'He was like a zombie':off-label prescription of antipsychotic drugs in dementia

This paper explores the legal position of the off-label prescription of antipsychotic medications to people with dementia who experience behavioural and psychological symptoms of dementia (BPSD). Dementia is a challenging illness, and BPSD can be very difficult for carers to manage, with evidence that this contributes to carer strain and can result in the early institutionalisation of people with dementia. As a result, the prescription of antipsychotic and other neuroleptic medications to treat BPSD has become commonplace, in spite of these drugs being untested and unlicensed for use to treat older people with dementia. In recent years, it has become apparent through clinical trials that antipsychotic drugs increase the risk of cerebrovascular accident (stroke) and death in people with dementia. In addition, these types of medication also have other risk factors for people with dementia, including over-sedation and worsening of cognitive function. Drawing on recent questionnaire (n = 185), focus group (n = 15), and interview (n = 11) data with carers of people with dementia, this paper explores the law relating to off-label prescription, and the applicability of medical negligence law to cases where adverse events follow the use of antipsychotic medication. It is argued that the practice of off-label prescribing requires regulatory intervention in order to protect vulnerable patients. © The Author [2012]. Published by Oxford University Press; all rights reserved.

A redesign of a road traffic accident reporting system using business process simulation

Business process simulation (BPS) is used to evaluate the effect of the redesign of a police road traffic accident (RTA) reporting system. The new system aims to provide timely statistical analysis of traffic behaviour to government bodies and to enable more effective utilisation of traffic police personnel. The simulation method is demonstrated in the context of assisting process change enabled by the use of information systems in an organisation in which there had been a historically mixed pattern of success in this activity.

Safety and health in mines: the rise of bureaucracy in the coal mining industry and its results as evidenced by the public enquiry into an accident at Houghton Main Colliery

This thesis is concerned with certain aspects of the Public Inquiry into the accident at Houghton Main Colliery in June 1975. It examines whether prior to the accident there existed at the Colliery a situation in which too much reliance was being placed upon state regulation and too Iittle upon personal responsibility. I study the phenomenon of state regulation. This is done (a) by analysis of selected writings on state regulation/intervention/interference/bureaucracy (the words are used synonymously) over the last two hundred years, specifically those of Marx on the 1866 Committee on Mines, and (b) by studying Chadwick and Tremenheere, leading and contrasting "bureaucrats" of the mid-nineteenth century. The bureaucratisation of the mining industry over the period 1835-1954 is described, and it is demonstrated that the industry obtained and now possesses those characteristics outlined by Max Weber in his model of bureaucracy. I analyse criticisms of the model and find them to be relevant, in that they facilitate understanding both of the circumstances of the accident and of the Inquiry . Further understanding of the circumstances and causes of the accident was gained by attendance at the lnquiry and by interviewing many of those involved in the Inquiry. I analyse many aspects of the Inquiry - its objectives. structure, procedure and conflicting interests - and find that, although the Inquiry had many of the symbols of bureaucracy, it suffered not from " too much" outside interference. but rather from the coal mining industry's shared belief in its ability to solve its own problems. I found nothing to suggest that, prior to the accident, colliery personnel relied. or were encouraged to rely, "too much" upon state regulation.

Rural road accident investigation and prevention in Iran

The objectives are to examine rural road accident data in order to develop a method by which high accident rate locations and accident causes can be identified, and also to develop proposals for improvements at such locations and to identify measures which will improve road safety throughout the country. The problem of road safety in Iran is an important issue, because of the tragic and unnecessary loss of life, and the enormous cost of accidents in the country. The resources available to deal with the problems are limited and must be allocated on priority basis. This study represents an initial effort to identify the extent of the problem in order to take remedial measures. A study was made of all the available road accident data collected by agencies related to road safety in Iran, and the major organisations responsible for road safety development were visited. The Vice Minister of Roads and Transportation selected for this study a 280 Km rural road in South West Iran. Mainly because of the lack of suitable maps and plans of the roads, it was not possible to accurately identify the location of accidents. Accident scene data was subsequently collected by the highway police and personally by the author. The data for the study road was then analysed to identify 'high accident rate' locations, and also to determine, as far as was possible, the reasons for the accidents. The study suggests specific improvements for each of the high accident rate locations examined (eg. the building of dual carriageways with central guard rails to reduce the risk of collision with oncoming vehicles, pedestrian facilities to allow pedestrians to cross dangerous roadsl]. In addition recommendations are made to guide and assist the major organisations responsible for road safety in Iran. These recommendations are: (al for improving accident data collection and storage (bl for subsequent analysis for taking remedial measures with a view to accident prevention

A critical evaluation of contrast susceptibility as a predictor of driving accident involvement

Contrast susceptibility is defined as the difference in visual acuity recorded for high and low contrast optotypes. Other researchers refer to this parameter as "normalised low contrast acuity". Pilot surveys have revealed that contrast susceptibility deficits are more strongly related to driving accident involvement than are deficits in high contrast visual acuity. It has been hypothesised that driving situation avoidance is purely based upon high contrast visual acuity. Hence, the relationship between high contrast visual acuity and accidents is masked by situation avoidance whilst drivers with contrast susceptibility deficits remain prone to accidents in poor visibility conditions. A national survey carried out to test this hypothesis provided no support for either the link between contrast susceptibility deficits and accidents involvement or the proposed hypothesis. Further, systematically worse contrast susceptibility scores emerged from vision screeners compared to wall mounted test charts. This discrepancy was not due to variations in test luminance or instrument myopia. Instead, optical imperfections inherent in vision screeners were considered to be responsible. Although contrast susceptibility is unlikely to provide a useful means of screening drivers' vision, previous research does provide support for its ability to detect visual deficits that may influence everyday tasks. In this respect, individual contrast susceptibility variations were found to reflect variations in the contrast sensitivity function - a parameter that provides a global estimate of human contrast sensitivity.

The collection and use of road and traffic information for road accident investigation and prevention

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT