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BMJ 2009; 339 doi: (Published 23 December 2009) Cite this as: BMJ 2009;339:b5430

In 1999 a disillusioned doctor left the NHS to help organisations improve the way they work. His medical vocation got the better of him, and he returned to the NHS, which he found still full of unhappy staff, little collaboration, and poor leadership. He set about improving NHS organisations and invented the CAREFUL programme to get the best for patients: Committed leaders, Active staff collaboration, Responsive organisations, Energetic leaders, Focus to strive for even impossible goals, Uniform efficient processes, and Leading organisations continue to maintain their position (

Skin-to-skin contact between mother and infant, together with oral 25% dextrose treatment, just two minutes before a moderately painful procedure for the baby (a hepatitis B vaccine) is more effective than either of these strategies alone at relieving neonatal pain (Pediatrics 2009;124:e1101-7, doi:10.1542/peds.2009-0993). This prospective, randomised, partly blinded trial was performed with 640 healthy term newborns. The four comparison groups were no analgesia (usual care), oral dextrose, skin-to-skin contact that lasted from two minutes before the procedure until it was completed, and a combination of dextrose and skin contact. …

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