Attitudes of Australian Heroin Users to Peer Distribution of Naloxone for Heroin Overdose: Perspectives on Intranasal Administration

Naloxone distribution to injecting drug users (IDUs) for peer administration is a suggested strategy to prevent fatal heroin overdose. The aim of this study was to explore attitudes of IDUs to administration of naloxone to others after heroin overdose, and preferences for method of administration. A sample of 99 IDUs (median age 35 years, 72% male) recruited from needle and syringe programs in Melbourne were administered a questionnaire. Data collected included demographics, attitudes to naloxone distribution, and preferences for method of administration. The primary study outcomes were attitudes of IDUs to use of naloxone for peer administration (categorized on a five-point scale ranging from “very good idea” to “very bad idea”) and preferred mode of administration (intravenous, intramuscular, and intranasal). The majority of the sample reported positive attitudes toward naloxone distribution (good to very good idea: 89%) and 92% said they were willing to participate in a related training program. Some participants raised concerns about peer administration including the competence of IDUs to administer naloxone in an emergency, victim response on wakening and legal implications. Most (74%) preferred intranasal administration in comparison to other administration methods (21%). There was no association with age, sex, or heroin practice. There appears to be strong support among Australian IDU for naloxone distribution to peers. Intranasal spray is the preferred route of administration. Kerr and Kelly are with the Joseph Epstein Centre for Emergency Medicine Research, Sunshine Hospital, St. Albans, Victoria, Australia; Kerr and Kelly are with the The University of Melbourne, Melbourne, Victoria, Australia; Dietze is with the Burnet Institute, Melbourne, Victoria, Australia; Dietze and Jolley are with the Monash Institute of Health Services Research, Melbourne, Victoria, Australia.     

纳洛酮治疗急性酒精中毒30例疗效观察

目的观察纳洛酮治疗急性酒精中毒的有效性及安全性。方法60例急性酒精中毒患者随机分为2组,治疗组30例采用纳洛酮治疗,对照组30例采用补液利尿常规治疗,比较两组的清醒时间。结果纳洛酮治疗急性酒精中毒清醒时间明显较对照组提前（P〈0．01）,且未发现副作用。结论纳洛酮治疗急性酒精中毒安全有效,值得推广。     

医院服务提供者流产后服务现状

目的:了解郑州市医院服务提供者对流产后服务的知识、态度、行为及服务存在问题,为今后开展流产后服务提供科学依据。方法:采取整群抽样方式,对郑州市10家医院从事流产后服务的234名医护人员进行了调查,调查采用自填与询问相结合方式。结果:避孕方法知识水平较好者为72.2%,最需要的信息是如何生动进行计划生育宣教(70.94%)。仅有1.28%的服务提供者经常向流产妇女提供免费避孕药具。认为有必要向流产妇女提供避孕咨询服务和免费避孕药具的比例分别为89.75%和73.93%。对于今后推广实施流产后服务,认为亟需解决的问题依次是免费避孕药具的获得、妇女在流产手术后疼痛、能否抽出时间及计划生育宣教资料的获得等。结论:郑州市应加强对医院服务提供者的培训,提高医院服务提供者做好流产后服务的意识,计划生育和卫生部门应加强合作、共同推进流产后服务工作使其走向规范化。     

婚前医学检查医师的基本素质与健康教育的关系

目的：探讨健康教育作为婚前技术服务的法定内容和重要策略，在实施婚前保健工作中的作用。方法：利用现代促进型健康教育模式。开展目标人群的健康教育。结果：健康教育有利于保障母婴健康，有利于帮助人们转变不良健康行为，有利于提高婚前保健服务质量。结论：健康教育已成为母婴保健服务的重要组成部份，在婚前保健中显得尤为突出，并提出从事这项工作的婚检医师应在伦理道德，业务能力等素质方面加强自身的提高。     

Attitudes of Ugandan medical students toward 'straight' and 'modified' ECT

In third world countries, limited resources of anaesthetists and resuscitation facilities mean that electroconvulsive therapy (ECT) is usually given 'straight'(i.e. without anaesthetic and muscle relaxant). This study compared the attitudes of Ugandan medical students towards ECT given straight and ECT administered with muscle relaxant and general anaesthesia (i.e.'modified' ECT). Results confirmed the clinical impression that students regarded straight ECT as an inhumane method of treatment. However, whilst this was a major factor influencing students' preference for modified ECT as a treatment for themselves or for a close friend, it was relatively unimportant in determining their choice of ECT technique for a patient. Convenience of administration was the main criterion applied by students when deciding whether they would prefer to administer straight or modified ECT to a patient. Implications for medical education and the development of professional attitudes are discussed.     

Violence against emergency medical services personnel: A systematic review of the literature

Background

Violence against emergency medical services (EMS) personnel is a growing concern. The aim of this systematic review is to synthesize the current literature on violence against EMS personnel.

Methods

We examined literature from 2000 to 2016. Eligibility criteria included English‐language, peer‐reviewed studies of EMS personnel that described violence or assaults. Sixteen searches identified 2655 studies; 25 studies from nine countries met the inclusion criteria.

Results

The evidence from this review demonstrates that violence is a common risk for EMS personnel. We identified three critical topic areas: changes in risk over time, economic impact of violence and, outcomes of risk‐reduction interventions. There is a lack of peer reviewed research of interventions, with the result that current intervention programs have no reliable evidence base.

Conclusions

EMS leaders and personnel should work together with researchers to design, implement, evaluate and publish intervention studies designed to mitigate risks of violence to EMS personnel.

     

甘肃省2006--2009年监测吸毒人群艾滋病知识行为及相关卫生服务利用情况分析

吸毒人群是我国艾滋病感染和传播的高危人群,在吸毒人群中开展相关知识行为调查及艾滋病感染率监测,可了解当地吸毒人群艾滋病知识认知水平、行为变化及流行趋势,并评估当地吸毒人群的艾滋病防治工作.     

'Nobody ever chooses this ...': a qualitative study of service providers working in the sexual violence sector – key issues and challenges

This paper describes the findings from the first stage of a study designed to assess the impact of sexual violence (SV) on the lives of Irish women. Stakeholder interviews ( n  = 18) were undertaken to explore experiences of delivering services to people who have experienced SV, in rural and urban settings in Ireland. A range of themes and sub-themes were identified through a thematic analysis, and interrelationships between two of the main themes (barriers to services and current gaps in service provision) are discussed. Sub-themes include: survivor guilt and shame, difficulties in naming the incident as SV, problems with the Criminal Justice System and the availability of Sexual Assault Treatment Units. Participants identified an urgent need for a co-ordinated national strategy in the form of a public awareness and education campaign in order to undermine commonly held rape myths and stereotypes. The findings will be of interest to all health and social care professionals who are in contact with women who have experienced SV. They will also help to raise an awareness of the 'hidden' costs of SV, and inform appropriate policies and community-based responses to this important social problem.     

Cultural diversity in the Dublin maternity services: the experiences of maternity service providers when caring for ethnic minority women

Background. Ireland has seen an expansion of new migrant communities over the past decade and the country has struggled to cope with this new multi-culturalism, especially within the health services. The maternity services in particular have seen an increase in deliveries from ethnic minority women. Little research has been done exploring this issue with maternity service providers.

Methods. Using a grounded theory approach, this study sought to explore the experiences, understanding and perspectives of maternity service providers when working with ethnic minority women in the Dublin maternity services during 2002 and 2003.

Results. Four themes emerged from the study: Communication difficulties, knowledge and use of services, cultural differences and ‘Them and Us’. These encompassed a variety of issues including inadequacy of interpretation services, childcare issues, coping with labour, identification as different and racism. Ethnic minority women are expected to adapt to the system rather than the maternity services being responsive or adapting to the new multi-cultural population.

Discussion. These issues were relevant a decade ago internationally and are still pertinent today for not only Irish services but also for other European countries. There is an opportunity to improve the services for all women by learning from the experience of Dublin maternity service providers.     

医疗服务提供者激励要素和激励机制的实验研究综述

建立符合医疗行业特点的激励机制是深化医药卫生体制改革的重要内容.医疗服务的特殊性要求服务提供者在提供医疗服务的过程中更多地考虑患者的健康福利,体现利他性.既能增加医疗服务提供者的动机和努力水平,又能维护其利他行为的激励机制成为改革的难点.激励机制的构建首先要明确有利于实现这一目标的激励要素和激励方式.实验研究作为可行的...     

上海市闸北区高剖宫产率供方因素定性研究

目的通过对上海市闸北区医护人员进行个人深入访谈以探讨服务提供者知、信、行和医疗制度对剖宫产率的影响。方法采用定性研究中半结构式访谈的方法，对上海市闸北区两所综合医院产科12名不同职称和职位的医生及护士进行个人深入访谈。现场进行录音，并用NVIVO8．0进行分类、归纳分析。结果共访谈接产医院12名医护人员，其中A院和B院各6名．．工作年限最长者30年，是助产士和护士长，最短的2年，是住院医师。12名访谈对象都充分认识到分娩方式对母婴健康的影响，并在产妇要求剖宫产时尽量劝说。有11名访谈对象表示，基本规范地实行上海市卫生局“选择性剖宫产不应安排在节假日、交接班和夜班”的规定，并较为严格地掌握剖宫产指征。所有访谈对象都否认医生会因为收入问题放宽44宫产指征。有10名访谈对象认为医院不会缺乏人手而采用更为省时的剖宫产，但是人力资源缺乏是这两所医院未开展“导乐全程陪伴分娩”和“减痛分娩”的主要原因。所有访谈对象都表示紧张的医患关系导致医生为规避医疗风险而放宽剖宫产指征。结论产科适宜技术项目开展的少，人力资源缺乏、紧张的医患关系及医疗制度是导致剖宫产率上升的主要因素，应积极改善，以增加产妇及家属对产科医生的信任，解除产科医生后顾之忧，更严格掌握剖宫产指征。     

Harlem service providers’ perceptions of the impact of municipal policies on their clients with substance use problems

Substance abuse is a significant health and social problem in many low-income urban communities. Finding appropriate help for drug users has been identified as a significant barrier to reducing the barm from drug abuse. This report presents findings from a survey of service providers in the Central and East Harlem communities, New York City, conducted in 2000 to identify policy obstacles that impeded clients’ attempts to overcome substance use and related problems. Policies can affect substance users by making access to drug treatment more difficult or by imposing unrealistic expectations on substance users for eligibility for benefit programs. Respondents to the survey were asked to rate 30 specific policies as harmful or helpful to their clients and to assess how the policies acted as barriers or facilitators to getting services and reducing drug use. Eleven policies in the areas of drug treatment, corrections, and Medicaid were rated as harmful to their clients by more than 50% of the respondents. We discuss the implications of these and other findings for drug users’ ability to seek and receive help for their problems.     

Patient at Risk: Emergency medical service providers’ opinions on improving an electronic emergency information form database for the medical care of children with special health care needs

BackgroundPatient at Risk (PAR) is an online database using an emergency information form (EIF) that parents of children with special health care needs (CSHCN) complete to store their child’s medical information. Emergency medical service (EMS) providers can then access PAR during medical emergencies or for pre-planning. PAR was active for over 10 years but use by patients and EMS was limited.ObjectiveTo determine EMS perspectives on why PAR was not used to its full potential and how to improve PAR for EMS.MethodsSeven questions regarding PAR were developed and presented in focus groups at 32 fire/ambulance houses in southeast and central Wisconsin from June to August 2017. Responses were transcribed and reviewed for themes.Results146 EMS providers participated and 11% were aware of PAR. Many did not use PAR because of a lack of follow up or barriers such as limited internet access, inconvenience, other urgent responsibilities, and not knowing when to use PAR. Solutions to these issues include developing or purchasing new technology, involving the dispatch operator in PAR, and returning to a paper-based EIF. The EIF layout and content received very positive reviews with few changes suggested. Most providers felt PAR was important because it would help them provide better care and feel more comfortable treating CSHCN.ConclusionDespite technological and logistical barriers, EMS providers want online EIF databases for pre-planning and utilization during ambulance runs so they can practice more informed and focused care, especially for vulnerable and medically challenging CSHCN.     

门诊医疗中医患纠纷及防范浅析

目的提高门诊医务人员医学道德水准，加强医务工作者医疗服务质量和技术水平，减少或避免门诊部医患纠纷的发生。方法加强门诊医务人员的管理，消除医患双方间的疑惑或误解，完善制度，伸张正义，奖罚分明，在改进中求发展。结果服务质量提高后，患者投诉率下降，医患纠纷减少，患者满意度提高。结论经严格的门诊管理措施，有效地解决了医患矛盾，确保了门诊工作正常有序地进行。     

新冠疫情期间保障急诊医疗服务质量的探究

目的基于公众对疫情期间急诊延误事故的反应,分析疫情期间如何保障急诊医疗服务质量。 方法采用Python网络爬虫抓取知乎平台下公众对某一疫情期间急诊延误事故相关问题的回答,采用词云图可视化展现回答内容,并统计公众关注的导致疫情期间急诊服务质量下降的原因、公众对法规改进和社区医疗的建议。 结果公众普遍认为,此次急诊事故的发生与疫情防控密切相关。公众关注的因素主要包括私立医院的营业性质、法规不合理、行政管理者、医院基层和社区的过失。通过进一步分析讨论可知,疫情对急诊就诊的影响主要在于急诊就诊资源减少、急诊流程延长和交叉感染风险增加等。私立医院存在大量监管漏洞,监管机构可以从检查方式和准入标准等方面强化监督。卫生行政管理部门应当合理统筹医疗资源,建设实时应急管理信息发布通道并严惩急诊拒诊。医院应当优化医院结构,设置不同等级的院感风险区,并设立专门值班室。社区卫生服务中心应当做好预检分流工作,落实双向转诊并优化医疗配置。 结论从政府、医院、社区多角度协同保障疫情期间的急诊医疗质量,可改善现有卫生管理的不足。