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Gallstone‐related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone‐disease is by laparoscopic cholecystectomy, which can be safely and cost‐effectively performed during a short hospital stay or as day‐case. This paper aims to evaluate the referral pattern of patients with gallstones, which treatment is given and whether patients admitted as emergency could have benefited from earlier elective referral. The management of these patients is examined in the context of payment by results to determine cost and potential savings.

The approach takens was prospective clinical audit and patient questionnaire in a district general hospital. Cost comparisons were made using secondary care income (NHS tariff) and estimated cost of hospitalisation, investigations and treatment.

Between May and July 2007, 114 patients were admitted with symptomatic gallstones, 62 (54.4 per cent) were emergencies. Cholecystectomy was performed in all 52 elective patients and performed or planned for 59/62 (95.2 per cent) emergencies. A total 17/62 emergencies (27.4 per cent) presented with complications of gallstones. 38/62 (61.3 per cent) had similar symptoms before, with 21/38 (55.3 per cent) diagnosed in primary care or by another hospital department. 11 (52.4 per cent) of these had not been referred for a surgical opinion; taking account of age, co‐morbidity and data acquired for elective admissions, the cost of their treatment could have been reduced by at least £16,194.

A large proportion of patients admitted with symptomatic biliary disease could have been referred earlier and electively. Such referral practice could improve the quality of care and reduce cost for the NHS both in primary and secondary care.

Discusses the long existing and confusing problems of establishing the relationship of who is, and who if not, a dependent worker. Reflects developments which have occurred in British law as it affects the employment field, plus an evaluation and analysis of some of the different types of employment relationships which have evolved by examining, where possible, the status of each of these relationships. Concludes that the typical worker nowadays finds himself in a vulnerable position both economically and psychologically owing to the insecurity which exists.

AFTER the little flurry of dispute recently whether Sir Keith Joseph should or should not have been invited to address the LA conference in Sheffield this year, the Secretary for Industry has himself withdrawn, on the grounds that he now finds himself obliged to lead an overseas trade delegation at the same time as the conference. Thus hot air doth dissolve into the atmosphere, as Hamlet might have said (but did not).

DO you recall the June Editorial wherein we asked you to write to your MP protesting about the increased postal rates? And we, for our part, sent out over 600 copies of “Work Study” to MPs containing the Leader in question. So you might think some sort of action would be generated.

The decade of the 1980s was unique for the sheer quantity of education reform reports and legislation. Virtually every state enacted education reform legislation, including reforms of teacher education, licensing, and comprehension. According to Darling‐Hammond and Berry, over 1,000 pieces of legislation related to teachers have been drafted since 1980, and “a substantial fraction have been implemented.” As I discussed in my 1989 RSR article, “Five Years after A Nation at Risk: An Annotated Bibliography,” two waves of 1980s reform reports were identified in the enormous body of primary and secondary literature dealing with education reform. The reform publications of the early 1980s stressed improvements in curricular standards, student performance outcomes, and changes to the education programs, such as salary increases, teacher testing, and stricter certification requirements. The second‐wave reform publications emphasized more complex issues centered around the concepts of restructuring the schools and teacher education programs, as well as empowering teachers to become more involved in curriculum and governance issues.