Commissioning Safe and Sustainable Specialised Paediatric Services provides a unique approach to the commissioning of specialised paediatric services.  It is of interest to those involved in commissioning or delivering specialised paediatric services, but it has broader implications. It provides for the first time a clinically agreed system for representing the nature of the relationships between specialised services. It sets out which services need to be delivered from the same location and which do not. This is of significance to anyone assessing the configuration of paediatric services and indeed any services that relate to them - both wider children’s services and services to adults.
Based on the Framework, a model is now being developed to assist the longer term planning of specialised children’s centres. Work is progressing in conjunction with colleagues from the National Specialised Commissioning Group and the regional Specialised Commissioning Groups. It will report in the Autumn.

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Editorial: Libel battles can make and break reputations, but only rarely do they bear on questions of life and death - The Guardian 13th September 2008
Libel battles can make and break reputations, but only rarely do they bear on questions of life and death. The legal case against the Guardian which Matthias Rath abandoned this week is an exception. The vitamin campaigner - who has long proffered his pills as a panacea in defiance of all evidence - objected to remarks our columnist Ben Goldacre made about his South African activities. In a country where 6 million are HIV positive, Mr Rath sought to persuade victims to take vitamins instead of antiretroviral drugs (ARVs). He played a part in the madness which allows Aids to claim 1,000 South African lives every day.

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Health Foundation tests current theory that the public release of performance data can increase the accountably of healthcare providers and motivate organisational quality improvement activities. The report tackles this by looking at the impact of reporting on selection and change. It explores whether public release prompts improvements in effectiveness, patient safety and patient centredness. It backs the current direction of policy by showing that transparent systematic, data-driven performance measurement and feedback have a key role in quality improvement. The study offers suggestions for implementation, finding that public release of outcome data can stimulate change at the level of the hospital. However, it has little effect on consumer selection of provider.

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Hello, kiddies.

I trust everyone had just a super long weekend. I know I did. I was ready to write this post this morning but it took a few extra hours to get the last remaining bits of alcohol drained out of my liver.

It's been a busy few days on both sides of the border in the world of politics - and... it's pretty much fucked in both countries. Let's start with here in Canada because, well let's face it, everyone always starts with America. :)

It looks like PM Harper is ready to send Canadians back to the voting boothes. It's seriously annoying. Currently we have a minority government which is actually working quite well... for us, y'know, citizens. It, however, does not work for any of the political parties.

Right now, since no one has a majority the parties are forced to work together and compromise. The end result, generally, is a compromise that tends to land somewhere in the middle of a left and right wing idea which keeps, at least most people, reasonably happy. it's not overly efficient in terms of the time it takes to get things done - but I find it does produce better results.

That, however, holds no appeal for Harper and the Conservatives who are, supposed to be, in power. And really - why would it? You don't really have power if you have to go to your opponent constantly and get them to agree. What any ruling party wants is a majority which allows them to push through whatever legislature they want, unopposed by any other party.

Idealy, this is how a government is supposed to run but in a country as divided as this one (and America0 currently is - it basically ensures that about 40 per cent of your population is very happy, 40 per cent is quite pissed off and 20 per cent are indifferent. That makes for a very unpleasant country and in all likelihood you're going to head back to the polls early again in anyway.

All that said - I don't know what the alternative is. With the minority the parties are unhappy and force you back to vote early - and if you have a majority then half the country is unhappy and you'll be voting early as well. What we need is a good leader. And I don't think we have that in this country right now. Someone who can unite a country and make people want to do what's best for the nation instead of for their own agenda. I don't think we've truly had that type of leader since Trudeau in Canada. Someone who makes you want to vote for him and forget the fact that, generally, you already know what party you're going to vote for when you walk in the door. Most people are set in their ways and don't pay attention to the issues or the personalities - they just know what side they fall in. That can be very dangerous and we need someone who can make people forget that.

Here's hoping.

There's no shortage of Political drama with our neighbours to the south either. I generally have no shortage of venom for the Republican Party in the good ol' U S of A but you have to give credit where it's due. It was the right thing to do to scale back their convention that was to be held in Minnesota thsi week out of respect for Mother Nature's wrath in the deep south. I would have rather seen it out and out postponed a week or two but I don't pretend to know enough about the logistics of that to criticize them for not going ahead with that part. It may very well have been impossible to move back - so at least they scaled it down.

John McCain has made his pick for his VP running mate and it's Alaska Governor Sarah Palin, a mother of 5. There are a few things I'd like to say about this. And before anyone jumps to any conclusions, it has nothing to do with the fact that her daughter is now pregnant out-of-wedlock. To be totally honest, that actually makes her seem a little more human as that is a problem that families just have sometimes.

First of all - no one should fool themselves about what this is. This is John McCain trying to snag up some extra votes. There is an army out there of women who were, pardon the expression, balls to the wall for Clinton to get the nomination and many of them are now furious. And they're not just the male-hating, butch as hell, golf playing dykes that I'm talking about that would follow any woman in to war if they thought it would put a dent in a "male controlled world". (note - the above does not apply to all lesbians - just the psycho ones). But there is a huge number of typical American women who were firmly behind Hilary and they range from the career oriented business woman to the stay-at-home mom and they will have their say on election day and it may not be for the Democrats. The Republicans would love to snag up even a quarter of those disgruntled Deomcrats who want to see a woman in the office more than they want to see their party in.

Let's be real, here. We are talking about the American Republican Party. They're not exactly known for their open-mindedness. This is the party of people who has forever been accused of wanting to see man over woman, black over white, war over peace and a million other negative stereotypes. I have a hard time believing that now, it's merely a co-incidence that they embrace a woman as vice president just months of slandering Clinton for being too emotional. It's not a co-incidence - it's politics! It's a desire to win votes.

That's fine. That's what we'd all expect. But I tend to wonder if this was the best woman to choose. As I said, I don't fault anyone for the fact that her unmarried teenage daughter is now pregnant just days after her selection. It would have been nice if the Party had known that first... but they didn't and you move on. My problem is with Governor Palin herself. My sources tell me (my sources being the CBC of course) that Palin may not exactly have a closet free of skeletons.

Apparently, not too long ago Palin's sister was dating a police officer in a city in Alaska and their relationship ended rather unceremoniously. Governor Palin at this point decided the right thing to do would be to contact that city's police Chief and tell him to fire the officer. Having no reason to fire him based on his performance, the Chief refused. Good for him. He did the right thing and that should have been the end of it. Unfortunately it was not and the Governor then had the Police Chief fired and had someone installed who would go ahead and fire this particular officer. Classy.

A little research would have gone a long long way for the Republican Party when it comes to things like this. Average, every day people don't take kindly to being abused by the government and they are not likely to vote for someone who has done things like this once it becomes common knowledge.

There never ceases to be something to talk about in politics - no matter which country you live in.

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Consultation document on proposals to introduce powers of suspension, and a single approach to the removal of chairs and non-executives of Strategic Health Authorities and other health bodies.
The consultation on removing or suspending chairs and non-executives of Health Bodies sets out a single approach to considering whether and if so how, a chair or non-executive member of a Strategic Health Authority (SHA), Special Health Authority (SpHA) or Health Body should be removed from office. The process may involve either seeking resignation or the termination of appointment and also introduces the potential use of a suspension function, as well as proposals for temporary non-executive member(s) or director(s) to be appointed during the period of suspension.
These proposals represent the second phase of a programme to introduce a legal framework for the Secretary of State to direct the Appointments Commission (AC) to suspend chairs and non-executive members or directors from office.
The first phase involved introducing powers of suspension to chairs and non-executives of Primary Care Trusts (PCTs) and NHS Trusts. Following a separate consultation and amendments to regulations, the Secretary of State directed the AC to operate a new suspension function for chairs and non-executives of NHS Trusts and PCTs from 16 June 2008.
Now in phase two, this consultation sets out proposals to extend powers of suspension to chairs and non-executive members of SHAs, SpHAs and other Health Bodies.

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Initial reports on the first few days when professional and amateur athletes arrived in China for the Beijing Games 2008 said that many athletes have difficulty coping with the pollution and heat in China. As they undergo with their last minute training and practices, you would find these well-trained and super fit athletes gasping for air and trying to breathe normally as theyre not accustomed to the climate in the tropics. The pollution in the city where they are being accommodated as well as the super tropical heat have taken a toll on them. Well, all I can say is that Good luck to them despite all these! They are in China at this point of time for the Olympics. And speaking about air pollution and the pinching pain of fuel price rise, who said that all SUVs are gas guzzlers? They are wrong! The Chevy Equinox which will soon be launched here in Thailand uses hydrogen and emits only water vapour. So, the problem of air pollution thats brought by the gasoline and crude-fueled cars is solved! Is it? Im not sure about that!
Today is very phenomenal 08.08.08 ! My favorite number, 8 or 38. The opening day of the Beijing Olympics 2008 in China, of course. My favorite tennis legend, Roger Federer, is there to compete and win gold for his country. The tennis event is a star-studded and Im going to check out the progress on a daily basis. I hope Federer will get the gold in the Mens Singles event. Some Thai and Filipino delegates also take their share of the limelight. President Gloria Macapagal-Arroyo of the Philippines and HRH Princess Maha Chakri Sirindhorn of the Kingdom of Thailand both went to offer support to their respective teams and to boost up their ego and enthusiasm in competing their games to their best for the countries that they represent. Good luck to them all and may the best sportsmen win! Tonight is a big celebration and Im going to celebrate and join with others in witnessing the grandeur opening ceremony of the Beijing Games which is now being broadcast live via CAT-Thailand to all TV stations althroughout the kingdom. I heard that its a magnificent show with super hi-tech and culturally-rich theme that displays the various countries richness of culture and symbol. Let me go home! See you at the Olympics.

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First Analysis Of Cancer Incidence, Mortality And Survival Combined Reveals Encouraging Trends In Europe, Smoking And Obesity-Related Cancers Increase
The first research to look at recent trends in European cancer incidence, mortality and survival together has shown that cancer prevention and management in Europe is moving in the right direction. However, the research reveals that variations between countries in policies for mass screening, access to health care and treatment are reflected in the different cancer rates.

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The justices ruled that such a punishment is cruel and unusual
Those people who rape children can no longer be executed, the U.S. Supreme Court ruled Wednesday. The death penalty is not a proportional punishment for the rape of a child, Justice Anthony Kennedy wrote for the majority in the 5-4 opinion. Joining him in the decision that the executions for such a crime violates the U.S. Constitution’s ban on cruel and unusual punishment were the four more liberal members of the court – John Paul Stevens, David Souter, Ruth Bader Ginsburg and Stephen G. Breyer. No one has been executed for a crime that did not involve the death of a victim for some 44 years. The landmark case revolved around the Patrick Kennedy, a 43-year-old Louisiana man who was sentenced to die for raping his 8-year-old stepdaughter. Another Louisianan was also condemned to death for rape. Executions for adult female rape victims was banned 31 years ago. During the Jim Crow era, Black men – even those falsely accused – were frequently executed by lynch mobs after being charged with rape. All but five states ban the death penalty for rape; the rest allow death for child rapists. If you’ve been previously convicted of raping a child in Montana, Oklahoma, South Carolina and Texas, you could be sentenced to death. Dissenting in Wednesday’s ruling were Clarence Thomas, Samuel Anthony Alito, Antonin Scalia and John G. Roberts, Jr. The harm that is caused to the victims and to society at large by the worst child rapists is grave, Alito wrote in the dissenting opinion. It is the judgment of the Louisiana lawmakers and those in an increasing number of other states that these harms justify the death penalty. But, Kennedy said, the fact that very few states allow execution for rape proves there is a national consensus against capital punishment for the crime of child rape.
Atlanta courthouse murder suspect wants the death penalty off the table
The Atlanta man accused of going on a killing spree during his daring courthouse escape three years ago is blaming the DA of covering up misconduct by the prosecutor and wants the death penalty taken off the table. Brian Nichols, whose defense is that his was mentally incapacitated when he allegedly snatched a deputy’s gun and shot to death a judge, court reporter, deputy and an immigration agent, is also asking that certain evidence be thrown out. Nichols was at a hearing on earlier rape charges when he managed the escape. He argues that the former prosecutor in that initial case, Gayle Abramson, who is likely to testify in the murder case, indulged in misconduct. Nichols’ defense team, however, has not divulged the alleged misconduct to the court, The Atlanta Journal-Constitution reports. In a statement to the newspaper Tuesday, Abramson and her husband, Rand Csehy, also a Fulton prosecutor, said that Nichols’ attorneys are attempting to kill the case by smearing her with a wiretap conversation involving another murder investigation, the Journal-Constitution reports. Not only is this document factually inaccurate and filled with intentional falsehoods, but it is incomplete, the couple said of the complaint. Nichols accuses Abramson of socializing with a murder suspect and his friends while on a trip to California.

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Tranzyme Pharma's Ghrelin Agonist TZP-102 Demonstrates Safety And High Oral Bioavailability In The Successful Completion Of A Phase I Trial
Tranzyme Pharma announced the successful completion of a Phase I, placebo-controlled, single ascending dose study of its orally administered ghrelin agonist, TZP-102. TZP-102 is the second drug candidate from Tranzyme's internal R D efforts to reach clinical development. It is a potent prokinetic agent initially being developed for the treatment of mild-to-moderate gastroparesis.

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Ever been frustrated by an industrial hygienist who just didnt seem to get it?  The dude comes in with his air tubes, calibrators, gizmos and gadgets, but barely says a peep to the workers.  Im not talking about the talented IHs out therewho understand that talking to the exposed workers is an integral part of their job. 
No, Im talking about the kind of IH whos called in by management to hit the shop floor, but doesnt venture too far away from his sampling pumps.  If workers symptoms persist, management resurrects those certified lab results to convince you that theres no problem herethe IH told us so.  Now, get back to work.
Mark Catlin found an amazing clip on YouTube from a 1952 television show.   I call it Avoid This Industrial Hygienist also known as Industrial Hygienist on Mars. (00:51 seconds)   If you dont laugh out loud, youve luckily not crossed paths with this species of IH. 
Celeste Monforton, MPH knows dozens of exceptional IHs and respects their work to protect workers from health hazards.  Its the bad apples in the bunch who can rot the whole barrel.

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health questionnaires every two to four years that included questions about coffee consumption, other dietary habits, and smoking status.

During 18 years of follow-up in the men and 24 years of follow-up in the women, roughly 4,500 deaths due to heart disease and 7,500 cancer deaths occurred. An additional 6,000 deaths were due to other causes.

After controlling for other risk factors such as weight, diet, smoking status, and disease status, the researchers concluded that people who drank coffee were less likely to die than those who didn't during the follow-up, and that the risk reduction was attributable to a lower risk for death from heart disease.

No association was seen between coffee drinking and cancer deaths.

The researchers conclude that the finding of a "modest" all-cause and heart disease death benefit for coffee consumption deserves further
study.

The research appears in the June 17 issue of the journal Annals of Internal Medicine.


Coffee Benefits Explored
It has been suggested that coffee may protect against heart disease by reducing inflammation. Coffee has also been shown to lower blood sugar levels, which could have a beneficial effect on diabetes risk.

For many people, coffee is the main dietary source of beneficial plant compounds known as polyphenols, which are powerful antioxidants, says coffee researcher and chemistry professor Joe Vinson, Ph.D.

"The antioxidant properties may or may not be the mechanism at work here. We can't really say," he tells WebMD.

Vinson says the newly reported study offers the best evidence yet linking coffee with a lower risk of death.

"This was a very rigorously designed study, and the findings are very intriguing," he says.

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Rep. Jefferson says he’s not giving up.
Little things like getting caught with $100,000 in his freezer, or being accused of peddling his power in exchange for the ultimate hookup for his family isn’t enough to keep Louisiana Congressman William Jefferson down and out. On Tuesday, the embattled lawmaker announced that he would not do what many of his colleagues and constituents were expecting: slip quietly into political oblivion. Instead, he sent out a statement saying that he’s running for re-election. I will run for re-election to the U. S. House of Representatives this fall. I will run on my record of effective service to the people of my district over the years and in particular over the last three years since Hurricane Katrina,” he said. “I have helped to keep the leaders of the House focused on helping with our recovery through frequent visits, on the ground hearings and assessments of our continuing needs and concrete responses to our problems. I have invited Speaker Pelosi, Majority Leader Hoyer and Majority Whip Clyburn to lead a delegation back to our city in late July of this year to continue a strong federal connection and commitment. It’s unlikely that he’ll be getting much support from Pelosi, the highest-ranking Democrat in the House, or Clyburn, the highest-ranking Black Democrat, since neither has offered public support during his political battles. “The fact that I am the target of an overly zealous prosecution has not prevented my delivering for our district and our state,” he said. “The U.S. Court of Appeals has already found that the raid of my office violated the Constitution, and the Supreme Court decided to let that ruling stand. We are mounting a forceful attack on the governments false factual allegations and its flawed legal theory, and we are going to continue to insist that I receive a fair trial. My family and I are going to fight these charges, and in the meantime, we are going to fight for you.”
Car-jacking victim escapes trunk
A man was carjacked and thrown into the trunk of the stolen car in Fayetteville, Ga., Monday, but he got away by pulling the emergency latch, according to police. One suspect snatched the unidentified victim’s Chevy Tahoe and drove off, while the other drove away in a Chevy Impala with the victim in the trunk. But in the chaos of the incident, the Impala driver crashed, and both suspects abandoned their cars and jetted off. Police nabbed one suspect, Travion Marquez Willis, 17, less than a mile from the crash. Willis is serving first offender probation in a March drug and criminal trespass case in Clayton County, court records show. They’re still looking for the other one, Christopher Deangelo Wakefield, 22. The two men took the victim’s keys and cell phone and forced him into the Impala trunk, police said. When the car stopped at a traffic light, the man saw his chance and pulled the emergency trunk release. He flagged a passing car, which took him to a shopping center where he called 911, according to police.

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A friend emailed me the URL to Health News Review web site. The site posts daily reviews of medical articles or news broadcast on popular news media, magazines, web sites, or TV, and rate the articles on a few critiria. The reviews and ratings are made by medical professionals. I think it's a near perfect solution to the general public's frequent complaint that medical advice on news media is often confusing and contradicting. It does not replace directly reading research articles, which give you the original source of how the control study was done and what the raw data looks like. But it's a great site for general reading and provokes critical thinking for all of us. The topic selection is also attractive; it highlights those that catch most people's eyes, weight loss, cardiovascular problems, etc. Rare diseases are, well, rarely selected.

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As we flip the calendar over from a very busy May into a sunny June, I want to reflect on the common themes in the blog entries of the past four days:
1. My PLoS Medicine article, “How Do US Journalists Cover Treatments, Tests, Products and Procedures? An Evaluation of 500 Stories.”
2. The Commonwealth Fund analysis on variations in child health care across the US.
3. Another more care isnt always better care study - this time in JAMA.
4. Consumer Reports releasing an online tool using Dartmouth Atlas data to allow you to look at aggressive vs. conservative care - comparing hospitals on this scale.
Connect the dots. Jack Wennbergs work rings through these themes.

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Parkinson’s practice, as it was structured until recently, involved an initial visit by house call, and then a cash-for-services rendered system, usually around $150 for an episode of care. “Much of the downfall of healthcare is that it’s been taken out of the community and made very impersonal,” Parkinson says. “For me, I have no overhead costs whatsoever. I have my computer, my Internet connection, and my iPhone. That’s my overhead. In my neighborhood, I can see 10 patients a day but take care of 25, which is a typical doctor load. Half of all office visits don’t need to be taken care of at the office by a doctor.

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