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Guidelines for management of heart failure
("mega- here means 220") while the humble kilobyte shortens to kbyte, presumably because of DNA bases. The symbol for the poise has been corrected, but avoid it anyway, Baron says. He also now distinguishes medical from scientific editors (and authors) but we will continue to do our best. Of those prefixes, perhaps nine will do for everyday (see panel). :
Before SI Twenty prefixes for SI units
are
now
recognised. Readers of biomedical journals will be happy in the middle of the range, having become familiar with pmol/L and fL and on to MJ and even GW if they are interested in power stations. I once tried to slip through a tiddly atto and a monstrous tera but editorial colleagues would have none of it. Four newcomers to Baron’s ever-helpful Units, symbols, and abbreviations, now in its fifth : edition,’ have few temptations, especially over the telephone. The booklet has changed very little in the past six years. We now have the megabyte or Mb
David Sharp ; 1
Baron DN, ed. Units, symbols, and abbreviations: a guide for medical and scientific editors and authors, 5th ed. London: Royal Society of Medicine Press. 1994. Pp 64. ISBN 0-905958780. £10.
Perinatal Jamaica Jamaica is
:
:
in
of many Europeans, dream-place for a tropical holiday", says the editorial introduction to a supplement of Paediatric and Perinatal Epidemiology (1994; vol 8: suppl). But Jamaica is also poor. The supplement contains reports of a survey initiated in 1986 by the Ministry of Health to identify the causes of perinatal deaths. It shows how good epidemiological investigation can be carried out in a developing country with many social and economic difficulties. It is no surprise that perinatal mortality is highest amongst women who do not have antental care, who are hypertensive during pregnancy, and who are anaemic. A surprise is that all types of perinatal death (antepartum, intrapartum, and postpartum) were associated with maternal syphilis. "In
the
mortality
John
hearts a
Bignall
News in brief
Guidelines for management of heart failure The eleventh in the Agency for Health : Care Policy and Research’s series of clinical practice guidelines is on left-ventricular systolic dysfunction. Although the assessment of patients for revascularisation and transplantation is discussed, this publication is a detailed guide to out-
patient care only. Angiotensin-converting
!
enzyme
(ACE)
Exercise is now recommended for patients with heart failure, though not necessarily in the context of a formal rehabilitation programme, unless the illness is severe or the patient feels the need for extra supervision says the panel. Exercise has not been shown to strengthen the failing heart, but peripheral muscular improvement increases patients’ ability to function. Recognising the problem of poor compliance in chronic diseases, the guide tries to encourage a partnership between the patient and the physician based on frank discussion. After recommendations on smoking, drinking, diet, and exercise, the accompanying patient guide says, "If you do not want to change the way you live or take medicines as prescribed ... explain your reasons to your health care
inhibitors are recommended to reduce the load on the heart and thereby arrest or slow the progress of heart failure at all stages, including mild and asymptomatic : disease. ACE inhibitors are not used widely enough or in sufficient doses, says the panel, because of fear of side effects. : However, the side-effects have been provider". shown to be less severe and limiting than The committee supports echocardiowas once feared. Furthermore, ACE and radionuclide ventriculography graphy inhibitors have ben shown by randomised in the initial assessment and diagnosis controlled trials to reduce both morbidity of heart failure, but they say there is no and mortality. Diuretics and digitalis-like evidence of the benefit of these expensive drugs have not been proven to reduce tests to monitor the course of the illness. mortality, in part because few randomised Symptoms indicate the success or failure controlled trials have been attempted. For of disease management adequately. The patients with mild dyspnoea on excertion, economic impact of the recommendations the guide says ACE inhibitors alone may will form phase II of the project. be sufficient. For moderate dyspnoea on exertion, or if clinical volume overload is evident, or if ACE inhitors alone do not resolve symptoms, diuretics should be Paul M Rowe added. If ACE inhibitors plus diuretics fail to resolve symptoms, or in cases of 1 Agency for Health Care Policy and research heart failure: evaluation and care of patients severe dyspnoea on exertion, the addition with left-ventricular systolic dysfunction of digoxin to the regimen is recommend(AHCPR pub no 94-0612). Rockville, ed. Still, some panel members continue to Maryland: 1994: Pp 120 (plus quick use digoxin routinely on all patients with reference and guide for patients and left ventricular systolic dysfunction. families). ,
US$379 million health-care fraud settlement A California-based hospital chain has agreed to plead guilty to charges of health-care fraud and to pay more than US$379 million in damages, civil fines, and criminal penalties, the largest such settlement in US history. According to the US Department of Justice, National Medical Enterprises (NME), Inc, paid doctors and others to refer federally insured patients to NME-owned facilities and then passed along the cost of these illegal kickbacks to the government by disguising them as reimbursable hospital expenses. The agreement also settles claims that the company admitted patients to its facilities unnecessarily and that it billed insurance programmes multiple times for the same service or for services not provided. The government will continue to pursue investigations of other companies and individuals who were involved in the alleged kickback schemes. Justice Department officials said that the size of the settlement should send a message that the Clinton administration has made health-care fraud a
major law-enforcement priority.
UK-Israel research agreement The British and Israeli governments have made an agreement to set aside funds GC100 000 per year for 3 years) to ensure joint scientific contacts. Philanthropic sources have pledged another jC 100 000 per year. Ten teams per year will be selected and funded equally in Britain and Israel. The research will focus on medical biotechonology, including molecular biology, electrooptics such as lasers, and materials
research,
especially
high-performance
materials.
123
Before SI Twenty prefixes for SI units
are
now
recognised. Readers of biomedical journals will be happy in the middle of the range, having become familiar with pmol/L and fL and on to MJ and even GW if they are interested in power stations. I once tried to slip through a tiddly atto and a monstrous tera but editorial colleagues would have none of it. Four newcomers to Baron’s ever-helpful Units, symbols, and abbreviations, now in its fifth : edition,’ have few temptations, especially over the telephone. The booklet has changed very little in the past six years. We now have the megabyte or Mb
David Sharp ; 1
Baron DN, ed. Units, symbols, and abbreviations: a guide for medical and scientific editors and authors, 5th ed. London: Royal Society of Medicine Press. 1994. Pp 64. ISBN 0-905958780. £10.
Perinatal Jamaica Jamaica is
:
:
in
of many Europeans, dream-place for a tropical holiday", says the editorial introduction to a supplement of Paediatric and Perinatal Epidemiology (1994; vol 8: suppl). But Jamaica is also poor. The supplement contains reports of a survey initiated in 1986 by the Ministry of Health to identify the causes of perinatal deaths. It shows how good epidemiological investigation can be carried out in a developing country with many social and economic difficulties. It is no surprise that perinatal mortality is highest amongst women who do not have antental care, who are hypertensive during pregnancy, and who are anaemic. A surprise is that all types of perinatal death (antepartum, intrapartum, and postpartum) were associated with maternal syphilis. "In
the
mortality
John
hearts a
Bignall
News in brief
Guidelines for management of heart failure The eleventh in the Agency for Health : Care Policy and Research’s series of clinical practice guidelines is on left-ventricular systolic dysfunction. Although the assessment of patients for revascularisation and transplantation is discussed, this publication is a detailed guide to out-
patient care only. Angiotensin-converting
!
enzyme
(ACE)
Exercise is now recommended for patients with heart failure, though not necessarily in the context of a formal rehabilitation programme, unless the illness is severe or the patient feels the need for extra supervision says the panel. Exercise has not been shown to strengthen the failing heart, but peripheral muscular improvement increases patients’ ability to function. Recognising the problem of poor compliance in chronic diseases, the guide tries to encourage a partnership between the patient and the physician based on frank discussion. After recommendations on smoking, drinking, diet, and exercise, the accompanying patient guide says, "If you do not want to change the way you live or take medicines as prescribed ... explain your reasons to your health care
inhibitors are recommended to reduce the load on the heart and thereby arrest or slow the progress of heart failure at all stages, including mild and asymptomatic : disease. ACE inhibitors are not used widely enough or in sufficient doses, says the panel, because of fear of side effects. : However, the side-effects have been provider". shown to be less severe and limiting than The committee supports echocardiowas once feared. Furthermore, ACE and radionuclide ventriculography graphy inhibitors have ben shown by randomised in the initial assessment and diagnosis controlled trials to reduce both morbidity of heart failure, but they say there is no and mortality. Diuretics and digitalis-like evidence of the benefit of these expensive drugs have not been proven to reduce tests to monitor the course of the illness. mortality, in part because few randomised Symptoms indicate the success or failure controlled trials have been attempted. For of disease management adequately. The patients with mild dyspnoea on excertion, economic impact of the recommendations the guide says ACE inhibitors alone may will form phase II of the project. be sufficient. For moderate dyspnoea on exertion, or if clinical volume overload is evident, or if ACE inhitors alone do not resolve symptoms, diuretics should be Paul M Rowe added. If ACE inhibitors plus diuretics fail to resolve symptoms, or in cases of 1 Agency for Health Care Policy and research heart failure: evaluation and care of patients severe dyspnoea on exertion, the addition with left-ventricular systolic dysfunction of digoxin to the regimen is recommend(AHCPR pub no 94-0612). Rockville, ed. Still, some panel members continue to Maryland: 1994: Pp 120 (plus quick use digoxin routinely on all patients with reference and guide for patients and left ventricular systolic dysfunction. families). ,
US$379 million health-care fraud settlement A California-based hospital chain has agreed to plead guilty to charges of health-care fraud and to pay more than US$379 million in damages, civil fines, and criminal penalties, the largest such settlement in US history. According to the US Department of Justice, National Medical Enterprises (NME), Inc, paid doctors and others to refer federally insured patients to NME-owned facilities and then passed along the cost of these illegal kickbacks to the government by disguising them as reimbursable hospital expenses. The agreement also settles claims that the company admitted patients to its facilities unnecessarily and that it billed insurance programmes multiple times for the same service or for services not provided. The government will continue to pursue investigations of other companies and individuals who were involved in the alleged kickback schemes. Justice Department officials said that the size of the settlement should send a message that the Clinton administration has made health-care fraud a
major law-enforcement priority.
UK-Israel research agreement The British and Israeli governments have made an agreement to set aside funds GC100 000 per year for 3 years) to ensure joint scientific contacts. Philanthropic sources have pledged another jC 100 000 per year. Ten teams per year will be selected and funded equally in Britain and Israel. The research will focus on medical biotechonology, including molecular biology, electrooptics such as lasers, and materials
research,
especially
high-performance
materials.
123