NICE guidance for moderate RA—a step in the right direction

AimsDementia is a progressive condition inflicting significant costs for health and social care services. In December 2017, there were 456,739 people on GP registers with a formal diagnosis of dementia. Making the right choice of anti-dementia medication with essential monitoring is one important aspect of care. Thus, the aim of this audit was to identify if current practice at Mossley Hill inpatients and outpatients service for older adults in Liverpool, was in accordance with the NICE Guideline NG97 (Dementia: assessment, management and support for people living with dementia and their carers). Additionally, we aimed to evaluate whether Memantine was commenced according to BNF/SPC recommendations about e-GFR and whether this was documented on patient records, as well as to highlight areas of improvement.MethodAn audit was carried out for all patients for whom Memantine was initiated, between June and August 2019. Sixty-nine patients were identified through trust Pharmacy records. Data were collected retrospectively, reviewing local electronic records (ePEX, RIO) and GP referrals. This included age, sex, diagnosis, indication for starting Memantine, decision context, prescriber, documentation of renal function status and communication of decision to the GP. Findings were compared to NICE guidance NG97 and presented at the local audit meeting with a view to recommend strategies for improvement.ResultResults indicated that most of the patients were female (64%) with the most common diagnosis being Alzheimer's disease (75%). Recurrent reasons for initiating Memantine were: contraindication for AChE treatment (25%); illness progression on AChE (22%); and severe dementia on initial presentation (23%). Usually, the decision to start Memantine treatment was made in MDT or after prescriber clinical review. In 68% of the reviewed cases, renal function status was documented. Patients' GP was informed of medication change in 86% of cases.ConclusionTo conclude, in the majority of cases Memantine initiation was in line with NICE guidance. However, documentation can be improved, so as to facilitate future audit. We recommended creating a checklist for prescribing Memantine that could be integrated within the electronic records system.

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Getting information across the acute medicine and primary care interface – steps in the right direction

Acute Medicine Journal ◽

10.52964/amja.0699 ◽

2018 ◽

Vol 17 (2) ◽

pp. 60-60

Author(s):

Daniel Lasserson ◽

Keyword(s):

Primary Care ◽

Medical Care ◽

Acute Care ◽

Information Needs ◽

Care Pathway ◽

Acute Medicine ◽

Nice Guidance ◽

Reduce Risk ◽

The Right ◽

Acute Medical Care

In the acute care pathway, patients often need to move from home to hospital and for the majority, back again. This movement across care interfaces ensures that assessments and interventions are delivered to reduce risk of harm and enhance recovery. However, information needs to move across interfaces too, which enables the clinician taking over care to understand the problem, what has been done and what remains to be done. This is as important for the journey into hospital as it is for the journey home again and is highlighted in the forthcoming NICE guidance on Emergency and Acute Medical Care.

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Investor-State Dispute Settlement under NAFTA Chapter 11: The Shape of Things to Come?

Canadian Yearbook of international Law/Annuaire canadien de droit international ◽

10.1017/s0069005800006652 ◽

1998 ◽

Vol 35 ◽

pp. 263-290

Author(s):

J. Anthony VanDuzer

Keyword(s):

Free Trade Agreement ◽

Dispute Settlement ◽

Trade Agreement ◽

Minimum Standards ◽

The North ◽

State Behaviour ◽

Nafta Chapter 11 ◽

To Come ◽

The Right

SummaryRecently, there has been a proliferation of international agreements imposing minimum standards on states in respect of their treatment of foreign investors and allowing investors to initiate dispute settlement proceedings where a state violates these standards. Of greatest significance to Canada is Chapter 11 of the North American Free Trade Agreement, which provides both standards for state behaviour and the right to initiate binding arbitration. Since 1996, four cases have been brought under Chapter 11. This note describes the Chapter 11 process and suggests some of the issues that may arise as it is increasingly resorted to by investors.

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What face familiarity feelings say about the lateralization of specific entities within the core system

Behavioral and Brain Sciences ◽

10.1017/s0140525x19001778 ◽

2019 ◽

Vol 42 ◽

Author(s):

Guido Gainotti

Keyword(s):

Temporal Lobe ◽

Memory System ◽

Core System ◽

The Core ◽

Memory Traces ◽

Specific Memory ◽

Target Article ◽

Temporal Structures ◽

The Right

Abstract The target article carefully describes the memory system, centered on the temporal lobe that builds specific memory traces. It does not, however, mention the laterality effects that exist within this system. This commentary briefly surveys evidence showing that clear asymmetries exist within the temporal lobe structures subserving the core system and that the right temporal structures mainly underpin face familiarity feelings.

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Address By The Right Honourable The Earl of Balfour, Chancellor of the University of Cambridge

Transactions of the International Astronomical Union ◽

10.1017/s0251107x00012670 ◽

1925 ◽

Vol 2 ◽

pp. 146-149

Keyword(s):

University Of Cambridge ◽

The Right ◽

The University

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Study of charge transfer in FeTi

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100075270 ◽

1983 ◽

Vol 41 ◽

pp. 296-297

Author(s):

J. Taft∅

Keyword(s):

Charge Transfer ◽

Charge Distribution ◽

Electron Scattering ◽

Periodic System ◽

Electron Distribution ◽

Scattering Amplitude ◽

Transition Elements ◽

Hartree Fock ◽

Cscl Structure ◽

The Right

It is well known that for reflections corresponding to large interplanar spacings (i.e., sin θ/λ small), the electron scattering amplitude, f, is sensitive to the ionicity and to the charge distribution around the atoms. We have used this in order to obtain information about the charge distribution in FeTi, which is a candidate for storage of hydrogen. Our goal is to study the changes in electron distribution in the presence of hydrogen, and also the ionicity of hydrogen in metals, but so far our study has been limited to pure FeTi. FeTi has the CsCl structure and thus Fe and Ti scatter with a phase difference of π into the 100-ref lections. Because Fe (Z = 26) is higher in the periodic system than Ti (Z = 22), an immediate “guess” would be that Fe has a larger scattering amplitude than Ti. However, relativistic Hartree-Fock calculations show that the opposite is the case for the 100-reflection. An explanation for this may be sought in the stronger localization of the d-electrons of the first row transition elements when moving to the right in the periodic table. The tabulated difference between fTi (100) and ffe (100) is small, however, and based on the values of the scattering amplitude for isolated atoms, the kinematical intensity of the 100-reflection is only 5.10-4 of the intensity of the 200-reflection.

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New Dimensions in Freeze-Etching

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100062920 ◽

1969 ◽

Vol 27 ◽

pp. 202-203 ◽

Cited By ~ 4

Author(s):

Russell L. Steere ◽

Michael Moseley

Keyword(s):

Fracture Surfaces ◽

Aluminum Specimen ◽

Specimen Holder ◽

Freeze Etching ◽

The Right

A redesigned specimen holder and cap have made possible the freeze-etching of both fracture surfaces of a frozen fractured specimen. In principal, the procedure involves freezing a specimen between two specimen holders (as shown in A, Fig. 1, and the left side of Fig. 2). The aluminum specimen holders and brass cap are constructed so that the upper specimen holder can be forced loose, turned over, and pressed down firmly against the specimen stage to a position represented by B, Fig. 1, and the right side of Fig. 2.

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Adrenocorticotropin Production by a Mammary Carcinoma

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100079759 ◽

1977 ◽

Vol 35 ◽

pp. 462-463

Author(s):

K.S. McCarty ◽

N.R. Wallace ◽

W. Litaker ◽

S. Wells ◽

G. Eisenbarth

Keyword(s):

Adrenocorticotropic Hormone ◽

Small Cell ◽

Hormone Production ◽

Carcinoma Of The Breast ◽

Ectopic Acth ◽

Ultrastructural Studies ◽

Subcutaneous Metastases ◽

Ectopic Acth Production ◽

The Right ◽

Pituitary Carcinomas

The production of adrenocorticotropic hormone by non-pituitary carcinomas has been documented in several tumors, most frequently small cell carcinoma of the lung, islet cell carcinomas of the pancreas, thymomas and carcinoids. Electron microscopy of these tumors reveals typical membrane-limited "neurosecretory" granules. Confirmation of the granules as adrenocorticotropin (ACTH) requires the use of OsO4 as a primary fixative to give the characteristic cored granule appearance in conjunction with immunohistochemical demonstration of the hormone peptide. Because of the rarity of ectopic ACTH production by mammary carcinomas and the absence of appropriate ultrastructural studies in the two examples of such ectopic hormone production in the literature of which we are aware (1,2), we present biochemical and ultrastructural data from a carcinoma of the breast with apparent ACTH production.The patient had her primary tumor in the right breast in 1969. The tumor recurred as visceral and subcutaneous metastases in 1976 and again in 1977.

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Z-line degradation and phagocytosis of sarcomeric fragments in myonecrosis

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100077529 ◽

1983 ◽

Vol 41 ◽

pp. 790-791

Author(s):

Melinda L. Estes ◽

Samuel M. Chou

Keyword(s):

Vastus Lateralis ◽

Inflammatory Myopathy ◽

Muscle Disease ◽

White Female ◽

Inflammatory Cell Infiltrate ◽

Limb Weakness ◽

Muscle Diseases ◽

History Of ◽

The Right ◽

Mononuclear Inflammatory Cell

Many muscle diseases show common pathological features although their etiology is different. In primary muscle diseases a characteristic finding is myofiber necrosis. The mechanism of myonecrosis is unknown. Polymyositis is a primary muscle disease characterized by acute and subacute degeneration as well as regeneration of muscle fibers coupled with an inflammatory infiltrate. We present a case of polymyositis with unusual ultrastructural features indicative of the basic pathogenetic process involved in myonecrosis.The patient is a 63-year-old white female with a one history of proximal limb weakness, weight loss and fatigue. Examination revealed mild proximal weakness and diminished deep tendon reflexes. Her creatine kinase was 1800 mU/ml (normal < 140 mU/ml) and electromyography was consistent with an inflammatory myopathy which was verified by light microscopy on biopsy muscle. Ultrastructural study of necrotizing myofiber, from the right vastus lateralis, showed: (1) degradation of the Z-lines with preservation of the adjacent Abands including M-lines and H-bands, (Fig. 1), (2) fracture of the sarcomeres at the I-bands with disappearance of the Z-lines, (Fig. 2), (3) fragmented sarcomeres without I-bands, engulfed by invading phagocytes, (Fig. 3, a & b ), and (4) mononuclear inflammatory cell infiltrate in the endomysium.

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