What Influences how New Zealanders use Information Displays? An Analysis of Electronic Gaming Machine Records

<p>Electronic gaming machines (slot machines) contribute to problem gambling in New Zealand and worldwide. Information displays are one harm minimisation feature of New Zealand electronic gaming machines that has been investigated in recent years. New Zealand gamblers see two types of displays: interruptive pop-up displays after a set period of time has passed, and elective displays if a player presses an information button. These displays inform the gambler about their current session with the intention that they will facilitate informed decisions about continuing play or quitting. The current study used a week-long set of electronic gaming machine data from across New Zealand to run an exploratory investigation into the utility of these information displays. We first observed that fewer than 2% of pop-up displays resulted in people quitting. On this basis it is unlikely that interruptive pop-up displays are meaningfully reducing harm. Our analysis also revealed timing differences in how pop-up displays are scheduled on machines produced by different manufacturers. The likelihood of quitting on a pop-up was influenced by complex interactions of machine and session characteristics, however these effects were small. Secondly, our investigation of elective displays also identified a low rate of access, indicating they are also unlikely to be working effectively as a harm minimisation tool. Analysis revealed players’ likelihood of accessing an elective display was mostly influenced by the venue type they were in and the manufacturer of the machine. Possible recommendations to improve both types of displays include changes to message content, scheduled timing and visual features.</p>

What Influences how New Zealanders use Information Displays? An Analysis of Electronic Gaming Machine Records

<p>Electronic gaming machines (slot machines) contribute to problem gambling in New Zealand and worldwide. Information displays are one harm minimisation feature of New Zealand electronic gaming machines that has been investigated in recent years. New Zealand gamblers see two types of displays: interruptive pop-up displays after a set period of time has passed, and elective displays if a player presses an information button. These displays inform the gambler about their current session with the intention that they will facilitate informed decisions about continuing play or quitting. The current study used a week-long set of electronic gaming machine data from across New Zealand to run an exploratory investigation into the utility of these information displays. We first observed that fewer than 2% of pop-up displays resulted in people quitting. On this basis it is unlikely that interruptive pop-up displays are meaningfully reducing harm. Our analysis also revealed timing differences in how pop-up displays are scheduled on machines produced by different manufacturers. The likelihood of quitting on a pop-up was influenced by complex interactions of machine and session characteristics, however these effects were small. Secondly, our investigation of elective displays also identified a low rate of access, indicating they are also unlikely to be working effectively as a harm minimisation tool. Analysis revealed players’ likelihood of accessing an elective display was mostly influenced by the venue type they were in and the manufacturer of the machine. Possible recommendations to improve both types of displays include changes to message content, scheduled timing and visual features.</p>

A mixed-methods systematic review of the prevalence, reasons, associated harms and risk-reduction interventions of over-the-counter (OTC) medicines misuse, abuse and dependence in adults

Background Over-the-counter (OTC) medicines are typically safe. However, there is evidence that OTC medicines can sometimes cause harm as a result of their misuse, abuse and dependence. Aim of the review To review the literature on OTC medicines misuse, abuse and dependence in adults and identify the implicated medicines, contributing factors, associated harms and risk-mitigating interventions. Methods Following PRISMA guidelines, electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO Web of Science and Google Scholar were searched for peer-reviewed journal articles published in English between January 2011 and March 2019. Quantitative, qualitative and mixed-methods studies assessing aspects of misuse, abuse and dependence of OTC medicines in individuals aged 18 years or more were included. Studies that solely focused on adolescents only, doping in sports or abuse of OTC medicines in people who are substance abusers were excluded. The random effect meta-analysis model was used to pool the prevalence among the population-based studies. Results Of 2355 peer-reviewed studies initially identified, 53 were included in this review. According to the study design, the prevalence varied, but the overall pooled prevalence in the population-based studies was: 16.2% for misuse, 2.0% for abuse, and 7.2% for dependence. The common OTC medicines groups involved in the problematic use were analgesics (with or without codeine), sedative antihistamines, cough mixtures containing dextromethorphan. Physical, psychological, social and financial harms were associated with problematic use of OTC medicines in addition to hospitalisation and death. Interventions for the affected individuals were provided mainly through the community pharmacies, general practices and specialised addiction centres. Conclusion The problematic use of OTC medicines is quite prevalent in adults, necessitating raising public awareness about their safe use. In addition, innovative harm minimisation models need to be developed, evaluated and implemented across health care settings.

Loot boxes, problem gambling and problem video gaming: A systematic review and meta-synthesis

Loot boxes (LBs) are video game-related purchases with a chance-based outcome. Due to similarities with gambling, they have come under increasing scrutiny from media, academics and policymakers alike. Initial evidence suggested that LB engagement might be associated with both problem gambling (PG) and problem video gaming (PVG). We therefore conducted a systematic review of the evidence for associations between LB purchasing, PG and PVG. For LB/PG, 12 of 13 publications reported a positive relationship, with a moderately sized mean effect of r = .27. For LB/PVG, the mean effect was r = .40, although this finding was drawn from only six surveys in total. For PG/PVG, the mean effect was r = .21, with only 11 of 20 studies reporting significant effects. While further evidence is required to determine the direction of causality, the strength of relationships suggests that policy action on LBs may have benefits for harm minimisation.

Harm minimisation for the management of self-harm: a mixed-methods analysis of electronic health records in secondary mental healthcare

Background Prevalence of self-harm in the UK was reported as 6.4% in 2014. Despite sparse evidence for effectiveness, guidelines recommend harm minimisation; a strategy in which people who self-harm are supported to do so safely. Aims To determine the prevalence, sociodemographic and clinical characteristics of those who self-harm and practise harm minimisation within a London mental health trust. Method We included electronic health records for patients treated by South London and Maudsley NHS Trust. Using an iterative search strategy, we identified patients who practise harm minimisation, then classified the approaches using a content analysis. We compared the sociodemographic characteristics with that of a control group of patients who self-harm and do not use harm minimisation. Results In total 22 736 patients reported self-harm, of these 693 (3%) had records reporting the use of harm-minimisation techniques. We coded the approaches into categories: (a) ‘substitution’ (>50% of those using harm minimisation), such as using rubber bands or using ice; (b) ‘simulation’ (9%) such as using red pens; (c) ‘defer or avoid’ (7%) such as an alternative self-injury location; (d) ‘damage limitation’ (9%) such as using antiseptic techniques; the remainder were unclassifiable (24%). The majority of people using harm minimisation described it as helpful (>90%). Those practising harm minimisation were younger, female, of White ethnicity, had previous admissions and were less likely to have self-harmed with suicidal intent. Conclusions A small minority of patients who self-harm report using harm minimisation, primarily substitution techniques, and the large majority find harm minimisation helpful. More research is required to determine the acceptability and effectiveness of harm-minimisation techniques and update national clinical guidelines.

Substance misuse teaching: a patient safety issue

AimsClinical substance misuse presentations are commonly managed by Psychiatry Core Trainees (CTs) out of hours. However, specialist teaching is not included in the Maudsley Training Program (MTP) induction. We aimed to investigate whether this was of clinical concern and, if so identify interventions to address it.BackgroundThe association of substance misuse disorder and mental illness is widely recognised. The Adult Psychiatric Morbidity Survey 2014 reported that half of people dependent on drugs other than cannabis were receiving mental health treatment. Substance use substantially impacts clinical risk; 57% of patient suicides in 2017 had a history of substance misuse. It also effects emergency psychiatric services: 55-80% of patients detained under S136 are intoxicated. Therefore, it is imperative for patient safety that CTs can assess and manage these patients appropriately.The Royal College of Psychiatrists recognises the need for specialist substance misuse knowledge and skills, and lists this as a key ‘Intended Learning Outcome’ for CTs. Unfortunately, the availability of specialist drug and alcohol service placements for CTs has significantly declined. Only one placement is available per MTP rotation. Teaching is therefore relied upon to gain these competencies.MethodUsing a cross-sectional survey we explored CTs confidence in recognising and managing substance misuse presentations, knowledge of where to seek guidance and asked for teaching suggestions. We surveyed two CT1 cohorts in 2017 and 2019.ResultFifty-one CTs took the survey. Of these 92% did not feel prepared to manage acute substance intoxication or withdrawal and 96% would like relevant teaching at the start of CT1. Furthermore, 67% did not know where they could seek guidance.CTs felt confident at recognising and managing alcohol related presentations. However, they were less confident in recognising opioid withdrawal, how to safely prescribe opioid substitution therapy (OST), and the usual doses of OST (65%, 94%, 94% rated ‘neither confident nor not confident’ or below, respectively). CTs were not confident at recognising GBL and cannabinoid withdrawal, principles of harm minimisation, assessing readiness to change, delivering Brief Interventions and teaching patients to use Naloxone.ConclusionThe results were exceptionally similar between cohorts, demonstrating reliability of our findings and that CTs lack of substance misuse knowledge is a significant clinical concern.To address this deficit of knowledge, we are writing an introductory lecture with supporting guidance in the induction pack, developing an online video resource, and moving key substance misuse lectures to earlier in the MTP taught programme.

Australian Community Pharmacy Harm-Minimisation Services: Scope for Service Expansion to Improve Healthcare Access

Community pharmacies are well positioned to participate in harm-minimisation services to reduce harms caused by both licit and illicit substances. Considering developments in pharmacist practices and the introduction of new professional pharmacy services, we identified a need to explore the contemporary role of community pharmacy in harm minimisation. Semi-structured interviews were undertaken to explore the opinions of stakeholders, pharmacy staff, and clients about the role of community pharmacy in harm minimisation, including provision of current services, experiences, and expectations. Participants (n = 28) included 5 stakeholders, 9 consumers, and 14 staff members from seven community pharmacies. Three over-arching themes were identified across the three participants groups: (i) scope and provision, (ii) complexity, and (iii) importance of person-centred advice and support in relation to community pharmacy harm minimisation services. Community pharmacies are valuable healthcare destinations for delivery of harm minimisation services, with scope for service expansion. Further education, support, and remuneration are needed, as well as linkage to other sector providers, in order to ensure that pharmacists and pharmacy staff are well equipped to provide a range of harm minimisation services.

Addressing unmet needs in opiate dependence: supporting detoxification and advances in relapse prevention

SUMMARY Despite record-breaking numbers of opiate related deaths in the UK in 2019, pharmacological management of opiate dependence has evolved little since the advent of methadone in 1965. Along with harm minimisation and psychosocial interventions, the mainstay of pharmacological treatment remains opioid substitution therapy (OST) using methadone or buprenorphine, with many patients receiving OST for many years. Even with these treatments, opiate users continue to face mortality risks 12 times higher than the general population, and emerging evidence suggests that individuals who remain on long-term OST present with a range of physical and cognitive impairments. Therefore, with a growing ageing opiate dependent population who would benefit from detoxification from OST, this article provides an overview of the current state of opiate dependence in clinical practice, explores the reasons why availability and acceptability of detoxification pathways are declining, and discusses emerging pharmacological therapies that could provide benefit in relapse prevention.

The effect of alcohol policy on intensive care unit admission patterns in Central Australia: A before–after cross-sectional study

Alcohol misuse is a disproportionately large contributor to morbidity and mortality in the Northern Territory. A number of alcohol harm minimisation policies have been implemented in recent years. The effect of these on intensive care unit (ICU) admissions has not been fully explored. A retrospective before–after cross-sectional study was conducted at the Alice Springs Hospital ICU between 1 October 2017 and 30 September 2019. The primary outcome was the proportion of admissions in which alcohol misuse was a contributing factor in the 12 months before (pre-reforms phase) versus the 12 months following (post-reforms phase) implementation of alcohol legislation reforms. Secondary outcomes were measures of critical care resource use (length of stay, need for and duration of mechanical ventilation). After exclusions, 1323 ICU admissions were analysed. There was a reduction in the proportion of admissions associated with alcohol misuse between the pre-reforms and post-reforms phases (18.8% versus 11.7%, P < 0.01). This was true for both acute (10.6% versus 3.6%, P < 0.01) and chronic misuse (13.3% versus 9.6%, P = 0.03). Rates of mechanical ventilation were unchanged during the post-reforms phase (18.3% versus 14.7%). Admissions with a primary diagnosis of trauma were lower (10.5% versus 4.7%, P < 0.01). This study demonstrated a reduction in ICU admissions associated with alcohol misuse following the implementation of new alcohol harm minimisation policies. This apparent reduction in alcohol-related harm is suggestive of the effectiveness of the Northern Territory’s integrated alcohol harm reduction framework.