Prescribing in liver disease

Abstract

Letters, which may not necessarily be published in full, should be restricted to not more than 250 words. When relevant, comment on the letter is sought from the author. Due to production schedules, it is normally not possible to publish letters received in response to material appearing in a particular issue earlier than the second or third subsequent issue. wider curriculum. The skills of the doctors providing training should also meet minimum standards. The doctors should be centrally funded for this role (at present in the UK nurses and pharmacists sometimes have to pay for themselves, or defer training until one of the small number of bursaries becomes available). In some states in the USA, pharmacists are certified by the same board as physicians, which aids local acceptability.Overall, there is a clear rationale to extend prescribing rights.While it needs continued evaluation, where it has been introduced it seems to have improved access, been liked and, on the evidence of a small number of case studies, been effective. Extending prescribing rights is also logical. The burden of knowledge associated with medicines is vast and expanding, so it makes sense to share the task of prescribing while retaining an integrated system of care.The role of the doctor is in a transition akin to that which theatre went through in the last century. The doctor's role has been like that of the great Victorian 'actor-managers' -controlling the whole show, making all the key decisions and being centre stage in the action. Medicine is getting too complex for that model to survive. Doctors should move to the equivalent of the theatre director of today. They can set direction, strategy and priorities, working with teams of colleagues, including non-medical prescribers.

Predicting drug interactions in addiction treatment

“…Accurate dose adjustment in liver impairment (cirrhosis or alcoholic hepatitis or both) is difficult because unlike in renal failure, a reliable predictor of hepatic drug clearance is lacking. Although standard tools for assessing severity of liver disease have been suggested (Child‐Pugh classification), they are not useful to guide dose adjustment in liver impairment . Rather, measures of clinical effects (desired, e.g.…”

“…Although standard tools for assessing severity of liver disease have been suggested (Child-Pugh classification), they are not useful to guide dose adjustment in liver impairment. 8 Rather, measures of clinical effects (desired, e.g. pain relief, and adverse, e.g.…”