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PubMed2004

Entangled identities and psychotropic substance use.

This paper reports the findings of a grounded theory study investigating drug users' concerns and experiences of their oral health. The aim of this paper is to demonstrate how the findings relate to various strands of literature which focus on processes and discourses of recovery from problematic drug use (biographical reconstruction), the chronic illness literature (biographical disruption), public/private discourses and the myth of addiction. Data were collected from four focus groups containing a total of 25 participants, and 15 in-depth interviews. Participants were recruited from drug detoxification programmes (27), recovery units following detoxification (9) and a drug rehabilitation unit (4). Data analysis revealed that the core concern of drug users' was talking about the 'entangled' nature of their identity whilst they were on drugs. Such 'entangled identities' emerged through what appeared to be a gradual sedimentation process of drug-using habits and routines that replaced those of the everyday self. Other concerns were distancing one's self from the drug using self (involving expressions of disgust) and recovery processes (disentangling). The paper discusses each of these core problems in the light of the literature on the recovery from drug use, the chronic illness literature and the myth of addiction. It concludes by briefly reflecting on problematic psychotropic substance use as another form of biographical disruption formed on the basis of a dialectic between private discourses of the entangled self and public discourses of addiction. It suggests that further work should be conducted in these areas.

Adaptation, Psychological↗

PubMed1995

Developing EDI messages and supporting data models: a "bottom up" approach based on "single business purpose" messages meets user needs.

Electronic Data Interchange (EDI) is increasingly being used for the exchange of patient, administrative, and clinical information. There is work in Europe and the United States directed at describing a preferred approach to the task of defining and modeling the information content of standard EDI messages. The literature is currently silent about the criteria for selecting the scope of an individual message. This paper argues the case for developing a larger number of discrete, simpler single purpose messages, rather than "superset" framework messages. The paper also questions the validity of the currently prevailing view that EDI messages should draw their initial content and business purpose from an already predefined model purporting to be "the model of the healthcare delivery system." The paper also examines the ongoing work on defining EDI scenarios of the Open EDI Group [1], which is developing an Open EDI Reference Model Standard on experience gained in using the approach to message development advocated in CR 1350:1993 [1] and the early experience in gaining user acceptance of the first messages developed using this approach.

Computer Communication Networks↗

PubMed1995

Simulation in computer of the mechanical ventilator Servo 900C made by Siemens Elema.

In our country, Intensive Care Units (ICU) for both adults and children include medical equipment of high technology that saves the lives of patients in critical condition. Many of these patients for different pathologies need the use of a mechanical ventilator which keeps the patient's respiration and allows the medical staff to assist them with other means. In practice, there are a lot of different situations that the medical staff have to face and make adequate decisions that will help save the patients' lives. In this case, the mechanical ventilator must be used, requiring a great deal of experience acquired along many years of work. The mechanical ventilator SERVO 900C made by Siemens Elema is available in all ICUs; this equipment is used for the treatment of more critical patients due to his reliability and technical features. Based on this fact, a simulator was designed to help train the less experienced staff in the use of the ventilator and to allow them to face real case simulations, making decisions that will be adequate or wrong with no risk to the patient's life. In this way, they would acquire the necessary knowledge on how to use the equipment in real-life situations. The created system displays the control panel of the ventilator allowing the user to interact. The control panel includes both analogical and digital devices that show different parameters and also the gases mixer which is connected to the equipment. During the work, the user can access a calculator to facilitate the adjustment of some parameters in case any calculation is needed. The system is divided into modules. The module "Exercises" permits you to choose one out of a set and solve it by means of the adjustment of the controls; this answer is analyzed and warning messages are displayed in case a control has been set incorrectly. The aim of these exercises is that the users learn how to handle the equipment by parts and are conceived for a sequence of question-answer. The module "Problems" describes the condition of a given patient which must be treated with the ventilator. The user will then simulate his performance in the adjustment of it. The sequence question-answer will change dynamically according to the evolution previously previewed for the patient by the professor. The simulator has a set of acoustic and visual alarms which are activated during the occurrence of different anomalies. These alarms work according to the professor's will at the moment of planning the lesson. The module "Information" gives the user the possibility of consulting topics about the equipment such as: functions, patient's safety, installation, clinical judgment and location of failures. In the last module "Options" the user defines the files (exercises or problems) he is going to use as well as the directory of work and the initialization file. The system uses pull-down menus, providing a context-sensitive on screen help with information about the function of each control and how to handle it. For the preparation of the files of exercises and problems only Servo editor can be used; this editor works independently from the simulator. The system requires a PC IBM Compatible with 640 kb RAM, MS-DOS operating system, and VGA color display. We consider that with the implementation this system the user can gain experience and knowledge about the use of the ventilator before he faces real situations.

Adult↗

PubMed2003

Psychostimulant dependence in a community sample.

OBJECTIVE: To examine the prevalence of psychostimulant dependence and the characteristics associated with nonmedical users' development of dependence. METHODS: The study sample was drawn from the 1995 to 1998 National Household Surveys on Drug Abuse. Statistical analysis was conducted on a total of 1047 individuals aged 12 or older who reported nonmedical use of stimulants in the past year. Multiple multinomial logistic regression identified factors related to stimulant dependence and dependence problems. RESULTS: Among all past year stimulant users, 19% met criteria for stimulant dependence in the past year, and an additional 16% reported having one to two dependence problems. Adjusting for demographics and drug use characteristics, female stimulant users were an estimated 2.6 times more likely than male users to develop dependence. Not only did the Western region of the United States have more recent stimulant users than other regions, its users also were more likely to meet criteria for dependence or experience dependence problems. Stimulant users who had increased odds of progressing into dependence were characterized by an early onset of stimulant use, coexisting multiple illicit drug use, and an onset of daily cigarette smoking between the ages of 13 and 17 years. CONCLUSIONS: Gender differences in initial stimulant use and progression to dependence require further investigation, including contextual, cultural, or perceptual factors related specifically to the choice of drugs by females.

Adolescent↗

PubMed2003

Traumatic stress and gender differences in relationship to substance abuse, mental health, physical health, and HIV risk behavior in a sample of adolescents enrolled in drug treatment.

Research on traumatic stress (TS) among adolescent substance users is limited, with research indicating that not all adolescents who experience trauma are substance users and not all adolescent substance users report symptoms of TS. In the general adolescent population, research on TS symptoms indicates gender differences, with more females reporting traumatic life events and more symptoms associated with traumatic stress. A gap in research exists, however, with regard to gender differences among adolescent substance users who report low versus acute levels of TS symptoms. This study included 274 male and 104 female adolescents enrolled in four drug treatment programs in Arizona. Comparisons between males and females and those with low versus acute levels of TS symptoms were examined with regard to substance use, mental health, physical health, and HIV risk-taking behavior. Results indicate significant differences between males and females and between those reporting low versus acute TS. In general, females and those with acute levels of TS symptoms had higher levels of substance use, mental health, and physical health problems as well as greater HIV risk behaviors when compared to males and those with low levels of TS symptoms. Results of this study indicate the need to assess adolescents for TS, including victimization and maltreatment histories, when entering substance abuse treatment and the need to simultaneously address issues of substance use, TS, and related mental health, physical health, and HIV sex risk behavior while in treatment.

Adolescent↗

PubMed2002

Research and development at the health and social care interface in primary care: a scoping exercise in one National Health Service region.

The present project aimed to identify research activity at the health and social care interface in primary care within one National Health Service region, and to determine levels of research capacity and support within social services. The study was commissioned by a primary care research network (PCRN) in order to assess opportunities to increase research capacity within social services. Data were collected in two phases from 61 managers, team leaders and senior practitioners in social care, and six public health representatives in health authorities, using telephone interviews and focus groups. The findings highlighted a lack of infrastructure and support for research and development in social care. However, many social care respondents wanted opportunities to develop research skills with healthcare colleagues. Despite poor support, many small-scale projects were described, and many respondents showed an enthusiasm for engaging with research. Methods in use included surveys, action research, needs analysis and evaluation of service developments. Many examples of user involvement were given. Interface projects were usually instigated by interagency forums and funded from multiple sources. Most project work was motivated by service improvement or development, rather than aiming to produce generalisable knowledge. Barriers to conducting research included lack of confidence, research skills and time, as well as workload demands, lack of cover to release staff for research and lack of supervision. Research was not seen as legitimate work in some social care environments or as part of a career path. Existing joint working initiatives (such as the National Service Frameworks) were highlighted as flashpoints for potential research and evaluation activity. The findings suggest clear opportunities for PCRNs to develop research capacity at the interface with social care; for example, by signposting available resources, providing training grants and secondments for social care staff, and supporting interagency networks with a focus on evaluation. In turn, experience in promoting user involvement in social services could add value to research expertise at the primary care-social care interface.

Cooperative Behavior↗

PubMed2005

General practitioners' use of online evidence during consultations.

BACKGROUND: Clinicians have many unanswered questions during clinical encounters which may impact on the quality and outcomes of decisions made. Provision of online evidence at the point of care is one strategy that provides clinicians with easy access to up-to-date evidence in clinical settings to support evidence-based decision-making. AIM: To determine if and when general practitioners use an online evidence system in routine clinical practice, the type of questions for which clinicians seek evidence and the extent to which the system provides clinically useful answers. DESIGN OF STUDY: A prospective cohort study which involved a 4-week clinical trial of Quick Clinical, an online evidence system specifically designed around the needs of general practitioners. SETTING: Two hundred and twenty-seven clinicians who had a computer with Internet access in their consulting rooms. METHODS: Computer logs and survey analysis. RESULTS: One hundred and ninety-three general practitioners used the online evidence system to conduct on average 8.7 searches/month. The majority of these (81%) were conducted from consulting rooms and carried out between 9a.m. and 7p.m. (83%). The most frequent searches conducted related to diagnosis (40%) and treatment (35%). 83% of clinicians believed that Quick Clinical (QC) had the potential to improve patient care, and one in four users reported direct experience of improvements in care. In 73% of queries with clinician feedback participants reported that they were able to find clinically useful information during their routine work. CONCLUSION: General practitioners will use an online evidence retrieval system in routine practice, and report that its use improves the quality of patient care.

Adult↗

PubMed2002

Determinants of loneliness of young adult drug users.

Loneliness is a subjective experience that is influenced by such variables as personality, life experiences, and situation. In the present study, the author examined the connection between the use of ecstasy (MDMA) and the antecedents of loneliness. MDMA users were compared with non-MDMA drug users and with a group of young adults in the general population who did not use drugs. A total of 818 participants from all 3 groups volunteered to answer a 30-item yes-no questionnaire reflecting on their experiences of loneliness and what caused them. Results showed that the predominant causes of loneliness were personal inadequacies, developmental deficits, unfulfilling intimate relationships, relocation or significant separations, and social marginality. There were significant differences between the scores of the MDMA users and scores of the other groups. Gender differences between and within groups were also examined.

Adolescent↗

PubMed2003

Simulation of functional neuromuscular stimulation assisted sit-to-stand movements.

Functional neuromuscular stimulation (FNS) has the potential to enhance the capability for individuals with a spinal cord injury (SCI) to perform activities of daily living. Individuals with SCI have successfully used FNS to stand, but the transition from sitting to standing is often awkward and may require excessive amounts of arm support. The long-term goal of this research project is to provide stimulation patterns that reduce the demands on an FNS user's arms and provide a smooth, stable sit-to-stand transition. A multi-segment, dynamic model has been developed to simulate different combinations of stimulated muscles and stimulation patterns. The model includes individualized anthropometric parameters, active and passive muscle and joint mechanics, and arm support forces (experimentally measured or an assumed pattern). Stimulated muscle properties were derived using SIMM software (Musculographics, Chicago, IL), and the simulations were run in Matlab (Mathworks, Natick, MA). Initial simulation results have estimated that ramped stimulation of the vastus lateralis and semimembranosus muscles reduces the peak vertical arm support forces from 91% to 42% of body weight as compared to unassisted sit-to-stand. Kinematic results also suggested that the hand support forces remained excessive due to a lack of joint coordination and insufficient ankle joint stiffness. In further simulations, additional muscles will be stimulated to increase joint stiffness and stimulation patterns will be designed to mimic able-bodied sit-to-stand motions. This model will be validated and improved using results of sit-to-stand experiments with FNS users once an optimized set of muscles and stimulation patterns has been determined.

Arm↗

PubMed2003

Perceptions on the development of a care pathway for people diagnosed with schizophrenia on acute psychiatric units.

Policy development and practice for hospital mental health care has shifted towards a user-focused and evidence-based direction. Important within this policy development has been a guideline for inpatient care, particularly the establishment of an inpatient Acute Care Forum. A vehicle to both commission and develop this agenda is the Implementation of a care pathway. A research study was designed to explore how a care pathway could be developed for inpatients diagnosed with schizophrenia. Interviews with a range of health care professionals and observation of the process of care pathway development were the data-collection tools. Analysis was driven by emergent themes across the data set. Themes were then presented as one possible interpretation of the factors to be considered for the development of a care pathway for people diagnosed with schizophrenia. Clinicians experienced many difficulties in finding and including evidence-based practice (EBP) within a care pathway. Professions on the whole felt that there was a certain futility to psychiatric care given the paucity of evidence to support practice. This may contribute towards the poor use of hospital care as a therapeutic intervention as part of the wider spectrum of care. Difficulties arise when trying to develop a care pathway with EBP, given the paucity of knowledge on why certain interventions are only partially effective. The development of a care pathway may inform the priorities of the inpatient Acute Care Forum for people diagnosed with schizophrenia. A care pathway should not be constrained, however, to EBP and should incorporate therapeutic activities to improve the overall experience of service users. Limitations on the study and the collection of evidence supporting these conclusions conclude the paper.

Attitude of Health Personnel↗

PubMed1990

Being positive: drug injectors' experiences of HIV infection.

There is a growing concern within Britain, Europe and North America that injecting drug users may pose the greatest risk of transmitting HIV infection to the wider heterosexual non-drug injecting population. However, we know very little about the reactions of injecting drug users to the knowledge of being HIV positive and thus are hampered in our attempts at estimating the actual risks such individuals pose to others. This paper is based upon interviews with 26 seropositive injecting drug users and examines their experiences in relation to the following areas: (1) hearing the news; (2) communicating the diagnosis to others; (3) current drug use and sexual behaviour; and (4) perceptions of the future. It is shown that injecting drug users have a wide range of responses in relation to each of these areas and while the implications for their care and counselling are drawn out it is suggested that the fact of this variability undermines any single approach to patient or client management.

Adaptation, Psychological↗

PubMed2006

Nursing and public participation in health: an ethnographic study of a patient council.

BACKGROUND: Conceptualisations of the nurse-patient relationship tend to view nursing as embodying an empowering approach to patients, one that places the service user perspective at the centre of decision-making. However, the relationship of nursing to public participation in health service planning and development has been under examined. AIMS: The aim is to explore the relationship of the nursing profession to public participation as enacted through a UK-based patient and public council, located in an acute hospital. The council was developed by nursing staff and aimed to achieve service user participation in strategic level health care decision-making. The views and experiences of participants and the applicability of the 'nurse-patient partnership' construct to public participation are considered. METHODS: The study employed integrative ethnography, involving multiple field methods: non-participant observation of council meetings, i.e. fourteen 3 h meetings (n=42 h); in-depth interviews with councillors (n=17) and with key hospital staff (n=18). A documentary review and mapping of the actions of the council was undertaken. RESULTS: A nurse-patient partnership was not initially intrinsic to the operation of the council or embedded in the perspectives of the nurse or patient participants. Professional vulnerability and the organisational context constrained the nursing response. Councillors and nursing staff moved to create a shared set of understandings in order to progress change in service organisation and delivery. Nurses' repositioning vis-à-vis the credibility of user experiences and status was central to the effective progression of the council. CONCLUSIONS: Partnership in public participation requires a shift by nurses' towards acceptance of members of the public functioning as informed, critical and powerful agents in health care decision-making. Equipping nurses with the skills to communicate with patient representatives in a position of interactional equality is likely to be a pre-requisite for successful engagement by nursing with public participation.

Anthropology, Cultural↗

PubMed2002

Appreciating the user's perspective: listening to the "methadonians".

Researchers have long neglected the user's perspective and experiences in assessing drug effects and drug use. With increased interest in Canada directed at prescribing heroin in place of methadone, researchers took the relatively unique approach of gathering data and information from methadone users to determine their views and experiences with methadone programs and alternative treatment choices. The results of that research portrayed very interesting and useful notions of users regarding methadone maintenance and the prescribing of heroin.

Canada↗

PubMed2007

Presentation and management of major complications of midurethral slings: Are complications under-reported?

AIMS: Midurethral slings have become the mainstay of stress urinary incontinence (SUI) treatment due to their efficacy and low complication rates. The purpose of this study was to report the presentation and treatment of major complications from these minimally invasive treatments presented to a tertiary referral practice and to highlight a discrepancy in major complications between literature and the food and drug administration (FDA) device failure database. METHODS: From 2001 through 2005, we reviewed all cases of midurethral sling complications that presented to our institution. A literature review of all complications due to midurethral slings during the same time period was performed as was the FDA manufacturer and user facility device experience (MAUDE) database queried for self-reported complications. RESULTS: A total of 26 patients referred to UCLA with voiding dysfunction after sling placement was found to have mesh in the urethra or bladder. Treatments required a combination of urethrolysis with mesh removal, urethral reconstruction with graft, and bladder excision. These were compared to major complications reported in the world literature of <1%. The MAUDE database contained 161 major complications out of a total of 928 complications reported for suburethral slings. There was significantly more major complications reported in MAUDE than in published literature. CONCLUSIONS: Although rare, major complications of midurethral slings are more common than appear in literature. Devastating complications involving urethral and bladder perforations can present with mild urinary symptoms and thus are likely under-diagnosed and under-reported. Most of these cases need to be managed with additional reconstructive surgery.

Databases, Factual↗

PubMedDate not supplied

Bsoft: image and molecular processing in electron microscopy.

Software for the processing of electron micrographs in structural biology suffers from incompatibility between different packages, poor definition and choice of conventions, and a lack of coherence in software development. The solution lies in adopting a common philosophy of interaction and conventions between the packages. To understand the choices required to have such common interfaces, I am developing a package called "Bsoft." Its foundations lie in the variety of different image file formats used in electron microscopy-a continually frustrating experience to the user and programmer alike. In Bsoft, this problem is greatly diminished by support for many different formats (including MRC, SPIDER, IMAGIC, SUPRIM, and PIF) and by separating algorithmic issues from image format-specific issues. In addition, I implemented a generalized functionality for reading the tag-base STAR (self-defining text archiving and retrieval) parameter file format as a mechanism to exchanging parameters between different packages. Bsoft is written in highly portable code (tested on several Unix systems and under VMS) and offers a continually growing range of image processing functionality, such as Fourier transformation, cross-correlation, and interpolation. Finally, prerequisites for software collaboration are explored, which include agreements on information exchange and conventions, and tests to evaluate compatibility between packages.

Computer Systems↗

PubMed1997

[Evidence-based medicine].

New instruments are required to allocate the available resources to services which are not only effective but also beneficial to the patients. These instruments are needed to manage the huge amount of new information in medicine and to appraise its quality. Evidence-based medicine (EBM) provides these instruments to find the relevant literature, to appraise its quality and to merge it with the user's clinical experience. EBM is different from "conventionally best medicine (CMB)" of four levels; conditions of clinical action, teaching goals, medicine at the patient, and goals of continued medical education. We can increase our chances to benefit from medical progress if we use these new instruments.

Cost-Benefit Analysis↗

PubMed1988

Caffeine physical dependence: a review of human and laboratory animal studies.

Although caffeine is the most widely used behaviorally active drug in the world, caffeine physical dependence has been poorly characterized in laboratory animals and only moderately well characterized in humans. In humans, a review of 37 clinical reports and experimental studies dating back to 1833 shows that headache and fatigue are the most frequent withdrawal symptoms, with a wide variety of other signs and symptoms occurring at lower frequency (e.g. anxiety, impaired psychomotor performance, nausea/vomiting and craving). When caffeine withdrawal occurs, severity can vary from mild to extreme (i.e. incapacitating). The withdrawal syndrome has an onset at 12-24 h, peak at 20-48 h, and duration of about 1 week. The pharmacological specificity of caffeine withdrawal has been established. The proportion of heavy caffeine users who will experience withdrawal symptoms has been estimated from experimental studies to range from 25% to 100%. Withdrawal symptoms have been documented after relatively short-term exposure to high doses of caffeine (i.e. 6-15 days of greater than or equal to 600 mg/day). Although animal and human studies suggest that physical dependence may potentiate the reinforcing effects of caffeine, human studies also demonstrate that a history of substantial caffeine intake is not a necessary condition for caffeine to function as a reinforcer. The similarities and differences between caffeine and classic drugs of abuse are discussed.

Animals↗

PubMed1993

Oral contraception in the former Czech and Slovak Federal Republic: attitudes and use.

This paper presents and discusses data on oral contraception from a national representative survey (n = 1072) on knowledge, attitudes and practice with regard to contraceptive use in the Czech and Slovak Federal Republic (CSFR). Only 7% of the women at risk of unplanned pregnancy used the pill. The low rate of use seems to be due to the general negative image of oral contraception, reinforced by the experiences of past users and opinions expressed by relative, friends, doctors, and the media. In particular, perceived psychological disadvantages have an important bearing on the decision not to use the method, whereas perceived advantages have hardly any impact. It is likely that this negative image is closely linked with the types of oral contraceptives that have been available in the country and also with the limited choice. Second- and third-generation oral contraceptives have only very recently become available. It is recommended that balanced information on the advantages and disadvantages of oral contraception be made available to doctors and to the general public on a large scale and through a variety of channels.

Adolescent↗