4 research outputs found
Healing the dragon : heroin use disorder intervention
The history of heroin use disorder intervention has been characterised by fads and fashions. Some of the
treatments that have been used have been, at best ineffective, and at worst harmful, and occasionally even
dangerous. It is a sad reflection upon the field that practices and procedures for the treatment of heroin use
disorders can so easily be introduced and applied without (or even contrary to) evidence. In South Africa, the
field of heroin use disorder intervention has been `in transition' since the outbreak of the heroin epidemic. Yet
despite growing evidence of an association between heroin dependents use of supplementary intervention
services (such as psychosocial and pharmacological/medical care) and intervention outcomes, and the fact that
international emerging standards for substance use disorder intervention have called upon treatment intervention
providers to enhance traditional substance use disorder services with services that address clients' psychological
and social needs, heroin use disorder intervention programmes in South Africa generally fail to meet these
research-based intervention standards. Much of what is currently delivered as intervention is based upon current
best guesses of how to combine some science-based (for example, cognitive-behavioural therapy and
pharmacotherapies) and self-help (12-step programmes) approaches into optimal intervention protocols. As
progression is made in the twenty-first century, scientific information is now beginning to be used to guide the
evolution and delivery of heroin use disorder care internationally. Regrettably, a scarcity of heroin use disorder
intervention research is noted in South Africa. The present study delved into the insights of ten heroin use
disorder specialists, and synthesised the findings with the results of a previous study undertaken by the author
relating to forty long-term voluntarily abstinent heroin dependents. In terms of theory and practice, findings of the
study suggest that the field is less in transition now than it was in 1995. It is an imperative that law-enforcement
action be followed by an integrated programme of psychological, social and pharmacological outreach. These
programmes will have to be expanded to address new demands and will need to include specialised skills
training. Many interventions and procedures have begun to be integrated routinely into clinical practice.Psychology(D. Phil. (Psychology)
An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa : the People Living with HIV Stigma Index
Background: The continued presence of stigma and its persistence even in areas where HIV prevalence is high
makes it an extraordinarily important, yet difficult, issue to eradicate. The study aimed to assess current and
emerging HIV/AIDS stigma and discrimination trends in South Africa as experienced by people living with HIV/AIDS
(PLHIV).
Methods: The PLHIV Stigma Index, a questionnaire that measures and detects changing trends in relation to
stigma and discrimination experienced by PLHIV, was used as the survey tool. The study was conducted in 10
clinics in four provinces supported by the Foundation for Professional Development (FPD), with an interview total
of 486 PLHIV. A cross-sectional design was implemented in the study, and both descriptive and inferential analysis
was conducted on the data.
Results: Findings suggest that PLHIV in this population experience significant levels of stigma and discrimination
that negatively impact on their health, working and family life, as well as their access to health services. Internalised
stigma was prominent, with many participants blaming themselves for their status.
Conclusion: The findings can be used to develop and inform programmes and interventions to reduce stigma
experienced by PLHIV. The current measures for dealing with stigma should be expanded to incorporate the issues
related to health, education and discrimination experienced in the workplace, that were highlighted by the study.Psycholog
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
Background
Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.
Methods
The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.
Results
A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).
Conclusion
Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)