Heroin prescription for heroin addiction – an English view

2004 ◽  
Vol 16 (5) ◽  
pp. 275-280 ◽  
Author(s):  
Tom Carnwath
Keyword(s):  
Best Practice ◽  
Good Practice ◽  
Heroin Addiction ◽  
Home Office ◽  
Adequate Funding ◽  
New Information ◽  
Heroin Prescription ◽  
Opiate Addicts ◽  
Set Up

Heroin has been prescribed in England for the treatment of heroin addiction for almost 100 years. For many years, England was almost the only country where this occurred, and the British system was consequently the subject of international curiosity. In spite of this long history, very little research has been carried out locally, and until recently, there were no guidelines as to best practice. In 1965, it was decided that only doctors with a Home Office license could prescribe heroin. Since that time, the proportion of opiate addicts treated with heroin has greatly diminished, as has the number of doctors willing to prescribe. One doctor in particular remained an enthusiastic proponent of heroin prescription. His claims impressed some Swiss clinicians, who proceeded to establish a multicentre trial in Switzerland. This was followed by a similar trial in the Netherlands. These trials apparently indicated that a proportion of treatment-resistant opiate addicts could respond well to heroin, although the researchers' conclusions have been disputed. The National Treatment Agency in England is now developing guidelines for good practice based on this new information and is planning to set up some pilot sites. It is likely that practise in England will remain somewhat different from continental practice, particularly with respect to long-term supervised injecting. It is unclear how much funding will be released to support heroin prescription. Without adequate funding, it is likely to disappear.

scholarly journals Consensus for the General Use of Equine Water Treadmills for Healthy Horses

Animals ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 305
Author(s):  
Kathryn Nankervis ◽  
Carolyne Tranquille ◽  
Persephone McCrae ◽  
Jessica York ◽  
Morgan Lashley ◽  
...  
Keyword(s):  
Working Group ◽  
Best Practice ◽  
Treadmill Exercise ◽  
Good Practice ◽  
Belt Speed ◽  
Research Programmes ◽  
Potential Benefits ◽  
Water Treadmill ◽  
Selection Of

Water treadmill exercise has become popular in recent years for the training and rehabilitation of equine athletes. In 2019, an equine hydrotherapy working group was formed to establish what was commonly considered to be best practice in the use of the modality. This article describes the process by which general guidelines for the application of water treadmill exercise in training and rehabilitation programmes were produced by the working group. The guidelines describe the consensus reached to date on (1) the potential benefits of water treadmill exercise, (2) general good practice in water treadmill exercise, (3) introduction of horses to the exercise, (4) factors influencing selection of belt speed, water depth and duration of exercise, and (5) monitoring movement on the water treadmill. The long-term goal is to reach a consensus on the optimal use of the modality within a training or rehabilitation programme. Collaboration between clinicians, researchers and experienced users is needed to develop research programmes and further guidelines regarding the most appropriate application of the modality for specific veterinary conditions.

MOSCOW'S INTERWAR INFILTRATION OF BRITISH INTELLIGENCE, 1919–1929

2003 ◽  
Vol 46 (4) ◽  
pp. 915-933 ◽  
Author(s):  
VICTOR MADEIRA
Keyword(s):  
Great Britain ◽  
First World War ◽  
World War ◽  
Home Office ◽  
Lead Agency ◽  
The First World War ◽  
Set Up ◽  
New Research ◽  
First World

The celebrated ‘Cambridge five’ have hitherto been believed to be the first long-term communist penetration agents in HM government, beginning with Donald Maclean in 1935. However, new research indicates that by 1919 another Cambridge man – like four of the ‘five’, a Trinity graduate – had already begun working for Moscow. This article is the first to examine how William Norman Ewer, known as ‘Trilby’ to his co-conspirators, organized networks in Great Britain and France to target the governments of those two powers. Under close Soviet supervision, Ewer's subordinates infiltrated half-a-dozen Whitehall departments, foremost among them Scotland Yard. Operating under the aegis of the home office, the Yard was a vital cog in the machinery of government set up to combat the ‘red menace’ in this country immediately after the First World War. By compromising the lead agency tasked with fighting them, the Bolsheviks thus created the requisite conditions for the metastasis in Great Britain of Soviet espionage in the 1920s.

scholarly journals Setting and Implementing Standards for Management of Wild Tigers

Land ◽  
2018 ◽  
Vol 7 (3) ◽  
pp. 93 ◽  
Author(s):  
M. Pasha ◽  
Nigel Dudley ◽  
Sue Stolton ◽  
Michael Baltzer ◽  
Barney Long ◽  
...  
Keyword(s):  
Support Groups ◽  
Best Practice ◽  
Regional Governance ◽  
Lessons Learned ◽  
Management Effectiveness ◽  
Conservation Areas ◽  
Adequate Funding ◽  
Tiger Conservation ◽  
Independent Assessment

Tiger numbers have collapsed so dramatically that conservationists are adopting a strategy of securing populations in priority conservation landscapes. This includes improving management effectiveness in these sites. The Conservation Assured|Tiger Standards (CA|TS) are designed to help ensure effectiveness and provide a benchmark against which to measure progress. CA|TS is a distillation of best practice and a roadmap to management effectiveness, linking management to expert-driven standards covering all aspects of management, including those which are tiger-specific (monitoring, maintenance of prey, control of poaching). Sites are audited against a set of standards and if met, are accredited as CA|TS Approved. We describe CA|TS in the context of tiger conservation, describe the evolution and philosophy of the system and consider its application across the tiger range, before drawing on lessons learned from 5 years of development. Important benefits include the independence of CA|TS from existing governmental or NGO institutions, the emphasis on regional governance and the existence of active support groups. Conversely, the participatory approach has slowed implementation. CA|TS remains more attractive to well managed sites than to sites that are struggling, although building capacity in the latter is its key aim. The close connections between people working on tiger conservation make some aspects of independent assessment challenging. Finally, if CA|TS is to succeed in its long term aims, it needs to go hand in hand with secure and adequate funding to increase management capacity in many tiger conservation areas.

Data Management at CEDA

2020 ◽  
Author(s):  
Kate Winfield
Keyword(s):  
Data Management ◽  
Best Practice ◽  
Climate Models ◽  
Good Practice ◽  
Environmental Data ◽  
Observation Data ◽  
Specific Data ◽  
Share Data ◽  
Earth Observation Data

<p>Sending data to a secure long-term archive is increasingly a necessity for science projects due to the funding body and publishing requirements. It is also good practice for long term scientific aims and to enable the preservation and re-use of valuable research data. The Centre for Environmental Data Analysis (CEDA) hosts a data archive holding vast atmospheric and earth observation data from sources including aircraft campaigns, satellites, pollution, automatic weather stations, climate models, etc. The CEDA archive currently holds 14 PB data, in over 250 millions of files, which makes it challenging to discover and access specific data. In order to manage this, it is necessary to use standard formats and descriptions about the data. This poster will explore best practice in data management in CEDA and show tools used to archive and share data.</p>

scholarly journals Specialist valve clinic in a cardiac centre: 10-year experience

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001262
Author(s):  
John B Chambers ◽  
Denise Parkin ◽  
Helen Rimington ◽  
Sheila Subbiah ◽  
Brian Campbell ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Best Practice ◽  
Heart Valve Disease ◽  
Detailed Data ◽  
Exclusion Criteria ◽  
Cardiac Centre ◽  
The Mean ◽  
Set Up

AimsGuidelines recommend specialist valve clinics as best practice for the assessment and conservative management of patients with heart valve disease. However, there is little guidance on how to set up and organise a clinic. The aim of this study is to describe a clinic run by a multidisciplinary team consisting of cardiologists, physiologist/scientists and a nurse.MethodsThe clinical and organisational aims of the clinic, inclusion and exclusion criteria, and links with other services are described. The methods of training non-clinical staff are detailed. Data were prospectively entered onto a database and the study consisted of an analysis of the clinical characteristics and outcomes of all patients seen between 1 January 2009 and 31 December 2018.ResultsThere were 2126 new patients and 9522 visits in the 10-year period. The mean age was 64.8 and 55% were male. Of the visits, 3587 (38%) were to the cardiologists, 4092 (43%) to the physiologist/scientists and 1843 (19%) to the nurse. The outcomes from the cardiologist clinics were cardiology follow-up in 460 (30%), referral for surgery in 354 (23%), referral to the physiologist/scientist clinic in 412 (27%) or to the nurse clinic in 65 (4.3%) and discharge in 230 (15%). The cardiologist needed to see 6% from the nurse clinic and 10% from the physiologist/scientist clinic, while advice alone was sufficient in 10% and 9%.ConclusionA multidisciplinary specialist valve clinic is feasible and sustainable in the long term.

Infections and use of antibiotics in residents of long-term care facilities in Hungary

2014 ◽  
Vol 155 (23) ◽  
pp. 911-917 ◽  
Author(s):  
Rita Szabó ◽  
Karolina Böröcz
Keyword(s):  
Urinary Tract ◽  
Long Term Care ◽  
Soft Tissues ◽  
Good Practice ◽  
Antibiotic Use ◽  
Prevalence Survey ◽  
Term Care ◽  
Care Facilities ◽  
Tract Infections

Introduction: Healthcare associated infections and antimicrobial use are common among residents of long-term care facilities. Faced to the lack of standardized data, the European Centre for Disease Prevention and Control funded a project with the aim of estimating prevalence of infections and antibiotic use in European long-term care facilities. Aim: The aim of the authors was to present the results of the European survey which were obtained in Hungary. Method: In Hungary, 91 long-term care facilities with 11,823 residents participated in the point-prevalence survey in May, 2013. Results: The prevalence of infections was 2.1%. Skin and soft tissues infections were the most frequent (36%), followed by infections of the respiratory (30%) and urinary tract (21%). Antimicrobials were mostly prescribed for urinary tract infections (40.3%), respiratory tract infections (38.4%) and skin and soft tissue infections (13.2%). The most common antimicrobials (97.5%) belonged to the ATC J01 class of “antibacterials for systemic use”. Conclusions: The results emphasise the need for a national guideline and education for good practice in long-term care facilities. Orv. Hetil., 2014, 155(23), 911–917.

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

scholarly journals Effects of disk tillage on soil condition, crop yield and weed infestation

2011 ◽  
Vol 48 (No. 1) ◽  
pp. 20-26
Author(s):  
M. Birkás ◽  
T. Szalai ◽  
C. Gyuricza ◽  
M. Gecse ◽  
K. Bordás
Keyword(s):  
Winter Wheat ◽  
Crop Yield ◽  
Field Experiments ◽  
Soil Layer ◽  
Soil Condition ◽  
Perennial Weeds ◽  
Weed Infestation ◽  
Set Up ◽  
Different Levels

This research was instigated by the fact that during the last decade annually repeated shallow disk tillage on the same field became frequent practice in Hungary. In order to study the changes of soil condition associated with disk tillage and to assess it is consequences, long-term tillage field experiments with different levels of nutrients were set up in 1991 (A) and in 1994 (B) on Chromic Luvisol at Gödöllö. The effects of disk tillage (D) and disk tillage combined with loosening (LD) on soil condition, on yield of maize and winter wheat, and on weed infestation were examined. The evaluation of soil condition measured by cone index and bulk density indicated that use of disking annually resulted in a dense soil layer below the disking depth (diskpan-compaction). It was found, that soil condition deteriorated by diskpan-compaction decreased the yield of maize significantly by 20 and 42% (w/w), and that of wheat by 13 and 15% (w/w) when compared to soils with no diskpan-compaction. Averaged over seven years, and three fertilizer levels, the cover % of the total, grass and perennial weeds on loosened soils were 73, 69 and 65% of soils contained diskpan-compaction.

scholarly journals Spectrum Based Power Management for Congested IoT Networks

Sensors ◽  
2021 ◽  
Vol 21 (8) ◽  
pp. 2681
Author(s):  
Kedir Mamo Besher ◽  
Juan Ivan Nieto-Hipolito ◽  
Raymundo Buenrostro-Mariscal ◽  
Mohammed Zamshed Ali
Keyword(s):  
Power Management ◽  
Network Performance ◽  
Channel Allocation ◽  
Battery Life ◽  
Packet Routing ◽  
Data Packets ◽  
Increasing Demand ◽  
Iot Devices ◽  
Set Up

With constantly increasing demand in connected society Internet of Things (IoT) network is frequently becoming congested. IoT sensor devices lose more power while transmitting data through congested IoT networks. Currently, in most scenarios, the distributed IoT devices in use have no effective spectrum based power management, and have no guarantee of a long term battery life while transmitting data through congested IoT networks. This puts user information at risk, which could lead to loss of important information in communication. In this paper, we studied the extra power consumed due to retransmission of IoT data packet and bad communication channel management in a congested IoT network. We propose a spectrum based power management solution that scans channel conditions when needed and utilizes the lowest congested channel for IoT packet routing. It also effectively measured power consumed in idle, connected, paging and synchronization status of a standard IoT device in a congested IoT network. In our proposed solution, a Freescale Freedom Development Board (FREDEVPLA) is used for managing channel related parameters. While supervising the congestion level and coordinating channel allocation at the FREDEVPLA level, our system configures MAC and Physical layer of IoT devices such that it provides the outstanding power utilization based on the operating network in connected mode compared to the basic IoT standard. A model has been set up and tested using freescale launchpads. Test data show that battery life of IoT devices using proposed spectrum based power management increases by at least 30% more than non-spectrum based power management methods embedded within IoT devices itself. Finally, we compared our results with the basic IoT standard, IEEE802.15.4. Furthermore, the proposed system saves lot of memory for IoT devices, improves overall IoT network performance, and above all, decrease the risk of losing data packets in communication. The detail analysis in this paper also opens up multiple avenues for further research in future use of channel scanning by FREDEVPLA board.

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