Measuring substance use in the club setting: a feasibility study using biochemical markers

Background

In South Africa, district social service offices are often the first point of entry into the substance abuse treatment system. Despite this, little is known about the profile of people presenting with substance-related problems at these service points. This has a negative impact on treatment service planning. This paper begins to redress this gap through describing patterns of substance use and service needs among people using general social services in the Western Cape and comparing findings against the profile of persons attending specialist substance abuse treatment facilities in the region.

Methods

As part of a standard client information system, an electronic questionnaire was completed for each person seeking social assistance. Data on socio-demographic characteristics, the range of presenting problems, patterns of substance use, perceived consequences of substance use, as well as types of services provided were analysed for the 691 social welfare clients who reported substance use between 2007 and 2009. These data were compared against clients attending substance abuse treatment centres during the same time period.

Results

Findings indicate that social services offices are used as a way of accessing specialist services but are also used as a service point, especially by groups under-represented in the specialist treatment sector. Women, people from rural communities and people with alcohol-related problems are more likely to seek assistance at social service offices providing low threshold intervention services than from the specialist treatment sector.

Conclusions

The study provides evidence that social services are a point of entry and intervention for people from underserved communities in the Western Cape. If these low-threshold services can be supported to provide good quality services, they may be an effective and efficient way of improving access to treatment in a context of limited service availability.     

Uterine balloon therapy for menorrhagia: a feasibility study of its use in the community setting

OBJECTIVES: To determine whether uterine balloon therapy (UBT) for menorrhagia can be performed safely in the community setting, obviating the need for hospital admission or general anaesthesia. DESIGN: Prospective case studies of 20 women undergoing Thermachoice endometrial ablation for menorrhagia. SETTING: Glasgow Centre for Family Planning and Reproductive Health Care, Greater Glasgow Primary Care NHS Trust, Glasgow, UK. PARTICIPANTS: Twenty women with menorrhagia unresponsive to medical therapy. MAIN OUTCOME MEASURES: Pain levels experienced by women during the procedure, measured by visual analogue scores and analgesia requirements postoperatively. RESULTS: Pain scores were in the range 0.1-6.6 (median 1.1) for outpatient hysteroscopy, compared to 0.1-9.8 (median 4.0) for uterine balloon therapy. No procedure was abandoned due to pain. CONCLUSION: UBT performed under local anaesthetic is tolerated well by patients. It is an effective treatment for menorrhagia, which is safe and easy to perform in the community setting.     

Task-specific practice of dressing tasks in a hospital setting improved dressing performance post-stroke: a feasibility study

Background: Practise of personal activities of daily living, including dressing improves outcomes for people living at home after a stroke. Less is known about dressing outcomes for hospital inpatients. Aim: This study aimed to investigate the feasibility and outcomes of a group‐based, task‐specific dressing retraining programme for inpatients post‐stroke. Methods: A pre‐post single group study design was used. Retrospective data were collected for stroke inpatients admitted to one hospital between 2007 and 2009. Participants attended a one‐hour dressing group twice weekly during admission, supervised by occupational therapists. Each participant had one or more dressing goals. Scores on the Functional Independence Measure (FIM) upper and lower body dressing items were compared at baseline and at discharge. Results: Of 119 participants who received group‐based training, a mean improvement was found of 2.2 FIM points (95% CI 1.9–2.5, P = 0.0001) for upper body dressing (range 0–7), 2.7 FIM points (95% CI 2.3–3.1, P = 0.0001) for lower body dressing (range 0–7) and 5.2 FIM points (95% CI 4.5–6.0, P = 0.0001) for total dressing scores (range 0–14). Of 242 goals recorded, 48% focussed on shirt/upper body dressing, 35% on pants/shorts, 11% on socks and shoes and 13% involved buttons/fastenings. Conclusions: Task‐specific practice of dressing tasks in a group setting was feasible and made clinically significant differences to dressing performance during inpatient rehabilitation. More rigorous methods of investigation are required in future to minimise selection, measurement and intervention biases.     

Mobile teledermatology: a feasibility study of 58 subjects using mobile phones

We investigated the diagnostic agreement between teledermatology based on images from a mobile phone camera and face-to-face (FTF) dermatology. Diagnostic agreement was assessed for two teledermatologists (TD) in comparison with FTF consultations in 58 subjects. In almost three-quarters of the cases (TD1: 71%; TD2: 76%), the telediagnosis was fully concordant with the FTF diagnosis. Furthermore, the diagnosed diseases were almost all in the same diagnostic category (TD1: 97%; TD2: 90%). If mobile teledermatology had been used for remote triage, TD1 could have treated 53% subjects remotely and 47% subjects would have had to consult a dermatologist FTF. TD2 could have treated 59% subjects remotely, whereas 41% subjects would have had to consult a dermatologist FTF. Forty-eight subjects responded to a questionnaire, of whom only 10 had any concerns regarding teledermatology. Thirty-one subjects stated that they would be willing to pay to use a similar service in future and suggested an amount ranging from euro5 to euro50 per consultation (mean euro22) (euro = pound0.7, US $1.4). These results are encouraging as patient acceptance and reimbursement represent potential obstacles to the implementation of telemedicine services.     

Patients as partners in a health research agenda setting: the feasibility of a participatory methodology

This article deals with the participation of patients in setting the agenda of health research that potentially directly affects their lives. The focus is on the communication problems encountered between lay people and medical professionals in developing a joint research agenda. The author argues that a participatory methodology can address these problems and thereby give patients "a say" in the types of health research that have the greatest chance of affecting them personally. The article uses a case example of people with spinal cord injuries participating in research to support the importance and value of patient participation. The case example also helps to rethink appropriate methodologies or at least to modify existing approaches by paying more attention to required social conditions, diversity, and the life world of patients to foster meaningful participation.     

An exploratory study of male recovering substance abusers living in a self-help, self-governed setting

Adult men (n=132; 92% of the population) with histories of alchol/drug use disorders were interviewed upon their entry to 11 Oxford Houses located in the state of Illinois. Individuals still in residence at a six-month follow-up (n=48) were reinterviewed; prior to the follow-up interview, 42 men had left voluntarily and 42 men had been evicted for abuse or disruptive behavior. The men remaining in residence tended to be older (M age=37 years), were disproportionately African American (56%), and were less pessimistic about their future. At the intake interview, individuals who would be evicted reported a lower expectation for abstinence social support from the other residents in Oxford House. The Oxford House model of social support for recovery from alcohol and drug dependence appears to help some residents maintain sobriety. Portions of this article were presented at the annual meeting of the American Psychological Association, August 1995, in New York City.     

Accuracy and confidence of allied health assistants administering the subjective global assessment on inpatients in a rural setting: a preliminary feasibility study

Aim

Malnutrition has a significant impact on patient outcomes and duration of inpatient stay. However, conducting timely nutrition assessments can be challenging for rural dietitians. A solution could be for allied health assistants (AHAs) to assist with these assessments. The present study aimed to assess the accuracy and confidence of AHAs trained to conduct the subjective global assessment (SGA) compared with dietitians.

Methods

A non‐inferiority study design was adopted. Forty‐five adult inpatients admitted to a rural and remote health service were assessed independently by both a trained AHA and dietitian within 24 hours. The order of assessment was randomised, with the second assessor blind to the outcome of the initial SGA. Levels of agreement were examined using kappa and percent exact agreement (PEA; set a priori at ≥80%). Rater confidence after each assessment was assessed using a 10‐point scale.

Results

Agreement for overall SGA ratings was high (kappa = 0.84; PEA 84.4%). PEA for individual sub‐components of the SGA ranged from 66.4 to 86.7%. Where discrepancies were identified in global SGA ratings, AHAs provided a more severe rating of malnutrition than dietitians. AHAs reported significantly lower confidence than dietitians (t = 4.49, P < 0.001), although mean confidence for both groups was quite high (AHA=7.5, dietitians = 9.0).

Conclusions

Trained AHAs completed the SGA with similar accuracy to dietitians. Using AHAs may help facilitate timely nutrition assessment in rural health services when a dietitian is not physically present. Further investigation is required to determine the benefits of incorporating this extended role into rural and remote health‐care services.     

Telecytology in East Africa: a feasibility study of forty cases using a static imaging system

We conducted a pilot study to assess the feasibility of telecytology as a diagnostic tool in difficult cases originating from a hospital in East Africa. Forty cytology cases considered difficult by a referring pathologist were posted on a telepathology website. Six pathologists independently assessed the static images. Telecytology diagnoses were compared with the consensus diagnoses made on glass slides and also with the histogical diagnoses when available. The diagnostic agreement of the six pathologists was 71-93% and tended to be higher for pathologists with more experience. Reasons for discordance included poor image quality, presence of diagnostic cells in thick areas of smears, sampling bias and screening errors. The consensus diagnoses agreed with histological diagnoses in all 17 cases in which a biopsy was performed. Diagnostic accuracy rates (i.e. telecytology diagnosis vs. histological diagnosis) for individual pathologists were 65-88%. To ensure diagnostic accuracy both referring and consulting pathologists must have adequate training in cytology, image acquisition and image-based diagnosis and the diagnostic questions of importance must be clearly communicated by the referring pathologist when posting a case.     

不同类型毒品使用者性病艾滋病相关危险行为分析

目的了解浙江省台州市新型毒品与传统毒品滥用者HIV、梅毒及HCV感染风险,为吸毒人群行为干预提供依据。方法采用国家哨点监测问卷对台州市2016—2019年艾滋病哨点监测的毒品滥用者进行调查,并采集血液标本进行HIV、梅毒及HCV抗体检测。结果1 612名毒品滥用者中,新型毒品与传统毒品滥用者分别占78.7%和21.3%。2组人群的性别、年龄、文化程度、民族、户籍差异均有统计学意义(P < 0.05)。新型毒品滥用者注射吸毒率为7.1%,低于传统毒品组(P < 0.001);共用针具率为8.9%,与传统毒品组差异无统计学意义(P>0.05)。新型毒品滥用者最近1年内毒品使用后性行为发生率为77.9%,高于传统毒品组(P=0.002);两者每次使用安全套的比例约为30.0%。新型毒品滥用者HIV抗体阳性率为0.2%,与传统毒品组差异无统计学意义(P>0.05);梅毒检测阳性率为12.6%,高于传统毒品组(P < 0.05);HCV检测阳性率为10.4%,低于传统毒品组(P < 0.001)。结论新型毒品滥用者面临经血液和经性接触传播疾病的双重风险,亟需进一步制定符合其相应行为特征的干预模式。     

Rural carers online: a feasibility study

Objective:  To test the feasibility (for a potential randomised controlled trial) of a computer intervention for improving social interaction and promoting the mental health of rural carers.
Design:  The study combined pre- and post-intervention measures with interviews to determine the feasibility of the intervention and the acceptability of the study design to participants. The intervention consisted of providing 14 rural carers with computers and a 4-week training program on basic computer skills, using email and the Internet.
Setting:  The study was conducted in a rural community setting.
Participants:  The carers were 12 women and two men, aged from 50 to 81 years, with an average of 65.5 years.
Main outcome measures:  Measures of social isolation (UCLA Loneliness Scale), depression (Geriatric Depression Scale), carer burden (Zarit Burden Interview) and computer confidence were taken at baseline and at a 3-month follow-up. Interviews were completed at follow-up to discuss outcomes of the study. A focus group discussion was conducted with 11 participants to discuss the study and resolve computer issues.
Results:  Most carers reported increased confidence in email and Internet use. There was improvement for most participants in depressive symptoms and social isolation, but little change in carer burden. Participants identified many social benefits associated with the computer intervention, such as intergenerational connection, community building, skills and confidence and preparation for the future.
Conclusion:  The intervention was found to be practical and acceptable for a group of older carers. It was concluded that it would be feasible to conduct a large randomised controlled trial of the intervention.     

Probiotics reduce symptoms of antibiotic use in a hospital setting: A randomized dose response study

Probiotics are known to reduce antibiotic associated diarrhea (AAD) and Clostridium difficile associated diarrhea (CDAD) risk in a strain-specific manner. The aim of this study was to determine the dose-response effect of a four strain probiotic combination (HOWARU^® Restore) on the incidence of AAD and CDAD and severity of gastrointestinal symptoms in adult in-patients requiring antibiotic therapy. Patients (n = 503) were randomized among three study groups: HOWARU^® Restore probiotic 1.70 × 10¹⁰ CFU (high-dose, n = 168), HOWARU^® Restore probiotic 4.17 × 10⁹ CFU (low-dose, n = 168), or placebo (n = 167). Subjects were stratified by gender, age, and duration of antibiotic treatment. Study products were administered daily up to 7 days after the final antibiotic dose. The primary endpoint of the study was the incidence of AAD. Secondary endpoints included incidence of CDAD, diarrhea duration, stools per day, bloody stools, fever, abdominal cramping, and bloating. A significant dose-response effect on AAD was observed with incidences of 12.5, 19.6, and 24.6% with high-dose, low-dose, and placebo, respectively (p = 0.02). CDAD was the same in both probiotic groups (1.8%) but different from the placebo group (4.8%; p = 0.04). Incidences of fever, abdominal pain, and bloating were lower with increasing probiotic dose. The number of daily liquid stools and average duration of diarrhea decreased with higher probiotic dosage. The tested four strain probiotic combination appears to lower the risk of AAD, CDAD, and gastrointestinal symptoms in a dose-dependent manner in adult in-patients.