scholarly journals How user knowledge of psychotropic drug withdrawal resulted in the development of person-specific tapering medication

2020 ◽  
Vol 10 ◽  
pp. 204512532093245 ◽  
Author(s):  
Peter C. Groot ◽  
Jim van Os
Keyword(s):  
Psychotropic Drug ◽  
Drug Withdrawal ◽  
Full Agreement ◽  
Randomised Controlled ◽  
The Uk ◽  
User Knowledge ◽  
First Time ◽  
Academic Strategy ◽  
Discontinuation Syndrome

Coming off psychotropic drugs can cause physical as well as mental withdrawal, resulting in failed withdrawal attempts and unnecessary long-term drug use. The first reports about withdrawal appeared in the 1950s, but although patients have been complaining about psychotropic withdrawal problems for decades, the first tentative acknowledgement by psychiatry only came in 1997 with the introduction of the ‘antidepressant-discontinuation syndrome’. It was not until 2019 that the UK Royal College of Psychiatrists, for the first time, acknowledged that withdrawal can be severe and persistent. Given the lack of a systematic professional response, over the years, patients who were experiencing withdrawal started to work out practical ways to safely come off medications themselves. This resulted in an experience-based knowledge base about withdrawal which ultimately, in The Netherlands, gave rise to the development of person-specific tapering medication (so-called tapering strips). Tapering medication enables doctors, for the first time, to flexibly prescribe and adapt the medication required for responsible and person-specific tapering, based on shared decision making and in full agreement with recommendations in existing guidelines. Looking back, it is obvious that the simple practical solution of tapering strips could have been introduced much earlier, and that the traditional academic strategy of comparisons from randomised trials is not the logical first step to help individual patients. While randomised controlled trials (RCTs) are the gold standard for evaluating interventions, they are unable to accommodate the heterogeneity of individual responses. Thus, a more individualised approach, building on RCT knowledge, is required. We propose a roadmap for a more productive way forward, in which patients and academic psychiatry work together to improve the recognition and person-specific management of psychotropic drug withdrawal.

scholarly journals Fisheries bycatch data provide insights into the distribution of the mauve stinger (Pelagia noctiluca) around Ireland

2010 ◽  
Vol 68 (3) ◽  
pp. 436-443 ◽  
Author(s):  
Thomas Bastian ◽  
David Stokes ◽  
Jane E. Kelleher ◽  
Graeme C. Hays ◽  
John Davenport ◽  
...  
Keyword(s):  
Climatic Factors ◽  
Northeast Atlantic ◽  
North West ◽  
Pelagia Noctiluca ◽  
Aquaculture Industry ◽  
Fisheries Bycatch ◽  
The Uk ◽  
First Time ◽  
Average Catch

Abstract Bastian, T., Stokes, D., Kelleher, J. E., Hays, G. C., Davenport, J., and Doyle, T. K. 2011. Fisheries bycatch data provide insights into the distribution of the mauve stinger (Pelagia noctiluca) around Ireland. – ICES Journal of Marine Science, 68: . There is concern that jellyfish populations are proliferating in the Northeast Atlantic and that their socio-economic impacts will increase. Using information from the Irish Groundfish Survey, data are presented on the distribution of the mauve stinger, Pelagia noctiluca, over an area >160 000 km² around Ireland and the UK in 2009. The species accounted for 93% of the overall catch of gelatinous organisms, with an average catch biomass of 0.26 ± 2.3 kg ha−1. The study area was divided into four subregions (North, West, Southwest, and South), and the distribution and abundance of P. noctiluca displayed both inter- and intraregional variations. Individual bell diameters ranged from 1 to 13.5 cm (median 4.5 cm, s.d. 1.2 cm), and the size distribution also varied spatially. It is the first time that such detailed information has been made available for P. noctiluca in a part of the Northeast Atlantic where its impact on the salmon aquaculture industry can be considerable. Finally, the possibility of using annual datasets from this type of fisheries survey to develop time-series that, in the future, will allow investigation of relationships between long-term variations of P. noctiluca populations and climatic factors in the area is addressed.

Long-term unemployment

2020 ◽  
Vol 47 (4) ◽  
pp. 713-727
Author(s):  
Emmanuel Apergis ◽  
Nicholas Apergis
Keyword(s):  
Working Environment ◽  
Employment Relations ◽  
Content Type ◽  
Different Types ◽  
The Uk ◽  
First Time ◽  
Robustness Check ◽  
Modelling Approach

PurposeThis paper empirically explores the role of skill losses during unemployment behind firms' behaviour in interviewing long-term unemployedDesign/methodology/approachThe analysis makes use of the Work Employment Relations Survey in the UK, while it applies a panel probit modelling approach to estimate the empirical findings.FindingsThe findings document that skill losses during long-term unemployment reduce the likelihood of an interview, while they emphasize the need for certain policies that could compensate for this deterioration of skills. For robustness check, the estimation strategy survives the examination of the same predictors under different types of the working environment.Originality/valueThe original values of the work 1 combines for the first time both duration and technology as predictors of interview probability. Until now, the independent variables were used to test whether an individual has managed to exit unemployment, thus skipping the step of the interview process.

scholarly journals Demographic variation in fit note receipt and long-term conditions in south London

2020 ◽  
Vol 77 (6) ◽  
pp. 418-426 ◽  
Author(s):  
Sarah Dorrington ◽  
Ewan Carr ◽  
Sharon A M Stevelink ◽  
Alexandru Dregan ◽  
David Whitney ◽  
...  
Keyword(s):  
Demographic Variables ◽  
Demographic Information ◽  
Long Term Conditions ◽  
Individual Level ◽  
Quality And Outcomes ◽  
The Uk ◽  
Patients With Epilepsy ◽  
First Time ◽  
Quality And Outcomes Framework

ObjectivesIntroduced in the UK in 2010, the fit note was designed to address the problem of long-term sickness absence. We explored (1) associations between demographic variables and fit note receipt, ‘maybe fit’ use and long-term conditions, (2) whether individuals with long-term conditions receive more fit notes and are more likely to have the ‘maybe fit’ option selected and (3) whether long-term conditions explained associations between demographic variables and fit note receipt.MethodsData were extracted from Lambeth DataNet, a database containing electronic medical records of all 45 general practitioner (GP) practices within the borough of Lambeth. Individual-level anonymised data on GP consultations, prescriptions, Quality and Outcomes Framework diagnostic data and demographic information were analysed using survival analysis.ResultsIn a sample of 326 415 people, 41 502 (12.7%) received a fit note. We found substantial differences in fit note receipt by gender, age, ethnicity and area-level deprivation. Chronic pain (HR 3.7 (95% CI 3.3 to 4.0)) and depression (HR 3.4 (95% CI 3.3 to 3.6)) had the highest rates for first fit note receipt. ‘Maybe fit’ recommendations were used least often in patients with epilepsy and serious mental illness. The presence of long-term conditions did not explain associations between demographic variables and fit note use.ConclusionsFor the first time, we show the relationships between fit note use and long-term conditions using individual-level primary care data from south London. Further research is required in order to evaluate this relatively new policy and to understand the needs of the population it was designed to support.

scholarly journals Understanding successful development of complex health and healthcare interventions and its drivers from the perspective of developers and wider stakeholders: an international qualitative interview study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e028756 ◽  
Author(s):  
Katrina M Turner ◽  
Nikki Rousseau ◽  
Liz Croot ◽  
Edward Duncan ◽  
Lucy Yardley ◽  
...  
Keyword(s):  
Real World ◽  
Development Process ◽  
Intervention Development ◽  
Grant Application ◽  
Successful Intervention ◽  
Qualitative Interview Study ◽  
Healthcare Interventions ◽  
Randomised Controlled ◽  
The Uk

ObjectiveIdentify how individuals involved in developing complex health and healthcare interventions (developers), and wider stakeholders in the endeavour, such as funders, define successful intervention development and what factors influence how interventions are developed.DesignIn-depth interviews with developers and wider stakeholders to explore their views and experiences of developing complex health and healthcare interventions.SettingInterviews conducted with individuals in the UK, Europe and North America.ParticipantsTwenty-one individuals were interviewed: 15 developers and 6 wider stakeholders. Seventeen participants were UK based.ResultsMost participants defined successful intervention development as a process that resulted in effective interventions that were relevant, acceptable and could be implemented in real-world contexts. Accounts also indicated that participants aimed to develop interventions that end users wanted, and to undertake a development process that was methodologically rigorous and provided research evidence for journal publications and future grant applications. Participants’ ambitions to develop interventions that had real-world impact drove them to consider the intervention’s feasibility and long-term sustainability early in the development process. However, this process was also driven by other factors: the realities of resource-limited health contexts; prespecified research funder priorities; a reluctance to deviate from grant application protocols to incorporate evidence and knowledge acquired during the development process; limited funding to develop interventions and the need for future randomised controlled trials (RCTs) to prove effectiveness. Participants expressed concern that these drivers discouraged long-term thinking and the development of innovative interventions, and prioritised evaluation over development and future implementation.ConclusionsTensions exist between developers’ goal of developing interventions that improve health in the real world, current funding structures, the limited resources within healthcare contexts, and the dominance of the RCT for evaluation of these interventions. There is a need to review funding processes and expectations of gold standard evaluation.

Use of community-based indices to monitor eutrophication in European rivers

1998 ◽  
Vol 25 (1) ◽  
pp. 22-29 ◽  
Author(s):  
MARTYN G. KELLY
Keyword(s):  
Organic Pollution ◽  
Theoretical Framework ◽  
Community Based ◽  
Ecological Response ◽  
Upper Limit ◽  
Diatom Communities ◽  
The Uk ◽  
First Time

New legislation has encouraged regulatory biologists in the UK to examine the impacts of eutrophication in rivers for the first time. The principal tools for this have been new indices based on macrophyte and diatom communities. The use of such indices is placed within an appropriate theoretical framework. The importance of recognizing the upper limit of sensitivity of such indices, as well as factors such as organic pollution, which can confuse interpretation, is discussed. Despite their limitations, community-based indices are valuable tools for reconnaissance studies and, in the long-term, as indicators of the extent to which nutrient reductions have led to an ecological response. Some general guidelines for monitoring eutrophication in rivers are proposed.

scholarly journals Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: the UK Flexible Sigmoidoscopy Screening randomised controlled trial

The Lancet ◽  
2017 ◽  
Vol 389 (10076) ◽  
pp. 1299-1311 ◽  
Author(s):  
Wendy Atkin ◽  
Kate Wooldrage ◽  
D Maxwell Parkin ◽  
Ines Kralj-Hans ◽  
Eilidh MacRae ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Flexible Sigmoidoscopy ◽  
Controlled Trial ◽  
Long Term Effects ◽  
Randomised Controlled ◽  
The Uk

Flexible Sigmoidoskopie kann viele Leben retten

2017 ◽  
Vol 79 (08/09) ◽  
pp. 590-590
Keyword(s):  
Flexible Sigmoidoscopy ◽  
Controlled Trial ◽  
Imperial College ◽  
Prevention Research ◽  
Long Term Effects ◽  
Screening And Prevention ◽  
Randomised Controlled ◽  
The Uk

Atkin W et al. Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: the UK Flexible Sigmoidoscopy Screening randomised controlled trial. Lancet 2017; 389: 1299–1311 Die Beobachtungsdauer zur Darmkrebsfrüherkennung mittels einer flexiblen Sigmoidoskopie im Alter zwischen 55 und 64 Jahren liegt inzwischen in Großbritannien bei 17 Jahren. Die von Wendy Atkin von der Cancer Screening and Prevention Research Group am Imperial College in London und Kollegen vorgestellten Ergebnisse bestätigen den Effekt des Darmkrebsscreenings mittels Endoskopie selbst bei einer einmaligen und begrenzten Maßnahme wie dieser.

Framing a Right to Treatment in English Law? Watts in Retrospective

2007 ◽  
Vol 14 (3) ◽  
pp. 263-285 ◽  
Author(s):  
Jean V. McHale
Keyword(s):  
Resource Allocation ◽  
Policy Makers ◽  
Allocation Policy ◽  
Secondary Hospital ◽  
Long Term Impact ◽  
The Uk ◽  
The Impact ◽  
First Time ◽  
Practical Impact

The Watts decision of the ECJ in 2006 led to consternation amongst media and policy makers alike in the UK. Did this really mean that EU law had granted NHS patients for the first time an explicit ‘right to treatment’? What would the implications be for individual patients and Member States? But as the dust has started to settled and we have time to take pause will Watts really prove a turning point or will time show that it is yet another healthcare law decision more noted for the publicity it receives in England and Wales than its long-term impact on law or on health policy? This article attempts to set Watts in the context of more general health law and policy in the UK. First it begins with a brief outline of the Watts case setting it in the context of domestic and ECJ jurisprudence. Secondly, it considers whether Watts does change the existing position and create a ‘right to healthcare’ in the context of NHS treatment. It considers the practical impact on patients seeking treatment abroad in relation to both primary care and secondary-hospital care. Thirdly, it considers the impact of the judgment on the NHS itself and on resource allocation in general. It suggests that while on its face the decision has the potential to undermine resource allocation policy the practical impact of the case may prove much more restrictive. Fourthly, it considers the impact of further EU developments post-Watts on access to healthcare across the EU.

Sign in / Sign up

Export Citation Format

Share Document