scholarly journals 719 The Routine Use of Opioid Medication for Post-Operative Pain Relief Can Risk Long Term Dependence, In Patients Previously Opiate Naive

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S McGurk ◽  
T Majeed ◽  
C Magee
Keyword(s):  
Pain Relief ◽  
Opiate Dependence ◽  
Prescribing Practices ◽  
Department Of Health ◽  
Opiate Use ◽  
Post Operative Pain ◽  
The Us ◽  
Observational Cohort ◽  
The Uk

Abstract Introduction Post-operative pain relief commonly involves opiates. Rising concerns about misuse has increased scrutiny of prescribing practices. In the UK, 12.5% of prescriptions are for opiates. In the US, the Department of Health and Human Services has declared an epidemic of opiate misuse. We aimed to evaluate opiate prescribing practices post-operatively, within a UK teaching hospital, and establish the risk of prolonged opiate use. Method A pan-speciality retrospective observational cohort study was performed. Patients who underwent surgery in the year 2018 were included. Patients were opiate naïve if their admission Medicine reconciliation and GP record described no opiates for the previous year. Endpoints: the proportion of patients discharged with opiates and the proportion of patients remaining on opiates at 1- and 2-years post admission. Results 20526 operations were performed on 17524 patients, across pan-specialities. 8772 patients were discharged on opiates. 673 required further opiates from their GP after discharge, of which 331 were previously opiate naive. At 1 year post op, 180 previously naive patients remained on opiates. Conclusions Attention needs to be given to the risk of developing opiate dependence post-operatively. An evidence-based approach should support clinicians in preventing an opiate crisis in the UK.

Founders without Limits

2021 ◽  
Author(s):  
Bobby V. Reddy
Keyword(s):  
Stock Exchange ◽  
High Growth ◽  
Global History ◽  
Public Markets ◽  
The Us ◽  
History Of ◽  
The Uk ◽  
Dual Class ◽  
Blue Chip

Big Tech has flourished on the US public markets in recent years with numerous blue-chip IPOs, from Google and Facebook, to new kids on the block such as Snap, Zoom, and Airbnb. A key trend is the burgeoning use of dual-class stock. Dual-class stock enables founders to divest of equity and generate finance for growth through an IPO, without losing the control they desire to pursue their long-term, market-disrupting visions. Bobby Reddy scrutinises the global history of dual-class stock, evaluates the conceptual and empirical evidence on dual-class stock, and assesses the approach of the London Stock Exchange and ongoing UK regulatory reforms to dual-class stock. A policy roadmap is presented that optimally supports the adoption of dual-class stock while still protecting against its potential abuses, which will more effectively attract high-growth, innovative companies to the UK equity markets, boost the economy, and unleash the true potential of 'founders without limits'.

The Economics of Air Traffic Control

1980 ◽  
Vol 33 (1) ◽  
pp. 23-29
Author(s):  
Angus Hislop
Keyword(s):  
Traffic Control ◽  
Air Traffic Control ◽  
Air Traffic ◽  
Air Transport ◽  
Civil Aviation ◽  
Department Of Transportation ◽  
Private Industry ◽  
The Us ◽  
The Uk

This paper is based mainly on a study carried out in 1976/7 for the UK Department of Industry into the long-term development of air traffic control systems in Europe by a team drawn from the Civil Aviation Authority, the Royal Signals and Radar Establishment and private industry, in which Coopers and Lybrand provided the economic expertise.Until the early 1970s, air traffic control was almost completely neglected by air transport economists. Economists contributed to the planning of airports and airline operations but not to the third facet of the air transport system. However, in 1970–1, in conjunction with a programme of expansion and improvement of the country's airports and airways, the US Department of Transportation launched a major study of the airport and airways system. This was designed to establish an equitable charging policy between the different categories of user but in the event its recommendations in this area have only recently begun to be followed.

The opioid crisis: evaluating the safety and efficacy of opioid analgesia in the management of acute post-operative dental pain

Dental Update ◽  
2021 ◽  
Vol 48 (10) ◽  
pp. 859-864
Author(s):  
Daniel Merrick ◽  
Michael O'Sullivan ◽  
Mary Clarke
Keyword(s):  
Management Strategies ◽  
Opioid Analgesics ◽  
Dental Pain ◽  
Opioid Analgesia ◽  
Dental Practice ◽  
Opioid Use ◽  
Safety And Efficacy ◽  
Post Operative Pain ◽  
The Us ◽  
The Uk

The use and misuse of opioid analgesics have been highlighted in recent years. This review assesses dental opioid use, the effectiveness of opioid-containing analgesics versus non-opioid alternatives and the implications for post-operative pain management strategies in the dental practice. Guidelines for the management of acute post-operative dental pain differ from country to country. The UK has a low dental opioid use rate when compared to the US. The combination of paracetamol and ibuprofen has similar, if not better, analgesic properties compared to opioid-containing alternatives, with fewer adverse effects. CPD/Clinical Relevance: Non-opioid analgesics are both a safe and effective alternative to opioid analgesics in the management of post-operative dental pain.

The Problem of Income Inequality

2019 ◽  
pp. 42-44
Author(s):  
Andrew Smithers
Keyword(s):  
Income Inequality ◽  
Gini Coefficient ◽  
Living Standards ◽  
Living Standard ◽  
The Gini Coefficient ◽  
The Us ◽  
The Uk ◽  
Distribution Of Income

Living standards change in line with GDP per head only if the distribution of incomes is unchanged. If incomes become less equally distributed the living standards of most people will fall even if GDP per head is stable. The Gini Coefficient is the most widely used indicator designed to measure the distribution of income. UK inequality, on this measure, has risen since 1977, stabilized since 1987, and fallen in recent years. In the US there has been a long-term increase in income inequality. Unless this US trend for increased income inequality halts, it is quite likely that even if GDP per head rises in the US, the living standard of the average voter will fall. The recent data suggest that changes in income inequality pose less of a threat to living standards in the UK then they do to those in the US.

scholarly journals Early intervention in psychosis: obstacles and opportunities

2005 ◽  
Vol 11 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Swaran P. Singh ◽  
Helen L. Fisher
Keyword(s):  
Early Intervention ◽  
Psychotic Disorders ◽  
Evidence Base ◽  
Early Intervention Services ◽  
Department Of Health ◽  
Short And Long Term ◽  
Intervention Services ◽  
The Uk ◽  
Early Intervention In Psychosis

By focusing therapeutic effort on the early stages of psychotic disorders, effective early intervention should improve short- and long-term outcomes. Strategies include pre-psychotic and prodromal interventions to prevent emergence of psychosis, detecting untreated cases in the community and facilitating recovery in established cases of psychosis. The evidence base for each of these strategies is currently limited, although several international trials are under way. The Department of Health in the UK has announced the intention of setting up 50 early intervention services nationally, several of which are already operational. In this article, we briefly discuss the differing ways in which early intervention is conceptualised, summarise the evidence supporting it in established cases of psychosis, suggest appropriate service models and describe two early intervention services in south-west London.

Cost Impact of Switching Histamine2-Receptor Antagonists to Nonprescription Status

2002 ◽  
Vol 36 (7-8) ◽  
pp. 1135-1141 ◽  
Author(s):  
Michelle D Furler ◽  
Mark S Rolnick ◽  
Kathleen S Lawday ◽  
Miranda W Mak ◽  
Thomas R Einarson
Keyword(s):  
Market Share ◽  
Insurance Coverage ◽  
Consumer Price Index ◽  
Population Data ◽  
Status Change ◽  
Prescribing Practices ◽  
Receptor Antagonists ◽  
The Us ◽  
The Uk ◽  
The Impact

BACKGROUND: There is a recent trend to switching medications from prescription to nonprescription status. Often, such switches are accompanied by dramatic changes in utilization due to increased availability or decreased insurance coverage. The histamine2-receptor antagonists (H2RAs) underwent such status change in the UK in 1994, the US in 1995, and Canada in 1996. OBJECTIVE: To examine the impact of the status change for H2RAs on the market for gastrointestinal (GI) agents in the US, UK, and Canada. METHODS: IMS market sales data from 1992 to 1997 were procured. All costs were converted to 1997 US dollars using the consumer price index. Per capita sales figures were determined using population data from the US Census Bureau's International Database. RESULTS: Overall spending on GI remedies increased in all 3 markets between 1992 and 1997; however, the contribution of prescription sales and number of prescriptions varied across the 3 countries. An increased market share for nonprescription H2RAs occurred in the US, correlating with a decline in prescription numbers for GI remedies. The opposing trend occurred in the UK, where market share of nonprescription H2RAs was minimal and use of prescription H2RAs increased. Prescription and nonprescription H2RA sales could not be differentiated for Canada. CONCLUSIONS: The impact of the H2RA status change varied across countries. Differences in utilization may be attributed to many factors such as differing healthcare systems, patient convenience, and physician prescribing practices. Further research is required to identify the reasons for differences in utilization and to quantify the potential clinical impact.

scholarly journals SP7.1.8 Routine use of opioids for post-operative pain in opioid naïve patient can risk long term dependence

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Talal Majeed ◽  
Simon Mcgurk ◽  
Jeremy Wilson ◽  
Conor Magee
Keyword(s):  
Opioid Dependence ◽  
Evidence Based ◽  
Opioid Use ◽  
Naive Patient ◽  
Opioid Prescription ◽  
Post Operative Pain ◽  
One Year ◽  
The Uk

Abstract Aims and Objectives Aim of our study was to evaluate the current practices of prescribing opioids for post-operative pain in opioid-naive patients in our region and the risk of prolonged opioid use among them. Methods A retrospective cohort study was performed where cohort consisted of patients who had surgery in 2018 with at least one year follow up. Endpoints were the proportion of all patients and opioid naïve patients, discharged on opioid prescription and proportion of opioid naïve patients who developed opioid dependence after one year. Results During 2018, 17524 patients underwent a total of 20526 surgical procedures by pan surgical specialties in our hospitals. 8772 patients (50%) were discharged with opioid prescription. 673 (7.70%) of those required further opiate prescriptions after discharge, of those requiring opiates, 331 had no opiate exposure before surgery (342 had previous opiate exposure). In opioid naïve patients, at 1 year follow up 151 (45%) had no further opiate prescriptions, but 180 (55%) required ongoing opiate prescriptions after one year follow up. The risk of opioid dependence after surgery is significant in opioid naïve patients. Conclusion Results are alarming and evidence-based strategies, national and local guidelines are needed to prevent the opioid crisis in the UK. There is a need for a national campaign to minimize the dependence on opioids and to find, better alternatives to opioids.

scholarly journals Access to dental care: examining the issues

2011 ◽  
Vol 93 (8) ◽  
pp. 269-269
Author(s):  
Paul Batchelor
Keyword(s):  
Dental Care ◽  
Advisory Group ◽  
Dental Practice ◽  
Research Committee ◽  
Dental Services ◽  
Department Of Health ◽  
The Us ◽  
Access To Dental Care ◽  
Care Systems ◽  
The Uk

The research committee and lay advisory group of the Faculty of General Dental Practice (UK) recently hosted a joint symposium at the College with the aim of understanding issues around access in dentistry. Access – what exactly is the problem? brought together key thinkers with a variety of expertise to give their perspective on what is meant by access and to explore where the main issues lie. Also discussed was how the Department of Health currently views these issues and how patients use dental services in the UK. Clearly, problems concerning access to healthcare are not limited to dentistry; the symposium also included perspectives from medicine and examined issues facing dental care systems overseas, specifically in the US.

At a Glance …

2012 ◽  
Vol 220 ◽  
pp. F2-F2
Keyword(s):  
Euro Area ◽  
List Type ◽  
Short Term ◽  
Structural Problems ◽  
The Us ◽  
Successful Resolution ◽  
Fiscal Austerity ◽  
The Uk ◽  
Global Growth

Our baseline forecast is for global growth of 3.7 per cent in 2012. Growth will accelerate to 4 per cent in 2013. These forecasts are little changed from our previous forecast.As in our previous forecast, we assume a delayed but ultimately successful resolution of the Euro Area crisis. Nevertheless, we expect a mild recession in the Euro Area as a whole, as well as in the UK. Downside risks to the Euro Area remain high. Fiscal austerity will weigh on growth in the short term, while medium to long term structural problems remain unresolved.We forecast growth of about 2 per cent in the US this year, while China and India, although slowing, will continue to drive world growth.

scholarly journals Time trends and treatment pathways in the prescribing of individual oral anticoagulants in patients with non-valvular atrial fibrillation: an observational study of more than three million patients from Europe and the United States

2021 ◽  
Author(s):  
Pareen Vora ◽  
Henry Morgan Stewart ◽  
Beth Russell ◽  
Alex Asiimwe ◽  
Gunnar Brobert
Keyword(s):  
United States ◽  
Atrial Fibrillation ◽  
Time Trends ◽  
Oral Anticoagulants ◽  
The United States ◽  
Common Data Model ◽  
Long Term Treatment ◽  
The Us ◽  
The Uk

Background: Data directly comparing trends in the use of different oral anticoagulants (OACs) among patients with atrial fibrillation (AF) from different countries are limited. We addressed this using a large-scale network cohort study in the United States (US), Belgium, France, Germany and United Kingdom (UK). Methods: We used nine databases (claims or electronic health records) that had been converted into the Observational Medical Outcomes Partnership Common Data Model with analysis performed using open-source analytical tools. We identified adults with AF and a first OAC prescription, either vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC) from 2010–2017. We described time-trends in use, continuation and switching. Results: In 2010, 87.5%–99.8% of patients started on a VKA. By 2017, the majority started on a DOAC: 87.0% (US), 88.3% (Belgium), 93.1% (France), 88.4% (Germany), 86.1%–86.7% (UK). In the UK, DOACs became the most common starting OAC in 2015, 2–3 years later than elsewhere. Apixaban was the most common starting OAC by 2017: 50.2%–57.8% (US), 31.4% (Belgium), 45.9% (France), 39.5% (Germany), 49.8%– 50.5% (UK), followed by rivaroxaban; 24.8%–32.5% (US), 25.7% (Belgium), 38.4% (France), 24.9% (Germany), 30.2%– 31.2% (UK). Long-term treatment was less common in the US than in Europe, especially the UK. A minority of patients switched from their index OAC, both in the short- and long-term. Conclusions: From 2010–2017, VKA use had significantly declined and DOAC use had significantly increased in the US and Europe; apixaban was the most prescribed OAC in 2017 followed by rivaroxaban.

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