one from the past im afraid;
http://www.youtube.com/watch?v=jtCNbERKvMs
and;
http://www.youtube.com/watch?v=RC2tlNmz4ao
Friday 27 December 2013
Tuesday 24 December 2013
Stoneage Diet = Paleo diet
Interesting diet, one which we as a species are physiologically designed ?
http://en.wikipedia.org/wiki/Paleolithic_diet
http://en.wikipedia.org/wiki/Paleolithic_diet
Wednesday 4 December 2013
Tuesday 3 December 2013
Thursday 7 November 2013
Thursday 31 October 2013
Tuesday 29 October 2013
Economics and bunk
an interesting view from Prof Steve Keen;
http://www.bbc.co.uk/programmes/b01j5h51
Quantitative easing and the road to eroded savings with Liam Halligan;
http://www.bbc.co.uk/programmes/b03dfpjt
and Upside down management, an interesting episode esp about employing felons;
http://www.bbc.co.uk/programmes/b03dvgh3
http://www.bbc.co.uk/programmes/b01j5h51
Quantitative easing and the road to eroded savings with Liam Halligan;
http://www.bbc.co.uk/programmes/b03dfpjt
and Upside down management, an interesting episode esp about employing felons;
http://www.bbc.co.uk/programmes/b03dvgh3
Tuesday 22 October 2013
Thursday 10 October 2013
Annual allowances NHS Pensions
the NHS pot increases by CPI and and index usually + 1.5%
this link is to historical CPI's - the one chosen for pensions is the september one;
http://www.swanlowpark.co.uk/cpirpimonthly.jsp
the NHS pension folk will send on a AA statement now - you need to be aware of the count back rule for AA allowances you can bring forward, the following link allows you to put the NHS figures into the HMRC calculator to calculate if you have run foul of the AA limit and owe them tax !!
http://www.hmrc.gov.uk/tools/pension-allowance/calculator.htm
there is no protection for AA like there is for the LTA.
you can stop contributing, but the pot will still inflate by the CPI + ? figure.
currently AA = 50K [Oct 2013]
April 2014 -> = 40K
this link is to historical CPI's - the one chosen for pensions is the september one;
http://www.swanlowpark.co.uk/cpirpimonthly.jsp
the NHS pension folk will send on a AA statement now - you need to be aware of the count back rule for AA allowances you can bring forward, the following link allows you to put the NHS figures into the HMRC calculator to calculate if you have run foul of the AA limit and owe them tax !!
http://www.hmrc.gov.uk/tools/pension-allowance/calculator.htm
there is no protection for AA like there is for the LTA.
you can stop contributing, but the pot will still inflate by the CPI + ? figure.
currently AA = 50K [Oct 2013]
April 2014 -> = 40K
Saturday 28 September 2013
Tuesday 17 September 2013
Tarrif 2013-2014
link to ye tarrif;
https://www.gov.uk/government/publications/payment-by-results-pbr-operational-guidance-and-tariffs
3rd down - link to tarrif spreadsheet
hit this and you will get the xls spreadsheet with procedural costings
https://www.gov.uk/government/publications/payment-by-results-pbr-operational-guidance-and-tariffs
3rd down - link to tarrif spreadsheet
hit this and you will get the xls spreadsheet with procedural costings
Wednesday 11 September 2013
Hepatitis B vaccines and GMS contract
one may ask from a business perspective what is the point of stocking them?
http://bma.org.uk/practical-support-at-work/doctors-as-managers/managing-your-practice/focus-hepatitis-b-immunisations
http://bma.org.uk/practical-support-at-work/doctors-as-managers/managing-your-practice/focus-hepatitis-b-immunisations
Friday 6 September 2013
Mead and its making
my only attempts so far have been emergency cysers (freezer failed last summer - defrosted soft fruit mix used as base with washings etc.).
but to summarise some advice from some on BKF -
1.
Having spent the day making some mead I think I can divulge the recipe that we used. apparently 6 hours isn't enough and it'll take at least 6 months before we can try it but we were coached by one of our local award winners so I'm hoping this works out but it is based on her "I know it's right by the taste of the honey/water mix" method.
3lbs+Cappings (I reckon approx 2.5lbs of honey on its own would do it, we used 8lbs of cappings in the end as most of the honey was in the bottom)
1/2 teaspoon Yeast Extract (marmite for the less commercially conscious)
1 cup black tea (for the tannin)
Wine yeast, about half a teaspoon
Table spoon of Lemon Juice.
Wash the cappings in 4pints warm water until honey dissolved. (you can use a hydrowhatsimacallit to be precise on this, I believe you want it be about 1.12-1.15 which should get you to around 13-15% alcohol)
While you're faffing around with dissolving the honey in the water sterilise a Demi-John using 1tsp Sodium Metabisulphate to a pint of water. Pour into the demijohn bung it up and leave it for at least 15 minutes.
Once sterilised, rinse thoroughly with water.
Dissolve the Marmite in the cold tea.
Add the yeast to the demijohn first
Then add the tea, lemon juice, honey/water solution and top up with water if necessary so it's just under the bottom of the neck. Add the airlock to the top and leave in a warm place and it should start to ferment and you'll see bubbles in the liquor and glugging from the airlock.
After 1-3 months depending on the speed of fermentation the bubbling will cease and the Mead will clear leaving sediment on the bottom. At this point, rack it off to another, sterile, demijohn and keep until bottling.
Older the better. Apparently the Buckfast abbey boys recommend maturing in oak barrels for 10 years. Here 6 months of preferably a year was recommended.
2.
Having studied brewing microbiology, being scottish and naturally lazy I have a low effort technique I can suggest for comparison.
Firstly - use the washings from cleaning your extraction equipment. if you use warm water to rinse the extractor into the filters and then into the buckets you can probably recover about a pound of honey that would otherwise go down the drain. Little and often recovers the honey with the least dilution and it cheers up a boring task.
Secondly - do not sterilise it. I am persuaded that there are all sorts of goodies in honey that are destroyed by heating and I hate the taste of sulphur dioxide. All equipement should be cleaned and then given a final rinse with tap water. Your ferment is most definitely not sterile, but the real danger is adding a dose of vinegar bacteria that have been lurking in the bottom of some old kit that was not properly cleaned last time round!
Thirdly - no measuring of weights or volumes, just use a hydrometer to get the specific gravity above at least 1.085. If you are not sterilising you need to give the yeast as much of a competitive advantage as possible so the liquor needs to be nice and sugary.
Fourthly - give a massive overdose of your chosen yeast. I use champagne yeast that I have started in a properly sterilised bottle well before I start to extract my honey. Make up at least a litre and make sure it is working well before it is added to the brew. You want it to take over immediately! Not all yeasts ferment to alcohol. Some go to polysaccharides ( wall paper paste anyone?) and I had one beer fermentation that produced a foam like polystyrene.
Fifthly - make sure the yeast is fed. I agree with the argument that honey is lacking in protein. I use yeast nutrient, but am very taken with a previous posters suggestion of marmite. I do know that yeast loves vitamins and organic acids - my old tutor swore by malic acid from apples but citric and ascorbic ( Vitamin C) also seem to work well.
Sixthly - keep the yeast happy. Warm, no changes in temperature, no drafts and regular feeding with more honey ( not too much or you can give it osmotic shock).
As a further cost saving, I use 2L PET pop bottles with the bubblers glued in with hot glue. Cheaper and easier to clean than demijohns and less dangerous than glass if you do misjudge it and let them explode.
My mead making is basically tied onto the end of cleaning up the honey extraction. All you need is a yeast culture, a hydrometer and some old pop bottles to get a real bonus.
but to summarise some advice from some on BKF -
1.
Having spent the day making some mead I think I can divulge the recipe that we used. apparently 6 hours isn't enough and it'll take at least 6 months before we can try it but we were coached by one of our local award winners so I'm hoping this works out but it is based on her "I know it's right by the taste of the honey/water mix" method.
3lbs+Cappings (I reckon approx 2.5lbs of honey on its own would do it, we used 8lbs of cappings in the end as most of the honey was in the bottom)
1/2 teaspoon Yeast Extract (marmite for the less commercially conscious)
1 cup black tea (for the tannin)
Wine yeast, about half a teaspoon
Table spoon of Lemon Juice.
Wash the cappings in 4pints warm water until honey dissolved. (you can use a hydrowhatsimacallit to be precise on this, I believe you want it be about 1.12-1.15 which should get you to around 13-15% alcohol)
While you're faffing around with dissolving the honey in the water sterilise a Demi-John using 1tsp Sodium Metabisulphate to a pint of water. Pour into the demijohn bung it up and leave it for at least 15 minutes.
Once sterilised, rinse thoroughly with water.
Dissolve the Marmite in the cold tea.
Add the yeast to the demijohn first
Then add the tea, lemon juice, honey/water solution and top up with water if necessary so it's just under the bottom of the neck. Add the airlock to the top and leave in a warm place and it should start to ferment and you'll see bubbles in the liquor and glugging from the airlock.
After 1-3 months depending on the speed of fermentation the bubbling will cease and the Mead will clear leaving sediment on the bottom. At this point, rack it off to another, sterile, demijohn and keep until bottling.
Older the better. Apparently the Buckfast abbey boys recommend maturing in oak barrels for 10 years. Here 6 months of preferably a year was recommended.
2.
Having studied brewing microbiology, being scottish and naturally lazy I have a low effort technique I can suggest for comparison.
Firstly - use the washings from cleaning your extraction equipment. if you use warm water to rinse the extractor into the filters and then into the buckets you can probably recover about a pound of honey that would otherwise go down the drain. Little and often recovers the honey with the least dilution and it cheers up a boring task.
Secondly - do not sterilise it. I am persuaded that there are all sorts of goodies in honey that are destroyed by heating and I hate the taste of sulphur dioxide. All equipement should be cleaned and then given a final rinse with tap water. Your ferment is most definitely not sterile, but the real danger is adding a dose of vinegar bacteria that have been lurking in the bottom of some old kit that was not properly cleaned last time round!
Thirdly - no measuring of weights or volumes, just use a hydrometer to get the specific gravity above at least 1.085. If you are not sterilising you need to give the yeast as much of a competitive advantage as possible so the liquor needs to be nice and sugary.
Fourthly - give a massive overdose of your chosen yeast. I use champagne yeast that I have started in a properly sterilised bottle well before I start to extract my honey. Make up at least a litre and make sure it is working well before it is added to the brew. You want it to take over immediately! Not all yeasts ferment to alcohol. Some go to polysaccharides ( wall paper paste anyone?) and I had one beer fermentation that produced a foam like polystyrene.
Fifthly - make sure the yeast is fed. I agree with the argument that honey is lacking in protein. I use yeast nutrient, but am very taken with a previous posters suggestion of marmite. I do know that yeast loves vitamins and organic acids - my old tutor swore by malic acid from apples but citric and ascorbic ( Vitamin C) also seem to work well.
Sixthly - keep the yeast happy. Warm, no changes in temperature, no drafts and regular feeding with more honey ( not too much or you can give it osmotic shock).
As a further cost saving, I use 2L PET pop bottles with the bubblers glued in with hot glue. Cheaper and easier to clean than demijohns and less dangerous than glass if you do misjudge it and let them explode.
My mead making is basically tied onto the end of cleaning up the honey extraction. All you need is a yeast culture, a hydrometer and some old pop bottles to get a real bonus.
Friday 30 August 2013
Wednesday 28 August 2013
Mental Capacity and LPA/EPA judgment
a rather deliciously ironic judgment;
http://www.justice.gov.uk/downloads/protecting-the-vulnerable/mca/orders-court-protection/re-collis.pdf
http://www.justice.gov.uk/downloads/protecting-the-vulnerable/mca/orders-court-protection/re-collis.pdf
Tuesday 27 August 2013
Wednesday 21 August 2013
Dr Ernest Noble Chamberlain
Liverpool grads will know him by the tome 'Symptoms and signs in clinical medicine';
http://enchamberlain.blogspot.co.uk/
amazon to 13th ed - but no Liverpool authors!
http://www.amazon.co.uk/Chamberlains-Symptoms-Signs-Clinical-Medicine/dp/0340974257
http://enchamberlain.blogspot.co.uk/
amazon to 13th ed - but no Liverpool authors!
http://www.amazon.co.uk/Chamberlains-Symptoms-Signs-Clinical-Medicine/dp/0340974257
Tuesday 20 August 2013
Quaint Cinemas
one in Belper, they have curtains in front of the screen, serve tea in a mug, have sofas for two AND let you eat cake;
http://www.ritz-belper.co.uk/
for parking - use No2 on this link;
http://en.parkopedia.co.uk/parking/belper/
one in Wirksworth, similar to above;
http://www.thenorthernlightcinema.co.uk/
http://www.ritz-belper.co.uk/
for parking - use No2 on this link;
http://en.parkopedia.co.uk/parking/belper/
one in Wirksworth, similar to above;
http://www.thenorthernlightcinema.co.uk/
Tuesday 13 August 2013
Everett and multiverses
a link to an interesting overview;
http://www.pbs.org/wgbh/nova/physics/many-worlds-theory-today.html
and one to his actual doctoral dissertation;
http://www.pbs.org/wgbh/nova/manyworlds/pdf/dissertation.pdf
http://www.pbs.org/wgbh/nova/physics/many-worlds-theory-today.html
and one to his actual doctoral dissertation;
http://www.pbs.org/wgbh/nova/manyworlds/pdf/dissertation.pdf
Friday 9 August 2013
Rules
indebted for the wise observation;
'..rules are made for fools to obey and those who hope one day to be wise to learn from, but they are the crate and not the beer..'
'..rules are made for fools to obey and those who hope one day to be wise to learn from, but they are the crate and not the beer..'
Thursday 8 August 2013
Drs aiming to work abroad
a useful link for once to a BMA website;
http://bma.org.uk/developing-your-career/career-progression/working-abroad/australia
http://bma.org.uk/developing-your-career/career-progression/working-abroad/australia
Wednesday 7 August 2013
Costings on healthcare provision
an interesting link to costings of certain agents;
http://www.pssru.ac.uk/project-pages/unit-costs/2012/#sections
http://www.pssru.ac.uk/project-pages/unit-costs/2012/#sections
NHS Pension and value 7/8/2013
credit to 'refusnik' for this sage analysis;
'..Congratulations on being awake and aware enough to question whether you will ever see the pension you have been promised.
It is relatively easy to transfer the Cash Equivalent Transfer Value (CETV) of your accumulated contributions to a SIPP. You can then carry on contributing to the SIPP with tax relief at your highest marginal tax rate, sans employer contributions.
You can invest in pretty much anything you like (including physical gold and mining equities)within the SIPP (at your own risk, of course). I'm personally betting that Mark Carney will do what all Central Bankers do best and print like a m***** f*****.
The NHS pension scheme is technically a Ponzi scheme backstopped by one of the most insolvent organisations in the world (the UK government).
The UK government currently has a debt of £1.2 trillion, additional unfunded public sector pensions liabilities of approximately £4.7 trillion, an annual income of £500 billion (tax receipts), and expenses of £700 billion (including £100 billion annual NHS spending).
http://www.zerohedge.com/news/2012-11-12/uks-most-disturbing-number-total-unfunded-pension-obligations-321-gdp
http://moneyweek.com/endofbritain/
http://www.debtbombshell.com/
Like all Ponzi schemes, the NHSP works very well as long as the contributions exceed the outgoings, which has been the case so far with the dramatic growth of the NHS since its inception. Like in all Ponzi schemes, early contributors have done very well.
Unfortunately, this arithmetic works equally well in reverse. A contracting NHS would spell trouble for the Ponzi.
The NHS in its current size is unsustainable, being paid for on a credit card with an accumulated balance of £1.2 trillion, the interest payments(£70 billion) on which are only affordable to the UK government because current Gilt rates are the lowest they been for 300 years. When the sovereign bond bubble pops and interest rates rise, we will all learn the true meaning of the word "austerity" (annual interest payments >> £70 billion, public spending <<£500 billion, NHS spending <<<£100 billion).
Given that the organisation backstopping the NHSP has a printing press, it is likely that the nominal promises will be largely honoured, with a haircut or two thrown in. Whether this amount will even cover your electricity bill is another matter altogether. History is littered with public sector pensions (and pensioners) destroyed by default by inflation.
"We can guarantee cash benefits as far out as whatever size you like, but we cannot guarantee their purchasing power". - Alan Greenspan, Federal Reserve Chairman....'
'..Congratulations on being awake and aware enough to question whether you will ever see the pension you have been promised.
It is relatively easy to transfer the Cash Equivalent Transfer Value (CETV) of your accumulated contributions to a SIPP. You can then carry on contributing to the SIPP with tax relief at your highest marginal tax rate, sans employer contributions.
You can invest in pretty much anything you like (including physical gold and mining equities)within the SIPP (at your own risk, of course). I'm personally betting that Mark Carney will do what all Central Bankers do best and print like a m***** f*****.
The NHS pension scheme is technically a Ponzi scheme backstopped by one of the most insolvent organisations in the world (the UK government).
The UK government currently has a debt of £1.2 trillion, additional unfunded public sector pensions liabilities of approximately £4.7 trillion, an annual income of £500 billion (tax receipts), and expenses of £700 billion (including £100 billion annual NHS spending).
http://www.zerohedge.com/news/2012-11-12/uks-most-disturbing-number-total-unfunded-pension-obligations-321-gdp
http://moneyweek.com/endofbritain/
http://www.debtbombshell.com/
Like all Ponzi schemes, the NHSP works very well as long as the contributions exceed the outgoings, which has been the case so far with the dramatic growth of the NHS since its inception. Like in all Ponzi schemes, early contributors have done very well.
Unfortunately, this arithmetic works equally well in reverse. A contracting NHS would spell trouble for the Ponzi.
The NHS in its current size is unsustainable, being paid for on a credit card with an accumulated balance of £1.2 trillion, the interest payments(£70 billion) on which are only affordable to the UK government because current Gilt rates are the lowest they been for 300 years. When the sovereign bond bubble pops and interest rates rise, we will all learn the true meaning of the word "austerity" (annual interest payments >> £70 billion, public spending <<£500 billion, NHS spending <<<£100 billion).
Given that the organisation backstopping the NHSP has a printing press, it is likely that the nominal promises will be largely honoured, with a haircut or two thrown in. Whether this amount will even cover your electricity bill is another matter altogether. History is littered with public sector pensions (and pensioners) destroyed by default by inflation.
"We can guarantee cash benefits as far out as whatever size you like, but we cannot guarantee their purchasing power". - Alan Greenspan, Federal Reserve Chairman....'
Tuesday 6 August 2013
Berwick vs Donaldson and NFC
An organisation with a Memory was published in 2000 by the CMO Sir Liam Donaldson;
http://www.aagbi.org/sites/default/files/An%20organisation%20with%20a%20memory.pdf
the debacle that was Stafford Hospital hit the fan in the late 'naughties',
then HMG commissioned an American, Prof Don Berwick to review patient safety;
https://www.gov.uk/government/publications/berwick-review-into-patient-safety
Granny sucks eggs every 13 yrs.
will they ever learn?
not until they smell the Kaffe;
http://www.patientforsakring.se/
http://www.patientforsakring.se/resurser/dokument/engelska_artiklar/swedish_system_right_to_compensation.pdf
http://www.aagbi.org/sites/default/files/An%20organisation%20with%20a%20memory.pdf
the debacle that was Stafford Hospital hit the fan in the late 'naughties',
then HMG commissioned an American, Prof Don Berwick to review patient safety;
https://www.gov.uk/government/publications/berwick-review-into-patient-safety
Granny sucks eggs every 13 yrs.
will they ever learn?
not until they smell the Kaffe;
http://www.patientforsakring.se/
http://www.patientforsakring.se/resurser/dokument/engelska_artiklar/swedish_system_right_to_compensation.pdf
Leaf cutter Ants and Antibiotics
Rather novel dont you think, and they dont get antibiotic resistence!;
http://en.wikipedia.org/wiki/Leafcutter_ant
and the east anglian leaf cutter colony;
http://www.rdmag.com/news/2013/07/leaf-cutter-ants-inspire-new-anti-cancer-drugs
and;
http://www.asknature.org/strategy/e26189eb7f07b5fe28dd58d4c9904f15
http://en.wikipedia.org/wiki/Leafcutter_ant
and the east anglian leaf cutter colony;
http://www.rdmag.com/news/2013/07/leaf-cutter-ants-inspire-new-anti-cancer-drugs
and;
http://www.asknature.org/strategy/e26189eb7f07b5fe28dd58d4c9904f15
Friday 2 August 2013
Diets/Starvation and dieticians
interesting slant on the whole diet industry;
http://www.zoeharcombe.com/2009/12/the-minnesota-starvation-experiment/
and what is and isnt 'The Mediterranean diet';
http://www.zoeharcombe.com/2013/02/the-mediterranean-diet-and-heart-disease/
http://www.zoeharcombe.com/2009/12/the-minnesota-starvation-experiment/
and what is and isnt 'The Mediterranean diet';
http://www.zoeharcombe.com/2013/02/the-mediterranean-diet-and-heart-disease/
Sunday 28 July 2013
Juridification [and its transgression into the market/medicine]
A Norwegian based definition;
https://www.sv.uio.no/arena/english/research/publications/arena-publications/workingpapers/working-papers2005/wp05_14.pdf
its transgression into Professionalism is all too evident;
http://www.lse.ac.uk/researchAndExpertise/units/CARR/events/previousSeminars/haines.aspx
interesting pdf on 'Judification in Europe' published 2012;
http://www.liberalforum.eu/en/publications.html
https://www.sv.uio.no/arena/english/research/publications/arena-publications/workingpapers/working-papers2005/wp05_14.pdf
its transgression into Professionalism is all too evident;
http://www.lse.ac.uk/researchAndExpertise/units/CARR/events/previousSeminars/haines.aspx
interesting pdf on 'Judification in Europe' published 2012;
http://www.liberalforum.eu/en/publications.html
Metcalfe's Law [power of the network]
wiki link;
http://en.wikipedia.org/wiki/Metcalfe's_law
its pertinence is to primary healthcare in the business arena.
http://en.wikipedia.org/wiki/Metcalfe's_law
its pertinence is to primary healthcare in the business arena.
Parkinson's Law [work/dysfunction fills a void]
wiki link;
http://en.wikipedia.org/wiki/Parkinson's_law
link to radio 4 programme extolling its virtues;
http://www.bbc.co.uk/programmes/p01bctk3
and the original text in The Economist;
http://www.economist.com/node/14116121
and finally mathematical confirmation of the great mans wit and observation;
http://arxiv.org/pdf/0808.1684.pdf
http://en.wikipedia.org/wiki/Parkinson's_law
link to radio 4 programme extolling its virtues;
http://www.bbc.co.uk/programmes/p01bctk3
and the original text in The Economist;
http://www.economist.com/node/14116121
and finally mathematical confirmation of the great mans wit and observation;
http://arxiv.org/pdf/0808.1684.pdf
Friday 26 July 2013
Thursday 25 July 2013
Wednesday 24 July 2013
Thursday 11 July 2013
Sense of Resonance ?
DrSoupDragon has been ruminating, as is his want, the human condition has the following senses;
1 - Sight - wavelength derived
2 - Hearing - wavelength derived
3 - Smell - ? resonance derived - see earlier posting
4 - Taste - ? modus but most of taste is smell derived
5 - Touch - one could say wavelength derived
6 - 'The 6th Sense' - some resonance affect ?
I am coming to the conclusion that we are creatures of QED in that most/all of or sensory antennae are resonance sensors, the concept of the 6th sense could only be mediated via resonance - in some manner?
1 - Sight - wavelength derived
2 - Hearing - wavelength derived
3 - Smell - ? resonance derived - see earlier posting
4 - Taste - ? modus but most of taste is smell derived
5 - Touch - one could say wavelength derived
6 - 'The 6th Sense' - some resonance affect ?
I am coming to the conclusion that we are creatures of QED in that most/all of or sensory antennae are resonance sensors, the concept of the 6th sense could only be mediated via resonance - in some manner?
Tuesday 9 July 2013
Tuesday 25 June 2013
nanotechnology vaccines
interesting use of micro-needle tech in patch form to deliver vaccines intradermally, generating an amplified immune response;
http://www.aibn.uq.edu.au/?page=44481
http://www.aibn.uq.edu.au/?page=44481
Quantum Biology
Rather fascinating to think beyond the 'ordinaire', and see that nature may be utilizing QED [look to Feynman] for its survival;
http://www.bbc.co.uk/news/science-environment-21150047
http://www.bbc.co.uk/news/science-environment-21150047
Thursday 13 June 2013
Lifeguard lung
Interesting patient this morning with symptoms of LGL;
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=1358
and,
http://www.ncbi.nlm.nih.gov/pubmed/9842376
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=1358
and,
http://www.ncbi.nlm.nih.gov/pubmed/9842376
Wednesday 12 June 2013
Anti-antibiotica
DrSoupDragon is always intrigued by geographic relativism, heres an interesting piece Re Antibiotics;
http://www.guardian.co.uk/society/datablog/2013/jun/11/antibiotic-prescription-by-gp-practice-mapped
http://www.guardian.co.uk/society/datablog/2013/jun/11/antibiotic-prescription-by-gp-practice-mapped
Renumeration Trusts and all that !
A young GP from north Notts - Dr C-S - illuminated me to this a few months ago - effectively separating ownership of a business from control, thereby allowing a RT and a 'different' taxation regimen.
The Company;
http://www.baxendalewalker.co.uk/library/
folk who can design a structure to facilitate a RT;
http://www.westwoodtrustees.co.uk/
some FAQ's;
http://remunerationtrust.co.uk/faqs/
some legal commentary;
http://thedailyranger.wordpress.com/2012/11/25/why-hmrc-lost-the-fttt-decision/
all rather interesting !
The Company;
http://www.baxendalewalker.co.uk/library/
folk who can design a structure to facilitate a RT;
http://www.westwoodtrustees.co.uk/
some FAQ's;
http://remunerationtrust.co.uk/faqs/
some legal commentary;
http://thedailyranger.wordpress.com/2012/11/25/why-hmrc-lost-the-fttt-decision/
all rather interesting !
Thursday 18 April 2013
'Cartilage' transplants
DrSoupDragon was intrigued by the latest 'true fit plug' nonsense he spied on a decent discharge letter, as always he goes scratching, and came up with this paper from 2011;
http://actaorthopaedica.be/acta/download/2011-6/01-Schindler.pdf
he is a little befuddled as to how fibrous tissue could be mistaken for a chondrocyte?
more port Matron?
http://actaorthopaedica.be/acta/download/2011-6/01-Schindler.pdf
he is a little befuddled as to how fibrous tissue could be mistaken for a chondrocyte?
more port Matron?
Thursday 4 April 2013
Wednesday 3 April 2013
Friday 22 March 2013
SLS criteria for Viagra et al
They all seem to want it nowadays ! here is a link to who get it on the NaSH;
http://www.southstaffordshirepct.nhs.uk/YourHealth/docs/meds/PPS/erectile_Dysfunction_Feb_08_.pdf
http://www.southstaffordshirepct.nhs.uk/YourHealth/docs/meds/PPS/erectile_Dysfunction_Feb_08_.pdf
Thursday 21 March 2013
QUEST session 20 march
1 hr child protection level 2 - courtesy of Dr RJF
1hr 30mins - Dietician presentation -> supplements - SR
then partners meeting
1hr 30mins - Dietician presentation -> supplements - SR
then partners meeting
Wednesday 13 March 2013
Mercia Healthcare Ltd ?
13/Mar/2013 - the date of Pope Francis's delivery from Buenos Aires!
As Mrs SoupDragon said '.... he looks a nice geezer....'.
As Mrs SoupDragon said '.... he looks a nice geezer....'.
Prof Donald Berwick
interesting chap, brought into the NaSH in the wake of the Francis report as 'The Enforcer';
http://en.wikipedia.org/wiki/Donald_Berwick
http://en.wikipedia.org/wiki/Donald_Berwick
Tuesday 12 March 2013
Steaming manure in March .................
Surely a manifestation of the Moonies?..................
http://www.changemodel.nhs.uk/pg/groups/33183/NHS+Change+Day/27?community=NHS+Change+Day
what utterly butterly bonkersness.
http://www.changemodel.nhs.uk/pg/groups/33183/NHS+Change+Day/27?community=NHS+Change+Day
what utterly butterly bonkersness.
Child protection
meeting last night with Dr A.H at HW centre - 7:30-9:30 level 3 stuff !
useful website;
http://www.core-info.cardiff.ac.uk/
useful website;
http://www.core-info.cardiff.ac.uk/
Time for some music ....................
one for Echo and the Bunnymen followers;
http://www.youtube.com/watch?v=VM6j14DDtGI
dont they all look _so_ young !
Classy tune i think....................
http://www.youtube.com/watch?v=VM6j14DDtGI
dont they all look _so_ young !
Classy tune i think....................
Sunday 10 March 2013
Friday 8 March 2013
Humerous analogies
work in progress;
'Like offering members a shit sandwich and then concluding they weren't hungry just because they passed up on the offer.'
' I've yet to meet anyone who thought the best end of the wedge to insert first was the thick end.'
'Like offering members a shit sandwich and then concluding they weren't hungry just because they passed up on the offer.'
' I've yet to meet anyone who thought the best end of the wedge to insert first was the thick end.'
BMA day of IA and pensions
'The BMA will protect your pension....'
It has tested the members and they have been found wanting.
'Like offering members a shit sandwich and then concluding they weren't hungry just because they passed up on the offer.'
This relates to the 2012 Gallipolli campaign with respect to HMG and NHS pension contribution thresholds, together with retirement ages.
It has tested the members and they have been found wanting.
'Like offering members a shit sandwich and then concluding they weren't hungry just because they passed up on the offer.'
This relates to the 2012 Gallipolli campaign with respect to HMG and NHS pension contribution thresholds, together with retirement ages.
Keynes vs Hayek
John Maynard Keynes;
http://en.wikipedia.org/wiki/John_Maynard_Keynes
Frederich Hayek;
http://en.wikipedia.org/wiki/Friedrich_Hayek
http://en.wikipedia.org/wiki/John_Maynard_Keynes
Frederich Hayek;
http://en.wikipedia.org/wiki/Friedrich_Hayek
Tuesday 5 March 2013
Teflon CEO ?
One wonders how all the following can be Moral, justified and coherent;
http://www.telegraph.co.uk/news/politics/9910554/Sketch-Need-an-excuse-You-cant-beat-the-system.html
http://www.telegraph.co.uk/health/healthnews/9905985/Sir-David-Nicholson-protected-by-neutered-Francis-report.html
http://www.telegraph.co.uk/news/politics/9910554/Sketch-Need-an-excuse-You-cant-beat-the-system.html
http://www.telegraph.co.uk/health/healthnews/9905985/Sir-David-Nicholson-protected-by-neutered-Francis-report.html
Stafford analysis
an interesting summation of the Francis report;
http://skwalker1964.wordpress.com/2013/02/26/the-real-mid-staffs-story-one-excess-death-if-that/
http://skwalker1964.wordpress.com/2013/02/26/the-real-mid-staffs-story-one-excess-death-if-that/
DoH authorizing gagging orders
http://www.bbc.co.uk/news/uk-21664707
misfeasance in public office is a serious issue, its ingredients contain;
http://en.wikipedia.org/wiki/Misfeasance_in_public_office
misfeasance in public office is a serious issue, its ingredients contain;
http://en.wikipedia.org/wiki/Misfeasance_in_public_office
Tuesday 26 February 2013
Police force and shotgun licenses
In light of Dunblane et al etc etc and recent changes to authentication for a license and a 'reverse' burden of duty upon Gp's, my collegaue 'jwc' has crafted the following letter;
'"Dear Mr Plod
Please find enclosed the original letter from yourselves informing us of the recent shotgun application for the named individual : “Grant or renewal of a firearm and/or shotgun certificate”. It is being returned to you along with this standard covering letter.
Irrespective of any agreement between the police and the BMA regarding the content of these letters, we are in no way bound by any such agreement. There is an implication that we will consider the content of the letter and inform you if we have any concerns. This cannot be done without a proper review of the medical notes. This is not an NHS service and there is no obligation for the practice to comply with this request.
If you feel you require a report on the medical condition of the patient in question, then you are welcome to request one. We would require a signed consent from the patient, and also an indication of the scope and information you would like to have in any such report. As this is not an NHS service, the writing of such a report will attract a fee. This can be discussed further with the practice manager.
For the avoidance of doubt, this is a standard letter which has been attached and returned to you immediately on receipt of your standard shotgun letter; the original letter has not been seen or considered by any of the clinicians in the practice.
Thank you
The surgery"
'"Dear Mr Plod
Please find enclosed the original letter from yourselves informing us of the recent shotgun application for the named individual : “Grant or renewal of a firearm and/or shotgun certificate”. It is being returned to you along with this standard covering letter.
Irrespective of any agreement between the police and the BMA regarding the content of these letters, we are in no way bound by any such agreement. There is an implication that we will consider the content of the letter and inform you if we have any concerns. This cannot be done without a proper review of the medical notes. This is not an NHS service and there is no obligation for the practice to comply with this request.
If you feel you require a report on the medical condition of the patient in question, then you are welcome to request one. We would require a signed consent from the patient, and also an indication of the scope and information you would like to have in any such report. As this is not an NHS service, the writing of such a report will attract a fee. This can be discussed further with the practice manager.
For the avoidance of doubt, this is a standard letter which has been attached and returned to you immediately on receipt of your standard shotgun letter; the original letter has not been seen or considered by any of the clinicians in the practice.
Thank you
The surgery"
Sunday 24 February 2013
GMC & IPSOS-MORI survey
DrSoupDragon has learnt of an intriguing survey directed at those age 55 and older holding GMC registration;
'..Dear Dr X,
Can you help?
We are pleased to invite you to take part in a web based survey that Ipsos MORI, the independent research agency, is undertaking on behalf of the GMC. As part of the GMC’s ongoing financial planning activities, they wish to explore doctors’ views of remaining on the register in order to more accurately forecast the number of doctors who are likely to leave the register over the next few months.'
'..Dear Dr X,
Can you help?
We are pleased to invite you to take part in a web based survey that Ipsos MORI, the independent research agency, is undertaking on behalf of the GMC. As part of the GMC’s ongoing financial planning activities, they wish to explore doctors’ views of remaining on the register in order to more accurately forecast the number of doctors who are likely to leave the register over the next few months.'
rather fascinating and plainly an interesting fishing expedition given the current medical climate in the UK wrt the toxic mixture of Pension Changes/Revalidation/CQC/ etc ad nauseum.
The GMC planning its finances !
Informal soundings suggest most asked are not replying in any constructive/instructive sense merely letting the survey stew, and not displaying their hand.
We may be seeing a receding tide prior to a Tsunami.............
Watch this space...................
Friday 22 February 2013
Integrative Governance
Work in Progress;
as John Reid was heard to say ' oh F*&* not health', Dr SoupDragon has plumped for IG and the mediation/resolution of internal/external COI within commissioning providers.
Plainly links to Governance structures will lay heavy on his mind over the next few weeks!
http://www.wales.nhs.uk/sitesplus/documents/829/Integrated%20Governance%20II%20-%20Governance%20Between%20Organisations%20Bullivant%20et%20al.pdf
http://nhschoicestraining.spinningclock.com/Documents/Information_for_Boards_-_Principles_of_Governance_with_HCAI.pdf
http://www.peterborough.nhs.uk/documents/Publications/Integrated%20Governance%20Framework%20-%20Approved%202008.pdf?preventCache=30%2F01%2F2009+08%3A57
http://www.see.nhs.uk/documents/meetings/public_29_07_2010/integrated%20governance%20strategy.pdf
http://www.nhsconfed.org/Publications/Documents/guide_to_governance_for_health_and_wellbeing_boards210612.pdf
and the francis reports 1 + 2
http://www.midstaffsinquiry.com/pressrelease.html
as John Reid was heard to say ' oh F*&* not health', Dr SoupDragon has plumped for IG and the mediation/resolution of internal/external COI within commissioning providers.
Plainly links to Governance structures will lay heavy on his mind over the next few weeks!
http://www.wales.nhs.uk/sitesplus/documents/829/Integrated%20Governance%20II%20-%20Governance%20Between%20Organisations%20Bullivant%20et%20al.pdf
http://nhschoicestraining.spinningclock.com/Documents/Information_for_Boards_-_Principles_of_Governance_with_HCAI.pdf
http://www.peterborough.nhs.uk/documents/Publications/Integrated%20Governance%20Framework%20-%20Approved%202008.pdf?preventCache=30%2F01%2F2009+08%3A57
http://www.see.nhs.uk/documents/meetings/public_29_07_2010/integrated%20governance%20strategy.pdf
http://www.nhsconfed.org/Publications/Documents/guide_to_governance_for_health_and_wellbeing_boards210612.pdf
and the francis reports 1 + 2
http://www.midstaffsinquiry.com/pressrelease.html
Homeopathy
whats all this nonsense about water being made more 'potent' by dilution?
As they say 'en France' BoooooooooooooooF.
As they say 'en France' BoooooooooooooooF.
Thursday 21 February 2013
Problems in secondary care and commissioners
Work in progress;
How to address probs generated in secondary care to commissioners under the guise of not fulfilling the criteria of contract and or Tarrif.
1 need to know tarrif cost and components of what cost should provide/deliver
2 need to know contract specification ie Service Level Agreement SLA.
3 people - who to address issue to -> CCG/FT etc etc
4 need to disseminate to whole of primary care so problems can be accurately defined and pushed back to originator.
How to address probs generated in secondary care to commissioners under the guise of not fulfilling the criteria of contract and or Tarrif.
1 need to know tarrif cost and components of what cost should provide/deliver
2 need to know contract specification ie Service Level Agreement SLA.
3 people - who to address issue to -> CCG/FT etc etc
4 need to disseminate to whole of primary care so problems can be accurately defined and pushed back to originator.
Link to Tarrif 2012-13
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132654
go down to the xls spreadsheet link named 'Download 2012-13 Tarrif information spreadsheet'
et voila,
go down to the xls spreadsheet link named 'Download 2012-13 Tarrif information spreadsheet'
et voila,
Wednesday 20 February 2013
Witch Doctor Blog and Accountability
a sage take on the Francis report and Accountability [or not] in the NaSH;
http://witchdoctor.wordpress.com/
http://witchdoctor.wordpress.com/
Noctors vs NotaVets
http://nhsblogdoc.blogspot.co.uk/
Physicians do not know much about surgery, haematologists do not know much about cardiology, psychiatrists do not know much about orthopaedics and GPs, well, they do not know much about anything. And yet, we all went to medical school and so, before we became specialists, we were doctors. We had learnt how to analyse problems and how to know our boundaries. Those five years were not wasted.
Another email arrives, this time from a Consultant Psychiatrist somewhere in the West Country. Her teenage daughter, who is herself about to go to medical school, fell off a horse last week and hurt her shoulder.
I had a look, and although I am but a humble psychiatrist, I knew it was a bust clavicle. Palpable lump, point tenderness, severe pain. Pretty obvious diagnosis. Sling and rest is all that is required but I am a psychiatrist. Better go to A/E and get it done properly. She should probably have an x-ray, just to confirm.
So far so good. I take daughter to the minor accident unit. Seen by an Nurse Practitioner, who carefully examines her, and diagnoses '?acromio-clavicular joint strain'
Oh well.
Off to x-ray. Nice radiographer chats to soon to be medical student daughter and points out the fracture to her.
“Cor!” says daughter.
Back to see NP. He looks at x-ray, gives daughter a sling and gives good advice about rest, mobility etc. I smell a small rat.
“How long do you think the fracture will take to heal?” I ask.
“Oh, it's not broken,” he said. “It's just a strain”.
Could I have I look at the film?” I say.
He in turn now smells a rat. “Do you know about X-Rays?” he asks. I say I am a psychiatrist, but I learnt a little about them at medical school. We look at the film. I point out the fracture.
“Oh, that's just a line on the film” he says, ignoring breaks in the line of the cortex, the increased density in the overlapping ends etc. etc.
“OK”, I say, “well, we'll wait for the report from the radiologist” and we leave. Daughter is impressed. "I never knew you could be tactful, Mum."
Now, this is all rather trivial really, but it illustrates a more important point. A poor examination gave a false diagnosis, which was then adhered to despite evidence to the contrary. We can all be guilty of this. But doctors are trained carefully, and have the knowledge to move on from this position of error. I have lost count of the number of times my teachers said 'Never make the facts fit a theory. Your theory must fit the facts.'
This NP, who was in charge of the unit, had obviously never gone through this process. It's not his fault. He is being used in a role for which he is simply not qualified.
In this case, no harm done. But what happens when he sends a child home with a sore throat, pyrexia and dribbling because he does not know of the significance of dribbling in a child who cannot can swallow?
I would not want this NP treating my daughter. Frankly, I would not want him treating my dog, which brings me on to the interesting case of Dr Susie Macleod who is an experienced veterinary surgeon in Hertfordshire. She employs a number of highly experienced veterinary nurses. In 2004 she set up a separate clinic seven miles away, entitled the Health4Pets clinic. This establishment was staffed wholly by veterinary nurses, with no resident veterinary surgeon on the premises, although there was regular communication by telephone with the main practice and webcam pictures could be transmitted between the premises. The clinic's main function was to furnish facilities for the vaccination of small animals by veterinary nurses at considerably lower cost than the charges made by practices where veterinary surgeons carried out vaccinations.
And why not indeed? Sending “nurse specialists” out into the community to manage asthmatics and elderly patient with heart failure and COPD is known to provide huge financial savings and free up doctors and hospitals for more important work. Why not apply the same cost savings to veterinary medicine?
The Royal College of Veterinary Surgeons were not persuaded. On the contrary. They considered that Susie Macleod’s behaviour constituted disgraceful conduct.
Section 19 of the Veterinary Surgeons Act 1966 makes it a criminal offence for anyone to undertake veterinary work unless they are fully qualified veterinary surgeons. Veterinary nurses are allowed to carry out certain limited procedures provided the animals concerned
are under the care of the veterinary surgeon and the treatment in each case is carried out by the nurses under the direction of the veterinary surgeon.
Susie accepted the following facts:
* a. she was not present at the clinic when the vaccinations were carried out;
* b. she had never examined the animals;
* c. she had never read the animals’ medical records;
* d. she had never discussed the animals with their owners or agreed to take on their care;
* e. she did not know of the animals’ presence at the clinic or their condition;
* f. she had no discussion with the nurse administering the vaccine about the animal or its proposed treatment;
* g. she had no knowledge of the animals at allSo what defence did Susie mount to these agreed facts?
Read the next bit carefully. You many have heard it before. Susie placed some emphasis, however, in her submissions to the Board,
on her provision of “protocols” to the nurses which they were strictly enjoined to follow. In each case the nurse had a sheet on which she was required to fill in details about the individual animal, ticking boxes as she went, with instructions to refer the case to a veterinary surgeon on making certain findings about its health or condition.
She went on to argue that…
a veterinary nurse could carry out booster injections, so long as it was under veterinary direction, which she interpreted as extending to the system whereby she gave standard directions to the nurses by means of the “protocols”.
And what did their Lordships think of that?
"Their Lordships also consider, however, that the treatment carried out by the veterinary nurses in vaccinating the animals cannot be said to have been done under the appellant’s direction. The appellant argued that her “protocols”, consisting of instructions to the nurses and forms which they had to complete, constituted sufficient direction to them. Their Lordships cannot agree. They do not wish to attempt to define in detail the circumstances in which treatment is carried on under the direction of a veterinary surgeon, for those circumstances may vary widely. The concept does, however, connote an element of immediacy and potential control of the treatment which was wholly lacking in the carrying out of vaccinations at the Health4Pets clinic.
…..At its hearing the Disciplinary Committee was advised by its legal assessor that disgraceful conduct in a professional respect is conduct which falls far short of that which is expected of the profession. Their Lordships consider that that was an appropriate definition and that the Committee was correctly advised...
…their Lordships have no hesitation in upholding the decision of the Disciplinary Committee that the appellant was guilty of disgraceful conduct in a professional respect. The detailed findings made by it and the expression of opinion contained in its judgment that the appellant’s actions were capable of jeopardising animal welfare give sustainable grounds for reaching its ultimate decision, and their Lordships are of opinion that that decision fell within the ambit of sustainable conclusions."
The Veterinary Profession is not dumbing down. It is not going to allow protocol driven tick-sheet veterinary medicine to be practiced by unqualified “veterinary care professionals.”
Susie Macleod was reprimanded for disgraceful professional behaviour. We can be sure that she will not in the future be letting her nurse specialists loose on animals.
The question for doctors, patients and the NHS is obvious and I will not labour it. But the next time the cardiac nurse quacktitioner pops in to treat grandma’s heart failure, or the next time you visit a quacktitioner run walk-in clinic, try to forget that it is illegal to treat a dog in this fashion.pen on nhs
Physicians do not know much about surgery, haematologists do not know much about cardiology, psychiatrists do not know much about orthopaedics and GPs, well, they do not know much about anything. And yet, we all went to medical school and so, before we became specialists, we were doctors. We had learnt how to analyse problems and how to know our boundaries. Those five years were not wasted.
Another email arrives, this time from a Consultant Psychiatrist somewhere in the West Country. Her teenage daughter, who is herself about to go to medical school, fell off a horse last week and hurt her shoulder.
I had a look, and although I am but a humble psychiatrist, I knew it was a bust clavicle. Palpable lump, point tenderness, severe pain. Pretty obvious diagnosis. Sling and rest is all that is required but I am a psychiatrist. Better go to A/E and get it done properly. She should probably have an x-ray, just to confirm.
So far so good. I take daughter to the minor accident unit. Seen by an Nurse Practitioner, who carefully examines her, and diagnoses '?acromio-clavicular joint strain'
Oh well.
Off to x-ray. Nice radiographer chats to soon to be medical student daughter and points out the fracture to her.
“Cor!” says daughter.
Back to see NP. He looks at x-ray, gives daughter a sling and gives good advice about rest, mobility etc. I smell a small rat.
“How long do you think the fracture will take to heal?” I ask.
“Oh, it's not broken,” he said. “It's just a strain”.
Could I have I look at the film?” I say.
He in turn now smells a rat. “Do you know about X-Rays?” he asks. I say I am a psychiatrist, but I learnt a little about them at medical school. We look at the film. I point out the fracture.
“Oh, that's just a line on the film” he says, ignoring breaks in the line of the cortex, the increased density in the overlapping ends etc. etc.
“OK”, I say, “well, we'll wait for the report from the radiologist” and we leave. Daughter is impressed. "I never knew you could be tactful, Mum."
Now, this is all rather trivial really, but it illustrates a more important point. A poor examination gave a false diagnosis, which was then adhered to despite evidence to the contrary. We can all be guilty of this. But doctors are trained carefully, and have the knowledge to move on from this position of error. I have lost count of the number of times my teachers said 'Never make the facts fit a theory. Your theory must fit the facts.'
This NP, who was in charge of the unit, had obviously never gone through this process. It's not his fault. He is being used in a role for which he is simply not qualified.
In this case, no harm done. But what happens when he sends a child home with a sore throat, pyrexia and dribbling because he does not know of the significance of dribbling in a child who cannot can swallow?
I would not want this NP treating my daughter. Frankly, I would not want him treating my dog, which brings me on to the interesting case of Dr Susie Macleod who is an experienced veterinary surgeon in Hertfordshire. She employs a number of highly experienced veterinary nurses. In 2004 she set up a separate clinic seven miles away, entitled the Health4Pets clinic. This establishment was staffed wholly by veterinary nurses, with no resident veterinary surgeon on the premises, although there was regular communication by telephone with the main practice and webcam pictures could be transmitted between the premises. The clinic's main function was to furnish facilities for the vaccination of small animals by veterinary nurses at considerably lower cost than the charges made by practices where veterinary surgeons carried out vaccinations.
And why not indeed? Sending “nurse specialists” out into the community to manage asthmatics and elderly patient with heart failure and COPD is known to provide huge financial savings and free up doctors and hospitals for more important work. Why not apply the same cost savings to veterinary medicine?
The Royal College of Veterinary Surgeons were not persuaded. On the contrary. They considered that Susie Macleod’s behaviour constituted disgraceful conduct.
Section 19 of the Veterinary Surgeons Act 1966 makes it a criminal offence for anyone to undertake veterinary work unless they are fully qualified veterinary surgeons. Veterinary nurses are allowed to carry out certain limited procedures provided the animals concerned
are under the care of the veterinary surgeon and the treatment in each case is carried out by the nurses under the direction of the veterinary surgeon.
Susie accepted the following facts:
* a. she was not present at the clinic when the vaccinations were carried out;
* b. she had never examined the animals;
* c. she had never read the animals’ medical records;
* d. she had never discussed the animals with their owners or agreed to take on their care;
* e. she did not know of the animals’ presence at the clinic or their condition;
* f. she had no discussion with the nurse administering the vaccine about the animal or its proposed treatment;
* g. she had no knowledge of the animals at allSo what defence did Susie mount to these agreed facts?
Read the next bit carefully. You many have heard it before. Susie placed some emphasis, however, in her submissions to the Board,
on her provision of “protocols” to the nurses which they were strictly enjoined to follow. In each case the nurse had a sheet on which she was required to fill in details about the individual animal, ticking boxes as she went, with instructions to refer the case to a veterinary surgeon on making certain findings about its health or condition.
She went on to argue that…
a veterinary nurse could carry out booster injections, so long as it was under veterinary direction, which she interpreted as extending to the system whereby she gave standard directions to the nurses by means of the “protocols”.
And what did their Lordships think of that?
"Their Lordships also consider, however, that the treatment carried out by the veterinary nurses in vaccinating the animals cannot be said to have been done under the appellant’s direction. The appellant argued that her “protocols”, consisting of instructions to the nurses and forms which they had to complete, constituted sufficient direction to them. Their Lordships cannot agree. They do not wish to attempt to define in detail the circumstances in which treatment is carried on under the direction of a veterinary surgeon, for those circumstances may vary widely. The concept does, however, connote an element of immediacy and potential control of the treatment which was wholly lacking in the carrying out of vaccinations at the Health4Pets clinic.
…..At its hearing the Disciplinary Committee was advised by its legal assessor that disgraceful conduct in a professional respect is conduct which falls far short of that which is expected of the profession. Their Lordships consider that that was an appropriate definition and that the Committee was correctly advised...
…their Lordships have no hesitation in upholding the decision of the Disciplinary Committee that the appellant was guilty of disgraceful conduct in a professional respect. The detailed findings made by it and the expression of opinion contained in its judgment that the appellant’s actions were capable of jeopardising animal welfare give sustainable grounds for reaching its ultimate decision, and their Lordships are of opinion that that decision fell within the ambit of sustainable conclusions."
The Veterinary Profession is not dumbing down. It is not going to allow protocol driven tick-sheet veterinary medicine to be practiced by unqualified “veterinary care professionals.”
Susie Macleod was reprimanded for disgraceful professional behaviour. We can be sure that she will not in the future be letting her nurse specialists loose on animals.
The question for doctors, patients and the NHS is obvious and I will not labour it. But the next time the cardiac nurse quacktitioner pops in to treat grandma’s heart failure, or the next time you visit a quacktitioner run walk-in clinic, try to forget that it is illegal to treat a dog in this fashion.pen on nhs
Tuesday 19 February 2013
Kant vs Mill's
Kant in the Blue corner;
http://en.wikipedia.org/wiki/Immanuel_Kant
Mill's in the Red corner;
http://en.wikipedia.org/wiki/John_Stuart_Mill
and as Harry Hill is want to say, FIGHT...................................
http://en.wikipedia.org/wiki/Immanuel_Kant
Mill's in the Red corner;
http://en.wikipedia.org/wiki/John_Stuart_Mill
and as Harry Hill is want to say, FIGHT...................................
Servant Leadership
endepted to Hemadri;
http://successinhealthcare.blogspot.co.uk/2013/02/servant-leaders.html
a rather interesting observation.
vertical vs horizontal organizational structures;
http://smallbusiness.chron.com/difference-between-horizontal-vertical-business-25653.html
http://successinhealthcare.blogspot.co.uk/2013/02/servant-leaders.html
a rather interesting observation.
vertical vs horizontal organizational structures;
http://smallbusiness.chron.com/difference-between-horizontal-vertical-business-25653.html
Blame and responsibility in the NaSH 2013.
interesting how language is being distorted to suit the ends needed;
If you are a leader you lead....if there is a disaster you take responsibility.
Otherwise it's authority without accountability.
&
The fact that they are using the word blame to avoid responsibility in this manner is pathognomonic of a bureaucracy where the bureaucrats are more important than the object of the enterprise to the powers that govern it.
this refers to the Francis report;
http://www.midstaffsinquiry.com/pressrelease.html
If you are a leader you lead....if there is a disaster you take responsibility.
Otherwise it's authority without accountability.
&
The fact that they are using the word blame to avoid responsibility in this manner is pathognomonic of a bureaucracy where the bureaucrats are more important than the object of the enterprise to the powers that govern it.
this refers to the Francis report;
http://www.midstaffsinquiry.com/pressrelease.html
NHS Boss for the chop?
it does look as if the past is coming back to visit itself;
http://www.telegraph.co.uk/news/9879216/NHS-boss-praised-scandal-hit-hospitals-during-the-height-of-care-debacle-letter-shows.html
http://www.telegraph.co.uk/news/9879216/NHS-boss-praised-scandal-hit-hospitals-during-the-height-of-care-debacle-letter-shows.html
A confused health minister ?
https://docs.google.com/file/d/1Wjx_6qH7V2xLtDvSc2sTDzndd6FLgYNJlPOaFyp8UcL4jMTHXcPUsK-TjLlA-1npm6RNiRuOhUGTG8vP/edit?usp=sharing
The highlights
GPs are accused of (1) not treating asthma in kids properly (2) sending half meningitis cases home (3) admitting too much "minor illness" that could be managed at home (4) using drugs for kids which have not been tested in paediatric population.
dr roscoe ->'If half the cases are sent home, that means that half of all cases of meningitis are spotted straight away.. Given that they are a minute percentage of our hot and unwell kids I think that statistic is in fact excellent. I got into this argument about cancer cases seeing their GP up to 3 times before being referred, letter eventually in the BMJ. '
sephiroth->'"(2) sending half meningitis cases home (3) admitting too much "minor illness" that could be managed at home"
Point 2 would say we are being too offensive, while point 3 would indicate we are being too defensive?? Make your mind up you wazzock??'
The highlights
GPs are accused of (1) not treating asthma in kids properly (2) sending half meningitis cases home (3) admitting too much "minor illness" that could be managed at home (4) using drugs for kids which have not been tested in paediatric population.
dr roscoe ->'If half the cases are sent home, that means that half of all cases of meningitis are spotted straight away.. Given that they are a minute percentage of our hot and unwell kids I think that statistic is in fact excellent. I got into this argument about cancer cases seeing their GP up to 3 times before being referred, letter eventually in the BMJ. '
sephiroth->'"(2) sending half meningitis cases home (3) admitting too much "minor illness" that could be managed at home"
Point 2 would say we are being too offensive, while point 3 would indicate we are being too defensive?? Make your mind up you wazzock??'
Friday 15 February 2013
QP avoidable emergency/urgent admissions
A rather wonderful arbitar of such by the ubiquitous Dr Spitfire;
'I have long since ignored diktats from above about reducing emergency admissions, attendences etc.
The managers will disappear over the horizon if the shit hits the fan because you failed to admit when needed.
When our QOF Qp indicators asked us to review our emergency admission referrals and identify any "inappropriate admissions", without actually specifying any criteria by which they were deemed inapporpriate, I set the standard thus:
The hospital team, on assessning the patient weere able, without bloods, Xrays or further investigation or monitoring beyond that of a GP service, to discharge the patient the same day.
I found we had no emergency admissions to hospital that met the criteria of inappropriate using this standard.
If the hospital team needs same day Xrays/bloods to arrive at a decision, then by default, that admission is appropriate. I will take criticism from managers or hospital consultants when patients are sent home without any investigations whatsoever. '
Johnleigh rightly comments;
'"Plus, you do know that most of the blood tests ordered on emergency admission patients are not requested by a doctor, but by the nurse at the door of the admission?"
On whose authority does the nurse do the tests?
Ah, "the doctor's" you reply.
I rest my case.'
and spitfire again;
'(to hospital colleagues, whom I admire a lot by the way to cope with heaving demands on them too):
tell you what in that case, next time you do a ward round on admissions as the senior doctor, tell your juniors you dont want to hear any results until you have clinically assessed the patient with the same equipment as a GP. Then decide if you can discharge without knowing them.
If you can, great, its an inappropriate referral/assessment. If you want to know the results before sending home, then you are in the same boat as the GP was.
It would be a useful teaching tool for the juniors, many of whom bemoan/interrogate us for sending up patients to be assessed (I remember I was guily of this too at that stage of training), to see if they can appreciate what it is like for us at the maximum uncertainty end, trying to make a decision in 10mins, or in an inadequate room on a soft sofa on a home visit to an acute abdomen.'
'I have long since ignored diktats from above about reducing emergency admissions, attendences etc.
The managers will disappear over the horizon if the shit hits the fan because you failed to admit when needed.
When our QOF Qp indicators asked us to review our emergency admission referrals and identify any "inappropriate admissions", without actually specifying any criteria by which they were deemed inapporpriate, I set the standard thus:
The hospital team, on assessning the patient weere able, without bloods, Xrays or further investigation or monitoring beyond that of a GP service, to discharge the patient the same day.
I found we had no emergency admissions to hospital that met the criteria of inappropriate using this standard.
If the hospital team needs same day Xrays/bloods to arrive at a decision, then by default, that admission is appropriate. I will take criticism from managers or hospital consultants when patients are sent home without any investigations whatsoever. '
Johnleigh rightly comments;
'"Plus, you do know that most of the blood tests ordered on emergency admission patients are not requested by a doctor, but by the nurse at the door of the admission?"
On whose authority does the nurse do the tests?
Ah, "the doctor's" you reply.
I rest my case.'
and spitfire again;
'(to hospital colleagues, whom I admire a lot by the way to cope with heaving demands on them too):
tell you what in that case, next time you do a ward round on admissions as the senior doctor, tell your juniors you dont want to hear any results until you have clinically assessed the patient with the same equipment as a GP. Then decide if you can discharge without knowing them.
If you can, great, its an inappropriate referral/assessment. If you want to know the results before sending home, then you are in the same boat as the GP was.
It would be a useful teaching tool for the juniors, many of whom bemoan/interrogate us for sending up patients to be assessed (I remember I was guily of this too at that stage of training), to see if they can appreciate what it is like for us at the maximum uncertainty end, trying to make a decision in 10mins, or in an inadequate room on a soft sofa on a home visit to an acute abdomen.'
Thursday 14 February 2013
Friday 8 February 2013
Thursday 7 February 2013
Wednesday 6 February 2013
Duty of candour....
the wiki definition is;
http://en.wikipedia.org/wiki/Duty_of_candor
i would contend candour can only be displayed if someone is listening and willing to action.
in a week when a politician Chris Huhne has displayed a decade-long gestation period to manifest 'candour', to be implored by the political classes is a bit rich.
nonetheless i would hypothecate the Ombudsman allied to the local Coroners Office with a little dusting of imagination and trust would be the perfect listening 'Auricle'. If this was made manifest it could stop Bristol, Alder Hay and Stafford ever happening again. It however requires political motivation and integrity.
interesting developments in the 'BMJ rapid response unit' [26 Feb 2013];
http://www.bmj.com/content/346/bmj.f1152?tab=responses
http://en.wikipedia.org/wiki/Duty_of_candor
i would contend candour can only be displayed if someone is listening and willing to action.
in a week when a politician Chris Huhne has displayed a decade-long gestation period to manifest 'candour', to be implored by the political classes is a bit rich.
nonetheless i would hypothecate the Ombudsman allied to the local Coroners Office with a little dusting of imagination and trust would be the perfect listening 'Auricle'. If this was made manifest it could stop Bristol, Alder Hay and Stafford ever happening again. It however requires political motivation and integrity.
interesting developments in the 'BMJ rapid response unit' [26 Feb 2013];
http://www.bmj.com/content/346/bmj.f1152?tab=responses
HeartSink remedy?
congratulations to drchuck ->'So I see this heartsink in clinic-chronic pain, under performing, recurrent S/A, quite probably a nightmare to manage as regrettably a number of issues have been medicalised needlessly and the unions and lawyers have been involved.
To cap it all the heartsink couldn't pour piss out of a boot with instructions on the heel.
The heartsink was accompanied by quite possibly one of the most hostile, belligerent people I have met who was acting as the heartsinks "advocate".
One of the complaints the heartsink has is that "no-one at work will take time to listen to me when I feel bad and my pain is at its worst".
The advocate thought this was an outrage, how dare they be unsympathetic and uncaring etc etc yaddah yaddah yaddah.
With some rather brave negotiation on my part I managed to persuade heartsink to the view that this wasn't really the role of colleagues or managers.
Well, snorted the advocate, if itsn't theirs, who the bloody hells is it?
Gently, oh so gently, I articulated the perspective that the patient was so lucky to have such a considerate and capable friend and that I felt the "patient" could usefully avail themselves of this persons support frequently and lengthily.
Cue horrified look on advocates face and beaming look of delight on patient.'
To cap it all the heartsink couldn't pour piss out of a boot with instructions on the heel.
The heartsink was accompanied by quite possibly one of the most hostile, belligerent people I have met who was acting as the heartsinks "advocate".
One of the complaints the heartsink has is that "no-one at work will take time to listen to me when I feel bad and my pain is at its worst".
The advocate thought this was an outrage, how dare they be unsympathetic and uncaring etc etc yaddah yaddah yaddah.
With some rather brave negotiation on my part I managed to persuade heartsink to the view that this wasn't really the role of colleagues or managers.
Well, snorted the advocate, if itsn't theirs, who the bloody hells is it?
Gently, oh so gently, I articulated the perspective that the patient was so lucky to have such a considerate and capable friend and that I felt the "patient" could usefully avail themselves of this persons support frequently and lengthily.
Cue horrified look on advocates face and beaming look of delight on patient.'
Thursday 31 January 2013
Baker-Bates-isms
For Liverpool graduates of a certain vintage who may still remember the great man;
1.Those DNUKers of a certain age may remember Baker-Bates' advice on retiring from the hospital. It was to buy a dog six months before retirement and on retirement present the dog to the telephonist (the former Liverpool Royal Infirmary switchboard was at the main hospital entrance). "It will be the only one to recognise you when you visit four weeks later".
2. mgbamber ->'I spent a year with Dr Baker-Bates and was well acquainted with 70 Rodney Street and the kitchen at the top where entire cooked chickens were put into a blender and various liquids added to make "soup" in which the bones made an interesting texture. I may be the only person to have left the flat by the webbing harness torque limiter device down the outside wall and then persuaded BB to follow my example.
A favourite comment was that which he attributed to Henry Cohen who was told that Maurice Pappworth had written 'A primer of medicine' to which Cohen was alleged to have replied, "I had always wanted to see my lecture notes in print".
One afternoon at the Providence Hospital in St Helens run by those nice nuns, he pulled the curtains around a patient's bed, then pulled off the bedclothes, exclaiming to us all, "Look, a man attached to a hydrocoele".
Howard Branley may not be old enough to remember Colin Ogilvie who was BB's houseman at one point.'
He had a little doctor's bag which contained the most enormous Queen Square pattern patella hammer and a towel. I saw Sir Cyril Clarke say to him on the Friday afternoon Grand Round, "Ah, Eric, I see you are doing neurology on elephants now". The towel was for opthalmoscopy. He would put it over his and the patients head to produce an instant dark room!
He lived above his private practice in rodney street looked after by a housekeeper, who I managed to call Mrs Willy, after an evening's generous entertainment there (I was drunk). He was prone to manic episodes and the police would often find him wandering the streets at 4am and gently lead him home, knowing who he was. He would wake up his houseman at 4 am other mornings having put the radio by the phone, shouting "Listen to this boy, it's very interesting".
Considered the senior physician during the war, all of the consultants were drafted into the medical corps. So he put all the teaching hospital regs into his Roller and drove around all the Merseyside hospitals, dropping them off in turn with the instruction, "You be the consultant here" and the hospital boards never argued. Fabulously rich, his wife was alleged to have run off with the chauffeur, but, unfortnately the Roller crashed at the roundabout just outside Clatterbridge Hospital. The boot flew open and a suitcase stuffed with ten pound notes scattered its contents all over the Wirral countryside.
He loved teaching and, long after his retirement took clinical pathology classes in the mortuary of the Royal Infirmary and applied physiology classes at the med school. He was very good. He brought in patients to the latter (the other ones were dead) to illustrate some principle, and he paid for the services of a private nurse to tend to them while he taught.
How come there are no teachers around any more who are a little eccentric? I think we are all too boring and serious!
He was also medical officer for Guinness and had wonderful bottles ofexport guinness which he then put into a big jug filled it with lemonade and lime!!!
I remember one cold Feruary morning driving this four litre Jaguar to St Helen's with him and two other students to St Helens at over 90 miles an hour along the East Lancs Road with all the windows open. As we went over the brow of the hill by Pilkingtons there was a lorry stuck in the road. He yelled at me to stop and told me to change down as well as braking madly. As the gear lever moved he shouted "aeshack meshack and in we go". I managed to stop,.... just.
Once when confronted by a wellknown lady of doubtful character who said to him....
"Eh pot belly yer cock is hanging out" replied without a trace of irony or a glance downwards "Dead birds madam never fall out of their nest".
He often told us to remember to "Choose your parents wisely".
His outpatients were highly unusual for the cake, coffee, fruit and the binocular case concealing brandy that sat on the huge table.
When someone was particularly thick in their reply he would tell us to "get the malaena ready boys" He would refer to Lord Cohen as "The earthly Lord".
He was definitely bipolar, but they really don't make them like that any more.'
1.Those DNUKers of a certain age may remember Baker-Bates' advice on retiring from the hospital. It was to buy a dog six months before retirement and on retirement present the dog to the telephonist (the former Liverpool Royal Infirmary switchboard was at the main hospital entrance). "It will be the only one to recognise you when you visit four weeks later".
2. mgbamber ->'I spent a year with Dr Baker-Bates and was well acquainted with 70 Rodney Street and the kitchen at the top where entire cooked chickens were put into a blender and various liquids added to make "soup" in which the bones made an interesting texture. I may be the only person to have left the flat by the webbing harness torque limiter device down the outside wall and then persuaded BB to follow my example.
A favourite comment was that which he attributed to Henry Cohen who was told that Maurice Pappworth had written 'A primer of medicine' to which Cohen was alleged to have replied, "I had always wanted to see my lecture notes in print".
One afternoon at the Providence Hospital in St Helens run by those nice nuns, he pulled the curtains around a patient's bed, then pulled off the bedclothes, exclaiming to us all, "Look, a man attached to a hydrocoele".
Howard Branley may not be old enough to remember Colin Ogilvie who was BB's houseman at one point.'
3. talbot ->'He indeed was a remarkable character. He was alleged to have a Luger pistol left over from the war. He was a consultant physician at several Liverpool hospitals and, for free, at 'The Providence' St Helen's run by the Little Sisters of the Poor, who worshipped the ground he walked on. He was prone to starting ward rounds by climbing on the table and asking "Whose the greatest" to which the nuns would all respond "You are Dr Baker-Bates." Long before they were fashionable, he wore short-sleeved shirts and took his dog on ward rounds. He once discharged his Luger into the ward ceiling.
He had a little doctor's bag which contained the most enormous Queen Square pattern patella hammer and a towel. I saw Sir Cyril Clarke say to him on the Friday afternoon Grand Round, "Ah, Eric, I see you are doing neurology on elephants now". The towel was for opthalmoscopy. He would put it over his and the patients head to produce an instant dark room!
He lived above his private practice in rodney street looked after by a housekeeper, who I managed to call Mrs Willy, after an evening's generous entertainment there (I was drunk). He was prone to manic episodes and the police would often find him wandering the streets at 4am and gently lead him home, knowing who he was. He would wake up his houseman at 4 am other mornings having put the radio by the phone, shouting "Listen to this boy, it's very interesting".
Considered the senior physician during the war, all of the consultants were drafted into the medical corps. So he put all the teaching hospital regs into his Roller and drove around all the Merseyside hospitals, dropping them off in turn with the instruction, "You be the consultant here" and the hospital boards never argued. Fabulously rich, his wife was alleged to have run off with the chauffeur, but, unfortnately the Roller crashed at the roundabout just outside Clatterbridge Hospital. The boot flew open and a suitcase stuffed with ten pound notes scattered its contents all over the Wirral countryside.
He loved teaching and, long after his retirement took clinical pathology classes in the mortuary of the Royal Infirmary and applied physiology classes at the med school. He was very good. He brought in patients to the latter (the other ones were dead) to illustrate some principle, and he paid for the services of a private nurse to tend to them while he taught.
How come there are no teachers around any more who are a little eccentric? I think we are all too boring and serious!
4. dphillips -> 'Ahh the "soup du jour" an endless pot that had things put in one after the other
My father was a butcher in Berry st round the corner from Rodney st and he used to sell BB ox tails mainly for his soup.He was also medical officer for Guinness and had wonderful bottles ofexport guinness which he then put into a big jug filled it with lemonade and lime!!!
5. davidhewitt ->'Oh I remember him very well in the mid to late sixties. He was very good to me and made me drive his car when I was on his and Cyril Clarke's firm.
I remember one cold Feruary morning driving this four litre Jaguar to St Helen's with him and two other students to St Helens at over 90 miles an hour along the East Lancs Road with all the windows open. As we went over the brow of the hill by Pilkingtons there was a lorry stuck in the road. He yelled at me to stop and told me to change down as well as braking madly. As the gear lever moved he shouted "aeshack meshack and in we go". I managed to stop,.... just.
Once when confronted by a wellknown lady of doubtful character who said to him....
"Eh pot belly yer cock is hanging out" replied without a trace of irony or a glance downwards "Dead birds madam never fall out of their nest".
He often told us to remember to "Choose your parents wisely".
His outpatients were highly unusual for the cake, coffee, fruit and the binocular case concealing brandy that sat on the huge table.
When someone was particularly thick in their reply he would tell us to "get the malaena ready boys" He would refer to Lord Cohen as "The earthly Lord".
He was definitely bipolar, but they really don't make them like that any more.'
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