Ministers are preparing to ban a clutch of antibiotics used routinely by farmers to make animals grow more quickly, which they fear are leading to the creation of drug-resistant bacteria.

Ministers are expected to make an announcement on phasing out the antibiotics soon. They fear that unless action is taken, the superbugs could spark a BSE-style health scare.

The move would lead to a massive overhaul in farming practices and would be a blow to intensive agriculture and drug companies. But public health advisers, consumer groups and environmentalists would welcome it.

Last year the Government’s Public Health Laboratory Service reported that one in six salmonella infections – the commonest cause of food poisoning – was by a strain resistant to at least four drugs.

A recent Effective Health Care Bulletin underlined the importance of cataract surgery.

The bulletin on management of cataracts has clear messages for primary and secondary health care and for patients. It tells us these things:-

Cataract surgery is highly effective - with improved levels of visual acuity in some 95% of patients. Since experience is that cataracts don't get better without treatment, this equates to a NNT of about 1.05 - a very effective treatment.

Cataract surgery is cost effective - but perhaps 20% of patients need laser treatment within two years of surgery for opacification of the posterior capsule.

Other adverse events are rare.

Day case surgery is as effective as inpatient surgery, is about 30% cheaper and acceptable to patients. Around 80% of cataract operations could be done as day cases - four times as many as now.

In December’s Evidence-Based Health Policy and Management, Professor Adrian Dixon highlights both the dangers from ‘imported’ guidelines and the fact that the UK is at times ahead of the game in evidence based medicine, at least on paper.

Dixon questions the archaic nature of the Canadian guidelines, which recommend an ‘oblique view’ that is never routinely used in the UK, thus demonstrating the differences in international clinical practice.

In 1995 UK guidelines recommend X-rays of the lumbar spine were not routinely indicated for back pain.³ Dixon proposes that patients with no adverse effects should not receive any imaging until conservative treatment has failed.

There will always be concern that serious spinal pathology might be missed, but Dixon points out that simple and readily available test, such as the erythrocyte sedimentation rate will help identify most patients with important disc space infections or tumours.

Dixon AK. Commentary. Evidence-Based Health policy and Management Dec 1998;12 Supplement: 98-99.

Suarez-Almazor ME, Belseck E, Russel AS, Mackel JV. Use of lumbar radiographs for the early diagnosis of low back pain: proposed guidelines would increase utilisation. JAMA 1997;277:1782-1786.

An article by Hofer and Hayward in Medical Care, some years ago, examined whether risk-adjusted mortality rates are a feasible indicator for identifying poor-quality hospitals. The researchers found that mortality rates were probably not accurate in identifying the overall quality of a hospital, and that attempts to base punitive measures on high mortality rates would penalise good or average hospitals.

In an accompanying editorial, magazine editors call this research important because many health care stakeholders are calling for methods like risk-adjusted mortality rates to evaluate medical facilities.

There is also the opportunity to offer advice on optimal search strategies and specialist information sources on the spot.

Randomised controlled trials of social interventions are rare. A recent Bandolier described a trial to prevent recurrent homelessness in mentally ill men in New York.

The study population was 102 men discharged to housing in New York City region in 1991-93. All the men had severe mental illness, usually schizophrenia. Randomisation was between usual services only, and a critical time intervention. The critical time was defined as the first month after discharge, and the intervention included a range of services provided by a worker with no special skills, though supervised by a mental health professional. The workers were "street smart", and gave as much as was needed by individual patients.