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On March 24, thirteen days after the 2011 Great East Japan Earthquake (GEJE), the Ishinomaki Zone Joint Relief Team (IZJRT) started the Melon Pan System – an ad hoc pharmaceutical coordination system – for the first time in Japan to efficiently prescribe, dispense, deliver, and explain medication to patients in evacuation centers and at their homes. The Japan Red Cross (JRC) Ishinomaki Hospital, a disaster base hospital (DBH), serves as a coordination hub for emergency medical teams (EMTs), pharmacists, and medication supplies.
Study Objective:
This study aimed to retrospectively examine trends in medication needs and delivery before (Phase A: March 11 to March 23; 13 days) and after (Phase B: March 24 to April 5; 13 days) the system’s implementation.
Methods:
Using an anonymized disaster medical record (DMR) database, patient characteristics, number of new and returning patients, prescription numbers, prescribed medications, and prescription durations in Phase A and Phase B were compared. The locations of the evacuation centers with significant improvements in Phase B were identified on a map.
Results:
There were 3,830 new patients in Phase A and 6,984 in Phase B. The number of returning patients increased significantly during Phase B. The overall number of prescriptions increased 2.6-times (353.7/day versus 935.2/day) and the number of prescribed medications increased 3.1-times (764.1/day versus 2,367.8/day) in Phase B. The median prescription duration of anti-hypertensive drugs increased from seven days (95% confidence interval [CI], 2-14 days) in Phase A to nine days (95% CI, 3-30 days) in Phase B (P < 0.0001), suggesting that medication was efficiently delivered to people in need. The effect of the system was more prominent in evacuation centers located within the tsunami-inundated areas or remote areas (>10km from the JRC Ishinomaki Hospital), considering that 33 (89.2%) of the 37 evacuation centers where prescriptions increased more than three-fold and 39 (94.9%) of the 41 evacuation centers where the prescription started in Phase B were located in such areas.
Conclusion:
The ad hoc pharmaceutical coordination system was effective and necessary, enabling EMTs to focus on patient care and pharmacists to provide personalized pharmaceutical assistance, especially in evacuation centers with limited access. The Melon Pan system was the first pharmaceutical coordination model to be developed in Japan to improve disaster health management.
This chapter outlines the fundamental steps common to psychiatric prescribing, from introducing yourself to the patient, to follow-up and documentation. It closes with some critiques of prevalent current practice, which the remainder of the book attempts to address.
Parliamentary Hansard records are texts that stand at an intersection between the representation of spoken discourse and the application of standardised written norms.While they are categorised as ‘verbatim’ accounts of what is said during parliamentary proceedings, they are also edited, official government publications, and are therefore likely to represent a normative, formalised version of the language that was used. Add to this the factors of changing standards over time, different varieties of English and evolving reporting methods, and they become a valuable historical record for charting shifting attitudes towards language prescription. This chapter analyses data from Australian and British Hansard, from 1901 to the present, to assess the degree to which prescriptive practices have been applied to the originally spoken text. It looks at language features that have been identified as being indicative of spoken or written style. These include use of contractions, split infinitives and singular agreement with plural nouns. The data show generally more acceptance of the informal option in Australia in recent times, but also in the early part of the twentieth century.
This chapter focuses on the law relating to sovereign territory. The concepts of territory and of territorial sovereignty are examined. The manner in which additional territory may be acquired is analysed. Mechanisms such as boundary treaties and boundary awards are noted, and then the methods of acquisition are discussed. These include an analysis of discovery, accretion, cession, the former use of force and conquest, and the exercise of effective control, including occupation of terra nullius and prescription. The impact of the concepts of the critical date and intertemporal law is noted. Attention then turns to the role of subsequent conduct, such as recognition, acquiescence and estoppel. The principles of territorial integrity and of self-determination in this context are then discussed, together with the doctrine of uti possidetis, both as to the colonial context and more generally. The role of subsequent practice is noted and the importance of sovereign effective control in the circumstances (‘effectivités’). The chapter continues by noting the relevance of leases and servitudes, then turns to international boundary rivers, and then the polar regions. The chapter concludes with a section on the law of outer space.
Standard American English is not the same as varieties of English that have emerged from the complex system of the language. It is an institutional construct, to the extent that schools convey the idea of a standard and attempt to teach prescriptions about the language. Usage manuals do not agree about what issues to cover. Some kinds of standardization of language, like standard spelling, are useful for the purposes of electronic communication, and standardization may make it easier to communicate across time and distance. What is more important is the idea of standards, and how that idea plays a role in social relations.
When and why did English grammars first start to be written, and by whom? Who else were involved in the grammar-writing process apart from the grammarians? And what was the grammarians’ expertise based on to begin with? This chapter will address these questions by discussing the rise of the English grammar-writing tradition during the late sixteenth century down to the end of the eighteenth century. Focusing on the linguistic climate of the period, it will show how grammars were written at a time when only Latin grammar was available as a descriptive model, and that grammarians gradually developed an eye for features specific to the English language. Contextualising research on the subject by discussing traditional and state-of-the-art research tools, it will show that writing grammars for English was increasingly professionalised, and that female grammarians played an important role in the process.
Based on discursive analysis, Chapter 3 focuses on the briefs produced in Madrid and the colony to mount the plaintiffs’ case for collective freedom. It examines the meanings of freedom in the Spanish Atlantic and the battery of legal tools, including the rarified one of prescription, deployed in the plaintiffs’ memorials to buttress their case of wrongful enslavement and collective freedom. The case entered unchartered terrain with the claim that belonging to a pueblo constituted a way of enacting and producing freedom collectively, an innovative claim based on notions of corporate belonging in the Spanish Atlantic world especially related to municipal bodies such as pueblos. The chapter parses a distinction between civil and political freedom made in some briefs. Civil freedom was understood in opposition to slavery as personal freedoms that free subjects could enjoy as royal vassals even in the context of colonialism and royal absolutism. Political freedom depended on municipal belonging, the space in which limited self-rule and citizenship could be locally enacted in an absolute monarchy. The chapter draws out the possible normative implications of this claim for Afro descendants at large who, at most, could only enjoy civil freedom rights in the empire.
Far from being cut-down versions of the adult form, children’s dictionaries constitute a distinct genre with their own history and methodology. The chapter charts the development of children’s dictionaries, from Renaissance bilingual dictionaries to the present day, showing how they have evolved to reflect changing perceptions of childhood. It discusses the bewildering range of dictionaries now available for children as they progress from ABCs and picture dictionaries to those for school use and creative writing, including innovative subgenres based on fictional worlds and dictionaries supporting language revitalisation. Drawing on historical and contemporary examples, the chapter explores content and page design adapted to engage young readers. It considers how lexicographers aim to reflect the world as experienced by children, from the selection of headwords to the framing of definitions, using dedicated corpora and reading programmes. The tension between descriptive and prescriptive approaches is often acute in children’s dictionaries, for example over the inclusion of slang and taboo words, and lexicographers aim to balance young dictionary users’ needs against adult perceptions of what a children’s dictionary is for.
Paediatric fruit and vegetable prescription programmes hold promise in improving food security and dietary patterns among youth. However, programme success is largely dependent upon caregiver and family engagement. The current study sought to gain a better understanding of environmental barriers to engagement in a paediatric fruit and vegetable prescription programme in one low-income, urban community (Flint, Michigan, USA). Following the implementation of a paediatric fruit and vegetable prescription programme, researchers conducted thirty-two semi-structured interviews with caregivers. Researchers explored caregivers’ understanding of the fruit and vegetable prescription programme, barriers to programme engagement, and recommendations for improvement. Telephone interviews were transcribed for textual analysis. Researchers used thematic analysis to examine qualitative data, determine patterns across transcripts, and develop emerging themes. Researchers concluded interviews when data saturation was reached. The majority of participants were female (94%), African American (66%), and residents of Flint (72%). Five recurrent themes emerged: (1) nutrition security; (2) prescription distribution; (3) prescription redemption; (4) educational supports; and (5) programme modifications. Although caregivers indicated that the prescription programme addressed household food insecurity, environmental barriers to engagement were apparent. Caregivers provided suggestions, such as partnering with large grocery stores and developing digital prescriptions, to address programme engagement challenges. Fundamental to the success of fruit and vegetable prescription programmes is the understanding of barriers to engagement from the perspective of participants. This study explores challenges with one paediatric fruit and vegetable prescription programme and provides actionable solutions, from the viewpoint of caregivers, to address these challenges.
Drug-related illness (DRI) is a common problem in the elderly. Misuse of medications and inappropriate prescribing account for over half of all hospital admissions for DRI and both are potentially preventable. Physicians are the gatekeepers to prescription medication access and, in this role, they have the opportunity to prevent exposure to unnecessary and inappropriate medication and influence the use of medications by their elderly patients. Effective interventions to improve physician prescribing have been identified but they are costly to introduce, they require ongoing maintenance to maintain their effectiveness, they do not address the problems created by multiple prescribers or the challenges of keeping up-to-date on the growing number of new drugs that enter the market each year. Computer-based drug information networks and expert decision-making support systems are proposed as one means of providing (1) an accurate record for the prescribing physicians of drugs currently dispensed to their elderly patients, (2) a review of problems in existing and new prescriptions, and (3) an expert resource to select drug treatment. Canada is in an ideal situation to pioneer the development of these systems, but to do so, policies need to be put in place to address three problems. First, there is inadequate information available about the risks and benefits of drugs in the elderly because older sicker adults are often excluded in clinical trials of drug-effectiveness. Requirements for drug approval need to be amended so that sufficient evaluation of the risks and benefits of new drugs are carried out in the elderly. Second, computerization in the health care sector is central to the development of electronic decision-support systems in health care delivery. Future policy needs to be directed to the development of an effective infrastructure to facilitate the transition to an integrated computerized health sector. Third, the ethical and legal issues related to the access of prescription data through electronic networks need to be identified and clear guidelines for use of this new technology need to be developed.
Our response to the opioid epidemic has been reactionary, however preventing future addiction saves lives and money. Methods to prevent opioid misuse and addiction are frequently placed in one of three categories: universal, selective, or indicated. Universal prevention addresses an entire group of people without respect to any factors that might predispose someone to addiction. Most school-based curricula and education for prescribers fall under this category. Selective interventions are geared towards a subset of a population indentified as a higher risk for opioid use disorder, for example programs developed for children who have experienced traumatic events. Finally, indicated prevention focuses on individuals who are already using opioids but do not yet meet criteria for a clinical diagnosis of opioid use disorder. No matter the type, all strategies have the potential to postiively impact individuals and communities through reduced rates of addiction, overdose, and death.
Children and young people with CHD benefit from regular physical activity. Parents are reported as facilitators and barriers to their children’s physical activity. The aim of this study was to explore parental factors, child factors, and their clinical experience on physical activity participation in young people with CHD.
Methods:
An online questionnaire was co-developed with parents (n = 3) who have children with CHD. The survey was then distributed in the United Kingdom by social media and CHD networks, between October 2021 and February 2022. Data were analysed using mixed methods.
Results:
Eighty-three parents/guardians responded (94% mothers). Young people with CHD were 7.3 ± 5.0 years old (range 0–20 years; 53% female) and 84% performed activity. Parental participation in activity (X2(1) = 6.9, P < 0.05) and perceiving activity as important for their child were positively associated with activity (Fisher’s Exact, P < 0.05). Some parents (∼15%) were unsure of the safety of activity, and most (∼70%) were unsure where to access further information about activity. Fifty-two parents (72%) had never received activity advice in clinic, and of the 20 who received advice, 10 said it was inconsistent. Qualitative analysis produced the theme “Knowledge is power and comfort.” Parents described not knowing what activity was appropriate or the impact of it on their child.
Conclusion:
Parental participation and attitudes towards activity potentially influence their child’s activity. A large proportion of young people performed activity despite a lack and inconsistency of activity advice offered by CHD clinics. Young people with CHD would benefit from activity advice with their families in clinics.
Our study was conducted to assess the sepsis-associated hospitalisations and antimicrobials prescribed for sepsis inpatients in Hong Kong. Demographic, diagnostic and antimicrobial prescription data were analysed for patients admitted to public hospitals with a diagnosis of septicaemia from 2000 to 2015. A total of 223 250 sepsis hospitalisations were recorded in Hong Kong from 2000 to 2015 during which the hospitalisation rate increased by 85.6%. The majority of the sepsis hospitalisations occurred in adults ≥65 years and children aged 0–4 years. Adults with a secondary diagnosis of sepsis were often admitted with a primary diagnosis of urological conditions or pneumonia; whereas diabetes mellitus was the most common secondary diagnosis among those with primary sepsis. Paediatric sepsis patients aged 0–4 years were often diagnosed with disorders relating to short gestation and low birthweight. Antimicrobial prescriptions increased by 51.1% and 34.4% for primary and secondary sepsis patients, respectively. β-Lactam and β-lactamase inhibitor combinations were the most used antibiotics whereas the usage of carbapenems increased more than 10 times over the study period. A substantial burden of hospitalisations was attributable to sepsis in Hong Kong, particularly in the extremes of age. Broad-spectrum and last-resort antibiotics had been increasingly dispensed for sepsis inpatients.
In this chapter we evaluate not only how different paradigms approach the topic of peacebuilding but also how they compare and contrast with one another. This essay suggests that despite some clear incompatibilities, realism, liberalism, constructivism, cosmopolitanism, critical theory, public policy, and localism share some common ideas about how to pragmatically resolve conflicts, including focusing on the participants of these conflicts, developing locally grounded solutions, maintaining long-term commitments, and focusing on comprehensive approaches to peace. The main divide, we suggest, is between understandings of power in practice, with the more monist approaches positing that local actions come from structures that are not easily perceived. This critique, however, is minimized by the reality that all of the paradigms agree that peace cannot be sustained without both tempering the prerogatives of power with ideas of equality and consulting local actors. We conclude this chapter with comments about the benefits a cross-paradigmatic approach to peacebuilding has from methodological and theoretical standpoints.
A private nuisance is an act or omission by D which constitutes a violation of C’s real property rights, entailing either an interference with C’s legal interest in the land (including some easement or other right which C possesses in connection with that land) or an interference with the amenity of the land, i.e., C’s right to use and enjoy that land.
The fundamental task of a general-purpose dictionary is to identify the words of a language, describe their actual use in speech and writing, and report what use shows about meanings. Supplementary—and controversial—tasks include describing social attitudes toward disputed usages and prescribing ‘correct’ usage. Dictionaries differ in the degree to which they honour the supplementary tasks. Some limit descriptions of status to labels attached to particular words or senses; others offer expansive guidance in usage notes appended to dictionary entries. Usage notes themselves differ—some implicitly prescribing as well as describing usage, others restricted to description of attitudes. This chapter explores the history of attempts to strike an acceptable balance between descriptive and prescriptive approaches to usage in select twentieth-century and twenty-first-century monolingual general-purpose English dictionaries, chiefly those of American Heritage, Merriam-Webster, and Oxford University Press.
Chapter 11 unveils Burke’s understanding of the French Revolution through the lens of his principles of political economy. In Reflections on the Revolution in France, Burke attacked the Revolution for violating prescriptive property rights and subverting the market principles of supply and demand that he later defended in Thoughts and Details. In addition, I provide a thorough treatment of Burke’s criticism of the monied interest and the revolutionaries’ frenzied issuance of paper money called assignats. In his judgment, these two aspects of the Revolution shook the foundations of France’s system of revenue and discouraged commercial activity. The monied interest in particular exploited their position as state creditors to drive their pursuit of avaricious self-interest and wield a nefarious influence in the conduct of government affairs, which helped provoke the expansion of the French state. Such financiers, as well as the new middle class, were driven by ambition and speculation, supplanting the landed nobility and unsettling the social order of France. In Burke’s view, the landed interest was necessary to tame and channel such influences because their family pedigrees, ancestral estates, modern disposition, and commitment to the common good provided a stable foundation for market exchange and foreign investment to flourish.
L’utilisation prolongée et les associations de benzodiazépines (BZD) anxiolytiques et hypnotiques exposent à des risques à court et long terme (dépendance, démence, troubles psychomoteurs…). Selon la Haute Autorité de santé (HAS), il n’y a pas lieu d’associer une BZD et un apparenté (zopiclone ou zolpidem) le soir.
Objectifs
– Évaluer les habitudes de prescription des BZD et de leurs apparentés hypnotiques dans une population de patients suivis en psychiatrie hospitalière.
– Suivre sur 6 années l’évolution de ces pratiques de prescription et l’émergence d’alternatives thérapeutiques aux BZD.
– Établir un parallèle avec les recommandations et les actualités de la littérature au sujet de ces risques pendant cette même période.
Méthode
L’étude rétrospective a été réalisée au centre hospitalier Henri-Laborit (Poitiers) en sélectionnant les ordonnances informatisées comportant des BZD et/ou apparentés sur une période allant du 1er janvier 2008 au 31 décembre 2013, par tranche d’une année. Les associations de ces molécules et leurs posologies ont été répertoriées.
Résultats
L’analyse de 6511 ordonnances a notamment mis en évidence que la prescription de zolpidem ou zopiclone seuls, sans association à une benzodiazépine, est majoritaire (77,5 % des ordonnances en moyenne) jusqu’en 2010. Puis elle diminue fortement (plus que 38 % en 2013) et elle est inférieure à celle de benzodiazépine seule pendant les 3 années suivantes. Parallèlement, le nombre total d’ordonnances dans cet hôpital est en constante augmentation. L’association de benzodiazépine et d’apparentés sur une même ordonnance reste peu courante, dans 2 % des prescriptions en moyenne, mais la prise des deux se situe le soir dans 91 % des cas (69–100 %).
Conclusion
L’étude montre une diminution de prescription d’hypnotiques apparentés aux BZD, allant de pair avec les mises en garde sur leurs effets indésirables et aux actions de l’HAS. Leur association en soirée à des BZD reste présente et une étude prospective auprès des prescripteurs pour connaître leur choix d’alternative thérapeutique est nécessaire.
To document if prescription opioid medications used for pain enhanced or worsened pain syndromes from medical conditions in patients who received a diagnosis of prescription opioid dependence as determined by a diagnosis by DSM-IV criteria. Further, whether detoxification improved or worsened pain perceptions and self reports in patients who chronically administered prescription opioid medications.
Methods:
Our study consisted of a retrospective sample of patients taken from the Addiction Treatment Unit at St. Lawrence Hospital in Lansing, Michigan. Patients were selected from those who voluntarily sought detoxification from opioid medications in an inpatient setting. Selection criteria for the study consisted of a DSM-IV diagnosis of opioid prescription medication dependence, willingness to undergo medical detoxification, cooperation with self-report scales and abstinence from opioid medications. Study patients were randomly selected from discharges in patient census for the years 2001-2003.
Results:
The significant findings were that self reported pain scores improved during the detoxification from admission to discharge, from a mean of 5.5 at admission to mean of 3.4 at discharge (0 is no pain, and 10 is the most pain). The detoxification period extended to an average of 5 days. While oxycodone CR (OxyContin) produced higher levels of self-reported pain at admission and discharge, these patients experienced significant levels of pain reduction as with other opioid medications.
Conclusions:
Patients with a DSM-IV diagnosis of prescription opioid dependence reported (self) less pain with detoxification and abstinence from the opioid medications.
La prescription des psychotropes dans l’autisme est une question complexe et non univoque. À l’EPSVE, le constat réalisé par le groupe « EPP les psychotropes dans l’autisme » est qu’il n’y a pas de données sur la symptomatologie, les traitements prescrits et le suivi dans cette population. L’objectif est d’évaluer la mise en route d’un traitement psychotrope chez des patients autistes de 0 à 18 ans et d’encadrer les pratiques des professionnels dans ce domaine par la mise en place d’un protocole de prescription validé.
Matériels et méthodes
L’enquête de pratique a servi d’outil d’évaluation et un questionnaire élaboré pour les médecins prescripteurs. Les unités concernées sont les unités qui prennent en charge des patients autistes de 0 à 18 ans. Les structures concernées sont : CMP enfant adolescent, HDJ, CATTP enfant adolescent, UHTP enfant adolescent, UHTP adulte.
Résultats et discussion
Le traitement est justifié par les troubles du comportement, les troubles du sommeil, l’angoisse. Les symptômes sont différents selon les structures. La molécule choisie par ordre s’effectue selon : expérience du clinicien, AMM octroyées dans d’autres pays et/ou données de la recherche, démarche empirique, indications du Vidal. Le bilan avant la mise sous traitement est réalisé dans 85,7 % des cas.
Conclusion
Ce travail va permettre d’encadrer la prescription des psychotropes dans l’autisme par des fiches d’aide à la mise en route du traitement. Il sera complété par l’élaboration de fiches d’information destinées aux familles. Ces fiches seront soumises pour validation à la COMEDIMS ; des actions de communication complèteront ce travail et permettront des échanges croisés entre prescripteurs et professionnels de la pharmacie.