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The merits or otherwise of publishing hospital specific death rates are much debated. This article compares the relative sensitivity of measures of process and outcome to differences in quality of care for the hospital treatment of myocardial infarction. Aspects of hospital care that have a proved impact on mortality from myocardial infarction are identified, and the results from meta-analysis and large randomised controlled trials are used to estimate the impact that optimal use of these interventions would have on mortality in a typical district general hospital. Sample size calculations are then performed to determine how many years of data would be needed to detect significant differences between hospitals. A comparison is then made with the amount of data that would be needed to detect significant differences if information about process of care was being collected. Process measures based on the results of randomised controlled trials were found to be able to detect relevant differences between hospitals that would not be identified by comparing hospital specific mortality, which is an insensitive indicator of the quality of care.

Numerous case-control studies have suggested a link between the oral contraceptive pill and liver cancer. The secular trends in liver cancer mortality rates for England and Wales from 1975 to 1992 were examined to determine whether an effect of the pill was apparent. Liver cancer mortality has remained constant in women in the age groups that have had major exposure to the pill.

Background: An analysis of the demand for the services of a sub-regional Family and Young Persons Unit which offers both in-patient and out-patient treatment for children and adolescents with psychiatric, emotional or psychological problems was performed., Methods: Interviews were held and questionnaires were sent to representatives of the principal and potential users of the service both within the local district and beyond., Results: The results demonstrated unmet demand for outpatient services but only limited demand for in-patient services in some districts. The role of market research in the new National Health Service and some of the difficulties of applying it are discussed. The implications of the findings for both the Family and Young Persons Unit and for child and adolescent psychiatry are considered., Conclusion: It is concluded that the effect of the market may be to bring about the closure of regional units unless there is intervention to protect them.

The translation of research into practice is currently a high-profile issue in the NHS. A number of regions have undertaken work in this area. Reports on a project that is part of the Anglia and Oxford Regions's "getting Research into Practice" (GRiP) initiative. The work focuses on the use of steroids in pre-term delivery, a procedure that medical evidence suggests can reduce neo-natal mortality and morbidity. Presents a number of findings which suggest that getting research into practice does not merely rest on the availability of well-researched evidence.

Trends in the incidence and mortality of endometrial and ovarian cancer are described for England and Wales from 1950 to 1991 and for other selected countries from 1955 to 1985. The mortality from endometrial cancer has been falling in England and Wales since 1950 in all age groups. This has not been reflected by a decline in incidence. Most of the other countries show a similar decline in mortality in all ages but stable incidence rates. Mortality from ovarian cancer has been declining in women aged under 55 in England and Wales since the early 1970s but has been rising in women over 55. The international pattern is varied, but several countries show a decline in mortality in younger women that began in the early 1970s. The incidence in younger women has not fallen to the same degree. It is difficult to explain the trends in endometrial cancer mortality in terms of the known risk factors for the disease. The trends in ovarian cancer mortality are consistent with an effect of the combined oral contraceptive pill.