The Commission for Patient and Public Involvement in Health (CPPIH) supersedes the Community Health Councils. The Commission's structure will comprise national, regional and local arrangements, intended to ensure that CPPIH becomes an influential means by which the public can become involved in health related decision making in the NHS and beyond. At the grass roots, patient and public forums will be established in all Primary Care Trusts and NHS Trusts, with new powers of inspection and representation on trust boards.

The structure of the Commission will include:

Nine regional offices across England with a responsibility for producing and implementing standards and quality control for patient forums, which will be run by local networks.

This interesting randomised controlled trial was set up and reported in the BMJ to determine whether routine review by telephone of patients with asthma improves access and is a good alternative to face to face reviews in general practices.

It was set in four general practices in England using 278 adults who had not been reviewed in the previous 11 months. The participants were randomised to either telephone review or face to face consultation with the asthma nurse.

The proportion of participants who were reviewed within three months of randomisation and disease specific quality of life, as measured by the Juniper mini asthma quality of life questionnaire was measured. Of 137 people randomised to telephone consultation, 74% were reviewed, compared with 48% of the people in the surgery group, a difference of 26% (number needed to treat 3.8).

Three months after randomisation the two groups did not differ in the Juniper score (risk difference – 0.08 (05% confidence interval – 0.40 to 0.27) or in satisfaction with the consultation. Telephone consultations were on average 10 minutes shorter than reviews held in the surgery

A recent Cochrane review looked at this topic. It is estimated that by 2020 road traffic crashes will have moved from ninth to third in the world disease burden ranking, as measured in disability adjusted life years, and second in developing countries.

The identification of effective strategies for the prevention of traffic related injuries is of global health importance. Area-wide traffic calming schemes that discourage through traffic on residential roads is one such strategy.

The study attempted to evaluate the effectiveness of area-wide traffic calming in preventing traffic related crashes, injuries, and deaths.

Randomised controlled trials, and controlled before-after studies of area-wide traffic calming schemes were examined. The authors found no randomised controlled trials, but 16 controlled before-after trials met our inclusion criteria. Seven studies were done in Germany, six in the UK, two in Australia and one in the Netherlands. There were no studies in low or middle income countries.

Eight trials reported the number of road traffic crashes resulting in deaths. The pooled rate ratio was 0.63 (0.14, 2.59 95% CI). Sixteen studies reported the number of road traffic crashes resulting in injuries (fatal and non fatal). The pooled rate ratio was 0.89 (0.80, 1.00 95% CI). Nine studies reported the total number of road traffic crashes. The pooled rate ratio was 0.95 (0.81, 1.11 95% CI). Thirteen trials reported the number of pedestrian-motor vehicle collisions . The pooled rate ratio was 1.00 (0.84, 1.18). There was significant heterogeneity for the total number of crashes and deaths and injuries.

The results from this review suggest that area-wide traffic calming in towns and cities may be a promising intervention for reducing the number of road traffic injuries, and deaths. However, further rigorous evaluations of this intervention are needed.

Ref: web

This BMJ paper was set up to investigate the national distribution of prolonged waiting for elective day case and inpatient surgery, and to examine associations of prolonged waiting with markers of NHS capacity, activity in the independent sector, and need.

It examined health service data for all of the NHS hospital trusts in England and looked at the characteristics of people waiting for elective treatment in the specialties of general surgery; ear, nose and throat surgery; ophthalmic surgery; and trauma and orthopaedic surgery.

It attempted to look at the characteristics of trusts with large numbers waiting six months or longer were examined by using logistic regression.

The results showed that between 52% and 83% of patients waiting longer than six months in the specialties studied were found in only one quarter of trusts, which in turn contributed 23-45% of the national throughput specific to the specialty.

There was little evidence to show that the number of operating theatres, dedicated day case theatres, available beds, and bed occupancy rate or private sector activity were associated with prolonged waiting, although exceptions were noted for individual specialties. There was an increase in prolonged waiting with increased numbers of anaesthetists across all specialties and with increased bed occupancy rates for ear, nose and throat surgery. Deprivation scores and rate of limiting long term illness were inversely associated with prolonged waiting.

Over all substantial numbers of patients waiting unacceptably long periods of elective surgery were limited to a small number of hospitals. Little or inconsistent support was found for associations of prolonged waiting with markers of capacity, independent sector activity, or patient need in the surgical specialties examined.

Ref: web