Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Nursing In the Faculty of Health and Wellness Sciences At the Cape Peninsula University of Technology, 2013 / The syringe driver is a battery-operated device which accurately delivers a continuous subcutaneous infusion of a combination of medication to alleviate symptoms, such as pain, nausea and vomiting, noisy moist breathing and preterminal restlessness. The researcher who works in a palliative care unit in Cape Town noticed the ambivalence and negative attitudes from family members regarding the use of the syringe driver. This gave rise to distress, conflict and ambivalence in patients and between family members. This study aimed to gain insight into the understanding, perceptions and expectations of families of terminally ill patients commenced on a syringe driver in a palliative care unit. A descriptive, qualitative research method was employed using semi-structured interviews, diaries, observation and documentation as the data collection methods. Data was coded and arranged into themes. Thematic analysis and coding were used to analyse the data during this study. This study found that the lack of education and written information were the two major contributing factors towards negative attitudes causing ambivalence in family members whose relatives were on a syringe driver. This study also highlighted the need for quality improvement control when using the syringe driver in the palliative care unit. The need for continuous education and written information and support for the immediate and extendedfamily members was evident. KEY WORDS: Syringe driver, Symptom control, Family members, Terminally ill, Palliative care unit.

No description available.

The aim of this study is to evaluate the supply of markers for the identification of syringes distributed by pharmacy needle exchanges and to determine if this product and service delivery offers a feasible method of marking syringes to promote the reduction of accidental sharing of syringes and needles amongst injecting drug users (IDU) and thereby reduce the risk of transmission of blood borne viruses (BBVs) and other related infections. This study involves the assessment, implementation and evaluation of syringe markers as a pilot study within three community pharmacy sites in Glasgow. The secondary aims of the study were to identify whether the supply of syringe markers from community pharmacy needle exchanges was acceptable to IDU and if it enabled them to mark their syringes. The literature review demonstrates that providing a means of identification of personal injecting equipment has been proposed as a viable option that should be promoted to prevent the inadvertent accidental sharing of syringes within a group setting. Needle exchanges (NEX) are important component parts of the harm reduction responses designed to reduce the physical health harms caused to individuals through injecting drug use. The literature is reviewed on BBV transmission and the historical, legal and policy context associated with the development of NEXs. Community pharmacies act as a source of health advice and can help to facilitate access to treatment services for those attending the NEX. However the specific aim of this study is not to investigate the totality of the benefits of a NEX but to examine the supply of a potential means of reducing accidental and unintentional sharing of all injecting equipment and thereby contribute to minimising some of the health harms linked to injecting drug use. Three established community pharmacies were identified as suitable sites to pilot the supply of syringe markers. A number of criteria were used to select the sites. These included an assessment of the geographic locations, staffing arrangements, NEX attendances and transactional activity and the availability of private consultation facilities. The health board central database which holds records on a range of factors including, the characteristics of those who attend NEX and detailed information on all transactions, was used to identify the most suitable sites to pilot the new intervention. This indicated that the characteristics of those who attended the three chosen sites were broadly similar to the wider NEX attending population. The evaluation was conducted in two separate periods. The first 4 week period was the supply phase where markers were distributed over this period to all patients receiving NEX packs from the 3 pharmacies. The second data collection phase was undertaken in the following 4 week period. Data was collected by means of a structured questionnaire. In order to reduce the potential interviewer bias it was decided to incorporate the use of peer researchers in the administration of the questionnaire. The Scottish Drugs Forum (SDF) was approached and agreement was reached to use members of the Service User Involvement Group (SUIG) to assist with the design and administration of the questionnaire. A submission was made to the health board Research Ethics Committee (REC) and approval was given to enable the study and the research evaluation to proceed. Before the start of the study, joint briefing and training sessions were held for pharmacy staff from the 3 sites and the 6 participating SUIG members. A total of 177 questionnaires were completed during the second data collection phase of the evaluation. Information was collected on personal details and injecting behaviours (including deliberate and accidental sharing), any current means of syringe identification, use of the markers and on the usefulness of the instruction card. Most individuals (75%, n=132) had been supplied with the markers to trial during the first supply phase of the study with 63% of the 132 (n=83) of those individuals reporting use of the markers. The results of the evaluation and subsequent analysis of the findings indicated that the syringe marker supply could be successfully implemented using pharmacy NEXs. The product and the supply method were acceptable to both staff and service users. Initial bivariate analysis was conducted using a number of dependent and independent variables identified within the questionnaire. These findings highlighted a number of areas worthy of further exploration, including emerging differences between male and female respondents, and indicated specific target groups for future developments in syringe identification. The contribution of the peer researchers was found to be a significant factor in successfully completing the evaluation. However it is not possible to make any definitive statements on how effective the intervention is in terms of reducing the transmission of BBVs and other related infections. The findings of the evaluation indicated a number of potential areas of work that could be usefully explored to investigate the effectiveness of the markers in reducing the transmission of infections. The limitations of the evaluation became apparent during the course of the study and the implications of these limitations are discussed.

This diploma thesis describes the origins of harm reduction (HR) in the Czech drug policy. It focuses on the role of HR in national strategies and the development of syringe and needle program and substitution treatment. The aim of the thesis is to describe and explain how the HR approach was developed in the Czech environment. Using the framework of policy diffusion, the author explains the mechanisms by which harm reduction was transferred from abroad. Thesis describes the history of drug policy and the development of the harm reduction approach in the world. This information forms the context in which the author advocates HR development in the Czech Republic's drug policy after 1989. By analysing expert texts and expert interviews she explains how the first national strategies were formed in which HR has been included since 1993. Similarly, it deals with the beginnings of syringe exchange, which has been in operation since 1986, and substitution treatment that was first used in 1992 and has been officially operational since 1997. The mechanisms of diffusion of HR from abroad to the Czech Republic are defined. In all three areas, the mechanism of learning is defined. Substitution treatment and national strategies are also defined by the mechanism of emulation. To a lesser extent, a mechanism of...

Background: Understanding concentrated areas with high rates of opioid use disorder (OUD) allows for improved placement of Narcan access points through syringe services programs (SSPs). People Who Inject Drugs (PWID) have lower risk of contracting infectious diseases the closer they are to SSPs. Tennessee law prohibits SSPs within 2000ft of a school or park, impacting the placement of SSPs in non-urban areas. Testing factors related to SSP siting placement within a system dynamic model can better determine the relationship between PWID risk environment and SSP access and utility. Methods: We identified areas of greatest need for harm reduction interventions within a non-urban Tennessee county with Emergency Medical Services (EMS) Narcan administrations data (Aim 1). We then created a Google map to determine a theoretical ideal location for an SSP. We then applied the current legal restrictions to SSP placement to find the next-closest legal location (Aim 2). We then developed a theoretical system dynamic model of SSP access and utility and Risk Environment (Aim 3). Results: We determined “EMS Zone 1” has a higher rate of EMS Narcan administrations than most EMS zones in the county and a higher rate compared to the whole county (Aim 1). We located a theoretical SSP location with shorter walk, drive, and public transportation times compared to the existing location. The closest legal SPP location still had an improvement in travel times but lacked other utility factors (Aim 2). Our theoretical model indicates that laws limiting SSP placement increase the distance PWID travel to SSPs. The distance of support services to SSP sites has a negative relationship with risk environment and to accessibility and utility of SSPs (Aim 3). Conclusion: County-level geographic data is too crude to determine true “hot spots” of OUD. This new method using EMS data can provide entities a process for determining the best location for SSPs. Identifying measures of utility/accessibility for PWID can identify improved locations for SSPs but legal restrictions may lower utility/accessibility of SSPs especially for non-urban PWID. Current “Policy” or “Structural” level factors as described by the Social Ecological Model negatively impact PWID risk environment. Structural” or “Policy” and “Community” level interventions among state, city, and county governments have the highest potential to positively impact PWID risk environment.

Earlier research shows that persons who inject drugs are in heightened need of healthcare and medical assistance. But research has also shown that it can be difficult for them to receive care and assistance due to their circumstances. Sweden has a long history of restrictive drug policy and practice. This has affected how care for drug users has been managed and formed. In recent years, due to a change in the Swedish legislation, it has become easier to establish needle exchange programs. As a result, there has been an increase in the number of needle exchange programs during the last five years. The aim of this study was to examine the harm reducing work that is done within the swedish needle exchange program. For this, the study primarily focused on how the staff perceived harm reduction work, its possibilities and difficulties. The data was collected through four semistructured interviews with staff at needle exchanges in Sweden. The participants were either nurses or counselors, working at either newer or more established needle exchanges. The data was coded into the following themes; Reduction of harm- and transmission of infectious diseases, The outlook on drug abuse and The importance of treatment and relations. The results show that harm reduction is perceived to be a pragmatic alternative to the traditional care of drug users by the staff. The participants do stress that needle exchange programs by themselves aren't enough to reduce the harms of addiction. The results also highlight the importance of the relational- and emotional work, which is a real factor for effective harm reduction work. By developing trust and relations, the target groups' needs are both easier expressed and met at needle exchanges.

Volym- och sprutpumpar används inom neonatalvården tillsammans med en specialanpassad kateter. De prematurfödda barnen är mycket känsliga för feldoseringar men det finns minimalt med dokumenterade projekt som undersöker hur väl den distribuerade dosen stämmer överens med den angivna på infusionspumpen. Målet med denna studie var att kontrollera om det fettbaserade läkemedlet Clinoleic flyter tillbaka i det gemensamma blocket, avgöra tiden det tar för läkemedel att flyta fram samt mäta mängden av läkemedel som kommer till mynningen av katetern. Antalet pumpar begränsades till startuppsättningen inom intensivvården på neonatalavdelningen, vilket är fyra pumpar. Mängden av läkemedlet för fem olika flöden undersöktes endast för läkemedlet Peyona med koffeinbas. Projektet genomfördes på Karolinska Universitetssjukhuset och i samarbete med Nya Karolinska Solna förbättrades förståelse för uppsättningens användning. Samtliga sjuksköterskor och ingenjörer vi kom i kontakt med på sjukhusen ansåg att fler studier behöver göras inom distribution av läkemedlen. Tydliga kopplingar kan ses mellan resultat som presenteras i arbetet och misstankar och förväntningar efter samtal med de som jobbar med pumpar. Möjliga framtida experiment som kan ge tydligare riktlinjer inom neonatalvården diskuteras. Det är några anmärkningsvärda resultat som redovisas i studien. De är att Clinoleic flyter bakåt i blocket och att fylla backventilen tar mellan 16 och 25 minuter för de undersökta flödena. Dessutom framgår det att distributionen av Peyona avviker minst för de högre flödena. / Volume and syringe pumps are used in neonatal care together with a customized catheter. The premature born children are extremely sensitive to incorrect dosage, but there are only a short number of documented projects that investigate how well the distributed dose corresponds to that indicated on the infusion pump. The aim of this study was to check whether the fat-based drug Clinoleic flows back into the common block, determine the time it takes for drug to flow and measure the amount of drug that comes to the orifice of the catheter. The number of pumps and drugs was limited to the initial set that is used in intensive care in the neonatal department. The setup consists of four pumps and the drugs Peyona, Clinoleic, Glucos and Sodium Chloride solution. The amount of medicine distributed for five different flows was investigated only for the caffeine-based drug Peyona. The project was implemented at Karolinska Universitetssjukhuset and with help of Nya Karolinska Solna the understanding for the used setup was improved. All nurses and engineers we came into contact with at the hospitals felt that more studies should be done in the subject of the distribution of the drugs. Obvious connections are seen between results that are presented and suspicions and expectations after consultation with those who work with pumps daily. Possible future experiments that provide clearer guidelines for neonatal care are discussed. There are some notable results reported in the study. They are that Clinoleic is flowing back into the block and filling the check valve takes between 16 and 25 minutes for the investigated flows. for the investigated flows and that that the smallest distribution deviation of Peyona is observed in higher flows.

Nesta tese foram desenvolvidos procedimentos analíticos fotométricos automáticos para determinação simultânea de sulfato e cloreto em coque de petróleo, molibdênio em plantas sem etapa de pré-concentração com solvente orgânico e zinco em águas empregando microextração líquido-líquido. Em todos os procedimentos reportados nesta tese, o módulo de análise foi baseado no processo de multicomutação, utilizou-se bomba de seringa como propulsor de fluidos e válvulas solenoide de três vias como dispositivos de comutação para controlar as inserções das alíquotas da amostra e dos reagentes no percurso analítico. As detecções fotométricas foram realizadas empregando fotômetros de LEDs, construídos para este projeto, equipados com celas de fluxo com caminho óptico longo (50,0 mm para cloreto, sulfato e zinco, 200,0 mm para molibdênio). O fotômetro foi construído com LEDs de alto brilho como máximos de emissão em 472 nm para cloreto, sulfato e molibdênio e 525 nm para zinco. Os procedimentos para determinação simultânea de sulfato e cloreto apresentaram faixa linear entre 10-700 mg L-1; 0,25-10 mg L-1; limite de detecção de 5,3 mg L-1; 0,16 mg L-1; coeficiente de variação de 3,0%; 0,9 % (n=10), respectivamente, e frequência de amostragem de 75 determinações por hora para cada analito. O procedimento para determinação de molibdênio apresentou faixa linear entre 50 - 500 ?g L-1, limite de detecção 9,1 ?g L-1, coeficiente de variação 1,07% (n=10) e frequência de amostragem de 51 determinações por hora. O procedimento para zinco apresentou uma faixa linear entre 10-100 ?g L-1, limite de detecção 8,3 ?g L-1, coeficiente de variação 3,3% (n=10) e frequência de amostragem de 19 determinações por hora / In this thesis, automated photometric analytical procedures for simultaneous determination of sulfate and chloride in petroleum coke, molybdenum in plants without pre-concentration step and zinc in water using liquid-liquid microextraction were developed. All procedures reported in this thesis, employed flow analysis modules based on multicommuted process, syringe pump for fluid propulsion and solenoid three-way valves as commutation devices the insertion aliquots of sample and reagents solutions in the analytical path. Photometric detections were performed, using LEDs-photometers, built for this project, equipped with flow cells with long optical path (50.0 mm for chloride, sulfate and zinc, 200.0 mm for molybdenum) and the high intense radiation beam LEDs with maximum emission at 472 nm for chloride, sulfate and molybdenum and 525 nm for zinc. The procedures for simultaneous determination of sulfate and chloride showed linear response between 10 to 700 mg L-1; 0.25 to 10 mg L-1; detection limit of 5.3 mg L-1; 0.16 mg L-1; variation coefficient of 3.0%; 0.9% (n = 10), respectively, and sampling throughput of 75 determinations per hour for each analyte. The procedure for molybdenum presented a linear response between 50 to 500 ?g L-1, detection limit of 9.1 ?g L-1, variation coefficient of 1.07% (n = 10) and sampling throughput of 51 determinations per hour. The procedure for zinc showed linear response between 10 to 100 ?g L-1, detection limit of 8.3 ?g L-1, variation coefficient of 3.3% (n = 10) and sampling throughput of 19 determinations per hour

Nesta tese foram desenvolvidos procedimentos analíticos fotométricos automáticos para determinação simultânea de sulfato e cloreto em coque de petróleo, molibdênio em plantas sem etapa de pré-concentração com solvente orgânico e zinco em águas empregando microextração líquido-líquido. Em todos os procedimentos reportados nesta tese, o módulo de análise foi baseado no processo de multicomutação, utilizou-se bomba de seringa como propulsor de fluidos e válvulas solenoide de três vias como dispositivos de comutação para controlar as inserções das alíquotas da amostra e dos reagentes no percurso analítico. As detecções fotométricas foram realizadas empregando fotômetros de LEDs, construídos para este projeto, equipados com celas de fluxo com caminho óptico longo (50,0 mm para cloreto, sulfato e zinco, 200,0 mm para molibdênio). O fotômetro foi construído com LEDs de alto brilho como máximos de emissão em 472 nm para cloreto, sulfato e molibdênio e 525 nm para zinco. Os procedimentos para determinação simultânea de sulfato e cloreto apresentaram faixa linear entre 10-700 mg L-1; 0,25-10 mg L-1; limite de detecção de 5,3 mg L-1; 0,16 mg L-1; coeficiente de variação de 3,0%; 0,9 % (n=10), respectivamente, e frequência de amostragem de 75 determinações por hora para cada analito. O procedimento para determinação de molibdênio apresentou faixa linear entre 50 - 500 ?g L-1, limite de detecção 9,1 ?g L-1, coeficiente de variação 1,07% (n=10) e frequência de amostragem de 51 determinações por hora. O procedimento para zinco apresentou uma faixa linear entre 10-100 ?g L-1, limite de detecção 8,3 ?g L-1, coeficiente de variação 3,3% (n=10) e frequência de amostragem de 19 determinações por hora / In this thesis, automated photometric analytical procedures for simultaneous determination of sulfate and chloride in petroleum coke, molybdenum in plants without pre-concentration step and zinc in water using liquid-liquid microextraction were developed. All procedures reported in this thesis, employed flow analysis modules based on multicommuted process, syringe pump for fluid propulsion and solenoid three-way valves as commutation devices the insertion aliquots of sample and reagents solutions in the analytical path. Photometric detections were performed, using LEDs-photometers, built for this project, equipped with flow cells with long optical path (50.0 mm for chloride, sulfate and zinc, 200.0 mm for molybdenum) and the high intense radiation beam LEDs with maximum emission at 472 nm for chloride, sulfate and molybdenum and 525 nm for zinc. The procedures for simultaneous determination of sulfate and chloride showed linear response between 10 to 700 mg L-1; 0.25 to 10 mg L-1; detection limit of 5.3 mg L-1; 0.16 mg L-1; variation coefficient of 3.0%; 0.9% (n = 10), respectively, and sampling throughput of 75 determinations per hour for each analyte. The procedure for molybdenum presented a linear response between 50 to 500 ?g L-1, detection limit of 9.1 ?g L-1, variation coefficient of 1.07% (n = 10) and sampling throughput of 51 determinations per hour. The procedure for zinc showed linear response between 10 to 100 ?g L-1, detection limit of 8.3 ?g L-1, variation coefficient of 3.3% (n = 10) and sampling throughput of 19 determinations per hour

No description available.