God Friday has been very sunny and just so relaxing as we had worked hard gardening and sorting things out.
Even though we are retired we still work on on the bases of having the weekend off.
We have been to the park with Louis again as he runs and runs in there. off lead and free. A dogs dream. There were many cars parked today. I expect the owners had walked into Canterbury. 7 miles. We did it once when we moved down here. Walked in and out it was a great walk. I wish we could still do it.
Canterbury to Whitstable railway opened in 1830 and quickly became affectionately known as the Crab & Winkle Line. It was the third railway ever to be built and the first to carry passengers regularly and to offer season tickets. A pioneer in railway engineering, there were embankments, cuttings and a 764 metre tunnel through the high ground at Tyler Hill (now under the University of Kent).
The locomotive ‘Invicta’ and the line were engineered by George Stephenson and his son Robert at their works in Newcastle upon Tyne. The ‘Invicta’, now on view at the Museum of Canterbury in Stour Street, was based upon the more famous ‘Rocket’ which actually came into service four months later. With only 12 horse power the Invicta could only be used on part of the line. Otherwise carriages were hauled by cables using steam driven engines at The Winding Pond in Clowes Wood and The Halt on Tyler Hill Road. Through the woods the railway men would apparently slow down so that pheasant traps could be checked and mushrooms picked!
Passengers were carried until 1931 and goods until the line closed in 1952, though it did re-open for several weeks in 1953, after the great floods cut the main coastal line.
With thanks to the Blean Heritage and Community Group
The Crab & Winkle Way. This family friendly cycle route was opened in 1999 in partnership between Canterbury City Council, the Crab & Winkle Line Trust, Kent County Council, Kentish Stour Countryside Partnership and Sustrans. It is part of Route 1 (Inverness to Dover) of the National Cycle Network developed by Sustrans.
Download Crab & Winkle Way leaflet/map.
For more information see the Crab & Winkle Line Trust’s website; a charity formed in 1997 they work to promote history and improve public access along the route.
As we played with Louis some came back with their dogs but our boy wasn’t interested he just wanted his own ball thrown and then stopped to eat the grass.
I came home and picked my own herbs to flavour the dinner. The mint went in the potatoes and peas and simmered away to flavour. I then chopped and sprinkled the flat leaf parsley over the Gammon steak and tomatoes.
Guess what was for sweet
Tiramisu Oh how lovely –and fattening.
We found a Interesting site today and a new gadget we all should have but especially in the trade
The Select Group, the ALERT project’s Exploitation Managers are responsible for production of the detector and taking it to market estimate that it will take 12 to 18 months to get the first production units for sale, with a target price of perhaps 600-700 Euros.
As production increases after the initial product launch, Select hope that costs may be cut even further,
making the detectors even more affordable for an individual plumber, electrician or building renovator.
“These tradespeople are the most frequently affected by asbestos-related diseases and most who get the diseases will die from them,” the team says.
By Michael D Rawlins President, Royal Society of Medicine
Published in the BMJ (British Medical Journal) 15th April 2014
You need to either be a member of the BMJ or to sign up for their 14 day trial
Many doctors, myself included, will have occasionally tried to treat individual patients – where all else has failed – with novel interventions. This may be where there is no recognised form of effective treatment; or when existing one(s) have not produced the desired effect. The legal basis for doing so, at least for pharmaceuticals, has been the so-called “named patient” provisions of Section 9 of the Medicines Act 19682 which permits any doctor to be able “to sell, procure or supply a medicinal product to a patient under his or her care”.
Although my own experience has been disappointing there have been occasions, when intervening in such a manner, have subsequently led to significant advances. Indeed, such observations are arguably a form of n-of-1 trial.
Confidence in using the “named patient” provisions of the Medicines Act has though become eroded. A number of legal authorities have pointed out that departing from what is regarded as “established practice” or “the standard of care” leaves a doctor open to an action for negligence. The definition of “the standard of care” traditionally follows the Bolam principle 2 as amended by the Bolitho decision3 but was forcefully criticised by Lady Butler-Schloss4 in her capacity as President of the Family Division of the High Court:
“The Bolam test ought not to be allowed to inhibit medical progress. And it is clear that if one waited for the Bolam
test to be complied with to its fullest extent, no innovative
work such as the use of penicillin or performing heart
transplant surgery would ever be attempted”.
The Medical Innovation Bill attempts to rectify this situation. It proposes legislation stating that it would not be negligent for a doctor to depart from the existing range of accepted medical treatments, for a condition, in carefully defined circumstances. These circumstances – allowing for responsible innovation – are laid out in later Sections of the Bill. They include a plausible basis for the use proposed treatment, and an assessment of the risks that could be reasonably expected to be associated with it. The Bill also proposes that, before embarking on such a treatment, the doctor should have discussed it with the patient, the multi-disciplinary team responsible for the patient’s care, and with the Institutions Responsible Officer. The Bill emphasises that its provisions are solely concerned with the patient’s best interests.
The Bill as originally introduced into the House of Lords in May 2013, as a Private Members Bill by Lord (Maurice) Saatchi, and has become known colloquially as “The Saatchi Bill”. The Department of Health is currently consulting on a draft version of it5. I was originally sceptical about the need for the Saatchi Bill but I have been persuaded otherwise. First, it is clear from the comments of Lady Butler-Schloss4, as well as other legal authorities Lord Saatchi has consulted, that there are serious legal impediments in civil law to using therapeutic interventions that do not represent the current standard of care. Second, although Lord Saatchi’s original Bill was confined to patients with malignant disease this restriction has, rightly in my view, been removed in the current draft. There are, after all, many other miserable conditions for which we have no, or very limited, remedies. Third, I did not believe that his suggestion for approval by a multi-disciplinary team, alone, provided sufficient safeguards: the inclusion, now, of agreement by a doctor’s Responsible Officer provides me with re-assurance.
Despite my strong support for the Medical Innovation Bill there are important consequences for the professions when (as I hope) it becomes law:
1) Just because a particular intervention appears to have been effective in an individual patient it cannot be assumed that the results are generalisable. Further research in the form of one or more randomised controlled trials, or case series, will be necessary to establish its effectiveness. To take a recent example, a case report6 describing the apparently successful treatment of generalised juvenile pustular psoriasis with etanercept, requires confirmation before it can be regarded as the current standard of care.
2) There may be occasions when Responsible Officers wish to seek other advice before approving the proposed use of an intervention in accordance with the provisions of the Medical Innovation Bill. This will often need to be provided very rapidly especially when a patient has a life-threatening illness. The Academy of Medical Sciences, or some of the specialist associations such as the British Pharmacological Society, could have an important role here in offering a speedy advice service.
3) If the intentions behind the Medical Innovation Bill are to be fulfilled, NHS hospital Trusts, and their Responsible Officers, will need to look on proposals sympathetically. Anecdotal evidence suggests that too many Trusts are fearful of departing from the prevailing standard of care because of the possibility of litigation. The Bill should provide them with adequate reassurance.
4) It is essential that the results of using the Bill’s provisions, in individual patients, are placed in the public domain whether or not they have been successful. This would allow others not only to learn from such experiences but – especially for interventions that appear to have been successful – to undertake formal research.
I believe that the use of the provisions in the draft Medical Innovation Bill offer benefits to patients – especially those with rarer diseases – as well as to the furtherance of medical science. Subject to the responses to consultation it is the government’s intention to have it on the statute book at the earliest opportunity5.
1. Medicines Act (1968). www.legislation.gov.uk/ukpga/1968/67 (accessed 12.04.14)
2. McNair J. Bolam v Friern Hospital Management Committee (1957) 1 WLR 582.www.e-lawresources.co.uk/Bolam-v—Friern-Hospital-Management-Committee.php (accessed 12.04.14)
3. House of Lords. Bolitho v City and Hackney Health Authority (1998) AC 232.www.bailii.org/uk/cases/UKHL/1997/46.html (accessed 12.04.14)
4. Butler-Schloss LJ. Simms v Simms (2002) FAM.83 para 48.www.bailii.org/ew/cases/EWHC/Fam/2002/2734.html (accessed 12.04.14)
5. Department of Health. Legislation to encourage medical innovation.www.gov.uk/government/uploads/system/uploads/attachment_data/file/285272/9959-TSO-2901828-Legislation_to_Encourage_Medical_Innovation.pdf (accessed 12.04.14)
6. Fialová J1, Vojáčková N, Vaňousová D, Hercogová J. Juvenile generalized pustular psoriasis treated with etanercept. 2014;2:105-8. doi:10.1111/dth.12065.
Sign the petition for the Medical Innovation Bill: http://chn.ge/1pqY6lS
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