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Badke K, Small SS, Pratt M, Lockington J, Gurney L, Kestler A, Moe J. Healthcare provider perspectives on emergency department-initiated buprenorphine/naloxone: a qualitative study. BMC Health Serv Res 2024; 24:211. [PMID: 38360620 PMCID: PMC10870432 DOI: 10.1186/s12913-023-10271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Take-home buprenorphine/naloxone is an effective method of initiating opioid agonist therapy in the Emergency Department (ED) that requires ED healthcare worker buy-in for large-scale implementation. We aimed to investigate healthcare workers perceptions of ED take-home buprenorphine/naloxone, as well as barriers and facilitators from an ED healthcare worker perspective. METHODS In the context of a take-home buprenorphine/naloxone feasibility study at a tertiary care teaching hospital we conducted a descriptive qualitative study. We conducted one-on-one in person or telephone interviews and focus groups with ED healthcare workers who cared for patients given take-home buprenorphine/naloxone in the feasibility study at Vancouver General Hospital from July 2019 to March 2020. We conducted 37 healthcare worker interviews from December 2019 to July 2020. We audio recorded interviews and focus groups and transcribed them verbatim. We completed interviews until we reached thematic saturation. DATA ANALYSIS We inductively coded a sample of transcripts to generate a provisional coding structure and to identify emerging themes, which were reviewed by our multidisciplinary team. We then used the final coding structure to analyze the transcripts. We present our findings descriptively. RESULTS Participants identified a number of context-specific facilitators and barriers to take-home buprenorphine/naloxone provision in the ED. Participants highlighted ED conditions having either facilitative or prohibitive effects: provision of buprenorphine/naloxone was feasible when ED volume was low and space was available but became less so as ED volume increased and space decreased. Similarly, participants noted that patient-related factors could have a facilitative or prohibitive effect, such as willingness to wait (willing to stay in the ED for study-related activities and buprenorphine/naloxone initiation activities), receptiveness to buprenorphine/naloxone, and comprehension of the instructions. As for staff-related factors, time was identified as a consistent barrier. Time included time available and time required to initiate buprenorphine/naloxone (including time building rapport). Healthcare worker familiarity with buprenorphine/naloxone was noted as either a facilitating factor or a barrier, and healthcare workers indicated that ongoing training would have been advantageous. Many healthcare workers identified that the ED is an important first point of contact for the target patient population. CONCLUSION Integrating a buprenorphine/naloxone program into ED care requires organizational supports (e.g., for managing buprenorphine/naloxone within limitations of ED volume, space, and time), and ongoing education of healthcare workers to minimize identified barriers.
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Affiliation(s)
- Katherin Badke
- Lower Mainland Pharmacy Services, Vancouver, BC, Canada.
- Pharmacy Department, Vancouver General Hospital, 899 W 12th avenue, Vancouver, BC, V5Z 1M9, Canada.
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
| | - Serena S Small
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Megan Pratt
- Social Work Department, Vancouver General Hospital, Vancouver, BC, Canada
| | - Julie Lockington
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Lara Gurney
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC, Canada
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada
- BC Centre for Disease Control, Vancouver, BC, Canada
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Gurney L, Chung V, MacPhee M, Chan E, Snyman C, Robinson J, Bertoli-Haley S, Baron E. Exploring the Impact of Storytelling for Hospitalized Patients Recovering from COVID-19. Healthcare (Basel) 2023; 11:healthcare11040589. [PMID: 36833123 PMCID: PMC9957174 DOI: 10.3390/healthcare11040589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
There are mental and physical deficits associated with COVID-19 infection, particularly among individuals requiring hospitalization. Storytelling is a relational intervention that has been used to help patients make sense of their illness experiences and to share their experiences with others, including other patients, families and healthcare providers. Relational interventions strive to create positive, healing stories versus negative ones. In one urban acute care hospital, an initiative called the Patient Stories Project (PSP) uses storytelling as a relational intervention to promote patient healing, including the development of healthier relationships among themselves, with families and with healthcare providers. This qualitative study employed a series of interview questions that were collaboratively developed with patient partners and COVID-19 survivors. The questions asked consenting COVID-19 survivors about why they chose to tell their stories and to flesh out more about their recovery process. Thematic analyses of six participant interviews resulted in the identification of key themes along a COVID-19 recovery pathway. Patients' stories revealed how survivors progress from being overwhelmed by their symptoms to making sense of what is happening to them, providing feedback to their care providers, feeling gratitude for care received, becoming aware of a new state of normal, regaining control of their lives, and ultimately discovering meaning and an important lesson behind their illness experience. Our study's findings suggest that the PSP storytelling approach holds potential as a relational intervention to support COVID-19 survivors along a recovery journey. This study also adds knowledge about survivors beyond the first few months of recovery.
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Affiliation(s)
- Lara Gurney
- Vancouver Coastal Health, Vancouver, BC V6T 1Z4, Canada
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada
- Correspondence: (L.G.); (M.M.)
| | - Vincci Chung
- Vancouver Coastal Health, Vancouver, BC V6T 1Z4, Canada
| | - Maura MacPhee
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada
- Correspondence: (L.G.); (M.M.)
| | - Evelyn Chan
- Vancouver Coastal Health, Vancouver, BC V6T 1Z4, Canada
| | - Claire Snyman
- Vancouver Coastal Health, Vancouver, BC V6T 1Z4, Canada
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Dehaene I, Lorthe E, Gurney L, Turtiainen P, Schwickert A, Svenvik M, Care A, Bergman L. Accuracy of the combination of commercially available biomarkers and cervical length measurement to predict preterm birth in symptomatic women: A systematic review. Eur J Obstet Gynecol Reprod Biol 2021; 258:198-207. [PMID: 33450711 DOI: 10.1016/j.ejogrb.2020.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
An accurate prognostic method for preterm birth (PTB) could avoid unnecessary treatment(s) with potentially negative effects. The objective was to explore the prognostic accuracy of commercially available bedside cervicovaginal biomarker tests in combination with cervical length (CL) compared to CL measurement alone and/or a biomarker test alone, for PTB within 7 days after testing symptomatic women at 22-34 weeks. The MEDLINE, Cochrane, Embase and Web of Science databases were searched from inception to August 28th, 2019. Seven hundred and eight articles were identified and screened using Rayyan. Studies reporting on the predictive accuracy of combined tests compared to CL or biomarker alone for the prediction of PTB within 7 days of testing in symptomatic women with intact membranes were included. A piloted data extraction form was used. Direct comparisons of the prognostic accuracy of the combination test with CL measurement or a biomarker alone were done, as well as comparisons of prognostic accuracy of the included combination tests (indirect comparisons). Twelve articles were included (seven on fetal fibronectin, four on phosphorylated insulin-like growth factor binding protein-1, one comparing both). A variety of CL cut-offs was reported. The results could not demonstrate superiority of a combination method compared to single methods. Due to data scarcity and quality, the superiority of either predictive test for PTB, either combination or single, cannot be demonstrated with this systematic review. We recommend further research to compare available biomarkers.
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Affiliation(s)
- I Dehaene
- Obstetrics and Gynecology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - E Lorthe
- EPIUnit - Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-600 Porto, Portugal.
| | - L Gurney
- Subspeciality Trainee in Maternal Fetal Medicine, West Midlands Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, UK.
| | - P Turtiainen
- Department of Obstetrics and Gynecology, University of Tampere, University Hospital of Tampere, Teiskontie 35, 33521, Tampere, Finland.
| | - A Schwickert
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - M Svenvik
- Department of Obstetrics and Gynecology, Region Kalmar County, S-391 85, Kalmar, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - A Care
- Harris Wellbeing Preterm Birth Research Group, Centre for Women and Children's Health Research, University of Liverpool, Liverpool Women's Hospital, Liverpool, UK.
| | - L Bergman
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Medicinaregatan 3A, PO Box 46, SE 405 30, Gothenburg, Sweden.
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Abstract
The "wobble room" is a wellness intervention designed to guide staff through unpredictable times that are not going away quickly. Emergency department teams are accustomed to trauma events and trauma debriefing, but the prolonged uncertainties and fears associated with COVID-19 have posed a unique challenge for healthcare workers. The wobble room has become a place where staff can make sense of how the pandemic is affecting them and create a "new normal" with respect to personal safety and team cohesion.
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Affiliation(s)
- Lara Gurney
- Head Nurse Educator Emergency Department, Vancouver General Hospital, Vancouver, BC
| | - Julie Lockington
- Nurse Clinician, Emergency Department, Vancouver General Hospital, Vancouver, BC
| | - Lori Quinn
- Manager, Emergency Department, Vancouver General Hospital, Vancouver, BC
| | - Maura MacPhee
- Professor, School of Nursing, University of British Columbia, Vancouver, BC
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Moe J, Badke K, Pratt M, Cho RY, Azar P, Flemming H, Sutherland KA, Harvey B, Gurney L, Lockington J, Brasher P, Gill S, Garrod E, Bath M, Kestler A. Microdosing and standard-dosing take-home buprenorphine from the emergency department: A feasibility study. J Am Coll Emerg Physicians Open 2020; 1:1712-1722. [PMID: 33392580 PMCID: PMC7771760 DOI: 10.1002/emp2.12289] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Emergency department (ED)-initiated buprenorphine may prevent overdose. Microdosing is a novel approach that does not require withdrawal, which can be a barrier to standard inductions. We aimed to evaluate the feasibility of an ED-initiated buprenorphine/naloxone program providing standard-dosing and microdosing take-home packages and of randomizing patients to either intervention. METHODS We broadly screened patients ≥18 years old for opioid use disorder at a large, urban ED. In a first phase, we provided consecutive patients with 3-day standard-dosing packages, and then we provided a subsequent group with 6-day microdosing packages. In a second phase, we randomized patients to standard dosing or microdosing. We attempted 7-day telephone follow-ups and 30-day in-person community follow-ups. The primary feasibility outcome was number of patients enrolled and accepting randomization. Secondary outcomes were numbers screened, follow-up rates, and 30-day opioid agonist therapy retention. RESULTS We screened 3954 ED patients and identified 94 with opioid use disorders. Of the patients, 26 (27.7%) declined participation: 10 identified a negative prior experience with buprenorphine/naloxone as the reason, 5 specifically cited precipitated withdrawal, and none cited randomization. We enrolled 68 patients. A total of 14 left the ED against medical advice, 8 were excluded post-enrollment, 21 received standard dosing, and 25 received microdosing. The 7-day and 30-day follow-up rates were 9/46 (19.6%) and 15/46 (32.6%), respectively. At least 5/21 (23.8%) provided standard dosing and 8/25 (32.0%) provided microdosing remained on opioid agonist therapy at 30 days. CONCLUSIONS ED-initiated take-home standard-dosing and microdosing buprenorphine/naloxone programs are feasible, and a randomized controlled trial would be acceptable to our target population.
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Affiliation(s)
- Jessica Moe
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Katherin Badke
- Department of Pharmaceutical SciencesVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Megan Pratt
- Social WorkVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Raymond Y Cho
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Pouya Azar
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Complex Pain and Addiction ServicesVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Heather Flemming
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - K. Anne Sutherland
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Barbara Harvey
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Lara Gurney
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Julie Lockington
- Department of Emergency MedicineVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Penny Brasher
- Centre for Clinical Epidemiology and EvaluationVancouverBritish ColumbiaCanada
| | - Sam Gill
- Rapid Access Addiction ClinicSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Emma Garrod
- Urban Health Program, Providence Health CareVancouverBritish ColumbiaCanada
| | - Misty Bath
- Regional PreventionVancouver Coastal Health AuthorityVancouverBritish ColumbiaCanada
| | - Andy Kestler
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Emergency MedicineSt. Paul's HospitalVancouverBritish ColumbiaCanada
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Gurney L, Al Wattar BH, Sher A, Echevarria C, Simpson H. Comparison of perinatal outcomes for all modes of second stage delivery in obstetric theatres: a retrospective observational study. BJOG 2020; 128:1248-1255. [PMID: 33142034 DOI: 10.1111/1471-0528.16589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare rates of vaginal delivery and adverse outcomes of instrumental delivery trials in obstetric theatre compared to primary emergency full dilation caesarean section. DESIGN Retrospective cohort study. SETTING University teaching hospital. POPULATION Women with singleton, non-anomalous, pregnancy undergoing instrumental delivery trial in obstetric theatre. METHODS Data were collected from consecutive cases during 2014 until 2018 using clinical records. Multivariate regression analysis was used comparing outcomes per first delivery method. MAIN OUTCOME MEASURES Primary outcome was completion of vaginal delivery between all methods of instrumental delivery. Secondary outcome was a composite of immediate perinatal adverse outcomes for instrumental delivery modes and primary full dilation caesarean section. RESULTS From 971 deliveries analysed: ventouse delivery was significantly less likely to achieve vaginal delivery compared with Keilland's forceps delivery (odds ratio [OR] 0.42, 95% CI 0.22-0.79). Once confounding factors were adjusted for, adverse outcome rates were less frequent in the Keilland's forceps group than with primary full dilation caesarean section (OR 0.37, 95% CI 0.16-0.81); however, the receiver operating characteristic curve produced from this model demonstrated a low predictive value (AUC 0.64). CONCLUSIONS Attempting instrumental delivery in delivery suite theatre, as an alternative to primary emergency full dilation caesarean section, is both reasonable and safe. In this study, ventouse delivery performed poorly in comparison with other modes of instrumental delivery. Further research in the form of randomised controlled trials to identify the optimal mode of second stage delivery is paramount. TWEETABLE ABSTRACT Instrumental delivery trials in theatre are safe but use of ventouse was associated with a higher rate of failure.
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Affiliation(s)
- L Gurney
- West Midlands Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - B H Al Wattar
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Sher
- Maternity Department, James Cook University Hospital, Middlesbrough, UK
| | - C Echevarria
- Respiratory Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - H Simpson
- Maternity Department, James Cook University Hospital, Middlesbrough, UK
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Abstract
Mesenchymal chondrosarcoma is a rare tumour with orbital involvement being an exceptional occurrence. We present a case of a 22-year old man with such disease, together with details of his management. A brief literature review of this uncommon tumour was also enclosed.
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Affiliation(s)
- A R A Razak
- Northern Centre for Cancer Treatment, Newcastle, UK.
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Baynes V, Gurney L, Collyer K. Standard care plans in orthopaedics. Nurs Stand 1989; 3:30-2. [PMID: 2495488 DOI: 10.7748/ns.3.24.30.s48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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