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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.

The purpose of this paper is to establish the effect of incorporating Centor scoring into antibiotic prescribing in primary care in London, UK, before and after the introduction of an educational package and prescribing software tool.

A quality improvement project with analysis of all sore throat presentations in patients aged 3-14 years, in two phases. Phase 1 (retrospective): 1 January-31 December 2013, followed by an intervention (software tool/education package) and Phase 2 (prospective): 1 March 2014-28 February 2015.

In the initial analysis, 162 out of 202 (80.2 per cent) patients were prescribed antibiotics. Following the educational/software intervention, 191 out of 231 (82.7 per cent) patients were prescribed antibiotics (p=0.56, χ² test). The mean Centor score decreased significantly following the education/software intervention (3.1 vs 2.7, p<0.001, χ² test). In all, 100 per cent of patients with tonsillar exudate were prescribed antibiotics in both phases. The apparent order of importance for predictive signs/symptoms given by the prescribers in both phases of the study was tonsillar exudate>lymphadenopathy>fever>absence of cough.

This is the first time a differential importance given by practitioners on individual Centor criteria has been described. With a low probability of bacterial infection, children with exudate or anterior lymphadenopathy almost always received antibiotics. This is interesting, since studies have previously found that the presence of tonsillar exudate had no significant association with culture-confirmed streptococcal tonsillitis.

The purpose of this paper is to present an automatic Medical Knowledge Elicitation System (MediKES), which is designed to improve elicitation and sharing of tacit knowledge acquired by physicians. The system leverages the clinical information stored in electronic medical record systems, by representing the acquired information in a series of knowledge maps.

The system architecture of the proposed MediKES is first discussed, and then a case study on an application of the proposed system in a Hong Kong medical organization is presented to illustrate the adoption process and highlight the benefits that can be realized from deployment of the MediKES.

The results of the case study show that the proposed solution is more reliable and powerful than traditional knowledge elicitation approaches in capturing physicians' tacit knowledge, transforming it into a machine‐readable form, as well as enhancing the quality of the medical judgment made by physicians.

A prototype system has been constructed and implemented on a trial basis in a medical organization. It has proven to be of benefit to healthcare professionals through its automatic functions in representing and visualizing physicians' diagnostic decisions.

Knowledge is key to improving the quality of the medical judgment of physicians. However, researchers and practitioners are still striving for more effective ways of capturing tacit knowledge and transforming it into a machine‐readable form so as to enhance knowledge sharing. In this paper, the authors reveal that the knowledge retrieval and the visual knowledge representation functions of the proposed system are able to facilitate knowledge sharing among physicians. Thus, junior physicians can use it as a decision support tool in making better diagnostic decisions.

Proposes use of the triboluminescence of blood and condensed exhaled air products (which accompanies mechano‐chemi‐emission effects in biological objects) as a quantative test of levels of exposure, for example, to radiation. Describes trial of this technique on victims of the Chernobyl accident. Offers an explanatory model.

The purpose of this paper is to ask what role robustness plays in current medicine and in how far medical practices influence human robustness and thus the ability to be adapted and survive under changing conditions.

In order to do this Bateson's concepts of learning and network pathologies are applied to the medical topic of immune reaction.

Current medical research does not take sufficiently into account that natural stimuli and therapeutic interventions might lead to a large‐scale of changes. This is mainly due to the lack of related epistemological tools.

This lack leads to a restricted validity of many medical findings. There is even some evidence that the current therapeutic approach might lead to a decline of human robustness.

This paper shows how systemic concepts can contribute to a deeper understanding of the therapeutic processes.

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.

Although I am honoured to have been asked to present this paper I feel somewhat diffident about my topic. Even in the United States documentalists refer to thesauri in disparaging terms and I sometimes get the impression that British documentalists are sure that their American counterparts are suffering from an epidemic of thesaurosis. Interestingly enough, there really is such a disease, and the twentieth edition of Stedman's Medical dictionary defines the condition as follows: ‘Abnormal or excessive storage in the body of phosphatides, fat, iron or other material’.

In years past, when life seemed simpler and the Law much less complicated, jurists were fond of quoting the age‐old saying: “All men are equal before the Law.” It was never completely true; there were important exemptions when strict legal enforcement would have been against the public interests. A classic example was Crown immunity, evolved from the historical principle that “The King can do no wrong”. With the growth of government, the multiplicity of government agencies and the enormous amount of secondary legislation, the statutes being merely enabling Acts, this immunity revealed itself as being used largely against public interests. Statutory instruments were being drafted within Ministerial departments largely by as many as 300 officers of those departments authorized to sign such measures, affecting the rights of the people without any real Parliamentary control. Those who suffered and lost in their enforcement had no remedy; Crown immunity protected all those acting as servants of the Crown and the principle came to be an officials' charter with no connection whatever with the Crown. Parliament, custodian of the national conscience, removed much of this socially unacceptable privilege in the Crown Proceedings Act, 1947, which enabled injured parties within limit to sue central departments and their officers. The more recent system of Commissioners—Parliamentary, Local Authority, Health Service—with power to enquire into allegations of injustice, maladministration, malpractice to individuals extra‐legally, has extended the rights of the suffering citizen.

Clinical coding is a process of accurate translation of written medical terms into codes. The Payment by Results initiative has focused attention on the quality of clinical coded data as all income for in patient services is derived from coded clinical data. The aim of this study was to evaluate the quality of clinical coded data by making comparisons between the information held on the dialect encoder system and the information recorded in the clinical case notes.

The 50 episodes for this study were randomly selected from a list of all episodes ending August 2005 within the ENT specialty in a teaching hospital.

There were only 17 (34 per cent) episodes with a structured summary within the case notes. Of the 50 recorded primary diagnoses 42 (84 per cent) were correctly coded. Of the 43 recorded primary procedures, 37 (86 per cent) were correctly coded.

This study promotes a better awareness of the impact of poor coding and gives recommendations that will be helpful to those involved in coding processes.