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"The Missing Links: Why Hyperlinks Must Be Treated as Attachments in Electronic Discovery" is an article that explores the challenges and complexities of handling hyperlinked documents in electronic discovery. It discusses the history of electronically stored information (ESI) in civil litigation discovery and emphasizes the importance of attorneys understanding their clients' information systems and digital data. The article criticizes a court decision that concluded hyperlinked documents are not attachments and argues that they should be treated as such in certain circumstances. It also discusses court cases that have addressed the burden of producing hyperlinked documents and suggests using automated methods or a case-by-case approach to handle them. The article concludes by emphasizing the need for parties to address the issue cooperatively to avoid disputes. [Extracted from the article]

Insomnia is a disturbance of normal sleep patterns. It is characterised by sleep onset latency and/or sleep maintenance. Short term insomnia is defined as having symptoms for less than 4 weeks, whilst long term insomnia is symptoms lasting more than 4 weeks. Hypnotics including the benzodiazepine and non-benzodiazepine (Z-drugs) can provide relief from the symptoms of insomnia; they do not treat any underlying cause. NICE guidance states "After consideration of the use of non-pharmacological measures, hypnotic drug therapy is considered appropriate for the management of severe insomnia interfering with normal daily life, it is recommended that hypnotics should be prescribed for short periods of time only, in strict accordance with their licensed indications". They also advise to use the lowest effective dose for the shortest period possible. Side effects are common with hypnotic usage. This includes most importantly developing tolerance and rebound insomnia. The aim of our project is to reduce hypnotic prescribing for patients on an Acute inpatient psychiatric ward. The ward is a Male ward containing 17 inpatient beds in the Northwest of England. The patients are 18 years onward with varying diagnosis. The reason for doing this project was most importantly for improving patient safety via reduction of unnecessary prescriptions and administration of medications, but also for cost and carbon footprint reduction of the NHS. Patients included in this project were inpatients on the selected ward between the 09/12/2020-20/01/2020 and 28/01/2020-10/03/2020. The interventions used to fulfil our aims included development of an educational presentation about Insomnia and sleep management, development of an Insomnia management flow chart to be used at admission point and at weekly reviews (Appendix 1), training session for ward staff, patient sleep hygiene and management educational sessions, face to face and email correspondence to inform medical trainees about this project and gathering feedback from patients and staff before and after this project. The data we collected included the specific Hypnotic medication, dose and quantity prescribed on the ward during these dates. With our interventions we have demonstrated a 44.5% reduction in hypnotic administration. This highlights the positive change the interventions have resulted in. This will improve patient safety by reducing the risk of side effects, and by reducing the number of patients being discharged on a regular prescription which will further reduce long term costs of hypnotic medications for the NHS. The small changes that we have applied have resulted in a massive improvement in our clinical care and patient safety, with the added benefit of a reduction in the pharmaceutical environmental impact that over prescribing can result in. [ABSTRACT FROM AUTHOR]

The use and efficacy of Doppler auscultation in assessing the status of the temporomandibular joint meniscus is described. The advantages of being noninvasive, readily available, portable, cost effective, and accurate make this a valuable adjunct to the present armamentarium. [ABSTRACT FROM AUTHOR]