Health and correctional staff acceptability of depot buprenorphine in NSW prisons.

BACKGROUND: Provision of opioid agonist treatment (OAT) in custodial settings is resource-intensive and may be associated with diversion, non-medical use, and violence. A clinical trial of a new OAT, depot buprenorphine (the UNLOC-T study), provided the opportunity to obtain health and correctional staff perspectives regarding this treatment prior to widespread roll-out. METHODS: Sixteen focus groups with 52 participants were conducted, including 44 health staff (nurses, nurse practitioners, doctors, and operational staff) and eight correctional staff. RESULTS: Key challenges to providing OAT identified as potentially being addressed by depot buprenorphine included 1) patient access, 2) OAT program capacity, 3) treatment administration procedures, 4) medication diversion and other safety issues and, 5) impact on other service delivery. CONCLUSIONS: The introduction of depot buprenorphine into correctional settings was considered to have the potential to increase safety for patients, improve staff / patient relations and advance patient health outcomes via expanded treatment coverage and efficiencies gained through enhanced health service delivery. Support was almost universal from both correctional and health staff participating in this study. These findings build on emerging research regarding the positive impact of more flexible OAT programs and could be used to engage support for the implementation of depot buprenorphine from staff in other secure settings.

Pneumothorax: Laparoscopic Intraoperative Management During Fundoplication Facilitates Management of Cardiopulmonary Instability and Surgical Exposure.

INTRODUCTION: Intraoperative pneumothorax may complicate surgery by obscuring surgical view and cause cardiorespiratory instability during fundoplication with large hiatus hernia. Proactive intraoperative treatment may reduce conversion and drain insertion and facilitate timely completion of surgery. MATERIALS AND METHODS: The authors present effective surgical and anesthetic measures to alleviate pneumothorax, which are helpful for hemodynamic stability and surgical visibility. CONCLUSION: Pneumothorax can complicate surgery by reducing surgical vision and causing cardiorespiratory instability. There is no requirement for laparoscopic or intercostal drainage. The authors provide various techniques to control intraoperative pneumothorax.