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PubMed1999

The clinical skills resource: a review of current practice.

This review is based on the findings of the Southampton Clinical Skills Project, which was a needs assessment and feasibility study to consider the development of a multiprofessional Clinical Skills Resource at Southampton. The project spanned a period of 18 months and used a range of methods of data collection, including visits to 12 clinical skills facilities in the UK. Most existing clinical skills centres have developed in response to changing healthcare policy, curricular initiatives and increasing emphasis on the quality of assessments and competencies. There is also increasing recognition that clinicians are no longer able to teach effectively all skills to students in the traditional ways, and that clinical skills training and assessment, particularly for undergraduates, is an area of deficiency. The potential scope of clinical skills centres is broad and encompasses not only clinical and communication skills but medical informatics, computer assisted learning, multiprofessional learning and assessment. Skills centres can also promote self directed and lifelong learning methods. The planning of skills centres involves a variety of stakeholders and users, including undergraduates, postgraduates, acute and community Trusts, Postgraduate Deans and medical schools. A successful skills centre needs to be flexible in its design, integral to the curriculum and relevant to educational and training requirements. This requires planning, organization and resources. Different organizational models can be used, depending on local factors. The management of skills centres involves consideration of issues such as security, safety, supervision of learners and staff development, informed by a network of experts and everyday users. The development of skills centres should include ongoing educational evaluation of outcomes and educational research. The use of a clinical skills centre has potential benefits for staff and students, including the provision of a safe environment in which to learn and practise skills before using them in the real clinical setting. This can reduce anxiety in students and protect patients from novice practice. Clinical skills centres provide a setting for structured learning with feedback as well as assessment of competence. The limitations of a skills centre are that it can only provide simulated experiences which are an adjunct to, but can never replace real clinical experience.

Clinical Competence↗

PubMed1993

The effect of carbamazepine on the white blood cell count in cocaine abusers.

Various medication therapies have been attempted to assist in detoxification and abstinence maintenance among cocaine users. The safety of these medications in this unique population has not been documented. Carbamazepine, an anticonvulsant being used with this population, is known to cause leukopenia and agranulocytosis in seizure patients. Analysis of data involving two different populations of cocaine users treated with carbamazepine revealed no statistically or clinically significant changes in total white blood cell count, or in any component white cell, using endpoint analysis, lowpoint analysis, or regression analysis. These results should be reassuring to the addiction medicine clinician.

Adolescent↗

PubMed1999

Prevalence of Mycobacterium tuberculosis infection among injection drug users in Toronto.

BACKGROUND: Injection drug users are at increased risk of Mycobacterium tuberculosis infection and active tuberculosis (TB). The primary objective of this study was to determine the prevalence of M. tuberculosis infection among injection drug users in Toronto, as indicated by a positive tuberculin skin test result. An additional objective was to identify predictors of a positive skin test result in this population. METHODS: A cross-sectional study was carried out involving self-selected injection drug users in the city of Toronto. A total of 171 participants were recruited through a downtown Toronto needle-exchange program from June 1 to Oct. 31, 1996. RESULTS: Of 167 subjects tested, 155 (92.8%) returned for interpretation of their skin test result within the designated timeframe (48 to 72 hours). Using a 5-mm cut-off, the prevalence rate of positive tuberculin skin test results was 31.0% (95% confidence interval 23.8% to 38.9%). Birth outside of Canada and increasing age were both predictive of a positive result. INTERPRETATION: There is a high burden of M. tuberculosis infection in this population of injection drug users. The compliance observed with returning for interpretation of skin test results indicates that successful TB screening is possible among injection drug users.

Adult↗

PubMed1976

Polydrug use by high-school students: involvement and correlates.

A hierarchical cluster analysis was performed on 273 self-admitted high-school drug users' descriptions of how frequently they had employed marijuana, stimulants, depressants, hallucinogens, solvents, and opiates during the preceding year. Four types of polydrug users were identified and considered as representing an ordinal scaling of the students along a continuum of overall involvement with drugs, and each user was assigned an index score based on his typal membership. A stepwise multiple regression was then performed to discover which of the students' background characteristics and attitudes were related to their polydrug involvement scores. The search for pleasant sensations, the desire for expanded creativity, and the belief that one would cease taking drugs if they were conclusively shown to be harmful were more powerful predictors of polydrug involvement than any of the sociocultural factors.

Adolescent↗

PubMedDate not supplied

Learning from adverse incidents involving medical devices.

While an adverse event involving a medical device is often ascribed to either user error or device failure, the causes are typically multifactorial. A number of incidents involving medical devices are explored using this approach to investigate the various causes of the incident and the protective barriers that minimised or prevented adverse consequences. User factors, including mistakes, omissions and lack of training, conspired with background factors--device controls and device design, storage conditions, hidden device damage and physical layout of equipment when in use--to cause the adverse events. Protective barriers that prevented or minimised the consequences included staff vigilance, operating procedures and alarms.

Clinical Competence↗

PubMedDate not supplied

Predictors of maintained high-risk behaviors among impoverished women.

The researchers sought to explore and describe the demographic, cognitive, psychosocial, and behavioral factors associated with the continued risky behavior of a convenience sample of homeless and drug-addicted women two to four weeks after they had completed an AIDS education program. The sample included 942 crack users and 767 women who had multiple sex partners. Analyses revealed that impoverished women who maintained multiple sexual partners were less likely to be in drug recovery programs than in homeless shelters. They were more likely to share needles and be involved sexually with male injection drug users compared with impoverished women who did not maintain multiple sexual partners. Persistent crack users were older than those who reported cessation of crack use, were more often African American, and were more likely to have sex partners who were injecting drug users. Women who demonstrated less improvement in depression and distress scores, concerns, use of affective coping, appraisal of threat, and social support were more likely to maintain crack use and multiple partners. The study's implications for the design of intervention programs aimed at risk reduction based on ethnicity are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Persistent neuropsychological problems after 7 years of abstinence from recreational Ecstasy (MDMA): a case study.

This case study concerns a 26-yr.-old male who had consumed large amounts of Ecstasy seven years previously. He stated that his increasingly intensive use of ecstasy over a 4-yr. period had led to the emergence of multiple psychiatric and psychological problems. Given these problems, he stopped using Ecstasy, but the problems had not resolved despite seven years of abstinence. The neurocognitive profile was very similar to that shown by current heavy Ecstasy users, with deficits in immediate and delayed verbal recall, moderately impaired memory function, but normal expressive language ability and perceptual functioning. Extremely high pathology was evident, including depression and phobic anxiety. Severe problems with sleep and sex were also reported. Further studies involving larger groups of abstinent former users are needed; adverse sequelae associated with intensive Ecstasy use may sometimes be enduring.

Adrenergic Uptake Inhibitors↗

PubMed1987

Drinking behaviour and social change among youths in Nigeria--a study of two cities.

Earlier studies on alcohol use in Nigeria identified young and middle-aged male adults as mainly concerned. In the last decade however, there has been a noticeable trend of youths getting more and more involved in alcohol use. Some of these latter studies, apart from indicating the increasing involvement of the female sex, have also shown various pathologies associated with alcohol use in Nigeria youths. Most of these reports only looked at alcohol use in the broader context of drug and alcohol abuse in the Nigerian society. However, in the present cross-sectional study of drug use involving 2079 senior secondary school students in two major cities of Nigeria (Ibadan and Abeokuta), prevalence rates of alcohol use was 56% for Ibadan and 51.5% for Abeokuta. The male/female ratio of the users was 1.1:1 in Ibadan and 1.2:1 in Abeokuta. Males used alcohol significantly more than females in each of the two cities (P less than 0.025). Alcohol use was found more common among younger students in the lower school classes and also among those from higher and medium socioeconomic background. Among contributing factors were parental deprivation and delinquency. Alcohol users were also found to be more involved in accidents and the use of other psycho-active drugs than non-users.

Adolescent↗

PubMed1997

Binge drinking, tobacco, and illicit drug use and involvement in college athletics. A survey of students at 140 American colleges.

Binge drinking (heavy, episodic alcohol consumption), tobacco, and illicit drug use among a random sample of 140 American colleges were examined by means of a mail survey. Students were divided into three groups on the basis of their involvement in athletics: whether they were involved, partly involved, or not involved. In addition, individual correlates of binge drinking among athletically involved students were studied. The survey results indicated that students involved in college athletics engaged in binge drinking and tobacco more often than students not involved in athletics, but were less likely to be cigarette smokers or marijuana users. The strongest predictors of binge drinking among students involved in athletics were residence in a fraternity or a sorority, a party lifestyle, engagement in other risky behaviors, and previous binging in high school. Coaches may play an important role in discouraging substance use and need to be a part of campus prevention efforts.

Adolescent↗

PubMed2006

The development and validation of the Epilepsy and Learning Disabilities Quality of Life (ELDQOL) scale.

Few suitable instruments exist for use with people, especially children, with both epilepsy and learning disabilities. One such measure is the Epilepsy and Learning Disabilities Quality of Life scale (ELDQOL), which has recently undergone revision following feedback from relevant users. This article reports on the final psychometric testing phase of this scale. ELDQOL consists of 70 items covering seizure severity, seizure-related injuries, antiepileptic drug side effects, behavior, mood, physical, cognitive, and social functioning, parental concern, communication, overall quality of life, and overall health. Revalidation involved a qualitative phase, to ascertain users' opinions on the wording, coverage, and layout of the questionnaire, and a quantitative phase, to examine internal consistency, test-retest reliability, and validity. There is very good evidence of the reliability and validity of the final version of ELDQOL, making it a promising instrument for assessing quality of life in children/young adults with epilepsy and learning disabilities.

Adolescent↗

PubMed2005

Analysis of mortality and risk factors associated with native valve endocarditis in drug users: the importance of vegetation size.

BACKGROUND: Native valve endocarditis in drug-user patients had a microbiology, a frequency of involvement of different cardiac valves, and a prognosis that differ from those in non-drug users. A retrospective study of native valve endocarditis cases in intravenous drug users diagnosed from 1985 to 1999 in our institution was performed to analyze the inhospital mortality of drug users with native valve endocarditis and to identify factors predictive of mortality. METHODS: All patients fulfilled the Duke's criteria for definite or probable endocarditis. Analysis of predictors of inhospital mortality was restricted to right-sided infective endocarditis (IE) with definite diagnosis and echocardiographic data. The following variables were analyzed: sex, HIV serostatus, CD4 cell count < 200/mm3, time of IE diagnosis (before 1993 or after 1993), previous valvulopathy, polymicrobial IE, fungal etiology (mixed or alone), neurological complication, arterial emboli, pulmonary emboli, congestive heart failure, vegetation size (VS) > 2 cm, and inhospital cardiac surgery. Logistic regression was used in a multivariate model to identify factors independently associated with mortality. Adjusted odds ratios (OR) and 95% CIs were examined. RESULTS: Four hundred ninety-three cases of IE were diagnosed in this period. Two hundred twenty cases of native valve endocarditis in intravenous drug users were identified. Fourteen cases in this group died (6%). Mean time from diagnosis to death was 18.5 +/- 15 days (range, 3-52). Vegetation size was available in 111 cases. Univariate analysis identified the following variables associated with inhospital mortality in right-sided cases: VS > 2 cm and fungal etiology. In multivariate analysis, the variables associated with mortality that achieved statistical significance were size of vegetation > 2 cm (P = .014, OR 10.2, 95% CI 1.6-78.0) and fungal etiology (P = .009, OR 46.2, 95% CI 2.4-1100.9). CONCLUSIONS: The main prognostic factors of inhospital mortality in right-sided IE in drug users in our series were VS > 2 cm and fungal etiology. The role of early surgery in these patients should be reevaluated.

Adult↗

PubMed1996

Lothian general practitioners, HIV infection and drug misuse: epidemiology, experience and confidence 1988-1993.

BACKGROUND: Lothian has a high prevalence rate of HIV infection associated particularly with injecting drug use in the mid-1980s. During the late 1980s a number of services were introduced to support general practitioners to care for drug users and people with HIV infection. AIM: To ascertain the practice distribution of patients with HIV infection and drug users, and the experience and confidence of Lothian GPs in a number of HIV and drug related tasks, and to see how these changed over a five year period after the introduction of support services. METHOD: Information about practice distribution of patients with HIV infection and drug users and information about GP experience and confidence was obtained from a survey of individual GPs in 1988. Two practice surveys in 1991 and 1993, using a chosen GP for each practice, gave information about practice distribution of people with HIV infection and drug users, while a second survey of individual GPs in 1993, concentrating on GP experience and confidence, acted as a follow up to the 1988 survey. RESULTS: GPs are in touch with an increasing number of people with symptomatic HIV infection. They are increasingly involved and confident in caring for drug users. Offering support and training to GPs appears to have encouraged their involvement. There are a significant number of people with HIV infection in Lothian who are not known to GPs or to hospital services. A combination of practice and individual GP surveys was found to provide the most reliable information. It is planned to repeat the practice survey in 1995.

Attitude of Health Personnel↗

PubMed2003

Does delivery matter? Users' perceptions of the significance of trust in the delivery of the Personal Advisor Service in the New Deal for Disabled Persons.

PURPOSE: In the context of welfare pluralism where government in the UK has been contracting a number of public services out to a range of private and voluntary sector organisations, the aim of this study is to explore the extent to which decisions to become involved in employment support programmes are affected by the users' perceptions of those delivering the service. METHOD: A qualitative design involving two focus groups of fourteen participants was employed to examine the attitudes and perceptions of participants in the government's New Deal for Disabled Persons. The study sample was purposefully selected from client records of Shaw Trust a national charity for disabled persons, one of the organisations who have been contracted by the government to provide this service. RESULTS: Two distinct but related themes of disillusionment with the government and the importance of trust emerged from the focus groups. Overall, the data suggests that the identity of those delivering the service significantly influences the decision to participate. As Shaw Trust is a voluntary organisation promoting the rights of disabled persons they were deemed to be trustworthy. The users were sceptical about the government's commitment to improving the lives of disabled people and were reluctant to engage with the state. CONCLUSIONS: Making the transition from dependency on disability benefits to paid employment is a quantum leap. For many the decision to put themselves forward for voluntary support schemes is affected by the extent to which they believe they can trust the agency delivering the service. It is imperative that the government listen to the service users who have been involved in these projects and learn from their experiences.

Adult↗

PubMed2004

Slow-moving vehicles in Swedish traffic.

The objective of this study was to reach a better understanding of accidents on Swedish roads involving slow-moving vehicles and to suggest ways of preventing such accidents. We analyzed accident data from a 5-year period (1992-1996) involving all types of farm vehicles as well as horses and horse-drawn vehicles. During each year of the period under investigation, slow-moving vehicles were involved in more than 250 traffic accidents on Swedish roads, and an average of 10 people were killed, 66 sustained serious injuries, and 192 sustained slight injuries. This was about 1.3% of all persons injured in traffic accidents in Sweden. The deaths and injuries mostly involved car drivers and passengers. Tractor drivers and unprotected road users (people walking or traveling by motorcycle, moped, or bicycle) also sustained serious injuries and deaths. Vehicles overtaking slow-moving vehicles from behind were the most common type of accident (30%), followed by turning accidents (27%), accidents at crossroads (26%), and with oncoming vehicles (17%). To strengthen the suggestions for improvement, a questionnaire was sent out to driving school teachers in Sweden. Subjects were asked about their experiences with farm vehicles on the roads and their suggestions for ways to increase traffic safety. Based on the accident data and the questionnaire responses, we developed several suggestions for reducing road accidents, including measures for making farm vehicles more visible, improvement of the training provided at driving schools, and information campaigns directed at drivers of farm vehicles and other road users. Further in-depth research is needed to analyze road accidents involving slow-moving vehicles and to test different intervention measures.

Accidents, Occupational↗

PubMed2001

Quality control by cocaine users: underdeveloped harm reduction strategies.

The use of any drug involves both values and rules of conduct (social sanctions) and patterns of behavior (social rituals). Based on an ethnographic study (1996-1999) among 111 cocaine users from the metropolitan area of Antwerp (Belgium), the self-regulatory mechanisms surrounding the methods of controlling the quality of a drug are described. Users' perceptions of reliable and unreliable sources of cocaine, quality and adulteration of cocaine and quality control techniques are confronted with objective information. It is argued that these informal control mechanisms may be crucial factors in the controlled use of any intoxicant, but myths are an important ingredient of the observed rituals, which indicates that knowledge about certain drugs and the best ways to use them in a safe way is still underdeveloped. Users are left to their own folk-experimental devices for testing tools or techniques, and many aspects of the natural processes of social learning are generally not based on objective information. Future harm reduction interventions should therefore also stimulate the development and dissemination of effective informal control mechanisms among illicit drug users.

Amphetamines↗

PubMed1979

Sexual differentiation among marijuana users: reality or inaccuracy.

This study, based on data (N = 134) obtained by self-administered questionnaires, examines the extent marijuana users can be sexually differentiated regarding usage patterns, acquisition, distribution, effects on social relationships, and other activities. Generally, no significant sexual variations were observed except that males were more likely to personally purchase, to have sold marijuana, to bring it along when visiting friends, to hesitate having friends be their only source, and to be confirmed about other users knowing of their use. It is suggested that sexual differentiation may reflect lesser involvement and that it may reduce as higher level users are examined.

Adult↗

PubMed1994

The external costs of traffic injury: definition, estimation, and possibilities for internalization.

The external costs of traffic injury in Norway are estimated. External costs are all costs that are imposed on others and not borne by the person whose activity generates the costs. Three types of external cost are identified: system externalities, physical injury externalities, and traffic volume externalities. System externalities are costs that road users impose on the rest of society. Physical injury externalities are costs that one group of road users impose on the rest of society. Physical injury externalities are costs that one group of road users imposes upon another in crashes in which both groups are involved. Traffic volume externalities are the costs imposed on other road users when an additional road user joins traffic. System externalities are estimated to be about 30% of the total cost of traffic injury. Physical injury externalities are estimated to be about 10% of the total cost of traffic injury. No precise estimate can be given for traffic volume externalities. Possibilities for internalizing the external costs are discussed. In Norway, current taxes on ownership and use of motor vehicles cover the external costs of traffic injury, although the taxes were not designed with this purpose in mind.

Accidents, Traffic↗

PubMed2005

The patient safety institute demonstration project: a model for implementing a local health information infrastructure.

The increasing focus on patient safety has uncovered many unsafe conditions in the current US. healthcare system. One of the most glaring problems is the inability of a fragmented healthcare system to provide critical and timely clinical information at the point of care. The Institute of Medicine has called for the development of a National Health Information Infrastructure to rectify this deficiency. This NHII will be built on Local Health Information Infrastructures, or LHIIs. The Patient Safety Institute is a potential model for an LHII that was developed and implemented in Seattle using the Swedish Medical Centers and associated ambulatory clinics. This model was piloted and evaluated among 365 clinical users across three hospitals, three clinics, and family practice residency programs involving access of records of more than 5300 distinct patients within a five-month period and involved the collection of more than 23 million clinical data results. User responses revealed the technology was intuitive to learn, easy to use, easy to navigate, and helpful in clinical care. The PSI demonstration project has developed an approach to the creation and implementation of LHIIs that is potentially transferable to other local communities.

Diffusion of Innovation↗