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At the start of 2006, two schools of thought contended over the future of Australia’s defence and strategic policy. On one side stood those who believed that Australia’s principal strategic risks and challenges over the following decades would come from instability on the margins of the international order – from weak and failing states, and from non-state actors, especially terrorists. On the other side stood those who believed that bigger and more important strategic concerns arose from the possibility that the core of the international order would be disrupted by the stresses flowing from changing economic relativities. This was especially true in Asia, as China and other Asian states’ economies grew.
As 2001 opened, security and defence issues were already more central to Australia’s national agenda, both domestically and internationally, than had typically been the case over the previous three decades. Only a few weeks before the start of 2001, on 6 December 2000, Prime Minister John Howard had tabled in Parliament a new Defence White Paper. Defence 2000: Our Future Defence Force committed his government to a new and more expansive conception of Australia’s strategic interests and military objectives and to substantial and sustained increases in defence funding. These decisions were in part a prudent policy response to long-term strategic and fiscal trends stretching back a decade or more. But the tone and style as well as the content of the White Paper clearly showed that, for Howard, security was also at the centre of the government’s political agenda at the start of what was certain to be a federal election year.
Behavioural and Psychological Symptoms of Dementia (BPSD) include a range of neuropsychiatric disturbances such as agitation, aggression, depression, and psychotic symptoms. These common symptoms can impact patients’ functioning and quality of life. Antipsychotic medication can be prescribed to alleviate some symptoms, but this comes with significant risks including cerebrovascular events and increased mortality. We aimed to review antipsychotic prescribing of the Harrogate Older Adult Community Mental Health Team (CMHT); to measure compliance with NICE guidance and local policy and thus improve the prescribing and monitoring process.
Methods
Using electronic patient records, we identified all patients under the care of the CMHT with a diagnosis of dementia currently receiving antipsychotic treatment; a total of 55 patients. A random sample of 24 patients were reviewed; their records were hand searched for relevant information.
The standards measured were derived from the NICE Guideline (NG97) June 2018: ‘Dementia: assessment, management and support for people living with dementia and their carers’ as well as local trust guidance.
Results
All 24 patients were receiving antipsychotics for severe distress or aggression. 88% of patients had an assessment of sources of distress before treatment was started, but only 42% had a non-pharmacological intervention before antipsychotic treatment was started. Once antipsychotic treatment had started this increased to 58%. For some patients, the reason for not receiving a non-pharmacological intervention was due to urgency of treatment or being on a waiting list for occupational therapy, but for most the reason was not explicitly documented.
For 63%, there was evidence of a discussion of the risks of treatment with the patient, carer or family member. 63% had initial baseline blood tests and 54% had a baseline ECG. Of the patients who did not have initial monitoring, a suitable reason was given for just over 60%. Only 33% of patients who had antipsychotic treatment for over 12 weeks had a trial of discontinuation or dose reduction. Less than 22% of patients had physical health monitoring at one year of treatment.
Conclusion
There were shortfalls in several areas including the offer of non-pharmacological interventions, regular review of the ongoing need for antipsychotics, and physical health monitoring.
Introduction of a checklist before antipsychotics are prescribed is recommended, to include discussion of risks and benefits, non-pharmacological interventions, and initial monitoring. Also recommended is a system to identify when monitoring and review of antipsychotics are due.
From grassroots conflicts to great power relations, this book explores some of the key concepts, methodologies, and dilemmas of researching Asia-Pacific affairs. The book deals with key questions about the Asia Pacific: Why should we study policy from the "ground up"? What are the human considerations for societies in conflict? Why is regionalism important and how do global powers play a role? Should Asia-Pacific researchers embrace the design-based revolution in the social sciences? Muddy Boots and Smart Suits is for students, scholars, and policymakers in the region looking for a new way to understand local, regional, and global security challenges.
By
Hugh White, Professor of Strategic Studies in the Strategic and Defence Studies Centre at the Australian National University (ANU)'s Coral Bell School of Asia Pacific Affairs.
The study of international relations today faces a formidable methodological problem: how to understand the role of power in relations between powerful states, and especially in the creation, maintenance, and decline of the international orders which frame those relations within groups or systems of states from time to time. The problem extends to explaining the role of power in general, but it is most acute in relation to power in its starkest form — military power. That is the focus of this chapter. It explores the role of military power in shaping orders in systems of states.
This is hardly a new question. Military power has been central to the conduct and study of international relations since states and state systems first emerged. But today it is poorly understood and its influence on current developments is generally underestimated, especially perhaps by analysts and decision makers in the West. This has big implications for our understanding of the choices that countries of the West now face, and of the risks they may confront at a time when, it is now generally accepted, we face a significant shift — or set of shifts — in international order. These choices and risks bear upon Australia as much as on any Western country, and perhaps more than on most. It therefore seems important, for very practical reasons, to make sure we refresh our understanding of the role of force in shaping international orders.
This chapter suggests a simple way to see this issue: an international order in a system of states is framed — its boundaries are defined — primarily or ultimately by what the great powers within the system are willing to go to war with one another over. Or, to be a little more precise, an order is framed by what the great powers can convince one another they are willing to go to war with one other over. One obvious example is the bipolar global order of the Cold War era, which was framed by the clear conviction on each side of the other's willingness to go to war to defend their established spheres of influence in the key European and Northeast Asian theatres.