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Nstrict, to choke). People taking a clinical history will understand that a variety of descriptions is utilized, including tightening, a lump inside the throat, stress, indigestion, wind, along with a need to have to maintain swallowing. Frequently a series of phrases for instance “I mean” or “you know” is used because the patient struggles to seek out words to get a sensation for PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20085829 which no shared language exists. Other forms of angina (Ludwig’s and Vincent’s) have now successfully disappeared so the qualification “pectoris” is largely redundant. TheBMJ VOLUME 317 29 AUGUST 1998 www.bmj.comExtra cost of subcutaneous apomorphine would pay for individual nursesEditor–In their editorial Chaudhuri and Clough advocate a higher use of subcutaneous apomorphine in patients with Parkinson’s illness and point out that a prefilled variable dose pen injector has not too long ago develop into out there.1 My local pharmacist informed me from the enhance in expense when a patient is switched for the use of these pens. My patient’s dose of apomorphine supplied in conventional vials fees 200 monthly; exactly the same dose supplied in injector pens fees 225 a month. I telephoned the manufacturer, Britannia Pharmaceuticals, to find out if there had been some error inside the pricing structure. I was told that the difference in cost was right and justified as the firm was hoping to recoup the expenses incurred in developing the pen injection method. That is surprising given that the technology has already been nicely created for insulin, at an increase of only 50 more than the cost of insulin in vials.Enhancing spend and working circumstances is superior than merely rewarding healthcare teamsEditor–I read with admiration, interest, amusement, and some sadness the editorial on rewarding healthcare teams by Bloor and Maynard.1 My admiration is for Maynard’s persistence. He has for a lot of years advocated the α-Cyperone site replacement of medical doctors by other healthcare experts as well as the abolition of distinction awards. He manages to mount a range of interesting option solutions to justify this. The only issue that he forgot to introduce in this editorial was his recent (and equally damaging and superficial) suggestion that not just ought to we replace doctors with nurse practitioners but that we really should make up for any remaining shortageLetterssensation of infarction is comparable but unrelieved by rest or vasodilators. The authors note the energy of television drama in conveying the incorrect image of a heart attack, which can be of a fat, red faced man suddenly gasping and clutching at his tie. Certainly the answer must be to supply the media with superior descriptions. Real depictions in the onset and evolution of myocardial infarction in EastEnders along with the Archers would be considerably more valuable than pamphlets that wrongly, it seems, instruct the public to look out for 15 minutes of central chest discomfort because the hallmark of heart attack.Tom Treasure Professor of cardiothoracic surgery St George’s Hospital, London SW17 0QT1 Ruston A, Clayton J, Calnan M. Patients’ action in the course of their cardiac occasion: qualitative study exploring differences and modifiable elements. [With commentary by J Green.] BMJ 1998;316:1060-5. (4 April.)in six months in accident and emergency. Much less than a third of those senior property officers intend to pursue a profession in surgery or accident and emergency.five The shortening of working hours and coaching of junior physicians makes it a lot more crucial than ever that instruction is effective; each clinical knowledge and formal teaching must be relevant. Priority of locations on advanc.