A randomized questionnaire-based study on the impact of providing numerical information on colorectal cancer screening.

OBJECTIVES: To establish whether the provision of numerical data using pictograms and framed as event rates affects subjects' attitudes to colorectal cancer (CRC) screening. DESIGN: Randomized questionnaire and telephone study comparing a control group given standard NHS CRC information leaflets with an intervention group given the same leaflet but enhanced with additional numerical and pictorial information. SETTING: District General hospital and two general practices in North East England. Study carried out immediately prior to the introduction of CRC screening. PARTICIPANTS: A total of 478 non-gastroenterological subjects (age range 60-70 years). MAIN OUTCOME MEASURES: The difference in the two groups' overall wish to be screened; comparison of the impact of enhanced vs. unenhanced summary points in the NHS information leaflet; the summary point that most influenced their decision on screening; the views of the intervention group on the additional numerical and pictorial information provided. RESULTS: A total of 256 (54%) responded (124 from the control group and 117 from the intervention group); 22% were interviewed by telephone; 90% of the control group and 85% of the intervention group wished to be screened (P = 0.34). Provision of numerical and pictorial information significantly changed the impact of five of the six summary points on the decision to be screened. Sixty-two percent of the intervention group found the pictograms helpful while 83% of those interviewed by telephone found the numerical data helpful; 73% of the control group when given by telephone the additional numerical information given to the intervention group said this would have been useful in aiding their decision-making. CONCLUSION: Providing additional numerical information would enhance the credibility of the screening programme without necessarily reducing the numbers screened.

"The cry of a trapped heart".

We present a case referred for endoscopy because of symptoms of dyspepsia and abnormal liver function tests. These more obvious symptoms masked an underlying history of shortness of breath on exertion and mild bipedal oedema. Physical examination revealed a raised jugular venous pulse with pulsus parodoxus, hepatomegaly, mild ascites and slight bipedal oedema. Investigations confirmed the presence of idiopathic calcific constrictive pericarditis. An early surgical pericardiectomy led to resolution of symptoms and signs, and a normalisation of liver biochemistry.

Assisting international medical graduates applying for their first post in the UK: what should be done?

The number of international medical graduates (IMGs) passing the Professional and Linguistic Assessment Board (PLAB) examination was six times greater in 2004 than in 2000. This has resulted in unprecedented numbers of applicants for junior posts, with some attracting over 1,000 overseas graduates. The Royal College of Physicians working group on IMGs was established in 2004 to address the problems that face newly qualified IMGs. The group has ascertained and now publishes current levels of competition for junior posts in order to inform overseas graduates of the levels of competition they are likely to encounter. The group is seeking ways of selecting applicants when such large numbers apply for posts and is looking at ways of improving clinical attachments. The paper considers these and other difficulties that IMGs face when they first seek employment in the UK and discusses possible solutions.