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With over 20 years of the opioid crisis, our collective response has evolved to address the ongoing needs related to the management of opioid use and opioid use disorder. There has been an increasing recognition of the need for standardized metrics to evaluate organizational management and stewardship. The clinical laboratory, with a wealth of objective and quantitative health information, is uniquely poised to support opioid stewardship and drive valuable metrics for opioid prescribing practices and opioid use disorder (OUD) management. To identify laboratory-related insights that support these patient populations, a collection of 5 independent institutions, under the umbrella of the Clinical Laboratory 2.0 movement, developed and prioritized metrics. Using a structured expert panel review, laboratory experts from 5 institutions assessed possible metrics as to their relative importance, usability, feasibility, and scientific acceptability based on the National Quality Forum criteria. A total of 37 metrics spanning the topics of pain and substance use disorder (SUD) management were developed with consideration of how laboratory insights can impact clinical care. Monitoring these metrics, in the form of summative reports, dashboards, or embedded in laboratory reports themselves may support the clinical care teams and health systems in addressing the opioid crisis. The clinical insights and standardized metrics derived from the clinical laboratory during the opioid crisis exemplifies the value proposition of clinical laboratories shifting into a more active role in the healthcare system. This increased participation by the clinical laboratories may improve patient safety and reduce healthcare costs related to OUD and pain management. [ABSTRACT FROM AUTHOR]

Background: elder maltreatment is a major risk for older adults' mental health, quality of life, health, institutionalisation and even mortality. Objectives: to perform a systematic review and meta-analysis of interventions designed to prevent or stop elder abuse. Methods: Studies that were posted between January 2000 and December 2014, written in English, specifically designed to prevent or stop elder maltreatment were included. Results: overall, 24 studies (and four records reporting on the same participants) were kept for the systematic review and the meta-analysis. Studies were broadly grouped into three main categories: (i) interventions designed to improve the ability of professionals to detect or stop elder maltreatment (n = 2), (ii) interventions that target older adults who experience elder maltreatment (n = 3) and (iii) interventions that target caregivers who maltreat older adults (n = 19). Of the latter category, one study targeted family caregivers, five targeted psychological abuse among paid carers and the remaining studies targeted restraint use. The pooled effect of randomised controlled trials (RCTs)/cluster-RCTs that targeted restraint use was significant, supporting the effectiveness of these interventions in reducing restraint use: standardised mean difference: -0.24, 95% confidence interval = -0.38 to -0.09. Interpretation: the most effective place to intervene at the present time is by directly targeting physical restraint by long-term care paid carers. Specific areas that are still lacking evidence at the present time are interventions that target (i) elder neglect, (ii) public awareness, (iii) older adults who experience maltreatment, (iv) professionals responsible for preventing maltreatment, (v) family caregivers who abuse and (vi) carers who abuse. [ABSTRACT FROM AUTHOR]

Purpose Patient and public involvement (PPI) has become an integral part of health care with its emphasis on including and empowering individuals and communities in the shaping of health and social care services. The aims of this study were to identify the impact of PPI on UK National Health Service (NHS) healthcare services and to identify the economic cost. It also examined how PPI is being defined, theorized and conceptualized, and how the impact of PPI is captured or measured. Data sources Seventeen key online databases and websites were searched, e.g. Medline and the King's Fund. Study selection UK studies from 1997 to 2009 which included service user involvement in NHS healthcare services. Date extraction Key themes were identified and a narrative analysis was undertaken. Results of data synthesis The review indicates that PPI has a range of impacts on healthcare services. There is little evidence of any economic analysis of the costs involved. A key limitation of the PPI evidence base is the poor quality of reporting impact. Few studies define PPI, there is little theoretical underpinning or conceptualization reported, there is an absence of robust measurement of impact and descriptive evidence lacked detail. Conclusion There is a need for significant development of the PPI evidence base particularly around guidance for the reporting of user activity and impact. The evidence base needs to be significantly strengthened to ensure the full impact of involving service users in NHS healthcare services is fully understood. [ABSTRACT FROM PUBLISHER]

Georgina Downs, a pesticide campaigner with personal experience of exposure to pesticides in crop sprays, sought review of the Government’s approach to the assessment of harm to residents and bystanders in its process of authorisation of pesticides. Collins J allowed the application and ordered the Secretary of State to reconsider and amend his policy as necessary. He found that she had justified her allegation that the risk model was inadequate and was supported in this respect by the report of Royal Commission on Environmental Pollution. Furthermore, the Secretary of State’s policy was in breach of the Plant Protection Products (Pesticides) Directive because compliance with Annex VI, which sets out uniform principles for evaluation, could only be achieved if the policy adequately protected residents, which it did not. On appeal, the Secretary of State contended that the judge had erred in (i) rejecting Defra’s submission that compliance with the uniform principles set out in Annex VI of the Directive was sufficient to ensure compliance with the requirements of Article 4.1(b); and (ii) substituting his own evaluation of the scientific evidence for that of the Secretary of State. The appeal was allowed. As to the first claim, compliance with the uniform principles in Annex VI was a sufficient test of the harmful effects of a pesticide on human health. If no harmful effects were found by applying these principles, authorisation would be in compliance with Article 4.1. The uniform principles were designed to provide a comprehensive code for all Member States to apply. The purpose of the Directive was to harmonise authorisation procedures and it would frustrate this purpose if Member States were able to introduce their own principles or policies for the purpose of establishing whether a pesticide had harmful effects on health. The Secretary of State had applied the uniform principles and Defra’s crop spraying authorisation policy was therefore compliant with the Directive. As to the second claim, the Court found that Collins J had substituted his own evaluation for that of the Secretary of State. It was for the Secretary of State, having considered the Report of the RCEP and the advice of the ACP, to decide whether the evidence raised real doubts as to the safety of the pesticides or whether it amounted only to a possible link that had not been scientifically confirmed. While the Secretary of State’s decision was not immune from review, the hurdle for establishing review was high and required a demonstration of ‘manifest error’. The disagreement between the RCEP and the ACP was evidence to there not being such a manifest error. The Secretary of State’s decision was not therefore erroneous in law. [ABSTRACT FROM PUBLISHER]

Background Despite current guidelines, there is uncertainty about the required duration and frequency of follow-up visits for patients with invasive primary cutaneous melanoma < 0·5 mm thick. Objectives To review patients with invasive melanoma thinner than 0·5 mm followed for at least 5 years to provide an evidence base for considering modification of guidelines. Methods A retrospective review of 430 patients diagnosed in the west of Scotland during 1992–2001 with melanoma < 0·5 mm was carried out. Recurrence, deaths from melanoma and second primary melanomas were all identified. Results From 1992 to 2001, 430 melanomas < 0·5 mm thick at diagnosis were diagnosed out of a total of 3036 primary cutaneous melanomas. To date there have been 593 deaths from melanoma (19%) in the whole group. Five of these deaths were reported in patients with melanomas < 0·5 mm, but on pathological review two were thicker than 0·5 mm at diagnosis (1·5 and > 3 mm), and the remaining three patients all developed thicker second primary melanomas (2·7, 12·0 and 19·0 mm) with a recurrence pattern and timing indicating that these thicker primaries were the cause of death. Fourteen further patients developed a second primary melanoma, and 13 are currently alive and disease free, one dying of other causes. Conclusions Our data indicate that recurrence and subsequent death from melanomas < 0·5 mm is a very rare event, and that quarterly follow-up for 3 years will yield very few events. Modification of current guideline recommendations are suggested to include a period of patient education concentrating on recognition of second primary tumours followed by rapid access to an expert opinion if required. [ABSTRACT FROM AUTHOR]

Stroke is the third leading cause of death of people in the world today and the highest cause of disability and handicap, producing a huge burden on individuals and society more broadly. Yet unlike its counterpart acute myocardial infarction (AMI), little has been done to promote early intervention in evolving strokes. Recommendations from the American Heart Association and more recently the European Stroke Initiative are available; however, in Australia (as with many other countries) practice guidelines are scarce and clinicians largely operate in an ad hoc manner with little awareness of ‘best practice’. The controversial role of thrombolysis with limitations in respect to selecting appropriate patients, in addition to a small window of opportunity for therapeutic beneficial effects and a high risk for haemorrhage, has inhibited its widespread application. As such, emergent stroke management clearly lags behind that of AMI—both with respect to the range of treatment options and the application of best practice. This paper reviews the literature regarding best practice management of evolving stroke and the crucial role of nurses in triaging and managing patients to deliver optimal outcomes within the Australian context. [Copyright &y& Elsevier]

The Green Paper Working together for a healthier Scotland is a landmark in the drive to improve health, with a vital emphasis on reducing inequalities. It paves the way for a considered approach to building a health promoting society, with a critical reappraisal of the traditional pre-eminence of disease and behavioural topics. Its three action levels - life circumstances, lifestyle topics and health topics - provide a framework for putting an end to unhelpful quarrels over approaches to health promotion and for doing what is best done at each of the three levels. Against the background of the Green Paper, this paper seeks to facilitate a common understanding among all concerned as a basis for the necessary united effort to promote health, calls for a wider recognition of the full scope of health - including well-being, and identifies implications and opportunities in the areas of research and evidence-based action [ABSTRACT FROM PUBLISHER]