A change in the NICE guidelines on antibiotic prophylaxis

Since 2008, NICE clinical guidelines have stated: ‘Antibiotic prophylaxis against infective endocarditis is not recommended for people undergoing dental procedures’. This put UK guidance at odds with guidance in the rest of the world, where antibiotic prophylaxis is recommended for patients at high-risk of infective endocarditis undergoing invasive dental procedures. Many dentists also felt this wording prohibited the use of antibiotic prophylaxis, regardless of the wishes of the patient or their personal risk of infective endocarditis and made it difficult for them to use their clinical judgment to deliver individualised care in the best interests of their patients. NICE have now changed this guidance to ‘Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.’ This article examines the implications of this small but important change

Quantifying the demand-side response capability of industrial plants to participate in power system frequency control schemes

© 2015 IEEE.Efficiency and sustainability considerations have propelled changes in power and process industries. These changes, which include the increased electrification of process industries, are causing concerns about the reliability of future electricity supplies, and therefore motivate the need for a Smart Grid on an industrial scale. This paper presents a method by which process automation engineers can assess the suitability of an oil and gas plant to participate in power system frequency control services. This paper discusses the necessary specifications for an automated system that enables effective variable operation by analysing the safe operating envelope of the plant. To do that, this paper proposes a methodology to characterise the appropriate actuators, variables and limits of set-point change. This methodology is applied to a case study representing an oil processing facility. The resulting analysis indicates demandside response capability that the facility can provide without jeopardising operations on-site

A change in the NICE guidelines on antibiotic prophylaxis: British Heart Valve Society update

The National Institute for Health and Care Excellence (NICE) has made an important change to Clinical Guideline 64 (CG64)1 adding the word ‘routinely’ to Recommendation 1.1.3: 'Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.' In a letter about the change to the MP Chris Philp,2 Sir Andrew Dillon, CEO of NICE, confirmed that '… in individual cases, antibiotic prophylaxis may be appropriate.

Comparison of opioid prescribing by dentists in the United States and England

Importance: The United States consumes most of the opioids worldwide despite representing a small portion of the world\u27s population. Dentists are one of the most frequent US prescribers of opioids despite data suggesting that nonopioid analgesics are similarly effective for oral pain. While oral health and dentist use are generally similar between the United States and England, it is unclear how opioid prescribing by dentists varies between the 2 countries. Objective: To compare opioid prescribing by dentists in the United States and England. Design, Setting, and Participants: Cross-sectional study of prescriptions for opioids dispensed from outpatient pharmacies and health care settings between January 1 and December 31, 2016, by dentists in the United States and England. Data were analyzed from October 2018 to January 2019. Exposures: Opioids prescribed by dentists. Main Outcomes and Measures: Proportion and prescribing rates of opioid prescriptions. Results: In 2016, the proportion of prescriptions written by US dentists that were for opioids was 37 times greater than the proportion written by English dentists. In all, 22.3% of US dental prescriptions were opioids (11.4 million prescriptions) compared with 0.6% of English dental prescriptions (28 082 prescriptions) (difference, 21.7%; 95% CI, 13.8%-32.1%; P \u3c .001). Dentists in the United States also had a higher number of opioid prescriptions per 1000 population (35.4 per 1000 US population [95% CI, 25.2-48.7 per 1000 population] vs 0.5 per 1000 England population [95% CI, 0.03-3.7 per 1000 population]) and number of opioid prescriptions per dentist (58.2 prescriptions per dentist [95% CI, 44.9-75.0 prescriptions per dentist] vs 1.2 prescriptions per dentist [95% CI, 0.2-5.6 prescriptions per dentist]). While the codeine derivative dihydrocodeine was the sole opioid prescribed by English dentists, US dentists prescribed a range of opioids containing hydrocodone (62.3%), codeine (23.2%), oxycodone (9.1%), and tramadol (4.8%). Dentists in the United States also prescribed long-acting opioids (0.06% of opioids prescribed by US dentists [6425 prescriptions]). Long-acting opioids were not prescribed by English dentists. Conclusions and Relevance: This study found that in 2016, dentists in the United States prescribed opioids with significantly greater frequency than their English counterparts. Opioids with a high potential for abuse, such as oxycodone, were frequently prescribed by US dentists but not prescribed in England. These results illustrate how 1 source of opioids differs substantially in the United States vs England. To reduce dental opioid prescribing in the United States, dentists could adopt measures similar to those used in England, including national guidelines for treating dental pain that emphasize prescribing opioids conservatively

Conceptualising and mapping coupled estuary, coast and inner shelf sediment systems

Whilst understanding and predicting the effects of coastal change are primarily modelling problems, it is essential that we have appropriate conceptual frameworks for (1) the formalisation of existing knowledge; (2) the formulation of relevant scientific questions and management issues; (3) the implementation and deployment of predictive models; and (4) meaningful engagement involvement of stakeholders. Important progress continues to be made on the modelling front, but our conceptual frameworks have not evolved at a similar pace. Accordingly, this paper presents a new approach that re-engages with formal systems analysis and provides a mesoscale geomorphological context within which the coastal management challenges of the 21st century can be more effectively addressed. Coastal and Estuarine System Mapping (CESM) is founded on an ontology of landforms and human interventions that is partly inspired by the coastal tract concept and its temporal hierarchy of sediment sharing systems, but places greater emphasis on a hierarchy of spatial scales. This extends from coastal regions, through landform complexes, to landforms, the morphological adjustment of which is constrained by diverse forms of human intervention. Crucially, CESM integrates open coastal environments with estuaries and relevant portions of the inner shelf that have previously been treated separately. In contrast to the nesting of littoral cells that has hitherto framed shoreline management planning, CESM charts a complex web of interactions, of which a sub-set of mass transfer pathways defines the sediment budget, and a multitude of human interventions constrains natural landform behaviour. Conducted within a geospatial framework, CESM constitutes a form of knowledge formalisation in which disparate sources of information (published research, imagery, mapping, raw data etc.) are generalised into usable knowledge. The resulting system maps provide a framework for the development and application of predictive models and a repository for the outputs they generate (not least, flux estimates for the major sediment system pathways). They also permit comparative analyses of the relative abundance of landforms and the multi-scale interactions between them. Finally, they articulate scientific understanding of the structure and function of complex geomorphological systems in a way that is transparent and accessible to diverse stakeholder audiences. As our models of mesoscale landform evolution increase in sophistication, CESM provides a platform for a more participatory approach to their application to coastal and estuarine management