scholarly journals Cannabis Use Among Veterans: It Should be Easier to Get Some

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 511-511
Author(s):  
Julie Bobitt
Keyword(s):  
Cannabis Use ◽  
Veterans Administration ◽  
Prescription Medications ◽  
Medical Cannabis ◽  
Structured Interviews ◽  
Policy Makers ◽  
Negative Side Effects ◽  
Inductive Thematic Analysis ◽  
Do So

Abstract and PTSD. From December 2020 – February 2021 we conducted 32 semi-structured interviews with Veterans who responded to our initial and follow-up surveys and agreed to discuss their cannabis use. We coded and themed the interviews using inductive thematic analysis. We found that many Veterans are using cannabis in place of other medications such as opioids and benzodiazepines and often do so to avoid the negative side effects. However, barriers such as Veterans Administration policies and cost of medical cannabis affect Veterans ability to obtain medical cannabis. Our results inform clinicians and policy makers on the use of cannabis as an alternative to prescription medications for treating chronic pain and other conditions in older Veterans.

scholarly journals Paradox of life among survivors of bladder cancer and treatments

2016 ◽  
Vol 50 (2) ◽  
pp. 224-231 ◽  
Author(s):  
Miriam Lopes ◽  
Lucila Castanheira Nascimento ◽  
Márcia Maria Fontão Zago
Keyword(s):  
Bladder Cancer ◽  
Methodological Approach ◽  
University Hospital ◽  
Social Dimensions ◽  
Structured Interviews ◽  
Hospital Data ◽  
Narrative Methodology ◽  
Journal Entries ◽  
Inductive Thematic Analysis

Abstract OBJECTIVE: To interpret the meanings attributed to the experience of bladder cancer among survivors in therapeutic follow-up. METHOD: Qualitative methodological approach, based on medical anthropology and narrative methodology. After approval by the research ethics committee of a public university hospital, data were collected from January 2014 to February 2015, by means of recorded semi-structured interviews, direct observation and field journal entries on daily immersion with a group of six men and six women, aged between 57 and 82 years, in therapeutic follow-up. Narratives were analyzed by means of inductive thematic analysis. RESULTS: The meanings revealed difficulties with the processes of disease and treatment, such as breakdown of normal life, uncertainty about the future due to possible recurrence of the disease, difficulty with continuity of care and emotional control, relating it to conflicting ways of understanding the present life. Thus, the meaning of this narrative synthesis is paradox. CONCLUSION: Interpretation of the meaning of experience with bladder cancer among patients provides nurses with a comprehensive view of care, which encompasses biological, psychological and social dimensions, and thereby systematizes humanized care.

Opioid and healthcare service use in medical cannabis patients with chronic pain: a prospective study

2021 ◽  
pp. bmjspcare-2020-002661
Author(s):  
Sharon Sznitman ◽  
Carolyn Mabouk ◽  
Zahi Said ◽  
Simon Vulfsons
Keyword(s):  
Chronic Pain ◽  
Service Use ◽  
Prescription Medication ◽  
Healthcare Services ◽  
Prescription Medications ◽  
Medical Cannabis ◽  
Opioid Prescription ◽  
Study Results ◽  
Small Effect Size

BackgroundVarious jurisdictions have legalised medical cannabis (MC) for use in chronic pain treatment. The objective of this study was to determine if the use of MC is related to a reduction in the use of prescription opioids and other prescription medications and healthcare services.MethodsA retrospective cohort study was conducted using the medical files of 68 Israeli patients with chronic pain using MC. Number of prescription medications filled and healthcare services used were recorded separately for the baseline period (6 months prior to the start of MC treatment) and 6 months’ follow-up. Paired t-tests were used to compare each individual to himself/herself from baseline to follow-up.ResultsPatients filled less opioid prescription medication at follow-up compared with baseline, and the reduction was of small effect size. There were no significant changes in the use of other medications or use of healthcare services from pre-MC treatment to follow-up.ConclusionsMC may be related to a significant yet small reduction in opioid prescription medication. Further prospective studies with representative samples are warranted to confirm the potential small opioid-sparing effects of MC treatment, its clinical importance, if any, and potential lack of association with other healthcare-related services and medication use. Due to methodological limitations of the data used in this study, results may be regarded as preliminary and causal inferences cannot be made.

scholarly journals Cohort study of medical cannabis authorization and motor vehicle crash-related healthcare visits in 2014–2017 in Ontario, Canada

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Cerina Lee ◽  
Don Voaklander ◽  
Jasjeet K. Minhas-Sandhu ◽  
John G. Hanlon ◽  
Elaine Hyshka ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Motor Vehicle ◽  
Emergency Department Visits ◽  
Motor Vehicle Crash ◽  
Cannabis Use ◽  
Medical Cannabis ◽  
The Impact

Abstract Background With increasing numbers of countries/jurisdictions legalizing cannabis, cannabis impaired driving has become a serious public health concern. Despite substantive research linking cannabis use with higher rates of motor vehicle crashes (MVC), there is an absence of conclusive evidence linking MVC risk with medical cannabis use. In fact, there is no clear understanding of the impact of medical cannabis use on short- and long-term motor vehicle-related healthcare visits. This study assesses the impact of medical cannabis authorization on motor vehicle-related health utilization visits (hospitalizations, ambulatory care, emergency department visits, etc) between 2014 and 2017 in Ontario, Canada. Methods A matched cohort study was conducted on patients authorized to use medical cannabis and controls who did not receive authorization for medical cannabis – in Ontario, Canada. Overall, 29,153 adult patients were identified and subsequently linked to the administrative databases of the Ontario Ministry of Health, providing up to at least 6 months of longitudinal follow-up data following the initial medical cannabis consultation. Interrupted time series analyses was conducted to evaluate the change in rates of healthcare utilization as a result of MVC 6 months before and 6 months after medical cannabis authorization. Results Over the 6-month follow-up period, MVC-related visits in medical cannabis patients were 0.50 visits/10000 patients (p = 0.61) and − 0.31 visits/10000 patients (p = 0.64) for MVC-related visits in controls. Overall, authorization for medical cannabis was associated with an immediate decrease in MVC-related visits of − 2.42 visits/10000 patients (p = 0.014) followed by a statistically significant increased rate of MVC-related visits (+ 0.89 events/10,000 in those authorized medical cannabis) relative to controls in the period following their authorization(p = 0.0019). Overall, after accounting for both the immediate and trend effects, authorization for medical cannabis was associated with an increase of 2.92 events/10,000 (95%CI 0.64 to 5.19) over the entire follow-up period. This effect was largely driven by MVC-related emergency department visits (+ 0.80 events/10,000, p < 0.001). Conclusions Overall, there was an association between medical cannabis authorization and healthcare utilization, at the population level, in Ontario, Canada. These findings have public health importance and patients and clinicians should be fully educated on the potential risks. Continued follow-up of medically authorized cannabis patients is warranted to fully comprehend long-term impact on motor vehicle crash risk.

scholarly journals Disclosure of alcohol-related harm: Children’s experiences

2018 ◽  
Vol 36 (3) ◽  
pp. 209-222 ◽  
Author(s):  
Ilona Tamutienė ◽  
Birutė Jogaitė
Keyword(s):  
Protective Factors ◽  
Risk Identification ◽  
Alcohol Problems ◽  
Social Risk ◽  
Structured Interviews ◽  
Policy Makers ◽  
Associative Stigma ◽  
Alcohol Related Harm ◽  
Informal Settings

Objectives: (1) to learn to whom children disclose experiences of harm caused by their parents’ or carers’ substance abuse, (2) to show whether professionals enable children to disclose this harm, and (3) to highlight what kind of assistance they provide after disclosure of harm. Methods: The study is based on in-depth semi-structured interviews with children living with alcohol-abusing caregivers in Lithuania. Twenty-three children, aged from 8 to 18 years, from social risk families participated in this study. Results: Children suffer not only from the maltreatment itself, but also from the associative stigma of the caregivers’ drinking. They prefer to disclose their troubles in informal settings because professionals often do not help children to disclose harm and may even ignore it. Conclusion: The analysis shows that when children reveal parental alcohol problems, there is no inquiry, follow-up, or management of the children’s problems related to the caregivers’ drinking. And yet, protective factors such as social support and positive experiences may enhance children’s resilience in adverse conditions. Policy-makers should reduce barriers to disclosure and refocus their strategies from risk identification to identification of protective factors. Professionals need to develop an understanding about how they can support children to disclose harms related to the caregivers’ drinking so that harms to children can be managed sensitively and well.

scholarly journals Cohort Study of Medical Cannabis Authorization and Motor Vehicle Crash-Related Healthcare Visits in 2014-2017 in Ontario, Canada

2020 ◽  
Author(s):  
Cerina Lee ◽  
Don Voaklander ◽  
Jasjeet K. Minhas-Sandhu ◽  
John G. Hanlon ◽  
Elaine Hyshka ◽  
...  
Keyword(s):  
Public Health ◽  
Cohort Study ◽  
Healthcare Utilization ◽  
Motor Vehicle ◽  
Motor Vehicle Crash ◽  
Cannabis Use ◽  
Medical Cannabis ◽  
The Impact

Abstract Background: With increasing numbers of countries/jurisdictions legalizing cannabis, cannabis impaired driving has become a serious public health concern. Despite substantive research linking cannabis use with higher rates of motor vehicle crashes (MVC), there is an absence of conclusive evidence linking MVC risk with medical cannabis use. In fact, there is no clear understanding of the impact of medical cannabis use on short- and long-term motor vehicle-related healthcare visits. This study assesses the impact of medical cannabis authorization on motor vehicle-related health utilization visits (hospitalizations, ambulatory care, emergency room visits, etc) between 2014-2017 in Ontario, Canada. Methods: A matched cohort study was conducted on patients authorized to use medical cannabis and controls who did not receive authorization for medical cannabis – in Ontario, Canada. Overall, 29153 adult patients were identified and subsequently linked to the administrative databases of the Ontario Ministry of Health, providing up to at least 6 months of longitudinal follow-up data following the initial medical cannabis consultation. Interrupted time series analyses was conducted to evaluate the change in rates of healthcare utilization as a result of MVC 6 months before and 6 months after medical cannabis authorization. Results: Over the 6-month follow-up period, MVC-related visits in medical cannabis patients were 0.50 visits/10 000 patients (p=0.61) and -0.31 visits/10 000 patients (p=0.64) for MVC-related visits in controls. Overall, authorization for medical cannabis was associated with an immediate decrease in MVC-related visits of -2.42 visits/10 000 patients (p=0.014) followed by a statistically significant increased rate of MVC-related visits (+0.89 events/10,000 in those authorized medical cannabis) relative to controls in the period following their authorization(p=0.0019). Overall, after accounting for both the immediate and trend effects, authorization for medical cannabis was associated with an increase of 2.92 events/10,000 (95%CI 0.64 to 5.19) over the entire follow-up period. This effect was largely driven by MVC-related emergency department visits (+0.80 events/10,000, p<0.001). Conclusions: Overall, medical cannabis authorization was associated with increased healthcare utilization as a result of a MVC, at the population level, in Ontario, Canada. These findings have public health importance and patients and clinicians should be fully educated on the potential risks. Continued follow-up of medically authorized cannabis patients is warranted to fully comprehend long-term impact on motor vehicle crash risk.

scholarly journals Characteristics of Older Veterans Enrolled in the Illinois Medical Cannabis Patient Program

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 477-478
Author(s):  
Julie Bobitt ◽  
Hyojung Kang
Keyword(s):  
Health Outcomes ◽  
Emotional Health ◽  
Clinical Care ◽  
Cannabis Use ◽  
Medical Cannabis ◽  
Post Traumatic Stress ◽  
Policy Makers ◽  
The Us ◽  
History Of ◽  
Post Traumatic

Abstract Veterans often struggle with disabling conditions such as chronic pain and post-traumatic stress disorder (PTSD) that tend to worsen as they age. Common treatments for these conditions include the use of opioids and benzodiazepines, yet these medications tend to have unwanted side effects and can even result in addiction. While cannabis use in the US has increased significantly over the past decade, research regarding the risks and benefits is mixed and a growing number of research studies have highlighted the benefits of taking cannabis for medical purposes. While previous studies have looked at cannabis use in older adults and in Veterans over 18, no research has looked at cannabis use specifically in older Veterans. We surveyed adults age 60 and over who were enrolled in the Illinois Medical Cannabis Patient Program as of September 2019. We collected demographics, reason for enrolling in the medical cannabis program, history of cannabis, opioids, and/or benzodiazepines use, and health outcomes. Of 3,768 responses, 593 were Veterans. Older Veterans in our study were predominately male (92.1%), reported using cannabis primarily for pain (80.1%), PTSD or emotional health problems (50.1%) (i.e. anxiety and depression), and reported that cannabis use has positively impacted their quality of life (89.4%), health outcomes (81.9%), pain (86%), and sleep quality (77.1%). Understanding why older Veterans use cannabis and the outcomes they experience from cannabis use can inform state and federal policy makers and enhance clinical care practices.

Individualized cancer follow-up supported by electronic Patient-Reported Outcomes: Development and evaluation (Preprint)

2020 ◽  
Author(s):  
Sissel Ravn ◽  
Henriette Vind Thaysen ◽  
Lene Seibaek ◽  
Victor Jilbert Verwaal ◽  
Lene Hjerrild Iversen
Keyword(s):  
Ct Scan ◽  
Advanced Cancer ◽  
Patient Reported Outcomes ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Structured Interviews ◽  
European Organization ◽  
Individualized Care ◽  
Patient Reported

BACKGROUND Cancer survivors experience unmet needs during follow-up. Besides recurrence, a follow-up includes detection of late side effects, rehabilitation, palliation and individualized care. OBJECTIVE We aimed to describe the development and evaluate the feasibility of an intervention providing individualized cancer follow-up supported by electronic patient-reported outcomes (e-PRO). METHODS The study was carried out as an interventional study at a Surgical and a Gynecological Department offering complex cancer surgery and follow-up for advanced cancer. The e-PRO screened for a priori defined clinical important symptoms and needs providing individualized follow-up. We included following questionnaires in the e-PRO; the general European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC validated for colorectal and ovarian cancer patients. To support individualization, we included three prioritized issues of the patient’s preference in each e-PRO. The response-algorithm was aggregated based on the severity of the patient’s response. To ensure the sensitivity of the e-PRO, we performed semi-structured interviews with five patients. All clinicians (surgeons and gynecologists) performing the consultations reviewed the e-PRO. The evaluation was divided in two, 1)The feasibility was assessed by a)Patients’ response rate of the e-PRO, b)Number of follow-up visits documenting the use of e-PRO and c)Patients’ prioritized issues prior to the consultation(‘yes’ / ‘no’), and after the follow-up 2)Patients assessment of a)The need and purpose of the follow-up visit and b)the support provided during the follow-up visit. RESULTS In total, 187 patients were included in the study, of which 73%(n=136/187) patients responded to the e-PRO and were subjected to an individualized follow-up. The e-PRO was documented as applied in 79% of the follow-up visits. In total, 23% of the prioritized issues did not include a response. Stratified by time since surgery, significantly more patients did not fill out a prioritized issue had a follow-up >6 months since surgery. In total, 72 % follow-up visits were evaluated to be necessary in order to discuss the outcome of the CT scan, symptoms, and/or prioritized issues. Contrary, 19% of the follow-up visits were evaluated to be necessary only to discuss the result of the CT scan. A range from 19.3–56.3% of patients assessed the follow-up visit to provide support with respect to physical (42% of patients), mental (56%), sexual (19%) or dietary (27%) issues. Further, a range from 34–60% of the patients reported that they did not need support regarding physical (43% of patients), mental (34%), sexual (63%) or dietary (57%) issues. CONCLUSIONS An individualized follow-up based on e-PRO is feasible, and support most patients surgically treated for advanced cancer. However, results indicate that follow-up based on e-PRO may not be beneficial for all patients and circumstances. A thorough cost-benefit analysis may be warranted before implementation in routine clinic.

scholarly journals Smart Cities in Turkey: Approaches, Advances and Applications with Greater Consideration for Future Urban Transport Development

Energies ◽  
2019 ◽  
Vol 12 (12) ◽  
pp. 2308 ◽  
Author(s):  
Can Bıyık
Keyword(s):  
Urban Areas ◽  
Planning Process ◽  
Smart Cities ◽  
Radical Change ◽  
Urban Transport ◽  
Transport Systems ◽  
Structured Interviews ◽  
Policy Makers ◽  
Comprehensive Survey ◽  
Future Vision

The smart city transport concept is viewed as a future vision aiming to undertake investigations on the urban planning process and to construct policy-pathways for achieving future targets. Therefore, this paper sets out three visions for the year 2035 which bring about a radical change in the level of green transport systems (often called walking, cycling, and public transport) in Turkish urban areas. A participatory visioning technique was structured according to a three-stage technique: (i) Extensive online comprehensive survey, in which potential transport measures were researched for their relevance in promoting smart transport systems in future Turkish urban areas; (ii) semi-structured interviews, where transport strategy suggestions were developed in the context of the possible imaginary urban areas and their associated contextual description of the imaginary urban areas for each vision; (iii) participatory workshops, where an innovative method was developed to explore various creative future choices and alternatives. Overall, this paper indicates that the content of the future smart transport visions was reasonable, but such visions need a considerable degree of consensus and radical approaches for tackling them. The findings offer invaluable insights to researchers inquiring about the smart transport field, and policy-makers considering applying those into practice in their local urban areas.

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