A case study of a graphical misrepresentation: drawing the wrong conclusions about the measles, mumps and rubella virus vaccine.

Graphs have been used in attempts to show a relationship between the measles, mumps and rubella virus (MMR) vaccine and autism. We examine the topic of graphical representation of data in general, and one of these graphs in particular: the one that appeared in a 1999 letter to The Lancet. That graph combined data from England and from California, USA. The author alleged that this graph illustrated a rise in autism rates linked to the use of the MMR vaccine. By examining the presentation closely, we are able to show how this graph misrepresented the data used. We give advice for both authors and publishers in the use of such graphical treatments of data.     

Midwives' support needs as childbirth changes

This paper reports on midwives' support needs as they were described by midwives in a large study of the supervision of midwives in England. The data are derived from six sites: five, very different, National Health Service (NHS) sites, and one composed of midwives outside the NHS. In-depth, ethnographic interviews were conducted with 168 midwives and a grounded theory approach was used for the analysis. The findings identified midwives' many and varied support needs. Midwives also clearly described the culture of midwifery in the NHS. This culture inhibited midwives from arranging to have their support needs met and acted as an obstacle to progress in developing midwifery practice. The dilemmas and tensions inherent in this situation are explored and suggestions made as to the way forward.     

A pilot study of intraperitoneal cisplatin in the management of gastric cancer

BACKGROUND: This phase II trial was designed to evaluate the feasibility,toxicity, relapse pattern and survival following adjuvant intraperitonealcisplatin in patients with gastric cancer at high risk of relapse. PATIENTS AND METHODS: Patients who had undergone complete surgical resection of adenocarcinomaof the stomach and who had positive serosa and/or regional lymphnodes and/or peritoneal washings has insertion of either a Tenckhoffcatheter or temporary peritoneal dialysis catheter and weretreated with cisplatin 60 mg/m² intraperitoneally every 21 daysfor 4–6 courses. Peritoneal lavage or cytology was donebefore each treatment. RESULTS: Eighteen patients were studied. Seventeen patients had serosalinvolvement, 11 had regional lymph node involvement and 2 hadpositive peritoneal washings before treatment. The median numberof courses of chemotherapy was 4 (range 2–6). Radioisotopetracer studies (6 patients) showed good distribution throughoutthe peritoneal cavity. No WHO grade 3/4 toxicity was seen. Twelvepatients (67%) have relapsed, 6 (33%) intra-abdominally, 4 (22%)with hepatic metastases and 2 (11%) outside the abdominal cavity.The median survival was 17 months. CONCLUSIONS: Cisplatin can be administered safely as adjuvant therapy topatients with gastric cancer, however, as single agent therapythe pattern of relapse and subsequent death was similar to thatexpected. The occurrence of distant metastases may argue forsystemic rather than local adjuvant treatment. gastric cancer, intraperitoneal cisplatin     

U.K. guidelines for the management of cutaneous melanoma

These guidelines for management of cutaneous melanoma present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation. To reflect the collaborative process for the U.K., they are subject to dual publication in the British Journal of Dermatology and the British Journal of Plastic Surgery.     

Spinal deformity in the adolescent athlete

Today more and more children with diagnoses of adolescent spinal deformity are participating in athletic competitions. Certain sports appear to have an increased association with spinal deformity, especially in the adolescent female population. Modern treatment techniques including bracing will allow participation in most athletic endeavors. Those treated with surgery need to have their postoperative care individualized. However, modern surgical techniques still allow continued participation in most activities.     

Intelligence after stroke in childhood: review of the literature and suggestions for future research

Review of published clinical and neuropsychologic outcome studies reveals limited information about intellectual functioning after childhood stroke. The extant data are supplemented here by analysis of intelligence quotient (IQ) results obtained from 38 children in an ongoing study of unilateral middle cerebral artery ischemic stroke. Evidence so far indicates that, after stroke, mean IQ falls significantly below the population mean but remains within the average range. There is no significant difference between hemispheric side of injury; the Verbal and Performance IQ lateralization profile widely recognized in adults with unilateral injury is not apparent in younger children, and there is only a trend toward this profile in older children. The effects of a number of other variables, including sex, site of stroke, and longitudinal assessment, are also considered. Although the generally minor effect of stroke on IQ is encouraging, a number of children do require extra help on return to school. Some suggestions for future research are highlighted in order to encourage further consideration of the issues raised here.     

Gingival squamous cell carcinoma appearing as a benign lesion: report of case

A case of a 37-year-old female who had a squamous cell carcinoma on the attached gingiva is discussed. The report emphasizes the importance of a correct diagnosis of all lesions, including lesions that appear atypical. A brief review of the literature also is presented.     

An audit of anti-D sensitisation in Yorkshire

Objective To determine the likely factors that contribute to RhD sensitisation.
Design Retrospective study of all new cases of RhD sensitisation occurring between 1988 and 1991.
Setting Leeds Blood Centre, National Blood Service, Yorkshire.
Population One hundred and forty-seven cases of RhD sensitisation from 15 obstetric units within the Yorkshire region, of which 129 (312 pregnancies) could be assessed.
Main outcome measures Identification of potential immunising events and adherence with recommendations on anti-D immunoglobulin administration.
Results Twenty-eight women (22%) had immune anti-D antibodies during their first pregnancy or at delivery and 50 (39%) in their second pregnancy. Overall, 98 potential immunising events were identified in 62 women, excluding delivery; 67 women (52%) had no events, other than delivery. Miscarriages and medical terminations of pregnancy accounted for 81% of all identified events. Iatrogenic failure to adhere to recommendations for the administration of anti-D immunoglobulin occurred in a significant proportion of women who subsequently developed immune anti-D antibodies. Anti-D immunoglobulin failed to protect against immunisation despite adherence to the protocol in 20 events (20%), 13 of which involved miscarriages or termination of pregnancy < 20 weeks of gestation. Potentially, antenatal prophylaxis might have prevented 86% of immunisations that were identified during the first pregnancy.
Conclusions The introduction of antenatal administration of anti-D immunoglobulin could significantly reduce the level of sensitisation in primigravidae, and adherence to recommendations for administration of anti-D immunoglobulin could be improved. Consideration should be given to reviewing the current recommendation that a dose of 250 IU of anti-D immunoglobulin is adequate following termination of pregnancy before a gestational age of 20 weeks.