scholarly journals A review of trial and real-world data applying a realist approach to identify behavioural mechanisms supporting practitioners to taper opioids

Author(s):  
Debi BHATTACHARYA ◽  
Hattie Whiteside ◽  
Emma Tang ◽  
Kumud Kantilal ◽  
Yoon Loke ◽  
...  

This realist enquiry applying behavioural theory aimed to identify behavioural mechanisms and contexts that facilitate prescribers tapering opioids. We identified relevant opioid tapering interventions and services from a 2018 international systematic review and a 2019 England-wide survey, respectively. Interventions and services were eligible if they provided information about contexts and/or behavioural mechanisms influencing opioid tapering success. A stakeholder group (n=23) generated draft programme theories based around the 14 domains of the theoretical domains framework. We refined these using the trial and service data. From 71 articles and 21 survey responses, 56 and 16 respectively were included, representing primary care, hospital, specialist pain facilities and prison services. We identified six programme theories that included five behavioural mechanisms: prescribers’ knowledge about how to taper; build prescribers’ beliefs about capabilities to initiate tapering discussions and manage psychological consequences of tapering; perceived professional role in tapering; the environmental context enabling referral to specialists; and facilitating positive social influence by aligning patient: prescriber expectations of tapering. No interventions are addressing all six mechanisms supportive of tapering. Work is required to operationalise programme theories according to organisational structures and resources. An example operationalisation is combining tapering guidelines with information about local excess opioid problems and endorsing these with organisational branding. Prescribers being given the skills and confidence to initiate tapering discussions by training them in cognitive-based interventions and incorporating access to psychological and physical support in the patient pathway. Patients being provided with leaflets about the tapering process and informed about the patient pathway.

Author(s):  
Julie Chas ◽  
Marine Nadal ◽  
Martin Siguier ◽  
Anne Fajac ◽  
Michel Denis ◽  
...  

2011 ◽  
Vol 2 (1) ◽  
pp. 45-48 ◽  
Author(s):  
PV Dhond ◽  
Rajesh Yadav ◽  
Mudit Mittal ◽  
Shashi Kant

ABSTRACT Objective This study evaluates the symptoms and effects of peroral intralesional injections in relieving the symptoms of oral submucosal fibrosis (OSMF) in our clinical settings. Study design Retrospective clinical review at a primary care hospital of 32 patients with extensive OSMF who underwent peroral intralesional injections of steroid, hyaluronidase, placentrex and lignocaine performed in office setting. Results The main symptoms were change in color of buccal mucosa, trismus, burning mouth, vesicles in oral cavity. All patients experienced considerable improvement in their symptoms over a duration of 2 to 6 weeks. Conclusions Though, a large number of Indian population is suffering and seeking treatment for OSMF, unfortunately not much has been done in this area. It is difficult to find studies on peroral intralesional injection technique. When there is lack of reliable evidence of oral submucosal fibrosis treatment, the old technique of peroral intralesion shots of steroid, hyaluronidase, placentrex in lignocaine is safe and effective in resolving the symptoms associated with OSMF. The therapy is very cost effective and also reduces the need of surgery.


2010 ◽  
Vol 17 (02) ◽  
pp. 286-290
Author(s):  
SOHAIL ASLAM ◽  
FAROOQ AKRAM ◽  
MEHBOOB SULTAN

Objective To study the duration and factors influencing exclusive breast feeding practice. Design: A cross sectional descriptive study Setting: A primary care hospital Gilgit, northern area of Pakistan. Period: Ten months from March 2007 to December 2007. Material & Method This study include 125 mothers with mean age of 24.3 years (SD 4.8),37% were illiterate while only 14% were matriculate or above among 125 babies (male 61%: female 39%). Results Out of total 125, eighty one (64.8%) babies were exclusively breast fed (EBF) for first six months of life and only five(4%) infants were not given breast milk at all . among 76 male infants ,52 (68.4%) were EBF for six months in comparison to 29 female (59.2%) out of 49. among 36 first born infants only 15 (41.7%) were EBF for six months in comparison to 66 (74.2%)out of 89 not first born(p<0.05). Conclusion: Exclusive breast feeding for complete 6 months is still not routinely practised by most of mothers and first born are deprived of this right in majority lower socioeconomic group and illiterate mothers are more likelyto breast feed, gender bias was also observed as a significantly high percentage of male babies were observed to be breast fed as compared to females. More efforts are required by health depart. And NGO’s to promote good breast feeding practices in our setup. 


2015 ◽  
Vol 20 (26) ◽  
Author(s):  
M Kanerva ◽  
K Skogberg ◽  
K Ryynänen ◽  
A Pahkamäki ◽  
J Jalava ◽  
...  

Binary file ES_Abstracts_Final_ECDC.txt matches


2018 ◽  
Vol 57 (11) ◽  
pp. 1318-1325 ◽  
Author(s):  
Tamar Robinson ◽  
Leah Bryan ◽  
Veda Johnson ◽  
Terri McFadden ◽  
Sarah Lazarus ◽  
...  

Background. The American Academy of Pediatrics and pediatric community recognize the importance of addressing social determinants of health. There are limited data on the prevalence of food insecurity or literature establishing protocols assessing food insecurity in the emergency department (ED). Methods. Two anonymous surveys were administered, one to families during their ED visit and another to ED staff to assess perceptions on the ED’s role in providing social support. Results. Thirty-three of 214 respondents (15.4%) reported food insecurity and are associated with economic risk factors ( P < .0001) and a lack of primary care ( P = .008). Overall, 83.2% of the ED staff believed knowing information about families’ social risk factors would help patient care and 77.6% believed that the ED staff should address families’ social needs. Conclusions. Food insecurity affects a significant portion of ED families across income ranges. Screening for food insecurity in the ED is important given association with lack of primary care. Hospital staff supports screening and intervention.


2020 ◽  
Vol 12 (2) ◽  
pp. 212-216
Author(s):  
Jingkun Yang ◽  
Surbhi Singhal ◽  
Yingjie Weng ◽  
Jason P. Bentley ◽  
Neel Chari ◽  
...  

ABSTRACT Background Internal medicine residents face numerous career options after residency training. Little is known about when residents make their final career choice. Objective We assessed the timing and predictive factors of final career choices among internal medicine residents at graduation, including demographics, pre-residency career preferences, and rotation scheduling. Methods We conducted a retrospective study of graduates of an academic internal medicine residency program from 2014 to 2017. Main measures included demographics, rotation schedules, and self-reported career choices for residents at 5 time points: recruitment day, immediately after Match Day, end of postgraduate year 1 (PGY-1), end of PGY-2, and at graduation. Results Of the 138 residents eligible for the study, 5 were excluded based on participation in a fast-track program for an Accreditation Council for Graduate Medical Education subspecialty fellowship. Among the remaining 133 residents, 48 (36%) pursued general internal medicine fields and 78 (59%) pursued fellowship training. Career choices from recruitment day, Match Day, and PGY-1 were only weakly predictive of the career choice. Many choices demonstrated low concordance throughout training, and general medicine fields (primary care, hospital medicine) were frequently not decided until after PGY-2. Early clinical exposure to subspecialty rotations did not predict final career choice. Conclusions Early career choices before and during residency training may have low predictability toward final career choices upon graduation in internal medicine. These choices may continue to have low predictability beyond PGY-2 for many specialties. Early clinical exposure may not predict final career choice for subspecialties.


Epidemiology ◽  
2019 ◽  
Vol 30 (2) ◽  
pp. e8-e9
Author(s):  
Andrea V. Margulis ◽  
Joan Fortuny ◽  
James A. Kaye ◽  
Brian Calingaert ◽  
Maria Reynolds ◽  
...  

2019 ◽  
Vol 6 (2) ◽  
pp. 130-137
Author(s):  
Nina Gustafsson ◽  
Peter Bo Poulsen ◽  
Sandra Elkjær Stallknecht ◽  
Lars Dybro ◽  
Søren Paaske Johnsen

Abstract Aims Detailed evidence on the societal costs of venous thromboembolism (VTE), i.e. deep vein thrombosis (DVT) and pulmonary embolism (PE), and of subsequent major bleeding events, e.g. intracranial and gastrointestinal bleedings, is limited. The objective was to estimate the average 3-year societal event costs attributable to VTE and subsequent major bleedings in Denmark. Methods and results Based on nationwide Danish registers, each incident patient diagnosed with VTE in the period from 2004 to 2016 was identified and matched with four non-VTE patients by nearest-neighbour propensity score matching. For bleeding patients, the reference cohort was VTE patients without bleedings. Event costs in terms of VTE, DVT, PE, and major bleedings in VTE patients were measured by the ‘difference-in-actual-cost’ method within 3 years after the incidence. Societal costs included healthcare costs (primary care, hospital, and prescription medicine), municipality home care services, and production loss. The study population included 74 137 VTE incident patients (DVT: 43 099; PE: 31 038), and 4887 VTE patients with a major bleeding within 3 years from VTE diagnosis. The 3-year attributable societal VTE event costs were 40 024 EUR (DVT: 34 509 EUR; PE: 50 083 EUR) with 53% of these costs appearing in the first incident year. Similar results for major bleedings were 51 168 EUR with 46% of these costs appearing in the first incident year. Conclusion The societal costs of VTE and subsequent major bleedings are substantial and ought to be considered. Estimated costs of events may be informative in evaluating the impact of preventive interventions targeting VTE and subsequent major bleedings.


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