Preliminary evaluation of a human laboratory model of impaired control over alcohol using intravenous alcohol self-administration.

Impaired control over alcohol is central to alcohol use disorder, but most research on impaired control is limited to self-report methods. This study applied intravenous alcohol self-administration to conduct a preliminary investigation of a novel human laboratory model of impaired control. Heavy episodic drinkers (ages 19-22 years) completed a two-hour intravenous alcohol self-administration session that involved an incentive to maintain breath alcohol concentration below 80 mg%. Impaired control was operationalized based on whether participants exceeded (impaired control positive; IC+) or adhered to (impaired control negative; IC-) the breath alcohol concentration limit, as well as the discrepancy between intended and actual peak breath alcohol concentration. Analyses of subjective processes revealed that IC+ participants tended to underestimate their peak breath alcohol concentration relative to IC- participants. Further, IC+ reported greater craving after an initial priming phase, and craving mediated the relationship between self-report impaired control and discrepancies between intended and actual breath alcohol concentration. IC+ participants also showed stronger within-person associations between state changes in stimulation and momentary alcohol self-administration throughout the session. Laboratory impaired control indices demonstrated convergent validity with an established self-report measure of impaired control. These findings provide preliminary validation of a novel human laboratory model of impaired control in a sample of young heavy episodic drinkers, and offer insight into the role of subjective responses (craving, stimulation) in impaired control.

Doctors' views of patient expectations of medical care in Zhejiang Province, China.

OBJECTIVE: Physicians' prescribing patterns may be influenced by how they perceive their patients' expectations of medical care. This study explored doctors' perceptions of patient expectations of medical care. DESIGN: Qualitative interviews and a cross-sectional survey (September 2014-September 2015). SETTING: Primary- and tertiary-care facilities in Zhejiang province, China. PARTICIPANTS: Primary care practitioners (PCPs) and hospital specialists. MAIN OUTCOMES: Perceived patients' expectations. RESULTS: Seven focus groups and 21 individuals were interviewed. Questionnaires were completed by 460 PCPs and 651 specialists (response rate: 78%). About 36.8% of doctors reported generating profit for the facility at which they practiced as a foremost consideration. Participants perceived patients as holding high expectations of clinical performance and use of medical products. Respondents perceived that their patients expected either drug prescriptions (48.2%) or intravenous (IV) therapy (45.2%). Perceived patient expectations of an arrangement of tests and consultation fee refunds if no prescriptions were made were reported by 29.7 and 22.7%, respectively. Doctors reported feeling undervalued and disrespected when patients requested consultation fee refunds. Compared to those who did not report a need for profit-making, doctors who did were significantly more likely to perceive that their patients expected medication-based treatments (AOR = 1.62, P < 0.001), IV therapy (AOR = 1.32, P = 0.037), the arrangement of tests (AOR = 2.06, P < 0.001), and consultation fee refunds when no prescriptions were made (AOR = 1.92, P < 0.001). CONCLUSIONS: Most doctors believed that patients had high expectations. Workplace profit-orientation demonstrated a strong association with doctors' perceptions.

Brinquedo terapêutico na administração de medicação endovenosa em crianças: estudo exploratório / Use of therapeutic play during intravenous drug administration in children: exploratory study / Juguete terapéutico en la administración de medicamentos intravenoso en niños: estudio exploratorio

OBJETIVO: Identificar reações de crianças na administração de medicação endovenosa, realizada anterior e posteriormente à técnica do Brinquedo Terapêutico, e analisar percepção dos acompanhantes em relação à influência da técnica no preparo para administração da medicação endovenosa. MÉTODO: Estudo exploratório, com abordagem qualitativa, realizado por meio de observações de administração medicamentosa endovenosa e das sessões de Brinquedo Terapêutico com crianças, e entrevista semiestruturada com acompanhantes. Os dados foram submetidos à análise temática. RESULTADOS: Crianças com dificuldade em aceitar a medicação endovenosa apresentaram mudanças positivas no comportamento após realização Brinquedo Terapêutico, principalmente aquelas entre 4 e 6 anos. Acompanhantes recomendam a realização dessa prática para melhoria do cuidado e redução do estresse durante a administração. CONCLUSÃO: Brinquedo terapêutico é uma relevante intervenção de enfermagem para minimizar as reações da criança durante o uso de medicações endovenosas, sendo importante a capacitação dos enfermeiros e o fomento da técnica para qualificação da assistência.

AIM: To identify the reactions of children during intravenous drug administration before and after the use of therapeutic play technique and to analyse their companions' perceptions regarding the technique's effects on the child's preparation for intravenous drug administration. METHOD: An exploratory study with a qualitative approach conducted through observations of intravenous drug administration and therapeutic play sessions with children and semi-structured interviews with their companions. The data were subjected to thematic analysis. RESULTS: Children who had difficulty accepting intravenous medication, especially those between 4 and 6 years, presented positive behavioural changes after the use of therapeutic play. The children's companions recommended the use of this technique to improve care and reduce stress during drug administration. CONCLUSION: Therapeutic play is a relevant nursing intervention for minimizing children's reactions during intravenous drug administration, and the training of nurses and the promotion of technique are important for improving care.

OBJETIVO: Identificar reacciones de niños en la administración de medicamentos intravenoso, realizada anterior y posteriormente a la técnica del Juguete Terapéutico, y analizar percepción de los acompañantes en relación a la influencia de la técnica en el preparo para la administración del medicamento intravenoso. MÉTODO: Estudio exploratorio, con enfoque cualitativo, realizado por medio de observaciones de administración medicamentosa intravenosa y de las sesiones de Juguete Terapéutico con niños, y entrevista semiestructurada con acompañantes. Los datos fueron sometidos al análisis temático. RESULTADOS: Niños con dificultad en aceptar el medicamento intravenoso presentaron cambios positivos en el comportamiento después la realización Juguete Terapéutico, principalmente aquellas entre 4 y 6 años. Acompañantes recomiendan la realización de esa práctica para mejora del cuidado y reducción del estrés durante la administración. CONCLUSIÓN: Juguete terapéutico es una relevante intervención de enfermería para minimizar las reacciones del niño durante el uso de medicamentos intravenosa, siendo importante la capacitación de los enfermeros y el fomento de la técnica para cualificación de la asistencia.

Factors associated with non-adherence and misuse of opioid maintenance treatment medications and intoxicating drugs among Finnish maintenance treatment patients.

BACKGROUND: The intravenous (IV) use of opioid maintenance treatment (OMT) medications and other intoxicating drugs among OMT patients is a challenge for many OMT units and affects treatment outcomes. The aim of this study is to examine factors associated with IV use of OMT medications and other intoxicating drugs among Finnish OMT patients. METHODS: A cross-sectional study was conducted among all Finnish OMT patients of whom 60% (n=1508) participated. The data were collected by anonymous questionnaire. Binominal regression analysis with unadjusted and adjusted ORs was conducted to evaluate predictors for IV use. FINDINGS: Factors associated with the injection of a patient's own OMT medication were: being treated with buprenorphine-naloxone (BNX) (OR 2.60, p=0.005) with a low dose (<9.0mg/day; OR 5.70, p<0.001) and being treated in a health-care centre (OR 2.03, p=0.029). Factors associated with the injection of illicit OMT medications were: being treated with BNX (OR 5.25, p<0.001) with a low dose (<9.0mg/day; OR 2.89, p=0.017), lack of psychosocial support (OR 2.62, p<0.001) and concurrent use of psychotropic medications from illicit sources (OR 4.28, p<0.001). Associated factors for the injection of other intoxicating drugs were: concurrent use of illicit drugs (OR 1.72, p=0.015), psychotropic medications from illicit sources (OR 4.78, p<0.001) and from a doctor (OR 1.93, p=0.004). CONCLUSIONS: More effort should be made to reduce concurrent injecting use during OMT. This may be done by addressing concurrent substance use orders more effectively, by ensuring that patients receive an optimal BNX dose and by providing more psychosocial support.

Implications of subcutaneous or intravenous delivery of trastuzumab; further insight from patient interviews in the PrefHer study.

BACKGROUND: The 2 Cohort randomised PrefHer trial examined the preferences of HER2+ve primary breast cancer patients for intravenous (IV) or subcutaneous (SC) delivery of trastuzumab via a Single Injectable Device (SID) or hand-held syringe (HHS). The novel approach and design of the study permitted an in-depth exploration of patients' experiences, the impact that different modes of delivery had on patients' well-being and implications for future management. METHODS: The preferences, experiences and general comments of patients in the PrefHer study were collected via specific semi-structured interview schedules. Exploratory analyses of data were conducted using standard methodology. The final question invited patients to make further comments, which were divided into 9 thematic categories - future delivery, compliments, time/convenience, practical considerations, pain/discomfort, study design, side-effects, psychological impact, and perceived efficacy. RESULTS: 267/467 (57%) patients made 396 additional comments, 7 were neutral, 305 positive and 86 negative. The three top categories generating the largest number of comments were compliments and gratitude about staff and being part of PrefHer (75/396; 19%), the potential future delivery of SC trastuzumab (73/396; 18%), and practical considerations about SC administration (60/396; 15%). CONCLUSIONS: Eliciting patient preferences about routes of administration of drugs via comprehensive interviews within a randomised cross-over trial yielded rich and important information. The few negative comments made demonstrated a need for proper staff training in SC administration Patients were grateful to have been part of the trial, and would have liked to continue with SC delivery. The possibility of home administration in the future also seemed acceptable. EUDRACT NUMBER: 2010-024099-25.

The impact of technology dependence on children and their families.

Advances in medical care and technologies have prolonged life for many children with medical complexity. These advances and their effects reinforce the need for further research to determine how children and their families are being affected by technology dependence and their quality of life. A review of the literature suggests that children, as well as their family members, are negatively affected by technology dependence in a variety of psychosocial domains. Implications for clinical care and future research of this population are discussed.

Aceptación y barreras para el inicio y la intensificación del tratamiento con insulina / Patient acceptance and barriers to the initiation and intensification of insulin therapy

La importancia del buen control metabólico en la prevención de las complicaciones crónicas de la diabetes quedó claramente probada para la diabetes tanto tipo 1 como tipo 2, en los estudios publicados en la década de los noventa. Asimismo, está bien establecido que la insulina es el fármaco más efectivo en la reducción de la glucemia. Sin embargo, existe una reticencia, que afecta tanto a pacientes como a los profesionales sanitarios, médicos especialistas, generalistas y educadores en diabetes, a iniciar la insulinización, que se traduce en una prolongación del mal control metabólico del paciente, con el consiguiente aumento de riesgo de desarrollar complicaciones de la diabetes. Las barreras a la insulinización pueden analizarse desde el punto de vista del paciente o del profesional sanitario, y en diversos aspectos son comunes a ambos. Entre los factores que dificultan la insulinización desde la perspectiva del paciente, cabe citar la ansiedad o incluso la fobia a la inyección, la complejidad del tratamiento con insulina, la culpabilización del paciente por considerar la insulinización como un fracaso en el control de la diabetes, la percepción de que la insulinización indica un agravamiento de la enfermedad y la consideración de que el uso de insulina implica una limitación en su estilo de vida, lo que supone la pérdida de calidad de vida o la posibilidad de sentirse estigmatizado socialmente. Por su parte, una porción significativa de profesionales sanitarios parecen mantener dudas acerca de la eficacia de la insulina en los pacientes con diabetes tipo 2, perciben el tratamiento con insulina como más complejo para el paciente (lo que dificulta el cumplimiento) y también para el propio profesional, que podría carecer del tiempo preciso para instruir al paciente. Finalmente, los efectos secundarios más importantes del tratamiento con insulina, así como el aumento de las hipoglucemias y de peso corporal suponen una preocupación tanto para el paciente como para el profesional sanitario. Muchas de las preocupaciones de los pacientes se superan con una información adecuada, la educación diabetológica y, finalmente, con la práctica. Asimismo, los avances técnicos en aspectos como sistemas de inyección, nuevos tipos de insulina o las nuevas formas de administración, como la insulina inhalada, reducen la dificultad para iniciar o intensificar el tratamiento con insulina (AU)

The importance of tight metabolic control in the prevention of the chronic complications of both type 1 and type 2 diabetes was clearly demonstrated in studies published in the 1990s. Likewise, it is well established that insulin is the most effective drug in reducing glycemia. However, there is a reluctance among both patients and health professionals – general practitioners, specialists, and educators in diabetes –to begin insulin therapy, which translates into a prolongation of poor metabolic control with a consequent increase in the risk of developing the complications of diabetes. The barriers to insulin therapy can be analyzed from the point of view of the patient or the health professional and several aspects are common to both. Among the factors that hamper the use of insulin therapy from the patient’s perspective are anxiety or eveninjection phobia, the complexity of insulin therapy, blaming patients by considering insulin therapy as a failure of diabetic control, the perception that insulin therapy indicates a worsening of the disease, and the belief that insulin use imposes a limitation on lifestyle, representing a lower quality of life or the possibility of social stigma. For their part, a significant percentage of health professionals still have doubts about the effectiveness of insulin therapy in patients with type 2 diabetes, perceive insulin therapy as more complex for the patient, thus hampering compliance, and also as more complex for professionals, who lack the time necessary to instruct the patient. Finally, the most important adverse effects of insulin therapy, an increase in hypoglycemic episodes and body weight, are a cause of concern both to patients and to health professionals. Patients’ concerns can usually be overcome with adequate information, education, and practice. Likewise, technical advances in aspects such as injection systems, new types of insulin, and new forms of administration such as inhaled insulin, reduce the difficulty of initiating or intensifying insulin therapy (AU)