mortality and poor outcomes. The present work aimed to systematically review key aspects of the nutritional support of stroke patients at risk of malnutrition and to provide evidence-based guidelines for use in clinical practice. The work was conducted as part of the process to develop the 4th edition of the Royal College of Physicians' ( RCP) ' National Clinical Guideline ( NCG) for Stroke'. Methods Questions were generated by the search team, together with contributions from members of the Virtual Stroke Group and the RCP Intercollegiate Stroke Working Party Guideline Development Group. Six questions covering several areas of nutritional support after stroke were defined and searches were conducted through to 31 October 2011 using five electronic databases ( Embase, Medline, CINAHL, Cochrane Library and Web of Science). All included studies were assessed for quality and risk of bias using the van Tulder criteria for randomised controlled trials ( RCTs) and the Quorum criteria for systematic reviews. Results In total, 4215 abstracts were identified, 24 papers were reviewed and 13 systematic reviews and RCTs were included to provide evidence for the nutritional support components of the guidelines. For each question, evidence statements, recommendations and practical considerations were developed. Conclusions This systematic review process has resulted in the development of evidence-based guidelines for use in clinical practice and has identified areas for further research. [ABSTRACT FROM AUTHOR]

This paper outlines a quality improvement project implemented in the United Kingdom (UK).The aim ofthe study was to reduce inconsistencies of care in general practice in managing early chronic kidney disease (CKD) using a care bundle approach. Areas under scrutiny are prevalence recording of CKD, proteinuria measurement, blood pressure control, cardiovascular risk recording and self-management opportunities for patients. Early results have shown improvements in reliability using a Plan- Do-Study-Act methodology. The integration ofa Patient and Service User Advisory Group into the project team has been invaluable. [ABSTRACT FROM AUTHOR]

The presence of undocumented migrants is increasing in many Western countries despite wide-ranging attempts by governments to increase border security. Measures taken to control the influx of immigrants include policies that restrict access to publicly funded health care for undocumented migrants. These restrictions to health care access are controversial, and evidence suggests they do not always have the intended effect. This study provides a comparative analysis of institutional, actor-related, and contextual factors that have influenced health care policy development on undocumented migrants in England and the Netherlands. For undocumented migrants, England restricts its access to care at the point of service, while the Netherlands restricts through the payment system for services. The study includes an analysis of policy papers and semistructured, in-depth interviews with various actors in both countries. Findings confirm the influence of such contextual factors as immigration considerations and cost concerns on health care policy making in this area. However, these factors cannot explain the differences between the two countries. Previously enacted policies, especially the organization of the health care system, affected the kind of restrictions for undocumented migrants. Concerns about the side effects of generous treatment of undocumented migrants on other groups played a substantial role in formulating restrictive policies in both countries. Evidently, policy development and implementation is critically affected by institutional rules, which govern the degree of influence that doctors and professional medical associations have on the policy process. [ABSTRACT FROM AUTHOR]

In this paper we present the findings of the first Infection Prevention Society membership survey conducted at the end of 2009. The survey sought to identify the views of current members in relation to the future direction and services provided by the Society and the reasons for some existing members leaving the Society. Around one-third of the membership responded to the survey. The findings reveal general satisfaction with the direction of the Society and point out areas of activity that can be developed and these have informed the current work of the Board in setting the strategic aims of the Society for the next 5 years. [ABSTRACT FROM AUTHOR]

Simple Summary: People are more likely to develop cancer as they become older, and as people live longer, the number of older adults with cancer is steadily increasing. Managing cancer in older adults is challenging because they often have long-term conditions and wider needs that complicate treatment decisions and outcomes. However, the care of older adults with cancer is not formally taught during undergraduate medical education or postgraduate training in the United Kingdom. In this review, we provide an overview of the current education that medical students and training trainee doctors receive to prepare them for caring for older adults with cancer and highlight where challenges exist. We summarise the research conducted and strategies implemented internationally and use this knowledge to provide recommendations which may improve the education and training of doctors to meet the needs of older adults with cancer. Cancer is a disease associated with ageing. Managing cancer in older adults may prove challenging owing to pre-existing frailty, comorbidity, and wider holistic needs, as well as the unclear benefits and harms of standard treatment options. With the ongoing advances in oncology and the increasing complexity of treating older adults with cancer, the geriatric oncology field must be a priority for healthcare systems in education, research, and clinical practice. However, geriatric oncology is currently not formally taught in undergraduate education or postgraduate training programmes in the United Kingdom (UK). In this commentary, we outline the landscape of geriatric oncology undergraduate education and postgraduate training for UK doctors. We highlight current challenges and opportunities and provide practical recommendations for better preparing the medical workforce to meet the needs of the growing population of older adults with cancer. This includes key outcomes to be considered for inclusion within undergraduate and postgraduate curricula. [ABSTRACT FROM AUTHOR]

The article focuses on issues discussed at a meeting held by the Section of Paediatrics of the Royal Society of Medicine in Great Britain on June 27-28, 1986. Doctor A. W. Chung described the development of child health care in China. The clinical and pathological features of Keshan disease, a form of cardiomyopathy endemic in certain parts of China, was discussed by Doctor X. Meng. Some salient facts about iron supplementation was presented by professor P. C. Elwood.

In this paper, a novel classification technique for large data set of mammograms using a deep learning method is proposed. The proposed model targets a three-class classification study (normal, malignant, and benign cases). In our model we have presented two methods, namely, convolutional neural network-discrete wavelet (CNN-DW) and convolutional neural network-curvelet transform (CNN-CT). An augmented data set is generated by using mammogram patches. To enhance the contrast of mammogram images, the data set is filtered by contrast limited adaptive histogram equalization (CLAHE). In the CNN-DW method, enhanced mammogram images are decomposed as its four subbands by means of two-dimensional discrete wavelet transform (2D-DWT), while in the second method discrete curvelet transform (DCT) is used. In both methods, dense scale invariant feature (DSIFT) for all subbands is extracted. Input data matrix containing these subband features of all the mammogram patches is created that is processed as input to convolutional neural network (CNN). Softmax layer and support vector machine (SVM) layer are used to train CNN for classification. Proposed methods have been compared with existing methods in terms of accuracy rate, error rate, and various validation assessment measures. CNN-DW and CNN-CT have achieved accuracy rate of 81.83% and 83.74%, respectively. Simulation results clearly validate the significance and impact of our proposed model as compared to other well-known existing techniques. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the prevalence of diabetic retinopathy in Type 2 diabetes, social deprivation and diabetes-related foot disease, and glycaemia control in white children and South Asian children.

Despite many initiatives taken by funding bodies and health care organisations, the 10/90 gap in health care and health system research between low and middle-income countries (LIMC) and high income countries is still widely recognised. We aimed to quantify the contribution of LMIC in high impact medical journals and compare the results with the previous survey conducted in 2000. Research articles were anaylsed to determine the origin of data and authorship affiliated countries in a calendar year (2017) for five journals: British Medical Journal, The Lancet, New England Journal of Medicine (NEJM), Annals of Internal Medicine and the Journal of the American Medical Association. Contributing countries were categorised into four regions; USA, UK, Other Euro-American countries (OEAC) and rest of the world (RoW). A total of 6491 articles were categorised where USA, UK and OEAC contributed 39.7%, 28.5% and 19.9% respectively. RoW countries contributed 11.9% of articles surveyed. The Lancet and NJEM had the highest numbers from RoW with 22.1% and 17.3% respectively. After 17 years, the trend remained comparable with the original survey carried out in 2000. RoW contributions increased from 6.5% to only 11.9% of the published articles from countries accounting for 88.3% of the world's population. [ABSTRACT FROM AUTHOR]

The article presents calendar of events for medical associations in Great Britain. The EuroSpine 2006 8th Annual Meeting of the Spine Society of Europe will be held on October 25 to 28. The International Symposium on The Adult Scoliosis, Conservative and Interventional Treatment Modalities will be on Novermber 2 to 3. The International 25th Jubilee Course for Percutaneous Endoscopic Spinal Surgery and Complementary Minimal Invasive Techniques will be on January 25 to 26, 2007.

Introduction: Emergency day case surgery for drainage of abscesses is an established care pathway that is not widely practised. This paper reviews the current length of stay for patients in England undergoing treatment, specifically for perianal abscesses. Methods: Data from Hospital Episode Statistics for 2010-2012 were reviewed to assess the length of stay for patients presenting as an emergency, with a perianal abscess. Results: From 3 years pooled data, more than 35,000 procedures were identified. There is wide variation in the rate of day case emergency surgery for this condition in England. At a provider level, day case rates vary from 10% to 77%, with a median value of 35%. If activity were undertaken to British Association of Day Surgery suggested rates of day surgery for this procedure, over 9,000 bed days per year could be saved. Discussion: Emergency management of perianal abscesses using Day Surgery ethos and resources is a previously reported pathway that remains underexploited in England, and the rationale and evidence base for further development is presented. Conclusion: This analysis suggests that we are delivering well short of the achievable standards of efficiency and quality, with few providers undertaking day case emergency abscess surgery at the advocated rate. Delivering emergency day case surgery for patients presenting with perianal abscesses offers a more timely and responsive service, with an opportunity for significant reduction in the use of hospital beds. [ABSTRACT FROM AUTHOR]

The article offers information about several papers discussed at a symposium on the early development of vaccines and its efficacy in preventing the spread of communicable diseases. The symposium featured several papers by prominent people in the immunology and allergy practice including G. Schild, M. Mackett, and F. Hay, among others.

The article focuses on issues discussed at the joint meeting of the Section of Radiology of the Royal Society of Medicine with the British Institute of Radiology and Royal College of Radiologists held in Great Britain on February 20, 1986. A historical review on Hodgkin's disease was given by Doctor A. M. Jelliffe. A historical review of follicular lymphomas which are B-cell neoplasms that architecturally and cytologically resemble the normal germinal centre was given by Doctor K. A. MacLennan.

The article traces the history of the Section of Neurology of the British Royal Society of Medicine. Physicians interested in building a neurological society held a meeting in London, England in November 1885. The foundation of the National Hospital for Nervous Diseases and Epilepsy provided a centre for clinical neurology and neurophysiology studies. In April 1878, the "Brain, A Journal of Neurology" had been founded. In 1926, the Society of British Neurological Surgeons was established.

In this article the editor reflects on the impact that decreased health funding and restructuring will have on Great Britain's National Health Service (NHS). In July 2010 Andrew Lansley, British Secretary of State for Health, issued a White Paper outlining changes to the NHS which many in the medical and nursing community are criticizing. Great Britain's Royal College of Nursing (RCN) has expressed concerns that the proposed changes may undermine quality patient care.

The article reports on the activities of the Veterinary Nurses Council (VNC) in Great Britain. The VNC has approved changes to the role of observers appointed by representative organizations. In future, such observers would be provided with papers in advance of a VNC meeting in order to give time to prepare an organizational statement for presentation at the meeting.

Background Acupuncture received a positive recommendation in the National Institute for Health and Clinical Excellence (NICE) clinical guideline for low back pain (LBP). However, no such recommendation was forthcoming in the NICE clinical guideline for osteoarthritis (OA). Importantly,the two guidelines adopted different treatment comparators in their economic analyses of acupuncture; in the LBP guideline ‘usual care’ was used (with no consideration of placebo/sham interventions), whereas ‘sham acupuncture’ was the comparator in the OA guideline. Objective To analyse the implications of using different control group comparators when estimating the cost-effectiveness of acupuncture therapy. Methods The NICE OA economic analysis for acupuncture was replicated using ‘usual care’ (ie, no placebo/sham component) as the treatment comparator. A ‘transfer-to-utility’ technique was used to transform Western Ontario and McMaster Osteoarthritis scores into EQ-5D utility scores to allow quality-adjusted life year (QALY) gains to be estimated. QALY estimates were combined with direct incremental cost estimates of acupuncture treatment to determine incremental cost effectiveness ratios (ICERs). Results When ‘usual care’ was used as the treatment comparator, ICER point estimates were below £20 000 per QALY gained for each acupuncture trial analysed in the OA clinical guideline. In the original analysis, using placebo/sham acupuncture as the treatment comparator, ICERs were generally above £20 000 per QALY gained. Conclusion The treatment comparator chosen in economic evaluations of acupuncture therapy is likely to be a strong determinant of the cost effectiveness results. Different comparators used in the OA and LBP NICE guidelines may have led to the divergent recommendations in the guidelines. [ABSTRACT FROM AUTHOR]

In this paper the author examines the Medical Act of 1858 passed by the British parliament. The author wishes to study the reason for why the Act formed the way it did. Discussed is the rhetoric of medical reform. Also discussed is the nature and underpinnings of medical authority in early and mid-Victorian times.

This article gives an overview of the development, remit, structure and working of the British Medical Association's Medical Ethics Committee. It situates it within a brief history of the Association and gives examples of current work. [ABSTRACT FROM AUTHOR]

The article explores the complexity of the role of general practice (GP) trainers in developing and implementing a national curriculum produced by the Royal College of General Practitioners in Great Britain. The author suggests how an action research approach to training can guide the professional judgment of GP trainers and enhance their participation in the evaluation process intended to develop the new curriculum.

The article offers information on the Medical Council on Alcoholism (MCA) and its journal "Alcohol and Alcoholism" in Great Britain. It highlights the success of the council and its journal in focusing several issues in alcohol research. It also indicates the events in the development of the publication including its adoption by the European Society for Biomedical Research on Alcoholism (ESBRA), appointment of Keith Tipton as joint chief editor, and the challenges of electronic publishing.

SUMMARY: Background: Supporting underrepresented groups in pursuing, applying and matriculating into medical education is a key issue in the field. In the United Kingdom, Gateway to Medicine programmes were created as a specific form of entry to medical education, to support diversification goals. Whilst well‐established, how these programmes are broadly designed and implemented, and how their functioning links to conceptual views of diversity, is not well described in the literature. Methods: This article explores relevant diversity‐related literature, including a specific review of all Gateway programmes. Findings: Key facets of diversity‐related work in medicine, including the distinction between 'widening participation' and 'widening access' are discussed. These distinctions frame the presentation of Gateway years; their selection process, structure and function are described. The purpose of these years is then discussed, with the lens of different discourses around diversity in medicine, to provide theoretical and practical considerations. Recommendations for how faculty can better explore diversity‐related issues are also provided. Conclusion: Gateway programmes may be effective, to some extent, in widening access to medical education, but require considerable resourcing to operate. Though heterogenous in nature, these programmes share common elements. However, discourses around the goals and purpose of this diversification vary based on individuals and institutions. These varied perspectives, as well as the societal and historical implications of diversity‐related work, are important for all clinical educators to understand with depth, and address directly, in order to reduce inequalities both within medical education and society at large. [ABSTRACT FROM AUTHOR]

The article questions the evidence underpinning Public Health England's (PHE) endorsement of the safety of efficacy of electronic cigarettes as an aid to quitting smoking. It defines the role of e-cigarettes and examines the quality of evidence cited by the PHE. Also discussed are the adverse health effects of e-cigarettes on young non-smokers, by-standers and the general public, and concerns about the lack of restrictions of e-cigarette use in cars.

The article offers information on changes to the official publication of the Royal Society of Medicine in Great Britain. The Council has decided to create a new look and title beginning January 1978. Called the "Journal of the Royal Society of Medicine," the new publication will feature papers of a high medicoscientic standard, aside from those communicated at meetings of the society's sections. Additional features include letters to the editors, signed editorials, and section news.

An introduction is presented in which the editor discusses various reports within the issue on topics related to the European Wound Management Association (EWMA) including the importance of patients' voice to improving wound care, patient self-help in the management of chronic wounds, and the journey of a patient post-amputation wound care.