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Comment

Quality improvement in the NHS

After more than a decade of reforms to the NHS in England, a Nuffield Trust report says a national quality programme is now needed. Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine, identifies four key challenges if quality improvement is to gain prestige and take its rightful place alongside highly respected activities such as research and education.

Research

Treating hypertension

The first of three research papers in this hypertension themed issue compares the effects of different regimens for reducing blood pressure in different age groups. An accompanying editorial says the paper provides strong support for blood pressure lowering drugs in elderly patients with hypertension. Have your say on the poll. The second paper and editorial looks at the accuracy of mean arterial pressure and blood pressure measurements in predicting pre-eclampsia. Finally, knowing daily patterns of use can help to explain poor blood pressure control. This study found that almost half of patients took at least one drug holiday a year, and poor daily adherence predicted early stopping of treatment.

Students

Flank pain radiating to the suprapubic region

A 33 year old woman presented at the urology department with a two year history of intermittent flank pain radiating to the suprapubic region. She had no medical or family history of note. Test yourself on our latest picture quiz. Iona Meryon and colleagues take us step by step through the diagnosis and management.

Careers

Working as a GP in the private sector

Every considered working as a GP for the UK private sector? Find out more about the career opportunities and potential contractual issues.

Comment

GPs filling the gap left by inadequate dental services

A shortage of NHS dentists in the UK means that GPs are doing their work without adequate remuneration, writes Alastair Bint. An increasing number of patients are visiting GP surgeries with dental problems. Dr Bint recorded a 1600% rise in the number of dental related consultations over the past 10 years in his Surrey practice of more than 10 000 registered patients.

Comment

Top grades not always needed to become a doctor

In 2001 King's College London launched its six-year extended medical degree programme (EMDP). Aimed at students from inner London's 15 most educationally deprived boroughs, the first students had average A level grades of CCC. How successful has it been? EMDP course director Pamela B Garlick and Gavin Brown, a lecturer in human geography, investigate.

Comment

Can a cell have a soul?

In the week that the UK parliament debates controversial amendments to the 1990 Human Fertilisation and Embryology Act, Professor John Burn, director of the Institute of Human Genetics at Newcastle University, asks at what point a cell becomes a human.

News

Darzi's five pledges fail to quell doctors' anxieties about polyclinics

Government reassurances over imminent reform of the NHS have failed to calm doctors' fears that large health centres, or "polyclinics", will become mandatory in all primary care trusts in England. The junior health minister Ara Darzi (pictured) has issued five pledges about how the changes to the NHS - expected to be announced next month - will be achieved, emphasising the central role of clinicians in any local decisions to change services.