Consideration of the novel psychoactive substances (‘legal highs’)

Original report can be found at: http://www.homeoffice.gov.uk/ Crown Copyright, the Advisory Council/ The Home Office. This work is published under an open government license.The Advisory Council on the Misuse of Drugs (ACMD) committed to providing the Government with advice on novel psychoactive substances (often colloquially termed „legal highs‟). This is a relatively recent phenomenon, exemplified by the drug known as mephedrone. The actions by the ACMD and subsequently by the Government on this drug have gone some way to reducing the potential harms caused by this substance. However, there is more that can be done. The advent of novel psychoactive substances has changed the face of the drug scene remarkably and with rapidity. The range of substances now available, their lack of consistency and the potential harms users are exposed to are now complex and multi-faceted. In light of this we have pleasure in enclosing the Council‟s report. This report provides advice on high level issues that ACMD believe the Government should give careful consideration to in addressing legally available psychoactive substances. The report does not purport to provide a single solution to the problem, but rather a number of practicable options that, in combination, seek to tackle the on-going sale, supply and consequential harms. It is important that the Government recognises that each and every department, that has a locus of responsibility in drug issues should both take personal ownership and share collective responsibility of the recommendations in this report. Tackling the issues that are raised by novel psychoactive substances requires a co-ordination of efforts that can only be realised by a strategic and co-operative approach. The ACMD has identified lead departments for each of the recommendations that should assist and guide the Government in this aim. The ACMD provides key recommendations in this report on legislation, public health, education and research. The key legislative measures are primarily concerned with tightening the enforcement of existing legislation and moving the responsibility for the supply of novel psychoactive substances to the vendors, such that the burden of proof falls to them. The ACMD believe it is for vendors to prove that such substances are neither analogues of current medicines nor products harmful to consumers in their intended form. The ACMD also makes key recommendations around public awareness from local to international initiatives.Final Published versio

M-health review: joining up healthcare in a wireless world

In recent years, there has been a huge increase in the use of information and communication technologies (ICT) to deliver health and social care. This trend is bound to continue as providers (whether public or private) strive to deliver better care to more people under conditions of severe budgetary constraint

Faculty and Student Perceptions of a Physical Therapy Professional Behavior Mentoring Program

Purpose: Mentoring is a process and a relationship between a novice and an expert that fosters intellectual, personal, and professional growth. The purposes and scope of this article are to describe 1) the structured professional development component of a comprehensive mentoring program for students in a physical therapy program; and 2) the perceptions of faculty and students regarding this mentoring program. Method: Faculty and students completed electronic questionnaires developed specifically for each group. Results: Return rate was 54.50% (N=286) for physical therapist students and 100% (N=18) for physical therapy faculty. Student positive ratings regarding the mentoring program exceeded 89.00%. Additionally, 76.75% of the students reported seeking feedback and advice from their faculty mentor to make informed decisions. Students perceived their mentors to be committed to helping them achieve their personal/professional goals (94.96%). Faculty mentors reported that they enjoy being mentors (94.12%), believe they have a responsibility to assist in the professional socialization of mentees (100.00%), and that mentees benefitted from meeting with them regarding professional behavior issues (92.86%). Conclusions: Faculty mentors and student mentees perceive that students benefit from mentoring regarding professional behavior issues and that the mentoring program is valuable and worth the time spent participating in it. We suggest that the process and documents developed by the Program in Physical Therapy may be used as a basis for critical dialogue within other academic units for the purpose of determining the desired professional behavior mentoring system for that particular academic entity

Rapid opioid overdose response system technologies

Purpose of review  Opioid overdose events are a time sensitive medical emergency, which is often reversible with naloxone administration if detected in time. Many countries are facing rising opioid overdose deaths and have been implementing rapid opioid overdose response Systems (ROORS). We describe how technology is increasingly being used in ROORS design, implementation and delivery. Recent findings  Technology can contribute in significant ways to ROORS design, implementation, and delivery. Artificial intelligence-based modelling and simulations alongside wastewater-based epidemiology can be used to inform policy decisions around naloxone access laws and effective naloxone distribution strategies. Data linkage and machine learning projects can support service delivery organizations to mobilize and distribute community resources in support of ROORS. Digital phenotyping is an advancement in data linkage and machine learning projects, potentially leading to precision overdose responses. At the coalface, opioid overdose detection devices through fixed location or wearable sensors, improved connectivity, smartphone applications and drone-based emergency naloxone delivery all have a role in improving outcomes from opioid overdose. Data driven technologies also have an important role in empowering community responses to opioid overdose. Summary  This review highlights the importance of technology applied to every aspect of ROORS. Key areas of development include the need to protect marginalized groups from algorithmic bias, a better understanding of individual overdose trajectories and new reversal agents and improved drug delivery methods.PostprintPeer reviewe

Systems mapping workshops and their role in understanding medication errors in healthcare

In this paper for Applied Ergonomics, one of the two leading journals for ergonomics/human factors, Buckle et al. discuss the role of mapping workshops in understanding medication errors in healthcare. They draw upon research that used mapping workshops as a method that systems designers, including human factors/ergonomics specialists, can use to help generate a knowledge base for better design requirements. Buckle et al. applied systems mapping workshops for the first time to the problem of medication errors in healthcare. The workshops were designed using experiential group work principles. They involved a range of stakeholders from within the health service as well as those who supply the health sector, including designers who may be able to enhance the safety of products and systems used in healthcare. The opportunity for using these methods to study patient safety issues arose as a result of a scoping study undertaken on behalf of the UK Department of Health and The Design Council. As the scope of patient safety issues within the healthcare system and the range of stakeholder groups is large (National Patient Safety Agency 2005), it was believed that mapping workshops might enhance system design in health. The results were rich from a design perspective, giving specific details of actual incidences, contexts and practices, with further depth of information emerging in the group working sessions. A wealth of detail on aspects of medication error, especially in the community, emerged from creative, primary, secondary and patient-support group sessions. As a process, similar stakeholder workshops could help designers understand better the complexity and range of factors to be taken into account. The methods are now being used in many areas of healthcare and social care design, for example by the Technology Strategy Board funded research into Telecare (see http://www.aktive.org.uk/)

Connected healthcare: Improving patient care using digital health technologies

Now more than ever, traditional healthcare models are being overhauled with digital technologies of Healthcare 4.0 being increasingly adopted. Worldwide, digital devices are improving every stage of the patient care pathway. For one, sensors are being used to monitor patient metrics 24/7, permitting swift diagnosis and interventions. At the treatment stage, 3D printers are currently being investigated for the concept of personalised medicine by allowing patients access to on-demand, customisable therapeutics. Robots are also being explored for treatment, by empowering precision surgery or targeted drug delivery. Within medical logistics, drones are being leveraged to deliver critical treatments to remote areas, collect samples, and even provide emergency aid. To enable seamless integration within healthcare, the Internet of Things technology is being exploited to form closed-loop systems that remotely communicate with one another. This review outlines the most promising healthcare technologies and devices, their strengths, drawbacks, and scopes for clinical adoption

A safer place for patients: learning to improve patient safety

1 Every day over one million people are treated successfully by National Health Service (NHS) acute, ambulance and mental health trusts. However, healthcare relies on a range of complex interactions of people, skills, technologies and drugs, and sometimes things do go wrong. For most countries, patient safety is now the key issue in healthcare quality and risk management. The Department of Health (the Department) estimates that one in ten patients admitted to NHS hospitals will be unintentionally harmed, a rate similar to other developed countries. Around 50 per cent of these patient safety incidentsa could have been avoided, if only lessons from previous incidents had been learned. 2 There are numerous stakeholders with a role in keeping patients safe in the NHS, many of whom require trusts to report details of patient safety incidents and near misses to them (Figure 2). However, a number of previous National Audit Office reports have highlighted concerns that the NHS has limited information on the extent and impact of clinical and non-clinical incidents and trusts need to learn from these incidents and share good practice across the NHS more effectively (Appendix 1). 3 In 2000, the Chief Medical Officer’s report An organisation with a memory 1 , identified that the key barriers to reducing the number of patient safety incidents were an organisational culture that inhibited reporting and the lack of a cohesive national system for identifying and sharing lessons learnt. 4 In response, the Department published Building a safer NHS for patients3 detailing plans and a timetable for promoting patient safety. The goal was to encourage improvements in reporting and learning through the development of a new mandatory national reporting scheme for patient safety incidents and near misses. Central to the plan was establishing the National Patient Safety Agency to improve patient safety by reducing the risk of harm through error. The National Patient Safety Agency was expected to: collect and analyse information; assimilate other safety-related information from a variety of existing reporting systems; learn lessons and produce solutions. 5 We therefore examined whether the NHS has been successful in improving the patient safety culture, encouraging reporting and learning from patient safety incidents. Key parts of our approach were a census of 267 NHS acute, ambulance and mental health trusts in Autumn 2004, followed by a re-survey in August 2005 and an omnibus survey of patients (Appendix 2). We also reviewed practices in other industries (Appendix 3) and international healthcare systems (Appendix 4), and the National Patient Safety Agency’s progress in developing its National Reporting and Learning System (Appendix 5) and other related activities (Appendix 6). 6 An organisation with a memory1 was an important milestone in the NHS’s patient safety agenda and marked the drive to improve reporting and learning. At the local level the vast majority of trusts have developed a predominantly open and fair reporting culture but with pockets of blame and scope to improve their strategies for sharing good practice. Indeed in our re-survey we found that local performance had continued to improve with more trusts reporting having an open and fair reporting culture, more trusts with open reporting systems and improvements in perceptions of the levels of under-reporting. At the national level, progress on developing the national reporting system for learning has been slower than set out in the Department’s strategy of 2001 3 and there is a need to improve evaluation and sharing of lessons and solutions by all organisations with a stake in patient safety. There is also no clear system for monitoring that lessons are learned at the local level. Specifically: a The safety culture within trusts is improving, driven largely by the Department’s clinical governance initiative 4 and the development of more effective risk management systems in response to incentives under initiatives such as the NHS Litigation Authority’s Clinical Negligence Scheme for Trusts (Appendix 7). However, trusts are still predominantly reactive in their response to patient safety issues and parts of some organisations still operate a blame culture. b All trusts have established effective reporting systems at the local level, although under-reporting remains a problem within some groups of staff, types of incidents and near misses. The National Patient Safety Agency did not develop and roll out the National Reporting and Learning System by December 2002 as originally envisaged. All trusts were linked to the system by 31 December 2004. By August 2005, at least 35 trusts still had not submitted any data to the National Reporting and Learning System. c Most trusts pointed to specific improvements derived from lessons learnt from their local incident reporting systems, but these are still not widely promulgated, either within or between trusts. The National Patient Safety Agency has provided only limited feedback to trusts of evidence-based solutions or actions derived from the national reporting system. It published its first feedback report from the Patient Safety Observatory in July 2005

Maintaining places of social inclusion : Ebola and the emergency department

We introduce the concept of places of social inclusion—institutions endowed by a society or a community with material resources, meaning, and values at geographic sites where citizens can access services for specific needs—as taken-for-granted, essential, and inherently precarious. Based on our study of an emergency department that was disrupted by the threat of the Ebola virus in 2014, we develop a process model to explain how a place of social inclusion can be maintained by custodians. We show how these custodians—in our fieldsite, doctors and nurses—experience and engage in institutional work to manage different levels of tension between the value of inclusion and the reality of finite resources, as well as tension between inclusion and the desire for safety. We also demonstrate how the interplay of custodians’ emotions is integral to maintaining the place of social inclusion. The primary contribution of our study is to shine light on places of social inclusion as important institutions in democratic society. We also reveal the theoretical and practical importance of places as institutions, deepen understanding of custodians and custodianship as a form of institutional work, and offer new insight into the dynamic processes that connect emotions and institutional work