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Last Build Date: Wed, 22 Mar 2017 16:06:46 GMT

 



Information about GP practices

Wed, 22 Mar 2017 14:09:56 GMT

Policies that might be covered in a practice leaflet and web site: ← Older revision Revision as of 14:09, 22 March 2017 (2 intermediate revisions not shown)Line 30: Line 30: :*The use of [[Mobile phone|mobile phones]] during consultations (if your phone goes off, you may be asked to leave and book another appointment) :*The use of [[Mobile phone|mobile phones]] during consultations (if your phone goes off, you may be asked to leave and book another appointment) *Self-care and when antibiotics are (and are not) appropriate - with links to e.g. the [http://www.whenshouldiworry.com "When should I worry"] leaflet. *Self-care and when antibiotics are (and are not) appropriate - with links to e.g. the [http://www.whenshouldiworry.com "When should I worry"] leaflet.  +*Services [[Private practice|not included in the NHS contract, and for which a fee may be charged]] (a good example is the [https://www.carltonhousesurgery.co.uk/about-us/fees-and-charges/ Carlton House Surgery web page][https://www.carltonhousesurgery.co.uk/about-us/fees-and-charges/ Carlton House Surgery. Fees and Charges: Private Charges in General Practice: FAQs. 2017; Updated April 1 2017; Accessed: 2017 (22 March).] *Violence, intimidation, and defamation *Violence, intimidation, and defamation *Situations in which a patient might be removed from the practice list, and the process, including e.g.: *Situations in which a patient might be removed from the practice list, and the process, including e.g.: Line 38: Line 39: ===Examples of GP practice leaflets=== ===Examples of GP practice leaflets=== ===Examples of GP web sites=== ===Examples of GP web sites=== - +*[https://www.carltonhousesurgery.co.uk/ Carlton House Surgery web site] {{Refsec}} {{Refsec}} [...]



Private practice

Wed, 22 Mar 2017 14:02:39 GMT

How much GPs can charge:

← Older revision Revision as of 14:02, 22 March 2017
Line 60: Line 60:
DNUK cannot provide legal advice, but it seems likely that while it is probably an offence to advise others as to what they should charge for a particular service, there is nothing wrong in publishing what you charge, and providing this information to others on request - ''as long as the information is in the public domain''. It is probably unwise to provide this information to others (other than clients or prospective clients) if it is not in the public domain.
DNUK cannot provide legal advice, but it seems likely that while it is probably an offence to advise others as to what they should charge for a particular service, there is nothing wrong in publishing what you charge, and providing this information to others on request - ''as long as the information is in the public domain''. It is probably unwise to provide this information to others (other than clients or prospective clients) if it is not in the public domain.
 +
 +
====Examples of information provided by practices on fees and charges====
 +
*[https://www.carltonhousesurgery.co.uk/about-us/fees-and-charges/ Carlton House Surgery web page on fees and charges][https://www.carltonhousesurgery.co.uk/about-us/fees-and-charges/ Carlton House Surgery. Fees and Charges: Private Charges in General Practice: FAQs. 2017; Updated April 1 2017; Accessed: 2017 (22 March).]
== Benefits ==  
== Benefits ==  



MediaWiki:Copyright

Tue, 21 Mar 2017 22:45:39 GMT

css error




Main Page

Tue, 21 Mar 2017 22:37:32 GMT

css error ← Older revision Revision as of 22:37, 21 March 2017 (2 intermediate revisions not shown)Line 3: Line 3:
-+

Welcome

Welcome

[[Image:The Principle Organs and Vascular and Urino-Genital Systems of a Woman.jpg|150px|left]] [[Image:The Principle Organs and Vascular and Urino-Genital Systems of a Woman.jpg|150px|left]] Line 18: Line 18:
- -
+

Contents

Contents

*[[Medical Specialties]] *[[Medical Specialties]] Line 40: Line 40:
 
 
+

Search

Search

[...]



Local health resilience partnerships

Tue, 21 Mar 2017 17:39:59 GMT

Created page with "{{stub}} Category:Emergency planning Local Health Resilience Partnerships (LHRP) are part of the health service' contribution to emergency planning arrangements. ==External ..."

New page

{{stub}}
[[Category:Emergency planning]]
Local Health Resilience Partnerships (LHRP) are part of the health service' contribution to emergency planning arrangements.

==External links==
*[https://www.england.nhs.uk/ourwork/eprr/lhrp/ Local Health Resilience Partnerships (LHRP) page] at [[NHS England]] web site.



Disaster planning

Tue, 21 Mar 2017 17:37:20 GMT

← Older revision Revision as of 17:37, 21 March 2017
Line 76: Line 76:
-
[[Category:Public health]][[Category:Emergency medicine]][[Category:Disaster medicine]]
+
[[Category:Public health]][[Category:Emergency medicine]][[Category:Disaster medicine]][[Category:Emergency planning]]



Abbreviations

Tue, 21 Mar 2017 17:36:34 GMT

L:

← Older revision Revision as of 17:36, 21 March 2017
Line 450: Line 450:
*LECC - [[London Olympics 2012|London Events Coordinating Calendar]] (correctly transcribed - but are sure it doesn't mean London Events Coordinating Committee??)
*LECC - [[London Olympics 2012|London Events Coordinating Calendar]] (correctly transcribed - but are sure it doesn't mean London Events Coordinating Committee??)
*LES - Local Enhanced Service - see [[Directly enhanced service|Directly enhanced service (DES)]]
*LES - Local Enhanced Service - see [[Directly enhanced service|Directly enhanced service (DES)]]
 +
*LHRP - [[Local health resilience partnerships|Local Health Resilience Partnerships (LHRP)]]
*LKKS - "Liver, Kidney, Kidney, Spleen". Used as shorthand in medical notes, usually in the negative ("No LKKS" meaning "liver, kidneys, and spleen not palpable/enlarged")
*LKKS - "Liver, Kidney, Kidney, Spleen". Used as shorthand in medical notes, usually in the negative ("No LKKS" meaning "liver, kidneys, and spleen not palpable/enlarged")
*LFTs - [[Liver function tests]]. Used on Lab forms. Usually [[bilirubin]] and some [[liver enzymes|enzymes]]. The term is imprecise.
*LFTs - [[Liver function tests]]. Used on Lab forms. Usually [[bilirubin]] and some [[liver enzymes|enzymes]]. The term is imprecise.



Witness

Tue, 21 Mar 2017 13:17:19 GMT

Practical points: ← Older revision Revision as of 13:17, 21 March 2017 (One intermediate revision not shown)Line 2: Line 2: [[Category:Medicolegal]][[Category:forensic medicine]] [[Category:Medicolegal]][[Category:forensic medicine]] Doctors may be asked to appear in court in a professional capacity. As such they may be a: Doctors may be asked to appear in court in a professional capacity. As such they may be a: -*Witness to fact;+  -*[[Witness#Professional witness|Professional witness]];+*[[Witness#Professional witness|Professional witness]] (also referred to as a ''witness to fact''); *[[Witness#Expert witness|Expert witness]] *[[Witness#Expert witness|Expert witness]] ==Professional witness== ==Professional witness==  +From [http://www.gmc-uk.org/guidance/ethical_guidance/13460.asp GMC web site] (accessed 21 March [[2017]]):  +  +  +:"81. Witnesses of fact (also known as professional witnesses) provide professional evidence of their clinical findings, observations and actions, and the reasons for them.  +  +:"82. As a witness of fact, your written and oral evidence should be clear and concise, and must be based on clinical records and notes made at the relevant period of time. You may include some opinion about the findings – for example, about how an injury to a child or young person has been caused – but you should make clear what is factual evidence and what is your opinion based on your professional judgement and experience."  +  + ==Expert witness== ==Expert witness== The general rule is that witnesses give evidence about facts rather than opinions that they may have formed from facts. The reason for this is that it is the job of the Tribunal (Judge, Magistrate or jury as the case may be) to hear the evidence and make appropriate inferences.   The general rule is that witnesses give evidence about facts rather than opinions that they may have formed from facts. The reason for this is that it is the job of the Tribunal (Judge, Magistrate or jury as the case may be) to hear the evidence and make appropriate inferences.   Line 15: Line 23: A expert in giving evidence may support his opinion, gained in the course of his training and experience, by reference to relevant articles, letters etc whether published or not, but it must bear on the facts of the case as proved by admissible evidence. That opinion may be based on work by members of a team led by the expert witness, but disclosure will need to be given of the names of such team members. A expert in giving evidence may support his opinion, gained in the course of his training and experience, by reference to relevant articles, letters etc whether published or not, but it must bear on the facts of the case as proved by admissible evidence. That opinion may be based on work by members of a team led by the expert witness, but disclosure will need to be given of the names of such team members. -  -http://www.ewi.org.uk/  In earlier decades in England a witness might be retained by either side - a defence expert or a prosecution or plaintiff's expert.  Even then the expert had an over-riding duty to the Court rather than to the side paying him, in theory.  More recently {{date}} this has been made more explicit. In earlier decades in England a witness might be retained by either side - a defence expert or a prosecution or plaintiff's expert.  Even then the expert had an over-riding duty to the Court rather than to the side paying him, in theory.  More recently {{date}} this has been made more explicit. Line 22: Line 28: ==Practical points== ==Practical points== When a doctor agrees to prepare a report for a court, they should be prepared, if requested by the court, to explain it in court - although this may not [...]



Talk:Main Page

Tue, 21 Mar 2017 00:42:13 GMT

outage ← Older revision Revision as of 00:42, 21 March 2017 Line 174: Line 174: :::::::::::::::::Blame today's outage on not being able to cope with all those attempts to exploit wordpress vulns in the news but the truth is our LAMP is beyond its sell by date and has been limping with daily maintenance for weeks and I was just seeing how long it could stay up for with present limits on concurrent apache processes. The answer is less than 36 hours with nasty net out there checking anything that serves php. Oh well. [[User:Mlj|Mlj]] 22:11, 10 February 2017 (UTC) :::::::::::::::::Blame today's outage on not being able to cope with all those attempts to exploit wordpress vulns in the news but the truth is our LAMP is beyond its sell by date and has been limping with daily maintenance for weeks and I was just seeing how long it could stay up for with present limits on concurrent apache processes. The answer is less than 36 hours with nasty net out there checking anything that serves php. Oh well. [[User:Mlj|Mlj]] 22:11, 10 February 2017 (UTC) ::::::::::::::::::Another predictable crash due to memory leak. Just wish some processes were not active that really should not have been as root when I went in. Will look at logs now back up.23:56, 16 March 2017 (UTC) ::::::::::::::::::Another predictable crash due to memory leak. Just wish some processes were not active that really should not have been as root when I went in. Will look at logs now back up.23:56, 16 March 2017 (UTC)  +:::::::::::::::::::Very flaky, will try some apache parameters that may decrease the 430 odd http processes that I found when I finally got in and that took an hour to kill. No definite DOS at time it went over [[User:Mlj|Mlj]] 00:42, 21 March 2017 (UTC) ==pubmed_caption_finder== ==pubmed_caption_finder== This has to be updated given PubMed's shift to https from tomorrow. From today it will generate https references BUT  the module still uses http call in php (as https call not recognised) to get all the info. This will no doubt change and give us message "Unable to contact Pubmed. This may be transient - please try again later. If this error recurs, please contact a ganfyd admin." If in due course I can enable php to do https I have version 20 of the module uploaded and ready to go and replace present version 21 (we were on version 19 before today) Cheers[[User:Mlj|Mlj]] 18:37, 26 September 2016 (BST) This has to be updated given PubMed's shift to https from tomorrow. From today it will generate https references BUT  the module still uses http call in php (as https call not recognised) to get all the info. This will no doubt change and give us message "Unable to contact Pubmed. This may be transient - please try again later. If this error recurs, please contact a ganfyd admin." If in due course I can enable php to do https I have version 20 of the module uploaded and ready to go and replace present version 21 (we were on version 19 before today) Cheers[[User:Mlj|Mlj]] 18:37, 26 September 2016 (BST) [...]



Witness

Mon, 20 Mar 2017 12:19:08 GMT

Agree the contract in advance. Ensure it includes the fee if you have to attend court.

← Older revision Revision as of 12:19, 20 March 2017
Line 19: Line 19:
In earlier decades in England a witness might be retained by either side - a defence expert or a prosecution or plaintiff's expert.  Even then the expert had an over-riding duty to the Court rather than to the side paying him, in theory.  More recently {{date}} this has been made more explicit.
In earlier decades in England a witness might be retained by either side - a defence expert or a prosecution or plaintiff's expert.  Even then the expert had an over-riding duty to the Court rather than to the side paying him, in theory.  More recently {{date}} this has been made more explicit.
 +
 +
==Practical points==
 +
When a doctor agrees to prepare a report for a court, they should be prepared, if requested by the court, to explain it in court - although this may not always be necessary. The contract should therefore always cover both the cost of the report ''per se'', and also the fee (and expenses) for a court appearance.



Eligibility for NHS secondary care

Sun, 19 Mar 2017 13:51:50 GMT

← Older revision Revision as of 13:51, 19 March 2017 (2 intermediate revisions not shown)Line 10: Line 10: {{England| {{England| -The situation for EEA nationals resident in the England is less clear - see [[#Eligibility for NHS hospital treatment for EEA nationals resident in England|Eligibility for NHS hospital treatment for EEA nationals resident in England]] for more detail.  +The situation for [[http://www.ganfyd.org/index.php?title=European_Economic_Area|EEA]] nationals resident in the England is less clear - see [[#Eligibility for NHS hospital treatment for EEA nationals resident in England|Eligibility for NHS hospital treatment for EEA nationals resident in England]] for more detail.   Those entitled to NHS care can access for free such NHS secondary care as has been commissioned for the population of the locality they are resident in. For some secondary care services that locality is the whole of England, for most it is the [[clinical commissioning group]] their GP practice is a member of. The issue is slightly more complicated if resident in Wales or Scotland and accessing services in England, but this is invisible to the patient. If not resident in the EU matters are more complicated. Many overseas patients will have paid a health care charge with their visa. See [https://www.gov.uk/guidance/nhs-entitlements-migrant-health-guide NHS England Migrant Health Guide] and [https://www.gov.uk/government/publications/guidance-on-overseas-visitors-hospital-charging-regulations Guidance on implementing the overseas visitor hospital charging regulations 2015]. This all changed with the [http://www.legislation.gov.uk/uksi/2015/238/made The National Health Service (Charges to Overseas Visitors) Regulations 2015], before the situation was similar in fine detail to the 1989 regulations for Scotland and Wales. Those entitled to NHS care can access for free such NHS secondary care as has been commissioned for the population of the locality they are resident in. For some secondary care services that locality is the whole of England, for most it is the [[clinical commissioning group]] their GP practice is a member of. The issue is slightly more complicated if resident in Wales or Scotland and accessing services in England, but this is invisible to the patient. If not resident in the EU matters are more complicated. Many overseas patients will have paid a health care charge with their visa. See [https://www.gov.uk/guidance/nhs-entitlements-migrant-health-guide NHS England Migrant Health Guide] and [https://www.gov.uk/government/publications/guidance-on-overseas-visitors-hospital-charging-regulations Guidance on implementing the overseas visitor hospital charging regulations 2015]. This all changed with the [http://www.legislation.gov.uk/uksi/2015/238/made The National Health Service (Charges to Overseas Visitors) Regulations 2015], before the situation was similar in fine detail to the 1989 regulations for Scotland and Wales. Line 28: Line 28: *Those receiving compulsory treatment under a court order, or who are detained in an NHS hospital or deprived of their liberty (for example, under the Mental Health Act 1983 or the Mental Capacity Act 2005) who are exempt from charge for all treatment provided, in accordance with the court order, or for the duration of their detention *Those receiving compulsory treatment under a court order, or who are detained in an NHS hospital or deprived of their liberty (for example, under the Mental Health Act 1983 or the Mental Capacity Act 2005) who are exempt from charge for all treatment provided, in accordance with the court order, or for the duration of their detention *Prisoners and immigration detainees *Prisoners and immigration detainees  +  +See Chapter 4 of [htt[...]



Personal demographics Service

Sat, 18 Mar 2017 23:53:17 GMT

moved [[Personal demographics Service]] to [[Personal demographics service]] Capitalisation!




Personal demographics Service

Sat, 18 Mar 2017 23:35:21 GMT

Created page with "{{stub}} The Personal Demographics Service (previously known as the patient demographics service) is a key part of the NHS' IT "spine". ==External links== *[https://digital.nhs...."

New page

{{stub}}
The Personal Demographics Service (previously known as the patient demographics service) is a key part of the NHS' IT "spine".

==External links==
*[https://digital.nhs.uk/Demographics NHS Digital page on the PDS]



Abbreviations

Sat, 18 Mar 2017 23:32:20 GMT

P: PDS

← Older revision Revision as of 23:32, 18 March 2017
Line 613: Line 613:
*PCV - [[Packed cell volume]] - see [[haematocrit]]
*PCV - [[Packed cell volume]] - see [[haematocrit]]
*PCV - [[Pneumococcal vaccine]]
*PCV - [[Pneumococcal vaccine]]
 +
*PDS - [[Personal demographics Service|Personal Demographics Service]] (previously Patient Demographics Service)
*PE - [[Pulmonary embolism]] or embolus
*PE - [[Pulmonary embolism]] or embolus
*PEA - [[Pulseless electrical activity]]
*PEA - [[Pulseless electrical activity]]



Talk:Main Page

Sat, 18 Mar 2017 20:26:38 GMT

DOS attack type has changed again

← Older revision Revision as of 20:26, 18 March 2017
Line 198: Line 198:
I don't really have the stamina now to tour the country telling people it is a good idea, besides, good ideas seem unfashionable this year.  [[User:Midgley|Midgley]] 20:03, 6 December 2016 (UTC)
I don't really have the stamina now to tour the country telling people it is a good idea, besides, good ideas seem unfashionable this year.  [[User:Midgley|Midgley]] 20:03, 6 December 2016 (UTC)
 +
==DOS attacks==
 +
We are being hit every day or so (less today) by someone running through every php script (mainly Wordpress) that is presumably vulnerable. Server just can not cope and there is no doubt that ultimately its exceeding our memory and site stops responding when goes into Swap. Ultimately the repeat attacks are enough after about two days to bring everything down as we definitely have a memory leak somewhere. Will see if I can alter Apache timeouts [[User:Mlj|Mlj]] 20:26, 18 March 2017 (UTC)



Eligibility for NHS secondary care

Sat, 18 Mar 2017 20:03:18 GMT

Eligibility for NHS hospital treatment for EEA nationals resident in England: ← Older revision Revision as of 20:03, 18 March 2017 (One intermediate revision not shown)Line 56: Line 56: :"[apart from non-EEA nationals] individuals do not need to be permanent or indefinite residents in order to be ordinarily resident here. Lawful, properly settled residence here for the time being is sufficient." :"[apart from non-EEA nationals] individuals do not need to be permanent or indefinite residents in order to be ordinarily resident here. Lawful, properly settled residence here for the time being is sufficient."  +It goes on to clarify "ordinary residence" in chapter 3:  +It says:[https://www.gov.uk/government/publications/guidance-on-overseas-visitors-hospital-charging-regulations Department of Health International Health and Public Health Policy Division. Guidance on implementing the overseas visitor hospital charging regulations 2015: Department of Health, 2016 (February 2016); p30] (or [https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/496951/Overseas_visitor_hospital_charging_accs.pdf pdf] -So how do EEA nationals establish that they have ''lawful, settled residence'' in England?  -  -The guidance says that they:   +:"Determining ordinary residence   +:"3.10 Whether a person is ordinarily resident in the UK is essentially a three-fold test (four-fold for non-EEA nationals) assessing whether that individual:  +:"(i) is lawfully in the UK;  +:"(ii) is here voluntarily – it will be rare for a person not to be in the UK voluntarily; and  +:"(iii) is properly settled here for the time being; and  +:"(iv) in the case of non-EEA nationals subject to immigration control, has ILR in the UK. -:"have an extended ‘right to reside’ beyond that period if they are ‘exercising a Treaty right’ as:  +:"Being lawfully in the UK  +:"3.11 British citizens have automatic right of abode in the UK, so are always here lawfully. EEA nationals are almost always here lawfully. It is important to note that a person does not need to meet the ‘right to reside test’ for certain benefits, for example, in order to be considered ordinarily resident in the UK. Non-EEA nationals usually need permission to be in the UK, except in some circumstances when they are not subject to immigration control, e.g. due to their relationship to an EEA national who is resident here, or when a diplomat."  +   +So how do EEA nationals establish that they have ''lawful, settled residence'' in England? The main "guidance…" document referred to above simply states that ''"EEA nationals are almost always here lawfully"''.  +   +A more detailed guidance document says, however, that they:[https://www.gov.uk/government/publications/guidance-on-overseas-visitors-hospital-charging-regulations  +Department of Health. 2016 (February). Guidance on implementing the overseas visitor hospital charging regulations 2015: Ways in which people can be lawfully resident in the UK, Department of Health (or [https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/496967/lawfully-resident-uk.pdf pdf]) (see S14, p6).  +   +  +:"have an extended ‘right to reside’ beyond that period [three months] if they are ‘exercising a Tr[...]



Levodopa

Sat, 18 Mar 2017 19:35:05 GMT

details

← Older revision Revision as of 19:35, 18 March 2017
Line 13: Line 13:
''Oral''
''Oral''
==Clinical Issues==
==Clinical Issues==
-
By itself it takes weeks to achieve maximum effectiveness with a 25% failure rate, mainly due to peripheral toxicity
+
By itself it takes weeks to achieve maximum effectiveness with a 25% failure rate, mainly due to peripheral toxicity. Accordingly it is commonly used as either [[co-careldopa]] or [[co-beneldopa]] or combined with [[entacapone]] as well.
===Toxicity===
===Toxicity===
====Contra-indications====
====Contra-indications====



1967

Sat, 18 Mar 2017 19:27:15 GMT

extra

← Older revision Revision as of 19:27, 18 March 2017
Line 1: Line 1:
{{JanusBox}}
{{JanusBox}}
-
First [[mumps]] vaccine by [[Maurice Hilleman]].
+
*First [[mumps]] vaccine by [[Maurice Hilleman]].
 +
*[[DOPA]] confirmed as an effective treatment for [[Parkinsons disease]].



DOPA

Sat, 18 Mar 2017 19:25:17 GMT

definition

New page

{{ChemistryBox||dihydroxyphenylalanine, 3,4-dihydroxyphenylalanine, levodopa, dextrodopa, (2S)-2-amino-3-(3,4-dihydroxyphenyl)propanoic acid|[[image:LevodopaMolecule.png|thumb|Levodopa molecule (DOPA)]][[image:Levodopa.png|right]]}}

[[DOPA]] is 3,4-'''d'''ihydr'''o'''xy'''p'''henyl'''a'''lanine (2-amino-3-(3,4-dihydroxyphenyl)propanoic acid).

See [[levodopa]] for the active precursor to the neurotransmitter [[dopamine]] and is the usual meaning of DOPA in medicine or biology.

Dextrodopa is a bone marrow toxin.

The racemic mixture of DOPA was convincingly reported as an oral treatment for [[Parkinsons disease]] in [[1967]][http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=5334614 Cotzias GC, Van Woert MH, Schiffer LM. Aromatic amino acids and modification of parkinsonism. The New England journal of medicine. 1967 Feb 16; 276(7):374-9.] as postulated would be the case in [[1958]] by [[Arvid Carisson]][http://www.nobelprize.org/nobel_prizes/medicine/laureates/2000/carlsson-lecture.pdf Arvid Carisson Nobel Prize Lecture 2000].
{{refsec}}
[[Category:Abbreviations]]
[[Category:Parkinsonism]]



Arvid Carisson

Sat, 18 Mar 2017 19:05:40 GMT

grammar

New page

Arvid Carisson (25/1/1923), a clinical pharmacologist, graduated in medicine from Lund University where he also discovered that [[dopamine]] was a neurotransmitter in the brain and first proposed in [[1958]] that [[levodopa]] was a potential treatment for [[Parkinsons disease]]. In fact just prior to this while in the USA he discovered in 1957 that [[DOPA]] reversed [[reserpine]]'s neurotransmitter depletion affects and so the link to [[Parkinsonism]] was there to be made. He and his cowarkers also developed the first SSRI to market (zimelidine, later withdrawn), were the first to understand how major tranquillizers worked by depleting dopamine.
{{refsec}}
[[Category:People|Carisson, Arvid]]
[[Category:Nobel laureates|Carisson, Arvid]]



Levodopa

Sat, 18 Mar 2017 19:01:45 GMT

references ← Older revision Revision as of 19:01, 18 March 2017 Line 34: Line 34: *'''1950s''' Birkmayer  Extracts of ''[[Rauwolfia serpentina]]'' recognised to control [[hypertension]] *'''1950s''' Birkmayer  Extracts of ''[[Rauwolfia serpentina]]'' recognised to control [[hypertension]] *'''[[1956]]'''  [[Reserpine]] recognised to cause parkinsonism[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=13344883  GIANNIOTTI G, GIBERTI F, SPIZZIRRI S. First results of a new treatment of Parkinson's disease and of parkinsonism; therapeutic effect of 3-phenyl-3-(beta-diethylamino-ethyl)-2, 6-dioxo piperidine alone and with reserpine and ritalin; preliminary note.. Gazzetta medica italiana. 1956 Mar; 115(3):71-4.][http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=13347457  BROWNE J. Parkinsonism as a result of treatment with reserpine, report of a case. The Medical journal of Malaya. 1956 Mar; 10(3):262-3.] *'''[[1956]]'''  [[Reserpine]] recognised to cause parkinsonism[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=13344883  GIANNIOTTI G, GIBERTI F, SPIZZIRRI S. First results of a new treatment of Parkinson's disease and of parkinsonism; therapeutic effect of 3-phenyl-3-(beta-diethylamino-ethyl)-2, 6-dioxo piperidine alone and with reserpine and ritalin; preliminary note.. Gazzetta medica italiana. 1956 Mar; 115(3):71-4.][http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=13347457  BROWNE J. Parkinsonism as a result of treatment with reserpine, report of a case. The Medical journal of Malaya. 1956 Mar; 10(3):262-3.] -*'''[[1957]]'''  [[Arvid Carisson]] Dopamine is a neurotransmitter in the brain[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=13483658  CARLSSON A, LINDQVIST M, MAGNUSSON T. 3,4-Dihydroxyphenylalanine and 5-hydroxytryptophan as reserpine antagonists. Nature. 1957 Nov 30; 180(4596):1200.]+*'''[[1957]]'''  [[Arvid Carisson]] Dopamine is a neurotransmitter in the brain[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=13483658  CARLSSON A, LINDQVIST M, MAGNUSSON T. 3,4-Dihydroxyphenylalanine and 5-hydroxytryptophan as reserpine antagonists. Nature. 1957 Nov 30; 180(4596):1200.]. -*'''1960'''  Brain [[dopamine]] deficit in Parkinson’s Disease reported[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=13726012  EHRINGER H, HORNYKIEWICZ O. Distribution of noradrenaline and dopamine (3-hydroxytyramine) in the human brain and their behavior in diseases of the extrapyramidal system.. Klinische Wochenschrift. 1960 Dec 15; 38:1236-9.]+*'''[[1958]]'''  [[Arvid Carisson]] postulates that levodopa will treat [[Parkinsons disease]][http://www.nobelprize.org/nobel_prizes/medicine/laureates/2000/carlsson-lecture.pdf Arvid Carisson Nobel Prize Lecture 2000][...]



L-dopa decarboxylase

Sat, 18 Mar 2017 18:22:00 GMT

redirect

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#redirect[[Aromatic L-amino acid decarboxylase]]



Levodopa

Sat, 18 Mar 2017 18:19:44 GMT

update ← Older revision Revision as of 18:19, 18 March 2017 Line 1: Line 1: [[category: Medicines]][[Category:Dopaminergic drugs]] [[category: Medicines]][[Category:Dopaminergic drugs]] -{{PharmacologyBox |Levodopa||[[image:LevodopaMolecule.png|thumb|Levodopa Molecule]]+{{PharmacologyBox |Levodopa, L Dopa, L-Dopa, hydroxy L tyrosine, 3-hydroxy-L-tyrosine, L 3,4 dihydroxyphenylalanine, L-3,4-dihydroxyphenylalanine, (2S)-2-amino-3-(3,4-dihydroxyphenyl)propanoic acid||[[image:LevodopaMolecule.png|thumb|Levodopa Molecule]][[image:Levodopa.png|right]]|||Precursor to dopamine; replenishes depleted striatal dopamine|Given with dopa decarboxylase inhibitor in clinical practice}} -[[image:Levodopa.png|right]]|||Precursor to dopamine; replenishes depleted striatal dopamine|Given with dopa decarboxylase inhibitor}}+ ==Introduction== ==Introduction== -Levodopa (L-dopa) gets metabolised to [[dopamine]] to work (d-dopa is not converted into dopamine and causes [[neutropenia]]). Accordingly it is usually added to inhibitors of this conversion in the periphery to minimise dopaminergic side effects. These tend to be [[carbidopa]] ([[co-careldopa]], Sinemet®) or [[benserazide]] ([[co-beneldopa]], not marketed in USA, Madopar®). Is also marketed in various parts of the world combined with [[entacapone]] (eg Stalevo® or Sastravi®) or as a product for duodenal infusion(Duodopa®).+Levodopa (L-dopa) can cross the blood brain barrier and gets metabolised to [[dopamine]] to work. Accordingly it is usually added to inhibitors of this conversion in the periphery to minimise dopaminergic side effects. These tend to be [[carbidopa]] ([[co-careldopa]], Sinemet®) or [[benserazide]] ([[co-beneldopa]], not marketed in USA, Madopar®). Is also marketed in various parts of the world combined with [[entacapone]] (eg Stalevo® or Sastravi®) or as a product for duodenal infusion(Duodopa®). ==Clinical Use== ==Clinical Use==  +Rarely if never used by itself since the early 1970s. ===Indications=== ===Indications=== *[[Parkinsonism]] *[[Parkinsonism]] Line 13: Line 13: ''Oral'' ''Oral'' ==Clinical Issues== ==Clinical Issues==  +By itself it takes weeks to achieve maximum effectiveness with a 25% failure rate, mainly due to peripheral toxicity ===Toxicity=== ===Toxicity=== ====Contra-indications==== ====Contra-indications==== Line 23: Line 24: ===Special advice=== ===Special advice=== ==Pharmacology== ==Pharmacology==  +D-dopa ((2R)-2-amino-3-(3,4-dihydroxyphenyl)propanoic acid) is not converted into dopamine and causes [[neutropenia]] amongst other potential toxicity. So impure levodopa could be problematical and certainly was during drug development. ===History=== ===History=== -[[Arvid Carisson]] had to wait until [[2000]] to get the [[Nobel prize]] for "''proving that dopamine is a neurotransmitter in the brain whose depletion leads to symptoms of Parkinson's disease''". Birkmayer published in an obscure journal in [[1961]] and also had issues with his collaborators delaying worldwide access to this advance by about 6 years. However it is unclear if such a drug with apparently a low therapeuti[...]



Co-beneldopa

Sat, 18 Mar 2017 17:53:18 GMT

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{{PharmacologyBox||Madopar®}}

Combination of the [[:Category:Dopa decarboxylase inhibitors|DOPA decarboxylase inhibitor]] [[benserazide]] and [[levodopa]] used for the treatment of [[Parkinsons disease]]. The ratio developed when [[levodopa]] was shown to be correct in most clinical practice by the end of the 1970s[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=574221 Rinne UK, Mölsä P. Levodopa with benserazide or carbidopa in Parkinson disease. Neurology. 1979 Dec; 29(12):1584-1589.](Print) ([http://dx.doi.org/10.1212/wnl.29.12.1584 Link to article] – subscription may be required.)[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=1266576 Pakkenberg H, Birket-Smith E, Dupont E, Hansen E, Mikkelsen B, Presthus J, Rautakorpi I, Riman E, Rinne UK. Parkinson's disease treated with Sinemet or Madopar. A controlled multicenter trial. Acta neurologica Scandinavica. 1976 May; 53(5):376-385.](Print) ([http://dx.doi.org/10.1111/j.1600-0404.1976.tb04355.x Link to article] – subscription may be required.) and is regarded by most as therapeutically equivalent to [[co-careldopa]][https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=73849 Greenacre JK, Coxon A, Petrie A, Reid JL. Comparison of levodopa with carbidopa or benserazide in parkinsonism. Lancet (London, England). 1976 Aug; 2(7982):381-384.](Print) ([http://dx.doi.org/10.1016/s0140-6736(76)92403-x Link to article] – subscription may be required.) at equivalent levodopa dose.
[[Category:Dopa decarboxylase inhibitors]]
{{refsec}}



Co-careldopa

Sat, 18 Mar 2017 17:50:40 GMT

summary

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{{PharmacologyBox||Sinemet®}}

Combination of the [[:Category:Dopa decarboxylase inhibitors|DOPA decarboxylase inhibitor]] [[carbidopa]] and [[levodopa]] used since the early 1970's for the treatment of [[Parkinsons disease]]. The original 1:10 ratio developed when [[levodopa]] was the only real competitor, admittedly briefly, was shown to be incorrect in most clinical practice by the end of the 1970s[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=574221 Rinne UK, Mölsä P. Levodopa with benserazide or carbidopa in Parkinson disease. Neurology. 1979 Dec; 29(12):1584-1589.](Print) ([http://dx.doi.org/10.1212/wnl.29.12.1584 Link to article] – subscription may be required.)[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=4669737 Streifler M, Vardi J, Kesten M. Treatment of parkinsonism with L-dopa and an L-aromatic amino acid inhibitor. Harefuah. 1972 Nov; 83(9):362-364.](Print) [https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=1266576 Pakkenberg H, Birket-Smith E, Dupont E, Hansen E, Mikkelsen B, Presthus J, Rautakorpi I, Riman E, Rinne UK. Parkinson's disease treated with Sinemet or Madopar. A controlled multicenter trial. Acta neurologica Scandinavica. 1976 May; 53(5):376-385.](Print) ([http://dx.doi.org/10.1111/j.1600-0404.1976.tb04355.x Link to article] – subscription may be required.) and the 1:4 ratio should be used at the lower doses used in initiation of therapy and is regarded by most as therapeutically equivalent to [[co-beneldopa]][https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=73849 Greenacre JK, Coxon A, Petrie A, Reid JL. Comparison of levodopa with carbidopa or benserazide in parkinsonism. Lancet (London, England). 1976 Aug; 2(7982):381-384.](Print) ([http://dx.doi.org/10.1016/s0140-6736(76)92403-x Link to article] – subscription may be required.) at equivalent levodopa dose.
[[Category:Dopa decarboxylase inhibitors]]
{{refsec}}



Benserazide

Sat, 18 Mar 2017 17:32:00 GMT

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{{PharmacologyBox||Benserazide hydrochloride, 2-amino-3-hydroxy-N'-[ (2,3,4-trihydroxyphenyl) methyl ]propanehydrazide, benserazide HCl, Ro 4-4602/001|[[image:{{PAGENAME}}Molecule.png|thumb|{{PAGENAME}} Molecule]]|[[image:{{PAGENAME}}.png|center]]|||}}
==Introduction==
A [[:Category:dopa decarboxylase inhibitors|DOPA decarboxylase inhibitor]] widely marketed in products combining [[benserazide]] and [[levodopa]] ([[co-beneldopa]]) in the treatment of [[Parkinson's disease]]. It works by[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=56427 Rinne UK, Birket-Smith E, Dupont E, Hansen E, Hyyppä M, Marttila R, Mikkelsen B, Pakkenberg H, Presthus J. Levodopa alone and in combination with a peripheral decarboxylase inhibitor benserazide (Madopar) in the treatment of Parkinson's disease: A controlled clinical trial. Journal of neurology. 1975 Dec; 211(1):1-9.](Print) ([http://dx.doi.org/10.1007/bf00312459 Link to article] – subscription may be required.)[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=4669737 Streifler M, Vardi J, Kesten M. Treatment of parkinsonism with L-dopa and an L-aromatic amino acid inhibitor. Harefuah. 1972 Nov; 83(9):362-364.](Print) [https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=1266576 Pakkenberg H, Birket-Smith E, Dupont E, Hansen E, Mikkelsen B, Presthus J, Rautakorpi I, Riman E, Rinne UK. Parkinson's disease treated with Sinemet or Madopar. A controlled multicenter trial. Acta neurologica Scandinavica. 1976 May; 53(5):376-385.](Print) ([http://dx.doi.org/10.1111/j.1600-0404.1976.tb04355.x Link to article] – subscription may be required.):
#blocking the peripheral actions of [[levodopa]], allowing in particular higher doses to be delivered across the blood brain barrier without nausea or vomiting.
#shorting the induction of equivalent benefit from levodopa from months to about a month
#allowing lower doses of levodopa to be absorbed from the gastrointestinal tract effectively doubling its therapeutic index
#modifying metabolic pathways so that [[pyridoxine]] no longer blocked the actions of [[levodopa]].
==Clinical Use==
===Indications===
===Administration===
''Oral''
==Clinical Issues==
===Contra-indications===
===Cautions and Interactions===
===Side effects===
===Special advice===
==Pharmacology==
As a substrate analogue its hydrazine group irreversibly binds to not only to [[dopa decarboxylase]] but also other pyridoxal 5'-phosphate-dependent enzymes as well as free pyridoxal 5'-phosphate.
[[Category:dopa decarboxylase inhibitors]]
[[Category:Parkinsonism]]
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Cocareldopa

Sat, 18 Mar 2017 17:16:18 GMT

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#redirect[[co-careldopa]]



Carbidopa

Sat, 18 Mar 2017 17:15:38 GMT

block buster in its time

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{{PharmacologyBox||Carbidopa hydrate, carbidopa monohydrate, (2S)-3-(3,4-dihydroxyphenyl)-2-hydrazinyl-2-methylpropanoic acid, N-aminomethyldopa, methyldopahydrazine, (S)-carbidopa, L-alpha-methyl-dopahydrazine, MK 486|[[image:{{PAGENAME}}Molecule.png|thumb|{{PAGENAME}} Molecule]]|[[image:{{PAGENAME}}.png|center]]|||}}
==Introduction==
A [[:Category:dopa decarboxylase inhibitors|DOPA decarboxylase inhibitor]] widely marketed in products combining [[carbidopa]] and [[levodopa]] ([[cocareldopa]]) as the combination revolutionised the treatment of [[Parkinson's disease]] in the early 1970's by[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=4938431 Calne DB, Reid JL, Vakil SD, Rao S, Petrie A, Pallis CA, Gawler J, Thomas PK, Hilson A. Idiopathic Parkinsonism treated with an extracerebral decarboxylase inhibitor in combination with levodopa. British medical journal. 1971 Sep; 3(5777):729-732.](Print) ([http://dx.doi.org/10.1136/bmj.3.5777.729 Link to article] – subscription may be required.)[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=4711885 Lieberman AN, Derby BM, Feigenson J, Goodgold A, Nesbitte J, Resurreccion EC, Valdivia F. MK 486 and levodopa in treatment of Parkinsonism. Diseases of the nervous system. 1973 Apr-May; 34(4):167-171.](Print) [https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=4691682 Marsden CD, Barry PE, Parkes JD, Zilkha KJ. Treatment of Parkinson's disease with levodopa combined with L-alpha-methyldopahydrazine, an inhibitor of extracerebral DOPA decarboxylase. Journal of neurology, neurosurgery, and psychiatry. 1973 Feb; 36(1):10-14.](Print) ([http://dx.doi.org/10.1136/jnnp.36.1.10 Link to article] – subscription may be required.):
#blocking the peripheral actions of [[levodopa]], allowing in particular higher doses to be delivered across the blood brain barrier without nausea or vomiting.
#shorting the induction of equivalent benefit from levodopa from months to about a month
#allowing lower doses of levodopa to be absorbed from the gastrointestinal tract effectively doubling its therapeutic index
#modifying metabolic pathways so that [[pyridoxine]] no longer blocked the actions of [[levodopa]].
==Clinical Use==
===Indications===
===Administration===
''Oral''
==Clinical Issues==
===Contra-indications===
===Cautions and Interactions===
===Side effects===
===Special advice===
==Pharmacology==
As a substrate analogue its hydrazine group irreversibly binds to not only to [[dopa decarboxylase]] but also other pyridoxal 5'-phosphate-dependent enzymes as well as free pyridoxal 5'-phosphate.
[[Category:dopa decarboxylase inhibitors]]
[[Category:Parkinsonism]]
{{refsec}}



Category:Dopa decarboxylase inhibitors

Sat, 18 Mar 2017 17:13:12 GMT

drug class

New page

{{DrugsInClass|
*[[Carbidopa]]
*[[Benserazide]]
}}
Inhibitors of [[DOPA decarboxylase]].
[[Category:Parkinsonism]]



L-tyrosine

Sat, 18 Mar 2017 17:12:03 GMT

redirect

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#redirect[[tyrosine]]
[[Category: Amino acids]]



Aromatic L-amino acid decarboxylase deficiency

Sat, 18 Mar 2017 17:10:36 GMT

subclude

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{{GeneticsBox}}
{{:Aromatic L-amino acid decarboxylase}}
[[Category:Genetic syndromes]]
[[Category:Metabolic disorders]]



Aromatic L-amino acid decarboxylase

Sat, 18 Mar 2017 17:08:50 GMT

update ← Older revision Revision as of 17:08, 18 March 2017 Line 1: Line 1: -{{BiochemistryBox|||DOPA decarboxylase, aromatic amino acid decarboxylase, {{EC|4.1.1.28}}}}+{{BiochemistryBox|||aromatic-L-amino-acid decarboxylase, DOPA decarboxylase, aromatic amino acid decarboxylase, {{EC|4.1.1.28}}, dopa decarboxylase, [[DDC]], AADC}} [[Category:Enzymes]] [[Category:Enzymes]]  +   +[[Aromatic L-amino acid decarboxylase]] is a 480 amino acid [[monoamine metabolism]] enzyme coded by the [[DDC]] gene at 7p12.1. This catalyzes the decarboxylation of L-3,4-dihydroxyphenylalanine ([[DOPA]]) to [[dopamine]], L-5-hydroxytryptophan to [[serotonin]] and L-tryptophan to [[tryptamine]]. This is in the case of dopamine the second step in its formation from [[L-tyrosine]]. There is an isoform found predominantly in the kidney, and probably up to 4 isoforms produced by alternative splicing. -[[Aromatic L-amino acid decarboxylase]] is a 480 amino acid [[monoamine metabolism]] enzyme coded by the [[DDC]] gene at 7p12.1. Aromatic L-amino acid decarboxylase (AADC) deficiency is manifest by progressive[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=23264832  Cellini B, Montioli R, Oppici E, Voltattorni CB. Biochemical and computational approaches to improve the clinical treatment of dopa decarboxylase-related diseases: an overview. The open biochemistry journal. 2012; 6:131-8.]([http://dx.doi.org/10.2174/1874091X01206010131 Link to article] – subscription may be required.):+   +   +[[Aromatic L-amino acid decarboxylase deficiency]] (AADCD, {{OMIM|608643}}) is manifest by progressive[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=23264832  Cellini B, Montioli R, Oppici E, Voltattorni CB. Biochemical and computational approaches to improve the clinical treatment of dopa decarboxylase-related diseases: an overview. The open biochemistry journal. 2012; 6:131-8.]([http://dx.doi.org/10.2174/1874091X01206010131 Link to article] – subscription may be required.): * Development delay * Development delay * Dyskinesias * Dyskinesias * Oculogyric crisis * Oculogyric crisis * Vegetative symptoms * Vegetative symptoms  +It has autosomal recessive infantile onset and both serotonin and catecholamine deficiency with often poor feeding, lethargy, [[ptosis]], intermittent hypothermia, and gastrointestinal disturbances. Some patients (particularly males) can respond to [[pyridoxine]], pyridoxal phosphate, [[:Category:Dopamine receptor agonists|dopamine agonists]], and [[:Category:Monoamine-oxidase-B inhibitors|monoamine oxidase B inhibitors]]. {{refsec}} {{refsec}} [...]



Aromatic-L-amino-acid decarboxylase

Sat, 18 Mar 2017 17:08:40 GMT

redirect

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#redirect[[Aromatic L-amino acid decarboxylase]]



Dopa decarboxylase

Sat, 18 Mar 2017 16:35:22 GMT

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#redirect[[Aromatic-L-amino-acid decarboxylase]]
[[Category:Enzymes]]
[[Category:Parkinsonism]]



Confidentiality

Fri, 17 Mar 2017 10:52:28 GMT

External links: ← Older revision Revision as of 10:52, 17 March 2017 Line 86: Line 86: {{UK|The [http://www.nigb.nhs.uk/ National Information Governance Board for Health and Social Care] is the independent statutory body established to promote, improve and monitor information governance in health and adult social care. Since the 1 January 2009 it has the responsibilities created under Section 251 of the NHS Act 2006 (originally enacted under Section 60 of the Health and Social Care Act 2001). Section 251 permits the common law duty of confidentiality to be set aside in specific circumstances for medical purposes. These duties were initially assigned to the [http://www.dh.gov.uk/ab/Archive/PIAG/index.htm The Patient Information Advisory Group(PIAG)] which was replaced under Section 158 of the Health and Social Care Act 2008 and formally wound up on 31 December 2008 {{UK|The [http://www.nigb.nhs.uk/ National Information Governance Board for Health and Social Care] is the independent statutory body established to promote, improve and monitor information governance in health and adult social care. Since the 1 January 2009 it has the responsibilities created under Section 251 of the NHS Act 2006 (originally enacted under Section 60 of the Health and Social Care Act 2001). Section 251 permits the common law duty of confidentiality to be set aside in specific circumstances for medical purposes. These duties were initially assigned to the [http://www.dh.gov.uk/ab/Archive/PIAG/index.htm The Patient Information Advisory Group(PIAG)] which was replaced under Section 158 of the Health and Social Care Act 2008 and formally wound up on 31 December 2008 }} }}  +*[https://www.themdu.com/guidance-and-advice/journals/inpractice-december-2013/disclosure-to-the-police Information on disclosure to the police] from the [[Medical indemnity|Medical Defence Union (MDU)]].  + ==Further reading== ==Further reading== Winston Churchill: Struggle for Survival 1940-1965  Constable, London 1967 ASIN: B000LQ8S20 Winston Churchill: Struggle for Survival 1940-1965  Constable, London 1967 ASIN: B000LQ8S20 {{refsec}} {{refsec}} [...]



Talk:Main Page

Thu, 16 Mar 2017 23:56:28 GMT

another crash - predictable but perhaps not ← Older revision Revision as of 23:56, 16 March 2017 Line 173: Line 173: ::::::::::::::::Went down about 30 minutes ago when I was in monitoring memory leak. Fails when swap greater than real memory and this suddenly happened when apparently server bombarded by over 400 httpd requests when it looked like we had 40% of memory still available - I thought I had limited number of apache processes to below this. Still there is an apache associated memory leak as I killed down apache first and this released very reasonable amount of memory, presumably in PHP as far as I can tell.Ah well00:11, 20 January 2017 (UTC) ::::::::::::::::Went down about 30 minutes ago when I was in monitoring memory leak. Fails when swap greater than real memory and this suddenly happened when apparently server bombarded by over 400 httpd requests when it looked like we had 40% of memory still available - I thought I had limited number of apache processes to below this. Still there is an apache associated memory leak as I killed down apache first and this released very reasonable amount of memory, presumably in PHP as far as I can tell.Ah well00:11, 20 January 2017 (UTC) :::::::::::::::::Blame today's outage on not being able to cope with all those attempts to exploit wordpress vulns in the news but the truth is our LAMP is beyond its sell by date and has been limping with daily maintenance for weeks and I was just seeing how long it could stay up for with present limits on concurrent apache processes. The answer is less than 36 hours with nasty net out there checking anything that serves php. Oh well. [[User:Mlj|Mlj]] 22:11, 10 February 2017 (UTC) :::::::::::::::::Blame today's outage on not being able to cope with all those attempts to exploit wordpress vulns in the news but the truth is our LAMP is beyond its sell by date and has been limping with daily maintenance for weeks and I was just seeing how long it could stay up for with present limits on concurrent apache processes. The answer is less than 36 hours with nasty net out there checking anything that serves php. Oh well. [[User:Mlj|Mlj]] 22:11, 10 February 2017 (UTC)  +::::::::::::::::::Another predictable crash due to memory leak. Just wish some processes were not active that really should not have been as root when I went in. Will look at logs now back up.23:56, 16 March 2017 (UTC) ==pubmed_caption_finder== ==pubmed_caption_finder== This has to be updated given PubMed's shift to https from tomorrow. From today it will generate https references BUT  the module still uses http call in php (as https call not recognised) to get all the info. This will no doubt change and give us message "Unable to contact Pubmed. This may be transient - please try again later. If this error recurs, please contact a ganfyd admin." If in due course I can enable php to do https I have version 20 of the module uploaded and ready to go and replace present version 21 (we were on version 19 before today) Cheers[[User:Mlj|Mlj]] 18:37, 26 September 2016 (BST) This has to be updated given [...]