Client preferences for the design and delivery of injectable opioid agonist treatment services: Results from a best-worst scaling task.

BACKGROUND AND AIMS: Clinical trials support injectable opioid agonist treatment (iOAT) for individuals with opioid use disorder (OUD) for whom other pharmacological management approaches are not well-suited. However, despite substantial research indicating that person-centered care improves engagement, retention and health outcomes for individuals with OUD, structural requirements (e.g. drug policies) often dictate how iOAT must be delivered, regardless of client preferences. This study aimed to quantify clients' iOAT delivery preferences to improve client engagement and retention. DESIGN: Cross-sectional preference elicitation survey. SETTING: Metro Vancouver, British Columbia, Canada. PARTICIPANTS: 124 current and former iOAT clients. MEASUREMENTS: Participants completed a demographic questionnaire package and an interviewer-led preference elicitation survey (case 2 best-worst scaling task). Latent class analysis was used to identify distinct preference groups and explore demographic differences between preference groups. FINDINGS: Most participants (n = 100; 81%) were current iOAT clients. Latent class analysis identified two distinct groups of client preferences: (1) autonomous decision-makers (n = 73; 59%) and (2) shared decision-makers (n = 51; 41%). These groups had different preferences for how medication type and dosage were selected. Both groups prioritized access to take-home medication (i.e. carries), the ability to set their own schedule, receiving iOAT in a space they like and having other services available at iOAT clinics. Compared with shared decision-makers, fewer autonomous decision-makers identified as a cis-male/man and reported flexible preferences. CONCLUSIONS: Injectable opioid agonist treatment (iOAT) clients surveyed in Vancouver, Canada, appear to prefer greater autonomy than they currently have in choosing OAT medication type, dosage and treatment schedule.

50 Years of the Radiation Exposure Information and Reporting System.

PURPOSE: As the Radiation Exposure Information and Reporting System (REIRS) celebrates 50 years of existence, this is an appropriate time to reflect on the innovative and novel system and how it has shaped the study of occupational radiation exposure. It is also fitting to appreciate the vision and initiative of the individuals who recognized the future value of the collection and analysis of this information to better inform regulations, policies, and epidemiologic studies, and thus contribute to the protection of workers and the public from the adverse health effects of radiation exposure. CONCLUSIONS: REIRS has evolved and expanded over its 50-year history and has played a central role in providing the radiation exposure monitoring records for the Million Person Study for individuals monitored as NRC licensees and at DOE facilities. REIRS has played two major functions in epidemiologic studies. First, it has provided dosimetry information on individual workers in occupational studies to ensure nearly complete ascertainment of career doses. Second, REIRS was used as the primary data source for large cohorts within the Million Person Study: nuclear power plant workers (n∼140,000) and industrial radiographers (n∼130,000). The legacy that REIRS continues to uphold is a model for creating and maintaining a successful tool throughout decades of political, technological, and demographic change.

Future Connectivity for Disaster and Emergency Point of Care.

OBJECTIVE: The goal of this paper is to identify strategies for connectivity that will optimize point-of-care testing (POCT) organized as small-world networks in disaster settings. METHODS: We evaluated connectivity failures during the 2010 Haiti Earthquake, applied small-world network concepts, and reviewed literature for point-of-care (POC) connectivity systems. RESULTS: Medical teams responding to the Haiti Earthquake faced connectivity failures that affected patient outcomes. Deploying robust wireless connectivity systems can enhance the efficiency of the disaster response by improving health care delivery, medical documentation, logistics, response coordination, communication, and telemedicine. Virtual POC connectivity education and training programs can enhance readiness of disaster responders. CONCLUSIONS: The admirable humanitarian efforts of more than 4000 organizations substantially impacted the lives of earthquake victims in Haiti. However, the lack of connectivity and small-world network strategies, combined with communication failures, during early stages of the relief effort must be addressed for future disaster preparedness.