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Objectives: The cost‐effectiveness of routine cervical cytology during follow‐up after treatment for carcinoma of cervix is examined. Subjects: All patients having routine follow‐up smears during the financial year 1993–1994. A total of 212 patients generated 311 smears, 96 had an intact cervix and 116 had surgical removal as part of their treatment. Ninety‐one patients with intact cervices and 109 without were evaluable. Results: Nine recurrences were detected, in every case this was expected, based on clinical findings. In two of these the smear was reported as normal. Two hundred and thirty smears were from entirely asymptomatic patients. Conclusions: Limiting cervical smears to those who are symptomatic, or where an abnormality is found on examination, would save approximately £3500 per year. This cost needs to be set beside the possibility of detecting an asymptomatic recurrence at an early stage; as reported by others. This suggests that the impact of this strategy is limited. A randomized trial with prospective economic assessment would be the only way to evaluate the cost‐effectiveness of routine cervical smears in the follow‐up of patients treated for cancer of cervix.

Considers recent developments that encourage the exploration of the potential of computers. Gives current examples of their treatment “as theatre” or to explore a novel “space of expression”. New design guidelines are emerging shaped by a foundational switch in approaches to thinking and doing. This shift is underwritten by recent findings in second‐order cybernetics concerning the importance of the orthogonal intersection of a variety of motor‐sensory correlations, for effective behaviour in a particular domain of action. Describes a recently built system which is representative of this shift. Theseus is both a methodology for multimedia applications and a model for learning a concrete implementation in the shape of a stand‐alone, multimedia training package.

Dynamics of population mutagenesis during 22 consecutive generations of animals, as well as genetic radioadaptation were studied in natural populations of small mammals (bank voles) under chronic low‐intensive irradiation due to the Chernobyl accident. The data obtained point to oppositely directed processes in irradiated populations: accumulation of mutations (genetic load of populations) and formation of genetic radioadaptation. It is suggested that the frequencies of genetic damages in populations could be higher in the absence of radioadaptation process. A relationship between the frequencies of cytogenetic injuries and low doses of radiation was revealed in animal generations studied. The non‐linear dose‐effect curves are most likely to be defined by the complicated microevolutionary processes in populations. The results obtained indicate the absence of genetic effect threshold of low dose radiation. Besides, they show that a dependence of cytogenetic effects on radiation low doses in series of irradiated generations cannot be revealed using linear equations.

Describes the exploratory use of a statistical technique called data envelopment analysis (DEA), which has been widely used in other parts of the service sector, to measure the efficiency of 52 general practices in three health districts, serving 378,500 patients (78 per cent of the resident population). DEA identified over half (60 per cent) of the 52 practices as less than 100 per cent efficient, with 25 per cent potentially capable of large increases in activity without higher resource levels. There was no significant relationship between efficiency and whether partnerships were training practices, computerized, holding regular meetings, or the total list size, or age structure of practice populations except that multi‐site practices were found to be significantly more efficient as list size increased. DEA efficiency ratings were compared with a proxy for effectiveness (the ability of practices to reach target levels set in the new GP contract). Practices which were below target levels before the new contract was introduced were far less likely to be able to reach these targets once the contract was in place if they had been classified by DEA as 100 per cent efficient (i.e. judged to be unable to achieve greater outputs without increased resources). More research effort now needs to be devoted to exploring the use of DEA in measuring efficiency in general practice, and to examining the relationship between measures of efficiency and effectiveness in primary care.

Lung cancer is the leading cause of death worldwide. Physical and chemical agents such as tobacco smoke are the leading cause of various lung cancers. The intrinsic heterogeneity of normal lung tissue may be affected in different ways, giving rise to different types of lung cancers classified as either small‐cell lung cancer (SCLC) or non‐small cell lung cancer (NSCLC). Adenocarcinoma, a NSCLC, accounts for 40 percent of all lung cancer cases and the incidence is increasing worldwide, especially among women. The survival rate and prognosis is poorest for adenocarcinoma. Therefore, diagnosis at the earliest stage (Stage I, localized) is critical for increasing survival rates of those suffering from lung cancer. However, many factors affect early diagnosis including the variable natural growth of tumors plus technological and human factors associated with manipulation of tissue samples and interpretation of results. This article reviews potential problems associated with diagnosing lung cancer and considers future directions of diagnostic technology.

The focus of the paper is on the relationship between General Practitioners (GPs) and central government. This relationship dates from the introduction of national health insurance in the UK. From the outset it had an impact on GPs’ medical role, their professional status and income. The structure created in 1911 meant that GPs operated as franchisees and, notwithstanding Labour’s policy objective of creating a salaried service, this role continued, effectively unchanged, after the creation of the National Health Service (NHS) in 1948. General Practice was also the poor relation in contrast to hospital medicine, a feature intensified by the priorities of the NHS. These forces meant that GPs had a dual role: that of clinician and gatekeeper to specialist hospital services, a role in which they exercised substantial clinical freedom: and running a small business, a feature which was exaggerated by the absence of grant aid to improve premises prior to the Family Doctor Charter of 1965. This structural relationship has been progressively transformed by changes in the 1980s and 1990s. On the one hand the emphasis on cost control has seen central government attempting to combine a financial with a clinical gatekeeping role. The crucial change in this respect is the creation of GP fundholding which, in turn, could be seen to have implications for the subordinate status of GPs within the medical profession. However, this has been combined with trends to greater measures of control over GPs. Of central importance in this respect were the changes introduced by the 1990 GP contract. The contract involved an attempt to substantially reduce clinical autonomy by building in much more detailed contractual duties with respect for example, to health promotion activities. This was combined with the use of financial incentives to reach, for example, immunization targets. Control over clinical autonomy has also involved constraints over prescribing and the shift from Family Practitioner Committees to Family Health Service Authorities. The rationale for this shift is the move from an administrative to a managerial body, acting as the agent of central government in enforcing the contract and imposing financial norms. GPs are thus to be made managerially accountable. The paper analyses the place of general practitioners in central government’s approach to health strategy and examines the tensions generated by the combination of conferring new powers on GPs and increasing controls over them. These tensions are related to current disputes over out‐of‐hours working and attempts by GPs to redefine a “core of service” approach to their job. The ambiguities of reliance on professionals combined with the desire to exert greater controls is traced in the recent policy statement by the Secretary of State Primary Care: The Future (1996). The paper thus aims to contribute to the critical discussion of the impact of central government managerialist initiative on key professional groups in the welfare state.

Following two pilot studies, Clinical Pathology Accreditation (CPA) accreditation was introduced to UK pathology laboratories in 1992. Since then, significant numbers of laboratories have undergone accreditation but many have never applied. We carried out a postal survey of 145 accredited laboratories in the UK to independently determine the opinions of laboratory managers/clinicians about CPA and whether accreditation had produced any significant benefits to pathology services. Ninety‐three replies were received (64 per cent) a good response to an unsolicited questionnaire. Most laboratories felt accreditation by CPA had resulted in better laboratory performance with more documentation and better health and safety and training procedures. CPA accreditation was believed to provide useful information by approximately 50 per cent of laboratories but was also felt by a significant proportion of laboratories to be over‐bureaucratic, inefficient and expensive (46 of 93 respondents). Many complaints were voiced about the excessive paperwork that CPA generated and there was also a significant body of opinion that felt that CPA assessed areas were the domain of other regulatory bodies such as the CPSM, IBMS and HSE.

The purpose of this paper is to screen cytotoxic activities of commonly used culinary plants in Malaysia, Pandanus amaryllifolius (daun pandan), Curcuma longa (turmeric leaves) and Etlingera elatior (kantan flower) against selected cancer cell lines.

Plant samples were extracted exhaustively with ethanol and concentrated under rotary evaporator. Cytotoxic evaluation was carried out with plant extracts (0‐100 μg/ml) using 72‐h MTT assay.

Exposure of plant extracts reduced cell viability of HepG2 (hepatocellular carcinoma), HT‐29 (colon carcinoma), MDA‐MB‐231 (non‐hormone‐dependent breast cancer), MCF‐7 (hormone‐dependent breast cancer) and HeLa (cervical cancer); 50 percent inhibitory values (IC₅₀) were obtained for MDA‐MB‐231, HepG2, HT‐29. Extracts within the concentrations of 10‐100 μg/ml were found not to be effective against proliferation of MCF‐7 and HeLa.

The paper shows how culinary plants – daun pandan, turmeric leaves and kantan flower displayed selective cytotoxic effects towards liver, colon and breast cancer in vitro.