Where information from randomised controlled trials is available it is included. However, many health issues do not lend themselves easily to investigation, or have not yet been studied, by this method. In these cases, high quality evidence has been sought from observational and other studies.

The Bulletins are applicable to a wide variety of settings;

• to assist Health Authorities with the planning and commissioning of healthcare

• to inform clinical practice

• to assist continuing education and audit

• to inform the development of the undergraduate and other curricula

• to identify potential areas for further research

Bulletins currently available are underlined. Others will become available during the year.

Medscape is one to watch as it has just been taken over by George Lundberg, who, as readers of the BMJ will know, was recently sacked from JAMA for publishing an article on sexual activity relevant to President Clinton’s recent danger of impeachment.

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This was the heading of a recent BMJ article about the National Institute for Clinical Excellence (NICE). Professor Sir Michael Rawlins, its chairman, said the most important thing on his agenda is to gain the early confidence of the health professions, as well as the public and parliament.

Sir Michael appeared before the Commons health committee as the government issued a discussion paper on how NICE intends to proceed. In a foreword, the health secretary, Frank Dobson, states that NICE will sort out the "wheat from the chaff" and protect patients from outdated and inefficient treatment.

Sir Michael described the functions of NICE as: to appraise all new technologies for their clinical and cost effectiveness and advise whether they should be in routine use in the NHS or not; to disseminate clinical guidelines based on clear scrutiny of the scientific literature in a form that is practical and useful to health professionals; and thirdly, to develop and promote clinical audit.

The discussion document gives details of how the NICE appraisal process will work. Initially it will select about 20-30 new interventions each year for appraisal and recommend which are suitable for routine clinical use in the NHS.

This is a shortened version of a recent BMJ article. Routine neonatal examination is universally accepted as good practice. No one has yet been brave enough to address the question with a randomised trial. A study from Aberdeen tells us firmly that one examination is sufficient, there is no need for a follow-up examination.

No benefits from a second examination were detected in a sample of 10,000 babies, though the study lacked the power confidently to compare outcomes for congenital dislocation of the hip and serious heart disease.

The examination and its individual components are, therefore, a form of screening and can be evaluated as such. Few of the target conditions meet the classic criteria for a screening test. Much of the anxiety expressed by many general practitioners about examining new-born infants is focused on two conditions, heart disease and congenital dislocation of the hips.

The Aberdeen group, like many others, noted that several cases of hip dislocation were missed. Screening for congenital dislocation of the hip is still problematic – and primary screening by ultrasound is not the answer. The most serious forms of congenital heart disease usually present within the first few days and demand prompt investigation. The concern is about missing defects that might present after the baby leaves the hospital and have rapidly progressive symptoms.

Phrase: It has long been known - Translation: I haven't bothered to look up the reference.

Phrase: It is generally believed. - Translation: A couple of other guys think so too

Phrase: The 4 hour sample was not studied - Translation: I dropped it on the floor