Maintenance prescribing

Ghodse (1983), describing the use of time-limited detoxification contracts, states There is obviously a risk of relapse and repeated contracts may be necessary. This raises the question of what is the distinction between repetition of time-limited contracts and longterm or maintenance prescribing. 

It is unfortunate that the term flexible prescribing seems to have rapidly come to be associated with maintenance prescribing , since any one approach to prescribing (whether maintenance or withdrawal) cannot, by definition, be very flexible. However, it is probably inevitable that a move from current clinic policies toward a more flexible approach would increase the number and length of extended prescriptions offered, and this has a number of implications which require consideration and evaluation. 

We now analyze the braking decisions for the wind turbines. We see in Table 1 that at the beginning of the maintenance period, no braking is ever employed in the farm. This is intuitive as remaining wind turbines should be in sufficient condition such that braking is not warranted. Table 2 shows the portion of the policy where p= 0.5. Note that there is no maintenance prescribed here for any of... 

MaintainabiUty is a characteristic of design, installation, and operation, usually expressed as the probabiUty that a system can be restored to specified operable conditions within a specified interval of time when maintenance is performed in accordance with prescribed procedures. The ease of fault detection, isolation, and repair are all influenced by system design and are principal factors contributing to maintainabiUty. Also contributing is the supply of spare parts, the supporting repair organization, and preventative maintenance practices. MaintainabiUty must be designed into the equipment. Some factors to consider foUow. 

The best dmg candidates for incorporation into prolonged action systems are uniformly absorbed throughout the gastrointestinal (GI) tract, have medium (2—8 h) biological half-Hves, and are prescribed for chronic maintenance use. Dmgs in large doses are difficult to formulate into such products... 

Operating experience has proven that unless a continuous program of required lubrication is followed, even the most well-designed units are sure to fail. A proper lubrication management program must incorporate a monthly lubrication schedule, an evaluation of new lubrication products, and supervision to ensure the prescribed procedures are carried out by maintenance personnel. 

Maintenance of records to demonstrate compliance with the prescribed regulations and effective operation of the management system... 

Effective shutdown management depends on absolute adherence to prescribed standards that define what type of work will be done during scheduled shutdowns. These decisions can not be made by the maintenance planner alone. To aid in the selection, planning and implementation of outage tasks, a management team is a fundamental requirement. This team should be composed of ... 

The expected outcomes for the patient may include an optimal response to therapy, maintenance of adequate nutrition, management of common adverse reactions, and an understanding of and compliance with the prescribed therapeutic or prevention regimen. 

TCAs Once-a-day dosing may be prescribed for maintenance therapy. When the nurse administers the total daily dosage at night, the sedative effects promote sleep, and the adverse reactions appear less troublesome Because protriptyline may produce a mild stimulation in some patients, it is usually not given as a single bedtime dose... 

Anxiety disorders are common in the population of opioid-addicted individuals however, treatment studies are lacking. It is uncertain whether the frequency of anxiety disorders contributes to high rates of illicit use of benzodiazepines, which is common in methadone maintenance programs (Ross and Darke 2000). Increased toxicity has been observed when benzodiazepines are co-administered with some opioids (Borron et al. 2002 Caplehorn and Drummer 2002). Although there is an interesting report of clonazepam maintenance treatment for methadone maintenance patients who abuse benzodiazepines, further studies are needed (Bleich et al. 2002). Unfortunately, buspirone, which has low abuse liability, was not effective in an anxiety treatment study in opioid-dependent subjects (McRae et al. 2004). Current clinical practice is to prescribe SSRIs or other antidepressants that have antianxiety actions for these patients. Carefully controlled benzodiazepine prescribing is advocated by some practitioners. 

Automatic process control involves the maintenance of a desired value of a measured or estimated quantity (controlled variable) within prescribed limits (deviations, errors), without the direct action of an operator. Generally, this involves three steps ... 

The guiding principles in test plot maintenance are to (1) minimize soil surface disturbance at all times, (2) ensure that control and treated plots are similarly maintained, (3) avoid applying other agrochemicals that may interfere with sample analysis or that are otherwise contrary to the purpose of the study, (4) follow the prescribed irrigation policy determined for the study site, and (5) keep bare-soil test plots free of vegetation, as follows. 

Consider initiation of buprenorphine or methadone maintenance treatment for opioid dependence. In the United States buprenorphine is easier to arrange since physicians can be approved to prescribe buprenorphine following a short course of federally-approved training. 

Divalproex sodium is comprised of sodium valproate and valproic acid. The delayed-release and extended-release formulations are converted in the small intestine into valproic add, which is the systemically absorbed form. It was developed as an antiepileptic drug, but also has efficacy for mood stabilization and migraine headaches. It is FDA-approved for the treatment of the manic phase of bipolar disorder. It is generally equal in efficacy to lithium and some other drugs for bipolar mania. It has particular utility in bipolar disorder patients with rapid cycling, mixed mood features, and substance abuse comorbidity. Although not FDA-approved for relapse prevention, studies support this use, and it is widely prescribed for maintenance therapy. Divalproex can be used as monotherapy or in combination with lithium or an antipsychotic drug.31... 

Hj antihistamines are the most commonly prescribed medications for AR. Hj antihistamines bind to and stabilize the Hj histamine receptor, thereby inhibiting mast cell and basophil mediator release and resulting in reduction of sneezing, itching, rhinorrhea, and ocular irritation. Antihistamines do not prevent histamine release, nor do they bind to already-released histamine. For this reason, maintenance therapy is considered optimal. However, antihistamines are also effective when taken on an as-needed basis.4,11,12 Antihistamines only minimally... 

Prescribing of psychotropic drugs, such as antipsychotics, antidepressants, anxiolytics and mood stabilizers, is common in psychiatric inpatients for acute and maintenance treatment of psychiatric illness. 

Corticosteroids (e.g., beclomethazone, flunisolide, triamcinolone) have anti-inflammatory and immunosuppressant actions. These drugs are used prophylactically to prevent the occurrence of asthma in patients with frequent attacks. Because they are not useful during an acute attack, corticosteroids are prescribed along with maintenance bronchodilators. These drugs are also administered by inhalation. Cromolyn is another anti-inflammatory agent used prophylactically to prevent an asthmatic attack. The exact mechanism of action of cromolyn is not fully understood however, it is likely to involve the stabilization of mast cells. This prevents the release of the inflammatory mast cell mediators involved in inducing an asthmatic attack. Cromolyn has proven effective in patients with exercise-induced asthma. 

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