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

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

Conceptual Hierarchies in a Flat Attractor Network: Dynamics of Learning and Computations

The structure of people’s conceptual knowledge of concrete nouns has traditionally been viewed as hierarchical (Collins & Quillian, 1969). For example, superordinate concepts (vegetable) are assumed to reside at a higher level than basic-level concepts (carrot). A feature-based attractor network with a single layer of semantic features developed representations of both basic-level and superordinate concepts. No hierarchical structure was built into the network. In Experiment and Simulation 1, the graded structure of categories (typicality ratings) is accounted for by the flat attractor network. Experiment and Simulation 2 show that, as with basic-level concepts, such a network predicts feature verification latencies for superordinate concepts (vegetable ). In Experiment and Simulation 3, counterintuitive results regarding the temporal dynamics of similarity in semantic priming are explained by the model. By treating both types of concepts the same in terms of representation, learning, and computations, the model provides new insights into semantic memory

Impact of CONSORT extension for cluster randomised trials on quality of reporting and study methodology : review of random sample of 300 trials, 2000-8

Peer reviewedPublisher PD

Time's up. Descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey

Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5-16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.This work was funded by the National Health and Medical Research Council ID (402793, 2006)

Multimorbidity and comorbidity of chronic diseases among the senior Australians: prevalence and patterns

Understanding patterns and identifying common clusters of chronic diseases may help policymakers, researchers, and clinicians to understand the needs of the care process better and potentially save both provider and patient time and cost. However, only limited research has been conducted in this area, and ambiguity remains as those limited previous studies used different approaches to identify common clusters and findings may vary with approaches. This study estimates the prevalence of common chronic diseases and examines co-occurrence of diseases using four approaches: (i) identification of the most occurring pairs and triplets of comorbid diseases; performing (ii) cluster analysis of diseases, (iii) principal component analysis, and (iv) latent class analysis. Data were collected using a questionnaire mailed to a cross-sectional sample of senior Australians, with 4574 responses. Eighty-two percent of respondents reported having at least one chronic disease and over 52% reported having at least two chronic diseases. Respondents suffering from any chronic diseases had an average of 2.4 comorbid diseases. Three defined groups of chronic diseases were identified: (i) asthma, bronchitis, arthritis, osteoporosis and depression; (ii) high blood pressure and diabetes; and (iii) cancer, with heart disease and stroke either making a separate group or "attaching" themselves to different groups in different analyses. The groups were largely consistent across the approaches. Stability and sensitivity analyses also supported the consistency of the groups. The consistency of the findings suggests there is co-occurrence of diseases beyond chance, and patterns of co-occurrence are important for clinicians, patients, policymakers and researchers. Further studies are needed to provide a strong evidence base to identify comorbid groups which would benefit from appropriate guidelines for the care and management of patients with particular disease clusters.This work was funded by the National Health and Medical Research Council ID (402793, 2006). The Australian Primary Health Care Research Institute is funded by the Australian Government Department of Health and Ageing as part of its Primary Health Care Research Evaluation and Development (PHCRED) Strategy

A counterfactual approach to measure the impact of wet grassland conservation on UK breeding bird populations

Wet grassland wader populations in the United Kingdom have experienced severe declines over the last three decades. To help mitigate these declines, the Royal Society for the Protection of Birds (RSPB) has restored and managed lowland wet grassland nature reserves to benefit these and other species. However, the impact that these reserves have on bird population trends has not been experimentally evaluated, as appropriate control populations do not readily exist. In this study, we compare population trends from 1994 ‐ 2018 for five bird species of conservation concern that breed on these nature reserves with counterfactual trends using matched breeding bird survey observations. Our results showed positive effects of conservation interventions for all four wader species that these reserves aim to benefit: Lapwing (Vanellus vanellus), Redshank (Tringa totanus), Curlew (Numenius arquata) and Snipe (Gallinago gallinago). There was no positive effect of conservation interventions on reserves for the passerine, Yellow Wagtail (Motacilla flava). We compared reserve trends with three different counterfactuals, based on different scenarios of how reserve populations could have developed in the absence of conservation, and found that reserve trends performed better regardless of the counterfactual used. Our approach using monitoring data to produce valid counterfactual controls is a broadly applicable method allowing large‐scale evaluation of conservation impact

The Quantum Socket: Three-Dimensional Wiring for Extensible Quantum Computing

Quantum computing architectures are on the verge of scalability, a key requirement for the implementation of a universal quantum computer. The next stage in this quest is the realization of quantum error correction codes, which will mitigate the impact of faulty quantum information on a quantum computer. Architectures with ten or more quantum bits (qubits) have been realized using trapped ions and superconducting circuits. While these implementations are potentially scalable, true scalability will require systems engineering to combine quantum and classical hardware. One technology demanding imminent efforts is the realization of a suitable wiring method for the control and measurement of a large number of qubits. In this work, we introduce an interconnect solution for solid-state qubits: The quantum socket. The quantum socket fully exploits the third dimension to connect classical electronics to qubits with higher density and better performance than two-dimensional methods based on wire bonding. The quantum socket is based on spring-mounted micro wires the three-dimensional wires that push directly on a micro-fabricated chip, making electrical contact. A small wire cross section (~1 mmm), nearly non-magnetic components, and functionality at low temperatures make the quantum socket ideal to operate solid-state qubits. The wires have a coaxial geometry and operate over a frequency range from DC to 8 GHz, with a contact resistance of ~150 mohm, an impedance mismatch of ~10 ohm, and minimal crosstalk. As a proof of principle, we fabricated and used a quantum socket to measure superconducting resonators at a temperature of ~10 mK.Comment: Main: 31 pages, 19 figs., 8 tables, 8 apps.; suppl.: 4 pages, 5 figs. (HiRes figs. and movies on request). Submitte

Did a physician-targeted intervention that reduced potentially inappropriate prescribing to elderly patients also reduce related hospitalizations?

Objectives: To determine whether a general practitioner focused intervention aimed at decreasing PIM prescribing in the elderly can decrease the risk of PIM-related hospitalizations. Poster presented at 2016 ISPOR conference in Washington DC.https://jdc.jefferson.edu/jcphposters/1005/thumbnail.jp