Designing a Nurse-Led Program for Self-Management of Substance Addiction Consequences: A Modified e-Delphi Study.

Therapeutic interventions for people with problematic use of psychoactive substances can help tackle specific needs related to substance addiction consequences. This modified e-Delphi study aimed to establish consensus on a training program for self-management of substance addiction consequences. The study was conducted between February and April 2022, with an experts' sample of 28 participants in the first round and 24 in the second. A priori consensus criteria were defined for each round. The results revealed a very strong consensus was achieved on the structure of the program and on clinical areas, such as the problematic use of substances, general health knowledge, health-seeking behavior and adherence, self-knowledge and well-being, social role and personal dignity, and family process. Additionally, over 80% participant consensus was achieved on an extensive number of interventions categorized as psychoeducational, psychotherapeutic, socio therapeutic, brief interventions, social skills training, problem solving techniques, relaxation techniques, and counseling. These findings may be able to fulfill a gap concerning structured treatment approaches for people with problematic use of psychoactive substances. Supporting self-management of the consequences of substance addiction and its application can change nurses' interventions.

Programa de suporte medicamentoso com pessoas dependentes de substâncias: Satisfação com os cuidados de enfermagem / Medication based program with substance dependent people: Satisfaction with nursing care

Resumo Contexto: Na saúde, a satisfação com os cuidados recebidos é um indicador relevante para a qualidade e é fundamental para a adesão terapêutica dos utentes. Objetivos: Caraterizar a satisfação com os cuidados de enfermagem numa população atendida por enfermeiros num programa de suporte medicamentoso para pessoas dependentes de substâncias. Métodos: Estudo quantitativo, observacional de corte transversal. Amostra de conveniência acedida em janeiro 2019. Elaborou-se um questionário para caraterização sociodemográfica e psicossocial, e utilizada a "Escala da satisfação dos utentes com os cuidados de enfermagem no centro de saúde", com 22 itens [resposta entre 0-66], que avaliam a satisfação em 6 dimensões (Qualidade na assistência; Envolvimento do utente; Formalização da informação; Promoção de elo de ligação; Informação de recursos; Individualização da informação). Obteve-se o parecer positivo de uma comissão de ética. Resultados: Participaram 181 (n) pessoas. Obteve-se um Alpha de Cronbach da escala, de 0,892. A média apurada foi 59,36 dp=8,19 [23-66]. A subescala que revelou maior índice de satisfação foi "Individualização da informação" (itens relacionados com explicação da informação, de forma compreensível, por parte dos enfermeiros, assim como garantir que o utente percebeu a informação). Com menor índice de satisfação "Informação de recursos" (preocupação em envolver os familiares, informação sobre utilização de outros recursos disponíveis ou serviços de saúde). Conclusões: A satisfação é elevada, sendo a maior dificuldade apontada à inclusão de outros agentes no processo de acompanhamento e a informação de outros recursos disponíveis. Os resultados mantêm aberta a discussão sobre a melhor forma de fazer investigação sobre satisfação.

Abstract Background: In health, satisfaction with received care is a relevant indicator for quality and is fundamental for the users' therapeutic adherence. Aim: To characterize satisfaction with nursing care in a population attended by nurses in a medication-based support program for people dependent on substances. Methods: Quantitative, observational cross-sectional study. Convenience sample accessed in January 2019. A questionnaire was designed for sociodemographic and psychosocial characterization and the "User satisfaction scale with nursing care at the health center" was used, with 22 items [answer between 0-66], that assess satisfaction in 6 dimensions (Quality of care; User involvement; Formalization of Information; Promotion of a link; Information of resources; Individualization of information). Positive opinion of an ethics committee was obtained. Results: 181 (n) people participated. A Cronbach's Alpha of 0.892 was obtained. The mean found was 59.36 SD = 8.19 [23-66]. The subscale that showed the highest level of satisfaction was "Individualization of information" (items related to explanation of information in an understandable way by nurses, as well as ensuring that the user perceived the information). With lower satisfaction index "Resource information" (concern with involving family members, information on the use of other available resources or health services). Conclusions: Satisfaction is high, with the greatest difficulty being the inclusion of other agents in the monitoring process and information about other available resources. The results keep open the discussion about the best way to do research on satisfaction.

Caracterização do cuidado de enfermagem numa equipa de tratamento para os comportamentos aditivos e dependências / Characterization of nursing care in a treatment team for addictive behaviors and dependencies

Resumo Contexto: Uma das respostas à dependência de substâncias psicoativas são os programas farmacológicos. O conhecimento sobre o impacto destes programas é escasso e é necessário avaliar o contributo e o impacto da consulta de enfermagem integrada nestes programas. Objetivo: Caracterizar o cuidado de enfermagem prestado com uma população com dependência de substâncias psicoactivas numa Equipa Técnica Especializada de Tratamento. Metodologia: Estudo transversal, observacional, analítico, de abordagem quantitativa, com uma população com dependência a substâncias psicoactivas, integrada em programa farmacológico e em consulta de enfermagem. Amostragem por conveniência. Utilizou-se formulário para caracterização sociodemográfica, psicossocial e estado de saúde; Escala Consequências da Dependência de Substâncias (CDS) e o Alcohol Use Disorders Identification Test (AUDIT). Registados dois diagnósticos e duas intervenções prioritárias. Resultados: Participaram 162 pessoas. Média de Idade 46,96, maioritariamente homens (76,5%), solteiros (51,9%), desempregados (58,6%), em programa farmacológico com metadona (68,6%), policonsumidores, com consumos nocivos e dependência face ao álcool (34,9%) e com várias comorbilidades. Sobre as CDS, e por ordem decrescente de severidade "ansiedade", "dificuldade em manter um emprego", "tristeza", "dificuldade em manter-se financeiramente", "problemas no relacionamento familiar". Diagnosticou-se "adesão ao regime terapêutico comprometido", "ansiedade presente", "uso de álcool abusivo/dependente". As principais intervenções de enfermagem "reforçar a relação terapêutica", "ensinar e incentivar o autocuidado", "ensinar/reforçar/assistir sobre adesão ao regime terapêutico". Conclusões: Os dados evidenciam que os diagnósticos mais trabalhados pelos enfermeiros são a adesão terapêutica, a minimização dos consumos e o autocuidado. Outros domínios serão eventualmente sub diagnosticados na prática clínica, de acordo com a avaliação das consequências do consumo de substâncias.

Abstract Context: One of the responses to addiction to psychoactive substances is medication-based programs. Knowledge about the impact of these programs is scarce and it is necessary to assess the contribution and impact of the nursing consultation integrated in these programs. Objective: To characterize the nursing care provided to a population with dependence on psychoactive substances in a Specialized Technical Treatment Team. Methodology: Cross-sectional, observational, analytical study, with a quantitative approach, with a population dependent on psychoactive substances, integrated in a pharmacological program and in a nursing consultation. Convenience sampling. A form was used for sociodemographic, psychosocial and health status characterization; Substance Addiction Consequences Scale (SAC) and the Alcohol Use Disorders Identification Test (AUDIT). Two diagnoses and two priority interventions were recorded. Results: 162 people participated. Average Age 46.96, mostly men (76.5%), single (51.9%), unemployed (58.6%), in a medication-based program with methadone (68.6%), polydrug users, with harmful consumption and dependence on alcohol (34.9%) and with several comorbidities. About SAC, and in decreasing order of severity "anxiety", "difficulty in maintaining a job", "sadness", "difficulty in maintaining financially", "problems in family relationships". "Adherence to the compromised therapeutic regime", "present anxiety", "abusive / dependent alcohol use" was diagnosed. The main nursing interventions "reinforce the therapeutic relationship", "teach and encourage self-care", "teach / reinforce / assist about adherence to the therapeutic regime". Conclusions: The data show that the diagnoses most worked by nurses are therapeutic adherence, minimizing consumption and self-care. Other domains will eventually be under diagnosed in clinical practice, according to the assessment of the consequences of substance use.

Intradural disc herniation at the L1-L2 level: A case report and literature review.

BACKGROUND: Why are intradural disc herniations (IDHs) (0.3% of all discs) so infrequent? One explanation has been the marked adherence of the posterior longitudinal ligament (PLL) to the ventral wall of the dura. Variability in symptoms and difficulty in interpreting magnetic resonance (MR) images with/without contrast make the diagnosis of an IDH difficult. Here, we reported a patient with an L1-L2 IDH and appropriately reviewed the relevant literature. CASE DESCRIPTION: A 57-year-old male presented with chronic low back and 1 month's duration of the left thigh pain. The lumbar MR with/without contrast demonstrated an IDH at the L1-L2 level, resulting in spinal cord compression. At surgery, the disc herniation was appropriately resected, the dura was closed, and an interbody fusion with pedicle screw fixation was performed. Postoperatively, the patient clinically improved. CONCLUSION: IDHs are rare, being seen in only 0.3% of all cases. MR findings, performed with/without contrast, may help signal the presence of an IDH. MR findings include a hypointense structure inside the dura; the "hawk beak" sign (e.g., beak-like mass with ring enhancement at the intervertebral disc space); the Y sign (e.g., ventral dura split into ventral dura and arachnoid by disc material); an abrupt loss of continuity of the PLL; a diffuse annular bulge with a large posterocentral extrusion; and an typical crumbled appearance of disc (e.g., "crumble disc sign"). At surgery, both the extradural and intradural components of the disc must be excised.

The Helix aspersa (brown garden snail) allergen repertoire.

BACKGROUND: Ingestion of snails can induce strong asthmatic or anaphylactic responses, mainly in house-dust-mite-sensitized patients. The aim of this study was to identify the Helix aspersa (Hel a), Theba pisana (The p) and Otala lactea (Ota l) allergens and the extent of their cross-reactivity with the Dermatophagoides pteronyssinus (Der p) mite. PATIENTS AND METHODS: In 60 atopic patients, skin prick tests (SPT) to snail and D. pteronyssinus, total and specific IgE, specific IgE immunoblots, RAST and immunoblot inhibition assays were performed. RESULTS: Mean total IgE was >1,000 kU/l. Mean specific IgE (class 6 for Der p and class 2 for Hel a) SPT were positive in 44 patients for snail and in 56 for mite. Isoelectric focusing (IEF) and SDS-PAGE followed by immunoblotting of H. aspersa extract enabled the identification of 27 and 20 allergens, respectively. Myosin heavy chains from snails (molecular weight >208 kDa) disclosed two major allergens. Hel a and Der p RAST were strongly inhibited by their homologous extracts, with Hel a RAST being inhibited by the Der p extract to a much greater extent (72.6%) than the inverse (5.6%). A complete inhibition of the immunoblots by their homologous extract was obtained. However, Hel a extract did not inhibit Der p IEF separated recognition. On the other hand, mite extract extensively inhibited snail immunoblots from both IEF and SDS-PAGE separations. Immune detection on chicken, pig, rabbit, cow and horse myosins did not reveal any IgE cross recognition with snail. CONCLUSIONS: In most cases of snail allergy, mite appeared to be the sensitizing agent. Nevertheless, snails may also be able to induce sensitization by themselves. This hypothesis is supported by the finding of specific IgE to Hel a in 2 patients who did not show specific IgE to Der p, and one of them was suffering from asthma after snail ingestion.