EDITORIAL

146 Implementation of guidelines for the prevention of cardiovascular diseases in Europe: Problems and challenges. Is the SCORE prediction system useful, or does it do more harm than good? Guidelines for cardiovascular risk assessment in Europe are now based on the SCORE system described by Graham in this issue. In their editorial Gjelvik and Brekke raise some important issues arising from this risk scoring system that need to be taken into consideration by GPs. ORIGINAL ARTICLES 148 The importance of total cardiovascular risk assessment in clinical practice At one time risk predictions for cardiovascular disease worldwide were based on a population study in Framingham in the United States. In 1994 the European Cardiology Society initiated the SCORE project to provide data specific to Europe. On the basis of risks calculated using this scoring system amended guidelines have been issued by the Third Joint European Task Force. These are described and their implications are discussed by Graham who was one of the authors of these revised guidelines. 156 Auditing secondary prevention of ischaemic heart disease in rural areas of Spain: An opportunity for improvement There are now a range of therapies proposed to reduce the risk of further events in patients who have had an event indicating ischaemic heart disease. Several studies have shown that not all patients who might benefit from such interventions receive them. Turon and colleagues have sought to determine what these factors are in rural Spain. 163 Quality of oral anticoagulation in patients with atrial fibrillation: a cross-sectional study in general practice Patients on oral anti-coaggulant therapy used to be monitored entirely in hospital. Nowadays, though, this is increasingly done in general practice and hence the quality of the care of these patients in now a general practice issue. Neree reports on an audit of such patients in Belgium. 169 Comparing costs of intramuscular and oral vitamin B₁₂administration in primary care: A cost-minimization analysis Vitamin B12 is commonly administered by general practitioners and has traditionally been given intramuscularly. However, high dose oral treatment may be equally effective. This being so raises other issues such as the comparative cost effectiveness of the two modes of administration. This is the subject of the study in this issue by Vidal Alaball and colleagues. 174 Job satisfaction among general practitioners: a systematic review A lot has been written about determinants of job satisfaction in general practitioners some of it, seemingly, contradictory. Van Ham and colleagues have undertaken a systematic review of the literature to try and identify those factors associated with increased and decreased job satisfaction. BRIEF RESEARCH REPORTS 181 Gikas and colleagues report on an audit of glycaemic and lipid control in Greek primary care. De Jong and Largo-Janssen report on the operation of the ‘glass ceiling’ for females in academic general practice in Western Europe. CASE REPORT 185 Van der Schueren provide us with an interesting and novel case report in which inexperience of life in general practice, rather than a lack of medical knowledge, was the source of a problem for a young physician. Money in a commentary draws out some of the wider implications of the case for us all.