The labels and models used to describe problematic substance use impact discrete elements of stigma: A Registered Report

Objectives: Problematic substance use is one of the most stigmatised health conditions leading research to examine how the labels and models used to describe it influence public stigma. Two recent studies examine whether beliefs in a disease model of addiction influence public stigma but result in equivocal findings – in line with the mixed-blessings model, Kelly et al. (2021) found that whilst the label ‘chronically relapsing brain disease’ reduced blame attribution, it decreased prognostic optimism and increased perceived danger and need for continued care; however, Rundle et al. (2021) conclude absence of evidence. This study isolates the different factors used in these two studies to assess whether health condition (drug use vs. health concern), aetiological label (brain disease vs. problem), and attributional judgement (low vs. high treatment stability) influence public stigma towards problematic substance use. Methods: 1613 participants were assigned randomly to one of eight vignette conditions that manipulated these factors. They completed self-report measures of discrete and general public stigma and an indirect measure of discrimination. Results: Greater social distance, danger, and public stigma but lower blame were ascribed to drug use relative to a health concern. Greater (genetic) blame was reported when drug use was labelled as a ‘chronically relapsing brain disease’ relative to a ‘problem’. Findings for attributional judgement were either inconclusive or statistically equivalent. Discussion: The labels used to describe problematic substance use appear to impact discrete elements of stigma. We suggest that addiction is a functional attribution, which may explain the mixed literature on the impact of aetiological labels on stigma to date

Patients’ and family caregivers’ experiences with a newly implemented hospital at home program in British Columbia, Canada: Preliminary results

The Hospital at Home (HaH) model of care, which enables the provision of acute-level care in the patient’s own home as an alternative to brick and mortar hospital admission, was introduced in British Columbia, Canada in November 2020, starting with 9 inpatient “beds” in the community. The AT-HOME research group applied a patient-oriented approach to evaluate the patients’ and family caregivers’ (FCGs) experiences with the program as it was implemented and expanded throughout Victoria, BC. In this paper, we discuss the development of the survey instruments, including process and timelines (three phases); and present preliminary findings of the observational research study (six months of patient and FCG feedback data). The preliminary results show that 100% of patients (n=75) and 95% of FCGs (n=57) had an overall positive experience with the program (rated 6-10 on a 10-point scale where 0 meant ‘very poor’ and 10 ‘very good’). 100% of these patients and 96% of these FCGs would recommend the program to their friends and family and 97% of these patients and 96% of these FCGs would choose the program again if faced with the same situation. The preliminary results on metrics pertaining to care quality; information sharing and experiences with the admission and discharge processes; FCG’s roles, medication management, and more are discussed here. The final results of the patient and FCG experiences will be reported at the end of the data collection period. We can conclude that this new HaH program has been positively received by patients and FCGs thus far and they support program expansion Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len

Engaging patients and families in developing, implementing, and evaluating hospital at home: A Canadian case study

The Hospital at Home (HaH) care model is naturally patient-centred, with improved patient and family experiences and outcomes firmly anchoring the innovative approach to care. Existing literature focuses largely on the health care and patient care outcomes of HaH; however, to date, none of the identified literature has reported on engaging patients and families in the development, implementation, or evaluation of the HaH model of care. A multi-stakeholder, Patient-Oriented Research team in Victoria, British Columbia, Canada engaged patients and family/friend caregivers (PFCs) across all components of the HaH program. Guided by best practices in patient and public engagement, the team collaborated to 1) explore the potential impact of in-home acute care on PFCs’ experiences; 2) identify health, social, and practice outcomes that matter to PFCs; 3) examine the social and environmental factors which may impact delivery of HaH; and 4) inform the HaH evaluation framework that includes PFC priority measures related to experience and outcomes. A public, online survey (n=543 PFC respondents) revealed both program-specific and evaluation-specific themes. These included a focus on patients achieving their own health goals and standard health outcomes, as well as patients and caregivers receiving training to support care at home. Engaging PFCs throughout HaH conception and implementation ensured the end program accurately reflected the priorities, concerns, and values of those that HaH is meant to serve. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

The labels and models used to describe problematic substance use impact discrete elements of stigma: A registered report.

Objectives: Problematic substance use is one of the most stigmatized health conditions leading research to examine how the labels and models used to describe it influence public stigma. Two recent studies examine whether beliefs in a disease model of addiction influence public stigma but result in equivocal findings — in line with the mixed-blessings model, Kelly et al. (2021) found that while the label “chronically relapsing brain disease” reduced blame attribution, it decreased prognostic optimism and increased perceived danger and need for continued care; however,Rundle et al. (2021) conclude absence of evidence. This study isolates the different factors used in these two studies to assess whether health condition (drug use vs. health concern), etiological label (brain disease vs. problem), and attributional judgment (low vs. high treatment stability) influence public stigma toward problematic substance use. Method: Overall, 1,613 participants were assigned randomly to one of the eight vignette conditions that manipulated these factors. They completed self-report measures of discrete and general public stigma and an indirect measure of discrimination. Results: Greater social distance, danger, and public stigma but lower blame were ascribed to drug use relative to a health concern. Greater (genetic) blame was reported when drug use was labeled as a“chronically relapsing brain disease” relative to a “problem”. Findings for attributional judgment were either inconclusive or statistically equivalent. Discussion: The labels used to describe problematic substance use appear to impact discrete elements of stigma. We suggest that addiction is a functional attribution, which may explain the mixed literature on the impact of etiological labels on stigma to date

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

My Queensland

The first forty-six years of my life were spent in Ipswich and Brisbane; the territory has imprinted itself at the deepest level of my being. The Queensland that my children and grandchildren know is still imbued with the same sense of place, though they make their own associations with it and the personal climate of their being is suffused with the atmosphere of now, not then. We do share this, though: to wake up in the morning with the freshness of air still to be beaten into by the sun, or to welcome the afternoon sea-breeze in summer as if it were an old friend, or at least something too good to be taken for granted. To live in that part of Queensland I come from is to know that everything is predictable, but nothing is. They say Queensland is a land of extremes, and within limits that is so. But there is also a sense that everything has happened before; wait long enough and the patterns become clearer - like the forty-year flood pattern that always takes us by surprise yet also seems inevitable