Syftet med studien var att undersöka om sjuksköterskans information till patienter, vid inläggning av perifer venkateter, följde gällande riktlinjer från Handbok för hälso- och sjukvårdspersonal. Författarna samlade in data genom att delta vid 60 inläggningar av perifer venkateter vilka genomfördes av femton olika sjuksköterskor. Insamlingen ägde rum på en dagkirurgiavdelning. Man observerade ett antal områden, resultatet på dessa kunde bli ja eller nej, där ja var det resultat man eftersökte. Antal ja-svar summerades och analyserades med oberoende t-tester för att se eventuella skillnader i yngre/äldre och män/kvinnor, inga skillnader påfanns. Resultatet visade att sjuksköterskornas information till patienter vid insättande av perifer venkateter hade uppenbara brister och inte följde gällande riktlinjer. I över hälften av observationsmomenten gavs bristande information eller ingen information alls. Det som sjuksköterskorna flitigast informerade om var att patienten vid insticket kunde känna smärta, denna information gavs till så gott som alla patienter. Två foldrar, en gällande patientinformation och en gällande sjuksköterskeinformation, har utformats av författarna för att kunna urskilja vad som kan vara nödvändigt när det gäller patientinformation. / The aim of this study was to investigate if given information to patients regarding insertion of a peripheral intravenous line was following national guidelines. The writers collected data by observing 60 insertions of peripheral intravenous lines that was performed by fifteen different nurses. The observations took place on a surgical ward. A specific number of areas were observed and the result of each observation could be answered with a yes or no, where yes was the result that was preferred. The yes-answers were summarized and analyzed using independent t-tests to find possible differences regarding gender and age, no differences were found. The result showed that given information to patients regarding the insertion of a peripheral intravenous line had obvious limitations and did not follow the national guidelines. In almost half of the observation areas the information was limited or none existing. The most common information that was given by the nurses was how the insertion of the peripheral intravenous line would feel, this information were given to almost every patient. Two information folders, one to the patients and one to the nurses, have been made by the writers to discern what can be necessary to inform the patient of.

Syftet med studien var att öka kunskapen om och förståelsen för hiv-smittade narkomaner i kriminalvård. Den övergripande frågeställningen löd; Hur beskriver ett mindre urval av hiv-smittade narkomaner i föremål för kriminalvård sina tankar och känslor kring sin sjukdom och sin livssituation? Studien var av kvalitativ design och den vetenskapliga positionen av hermeneutisk karaktär. Det empiriska materialet bestod av intervjuer med fem hiv-smittade narkomaner i kriminalvård. Tre teman var grundläggande i intervjuerna; Tankar, känslor och reaktioner kring hiv-diagnosen, Existentiella frågor, drivkraft och copingstrategier samt Bemötande i och utanför kriminalvården. Studiens teoretiska perspektiv; kristeori, existentialistisk teori, upplevelseteori och hälsoteori, valdes i syfte att nå en ökad förståelse för intervjupersonernas upplevelse av sin livssituation. Studiens resultat och analys visade att hiv-smittan fått olika konsekvenser för de intervjuade. För tre personer blev livet bättre genom sjukdomen; två av dem menade att de annars skulle varit döda. För de övriga två innebar sjukdomen i stället att döden kommit närmare och grusat alla förhoppningar om ett bättre liv. Tolkningen visade att en möjlig förklaring till de olika förhållningssätten kunde bero på skillnader i vilken inre privat betydelse sjukdomen haft för de intervjuade, samt i vilken mån de lyckats komma igenom krisen.

Secondary infusions are a common and convenient method to administer intermittent infusions unattended through a single IV access using infusion pump technology. Previous studies have indicated that clinicians have a high frequency of committing operation errors while administering secondary infusions, which can cause patient harm. The purpose of this study was to evaluate the safety of secondary infusion practice by identifying and analyzing potential failure modes when delivering secondary infusions on five different smart infusion pumps. Healthcare Failure Mode and Effect Analysis (HFMEA) was used to prioritize potential failure modes that are considered high-risk for each pump. Results showed that four of the five pumps were not able to mitigate physical set-up errors. As well, each pump contributed differently to programming errors due to difference in interface design. Recommendations from this study focused on outlining desired infusion pump features and mitigation strategies to help alleviate high-risk secondary infusion failure modes.

Secondary infusions are a common and convenient method to administer intermittent infusions unattended through a single IV access using infusion pump technology. Previous studies have indicated that clinicians have a high frequency of committing operation errors while administering secondary infusions, which can cause patient harm. The purpose of this study was to evaluate the safety of secondary infusion practice by identifying and analyzing potential failure modes when delivering secondary infusions on five different smart infusion pumps. Healthcare Failure Mode and Effect Analysis (HFMEA) was used to prioritize potential failure modes that are considered high-risk for each pump. Results showed that four of the five pumps were not able to mitigate physical set-up errors. As well, each pump contributed differently to programming errors due to difference in interface design. Recommendations from this study focused on outlining desired infusion pump features and mitigation strategies to help alleviate high-risk secondary infusion failure modes.

Injection drug users (IDUs) account for an estimated 44% of people living with HIV/AIDS in China and are the major driving force behind the expanding epidemic. Developing effective antiretroviral therapy (ART) adherence interventions in the Chinese IDU population is a major challenge. In conjunction with ART scale-up in Yunnan province, our goal was to gather patient perspectives on ART and ideas for feasible adherence support. Between December 2005 and March 2006, eight focus groups with a total of 55 HIV positive IDUs were conducted at three sites in Yunnan to ascertain ART knowledge, barriers to adherence, and acceptable adherence support methods. Focus groups included ART experienced and naïve participants, and HIV positive IDUs in methadone maintenance clinics. Discussions were audiotaped, notes were transcribed and coded for analyses. All participants were former or current IDUs and 31 were from the rural countryside (59.6%), and 19 (36.5%) resided in a small city. ART was viewed positively but the principal barriers for urban IDUs were stigma and discrimination, while geography was the main problem for rural IDUs. Major themes were stratified between four components: knowledge, motivation, cues to action, and access to care. Adherence tools that were spontaneously endorsed included watches, pill boxes, and diaries. Directly observed therapy (DOT) within methadone programs was acceptable but community-based DOT would need to address stigma issues in urban areas. Two separate HIV epidemics exist within IDUs in China, stratified between small-city urban and rural populations. No single model for adherence will work and interventions must be broad-based. This study provides an expanded conceptual framework for ART adherence in the HIV positive IDU population, which includes the unique barriers posed by the ecological context surrounding this doubly-discriminated population.

published_or_final_version / Pharmacology and Pharmacy / Doctoral / Doctor of Philosophy

Dopamine increases in the nucleus accumbens after contingent and noncontingent ethanol administration in rats, but the contributions of the core, coreshell border, and shell subregions to this response are unclear. Also, it is not fully understood if increases in dopamine under these circumstances are due to the pharmacological effects of ethanol, stimuli associated with administration, or both. The studies presented in this dissertation were conducted to investigate dopamine’s role in each of these accumbal regions during ethanol administration and presentation of associated stimuli. Using microdialysis, ethanol and dopamine concentrations in accumbal subregions were measured every five minutes before, during, and after either experimenter-delivered intravenous ethanol or operant ethanol self-administration. After intravenous ethanol infusions, the increase in dopamine in the shell of the accumbens was significantly higher than that observed in the core. During operant ethanol self-administration, the core, core-shell border, and shell, all exhibited significant increases in dopamine during transfer of the animal into the operant chamber, with animals trained to drink sucrose + ethanol showing significantly higher increases when compared to those trained to drink sucrose alone. Dopamine increased significantly only in the core-shell border during ethanol consumption, and dopamine levels in the core and shell responded in a similar manner during all phases of the experiment. Together, these results suggest that dopamine responses to intravenous ethanol infusions and operant ethanol self-administration are subregion specific. Also, while increases in dopamine resulting from intravenous ethanol infusions in naïve animals appear to be due to the pharmacological effects of the drug, increases in ethanol-experienced animals during transfer into the operant chamber, and during ethanol consumption, may also be due to stimuli associated with ethanol administration. / text

Šiame magistro darbe yra nagrinėjamos injekcinių narkotikų vartotojų socialinės ir demografinės charakteristikos bei socialinių ir medicininių paslaugų poreikiai. Darbo uždaviniai – atskleisti injekcinių narkotikų vartotojų, kaip specifinės socialinių paslaugų gavėjų grupės, socialinį bei demografinį statusą Lietuvoje; jį apibūdinančius kokybinius bei kiekybinius kriterijus; apibrėžti pagrindinius injekcinių narkotikų vartotojų socialinius bei medicininius poreikius; įvertinti socialinių paslaugų teikimo siekiant padėti injekcinių narkotikų vartotojams patenkinti socialinius ir medicininius poreikius galimybes bei problemas Lietuvoje. Rašant darbą naudoti įvairūs teoriniai (loginis, lyginimo, istorinis, sisteminis) bei empiriniai (dokumentų analizė, profesinės praktikos apibendrinimas, anketavimas) mokslinio tyrimo metodai. / This final work of postgraduate studies is committed to the analysis of socio-demographics characteristics of intravenous drug users and their needs for social and medical services. The goals of this work is to describe socio-demographics status of intravenous drug users in Lithuania; to analyze its quantitative and qualitative criterions; evaluate main social and medical needs of intravenous drugs users; to lay down concepts, forms and means which is necessary in order to organize effective social services in Lithuania which could help intravenous drugs users to satisfy their basic medical and social needs. The main scientific methods which were used to complete this work were both theoretical (logical, comparative, systemic, historical) and empiric (analysis of documents, generalization of professional experience, inquiry of intravenous drugs addicts who are registered in Lithuanian HIV center). It is necessary to mention that the main results of this work are that it describes addiction to intravenous drugs as a social problem, reveals essential social and demographics features of intravenous drugs users, analyze problems, which are related with functioning of social and medical services system for such persons. On this aspect this study also evaluates possibilities for the improvement of social and medical services in Lithuania. One part of this work describe results of practical survey (inquiry) which was carried out between 122 intravenous drug users who are... [to full text]

Background: Approximately 170 million persons are infected with the hepatitis C viral infection (HCV), globally. Of this number, 3.2 – 4 million persons in the U. S. are infected with HCV. Although previous research has indicated a decrease in the rates of Hepatitis C in the U.S. approximately 12,000 deaths occur annually from those who suffer from chronic liver disease, as a result of being chronic carriers of HCV. Being a recipient of blood transfusions prior to 1992, intravenous drug users (IDUs), or persons with multiple sex partners are associated with increased risk for HCV infection. IDUs constitute the largest cohort for those infected with HCV. Due to the few clinical manifestations HIV and HCV share and HIV patients living longer due to Highly Active Antiretroviral Therapy (HAART), Many individuals infected with HIV are discovering co-morbidities with HCV. Methods: Secondary Data from the State Electronic Notifiable Disease Surveillance System (SENDSS) were used to analyze all confirmed cases of hepatitis C in the state of Georgia for the year 2009. All subjects in this analysis were confirmed as Hepatitis C infected. Descriptive frequencies for all categorical data were tested and analyzed, which included: gender, race, geographic region, disease status, age distribution, risk factor data such as injection drug use, blood transfusion prior to 1992, long term hemodialysis, accidental needle stick, tattoo, sexual contacts, and incarceration. Binary logistic regression for univariate and multivariate analysis was used to test the associations between geographic region of all HCV cases and their demographic characteristics. Results: Descriptive analysis of the prevalence of HCV cases in Georgia in 2009 reveal higher rates of HCV in rural regions (GOA) of the state among White males of non-Hispanic origin. In this same region, these cases were more likely to report risk factors involving injection drug use, blood transfusions prior to 1992, incarceration, or tattoos. Prevalence of most cases of HCV in Georgia for the year 2009 are seen in those age 20 – 30 and those 40 – 60. A higher number of those reporting intravenous drug use in metropolitan Atlanta (MSA) are Black of non-Hispanic origin. Bivariate logistic regression reveals that White Non-Hispanics living in rural areas of Georgia (GOA) have a 3.48 higher odds of being infected with Hepatitis C than Black Non-Hispanics (OR = 3.48, p < 0.001, CI 2.54 – 4.77). Conclusion: Resources for prevention of Hepatitis C should be directed to marginalized communities within Georgia regions outside of the Atlanta Metropolitan Statistical Area. The primary focus of prevention should also be tailored to new initiates of intravenous drug use and those 20 – 30 and 40 – 60 years of age. Further knowledge and understanding of behaviors that put individuals at risk for acquiring Hepatitis C, such as intravenous drug use, in rural Georgia may warrant interventions tailored to benefit these communities from acquiring or spreading Hepatitis C.

Insect repellent N,N-diethyl-m-toluamide (DEET) and sunscreen oxybenzone are commonly incorporated into commercially available repellent and sunscreen preparations. Both compounds have demonstrated an increased percutaneous permeation and systemic disposition after concurrent application in vitro and in vivo. The permeation enhancement between DEET and oxybenzone not only compromises their respective protective efficacy against biting insects and UV radiation, but also potentiates toxicological properties in susceptible subjects. The pharmacokinetic and toxicological profiles from concurrent use of DEET and oxybenzone were evaluated and compared in this thesis. DEET and oxybenzone were administered by intravenous and topical routes in rats, either alone and/or in combination, to compare the pharmacokinetics of parent compounds and their primary metabolites in vivo. To evaluate toxicological characteristics, rat primary cortical neurons and astrocytes, and rat hepatoma 1548 cells were exposed to DEET, oxybenzone and their metabolites in vitro, and cell viability was analyzed. Various behavioral testing protocols were also performed to assess arousal, locomotion, habituation, and motor coordination of rats over a 30-day study period. Concurrent topical application of DEET and oxybenzone enhanced the disposition of DEET and its metabolites in rats, but did not consistently affect the distribution of oxybenzone and its metabolites. The disappearance of DEET from skin application site was accelerated; its apparent elimination half-life was decreased while its plasma and tissue concentrations were predominantly increased. Cellular toxicity occurred at 1 μg/ml for neurons and 7-day exposure for both astrocytes and neurons. Viability of hepatoma cells was also reduced when treated with DEET, oxybenzone and their metabolites, either alone or in combination, most notably after 72 hours of exposure. However, no overt signs of toxicity were observed from behavioral testing in rats after a 30-day topical study. The pharmacokinetic data obtained was beneficial in understanding and elucidating absorption and biodistribution of DEET and oxybenzone in vivo. The toxicological data suggested that the risk for increasing adverse effects from concurrent skin application of repellents and sunscreens would be low and marginal in healthy individuals. Nevertheless, further studies should be carried out to assess the long-term health impact of these compounds in susceptible subjects, especially at higher application doses.