Process and predictors of drug treatment referral and referral uptake at the Sydney Medically Supervised Injecting Centre

Introduction and Aims . Low‐threshold drug services such as drug consumption rooms (DCRs) have been posited as referral gateways to drug treatment for injecting drug users (IDUs). We examined the process and predictors of drug treatment referral and referral uptake at an Australian DCR. Design and Methods . We undertook behavioural surveillance of the Sydney Medically Supervised Injecting Centre (MSIC) client cohort between May 2001 and October 2002. Data were collected for 3715 IDUs on demographics, injecting and drug use behaviours at registration and all subsequent MSIC service utilisation, including referrals. Referral uptake (defined as presentation for assessment at the relevant agency) was traced via reply‐paid postcards included with written referrals. Results . Sixteen per cent of clients who received written referrals to drug treatment had confirmed drug treatment referral uptake. Factors associated with drug treatment referral were frequent MSIC attendance [adjusted odds ratios (AOR = 9.4], receipt of written health (AOR = 4.8) or psychosocial (AOR = 4.3) referrals, heroin as main drug injected (AOR = 1.9) and completion of high school education (AOR = 1.6). Factors associated positively with drug treatment referral uptake were recent sex work (AOR = 2.6) and at least daily injection (AOR 2.3). Previous psychiatric illness or self‐harm was associated negatively with drug treatment referral uptake (AOR = 0.2). Discussion and Conclusions . MSIC engaged IDUs successfully in drug treatment referral and this was associated with presentation for drug treatment assessment and other health and psychosocial services. To improve rates of drug treatment referral and uptake, those with a history of mental health issues may require more intensive referral and case management.     

Successful methotrexate therapy in oral florid papillomatosis

Successful methotrexate therapy in oral florid papillomatosis Oral florid papillomatosis is a rare syndrome, which was first described under this name by Rock & Fisher in i960. The same syndrome had been previously described as papillomatosis mucosae oris carcinoides by Scheicher-Gottron (1958). It is a benign condition, capable of malignant degeneration. Surgical excision and electrocoagulation are the most widely used therapeutic methods, despite the fact that relapse of symptoms after treatment by these methods is common. The literature comprises a few reports on favourable therapeutic effects obtained with small doses of methotrexate. This paper describes a patient with a multifocal, very extensive form of oral florid papillomatosis, in whom both surgical excision and electrocoagulation were regarded as inadequate in view of the extensiveness of the lesion. Chemotherapy with methotrexate proved to be effective and resulted in complete remission. No relapse has occured during a follow-up period of over 2 years. The value of chemotherapy with methotrexate in the treatment of an extensive form of oral florid papillomatosis is emphasized.     

The Closed-Eye Swelling Response of the Cornea to Polycon and Menicon 02 Gas-permeable Hard Lenses

ABSTRACT The corneal swelling response to Polycon and Menicon O, lenses was monitored over six hours of eye closure. For five subjects, the average corneal swelling with the Polycon and Menicon O, lenses was 15.9 ± 4.8% and 15.2 ± 4.3% respectively. Two of the subjects experienced more than 19% edema with both lenses. In view of the high levels of edema, neither lens is considered capable of supporting extended wear and patients should be advised accordingly. Patients should also be cautioned regarding napping with these lenses, as they can induce approximately 6% edema in 1 hour and 9% edema in 2 hours. It is suggested that in order for a gas-permeable lens to be considered for extended wear it should have an oxygen transmissibility of at least 25 × 10-9 (cm × ml 02)/(sec × ml × mm Hg).     

The first year: employment patterns and job perceptions of nursing assistants in a rural setting

Meyer D., Raffle H. & Ware L.J. (2014) Journal of Nursing Management 22 , 769–778 The first year: employment patterns and job perceptions of nursing assistants in a rural setting Aim The aim of this study was to follow rural certified nursing assistants (CNAs) (n = 123) in the United States for 1 year post-training to identify retention and turnover issues in the long-term care (LTC) setting by exploring the CNAs’ perceptions of the LTC work experience. Background Turnover among CNAs impacts the quality of care, imposes a financial burden on facilities and taxpayers, and creates increased stress and workloads on those who remain. Method A longitudinal survey design was used to track individuals completing CNA training for 1 year. Results At 1 year post-training, 53.7% of respondents currently worked in LTC, 30.9% worked in LTC and left, and the remaining 15.4% never worked in LTC. Conclusion While the training site does not appear to impact retention, the first 6 months of employment appear critical. The CNAs cited pay as a reason for leaving LTC, but better pay did not characterize the jobs taken by the CNAs who left. Implications for nursing management This study highlights the importance of the first 6 months of employment to retention and provides practical information for nurse managers evaluating the resource-effectiveness of hosting training programmes. Additionally, the key issues influencing retention were identified and practical suggestions for nurse managers to improve retention are provided.     

HIV AIDS Public Service Announcements Around the World: A Descriptive Analysis

This article provides a detailed analysis of message and production values used by government health agencies and television networks in 33 countries to create HIV AIDSrelated Public Service Announcements (PSAs). Although the first half of the article examines message factors in 317 PSAs, the second half presents a correlational analysis linking message factors to country characteristics such as level of social vulnerability, gross national product, human freedom, and female status.     

Atrial Fibrillation in Heart Failure:

Atrial fibrillation and congestive heart failure are commonly occurring cardiac disorders that often exist concomitantly. The prognostic significance of the presence or absence of atrial fibrillation, as an independent risk factor, in patients with heart failure remains controversial. Antiarrhythmic drugs with good hemodynamic profiles and neutral effects on survival are preferred treatments for converting atrial fibrillation and maintaining sinus rhythm. Other standard therapies for congestive heart failure, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers also have a role in the treatment of these coexisting disease states. The article presents an overview of atrial fibrillation in patients with heart failure and reviews the prevalence, prognostic significance, and efficacy of various antiarrhythmic agents for the conversion and maintenance of sinus rhythm. (J Cardiovasc Electrophysiol, Vol. 14, pp. S281-S286, December 2003, Suppl.)     

Eye tracking dysfunction and schizophrenia: an overview with special reference to the genetics of schizophrenia

A high prevalence of eye tracking dysfunction (ETD) among schizophrenic patients and their relatives is one of the most widely replicated findings in experimental psychopathology. Almost 25 years of research have shown the following: (1) ETD occurs in about half of schizophrenics, and is not a function of psychotic state, inattention or neuroleptic drug treatment; (2) ETD involves primarily an impairment of smooth pursuit eye movements, characterized by reduced gain and increased compensatory saccades; (3) ETD also occurs in a substantial proportion of unaffected first-degree relatives of schizophrenics, including clinically discordant co-twins of schizophrenics, suggesting that ETD is under genetic control; (4) the prevalence of ETD in relatives of schizophrenics is higher than the recurrence risk for schizophrenia. ETD is one of several traits associated with schizophrenia and genetically related to schizophrenia. The use of co-familial traits like ETD, in addition to schizophrenia, increases the power of linkage studies to find a gene(s) for schizophrenia compared with conventional methods of linkage analysis, which use only the presence of the schizophrenic psychosis as the phenotype.     

Assessing Psychotropic Medication Side Effects Among Children A Reliability Study

The Dosage Record Treatment Emergent Symptom Scale (DOTES) is a rating scale for measuring the presence and intensity of psychotropic medication side effects. Studies to evaluate its reliability have not been published. The purposes of this pilot study are to (1) develop a protocol for training raters to use the DOTES, (2) assess inter-rater agreement, 3) examine the reasons for disagreement among raters to clarify training procedures and symptom definitions, and (4) further refine this instrument for use in clinical and research settings.
Five nurses were trained to use the DOTES to rate the absence or presence and intensity of specific medication side effects. After training, Raters 1,2, and 3 watched a videotape of a nurse interviewing a 13-year-old child and completed the DOTES rating scale. There was agreement on the intensities of 6 (67%) of the 9 symptoms identified as present and agreement on 17 (89%) of the 19 symptoms identified as absent.
Process tracings were conducted on the ratings of Nurses 4 and 5 to elicit the criteria they used to determine their ratings. The results of the process tracings were used to identify ambiguities that led to disagreement among raters so that the training protocol and interview could be improved.