1
|
Brooks HL, Speed KA, Dong K, Salvalaggio G, Pauly B(B, Taylor M, Hyshka E. Perspectives of patients who inject drugs on a needle and syringe program at a large acute care hospital. PLoS One 2024; 19:e0297584. [PMID: 38359010 PMCID: PMC10868849 DOI: 10.1371/journal.pone.0297584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND People who inject drugs in North America often continue to inject while hospitalized, and are at increased risk of premature hospital discharge, unplanned readmission, and death. In-hospital access to sterile injection supplies may reduce some harms associated with ongoing injection drug use. However, access to needle and syringe programs in acute care settings is limited. We explored the implementation of a needle and syringe program integrated into a large urban tertiary hospital in Western Canada. The needle and syringe program was administered by an addiction medicine consult team that offers patients access to specialized clinical care and connection to community services. METHODS We utilized a focused ethnographic design and semi-structured interviews to elicit experiences and potential improvements from 25 hospitalized people who inject drugs who were offered supplies from the needle and syringe program. RESULTS Participants were motivated to accept supplies to prevent injection-related harms and access to supplies was facilitated by trust in consult team staff. However, fears of negative repercussions from non-consult team staff, including premature discharge or undesired changes to medication regimes, caused some participants to hesitate or refuse to accept supplies. Participants described modifications to hospital policies regarding inpatient drug use or access to an inpatient supervised consumption service as potential ways to mitigate patients' fears. CONCLUSIONS Acute care needle and syringe programs may aid hospital providers in reducing harms and improving hospital outcomes for people who inject drugs. However, modifications to hospital policies and settings may be necessary.
Collapse
Affiliation(s)
- Hannah L. Brooks
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kelsey A. Speed
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Ginetta Salvalaggio
- Department of Family Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bernadette (Bernie) Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Marliss Taylor
- Streetworks, Boyle Street Community Services, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
2
|
Chung E, Rhee H. Impact of Physical Exercise Program Interventions on Erectile Function and Cardiovascular Health in Males with Prostate Cancer. World J Mens Health 2022; 40:361-367. [PMID: 34169682 PMCID: PMC9253808 DOI: 10.5534/wjmh.210032] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 11/15/2022] Open
Abstract
Prostate cancer (PC) and its associated treatments can cause significant cardiovascular and sexual dysfunctions. While structured exercise interventions can induce positive outcomes in males with PC, there are limited data on its effects on cardiovascular health, erectile function, or the combination of these outcomes. It has been proposed that positive changes in biomarkers of cardiovascular health through physical exercise programs, can result in cardiovascular remodelling and improve penile haemodynamic and erectile function recovery in those with metabolic syndrome and/or cardiovascular diseases, although the data is accruing in males who are diagnosed and/or treated for PC. While the results of this review article support structured physical exercise interventions to effectively prevent and mitigate the development of both sexual and cardiovascular dysfunctions in males with PC, appropriate caution should be maintained and future clinical research should focus on the development of standardised and evidence-based exercise guidelines in the setting of PC survivorship.
Collapse
Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, QLD and Sydney, NSW, Australia
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Macquarie University Hospital, Sydney, NSW, Australia.
| | - Handoo Rhee
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
3
|
Chan BYH, Roczkowsky A, Cho WJ, Poirier M, Sergi C, Keschrumrus V, Churko JM, Granzier H, Schulz R. MMP inhibitors attenuate doxorubicin cardiotoxicity by preventing intracellular and extracellular matrix remodelling. Cardiovasc Res 2021; 117:188-200. [PMID: 31995179 PMCID: PMC7797218 DOI: 10.1093/cvr/cvaa017] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/18/2019] [Accepted: 01/21/2020] [Indexed: 12/20/2022] Open
Abstract
AIMS Heart failure is a major complication in cancer treatment due to the cardiotoxic effects of anticancer drugs, especially from the anthracyclines such as doxorubicin (DXR). DXR enhances oxidative stress and stimulates matrix metalloproteinase-2 (MMP-2) in cardiomyocytes. We investigated whether MMP inhibitors protect against DXR cardiotoxicity given the role of MMP-2 in proteolyzing sarcomeric proteins in the heart and remodelling the extracellular matrix. METHODS AND RESULTS Eight-week-old male C57BL/6J mice were treated with DXR weekly with or without MMP inhibitors doxycycline or ONO-4817 by daily oral gavage for 4 weeks. Echocardiography was used to determine cardiac function and left ventricular remodelling before and after treatment. MMP inhibitors ameliorated DXR-induced systolic and diastolic dysfunction by reducing the loss in left ventricular ejection fraction, fractional shortening, and E'/A'. MMP inhibitors attenuated adverse left ventricular remodelling, reduced cardiomyocyte dropout, and prevented myocardial fibrosis. DXR increased myocardial MMP-2 activity in part also by upregulating N-terminal truncated MMP-2. Immunogold transmission electron microscopy showed that DXR elevated MMP-2 levels within the sarcomere and mitochondria which were associated with myofilament lysis, mitochondrial degeneration, and T-tubule distention. DXR-induced myofilament lysis was associated with increased titin proteolysis in the heart which was prevented by ONO-4817. DXR also increased the level and activity of MMP-2 in human embryonic stem cell-derived cardiomyocytes, which was reduced by ONO-4817. CONCLUSIONS MMP-2 activation is an early event in DXR cardiotoxicity and contributes to myofilament lysis by proteolyzing cardiac titin. Two orally available MMP inhibitors ameliorated DXR cardiotoxicity by attenuating intracellular and extracellular matrix remodelling, suggesting their use may be a potential prophylactic strategy to prevent heart injury during chemotherapy.
Collapse
Affiliation(s)
- Brandon Y H Chan
- Department of Pediatrics and Pharmacology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB T6G 2S2, Canada
| | - Andrej Roczkowsky
- Department of Pediatrics and Pharmacology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB T6G 2S2, Canada
| | - Woo Jung Cho
- Faculty of Medicine and Dentistry Cell Imaging Centre, University of Alberta, Edmonton, AB, Canada
| | - Mathieu Poirier
- Department of Pediatrics and Pharmacology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB T6G 2S2, Canada
| | - Consolato Sergi
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Vic Keschrumrus
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, USA
| | - Jared M Churko
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, USA
| | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, USA
| | - Richard Schulz
- Department of Pediatrics and Pharmacology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB T6G 2S2, Canada
| |
Collapse
|
4
|
Speed KA, Gehring ND, Launier K, O'Brien D, Campbell S, Hyshka E. To what extent do supervised drug consumption services incorporate non-injection routes of administration? A systematic scoping review documenting existing facilities. Harm Reduct J 2020; 17:72. [PMID: 33028363 PMCID: PMC7539556 DOI: 10.1186/s12954-020-00414-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Most of the existing research on supervised consumption services (SCS) is focused on injection drug use. Less is known about the applicability of SCS for people who consume drugs orally, intranasally, or through inhalation. This is problematic because people who use drugs through modes other than injection are also at risk of overdose death and other harm, and experience barriers accessing health and social services. We aimed to describe existing SCS models that accommodate these alternate routes of drug consumption, and synthesize available information on characteristics of program participants. METHODS We conducted a systematic scoping review of 9 peer-reviewed and 13 grey literature databases on SCS that incorporate non-injection routes of consumption. We screened 22,882 titles, and excluded 22,843 (99.8%) articles. We ultimately included 39 (0.2%) full-text articles; 28 (72%) of these articles explicitly identified SCS that permit alternate routes of consumption and 21 (54%) discussed characteristics of participants who consume drugs through non-injection routes. Data on study characteristics, terms and definitions, and site and program participant characteristics were extracted and double-coded. Extracted data were analyzed using descriptive statistics and narrative synthesis. RESULTS Included articles describe 48 SCS that permit non-injection routes of consumption, most of which were located in Germany. The majority of these SCS were legally sanctioned and had models of care that were largely comparable to supervised injection services. Notable differences included physical infrastructure such as ventilated rooms or outdoor areas to accommodate inhalation, and shorter time limits on non-injection drug consumption episodes. Program participants engaging in non-injection forms of consumption were typically men over the age of 30 and structurally vulnerable (e.g., experiencing homelessness or unstable housing). CONCLUSIONS Extant academic and grey literature indicates that site characteristics and demographics of program participants of SCS that permit non-injection routes of consumption largely reflect those of supervised injection services. Further research on the range of existing SCS that incorporate non-injection routes of consumption is needed to ensure high quality service provision, and improved health outcomes for people who consume drugs via oral, intranasal, and inhalation routes.
Collapse
Affiliation(s)
- Kelsey A Speed
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Nicole D Gehring
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Katherine Launier
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Daniel O'Brien
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Sandy Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada.
| |
Collapse
|
5
|
McKinney M, Smith KE, Dong KA, Babenko O, Ross S, Kelly MA, Salvalaggio G. Development of the Inner City attitudinal assessment tool (ICAAT) for learners across Health care professions. BMC Health Serv Res 2020; 20:174. [PMID: 32143705 PMCID: PMC7059309 DOI: 10.1186/s12913-020-5000-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many health professions learners report feeling uncomfortable and underprepared for professional interactions with inner city populations. These learners may hold preconceptions which affect therapeutic relationships and provision of care. Few tools exist to measure learner attitudes towards these populations. This article describes the development and validity evidence behind a new tool measuring health professions learner attitudes toward inner city populations. METHODS Tool development consisted of four phases: 1) Item identification and generation informed by a scoping review of the literature; 2) Item refinement involving a two stage modified Delphi process with a national multidisciplinary team (n = 8), followed by evaluation of readability and response process validity with a focus group of medical and nursing students (n = 13); 3) Pilot testing with a cohort of medical and nursing students; and 4) Analysis of psychometric properties through factor analysis and reliability. RESULTS A 36-item online version of the Inner City Attitudinal Assessment Tool (ICAAT) was completed by 214 of 1452 undergraduate students (67.7% from medicine; 32.3% from nursing; response rate 15%). The resulting tool consists of 24 items within a three-factor model - affective, behavioural, and cognitive. Reliability (internal consistency) values using Cronbach alpha were 0.87, 0.82, and 0.82 respectively. The reliability of the whole 24-item ICAAT was 0.90. CONCLUSIONS The Inner City Attitudinal Assessment Tool (ICAAT) is a novel tool with evidence to support its use in assessing health care learners' attitudes towards caring for inner city populations. This tool has potential to help guide curricula in inner city health.
Collapse
Affiliation(s)
- Mark McKinney
- Inner City Health and Wellness Program, Edmonton, AB Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON Canada
| | - Katherine E. Smith
- Alberta Health Services, Edmonton, AB Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, AB Canada
| | - Kathryn A. Dong
- Inner City Health and Wellness Program, Edmonton, AB Canada
- Alberta Health Services, Edmonton, AB Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, AB Canada
| | - Oksana Babenko
- Department of Family Medicine, University of Alberta, Edmonton, AB Canada
| | - Shelley Ross
- Department of Family Medicine, University of Alberta, Edmonton, AB Canada
| | - Martina A. Kelly
- Department of Family Medicine, University of Calgary Cumming School of Medicine, Calgary, AB Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program, Edmonton, AB Canada
- Department of Family Medicine, University of Alberta, Edmonton, AB Canada
- Department of Family Medicine, University of Alberta Faculty of Medicine & Dentistry, 610 University Terrace, Edmonton, AB T6G 2T4 Canada
| |
Collapse
|
6
|
Kerber K, Kolahdooz F, Otway M, Laboucan M, Jang SL, Lawrence S, Aronyk S, Quinn M, Irlbacher-Fox S, Milligan C, Broadhead S, DeLancey D, Corriveau A, Sharma S. Opportunities for improving patient experiences among medical travellers from Canada's far north: a mixed-methods study. BMJ Open 2019; 9:e030885. [PMID: 31806609 PMCID: PMC6924833 DOI: 10.1136/bmjopen-2019-030885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES This paper explores patient experiences and identifies barriers and opportunities for improving access to healthcare for patients from the Canadian north who travel to receive medical care in a Southern province. DESIGN A mixed-methods, cross-sectional study involved one-on-one interviews, focus group discussions and key informant interviews. PARTICIPANTS 52 one-on-one interviews with Northwest Territories (NWT) patients and patient escorts and two focus group discussions (n=10). Fourteen key informant interviews were conducted with health workers, programme managers and staff of community organisations providing services for out-of-province patients. A Community Advisory Board guided the development of the questionnaires and interpretation of results. RESULTS Respondents were satisfied with the care received overall, but described unnecessary burdens and bureaucratic challenges throughout the travel process. Themes relating to access to healthcare included: plans and logistics for travel; level of communication between services; clarity around jurisdiction and responsibility for care; indirect costs of travel and direct costs of uninsured services; and having a patient escort or advocate available to assist with appointments and navigate the system. Three themes related to healthcare experiences included: cultural awareness, respect and caring, and medical translation. Respondents provided suggestions to improve access to care. CONCLUSIONS Patients from NWT need more information and support before and during travel. Ensuring that medical travellers and escorts are prepared before departing, that healthcare providers engage in culturally appropriate communication and connecting travellers to support services on arrival have the potential to improve medical travel experiences.
Collapse
Affiliation(s)
- Kate Kerber
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Fariba Kolahdooz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Meeka Otway
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Melinda Laboucan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Se Lim Jang
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sue Lawrence
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Suzanne Aronyk
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Quinn
- Regional Public Health Office, Beaufort-Delta Health and Social Services, Inuvik, Northwest Territories, Canada
| | - Stephanie Irlbacher-Fox
- Hotıì ts'eeda Northwest Territories SPOR Support Unit, Yellowknife, Northwest Territories, Canada
| | - Crystal Milligan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Broadhead
- Department of Health and Social Services, Government of the Northwest Territories, Yellowknife, Northwest Territories, Canada
| | - Debbie DeLancey
- Hotıì ts'eeda Northwest Territories SPOR Support Unit, Yellowknife, Northwest Territories, Canada
| | - Andre Corriveau
- Department of Health and Social Services, Government of the Northwest Territories, Yellowknife, Northwest Territories, Canada
| | - Sangita Sharma
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|