Managing alcohol‐related problems among Indigenous Australians: what the literature tells us

Objective: To contextualise and provide an overview of two review papers – prepared as part of a larger research program – dealing with different aspects of the treatment of Indigenous Australians with alcohol‐related problems. Method: The papers were reviewed thematically and compared to identify key issues raised in them. Findings: Together, the papers highlight the paucity of the evidence base for the provision of treatment for Indigenous Australians with alcohol‐related problems. Among the key issues identified are: the need to engage with clients in culturally safe ways; practitioner, organisational and client barriers to engagement; the contexts in which Indigenous drinking and treatment take place; the need to develop rigorous methods of evaluation more appropriate to Indigenous cultural and service provision settings; and the importance of effective partnerships in the provision of services. Conclusion: For those working in the field, the reviews direct attention to the need to review and interrogate our current practice. They also provide clear directions for future research.     

Identification of Physician Barriers to the Application of Screening and Brief Intervention for Problem Alcohol and Drug Use

Alcohol/other drug use (AOD) is related to many other health problems, thus making the topic of great public health significance. This article presents the results of focus groups conducted with physicians across the State of Pennsylvania as part of the Screening, Brief Intervention, and Referral to Treatment (PA SBIRT) project. The purpose was to ascertain the barriers to identifying problem AOD use in patients by practicing physicians. Physicians statewide acknowledged key barriers to screening, including time, access to treatment, and financial resources, both patient financial issues and reimbursement from insurers or commercial payers. Additional barriers that were identified as a result of the focus groups included the stigmatizing attitude toward AOD use, physicians' lack of self-efficacy in managing AOD use disorders, and lack of knowledge in this area, among others. The study discusses the results of the focus groups and explores educational and other strategies that could be offered to physicians in order to increase their knowledge, capabilities, and motivation in the area of screening and the identification of problem AOD use.     

十二指肠乳头括约肌小切开后大球囊扩张在治疗胆总管结石中的应用

目的回顾性分析十二指肠乳头括约肌小切开后大球囊扩张治疗胆总管结石的有效性与安全性。方法 138例MRCP证实小于20mm的胆总管结石行小切开后以8～20mm球囊扩张后取石。结果完全取石率95.7%（132/138）,术后并发症胰腺炎10.1%,胆管炎1.45%,胆囊炎2.17%,无出血及死亡病例。结论十二指肠乳头括约肌小切开后大球囊扩张治疗胆总管结石安全有效,且保留了括约肌功能。     

CAN WE BE BRIEF?

The author explores the subjective and objective nature of time in relation to brief psychotherapy, the contemporary contexts for this work and the impact of research on the changing culture of provision of counselling/psychotherapy. She describes clinical treatment using a brief Dynamic Relational approach with a traumatized patient in primary care who presents with panic and depression. Through this case she illustrates the most significant points of technique in her interpretation of this approach: assessment through interactional aspects of the first and second meetings, further assessment through history-taking and the development of narrative, forming a collaborative focus based on a maladaptive relational pattern, selective inattention and benign neglect, interpretative ‘action’, termination and the collaborative therapeutic summary and use of other attachment figures available in the primary care team setting, particularly during the termination phase. The patient's unconscious and conscious internalization processes enable brief treatment to be durable, and it is argued that depth can be achieved. The author contends that brief therapy requires specific techniques but also makes connections with long-term analytic work, for example, the parallel between Bion's concept of the ‘selected fact’ and the ‘focus’ in brief therapy.     

A randomized controlled trial of an internet-based intervention for alcohol abusers

Objective   Misuse of alcohol imposes a major public health cost, yet few problem drinkers are willing to access in-person services for alcohol abuse. The development of brief, easily accessible ways to help problem drinkers who are unwilling or unable to seek traditional treatment services could therefore have significant public health benefit. The objective of this project is to conduct a randomized controlled evaluation of the internet-based Check Your Drinking (CYD) screener ( http://www.CheckYourDrinking.net ).
Method   Participants ( n  = 185) recruited through a general telephone population survey were assigned randomly to receive access to the CYD, or to a no-intervention control group.
Results   Follow-up rates were excellent (92%). Problem drinkers provided access to the CYD displayed a six to seven drinks reduction in their weekly alcohol consumption (a 30% reduction in typical weekly drinking) at both the 3- and 6-month follow-ups compared to a one drink per week reduction among control group respondents.
Conclusions   The CYD is one of a growing number of internet-based interventions with research evidence supporting its efficacy to reduce alcohol consumption. The internet could increase the range of help-seeking options available because it takes treatment to the problem drinker rather than making the problem drinker come to treatment.     

Global emergence of trimethoprim/sulfamethoxazole resistance in Stenotrophomonas maltophilia mediated by acquisition of sul genes

Trimethoprim/sulfamethoxazole (TMP/SMX) resistance remains a serious threat in the treatment of Stenotrophomonas maltophilia infections. We analyzed an international collection of 55 S. maltophilia TMP/SMX-sensitive (S) (n=30) and -resistant (R) (n=25) strains for integrons; sul1, sul2 and dhfr genes; and insertion element common region (ISCR) elements. sul1, as part of a class 1 integron, was detected in 17 of 25 TMP/SMX-R. Nine TMP/SMX-R strains carried sul2; 7 were on large plasmids. Five TMP/SMX-R isolates were positive for ISCR2, and 4 were linked to sul2; 2 others possessed ISCR3. Two ISCR2s were adjacent to floR. Six TMP/SMX-S isolates harbored novel ISCR elements, ISCR9 and ISCR10. Linkage of ISCR3, ISCR9, and ISCR10 to sul2 and dhfr genes was not demonstrated. The data from this study indicate that class 1 integrons and ISCR elements linked to sul2 genes can mediate TMP/SMX resistance in S. maltophilia and are geographically widespread, findings that reinforce the need for ongoing resistance surveillance.