Improving Shared Situation Awareness for High-risk Therapies in Hospitalized Children

BACKGROUND: High-risk therapies (HRTs), including medications and medical devices, are an important driver of preventable harm in children’s hospitals. To facilitate shared situation awareness (SA) and thus targeted harm prevention, we aimed to increase the percentage of electronic health record (EHR) alerts with the correct descriptor of an HRT from 11% to 100% on a high-acuity hospital unit over a 6-month period. METHODS: The interdisciplinary team defined an HRT as a medication or device with a significant risk for harm that required heightened awareness. Our aim for interventions was to (1) educate staff on a new HRT algorithm; (2) develop a comprehensive table of HRTs, risks, and mitigation plans; (3) develop bedside signs for patients receiving HRTs; and (4) restructure unit huddles. Qualitative interviews with families, nurses, and medical teams were used to assess shared SA and inform the development and adaptation of interventions. The primary outcome metric was the percentage of EHR alerts for an HRT that contained a correct descriptor of the therapy for use by the care team and institutional safety leaders. RESULTS: The percentage of EHR alerts with a correct HRT descriptor increased from an average of 11% to 96%, with special cause variation noted on a statistical process control chart. Using qualitative interview data, we identified critical awareness gaps, including establishing a shared mental model between nursing staff and the medical team as well as engagement of families at the bedside to monitor for complications. CONCLUSIONS: Explicit, structured processes and huddles can increase HRT SA among the care team, patient, and family.

Prevention and education evidence review: Gambling-related harm

This report supports an evidence-based approach to the prevention and education objective of the National Strategy to Reduce Harm from Gambling. Applying a public health policy lens, it considers three levels of measures: universal (for the benefit of the whole population), selective (for the benefit of at-risk groups), and indicated (for the benefit of at-risk individuals). Six measures are reviewed by drawing upon a range of evidence in the academic and grey literature. The universal level measures are “Regulatory restriction on how gambling is provided” and “Population-based safer gambling/responsible gambling efforts.” Selective measures focus on age cohorts in a chapter entitled, “Targeted safer gambling campaigns for children, youth, and older adults.” The indicated measures are “Brief internet delivered interventions for gambling,” “Systems and tools that produced actual (‘hard’) barriers and limit access to funds,” and “Self-exclusion.” Since the quantity and quality of the evidence base varied by measure, appropriate review methods were selected to assess publications using a systematic, scoping, or narrative approach. Some measures offered consistent findings regarding the effectiveness of interventions and initiatives, while others were less clear. Unintended consequences were noted since it is important to be aware of unanticipated, negative consequences resulting from prevention and education activities. After reviewing the evidence, authors identified knowledge gaps that require further research, and provided guidance for how the findings could be used to enhance the prevention and education objective. The research evidence is supplemented by consultations with third sector charity representatives who design and implement gambling harm prevention and education programmes. Their insights and experiences enhance, support, or challenge the academic evidence base, and are shared in a separate chapter. Overall, research evidence is limited for many of the measures. Quality assessments suggest that improvements are needed to support policy decisions more fully. Still, opportunities exist to advance evidence-based policy for an effective gambling harm prevention and education plan.

Investigation on heroin and cocaine quality in Luxembourg

Background Heroin and cocaine are among the most dangerous illicit drugs available and their presence on the market is increasing. These facts have led to the investigation of the quality of heroin and cocaine samples seized in Luxembourg by police and customs but also collected at the national supervised drug consumption facilities. Methods Samples obtained from 2019 to 2020 were analyzed to determine their composition and content using GC–MS, HPLC-UV and LC-Q-ToF. The statistical evaluation of concentration changes depending on the source of collection is based on an ANOVA single factor test and a two-tailed t test. Results Results showed important differences between seizure and collection sources. For both drugs, customs samples had significantly higher concentrations than police samples and the latter had significantly higher concentrations than samples from drug consumption facilities, whereas for heroin two cutting steps were identified, for cocaine samples only one appears to occur on the local market. Indeed, cocaine samples seized by police consisted of a mixture of low and high concentration samples. Conclusion The results show that extensive adulteration with pharmacological active and inactive compounds takes place at local levels, which, however, are different for heroin and cocaine. This knowledge on variability of quality of drugs should be considered in the elaboration of drug and harm prevention strategies.

A randomized iterative approach to optimizing an online substance use intervention for collegiate athletes

Lay Summary Rates of drug use among collegiate athletes are high, yet there are few evidence-based interventions for this population, and the few existing interventions only address alcohol use. In addition, alcohol and drug use interventions targeting college students are not always as effective or efficient as they could be. Our goal was to strengthen modules from myPlaybook, an online drug use intervention for collegiate athletes as a way to optimize the full intervention package. We conducted three intervention trials. Each trial occurred in separate academic years and included 2,000–3,000 athletes from 40 to 50 colleges and universities. We randomly assigned athletes to receive one or more intervention modules that target known risk factors for drug use (i.e., social norms, expectancies about the effects of drug use, harm prevention strategies, and life skills). We used the results about the effects of each module to improve the module prior to the next trial. After these trials, the revised modules targeting social norms and expectancies about drug use had meaningful effects, increasing the likelihood that the full myPlaybook intervention will lead to clinical reductions in drug use among collegiate athletes.

Contesting constructs and interrogating research methods: Re-analysis of qualitative data from a hospital-based case study of self-harm management and prevention practices

Discourses of self-harm, and also suicide, are often underpinned by a central tenet: prevention is the priority. This belief is seemingly so inscribed in research that it is rarely interrogated. The present paper re-analyses qualitative data from a hospital-based study of self-harm management and prevention practice. It aims to reflect upon, and disrupt, the authors’ latent assumptions about the construct of ‘prevention’, while reflecting on the research method used. Twenty-five individuals participated in semi-structured interviews: healthcare and affiliated professionals ( n = 14); parents and carers ( n = 8); and children and young people (aged 9–16 years) who had presented to an emergency department for self-harm, with or without suicidal intent ( n = 3). We offer two central discursive considerations: (1) Self-harm prevention is largely an unintelligible concept, having to be reflexively constructed in situ. As such, it is questionable whether it makes sense to discuss the prevention of this amorphous and dynamic phenomenon, which cannot always be disentangled from everyday life; (2) Interviews entail significant biographical work for participants, notably the performance of personal and professional competence for the audience. These interactional dynamics offer a glimpse into the priorities, meanings and needs for participants in relation to self-harm. Together these considerations provide useful insights into how the interview method can serve as both a limiting and illuminating site of knowledge creation.

Part III Conceptual Pillars, Ch.16 Harm Prevention

This chapter addresses how international environmental law originates from and revolves around the harm prevention rule. It focuses on three points of contention, each related to the role of due diligence in harm prevention, and each highlighted by recent judicial engagements with the harm prevention rule. First, it is generally accepted that a state's obligation to prevent environmental harm is not absolute, but requires due diligence in the face of risk of significant harm. However, it is unclear whether a failure to act diligently to avert harm on its own—absent actual harm—can amount to a breach of the harm prevention rule. Second, the relationship between the procedural and substantive dimensions of the harm prevention rule remains ambiguous. Third, there is some uncertainty as to where the line runs between the harm prevention obligation and the precautionary principle, given the focus of both notions on risk. These inter-related conceptual questions affect the harm prevention rule's function as a reference point for international environmental law.

Part V Subject Matter, Ch.29 Climate Change

This chapter provides an overview of international regulatory efforts to address climate change. It focuses on the UN climate change regime, which comprises the 1992 UNFCCC (United Nations Framework Convention on Climate Change), the Kyoto Protocol, the Paris Agreement, and decisions of parties under these instruments. However, the universe of climate change law extends well beyond the UN climate change regime. There are rules and principles of general international law, such as the harm prevention principle, due diligence, and state responsibility, which apply to climate change. There are treaty regimes and institutions, including those addressing other areas of international environmental law or other fields of international law, which intersect with, complement, and function to implement the UN climate change regime. There are also a multiplicity of rules, regulations, and institutions at the regional, sub-regional, and national levels that directly or indirectly address climate change, many of which have been put in place in response to the UN treaties.

Integrity and rights to gender-affirming healthcare

Gender-affirming healthcare (GAH) interventions are medical or surgical interventions that aim to allow trans and non-binary people to better affirm their gender identity. It has been argued that rights to GAH must be grounded in either a right to be cured of or mitigate an illness—gender dysphoria—or in harm prevention, given the high rates of depression and suicide among trans and non-binary people. However, these grounds of a right to GAH conflict with the prevalent view among theorists, institutions and activists that trans and non-binary people do not have a mental illness and that one can be trans and entitled to GAH without being depressed or suicidal. This paper challenges the orthodoxy that a right to GAH must be grounded in either of these ways and instead argues for a right to GAH grounded in a right to live and act with integrity. The standard view, which this paper explains, is that our rights to live and act with integrity ground a right to religious accommodation in many cases such as a right to not be denied social security due to one’s refusal to work a job on a holy day. This paper argues that if our rights to live and act with integrity can ground prima facie rights to religious accommodation, our rights to live and act with integrity ground prima facie rights to GAH.

Gendered Justice: The Impact of Gender on Criminal Justice Policies and Legislation throughout the United Kingdom

<h2>This article discusses the role of gender in the commission of crime, criminality, and harm prevention, by critically examining the notion of crime within theories about women’s and men’s criminality, and the gendered nature of crime control policies throughout the United Kingdom (UK), England, Wales, and Scotland. Throughout the literature, there has been a continued focus on women needing to be ‘repaired’ when they commit crime, because women are seen as having gone outside the traditional role of what it means to be female. On the other hand, the link between hegemonic masculinity and criminal behaviour among men is often ignored within criminal justice policies. It will be argued that both women and men are failed by a system that does not engage with gendered power and harms within society. A combination of targeted approaches that focus on the factors that lead to offending is required to reduce crime. </h2>