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Inflammation, infectious or sterile, of the middle ear. In children this is often complicated by fluid buildup behind the eardrum. This raises the anxiety levels of conscious parents, debating the three-decade-old question, “Antibiotics?”. They may fear the realistic (and unrealistic) effects of the drug, weighed against the anguish of a center-of-attention complaining child and the knee-jerk agitation they feel (particularly the mother...see OXYTOCIN). Then, when three months of antibiotic therapy doesn’t work for some children (and they now show the brand-new signs of having become allergic...”No connection with the antibiotics at all” sez the pediatrician), the parents have descended to another level of Parent Bardo...”Tubes in his ears?!” You can guess my feelings. I am not, however, suggesting ignoring your pediatrician. There are presently strong, if minority, medical currents against these approaches...you may have a Ped. that starts with antibiotics the first day and practically pre-schedules a three-month-away intubation visit...Let Your Fingers Do The Walking (see YELLOW PAGES). Another BabyDoc may not want to use antibiotics UNLESS other measures have failed and there is the extended presence of pus behind the eardrum. Turning away from such conservative an approach can hurt the kid...and is giving the careful physician a session in Negative Reinforcement Therapy. “Antibiotics Ÿber alles!” proclaims a banner in the waiting room next visit, and there may be a case displaying the newest line of Swatch Eartubes.... otitis media

the framework through which the NHS aims to deliver high-quality services within a safe system, with continuous efforts for service improvement. Introduced in 1998, clinical governance emphasizes the concept of accountability: organizations, teams, and individuals should understand and accept their roles and responsibilities in delivering care. The range of activities undertaken under the banner of clinical governance includes ensuring clinical effectiveness of treatments, *risk management, *clinical audit, *quality assurance, patient and public involvement (in local *Healthwatch groups), staff education, development, and training (see appraisal; revalidation), and research. There is a push in the NHS towards integrated governance: a cohesive approach to all governance arrangements (clinical, corporate, and financial) in organizations, with an emphasis on involving patients and external stakeholders in the development of future arrangements. See also Care Quality Commission; integrated care pathway; NICE; national service frameworks.... clinical governance