An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions

BACKGROUND: In an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriate therapeutic uses of these drugs with the risk of developing dependence. This article discusses pros and cons of PDMP in reducing diversion of prescription opioids, without hampering access to those medications for those with genuine needs, and highlights tensions around PDMP implementation. DISCUSSION: PDMPs may help alleviate diversion, over-prescription and fraudulent prescribing/dispensing; prompt drug treatment referrals; avoid awkward drug urine test; and inform spatial changes in prescribing practices and help designing tailored interventions. Fear of legal retribution, privacy and data security, potential confusion about addiction and pseudo-addiction, and potential undue pressure of detecting misuse/diversion - are the major problems. There are tensions about unintended consequence of excessive regulatory enforcements, corresponding collateral damages particularly about inadequate prescribing for patients with genuine needs, and mandatory consultation requirements of PDMP. SUMMARY: In this era of information technology PDMP is likely to flourish and remain with us for a long time. A clear standard of practice against which physicians' care will be judged may expedite the utilisation of PDMP. In addition, adequate training on addiction and pain management along with public awareness, point-of-supply data entry from pharmacy, point-of-care real-time access to data, increasing access to addiction treatment and appropriate regulatory enforcement preferably through healthcare administration, together, may help remove barriers to PDMP use

Process Evaluation Insights on Program Implementation

This white paper has the explicit intention to draw lessons learned from the past 30 years of energy efficiency program evaluation in order to facilitate improved program design and implementation going forward. The discussion in this white paper is developed based on interviews with 43 individuals who are either practitioners or users of process and market evaluation. In addition, we obtained references to published materials from our contacts and reviewed conference proceedings dating from 1992 to 2008, which resulted in a review of nearly 100 articles or reports documenting the results of, or commenting on, process and market evaluations

Consultations with complementary and alternative medicine practitioners by older Australians: results from a national survey

BACKGROUND The use of complementary and alternative medicines (CAM) and CAM practitioners is common, most frequently for the management of musculoskeletal conditions. Knowledge is limited about the use of CAM practitioners by older people, and specifically those with other long term or chronic conditions. METHODS In 2011 we conducted an Australia wide survey targeting older adults aged over 50 years (n = 2540). Participants were asked to identify their chronic conditions, and from which health professionals they had 'received advice or treatment from in the last 3 months', including 'complementary health practitioners, e.g. naturopath'. Descriptive analyses were undertaken using SPSS and STATA software. RESULTS Overall, 8.8% of respondents reported seeing a CAM practitioner in the past three months, 12.1% of women and 3.9% of men; the vast majority also consulting medical practitioners in the same period. Respondents were more likely to report consulting a CAM practitioner if they had musculoskeletal conditions (osteoporosis, arthritis), pain, or depression/anxiety. Respondents with diabetes, hypertension and asthma were least likely to report consulting a CAM practitioner. Those over 80 reported lower use of CAM practitioners than younger respondents. CAM practitioner use in a general older population was not associated with the number of chronic conditions reported, or with the socio-economic level of residence of the respondent. CONCLUSION Substantial numbers of older Australians with chronic conditions seek advice from CAM practitioners, particularly those with pain related conditions, but less often with conditions where there are clear treatment guidelines using conventional medicine, such as with diabetes, hypertension and asthma. Given the policy emphasis on better coordination of care for people with chronic conditions, these findings point to the importance of communication and integration of health services and suggest that the concept of the 'treating team' needs a broad interpretation

Fossil vertebrate tracks near Murraysburg, Cape Province

The presence of a palaeosurface with a set of relatively large concave epirelief tracks that extend for some 60 m is documented and described. The trackmaker is believed to be a member of the genus Aulacephalodon Seeley 1898 or Rhachiocephalus Seeley 1898 and to have walked across a submerged silty surface on a floodplain. A mud veneer deposited under relatively low energy conditions soon after the tracks were made, and the thermal alteration of the sediment by nearby diabase intrusives, contributed to the preservation of this set of fossil tracks

New Anticoagulants for the Prevention and Treatment of Venous Thromboembolism

Anticoagulant therapy is effective at preventing the development of venous thromboembolism in high-risk patients, and reduces morbidity and mortality in individuals with established thromboembolic disease. Vitamin K antagonists and heparins are currently the most commonly used anticoagulant drugs, but they have practical limitations. Therefore, new antithrombotic agents with predictable dose-responses (thereby decreasing the need for monitoring without compromising efficacy or safety), ideally available in an oral formulation and with a rapidly reversible anticoagulant effect, are needed. New drugs fulfilling some of the above criteria have been developed and have proven to be effective agents for the treatment and prevention of venous thromboembolism

Carbohydrate-electrolyte drink ingestion and skill performance during and after 2 hr of indoor tennis match play

Twenty-two tennis players were individually studied on 2 occasions. They performed a prematch skill test, a 2-hr tennis match against an equally ranked opponent, and a postmatch skill test. A carbohydrate-electrolyte (CHO-E; Lucozade Sport) or flavor-matched placebo-electrolyte (PL) beverage was administered in a double-blind fashion. During the trials, heart-rate and movement intensity were monitored, and the match was recorded for performance analysis. There were no differences in skill-test scores pre- to postmatch or between trials (154 ± 38 pre- and 160 ± 35 postmatch on PL, 155 ± 36 pre- and 165 ± 33 postmatch on CHO-E). CHO-E ingestion elevated blood glucose concentration throughout the match, and participants reported feeling more energetic (general activation) and more tense (high activation) 1 hr into the match than at baseline (p less than .05). Participants in the CHO-E trial spent more time in moderate-intensity activity and less time in low-intensity activity than on PL. Performance analysis revealed that CHO-E ingestion increased overall serve success (M ± SD, 68% ± 7% for CHO-E vs. 66% ± 7% for PL; p less than .05) and success of first serves (65% ± 9% for CHO-E, 61% ± 7% for PL; p less than .01) and serves to the advantage side (70% ± 9% for CHO-E, 66% ± 7% for PL; p less than .05). Return success was greater during the second set of the match (p less than .05) in the CHO-E trial. Differences in serve and return success were not associated with blood glucose response to CHO or player abilit

People with multiple unhealthy lifestyles are less likely to consult primary healthcare

BACKGROUND Behavioural interventions are often implemented within primary healthcare settings to prevent type 2 diabetes and other lifestyle-related diseases. Although smoking, alcohol consumption, physical inactivity and poor diet are associated with poorer health that may lead a person to consult a general practitioner (GP), previous work has shown that unhealthy lifestyles cluster among low socioeconomic groups who are less likely to seek primary healthcare. Therefore, it is uncertain whether behavioural interventions in primary healthcare are reaching those in most need. This study investigated patterns of GP consultations in relation to the clustering of unhealthy lifestyles among a large sample of adults aged 45 years and older in New South Wales, Australia. METHODS A total of 267,153 adults participated in the 45 and Up Study between 2006 and 2009, comprising 10% of the equivalent demographic in the state of New South Wales, Australia (response rate: 18%). All consultations with GPs within 6 months prior and post survey completion were identified (with many respondents attending multiple GPs) via linkage to Medicare Australia data. An index of unhealthy lifestyles was constructed from self-report data on adherence to published guidelines on smoking, alcohol consumption, diet and physical activity. Logistic and zero-truncated negative binomial regression models were used to analyse: (i) whether or not a person had at least one GP consultation within the study period; (ii) the count of GP consultations attended by each participant who visited a GP at least once. Analyses were adjusted for measures of health status, socioeconomic circumstances and other confounders. RESULTS After adjustment, participants scoring 7 unhealthy lifestyles were 24% more likely than persons scoring 0 unhealthy lifestyles not to have attended any GP consultation in the 12-month time period. Among those who attended at least one consultation, those with 7 unhealthy lifestyles reported 7% fewer consultations than persons with 0 unhealthy lifestyles. No effect modification was observed. CONCLUSION To optimise the prevention of lifestyle-related diseases, interventions for positive behavioural change need to incorporate non-primary healthcare settings in order to reach people with multiple unhealthy lifestyles.The research reported in this paper is a project of the Australian Primary Health Care Research Institute at the Australian National University, which is supported by a grant from the Australian Government Department of Health

Consultations with complementary and alternative medicine practitioners by older Australians: results from a national survey

BACKGROUND: The use of complementary and alternative medicines (CAM) and CAM practitioners is common, most frequently for the management of musculoskeletal conditions. Knowledge is limited about the use of CAM practitioners by older people, and specifically those with other long term or chronic conditions. METHODS: In 2011 we conducted an Australia wide survey targeting older adults aged over 50 years (n = 2540). Participants were asked to identify their chronic conditions, and from which health professionals they had ‘received advice or treatment from in the last 3 months’, including ‘complementary health practitioners, e.g. naturopath’. Descriptive analyses were undertaken using SPSS and STATA software. RESULTS: Overall, 8.8% of respondents reported seeing a CAM practitioner in the past three months, 12.1% of women and 3.9% of men; the vast majority also consulting medical practitioners in the same period. Respondents were more likely to report consulting a CAM practitioner if they had musculoskeletal conditions (osteoporosis, arthritis), pain, or depression/anxiety. Respondents with diabetes, hypertension and asthma were least likely to report consulting a CAM practitioner. Those over 80 reported lower use of CAM practitioners than younger respondents. CAM practitioner use in a general older population was not associated with the number of chronic conditions reported, or with the socio-economic level of residence of the respondent. CONCLUSION: Substantial numbers of older Australians with chronic conditions seek advice from CAM practitioners, particularly those with pain related conditions, but less often with conditions where there are clear treatment guidelines using conventional medicine, such as with diabetes, hypertension and asthma. Given the policy emphasis on better coordination of care for people with chronic conditions, these findings point to the importance of communication and integration of health services and suggest that the concept of the ‘treating team’ needs a broad interpretation

Measured Behavior of a Deep Excavation in Weathered Rock

An instrumented deep excavation in weathered rock adjacent to a deflection-sensitive historical building is described. Two permanent shoring systems were used, presenting an opportunity to measure and compare their behaviors. Adjacent to the historic structure, a tied-back drilled pier wall was used, while the remainder of the excavation was supported by a tied-back shotcrete wall constructed in top-down fashion. Instrumentation included inclinometers, tiltmeters, and tieback load cells, supplemented by optical surveys. Both support systems performed well, with movements within acceptable ranges. The maximum horizontal deflection of the drilled piers was 0.33 inch (8 mm), one-third to one-fifth that of the shotcrete. Settlements behind the drilled piers were significantly less than behind the shotcrete. Isolated minor cracking and widening of existing cracks occurred in the existing building. Tieback load cell data indicate that the source of movements can extend beyond the theoretical failure wedge