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In this edition, the international status of the journal is obvious with papers from around the globe. Europe, Australasia and North America are frequently present, even the Koreans have begun to appear. The Iranians are new and very welcome!

Designing the system

In this edition there is a challenge to think about what we are trying to do in our Emergency Departments. Higginson suggests that, in providing a service, we need to consider our consumer base. I would not have put the airline operation Ryanair and The Cleveland Clinic as together as exemplars of a concept but the case for taking such a patient point of view is well made (See page 3).

Following on, there are two papers highlighting the potential effect of political drivers on our system. Thompson et al describe the change to one Emergency Department’s attendance following the change in Primary Care Out-of-Hours care provision at the end of 2004. Whilst there is a careful summary of all the confounding factors that might account for …

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