What GPs need to know about palliative-care drugs : methadone

This is the second in a short series of articles that focus on what GPs should consider when monitoring and prescribing specialist‐initiated palliative‐care drugs. Here, the authors summarise the key issues around the use of methadone for pain management.

Designing a questionnaire to gather carer input to pain assessment for hospitalized people with dementia

We describe development of a questionnaire to elicit pain symptoms and experience, for use by people with dementia or their carers, at hospital admission. The questionnaire provided contextual information to support professionals’ use of the Abbey Pain Scale, a validated tool used by nursing staff internationally. Appropriate information and physical design were required in order, not only to create an approachable questionnaire for patients and carers, but also to ensure fit with hospital processes. Fit with hospital process had significant influence on the final form of the questionnaire, compromising some aspects of design for patients and carers, but this compromise was considered essential to ensure pain management procedures were supplemented by wider, contextual information.

Rapid-onset opioids and the management of episodic pain

This is the fourth in a short series of articles that focus on what GPs should consider when monitoring and prescribing specialist-initiated palliative-care medicines. Here, the authors summarise the key issues around the use of apid onset opioids in palliative care.

Mapping Educational Specialist knowHow (MESH): the building of a knowledge management system for research informed practice

In this invited article the authors present an evaluative report on the development of the MESHGuides project (http://www.meshguides.org/). MESHGuides’ objective is to provide education with an international knowledge management system. MESHGuides were conceived as research summaries for supporting teachers’ in developing evidence-based practice. Their aim is to enhance teachers’ capacity to engage actively with research in their own classrooms. The original thinking for MESH arose from the work of UK-based academics Professor Marilyn Leask and Dr Sarah Younie in response to a desire, which has recently gathered momentum in the UK, for the development of a more research-informed teaching profession and for the establishment of an on-line platform to support evidence-based practice (DfE, 2015; Leask and Younie 2001; OECD 2009). The focus of this article is on how the MESHGuides project was conceived and structured, the technical systems supporting it and the practical reality for academics and teachers of composing and using MESHGuides. The project and the guides are in the early stages of development, and discussion indicates future possibilities for more global engagement with this knowledge management system.

Specialist trade contracting: a review

This book is designed to promote a positive approach to the good management of the relationships between clients, designers, contractors and specialist trade contractors. It covers the integration of specialist contractor design into the overall design; the influences of production processes on design; and management.

Construction contracts: law and management (3rd edition)

This book is aimed primarily at students for whom the study of building or civil engineering contracts forms part of a construction-based course. We have had in mind the syllabus requirements for first degrees in Building, Civil Engineering, Architecture, Quantity Surveying and Building Surveying, as well as those of postgraduate courses in Construction Management and Project Management. We have also assumed that such students will already have been introduced to the general principles of English law, especially those relating to contract and tort. As a result, while aspects of those subjects that are of particular relevance to construction are dealt with here, the reader must look elsewhere for the general legal background. In producing this third edition, we have again been greatly assisted by the many helpful comments made by reviewers and users of its predecessor. Nonetheless, our basic aim is identical to that which underpinned the first edition: to provide an explanation of the fundamental principles of construction contract law, rather than a clause-by-clause analysis of any particular standard-form contract. As a result, while we draw most frequently upon JCT 98 for our illustrations of particular points, this merely reflects the pre-eminent position occupied by that particular form of contract in the UK construction industry. We conclude by repeating our previous warning as to the dangers inherent in a little learning. Neither this book, nor the courses for which it is intended, seek to produce construction lawyers. The objective is rather to enable those who are not lawyers to resolve simple construction disputes before they become litigious, and to recognize when matters require professional legal advice. It should be the aim of every construction student to understand the legal framework sufficiently that they can instruct and brief specialist lawyers, and this book is designed to help them towards that understanding.

A survey of dairy effluent management in the south of Chile

A survey was carried out on 55 commercial dairy farms located in the South of Chile during 1995-97. A questionnaire was developed to obtain informed estimates of dairy effluent management on those farms. Information was analysed on an annual basis using a computer spreadsheet linking all the parameters surveyed. In addition, slurry samples were taken for analysis of dry matter content (DM). Herd size varied between 50 and 800 cows per farm. A large proportion of the total volume of effluents produced came from rainfall (46%), dirty water accounted for 29% with only 25% from cow's faeces and urine. The large volume of effluents produced resulted in a reduced storage capacity (on average of 2 months) or more frequent and higher application rates to the field. Only 37% of the farmers knew the application rates of manure and there was a wide range in the quantity used per year (12 m(3)/ha to 300 m(3)/ha). Dairy effluents were applied mainly on grass (71%) throughout the year but, mostly concentrated during the winter and spring time using only surface irrigation system. The total solids contents of effluents was very low, with 62% of the samples being <4% DM. This reflected the large volumes of clean water that the storage tanks received. The information collected has identified problems in effluent management in Chilean dairy farms where research and technology transfer will be necessary to avoid pollution problems.

Patients' attitudes towards, and information needs in relation to, nurse prescribing in rheumatology

Aims and objectives: To assess the level of confidence that rheumatology patients would have in nurse prescribing, the effects on likely adherence and particular concerns that these patients have. In addition, given that information provision has been cited as a potential benefit of nurse prescribing, the present study assessed the extent to which these patients would want an explanation for the selected medicine, as well as which types of information should be included in such an explanation. Background: Nurse prescribing has been successfully implemented in the UK in several healthcare settings. Existing research has not addressed the effects on patients' confidence and likely adherence, nor have patients' information needs been established. However, we know that inadequate medicines information provision by health professionals is one of the largest causes of patient dissatisfaction. Methods: Fifty-four patients taking disease-modifying drugs for inflammatory joint disease attending a specialist rheumatology clinic self-completed a written questionnaire. Results: Patients indicated a relatively high level of confidence in nurse prescribing and stated that they would be very likely to take the selected medication. The level of concern was relatively low and the majority of concerns raised did not relate to the nurse's status. Strong support was expressed for the nurse providing an explanation for medicine choice. Conclusion: This research provides support for the prescription of medicines by nurses working in the area of rheumatology, the importance of nurses providing a full explanation about the selected medicines they prescribe for these patients and some indication as to which categories of information should be included. Relevance to clinical practice: Rheumatology patients who have not yet experienced nurse prescribing are, in general, positive about nurses adopting this role. It is important that nurses provide appropriate information about the prescribed medicines, in a form that can be understood.

Effect of patient age on management decisions in breast cancer: consensus from a national consultation

This qualitative study investigated the attitudes, perceptions, and practices of breast cancer specialists with reference to the effect of patient age on management decisions in breast cancer, and attempted to identify national consensus on this issue. One hundred thirty-three relevant specialists, including 75 surgeons and 43 oncologists, participated in a virtual consultation using e-mailed questionnaires and open-ended discussion documents, culminating in the development of proposed consensus statements sent to participants for validation. A strong consensus was seen in favor of incorporating minimum standards of diagnostic services, treatment, and care for older patients with breast cancer into relevant national guidance, endorsed by professional bodies. Similarly, an overwhelming majority of participants agreed that simple, evidence-based protocols or guidelines on standardizing assessment of biological and chronological age should be produced by the National Institute for Health and Clinical Excellence and the Scottish Medicines Consortium, developed in collaboration with specialist oncogeriatricians, and endorsed by professional bodies. A further recommendation that all breast cancer patient treatment and diagnostic procedures be undertaken in light of up-to-date, relevant scientific data met with majority support. This study was successful in gauging national specialist opinion regarding the effect of patient age on management decisions in breast cancer in the U.K.