Reforming the contract of UK consultants

The NHS Plan expressed the intention of government to "fundamentally overhaul" the national contract for UK hospital specialists to "reward and incentivise those who do most for the NHS." How can this be achieved

Challenges for the National Institute for Clinical Excellence

Rationing health care is inevitable, and NICE should inform NHS decision making. Adoption of new technologies by NHS clinicians should be informed by costs as well as effectiveness. The NHS needs better information from NICE on the equity implications of new and existing technologies. NICE appraisal should focus not only on service enhancement but also on withdrawal of existing ineffective or inefficient therapies. Giving NICE a real budget to fund its recommendations would encourage it to examine the effect of its decisions on the whole NHS

A cognitive model of fiction writing.

Models of the writing process are used to design software tools for writers who work with computers. This thesis is concerned with the construction of a model of fiction writing. The first stage in this construction is to review existing models of writing. Models of writing used in software design and writing research include behavioural, cognitive and linguistic varieties. The arguments of this thesis are, firstly, that current models do not provide an adequate basis for designing software tools for fiction writers. Secondly, research into writing is often based on questionable assumptions concerning language and linguistics, the interpretation of empirical research, and the development of cognitive models. It is argued that Saussure's linguistics provides an alternative basis for developing a model of fiction writing, and that Barthes' method of textual analysis provides insight into the ways in which readers and writers create meanings. The result of reviewing current models of writing is a basic model of writing, consisting of a cycle of three activities - thinking, writing, and reading. The next stage is to develop this basic model into a model of fiction writing by using narratology, textual analysis, and cognitive psychology to identify the kinds of thinking processes that create fictional texts. Remembering and imagining events and scenes are identified as basic processes in fiction writing; in cognitive terms, events are verbal representations, while scenes are visual representations. Syntax is identified as another distinct object of thought, to which the processes of remembering and imagining also apply. Genette's notion of focus in his analysis of text types is used to describe the role of characters in the writer's imagination: focusing the imagination is a process in which a writer imagines she is someone else, and it is shown how this process applies to events, scenes, and syntax. It is argued that a writer's story memory, influences his remembering and imagining; Todorov's work on symbolism is used to argue that interpretation plays the role in fiction writing of binding together these two processes. The role of naming in reading and its relation to problem solving is compared with its role in writing, and names or signifiers are added to the objects of thought in fiction writing. It is argued that problem solving in fiction writing is sometimes concerned with creating problems or mysteries for the reader, and it is shown how this process applies to events, scenes, signifiers and syntax. All these findings are presented in the form of a cognitive model of fiction writing. The question of testing is discussed, and the use of the model in designing software tools is illustrated by the description of a hypertextual aid for fiction writers

Naughty or not: an investigation into student teachers’ perceptions of attachment disorder

This paper will present a small-scale study into the perceptions of student teachers from a University in England (UK) to drivers behind children's behaviour. The study will examine students’ perceptions before and after they have been given a short introduction to the theory and practice around Attachment Disorder in the UK. This paper will also consider what the implications are for inclusive practice when an understanding of a child's emotional development is considered by the teachers they encounter. This study will be placed in the context of current research, legislature, political ideology and socio-economic drivers in England and Wales (UK)

Impact of NICE guidance on laparoscopic surgery for inguinal hernias: analysis of interrupted time series

After the introduction of Bassini's procedure in the late 19th century, methods of repairing hernias changed little until the 1990s, when synthetic mesh and laparoscopic methods arrived. In contrast to the open mesh technique, laparoscopic surgery remains uncommon. In January 2001, the National Institute for Clinical Excellence (NICE) issued guidance that stated, "For repair of primary inguinal hernia, open [mesh] should be the preferred surgical procedure." We describe patterns of surgical repair of inguinal hernias and assess the impact of NICE's guidance

Preventing opioid overdoses in Europe:a critical assessment of known risk factors and preventative measures

This report is the outcome of a project into opioid overdoses. The remit was to focus on finding practical methods of overdose prevention. In order to fulfil this remit, a critical review of existing knowledge on overdose prevention was conducted. The report adds value to existing information by developing a methodology to classify and analyse risk and protective factors stratified by those involved (drug users, observers and organisations). The report then assesses the extent to which risk and protective factors can be potentially modified at different levels, e.g. individual, treatment setting, organisational and strategic. The report therefore has the potential to be updated as new information emerges

The cornerstone of Labour's 'New NHS': reforming primary care

Two remarkable aspects of the Thatcher ‘internal market’ reforms of the NHS were the focus on creating a market for hospital services and the way in which primary care was treated almost peripherally in the 1989 White Paper (Department of Health 1989a). The 1991 NHS reforms introduced general practitioner (GP) fundholding almost as an afterthought, and the revision of the GP contract in 1990 Paper (Department of Health 1989b) was conducted separately from the implementation of other health care reforms. In contrast the principal focus of Labour’s ‘new NHS’ reform is primary care (Department of Health 1997). The intention of the government is both to improve the efficiency and equity of primary care provision and to develop Primary Care Groups and Primary Care Trusts which both provide care efficiently and act as agents who purchase secondary and tertiary care on behalf of patients. This is an ambitious agenda. This paper explores the policy context of Primary Care Groups in sections 1 and 2, describes and appraises the government proposals in section 3, and identifies major issues involved in the implementation of change in section 4.fundholding, rationing