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Day case tonsillectomy has been advocated as a means of reducing health care costs associated with inpatient care. The authors studied 74 consecutive children undergoing conventional overnight stay tonsillectomy using a parental questionnaire and a retrospective case note review. Medical exclusion criteria for day surgery were present in 21 per cent, and social exclusion criteria in 82 per cent. Overall, only 16 per cent of children satisfied all the criteria for suitability. On the day of surgery, 29 per cent of children were reported as having poorly controlled pain and 31 per cent as having nausea and vomiting, such that unplanned admission would have been likely had they been done as day cases. In total 63 per cent of parents were unhappy or very unhappy with the possibility of same day discharge. The authors do not plan to introduce day case tonsillectomy in Cumbria.

The published evidence in support of a tonsillectomy is equivocal relying on historical studies using objective outcome measures. Based on this, NICE have suggested that tonsillectomy is a “low clinical value treatment” and its funding curtailed by PCTs. This paper aims to prospectively evaluate the effect of a tonsillectomy on quality of life (QOL) of children affected by recurrent infective tonsillitis using a qualitative patient reported outcome measure (PROM).

Parents of children under the age of 16, undergoing a tonsillectomy, were enrolled. Parents completed a paediatric throat disorders outcome (PTDO) test prior to their child's surgery and then six months post‐operatively. Results were analysed using the Mann‐Whitney U test. The power of the study was 0.8 to detect a difference of 10 in a total score of 70.

A total of 63 children participated and an 86 per cent response rate was received at six months. The mean total score improved from 31.29 pre‐op to 7.41 post‐op (p<0.001). The mean score for the first two subgroups remained static but for the remaining 12 sub‐groups significantly improved post‐op.

The study demonstrates that performing tonsillectomies in a carefully selected cohort of children, significantly improves their QOL. It adds to a growing body of evidence that tonsillectomy is not a “low clinical value procedure” and has a substantial impact on the patients' symptoms.

This chapter develops a productivity analysis of the New Jersey PPO Health Insurance Industry for 2018. The chapter concerns five New Jersey PPO insurance companies. The two output variables are claims paid and loss ratio. The two input variables include premiums collected and assets.

This article has been withdrawn as it was published elsewhere and accidentally duplicated. The original article can be seen here: 10.1108/14664109910306785. When citing the article, please cite: Haytham Kubba, Ralph Messersmith, (1999), “Is day case tonsillectomy suitable for children in Cumbria?”, British Journal of Clinical Governance, Vol. 4 Iss: 2, pp. 56 - 6.

The advantages of Goal Programming (GP) over linear programming (LP) are discussed in the context of the healthcare industry. Decision makers must give considerable attention to the formulation of a GP model. However, long‐ and short‐term solutions must not be confused. Solutions also require implementations, which may be impractical or difficult. The full utilisation of facilities is recommended in an attempt to reduce unit costs and increase output.

The purpose of this paper is to enable busy health care professionals to gain a quick overview of the current articles in CGIJ.

The paper takes the form of a review.

Clinical governance continues to be an important issue in contemporary healthcare and the concept is being applied to many different facets of healthcare provision.

The papers in the issue recommend changes to: knowledge sharing, risk management, defining low value/high value treatments, use of voice recognition software and clinical supervision.

Knowledge sharing and considering patient quality of life (QOL) rather than basing treatment decisions on cost alone are considered.

The paper provides an overview of current subjects.

Multiple connotations and conceptions of health need are currently in use. The purpose of this paper is to specify some important distinctions regarding this confusing multiplicity in a taxonomic fashion relevant to the economic problems that arise in addressing health need. Classification is possible with the relevant concepts in conventional economic theory. The classification applies wherever economic considerations bear upon health need.

Initially, some seminal economic ideas about need are presented from Marshall, Pauly, Banfield, Jevons, Deaton and Meullbauer, and Georgescu‐Roegen. Recent discussions of basic needs by Sen and Nussbaum concerning “capabilities” and human flourishing are also considered. Ruger's subsequent developments of these concepts specifically for health are noted. The paper then specifies and classifies the current economic connotations of “health need” by applying positive economic analysis and the framework of economic theory. In particular, the conventional theories of consumer demand and production supply are useful. Geometric tools of analysis along with illustrations from the health sector specify various distinctions and classifications.

The uses of the generic term “need” relate to quite different economic problems. The findings show how diverse interpretations of need can be specified.

Distinctions over health need are important since, in many Western countries, need is one of the “pillars” of the Welfare State. Effective policy requires sound conceptions and measurements of need. Given the relevance of economics for approaching competing resource uses in the face of health need, measurement of need is improved with taxonomy, and confusion reduced.

Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG compliance among practitioners so far would aid the understanding of factors influencing CPG compliance. This study seeks to provide this.

A general review and discussion of CPGs in areas of their attributes, benefits and pitfalls were carried out. Articles concerning the assessment of CPG compliance were also reviewed to understand the kind of data collected for such assessments (qualitative vs quantitative), the methods used to collect data (objective versus subjective), and the assessment measures employed (process versus outcome).

A total of 57 CPG compliance assessment studies were reviewed. Almost two‐thirds employed objective methods. Of the subjective assessments, 47 per cent analysed solely quantitative data, 32 per cent analysed solely qualitative information and 21 per cent analysed both. More than four‐fifths of all studies used process measures to determine CPG compliance and only 5 per cent used solely outcome measures.

Depending on the methods used, assessments can help identify various factors influencing CPG compliance. Such factors may be related to the physician, guidelines, health system or patient. A good understanding of these factors and their role in influencing compliance behaviour will help health regulators and administrators plan better and more effective strategies to improve doctors' CPG compliance.

This review looks at the various aspects of CPGs to understand how these influence practitioners' compliance.

Presents a model of service encounter satisfaction offering conceptual and pragmatic advantages over the dominant disconfirmation paradigm. Expectations are compared with performance, at three separate stages, which directly combine into one overall consumer service encounter judgment. Offers service practitioners increased insight into understanding consumers′ satisfaction processes.

Most studies looking into completion of the audit cycle, have investigated specific interventions rather than entire projects. This study was carried out to evaluate the successful completion of the audit cycle depending on whether or not recommendations were acted on; and to find out relevant confounding factors. This was a retrospective review of the recommendations of audits between March 1999 and October 2002. There were 29 projects with a total of 63 recommendations. While 24 had been implemented, action had been only initiated in two and was in progress in one. A total of 17 recommendations were still under discussion. There were three types of inaction – no action because of no recommendations (n=8), action no longer appropriate (n=1) and specific obstacles preventing implementation (n=10). There were no significant differences between the outcomes (Chi square=0.128, dF=1, p=0.720). Investigation into the outcomes of audit recommendations is a useful way of assessing the entire audit cycle. However it also throws up a number of contextual issues that can influence outcome and should be taken into account when monitoring change in clinical settings.