Where are the leaders?

RE: Where are the leaders?

vetbl.locum — Thu, 23 Apr 2020 09:09:08 GMT

Maybe it is bull.

Your brother sounds a lot worse than our dear leader whose stay in hospital was alot shorter.

At least let us have a stirring video message to rouse the nation!

RGds

PS Yes there should be plan and Hancock is doing his best despite the bad hand he was given. Sunack seems to be stepping up.

RE: Where are the leaders?

Clive Ansell — Wed, 22 Apr 2020 05:08:26 GMT

[quote userid="11202" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221948"]

During a pandemic with more than a 1000 people dying a day, well before recommended by his doctor.

He is the leader and has a crisis to sort. He was not on ventilator and made of right stuff so yesterday

Rgds

[/quote]

Sorry, but that is bull.

Regardless of who or what he is, whether you like him or not, he has been/is very ill (we are told) and needs a proper period of rest, recovery and recuperation. One would not expect him back to work until he is fully recovered.

My brother developed a severe respiratory infection while he and I were in Nepal in 2001, he finished up with pneumonia and exudative pleurisy and was hospitalized on his return to the UK for 8 weeks, including about 5 days in ICU. It was a very debilitating illness in which he lost about 3 stone, and his full recovery took 18 months even with with good medical care and physiotherapy. No organism was ever found or cultured, and it was assumed to be viral.

Regarding BJ. There must be a contingency plan within any government in the even that the leader is suddenly incapacitated or died, or even killed. BJ isn't the government in his own right, he just leads it.

RE: Where are the leaders?

vetbl.locum — Wed, 22 Apr 2020 00:04:43 GMT

In normal times as long as required

During a pandemic with more than a 1000 people dying a day, well before recommended by his doctor.

He is the leader and has a crisis to sort. He was not on ventilator and made of right stuff so yesterday

Rgds

RE: Where are the leaders?

Rob Loxley — Tue, 21 Apr 2020 19:22:14 GMT

[quote userid="11202" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221891"]

Where is our Leader?

Still at country retreat with his current love and his girl friend?

[/quote]

How long after being in intensive care should one be expected to be back at one's desk?

RE: Where are the leaders?

Anthony Todd — Tue, 21 Apr 2020 11:26:42 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221377"]Manufacturing and licensing of smaller bottles will prevent this I believe.[/quote]

Love to see any reasoning for that?

Could it be that there is less profit in smaller bottles as purchased quantities and therefore quantities and [waste] is sorry less, but I still make the point.

Bet there will be no contra argument except the self-serving "law"...............

RE: Where are the leaders?

vetbl.locum — Tue, 21 Apr 2020 09:17:34 GMT

Where is our Leader?

Still at country retreat with his current love and his girl friend?

Rgds

PS That wedding seating plan must be very tricky to sort.

RE: Where are the leaders?

Julian Earl — Wed, 08 Apr 2020 18:12:40 GMT

[quote userid="5904" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221565"]

Any dinovets report problems with drug integrity/safety/reactions back in the day???

The only problem remotely relevant was when I got thiopentone. outside the vein................

[/quote]

Not that I am a dinovet of course, having qualified just a few years ago in 1981, but i have always reported adverse reactions and failures. So much so, that somewhre I hav a letter from the VMD, thanking me for my enthusiasm in doing so! The letter dates back to the late 1980s.

Thiopentone, subcutaneously ?/ Not nice s it? Been there, done that, I'm sorry to say!

RE: Where are the leaders?

Anthony Todd — Wed, 08 Apr 2020 13:09:22 GMT

Don't worry, if it was financially advantageous the manufacturers would, and obviously did, do enough tests to satisfy practicing vets for years.

Every injection still had an expiry date!

Any dinovets report problems with drug integrity/safety/reactions back in the day???

The only problem remotely relevant was when I got thiopentone. outside the vein................

RE: Where are the leaders?

Iain Richards — Wed, 08 Apr 2020 10:52:56 GMT

and you have evidence that the preservatives don't degrade with time, don't react with the active with time, don't oxidise with time, don't become hygroscopic with time?
If not a 28 day, what time would be acceptable to you?

RE: Where are the leaders?

Anthony Todd — Wed, 08 Apr 2020 09:46:14 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221548"] "How does the VMD ensure that the products we use from multi-dose bottles remain sterile from first dose to last, given that the time interevals can be prolonged in low use products."[/quote]

By preserving the contents of the bottle using methods/chemicals used for many years prior to the EU and the ***ing EU inspired regs.

As for"evidence", just how would I be able to provide evidence when there is no current evidence of preserved injectables' previous safety in the past and little, apart from current human permissive guidelines.

Of course the contra evidence would be to show harm when the regs. are disregarded. None, thought not!!

Oh, forgot, it's OK for humans if you are careful......

RE: Where are the leaders?

Andrea Tarr — Wed, 08 Apr 2020 09:40:10 GMT

The 28-day rule is an international pharmaceutical standard for preserved sterile products. What is it that vets have allowed to happen? Is it that the VMR makes it an offence to use a product outwith the terms of the marketing authorisation (except when it can be clinically justified)?

RE: Where are the leaders?

Iain Richards — Wed, 08 Apr 2020 09:23:48 GMT

As I've said Anthony, get off your horse and drink your milk, sorry, that was John Wayne. I've suggested how you can take this on. Gather the evidence, present it to the VMD. WHile you are at it, answer the question, "How does the VMD ensure that the products we use from multi-dose bottles remain sterile from first dose to last, given that the time interevals can be prolonged in low use products."

RE: Where are the leaders?

vetbl.locum — Wed, 08 Apr 2020 08:35:52 GMT

"some investigative journalists"

If UK have any left, I suspect they may be busy with other stuff eg Russian report , PPE supplies etc

BTW I tend to agree with you that it is baloney but the profession allowed/ accepted/acquiesced to it

Rgds

RE: Where are the leaders?

Anthony Todd — Tue, 07 Apr 2020 17:35:15 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221535"]And most of us have learned to live with it and pass on the cost.[/quote]

I can't believe that vets with, probably the highest intelligence, but obviously the smallest bollocks, can accept this!!

It is baloney, backed by nothing, and I do hope some investigative journalists get hold of it and let's see how the great and the good, and your average practicing GPVET copes with the ordure which, rightfully, should fall on them!

RE: Where are the leaders?

Iain Richards — Tue, 07 Apr 2020 17:11:12 GMT

Well, given that a breach of the VMR is a criminal act, it could land you infront of the beak and the RCVS. It may well be wasteful, it may well be an utter pain, it may well have no logic (except a precautionary principle) but it is what it is. And most of us have learned to live with it and pass on the cost.

RE: Where are the leaders?

Anthony Todd — Tue, 07 Apr 2020 15:45:10 GMT

[quote userid="2675" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221515"]

Most of this legislation is protecting rear ends, not animal or client orientated at all.

Usual caveat - owner aware and in agreement

[/quote]

So why the yuck are 99.9 of MRCVSs just sighing and saying "it's the law".

Not the slightest evidence of harm or loss of efficacy, crikey all you vets, where's your mojo!!

Should be so easy to get evidence of the massive waste, oh 'hit no, forgot, it's passed on to the client, even if the bottle nearly full,m is fine and would have helped any injured in the Viet Nam war!

Jeepers, it's a very sad day, and arguably immoral, when a matter of EBVM is justified by "the cost is passed onto the client"!

RE: Where are the leaders?

Lucy Fleming — Tue, 07 Apr 2020 15:26:21 GMT

[quote userid="2675" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221515"] but they tried them and they all worked.[/quote]

This is probably very childish of me, but when I read this I thought it sounded like they tried the drugs themselves... (on themselves...)

RE: Where are the leaders?

Anthony Todd — Tue, 07 Apr 2020 15:06:52 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221526"]Otherwise, I'm afraid we are stuck with it.[/quote]

Come on, they abolished hanging so it can't be impossible!!

But you'll need evidence.

And

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221526"]It's reasonable to pass the charge to the client.[/quote]

Doesn't ring of EBVM to me, in fact just very very embarrassing to me, and I've retired!

RE: Where are the leaders?

Anthony Todd — Tue, 07 Apr 2020 15:02:47 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221525"]Anthony - VMR 2013, on the VMD web site.[/quote]

They are all so young, and attractive too, things have changed!

Is that the only point [although the badges look pretty strongly against something??

RE: Where are the leaders?

Iain Richards — Tue, 07 Apr 2020 14:55:17 GMT

[quote userid="2246" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221522"]allow the veterinary profession to use its discretion and make a risk assessment[/quote]

Well you might be able to use it under the cascade, but you'd have to have an excellent reason eg only bottle, no delivery till Tuesday because its a bank holiday.
Otherwise, I'm afraid we are stuck with it. It's reasonable to pass the charge to the client.

RE: Where are the leaders?

Iain Richards — Tue, 07 Apr 2020 14:52:51 GMT

Anthony - VMR 2013, on the VMD web site.

RE: Where are the leaders?

Anthony Todd — Tue, 07 Apr 2020 14:26:19 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221377"]Manufacturing and licensing of smaller bottles will prevent this I believe.[/quote]

And I wonder why?

Tish, silly me, it is regulation......

PS has anyone got access to the appropriate regulations, I'll bet they are not designed to be sensible obvious or straightforward nor any references to documented harm.

Lots of stuff about the bottles and the glass and the caps, not much reasonable!

RE: Where are the leaders?

jamie winstone — Tue, 07 Apr 2020 13:33:54 GMT

Richard`s reply does say it all. At the moment nearly all drugs are minimally used because we are only seeing emergencies. It just needs a bit of leadership to allow the veterinary profession to use its discretion and make a risk assessment. 28 days= O.K. 29 days and we are breaking some legislation or other.

Really the situation needs addressing. Come on RCVS or BVA or even the VMD.

RE: Where are the leaders?

Andrea Tarr — Tue, 07 Apr 2020 13:19:54 GMT

Most human injectables are single use. Multi-dose (preserved) is used for vaccination (of several individuals) and heparin analogues, growth hormone, insulin (multiple use in single individual). In human medicine they're grappling with a different problem - multi use of vials in different patients due to critical shortages, so they're developing protocols that take account of risk and transfer of product liability.

RE: Where are the leaders?

Andrea Tarr — Tue, 07 Apr 2020 13:12:57 GMT

[quote userid="12930" url="~/001/nonclinical/f/life-in-practice-discussions/28998/where-are-the-leaders/221511"]Dimazon (furosemide),but I don't throw it away unless there is a full-unbroached,in-date bottle physcailly sitting on the shelf behind it. Use very little of it, but not a drug you want to find yourself without at the wrong time![/quote]

Thanks. Surprising that Dimazon 10mL is the only authorised veterinary furosemide injection. I see it's authorised for horses and cattle as well as cats and dogs, so one size fits all.