The fentanyls: pharmacological and clinical aspects relevant to Australia

2020 ◽  
Vol 28 (5) ◽  
pp. 542-544
Author(s):  
Shaun L Greene ◽  
Anton Scamvougeras ◽  
Amanda Norman ◽  
Yvonne Bonomo ◽  
David J Castle
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
North American ◽  
Clinical Aspects ◽  
Clinical Effects ◽  
Care Providers ◽  
Policy Makers ◽  
Drug And Alcohol ◽  
Overdose Deaths

Objective: North American and other jurisdictions have seen an alarming rise in the abuse of the fentanyls, with related overdose deaths. We sought to review this group of drugs to alert Australian psychiatrists and drug and alcohol clinicians to their clinical effects and potential harms. Conclusions: The extreme potency of the fentanyls underlie their lethality. Vigilance and investment from both policy makers and health care providers are required to mitigate harm from a possible future Australian fentanyl epidemic.

scholarly journals Reproductive awareness and recognition of unintended pregnancy: young women, key informants and health care providers perspectives in South Africa

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Oluwaseyi Dolapo Somefun ◽  
Jane Harries ◽  
Deborah Constant
Keyword(s):  
South Africa ◽  
Health Care ◽  
Unintended Pregnancy ◽  
Health Care Providers ◽  
Signs And Symptoms ◽  
Second Trimester ◽  
Care Providers ◽  
Policy Makers ◽  
Abortion Care ◽  
Pregnancy Status

Abstract Background South Africa has a liberal abortion law, yet denial of care is not uncommon, usually due to a woman being beyond the legal gestational age limit for abortion care at that facility. For women successfully obtaining care, time from last menstrual period to confirmation of pregnancy is significantly longer among those having an abortion later in the second trimester compared to earlier gestations. This study explores women’s experiences with recognition and confirmation of unintended pregnancy, their understanding of fertile periods within the menstrual cycle as well as healthcare providers’ and policy makers’ ideas for public sector strategies to facilitate prompt confirmation of pregnancy. Methods We recruited participants from July through September 2017, at an urban non-governmental organization (NGO) sexual and reproductive health (SRH) facility and two public sector hospitals, all providing abortion care into the second trimester. We conducted in-depth interviews and group discussions with 40 women to elicit information regarding pregnancy recognition and confirmation as well as fertility awareness. In addition, 5 providers at these same facilities and 2 provincial policy makers were interviewed. Data were analysed using thematic analysis. Results Uncertainties regarding pregnancy signs and symptoms greatly impacted on recognition of pregnancy status. Women often mentioned that others, including family, friends, partners or colleagues noticed pregnancy signs and prompted them to take action. Several women were unaware of the fertility window and earliest timing for accurate pregnancy testing. Health care providers and policy makers called for strategies to raise awareness regarding risk and signs of pregnancy and for pregnancy tests to be made more readily accessible. Conclusion Early recognition of unintended pregnancy in this setting is frustrated by poor understanding and awareness of fertility and pregnancy signs and symptoms, compounded by a distrust of commercially available pregnancy tests. Improving community awareness around risk and early signs of pregnancy and having free tests readily available may help women confirm their pregnancy status promptly.

Refugee and Immigrant Women’s Experience of Postpartum Depression: A Meta-Synthesis

2017 ◽  
Vol 29 (1) ◽  
pp. 84-100 ◽  
Author(s):  
Carolyn L. Tobin ◽  
Pam Di Napoli ◽  
Cheryl Tatano Beck
Keyword(s):  
Health Care ◽  
Postpartum Depression ◽  
Health Care Providers ◽  
Help Seeking ◽  
Immigrant Women ◽  
Care Providers ◽  
Policy Makers ◽  
Raising Awareness ◽  
Effective Care ◽  
Insight Into

The aim of this work is to synthesize qualitative research on refugee and immigrant women’s experiences of postpartum depression (PPD) to gain insight into the unique needs of this group of women. This population is more at risk of developing PPD due to a complexity of issues including pre- and postmigratory stressors; however, there is currently little research on this topic available to health care providers and policy makers. Thirteen articles met inclusion criteria, and five themes emerged from the meta-synthesis: (a) suffering in solitude, (b) the invisible illness, (c) cultural conceptualizations, (d) barriers to help seeking, and (e) facilitators of help seeking. Conclusions suggest immigrant women with PPD may lack understanding of their condition, are often isolated, are alone, fear stigmatization, and risk being considered an unfit mother. Raising awareness with health care providers of the meaning of PPD for immigrant women is key to the provision of effective care.

The moral challenges of health care providers brain drain phenomenon

2020 ◽  
pp. 147775092094661
Author(s):  
Faith Atte
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Brain Drain ◽  
Health Care Professionals ◽  
Global Justice ◽  
Health Workers ◽  
Work Environments ◽  
Care Providers ◽  
Policy Makers ◽  
Left Behind

The migration of health-care professionals has often produced morally charged discussions among ethicists, politicians, and policy makers in the migrant-sending and migrant-receiving countries because of its devastating effects on the health of those left behind in the countries of origin.This movement of skilled professionals – their decision to leaving their countries of origin in search of better work environments – has created a phenomenon that has been described as brain drain. Although the migration of health workers continue to bring prosperity to millions of people around the world, they have also evoked hopelessness in many more people. Thus, questions of global justice manifest themselves when it comes to the matters of brain drain and the just distribution of health and healthcare professionals.

Medical Care in a Police Intervention with Conducted Electrical Weapons: Zaragoza (Spain) Fire Department Protocol

2021 ◽  
pp. 1-6
Author(s):  
Armando Cester-Martínez ◽  
Leticia Serrano-Lasaosa ◽  
Diego Borraz-Clares
Keyword(s):  
Health Care ◽  
Law Enforcement ◽  
Health Care Providers ◽  
Medical Literature ◽  
Fire Department ◽  
Risk Groups ◽  
Clinical Effects ◽  
Care Providers ◽  
Law Enforcement Agencies ◽  
The Subject

Abstract In the last decade, conducted electrical weapons (CEWs) have become a new tool for law enforcement agencies as an alternative to firearms. They provide security in the intervention for both the police and the citizen and try to cause the least possible harm to the subject to immobilize. The health care providers who perform in joint actions with the police in which CEWs are used should be aware of how they work, risk groups, as well as the most frequent clinical effects associated with the application of electrical discharge, and the complications that can be produced according to the area of impact of the electrodes. For this purpose, the current medical literature was reviewed by consulting the main health care sciences database (PubMed) to determine the medical measures to be taken before, during, and after the use of these weapons. Also presented and shared is the Zaragoza (Spain) Fire Department protocol.

Critical Care Thresholds in Children with Bronchiolitis

2020 ◽  
Vol 37 (S 02) ◽  
pp. S42-S45
Author(s):  
Steve Cunningham
Keyword(s):  
Health Care ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Health Care Providers ◽  
Clinical Characteristics ◽  
Clinical Aspects ◽  
Care Providers ◽  
Admission Rates ◽  
High Flow Oxygen ◽  
Critical Care Admission

Reduction in mortality from bronchiolitis in developed health is principally achieved from the availability of critical care. Different health care providers and countries demonstrate considerable variance in admission rates, but globally the use and cost of this resource are increasing. The reasons of this are multifold and include organizational, cultural, and clinical aspects. The organization of care has evolved differently in different health care settings at the threshold of critical need, with local priorities and resources determining the location of care (ward or critical care). Critical care areas adopting high-flow oxygen therapy (HFOT) (a ward-based therapy in some institutions) have seen significant increase in their occupancy, without change in rates of mechanical ventilation. Culturally, some countries appear to have a lower threshold for intubation and mechanical ventilation: United States (18%), Finland (4%), and even in countries with high rates of critical care admission (27% in Australia and New Zealand), intubation rates can decline with time (reducing from 27% to 11%). Baseline clinical characteristics of children admitted to critical care are remarkably similar, children are young (c30–60 days) and often born prematurely (21–46%). Clinical thresholds for admission as predefined by critical care units in online guidance focus on presence of apnea (observed in 7–42% of admissions), low pulse oxygen saturation and subjective measures (exhaustion and reduced consciousness). Clinical characteristics of children at the time of admission are commonly reported in relation to the modified Woods Clinical Asthma Score (mean = 3.8 to ≥7) and raised pCO2 (range = 8.0–8.8 kPa), with pCO2 the only significant parameter in a multivariate analysis of factors associated with intubation. Key Points

Patient safety in the ICU

2016 ◽  
Author(s):  
Bradford D. Winters ◽  
Peter J. Pronovost
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Health Care Providers ◽  
Model Building ◽  
Care Providers ◽  
Health Care Environment ◽  
Policy Makers ◽  
Process Improvements ◽  
Safety Issues ◽  
Sustainable Improvement

While patient safety and quality have become a major focus of health care providers, policy makers, and customers over the last decade and a half, progress has been limited and wide quality gaps, where patient do not receive the care they should, remain. While technical improvements have gone a long way in these efforts, adaptive improvements in the culture of safety need to be more vigorously addressed. Likewise, quality metrics and a scientific approach to patient safety is necessary to ensure that interventions actually work. The Comprehensive Unit Safety Program (CUSP) strategy and its embedded Learning from Defects (LFD) process are central to creating a sustainable improvement in the culture of patient safety and quality, and in real outcomes and process improvements. CUSP is a bottom-up approach that relies on the wisdom and efforts of front-line providers who best know the safety issues in their immediate environment. The LFD process seeks to translate evidence into practice (TRiP model) building interventions and tools to improve safety and close the quality gap. The development of these interventions and tools are guided by the principles of safe design and the application of the four E’s (engagement, education, execution, and evaluation) can be successfully implemented into the health care environment with substantial improvements in safety and quality.

scholarly journals Barriers and Facilitating Factors for Research Involvement in Cancer Centers

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481876547 ◽  
Author(s):  
Christoph Kowalski ◽  
Stefan Post ◽  
Thomas Seufferlein ◽  
Stefan R. Benz ◽  
Julia Ferencz ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Organizations ◽  
Care Providers ◽  
Online Questionnaire ◽  
Cancer Society ◽  
Policy Makers ◽  
Cancer Centers ◽  
Principal Investigators ◽  
Research Involvement

Improvements in health care depend on research involving health-care providers (HCPs) and health-care organizations (HCOs). Existing research suggests that involvement in research studies is still much lower than it could be. This study investigates factors that may impede or facilitate research involvement. A standardized online questionnaire was used to carry out a survey, in 3 countries, of key informants in colorectal cancer centers that hold certification in accordance with the requirements of the German Cancer Society. A total of 184 individuals responded (response rate 65%). The respondents found it difficult to identify studies suitable for their patients (40% agreement), criticized the small overall number of studies available (48%), and found that many studies are not worthwhile financially (56%). Among respondents who were not involved in studies as the principal investigators (PIs), 66% agreed they lacked the research infrastructure needed and 81% that they did not have enough staff. Among respondents who were involved as PIs, only 22% indicated that their hospital management encouraged them to initiate and conduct clinical trials. Eighty-five percent of the respondents agreed that the general population lacks information about the importance of studies. Five recommendations for health policy makers are derived from these findings for ways of increasing the involvement of HCPs and HCOs in research, and in cancer research in particular.

scholarly journals Using eHealth to Support COVID-19 Education, Self-Assessment, and Symptom Monitoring in the Netherlands: Observational Study (Preprint)

2020 ◽  
Author(s):  
Thomas Timmers ◽  
Loes Janssen ◽  
Joep Stohr ◽  
J L Murk ◽  
M A H Berrevoets
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Regional Distribution ◽  
Care Providers ◽  
Self Assessment ◽  
Health Care Consumption ◽  
Policy Makers ◽  
Support Policy ◽  
Interactive Map ◽  
Symptom Diary

BACKGROUND The coronavirus disease (COVID-19) situation demands a lot from citizens, health care providers, and governmental institutions. Citizens need to cope with guidelines on social interaction, work, home isolation, and symptom recognition. Additionally, health care providers and policy makers have to cope with unprecedented and unpredictable pressure on the health care system they need to manage. By providing citizens with an app, they always have access to the latest information and can assess their own health. This data could be used to support policy makers and health care providers to get valuable insights in the regional distribution of infection load and health care consumption. OBJECTIVE The aim of this observational study is to assess people’s use of an app to support them with COVID-19 education, self-assessment, and monitoring of their own health for a 7-day period. In addition, we aim to assess the usability of this data for health care providers and policy makers by applying it to an interactive map and combining it with hospital data. The secondary outcomes of the study were user’s satisfaction with the information provided in the app, perceived usefulness of the app, health care providers they contacted, and the follow-up actions from this contact. METHODS This observational cohort study was carried out at the nonacademic teaching hospital “Elisabeth Twee Steden” (ETZ) in Tilburg, Netherlands. From April 1, 2020, onwards ETZ offered the COVID-19 education, self-assessment, and symptom tracking diary to their already existing app for patient education and monitoring. RESULTS Between April 1 and April 20, 2020, a total of 6194 people downloaded the app. The self-assessment functionality was used abundantly to check one’s health status. In total, 5104 people responded to the question about severe symptoms, from which 242 indicated to suffer from severe symptoms. A total of 4929 people responded to the question about mild symptoms, from which 3248 indicated to suffer from these. The data was successfully applied to an interactive map, displaying user demographics and health status. Furthermore, the data was linked to clinical data. App users were satisfied with the information in the app and appreciated the symptom diary functionality. In total, 102 users reached out to a health care provider, leading to 91 contacts. CONCLUSIONS Our study demonstrated the successful implementation and use of an app with COVID-19 education, self-assessment, and a 7-day symptom diary. Data collected with the app were successfully applied to an interactive map. In addition, we were able to link the data to COVID-19 screening results from the hospital’s microbiology laboratory. This data could be used to support policy makers and health care providers to get valuable insights in the regional distribution of infection load and health care consumption. CLINICALTRIAL Netherlands Trial Register NL8501; https://www.trialregister.nl/trial/8501

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